A Data-Driven Guide for Senior Living & Long-Term Care Owner/Operators

Audience: CFOs, risk managers, owners, boards
Scope: U.S. senior living and long-term care (SNF, AL, IL, MC, CCRC and related aging services)

How to Use This Report

Each year, Echo Assurance analyzes:

• P&C industry outlooks from rating agencies and reinsurers
• Broker market reports focused on senior living and aging services
• Rate and capacity trends across property, casualty, and specialty lines

to help senior living owner/operators:

1. Anticipate where pricing pressure will rise or ease

2. Prepare smarter, earlier renewal strategies

3. Budget with more confidence

4. Identify opportunities to strengthen coverage and potentially reduce costs

This 2026 outlook is grounded in public market data. However, market conditions can change quickly—especially after major CAT events or legal shifts—so treat this as a roadmap, not a guarantee.

1. Big Picture: Where the P&C Market Stands Heading into 2026

1.1 Overall P&C Industry Health

Several independent sources point to a profitable but increasingly competitive P&C market heading into 2026:

• • Swiss Re projects US P&C premium growth of about 5% in 2025 and 4% in 2026, with industry ROE around 10% in both years and combined ratios deteriorating modestly toward ~99% by 2026 as rates decelerate and catastrophe activity remains elevated. 
  • Deloitte’s 2026 global insurance outlook notes that P&C is moving from a long hard cycle into a period of slower premium growth and margin pressure, driven by heightened competition and diminishing rate momentum. 
  • Fitch maintains a neutral sector outlook for US P&C in 2026, expecting combined ratios in the 96–97 range and returns on surplus around 9–10%, supported by strong capital and investment income even as rates soften. 

At the same time, global commercial insurance rates have declined for five consecutive quarters through Q3 2025—down ~4% globally in Q2 and Q3 2025—driven largely by property rate reductions and abundant capacity. 

What this means for you:

• • The overall P&C industry is entering 2026 from a position of strength, not distress.
  • Competition is returning, particularly in property and some specialty lines, creating opportunities to improve terms and pricing.
  • However, liability lines remain under pressure from social inflation and litigation trends, especially in healthcare and long-term care.

2. The Senior Living & Aging Services Landscape

2.1 Operating Context

Senior living and long-term care face a unique mix of tailwinds and headwinds:

• • The U.S. 65+ population is projected to reach ~82 million by 2050, nearly double 2020 levels, ensuring sustained demand for senior housing and care. 
  • Aging infrastructure, staffing shortages, wage pressure, and inflation are pushing operating margins down. 
  • New CMS minimum staffing standards for nursing homes (3.48 hours of nursing care per resident per day for Medicare/Medicaid facilities) are increasing labor costs and liability exposure for skilled nursing.

CRC, EPIC and others describe an environment where demand is strong but risk is elevated, driven by:

• • Private equity ownership and M&A reshuffling operators and standards
  • Regulatory scrutiny in states like CA and FL
  • Persistent nuclear verdicts and litigation funding in healthcare liability

2.2 Senior Living–Specific Insurance Conditions

Several senior living–focused broker reports paint a consistent picture:

• • WTW’s “Insurance Marketplace Realities 2026 – Senior Living” gives explicit rate predictions by line for 2026:
    • Healthcare professional liability (including GL/PL towers): flat to +15%, with excess layers seeing the higher end
  • Property: flat to +7%
  • Auto liability: +10% to +20%
  • Workers’ compensation: –5% to +5%

The same WTW report highlights: limited capacity, especially in litigious venues (NY, NJ, CA, FL, Philadelphia, Cook County); capacity for most accounts generally in the $5–15M per carrier range; and increasing reluctance to deploy large excess limits. 

• • EPIC’s 2025 Aging Services report notes property replacement costs up ~45% from 2020–2023, increased CAT-driven property costs, and underwriters viewing senior care facilities as high risk, particularly in disaster-prone states.
  • AmWINS describes the liability market for senior care as fragmented, with experienced carriers cutting limits and tightening terms, while new entrants undercut price—especially in memory care and dementia operations, where higher deductibles, abuse sublimits, and exclusions are common. 
  • CRC emphasizes that senior living demand is rising but so are nuclear verdicts, staffing and regulatory pressures, and that success increasingly depends on how well you tell your story and document your controls. 

Bottom line:

• • Property and workers’ compensation offer the best opportunities for relief or stability in 2026, particularly for well-run, non-CAT-exposed portfolios.
  • Professional and general liability remain structurally challenging, especially in high-hazard venues or distressed operations.
  • Auto liability is a problem child: frequency/severity and resident transport exposures are under intense scrutiny.

