The report highlights a distinct evolution in how nonprofit systems scale. Growth is currently driven by a combination of campus expansions and strategic acquisitions rather than new ground-up development. Data from the last decade shows an average annual growth rate of 2.7 percent in total units, though the composition of care is changing. While independent and assisted living capacity continues to climb, the number of traditional nursing care beds is steadily declining.

Leading the industry in scale are major organizations including National Senior Communities in Washington, D.C., The Evangelical Lutheran Good Samaritan Society in Sioux Falls, and Presbyterian Homes and Services in Roseville. These entities, alongside others like HumanGood and Acts Retirement-Life Communities, serve as the primary indicators for sector health. Katie Smith Sloan, president and CEO of LeadingAge, noted that these nonprofit members act as the standard-bearers for innovation in aging services, while Ziegler CEO Dan Hermann emphasized that the data helps map regional and national growth trajectories for providers looking to navigate a complex financial landscape.