The 16th Annual LeadingAge Ziegler 200 (LZ 200) report offers some interesting data about life plan and assisted living communities operated by the nation’s 200 largest, most complex nonprofit senior living organizations as of Dec. 31, 2018.

The report, released in November by LeadingAge and Ziegler, ranks and analyzes LZ 200 organizations, outlines relevant business trends in the field of aging services, and showcases the variety of older adult services and offerings provided in the sector.

“The LZ 200 report provides insight into trends in aging services,” says Ruth Katz, senior vice president of public policy/advocacy at LeadingAge. “All LeadingAge members—not just those in the report—can gain perspective about how our field is evolving and use the findings to inform their choices about the future.”

Counting Life Plan Communities

LZ 200 organizations operate 691 life plan communities in 43 states and the District of Columbia, according to the report. The 2019 LZ 200 organizations saw a 2.6% average annual growth in total life plan communities between 2000 and 2018.

States with the most LZ 200-operated life plan communities include:

• Pennsylvania, with 104.
• Ohio, with 52.
• Minnesota, with 48.
• California, with 43.
• Illinois, with 36.

Almost a fifth (18%) of LZ 200 organizations do not operate life plan communities, according to the report. Of those organizations with life plan communities:

• 50% reported that all of their life plan communities are entry-fee.
• 32% reported operating rental life plan communities.

Counting Assisted Living Communities

LZ 200 organizations operate 277 assisted living communities in 32 states. The 2019 LZ 200 organizations saw a 3.8% average annual growth in total assisted living communities between 2000 and 2018.

States with the most LZ 200-operated assisted living communities include:

• Minnesota with 70.
• Michigan with 35.
• Wisconsin with 18.
• New York with 14.
• Pennsylvania with 13.

The report suggests a clear trend toward private, rather than shared, assisted living units among LZ 200 organizations. Almost a quarter of assisted living units (73%) are private units, according to the report.

Roughly 73% of LZ 200 organizations offer memory support, with more than 32% offering both assisted living and skilled memory care services. An additional 33% offer only assisted living memory support.

Other Lz 200 Findings

Overall Growth: The 2019 LZ 200 listing shows that senior living providers have grown primarily through community expansions and renovations, and affiliations. The report notes that 67 affiliations took place between 2015 and 2018, an increase from 52 affiliation from 2010 through 2014. However:

• 56% of respondents said they would not consider affiliating this year or next.
• 50% of respondents said they would not add new communities.

Home-based services: Home health, home care, adult day services, continuing care at home (CCaH) programs, and Program for All-Inclusive Care for the Elderly (PACE), continue to grow.

• Approximately half of LZ 200 organizations offer some type of home and community-based service to non-residents.
• Only 10% of LZ 200 organizations offer the CCaH model, down 2% from 2018.

Technology: Adoption of new technologies decreased slightly among LZ 200 organizations.

• 75% use electronic point of care/point of service documentation systems and electronic health/medical records.
• Less than 60% adopted health and wellness technologies.
• 49.5% are using social connectedness/resident engagement technologies.

Joint ventures: Formal joint venture engagements decreased marginally this year.

• Slightly more than 30% of LZ 200 organizations engaged in a formal joint venture.
• Most joint ventures were with another senior living provider, a health system, or a home health/home care agency.

Health reform: Engagement in a formal health care reform contract has increased steadily.

• More than 4 out of 10 LZ 200 organizations reported engaging in either an Accountable Care Organization or a bundled payment agreement.