These 10 Largest Nonprofit Nursing Home Providers Own 30% of Facilities Nationwide

Over the past decade, the nonprofit nursing home sector has experienced steady growth, with an average annual growth rate of 2.2%, while mergers and acquisitions activity has resulted in the ten largest providers representing nearly 30% of all facilities in the industry.

This is according to the LeadingAge Ziegler 200 report released Thursday, which identified relevant business trends, including several technological advancements and downsizing trends, among 200 providers within the nonprofit nursing home sector.

And while independent living and assisted living have shown consistent growth as well, there has been a decline in the number of nursing care beds. Notably, specialized memory care units are on the rise, with 69% of LZ 200 providers offering such services.

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Size matters

The report also highlights the diverse size range of nursing home operators, with the number of units ranging from 394 to 21,959 units.

These were the top nonprofit nursing home providers, ranked by the number of nursing home beds:

  1. The Evangelical Lutheran Good Samaritan Society – 8,423
  2. Ascension Living – 3,689
  3. The Carmelite System, Inc. – 2,349
  4. Benedictine – 2,093
  5. Trinity Health Senior Communities – 2,029
  6. ArchCare – 1,723
  7. Acts Retirement-Life Communities – 1,523
  8. Presbyterian Homes & Services – 1,472
  9. Cassia – 1,386
  10. Covenant Health – 1,332

It is important to note that these numbers are based on data from the end of 2022, and Good Samaritan has downsized significantly this year, trimming about 30% of its capacity from a large portfolio of skilled nursing facilities and other senior care communities.

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The LZ 200 report found that providers have primarily expanded through unit expansions within existing campuses, while simultaneously disposing of outdated nursing homes or financially stressed communities. There has also been an increase in organizations growing through affiliation, acquisition, or merger.

Home and community based services

The report highlights the growth of home-based services, including home health, home care, adult-day care, continuing care at home (CCaH) programs, and Program for All-Inclusive Care for the Elderly (PACE).

About 45% of LZ 200 providers now offer some form of home and community-based services. The CCaH model has gained popularity, with over 10% of LZ 200 organizations adopting it.

LZ 200 providers offer market-rate senior living services in 48 states. Pennsylvania is home to the highest number of system headquarters, while Minnesota had the largest total number of senior living communities, with 212 in total.

Technological advancements and new categories

On the technological front, 72% of communities adopted electronic documentation systems and electronic health/medical records. Although adoption was lower for health and wellness technologies like medication monitoring or telehealth remote monitoring, 57% use management and coordination software, 60% use social connectedness engagement technology, and 42% employ advanced analytical tools.

In response to the Covid-19 pandemic, new categories were introduced in the report. In 2021, 55% of LZ 200 providers implemented staff and resident screening, and the same percentage added infection control technologies. In 2022, two new categories were added concerning robotic technology, with 30% implementing robotic process automation and 70% adopting physical robotics.

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