Many hospices in 2025 are driving to expand in the senior housing and assisted living space.

More than 818,000 people in the United States dwell in more than 30,600 assisted living communities nationwide with an aggregate 1.2 million licensed beds, according to the American Health Care Association and the National Center for Assisted Living (AHCA/NCAL).

Many seniors are looking to assisted or senior living facilities as they age, Susan Ponder-Stansel, CEO of Florida-based Alivia Care, said at the Hospice News ELEVATE conference in Orlando, Florida.

“My generation, baby boomers, we’re not going to a nursing home. We’re looking at assisted living, senior living, that sort of thing,” Ponder-Stansel told Hospice News. “To the extent that the hospice program can really bring not just hospice, but some of that continuum of care to allow people to remain where they are and receive care where they lived for a long period of time. To me, that’s a great opportunity.”

Alivia Care emerged in 2020 when Community Hospice & Palliative Care, now an affiliate, formed a larger company with a broader range of services. The nonprofit provides home care, hospice, advance care and supportive and palliative care across northern Florida and southern Georgia. Alivia Care also offers care coordination through its Programs of All-Inclusive Care for the Elderly (PACE) services.

The lion’s share of assisted living residents are aged 85 or older, AHCA/NCAL reported. This dovetails to a large extent with the demographics of the hospice population. In 2022, more than 907,000 Medicare hospice decedents were older than 85, out of 1.7 million total patients, according to the National Alliance for Care at Home.

More than 22% of hospice leader respondents to the 2025 Hospice News/Homecare Homecase Outlook Survey said that senior living represented their greatest referral growth opportunity for 2025, a higher proportion than hospitals, skilled nursing facilities, home health agencies or physician offices, among others.

But the most successful hospices in the senior living arena are those who can offer a larger continuum of care, according to Ponder-Stansel.

“Those who are successful in our service area have additional upstream or wrap-around services like care navigation, like home health. We’ve even seen [Medicare] Part B therapy, services, home-delivered primary care, those sorts of things that really allow people to receive everything they need in one place,” Ponder-Stansel said. “And for those hospices that maybe don’t have the ability to add all of those things, can you be a partner to those who maybe only have the home health or the therapy, and really extend that reach?”

The Pennant Group (NYSE: PNTG) is among the companies that offer that continuum of care in the senior and assisted living space. Pennant is the holding company for a cluster of independent hospice, home health and senior living providers located across 13 states.

Patients in assisted living tend to be sicker than the home-based population, Dr. Derrell Walker, chief medical officer for The Pennant Group, said at ELEVATE. This is driving up demand for services that Pennant provides, such as home health, hospice, palliative care and home-based primary care, according to Walker. 

“Hospital systems, because of different payment structures, are pushing patients out sooner, so the level of care included in skilled nursing and assisted living consistently has increased significantly over the past number of years,” Walker told Hospice News. “That leads to a care setting where the patient’s need is a lot higher than it used to be.”

Senior living operators are also recognizing the greater need for hospice for their residents.

In August 2024, two Ohio-based senior living operators created a joint venture branded as Hospice of Greater Cleveland. Judson Senior Living and McGregor Senior Living Communities have been long-time collaborators. Each company had been running their own hospice programs within their facilities, which they then combined through the JV.

Also last year, senior living and health care services operator The Dover Companies launched a home health and hospice business branded as Dover Health.

Dover Health offers patients a suite of wraparound services, including for the terminally ill, to support quality of life and aging in place. Its parent organization also operates senior living, pharmacy, development, independent living, personal care, assisted living and memory care businesses, among others.

However, while opportunities exist for hospices in senior living, competition for those referral relationships has become fierce.

“There’s a lot of competition in that space, because you have a lot of people under one roof,” Ponder-Stansel said. “It’s definitely very feasible versus going from home to home.”