CALA News & Views | Issue 53 | CALA at 30

30 Years of IMPACT SHAPING POLICIES THAT SUPPORT ASSISTED LIVING ACROSS CALIFORNIA

30 Years IN CCRCS changes of

THE FUTURE OF ASSISTED LIVING Ahead Looking

CALA AT 30

NURTURE  LOVE  SUPPORT

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CALA AT 30

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CALA’s 30 Years

30 Years of Impact

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Driving Resident-Centered Regulations: When to Call 9-1-1 The Evolution of Caring for Assisted Living Residents with Dementia Shining Stars: Celebrating Our Northern California Award Recipients

For three decades, CALA has been more than an organization – it’s been a community. A community of leaders, innovators and advocates, all working together to elevate the lives of those we serve. Since 1995, CALA members have supported each other, shared ideas and advanced a model of care centered on dignity, choice and well-being. That spirit of collaboration is what built CALA – and what continues to power its momentum today. It has been my honor to be part of this journey for the past 24 years. I’ve witnessed firsthand the passion and perseverance of our members as they navigated challenges, embraced opportunities and redefined what’s possible in Assisted Living, Memory Care and Continuing Care Retirement Communities. From our earliest conferences to today’s dynamic advocacy and education programs, CALA’s story has always been shaped by its members – and your commitment to person centered care. As we celebrate 30 years, I’m inspired by the words our members used in our recent anniversary word cloud: community, compassion, purpose, innovation, impact. These aren’t just reflections of where we’ve been – they’re guideposts for where we’re going. I can’t wait to see how CALA members continue to grow, lead and deliver exceptional experiences for residents in the years ahead. Happy anniversary to this extraordinary community – and thank you for all you do!

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30 Years of Change in CCRCs

Progress with Purpose: Technology Advances in Assisted Living

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The Creative View

Looking Ahead: The Future of Assisted Living

Blueprints for What’s Next

CALA News & Views – Submission Policy At this time, CALA does not accept unsolicited articles or queries. Many of the articles we publish are written by our regular contributing writers. We appreciate the time and energy people put into making suggestions for our current and future issues. Our organization’s policy, however, prevents us from accepting for review any unsolicited submissions.

Cindi Alvidrez, Membership Manager cindi@CAassistedliving.org

Pam Amundsen, Director of Meetings & Events pam@CAassistedliving.org Denise Brandt, Director of Workforce Development denise@CAassistedliving.org Selena Coppi Hornback, Senior Director of Public Policy selena@CAassistedliving.org Agnes de la Vega, Senior Workforce Development Specialist agnes@CAassistedliving.org Daniel Gonzalez, Advocacy Engagement Specialist daniel@CAassistedliving.org Heather Harrison, President & CEO heather@CAassistedliving.org Katherine McLoskey, Director of Operations katherine@CAassistedliving.org Danielle Parsons, Vice President of Government Affairs danielle@CAassistedliving.org Haty Pietrasz, Director of Creative Design haty@CAassistedliving.org Brandi Pittman, Administrative Specialist brandi@CAassistedliving.org Kevin Swartzendruber, Director of Marketing & Communications kevin@CAassistedliving.org Jan Trifiro, Vice President of Professional Development jan@CAassistedliving.org

Heather Harrison, President & CEO

CALA STAFF

CALA Board of Directors

OFFICERS Board Chair David Eskenazy, CEO, Cogir Management USA, Inc. Vice Chair Danielle Morgan, CEO, Clearwater Living Treasurer Laura Fischer, President, Integral Senior Living

Secretary Courtney Siegel, President & CEO, Oakmont Management Group Past Chair Rick Jensen, President & CEO, Northstar Senior Living

DIRECTORS

Michel Augsburger, Chairman & CEO, Chancellor Health Care, Inc Mark Cimino , CEO & Co-Owner, CiminoCare Dave Coluzzi, President & CEO, Carlton Senior Living Tara Cope, Chief Legal and Administrative Officer, Vi Senior Living Denise Falco , Senior Vice President of North American Field Operations, Sunrise Senior Living Paula Hertel, Founder, Senior Living Consult Darolyn Jorgensen-Kares, Chief Operating Officer, Continuing Life, LLC Rodger Lederer, Senior Vice President, Marsh Senior Care Practice Ray Leisure, Division Vice President, West Division, Brookdale Senior Living Douglas Lessard, COO & Executive Vice President, Belmont Village Senior Living Tana McMillon , Regional Vice President of Operations, Silverado Memory Care Nancy Schier Anzelmo, Principal, Alzheimer’s Care Associates LLC Todd Shetter, Chief Operating Officer, ActivCare Living Jay Thomas , Assistant General Counsel, Operations, Atria Senior Living

455 Capitol Mall, Suite 222 Sacramento, CA 95814 Phone: (916) 448-1900 www.CAassistedliving.org

EX-OFFICIO DIRECTORS Josh Allen, Principal, Allen Flores Consulting Group Joel Goldman, Partner, Hanson Bridgett

Copyright © 2025 California Assisted Living Association. All rights reserved. No part of this publication may be reproduced or transmitted in any form - print, electronic or otherwise - without written permission from CALA.

