CCRC. ADL. IL. IA/IL. What does it all mean? If you don't know, you might want to think twice about entering the senior housing market. From the outside, senior housing might look a lot like traditional multifamily housing, but on the inside, it's an industry with its own set of operational challenges.

Senior housing is far more than just a real estate investment, explains Karen Anderson, president and CEO of Cordia Senior Living, a manager of independent and assisted living facilities based in Boston. With senior housing you are investing in an operating business that requires the melding of the real estate, hospitality, and health care industries, says Michael Grust, president of Senior Resource Group LLC, a developer of congregate living communities based in San Diego.

At The Village at Sherman Oaks, a Senior Resource Group LLC senior community in Sherman Oaks, Calif., dining is one of the many services provided to its residents.
At The Village at Sherman Oaks, a Senior Resource Group LLC senior community in Sherman Oaks, Calif., dining is one of the many services provided to its residents.

Whether you are operating a continuing care retirement community (CCRC), an assisted living residence (AL), or an independent living community (IL) you need to be able to provide some of the same services hotels offer, such as commercial kitchens, recreation, laundry services, and transportation. In addition, you have to take care of the personal care needs of an elderly population, while encouraging them to maintain their independence, says Anderson.

In assisted living communities, it's important to provide assistance with daily living (ADL), such as bathing, distributing medication, and assisting with movement around a community, hygiene, and eating, says Anderson.

One of the biggest challenges in assisted living is when a couple moves in and requires different levels of care, says Adam Rosenblum, vice president of marketing and sales at The Palace Management Group, a provider of senior housing in the Florida market. It's important to meet both residents' physical and emotional needs in the same environment. One solution is for the couple to reside on the same campus but in separate accommodations. A more popular solution is to share an apartment, but the more alert spouse can participate in a different building activities.

Help Wanted The biggest mistake multifamily owners, managers, and developers make is not understanding the importance of management, says Grust. In his experience, multifamily developers typically don't understand how complex the management matrix is to provide service–it's not enough to just offer food service, he says. It takes the right mix of people.

Senior housing is a people intensive business that is experiencing a shortage of people–especially qualified nurses, explains Ed Kenny, executive vice president of operations at Life Care Services, a senior housing provider based in Demoin, Iowa. "The cost of recruiting and retaining employees has placed significant pressure for those communities that have and require nurses," he says.

he Shelter Group, a developer and manager of multifamily and senior housing projects based in Baltimore, budgets to staff nurses 24 hours per day at its assisted living properties, but in many cases, it hasn't been able to meet those staffing needs. The company always has a nurse for the first two shifts of the day. "Sometimes I can't find the third shift," says Susan Eckert, vice president of operations. As a solution, the company trains senior resident assistants to perform supervisory tasks. On shifts without nurses, if there is an emergency, there is always a nurse on-call who can be in the building in 10 minutes, she adds.