LARGEST PROVIDERS REPORT 2020 - A closer look at the 150 largest providers in senior living, plus a post-COVID-19 outlook - Argentum
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A closer look at the 150 largest
providers in senior living,
plus a post-COVID-19 outlook
2020
LARGEST
PROVIDERS
Sponsored by:
REPORT
2020 LARGEST PROVIDERS REPORT 1
ABOUT FOX REHABILITATION
Founded in 1998, FOX Rehabilitation is a high-growth, entrepreneurial private practice of physical,
occupational, and speech therapists that provides proactive, clinically excellent, and evidence-based treatment
interventions to the older population. A proud, longstanding member of Argentum and corporate sponsor, FOX
was built on the strong clinical foundation of Geriatric House Calls™, and throughout its growth, the practice has
stayed true to its mission of rehabilitating lives by believing in the strength of people. FOX clinicians help older
adults be stronger so they can live better longer. For more, see foxrehab.org.
ABOUT ARGENTUM
Argentum is the leading national association exclusively dedicated to supporting companies operating
professionally managed, resident-centered senior living communities and the older adults and families they serve.
Since 1990, Argentum has advocated for choice, independence, dignity, and quality of life for all older adults.
Argentum member companies operate senior living communities offering assisted living, independent living,
continuing care, and memory care services. Along with its state partners, Argentum’s membership represents
approximately 75 percent of the professionally-managed communities in the senior living industry—an industry
with a national economic impact of nearly a quarter of a trillion dollars and responsible for providing over 1.6
million jobs. These numbers will continue to grow as the U.S. population ages.
Argentum’s programs and initiatives are driven by its membership. For more information about joining
Argentum, please visit argentum.org/membership. Learn more at argentum.org.
Notes: Data, unless otherwise noted, was voluntarily self-reported and represents U.S. data as of December 31, 2019. The information
contained in this report was obtained from sources deemed to be reliable. Every effort was made to obtain accurate and complete
information; however, no representation, warranty or guarantee, express or implied, may be made as to the accuracy or reliability of the
information contained herein. This is not intended to be a forecast of future events and this is not a guaranty regarding a future event.
This is not intended to provide specific investment advice and should not be considered as investment advice.
2 2020 LARGEST PROVIDERS REPORT
SURVEYING THE INDUSTRY SURROUNDINGS
The line charts since March 2020, when the COVID-19 pandemic took hold in the United States, look
daunting: sharp spikes, precipitous drop-offs, and tangled vines. In senior living, operating losses are up,
move-ins down, payments sometimes deferred, and relief uncertain. And when it will be over? That’s lost
in the fog, with predictions ranging from the fourth quarter of 2020 to the fourth of 2024.
However, there are a few known knowns: The demographics still point to increasing need. Investors
aren’t yet stuffing their mattresses; they’re still looking for good prospects, which could keep the
industry’s recession-proof reputation intact. As COVID-19 case numbers continue to come in,
professionally managed senior communities are looking more and more like particularly safe and healthy
places to live.
But the biggest positives the industry has going for it are the intangibles: innovation, creativity, dedication.
The crisis pushes these to heroic levels, every day, from the CEO who built protected visiting booths to
the caregiver ensuring that a memory care resident in isolation doesn’t feel alone. New and renewed
commitments to diversity, equity, and inclusion measures clear the paths to new systems, new talent, and
new markets. Among all the disruption, the greatest value in this industry remains our values.
Even pre-pandemic, the industry wasn’t exactly halcyon. Providers were looking at what some termed
oversupply—for instance, 9,175 assisted living units added in 2019, according to the National Investment
Center for Seniors Housing & Care (NIC). Concerns about competition from aging at home trends and
a growing middle market were compounded by a workforce environment where competition rose as
unemployment fell—both at unprecedented levels.
This data captures the picture from that height: December 31, 2019. We chose that date for several
reasons: Data lags, and is difficult to collect under crisis conditions; COVID-19 would distort the picture;
and it begins the process of reconciling these yearly Largest Provider Reports to records based on whole
years rather than first quarters. Last year’s report, available here, is from March 31, 2019.
What shape will 2020 take? Hockey stick, swoosh, V, triple W? Hope to see you here next year to find out.
