1. Elder Care Services to 2016
Report Details:
Published:December 2012
No. of Pages: 266
Price: Single User License – US$4900
This study analyzes the US elder care service industry. It presents historical demand data (2001,
2006, 2011) and forecasts for 2016 and 2021 by type (e.g., skilled nursing care facilities, home
health care services, continuing care retirement communities, social services, assisted living
facilities), provider (for-profit, nonprofit), payment source (e.g., Medicaid, Medicare, out-of-pocket,
private insurance) and region. The study also considers market environment factors, details
industry composition, evaluates company market share and profiles major players.
US revenues to grow 5.2% annually through 2016
Revenues for the elder care services industry (i.e., skilled nursing, home health care, social
services, continuing care, and assisted living) are expected to grow 5.2 percent per year through
2016 to $319.5 billion. Advances will be driven largely by demographic changes in light of
increasing life expectancy, which is contributing to the rising number of individuals in the older
population segments. Growth is further boosted by the large, post-World War II “baby boom”
generation entering their retirement years.
The market will be restrained by continuing efforts at the state and federal levels to curb Medicaid
and Medicare expenditures, often by limiting reimbursements or by directing patients to less
expensive forms of care. For instance, the 2010 Patient Protection and Affordable Care Act
expands support for home and community based services, including home health care and social
services. Elder care service providers compete functionally with informal caregivers, typically
family members; however, a growing number of older adults either do not have family members
who are able to care for them, or simply prefer using professional care.
Home, community based services to grow the fastest
In 2011, skilled nursing facilities accounted for the largest share of elder care service revenue with
43 percent. However, home and community based services (e.g., home health care, social
services, assisted living) are projected to achieve the fastest growth. Advances will be driven by
continued state and federal efforts to shift Medicaid payments away from skilled nursing to more
cost effective community based services. Additionally, many older adults prefer to age in place,
remaining in their homes as long as possible.
Nonprofits to outpace for-profit entities
For-profit entities accounted for twothirds of elder care service revenues in 2011, benefiting from
the growing use of the chain and franchise business model. However, nonprofits (e.g., charitable
organizations and government-related agencies) are expected to slightly outpace for-profits

2. through 2016.
Medicaid to remain leading payment source
Medicaid will continue to be the leading payment source for the elder care services industry
despite efforts at the state and federal levels to curb expenditures. Medicare payments will
experience the fastest annual growth, though future legislative changes and fluctuating
reimbursement rates have the potential to affect that outlook. Out-of-pocket expenditures continue
to be important in the continuing care and assisted living industries, as many of the costs of these
services are not covered by Medicare or Medicaid. Private insurance coverage will rise as the
aged population grows and individuals who doubt the government’s ability to provide future care
purchase long term care insurance. Other payment sources include charitable donations, private
grants, and other government resources such as the US Veterans’ Administration.
Company Profiles
Profiles 40 competitors, such as Atria Senior Living, Brookdale Senior Living, Emeritus, Five Star
Quality Care, Genesis Healthcare, Golden Living, HCP, and Manor Care
Additional Information
This study analyzes the US market for elder care services. Historical data are provided for 2001,
2006, and 2011, with forecasts for 2016 and 2021. Data are presented for US elder care service
revenues in millions of US dollars by
•type of service (e.g., institutional skilled nursing, home health care, continuing care, social
services, assisted living, and personal emergency response service)
•provider (i.e., nonprofit and for-profit)
•payment source (e.g., Medicaid, Medicare, private insurance, outof- pocket, and others)
The entire study is framed within the overall industry’s economic, technological, and market
environment. In addition, major elder care service providers are identified and profiled, and the key
competitive variables are discussed. For the purposes of this study, “public” means companies
that have publicly traded stock; public does not refer to governmental agencies. This study
includes elder care services provided by for-profit businesses and nonprofit agencies, but does not
include services provided -- either formally or informally -- by family members, friends, and other
caregivers who are either uncompensated or compensated in “under-the-table” arrangements.
Tabular details may not add to totals due to rounding, and some ratios are based on unrounded
numbers. Macroeconomic indicators presented in this study were obtained from The Freedonia
Group Consensus Forecasts dated August 2012. Because of the Bureau of Economic Analysis’
use of chainweighted price indexes, inflation-adjusted gross domestic product components (2005
dollars) do not necessarily add to the total.
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Major points covered in Table of Contents of this report include
TABLE OF CONTENTS
INTRODUCTION ix

