The Changing Face of the Nursing and Residential Care Industry
August 26, 2026Facilities in the nursing and residential care subsector provide residential care combined with either nursing, supervisory, or other types of care required by the residents. In the United States in 2025, there were 95,400 nursing and residential care facilities (all ownerships) employing 3.6 million workers. The nation’s nursing and residential care industry lost 400,900 employees from early 2020 (pre-pandemic) to the end of 2022, according to the Bureau of Labor Statistics. This amount of job loss in these industries far outpaced other health care sectors in the nation. But by the end of 2025, the sector recovered the pandemic job-loss, adding back 441,700 jobs.
Differences Between Nursing and Residential Care Facilities
There are notable differences between the nursing and residential care industries. The residential care industry comprises establishments primarily engaged in providing residential and personal care for people who choose to maintain their independence and do not need round-the-clock medical care. According to the National Institute on Aging, assisted living residents usually live in their own apartments and share common areas. They have access to many services such as three meals a day, assistance with personal care, housekeeping, and laundry.
Establishments in the nursing home industry provide round-the-clock residential care combined with either nursing, supervisory, or other types of care as required by the residents. These facilities are a significant part of the production process and the care provided is a mix of health and social services with the health services being largely some level of nursing services.
Oregon’s Private Nursing and Residential Care Industry: Employment and Establishments
The private nursing and residential care industry in Oregon consisted of more than 1,700 facilities employing an average of 45,100 workers in first quarter 2026. The industry experienced a net loss of 3,500 jobs during 2020 to 2023 but has now gained back nearly three times the jobs lost during the recession.
Employment trends in Oregon’s residential care facilities have not matched the employment trends in Oregon’s nursing homes. Since 2001, employment in residential care consistently grew by an average of about 800 jobs a year until the pandemic hit in early 2020. Nursing homes, on the other hand, experienced employment growth averaging -0.6% from 2001 through 2022. After the COVID recession, the nursing industry rapidly added employment from August 2022 to March 2026 – gaining 3,900 jobs.
Demand for long-term care options for seniors is expected to increase as Oregon’s older population continues to grow. Oregon’s Industry Projections show that the nursing and residential care facilities are projected to add 9,800 new jobs during 2024-2034. In addition, for every one job opening in nursing and residential care facilities due to growth, Oregon’s projections show an additional nine replacement openings due to workers exiting the workforce or changing careers.
According to Office of Economic Analysis, Oregon’s population 65 years and older is expected to increase by 155,200, or by 17%, from 2025 to 2035, reaching a population of 1,052,800 by 2035. In stark contrast, the state’s population ages 24 years and younger is expected to decline by 82,800 or by -6.9%, reaching a population of 1,109,800 by 2035.
A similar picture emerges nationally, where the 65 and older population is projected to nearly double in size from 49 million in 2016 to 95 million in 2060. By 2060, the share of people aged 65 and older will compose nearly one-quarter of the population in the United States, according to the U.S. Census Bureau.
Jobs in nursing home and residential care vary from health care services to food serving, grounds keeping, and building maintenance. Although varied, the majority of occupations (59%), or 1.9 million workers in the nation were in healthcare practitioner and healthcare support sectors during 2024. These specific occupations included home health and personal care aides, nursing assistants, home health and personal care aides, licensed practical and vocational nurses, and registered nurses. The next largest occupations were food servers, maids and housekeeping cleaners, and cooks.
Oregon’s 2026 average hourly wage for the nation’s two largest occupations in long-term care ranged from $22.00 for home health and personal care aides to $25.72 for nursing assistants, orderlies, and psychiatric aides, which are both healthcare support occupations. The average hourly wage in Oregon for all healthcare support occupations was $24.42 in 2026.
Long-term care support includes more than just nursing and assisted living facilities. According to the 2024 Oregon Long-Term Care State Report from the Oregon Health Care Association, “long-term care is a continuum of services and supports, including health care, social services, and housing, provided to individuals living with chronic conditions or disabilities that affect their ability to perform activities of daily life.” In the state, more than 75,000 Oregonians receive long-term care services each day and this number is expected to grow as Oregon’s population continues to age.
The long-term care continuum includes in-home care, senior retirement housing, assisted living and residential care communities, memory care communities, and long and short stay skilled nursing/rehab communities.
| Provider Type | Number of Providers | Number of Oregonians Served |
|---|---|---|
| Assisted Living/Residential Care | 575 | 22,485 |
| Home Care Commission (OHCC) Workers* | 16,000 | 19,000 |
| Independent Living | 200 | 12,000 |
| In-Home Care Agencies | 200 | 10,000 |
| Nursing Facilities | 129 | 6,491 |
| Adult Foster Homes | 1,329 | 5,316 |
Future Trends and Challenges in Long-Term Care
According to the Long Term Care 2026 Trends and Outlook report by the American Healthcare Association and National Center for Assisted Living, the number of older adults in the nation will more than double over the next several decades to top 88 million people and represent over 20% of the population by 2050. This silver tsunami promises to reshape senior living and will require providers to address a complicated number of trends and challenges which include evolving care models, new technologies, and dynamic new design paradigms. Five major trends in long-term care emerged from this report:
- Mastering New Care Models: The expansion of Medicare Advantage and Managed Medicaid will require the industry to respond to tighter margins and higher administrative costs and burdens for providers. Providers need to have a granular understanding of Medicare contracts and what their margin is for providing care.
- Clinical Diversification and High-Acuity Care: As the population ages, the complexity of care will increase as providers will be asked to service residents with greater clinical and behavioral needs. As costs increase accordingly, providers will need to find new and innovative ways of increasing revenues. Some examples include the addition of high-acuity services such as memory care and hospital services such as ventilator units and onsite dialysis so residents can receive high-level care onsite.
- Leveraging Artificial Intelligence, Intelligently: Using improved fall detection technology to better capture the broader range involved in falls and monitor resident safety. Another frontier is using predictive AI to better understand large datasets and flag potential health risks.
- Higher Quality Environments: In the future, older adults will be more discerning about their environment and the demand for long-term facilities with resort-style communities with wellness amenities and beautiful design and surroundings will increase. One such trend in senior living spaces will be more sunlight. Since the cost of windows has declined, it is easier for communities to give their residents bright sunlight interiors.
- The Path Forward: The senior living industry still faces challenges such as workforce shortages, changing regulations, and finding cuts. Successful facilities will have a clear strategy for creating workforce stability, designing decision-making tools, and using technology effectively.
Additional research and information on long-term care can be found at Data & Research on the American Health Care Association and the National Center for Assisted Living website.