By Kevin Swartzendruber, CALA Director of Marketing and Communications

CALA’s

Thirty years ago, a small group of providers came together around a shared belief: that Assisted Living and Memory Care offered something distinct and essential – and that California needed a strong, unified voice to represent that model of care. From those early conversations, the California Assisted Living Facility Association was born, soon after renamed the California Assisted Living Association. CELEBRATING THREE DECADES OF ADVOCACY , EDUCATION AND MEMBER POWERED PROGRESS .

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“We didn’t have a lot, but we had heart,” remembers Michel Augsburger, one of CALA’s early board members and chairman and CEO of Chancellor Health Care, Inc. “We leaned on each other. We called in favors. We were determined to build something real.” “I still remember our first regional meeting,” said Joel Goldman , also a founding board member and partner at Hanson Bridgett . “It was at the Claremont Hotel, and maybe 30 or 40 people showed up. But there was energy in the room. We knew we were starting something important.” “We didn’t even have an executive director when we held our first conference,” said Sue Farrow , CALA’s first board chair and founder of Integral Senior Living/ Solstice Senior Living. “But we knew we needed CALA – and we were determined to build it. It was exciting, exhausting and worth every bit of effort.” Finding a Steady Path Forward The building began in earnest when the board hired Sally Michael as president and CEO – a decision that would shape the next three decades.

“We needed some leadership,” recalls Nancy Schier Anzelmo, principal at Alzheimer’s Care Associates LLC . “We wanted to raise the bar, align around quality, and build a better way forward – together.” Schier Anzelmo has been involved with CALA since its inception, initially supporting W. Major Chance – founding member of CALA and former CEO of Health Care Group, who is fondly remembered following his passing. Humble Roots, Determined Hearts From the beginning, CALA was fueled by passion, volunteerism and grit. It began with no staff beyond a part-time executive director, and board members often rolled up their sleeves to keep things moving. Most of the early work was carried out by providers themselves.

“That was a defining moment,” Schier Anzelmo said. “We needed someone who could lead with integrity and vision. Sally brought all of that.” “Hiring Sally was among the decisions that changed everything,” Augsburger said. Gaining Influence in the Capitol With new leadership in place and clearer direction, CALA began to evolve from a scrappy startup to a respected force. A pivotal moment came when the board decided to bring on a lobbyist – a step that helped establish CALA’s presence in the Capitol and elevated its role in policymaking. “That gave us real credibility,” Schier Anzelmo said. “We could start enacting legislation and advocating on behalf of members in a way that truly mattered.” That advocacy soon paid off. In 2014, CALA faced a wave of 14 bills – many of which would have 0 years

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Advice for the Next Generation To the next generation of CALA leaders, the advice is unanimous: “Stay grounded in CALA’s mission,” Augsburger said. “And remember, the strength of this organization has always come from its members – people willing to show up, speak out, and support each other.” “Get involved,” Goldman said. “Join a committee. Show up. That’s how this association was built –and how it will continue to thrive.” “Stay focused, but stay open,” Schier Anzelmo said. “Honor the past, protect the integrity and never stop looking for ways to do better.” “Don’t be afraid to pivot,” Farrow said. “This field moves fast, and CALA has always been good at adapting. That’s the key to staying relevant and responsive.” After 30 years of growth, challenges, advocacy and community, CALA stands strong – still united by the same purpose that brought a small group of pioneers together in 1995: to improve lives, elevate care and build something lasting. g CHECK OUT CALA's PHOTO GALLERY HERE

dramatically hindered providers' ability to operate and ultimately negatively impact resident access to services. The organization rallied, pushed back and emerged stronger. “That year was a litmus test,” Goldman said. “It showed everyone – lawmakers, providers, even our critics – that CALA wasn’t just another association. We were a serious voice for quality care.” Raising the Bar Through Education As the field matured, so did CALA’s programs and priorities. Today, CALA represents a broad spectrum of providers across the state – including Continuing Care Retirement Communities – offers best-in-class conferences and remains a powerful voice in Sacramento. And for many, the heart of the organization lies in its education. Schier Anzelmo has volunteered on CALA’s Education Committee for decades along with Paula Hertel, founder of Senior Living Consult . “From day one, we’ve been focused on high-quality content. We didn’t want to just fill slots. We wanted visionary speakers – people who would challenge and inspire. That’s how you raise the bar.” “Our conferences today are among the best in the country,” Goldman said. “People tell me all the time how impressed they are with what CALA puts together.” Facing the Future Looking ahead, CALA leaders see new challenges – and new opportunities. From AI and workforce shortages to evolving care models and the changing needs of aging Californians, the road ahead is dynamic and complex. “We need to keep expanding our reach in education,” Schier Anzelmo said. “We have so many great speakers and so much content – we’re exploring more ways to bring high quality education to members. People are hungry for it.” “Technology is going to change everything,” Goldman said. “And we have to be ready for that – while continuing to advocate, educate and support providers across the state.” Staying True to Our Purpose Still, some things haven’t changed – and won’t. “CALA has always been about collaboration over competition,” Augsburger said. “Whether you run one community or 100, you have a seat at the table.” “It’s never been about the individual companies,” Schier Anzelmo said. “It’s about the people we serve – the residents, the families and the team members who show up every day. That’s who CALA is for.” “We’re going to need a strong association to help us navigate what’s coming,” Farrow said, “to help make sure every Californian has the opportunity to age with dignity in a community that supports them.”