3. I. EXECUTIVE SUMMARY 1
II. MARKET ENVIRONMENT 4
General 4
Demographic Trends 4
Macroeconomic Outlook 9
Consumer Spending Trends 12
Building Construction Trends 15
Business Establishment Trends 18
Service Sector Outlook 21
Health Care Trends 24
National Health Expenditures 25
Medical Conditions 27
Chronic Conditions 28
Acute Conditions 30
Regulatory Environment 32
World Markets 35
III. SERVICES 38
General 38
Skilled Nursing Care Facilities 41
Overview 42
Employees 45
Regulations 47
Providers 49
Payment Sources 51
Home Health Care Services 53
Overview 54
Employees 57
Regulation 59
Personal Emergency Response Services 59
Providers 63
Payment Sources 65
Social Services 66
Overview 67
Adult Day Care 69
Non-Medical Home Care 72
Others 74
Providers 74
Payment Sources 75
Continuing Care Retirement Communities 77
Overview 78
Providers 81
Payment Sources 84

4. Assisted Living Facilities 86
Overview 87
Employees 89
Regulations 90
Providers 91
Payment Sources 93
IV. SERVICE PROVIDERS 95
General 95
For-Profit 97
Nonprofit 101
V. PAYMENT SOURCES 105
General 105
Medicaid 108
Overview 108
Medicaid Payments for Elder Care Services 110
Out-of-Pocket 113
Medicare 117
Overview 118
Medicare Payments for Elder Care Services 121
Private Insurance 125
Overview 126
Long Term Care Insurance 129
Private Insurance Payments for Elder Care Services 131
Other 134
VI. REGIONAL MARKETS 137
General 137
Regional Population Aged 65 & Over 137
Regional GDP 139
Elder Care Services by Region 141
Northeast 144
Midwest 146
South 147
West 150
VII. INDUSTRY STRUCTURE 153
General 153
Industry Composition 153
Market Share 157
Competitive Strategies 163
Marketing 166
Mergers & Acquisitions 168
Cooperative Agreements 176
Company Profiles 180

5. Active Day, see Senior Care Centers of America
ADT Corporation 181
Adult Day Care Group 182
Advocat Incorporated 183
Advocate Hospice, see Gentiva Health Services
Aegis Therapies, see GGNSC Holdings
Altura Homecare & Rehab, see Skilled Healthcare Group
Amedisys Incorporated 185
American Senior Communities LLC 187
AseraCare, see GGNSC Holdings
Assisted Living Concepts Incorporated 190
Atria Senior Living Group Incorporated 191
Beacon Hospice, see Amedisys
Benedictine Health System 192
Brookdale Senior Living Incorporated 194
Capital Senior Living Corporation 197
Chemed Corporation 200
CK Franchising, see Sodexo
Comfort Keepers, see Sodexo
Cornerstone Hospice, see Skilled Healthcare Group
Countryside Hospice Care, see Sun Healthcare Group
Covenant Care Incorporated 202
Ecumen 203
Emeritus Corporation 204
Evangelical Lutheran Good Samaritan Society 207
Extendicare Incorporated 210
Family Comfort Hospice, see Chemed
Five Star Quality Care Incorporated 212
Genesis HealthCare Corporation 214
Gentiva Health Services Incorporated 217
GGNSC Holdings LLC 220
Griswold Home Care Incorporated 222
Harbinger Hospice, see Sun Healthcare Group
HCP Incorporated 223
Heart to Heart Hospice of Starkville, see Gentiva Health
Services
Home Instead Incorporated 225
Horizon Bay Realty, see Brookdale Senior Living
Hospice of Hackensack University Medical Center, see
Amedisys
Interim HealthCare Incorporated 226
Kindred Healthcare Incorporated 228

