investing in healthy aging

McKinsey Makes the Economic Case for Investing in Healthy Aging

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I like to highlight and promote new and innovative ideas around aging, senior living and care in this space. But I would not be surprised if some readers react by asking themselves, “Those ideas sound wonderful, but are they really practical?”

For those who have had that thought, I would point to a Sept. 2025 report from the McKinsey Health Institute that makes the economic case for investing in healthy aging in the U.S.

The report shows that initiatives that improve healthy aging often produce real social and economic benefits.

Many in our field — myself included — talk about the qualitative benefits of initiatives aimed at helping older Americans. But it’s good to see McKinsey take a quantitative approach to the issue.

McKinsey examined 18 interventions in eight categories (or “avenues,” as they call them), and estimated their potential return on investment. On average, for every $1 invested, the interventions produced a $3 return in economic and healthcare benefits.

In the chart shared below, McKinsey placed the interventions on a graph that rates their impact (x axis) and feasibility (y axis). The larger the circle, the greater the ROI.

mckinsey healthy aging interventions

Several interventions jumped out at me, led by the big blue circle in the upper-right corner: orchestrating volunteer-matching programs.

McKinsey gives that intervention an ROI multiple of 24.3 — significant benefit for minimal investment, in other words. On scales of 1 to 4, it rates above 3 in both impact and feasibility.

I’m not surprised this intervention would score well. It’s about engagement — pairing older adults with young people. And it’s about the power of volunteerism.

Those sorts of activities create connections and help older adults feel as though they’re making a difference. There’s no doubt that both are important factors in healthy aging.

Other interventions that stood out to me included:

▶️Subsidizing defensive driving courses (14.4 ROI multiple)

▶️Investing in at-home medication technology (7.6)

▶️Expanding scam awareness training programs (4.8)

▶️Enabling employment re-entry (4.3)

All of the interventions listed above scored a 3.0 or more on ROI, 2.25 or more on impact, and 2.0 or more on feasibility.

I couldn’t agree more with the assertion made in the report: We have reached the point where we need to make “a once-in-a-generation choice: adapt and reimagine systems to support longevity for all or risk stagnation with outdated structures.”

Or, as I often ask, will the longevity our society has gained in the last century be a triumph or a tragedy for older adults in the 21st century? Research like McKinsey’s can help chart the course toward a triumph.

joyspan senior housing aging services

How Senior Housing and Aging Services Can Extend ‘Joyspan’

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“A lengthy life span does not equal a life well lived: You have to like your life, too.”

That’s how a recent New York Times piece sums up Dr. Kerry Burnight’s idea of “joyspan,” and I was thrilled to see the concept — and her new book, “Joyspan: The Art and Science of Thriving in Life’s Second Half” — featured there.

Like health span, joyspan is an important factor in getting the most out of our later years. There are four “nonnegotiable” actions you can take to extend your joyspan, Kerry says:

▶️Grow
▶️Adapt
▶️Give
▶️Connect

I think “Give” and “Adapt” are especially important.

Giving

“Everyone has something to give, [Burnight said], whether it’s ‘time, attention, patience, wisdom or kindness.’”

I, of course, agree.

The challenge for senior housing and aging services is whether we can recognize that ability among our residents and program participants.

Even more challenging, can we provide customized opportunities for them to give, even if they face physical or cognitive challenges?

Artificial intelligence and other technology may help. But we need to recognize what a difference it could make. All of us get something out of giving. Finding ways for older adults to give will help them feel connected and that they have value in others’ lives.

Adaptation

Kerry’s focus on adapting is important to note, as well.

Listing things that have gotten better as you’ve gotten older and brainstorming ways to adapt are good suggestions for older adults facing challenges.

It also strikes me that senior housing and care staff and sales teams can play a key role in helping people to adapt, finding positive ways they can express who they are, and do the things they used to take enormous pleasure in.

Staff can lead residents toward a more constructive frame of mind by asking questions like “Can you tell me about some things that have gotten better for you as you’ve gotten older?”

