Redefining Senior Care with Joe Walker (Larry H. Miller Senior Health)

In a recent episode of The Healthcare CEO Show produced by Allegrow, host Daniel Fernandez sat down with Joe Walker, President of Larry H. Miller Senior Health, to explore how a family-owned enterprise moved decisively into senior healthcare during one of the most challenging moments in modern public health. The conversation covers a sweeping agenda: why the Larry H. Miller organization refocused from sports and auto businesses to senior health, how it is building an integrated continuum of post-acute care, the realities of scaling across multiple states, and practical approaches to long-standing sector problems such as the caregiver shortage, fragmented post-acute markets, and the smart adoption of technology.

Introduction: A New Chapter in an Established Name

Larry H. Miller is a household name in the Mountain West, historically associated with sports ownership and one of the largest privately held auto dealer groups. Over the last several years, however, the Miller family has shifted its platform, deliberately investing in three core areas: senior health, sports entertainment, and real estate development. When they acquired the senior health business on December 31, 2020, at the height of the COVID-19 pandemic, they made a bold statement about the importance and resilience of senior healthcare.

Joe Walker, who now leads Larry H. Miller Senior Health, describes that acquisition and the subsequent pivot as a mission-driven decision: “Their stated purpose is to enrich lives,” Walker explained, and that purpose has guided investments across home health, hospice, assisted living, and skilled nursing. Today, the organization operates in 12 states with projects expanding into more markets, and the leadership is committed to building a coordinated, patient-centered post-acute continuum rather than isolated lines of service.

Why Build a Continuum of Care?

The traditional post-acute landscape is highly fragmented. Historically, short-term skilled nursing facilities (SNFs), home health agencies, hospice providers, and assisted living operators have functioned independently. Families faced the burden of navigating disjointed systems when a loved one experienced a decline in health, falls, strokes, or other acute events that triggered a transition out of the hospital.

Larry H. Miller Senior Health believes the future belongs to operators who can offer a meaningful segment of the post-acute continuum. This is not merely branding or vertical integration for its own sake. Instead, the continuum approach is grounded in demonstrable clinical and economic benefits: lower costs per episode, reduced readmissions, more consistent patient experience, and better clinical outcomes.

From a patient and family perspective, the continuum reduces decision friction. When the care team in an SNF can say, “If you need home health, we can provide it, and if assisted living should be next, we can help you transition seamlessly,” that message builds trust. It eliminates the need for families to start over with new providers at every juncture.

Operational Benefits of a Unified Continuum

• Improved care coordination across transitions.
• Reduced administrative friction in handovers.
• Consistent clinical pathways and standards across settings.
• Stronger relationships with referral partners such as hospitals and health systems.
• Brand trust that translates to patient preference and higher occupancy.

Walker and his team piloted integrated models in several markets and observed measurable improvements. That evidence became the basis for scaling up intentional expansion plans to bring integrated post-acute care to more communities.

From Local Brand to Multi-State Operator: Scaling with Intention

When an operator expands beyond its home market, it must overcome brand recognition gaps, regulatory differences, local competition, and talent recruitment challenges. Joe Walker emphasizes that the work starts well before opening doors: success hinges on stakeholder conversations and the capacity to deliver on promises made in those conversations.

The key to market entry is persuasive relationship-building with hospital presidents, health system leaders, physicians, and patient advocates. Those stakeholders must believe in a provider’s clinical model and trust its ability to reduce length of stay, lower episode costs, and keep patients safer post-discharge.

People Deliver the Promise

At the heart of every market expansion is the same truth: organizational success blossoms or fails on frontline caregivers and local leaders. Walker states plainly that while corporate strategy opens doors, “everything we try and do here in our corporate office rises and falls on the backs of our healthcare workers.” The right clinical leaders, skilled nurse managers, directors of nursing, therapists, and CNAs, are “gamechangers” whose presence can make or break a market launch.