3. Line-by-Line Outlook for 2026 (Senior Living Focus)

3.1 Senior Living Professional & General Liability (Including Abuse/Molestation)

Rate Outlook (2026):

• • WTW: Flat to +15%, with excess layers at the higher end of the range. 
  • Other senior care specialists (EPIC, AmWINS, CRC) confirm that claim severity and nuclear verdicts remain elevated, particularly for falls, pressure injuries, abuse, elopement and wrongful death.

Key Drivers:

• • Social inflation & nuclear verdicts: Slip/fall cases that once settled around $150K are more commonly resolving in the $300K range or higher, especially in plaintiff-friendly venues. 
  • Staffing & acuity: Chronic staffing shortages, burnout, reliance on agency staff, and rising resident acuity (especially dementia) drive both frequency and severity of claims.
  • Venue & regulatory environment: CA, FL, NY, NJ, parts of PA and IL remain heavily scrutinized. Tort reforms (e.g., Georgia Senate Bill 68) may help at the margins but have not reversed national trends yet. 

Capacity & Terms:

Typical per-claim limits from a single carrier: $1–5M primary, excess capacity often $5–15M per carrier, with some carriers cutting excess offerings from $10M down to $5M layers. 

1. More frequent:

• • • Abuse sublimits
    • Class action exclusions
    • Punitive damage exclusions
    • Communicable disease / COVID-type limitations 

Implications for 2026 in the property and casualty insurance market:

• • Expect continued upward pressure on pricing and deductibles for loss-challenged accounts, high-hazard venues, memory care–heavy portfolios, and distressed operators.
  • Best-in-class operators (strong CMS/star ratings, clean survey history, robust staffing metrics, documented falls and elopement controls) may see flat to single-digit increases if marketed well.

3.2 Property

Rate Outlook (2026):

• • WTW (senior living): Flat to +7%. 
  • Broader commercial property market: Gallagher, Ryan Specialty and IMA report a softening trend in 2025 with expanded capacity and competitive pricing, though CAT-exposed risks remain challenging. 

Key Drivers:

• • CAT losses remain high (convective storms, wildfires, floods), but reinsurance pricing has started to ease and new capital has entered, driving competition. 

Property replacement costs rose roughly 45% from 2020–2023 for aging services facilities, driven by construction inflation and supply chain issues.

Underwriters are intensely focused on:

• • Adequate TIV and BI valuations
  • Sprinklers (including attics), roof age, plumbing and HVAC age
  • Water damage controls and deductibles
  • CAT modeling and secondary modifiers (roof type, elevation, defensible space, etc.) 

Implications for 2026:

• • For non-CAT, well-maintained portfolios with good loss history, property is one of the most “insured-friendly” lines in 2026. Rate decreases are possible in competitive marketing situations, though senior living is still viewed as high-risk habitational. 
  • For CAT-exposed, older, or loss-heavy facilities, expect above-average increases, higher deductibles, and close scrutiny on coinsurance, BI limits, and flood/wind/hail sublimits.

3.3 Auto Liability (Including Resident Transport)

Rate Outlook (2026):

• • WTW senior living: +10% to +20%. 
  • Broader P&C: commercial auto remains one of the most challenged lines, with elevated loss trends compared to other commercial segments. 

Key Drivers:

Large passenger vans and transport vehicles used for resident transportation are harder and more expensive to insure.

• • Underwriters now routinely require:
  • Detailed driver lists and MVR criteria
  • Documented driver training, telematics, and minimum personal auto limits
  • Clear controls on resident loading/unloading, wheelchair tie-downs, supervision during transport 

Implications for 2026:

• • Expect continued double-digit rate increases unless you can demonstrate disciplined fleet safety and low loss frequency.
  • Resident transport is often a go/no-go issue for some markets; creative use of vetted ride-share programs (Uber/Lyft senior options) is increasingly discussed to manage exposure. 

3.4 Workers’ Compensation

Rate Outlook (2026):

• • WTW senior living: –5% to +5%. 
  • Multiple market reports describe workers’ comp as a profitable, “bright spot” line, providing budget relief even as other casualty lines struggle. 

Key Drivers:

Despite high injury rates—up to ~93% of nursing homes reporting at least one occupational injury annually—pricing remains more stable due to strong underlying line profitability and competition among carriers.