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CALA’S BOARD CHAIRS

30 TH

1994 John Knudson, (chair of planning group) 1995 Sue Griesemer (Farrow) 1996 Sue Griesemer (Farrow)

2025 CALA FALL CONFERENCE & TRADE SHOW Elevate november 10-12 RENAISSANCE PALM SPRINGS HOTEL & PALM SPRINGS CONVENTION CENTER

1997 Joel Goldman 1998 Paula Hertel 1999 Paula Hertel

2000 Michel Augsburger 2001 Michel Augsburger

2002 Loren Shook 2003 Loren Shook

early bird deadline: october 3

2004 Michael Carrick M.D. 2005 Michael Carrick M.D.

register now

2006 Melanie Werdel 2007 Melanie Werdel

2008 Vicki Clark 2009 Vicki Clark

relationships! IT'S ALL ABOUT FEDERAL DAY IN YOUR DISTRICT AUGUST 20 Federal Day in Your District presents an opportunity for you to meet with your representatives in their district offices – close to your communities - getting to know staff and foster relationships. Establish yourself as a resource and an expert. It’s easy and it’s fun!

2010 Sue McPherson 2011 Sue McPherson 2012 Don Petersen 2013 Don Petersen 2014 Sheila Garner 2015 Sheila Garner 2016 Todd Shetter 2017 Todd Shetter 2018 Rick Jensen 2019 Rick Jensen 2020 Michelle Egerer

2021 Michelle Egerer through mid-May 2021 Danielle Morgan beginning mid-May

2022 Danielle Morgan 2023 Danielle Morgan 2024 Ron Mead 2025 Dave Eskenazy

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30 Years

IMPACT of Resident Centered Care COVID Respo and Im

SHAPING POLICIE ASSISTED LIVING ACROSS

For 30 years, CALA has been committed to promoting a vibrant, diverse and innovative model of care that meets the changing needs of California’s older adults. Through strong legislative and regulatory advocacy, CALA has worked to create a balanced regulatory environment, promoting operational effectiveness and the integrity of licensing practices, all while keeping the resident experience front and center. CALA has achieved significant legislative and regulatory changes that enhance resident-centered care. This success is due to the collective work of CALA’s board leadership, committee and task force members, strong stakeholder relationships within and beyond the long-term services and supports system, and a strong problem-solving approach with legislators and regulators. As we look to the future, CALA continues its advocacy work to enhance the quality of care and operational effectiveness of Assisted Living, Memory Care and CCRCs. T By Heather Harrison, CALA President & CEO and Selena Coppi Hornback, CALA Senior Director of Public Policy

D-19 onse mpact

Licensing Integrity

Operational Effectiveness

ES THAT SUPPORT S CALIFORNIA

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RESIDENT-CENTERED CARE

OPERATIONAL EFFECTIVENESS

Like our members, CALA has consistently focused on ensuring that residents are at the heart of our work. Over the years, CALA has successfully advocated for policies and legislative changes to ensure that older adults receive care in the least restrictive environment, allowing them to age in place whenever possible. Key accomplishments early in CALA’s 30 years include significant changes in hospice care, allowing residents to remain in Assisted Living communities when they enter hospice and eliminating the need for exceptions regarding prohibited conditions like total care (if the conditions were addressed in a hospice care waiver). CALA has also made substantial progress in dementia care, advocating at CALA’s formation for legislation allowing secured perimeters in Assisted Living and more recently collaborating with the Alzheimer’s Association on legislation to strengthen medication training requirements and establish specialized dementia training for caregivers. Additionally, CALA’s efforts to update California’s building codes have led to enhanced safety for residents with dementia. CALA has been instrumental in advocating for flexibility in the Medi-Cal Assisted Living Waiver program to allow more inclusion of residents with dementia and to incorporate safety measures such as delayed egress and secured perimeters. This work continues today as CALA supports new Medi-Cal programs like CalAIM Community Supports, working to strengthen collaboration between Assisted Living providers and managed care health plans to ensure residents’ needs are met and more people can access Assisted Living. As Continuing Care Retirement Communities (CCRCs) were added to CALA's membership, the strength of CCRC subcommittee members has greatly contributed to CALA’s advocacy successes. CALA provided the foundation needed to lessen the negative impact of a bill intended to incentivize fast repayment of entrance fees for CCRC contracts but without helping locate a buyer, would have resulted in higher fees for existing and future residents. Recently, CALA prevented a harmful provision in legislation that could have disrupted CCRC contracting, instead ensuring residents receive appropriate rights documentation. Whether working with legislators, regulators or other stakeholders, CALA’s advocacy focuses efforts to ensure strength and viability of the CCRC model for current and future residents, working to ensure flexibility, innovation and strong consumer choice.

