Ownership transitions are a routine aspect of the long-term care industry lifecycle, frequently resulting from retirement, succession planning, or shifts in organizational strategy. With ongoing industry expansion, both the frequency and complexity of these transitions are increasing.
The assisted living sector has demonstrated sustained growth over the past decade. In the United States, more than 30,000 assisted living communities serve over 800,000 residents, reflecting increased demand associated with an aging population (The Senior List, 2026). However, workforce stability remains a significant challenge, as many providers experience high staff turnover rates that affect operational consistency and continuity of care.
Industry growth, ongoing ownership transitions, and workforce challenges have prompted providers to consider ownership structures that promote long-term stability, workforce engagement, and organizational alignment. For staff, changes in ownership can affect leadership structures and workplace expectations. For residents and their families, continuity of care and environmental stability remain primary concerns.
The Employee Ownership Trust (EOT) is one ownership model under consideration in this context. In an EOT, a trust holds a controlling interest in the company on behalf of employees. Employees do not hold individual shares but participate collectively through profit sharing and structured involvement in governance. Unlike Employee Stock Ownership Plans (ESOPs), EOTs do not require individual share allocation and are generally designed to reduce administrative complexity.
Organizations adopting an EOT typically establish governance structures that include trustees, boards of directors, and executive leadership, as well as defined profit-sharing frameworks and mechanisms for employee participation. Effective implementation requires clear communication, financial transparency, and alignment between ownership structure and daily operations. In regulated environments such as long-term care, compliance with state and federal requirements is essential.
The EOT model is well established in the United Kingdom, where it has been widely adopted since 2014. It is also gaining traction in the United States as organizations seek alternatives to traditional ownership transitions.
LiveOak Living Community, a Texas-based provider established in 2002, transitioned to an Employee Ownership Trust in 2025 as part of its ownership succession strategy. At the time, the EOT model was relatively uncommon in the United States. Within Texas, LiveOak was among the earliest adopters and one of approximately three organizations operating under this structure.
Implementation at LiveOak has emphasized integrating the EOT model into existing operations. More than 75 percent of staff now participate as employee owners, and approximately half are involved in employee-led committees focused on operations, organizational culture, and resident life. A profit-sharing distribution was issued in February 2026, establishing a direct link between organizational performance and employee benefit. Quarterly Town Halls serve as forums for reviewing financial performance, reinforcing transparency, and connecting individual roles to broader organizational outcomes. Governance is supported by a Board of Directors, a Trustee and Trust Protector, and employee-led committees.
Employee Ownership Trusts constitute one approach to ownership within long-term care. For organizations considering succession strategies, this model provides a structure that links ownership, operations, and workforce participation.
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By Rachel Medina, CEO of LiveOak Living Community, Angelica Carballo, Director of Development, and Janell Guerrero, Associate Director of Development
