Senior living a growth area for LeadingAge Ziegler 200 not-for-profit providers


Source: McKnights Senior Living

National Senior Communities in Washington, DC, retained its top spot for the eighth consecutive year on the 2023 LeadingAge Ziegler 200 list of largest not-for-profit multi-site senior living and care organizations, based on number of units. The 20th anniversary report was released Thursday.

NSC, formerly National Senior Campuses, is the supporting organization to the continuing care retirement communities developed and managed by Erickson Senior Living.

The LZ 200 list counts total units, including independent living, assisted living and skilled nursing. In the past 10 years, the average annual growth rate in total units was 2.2%, with independent living and assisted living growth each year but declines in the number of nursing care beds, according to LeadingAge and Ziegler. Memory care also is becoming increasingly important, with 60% of organizations on the list now offering specialized memory care units, the report noted.

The 2023 LZ 200 saw some movement among the top 10 overall providers. The Evangelical Lutheran Good Samaritan Society (No. 2), Ascension Living (No. 5), Trinity Health Senior Communities (No. 9) and Benedictine (No. 10) all retained their spots from the 2022 list.

Acts Retirement–Life Communities (No. 4), swapped places with Presbyterian Homes & Services (No. 3) this year. Lifespace Communities jumped from No. 8 last year to No. 6 this year, and HumanGood dropped to No. 7 this year compared with its No. 6 spot last year.

The 200 organizations represented a total of 300,000 market-rate units and almost 1,600 market-rate communities, based on data as of Dec. 31. Almont 30% of the total number of units for all long-term care systems in the LZ 200 are represented by the 10 largest providers. They are:

  1. National Senior Communities, Springfield, VA
  2. The Evangelical Lutheran Good Samaritan Society, Sioux Falls, SD
  3. Presbyterian Homes & Services, Roseville, MN
  4. Acts Retirement-Life Communities, Fort Washington, PA
  5. Ascension Living, St. Louis
  6. Lifespace Communities Inc., Iowa
  7. HumanGood, Pleasanton, CA
  8. Covenant Living Communities & Services, Skokie, IL
  9. Trinity Health Senior Communities, Livonia, MI
  10. Benedictine, Duluth, MN

Companies with the overall biggest changes in the number of units from 2022 to 2023 were BHI Senior Living in Indiana, which gained 1,103 units since last year, and Retirement Housing Foundation in California, which shed 1,563 units.

The organization offering the greatest number of independent living units was National Senior Communities, with 19,140. Presbyterian Homes & Services was the provider with the greatest number of assisted living units, at 2,867, and Good Samaritan was named the largest provider of skilled nursing, with 8,423 units.

Organizations provide market-rate senior living in 48 states, with Pennsylvania hosting the highest number of system headquarters, at 26, and Minnesota claiming the largest total number of communities, with 212.

An additional list of the country’s largest not-for-profit single-campus organizations was led by Shell Point Retirement Community in Fort Myers, FL, with 1,869 units. National Church Residences led the list of largest multi-site providers with total market-rate and affordable senior living units combined, with 25,063 units. Riderwood Village, a National Senior Communities campus in Silver Spring, MD, led the list of largest individual campuses, with 2,153 market-rate units.

Trends highlighted

This year’s report also includes insights into trends in future growth plans, joint ventures, third-party management, rental life plan communities, technology adoption and home- and community-based services.

Similar to the past several years, today’s not-for-profit providers primarily are growing through unit expansion and affiliation or acquisition activity, according to Ziegler President and CEO Dan Hermann. Approximately 71% of organizations said they intend to expand or reposition an existing campus in 2023 or 2024, about 16% said they intend to grow through construction of new communities, and 12% reported their intent to become bigger through affiliations.

Technology use continues to increase in the sector, with 72% of communities adopting electronic point of care/point of service documentation systems and electronic health/medical records. Other technology categories climbing in use among senior living and care providers included social connectedness/resident engagement (used by 60% of organizations), analytical tools (42%), staff and resident screening (55%), infection control technologies (55%), robotic process automation (30%) and physical robotics (70%).

Thirty-two percent of the 2023 LZ 200 organizations provide affordable senior housing, up from 31% last year.

The offering of HCBS also is growing through home health, home care, adult care, continuing care at home or Program for All-Inclusive Care for the Elderly programs: 45% of providers on the list offer HCBS services to non-residents, with continuing care at home now offered by more than 10% of LZ 200 organizations.

More than 75% of the LZ 200 organizations have a religious affiliation — predominantly Lutheran, Presbyterian, Methodist and Catholic — or a fraternal (2.5%) or military (0.5%) affiliation. Lutheran organizations represent the largest presence by number of units, with more than 50,000, followed by Presbyterian affiliations, with more than 41,500 units.

The complete LZ 200 report is available for download on the websites of LeadingAge and Ziegler.