By James A. Lomastro, PhD
James Lomastro is Chair of DignityMA’s Facilities Workgroup and a member of the Coordinating Committee.
The senior housing and care industry is trying to reinvent itself. Leaders are moving away from “end-stage living” language and pushing “next-stage living” instead — a more aspirational model centered on engagement, autonomy, and health span. They’re even dropping terms like “senior,” “elder,” and “silver tsunami,” calling them ageist. New models — from multigenerational housing to small-home communities — are being touted as the future. On the surface, this is good news. Reframing aging as opportunity rather than decline challenges deep-seated ageism. It acknowledges what many older adults have long wanted: life in later years should be about connection, growth, and dignity, not just managing decline. For advocates, there’s a chance to leverage this narrative shift. If the industry claims to offer a “continuum of engagement,” then we should insist that regulators measure it — with real metrics around resident autonomy, caregiver support, and quality of community life. But here’s the caution: rebranding does not equal reform. Calling something “next-stage living” doesn’t guarantee safe staffing, affordability, or equity. Too often, aspirational products target affluent consumers while those with fewer resources — especially dually eligible older adults — remain in underfunded, care-driven institutions. And by emphasizing lifestyle and choice, the industry risks downplaying the structural changes we know are needed: fair reimbursement, workforce investment, and accountability for private equity ownership. For independent advocates, especially those not financially tied to providers or investors, this pivot is a signal, not a solution. Our role is to inform without endorsing:
- Center the voices of older adults and caregivers in defining what “next-stage living” should mean.
- Demand transparency in access, cost, and outcomes.
- Press for equity, ensuring innovation isn’t reserved for those who can pay privately.
- Link rhetoric to policy reform — so that “engagement” and “autonomy” become measurable outcomes, not marketing slogans.
A cultural shift in how we talk about aging is welcome, but language alone will not solve the structural problems in long-term care. If advocates seize this moment, we can push the conversation from branding to justice. If not, “next-stage living” may end up as just another slogan. Question for colleagues and readers: How do you see the balance between marketing narratives and structural reform in aging services? Can the industry’s pivot create real change, or does it risk masking deeper inequities?
How Independent Advocates Should Respond to the Senior Care Industry’s “Next-Stage Living” Narrative
The senior housing and care industry is attempting a rebrand. Leaders no longer want to describe their work as “end-stage living” or frame aging as decline. Instead, they talk about “next-stage living” — an aspirational model meant to emphasize engagement, autonomy, and what some call health span rather than lifespan. The vocabulary of “senior,” “elder,” or “silver tsunami” is now labeled ageist. Providers tout new forms of housing — small homes, multigenerational communities, or “blue ocean” products — as alternatives to traditional institutional models. This pivot is more than semantics. It reflects an industry sensing both consumer demand and cultural change. Baby boomers, entering later life, are unlikely to accept the stereotypes of dependency that shaped their parents’ experiences. Companies that can market aging as opportunity, not burden, hope to capture this generation’s dollars and reshape public perception in the process. For independent advocates, especially those not financially tied to providers or investors, this moment is both promising and perilous.
The Promise of a New Narrative
The most obvious opportunity lies in dismantling ageism. For too long, American culture has portrayed aging as decline — reinforced in both everyday jokes and institutional practices. A shift toward “next-stage living” can help recast older adulthood as a stage of possibility, connection, and contribution. Advocates can use this language strategically. If the industry claims to offer a “continuum of engagement,” then advocates should push regulators to measure it. Beyond clinical outcomes, policymakers should track resident autonomy, community participation, and caregiver well-being. These metrics can be built into Medicaid contracts, manage long-term services and supports (MLTSS) oversight, or state licensing requirements. Marketing rhetoric can thus be converted into concrete accountability. The aspirational framing also offers a cultural opening. College students hearing they may live to 100 will need more than a story of decline. A broader embrace of aging as a dynamic life stage could strengthen public support for policies that expand options across the lifespan, from home- and community-based services to innovative housing models.
The Risks of Market Repositioning
Yet independent advocates must be wary. A new narrative may mask old problems. Calling a facility “next-stage living” does not guarantee safe staffing, affordable access, or meaningful autonomy. Without structural change, the pivot risks becoming little more than branding. Equity is a particular concern. “Aspirational” products often target affluent consumers, while low-income older adults — particularly those dually enrolled in Medicare and Medicaid — remain in underfunded, care-driven facilities. If the new narrative is used to create a two-tiered system, disparities will deepen rather than shrink.
There is also the danger of depoliticization. By focusing on lifestyle and personal choice, the pivot may draw attention away from structural reforms: financing of long-term care, mandatory staffing standards, and public investment in the direct care workforce. Industry leaders may prefer to talk about wellness and multigenerational housing rather than Medicaid reimbursement or accountability for private equity ownership. Advocates must resist that deflection.
What Advocates Should Do
The challenge for independent advocates is to inform without endorsing. The pivot should be seen as a signal of shifting attitudes, not as evidence of systemic reform. First, center the voices of older adults and family caregivers. Any definition of “next-stage living” must emerge from their lived experiences, not just from marketers and investors. Second, demand transparency. Who is accessing these new models? What do they cost? What are the outcomes compared to traditional care settings? Public reporting on affordability, accessibility, and quality is essential. Third, push for equity. If industry leaders want to speak about health span and engagement, then those principles must apply across income and racial lines. Innovations cannot be reserved for those who can pay privately. Finally, link narrative change to policy reform. The rhetoric of engagement and aspiration should become leverage for stronger oversight, better financing, and expanded support for family caregivers. Otherwise, it risks becoming a distraction from the hard choices required to fix long-term care.
Beyond Marketing to Justice
The industry’s pivot to “next-stage living” should not be dismissed outright. It reflects genuine cultural shifts and may reduce the stigma surrounding aging. But advocates cannot allow a change in language to substitute for meaningful reform. If seized upon, this moment could move the debate toward dignity, autonomy, and equity in later life. If left unchallenged, it could become another marketing strategy that leaves structural problems untouched. Independent advocates have a responsibility — and an opportunity — to ensure the conversation moves beyond branding to justice.