Therefore, Larry H. Miller Senior Health invests in leadership bench development and local talent acquisition practices tailored to each market’s dynamics. They blend approaches, new construction where feasible, acquisitions when assets can be obtained below construction cost, and leasing where a market partnership makes sense.

Practical Approaches to Expansion

• Strategic acquisitions to accelerate market entry where construction is cost-prohibitive.
• Leasing legacy facilities from outgoing operators and implementing brand/clinical upgrades.
• Rigorous selection and development of local leaders to ensure operational surfacing of corporate standards.
• Conservative capital deployment to accommodate rising construction and labor costs.

The Demographic Imperative: Baby Boomers and the Capacity Gap

One of the central themes of the conversation is the demographic tidal wave approaching healthcare systems: “11,000 new people turning 65 every day,” Walker reminds listeners. That rate of aging will place unprecedented demand on post-acute services. Simultaneously, life-extension advances suggest longer lifespans, and therefore longer healthcare needs, potentially increasing the duration and intensity of care required by seniors.

This confluence of factors— rapidly growing senior population, rising life expectancy, higher quality expectations, and constrained capacity —creates a formidable policy and operations problem. Walker emphasizes that the market was already behind before the pandemic, and the pause in new construction during those years compounded delays: “Nothing got built for three years.” Now, rising construction costs and labor expenses make it difficult to justify new builds economically, so operators must be creative about how they expand capacity.

Why Capacity Won’t Catch Up Easily

1. High cost of construction and building materials increases project breakeven points.
2. Labor inflation and ongoing caregiver shortages increase operating expenses.
3. Reimbursement rates, particularly government-driven ones, are often inflexible and don’t keep pace with rising costs.
4. Fragmented ownership and a mix of financially distressed operators complicate industry consolidation and modernization.

Walker’s assessment is blunt: private capital has been aligning behind the baby boomer opportunity for years, but capital alone won’t close the gap if construction and workforce constraints persist. The industry needs scalable, pragmatic solutions that combine capital, talent, technology, and policy engagement.

Addressing the Caregiver Shortage: A Multi-Pronged Strategy

The workforce crisis is one of the most urgent challenges in senior care. Walker notes that fewer students are entering nursing programs, many healthcare workers plan to leave the field within a short timeframe, and burnout has accelerated retirements. Larry H. Miller Senior Health’s response is deliberately multi-pronged.

Retention and Meaningful Work

Retention begins with the work environment. Walker outlines initiatives designed to make healthcare roles sustainable and meaningful in the long run:

• Designing shifts and responsibilities that limit burnout and support work-life balance.
• Creating career ladders to help staff see progression from CNA to nurse to clinician to leader.
• Investing in employee development programs and dedicated talent teams focused on internal mobility and leadership cultivation.
• Maintaining an organizational culture focused on patient impact and pride in the work, sustaining the deep sense of purpose that many caregivers felt during the pandemic.

Expanding the Talent Pipeline

Long-term workforce scale requires new pipelines. Larry H. Miller Senior Health is engaged in programs that draw nontraditional candidates into caregiving careers. For example, the organization partners with initiatives like Proxima in Utah to recruit from disadvantaged communities. These programs emphasize wraparound support, helping recruits access public services for housing, childcare, food, and education, because often a single emergency expense or lack of support can derail an individual’s attempt to complete training and sustain employment.

Global and Policy Solutions

Walker also highlights international recruitment. Bringing nurses from the Philippines, Africa, and other regions is an important component. Yet he candidly recognizes the limits imposed by immigration policy and calls for pragmatic reforms: “I truly believe we will not solve this healthcare crisis without a common sense immigration solution.” The combination of local recruitment, domestic pipeline development, and international talent can be powerful, provided regulatory frameworks evolve to support mobility and timely licensure.

