As regular readers may know, I have been advocating for residents of Continuing Care and Life Plan Communities to have voting positions on Governing Boards for a number of years. I first raised this in a formal way when I testified in Washington, D.C., before the United States Senate Committee on Aging in July, 2010.
The reasoning is simple: residents on boards can provide real-life perspectives on all issues that impact operations, including but not limited to financial solvency concerns. Their voices “reality test” the positions taken by management. Residents on governing boards are not a panacea against irresponsible actions by officers, but certainly the fact that residents are “stakeholders” who are not just interested, but dependent, on long-term solvency gives them incentives to speak that may be missing with less-involved board members.
Recently, a guest speaker in my Spring 2026 course on “Nonprofit Organizations Law,” who is a long-serving Chairman of the Board for a federally qualified health center (FQHC) in Pennsylvania, shared his own experiences and support for “user” positions on governing boards. He noted that federal law actually requires at least “51%” of FQHC boards to be active patients of the facility. (Imagine that!) The law is found at 42 U.S.C. Section 254b(k)(3)(H)(i). The Chair noted that the patients raised points about the operations that he could not see easily as a mere “visitor” to the lobby and he welcomed their observations. This approach is consistent with a mantra offered by Disability Rights advocates: “Nothing About Us, Without Us.”
For more than ten years, Maryland law has required that CCRCs must have “at least one” resident (called a “subscriber” in the law) as a “full and regular member” on governing bodies. In apparent recognition of the importance of voting participation on boards, in 2026, the state legislature added a requirement that if the governing body has “only” one subscriber, it shall also have an “alternate subscriber” available if the “regular subscriber is unable to fulfill the subscriber’s duties,” including voting. The alternate is statutorily authorized to attend all meetings. See Md. Human Services Section 10-427 (as amended, effective January 1, 2026).
Since November 2025, I have been following several proceedings in federal bankruptcy courts in Pennsylvania where senior living operations (of various types) have filed Chapter 11 proceedings. Pennsylvania law currently does not “require” residents on governing boards — and in at least one CCRC bankruptcy court matter, I have noticed there was no resident on the governing board during the key years (in contrast to the history of residents as board members from earlier years) when the financial problems were deepening. The absence of a resident on the board does seem to matter — and the absence of a statutory mandate allows “gaps” without resident voices. At a minimum it means one “check and balance” was missing when boards were considering annual budgets, growth plans, scope of services, and the emerging financial problems.
That company is now emerging from a Chapter 11 process with new ownership that has already held productive “town halls” with residents. It will be interesting to see if the new “owner” of that enterprise also makes a “voluntary” decision to returns residents to their governing board.