Market Needs and the Economic Impact of LeadingAge Members

Steven J. Appold, Ph.D. Kenan Institute of Private Enterprise, University of North Carolina at Chapel Hill

Allan M. Parnell, Ph.D. Cedar Grove Institute for Sustainable Communities

James H. Johnson, Jr. Ph.D. Kenan Institute of Private Enterprise, University of North Carolina at Chapel Hill

September 13, 2018

Study Contributions Special thanks to the organizations who gave beyond their annual dues to make this project a reality: Goodwin House; LifeSpire of Virginia; Pinnacle Living; Westminster-Canterbury; United Church Homes & Services; Village at Orchard Ridge; Westminster-Canterbury on ; Westminster Canterbury Lynchburg; Westminster Canterbury of the Blue Ridge; and Westminster Canterbury Richmond.

2 — Market Needs and the Economic Impact of LeadingAge Virginia Members Executive Summary tinuum of care, CCRC residents need not leave the community as their health and functional abilities Over the next two decades, Virginia’s senior popu- decline. CCRCs therefore are a type of serviced lation (aged 65 and above) is projected to increase real estate – that is, real estate bundled with a set by 51.4 percent – from 1.3 million in 2017 to 1.9 of guaranteed services which are partially pre- million in 2040. During this period, Virginia’s to- paid. However, given shifting economic and de- tal population is only expected to increase by 20.4 mographic trends in the marketplace, a number of percent – from 8.5 million in 2017 to 10.2 million CCRCs are beginning to expand services beyond in 2040. LeadingAge Virginia works with a range their campuses. CCRCs are now increasingly po- of member organizations to help meet the needs sitioning themselves as Life Plan Communities in of the aging Virginia population. LeadingAge Vir- order to emphasize that the majority of their resi- ginia is the professional association representing dents do not need intensive medical care. the not-for-profit continuum of aging services throughout Virginia, including nursing homes, Licensed through the Virginia State Corporation adult day, assisted livings, home and community Commission, there are 53 CCRCs in Virginia; 42 based services, life plan/continuing care retire- are LeadingAge Virginia members. The member ment communities, and senior housing. organizations are led by volunteer, unpaid board members that are business leaders in the broader The central focus of this report is the economic community. Almost all (51) provide independent impact of LeadingAge Virginia members. In 2016 living, 45 offer assisted living, 33 operate nursing (the latest year for which data are available), care (another 11 operate assisted living), and 6 LeadingAge Virginia’s 133 not-for-profit member have dementia care. Occupancy rates are nearly organizations served a total of 18,000 seniors: 90 percent for the independent and assisted liv- 13,000 in CCRCs, 3,600 in other types of residen- ing units with a degree of variation among the 53 tial settings, and 1,300 in day programs. They communities. employed an estimated 18,000 mission-oriented staff across all skill levels in 108 client-serving CCRCs are concentrated in or near major met- locations (for which we could estimate informa- ropolitan areas and in selected retirement areas tion out of a total of 121). Members’ total ongoing within the state. The annual cost of living/care in purchases ($1.1 billion), including payroll ($595 a CCRC is determined in part by land costs. As a million), generated an estimated total economic consequence, to balance demand and cost, CCRCs impact of $1.9 billion. This included $44 million may increasingly locate near the suburban fron- in direct and indirect state and county taxes and tier of the largest, rapidly-growing metropolitan $166 million in federal taxes. LeadingAge Virgin- areas – in , Norfolk, and Rich- ia CCRC communities alone provided services to mond – over the next few decades. 13,000 residents with an economic impact of $1.4 billion based on $828 million in direct expendi- Two decades from now, in 2040, CCRCs are pro- tures, employing 12,000 directly with a total of jected to house 24,840 residents and employ 16,000 jobs in the state linked to CCRCs. 22,149 workers. CCRCs’ total ongoing purchases ($[1.5 billion), including payroll ($798 million), CCRCs account for 75% of LeadingAge Virginia’s will generate an estimated total economic impact economic impact. Necessarily, much of this re- of $2.6 billion, including $61 million in direct and port focuses on them. CCRCs are both central indirect state and county taxes and $229 million in LeadingAge Virginia membership and are im- in federal taxes. portant residential and care options for Virginia’s rapidly growing population of seniors. CCRCs Beyond our projection horizon, insufficient are institutional entities that meet the health and wealth accumulation may constrain or prevent lifestyle needs of older adults as they age. CCRCs subsequent cohorts of seniors from considering typically include independent living units, assist- CCRCs as realistic residential and care options in ed living units, and nursing care. With this con- their maturing years. Recently, in anticipation of Market Needs and the Economic Impact of LeadingAge Virginia Members — 3 this potentiality, CCRCs have extended their cir- death.2 Unfortunately, we are not there yet. The cles of care beyond their core clientele to include present is still characterized by a significant in- individuals with a net worth below their normal cidence of chronic diseases which decrease the requirements and to seniors in the local commu- quality of life and increase the burden of care. nity opting to age in place. As they continue to The pace of this transition from chronic-disease- do so, they will increasingly need to deal with the induced to senescence-induced death will impact effects of growing income inequality and with the the future need for and burden of care. impacts of rising health threats, such as obesity and its consequences, on aging cohorts. Second, the growth of income inequality combined with hyper-residential segregation along race and Above and beyond their economic impact, Lead- ethnic lines create a situation wherein means and ingAge Virginia member organizations contrib- needs do not necessarily coincide. Growing num- ute significantly to their communities through bers of seniors are aging in place in households benevolent and charitable contributions and ac- with few (if any) financial assets and in commu- tivities. The breadth of these contributions is nities characterized by regional economic decline difficult to quantify with existing data, but both and/or concentrated poverty. financial contributions and community support are identified in this report. Developing standard Third, as a retiree migration destination, uncer- methods for documenting contributions to their tainty regarding whether future migration to Vir- communities will allow greater specificity of their ginia will continue unabated, accelerate, or pla- impact. In addition, a strategy for simultaneously teau raises questions about the future volume of broadening economic impact and strengthening demand for senior services. commitment to diversity through the adoption of inclusive sourcing policies, procedures, and prac- Fourth, an array of service delivery alternatives tices is outlined. increases the business risks of any individual model. 1.0 Introduction and Purpose The first and second factors have been working in Population aging creates a service need and con- tandem to create a situation which could be char- stitutes a major opportunity for business develop- acterized as fragmenting aging wherein one set of ment and job growth in Virginia. Virginia’s sen- seniors can look forward to a lengthening, increas- ior population (aged 65 and above) is large and ingly healthy and financially secure aging process growing.1 Several forces contribute to this state while for another set aging will begin earlier, be of affairs: a century-long secular decline in fertil- plagued by chronic disease, and be haunted with ity; increased longevity among a subset of those financial worry. In its principle outline, fragment- reaching maturity; the aging of the post WWII ing aging is a direct and indirect consequence of baby boom cohort; and the continuing attractive- increasing inequality and the precarious state of ness of the state as a migration destination for re- those in, especially, the lower half of the income tirees. distribution. The third and fourth factors serve to heighten risk in this segmented market. Four factors introduce uncertainty into business and employment opportunities for serving the LeadingAge Virginia is the professional associa- growing senior population. tion representing the not-for-profit continuum of aging services throughout Virginia, including First, we are in the midst of a major transition nursing homes, adult day, assisted livings, home where senescence – organ system frailty without and community based services, life plan/continu- any discernible external cause (old age) – may ing care retirement communities, and senior hous- replace chronic illnesses as the primary cause of 2 James F. Fried (2000) “Compression of morbidity in the elderly,” Vac- cine 18: 1584-1589; James F. Fried (1980) “Aging, natural death, and 1 The choice of age 65 as a demarcation is based on traditional usage the compression of morbidity,” New England Journal of Medicine 303: and the age of Medicare eligibility. 130-135. 4 — Market Needs and the Economic Impact of LeadingAge Virginia Members ing.3 These levels of care are regulated through nancial stress.5 Construction of new capacity has various state or federal agencies. Nursing homes been muted in comparison to other types of sen- are licensed and regulated by the Virginia Depart- ior housing.6 Many CCRCs are now beginning to ment of Health, Office of Licensure and Certifica- offer LifeCare as only one of their options. Some tion. For those nursing homes that are certified CCRCs appear to have ceased offering LifeCare for federal reimbursement under Medicare and/ contracts or have phased them out completely, or Medicaid, they are also regulated by the Centers in part due to the inherent actuarial risks implied for Medicare and Medicaid Services (CMS). Adult by the uncertain mortality transition alluded to days and assisted livings are licensed and regu- above and in part due to an increasingly sophis- lated by the Virginia Department of Social Servic- ticated and well-informed clientele. Accordingly, es, and continuing care retirement communities LeadingAge Virginia members now offer a variety (CCRCs) through the Virginia State Corporation of residential and non-residential services. Lead- Commission, Bureau of Insurance (SCC). The ingAge Virginia includes service providers offer- nursing home and assisted living levels are regu- ing a variety of services to a broader range of mar- lated by the above-mentioned agencies. Gener- ket segments, including subsidized housing for ally, the independent living level is not regulated; independent living and adult day care. however, a CCRC can voluntarily choose to regu- late it through the Virginia Department of Social Almost all LeadingAge Virginia member commu- Services. Life Plan communities are not statuto- nities operate in regulated markets. As a conse- rily defined and can refer to a CCRC or a campus quence, it needs critical and timely information offering various levels of care. Section 202 and that elected officials and governmental officials Section 8 senior housing are regulated by the U.S. require when considering governance issues af- Department of Housing and Urban Development. fecting all types of senior service providers. Lead- ingAge Virginia member communities also op- Continuing Care Retirement Communities have erate in a labor-intensive economic sector that formed the backbone of LeadingAge membership. requires significant capital investment. It there- CCRCs are residential communities that strive to fore also needs information on the likely future meet the health and lifestyle needs of older adults demand for member services and future human as they age. CCRC campuses typically include resource supply. independent living, assisted living, and nurs- ing care. Some are adding dementia care to the The purpose of this study is to provide Leadin- service mix. This continuum of care means that gAge Virginia with the mission critical informa- CCRC residents need not move outside the com- tion required to both serve the strategic planning munity as their health and functional abilities de- needs of its members and represent them in the cline. CCRCs therefore are a type of serviced real broader senior services marketplace. To set the estate – that is, real estate bundled with a set of context for the research, we begin with essential guaranteed services.4 In addition, in response to background information on LeadingAge Virginia market forces, some CCRCs are expanding beyond member organizations and the economic and de- their campuses to offer services like non-medical mographic context in which they currently oper- home care in their local communities. ate and will likely operate in the foreseeable fu- ture. This is a complex time for CCRCs. Not-for-profit organizations dominate the CCRC market due to 2.0 Critical Background and Context historical legacy and to a capital funding advan- tage. Nevertheless, business risks remain and LeadingAge Virginia’s 133 not-for-profit member mergers among CCRCs are driven in part by fi- organizations statewide employ nearly 18,000 5 “The Enigma Of The CCRC Market: The Care Model That Won’t Die,” 3 CCRCs have been increasingly positioning themselves as Life Plan Irving Levin Associates, Inc. (2018) https://seniorcare.levinassociates. Communities. com/1706/enigma-ccrc-market-care-model/. 4 For additional background, see Patricia E. Sprigg (2010) “Continuing 6 Lana Peck “CCRC/LPC Market Trends: 4Q2017,” National Investment Care Retirement Communities in North Carolina,” North Carolina Medical Center, March 28, 2018, http://www.nic.org/blog/ccrc-lpc-market-trends- Journal 71: 170-172. 4q2017/. Market Needs and the Economic Impact of LeadingAge Virginia Members — 5 mission-oriented staff in 108 client-serving lo- primarily oriented towards those with significant cations (out of a total of 121) to serve a total of wealth-based income—savings (including from approximately 18,500 seniors: 13,493 in CCRCs, pensions) and investments typically accumu- 3,643 in other types of residential settings, and lated from well-paying employment and profit- 1,341 in day programs.7 Despite the challenges able business ownership. Factors which affect mentioned above, in the foreseeable future CCRCs the ability to earn and save will impact the size may grow in appeal as a popular residential and of the market for CCRC services. Average return care choice for retirees as baby boomers moves on investments will also impact market size. Ad- further into retirement age. Although national ditionally, expected longevity will impact market population trends are reasonably well-defined, size in two ways: the sufficiency of savings to pay state and local trends are less predictable, par- for services is determined in part by the expected ticularly when the target market may be a rela- duration of need and expected (healthy) life ex- tively small proportion of the population. Several pectancy at age of entry helps determine level and factors increase uncertainty. nature of services needed.

First, a significant proportion of the Virginia pop- Third, a significant proportion of CCRC residents ulation has migrated to the state recently. Over typically have lived in the communities near their the 2000-2010 decade, retirement migration to final destination before entering. Although senior the state was significant. The degree to which the migration may be rising, the rates are still low and, retirement migration trend will continue is un- nation-wide, they tend to concentrate around the clear as the nature of the housing market, includ- 60s, when CCRC entry is often a decade or more ing relative housing prices, continues to evolve. in the future. The evolving nature of the Virginia Moreover, the degree to which present residents economy – impacted by skill requirement chang- will remain in the state as they age and retire is es, sectoral shifts, corporate restructuring, and also unknown; they may themselves move to other modification of location preferences – will influ- locations and states. Results from the Genworth ence the strength of the various feeder markets. 2017 Cost of Care Survey, seen in Table 1, reveals On the one hand, those Virginia regions heavily that Virginia continues to be an attractive oppor- dependent upon agriculture and manufacturing tunity compared to the national average and some may decline in their ability to generate clientele. other states but less attractive compared to others On the other, Virginia regions with strong eco- – and the attractiveness varies by the type of care. nomic growth and related in-migration may con- Looking only at the median values, Virginia offers tinue to grow in relative strength. As such growth costs that are below the national norm for home moves towards regional peripheries and down the health care (homemaker and home health aide urban hierarchy of the large attractors, the future services), for adult day, and some nursing home markets for the services of LeadingAge Virginia care. Virginia comes out as less attractive to con- members may spread. sumers for assisted living and basic nursing home care. These are state-wide figures and the mini- Many LeadingAge Virginia members mainly serve mums and maximums in the table suggest large those aging in their communities. Most seniors cost variations. Some of Virginia’s neighbors and who use adult day service, low income senior common retirement destinations appear to be housing, home health, and nursing care come more cost-effective for consumers while others from their communities. Seniors receiving these appear to offer less value. This suggests a degree services who have moved likely moved to be near of uncertainty based on relative costs.8 their children. The financial resources for many of the clients and residents for these services are Second, LeadingAge Virginia CCRC members are below the financial resources for CCRC residents. 7 We were unable to find or estimate employment information for 13 client-serving members and were unable to find or estimate the client The size and location of the market, combined population of 15 client-serving members. Therefore, the results to not reflect their impact. with employment separation patterns, will largely 8 Genworth 2017Cost of Care Survey, available at https://pro.genworth. determine workforce needs in CCRCs and other com/riiproweb/productinfo/pdf/179703.pdf. 6 — Market Needs and the Economic Impact of LeadingAge Virginia Members Table 1: Annual Cost of Care, 2017 Home Health Care Homemaker Services 1 Home Health Aide 1 5 –Year 5 –Year Location Minimum Median Maximum Annual Minimum Median Maximum Annual Growth 2 Growth 2 USA — $18,304 $47,934 $114,400 3% $18,304 $49,192 $125,748 3% National District of $45,760 $45,760 $45,760 N/A $45,760 $45,760 $45,760 N/A Columbia $22,880 $44,044 $70,356 3% $27,502 $45,760 $70,356 2% $32,032 $49,718 $60,632 3% $33,176 $52,281 $62,920 3% North $18,304 $41,184 $57,200 2% $20,592 $42,328 $57,200 1% Carolina New York $25,168 $51,480 $74,360 2% $29,744 $54,340 $74,360 2% Virginia $28,600 $45,440 $70,928 2% $32,032 $47,430 $70,928 3% Adult Day Health Care 3 Assisted Living 4 Adult Day Health Service Private, One Bedroom Location Minimum Median Maximum 5 –Year Minimum Median Maximum 5-Year Annual Annual Growth 2 Growth 2 USA — $1,300 $18,200 $126,880 3% $6,870 $45,000 $254,880 3% National District of N/A N/A N/A N/A N/A N/A N/A N/A Columbia Florida $11,050 $16,900 $42,900 2% $11,700 $37,200 $96,000 2% Maryland $11,960 $20,150 $22,165 0% $18,000 $49,800 $127,200 5% North $7,800 $13,780 $37,700 0% $14,184 $39,000 $93,600 2% Carolina New York $3,900 $20,800 $52,650 8% $14,280 $47,850 $164,250 2% Virginia $2,600 $17,649 $118,643 4% $13,200 $54,090 $100,080 5% Nursing Home Care5 Semi-Private Room Private Room 5 –Year 5 –Year Location Minimum Median Maximum Annual Minimum Median Maximum Annual Growth 2 Growth 2 USA — $19,345 $85,775 $515,380 3% $23,334 $97,455 $515,380 4% National District of $109,500 $118,443 $129,575 7% $109,500 $126,838 $139,430 6% Columbia Florida $73,000 $94,900 $172,463 4% $76,650 $106,580 $173,193 5% Maryland $77,015 $109,500 $152,205 4% $80,300 $118,990 $172,645 4% North $43,800 $82,125 $127,020 3% $60,225 $91,250 $253,310 4% Carolina New York $86,140 $132,907 $394,565 2% $87,965 $140,416 $394,565 3% Virginia $67,525 $85,775 $149,650 4% $70,810 $94,900 $175,200 3% 1 Based on 44 hours per week by 52 weeks 2 Represents the compound annual growth rate based on Genworth Cost of Care Survey 3 Based on 5 days per week by 52 weeks 4 Based on 12 months of care, private, one bedroom 5 Based on 365 days of care N/A=data not available

Source: Genworth 2017 Cost of Care Survey, conducted by CareScout®, June 2017, www.genworth.com/costofcare

Market Needs and the Economic Impact of LeadingAge Virginia Members — 7 senior service organizations. market demand projections –information that can be used by member communities to support LeadingAge Virginia and its constituent mem- short- and long-term strategic planning deci- bers are already responding to important senior sions; and (2) to derive estimates of the economic care challenges. Table 2 lists the 133 LeadingAge contributions of LeadingAge Virginia members members and identifies the services offered. Of —information that LeadingAge can reference in these, 12 are organizational headquarters not discussions with public officials. engaged directly in client service. The remain- der, 121, directly serves clients. Of these, 42 are To achieve these objectives, two types of data CCRCs, 44 provide other types of residential ser- were required: broad demographic and contextu- vice from independent living to assisted living to al data for the nation and the state; and statistical nursing care, and 37 offer adult day care. Most of information pertaining specifically to LeadingAge the residential organizations offer multiple levels member operations in Virginia. Much of the req- of care. Eighteen member organizations offer be- uisite data were obtained via public sources. low-market housing options. By law, the organi- zations providing HUD-subsidized senior hous- The broad contextual data were extracted from ing are barred from offering health services but multiple sources: counts of individuals and house- they may contract with outside entities to provide holds by age, sex, and income were extracted from such services. Four CCRCs offer LifeCare cover- Census estimates and the American Community age to those living off-campus. At least one oth- Survey; county-level population projections were er member appears to offer both residential and taken from a source compiled by the Demograph- non-residential services. ics Research Group of the Weldon Cooper Center for Public Service at the University of Virginia9; A large proportion of LeadingAge CCRCs and information about household wealth came from some of the nursing homes (NHs) appear to be The Survey of Consumer Finances; and informa- faith-based, but the nature of their relationship tion about trends in occupational employment to a broader organization varies. A number of demand and supply were taken from the Bureau the denomination-based CCRCs are managed or of Labor Statistics.10 These sources are discussed owned by denominationally-affiliated manage- in greater detail below as their data are analyzed. ment bodies. In some cases, the management organizations appear to operate as advisory or Data specific to LeadingAge Virginia member or- support firms. In others, they appear to exert ganizations stem from a variety of sources. The substantial direct control. In many cases, the de- LeadingAge membership list includes informa- nominational links are informal in the sense that tion about the reported activities of its members there may be overlapping leadership but no for- and program revenue information for a significant mal legal responsibility. Because they are not re- proportion of the member organizations. We sur- quired to file detailed information, the organiza- veyed LeadingAge Virginia members, receiving 34 tional form of other providers is less clear. Figure responses to our survey, including two covering 1 maps LeadingAge Virginia members. Members member headquarters. We queried selected as- tend to concentrate along two broad corridors, pects of member operations, including revenues the first stretching between Northern Virginia and expenditures, client population, work force, and Roanoke and the other between Richmond and benevolent care. and Norfolk. CCRCs and Nursing Homes are required to file 3.0 Objectives, Data Sources, and information with Virginia’s State Corporation Organization of the Study Commission (SCC) and the federal Centers for Medicare and Medicaid Services (CMS), respec- 9 https://demographics.coopercenter.org/ The objectives of this study are twofold: (1) to pro- 10 Other data sources, such as the Health and Retirement Study and the Panel Study of Income Dynamics provide strong estimates of life course vide LeadingAge Virginia members with baseline trajectories but they are not oriented towards the income segment of most relevant interest. 8 — Market Needs and the Economic Impact of LeadingAge Virginia Members Table 2: List of LeadingAge Virginia Members and Services Provided as of September 2017

Adult Affordable Independent Assisted Nursing Memory Provider City CCRC Day Housing Living Living Home Care 1 Coordinated Services Management, Inc. Roanoke 2 Friendship Roanoke 3 Goodwin House Incorporated Alexandria 4 Ingleside Washington 5 LifeSpire of Virginia Glen Allen 6 National Lutheran Communities & Services Rockville 7 Pinnacle Living Glen Allen 8 Retirement Housing Foundation Long Beach 9 Riverside Lifelong Health Newport News 10 Sunnyside Retirement Communities Harrisonburg 11 United Church Homes & Services Newton 12 Virginia Lutheran Homes, Inc. Roanoke 13 A Grace Place Adult Care Center Richmond * 14 Adult Care Center of Central Virginia Lynchburg * 15 Adult Care Center of Roanoke Valley, Inc. Salem * 16 Adult Day Care Center of the N. Shen. Valley Winchester * 17 Alexandria Adult Day Services Center Alexandria * 18 Atlantic Shores Virginia Beach * * * * 19 Bay Aging - Essex Adult Day Care Tappahannock * 20 Bay Aging - Gloucester Adult Daybreak Gloucester * 21 Bedford Adult Day Center Bedford * 22 Beth Sholom Lifecare Community Richmond * * * * * 23 Beth Sholom Village Virginia Beach * * * 24 Birmingham Green Manassas * * 25 Brandermill Woods Midlothian * * * * * 26 Brandon Oaks Roanoke * * * 27 Bridgewater Retirement Community Bridgewater * * * * * 28 Carlin, The Arlington * 29 Cedarfield Richmond * * ** * * 30 Centra Health Senior Care Services Division Lynchburg * 31 Chesapeake, The Newport News * * * * * 32 Circle Center Adult Day Services Richmond * 33 Covenant Woods Mechanicsville * * * * * 34 Culpeper, The Culpeper * * * 35 Culpepper Garden Arlington * * * 36 Daily Living Center Waynesboro * 37 Eastern Loudoun Adult Day Center Ashburn * 38 Edinburgh Square Roanoke * * 39 Edwards Adult Day Center Martinsville * 40 Elm Manor Roanoke * * 41 Fairfax County Health Department Fairfax * Fairmont Crossing Health and Rehabilitation Amherst 42 * Center 43 Falcons Landing Potomac Falls * * * * 44 Feinour Center - Adult Medical Day Care Roanoke * 45 Fellowship Square Foundation Reston * 46 Friendship Apartment Village Corporation Roanoke * 47 Friendship Assisted Living Roanoke * 48 Friendship Health and Rehab Center Roanoke * 49 Friendship Health and Rehab Center South Cave Spring * 50 Generations Crossing Harrisonburg *