While providing high quality essential care and support, Assisted Living communities must also operate effectively and efficiently, and for 30 years CALA has advocated for policies that make it easier for providers to do just that. In addition to working with the Department of Social Services (DSS), CALA regularly communicates with other state agencies to voice concerns and seek solutions that streamline operational processes for members. CALA has played a crucial role in strengthening emergency preparedness for RCFEs. Through advocacy and collaboration, CALA built on experience, tapped broad expertise and successfully promoted a new standard for comprehensive disaster planning for RCFEs and CCRCs. CALA members contributed to several emergency preparedness resources to help with preparation and consideration of various types of emergencies that can be accessed from our Emergency Preparedness webpage. CALA also played a vital role on the California Department of Aging’s Access Policy Workgroup, advocating for residents’ rights to in-person visits during emergencies—reinforcing that visitor access should be protected with the same safeguards used for staff. CALA stood firm against legislation that would have opened the door to increased frivolous litigation and higher care costs across the state. A major milestone was achieved with the reform of the Private Attorneys General Act (PAGA), which culminated in legislation to reduce lawsuit abuse by introducing a right to cure, limiting who can sue, capping penalties and establishing a one-year statute of limitations. This underscores the importance of thoughtful legal reform – balancing the need to protect vulnerable individuals while preventing exploitation of the system.

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LICENSING INTEGRITY Licensing integrity is a cornerstone of CALA’s advocacy. Over the years, CALA has worked closely with DSS to address issues that arise in the field, ensuring licensing enforcement is clear and consistent. CALA’s success in securing budget increases for CCLD has allowed for necessary staff expansions and improved the licensing process. This has always been a strong focus of CALA’s efforts and continues today. A major victory in this area was the restoration of annual RCFE licensing inspections, which at one point were only conducted every five years. This change was made possible through CALA’s advocacy for increased DSS funding in the 2015–2016 State Budget. Additional COVID-19 RESPONSE AND IMPACT The COVID-19 pandemic presented unprecedented challenges for Assisted Living providers. CALA worked alongside its members to secure necessary resources and advocate for policies that would protect both residents and staff. CALA’s efforts included advocating for flexibility in hiring, securing protective equipment and addressing staff testing and treatment needs. Throughout the pandemic, CALA ensured that Assisted Living providers had priority access to COVID-19 testing, vaccinations and treatment. CALA’s leadership on the Vaccine Advisory Task Force helped shape vaccine rollout, ensuring that Assisted Living communities received timely access to vaccines and booster shots. Additionally, CALA secured access to affordable PCR testing through the state’s Valencia Lab and worked with the Department of Health Care Services (DHCS) to expand the availability of CLIA waivers for antigen testing. In response to the evolving guidance from multiple agencies, CALA worked to reduce duplicative reporting requirements and clarify confusing protocols. CALA’s ongoing engagement with local and state officials helped ensure that Assisted Living communities had access to clear, consistent and timely information. As COVID-19 became more manageable, CALA advocated for the removal of overly restrictive quarantine measures and helped guide the transition back to a more natural living environment for residents. By successfully arguing that Assisted Living communities are residential settings, CALA helped lift mask and vaccine mandates and improve communication, easing staffing challenges.

budget increases resulted in the hiring of key staff, including a registered nurse to offer medical expertise, and the creation of a Quality Assurance Unit. In terms of background checks, CALA has led the charge to improve the Guardian IT system. After working to secure state funding and overhaul processes, CALA’s efforts have resulted in faster background checks and improved efficiency in the system. CALA continues to collaborate with DSS to improve the background check process, reduce delays, and provide more flexible solutions for providers. This continues to have a positive impact on the senior care workforce.

LOOKING TO 2025 AND BEYOND

As CALA looks ahead, 2025 and beyond present both challenges and opportunities. A major recent development in dementia care regulations will allow residents with dementia to age in place, providing more flexibility in how they are cared for. CALA was instrumental in these changes, providing members with resources and educational opportunities to help them adapt to the new regulations. Processing times for administrator certifications, which had reached a peak of 10 months, are now down to approximately two months, thanks to CALA’s ongoing advocacy. This improvement, along with the launch of an online portal for new administrators, will continue to streamline the certification process for providers. CALA has been advocating for DSS to clarify expectations regarding the use of 9-1-1 services for Assisted Living communities. The current 9-1-1 requirements have created tension among emergency responders who aren’t aware of our requirements. The recent PIN provides details on when 9-1-1 must be called and examples of when other medical care, like mobile X-Ray, can be sought to help provide timely care and avoid inappropriate use of the emergency response system. CALA will continue advocating for changes to ensure that emergency calls are used appropriately and efficiently, based on residents’ needs, as DSS works on updates to 87465 . As CALA continues to advocate for the future of Assisted Living, Memory Care and CCRCs in California, it remains focused on enhancing the quality of care, expanding access and creating a system that promotes flexibility and innovation, while supporting providers in meeting the complex demands of this model of care. Issues related to emergency preparedness, staffing models, reoccurring licensing delays and care delivery will continue to arise, and we are ready. Building on a strong foundation of member engagement and success, CALA is well prepared for the next 30 years.

