National Senior Communities, Good Samaritan Society, Presbyterian Homes Top List of Largest Senior Living Nonprofits

National Senior Communities, the Evangelical Lutheran Good Samaritan Society and Presbyterian Homes & Services have again landed at the top of the annual LeadingAge Ziegler 200 report, which was released Thursday.

The annual report, now in its 20th release, ranks the largest senior living nonprofits in the country by various measures, including total unit count. This year, there were only a few small shifts in top 10 largest operators, which still make up a little fewer than one-third of the total units listed in the report.

National Senior Communities, alongside continuing to secure its number one spot by growing its unit count by 206 units compared to last year. In the No 2. spot is the Good Samaritan Society, which is part of Sanford Health. The health system this year had initially planned to merge with another system, Fairview Health Services, in a move that would potentially have joined the Good Samaritan Society with another senior living nonprofit, Ebenezer. That merger was called off in July.


Third on the list was Presbyterian Homes & Services, which has grown in the roughly last two years through acquisitions and construction. Presbyterian Homes & Services this year swapped places with Acts Retirement-Life Communities, for third and fourth place, respectively.

Among the top 10, the largest shift comes from Lifespace Communities, Inc., which moved from 8th last year to 6th, partially aided by its acquisition of three Texas communities in 2022.

The 10 largest multi-site senior housing and care nonprofits in 2023 were:

  • National Senior Communities, 21,959 units
  • The Evangelical Lutheran Good Samaritan Society, 15,820 units
  • Presbyterian Homes & Services, 9,646 units
  • Acts Retirement-Life Communities, 9,432 units
  • Ascension Living, 6,692 units
  • Lifespace Communities, 5,958 units
  • HumanGood, 5,817 units
  • Covenant Living Communities & Services, 5,649 units
  • Trinity Health Senior Communities, 5,136 units
  • Benedictine, 4,625 units

The report also revealed an uptick in the number of joint ventures between organizations, up to 36% of operators on the LZ200 compared to 35% in last year’s report. Most of these joint ventures are with another provider, health system or home health/home care agency, according to the report.

The greatest growth by unit count compared to the 2022 report was BHI Senior Living, which added 1,103 units to a grand total of 2,808. The greatest decrease in total unit count came from Retirement Housing Foundation, which lost 1,563 units, decreasing its total to 2,576 units, according to the report.

The overall greatest increase in ranking came from Life Enriching Communities, which jumped 39 positions to land at rank 44. Other upward movers included Goodwin Living, which ranked No. 83 in 2023 after being at 107 in 2022.

The greatest form of unit growth comes from campus expansions, according to the report’s author, with new campus growth “slowing in recent years.” The number of affiliations, acquisitions and mergers have also been on the rise for nonprofit organizations.

Non-profit operators are also continuing to embrace community and home-based services, according to the ranking. Of the 200 featured on the list, 45% “offer some type of home and community-based services to non-residents.” Additionally, continuing care at home services have increased from 7% to 10% of the communities featured on the list compared to 2022.

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