National Senior Communities, Evangelical Lutheran Society, Presbyterian Homes Top New List of Largest Senior Living Nonprofits 

National Senior Communities, The Evangelical Lutheran Society and Presbyterian Homes & Services are again the top-three largest senior living non-profits in the U.S.

That’s according to the latest LeadingAge Ziegler 200, an annual release that tracks the 200 largest nonprofit providers for the sector along with the trends that have occurred over the past year.

The top-10 largest operators on the LZ 200 make up roughly 30% of the total unit counts for the sector.

While the 10 largest nonprofit operators have not changed, their positions have seen slight shifts compared to 2025: 

• National Senior Communities, 24,039 units 

• The Evangelical Lutheran Good Samaratan Society, 12,330 units 

• Presbyterian Homes & Services, 10,746 units 

• Acts Retirement-Life Communities, Inc. & Associates, 10,540 units 

• Ascension Living, 6,692 units 

• HumanGood, 6,098 units 

• Covenant Living Communities and Services, 5,933 units 

• Trinity Health Senior Communities, 5,039 units 

• Benedictine, 4,980 units 

• Lifespace Communities, Inc., 4,917 units  

“In the last 10 years, the average annual growth rate in total units is 2.7%, with independent living and assisted living growth each year, but decline in the number of nursing care beds,” the report’s authors wrote. “Memory care units are becoming an increasingly important component of the annual unit counts, with 66% of the LZ 200 offering specialized memory care units.”

Growth from joint ventures saw a decrease year-over-year, with 44% of the list engaging with a formal joint venture partner such as a provider, health system or home care agency compared to the 49% seen in 2025.

Nearly half, or 46%, of the providers on the list report offering some type of home and community-based services to non-residents, with the continuing care at home (CCaH) model offered by 14% of operators, up 2% compared to the previous year.

The number of nonprofit operators adopting technology such as electronic point of care/point of service documentation systems and electronic health/medical records saw an increase to 78% from 73% in 2025, and while lower, health and wellness technologies, such as medication monitoring or telehealth remote monitoring; and care/case management software usage increased to 61% of operators from 57%, according to the report.