Innovation and Technology: Complementing Care, Not Replacing Humans

Technology is framed not as a panacea but as a multiplier that can help caregivers spend more time with patients. Walker is optimistic about what technology can do, from AI charting to robots that perform routine tasks. Yet, he emphasizes the right mindset: technology should increase meaningful caregiver-patient interactions, not simply replace staff.

Examples of Technology Initiatives

• Robotics pilots to explore passive tasks (water distribution, mobility assistance, routine vital checks).
• AI-enabled clinical documentation reduces administrative burden, freeing nurses for bedside care.
• Implementing interoperable care platforms across continuum settings can minimize information loss during transitions.
• Virtual therapy tools and telehealth integration for extending clinical reach into home and assisted living settings.

Walker highlights the speed of technological progress during the COVID era, pointing to the mRNA vaccine development timeline as an example of rapid scientific and technological achievement. He argues that healthcare can similarly benefit from accelerated adoption, though the sector will likely remain a late adopter until margin structures allow more investment.

Interoperability: The Hidden Challenge

One of the biggest technical obstacles is interoperability. With roughly 13,000 skilled nursing facilities nationwide and highly fragmented ownership, achieving seamless data exchange across electronic health records (EHRs), therapy platforms, and remote monitoring tools is a systemic challenge. Walker suggests that when policymakers mandated EHR adoption under Obamacare, they missed an opportunity to enforce consistent data standards that would support cross-setting continuity. Going forward, concerted industry efforts and regulation are needed to standardize how health data travels across the post-acute continuum.

Designing Assisted Living Differently: Therapeutic, Goal-Oriented Care

Assisted living is often viewed as a one-way trajectory into institutionalization. Walker challenges that assumption. In one example, after acquiring an assisted living community and investing a modest capital upgrade (including replacing a small movie theater with a gym and therapeutic spaces), the organization helped nine residents recover enough to return home within 18 months.

That outcome is emblematic of the philosophy driving Larry H. Miller Senior Health: assisted living can be a site of restoration and rehabilitation, not merely custodial care. The problem is that such restorative outcomes may not align with traditional financial metrics, because success can reduce long-term census and occupancy. Walker calls this “the right thing for patients but a terrible business model” if operators remain focused purely on occupancy rates rather than population health outcomes.

Principles for Restorative Assisted Living

• Invest in physical therapy and occupational therapy to maximize independence.
• Design social and physical environments that encourage engagement and mobility.
• Create individualized care plans with measurable recovery goals and timelines.
• Measure success in terms of patient outcomes (discharges to home, functional improvement), not just census.

Capital, Mission, and Long-Term Orientation

One of the distinctive advantages of Larry H. Miller Senior Health is its alignment with mission-driven capital. Rather than being beholden to short-term quarterly returns typical of public companies or private equity timelines, the Miller family office seeks to “enrich lives”. It is willing to support investments that might compress short-term margin but produce better long-term outcomes for patients and employees.

Walker points to a fundamental advantage of this capital structure: the ability to prioritize investments that enhance patient outcomes and employee conditions even when those decisions delay or reduce immediate financial returns. When he raises capital needs for patient-centered investments, his primary interlocutor is often Gail Miller (the family principal), and the first question is, “How are our patients doing?” That orientation changes the calculus for what projects are approved and how success is measured.

Why Mission-Driven Capital Matters

• It enables patient-centered investments with longer payoff horizons.
• It reduces pressure to pursue tactics that maximize short-term margins at the expense of care quality.
• It attracts leaders and clinicians who value mission and impact over purely financial incentives.
• It can inspire other family offices and long-term capital to enter the sector with similar expectations for patient outcomes.

Challenges and Strategic Priorities

As the organization charts a path forward, Walker identifies two central imperatives: discipline and focus. With so many unmet needs in the senior care ecosystem, from affordable housing and workforce development to memory care innovation and home-based care, there is a temptation to try to solve everything. Walker counsels restraint: pick the problems the organization can solve best and stay disciplined, while collaborating with partners for complementary solutions.

