• Nancy Griffin

LeadingAge & Ziegler Release 19th Annual LZ 200 Report

The 19th annual report ranks and analyzes the nation’s 200 largest not-for-profit senior living organizations representing more than 306,000 market-rate units and nearly 1,600 market-rate communities across the country.


LeadingAge, the association of nonprofit providers of aging services, and Ziegler, the nation’s leading underwriters of financings for not-for-profit senior living providers, released the 19th annual LeadingAge Ziegler (LZ 200) report. The LZ 200 lists the largest not-for-profit systems providing aging services through senior living in the United States, in order of total owned market-rate units, as of December 31, 2021.

Consistent with the last several years, the 2022 LZ 200 listing shows that not-for-profit senior living providers have grown primarily through community expansions from existing campuses as well as affiliation and acquisition activity. Nearly 30 percent of the total number of units for all senior living systems in the LZ 200 are represented by the 10 largest providers.

The 10 largest not-for-profit multi-site senior living organizations include:

  1. National Senior Campuses – Wellesley, MA

  2. The Evangelical Lutheran Good Samaritan Society – Sioux Falls, SD

  3. Acts Retirement Services, Inc. – Fort Washington, PA

  4. Presbyterian Homes and Services – Roseville, MN

  5. Ascension Living – St. Louis, MO

  6. HumanGood – Pleasanton, CA

  7. Covenant Living Communities & Services – Skokie, IL

  8. Lifespace Communities, Inc. – West Des Moines, IA

  9. Trinity Health Senior Communities – Livonia, MI

  10. Benedictine – Duluth, MN

The LZ 200 also showed that in the last 10 years, the average annual growth rate in total units since 2000 is 2.3 percent, with independent living and assisted living units growing each year, but decline in the number of nursing care beds.

“Since the publication’s introduction almost two decades ago, we have captured the factors and trends driving innovation and change in how older adults live,” stated Katie Smith Sloan, President and CEO of LeadingAge. “The LZ200’s valuable findings demonstrate the significant role of LeadingAge members both in providing the resources and services older adults seek and also in shaping the sector’s future.”

“This LZ 200 report is a critical annual report that captures the behaviors and characteristics of the country’s largest not-for-profit senior living organizations in the country,” stated Dan Hermann, President & Chief Executive Officer and Head of Investment Banking at Ziegler. “Readers are also able to gain insights into the fastest growing and most progressive organizations nationally, regionally and in their respective states. This information helps to pave a path forward for overall sector growth among not-for-profit providers.”

The LZ 200 report, developed annually through the LeadingAge/Ziegler partnership, includes more than 200 providers of multi-site systems, more than 150 single-site campuses, and government-subsidized multi-site housing providers. Previously known as the LZ 100 and LZ 150, the report was expanded in 2014 from LZ 100 to the LZ 150 and to the LZ 200 in 2018 in response to the growing industry and increasing interest.

Key Findings

  • The 10 largest providers of senior living represent nearly 30% of the total number of units for all systems in LZ 200.

  • Memory care units are becoming an increasingly important component of the annual unit counts, with 64% of the LZ 200 offering specialized memory care units.

  • The LZ 200 have grown primarily through expansion, with most of the growth in recent years from within existing campuses.

  • Of the LZ 200, 42% offer some type of home and community-based services to non-residents.

Importance of Not-for-Profits


The report stressed that not-for-profit providers offer some of the best care and services in the country because of their passion and commitment to the not-for-profit philosophy.


"This dedicated enthusiasm of not-for-profits has inspired boards of directors, attracted volunteers and devoted staffs, and led to groundbreaking innovations in the way we care for the elderly. A mission-driven philosophy of service with dignity and respect for the person is the inherent benefit the families, residents, and clients of not-for-profit senior living communities have found (whether independent living, assisted living, nursing care, memory support, or home and community-based services).


Many not-for-profit providers rose from modest beginnings more than a century ago into vital community resources today. In fact, listed in the LeadingAge Ziegler 200 rankings are nearly 50 organizations that were founded more than 100 years ago."


To view the full report, click here.

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