Market Needs and the Economic Impact of LeadingAge Virginia Members — 9 Table 2: List of LeadingAge Virginia Members and Services Provided as of September 2017 Continued

Adult Affordable Independent Assisted Nursing Memory Provider City CCRC Day Housing Living Living Home Care 51 Glebe, The Daleville * * * * 52 Goodwin House Alexandria Alexandria * * * * * 53 Goodwin House Bailey’s Crossroads Falls Church * * * * * 54 Hanover Adult Center Mechanicsville * 55 Harbor’s Edge Norfolk * * * * * 56 Hermitage in Northern Virginia Alexandria * * * * 57 Hermitage in Richmond Richmond * * * * * 58 Hermitage on the Eastern Shore Onancock * * * * 59 Hermitage Roanoke Roanoke * * * * 60 Herndon Harbor Adult Day Health Care Herndon * 61 Insight Memory Care Center Fairfax * 62 Interfaith Adult Day Care Petersburg * 63 JABA Adult Care Center Charlottesville * 64 JFS (Jewish Family Services) - home care only Richmond 65 Kendal at Lexington Lexington * * * * 66 King’s Grant Retirement Community Martinsville * * * * * 67 Lake Prince Woods Suffolk * * * * 68 Lakewood Richmond * * * * * 69 Leesburg Adult Day Center Leesburg * 70 Legacy at North Augusta Staunton * 71 Lewinsville Adult Day Health Center Falls Church * 72 Lewinsville, The McLean * 73 Lincolnia Adult Day Health Care Alexandria * 74 Little Sisters of the Poor Richmond * * * 75 Luther Manor Virginia Beach * 76 Lydia H. Roper Home Norfolk * SCC 77 Mac Brownell Adult Day Center Purcellville * 78 Marian Manor Virginia Beach * 79 Martha Jefferson House Charlottesville * * ** 80 Maryview Nursing Care Center Suffolk * 81 Marywood Richmond * 82 Masonic Home of Virginia Richmond * * * * 83 McGurk House Lynchburg * 84 Mennowood Retirement Community Newport News * * * * 85 Mountain Empire PACE Big Stone Gap * 86 Mountain View Nursing Home Aroda * 87 Mt. Vernon Adult Day Health Care Alexandria * 88 Norfolk Senior Center t/a Primeplus Norfolk * 89 Oakwood Health and Rehabilitation Center Bedford * 90 Our Lady of Hope Richmond * * * 91 Our Lady of Peace Charlottesville * * * 92 Our Lady of Perpetual Help Virginia Beach * * * 93 Our Lady of the Valley Roanoke * * 94 Patriots Colony at Williamsburg Williamsburg * * * * * 95 Petersburg Home for Ladies Petersburg * * 96 Prince William Adult Day Health Care Woodbridge * 97 Pulaski Adult Day Service Center Dublin * 98 Rappahannock Westminster-Canterbury Irvington * * * * 99 Raspberry Hill Adult Daytime Center Forest * 100 Richfield Living Salem * * * * *

10 — Market Needs and the Economic Impact of LeadingAge Virginia Members Table 2: List of LeadingAge Virginia Members and Services Provided as of September 2017 Continued

Adult Affordable Independent Assisted Nursing Memory Provider City CCRC Day Housing Living Living Home Care 101 Russell House Virginia Beach * 102 Saint Francis Home Richmond * 103 Scott Hill/Briarcliffe Clifton Forge * 104 Seton Manor Hampton * 105 Shenandoah Valley Westminster-Canterbury Winchester * * * * 106 South Richmond Adult Day Care Center Richmond * 107 St. Mary’s Woods Retirement Community Richmond * 108 Sullivan House Virginia Beach * 109 Summit Health and Rehabilitation Center Lynchburg * 110 Summit Square Retirement Community Waynesboro * * * * * 111 Summit, The Lynchburg * * ** * 112 Sunnyside Retirement Community Harrisonburg * * * * * 113 Swift Creek Day Center Midlothian * VCU Health Adult and Intergenerational Richmond 114 * Center 115 Village at Orchard Ridge, The Winchester * * * * 116 Village at Woods Edge Franklin * * * ** 117 Village Gardens Norfolk * 118 Village Pointe Senior Housing Norfolk * 119 Vinson Hall Retirement Community McLean * * * * * 120 Virginia Baptist Hospital Division Center Lynchburg ** 121 Virginia Mennonite Retirement Community Harrisonburg * * * * * * 122 Virginia Tech Adult Day Services Blacksburg * 123 Virginian, The Fairfax * * * * * 124 Walter Reed Adult Day Health Care Center Arlington * 125 Warm Hearth Village Blacksburg * * * * *** 126 Warwick Forest Newport News * * * * * 127 Westminster at Lake Ridge Lake Ridge * * * *

128 Westminster Canterbury Lynchburg Lynchburg * * * * *

129 Westminster Canterbury Richmond Richmond * * * * * 130 WEstminster-Canterbury of the Blue Ridge Charlottesville * * * * * 131 Westminster-Canterbury on Chesapeake Bay Virginia Beach * * * * * 132 Williamsburg Landing, Inc. Williamsburg * * * * * * 133 WindsorMeade Williamsburg Williamsburg * * * * * Note: * * No CMS provider number could be found; * * * No listing with the Virginia State Corporation Commission

Market Needs and the Economic Impact of LeadingAge Virginia Members — 11 Figure 1: Locations of LeadingAge Virginia Members as of September 2017

AD = Adult Day AL = Assisted Living CCRC = Continuing Care Retirement Community HQ = Member Headquarters Location IL = Independent Living SNF = non-CCRC Skilled Nursing

Source: Based on LeadingAge Virginia information tively. The SCC filings concentrate on financial and occupancy data while the CMS data focus on Matches across data sources were sometimes the quality of care but also include some financial problematic. LeadingAge provided us with or- and occupancy data. Information on those or- ganizational names and cities but not addresses ganizations is also available from state sources. or unambiguous identifiers, such as license num- Given the legal requirement to file, data from both bers or Employer Identification Numbers. In sources is deemed to be accurate and reasonably most cases, the correspondence across sources complete. Almost all Virginia CCRCs are not-for- was clear. However, some organizations have re- profit organizations; almost all of those are Lead- cently gone through name changes and the use of ingAge members. A smaller proportion of Virgin- alternative (“doing business as”) names was com- ia Nursing Homes are members, all of which are mon. We are unsure that all possible matches part of campus-based entities that include Nurs- were found. In addition, the different purposes of ing Homes, Assisted Living and memory care. In the several data sources combined with the sev- addition, data were available in some cases from eral legal and administrative strategies of Leadin- a commercial source, InfoGroup (InfoUSA), and gAge members can result in a lack of clarity with from the Internal Revenue Service’s database on respect to the scope of the information provided. not-for-profit organizations (accessed through For example, the CMS information may only per- the Urban Institute’s National Center for Charita- tain to the nursing care portion of the organiza- ble Statistics). Virginia Health Information also tion while the IRS data may apply to a broader provided some information on adult day provid- organization than an individual organization or ers. Data quality is likely the highest for CCRCs location. A single physical location may entail and non-CCRC Nursing Homes but possibly less multiple inter-locking legal organizations for real so for other housing providers and adult day pro- estate ownership, service provision, and strategic vider members. In many cases, the data availa- management. ble across sources is consistent. In some cases, a judgment was used with respect to the best source Because data were sometimes incomplete, miss- of information to use. ing information was imputed from existing data 12 — Market Needs and the Economic Impact of LeadingAge Virginia Members and sector-wide patterns drawn from the latest was performed for 2016 and 2040. Economic Census or County Business Pattern data for not-for-profit establishments within the Part 7 discusses benevolent care and charitable relevant sector. Data were converted into aver- giving among LeadingAge Virginia communities. age expenditure per resident and averages based Part 8 hones in on member CCRCs to assess fu- on revenue. This procedure abstracts from indi- ture labor force requirements based on the mar- vidual institution’s differences in service offer- ket projections derived in Part 5. Estimates of the ings, variations in cost, and the impacts of scale size and mix of pay/skill and experience needed but preserves a degree of confidentiality. Table 3 to staff Virginia’s CCRCs and other senior care or- provides an overview of the information sources ganizations as the resident population grows are used in creating our dataset. included. An assessment of the potential impacts of labor supply on labor costs is also included. The remainder of this study is organized as fol- lows: In Part 9, we summarize our major findings and present our conclusions. Supporting documents Because emergent shifts in the demography and appear in the appendices. economy of Virginia will have a direct impact on member operations, Part 4 provides baseline 4.0 LeadingAge Virginia Communities contextual information on size, composition, and in Context health status of Virginia’s total and senior popula- tions. It also highlights the importance of Virginia The demography and economy of Virginia are CCRCs as residence and care options given the critical factors affecting the strategic management state’s demographic shifts. of housing and other services for seniors while the size and well-being of the senior population are a Part 5 provides baseline projections of market critical aspect of the state’s demography. In this demand over the coming 23 years (2017 through section, we provide a brief overview of Virginia’s 2040), including: present and recent demography as it pertains to • 20-year projections for the population age 55 the location and depth of the potential demand and older by age groups. for services provided by LeadingAge Virginia • Forecasts of the wealth, income and other eco- members. The next section will discuss expecta- nomic measures for retirees and near-retirees. tions for the future. • Projections of long-term trends in the health status of retirees, including trends in disability Virginia’s population has grown significantly and active-life expectancy. over the past two decades. The Census Bureau estimates the 2017 population at 8,470,020, an Based on a synthesis of the foregoing demograph- increase of 5.5 percent since 2010 (8,025,206) ic, economic, and health forecasts, Part 5 con- and an increase of 19.2 percent (7,105,817) since cludes with an empirically–based portrait of the 2000.11 Consistant with national trends, Virgin- potential senior care market in the coming dec- ia’s population as a whole is aging rapidly. This ades. is primarily due to a long-term secular decline in fertility which began more than a century ago. Part 6 presents the results of our analysis of the The general fertility rate is now at a record low of economic impact of LeadingAge Virginia mem- 60.2 births per 1,000 women between the ages of bers, collectively, on the Virginia economy, and, 15 and 44. The total fertility rate – an estimate of individually, on the county economies where they how many babies a hypothetical group of 1,000 are located. For the purposes of this study, eco- women would likely have over their lifetime – is nomic impact included the spending of CCRC now 1,764.5 births per 1,000 women. The re- residents, the purchases of LeadingAge Virginia placement rate is 2,100 births per 1,000 women. members for operations and investment, and the backward linkages of such spending. The analysis 11 Population estimates, rather than decennial Census counts, are used to ensure consistent full-year comparisons. Market Needs and the Economic Impact of LeadingAge Virginia Members — 13 Table 3: List of LeadingAge Virginia Members and Sources of Data (as of September 2017)

Provider LeadingAge Virginia Survey SCC CMS IRS InfoUSA 1 Coordinated Services Management, Inc. Y 2 Friendship Y 3 Goodwin House Incorporated Y 4 Ingleside 5 LifeSpire of Virginia Y 6 National Lutheran Communities & Services 7 Pinnacle Living Y Y Y 8 Retirement Housing Foundation 9 Riverside Lifelong Health & Aging Related Services Y Y 10 Sunnyside Retirement Communities Y Y 11 United Church Homes & Services 12 Virginia Lutheran Homes, Inc. Y 13 A Grace Place Adult Care Center Y 14 Adult Care Center of Central Virginia Y Y 15 Adult Care Center of Roanoke Valley, Inc. Y 16 Adult Day Care Center of the N. Shenandoah Valley Y 17 Alexandria Adult Day Services Center 18 Atlantic Shores Y 19 Bay Aging - Essex Adult Day Care Y Y Y 20 Bay Aging - Gloucester Adult Daybreak Y Y 21 Bedford Adult Day Center 22 Beth Sholom Lifecare Community Y Y Y Y 23 Beth Sholom Village Y Y Y Y 24 Birmingham Green Y Y Y Y 25 Brandermill Woods Y Y Y Y 26 Brandon Oaks Y Y Y Y 27 Bridgewater Retirement Community Y Y Y Y Y Y 28 Carlin, The Y 29 Cedarfield Y Y 30 Centra Health Senior Care Services Division Y 31 Chesapeake, The Y Y Y Y 32 Circle Center Adult Day Services Y Y Y 33 Covenant Woods Y Y Y Y 34 Culpeper, The Y Y Y Y Y 35 Culpepper Garden Y Y 36 Daily Living Center Y Y 37 Eastern Loudoun Adult Day Center 38 Edinburgh Square Y Y 39 Edwards Adult Day Center Y 40 Elm Manor Y 41 Fairfax County Health Department 42 Fairmont Crossing Health and Rehabilitation Center Y 43 Falcons Landing Y Y Y Y Y 44 Feinour Center - Adult Medical Day Care 45 Fellowship Square Foundation Y 46 Friendship Apartment Village Corporation Y Y 47 Friendship Assisted Living 48 Friendship Health and Rehab Center Y Y 49 Friendship Health and Rehab Center South Y 50 Generations Crossing Y Y 51 Glebe, The Y Y Y Y

14 — Market Needs and the Economic Impact of LeadingAge Virginia Members Table 3: List of LeadingAge Virginia Members and Sources of Data (as of September 2017)

Provider LeadingAge Virginia Survey SCC CMS IRS InfoUSA 52 Goodwin House Alexandria Y Y Y 53 Goodwin House Bailey’s Crossroads Y Y Y Y Y 54 Hanover Adult Center Y Y 55 Harbor’s Edge Y Y Y Y 56 Hermitage in Northern Virginia Y Y 57 Hermitage in Richmond Y Y Y 58 Hermitage on the Eastern Shore Y Y 59 Hermitage Roanoke Y Y 60 Herndon Harbor Adult Day Health Care Y 61 Insight Memory Care Center Y 62 Interfaith Adult Day Care Y Y 63 JABA Adult Care Center Y Y 64 JFS (Jewish Family Services) - home care only Y 65 Kendal at Lexington Y Y Y Y Y 66 King’s Grant Retirement Community Y Y Y Y 67 Lake Prince Woods Y Y Y Y Y 68 Lakewood Y Y Y Y 69 Leesburg Adult Day Center Y 70 Legacy at North Augusta Y 71 Lewinsville Adult Day Health Center 72 Lewinsville, The Y Y 73 Lincolnia Adult Day Health Care Y 74 Little Sisters of the Poor Y Y Y 75 Luther Manor Y 76 Lydia H. Roper Home Y Y 77 Mac Brownell Adult Day Center 78 Marian Manor Y Y 79 Martha Jefferson House Y Y 80 Maryview Nursing Care Center Y Y Y 81 Marywood Y Y 82 Masonic Home of Virginia Y Y Y Y 83 McGurk House Y 84 Mennowood Retirement Community Y Y 85 Mountain Empire PACE Y Y 86 Mountain View Nursing Home Y Y Y 87 Mt. Vernon Adult Day Health Care Y 88 Norfolk Senior Center t/a Primeplus Y 89 Oakwood Health and Rehabilitation Center Y 90 Our Lady of Hope Y Y Y 91 Our Lady of Peace Y Y Y 92 Our Lady of Perpetual Help Y Y Y Y 93 Our Lady of the Valley Y Y Y Y 94 Patriots Colony at Williamsburg Y Y Y Y 95 Petersburg Home for Ladies Y Y 96 Prince William Adult Day Health Care 97 Pulaski Adult Day Service Center Y 98 Rappahannock Westminster-Canterbury Y Y Y 99 Raspberry Hill Adult Daytime Center Y 100 Richfield Living Y Y Y Y 101 Russell House Y Y 102 Saint Francis Home Y

Market Needs and the Economic Impact of LeadingAge Virginia Members — 15 Table 3: List of LeadingAge Virginia Members and Sources of Data (as of September 2017)

Provider LeadingAge Virginia Survey SCC CMS IRS InfoUSA 103 Scott Hill/Briarcliffe 104 Seton Manor Y 105 Shenandoah Valley Westminster-Canterbury Y Y Y Y Y 106 South Richmond Adult Day Care Center Y Y 107 St. Mary’s Woods Retirement Community Y Y Y 108 Sullivan House Y 109 Summit Health and Rehabilitation Center Y 110 Summit Square Retirement Community Y Y Y 111 Summit, The Y Y 112 Sunnyside Retirement Community Y Y Y 113 Swift Creek Day Center Y 114 VCU Health Adult and Intergenerational Center 115 Village at Orchard Ridge, The Y Y Y Y 116 Village at Woods Edge Y Y 117 Village Gardens Y 118 Village Pointe Senior Housing Y 119 Vinson Hall Retirement Community Y Y Y Y Y 120 Virginia Baptist Hospital Division Center 121 Virginia Mennonite Retirement Community Y Y Y Y Y 122 Virginia Tech Adult Day Services Y 123 Virginian, The Y Y Y 124 Walter Reed Adult Day Health Care Center Y 125 Warm Hearth Village Y Y Y Y Y 126 Warwick Forest Y Y Y Y 127 Westminster at Lake Ridge Y Y Y Y Y 128 Westminster Canterbury Lynchburg Y Y Y Y Y 129 Westminster Canterbury Richmond Y Y Y Y Y Y 130 Westminster-Canterbury of the Blue Ridge Y Y Y Y Y 131 Westminster-Canterbury on Chesapeake Bay Y Y Y Y Y 132 Williamsburg Landing, Inc. Y Y Y Y 133 WindsorMeade Williamsburg Y Y Y Y

According to the National Center for Health Sta- range affected by the aging baby boomers – which tistics, that rate has generally been below replace- grew by 32.8 percent between 2010 and 2017. ment level since 1971. A steady stream of immi- (With an increase of over 99,000, the 70-74 age grants has prevented the U.S. population from group showed the highest percentage increase at aging more quickly. 42.8 percent.) The oldest old, those ages 85 and older, also grew significantly since 2010, increas- The products of the one aberration in that long- ing by almost 25,000 to 148,534, an increase of term fertility decline – those born between 1946 20.2 percent. and 1964 – are just now entering the ranks of seniors, complicating an orderly process because Long-term fertility decline, which results in popu- a bulge will enter and then pass on. In 2010, Vir- lation pyramids increasingly appearing to be cyl- ginia had 983,624 residents ages 65 and older, inders, and the aging of the Baby Boom, which 12.2 percent of the population. The first Baby resembles an over-size bulge moving through the Boomer reached age 65 in 2011, the year after the pyramid, are not the only factors responsible for 2010 census. Between 2010 and 2017, the popu- aging. Those who have survived to the upper ages lation age 65 and older grew by nearly 288,000, can expect increases in life expectancy. While increasing by 29.3 percent. The largest numerical the current oldest old were born in the depths of growth was in the age group ages 65-69 – the first the Great Depression, Baby Boomers were born 16 — Market Needs and the Economic Impact of LeadingAge Virginia Members Figure 2: Virginia Population by Age, Sex, and Race, 2017

Source: U.S. Census Bureau Population Estimates into an era of comparative prosperity. Decades African Americans account for 12.7 percent of the of rising economic welfare, political stability, and population in 2016, but only 9.1 percent of those rising educational opportunities, have had an ef- ages 65 and older. Asians comprised 5.4 percent fect. Advances in health care and greater access of the country’s population and 6.4 percent of the to health services have likely had supplemental senior population. Hispanics across the country effects. are notably younger, comprising 17.8 percent or the total population but only 8 percent of the sen- As throughout the country, seniors in Virginia are ior population. disproportionately white. In 2017, whites com- prised 61.9 percent of the total population but 4.1 Regional Demographic Patterns 76.0 percent of the population age 65 and older. African Americans were 19.1 percent of the total Virginia’s population is concentrated in the ma- population, but only 15.4 percent of seniors. His- jor metropolitan areas, especially in northern Vir- panics comprised 9.4 percent of the total popu- ginia – the counties and cities in the Washington, lation and 2.9 percent of the senior population. D.C. metropolitan area – (2,933,397), the Norfolk- Asians made up 6.7 percent of Virginia’s popu- Virginia Beach-Newport News metropolitan area lation and 4.7 percent of the senior population. (1,725,246), and the Richmond metropolitan area Compared to the U.S. as a whole, the state has a (1,294,204). Together, these three metropolitan lower representation of Hispanics but a higher areas account for over 70 percent of Virginia’s representation of Blacks. Figure 2 charts Vir- total population, with Northern Virginia being ginia population by age, sex, and race. Note that clearly dominant. Growth in these three metro- the fastest-growing group over the last several politan areas accounted for 94.5 percent of the net decades has barely had an impact on the senior population growth in the state since 2010. Figure population of Virginia. For comparison, white 3 maps the total population (upper panel) and the comprised 61.1% of the country’s population but senior (aged 65 and above) (lower panel) in Vir- 77.3 percent of the population age 65 and older. ginia for 2017. The concentration of population

Market Needs and the Economic Impact of LeadingAge Virginia Members — 17 Figure 3: Total and Senior Population by County, 2017 Total and Senior Population by County 2017

One dot = 15,000 people Senior (aged 65+) Population 2017

One dot = 2,000 people

Source: U.S. Census Bureau Population Estimates

18 — Market Needs and the Economic Impact of LeadingAge Virginia Members in the three regions just named is clearly visible retirement-age populations, again suggesting a in the upper panel. The senior population (lower fragmented market. Table 4 understates the de- panel) appears to be less concentrated. The major gree of geographic concentration because several concentrations are still visible but so are smaller populous jurisdictions are adjacent to each other. concentrations near Roanoke and Lynchburg as is Sixty-two of the counties and independent cities a sprinkling throughout rural areas. in Virginia have lost population since 2010. Pop- ulation loss has occurred in Virginia In 2017, sixty percent (1,271,428) of the state’s (e.g. Danville -4.1 percent, Petersburg -2.3 per- senior population (65 and older) lived in Leadin- cent, and Emporia -10.8 percent), in the moun- gAge Virginia counties/independent cities. Four tains (e.g. Tazwell County -8.9 percent, Bristol counties/independent cities – Fairfax County, -5.5 percent and Bath County -9.0 percent), and Virginia Beach, Chesterfield County, and Hen- the (e.g. Richmond County -3.7 rico County – account for nearly one-quarter of percent and Lancaster County -5.0 percent). Fig- the state’s retirement-age population with Fairfax ure 4 shows the patterns of population gain and County alone being responsible for over 150,075 loss across Virginia. seniors (11.8 percent of the state total). Virginia Beach, the next-largest concentration, accounted The relatively lower concentration of seniors in for 61,631 seniors. With the addition of Prince the major population centers is a product of the William County, Loudoun County, and Chesa- interaction between a changing economic base peake, seven counties/independent cities ac- and the age selectivity of migration. Poor pros- counted for one-third of the state’s seniors. Sever- pects and employment loss in manufacturing, al of the LeadingAge Virginia counties have small mining and farming together with opportunities

Figure 4: Population Change in Virginia Counties and Independent Cities, 2010-2017

Source: U.S. Census Bureau Population Estimates

Market Needs and the Economic Impact of LeadingAge Virginia Members — 19 Table 4: Total and Senior Population in order of Decreasing Senior Population Size, 2017

