Presbyterian Homes and Services tops the 2024 LeadingAge Ziegler 200 list of largest not-for-profit multi-site senior living and care organizations with respect to assisted living units, with 2,927 units, and National Senior Communities tops the list based on total independent living units, with 19,026 units.
The rankings were released Thursday.
National Senior Communities also retained its top spot on the overall list, which marked its ninth consecutive year in that spot.
NSC, formerly National Senior Campuses, is based in Washington, DC, and is the supporting organization to the continuing care retirement / life plan communities developed and managed by Erickson Senior Living.
The LZ 200 list ranks the nation’s 200 largest not-for-profit senior living organizations across the county as of Dec. 31, 2023, counting total units in independent living, assisted living and skilled nursing. The report also highlights the largest single-site providers, the largest affordable senior housing providers, and providers offering management services to other senior living and care communities.
The top five US providers on the 2024 list with the most assisted living units are:
- Presbyterian Homes and Services, Roseville, MN
- Evangelical Lutheran Good Samaritan Society, Sioux Falls, SD
- Cassia, Edina, MN
- Benedictine, Fridley, MN
- Ecumen, Shoreview, MN
The top five US providers on the 2024 list with the most independent living units are:
- NSC, Washington, DC
- Acts Retirement–Life Communities and affiliates, Fort Washington, PA
- Presbyterian Homes and Services, Roseville, MN
- Lifespace Communities, Dallas
- Good Samaritan Society, Sioux Falls, SD
Little movement occurred among the overall top 10 ranked organizations from 2023. Acts and Presbyterian Homes and Services swapped the No. 2 and 3 places from last year, HumanGood jumped up a spot from No. 7 in 2023 to No. 6 this year, as did Covenant Living Communities and Services, moving from No. 8 last year to No. 7 this year. And Lifespace Communities dropped from No. 6 last year to No. 8 this year.
The 200 organizations overall represent a total of 300,000 market-rate units and almost 1,600 market-rate communities. The top 10 are:
- NSC, Washington, DC
- Good Samaritan Society, Sioux Falls, SD
- Acts, Fort Washington, PA
- Presbyterian Homes and Services, Roseville, MN
- Ascension Living, St. Louis
- HumanGood, Pleasanton, CA
- Covenant Living Communities & Services, Skokie, IL
- Lifespace Communities, Dallas
- Trinity Health Senior Communities, Livonia, MI
- Benedictine, Fridley, MN
Pacific Retirement Services in Oregon had the greatest increase in its number of units from 2022 to 2023, gaining 871 units, whereas the Good Samaritan Society experienced the greatest decrease, shedding 2,540 units.
An additional list of the country’s largest single-campus senior living and care communities was led again by Shell Point Retirement Community in Fort Myers, FL, with 1,870 units. Riderwood Village, an NSC campus in Silver Spring, MD, led the list of largest individual campuses, with 2,147 units.
Additional insights
This year’s report includes insights into trends in home- and community-based services, third-party management, renal CCRCs, technology adoption, joint ventures and future growth plans. Consistent with the past several years, the report notes that not-for-profit senior living and care providers are growing primarily through unit expansion and affiliation or acquisition activity, according to Ziegler President and CEO Dan Hermann.
When it comes to future growth plans, approximately 74% of organizations on the list said that they intend to expand or reposition an existing campus this year or next year, 12% intend to grow through new construction, and 17% said they intend to grow from affiliations.
IL and AL units grow, and SNF beds decline
The 20 largest senior living and care providers represent almost 30% of the total number of units for all systems in the report. In the past 10 years, the average annual growth rate in total units was 2.1%, with independent living and assisted living growth each year, but declines in the nursing care beds. Memory care units are increasing in importance, with 70% of the LZ 200 companies reporting offering specialized memory care units.
Pennsylvania had the highest number of system headquarters on the list, with Minnesota claiming the largest total number of communities, at 238.
Several organizations on the list reported obtaining accreditation from various organizations. A total of 105 communities on the list were accredited through the Commission on Accreditation of Rehabilitation Facilities, 42 are accredited through Educational Assessment Guidelines Leading toward Excellence, and 28 earned accreditation through the Joint Commission on the Accreditation of Healthcare Organizations.
Many companies displayed a commitment to affordable senior housing, with 36% of organizations on the list having affordable housing units. National Senior Communities led the pack, with 21,871 affordable senior living units, followed by National Church Residences, with 21,522 units.
The offering of HCBS also is growing — 45% of companies offer some type of HCBS — through home health, home care, adult day care, continuing care at home programs or Programs for All-Inclusive Care for the Elderly. The continuing care at home model is now offered by more than 16% of companies on the list, up 3% from last year’s report.
On average, 73% of communities on the list reported adopting electronic point of care/point of service documentation systems and electronic health/medical records. The adoption rate for health and wellness technologies — medical monitoring or telehealth remote monitoring — was lower.
Other technologies climbing in use among senior living and care providers include those facilitating social connectedness/resident engagement (60%), analytics (47%), staff and resident screening (50%), infection control (51%), robotic process automation (32%) or physical robotics (68%)
Consistent with the 2023 report, 36% of organizations said they were engaged in a joint venture, most commonly with another provider, a health system or a home health/home care agency.
The complete LZ 200 report is available for download on the websites of LeadingAge and Ziegler.
