Good Samaritan Society remains the nation’s largest nonprofit provider of skilled nursing beds with more than 7,000 across its footprint, according to the annual LeadingAge Ziegler 200 report published Wednesday.
Despite only minor changes at the top of the nursing care list, the annual examination of business and operational trends offers other, more complex insights into the shifting role of skilled care within multi-site organizations and life plan communities.
Some 322 nursing homes were represented in this year’s report, which included data from more than 200 multi-site organizations and more than 200 single-site campuses across 47 states.
LZ200 data shows an average annual growth rate of 2.3% in total units over the last decade, with independent living and assisted living units growing each year but nursing care beds declining.
“LeadingAge members are creatively addressing complex challenges,” President and CEO Katie Smith Sloan noted in a letter opening the report. “Governing boards and senior leaders are engaging in effective strategic planning to reposition, grow, change, partner,
innovate and venture into new service possibilities.”
To that end, the 2025 report demonstrates the increasing importance of memory care units, with 64% of the LZ200 participants offering them. Among the largest 10 providers, 90% offered memory support.
Overall, more than 22% of respondents offered both assisted living and skilled nursing memory care services. Another 10% offered memory care only under a SNF license, while 38% operated memory care only as assisted living.
The report also tracks the proportion of private skilled nursing rooms, with 2025 results indicating what authors called “a clear trend” toward single rooms. Some 68% of respondents said they offer private nursing rooms — a large jump from rates that have typically ranged between 40% and 56% since 2014. The lone exception was in 2020, during the pandemic.
It’s important to note that organizations that take part in the survey can vary from year to year.
One area where the LZ200 continues to see an upward trend is in partnerships and collaboration. Slightly more than one-third of participations organizations reported being in a joint venture,
most commonly, with another not-for-profit organization, a hospital/health system or a home health/home care agency.
This year’s top 10 nonprofit providers when ranked by their nursing care beds are broken out below, with their 2024 LZ200 ranking in parentheses.
1. Good Samaritan Society, South Dakota, 7,098 beds (1)
2. Ascension Living, Missouri, 3,689 beds (2)
3. Benedictine, Minnesota, 2,089 (4)
4. The Carmelite System, New York, 2,003 (3)
5. Trinity Health Senior Communities, Michigan, 1,938 (5)
6. ArchCare, New York, 1,723 (6)
7. ACTS Retirement-Life Communities, Pennsylvania, 1,663 (7)
8. Presbyterian Homes & Services, Minnesota, 1,448 (11)
9. Cassia, Minnesota, 1,386 (10)
10. Otterbein SeniorLife, Ohio, 1,338 (9)
Good Samaritan also ranks as the second-largest senior care provider nationally when all service types are included. But amid an intentional downsizing, it experienced the second-largest decrease in total beds last year, losing 475.
In contrast, the nation’s largest overall provider, National Senior Communities, added 1,458 beds last year. Still, that organization fell from the eighth largest nonprofit provider of nursing beds to number 11, with 1,008 as of Dec. 31.
A spokeswoman for LeadingAge said Wednesday that nonprofit organizations are reenvisioning their service lines and bed allotments based on factors such as policy and payment changes, shifting demographics, consumer demand and labor markets.
“Depending on those, we see a variety of strategic approaches to the question of whether or not to offer skilled nursing,” she said. “Some members are eliminating skilled care, others rightsizing by limiting beds or, in the case of multiple campuses, consolidating locations. Still others are rethinking their approach — continuing to offer caregiving services, but at a different certification level. This is a complex environment, to be sure.”