Jurisdiction Total Seniors Percent of Cumulative Seniors Percent Virginia 8,470,020 1,271,428 Fairfax County LeadingAge Virginia 1,148,433 150,075 11.80% 11.80% Virginia Beach city LeadingAge Virginia 450,435 61,631 4.85% 16.65% Chesterfield County LeadingAge Virginia 343,599 49,565 3.90% 20.55% Henrico County LeadingAge Virginia 327,898 49,189 3.87% 24.42% Prince William County LeadingAge Virginia 463,023 43,886 3.45% 27.87% Loudoun County LeadingAge Virginia 398,080 35,607 2.80% 30.67% Chesapeake city 240,397 30,830 2.42% 33.10% Richmond city LeadingAge Virginia 227,032 28,999 2.28% 35.38% Norfolk city LeadingAge Virginia 244,703 26,519 2.09% 37.46% Arlington County LeadingAge Virginia 234,965 24,214 1.90% 39.37% Newport News city LeadingAge Virginia 179,388 22,672 1.78% 41.15% Hampton city LeadingAge Virginia 134,669 20,276 1.59% 42.74% Roanoke County LeadingAge Virginia 93,730 19,552 1.54% 44.28% Albemarle County 107,702 19,153 1.51% 45.79% James City County 75,524 18,681 1.47% 47.26% Hanover County LeadingAge Virginia 105,923 18,271 1.44% 48.69% Spotsylvania County 133,033 18,218 1.43% 50.13% Alexandria city LeadingAge Virginia 160,035 17,715 1.39% 51.52% Bedford County LeadingAge Virginia 77,974 16,184 1.27% 52.79% Roanoke city LeadingAge Virginia 99,837 16,103 1.27% 54.06% Augusta County 75,144 15,357 1.21% 55.27% Rockingham County LeadingAge Virginia 80,227 14,933 1.17% 56.44% Stafford County 146,649 14,782 1.16% 57.61% Frederick County 86,484 14,555 1.14% 58.75% Portsmouth city 94,572 13,831 1.09% 59.84% Pittsylvania County 61,258 13,454 1.06% 60.90% Franklin County 56,445 12,995 1.02% 61.92% Suffolk city LeadingAge Virginia 90,237 12,586 0.99% 62.91% Henry County 51,227 12,056 0.95% 63.86% Washington County 54,387 12,034 0.95% 64.80% Montgomery County LeadingAge Virginia 98,559 12,009 0.94% 65.75% Lynchburg city LeadingAge Virginia 80,995 11,669 0.92% 66.67% Fauquier County 69,465 11,150 0.88% 67.54% Campbell County 55,010 10,611 0.83% 68.38% York County 67,739 10,564 0.83% 69.21% Shenandoah County 43,225 9,169 0.72% 69.93% Tazewell County 41,095 8,894 0.70% 70.63% Danville city 41,130 8,428 0.66% 71.29% Halifax County 34,563 8,167 0.64% 71.93% Culpeper County LeadingAge Virginia 51,282 7,803 0.61% 72.55% Mecklenburg County 30,686 7,735 0.61% 73.16% Pulaski County LeadingAge Virginia 34,184 7,648 0.60% 73.76% Accomack County LeadingAge Virginia 32,545 7,402 0.58% 74.34% Botetourt County LeadingAge Virginia 33,192 7,325 0.58% 74.92% Orange County 36,073 7,305 0.57% 75.49% Carroll County 29,708 7,065 0.56% 76.05% Louisa County 35,860 6,937 0.55% 76.59%

20 — Market Needs and the Economic Impact of LeadingAge Virginia Members Table 4: Total and Senior Population in order of Decreasing Senior Population Size, 2017 Continued

Jurisdiction Total Seniors Percent of Cumulative Seniors Percent Gloucester County LeadingAge Virginia 37,292 6,869 0.54% 77.13% Isle of Wight County 36,552 6,778 0.53% 77.66% Wise County LeadingAge Virginia 38,586 6,757 0.53% 78.20% Smyth County 30,656 6,598 0.52% 78.72% Amherst County LeadingAge Virginia 31,594 6,515 0.51% 79.23% Warren County 39,563 6,141 0.48% 79.71% Wythe County 28,882 6,095 0.48% 80.19% Rockbridge County 22,659 5,728 0.45% 80.64% Russell County 27,048 5,632 0.44% 81.08% Charlottesville city LeadingAge Virginia 48,019 5,394 0.42% 81.51% Petersburg city LeadingAge Virginia 31,750 5,252 0.41% 81.92% Fluvanna County 26,452 5,182 0.41% 82.33% Prince George County 37,809 5,174 0.41% 82.74% Staunton city LeadingAge Virginia 24,528 5,166 0.41% 83.14% Scott County 21,865 5,153 0.41% 83.55% Powhatan County 28,601 5,073 0.40% 83.95% Harrisonburg city LeadingAge Virginia 54,215 4,988 0.39% 84.34% Page County 23,731 4,983 0.39% 84.73% Goochland County 22,685 4,896 0.39% 85.12% Caroline County 30,461 4,876 0.38% 85.50% Lee County 23,758 4,868 0.38% 85.88% Dinwiddie County 28,208 4,835 0.38% 86.26% Salem city LeadingAge Virginia 25,862 4,798 0.38% 86.64% Buchanan County 21,514 4,682 0.37% 87.01% Patrick County 17,665 4,576 0.36% 87.37% Westmoreland County 17,780 4,423 0.35% 87.72% Northumberland County 12,275 4,418 0.35% 88.06% Winchester city LeadingAge Virginia 27,932 4,307 0.34% 88.40% Waynesboro city LeadingAge Virginia 22,327 4,048 0.32% 88.72% Manassas city LeadingAge Virginia 41,501 3,994 0.31% 89.03% Nelson County 14,943 3,943 0.31% 89.34% Lancaster County LeadingAge Virginia 10,788 3,836 0.30% 89.65% Grayson County 15,665 3,757 0.30% 89.94% Prince Edward County 22,703 3,689 0.29% 90.23% Alleghany County LeadingAge Virginia 15,122 3,649 0.29% 90.52% New Kent County 21,682 3,648 0.29% 90.81% Giles County 16,837 3,642 0.29% 91.09% Colonial Heights city 17,830 3,524 0.28% 91.37% Fairfax city LeadingAge Virginia 24,097 3,512 0.28% 91.65% Bristol city 16,790 3,507 0.28% 91.92% Floyd County 15,755 3,497 0.28% 92.20% Hopewell city 22,621 3,482 0.27% 92.47% Southampton County 17,750 3,481 0.27% 92.74% Brunswick County 16,244 3,393 0.27% 93.01% King George County 26,337 3,363 0.26% 93.28% Middlesex County 10,679 3,318 0.26% 93.54% Greene County 19,612 3,251 0.26% 93.79% Buckingham County 17,065 3,231 0.25% 94.05%

Market Needs and the Economic Impact of LeadingAge Virginia Members — 21 Table 4: Total and Senior Population in order of Decreasing Senior Population Size, 2017 Continued

Jurisdiction Total Seniors Percent of Cumulative Seniors Percent Appomattox County 15,681 3,198 0.25% 94.30% Dickenson County 14,782 3,154 0.25% 94.55% Fredericksburg city 28,360 3,087 0.24% 94.79% Northampton County 11,846 3,046 0.24% 95.03% Clarke County 14,508 2,972 0.23% 95.26% Nottoway County 15,434 2,896 0.23% 95.49% Madison County LeadingAge Virginia 13,277 2,885 0.23% 95.72% Mathews County 8,779 2,704 0.21% 95.93% Charlotte County 12,119 2,639 0.21% 96.14% King William County 16,708 2,635 0.21% 96.34% Lunenburg County 12,235 2,627 0.21% 96.55% Martinsville city LeadingAge Virginia 13,142 2,524 0.20% 96.75% Amelia County 13,020 2,487 0.20% 96.94% Essex County LeadingAge Virginia 11,028 2,448 0.19% 97.14% Poquoson city 12,053 2,321 0.18% 97.32% Williamsburg city LeadingAge Virginia 15,031 2,294 0.18% 97.50% Cumberland County 9,811 2,143 0.17% 97.67% Rappahannock County LeadingAge Virginia 7,321 1,938 0.15% 97.82% Sussex County 11,373 1,933 0.15% 97.97% Richmond County 8,939 1,907 0.15% 98.12% Falls Church city LeadingAge Virginia 14,583 1,848 0.15% 98.27% Greensville County 11,679 1,736 0.14% 98.40% Charles City County 7,004 1,644 0.13% 98.53% Radford city 17,658 1,604 0.13% 98.66% Franklin city LeadingAge Virginia 8,176 1,582 0.12% 98.78% King and Queen County 7,003 1,567 0.12% 98.91% Bland County 6,350 1,437 0.11% 99.02% Surry County 6,540 1,412 0.11% 99.13% Galax city 6,625 1,388 0.11% 99.24% Manassas Park city 16,591 1,291 0.10% 99.34% Buena Vista city 6,327 1,206 0.09% 99.44% Covington city 5,531 1,200 0.09% 99.53% Bath County 4,297 1,175 0.09% 99.62% Lexington city LeadingAge Virginia 7,106 1,157 0.09% 99.72% Craig County 5,062 1,139 0.09% 99.81% Emporia city 5,282 1,022 0.08% 99.89% Norton city 3,936 733 0.06% 99.94% Highland County 2,212 723 0.06% 100.00%

22 — Market Needs and the Economic Impact of LeadingAge Virginia Members Figure 5: Population Pyramid for Non-Metropolitan Virginia, 2012-2016

in service sectors has resulted in the out-migra- or non-metropolitan. Figure 5 shows the age-sex tion of young adults from many areas. Because structure (the percentage in each age group for young adults are likely in the life stage of family women and men) of non-metropolitan Virginia. formation, the number of potential parents, and Figure 6 shows the age-sex structure for metro- thus children, is reduced. Consequently, 45 of the politan Virginia. counties and independent cities that lost popula- tion had both more deaths than births and more The differences are readily apparent. In non-met- people moving out than moving in. ropolitan areas (Figure 5), the population between 25 and 44 accounts for a much smaller percentage Because these areas experiencing population de- than in metropolitan areas, especially ages 25-34. cline have fewer young adults and children, the Many young adults have left non-metropolitan proportion of seniors among those remaining is areas, while many young adults have moved to relatively higher. For example, 15.0 percent of metropolitan areas. The relative percentages of Virginia’s population was age 65 and older. Com- children are notably smaller in non-metropolitan pare this with Martinsville (19.2 percent), Hali- areas. The baby boom cohorts are much more fax County (23.6 percent), Franklin County (23.0 apparent in non-metropolitan areas, as are the percent), Lancaster County (35.6 percent), and older age groups. Note that there are higher Northumberland County (36.0 percent). Five ju- percentages of women than men at older ages in risdictions had senior population which exceed- both metropolitan and non-metropolitan areas of ed 30 percent of the total; in another seven, the the state. Nevertheless, while those age 65 and proportion was greater than one-fourth. These older account for a higher proportion of the total effects can be summarized by categorizing all population in rural areas, the absolute numbers counties and independent cities as metropolitan of seniors are much higher in metropolitan areas.

Market Needs and the Economic Impact of LeadingAge Virginia Members — 23 Figure 6: Population Pyramid for Metropolitan Virginia, 2012-2016

These figures suggest two different types of local status. A discussion of the long-term market for senior markets – ones which are large and grow- CCRCs in Virginia, which depends on a sufficient- ing with ample potential workforces and others ly large retiree population with adequate wealth, which are smaller, potentially shrinking, and po- will follow. Following the trend towards increas- tentially workforce-starved. ing inequality in the U.S., we find evidence that a set of seniors have ample financial and health Most LeadingAge Virginia members are in ar- resources while others command less ample re- eas that are growing or at least demographically sources. stable. However, there are Adult Day members, Nursing Home members, and CCRC members in The goal of this section of the study is to forecast areas where the population is in decline. In the the size and economic characteristics of the mar- long run, this demographic pattern will affect ket of potential clients for LeadingAge Virginia both recruitment of residents and the labor force members with a focus on the CCRC communities. as well as the potential financial/economic viabil- We employed a four-fold strategy. ity of those organizations. First, we used 2017 Census Bureau population 5.0 Projections of Market Demand estimates and projections prepared by the Wel- don Cooper Center at the University of Virginia The key long-term parameters for demand for ser- to establish a baseline 20-year projection for the vices for seniors are the growth of the population senior population for the state and each county.12 of seniors, health status, and the ability to pay. We 12 The 2017 estimates can be accessed at the Census website: https:// www.census.gov/data/datasets/2017/demo/popest/counties-detail.html. begin with a discussion of the first parameter be- The Bureau’s estimation procedure is outlined there. The projections can fore proceeding to a discussion of trends in health be found at the office’ website: https://demographics.coopercenter.org/ virginia-population-projections. The Cooper Center uses a combination 24 — Market Needs and the Economic Impact of LeadingAge Virginia Members Within the broad senior population, we separated as the baby boomers age, whether the services are trends and projections for the youngest old (ages adult day or CCRCs or other services. Given the 65-74), the middle old (ages 75-84), and the old- average age at CCRC entry, Baby Boomers will est-old (ages 85 and older). These age groups are likely not begin having direct visible impacts on the demographic market for all LeadingAge mem- CCRCs until around 2026. The same is likely for ber whether adult day, senior housing or CCRCs. nursing care.

Second, we used county-level information on the Population projections forecast changes in popu- income distribution among senior households lation size and composition based on assumptions from the 2012-2016 American Community Survey about expected patterns of fertility, mortality and as a basis to project the number of high-income migration. Like all population projections, the seniors who can afford the CCRC option. further into the future we look, the greater the potential for error. Fluctuations in fertility rates Third, we used information on the capture rates impact the senior population only with a decades- of CCRCs by age and sex to estimate the number long lag and mortality rates are well-measured and location of qualified seniors choosing CCRCs and stable. However, migration into and out of as their preferred residential and care option. Be- Virginia, and especially localities, can be affected cause the local number is not always sufficiently by economic downturns, as was seen in the Great high to support a CCRC, these individuals may Recession. Therefore, uncertainty regarding the choose to relocate. future trajectory of retirement migration is a con- cern in attempting to derive reliable projections Fourth, we determined how trends in migration, of the long-term demographic market for services health status, and wealth accumulation could af- for seniors provided by LeadingAge. Some con- fect our baseline projections. siderations are discussed after the central trends and patterns have been discussed. 5.1 Projections of Virginia’s Senior Population Virginia’s population growth is projected to con- Our aging society receives considerable attention tinue, with a projected total population of over in the press and from policy makers. While Baby 9.1 million by 2025 and more than 10 million by Boomers will gradually come to dominate the sen- 2040. Accordingly, significant growth of the sen- ior population over the next three decades, most ior population and the oldest old is projected to Americans age 65 and older were born during or continue. Figure 7 charts the age distribution by before World War II, and are in relatively small sex and race of projected population for Virginia cohorts (due to lower fertility during the Depres- in 2040.13 sion and the years thereafter). For the period of concern in this report, the focus is split between Figure 8 charts the senior population (age 65 and the pre-boomers who have been able to benefit older) – disaggregated into youngest old (ages 65- from a period of generous career and investment 74), middle old (ages 75-84), and the oldest old opportunities, the Boomers who are now begin- (ages 85+) – in the U.S. and Virginia in selected ning to have impacts, and the post-boomers who years from 2010 through 2040. The U.S. popula- will be in the mix by the final decade covered by tion is indicated by the left scale while Virginia’s is the report. However, while the first of the Baby scaled on the right. Virginia is expected to roughly Boomers are now in the mid- and late-60s, the follow U.S. trends but there are some visible dif- first boomer won’t turn 75 until 2021, and the first ferences. The older the age group, the greater the boomer won’t turn 85 until 2031. The last Boom- deviance with the growth of Virginia’s oldest old ers will turn 65 around 2029. All services for sen- most visibly lagging. One possible explanation is iors provided by LeadingAge Virginia members that Virginians have higher death rates than the will increase with the growing senior population 13 The Cooper Center does not project Virginia’s population by age, sex, of exponential growth, linear extrapolation, and Hamilton-Perry method and race. We generated the projections for age, sex, and race using the (a variation of the cohort-component method) to derive the projections. A Cooper projections as targets for the age-sex categories and, separately, full description of the methodology is included on their website. the race categories (which were not reported by age or sex). Market Needs and the Economic Impact of LeadingAge Virginia Members — 25 Figure 7: Virginia Population by Age, Sex, and Race, 2040

Source: Analysis of combined data sources

Figure 8: Projected Trends in the Senior Population, U.S. and Virginia, 2017-2040

Source: Census Bureau and Cooper Center

26 — Market Needs and the Economic Impact of LeadingAge Virginia Members Table 5: Estimates and Projections of U.S. and Virginia Senior Population, 2017-2040

2010 2017 2020 2030 2040 Senior Population 65-74 21,858,044 29,683,446 32,789,443 38,686,374 35,878,884 75-84 13,079,715 14,706,551 16,561,256 25,377,364 30,517,886 United States 85 + 5,543,134 6,468,682 6,700,882 9,073,867 14,429,861 65 and up 40,480,893 50,858,679 56,051,581 73,137,605 80,826,631 65-74 554,380 759,518 836,321 992,855 912,432 75-84 305,698 363,376 407,129 615,891 729,211 Virginia 85 + 123,546 148,534 149,399 194,658 283,507 65 and up 983,624 1,271,428 1,392,849 1,803,404 1,925,150 2010-2017 2017-2020 2010-2020 2020-2030 2030-2040 Change in Senior Population

65-74 205,138 76,803 281,941 156,534 -80,423 75-84 57,678 43,753 101,431 208,762 113,320 Virginia 85 + 24,988 865 25,853 45,259 88,849 65 and up 287,804 121,421 409,225 410,555 121,746 Percent Change in Senior Population 65-74 35.8% 10.5% 50.0% 18.0% -7.3% 75-84 12.4% 12.6% 26.6% 53.2% 20.3% United States 85 + 16.7% 3.6% 20.9% 35.4% 59.0% 65 and up 25.6% 10.2% 38.5% 30.5% 10.5% 65-74 37.0% 10.1% 50.9% 18.7% -8.1% 75-84 18.9% 12.0% 33.2% 51.3% 18.4% Virginia 85 + 20.2% 0.6% 20.9% 30.3% 45.6% 65 and up 29.3% 9.5% 41.6% 29.5% 6.8% country as a whole.14 and 2040, the population of seniors is projected Table 5, corresponding to Figure 8, provides to grow by 121,746, 6.7 percent, to 1,925,150. By more detail. In 2017, Virginia was home to an then the rapid growth will be moving into the old- estimated 1,271,428 residents age 65 and older. est age group and countered by a decline in the By 2020, the state’s senior population is pro- young old. The oldest old population (ages 85 and jected to have grown by 409,225 from 983,624 in older) is projected to grow to 283,507 by 2040, a 2010 to 1,392,849 – an increase of 41.6 percent. 90 percent increase from 2017. The demands for The young old (65-74) account for over half that housing and other services (e.g. Adult Day) for the growth as the Baby Boomers age. Between 2020 senior population will be growing at a challenging and 2030, the Virginia senior population is pro- rate. jected to grow by 410,555 residents, 29.5 percent, to reach 1,803,404. The young old (65-74) are Over the next twenty years, the senior popula- projected to grow by 156,534 (18.7 percent) while tion will become increasingly diverse. By 2040, the middle old are projected to grow by 208,762 the U.S. population will be 51.3 percent non-His- (51.3 percent) as Baby Boomer move into these panic white but the senior population is expected ages. The oldest old (85 and older) are projected to be 65.7 percent non-Hispanic white while the to grow by 45,259, 30.3 percent.15 Between 2030 population of the oldest old will be 74.2 percent 14 Another possibility is that the difference is an artifact of the state’s non-Hispanic white. In 2040, we expect Virginia projection methodology. In “A Long Term Test of the Accuracy of the Hamilton-Perry Method for Forecasting State Populations by Age,” David to be 44.0 percent non-Hispanic White, 15.4 per- A. Swanson and Jeff Tayman (2017, The Frontiers of Applied Demogra- cent non-Hispanic Black, 21.6 percent Hispanic, phy pp. 491-513, Springer) state, “we do not suggest using this method beyond a ten-year forecast horizon.” and 13.7 percent non-Hispanic Asian. The cor- 15 In an Appendix table the effect of the Baby Boomers aging out can be 55 to 59 and a decline of over 27,000 (-5 percent) among those aged 60 seen in the decline of almost 76,000 (-12.9 percent) among those aged to 64. Market Needs and the Economic Impact of LeadingAge Virginia Members — 27 Table 6: Projected Senior Population Change in LeadingAge Counties and Cities, 2017-2040

2017 Increase 2017-2020 Increase 2017-2030 Increase 2017-2040

Jurisdiction Seniors Percent of total Number Percent Number Percent Number Percent Virginia 1,271,428 15.01 121,421 9.55 531,976 41.84 653,722 51.42 Fairfax County 150,075 13.07 6,002 4.00 43,014 28.66 51,483 34.31 Prince William County 43,886 9.48 10,311 23.50 40,946 93.30 62,789 143.07 Virginia Beach city 61,631 13.68 5,779 9.38 29,873 48.47 33,459 54.29 Loudoun County 35,607 8.94 11,046 31.02 53,728 150.89 93,234 261.84 Chesterfield County 49,565 14.43 7,331 14.79 25,468 51.38 30,823 62.19 Henrico County 49,189 15.00 5,658 11.50 21,865 44.45 27,108 55.11 Norfolk city 26,519 10.84 1,246 4.70 8,600 32.43 8,855 33.39 Arlington County 24,214 10.31 -1,043 -4.31 4,698 19.40 8,374 34.58 Richmond city 28,999 12.77 -1,916 -6.61 3,673 12.67 2,671 9.21 Newport News city 22,672 12.64 989 4.36 7,308 32.23 6,456 28.48 Alexandria city 17,715 11.07 135 0.76 6,529 36.85 11,546 65.18 Hampton city 20,276 15.06 761 3.76 6,689 32.99 4,093 20.19 Hanover County 18,271 17.25 2,131 11.67 10,027 54.88 12,524 68.55 Roanoke city 16,103 16.13 600 3.73 3,547 22.03 3,386 21.03 Montgomery County 12,009 12.18 1,030 8.58 4,074 33.92 5,553 46.24 Roanoke County 19,552 20.86 1,882 9.63 5,204 26.62 4,963 25.38 Suffolk city 12,586 13.95 2,493 19.81 9,003 71.53 12,519 99.47 Lynchburg city 11,669 14.41 881 7.55 2,375 20.35 1,766 15.14 Rockingham County 14,933 18.61 1,752 11.73 6,423 43.01 7,608 50.94 Bedford County 16,184 20.76 2,124 13.12 7,707 47.62 8,777 54.23 Harrisonburg city 4,988 9.20 89 1.79 1,397 28.00 1,934 38.77 Culpeper County 7,803 15.22 1,407 18.03 4,756 60.96 6,257 80.18 Charlottesville city 5,394 11.23 -553 -10.25 1,326 24.58 1,883 34.91 Manassas city 3,994 9.62 48 1.20 1,787 44.73 2,323 58.17 Wise County 6,757 17.51 711 10.52 996 14.74 530 7.85 Gloucester County 6,869 18.42 815 11.86 3,251 47.33 3,226 46.96 Pulaski County 7,648 22.37 319 4.17 1,121 14.65 1,328 17.37 Botetourt County 7,325 22.07 480 6.55 2,139 29.20 2,132 29.11 Accomack County 7,402 22.74 -379 -5.12 926 12.51 155 2.10 Petersburg city 5,252 16.54 229 4.35 1,147 21.84 730 13.89 Amherst County 6,515 20.62 240 3.69 1,337 20.53 1,188 18.24 Winchester city 4,307 15.42 345 8.00 1,419 32.95 1,496 34.73 Salem city 4,798 18.55 147 3.07 926 19.31 699 14.58 Staunton city 5,166 21.06 541 10.47 1,406 27.22 1,105 21.39 Fairfax city 3,512 14.57 361 10.28 1,123 31.97 1,154 32.85 Waynesboro city 4,048 18.13 37 0.92 663 16.38 621 15.34 Alleghany County 3,649 24.13 241 6.61 407 11.17 45 1.24 Williamsburg city 2,294 15.26 408 17.80 862 37.56 773 33.70 Falls Church city 1,848 12.67 112 6.06 674 36.48 776 41.97 Madison County 2,885 21.73 307 10.63 855 29.64 633 21.96 Martinsville city 2,524 19.21 166 6.57 469 18.60 131 5.17 Essex County 2,448 22.20 214 8.76 533 21.77 364 14.85 Lancaster County 3,836 35.56 257 6.70 604 15.74 95 2.48 Franklin city 1,582 19.35 133 8.38 306 19.32 149 9.42 Rappahannock County 1,938 26.47 89 4.58 329 16.98 133 6.85 Lexington city 1,157 16.28 -31 -2.72 -42 -3.65 -100 -8.67