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When to Call 9-1-1 By Selena Coppi Hornback, CALA Senior Director of Public Policy DRIVING Resident-Centered REGULATIONS:

T he regulation requiring licensees to call 9-1-1 was written at a time when calling 9-1-1 was generally the best option for residents. Advances in technology and other alternatives have created new options that allow residents to receive care quickly and in a familiar environment. Unfortunately, the regulations have not kept pace and do not recognize those options. The results are rigid requirements that are not resident-centered and frustrated emergency responders who believe they are being called repeatedly for issues they don’t consider to be true emergencies. With that in mind, CALA has been encouraging DSS to find a solution to the requirement to immediately call 9-1-1 when an “injury or other circumstance has resulted in an imminent threat to a resident's health including, but not limited to, an apparent life-threatening medical crisis,” which effectively led to calling 9-1-1 in most circumstances, even when other more appropriate options are available. It can be challenging for residents living with dementia to go to the emergency room where they may have to sit for hours in unfamiliar surroundings as they wait for care. During COVID, many residents didn’t want to go to the emergency room if it could be avoided and emergency rooms were overwhelmed, which necessitated finding new

ways to care for residents. Telehealth appointments and having providers come onsite with mobile X-ray or other medical professionals providing concierge services proved there were options for residents not experiencing emergency medical conditions that didn’t require calling 9-1-1. Putting the care of residents first combined with the additional scrutiny RCFE providers have faced from emergency responders led to DSS releasing a PIN with additional guidance for calling 9-1-1 until they can update the regulation . ● Information about the reason for the PIN , which is to address advances in medical care options since the regulation was adopted, ensure residents receive timely care in a familiar setting when possible and promote proper use of the 9-1-1 system. ● A list of symptoms/conditions is included for which DSS expects licensees to call 9-1-1. They remind licensees it is not an exhaustive list, and they should use their best judgment. When in doubt, call 9-1-1. The final PIN was released in June. An overview of the main points of the PIN is as follows:

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● Onsite medical professionals acting within their scope of practice can assist in determining if an injury or other circumstance is an imminent threat to a resident’s health. This is an important change. Previously, an onsite nurse or doctor could not assess a resident and 9-1-1 would still have to be called. ● A list of alternative options to calling 9-1-1 is included when a circumstance doesn’t constitute an imminent threat. ● The regulation for Advance Directives and Requests Regarding Resuscitative Measures is included for ease of reference. It outlines licensee responsibilities to ensure care aligns with a resident's wishes and how to handle situations for residents on hospice. ● A section on resident rights is included to remind licensees that they have the right to refuse medical treatment, but in cases where the licensee is required to call 9-1-1 the resident or their representative, if applicable, will have to refuse medical treatment, transportation to the hospital, etc. when the emergency responder arrives. DSS recommends documenting refusal in the resident record as a best practice. ● A reminder about having adequate staff to assist residents with mobility or transferring from one position to another when there is no apparent injury (“lift assists”). Information on developing fall prevention plans is also included. We are grateful for the additional guidance to help residents receive timely care that is appropriate and not have to call 9-1-1 unnecessarily. Documentation is key when an alternative to 9-1-1 is used to show LPAs how resident care was addressed. As with any new guidance, let Selena know if you run into challenges or have questions that should be shared with DSS as they evaluate the effectiveness of these changes. g

Considerations for Calling 9-1-1 for a Resident Fall Josh Allen, RN and principal, Allen Flores Consulting Group If a resident falls, 9-1-1 should be called if there is an imminent threat but if they seem fine otherwise, staff should assist residents getting up but not lifting a resident that is immobile. If a resident is unable to participate in getting up, then licensees should consider calling 9-1-1 as that could be a sign of injury. Licensees should notify their healthcare professional and their representative, if applicable, and utilize an alternative option for resident evaluations to ensure there is no unseen injury. Licensees should continue to monitor the resident for 48 hours as a best practice.

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for Assisted Living Residents with Dementia

Caring for residents living with dementia in Assisted Living communities has changed dramatically over the last 30 years. CALA members have been leaders in designing and delivering resident-centered care for those with dementia. As this area continues to evolve with recent changes to dementia care regulations that attempt to provide a person-centered approach that focuses on a resident’s changing needs and not just a diagnosis, CALA asked two experts in the field, Todd Shetter and Nancy Schier Anzelmo , to share their role in getting us to where we are now and what they would like to see as we look to the future.