He also underscores reputational and industry challenges. The senior care industry has endured negative press due to historical failures and lapses in care. Overcoming stigma requires relentless quality improvement, transparency, and public education so families understand that modern senior care can enhance life rather than merely substitute for it.

Top Challenges Identified

1. Rising construction and operating costs amid inflexible reimbursement systems.
2. Workforce shortages and the associated risk to care quality and expansion plans.
3. Overcoming negative public perceptions and stigma associated with institutional care.
4. Technology interoperability and the slow pace of sector-wide digital standardization.
5. Maintaining focus amid numerous potential opportunities and social problems that need attention.

Opportunities to Lead and Influence

Despite the challenges, Walker believes the organization has a unique window of opportunity. The combination of mission-driven capital, an experienced operations team, and a willingness to experiment with new models positions Larry H. Miller Senior Health to be a leader in shaping the modern senior care ecosystem.

Potential areas of influence include:

• Championing integrated continuum models that reduce fragmentation and improve patient outcomes.
• Demonstrating restorative assisted living models that return residents home whenever possible.
• Piloting technology applications that measurably improve caregiver efficiency and patient time with clinicians.
• Scaling workforce innovations, including community-based recruitment and robust retention programs.
• Using mission capital as a template for other family offices and long-term investors to follow suit.

Leadership Lessons and Practical Advice

Walker shares practical leadership advice that applies to healthcare executives at every level. Key themes include beginning with the end in mind, maintaining focus on patient outcomes, and cultivating organizational humility about what any single company can accomplish alone.

“Begin with the end in mind,” Walker advises. “The privilege of being in healthcare for me is that healthcare is where we’re all human…We take people in some of their darkest moments and we help bring them back.”

This perspective anchors strategic trade-offs and daily decisions. When leaders keep patient outcomes and the human consequences of their decisions central, financial, operational, and cultural choices tend to align more sustainably.

Recommended Readings

Walker cited two books that have shaped his thinking: Jim Collins’ Good to Great, which underscores disciplined focus and the importance of organizational culture in achieving exceptional performance; and Atomic Habits by James Clear, which explores how small, consistent changes can compound into meaningful personal and organizational improvement.

Practical Steps for Healthcare Executives

• Clarify your organization’s mission and let it guide capital allocation and operational priorities.
• Invest in leader development and ensure there is bench strength before expanding into new markets.
• Measure outcomes beyond traditional financial metrics, track discharges to home, readmissions, patient-reported outcomes, and caregiver retention.
• Be realistic about the role of technology: pursue tools that free caregivers to spend more time with patients, and prioritize interoperability.
• Engage in community-based pipeline programs to broaden recruitment and reduce attrition risks.

Case Study: Turning Assisted Living into a Pathway Back Home

A practical vignette from Walker’s work illustrates the broader strategy in action. After acquiring an assisted living facility, the organization invested a few million dollars to upgrade the site to therapeutic standards, adding a fitness space and removing an eight-seat theater to create a gym and rehab areas. Over 18 months, nine residents who had believed they could no longer live independently regained enough function to return home.

That outcome demonstrates several lessons:

• Capital investments targeted at therapy and rehabilitation can return outsized human benefits even when they compress short-term margins.
• Assisted living should be reimagined as an active recovery environment rather than a passive holding space.
• Success should be measured in lives improved and independence regained, not just occupancy statistics.

How to Think About Partnerships and Ecosystem Work

No organizational approach can fully solve the sector’s problems alone. Walker argues for the importance of constructive partnerships across hospitals, payers, technology vendors, academic institutions, and other providers. Rather than trying to own every element of the continuum, the more realistic and scalable approach is to excel at a defined set of services and partner where complementary expertise is required.

Partnership examples include:

• Integrated care pathways with local hospitals and health systems for predictable transitions.
• Technology partnerships focused on interoperability and clinician workflow enhancement.
• Community education and outreach to reframe public perceptions of senior care.
• Workforce development partnerships with community colleges, NGOs, and immigrant support organizations.