Source: Census Bureau and Cooper Center

28 — Market Needs and the Economic Impact of LeadingAge Virginia Members responding figures for seniors will be 59.7, 16.4, will have long-term consequences on these areas. 11.0, and 10.9 percent, respectively.16 With re- The counties in the Washington Metropolitan spect to the oldest old, 69.7 percent will be non- Area (Loudoun County, Fauquier County, Prince Hispanic White in Virginia compared to 79.2 per- Williams County, Fairfax County, and Stafford cent in 2017. County), counties in the Richmond Metropoli- tan Area (Chesterfield County, Hanover County, Table 6 summarizes the projected change in the Spotsylvania County), and the two counties near senior population for Virginia and counties and universities (Albemarle County and Montgom- independent cities with LeadingAge members ery County) have strong absolute and percentage from their 2017 base. Absolute and percent in- increases in their senior populations. Growth in crease for 2017-2020, 2017-2030, and 2017-2040 counties projected to grow at a rapid pace (e.g. are shown. There is geographic variation in the Loudoun. Prince William and Spotsylvania) will proportion of an area that is over 65, with grow- be driven by people moving there, not by aging in ing metropolitan areas having larger numbers but place. Even so, the number of those aged 55-59 smaller proportions of seniors, while rural areas and 60-64 will mostly be smaller after the Baby that are losing population have high proportions Boomers age. Decline is also projected in most of seniors because of the loss of young adults and places among those ages 65 to 69. The aging their families – in effect, creating two different Baby Boomers account for the significant growth types of markets. The complete estimates and among the middle old (ages 75 to 84) and the old- projections by county for 2017, 2020, 2030 and est old (ages 85 and older). Even most areas pro- 2040 are in Appendix Table 1. The counties and jected to have slow growth or declining popula- independent cities containing LeadingAge mem- tions have significant growth at older ages from bers are marked. In addition, the Appendix Table aging in place. Figure 9 maps the distribution of 2 through Appendix Table 5 show the population population (upper panel) and senior population ages 55-59 and 60-64 – the pipeline for CCRC (lower panel) in 2040. residents in the extended future – and the chang- es in their levels. 5.1.1 Projections of Virginia’s CCRC Market

There is considerable variability among the se- CCRCs, as they are now constituted, are orient- lected cities and counties in the changes among ed towards a high-income, high-wealth market. the senior population. Metropolitan growth is Projections of the total senior population may projected to continue, especially in northern Vir- therefore yield an inaccurate picture of future ginia and in the Richmond metropolitan area. For baseline demand. Figure 10 shows the 2040 dis- example in Northern Virginia, from 2017 to 2040 tribution of the high-income senior population the increase in the Loudoun County senior popu- in Virginia (at least $150k household income in lation is projected to be over 260 percent of its 2016 dollars). That high-income population was present level. Similarly, the Prince William Coun- projected by measuring the proportion of the sen- ty senior population is projected to increase by 43 ior population in such households in 2016 using percent of its 2017 level. In the Richmond area, the 2012-2016 American Community Survey and the Henrico County senior population is project- multiplying that proportion by the senior popula- ed to grow by over 55 percent of its 2017 level by tion in 2040 and by an adjustment factor derived 2040 and in Chesterfield County the correspond- from Woods and Poole’s Wealth Index to account ing figure is 62 percent. Fewer counties and cit- for the rising and diminishing fortunes of regional ies are projected to lose population between 2017 economies.17 This sub-population is more tightly and 2040 (20), but another 37 counties and cities 17 The Woods and Poole Wealth Index is an average of regional income per capita (80% of the index), the regional proportion of income from are projected to grow by fewer than 1,000 people dividends/interest/rent (10% of the index), and proportion of income from over this period. This demographic stagnation transfers (10% of the index) all relative to their respective national aver- age levels. The reciprocal of the last term is used so that that income 16 The Cooper Center expects the state’s population to be 47.35 percent transfers are weighted negatively. The second term is a good indicator of non-Hispanic White in 2040, compared to our estimate of 44.0 percent. assets. The imputed rent of owner-occupied homes is included as rental The difference is primarily due to our classification of all people identified income in calculating total personal income. 2018 Complete Economic as having two or more races as “other.” and Demographic Data Source (CEDDS) Technical Documentation, Market Needs and the Economic Impact of LeadingAge Virginia Members — 29 Figure 9: Total and Senior Population by County, 2040 Total Population 2040

One dot = 2,000 people Senior (aged 65+) Population 2040

One dot = 15,000 people

Source: Demographics Research Group of the Weldon Cooper Center for Public Service for 2040

30 — Market Needs and the Economic Impact of LeadingAge Virginia Members Figure 10: Projected Senior Households with Incomes of $150k or more annually, 2040

One dot = 600 households Source: Analysis of Combined Data Sources concentrated in the metropolitan markets, where distance was 95 miles, suggesting that, building CCRCs already congregate, than the senior popu- on a solid local base, a minority of residents relo- lation as a whole is. cated from quite a distance. The motivation for the local moves seems obvious but the long-dis- Given that information, we hazarded a tentative tance moves less so. It could be that aging parents projection of CCRC residents in 2040 by county re-locate nearer to a child. But it is also possible based on the sex-specific capture rates found in that some of the CCRCs may draw upon specific our North Carolina study.18 The age and sex-spe- populations, such as ministers from their church cific capture rates appear to be approximately 76 of affiliation or offer particular attractions. We percent of those in North Carolina.19 The number expect that similar patterns hold among Virginia of residents is projected to grow from an estimat- CCRCs. ed 13,493 in 2017 to an estimated 14,541 in 2020, 20,216 in 2030, and 24,840 in 2040. The pro- Given that the cost of CCRC living is closely tied to jected distribution of potential CCRC residents in the price of local residential real estate, such close 2040 appears in Figure 11. geographic proximity may need to loosen in the future as the expanding cities of especially North- Local population is important in projecting mar- ern Virginia build outward. It may be that in the ket demands. An analysis of the previous ad- future, prospective residents will choose CCRCs dresses (zip codes) of the residents of five North in locations near the metropolitan periphery or Carolina CCRCs indicates that the home market make jumps to the smaller cities within the orbits is critical to CCRCs. Overall, over half of the resi- of larger metropolitan areas. dents’ previous addresses were within ten miles of the CCRC chosen. Three-fourths of the residents 5.2 Factors Influencing the Senior Population came from within 60 miles. However, the average Projections

Woods & Poole Economics, Inc., p. 39. 18 Stephen J. Appold, James H. Johnson, and Allan Parnell (2015) Many events and factors could cause deviations Market Needs and Economic Impact of Continuing Care Retirement Com- from these baseline projections. Among these are munities in North Carolina, Report, 22 June. 19 Our survey of CCRC’s in North Carolina included items about the age, trends in migration which could affect the size of sex, and household structure of CCRC residents. The Virginia survey did the senior population. Health status trends could not. Market Needs and the Economic Impact of LeadingAge Virginia Members — 31 Figure 11: Projected Potential CCRC residents, 2040

One dot = 40 persons Source: Analysis of Combined Data Sources impact the demand for chronic illness medical ally attractive to retirement migrants, whether care. The availability of affordable housing may home place moves, moves to be near family or as affect whether some seniors age in their commu- retirement destinations. The population projec- nity or move to be near family. Trends in wealth tions assume that migration over the next twenty accumulation could raise or lower demand for years will follow the 2000-2010 patterns. Even if CCRC services among the population in Virginia. short-term interruptions in migration trends are caused by significant economic downturns, there 5.2.1 Trends in Retirement Migration is considerable evidence that migration streams continue for decades albeit with some life-cycle The size of the senior population in a community related wrinkles. results from a combination of aging in place—ag- ing in your home—and migration into and away The level and geographic distribution of Virginia from a community. Aging in place is preferred by migration was discussed above. The age pattern many, but many have to age in place due to eco- of migration is also important to assessing the nomic constraints. Common forms of retirement future size of the senior population. Figure 12 migration are home place migrations (returning depicts the number of net migrants by five-year to family and other connections), migration to be age group for Virginia during the previous six near family no longer living near the old home decades.20 A graph of age-specific migration rates place, seasonal migration (e.g. seasonal moves (not shown) is comparable. The curves for each between Florida and Virginia mountains), and decade are similar. People tend to move in their migration to retirement destinations, such as ei- late teens for work or college and in their early ther side of the Shenandoah Mountains and the 20s for work before settling down for their prime greater Virginia Beach area. Retirement desti- working years. Migration continues with mid-ca- nations often have natural or social amenities and reer movements and career changes throughout high-quality health care. people’s lives but at a comparatively lower level than in their 20s. Migration tends to rise again The current demographic situation in a commu- as careers approach their ends, reaching a minor nity is an important indicator of the extent and 20 Data are from: Winkler, Richelle, Kenneth M. Johnson, Cheng Cheng, characteristics of those aging in place as well as Jim Beaudoin, Paul R. Voss, and Katherine J. Curtis. Age-Specific Net an indicator of retirement migration into the Migration Estimates for US Counties, 1950-2010. Applied Population Laboratory, University of - Madison, 2013. Web. Accessed 24 community. Areas with strong growth are usu- July 2018, http://www.netmigration.wisc.edu/. 32 — Market Needs and the Economic Impact of LeadingAge Virginia Members Figure 12: Net Migrants to Virginia by Age, 1950-2010

Source: Winkler, Richelle, Kenneth M. Johnson, Cheng Cheng, Jim Beaudoin, Paul R. Voss, and Katherine J. Curtis. Age-Specific Net Migration Estimates for US Counties, 1950-2010. Applied Population Laboratory, University of Wisconsin- Madison, 2013. Web. Ac- cessed 24 July 2018, http://www.netmigration.wisc.edu/. peak in the late 60s. Either semi-retirement jobs the greatest number by out-migration between are sought to help ease the transition out of the 2000 and 2010. Arlington County, with one-sixth labor force or household members withdraw from the senior population of Fairfax, lost a higher pro- the labor force. As they age, seniors tend to re- portion of seniors to out-migration. High hous- main in place. By about age 70, rates of migra- ing costs are likely the main factor driving this tion have reached a life-cycle low. The life-stage pattern. Richmond, Alexandria, and several in- pattern of migration differs by place but tends to dependent cities in the Norfolk region also lost remain fairly stable over time for individual plac- seniors to out-migration. Suffolk and Lynchburg es. In Virginia’s case, the net migration rates were were the only two independent cities to gain over positive across all age groups but in the last two 1,000 seniors due to net in-migration. Seniors decades retirement migration has been markedly migrated to the outer suburban counties of the visible on a state-wide basis. three large metropolitan areas and to counties on either side of the Shenandoah Mountains.21 Table 7 details the evidence in the preceding para- graph by tabulating the net migration of seniors 5.2.2 Trends in Disability-Free Life Expectancy between 2000 and 2010 for selected jurisdictions. The jurisdictions showing the highest gains and 21 Hamilton Lombard (2013) “Retirement patterns: Anywhere but cities,” the greatest losses in seniors through migration St@tChat, From the Demographics Research Group of UVA (http://stat- are shown. Although Fairfax County is home to chatva.org/2013/11/25/retirement-patterns-anywhere-but-cities/), Novem- ber 25, remarks that university towns have not attracted large numbers of the largest number of seniors by far, it also lost senior in-migrants. Market Needs and the Economic Impact of LeadingAge Virginia Members — 33 Table 7: Net Migration of the Senior Population, 2000-2010, Selected Virginia Jurisdictions

Jurisdiction Total Population Senior Population Percent Senior Net Senior Senior Migration 2010 2010 2010 Migration Rate 2000-2010 2000-2010 Largest Gainers of Seniors Loudoun County 313,188 20,278 6.48% 5,460 26.93% James City County 66,911 13,761 20.57% 4,159 30.22% Henrico County 307,836 37,671 12.24% 3,938 10.45% Chesterfield County 316,810 32,628 10.30% 2,887 8.85% Prince William Co. 404,956 27,038 6.68% 2,854 10.56% Albemarle County 98,863 14,014 14.18% 2,413 17.22% Spotsylvania County 122,562 12,021 9.81% 2,120 17.64% Suffolk city 85,002 9,675 11.38% 1,716 17.74% Frederick County 78,197 9,867 12.62% 1,630 16.52% Hanover County 99,618 13,000 13.05% 1,588 12.22% Franklin County 55,994 9,796 17.50% 1,311 13.38% Shenandoah County 41,875 7,699 18.39% 1,188 15.43% Stafford County 129,313 9,391 7.26% 1,182 12.59% Culpeper County 46,803 5,655 12.08% 1,168 20.65% Rockingham County 76,117 11,861 15.58% 1,134 9.56% Lynchburg city 75,719 10,488 13.85% 1,103 10.52% Orange County 33,441 6,014 17.98% 1,085 18.04% Largest Losers of Seniors Portsmouth city 96,259 12,564 13.05% -1,225 -9.75% Hampton city 138,345 16,781 12.13% -1,256 -7.49% Newport News city 181,954 19,111 10.50% -1,562 -8.17% Norfolk city 244,724 22,691 9.27% -2,544 -11.21% Alexandria city 140,924 12,728 9.03% -2,759 -21.68% Richmond city 205,818 22,536 10.95% -2,775 -12.31% Arlington County 208,455 17,944 8.61% -5,866 -32.69% Fairfax County 1,085,138 105,623 9.73% -23,023 -21.80%

As life expectancy at older ages has increased, one time they live with either one or more Activities key issue is whether this increase in life expec- of Daily Living (ADL) limitations or one or more tancy is an increase in the time living with seri- Instrumental Activities of Daily Living (IADL) ous disability or an increase in healthy life. CCRC limitation. Those who reached age 70 with one or contracts are a form of care insurance for which more ADL or IADL also had an increase in aver- there is a market based on the willingness of both age disability-free life expectancy; many recover resident and organization. Should disability rates from the condition that resulted in their limita- shift or become more (or less ) predictable, that tion at age 70. could affect the willingness of either party to enter a contract and lead to another residential and care Americans 55 and older, interviewed for the most option being chosen. Recent analysis calculated recent wave of the Health and Retirement survey, that life expectancy without a disability for those were classified into one of four mutually exclusive who reach age 70 without a disability was on av- and exhaustive functioning states. Those report- erage 11.87 years, an increase of half a year from ing difficulty with (including an inability to do) ten years earlier.22 Those reaching age 70 with- at least one of six activities of daily living (ADL) out a disability showed no increase in the average – walking across a room, dressing, bathing, eat-

22 Crimmins, EJ, MD Hayward, A Hagedorn, Y Saito and N Brouard, ing, getting in and out of bed, and toileting—are 2009. “Change in Disability-Free Life Expectancy for Americans 70 Years classified as having an ADL limitation. Those Old and Older” Demography 46: 627–646. 34 — Market Needs and the Economic Impact of LeadingAge Virginia Members Figure 13: Health Status of Seniors in Five-year Bands

Source: Analysis of Health and Retirement Survey data without such limitations but reporting some dif- are in their late 60s, somewhat over one-third ficulty with (or inability to do) at least one of five could be considered healthy. A large proportion instrumental activities of daily living (IADL) – us- in each age band has one or more physical func- ing a telephone, managing money, taking medi- tional limitation. The proportion of those who are cations, shopping for groceries, and preparing unable to complete one or more of the activities of meals – were classified as having an IADL limita- daily living increases from approximately 12 per- tion. Those without ADL or IADL limitations but cent in the late 50s to over 40 percent in the late reporting some difficulty with at least 1 of 11 func- 80s. Figure 13 charts health status by age. tions – walking one block, walking several blocks, sitting for two hours, getting up from a chair after The aggregate average patterns over time are en- sitting for long periods, climbing several flights of couraging, but there are significant differences in stairs without resting, climbing one flight of stairs life expectancy and healthy life expectancy among without resting, stooping/kneeling/crouching, groups of Americans. “Socioeconomic status is lifting or carrying weights more than 10 pounds, related to virtually all health outcomes in most picking up a dime from a table, reaching arms countries. People with more education or income above shoulder level, and pushing or pulling large live longer and experience fewer adverse health objects – were classified as having a functional effects.”23 Years of education have a strong effect limitation. Adults reporting no functional difficul- on life expectancy and healthy life expectancy. ties of any kind were classified as healthy. In each For White men and women and African American case, short-term limitations were excluded from men and women, those with 13 or more years of the classification. education have significantly longer life expectan- cy at age 65 and healthy life expectancy at age 65 Of those in the 55-59 year-old age band, less than than those with less education. For U.S. males, half could be considered healthy. That proportion 23 Crimmins, EJ and Y Saito. 2001, “Trends in healthy life expectancy in decreased steadily with age. By the time people the United States 1970-1990: gender, racial and educational differences.” Social Science and Medicine 52: 1629-1641. Market Needs and the Economic Impact of LeadingAge Virginia Members — 35 there is a life expectancy gap of 6.9 years at age 25 of CCRCs in the future. (after the dangers of young adulthood but before aging begins taking its toll) between the most and Figure 15 traces changes in the median net worth the least educated. For U.S. females, the gap is by age of householder over time. The Great Reces- smaller, 3.8 years.24 A recent eight-country Euro- sion has had an obvious impact on all age groups. pean study reported similar findings with educa- Net worth in 2016, the latest SCF survey, seems to tion having a greater positive effect on healthy life have stabilized after a rocky decade. However, net expectancy than income.25 The proportion that worth was lower for all age groups except those was classified as healthy in the Health and Retire- over 75 than it was in the middle of last decade. ment Survey are graphed by education in Figure Those who were aged 65-74 in 2016, and thus at 14. At age 65, approximately half of all university prime age for entering CCRCs in about a decade, graduates could be classified as healthy while only have likely reached their peak wealth – which is 30 percent of high school graduates and 20 per- significantly lower than it was for the equivalent cent of those with less than a high school diploma group a decade ago – and their wealth is likely less were. Even at age 85 and above, university gradu- than it was a decade ago. Although the future tra- ates were significantly more likely to be healthy. jectory is unknown, the oldest group has approxi- mately the same net worth today as those entering The data are not available for the complex mul- CCRCs today had a decade ago when they were in ti-state modeling that would be necessary to es- the same age group. Even if they maintain parity timate disability-free or healthy life expectancy with earlier cohorts, they have likely lost wealth for the LeadingAge Virginia potential residents. as a cohort, however, and the impact that loss However, the strength and consistency of re- will have on their behavior is unknown. The age search results strongly indicate that CCRC popu- groups still younger have lost more wealth. lations should on average have longer life expec- tancy and disability-free life expectancy because Similarly, even the age group which suffered the of their higher socioeconomic status. However, most dramatic loss in median net worth over the as CCRCs seek to extend their circles of care, the past decade, the 55-64 year-olds who will be en- geographic variation discussed above and the ed- tering CCRCs in approximately 20 years, have ucation-linked variations in health status will be approximately the same net worth as their coun- important considerations. Moreover, as indicat- terparts 20 years ago. Those who are aged 45-54 ed above, we have not traced the over-time trends and 35-44 are, in general, doing worse than their in health status among those with higher incomes counterparts did in earlier times at equivalent or educations. stages of life. These figures suggest that there will be a period of ambiguity as the economic recov- 5.2.3 Trends in Median Wealth ery continues to take shape. They do not suggest large wealth-based changes in behavior for poten- Over the course of the Great Recession, many tial CCRC residents over the next several years. families lost significant wealth, eroding a signif- Longer term, however, the wealth accumulation icant portion of their retirement savings. Some picture appears cloudy. types of wealth have since recovered; others con- tinue to lag. In particular, some portions of the Figure 16 tracks changes in median net worth by housing market and the stock market have been selected cohorts between 1989 and 2016. Those performing well recently. Trends in net wealth by who were 81 years of age or older in 2016 (born in age over time help predict the level of wealth tra- 1933 or earlier) have, as a cohort, rebounded from jectories of those who will be potential residents their losses in the Great Recession. The six-year age bands were chosen to correspond to the three 24 National Center for Health Statistics (2012) Health, United States, 2011: With Special Feature on Socioeconomic Status and Health, Hyatts- year intervals of the Survey of Consumer Finance. ville (MD): National Center for Health Statistics, Report No.: 2012-1232, Those who were 75-80 years old (born 1934-1941) May. 25 Maki, N. et al. 2013. “Educational differences in disability-free life ex- and 69-74 (born 1942-1947) lost less in the Reces- pectancy: a comparative study of long-standing activity limitation in eight sion but have less wealth than those who are old- European countries.” Social Science and Medicine 94. 36 — Market Needs and the Economic Impact of LeadingAge Virginia Members Figure 14: Percent of Five-year Age Band Healthy by Education

Source: Analysis of Health and Retirement Survey data

Figure 15: Median Household Net Worth by Age of Householder, 1989-2016

Source: Survey of Consumer Finance

Market Needs and the Economic Impact of LeadingAge Virginia Members — 37 Figure 16: Trends in Median Cohort Net Worth, 1989-2016

Source: Survey of Consumer Finance er. Because wealth accumulation tends to peak Economic impact is an important consideration before those ages, they will likely not make up the in strategic decision-making and policy decisions. difference. Those who were younger were less We measured the economic impact of LeadingAge well-off in 2016 than they were a decade earlier. Virginia members on state and local economies in two ways. First, we estimated the impact of on- Those trends would seem to suggest a shift in the going member expenditures – that is, excluding CCRC market. However, an analysis of the dis- large capital projects – on the state economy as a tribution of wealth among seniors over time pro- whole and on the local economies of the counties vides a basis for nuance. Figure 17 tracks selected in which they are located. Second, we estimated percentiles of senior wealth from 1989 through the impact of the consumer expenditures of CCRC 2016. Although the last several years have been residents only on the state economy as a whole. rocky with respect to wealth accumulation, they LeadingAge Virginia members serve a wide ar- have been generally kind at the upper end. The ray of Virginians across all income categories in net worth of those in the 75th percentile has been myriad ways but we do have some information relatively stable over time. Those in the 90th and pertaining to CCRC resident average incomes al- 95th percentile have done well. Given that CCRCs lowing us to estimate the economic impact of the often cater to those who are located towards the spending of this subset of LeadingAge Virginia’s upper end of the wealth distribution, the financial clientele. Because a substantial portion of resi- aspects of the CCRC market will likely be secure. dent consumer expenditures is devoted to the The figure also reinforces the point that the large housing, meals, and other services provided by majority of seniors have significantly lower re- CCRCs, these impacts overlap to a large degree. sources to pay for their eventual care needs. For for-profit firms, revenues are a good measure 6.0 The Economic Impact of of direct economic impact. In that case, revenues LeadingAge Virginia Members indicate the value consumers place on the goods and services offered. However, LeadingAge mem-

38 — Market Needs and the Economic Impact of LeadingAge Virginia Members Figure 17: Trends in the Distribution of Wealth among Seniors

Source: Survey of Consumer Finance bers are not-for-profit organizations, often with a and county levels.26 strong component of benevolent care. This im- The inputs into the analysis were estimated from plies that the value of their services may be great- a number of sources. Several LeadingAge Vir- er than their revenues, in part, because reason- ginia members provided cash flow statements to able profits are often foregone. In this analysis, support this analysis. The LeadingAge Virginia we used a mixture of revenues and expenditures membership data includes program revenue data to measure direct economic impact, recognizing for a significant proportion of the member organi- that the true value to LeadingAge clientele may be zations. Members operating as CCRCs, file finan- understated. cial and occupancy data with the Virginia State Corporation Commission. These are reasonably Such measures are also incomplete. Member complete. Operators of Nursing Homes are re- and resident expenditures circulate through local quired to report to the federal Centers for Medi- economies, generating further business revenue care and Medicaid Services (CMS). Information and consequently employment and tax payments. on those organizations is also available from state Member employees, and those of their suppliers, sources. In addition, data were available in some also make purchases, resulting in further eco- cases from InfoGroup (InfoUSA) and from the nomic impacts. Not all of this follow-on spending Internal Revenue Service’s database on not-for- is local but much of it is. For our analysis, we uti- profit organizations (accessed through the Urban lized an input-output model known as IMPLAN. Institute’s National Center for Charitable Statis- This model is based on inter-industry purchasing tics). In many cases, the data available across patterns, consumption patterns, and local pro- 26 The IMPLAN model is broadly used in economic impact analyses. It duction, retail, and service availability. IMPLAN uses data provided by the U.S. Bureau of Economic Analysis, the Bureau of Labor Statistics, and various state and federal agencies. The model traces consumer spending through over 500 sec- generates, among other results, the number of jobs, labor income, and tors of Virginia’s economy to estimate a variety of taxes created by a specified input. It also generates economic output, roughly equated to business revenue, resulting from a group’s direct, in- economic impacts at the state, metropolitan area, direct, and induced economic impacts. In the Implan model, CCRCs and Nursing Care are treated as being in NAICS code 623. Adult Day Care and other providers are treated as being in NAICS code 624. Market Needs and the Economic Impact of LeadingAge Virginia Members — 39 Table 8: State-wide Economic Impacts of LeadingAge Virginia Members, 2017