Or they could address the loss of a certain ability by asking “What are some things that you can do instead that would give you a sense of satisfaction and joy?”

Salespeople — whose job is connecting with prospective residents and letting them know they understand their situation — can explain how moving into their community is a good way to adapt to the challenges that they face.

For instance, if an older adult used to travel the world but no longer can, the sales staff might suggest, “Here, you could lead presentations on all the places you’ve traveled and even lead virtual tours to those places.”

The key is finding ways to make a person feel that they still have value. Acknowledge that they still have something to contribute, and the community would be thrilled to have them contribute.

You certainly don’t need to be on the sales team or the staff of a senior housing and care organization to get something out of the idea of joyspan. I strongly recommend giving this piece — not to mention Kerry’s book —  a look.

co-housing Casa Verde Commons

4 Reasons Cohousing Has Serious Growth Potential as a Senior Housing Option

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If you’re trying to understand what Boomers and older Gen Xers really want in senior housing, this piece by Adrienne Matei in the Guardian is not a bad place to start.

I would quibble with one assumption the piece makes: That there are essentially two options in today’s senior housing world: living alone and becoming lonely or moving into an institutional setting. There’s already far more available than these two unattractive extremes.

But cohousing — multigenerational or senior-specific communities where people live, interact with and care for their neighbors — has real potential to grow. The Guardian piece provides four good reasons why:

👉 Older Adults Value Their Independence and Agency.

One subject of Matei’s piece says she chose cohousing in part because “institutions ‘take away the ability to decide what your day is going to look like,’ offering scheduled activities and mealtimes that reduce individual agency.”

In cohousing, residents set their own schedules. And they do most things for themselves.

It avoids instilling what I call the “learned helplessness” that grows in some other settings.

As retired gerontologist Anne P. Glass says in the piece, “Contrary to what society may believe, older people are really quite competent.”

👉 Older Adults Want Community.

This piece makes it clear that older adults long for community and a sense of connection.

Angela Maddamma, 72, talked about the visits she received from new neighbors the day she moved into her cohousing community. She’s on a community committee and enjoys spontaneous connections with neighbors — but she can go home and “veg out” whenever she desires, too.

That’s a key aspect of community within cohousing: Having ample opportunity to connect with others, but on your own terms.

👉 A Trend From the 1960s Makes a Comeback.

The idea of living with a group of like-minded people and collaborating to support each other might sound familiar. In the 1960s and ’70s, these living arrangements were called communes.

Communes and cohousing are both centered around community, not care.

These alternative arrangements are not for everyone, and they’re difficult to scale, but they still are attractive to a significant number of older adults.

👉 A Market Gap Has Opened Up.

Thanks to increased longevity, markedly different segments make up what we used to simply call “senior citizens.”

There are many adults in their 60s, 70s and 80s who are seeking a housing lifestyle option, and others in their 80s or 90s who have care-driven needs.

It’s not surprising that the former group wants something different.

Because of this growing segment, I hope and think you’ll see cohousing grow.

Will it ever house millions? I don’t think so. But I expect to see all sorts of alternative lifestyle options develop for Boomers and Gen X. There’s certainly a desire for new options.

Senior Living and the Need for a New Narrative About Aging

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“They don’t have a friggin’ clue.”

That’s how Dr. Joe Coughlin, director of the MIT AgeLab, described Baby Boomers and Gen Xers during our joint session at the 2025 NIC Spring Conference.

To be fair, it wasn’t a blanket condemnation of the two generations that are so important to senior housing and aging services providers. No, Joe was speaking about older adults’ expectations and desires for their later years — a period that is, thanks to increased longevity, becoming a new stage of life.

There’s no roadmap and no narrative for this stage. It’s a problem for Boomers and Xers, but an opportunity for aging services providers.

As Joe said during our session, the industry is at a crossroads. Longevity has opened up new possibilities, but older adults are unsure of how to think about a new stage of life — or how to prepare for it.

