INTRODUCTION ix
I. EXECUTIVE SUMMARY 1
II. MARKET ENVIRONMENT 4
General 4
Demographic Trends 4
Macroeconomic Outlook 8
Consumer Spending Trends 13
Building Construction Trends 16
Business Establishment Trends 19
Service Sector Outlook 21
Healthcare Trends 24
National Health Expenditures 25
Medical Conditions 28
Chronic Conditions 29
Acute Conditions 31
Regulatory Environment 33
World Markets 36
III. SERVICES 40
General 40
Skilled Nursing Care Facilities 43
Overview 44
Employees 48
Regulations 50
Providers 53
Payment Sources 55
Home Healthcare Services 58
Overview 58
Employees 61
Regulation 64
Personal Emergency Response Services 65
Providers 69
Payment Sources 71
Social Services 73
Overview 73
Adult Day Care 78
Non-Medical Home Care 81
Other Services 84
Employees 84
Providers 85
Payment Sources 86
Continuing Care Retirement Communities 88
Overview 89
Providers 93
Payment Sources 96
Assisted Living Facilities 98
Overview 99
Employees 102
Regulations 103
Providers 104
Payment Sources 106
IV. SERVICE PROVIDERS 108
General 108
For-Profit 111
Nonprofit 114
V. PAYMENT SOURCES 119
General 119
Medicaid 122
Overview 122
Medicaid Payments for Elder Care Services 124
Medicare 127
Overview 128
Medicare Payments for Elder Care Services 132
Out-of-Pocket 136
Private Insurance 140
Overview 141
Long-Term Care Insurance 144
Private Insurance Payments for Elder Care Services 146
Other 149
VI. REGIONAL MARKETS 153
General 153
Regional Population Aged 65 & Over 153
Regional GDP 155
Elder Care Services by Region 158
Northeast 160
New England 162
Middle Atlantic 165
Midwest 167
East North Central 171
West North Central 173
South 175
South Atlantic 178
East South Central 181
West South Central 183
West 186
Mountain 188
Pacific 190
VII. INDUSTRY STRUCTURE 193
General 193
Industry Composition 193
Market Share 197
Competitive Strategies 203
Marketing 206
Mergers & Acquisitions 208
Cooperative Agreements 216
Company Profiles 218
ADT Corporation 219
Adult Day Care Group 220
Advocat, see Diversicare Healthcare Services
Aegis Therapies, see GGNSC Holdings
Amedisys Incorporated 221
AseraCare, see GGNSC Holdings
Assisted Living Concepts, see Enlivant
Atria Senior Living Group Incorporated 224
Bayada Home Healthcare 225
Brookdale Senior Living Incorporated 227
Capital Senior Living Corporation 232
CareSouth Health System Incorporated 235
Catholic Health Initiatives 237
Centerre Healthcare, see Kindred Healthcare
Chemed Corporation 240
CK Franchising, see Sodexo
Comfort Keepers, see Sodexo
Compassionate Care Hospice LLC 242
Covenant Care Incorporated 243
Diversicare Healthcare Services Incorporated 244
Emeritus, see Brookdale Senior Living
Encompass Home Health Incorporated 247
Encore Senior Living, see LCS
Enlivant 249
Evangelical Lutheran Good Samaritan Society 250
Extendicare Incorporated 252
Family Matters, see Senior Care Centers of America
Five Star Quality Care Incorporated 254
Genesis HealthCare Corporation 256
Gentiva Health Services Incorporated 259
GGNSC Holdings LLC 262
Griswold Home Care Incorporated 264
Harden Healthcare Holdings, see Gentiva Health Services
HCP Incorporated 265
Holland Health, see Senior Care Centers of America
Home Instead Incorporated 268
IntegraCare Holdings, see Kindred Healthcare
Interim HealthCare Incorporated 269
Intrepid USA Healthcare Services 271
Kindred Healthcare Incorporated 273
LCS LLC 278
Life Alert Emergency Response Incorporated 281
Life Care Centers of America 282
LivHOME Incorporated 283
Manor Care Incorporated 285
National HealthCare Corporation 287
Nurse On Call, see Brookdale Senior Living
Odyssey HealthCare, see Gentiva Health Services
Philips Lifeline, see Royal Philips
Professional HealthCare, see Kindred Healthcare
Royal Philips NV 291
SavaSeniorCare LLC 293
Senior Care Centers of America Incorporated 294
Senior Home Care, see Kindred Healthcare
Skilled Healthcare Group Incorporated 296
Sodexo 299
Solari Hospice Care, see Chemed
Sunrise Senior Living LLC 301
TherEX, see Kindred Healthcare
VITAS Healthcare, see Chemed
Wake Forest Baptist Health Care at Home, see Gentiva
Health Services
Western Reserve Senior Care, see Kindred Healthcare
Other Elder Care Companies 304