Todd Shetter Chief Operating Officer ActivCare Living

Nancy Schier Anzelmo Principal Alzheimer's Care Associates LLC

What role did you play in the introduction of Memory Care, or caring for residents living with dementia in Assisted Living? Todd: I was working for W. Major Chance and Health Care Group beginning in 1988. I was fortunate to see the birth of secured Memory Care in California become

a new level of care through the changes to DSS regulations after the passage of SB 732 in 1995 that allowed secured perimeters in Assisted Living. I was working in the Public Relations/Marketing and Sales department of Health Care Group and created the name ActivCare, which became our signature memory care level of care following the approval by DSS.

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What opportunities and challenges do you see for Assisted Living providers regarding implementation of the recent dementia care and miscellaneous regulations, whether they provide Memory Care exclusively or do not accept or retain residents with a dementia diagnosis or major Neurocognitive Disorder (major NCD)? Todd: As licensed care providers we need to be able to successfully and consistently care for those with dementia from early diagnosis through end of life. We are the only option for compassionate and appropriate care outside of the family home. We have the right environments, well trained staff and access to medical support to care for those with memory loss and aging related care needs. Nancy: The opportunity to support a resident in the least restrictive environment and not based on a diagnosis is a new milestone to celebrate but with ongoing support and increased monitoring. This is important to ensure the best possible outcome for a high quality of daily living while providing safety and accountability for the best fit possible for each individual resident. The challenge will remain to support each resident with NCD with enrichment and engagement that meets the specified regulations to support each resident in a person centered approach to lifestyle and well-being. What do you envision caring for residents with dementia or major NCD in Assisted Living will look like 30 years from now? Todd: I’m hoping that humans are still at the forefront of providing direct, hands-on, personalized care to seniors who need a compassionate, caring, human touch. Nancy: My hope is an inclusive approach for residents within an environment designed to support any diagnoses in one community through modifications in supportive technology and care to improve overall access and provide a home and community that is individualized and purposeful for everyone who resides there. g Todd Shetter is a CALA board member and chief operating officer for ActivCare Living , which specializes in residential memory care for residents living with dementia, with six locations in California. Nancy Schier Anzelmo is a gerontologist and principal with Alzheimer's Care Associates LLC and also a CALA board member.

Nancy: I was hired to create a Memory Care outreach plan for Health Care Group, which had three out of the six secured communities in the pilot project conducted by the state that showed the need for a Memory Care delayed egress environment. In 1995, when SB 732 was put into statute in California, it was an entirely new model of care then that only existed in one other state in the U.S. How has caring for residents living with dementia in Assisted Living evolved over the years? Todd: We have all progressed and learned so much more about approach, communication and successful ways to care for those with dementia. There also has been so much advancement on the diagnostic side of the disease. We are seeing so many other forms of dementia, other than just Alzheimer’s. Nancy: The opportunity for person-centered programs to support the residents in a memory support environment has become the standard for daily programs that will engage residents, provide meaningful events and interesting activities to support them in a purposeful environment. And, additionally, providing support to family members.

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2025 NORTHERN CA The Excellence in Service Awards is a celebration of the exceptional contributions made by those who serve within Assisted Living communities. These individuals stand out among their peers exemplifying the values and qualities that distinguish someone dedicated to providing exceptional service to residents. This esteemed recognition highlights their commitment to creating a vibrant, engaged and joyful community for residents. These Northern California Excellence in Service Award Recipients were honored at CALA Elevate: Spring Conference & Trade Show in Sacramento in June: Shining Stars: Celebrating Our Northern California Award Recipients

Outstanding Caregiver

Aalyah Rodriguez Resident Medication Assistant, Atria Carmichael Oaks

Aalyah exemplifies the best of Assisted Living caregiving. With compassion, calm leadership and a proactive approach, she enhances residents’ well-being – whether through thoughtful medication support, stepping up in challenging moments or providing comfort at the end of life. Her dedication and genuine connections inspire excellence in those around her.

Outstanding Team Member

James Victor “Vic” Watson Driver, Carlton Senior Living, Davis

Vic’s steady, respectful service makes a lasting impact. From restoring a resident’s independence after the Camp Fire to mentoring new drivers and supporting community events, he goes above and beyond. His initiative, kindness and leadership elevate daily life for residents and strengthen the culture of care across his team.

Outstanding Department Director

Allyson Fujii Memory Programs Director, Belmont Village San Jose

Allyson brings creativity, empathy and leadership to memory care. From guiding families through transitions to designing inclusive, purpose-filled programs, she inspires connection and joy. A mentor and innovator, her work enhances quality of life for residents and has helped elevate Belmont Village San Jose as a leader in Memory Care.

Outstanding Community Nurse

Cathyren “Cat” Cole Resident Services Supervisor, Atria El Camino Gardens

Cat exemplifies expert, resident-centered care. Rising from caregiver to LVN and now leading resident services, she brings calm leadership, clinical precision and heartfelt dedication. Whether navigating emergencies or pharmacy shortages, her steady presence ensures residents’ needs are met with dignity – earning admiration from colleagues and national recognition for her community.

Outstanding Executive Director

Miriam Faris Executive Director, Carlton Senior Living, Davis

With over 20 years in senior living, Miriam leads with heart and action. From reuniting a resident with family for the holidays to mentoring rising leaders, she models hands-on dedication and compassion. Her leadership uplifts both residents and staff, creating a culture of respect, growth and meaningful connection.