So most simply seek to avoid or delay “becoming old” as long as possible.

To them, getting “old” means the end of independent agency, of purpose and passions, of meaningful contributions to the world. They fear it’s an interminable period of decline.

Senior living falls into the same category as getting old in their minds: Something to be avoided or delayed to the very last moment.

Obviously, that’s not where we want to be as an industry.

To transform from an avoidance setting to one that can excite and delight, we’ll have to create a new narrative about this stage of life and our role in it.

As Joe says, this transformation is not optional, it is essential.

In our session, Joe outlined several steps senior living can take to shape the aging narrative. He encourages the industry to reframe its language, integrate with the community and build “aspirational positioning,” among other smart suggestions.

To me, Joe’s proposals are part of a necessary move from being a provider to being a curator of experiences. And perhaps more importantly, moving from a focus on what is done for and to older adults, to what is done by and with them.

We have to present a vision of something people can aspire to as they get older, with messaging that:

👉 Starts early

We need to reach older adults well before they move in as residents, meeting them where they are — in their single-family homes, apartment communities and membership clubs — and establishing our ability to excite and delight in this new stage of life.

👉 Shows support

We must show that we will support their efforts to get more life out of their years and prioritize extending their healthspan, not just their lifespan.

👉 Emphasizes growth

Let’s demonstrate how residents continue to find purpose and pursue passions with us — instead of simply managing decline.

There’s an additional piece of the puzzle, too: the responsibility of the resident to take advantage of the independent agency that we encourage.  I wrote about that in a March 2025 LinkedIn post.

seniors need risk

Why Seniors Need Some Risk in Their Lives

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Joel Theisen caught my attention recently by writing that, in order to truly thrive, older adults “need to move beyond the well-planned life to add something unexpected: personal risk.”

I’m with Joel on this. To me, adding (or maintaining) an element of risk in our later years is about a vital feeling of personal agency.

With agency, older adults are more motivated to tackle challenges, and more likely to find meaning in each day, thinking, “Hey, I can still do things.”

To many, unfortunately, risk and old age don’t go together. Even the senior care field, with the best of intentions, tends to guard older adults from risk. Instead, we promise a life of ease, where absolutely everything is taken care of for you.

As Joel writes in his piece:

“We’ve become so preoccupied with surplus safety at all times for seniors that we have stripped away too many of the surprises and unexpected twists that make life worth living.”

Joel — the CEO of Lifespark — writes about the benefits of challenges and games for older adults. He sees some trying to set personal records on their fitness trackers. Others compete in Lifespark’s team competitions: the TRY-athlon Tournament, the Grip Games and the Spark Challenge.

Participants in activities like these court risks — such as falling while racing down the hallway with a walker. It’s natural to worry about downsides like that.

But we must acknowledge that the downsides of not taking risks are significant:

➡️ It deprives older adults of the sense of purpose, belonging and connection that a more active (and risky) life offers.

➡️ It leads to loneliness and a loss of physical strength.

➡️ It reinforces learned dependency — a state where older adults increasingly rely on others to do things for them, including taking responsibility for their health.

➡️ At its worst, a risk-free life infantilizes the “safe” older adult.

All of this stands in opposition to what an older adult needs to enjoy healthy longevity.

The better alternative is encouraging a sense of self-control and self-determination. Adding (reasonable) risks to life is a great way to accomplish that goal.

When older adults take on challenges and risks, they tell themselves, “Wow, I’m doing something significant. I’m making a difference.”

When they lose that sense — when risk is eradicated from their lives — they instead ask themselves a troubling question: “Why keep going?”

demand for senior housing

How Will We Meet Rising Demand for Senior Housing? We Have to Innovate.

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In the senior housing and care industry’s current state, supply is not going to meet demand any time soon.

The need for our services is growing quickly, fueled by the demographics of an aging society. The cost of building new communities and providing the services is growing quickly, too, as construction remains expensive and labor scarce. The product is unaffordable for many now, and unlikely to become more affordable as-is.