LIST OF TABLES

SECTION I -- EXECUTIVE SUMMARY
Summary Table 3
SECTION II -- MARKET ENVIRONMENT
1 Population & Households 8
2 Macroeconomic Indicators 13
3 Personal Consumption Expenditures 16
4 Building Construction Expenditures 18
5 Business Establishments 21
6 Services Income 24
7 National Health Expenditures by Category 28
8 Chronic Conditions by Type 31
9 Acute Conditions by Type 32
SECTION III -- SERVICES
1 Elder Care Service Revenues by Service Type 42
2 Skilled Nursing Overview 48
3 Skilled Nursing Care Revenues by Provider Type 54
4 Skilled Nursing Revenues by Payment Source 57
5 Home Healthcare Service Overview 61
6 Personal Emergency Response Service Overview 69
7 Home Healthcare Revenues by Provider Type 71
8 Home Healthcare Revenues by Payment Source 73
9 Social Services Overview 77
10 Social Service Revenues by Provider Type 86
11 Social Service Revenues by Payment Source 88
12 Continuing Care Communities Overview 93
13 Continuing Care Community Revenues by Provider Type 96
14 Continuing Care Community Revenues by Payment Source 98
15 Assisted Living Facilities Overview 102
16 Assisted Living Facility Revenues by Provider Type 106
17 Assisted Living Facility Revenues by Payment Source 107
SECTION IV -- SERVICE PROVIDERS
1 Elder Care Service Revenues by Service Provider 110
2 For-Profit Elder Care Service Revenues by Service Type 114
3 Nonprofit Elder Care Service Revenues by Service Type 118
SECTION V -- PAYMENT SOURCES
1 Elder Care Service Revenues by Payment Source 121
2 Selected Medicaid Statistics, 2003-2013 124
3 Medicaid Payments for Elder Care Services 126
4 Selected Medicare Statistics, 2003-2013 132
5 Medicare Payments for Elder Care Services 135
6 Out-of-Pocket Payments for Elder Care Services 139
7 Selected Private Insurance Statistics, 2003-2013 144
8 Private Insurance Payments for Elder Care Services 148
9 Other Payment Sources for Elder Care Services 151
SECTION VI -- REGIONAL MARKETS
1 Resident Population 65 Years & Over by Region 155
2 Regional Gross Domestic Product 158
3 Elder Care Service Revenues by Region 159
4 Northeast: Elder Care Service Revenues by Source
& Subregion 162
5 New England: Elder Care Service Revenues by State 165
6 Middle Atlantic: Elder Care Service Revenues by State 167
7 Midwest: Elder Care Service Revenues by Source
& Subregion 170
8 East North Central: Elder Care Service Revenues by State 173
9 West North Central: Elder Care Service Revenues by State 175
10 South: Elder Care Service Revenues by Source & Subregion 178
11 South Atlantic: Elder Care Service Revenues by State 181
12 East South Central: Elder Care Service Revenues by State 183
13 West South Central: Elder Care Service Revenues by State 186
14 West: Elder Care Service Revenues by Source & Subregion 188
15 Mountain: Elder Care Service Revenues by State 190
16 Pacific: Elder Care Service Revenues by State 192
SECTION VII -- INDUSTRY STRUCTURE
1 Elder Care Service Revenues by Company, 2013 196
2 Selected Acquisitions & Divestitures 212
3 Selected Cooperative Agreements 217

LIST OF CHARTS

SECTION III -- SERVICES
1 Elder Care Service Revenues by Service Type, 2003-2013 43
2 Social Service Caregivers, 2013 78
SECTION IV -- SERVICE PROVIDERS
1 Elder Care Service Revenues by Service Provider, 2003-2023 110
SECTION V -- PAYMENT SOURCES
1 Elder Care Service Revenues by Payment Source, 2013 121
2 Medicaid Payments for Elder Care Services, 2003-2023 127
3 Medicare Payments for Elder Care Services, 2013 136
4 Out-of-Pocket Payments for Elder Care Services, 2013 140
5 Private Insurance Payments for Elder Care Services, 2013 149
6 Other Payments for Elder Care Services, 2013 152
SECTION VI -- REGIONAL MARKETS
1 Elder Care Service Revenues by Region, 2013 160
SECTION VII -- INDUSTRY STRUCTURE
1 Elder Care Service Market Share, 2013 197