2026 EXCELLENCE IN SERVICE AWARDS TELL US ABOUT YOUR OUTSTANDING ASSOCIATES

Nominations Now Open!

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30 years IN CCRCs change of

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Over the past three decades, Continuing Care Retirement Communities (CCRCs) have experienced a remarkable transformation. Today’s CCRCs are more dynamic and diverse than ever, offering a broad spectrum of experiences that reflect the evolving expectations, lifestyles and priorities of older adults. With enhanced amenities, thoughtful design and deeper resident engagement, the model has increasingly come to represent wellness, purpose and choice. Few have seen this evolution more closely than Paul Gordon, partner at Hanson Bridgett , who has worked with CCRCs for 50 years. “When CCRCs first emerged in California, they followed a fairly consistent model – similar in structure, philosophy and scope,” he said. “Over time, that’s changed. We’ve seen a real diversification in how communities are structured and the types of experiences they offer.” That diversity is evident in today’s wide range of community designs and cultural orientations. “You now have everything from traditional campus models to lifestyle-specific communities,” he said. “It speaks to how CCRCs are adapting to meet different values and expectations.” Gary Smith, CEO of Vi Senior Living , echoed that sentiment. “Across the board, expectations have shifted – people want more choices, more engagement and more flexibility in how they live,” he said. HOW THIS MODEL OF CARE IS ADAPTING TO A NEW ERA By Kevin Swartzendruber, CALA Director of Marketing and Communications

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Market Expansion One of the most significant shifts has been the entrance of new providers and many have affiliated, merged or evolved over time. The main reason is to achieve operational efficiency and keep the communities current with amenities to be competitive. For Sheri Peifer, president and CEO of Eskaton , the trend mirrors a broader shift in values. “There’s more emphasis on lifestyle than ever before,” she said. “Today’s residents want gyms, pools, spas and a wellness-oriented environment.” Smith agreed that wellness is now central. “We’ve always focused on lifestyle, but with the baby boomers entering this space, it’s evolving further. We’re constantly adapting the experience to reflect what today’s resident wants.” This lifestyle-forward focus has led many organizations to rebrand CCRCs as “Life Plan Communities,” emphasizing engagement, independence and holistic wellbeing. Innovating Dementia Care The scope of services has also expanded in meaningful ways – particularly in dementia care. “There’s been a noticeable move away from skilled nursing on campus,” Gordon said. “Communities have found other ways to support residents’ health – especially those living with cognitive conditions. The range of what can be managed in less institutional settings has expanded significantly.” “The addition of Memory Care as its own level of care – to specialize in with programming – is new to CCRCs that were built 30-plus years ago,” Peifer said. Darolyn Jorgensen-Kares, president and CEO of Continuing Life , said many communities have reconfigured space or programming to meet this growing need. “The ability to deliver specialized memory support in a thoughtfully designed environment is now a core expectation,” she said. Smith added, “We’re seeing a more personalized approach to memory care. Residents and their families want thoughtful environments, consistent staffing and programs that promote dignity and connection.” Dining, Amenities and Expectations Have Skyrocketed Today’s residents are arriving with a fresh set of expectations – and communities are meeting the moment. “Communities today are adding not just fitness centers, but also spas, salons, pickleball courts, personal training and holistic health services like acupuncture and massage,” Jorgensen-Kares said. Dining experiences are also being reimagined. “We’ve seen menus shift to reflect modern tastes – fast casual options, curated small plates and flexible dining times,” said Smith, noting Vi’s long-standing partnership with the Culinary Institute of America to keep their offerings fresh and relevant.

Peifer emphasized the new outlook. “It’s not just about comfort anymore – it’s about successful aging. Staying well in mind, body and spirit is the new standard.” Residents as Partners, Not Just Participants Resident engagement has reached new levels of collaboration. “They really want to take an active role in both what’s available at the community and how it’s delivered,” Jorgensen-Kares said. “Committees have always been important, but now we see more resident-led initiatives,” Smith said. “It’s a true partnership. We listen and respond to their ideas, and that keeps the community vibrant.” Peifer agreed. “Our resident councils are not just symbolic – they’re instrumental in shaping programs, services and community culture.” Tech, Transparency and the Next Generation Digital expectations are also rising, and communities are embracing technology to enhance connection and convenience. “The demand for streaming and to have your technology infrastructure up to speed is really important for new prospective residents,” Jorgensen-Kares said. At Vi, Smith shared that every community now has a “tech concierge” to help residents with devices and digital tools. “Residents today are more tech-savvy. They want digital convenience, but they also want a human touch when they need help.” Peifer noted that trust and transparency are equally essential. “Residents want to understand how decisions are made, and they value being part of organizations that invest in long-term excellence.” Continuing with a Fresh Vision Even as CCRCs grow and adapt, their foundational purpose remains clear. “The resident that moves into a CCRC, they’re planners by nature,” Peifer said. “They want to have better-than-average healthcare available to them.” “People are entering communities later – typically in their late 70s or early 80s – and staying longer,” Gordon said. “The model has changed but the promise remains the same – security, dignity and the ability to age on your own terms. With the level of demand we have, I think we’ll continue to see expansion and innovation across the board.” Smith reflected on what makes this moment in time especially exciting. “The front edge of the baby boomers is just now turning 79, and their influence will shape the next 20 years. We’re not standing still – we’re evolving to meet the next generation where they are, and where they want to go.”

