Assisted living was meant for mostly independent seniors. But as more frail seniors go there, experts worry facilities aren’t as prepared as nursing homes for complex medical issues.
By James Walsh
The Minnesota Star Tribune
September 24, 2025 at 11:00AM
That choice often comes down to how a place makes people feel, said Toby Pearson, president and CEO of Care Providers of Minnesota, which represents assisted living facilities and long-term care providers. Many are drawn to assisted living’s more home-like environment, he said.
By comparison, he said, some see nursing homes as a place from which they won’t return. And that can mean people sometimes aren’t candid about their health needs.
“When you’re doing the assessment, the individual or the family doesn’t always tell you everything,” he said. “On some level, they may not know. But on another level, especially with dementia, and the person is going to keep declining, well, if I was in their situation, would I want to admit that they need to go into a nursing facility?”
Ben Hansen, a spokesman for LeadingAge Minnesota, which represents organizations serving older adults, said choosing senior care “is a deeply personal decision. Families weigh many factors — including the person’s care needs, financial situation, location, social connections and personal preferences — to find the setting that feels right for them.”
There is no data, he said, suggesting people are choosing settings that are not appropriate.
“What we see is a system designed to give older adults and their families options — so they can find a place that aligns with their goals, values and needs,” he said.
Federal officials designate assisted living as home and community-based services while nursing homes are designated as institutional living, but Shippee said such distinctions are blurring.
“Now, 50% of assisted living residents have dementia,” she said. “And, in Minnesota, the acuity of assisted living residents now mirrors the acuity of residents who were in nursing homes 10 to 15 years ago.”
But Kristine Sundberg of Elder Voice Advocates isn’t hopeful.
“It’s going to be difficult, because we have a huge budget crunch federally and on the state level, and we’ve already seen huge cuts,” she said. “Our advocacy work has never been more direly needed than any time.”
Increase in complaints about assisted living
Starting in August 2021, Minnesota began requiring assisted living facilities to be licensed and monitored by the state Department of Health. There are about 2,200 assisted living facilities in Minnesota, compared to 329 Medicaid-certified nursing homes.
It didn’t take long for complaints alleging abuse, neglect and poor care at assisted living facilities to start pouring in.