It’s easy to look at the situation and get discouraged when it comes to how we will meet escalating demand.

Instead, I like to point out that this moment is made-to-order for innovation. It’s the perfect time to figure out new ways of delivering our services and trying new models.

Tim Regan’s recent piece in Senior Housing News did a good job of explaining why we’re where we are now. By 2030, the youngest Baby Boomers will be 65 years old. We don’t have enough senior housing now, and to meet the need in five years, a lot of construction needs to start now.

“While the cost of capital has improved slightly since last year, many projects still don’t pencil out,” NIC Senior Principal Omar Zahraoui told Regan, “and the floodgates for new development are unlikely to open in the next 12 months.”

Regan’s piece touches on tariffs, too, which could increase costs further, as well as the large number of promised deportations, which could make labor harder to find and more expensive.

It’s clear that we can’t just sit and wait for conditions to improve. We’ve got to innovate, figuring out new ways of delivering more for less. The needs are too great and the costs are too high to just stick with one fixed model.

Instead, we need models that are scalable, in several different categories:

👉 Middle-market models that wrap around supportive services.
👉 “Active adult” models that focus on lifestyle, wellness and health span.
👉 Community-based models organized around wellness clubs, membership programs and “PACE-like” services.
👉 Models in which our services are delivered into the home.

For the senior housing and care industry to meet the needs of a rapidly growing population of older adults, it has to morph into something beyond just a bricks-and-mortar solution.

The companies that figure out more innovative ways of reaching more people with the services they need — and in ways that they can both access them and afford them — are going to be huge winners in the future. To the extent the industry does not seize this opportunity, outside disruptors and innovators surely will.

5 Shifts That Are Changing the Future of Senior Housing and Aging Services

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I’ve written before that we’re in a transitional decade for senior housing and care, as aging services move from serving the Greatest and Silent generations to serving the Boomers and older Gen-Xers.

In talks I give as part of the NIC Academy (specifically, the Fundamentals of Underwriting Senior Housing & Care introductory-level course), I identify 10 factors that I believe will influence the future of senior housing and aging services. Here I want to mention five shifts that are going on at the same time, where the speed of the shifts and how providers respond to them will be critical.

Shift 1: Moving from a focus on health care as “sick care” to a focus on health care as “well care.” The former is reactive and the consumer has a passive role in it. The latter is proactive, with a participatory role for the consumer.

Shift 2: Moving from a focus on adding years to life, the primary goal of the last generation of senior housing and aging services, to a focus on adding life to years, which is what the Boom/X generation desires. 

Shift 3: The discovery that community is not just physical proximity. Instead, it depends on fostering engagement, belonging, inclusion and a sense of purpose. 

Shift 4: The infusion of private sector capital to drive innovation in products, services and delivery systems, as well as the arrival of new capital structures for senior housing that spur investment in people, technology and systems, not just buildings.

Shift 5: The transition from a fee-for-service payment model based on volume to a value-based reimbursement model that focuses on outcomes and prevention. 

Under the old payment model, senior housing and care simply provides older, sicker patients to feed the volume-driven health care industry, while the new model recognizes that senior housing and care plays a vital, preventative role that can improve health while reducing costly hospitalizations, because it addresses social determinants of health. 

The speed of Shifts 1 and 5, which involve changes in our health care system, are not something within the control of the senior housing and care sector. But the other shifts are very much under our control. They are opportunities to lead instead of follow.

active adult

Let’s Rebrand ‘Active Adult’

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The fastest-growing property type within senior housing is active adult communities. Before it gets too much bigger, we should ask ourselves: Is “active adult” really the best name to market this product to the consumer?

As I said in a side conversation at last week’s NIC Fall Conference, I don’t think it is.

For starters, what does the term “active adult” say about residents in other types of senior housing? When they can no longer live in “active adult,” do they become inactive? Is it time to put them on ice?