Underwriters scrutinize:

• • Use of 1099 caregivers (many carriers push to treat them as employees) 
  • Return-to-work programs and modified duty
  • Injury prevention, lift equipment, falls prevention, and training

Implications for 2026:

Many senior living operators can reasonably budget for flat to modestly down WC pricing, particularly where they can show:

• • Strong safety culture
  • Declining frequency
  • Early-return-to-work success stories

3.5 Cyber, D&O and EPL (Briefly)

While not in WTW’s senior living rate table, these lines are increasingly material for operators:

• • EPIC notes healthcare and aging services as among the costliest industries for cyber breaches, relying heavily on digital systems and storing large volumes of PHI.
  • Marsh’s global market index shows continued rate decreases in financial and professional lines (including cyber and D&O) in 2025 as capacity and competition increase, though senior living’s high-sensitivity data and ransomware exposure mean underwriters remain selective. 
  • EPIC reports rising EPL claims with average settlements around $75K and average jury awards around $217K, along with increased discrimination and wrongful termination suits in aging services.

Implications for 2026:

• • Cyber and management liability may offer pricing relief or broader limits for operators with good controls (MFA, backups, training, governance), but expect underwriters to ask more detailed questions.
  • EPL is likely to track broader liability trends: ongoing pressure in high-turnover, low-wage environments with staffing mandates and workforce litigation.

4. Where Pricing Pressure Will Rise or Ease in 2026

4.1 Likely Pressure Points

You should plan for continued or rising pressure if you have:

Facilities in high-hazard venues (CA, FL, NY, NJ, Philadelphia, Cook County, etc.) 

Significant losses from:

• • Falls, elopements, resident-on-resident aggression
  • Abuse, neglect, or high-profile deaths
  • Large auto losses involving residents or staff
  • Memory care–heavy portfolios with limited locked-door protocols, inadequate staffing ratios, or poor documentation 
  • Aging, CAT-exposed buildings with inadequate valuations, limited mitigation, or poor loss history

In these situations, assume:

• • PL/GL: +10–25% is realistic in 2026 if losses or venue are adverse (the upper end extrapolates beyond the WTW base range, but is consistent with current trends for distressed risks)
  • Auto: +15–30%
  • Property: high single-digit to double-digit increases if CAT-exposed or loss-heavy

4.2 Areas Where Pressure Is Likely to Ease

Conversely, you may see flat or improving outcomes if you can credibly present as:

• • Best-in-class operator
  • Higher CMS star ratings and favorable survey history 
  • Documented fall-prevention, elopement prevention, and abuse prevention programs
  • Stable staffing with low agency use

Well-maintained, non-CAT property portfolio

• • Updated roofs, sprinklers (including attics), water controls
  • Accurate valuations

Strong workforce management

• • Mature return-to-work and safety programs
  • Declining frequency trends

In the current environment of softening commercial property and specialty rates, many clean senior living accounts will be able to: 

• • Hold property and WC flat or even secure modest rate reductions
  • Hold primary pro/GL near flat, while carefully structuring excess placements
  • Negotiate more favorable terms/conditions (not just price)

5. Renewal Strategy Playbook: How to Prepare Smarter & Earlier

Think in terms of a 180–240-day runway for major renewals, especially where you have size, complexity, or known loss issues.

5.1 6–8 Months Before Renewal

1. Build a unified “story of the operator.”
Draw on themes stressed by AmWINS, CRC, EPIC and WTW: submissions that tell the full story consistently receive better terms. 

Include:

• • Ownership and governance: who makes care decisions vs. who owns the real estate
  • Portfolio map: number of facilities, bed mix (SNF, AL, IL, MC), geography
  • High-level operating metrics: census, acuity mix, staff-to-resident ratios, turnover

2. Clean up loss history and documentation.

• • Compile 10 years of loss runs where possible, including prior owners if the facility changed hands. 
  • Summarize large losses with cause, corrective action, and current status.
  • Highlight favorable trends (decreasing frequency, improved severity, improvements after a tough year).

3. Validate property values and CAT profile.

• • Revisit replacement cost and BI values; under-valuation is a deal-breaker in 2026.
  • Document roof age, sprinklers (including attics), water damage mitigation, and critical infrastructure upgrades.

5.2 3–5 Months Before Renewal

4. Deep dive into operational risk controls.

Underwriters explicitly value:

Staffing & quality metrics

• • Ratios by shift
  • Use of agency staff
  • Training programs,
  • Tenure data

Clinical risk programs

• • Fall prevention, pressure injury prevention, elopement prevention
  • Incident reporting and follow-up

Technology

• • EMR, eMAR systems
  • Falls detection or monitoring technology
  • Cybersecurity controls (MFA, backups, segmentation)

5. Align the program structure with your risk appetite.

• • Model the tradeoff between higher retentions and premium credits; WTW notes that increased retentions often don’t earn commensurate premium relief in this space, so you should validate any proposed changes quantitatively. 
  • Review tower design: primary vs. excess, abuse limits, defense-inside vs. outside limits, tail coverage vs. discontinued operations.