Frequently Asked Questions (FAQ)

Q: What does “continuum of care” mean for senior health in practical terms?

A: Continuum of care refers to organizing services so patients experience a coordinated journey across settings, hospital, short-term skilled nursing, home health, assisted living, and hospice, without losing information, standards of care, or continuity of relationships. Practically, this involves shared care plans, interoperable data, consistent clinical protocols, and a single brand or care team guiding patients and families through transitions.

Q: How does mission-driven capital change strategic decisions?

A: Mission-driven capital enables long-term investments that prioritize patient outcomes and workforce sustainability over immediate financial returns. It creates space to invest in rehabilitative services, clinician development, and technologies that may take longer to pay back but produce better long-term value for patients and communities.

Q: Is technology going to replace caregivers?

A: No. The goal is augmentation, not replacement. Technology should reduce administrative burden, automate routine tasks, and enable clinicians to spend more time at the bedside. Robotics and AI can handle tasks like passive vital monitoring, repetitive supplies distribution, or documentation assistance, but the relationship between caregiver and patient remains irreplaceable, especially in senior care.

Q: What are realistic ways to address the caregiver shortage now?

A: A multifaceted approach is required. Short-term strategies include retention incentives, scheduling changes to reduce burnout, and targeted recruitment. Mid- to long-term strategy involves building domestic training pipelines, partnering with community programs that provide wraparound support, and pursuing pragmatic international recruitment policies. Policy reform around immigration and more predictable reimbursement models would also help address structural issues.

Q: How can assisted living be therapeutic rather than custodial?

A: By reallocating resources toward therapy services, designing spaces that encourage mobility and engagement, creating measurable functional goals for residents, and aligning reimbursement or funding mechanisms with restorative outcomes rather than occupancy alone. Assisted living can be structured as a short-term, goal-driven phase with the explicit aim of returning residents to independent living wherever possible.

Q: Is the industry ready for widespread interoperability and data-sharing?

A: Not yet. The industry remains fragmented, and past policy efforts did not standardize data formats sufficiently. However, momentum is building around interoperable standards, and leading operators that prioritize seamless data flow across their own continuum can serve as proof points for broader adoption. Public policy and vendor commitment to open standards will accelerate this transition.

Conclusion: Building Extra Weddings, Extra Holidays, Extra Memories

The vision Joe Walker lays out for Larry H. Miller Senior Health is grounded in a simple, powerful human outcome: enabling families to share more moments with the people they love. He frames the work not as an industry chasing margins but as a public-purpose endeavor, creating “extra weddings with grandma,” “extra Christmases,” and more memories that would not otherwise exist.

That perspective informs strategy across capital decisions, workforce investments, technology pilots, and service design. It demands discipline, choosing a set of problems to solve exceptionally well, and the humility to partner where other stakeholders can contribute. Walker’s leadership offers a template for mission-driven growth: start with patient outcomes, invest in leaders and caregivers, and apply technology thoughtfully to multiply human connection.

For healthcare executives wrestling with the same structural challenges, the practical counsel is clear: maintain focus on the end in mind, build talent pipelines that are resilient and inclusive, and let mission-guided capital steer investments that produce durable, measurable improvement in the lives of seniors.

As the baby boomer wave continues to reshape demand, organizations that can combine capital, compassion, operational excellence, and technological enablement will be the ones delivering not only better care metrics but also the most meaningful human outcomes. Larry H. Miller Senior Health’s journey, from a pandemic-era acquisition to a multi-state operator experimenting with continuum models, is a case study in what disciplined, mission-centered scaling can achieve.

Final Thought

In a sector where the stakes are measured in human relationships and years of life with dignity, the combination of vision, capital, patience, and relentless focus on the patient experience is not just a competitive advantage; it is a moral imperative.