Because of what it implies about everyone else, I think “active adult” is an ageist phrase. That’s reason enough to make a change.

But research also shows that people looking for active adult communities don’t use the term as they search. They’re much more likely to say they’re looking for “retirement communities” or “senior housing.” So the term is not yet well known or accepted by the customer we are targeting. That presents an opportunity.

Given the growing popularity of active adult communities, now is the time to rebrand. Soon, it will be too late or, at a minimum, very costly and difficult, to rebrand once “active adult” is the accepted terminology among BoomX customers.

I lean toward something like “lifestyle housing.” No matter the name, I think we need terminology that signals that these communities are aspirational settings — the sort of place Boomers and older Gen Xers will want to move into.

I’m curious what you think: Is it time to rename active adult communities? If so, what should the new name be? Leave a comment with your idea on my LinkedIn post on this topic.

SLIF Bob Kramer Crucial Questions for Senior Living

Senior Living Has Made It To ‘Broadway’ — But We’re Still Vulnerable

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The senior living industry has wanted to be in the spotlight for some time, and as I said in my talk earlier this week at the Senior Living Innovation Forum (SLIF), we’re finally there.

There are pros and cons on making it to “Broadway” after years of playing in “New Haven,” but I’ll highlight one potential drawback here: Greater attention has found senior living at a moment that the industry is especially ripe for disruption.

Here’s why we’re vulnerable:

  • There’s huge demand for our product right now.
  • Our product currently is costlier than nearly 90 percent of the market can afford.
  • Most customers dread having to use our product because of what it signifies about their life and their sense of independent agency and purpose.
  • Most significantly, most of our industry thinks we’re sitting pretty. Too many people seem to be thinking “Just watch them come to us. They have no choice.”

Our industry is at a crucial point. I hope you’ll watch my entire talk.

And I have a question for you: Are you a disrupter, or are you confident you can keep doing the same thing and not be disrupted? Let me know on LinkedIn.

ageism word cloud

The Greatest Challenge to Senior Housing and Aging Services: Our Own Ageism

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Having worked in senior housing and aging services for almost 40 years, I’m often asked, “What do you think is the greatest challenge we face in providing older adults with the housing, health care, supportive services and community that they need?”

The more I’ve reflected on this, and the longer I’ve been in the field, the more convinced I am that our greatest challenges are the ageist assumptions, prejudices and stereotypes that permeate our society.

If you’re like me, you’re disappointed but not surprised when those who don’t work in our industry use ageist phrases like the ones in the graphic above. And you’ve probably also seen how ageism can guide the actions of employers, policy-makers, regulators, researchers and others who don’t work in senior living and long-term care.

But sadly, many in our profession unconsciously fall prey to ageist stereotypes and language, too. It happens with well-meaning intentions, to be sure, but it can do real damage.

It diminishes the agency, identity and value of the older adults with whom we work.

One small example of this sort of ageism is the concept of a “continuum of care.” While on one hand, this concept can accurately describe the need for often-increasing levels of care and supportive services for older adults, it has an unfortunate and unintended consequence.

When we talk about a “continuum of care,” we frame our work around a declinist view of those we serve. It casts them as people who are beset by ever-increasing deficits, and that leads to further disempowering and devaluing them — discounting their desire and ability to contribute to their life, the lives of those close to them, and the issues that they care about most.

We need to offer a continuum of engagement, not a continuum of care. When we focus on engagement, we prioritize the things that give those we serve a sense of self-worth, identity, purpose and belonging — instead of diminishing the individual by making them a sum of their needs for care and functional support .

To be honest, I didn’t know this when I started my career. I have come to the realization over time.

But today, with experience, I’m certain that everything we do should start with engaging with the older adult, and asking what matters to them. Then we need to frame our work based on their responses.

That doesn’t mean we should ignore very real needs for care and support. But it does mean acknowledging that those we care for have a desire to stay meaningfully engaged in life. Or, more succinctly, acknowledging that there’s still a person there.

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