The share of nursing beds among the nation’s largest nonprofit senior living and care providers continued its downward slide in 2021, according to the 19th annual LZ200 Report.

Overall, nursing care beds as a share of occupancy mix have fallen from 39.8% when Ziegler issued its first report to 28.8% in 2021, following five consecutive years of decline.

The latest report, released Thursday, showed the five largest nonprofit providers of nursing care beds stayed at the top in 2021, with just some minor shuffling since 2020. The No. 2 provider,  Ascension Living, stayed in the same spot but reported dropping more than 1,000 nursing care beds.

The top providers in 2021 ranked by nursing care beds were:

1.The Evangelical Lutheran Good Samaritan Society (8,542 beds, down from 8,602);

2. Ascension Living (3,689 beds, down from 4,802);

3 The Carmelite System (2,349 beds, no change, but moving up from fourth); 

4. Benedictine (2,128 beds, down from 2,160 beds but up from fifth);

5. Trinity Health Senior Communities (2,029 beds, down from 2,458 beds and third).

The LZ200, produced in partnership between LeadingAge and investment bank Ziegler,  ranks and analyzes the nation’s 200 largest not-for-profit senior living organizations across the country as of Dec. 31, 2021.

The downward trend in nursing care beds is not only the fault of the pandemic and its impact on staffing leading to lower census, Lisa McCracken, Ziegler’s director of senior living research and development, told McKnight’s Long-Term Care News on Friday.

“The confounding factor with the pandemic, there were a lot of nursing beds that went offline and people are wondering if it’s permanent,” she said. “Some of that was pandemic-related in terms of containment, and now it’s staffing related, and occupancy being influenced by the ability to staff.

“We know in the not-for-profit sector, we don’t see people saying, ‘We’re going to exit.’ The commitment is still there, it’s just, what is the appropriate number of beds for their system? It’s a gradual change. It’s people making adjustments, but not a full exit.”

One of the strategies for reducing beds was to convert semi-private rooms to private, McCracken noted. But even that had started before the pandemic.

“It accelerated simply because of trying to mitigate spread and wanting people in separate rooms,” she said. “That’s going to be dependent on payer mix and when you go from semi- private to private rooms with the same square footage ,obviously your revenue is decreased.”

McCracken said new developments leaned toward assisted living and memory care, while sales and closures leaned toward nursing care.

“(Sellers) were feeling a lot of the pressures nursing providers were feeling and it made sense to make some business decisions,” she said.

McCracken predicts a continuation of right-sizing of unit mix and new development that remain heavier toward independent living until there’s more stability in the workforce. 

“We’ve asked them how they’d like to grow, and it’s consistent with those trends,” she said. “The trends we see here, we’ll continue to see play out the next couple years.”

For additional coverage of the LZ 200 report, see McKnight’s Senior Living and the McKnight’s Business Daily.