As CCRCs continue to evolve, their enduring mission is clear: to offer not just a place to live, but a place to thrive. g

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As the California Assisted Living Association celebrates 30 years of advocacy and leadership, it feels like the right time to reflect on the changes we’ve seen in our communities – especially when it comes to technology. So much of what we now take for granted didn’t exist when CALA got its start. But at every turn, the goal has remained the same: to support older adults in living with dignity, connection and purpose.

By Liz Jensen, PhD, MSN

TECHNOLOGY ADVANCES IN ASSISTED LIVING with Purpose Progress

O ver the past three decades, the tools have changed, but the commitment hasn’t. Here’s a look at how technology has shaped – and continues to shape – Assisted Living in five important areas. Resident Care & Health Monitoring Thirty years ago, we relied heavily on direct observation and written documentation to track how residents were doing. Care was responsive, but often reactive – based on what we could see or what residents reported. Today, many communities use passive monitoring tools and wearable devices that quietly gather data on movement, sleep and even vital signs. These tools give us early warning signs when something’s not quite right. Telehealth – unthinkable back then – is now a reliable way to connect residents with primary care providers and specialists, without the disruption of leaving the building. The biggest win? Spotting changes earlier and responding sooner – supporting better outcomes and helping residents stay where they’re most comfortable: at home in the community. Medication Management If you’ve been in this field a while, you’ll remember the wall to-wall binders of medication administration records, and the painstaking work of triple-checking handwritten orders. Technology has taken a lot of the guesswork – and the paperwork – out of the equation. Electronic medication administration records (eMARs), barcoded scanning and automated refill systems help ensure the right medication gets to the right resident at the right time. And with pharmacy integration, staff are no longer chasing down faxes or playing phone tag to clarify prescriptions. This is about more than efficiency – it’s about safety, reliability and peace of mind for families, residents and staff alike. Family Communication & Engagement There was a time when families had to call the front desk or wait for care conferences to find out how their loved one was doing. Today, digital platforms and family portals provide real-time updates, photos and even access to activity calendars. Many communities offer secure messaging, virtual visits and regular digital updates, helping families feel more involved and reassured – especially when they live far away or can’t visit often. This shift toward transparency and collaboration has strengthened relationships and trust, especially during challenging times like the pandemic. Staff Support & Training The last 30 years have brought a new understanding of just how critical our workforce is – and how technology can support them, not replace them. From mobile scheduling tools to on-demand training modules, we’ve seen a shift in how frontline staff engage with their work. They can now access continuing education from a smartphone, check schedules in real time and communicate with team

members instantly. These tools help reduce burnout, improve flexibility and support retention – key priorities in a sector that continues to face workforce challenges. When staff feel more supported and equipped, residents benefit. Safety & Emergency Preparedness We’ve come a long way from wall-mounted pull cords and handwritten disaster plans. Today’s safety systems are smarter, more responsive and better integrated. Machine vision cameras, motion sensors, smart lighting, door alerts and geofencing help reduce risk while supporting resident independence. Emergency notification platforms allow us to communicate quickly and clearly with staff, residents and families during power outages, wildfires or other urgent events – a vital capability in California. Technology can’t eliminate risk, but it can help us manage it more thoughtfully and proactively. Looking Ahead As we look ahead to the next 30 years, we can begin to imagine a future where buildings themselves play a more active role in care. What if the environment could be a proactive member of the caregiving team? With greater interoperability across platforms, smarter passive monitoring and seamless communication among systems, we’re edging closer to that vision. We can envision buildings that learn from patterns of resident behavior, adjust lighting or temperature automatically, and alert staff before a risk becomes a reality. In this model, the physical environment becomes intuitive and responsive – not just for those who live there, but also for those who work there. This evolution – from technology as a tool to the building as a caregiver – could transform how we deliver care, prevent issues and support both quality of life and workforce sustainability. and intentionality of use. And we must keep our eyes on the policies and funding opportunities that will make sustained progress possible. As technology becomes more central to care and operations, we’ll need to advocate for resources that support not only implementation, but also ongoing training, maintenance and upgrades. Ensuring equitable access to these tools – regardless of community size or location – will be key to making technology work for everyone. Technology should never overshadow the human connection at the heart of Assisted Living. Instead, it should help us do what we’ve always done – just with more clarity, responsiveness and confidence. Artificial intelligence is transforming the world as we know it. Applying these powerful tools requires clear purpose

Congratulations to CALA on 30 years of service and stewardship! Cheers! g

Liz Jensen, PhD, MSN, is clinical director of Direct Supply Innovation & Technology Center @MSOE.

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