LeadingAge Virginia Members state-wide Total Residents (Clients) 17,979 Estimated Total Employees 17,903 Estimated Total Salary Payments 595,190,250 Estimated Non-salary Payments 498,477,418 Estimated Total Ongoing Expenditures 1,093,667,668 Economic Impacts Direct Effect $1,173,939,505 Indirect Effect $321,220,394 Induced Effect $390,606,712 Total Effect $1,885,766,611 Employment 21,975 Labor Income $859,190,054 State and County Tax Impacts Employee Compensation $8,808 Indirect Business Tax $24,736,483 Households $18,789,509 Corporations $497,039 Total State and County Tax $44,031,839 Federal Tax Impacts Employee Compensation $96,745,700 Proprietor Income $2,014,876 Indirect Business Tax $4,575,845 Households $56,027,653 Corporations $6,182,028 Total Federal Tax $165,546,102 sources is consistent. In some cases, a judgment information on CCRC entry fees and monthly ex- was made with respect to the best source to use. penses and from prior research. Because the Im- Because data were sometimes incomplete, miss- plan software does not have data on age-specific ing information was imputed from existing data consumption patterns, the household expendi- and sector-wide patterns. Data were converted ture patterns of those with $75,000-$100,000 into average expenditure per resident and aver- income were used as proxies for resident expen- ages based on revenue. This procedure abstracts ditures. Again, this procedure abstracts from the from individual institution’s differences in ser- differences in the populations served by CCRCs. vice offerings, variations in cost, and the impacts of scale but preserves a degree of confidential- Our estimates of the state-wide economic impacts ity. Only on-going expenditures are included in of LeadingAge Virginia member expenditures are the analysis because major capital projects are summarized in Table 8. The top panel of the ta- episodic and including them in the analysis might ble provides information on the basic economic yield a biased estimate of normal impacts. Data parameters of the association’s members. This quality is likely the highest for CCRCs and non- information is discussed in more detail elsewhere CCRC Nursing Homes but possibly less so for in this report. The second panel summarizes the other housing providers and adult day provider top-level economic impacts. The direct impact members. is equivalent to the total member expenditures. Those expenditures generate indirect impacts As noted above, we have no direct measure of the as other businesses act as suppliers, employing incomes of CCRC residents. We imputed their workers to do so, and induced impacts as the em- income and consumer spending from available ployees make consumer purchases on the basis of

40 — Market Needs and the Economic Impact of LeadingAge Virginia Members their earned labor income. A summary of the results of an initial analysis of Given the high service content, member expendi- the economic impact of CCRC resident estimated tures have relatively large local impacts. The es- buying power in 2016 is contained in Table 10. As timated $1.2 billion in member expenditures gen- noted, much of this impact is conveyed through erated an estimated total economic impact of $1.9 resident payments to the CCRCs themselves. billion in 2016. An estimated total of 22,000 jobs However, CCRC residents make other purchases, were created across all skill levels, including the some of which are within the state but others, such 17,903 generated directly by the members them- as for travel, have little impact on the state’s econ- selves. This resulted in an estimated total of $859 omy, even if they are purchased at home. The es- million in labor income. This economic activity timated $969 million in CCRC resident consumer also generated an estimated total of $44 million expenditures generated an estimated total eco- in state and local tax revenues (members are as- nomic impact of just over $1 billion in 2016. An sumed to not be subject to taxation) and $166 estimated total of 7,000 jobs were created across million in Federal tax payments. all skill levels. This resulted in an estimated total of $322 million in labor income. This economic Appendix Table 6 summarizes the economic char- activity also generated an estimated total of $56 acteristics of LeadingAge Virginia members, in- million in state and local tax revenues and $82 cluding the input data for the individual institu- million in Federal tax payments. Because these tions. Appendix Table 7 summarizes the results estimates were generated by data and model co- of the analyses of the economic impacts of the in- efficients not specific to the CCRC age bracket, dividual members on their home counties. these estimates need to be interpreted with cau- tion. Refining estimates of CCRC resident spend- Focusing on LeadingAge Virginia CCRCs, Table 9 ing and their impacts is an important task for fu- isolates their economic impact in 2016 and pro- ture research. jects that impact forward to 2040. The estimated $828 million in member expenditures generated These results generate a useful description of the an estimated total economic impact of $1.4 billion magnitude of the economic impact of LeadingAge in 2016. An estimated total of 16,018 jobs were Virginia members. Although LeadingAge Vir- created across all skill levels, including the 12,031 ginia members support clients with a wide range generated directly by the members themselves. of incomes, CCRC residents can be generalized to This resulted in an estimated total of $640 mil- the consumer spending impact of a largely high- lion in labor income. This economic activity also income senior population. Whether CCRC resi- generated an estimated total of $33 million in dents or not, the individuals in the relevant age state and local tax revenues (members are again group and income class would likely be spending assumed to not be subject to taxation) and $124 approximately the same amounts on housing, million in Federal tax payments. In 2040, the eating, medical care and the like. Some of that growth of CCRCs to keep up with senior popula- spending would otherwise accrue to independent tion growth, the projected $1.5 billion in member living communities. Some would otherwise go to expenditures will generate a projected total eco- assisted living and nursing homes. Some CCRC nomic impact of $2.6 billion. An estimated to- residents would likely live in their own homes and tal of 29,000 jobs will be created across all skill purchase health and home services much as other levels, including the 22,149 generated directly seniors. Measuring the efficiencies of residential by the members themselves. This will result in and health service provision in the CCRC context a projected total of $1.2 billion in labor income. over alternatives would be a critical task for fu- Assuming constant tax rates, this economic activ- ture investigation that LedingAge Virginia might ity will generate a projected total of $61 million in consider. state and local tax revenues and $229 million in Federal tax payments. (All financial figures are in 7.0 Benevolent Care and Charitable constant 2016 dollars.)

Market Needs and the Economic Impact of LeadingAge Virginia Members — 41 Table 9: State-wide Economic Impacts of LeadingAge CCRCs, 2017 and 2040

2016 2040 Total Residents (Clients) 13,493 24,840 Estimated Total Employees 12,031 22,149 Estimated Total Salary Payments $433,655,465 $798,366,636 Estimated Non-salary Payments $394,100,535 $725,545,377 Estimated Total Ongoing Expenditures $827,756,000 $1,523,912,013 Economic Impacts Direct Effect $866,079,535 $1,594,466,254 Indirect Effect $239,624,479 $441,152,492 Induced Effect $295,217,238 $543,499,649 Total Effect $1,400,921,254 $2,579,118,399 Employment 16,018 29,489 Labor Income $639,999,726 $1,178,249,715 State and County Tax Impacts Employee Compensation $6,561 $12,079 Indirect Business Tax $18,700,258 $34,427,473 Households $14,290,024 $26,308,162 Corporations $373,484 $687,591 Total State and County Tax $33,370,327 $61,435,305 Federal Tax Impacts Employee Compensation $71,739,700 $132,073,933 Proprietor Income $1,510,190 $2,780,284 Indirect Business Tax $3,427,372 $6,309,846 Households $42,799,902 $78,795,303 Corporations $4,647,204 $8,555,577 Total Federal Tax $124,124,368 $228,514,943

Table 10: State-wide impacts of CCRC Resident Consumption, 2017

All CCRC residents state-wide Total Residents 13,847 Estimated Total Consumer Spending 969,258,500 Economic Impacts Total Effect $1,008,297,866 Employment 6,878 Labor Income $321,637,537 State and County Tax Impacts Employee Compensation $3,125 Indirect Business Tax $46,855,842 Households $8,382,450 Corporations $1,226,496 Total State and County Tax $56,467,913 Federal Tax Impacts Employee Compensation $33,673,157 Proprietor Income $1,459,764 Indirect Business Tax $6,619,403 Households $25,296,895 Corporations $15,132,869 Total Federal Tax $82,182,088

42 — Market Needs and the Economic Impact of LeadingAge Virginia Members Table 11: Number, Distribution, and Salaries of Employees of Continuing Care Retirement Communities and Assisted Living for the Elderly, Nation-wide May 2017

Occupation title Employment Percent of Total Median Mean Annual Mean Employment Hourly Wage Hourly Wage Wage Management Occupations 29,610 3.24 35.87 40.05 83,310 Business and Financial Operations Occupations 8,310 0.91 25.91 27.09 56,340 Computer and Mathematical Occupations 520 0.06 26.38 27.74 57,710 Community and Social Service Occupations 7,900 0.86 20.18 21.14 43,970 Education, Training, and Library Occupations 160 0.02 13.36 15.52 32,270 Arts, Design, Entertainment, Sports, and Media Occ’s 740 0.08 24.82 25.86 53,780 Healthcare Practitioners and Technical Occupations 98,180 10.76 24.27 25.39 52,810 Healthcare Support Occupations 259,090 28.38 12.10 12.68 26,380 Protective Service Occupations 5,370 0.59 13.37 14.08 29,290 Food Preparation and Serving Related Occupations 162,440 17.79 11.14 12.02 25,000 Building and Grounds Cleaning and Maintenance Occ’s 56,360 6.17 11.36 12.13 25,220 Personal Care and Service Occupations 195,400 21.40 11.51 12.26 25,510 Sales and Related Occupations 4,690 0.51 23.53 23.98 49,870 Office and Administrative Support Occupations 47,990 5.26 14.67 16.10 33,480 Farming, Fishing, and Forestry Occupations 70 0.01 9.16 11.12 23,130 Construction and Extraction Occupations 610 0.07 19.98 20.54 42,720 Installation, Maintenance, and Repair Occupations 21,310 2.33 17.24 18.30 38,060 Production Occupations 5,110 0.56 11.30 11.95 24,850 Transportation and Material Moving Occupations 9,000 0.99 12.98 13.51 28,090 Industry Total 912,880 100.00 12.36 15.25 31,720

Source: Bureau of Labor Statistics, Occupational Employment Statistics, http://www.bls.gov/oes/current/naics4_623300.htm

Giving Among LeadingAge Virginia Members LeadingAge Virginia members are a diverse set of organizations with varied financial resources. LeadingAge members are focused on the social Member organizations employ a range of be­ accountability of their organizations, with an em­ nevolent care and charitable giving strategies. phasis on strengthening the greater communities Benevolent care and charitable giving are integral in which they operate. Social Accountability is components of members’ missions. Currently defined as a measure of an organization’s com- there is no standard way that members compile mitment to its mission, its stakeholders and the benevolent care and charitable giving or monetize greater community; and demonstrates fulfillment other con­tributions, so LeadingAge Virginia has of the requirements and expectations of tax-ex- convened a task force to develop standardized so- empt organizations. cial accountability measures.

Member organizations provide benevolent care, 8.0 Assessments of Labor Supply Needs financial contributions to other not-for-profit or- ganizations and also make many important in- The goal of this section is to summarize present kind contributions ranging from free or low-cost and assess future labor force requirements, in- meeting space to commu­nity groups to providing cluding the size and mix of pay/skill and experi- leadership to community not-for-profit organiza- ence needed to staff Virginia’s CCRCs as the resi- tions. In addition, LeadingAge­ members are ex- dent population grows. CCRCs have the largest panding to serving middle and low-income sen- number of employees among LeadingAge Virginia iors through a more diverse set of housing, home members, so we focus on them. Lacking informa- and community based ser­vices and through adult tion about the number of employees by category day care. for LeadingAge members, we rely on data from

Market Needs and the Economic Impact of LeadingAge Virginia Members — 43 Table 12: Average Salaries for Selected LeadingAge Virginia Member Employees, 2016

Responses 25th Pctl Median Mean 75th Pctl Administrative 22 37,414 46,719 54,158 57,949 Site management 21 40,800 51,622 64,643 88,312 Maintenance 21 38,750 44,329 44,339 47,940 Directors of Nursing 22 82,264 95,803 94,732 102,835 Registered Nurse 25 55,370 62,234 63,167 70,212 Licensed Practical Nurse 21 44,001 49,153 50,360 55,182 Certified Nursing Assistant 25 25,696 28,315 28,257 30,838 Program Director & Program Staff 1 30,657 30,657 30,657 30,657 Social Workers 1 41,683 41,683 41,683 41,683 Medical Technicians 10 28,560 29,900 31,358 35,693 Medicare Records Assistant 13 34,762 36,504 39,873 44,429 the Bureau of Labor Statistics which represent clerks to the HR department to those in charge of national staffing averages for establishments in ensuring adequate food and other supplies), those the “Continuing Care Retirement Communities involved in site management (those who are di- and Assisted Living Facilities for the Elderly” sec- rectly involved with the daily non-care functions), tor (NAICS 623300) in making estimates. maintenance workers (those who maintain the physical infrastructure), the Directors of Nurs- We begin with an examination of the current em- ing, registered nurses, licensed practical nurses, ployee structures at Virginia’s CCRCs. With infor- certified nursing assistants, the program staff, mation from the member CCRCs, we categorized social workers, medical technicians, and medi- current employees by primary job category, cer- cal records assistants. Although the matches are tification and educational requirements, and the inexact, the Virginia and national data appear to skills and experience levels needed for each job be roughly comparable. We do not have sufficient category. What follows are baseline projections. data to compare salary costs in Northern Virginia with lower cost portions of the state. Data from the Bureau of Labor Statistics provides a nation-wide basis for estimating the numbers Virginia State Corporation Commission informa- of CCRC employees and their salaries. Table 11 tion indicates that, as of 2016, 13,493 people re- summarizes the number and salaries of CCRC sided in Virginia CCRCs. Based on an estimated employees by major occupational title in 2017. A 1.1215 residents per staff member (calculated from task for future research, using a broader database, available data), there were an estimated 12,031 might be to rigorously assess the degree to which staff members working in Virginia CCRCs for a Virginia CCRCs differ from the national pattern total payment of $433,655,465. Table 13 summa- and vary among themselves. Those CCRCs with a rizes the estimated number of CCRC employees relatively low proportion of residents who require as of 2016. assistance would likely employ fewer medical care employees. The table was constructed from the estimated state total number of CCRC employees and na- The limited human resource data available from tional data by occupational title. Some 138 spe- our survey provides one basis for comparing cific job titles at Virginia CCRCs were categorized LeadingAge Virginia members to the national av- into four skill levels and seven functions. The erage. Table 12 summarizes the available infor- classification of employees was somewhat arbi- mation on salaries for selected positions among trary, particularly with respect to level. Line per- member communities. Information is presented sonnel, in particular, includes unskilled workers for administrative personnel (those who are in- along with those who have accumulated a fair volved in office functions supporting the opera- level of skill and possibly certification. Certified tion of the organization: everyone from billing nursing assistants and licensed practical nurses 44 — Market Needs and the Economic Impact of LeadingAge Virginia Members Table 13: Estimated number of Virginia CCRC employees, 1 January 2016

Function Total Manager Professional Supervisor Line personnel Total 12,031 388 763 364 10,516 Office functions 1,026 210 121 53 642 Spiritual support 12 . 12 . . Social support 2,693 23 92 106 2,472 Medical care 4,821 122 522 . 4,177 Transportation 119 . . 2 116 Physical plant maintenance 1,169 1 . 71 1,097 Food preparation 2,191 32 15 132 2,012

Table 14: Estimated Total salaries and benefits of Virginia CCRC employees, 1 January 2016

Function Total Manager Professional Supervisor Line personnel Total 433,655,465 36,736,808 51,665,484 18,357,243 326,895,931 Office functions 56,279,471 21,084,074 7,709,426 3,121,963 24,364,008 Spiritual support 663,875 . 663,875 . . Social support 80,742,309 1,730,469 4,482,356 4,952,548 69,576,935 Medical care 190,402,995 11,632,641 37,930,763 . 140,839,591 Transportation 3,774,417 . . 115,982 3,658,435 Physical plant maintenance 37,935,747 65,349 . 3,838,186 34,032,212 Food preparation 63,856,651 2,224,275 879,063 6,328,565 54,424,749 were coded as line personnel as were cooks and total personnel costs in Virginia as of 2016. As in dining room aides, with mainly the function clas- the preceding table, the information is categorized sification to differentiate among them. by function and level. With some adjustment for the positions requiring more education and expe- Not surprisingly, the largest number of employ- rience, the distribution of labor costs follows the ees state-wide (10,518 or 87.4 percent) was clas- distribution of personnel discussed above. sified as line personnel and the largest functional These numbers need to be seen as tentative esti- domain was medical care, with 40.1 percent of mates. They are based on national aggregate data the personnel (4,821). At 34.7 percent of the total and a modest number of select CCRCs. Individual (4,177), line personnel in medical care were the CCRCs engage in unique sets of tasks. Some of- most numerous type of employee. After medical fer more assisted living or nursing care than oth- care, social support – which includes a range from ers. A few offer memory care – a category which counselors to event organizers to barbers – repre- is likely to grow rapidly over the next few years, sented the second-largest category of employee at while other members do not yet do so. The size 22.4 percent of the total (2,693). Food prepara- and nature of living quarters varies by member tion was responsible for another 18.2 percent of institution, affecting the magnitude of mainte- the personnel (2,191). Maintenance of the physi- nance and landscaping needs. None of these vari- cal plant accounted for 9.7 percent of the employ- ations have been taken into account in this aggre- ees (1,169). CCRCs tend to employ a number of gate summary. bus drivers (116), which accounts for the presence of transportation. CCRCs sometimes had chap- A baseline projection of aggregate personnel lains on the payroll. Office functions, including needs in 2040 is shown in Table 15. This projec- management, accounted for 8.5 percent of em- tion was formed by maintaining the present-day ployment (1,026). distribution of employees and calculating how many of each category would be needed given the Table 14 summarizes the information on CCRC projected CCRC population in 2040. This projec- Market Needs and the Economic Impact of LeadingAge Virginia Members — 45 Table 15: Estimated number of Virginia CCRC employees, 1 January 2040

Function Total Manager Professional Supervisor Line personnel Total 22,149 715 1,404 670 19,360 Office functions 1,889 387 223 97 1,181 Spiritual support 23 . 23 . . Social support 4,958 42 170 195 4,550 Medical care 8,876 225 960 . 7,691 Transportation 218 . . 4 214 Physical plant maintenance 2,152 2 . 131 2,019 Food preparation 4,033 59 28 243 3,704

Table 16: Estimated Total salaries and benefits of Virginia CCRC employees, 1 January 2040

Function Total Manager Professional Supervisor Line personnel Total 798,359,712 67,632,463 95,116,155 33,795,685 601,815,409 Office functions 103,610,507 38,815,781 14,193,053 5,747,533 44,854,139 Spiritual support 1,222,194 . 1,222,194 . . Social support 148,646,590 3,185,793 8,252,018 9,117,641 128,091,138 Medical care 350,531,914 21,415,691 69,830,535 . 259,285,687 Transportation 6,948,701 . . 213,522 6,735,179 Physical plant maintenance 69,839,711 120,307 . 7,066,101 62,653,303 Food preparation 117,560,095 4,094,891 1,618,354 11,650,887 100,195,963 tion assumes no change in technology or relative uum of residential and non-residential services to wages and no constraints on labor supply. approximately 18,500 seniors. In 2016, Leadin- gAge members of all types had a statewide eco- Table 16 provides projected estimates of salary nomic impact of $1.886 billion with $1.1 billion and benefit needs in 2040. The estimates are in in direct expenditures. Almost 18,000 Virginians 2016 dollars and do not account for inflation. Fu- are directly employed by LeadingAge members, ture work might assess how wages might evolve with 22,000 jobs in the state linked to Leadin- in conjunction with labor supply. A wider data- gAge members. CCRCs accounted for much of base and extending the analysis into the period in that. LeadingAge CCRC communities provided which the Baby Boomers enter CCRCs in appre- services to 13,000 residents with an economic im- ciable numbers while labor supply is somewhat pact of $1.4 billion based on $828 million in di- more restricted would yield interesting results. rect expenditures. They employed 12,000 direct- ly with a total of 16,000 jobs in the state linked to These are baseline estimates and projections. The CCRCs. Virginia’s senior population is projected reality will be very much affected by unfolding to grow to 1.9 million in 2040 as baby boomers trends in health status. Needs may also possibly age and Virginia continues to be a destination for be tempered by the willingness and ability to pay. retirees in other states. With this growing popu- Outlining key scenarios is a task for future work. lation of seniors, the economic impact of CCRCs in the state is estimated to grow to $2.6 billion 9.0 Summary and Conclusions and employment will grow to 22,000.

This report summarizes the demographic and Both the demographic and economic environ- economic environments that structure challeng- ments have been and will be heavily impacted by es and opportunities for LeadingAge Virginia’s migration patterns, including retirement migra- members now and into the future. LeadingAge tion. Any changes in the attractiveness of Virginia Virginia’s members provide homes and a contin- as a retirement destination can affect the level of

46 — Market Needs and the Economic Impact of LeadingAge Virginia Members Table 17: Vendor Categories in a CCRC/LPC Supply Chain Ambulance Service Fitness Refrigeration Bank Branch Finance/Accounting/Auditors Researchers Beautician/Salon Fireplace Repair Roofing Contractors for Renovations/Repairs Food Service Security Carpet Cleaning Furniture Repair/Restoration Staffing Agencies Carpet/Flooring Installation Glass Repair Storage Cleaning Service Gutter Services Therapy Services Communication Services HVAC Installation/Repair (Heating & Air) (Physical, Occupational, Speech, Recreational, Art, Music) Computer Service/Repair Home Organization/Move Manager Concrete & Foundation Repair Home Care/Home Health/Hospice Transportation (with assistance) Drilling Services Interior Design Well Services Durable Medical Equipment Lab Services Window Repair/Replacement Electrician Landscaping Window Treatments Energy Medical Services Window Washing Exterminator Moving Companies Fencing Painting- Interior/Exterior Pet Care Plant Watering Plumbing migration. Although with a lag due to the gap be- large unknowns remain. Understanding retire- tween prime earning years and CCRC residence ment preferences of minority older adults may years, CCRCs may be impacted by setbacks to be another important next step—as recently has wealth accumulation due to a harsher economic been done by LeadingAge North Carolina (see environment and by evolving patterns of inequal- Johnson, Parnell, and Johnson, 2018). ity. CCRCs may be affected by changing patterns of health status, although we suspect that the Income considerations, along with evolving present target population is to an extent shielded preferences in living arrangements, may lead to from some of the increase in specific chronic ill- somewhat different CCRCs than now exist. Mi- nesses which require extended care. gration data suggest a desire for residential stabil- ity which sets in at a somewhat younger age than This report has presented baseline projections of that of entry to CCRCs. That age gap may be tied market demand, human resource needs, and eco- to unmeasured sub-group preferences but it may nomic impact. Future work will need to explore be that CCRCs may consider more open arrange- variations in CCRCs and contingencies in the en- ments which also appeal to those a decade or more vironment. Scenarios to aid strategic planning, younger than their present residents in order to particularly with respect to potentially extending capture a larger portion of the senior population the circle of care to include CCRC residents and and of the oldest old. non-residents, those with high wealth and those with less, may be an important next step. Such arrangements may be adapted to serving the Baby Boom. This large cohort will require accom- CCRCs now serve those in the top portion of the modation but, by the time they need care, the du- income distribution. A challenge for Virginia ration of the care needs may be too short to justify CCRCs, in particular, may be to adapt to the needs the large capital costs entailed in developing the of those with somewhat less financial means than age-graded housing and single-purpose care sites. those now served. Even accounting for income, An alternative may be to build future CCRCs to

Market Needs and the Economic Impact of LeadingAge Virginia Members — 47 be recyclable – so that younger small households might also find the living situations attractive as the peak needs soften and possibly abate.

