Assisted Living Facilities: Locating the Best Cities to Build
As America’s population ages, the demand for assisted living facilities (ALFs) continues to rise. But while the need is national, the opportunity is not evenly distributed. Developers, investors, and operators who want to build successful communities must look beyond broad demographic trends and identify cities where economic, regulatory, and cultural conditions align to support long‑term viability.
Choosing the right location is both an art and a science. It requires understanding not only where seniors live, but where they want to live—and where their families can support them. It also means evaluating local competition, workforce availability, and the financial realities of construction and operation. Below is a strategic framework for identifying the best cities to build assisted living facilities, along with the characteristics that consistently define high‑potential markets.
1. Demographics: Follow the Aging Population
The most obvious indicator of opportunity is the size and growth of the senior population. Cities with rapidly expanding populations aged 65+ create natural demand for assisted living.
Key demographic indicators
- Strong growth in the 75+ age bracket
- High percentage of retirees relocating to the region
- A large “adult child” population (ages 45–64) who often influence care decisions
- Migration patterns showing sustained inflow rather than temporary spikes
Cities in states like Florida, Arizona, Texas, and the Carolinas consistently rank high due to warm climates, tax advantages, and established retiree communities. But emerging markets—such as parts of Colorado, Utah, and Tennessee—are seeing fast growth as well.
2. Economic Conditions: Affordability Meets Opportunity
Even in high‑demand markets, affordability can make or break a project. Assisted living is a private‑pay model for most residents, so the financial profile of the local population matters.
Economic factors to evaluate
- Median household income of seniors and their adult children
- Local real estate and construction costs
- State tax policies affecting retirees
- Availability of financing incentives or development grants
Cities with moderate construction costs and strong middle‑class populations often offer the best balance between demand and profitability. Overly expensive markets can limit occupancy, while low‑income markets may struggle to support private‑pay rates.
3. Competition and Market Saturation
A city with many existing facilities isn’t necessarily a bad choice—but it requires deeper analysis. Some markets are saturated, while others have aging inventory that no longer meets modern expectations.
Questions to ask
- Are existing facilities full, or do they have high vacancy rates?
- How old is the current inventory?
- Are new developments underway that could shift supply?
- What amenities and care levels are competitors offering?
Markets with outdated facilities or limited memory‑care options often present strong opportunities for modern, amenity‑rich communities.
4. Workforce Availability: The Hidden Deal‑Breaker
Even the best‑located facility cannot operate without a reliable workforce. Assisted living communities depend on caregivers, nurses, dining staff, and administrators—roles that are increasingly difficult to fill nationwide.
Workforce indicators
- Availability of CNAs, LPNs, and RNs
- Proximity to nursing schools or training programs
- Competitive wage levels
- Local unemployment rates
Cities with strong healthcare ecosystems—such as those near major hospitals or medical colleges—tend to offer more stable staffing pipelines.
5. Regulatory Environment and State Support
State regulations can significantly impact operating costs and development timelines. Some states have streamlined processes and supportive policies, while others impose stricter requirements that increase complexity.
Regulatory considerations
- Licensing requirements and inspection frequency
- Staffing mandates
- Medicaid waiver programs (if applicable)
- Zoning rules for senior housing
States with clear, predictable regulatory frameworks are often more attractive for long‑term investment.
6. Quality‑of‑Life Factors: What Seniors Value
Seniors and their families increasingly prioritize lifestyle when choosing assisted living. Cities that offer a blend of comfort, safety, and community engagement tend to attract more residents.
Lifestyle factors
- Access to healthcare and specialty providers
- Safe neighborhoods and low crime rates
- Cultural amenities (parks, libraries, community centers)
- Transportation options for seniors
Cities that promote active aging—through walkability, recreation, and social programs—often outperform purely demographic expectations.
Cities That Often Rank Highly for Assisted Living Development
While the “best” city depends on a developer’s strategy, several markets consistently stand out due to their demographics, economics, and growth patterns:
1. Phoenix, Arizona
A long‑time retiree magnet with strong population growth and relatively affordable construction costs.
2. Austin and San Antonio, Texas
Fast‑growing metros with strong middle‑class populations and expanding healthcare systems.
3. Raleigh–Durham, North Carolina
High quality of life, strong workforce pipeline, and steady senior population growth.
4. Tampa and Orlando, Florida
Large retiree populations, favorable tax environments, and strong demand for modern facilities can be found in Orlando and Tampa, Florida.
5. Denver and Colorado Springs, Colorado
Rapidly aging population and high demand for upscale senior living options.
These cities are not the only opportunities, but they illustrate the types of markets where assisted living development tends to thrive.
Conclusion: The Best Cities Share the Same DNA
The ideal location for an assisted living facility is not defined by a single factor—it’s the intersection of demographic demand, economic feasibility, workforce strength, and quality of life. Developers who take a data‑driven approach, while also understanding the human side of senior living, are best positioned to build communities that succeed both financially and socially.
If you’d like, I can also create:
- A data‑driven ranking of the top 10 U.S. cities
- A market‑analysis table comparing demographics, costs, and competition
- A version of this article tailored for investors, policymakers, or operators
Read other articles of interest here.
