Long-term care sector faces growing strain

The number of Spokane-area residents aged 85 and older is projected to nearly quadruple over the next quarter-century, jumping from 10,700 in 2025 to 40,400 by 2050, according to data from the Washington State Department of Social and Health Services. That growth rate outpaces every other age group in the region and is expected to put significant strain on the long-term care sector, which includes assisted living, skilled nursing, memory care, and adult family homes.

Washington state as a whole is bracing for a 260% increase in its 85-and-older population by 2050. This rate is five times faster than the 75-to-84 age bracket. Spokane County is on track to exceed even that, with its oldest demographic set to grow by nearly 280%, according to state projections. That figure is roughly double the 147% expansion rate expected for the rest of the country.

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Lauri St. Ours, executive vice president for communications and government relations for the Washington Health Care Association, suggests the state must prepare the entire healthcare system for a dramatic increase in demand. The economic footprint of the sector is already substantial. Spokane County employed about 10,500 direct care workers as of 2023, a concentration of roughly 19 workers per 1,000 residents.

Demographic math is shifting. State data shows the ratio of working-age adults to those 85 and older is expected to fall from 30-to-1 today to 9-to-1 by 2050. St. Ours notes that while the hard work of caregivers is reliable, the industry is not ready to provide for the needs of such a large population. She adds that current efforts will determine future preparedness.

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Part of that preparation involves a move toward smaller residential settings, a trend already reshaping the sector. Washington operates more than 6,000 licensed adult family homes statewide, compared with fewer than 600 assisted-living communities, making it one of the largest networks of small residential care providers, says Kenyon Durr, co-founder of Silver Age Senior Living Advisors.

Adult family homes are seeing strong growth in Spokane and Vancouver. Rising construction costs and lengthy development timelines make large assisted-living projects harder to build. Durr explains that such communities require significant capital investment and years to develop. These small homes fill an important gap by expanding care capacity in smaller residential settings.

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Statewide, Washington has over 550 licensed assisted-living facilities serving nearly 40,000 residents and employing about 32,000 workers. Those facilities generate an estimated $3.74 billion in economic activity and about $418 million in annual tax revenue. The state also has roughly 200 licensed skilled nursing facilities caring for 13,000 residents and employing more than 18,000 workers.

Residents arrive later in life and with more complex medical needs. More than half of assisted-living residents are at least 85 years old, and over half have a diagnosed Alzheimer’s or dementia-related condition.