Now and continuing on through the foreseeable future, CCRCs are an important option in the set of senior residence and service options. They house a considerable number of seniors and are welcome additions to their communities, often drawing upon community opportunities through organized and informal outings. Residents of- ten contribute to the quality of community life. CCRCs are important employers in their com- munities generating employment for those across all skill levels and in many specialties. Moreo- ver, through their purchases and payrolls, CCRCs make significant contributions to local economies and to the tax base.

A propitious opportunity exists for LeadingAge Virginia CCRCs to increase their economic im- pact by adopting inclusive sourcing policies, pro- cedures, and practices. Further, as the clientele for the services offered by LeadingAge Virginia members grows more racially diverse in the com- ing decades, a strategy for inclusive sourcing will not only increase economic impact but will also advance opportunities to grow a more diverse cli- ent base especially in CCRCs.

LeadingAge Virginia members have a significant economic impact in their communities and across Virginia. This economic impact will grow as the baby boom cohort advances in age and demand for services grows. Services and organizational structures are likely to evolve with this growing demand, for example Community Based Continu- ing Care. In addition, as services evolve, Leadin- gAge Virginia members should develop process- es to document the broader economic impact in communities from charitable contributions.

48 — Market Needs and the Economic Impact of LeadingAge Virginia Members Market Needs and the Economic Impact of LeadingAge Virginia Members — 49 APPENDIX TABLES Appendix Table 1: Population estimates and projections for Virginia, Counties, and Independent Cities, 2017, 2020, 2030, and 2040

2017 2020 2030 2040 Jurisdiction Total Seniors Total Seniors Total Seniors Total Seniors Virginia 8,470,020 1,271,428 8,744,273 1,392,849 9,546,958 1,803,404 10,201,530 1,925,150 Accomack County LeadingAge Virginia 32,545 7,402 33,775 7,023 30,369 8,328 26,615 7,557 Albemarle County 107,702 19,153 110,669 22,084 126,988 28,267 141,221 28,924 Alleghany County LeadingAge Virginia 15,122 3,649 14,851 3,890 13,622 4,056 12,231 3,694 Amelia County 13,020 2,487 13,086 2,799 13,994 3,655 14,690 3,730 Amherst County LeadingAge Virginia 31,594 6,515 31,678 6,755 31,546 7,852 30,982 7,703 Appomattox County 15,681 3,198 15,875 3,414 16,923 4,271 17,716 4,444 Arlington County LeadingAge Virginia 234,965 24,214 261,692 23,171 289,809 28,912 313,352 32,588 Augusta County 75,144 15,357 75,779 17,203 81,385 21,238 85,754 21,672 Bath County 4,297 1,175 4,715 1,205 4,469 1,379 4,167 1,345 Bedford County LeadingAge Virginia 77,974 16,184 79,931 18,308 86,594 23,891 91,925 24,961 Bland County 6,350 1,437 6,548 1,538 6,378 1,613 6,124 1,652 Botetourt County LeadingAge Virginia 33,192 7,325 33,732 7,805 35,477 9,464 36,696 9,457 Brunswick County 16,244 3,393 16,456 3,464 15,356 3,804 14,066 3,356 Buchanan County 21,514 4,682 21,978 4,741 19,180 5,119 16,176 4,410 Buckingham County 17,065 3,231 16,815 3,409 17,602 4,159 18,129 4,210 Campbell County 55,010 10,611 57,287 11,262 60,257 13,443 62,335 13,657 Caroline County 30,461 4,876 30,910 5,528 35,773 7,024 40,043 7,541 Carroll County 29,708 7,065 28,560 7,425 28,386 8,121 27,825 8,137 Charles City County 7,004 1,644 7,386 1,824 7,602 2,369 7,710 2,342 Charlotte County 12,119 2,639 12,313 2,743 12,215 3,240 11,951 3,107 Chesterfield County LeadingAge Virginia 343,599 49,565 349,182 56,896 395,440 75,033 435,294 80,388 Clarke County 14,508 2,972 14,337 3,119 15,266 4,057 15,965 4,086 Craig County 5,062 1,139 5,184 1,205 5,215 1,484 5,173 1,460 Culpeper County LeadingAge Virginia 51,282 7,803 50,912 9,210 60,253 12,559 68,572 14,060 Cumberland County 9,811 2,143 9,914 2,205 10,488 2,549 10,906 2,499 Dickenson County 14,782 3,154 14,818 3,309 14,016 3,524 13,037 3,186 Dinwiddie County 28,208 4,835 29,396 5,152 31,985 6,359 34,080 6,283 Essex County LeadingAge Virginia 11,028 2,448 10,684 2,662 11,222 2,981 11,594 2,812 Fairfax County LeadingAge Virginia 1,148,433 150,075 1,172,027 156,077 1,269,509 193,089 1,347,487 201,558 Fauquier County 69,465 11,150 70,302 12,672 78,259 17,205 84,973 18,102 Floyd County 15,755 3,497 15,539 3,693 16,461 4,253 17,137 4,416 Fluvanna County 26,452 5,182 26,546 5,969 30,410 7,566 33,774 8,297 Franklin County 56,445 12,995 56,462 14,976 62,085 18,066 66,736 18,455 Frederick County 86,484 14,555 86,574 16,104 101,471 22,062 114,663 24,648 Giles County 16,837 3,642 17,051 3,886 17,278 4,328 17,262 4,410 Gloucester County LeadingAge Virginia 37,292 6,869 37,198 7,684 38,456 10,120 39,158 10,095 Goochland County 22,685 4,896 22,754 5,572 26,180 7,504 29,174 8,309 Grayson County 15,665 3,757 16,574 3,747 15,248 4,547 13,738 4,443 Greene County 19,612 3,251 21,197 3,950 24,092 5,818 26,596 6,653 Greensville County 11,679 1,736 11,399 2,158 11,481 2,540 11,404 2,425 Halifax County 34,563 8,167 35,276 8,630 33,978 9,507 32,239 8,873 Hanover County LeadingAge Virginia 105,923 18,271 107,716 20,402 118,679 28,298 127,780 30,795 Henrico County LeadingAge Virginia 327,898 49,189 333,100 54,847 369,454 71,054 399,966 76,297

50 — Market Needs and the Economic Impact of LeadingAge Virginia Members Appendix Table 1: Population estimates and projections for Virginia, Counties, and Independent Cities, 2017, 2020, 2030, and 2040 Continued

2017 2020 2030 2040 Jurisdiction Total Seniors Total Seniors Total Seniors Total Seniors Henry County 51,227 12,056 51,552 12,424 47,811 13,889 43,489 13,295 Highland County 2,212 723 2,234 712 2,047 819 1,835 688 Isle of Wight County 36,552 6,778 37,459 7,982 41,640 11,213 45,161 11,788 James City County 75,524 18,681 79,404 24,032 95,549 33,684 110,044 37,910 King and Queen County 7,003 1,567 7,405 1,559 7,725 1,970 7,931 1,939 King George County 26,337 3,363 25,510 3,979 30,494 5,613 34,955 6,505 King William County 16,708 2,635 16,516 2,881 18,457 3,639 20,105 3,876 Lancaster County LeadingAge Virginia 10,788 3,836 11,192 4,093 10,935 4,440 10,533 3,931 Lee County 23,758 4,868 24,775 5,262 25,657 5,627 26,167 5,775 Loudoun County LeadingAge Virginia 398,080 35,607 440,445 46,653 572,994 89,335 694,911 128,841 Louisa County 35,860 6,937 35,197 8,039 40,656 10,724 45,443 11,225 Lunenburg County 12,235 2,627 11,995 2,815 11,440 3,060 10,740 2,717 Madison County LeadingAge Virginia 13,277 2,885 12,889 3,192 13,182 3,740 13,288 3,518 Mathews County 8,779 2,704 8,509 2,625 8,138 2,739 7,663 2,545 Mecklenburg County 30,686 7,735 30,572 8,462 29,848 9,372 28,727 8,659 Middlesex County 10,679 3,318 11,174 3,567 11,857 4,156 12,363 4,007 Montgomery County LeadingAge Virginia 98,559 12,009 101,433 13,039 110,321 16,083 117,505 17,562 Nelson County 14,943 3,943 14,941 4,242 15,200 4,726 15,244 4,295 New Kent County 21,682 3,648 22,465 4,415 26,946 6,675 30,964 7,580 Northampton County 11,846 3,046 11,964 3,306 11,274 3,798 10,442 3,279 Northumberland County 12,275 4,418 12,099 4,087 11,989 4,367 11,716 3,815 Nottoway County 15,434 2,896 16,608 3,181 16,848 3,982 16,850 3,968 Orange County 36,073 7,305 34,442 8,660 39,587 10,565 44,080 11,125 Page County 23,731 4,983 23,387 5,299 23,583 6,113 23,450 6,179 Patrick County 17,665 4,576 18,380 4,893 17,618 5,728 16,630 5,907 Pittsylvania County 61,258 13,454 62,912 14,544 63,473 17,302 63,149 16,868 Powhatan County 28,601 5,073 28,752 6,216 32,567 8,646 35,854 9,880 Prince Edward County 22,703 3,689 23,827 4,505 26,250 5,557 28,262 5,886 Prince George County 37,809 5,174 38,379 6,123 40,816 9,046 42,640 10,929 Prince William County LeadingAge Virginia 463,023 43,886 483,750 54,197 588,058 84,832 682,111 106,675 Pulaski County LeadingAge Virginia 34,184 7,648 34,748 7,967 34,317 8,769 33,422 8,976 Rappahannock County LeadingAge Virginia 7,321 1,938 7,236 2,027 7,401 2,267 7,460 2,071 Richmond County 8,939 1,907 8,982 2,017 9,125 2,411 9,139 2,423 Roanoke County LeadingAge Virginia 93,730 19,552 94,883 21,434 99,516 24,756 102,683 24,515 Rockbridge County 22,659 5,728 21,993 6,565 22,737 7,850 23,152 7,938 Rockingham County LeadingAge Virginia 80,227 14,933 81,624 16,685 88,608 21,356 94,227 22,541 Russell County 27,048 5,632 27,177 5,958 25,465 6,706 23,437 6,300 Scott County 21,865 5,153 22,346 5,361 21,764 5,780 20,894 5,722 Shenandoah County 43,225 9,169 42,363 10,519 46,803 12,229 50,507 12,514 Smyth County 30,656 6,598 30,661 6,799 29,346 7,287 27,654 7,051 Southampton County 17,750 3,481 18,499 3,773 19,078 5,175 19,382 5,380 Spotsylvania County 133,033 18,218 135,026 21,702 159,641 31,198 181,549 36,023 Stafford County 146,649 14,782 150,881 17,833 181,428 28,363 208,845 33,571 Surry County 6,540 1,412 6,597 1,460 6,545 1,865 6,403 1,728 Sussex County 11,373 1,933 11,687 2,197 11,197 2,559 10,563 2,398 Tazewell County 41,095 8,894 43,062 9,813 42,400 10,407 41,167 9,589

Market Needs and the Economic Impact of LeadingAge Virginia Members — 51 Appendix Table 1: Population estimates and projections for Virginia, Counties, and Independent Cities, 2017, 2020, 2030, and 2040 Continued

2017 2020 2030 2040 Jurisdiction Total Seniors Total Seniors Total Seniors Total Seniors Warren County 39,563 6,141 39,925 6,786 44,444 9,079 48,256 9,697 Washington County 54,387 12,034 53,365 12,939 54,997 14,659 55,838 14,576 Westmoreland County 17,780 4,423 17,941 4,478 18,482 5,112 18,758 4,793 Wise County LeadingAge Virginia 38,586 6,757 38,554 7,468 38,166 7,753 37,260 7,287 Wythe County 28,882 6,095 28,253 6,852 28,813 7,716 28,965 8,011 York County 67,739 10,564 73,161 12,084 81,370 16,906 88,288 17,590 Alexandria city LeadingAge Virginia 160,035 17,715 179,332 17,850 198,796 24,244 215,119 29,261 Bristol city 16,790 3,507 17,405 3,675 17,454 3,827 17,262 3,590 Buena Vista city 6,327 1,206 6,959 1,240 7,220 1,295 7,377 1,229 Charlottesville city LeadingAge Virginia 48,019 5,394 52,839 4,841 54,563 6,720 55,501 7,277 Chesapeake city 240,397 30,830 253,355 34,394 277,475 49,999 297,274 53,268 Colonial Heights city 17,830 3,524 17,008 3,909 17,100 4,285 16,955 4,126 Covington city 5,531 1,200 6,409 1,146 6,294 1,368 6,096 1,433 Danville city 41,130 8,428 42,009 8,642 37,832 9,257 33,220 7,993 Emporia city 5,282 1,022 6,214 1,092 6,447 1,287 6,586 1,256 Fairfax city LeadingAge Virginia 24,097 3,512 23,732 3,873 24,689 4,635 25,286 4,666 Falls Church city LeadingAge Virginia 14,583 1,848 16,066 1,960 18,474 2,522 20,577 2,624 Franklin city LeadingAge Virginia 8,176 1,582 8,477 1,715 8,543 1,888 8,490 1,731 Fredericksburg city 28,360 3,087 29,596 3,034 34,481 3,853 38,790 4,282 Galax city 6,625 1,388 7,031 1,652 7,118 1,821 7,106 1,885 Hampton city LeadingAge Virginia 134,669 20,276 139,453 21,037 133,310 26,965 125,458 24,369 Harrisonburg city LeadingAge Virginia 54,215 4,988 58,687 5,077 67,154 6,385 74,521 6,922 Hopewell city 22,621 3,482 23,302 3,833 23,557 4,501 23,482 4,540 Lexington city LeadingAge Virginia 7,106 1,157 7,745 1,126 8,051 1,115 8,239 1,057 Lynchburg city LeadingAge Virginia 80,995 11,669 81,445 12,550 89,753 14,044 96,652 13,435 Manassas city LeadingAge Virginia 41,501 3,994 45,212 4,042 49,162 5,781 52,352 6,317 Manassas Park city 16,591 1,291 17,082 1,466 20,544 2,348 23,652 2,998 Martinsville city LeadingAge Virginia 13,142 2,524 13,143 2,690 11,766 2,993 10,255 2,655 Newport News city LeadingAge Virginia 179,388 22,672 185,620 23,661 186,514 29,980 184,820 29,128 Norfolk city LeadingAge Virginia 244,703 26,519 250,760 27,765 257,478 35,119 260,509 35,374 Norton city 3,936 733 3,928 690 3,928 747 3,875 708 Petersburg city LeadingAge Virginia 31,750 5,252 31,673 5,481 30,338 6,399 28,613 5,982 Poquoson city 12,053 2,321 12,528 2,531 12,966 3,063 13,216 3,005 Portsmouth city 94,572 13,831 97,920 14,641 94,794 17,751 90,427 16,941 Radford city 17,658 1,604 18,355 1,454 19,261 1,555 19,882 1,539 Richmond city LeadingAge Virginia 227,032 28,999 230,720 27,083 242,451 32,672 250,600 31,670 Roanoke city LeadingAge Virginia 99,837 16,103 101,951 16,703 104,398 19,650 105,357 19,489 Salem city LeadingAge Virginia 25,862 4,798 25,979 4,945 26,256 5,724 26,165 5,497 Staunton city LeadingAge Virginia 24,528 5,166 25,238 5,707 25,519 6,572 25,442 6,271 Suffolk city LeadingAge Virginia 90,237 12,586 95,879 15,079 112,920 21,589 128,053 25,105 Virginia Beach city LeadingAge Virginia 450,435 61,631 467,134 67,410 482,578 91,504 491,054 95,090 Waynesboro city LeadingAge Virginia 22,327 4,048 22,493 4,085 23,842 4,711 24,835 4,669 Williamsburg city LeadingAge Virginia 15,031 2,294 15,586 2,702 17,372 3,156 18,882 3,067 Winchester city LeadingAge Virginia 27,932 4,307 28,705 4,652 31,107 5,726 33,031 5,803

52 — Market Needs and the Economic Impact of LeadingAge Virginia Members Appendix Table 2: Projected Absolute Change by Age Groups 2020 to 2030, Virginia and Selected Counties and Independent Cities

Total 55 to 59 60 to 64 65 to 69 70 to 74 (65-74) 75 to 79 80 to 84 (75-84) 85+ Virginia 802,684 -75,813 -27,206 69,404 87,130 156,534 109,299 99,463 208,762 45,259 Albemarle County 16,319 -1,365 -933 -398 1,016 619 2,301 1,963 4,264 1,300 Arlington County 28,117 625 753 1,853 1,210 3,063 1,084 1,405 2,489 189 Augusta County 5,606 -940 -379 331 693 1,024 1,224 1,080 2,304 707 Bedford County 6,663 -956 -637 887 1,447 2,334 1,300 1,331 2,631 618 Chesterfield County 46,258 -1,706 -1,181 532 2,245 2,777 6,168 6,148 12,316 3,044 Fairfax County 97,482 -8,116 -3,122 4,632 4,906 9,538 9,221 11,750 20,972 6,503 Fauquier County 7,957 -1,425 -193 1,164 876 2,040 980 975 1,955 538 Frederick County 14,898 -808 267 937 1,167 2,103 1,470 1,440 2,910 945 Hanover County 10,963 -1,621 -346 1,641 1,675 3,317 1,874 1,727 3,601 977 Henrico County 36,353 -1,703 -885 1,463 3,297 4,760 5,705 4,626 10,331 1,116 James City County 16,145 -677 -209 918 1,339 2,257 2,825 2,443 5,269 2,126 Loudoun County 132,549 599 4,755 12,155 7,755 19,910 9,538 7,956 17,493 5,279 Montgomery County 8,887 123 22 292 503 794 947 891 1,838 411 Pittsylvania County 561 -991 -646 272 648 921 808 692 1,500 337 Prince William County 104,308 501 3,170 7,025 5,406 12,431 6,996 6,603 13,599 4,605 Roanoke County 4,633 -711 -529 -295 215 -80 1,467 1,555 3,022 380 Rockingham County 6,984 -786 -372 571 1,185 1,756 1,375 1,023 2,398 518 Spotsylvania County 24,616 -870 660 1,643 1,491 3,134 2,755 2,357 5,112 1,250 Stafford County 30,547 -1,819 672 2,813 2,205 5,018 2,367 2,071 4,438 1,074 Alexandria City 19,464 1,103 1,372 2,125 1,576 3,701 1,025 1,394 2,419 274 Charlottesville City 1,725 -372 -72 683 684 1,367 358 202 560 -48 Chesapeake City 24,120 -4,148 -1,823 4,226 4,883 9,109 3,293 2,213 5,505 991 Danville City -4,177 -810 -975 -216 422 207 334 275 609 -200 Fairfax City 957 -380 -46 175 146 321 120 266 385 55 Falls Church City 2,408 -96 -59 65 92 157 212 171 383 23 Fredericksburg City 4,885 16 5 250 159 409 229 196 424 -14 Hampton City -6,142 -3,979 -2,858 1,380 2,314 3,694 1,264 754 2,019 215 Harrisonburg City 8,467 -106 -102 242 327 569 357 339 696 42 Lynchburg City 8,308 -591 -630 -178 316 138 790 596 1,386 -30 Newport News City 894 -3,123 -1,902 1,494 2,381 3,875 1,254 1,056 2,310 134 Norfolk City 6,718 -1,962 -1,871 1,164 2,967 4,130 2,281 1,305 3,586 -363 Petersburg City -1,335 -790 -218 229 329 558 277 130 407 -46 Portsmouth City -3,126 -1,555 -1,226 495 1,301 1,795 1,012 462 1,474 -159 Richmond City 11,731 -2,179 -2,100 550 2,242 2,792 1,987 1,239 3,226 -429 Roanoke City 2,448 -784 -810 171 811 982 1,224 982 2,206 -240 Salem City 276 -276 -379 48 313 361 232 186 419 0 Staunton City 280 -348 -331 47 199 246 281 274 555 65 Suffolk City 17,041 -363 380 1,861 1,471 3,333 1,517 1,130 2,646 531 Virginia Beach City 15,444 -7,404 -2,977 4,907 6,845 11,751 5,389 4,936 10,325 2,018 Winchester City 2,402 -315 -150 188 228 416 379 263 642 16

Market Needs and the Economic Impact of LeadingAge Virginia Members — 53 Appendix Table 3: Projected Percentage Change by Age Groups 2020 to 2030, Virginia and Selected Counties and Independent Cities

Total 55 to 59 60 to 64 65 to 69 70 to 74 (65-74) 75 to 79 80 to 84 (75-84) 85+ Virginia 9.2% -12.9% -5.0% 15.1% 23.1% 18.7% 43.2% 64.6% 51.3% 30.3% Albemarle County 14.7% -21.7% -14.1% -5.9% 18.4% 5.0% 61.1% 73.7% 66.3% 38.7% Arlington County 10.7% 4.5% 6.8% 23.6% 18.8% 21.4% 25.6% 62.5% 38.3% 8.0% Augusta County 7.4% -16.0% -6.6% 6.0% 15.2% 10.2% 35.5% 54.6% 42.5% 40.6% Bedford County 8.3% -14.2% -9.3% 14.9% 28.2% 21.0% 37.8% 64.9% 47.9% 35.9% Chesterfield County 13.2% -7.7% -5.7% 2.7% 13.9% 7.8% 60.4% 108.6% 77.6% 55.5% Fairfax County 8.3% -10.4% -4.7% 9.0% 11.4% 10.1% 33.1% 70.8% 47.1% 38.0% Fauquier County 11.3% -23.8% -3.9% 27.6% 25.4% 26.6% 39.8% 71.8% 51.2% 45.6% Frederick County 17.2% -14.1% 4.8% 18.7% 26.1% 22.2% 49.2% 73.0% 58.7% 56.8% Hanover County 10.2% -18.4% -4.4% 24.5% 31.2% 27.5% 50.2% 77.3% 60.4% 41.3% Henrico County 10.9% -8.1% -4.5% 8.1% 23.0% 14.7% 60.4% 76.6% 66.7% 15.8% James City County 20.3% -12.6% -3.6% 12.9% 21.6% 16.9% 59.9% 84.2% 69.1% 68.6% Loudoun County 30.1% 2.2% 25.3% 76.3% 62.4% 70.2% 106.9% 163.6% 126.9% 116.9% Montgomery County 8.8% 2.5% 0.5% 7.0% 14.5% 10.4% 40.7% 56.4% 47.1% 27.2% Pittsylvania County 0.9% -18.7% -12.5% 5.6% 16.6% 10.5% 29.0% 42.0% 33.8% 24.8% Prince William County 21.6% 1.7% 13.8% 37.0% 34.7% 36.0% 72.3% 121.0% 89.8% 102.7% Roanoke County 4.9% -10.7% -7.9% -4.6% 3.6% -0.6% 37.1% 59.6% 46.0% 15.3% Rockingham County 8.6% -13.6% -6.5% 11.1% 27.6% 18.6% 45.3% 47.9% 46.4% 25.2% Spotsylvania County 18.2% -9.7% 8.6% 22.4% 24.0% 23.1% 72.2% 102.7% 83.7% 61.6% Stafford County 20.2% -17.8% 8.6% 44.3% 43.7% 44.0% 72.3% 119.6% 88.6% 75.3% Alexandria City 10.9% 9.9% 14.8% 34.3% 30.5% 32.6% 33.5% 83.7% 51.2% 15.4% Charlottesville City 3.3% -12.9% -2.7% 38.2% 52.7% 44.3% 44.5% 42.2% 43.6% -10.2% Chesapeake City 9.5% -21.9% -10.8% 34.5% 53.3% 42.6% 55.3% 61.0% 57.5% 29.1% Danville City -9.9% -28.4% -28.9% -8.2% 18.9% 4.3% 22.4% 26.6% 24.1% -15.8% Fairfax City 4.0% -23.3% -3.0% 16.0% 13.3% 14.6% 17.7% 55.4% 33.3% 10.5% Falls Church City 15.0% -9.0% -7.2% 9.2% 15.9% 12.2% 66.3% 93.2% 76.1% 13.1% Fredericksburg City 16.5% 1.1% 0.5% 25.2% 19.5% 22.6% 44.9% 59.2% 50.6% -3.5% Hampton City -4.4% -38.6% -28.6% 19.3% 42.6% 29.4% 33.5% 30.8% 32.4% 9.7% Harrisonburg City 14.4% -5.4% -5.9% 16.8% 26.2% 21.2% 40.6% 50.5% 44.9% 5.0% Lynchburg City 10.2% -15.4% -16.2% -4.8% 10.2% 2.0% 36.1% 38.1% 36.9% -1.5% Newport News City 0.5% -26.9% -17.2% 19.3% 37.7% 27.6% 30.3% 39.1% 33.8% 4.8% Norfolk City 2.7% -14.1% -13.8% 11.4% 40.9% 23.7% 51.4% 47.7% 50.0% -11.5% Petersburg City -4.2% -30.8% -9.5% 11.9% 24.2% 16.9% 29.0% 22.5% 26.5% -7.0% Portsmouth City -3.2% -23.0% -18.7% 9.8% 34.9% 20.5% 40.7% 29.3% 36.3% -8.7% Richmond City 5.1% -16.8% -16.4% 5.6% 31.0% 16.4% 47.6% 47.4% 47.5% -13.3% Roanoke City 2.4% -11.4% -12.3% 3.1% 18.0% 9.7% 45.1% 57.0% 49.7% -11.1% Salem City 1.1% -15.9% -20.0% 3.2% 24.7% 13.0% 24.6% 32.7% 27.7% -0.1% Staunton City 1.1% -20.7% -19.1% 2.9% 13.9% 8.0% 25.5% 35.3% 29.6% 8.4% Suffolk City 17.8% -5.1% 6.4% 35.6% 35.5% 35.5% 56.8% 72.3% 62.5% 36.1% Virginia Beach City 3.3% -23.6% -10.1% 22.1% 37.2% 28.9% 45.5% 67.2% 53.8% 26.6% Winchester City 8.4% -18.2% -9.7% 13.0% 19.2% 15.8% 46.3% 47.9% 46.9% 2.5%

