Brookdale Senior Living, Atria Senior Living and LCS have maintained their top three positions as the country’s largest senior living operators, according to Argentum’s 2023 Largest Providers Report.

The report, released Sept. 14, ranks U.S. senior living operators on a variety of self-reported metrics, including total units and total employees. It also showcases some of the ways the industry has grown and evolved in the last 12 months, and where it might be heading next.

Brentwood, Tennessee-based Brookdale Senior Living has maintained its spot at the top of the list for the fourth year in a row despite the total units and communities continuing to decrease compared to 2022, with 55,430 total units and 673 communities. Brookdale in 2023 has focused on its growing HealthPlus model, which CEO Cindy Baier touted as helping the senior living operator be “uniquely positioned to help seniors who are looking for that as they continue their life.”

Louisville, Kentucky-based Atria Senior Living held its No. 2 spot with 42,501 units and 344 communities, down from the 49,000 units and 383 communities it had last year. With more than 30,692 independent living units, Atria was the second-largest owner of the product type behind real estate investment trust (REIT) Ventas (NYSE: VTR), this year’s list showed.

Des Moines, Iowa-based LCS rounded out the top three with a total of 31,523 units and 131 communities. The company saw an overall decrease of total units from 2022, when it had 32,196 units and 135 communities. The company in 2023 is making headway on a variety of initiatives, from recovery to data collection and analysis, LCS CEO Joel Nelson told Senior Housing News earlier this year.

While the list’s top-three operators did not change from 2022 to 2023, many others farther down the list changed places.

Erickson Senior Living moved up from fifth place to fourth, showing continued growth after moving up from seventh place in 2022. Sunrise Senior Living moved from sixth to fifth, Discovery Senior Living moved from eighth to seventh and Watermark Retirement Communities moved from 10th to ninth.

AlerisLife’s Five Star Senior Living brand dropped from fourth to sixth; Senior Lifestyle dropped from seventh to eighth and Integral Senior Living dropped from ninth to 10th after breaking into the top 10 in 2022.

While outside of the top 10, Cogir Management USA Inc. made a significant jump by 53 positions, moving up from 72 to 19. It now has 7,055 units and 58 communities. The company in 2023 grew even further with the creation of a new management platform with REIT Welltower (NYSE: WELL).

This year’s list is set against a backdrop of growth and headwinds as senior living operators build operations to meet the looming demand from millions of older adults in the coming years. The number of people at least 85 years old is on track to grow by a whopping 117% between 2020 and 2040, according to Argentum’s report.

At the same time, senior living operators need to fill 3 million job openings between 2021 and 2040, the report noted.

“We are facing a significant worker shortage across the economy generally but within senior care,” the report’s authors wrote. “This demographic shift presents both opportunities and challenges for senior living providers.”