10 Largest Nonprofit Senior Living Operators in 2021 Ranked

Just under a third of non-profit senior housing units belonged to a top-10 largest operator in 2021 as the sector continued to diversify and evolve.

That’s according to the latest and 19th LeadingAge Ziegler 200, released Thursday. The yearly report ranks the largest senior living non-profits in the U.S. and identifies trends in the space.

Almost 30% of the total number of units in this year’s report belonged to one of these top 10 operators as of the end of 2021:

  • National Senior Campuses, 21,753 units
  • The Evangelical Lutheran Good Samaritan Society, 15,447 units
  • Acts Retirement Services, 9,404 units
  • Presbyterian Homes and Services, 9,391 units
  • Ascension Living, 6,692 units
  • HumanGood, 5,821 units
  • Covenant Living Communities & Services, 5,432 units
  • Lifespace Communities, 5,279 units
  • Trinity Health Senior Communities, 5,136 units
  • Benedictine, 4,576 units

The top 10 operators in this year’s list remained unchanged from last year; but some operators moved up or down in the ranking compared to last year, particularly among those with similar numbers of units.

Key findings in this year’s report included the diversification of services among senior living nonprofits. Less than half (42%) of the respondents reported offering some type of home- and community-based service; while almost 10% offered continuing care at home programs.

The operators on the LZ 200 list have grown through campus expansions in recent years, with portfolios continuing to evolve through dispositions of “dated nursing homes or financially stressed communities,” the report noted.


Non-profit senior living operators are still keen on technology, with 65% reporting using point of care or point of service documentation systems and electronic health or medical records. Another 57% reported using health and wellness technologies, such as medication monitoring or telemedicine services and care management and coordination. 

More than half of the communities on the list (54%) have implemented some kind of “robotic process automation,” while 40% have added physical robotics to their operations.

Formal joint ventures also gained some popularity between this year’s report and last year’s, with a little more than a third (35%) of LZ 200 organizations engaged in a formal joint venture, most commonly with another provider, a health system or a home care agency. About 29% of respondents said the same in the 2021 report.

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