54 — Market Needs and the Economic Impact of LeadingAge Virginia Members Appendix Table 4: Projected Absolute Change by Age Groups 2020 to 2040, Virginia and Selected Counties and Independent Cities

Total 55 to 59 60 to 64 65 to 69 70 to 74 (65-74) 75 to 79 80 to 84 (75-84) 85+ Total 55 to 59 60 to 64 65 to 69 70 to 74 (65-74) 75 to 79 80 to 84 (75-84) 85+ Virginia 9.2% -12.9% -5.0% 15.1% 23.1% 18.7% 43.2% 64.6% 51.3% 30.3% Virginia 1,457,257 -21,347 -55,635 7,372 68,739 76,111 164,141 157,941 322,082 134,108 Albemarle County 14.7% -21.7% -14.1% -5.9% 18.4% 5.0% 61.1% 73.7% 66.3% 38.7% Albemarle County 30,552 -698 -1,397 -1,711 126 -1,585 1,885 2,779 4,664 3,762 Arlington County 10.7% 4.5% 6.8% 23.6% 18.8% 21.4% 25.6% 62.5% 38.3% 8.0% Arlington County 51,661 5,452 2,079 2,429 1,777 4,205 2,270 2,063 4,333 878 Augusta County 7.4% -16.0% -6.6% 6.0% 15.2% 10.2% 35.5% 54.6% 42.5% 40.6% Augusta County 9,976 -427 -849 -532 377 -155 1,454 1,523 2,977 1,647 Bedford County 8.3% -14.2% -9.3% 14.9% 28.2% 21.0% 37.8% 64.9% 47.9% 35.9% Bedford County 11,995 -1,552 -1,652 -9 873 864 1,947 2,257 4,204 1,584 Chesterfield County 13.2% -7.7% -5.7% 2.7% 13.9% 7.8% 60.4% 108.6% 77.6% 55.5% Chesterfield County 86,112 1,371 -1,109 -746 1,292 546 6,440 7,702 14,142 8,804 Fairfax County 8.3% -10.4% -4.7% 9.0% 11.4% 10.1% 33.1% 70.8% 47.1% 38.0% Fairfax County 175,460 -38 -4,467 -508 2,903 2,395 12,135 14,780 26,915 16,172 Fauquier County 11.3% -23.8% -3.9% 27.6% 25.4% 26.6% 39.8% 71.8% 51.2% 45.6% Frederick County 14,672 -757 -926 -63 732 669 1,884 1,548 3,432 1,330 Frederick County 17.2% -14.1% 4.8% 18.7% 26.1% 22.2% 49.2% 73.0% 58.7% 56.8% Fauquier County 28,089 -91 -102 167 1,470 1,686 2,246 2,303 3,339 2,359 Hanover County 10.2% -18.4% -4.4% 24.5% 31.2% 27.5% 50.2% 77.3% 60.4% 41.3% Hanover County 20,064 -1,506 -1,953 203 1,404 1,607 3,174 2,928 6,102 2,683 Henrico County 10.9% -8.1% -4.5% 8.1% 23.0% 14.7% 60.4% 76.6% 66.7% 15.8% Henrico County 66,865 -261 -1,810 139 2,603 2,742 6,766 6,991 13,757 4,950 James City County 20.3% -12.6% -3.6% 12.9% 21.6% 16.9% 59.9% 84.2% 69.1% 68.6% James City County 30,640 542 -515 0 1,109 1,109 3,710 3,553 7,263 5,506 Loudoun County 30.1% 2.2% 25.3% 76.3% 62.4% 70.2% 106.9% 163.6% 126.9% 116.9% Loudoun County 254,466 279 2,515 13,175 13,003 26,178 23,283 15,821 39,103 16,907 Montgomery County 8.8% 2.5% 0.5% 7.0% 14.5% 10.4% 40.7% 56.4% 47.1% 27.2% Montgomery County 16,071 643 -106 466 545 1,010 1,138 1,233 2,371 1,141 Pittsylvania County 0.9% -18.7% -12.5% 5.6% 16.6% 10.5% 29.0% 42.0% 33.8% 24.8% Pittsylvania County 237 -1,115 -1,250 -626 99 -527 971 1,061 2,032 818 Prince William County 21.6% 1.7% 13.8% 37.0% 34.7% 36.0% 72.3% 121.0% 89.8% 102.7% Prince William County 198,361 6,055 4,422 7,831 8,447 16,278 12,921 10,685 23,606 12,593 Roanoke County 4.9% -10.7% -7.9% -4.6% 3.6% -0.6% 37.1% 59.6% 46.0% 15.3% Roanoke County 7,800 -623 -1,091 -878 -237 -1,115 1,164 1,677 2,841 1,354 Rockingham County 8.6% -13.6% -6.5% 11.1% 27.6% 18.6% 45.3% 47.9% 46.4% 25.2% Rockingham County 12,604 -609 -814 -144 858 714 1,811 1,868 3,678 1,463 Spotsylvania County 18.2% -9.7% 8.6% 22.4% 24.0% 23.1% 72.2% 102.7% 83.7% 61.6% Spotsylvania County 46,523 273 288 877 2,204 3,081 4,141 3,435 7,576 3,665 Stafford County 20.2% -17.8% 8.6% 44.3% 43.7% 44.0% 72.3% 119.6% 88.6% 75.3% Stafford County 57,964 367 -81 1,285 2,878 4,163 4,778 3,698 8,475 3,098 Alexandria City 10.9% 9.9% 14.8% 34.3% 30.5% 32.6% 33.5% 83.7% 51.2% 15.4% Alexandria City 35,787 2,425 1,896 3,076 2,616 5,692 2,369 2,302 4,671 1,048 Charlottesville City 3.3% -12.9% -2.7% 38.2% 52.7% 44.3% 44.5% 42.2% 43.6% -10.2% Charlottesville City 2,662 921 529 394 641 1,035 785 555 1,340 61 Chesapeake City 9.5% -21.9% -10.8% 34.5% 53.3% 42.6% 55.3% 61.0% 57.5% 29.1% Chesapeake City 43,918 -1,060 -2,688 792 3,438 4,230 6,353 5,267 11,620 3,024 Danville City -9.9% -28.4% -28.9% -8.2% 18.9% 4.3% 22.4% 26.6% 24.1% -15.8% Danville City -8,788 -907 -1,534 -876 -336 -1,212 166 511 678 -116 Fairfax City 4.0% -23.3% -3.0% 16.0% 13.3% 14.6% 17.7% 55.4% 33.3% 10.5% Fairfax City 1,554 -390 -289 -108 116 9 237 359 596 187 Falls Church City 15.0% -9.0% -7.2% 9.2% 15.9% 12.2% 66.3% 93.2% 76.1% 13.1% Falls Church City 4,511 -39 10 5 48 53 255 224 479 131 Fredericksburg City 16.5% 1.1% 0.5% 25.2% 19.5% 22.6% 44.9% 59.2% 50.6% -3.5% Fredericksburg City 9,194 389 18 281 169 450 404 294 699 99 Hampton City -4.4% -38.6% -28.6% 19.3% 42.6% 29.4% 33.5% 30.8% 32.4% 9.7% Hampton City -13,995 -3,632 -4,021 -1,846 131 -1,715 2,173 2,091 4,265 782 Harrisonburg City 14.4% -5.4% -5.9% 16.8% 26.2% 21.2% 40.6% 50.5% 44.9% 5.0% Harrisonburg City 15,834 515 142 172 243 415 549 596 1,145 284 Lynchburg City 10.2% -15.4% -16.2% -4.8% 10.2% 2.0% 36.1% 38.1% 36.9% -1.5% Lynchburg City 15,207 199 -659 -679 -223 -902 616 800 1,416 372 Newport News City 0.5% -26.9% -17.2% 19.3% 37.7% 27.6% 30.3% 39.1% 33.8% 4.8% Newport News City -800 -1,811 -2,726 -902 926 24 2,226 2,440 4,666 777 Norfolk City 2.7% -14.1% -13.8% 11.4% 40.9% 23.7% 51.4% 47.7% 50.0% -11.5% Norfolk City 9,750 1,140 -965 -304 1,604 1,301 2,971 2,920 5,891 417 Petersburg City -4.2% -30.8% -9.5% 11.9% 24.2% 16.9% 29.0% 22.5% 26.5% -7.0% Petersburg City -3,060 -342 -675 -416 177 -239 408 296 704 37 Portsmouth City -3.2% -23.0% -18.7% 9.8% 34.9% 20.5% 40.7% 29.3% 36.3% -8.7% Portsmouth City -7,493 -722 -1,281 -719 386 -332 1,316 1,154 2,470 162 Richmond City 5.1% -16.8% -16.4% 5.6% 31.0% 16.4% 47.6% 47.4% 47.5% -13.3% Richmond City 19,880 331 -2,360 -1,078 739 -339 2,264 2,400 4,664 262 Roanoke City 2.4% -11.4% -12.3% 3.1% 18.0% 9.7% 45.1% 57.0% 49.7% -11.1% Roanoke City 3,406 -565 -922 -416 185 -232 1,301 1,448 2,749 268 Salem City 1.1% -15.9% -20.0% 3.2% 24.7% 13.0% 24.6% 32.7% 27.7% -0.1% Salem City 186 -286 -677 -183 5 -178 257 367 624 106 Staunton City 1.1% -20.7% -19.1% 2.9% 13.9% 8.0% 25.5% 35.3% 29.6% 8.4% Staunton City 203 -233 -372 -282 -106 -387 306 411 717 235 Suffolk City 17.8% -5.1% 6.4% 35.6% 35.5% 35.5% 56.8% 72.3% 62.5% 36.1% Suffolk City 32,174 610 242 1,588 1,863 3,451 2,946 2,062 5,009 1,566 Virginia Beach City 3.3% -23.6% -10.1% 22.1% 37.2% 28.9% 45.5% 67.2% 53.8% 26.6% Virginia Beach City 23,919 -3,821 -5,040 -1,214 4,438 3,224 8,969 9,396 18,365 6,091 Winchester City 8.4% -18.2% -9.7% 13.0% 19.2% 15.8% 46.3% 47.9% 46.9% 2.5% Winchester City 4,325 -130 -153 -91 98 7 521 413 934 211

Market Needs and the Economic Impact of LeadingAge Virginia Members — 55 Appendix Table 5: Projected Percentage Change by Age Groups 2020 to 2040, Virginia and Selected Counties and Independent Cities

Total 55 to 59 60 to 64 65 to 69 70 to 74 (65-74) 75 to 79 80 to 84 (75-84) 85+ Virginia 16.7% -3.6% -10.3% 1.6% 18.2% 9.1% 64.9% 102.5% 79.1% 89.8% Albemarle County 27.6% -11.1% -21.1% -25.3% 2.3% -12.9% 50.1% 104.4% 72.5% 112.1% Arlington County 19.7% 39.4% 18.7% 30.9% 27.6% 29.4% 53.5% 91.7% 66.7% 37.0% Augusta County 13.2% -7.3% -14.7% -9.7% 8.3% -1.5% 42.1% 77.0% 54.9% 94.6% Bedford County 15.0% -23.1% -24.0% -0.2% 17.0% 7.8% 56.6% 110.0% 76.6% 92.1% Chesterfield County 24.7% 6.2% -5.4% -3.8% 8.0% 1.5% 63.1% 136.0% 89.1% 160.6% Fairfax County 15.0% 0.0% -6.8% -1.0% 6.7% 2.5% 43.5% 89.0% 60.5% 94.4% Frederick County 20.9% -12.7% -18.6% -1.5% 21.2% 8.7% 76.5% 113.9% 89.8% 112.7% Fauquier County 32.4% -1.6% -1.8% 3.3% 32.9% 17.8% 75.2% 116.8% 67.3% 141.9% Hanover County 18.6% -17.1% -24.9% 3.0% 26.1% 13.3% 85.1% 131.1% 102.3% 113.4% Henrico County 20.1% -1.2% -9.2% 0.8% 18.1% 8.5% 71.6% 115.8% 88.8% 70.3% James City County 38.6% 10.1% -8.9% 0.0% 17.9% 8.3% 78.7% 122.4% 95.3% 177.8% Loudoun County 57.8% 1.0% 13.4% 82.7% 104.6% 92.3% 260.9% 325.3% 283.7% 374.5% Montgomery County 15.8% 13.1% -2.3% 11.2% 15.8% 13.3% 49.0% 77.9% 60.7% 75.5% Pittsylvania County 0.4% -21.0% -24.3% -12.9% 2.5% -6.0% 34.8% 64.5% 45.8% 60.3% Prince William County 41.0% 20.7% 19.3% 41.2% 54.3% 47.1% 133.4% 195.8% 155.9% 280.8% Roanoke County 8.2% -9.4% -16.2% -13.6% -4.0% -9.0% 29.4% 64.3% 43.3% 54.7% Rockingham County 15.4% -10.6% -14.2% -2.8% 20.0% 7.5% 59.7% 87.4% 71.1% 71.3% Spotsylvania County 34.5% 3.1% 3.8% 11.9% 35.4% 22.7% 108.5% 149.7% 124.0% 180.7% Stafford County 38.4% 3.6% -1.0% 20.2% 57.0% 36.5% 145.9% 213.5% 169.3% 217.2% Alexandria City 20.0% 21.8% 20.4% 49.7% 50.7% 50.1% 77.4% 138.3% 98.8% 59.1% Charlottesville City 5.0% 31.8% 20.1% 22.0% 49.4% 33.5% 97.5% 115.8% 104.3% 13.0% Chesapeake City 17.3% -5.6% -15.9% 6.5% 37.5% 19.8% 106.7% 145.3% 121.3% 88.7% Danville City -20.9% -31.8% -45.5% -33.4% -15.0% -25.0% 11.2% 49.5% 26.9% -9.1% Fairfax City 6.5% -23.9% -18.4% -9.8% 10.6% 0.4% 35.1% 74.9% 51.6% 36.0% Falls Church City 28.1% -3.7% 1.2% 0.7% 8.3% 4.1% 79.7% 122.5% 95.3% 76.4% Fredericksburg City 31.1% 26.8% 1.5% 28.3% 20.8% 24.9% 79.5% 89.1% 83.3% 25.5% Hampton City -10.0% -35.3% -40.2% -25.8% 2.4% -13.6% 57.6% 85.3% 68.5% 35.1% Harrisonburg City 27.0% 26.3% 8.2% 11.9% 19.5% 15.4% 62.5% 88.7% 73.8% 34.0% Lynchburg City 18.7% 5.2% -17.0% -18.4% -7.2% -13.3% 28.1% 51.1% 37.7% 18.6% Newport News City -0.4% -15.6% -24.7% -11.6% 14.7% 0.2% 53.8% 90.3% 68.2% 28.2% Norfolk City 3.9% 8.2% -7.1% -3.0% 22.1% 7.5% 66.9% 106.8% 82.1% 13.2% Petersburg City -9.7% -13.3% -29.5% -21.5% 13.0% -7.3% 42.8% 51.1% 45.9% 5.6% Portsmouth City -7.7% -10.7% -19.5% -14.3% 10.4% -3.8% 53.0% 73.3% 60.9% 8.8% Richmond City 8.6% 2.6% -18.4% -11.0% 10.2% -2.0% 54.2% 91.8% 68.6% 8.1% Roanoke City 3.3% -8.2% -14.0% -7.4% 4.1% -2.3% 47.9% 84.1% 62.0% 12.4% Salem City 0.7% -16.5% -35.7% -12.1% 0.4% -6.4% 27.3% 64.4% 41.3% 16.2% Staunton City 0.8% -13.9% -21.5% -17.4% -7.4% -12.7% 27.8% 53.1% 38.2% 30.4% Suffolk City 33.6% 8.6% 4.0% 30.4% 45.0% 36.8% 110.3% 131.9% 118.3% 106.5% Virginia Beach City 5.1% -12.2% -17.0% -5.5% 24.1% 7.9% 75.8% 127.9% 95.7% 80.3% Winchester City 15.1% -7.5% -9.9% -6.3% 8.3% 0.2% 63.6% 75.2% 68.2% 32.5%

56 — Market Needs and the Economic Impact of LeadingAge Virginia Members Appendix Table 6: Summary of Economic Characteristics of LeadingAge Virginia Members (Client-serving locations only) Estimated Estimated Estimated Estimated Estimated Total Total Total County Total Total Non-salary Residents Ongoing Consumer Employees Salary Payments Expenditures Spending A Grace Place Adult Care Center Richmond - 69 - - Adult Care Center of Central Virginia Lynchburg 6 7 149,461 191,943 341,404 Adult Care Center of Roanoke Valley, Salem 18 13 479,405 424,521 903,926 Inc. Adult Day Care Center of the N. Shen. Winchester 7 11 192,198 204,188 396,386 Valley Alexandria Adult Day Services Center Alexandria - - - - Atlantic Shores Virginia Beach 50 - - - Bay Aging - Essex Adult Day Care Essex 285 202 7,638,386 5,518,081 13,156,467 Bay Aging - Gloucester Adult Daybreak Gloucester 5 4 145,367 206,834 352,201 Bedford Adult Day Center Bedford - - - - Beth Sholom Lifecare Community Richmond 116 150 8,769,880 5,473,203 14,243,083 Beth Sholom Village Virginia Beach 120 26 7,689,452 4,798,917 12,488,369 Birmingham Green Manassas 317 383 10,136,103 -4,436,396 5,699,707 Brandermill Woods Chesterfield 319 285 10,808,106 9,283,698 20,091,804 22,330,000 Brandon Oaks Roanoke 317 342 10,933,679 11,287,781 22,221,460 22,190,000 Bridgewater Retirement Community Rockingham 457 343 13,015,372 11,179,644 24,195,016 31,990,000 Carlin, The Arlington 39 28 1,043,480 869,565 1,913,045 Cedarfield Richmond 436 318 15,241,880 13,092,118 28,333,998 30,520,000 Centra Health Senior Care Services Lynchburg 166 91 513,375 320,392 833,767 Division Chesapeake, The Newport News 379 272 10,622,632 12,962,088 23,584,720 26,530,000 Circle Center Adult Day Services Richmond 22 44 602,474 650,863 1,253,337 Covenant Woods Hanover 304 407 12,477,523 11,165,723 23,643,246 21,280,000 Culpeper, The Culpeper 141 187 4,246,454 5,256,011 9,502,465 9,870,000 Culpepper Garden Arlington 135 95 3,618,104 -684,705 2,933,399 Daily Living Center Waynesboro - 10 - - Eastern Loudoun Adult Day Center Loudoun - - - - Edinburgh Square Roanoke 22 7 592,996 530,019 1,123,015 Edwards Adult Day Center Martinsville 8 6 215,002 179,169 394,171 Elm Manor Roanoke 7 5 178,673 148,893 327,566 Fairfax County Health Department Fairfax - - - - Fairmont Crossing Health and Reha- Amherst 120 128 4,847,324 3,025,170 7,872,494 bilitation Center Falcons Landing Loudoun 444 425 15,447,749 14,574,431 30,022,180 31,080,000 Feinour Center - Adult Medical Day Roanoke - - - - Care Fellowship Square Foundation Fairfax 33 24 894,196 745,162 1,639,358 Friendship Apartment Village Corpora- Roanoke 315 24 2,200,677 2,526,564 4,727,241 22,050,000 tion Friendship Assisted Living Roanoke - - - - Friendship Health and Rehab Center Roanoke 373 633 16,485,020 13,875,155 30,360,175 Friendship Health and Rehab Center Roanoke 120 68 - - South Generations Crossing Harrisonburg 6 15 150,578 125,482 276,060 Glebe, The Botetourt 218 207 7,149,887 7,468,329 14,618,216 15,260,000

Market Needs and the Economic Impact of LeadingAge Virginia Members — 57 Appendix Table 6: Summary of Economic Characteristics of LeadingAge Virginia Members Continued (Client-serving locations only)

County Total Estimated Estimated Estimated Estimated Estimated Residents Total Total Non-salary Total Total Employees Salary Payments Ongoing Consumer Expenditures Spending Goodwin House Alexandria Alexandria 376 431 16,341,067 12,078,281 28,419,348 26,320,000 Goodwin House Bailey’s Crossroads Falls Church 456 880 18,882,526 19,344,613 38,227,139 31,920,000 Hanover Adult Center Hanover 14 24 370,875 400,146 771,021 Harbor’s Edge Newport News 244 10 10,020,051 6,868,489 16,888,540 17,080,000 Hermitage in Northern Virginia Alexandria 150 155 4,802,333 5,847,766 10,650,099 10,500,000 Hermitage in Richmond Richmond 188 201 5,949,658 5,026,501 10,976,159 13,160,000 Hermitage on the Eastern Shore Accomack 93 86 1,473,283 1,265,486 2,738,769 6,510,000 Hermitage Roanoke Roanoke 91 66 1,804,552 2,580,162 4,384,714 6,370,000 Herndon Harbor Adult Day Health Care Fairfax - 9 - - Insight Memory Care Center Fairfax 35 25 929,846 803,317 1,733,163 Interfaith Adult Day Care Petersburg 2 8 56,244 72,093 128,337 JABA Adult Care Center Charlottesville 62 95 1,653,342 1,365,601 3,018,943 JFS (Jewish Family Services) - home care Richmond 56 40 1,502,133 1,251,775 2,753,908 only Kendal at Lexington Lexington 200 211 7,970,580 6,852,301 14,822,881 14,000,000 King’s Grant Retirement Community Martinsville 209 115 4,383,154 5,066,934 9,450,088 14,630,000 Lake Prince Woods Suffolk 270 130 5,636,282 6,495,025 12,131,307 18,900,000 Lakewood Richmond 441 367 12,930,027 12,348,310 25,278,337 30,870,000 Leesburg Adult Day Center Loudoun - - - - Legacy at North Augusta Staunton 82 58 2,199,084 1,832,568 4,031,652 Lewinsville Adult Day Health Center Falls Church - - - - Lewinsville, The Fairfax 24 5 634,329 528,606 1,162,935 Lincolnia Adult Day Health Care Alexandria - 9 - - Little Sisters of the Poor Richmond 32 177 4,970,751 1,563,936 6,534,687 Luther Manor Virginia Beach 25 17 662,448 552,038 1,214,486 Lydia H. Roper Home Norfolk 26 20 245,446 717,219 962,665 1,820,000 Mac Brownell Adult Day Center Loudoun - - - - Marian Manor Virginia Beach 116 158 3,111,255 1,566,315 4,677,570 Martha Jefferson House Charlottesville 28 113 2,319,613 2,621,121 4,940,734 Maryview Nursing Care Center Suffolk 120 163 5,274,186 3,591,251 8,865,437 Marywood Richmond 21 8 567,676 399,281 966,957 Masonic Home of Virginia Richmond 343 257 4,764,177 9,414,375 14,178,552 24,010,000 McGurk House Lynchburg 19 13 499,645 416,371 916,016 Mennowood Retirement Community Newport News 81 104 2,165,920 1,772,427 3,938,347 Mountain Empire PACE Wise 240 348 6,443,828 6,631,800 13,075,628 Mountain View Nursing Home Madison 40 113 1,401,128 1,412,667 2,813,795 Mt. Vernon Adult Day Health Care Alexandria 3 3 91,927 91,744 183,671 Norfolk Senior Center t/a Primeplus Norfolk 16 28 438,457 474,303 912,760 Oakwood Health and Rehabilitation Center Bedford 111 53 - - Our Lady of Hope Richmond 60 305 5,491,374 3,983,286 9,474,660 Our Lady of Peace Charlottesville 30 186 4,663,032 3,012,510 7,675,542 Our Lady of Perpetual Help Virginia Beach 30 234 4,600,209 2,795,553 7,395,762 Our Lady of the Valley Roanoke 70 265 5,672,682 3,254,072 8,926,754 Patriots Colony at Williamsburg Williamsburg 310 285 10,815,355 10,144,202 20,959,557 21,700,000 Petersburg Home for Ladies Petersburg 43 54 1,151,563 959,635 2,111,198