6. Engage markets early and strategically.

• • Senior living has limited specialist markets. Early, transparent partnership with carriers pays off, particularly after a bad claim year. 
  • Use wholesalers with deep senior care expertise when accessing E&S or specialty programs.

6. Budgeting Framework for 2026

Below is a practical budgeting lens based on current published rate guidance plus observed market behavior. Actual results will vary, but this can anchor your 2026 budgeting conversation.

6.1 Illustrative 2026 Rate Planning Ranges (US Senior Living)

For portfolio-level planning (not a guarantee):

Best-in-Class Operator

Strong financials and surveys, high star ratings, non-CAT properties, low loss frequency

• • Professional/GL: –5% to +5% (within WTW’s flat to +15% range for the segment) 
  • Property: –5% to +5% (WTW base flat to +7%; competitive markets may dip below flat for clean risks) 
  • Auto: +5% to +15% (lower half of WTW’s +10–20% range if fleet control is strong) 

WC: –10% to +5% (reflecting ongoing profitability and competition) 

Typical / Mixed-Performance Operator

Moderate losses, mixed survey results, some older buildings, some staffing challenges

• • Professional/GL: +5% to +15%
  • Property: flat to +10%
  • Auto: +10% to +20%

WC: –5% to +5%

Distressed Operator or High-Hazard Portfolio

Adverse loss history, weak surveys, heavy memory care or high-hazard venues

• • Professional/GL: +15% to +30% (some accounts see even higher)
  • Property: +10% to +25% (especially CAT-exposed or under-maintained)
  • Auto: +15% to +30%
  • WC: flat to +10% (if loss experience is poor)

These bands are illustrative scenario ranges, not hard predictions, but they are consistent with currently published segment guidance and broader market behavior.

7. Where to Look for Coverage Improvements & Cost Savings

7.1 Property & CAT Strategy

In a softening property market, the levers to pull are:

Valuations & BI: Bring credible third-party support for TIV and BI calculations to protect against punitive coinsurance or margin clauses.

Deductible and sub-limit engineering:

• • Trade higher wind/hail deductibles for rate relief where appropriate
  • Negotiate flood, water damage, and equipment breakdown terms carefully

Engineering partnerships: Respond proactively to loss-control recommendations; property underwriters are more willing to compete on accounts that show they take engineering seriously. 

7.2 Liability Tower Optimization

• • Abuse & molestation limits: ensure abuse coverage carries to the top of the excess tower where possible; WTW notes capacity is currently available. 
  • Defense outside the limits: given verdict severity, prioritize defense-outside-limits structures where attainable. 
  • Tail vs. discontinued operations: for divested facilities, carefully compare tail options vs. blending into ongoing programs; Echo currently favors tail purchase and removal from existing policies for clarity. 

7.3 Alternative Risk & Program Design

For larger portfolios, some brokers and advisors highlight:

• • Captives, risk retention groups, and large-deductible structures as tools for operators facing limited capacity, especially with rapidly rising liability costs or carrier exits. 
  • These structures may help stabilize long-term costs, but they require strong risk management, good data, and enough scale to absorb volatility.

7.4 Cyber & Management Liability

Given the broader softening in financial and professional lines:

Review cyber and D&O/EPL for:

• • Limits adequacy vs. today’s claim costs
  • Opportunities to broaden coverage (e.g. ransomware, business interruption, regulatory investigations)
  • Potential rate relief in 2026 for operators with strong controls and clean loss history

8. Practical Checklist for CFOs, Risk Managers, and Owners

To put this into action for 2026:

1. 1. Set line-by-line budgeting assumptions now using scenario ranges for best-case, base-case, and worst-case outcomes.

   2. Start your renewal process 6–8 months out, especially if you have size, complexity or loss challenges.

   3. Invest time in your narrative: ownership, staffing, quality metrics, technology, and risk-mitigation efforts must be clearly documented in the submission.

   4. Use the property softening strategically: shop CAT and non-CAT property where it makes sense, but don’t sacrifice relationship and claims handling quality for small rate wins.

   5. Protect your liability tower: focus on abuse limits, defense-outside-limits, venue management, and robust documentation—especially for falls, elopement and abuse.

   6. Leverage workers’ comp and cyber as areas where strong risk management can produce both coverage enhancements and cost relief.

   7. Consider alternative risk solutions if you are consistently facing double-digit liability increases and have the scale and risk appetite to justify a captive or RRG.