It’s no secret that more assisted living communities are competing with skilled care operators for high-need residents. But a recent piece in the New York Times is sure to raise troubling questions about this emerging strategy.

The story in question is headlined “Where There’s Rarely a Doctor in the House: Assisted Living.” Its basic premise is that assisted living operators rarely have a physician on site or on call, whereas about half don’t even have nurses available. As a result, when a resident becomes ill or injured, communities can do little more than call 911 and wait for an ambulance.

The piece offers several interesting perspectives. One is from Christopher Laxton, executive director of AMDA – The Society for Post-Acute and Long-Term Care Medicine. It repeats an assertion Laxton earlier made in a guest blog appearing on the McKnight’s Senior Living website: that medical services should be offered as part of the assisted living experience.

“In the end, it’s time to stop talking about this and to start thoughtfully and intentionally integrating medical care into assisted living,” he noted.

Lindsay Schwartz, an executive with the National Center for Assisted Living, is quoted as saying “assisted living has certainly expanded its role in providing medical care over the years by adding nursing staff and partnering with other healthcare providers, among other ways.”

To be sure, that is absolutely the case. But it’s also the case that many assisted living operators remain reluctant to embrace medical care for two simple reasons. One is a fear of more lawsuits. The other is a fear of more regulations.

So what are we to make of all this?

I think some perspective might be helpful here. We should remember that assisted living has its roots in a real estate model that emphasizes hospitality over medical care. In fact, assisted living has until recent times positioned itself as a counterpoint to nursing home care. The promise made to residents and their loved ones was that more choice and independence could be exercised in an environment staffed with helpers, not healthcare professionals.

That clearly is changing.

What is not changing so quickly is the real estate equation. Most assisted living communities continue to look and feel quite a bit like independent living communities. And many independent living communities look an awful lot like apartment complexes.

The presentation may be more visually inviting than what a hospital can offer. But let’s face it, there’s a reason why hospitals (and other high-end post-acute environments) look the way they do.

It’s becoming increasingly clear that we are on the verge of a sector split. One camp likely will remain entrenched in the hospitality-based, private-pay model that was once the norm. But we also are going to see a glacial calving of communities that embrace on-site healthcare offerings as part of their service mix.

My strong suspicion is that as time goes on, necessity and opportunity will drive more operators into this second camp. And as that takes hold, it is going to become increasingly problematic for the rest to rely on the mercies of first responders.