Presbyterian Homes and Services tops the 2024 LeadingAge Ziegler 200 list of the largest nonprofit, multi-location senior living and care organizations by number of assisted living units with 2,927 units, while National Senior Communities leads by number of independent living units with 19,026 units.
The rankings were released on Thursday.
National Senior Communities also maintained its top spot in the overall rankings, keeping it at the top for the ninth consecutive year.
NSC (formerly National Senior Campuses) is a Washington, DC-based organization that supports continuing care retirement/life planning communities developed and managed by Erickson Senior Living.
The LZ 200 list ranks the nation’s 200 largest nonprofit senior living organizations based on the number of independent living, assisted living and skilled nursing units as of Dec. 31, 2023. The report also highlights the largest single-site providers, the largest affordable senior housing providers and providers that provide management services to other senior living and care communities.
Here are the top five U.S. providers with the most assisted living units on the 2024 list:
Presbyterian Homes and Services (Roseville, Minnesota) Evangelical Lutheran Good Samaritan Society (Sioux Falls, South Dakota) Cassia (Edina, Minnesota) Benedictine (Fridley, Minnesota) Ecumene (Shoreview, Minnesota)
Here are the top five U.S. providers with the most independent living units on the 2024 list:
NSC, Washington, DC Acts Retirement–Life Communities and affiliates, Fort Washington, Pennsylvania Presbyterian Homes and Services, Roseville, Minnesota Lifespace Communities, Dallas Good Samaritan Society, Sioux Falls, South Dakota
There were few changes in the top 10 organizations overall for 2023. Acts and Presbyterian Homes and Services swapped places from last year’s No. 2 and No. 3, HumanGood moved up from No. 7 in 2023 to No. 6 this year, Covenant Living Communities and Services also moved up from No. 8 last year to No. 7 this year, and Lifespace Communities dropped from No. 6 last year to No. 8 this year.
Across the 200 organizations, a total of 300,000 market-price units and approximately 1,600 market-price communities are represented. The top 10 are:
NSC, Washington DC Good Samaritan Society, Sioux Falls, SD Act, Fort Washington, Pennsylvania Presbyterian Homes and Services, Roseville, Minnesota Ascension Living, St. Louis HumanGood, Pleasanton, California Covenant Living Community & Services, Skokie, Illinois LifeSpace Community, Dallas Trinity Health Senior Community, Livonia, Michigan Benedict, Fridley, Minnesota
Pacific Retirement Services in Oregon saw the largest increase in units from 2022 to 2023, up 871 units, while Good Samaritan Society saw the largest decrease, down 2,540 units.
On the list of the largest single-campus senior living and care facilities in the country, Shell Pointe Retirement Community in Fort Myers, Fla., once again topped the list with 1,870 units. Riderwood Village, an NSC campus in Silver Spring, Md., topped the list of largest individual campuses with 2,147 units.
Additional Insights
This year’s report includes insights into trends related to home- and community-based services, third-party management, renal CCRCs, technology adoption, joint ventures and future growth plans. As in past years, not-for-profit senior living and care providers are growing primarily through unit expansion and partnership or acquisition activity, Ziegler President and CEO Dan Hermann noted in the report.
When it comes to future growth plans, about 74% of the organizations on the list said they plan to expand or reposition their existing campuses this year or next, while 12% plan to grow through new construction and 17% plan to grow through partnerships.
IL and AL units are increasing, SNF beds are decreasing
The 20 largest senior living and care facilities companies account for approximately 30% of the total number of units across all systems featured in the report. Over the past decade, the average annual growth rate in total units has been 2.1%, with independent and assisted living growing each year while the number of nursing beds has decreased. Memory care units are growing in importance, with 70% of LZ 200 companies reporting that they offer specialized memory care units.
Pennsylvania had the most system headquarters on the list, while Minnesota had the most total communities with 238.
Several organizations on the list reported receiving accreditation from a variety of organizations: A total of 105 communities on the list are accredited by the Commission on Accreditation of Rehabilitation Facilities, 42 are accredited by the Educational Assessment Guidelines for Excellence, and 28 are accredited by the Joint Commission on Accreditation of Healthcare Organizations.
Many businesses have demonstrated a commitment to affordable senior housing, with 36 percent of organizations on the list owning affordable housing units. National Senior Communities tops the list with 21,871 affordable senior housing units, followed by National Church Residences with 21,522 units.
HCBS offerings are also on the rise, with 45% of companies offering some form of HCBS, including home health care, home nursing care, adult day care, home continuing care programs, comprehensive senior care programs, etc. The home continuing care model is now offered by more than 16% of companies on the list, up 3% from last year’s report.
An average of 73% of communities on the list reported having electronic point-of-care/point-of-service documentation systems and electronic health/medical records in place. Adoption of health and wellness technologies, such as medical monitoring and telehealth remote monitoring, was low.
Other technologies seeing increased use in senior living and care facilities include those that facilitate social connections and resident engagement (60%), analytics (47%), staff and resident screening (50%), infection control (51%), robotic process automation (32%) and physical robots (68%).
Consistent with the 2023 report, 36% of organizations reported engaging in joint ventures, most commonly with other providers, health systems, or home health/home care agencies.
The complete LZ 200 report can be downloaded from the LeadingAge and Ziegler websites.