58 — Market Needs and the Economic Impact of LeadingAge Virginia Members Appendix Table 6: Summary of Economic Characteristics of LeadingAge Virginia Members Continued (Client-serving locations only)

Estimated Estimated Estimated Estimated Estimated Total Total Total County Total Total Non-salary Residents Ongoing Consumer Employees Salary Payments Expenditures Spending Prince William Adult Day Health Care Prince William - - - - Pulaski Adult Day Service Center Pulaski 3 2 81,214 67,679 148,893 Rappahannock Westminster-Canter- Lancaster 233 328 8,513,672 9,376,671 17,890,343 16,310,000 bury Raspberry Hill Adult Daytime Center Bedford - 5 - - Richfield Living Salem 315 433 16,419,213 16,370,933 32,790,146 Russell House Virginia Beach 21 15 566,450 550,912 1,117,362 Saint Francis Home Richmond 49 35 1,320,422 1,100,351 2,420,773 Scott Hill/Briarcliffe Alleghany 28 20 761,560 634,632 1,396,192 Seton Manor Hampton 18 13 490,680 408,899 899,579 Shenandoah Valley Westminster- Winchester 311 385 12,507,404 10,437,149 22,944,553 21,770,000 Canterbury South Richmond Adult Day Care Center Richmond 5 9 129,447 149,192 278,639 St. Mary’s Woods Retirement Com- Richmond 109 113 2,928,539 1,150,107 4,078,646 munity Sullivan House Virginia Beach 14 10 372,693 310,577 683,270 Summit Health and Rehabilitation Lynchburg 120 63 5,693,880 3,553,498 9,247,378 Center Summit Square Retirement Community Waynesboro 118 76 3,224,341 2,746,989 5,971,330 8,260,000 Summit, The Lynchburg 121 51 1,915,022 2,261,343 4,176,365 8,438,500 Sunnyside Retirement Community Harrisonburg 435 239 12,104,814 9,566,080 21,670,894 30,450,000 Swift Creek Day Center Chesterfield - 7 - - VCU Health Adult and Intergenera- Richmond - - - - tional Center Village at Orchard Ridge, The Winchester 363 185 6,994,411 12,127,679 19,122,090 25,410,000 Village at Woods Edge Franklin 109 168 2,923,090 2,792,175 5,715,265 Village Gardens Norfolk 3 2 70,051 58,377 128,428 Village Pointe Senior Housing Norfolk 3 2 84,093 70,077 154,170 Vinson Hall Retirement Community Fairfax 311 250 13,507,859 15,514,200 29,022,059 21,770,000 Virginia Baptist Hospital Division Lynchburg - - - - Center Virginia Mennonite Retirement Com- Harrisonburg 469 487 13,836,202 3,891,072 17,727,274 32,830,000 munity (VMRC) Virginia Tech Adult Day Services Montgomery - 12 - 290,192 Virginian, The Fairfax 331 226 15,250,790 14,407,383 29,658,173 23,170,000 Walter Reed Adult Day Health Care Arlington - 9 - 113,975 Center Warm Hearth Village Montgomery 354 320 8,480,432 3,236,435 11,716,867 24,780,000 Warwick Forest Newport News 267 233 8,823,501 5,377,926 14,201,427 18,690,000 Westminster at Lake Ridge Prince William 335 384 12,164,813 10,455,520 22,620,333 23,450,000 Westminster Canterbury Lynchburg Lynchburg 407 547 13,739,738 12,228,299 25,968,037 28,490,000 Westminster Canterbury Richmond Richmond 831 809 30,364,410 29,939,192 60,303,602 58,170,000 Westminster-Canterbury of the Blue Charlottesville 390 305 22,323,136 11,141,767 33,464,903 27,300,000 Ridge Westminster-Canterbury on Chesa- Virginia Beach 1,206 848 27,770,981 18,480,770 46,251,751 84,420,000 peake Bay Williamsburg Landing, Inc. Williamsburg 431 496 15,000,052 16,449,590 31,449,642 30,170,000 WindsorMeade Williamsburg Williamsburg 207 159 7,451,869 6,852,855 14,304,724 14,490,000

Market Needs and the Economic Impact of LeadingAge Virginia Members — 59 Appendix Table 7: Economic Impact of LeadingAge Virginia Members (Client-serving locations only)

Economic Impacts Tax Impacts Total State Total Direct Indirect Induced Total Labor Employment and Federal Effect Effect Effect Effect Income County Tax Tax A Grace Place Adult Care Center * Adult Care Center of Central Virginia $298,497 $75,830 $86,610 $460,937 9 $186,289 $6,694 $33,781 Adult Care Center of Roanoke Valley, Inc. $957,449 $239,681 $313,164 $1,510,295 25 $683,903 $24,919 $120,420 Adult Day Care Center of the N. Shenandoah Valley $383,851 $86,659 $178,351 $648,861 10 $297,154 $13,425 $55,743 Alexandria Adult Day Services Center * Atlantic Shores * Bay Aging - Essex Adult Day Care $100,000 $18,506 $32,334 $150,841 3 $65,574 $2,974 $12,110 Bay Aging - Gloucester Adult Daybreak $290,322 $53,536 $68,339 $412,197 8 $171,667 $6,967 $36,516 Bedford Adult Day Center * Beth Sholom Lifecare Community $17,514,858 $5,446,969 $4,394,605 $27,356,432 299 $13,074,694 $453,850 $2,187,656 Beth Sholom Village $15,357,069 $5,012,546 $6,384,739 $26,754,354 315 $11,450,245 $758,378 $2,395,822 Birmingham Green $20,243,424 $5,245,306 $6,995,186 $32,483,916 373 $14,770,590 $860,547 $3,034,782 Brandermill Woods $21,585,522 $7,123,902 $9,568,600 $38,278,024 443 $16,379,940 $1,077,406 $3,467,946 Brandon Oaks $21,836,311 $6,140,090 $6,905,392 $34,881,793 413 $15,815,330 $775,295 $2,943,481 Bridgewater Retirement Community $25,993,786 $7,263,468 $10,621,169 $43,878,423 533 $18,562,671 $1,093,167 $3,673,029 Carlin, The $2,083,997 $529,640 $528,729 $3,142,366 32 $1,568,941 $65,882 $276,373 Cedarfield $30,440,479 $9,466,726 $7,637,737 $47,544,942 520 $22,723,560 $788,782 $3,802,102 Centra Health Senior Care Services Division $1,025,292 $234,040 $324,424 $1,583,755 19 $712,750 $33,665 $131,247 Chesapeake, The $21,215,100 $5,043,073 $6,027,136 $32,285,309 362 $15,213,968 $636,293 $2,527,069 Circle Center Adult Day Services $1,203,238 $341,572 $292,835 $1,837,645 30 $837,558 $22,098 $136,741 Covenant Woods $24,919,615 $4,100,779 $7,936,306 $36,956,701 431 $18,097,794 $918,224 $3,858,019 Culpeper, The $8,480,849 $1,864,845 $3,023,625 $13,369,319 153 $6,233,708 $337,271 $1,265,530 Culpepper Garden $7,225,935 $1,836,444 $1,833,284 $10,895,664 112 $5,440,058 $228,438 $958,281 Daily Living Center * Eastern Loudoun Adult Day Center * Edinburgh Square $1,184,308 $333,012 $374,519 $1,891,839 22 $857,756 $42,048 $159,642 Edwards Adult Day Center $429,394 $67,043 $124,279 $620,716 12 $262,570 $9,815 $54,222 Elm Manor $356,838 $100,338 $112,844 $570,021 7 $258,446 $12,670 $48,101 Fairfax County Health Department * Fairmont Crossing Health and Rehabilitation Center $9,680,883 $1,053,488 $1,712,195 $12,446,566 183 $5,531,431 $243,116 $1,225,794 Falcons Landing $30,851,633 $8,414,873 $10,637,893 $49,904,399 551 $23,488,226 $1,364,925 $4,891,392 Feinour Center - Adult Medical Day Care * Fellowship Square Foundation $1,785,853 $532,476 $698,161 $3,016,489 31 $1,449,253 $79,291 $286,712 Friendship Apartment Village Corporation $4,395,105 $1,235,847 $1,389,883 $7,020,835 83 $3,183,232 $156,047 $592,450 Friendship Assisted Living * Friendship Health and Rehab Center $32,923,230 $9,257,589 $10,411,457 $52,592,275 622 $23,845,224 $1,168,934 $4,437,971 Friendship Health and Rehab Center South * Generations Crossing $300,729 $126,747 $86,906 $514,382 12 $154,021 $8,113 $35,729 Glebe, The $14,279,472 $2,792,589 $3,214,606 $20,286,667 270 $8,934,396 $457,517 $1,929,378 Goodwin House Alexandria $32,635,732 $9,142,842 $11,455,938 $53,234,512 538 $25,751,190 $1,390,981 $5,148,311 Goodwin House Bailey’s Crossroads $37,711,433 $11,244,161 $14,742,896 $63,698,490 657 $30,603,528 $1,674,368 $6,054,423 Hanover Adult Center $740,696 $129,966 $209,462 $1,080,124 20 $478,289 $19,603 $101,266 Harbor’s Edge $20,011,649 $4,756,998 $5,685,240 $30,453,888 341 $14,350,938 $600,198 $2,383,718

* Insufficient data to estimate economic impact

60 — Market Needs and the Economic Impact of LeadingAge Virginia Members Appendix Table 7: Economic Impact of LeadingAge Virginia Members Continued (Client-serving locations only)

Economic Impacts Tax Impacts Total State Total Direct Indirect Induced Total Labor Employment and Federal Effect Effect Effect Effect Income County Tax Tax Hermitage in Northern Virginia $9,591,030 $2,686,910 $3,366,685 $15,644,625 158 $7,567,792 $408,783 $1,512,992 Hermitage in Richmond $11,882,421 $3,695,330 $2,981,385 $18,559,137 203 $8,870,127 $307,901 $1,484,148 Hermitage on the Eastern Shore $2,942,382 $528,778 $769,253 $4,240,413 53 $1,947,105 $99,289 $390,505 Hermitage Roanoke $3,603,980 $1,013,393 $1,139,702 $5,757,075 68 $2,610,245 $127,959 $485,807 Herndon Harbor Adult Day Health Care * Insight Memory Care Center $1,857,051 $553,704 $725,995 $3,136,750 32 $1,507,031 $82,451 $298,142 Interfaith Adult Day Care $112,328 $27,786 $26,639 $166,753 5 $53,926 $2,717 $10,968 JABA Adult Care Center $3,301,990 $1,046,112 $999,206 $5,347,308 91 $2,276,580 $90,845 $413,230 JFS (Jewish Family Services) - home care only $3,000,000 $851,633 $730,118 $4,581,751 74 $2,088,260 $55,096 $340,933 Kendal at Lexington $15,918,527 $2,547,083 $4,400,074 $22,865,684 285 $10,807,851 $517,628 $2,142,356 King’s Grant Retirement Community $8,753,861 $1,472,792 $2,775,204 $13,001,857 169 $5,866,811 $298,563 $1,225,270 Lake Prince Woods $11,256,560 $2,489,018 $3,671,695 $17,417,273 217 $7,675,094 $466,806 $1,599,036 Lakewood $25,823,338 $8,030,835 $6,479,263 $40,333,436 441 $19,276,904 $669,142 $3,225,408 Leesburg Adult Day Center * Legacy at North Augusta $4,391,924 $960,642 $1,512,119 $6,864,685 86 $3,024,016 $169,806 $616,914 Lewinsville Adult Day Health Center * Lewinsville, The $1,266,856 $377,730 $495,264 $2,139,850 22 $1,028,077 $56,247 $203,388 Lincolnia Adult Day Health Care * Little Sisters of the Poor $9,927,388 $3,087,332 $2,490,853 $15,505,573 170 $7,410,711 $257,241 $1,239,958 Luther Manor $1,323,014 $431,832 $550,046 $2,304,892 27 $986,440 $65,334 $206,401 Lydia H. Roper Home $490,195 $134,942 $92,626 $717,763 8 $343,066 $10,974 $49,087 Mac Brownell Adult Day Center * Marian Manor $6,213,676 $2,028,143 $2,583,351 $10,825,170 127 $4,632,923 $306,849 $969,382 Martha Jefferson House $4,632,639 $1,364,631 $1,542,274 $7,539,544 83 $3,526,097 $179,896 $641,854 Maryview Nursing Care Center $10,533,396 $2,329,114 $3,435,811 $16,298,321 203 $7,182,017 $436,817 $1,496,308 Marywood $1,133,741 $352,584 $284,464 $1,770,788 19 $846,328 $29,378 $141,608 Masonic Home of Virginia $9,514,826 $2,959,029 $2,387,339 $14,861,193 162 $7,102,737 $246,551 $1,188,429 McGurk House $997,872 $227,781 $315,747 $1,541,400 19 $693,688 $32,764 $127,737 Mennowood Retirement Community $4,325,689 $1,028,266 $1,228,913 $6,582,868 74 $3,102,078 $129,738 $515,260 Mountain Empire PACE $12,869,359 $1,659,239 $3,784,226 $18,312,823 347 $7,906,405 $269,127 $1,432,436 Mountain View Nursing Home $2,798,277 $341,970 $408,817 $3,549,064 55 $1,509,134 $75,056 $342,444 Mt. Vernon Adult Day Health Care $183,592 $47,227 $58,864 $289,683 4 $132,875 $5,489 $26,184 Norfolk Senior Center t/a Primeplus $875,668 $271,765 $196,785 $1,344,217 25 $572,770 $15,893 $82,090 Oakwood Health and Rehabilitation Center * Our Lady of Hope $10,967,154 $3,410,690 $2,751,738 $17,129,583 187 $8,186,888 $284,184 $1,369,829 Our Lady of Peace $9,312,824 $2,743,268 $3,100,376 $15,156,468 166 $7,088,383 $361,640 $1,290,294 Our Lady of Perpetual Help $9,187,356 $2,998,752 $3,819,666 $16,005,774 188 $6,850,101 $453,698 $1,433,299 Our Lady of the Valley $11,329,256 $3,185,641 $3,582,700 $18,097,597 214 $8,205,411 $402,243 $1,527,156 Patriots Colony at Williamsburg $21,600,000 $6,367,194 $7,003,116 $34,970,310 430 $14,984,831 $885,729 $3,272,858 Petersburg Home for Ladies $2,299,857 $467,068 $708,500 $3,475,426 48 $1,437,502 $89,303 $301,401 Prince William Adult Day Health Care *

* Insufficient data to estimate economic impact

Market Needs and the Economic Impact of LeadingAge Virginia Members — 61 Appendix Table 7: Economic Impact of LeadingAge Virginia Members Continued (Client-serving locations only)

Economic Impacts Tax Impacts Total State Total Direct Indirect Induced Total Labor Employment and Federal Effect Effect Effect Effect Income County Tax Tax Pulaski Adult Day Service Center $162,198 $26,748 $29,899 $218,845 6 $82,093 $3,023 $15,210 Rappahannock Westminster-Canterbury $17,003,169 $4,588,530 $6,351,505 $27,943,204 343 $11,824,015 $757,435 $2,539,472 Raspberry Hill Adult Daytime Center * Richfield Living $32,791,803 $9,220,633 $10,369,895 $52,382,331 620 $23,750,036 $1,164,268 $4,420,255 Russell House $1,131,292 $369,254 $470,337 $1,970,883 23 $843,492 $55,867 $176,490 Saint Francis Home $2,637,095 $820,114 $661,666 $4,118,875 45 $1,968,569 $68,333 $329,380 Scott Hill/Briarcliffe $1,520,957 $176,091 $347,879 $2,044,926 28 $931,376 $40,886 $184,032 Seton Manor $979,966 $199,768 $288,054 $1,467,788 19 $646,127 $34,686 $117,570 Shenandoah Valley Westminster-Canterbury $24,979,292 $6,782,868 $11,649,090 $43,411,250 515 $19,228,110 $1,190,995 $3,901,971 South Richmond Adult Day Care Center $258,527 $73,390 $62,918 $394,835 6 $179,957 $4,749 $29,380 St. Mary’s Woods Retirement Community $5,848,762 $1,818,914 $1,467,497 $9,135,173 100 $4,366,051 $151,555 $730,527 Sullivan House $744,328 $242,949 $309,456 $1,296,733 15 $554,972 $36,758 $116,122 Summit Health and Rehabilitation Center $11,371,591 $2,595,752 $3,598,209 $17,565,551 215 $7,905,160 $373,384 $1,455,671 Summit Square Retirement Community $6,439,526 $1,408,512 $2,217,099 $10,065,137 127 $4,433,872 $248,974 $904,531 Summit, The $3,824,606 $873,029 $1,210,185 $5,907,820 72 $2,658,742 $125,580 $489,585 Sunnyside Retirement Community $24,175,256 $6,755,314 $9,878,110 $40,808,680 495 $17,264,024 $1,016,689 $3,416,063 Swift Creek Day Center * VCU Health Adult and Intergenerational Center * Village at Orchard Ridge, The $13,968,961 $3,793,127 $6,514,423 $24,276,511 288 $10,752,776 $666,029 $2,182,068 Village at Woods Edge $5,837,879 $1,167,398 $1,496,142 $8,501,419 124 $3,462,025 $205,928 $706,467 Village Gardens $139,904 $38,513 $26,436 $204,853 2 $97,913 $3,132 $14,009 Village Pointe Senior Housing $167,947 $46,233 $31,735 $245,915 3 $117,539 $3,759 $16,818 Vinson Hall Retirement Community $26,977,361 $8,043,656 $10,546,521 $45,567,538 470 $21,892,629 $1,197,781 $4,331,109 Virginia Baptist Hospital Division Center * Virginia Mennonite Retirement Community $27,633,115 $7,721,547 $11,291,006 $46,645,668 566 $19,733,348 $1,162,109 $3,904,672 Virginia Tech Adult Day Services $290,192 $72,825 $88,614 $451,631 9 $183,869 $6,720 $35,303 Virginian, The $30,458,274 $9,081,536 $11,907,348 $51,447,158 531 $24,717,455 $1,352,333 $4,889,956 Walter Reed Adult Day Health Care Center $113,975 $24,499 $28,484 $166,959 2 $82,581 $2,545 $14,304 Warm Hearth Village $16,936,784 $4,188,536 $5,617,358 $26,742,677 330 $11,674,514 $592,679 $2,304,074 Warwick Forest $17,621,947 $4,188,939 $5,006,334 $26,817,220 301 $12,637,213 $528,525 $2,099,066 Westminster at Lake Ridge $24,295,083 $6,295,137 $8,395,251 $38,985,472 448 $17,726,879 $1,032,784 $3,642,184 Westminster Canterbury Lynchburg $27,440,462 $6,263,734 $8,682,735 $42,386,931 519 $19,075,716 $901,003 $3,512,639 Westminster Canterbury Richmond $60,642,599 $18,859,324 $15,215,667 $94,717,590 1,035 $45,269,187 $1,571,388 $7,574,431 Westminster-Canterbury of the Blue Ridge $44,582,884 $13,132,728 $14,842,298 $72,557,910 795 $33,933,912 $1,731,260 $6,176,972 Westminster-Canterbury on Chesapeake Bay $55,463,105 $18,103,152 $23,058,923 $96,625,179 1,136 $41,353,344 $2,738,932 $8,652,679 Williamsburg Landing, Inc. $29,957,511 $8,830,800 $9,712,775 $48,501,086 596 $20,782,788 $1,228,437 $4,539,199 WindsorMeade Williamsburg $14,882,578 $4,387,049 $4,825,205 $24,094,832 296 $10,324,672 $610,274 $2,255,027

* Insufficient data to estimate economic impact

62 — Market Needs and the Economic Impact of LeadingAge Virginia Members Appendix Table 8: Survey Summary Data on Benevolent Care and Charitable Giving

Benevolent Any Other Volunteer Volunteer Sponsor/Steering Care or Contractual Community Staff Resident Notes Organization Charity Allowance Financial Hours Hours Care Contributions Birmingham Green 75,597 - - - - Bridgewater Retirement Community 30,000 2,767,041 - - - Circle Center Adult Day Services - 337,156 - - - Virginia Lutheran Homes, Inc. 3,835,211 - - - - Daily Living Center - - 89,940 - - Incoming donations Falcons Landing 10,731 - 248,636 - - Generations Crossing 55,563 - - - - Goodwin House Incorporated 717,245 - 24,448 - - Interfaith Adult Day Care 5,000 - - - - Kendal at Lexington - 406,600 50,000 - Lake Prince woods United Church Homes 116,302 - - - - and Services Westminster-Canterbury of the Blue 175,899 - 6,669 - Ridge LifeSpire Consolidated HQ LifeSpire Consolidated - - 10,284 181 - Lakewood LifeSpire Consolidated - 16,800 - 458 1,818 Culpeper LifeSpire Consolidated - 6,448 - 192 483 Glebe LifeSpire Consolidated - 49,547 - 1,500 - Chesapeake LifeSpire Consolidated - 14,225 - 495 430 Innsbrook Pinnacle Living - - - - - Northern Virginia Pinnacle Living 214,664 - - - - Richmond Pinnacle Living 450,593 - - - - Eastern Shore Pinnacle Living 62,187 - - - - Roanoke Pinnacle Living 130,302 - - - - Roper Pinnacle Living 2,682 - - - - Cedarfield Pinnacle Living 62,284 - - - - WindsorMeade Pinnacle Living 113,898 - - - - from SCC Shenandoah Valley Westminster 195,098 - 37,401 - Canterbury VT Adult Day Services 30,000 - 1,300 - - The Village at Orchard Ridge 71,782 419,058 - - - Vinson Hall 247,176 - 11,051 - - Virginia Mennonite Retirement 1,500,000 - 6,000 - Community Walter Reed Adult Day Health Care Aging and Disability - - - - - Center Services/Department of Human Services/ Arlington County Government Warm Hearth Village 640,000 - 16,000 - - WC Cheasapeake Bay 994,089 1,505,911 30,000 - - Westminster Canterbury of 285,786 - 742,699 - Lynchburg Westminster Canterbury Richmond 3,711,647 - 283,303 -

Market Needs and the Economic Impact of LeadingAge Virginia Members — 63 4201 Dominion Blvd. Suite 100 Glen Allen, VA 23060 (804) 965-5500 www.leadingagevirginia.org