6. LCS LLC 232
Life Alert Emergency Response Incorporated 234
Life Care Centers of America 235
LivHOME Incorporated 236
Manor Care Incorporated 238
Masonicare 240
National HealthCare Corporation 242
North Mississippi Hospice, see Gentiva Health Services
Odyssey HealthCare, see Genesis HealthCare
ParaMed Home Health Care, see Extendicare
Philips Lifeline, see Royal Philips Electronics
Professional HealthCare, see Kindred Healthcare
Royal Philips Electronics NV 246
SavaSeniorCare LLC 248
Senior Care Centers of America Incorporated
(formerly Active Day) 249
Skilled Healthcare Group Incorporated 251
Sodexo 254
Sun Healthcare Group Incorporated 256
Sunrise Senior Living Incorporated 258
Tyco International Limited 261
United Home Care Group, see Gentiva Health Services
VITAS Healthcare, see Chemed
Other Elder Care Companies 263
LIST OF TABLES
SECTION I -- EXECUTIVE SUMMARY
Summary Table 3
SECTION II -- MARKET ENVIRONMENT
1 Population & Households 8
2 Macroeconomic Indicators 12
3 Personal Consumption Expenditures 15
4 Building Construction Expenditures 18
5 Business Establishments 21
6 Services Income 24
7 National Health Expenditures by Category 27
8 Chronic Conditions by Type 30
9 Acute Conditions by Type 32
SECTION III -- SERVICES
1 Elder Care Service Revenues by Service Type 40
2 Skilled Nursing Care Service Overview 45
3 Skilled Nursing Care Revenues by Provider Type 50
4 Skilled Nursing Revenues by Payment Source 53

7. 5 Home Health Care Service Overview 56
6 Personal Emergency Response Service Overview 63
7 Home Health Care Revenues by Provider Type 64
8 Home Health Care Revenues by Payment Source 66
9 Social Services Overview 69
10 Social Service Revenues by Provider Type 75
11 Social Service Revenues by Payment Source 77
12 Continuing Care Communities Overview 81
13 Continuing Care Community Revenues by Provider Type 83
14 Continuing Care Community Revenues by Payment Source 86
15 Assisted Living Facilities Overview 89
16 Assisted Living Revenues by Provider Type 92
17 Assisted Living Revenues by Payment Source 94
SECTION IV -- SERVICE PROVIDERS
1 Elder Care Service Revenues by Service Provider 96
2 For-Profit Elder Care Service Revenues by Service Type 100
3 Nonprofit Elder Care Service Revenues by Service Type 104
SECTION V -- PAYMENT SOURCES
1 Elder Care Service Revenues by Payment Source 107
2 Selected Medicaid Statistics 110
3 Medicaid Payments for Elder Care Services 112
4 Out-of-Pocket Payments for Elder Care Services 116
5 Selected Medicare Statistics 121
6 Medicare Payments for Elder Care Services 124
7 Selected Private Insurance Statistics 129
8 Private Insurance Payments for Elder Care Services 133
9 Other Payments for Elder Care Services 136
SECTION VI -- REGIONAL MARKETS
1 Resident Population 65 Years & Over by Region 139
2 Regional Gross Domestic Product 141
3 Elder Care Service Revenues by Region 143
4 Northeast Elder Care Service Revenues 145
5 Midwest Elder Care Service Revenues 147
6 South Elder Care Service Revenues 150
7 West Elder Care Service Revenues 152
SECTION VII -- INDUSTRY STRUCTURE
1 Elder Care Service Revenues by Company, 2011 156
2 Selected Acquisitions & Divestitures 171
3 Selected Cooperative Agreements 178
LIST OF CHARTS
SECTION III -- SERVICES
1 Elder Care Service Revenues by Service Type, 2011 41

8. SECTION IV -- SERVICE PROVIDERS
1 Elder Care Service Revenues by Service Provider, 2001-2021 97
SECTION V -- PAYMENT SOURCES
1 Elder Care Service Revenues by Payment Source, 2011 107
2 Medicaid Payments for Elder Care Services, 2001-2021 113
3 Out-of-Pocket Payments for Elder Care Services, 2001-2021 117
4 Medicare Payments for Elder Care Services, 2001-2021 125
5 Private Insurance Payments for Elder Care Services, 2001-2021 134
6 Other Payments for Elder Care Services, 2001-2021 136
SECTION VI -- REGIONAL MARKETS
1 Elder Care Service Revenues by Region, 2011 143
SECTION VII -- INDUSTRY STRUCTURE
1 Elder Care Service Market Share by Provider, 2011 157
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