Even after beginning a significant downsizing last year, Good Samaritan Society remains the nation’s largest nonprofit provider of senior care based on its number of nursing beds.
The South Dakota-based organization maintained more than 7,500 nursing beds as of Dec. 31, still thousands ahead of Ascension Living, which came in second in the 21st Annual LeadingAge Ziegler LZ 200 Report published Thursday.
The most significant change among the top 10 nursing bed providers was National Senior Communities’ jump to No. 8 this year, up from No. 15 in the 2023 report. Washington, DC-based National Senior, which has nearly 22,000 units across senior living, topped the overall list of largest nonprofit senior care providers by total senior living units for the ninth straight year. As of Dec. 31, it had more than 1,540 nursing beds.
In other movement, Otterbein SeniorLife of Ohio climbed from No. 11 to No. 9, while Minnesota-based Cassia slid from No. 9 to No. 10.
The jostling isn’t surprising, given that many of the multi-site providers are listed in the annual publication operate as continuing care retirement communities. Nationally, many of them have made a strategic decision to reduce or even eliminate their skilled nursing services amid increased financial and regulator pressures.
Good Samaritan is conducting a large-scale off across categories to focus on seven core states, but leaders have told McKnight’s Long-Term Care News that they planned to maintain their existing balance between senior living and skilled nursing. Many of Good Sam’s nursing beds are in standalone, rural facilities, rather than part of larger CCRC communities.
“This rich report contains valuable insights into current trends — and also provides an intriguing glimpse into how senior living will grow in the future,” Katie Smith Sloan, president and CEO of LeadingAge, said in a press release announcing the results.
This year’s report represents more than 300,000 units and nearly 1,600 communities across the country. It also examines business and technology adoption trends. The 2024 LZ 200 listing shows that not-for-profit senior living providers continue to grow primarily through community expansions from existing campuses, as well as affiliation and acquisition activity.
In addition to facility growth, more providers are exploring expansion of services. The report found increasing interest by operators in home health, home care, adult-day care, continuing care at home (CCaH) and PACE programs. Of the LZ 200, 45% offer some type of home and community-based services to non-residents.
The CCaH model is now offered by more than 16% of the LZ 200, up 3% from last year.
Large players still dominate
Nearly 30% of the total number of units for all senior living systems in the LZ 200 are represented by the 10 largest providers, the same percentage as last year.
When ranked by nursing home beds, the full list includes:
- Good Samaritan Society
- Ascension Living
- The Carmelite System (NY)
- Benedictine (MN)
- Trinity Health (MI)
- ArchCare (NY)
- Acts Retirement-Life Communities (PA)
- National Senior Communities
- Otterbein SeniorLife
- Cassia
More are less
The percentage of nursing home beds as a share of units among all nonprofit providers included is now at its lowest point (27.9%) since LeadingAge and Ziegler launched the report 21 years ago.
All but the top 16 providers have fewer than 1,000 beds, and 151 have fewer than 500 beds. Five years ago, in the LZ2019, the top two organizations had far more beds than they do today. The rest of the distribution was remarkably similar even then: All but 16 organizations also had fewer than 1,000 beds and 151 had fewer than 500.
It’s at the bottom of the list where the transition becomes clearer. Since the 2019 report, the number of top 200 nonprofit providers without any nursing beds has grown from five to nine. Meanwhile, 31 now have fewer than 100 nursing beds, up from 23 five years ago.
Meanwhile, the average annual growth rate in total number of units is 2.1%, with independent living and assisted living growth in each of the last 10 years.
On the opposite end, of the 349 community dispositions, or times properties were sold or otherwise “disposed” of, during the 1980-2023 span among the LZ 200, about 332 were in the last decade. The report noted they were most commonly dispositions of free-standing nursing homes or assisted living and financially distressed Life Plan Communities.