Sara Wildberger,
Editor
DOWNLOAD THE 150 LARGEST PROVIDERS LIST
All the numbers, in Excel spreadsheet form, so you can create your own data sets:
argentum.org/largestproviders
2020 LARGEST PROVIDERS REPORT 3
2020 LARGEST PROVIDERS
TOTAL TOTAL TOTAL TOTAL TOTAL U.S.
RANK PROVIDER CHIEF EXECUTIVE TITLE CITY/STATE WEBSITE
UNITS AL UNITS IL UNITS MC UNITS EMPLOYEES PROPERTIES
1 Brookdale Senior Living 68,044 34,572 23,504 9,968 57,818 763 Lucinda M. “Cindy” Baier President and CEO Brentwood, TN brookdale.com
2 Life Care Services (LCS) 36,739 6,243 27,910 2,586 28,458 144 Joel Nelson President and CEO Des Moines, IA lcsnet.com
3 Holiday Retirement 31,684 412 31,272 n/a 8,451 261 Lilly Donohue CEO Orlando, FL holidaytouch.com
4 Five Star Senior Living 27,656 12,885 11,196 3,575 — 264 Katie Potter President and CEO Newton, MA fivestarseniorliving.com
5 Sunrise Senior Living 23,066 14,550 3,255 5,801 25,927 270 Chris Winkle CEO McLean, VA sunriseseniorliving.com
6 Erickson Living 22,010 1,269 20,221 520 14,643 19 R. Alan Butler CEO Catonsville, MD ericksonliving.com
7 Atria Senior Living 21,662 9,673 9,272 2,717 14,544 178 John Moore Chairman and CEO Louisville, KY atriaseniorliving.com
8 Senior Lifestyle 17,662 7,931 7,099 2,632 11,117 176 Jon A. DeLuca President and CEO Chicago, IL seniorlifestyle.com
9 ALG Senior 12,863 7,819 1,767 3,277 7,000 155 Charles E. Trefzger President and CEO Hickory, NC algsenior.com
10 Capital Senior Living 11,878 6,065 4,424 1,389 6,204 124 Kimberly S. Lody President, CEO, and Director Dallas, TX capitalsenior.com
11 Enlivant 10,798 9,798 76 924 7,340 229 Jack Callison CEO Chicago, IL enlivant.com
12 Trilogy Health Services 9,858 8,550 820 488 13,100 109 Randall Bufford Chairman Louisville, KY trilogyhs.com
13 Watermark Retirement Communities 9,393 3,465 4,569 1,359 7,000 59 David Barnes President and CEO Tucson, AZ watermarkcommunities.com
14 Discovery Senior Living 9,307 5,325 2,945 1,037 4,995 62 Richard J. Hutchinson CEO Bonita Springs, FL discoveryseniorliving.com
15 Leisure Care, LLC 9,113 3,570 4,861 680 4,277 54 Dan Madsen President and CEO Seattle, WA leisurecare.com
16 Frontier Management, LLC 8,728 3,737 904 4,087 6,075 108 Gregory Roderick President and CEO Portland, OR frontiermgmt.com
17 Eclipse Senior Living 8,710 5,821 1,638 1,235 5,547 108 Kai Hsiao CEO Lake Oswego, OR eclipseseniorliving.com
18 Merrill Gardens 8,195 3,853 2,937 1,405 n/a 68 Tana Gall President Seattle, WA merrillgardens.com
19 Integral Senior Living 7,806 2,212 4,659 935 3,617 70 Collette Gray President/CEO Carlsbad, CA islllc.com
20 Pacifica Senior Living 7,354 3,614 1,598 2,142 6,172 75 Deepak Israni President and Managing Partner San Diego, CA pacificaseniorliving.com
Timothy P. O’Brien
21 Meridian Senior Living 7,132 4,563 1,125 1,444 4,834 80 Co-CEOs Bethesda, MD meridiansenior.com
& Robert A. Sweet
22 American House Senior Living Communities 6,717 1,199 4,928 61 2,473 60 Dale Watchowski President and CEO Southfield, MI americanhouse.com
23 Spectrum Retirement Communities 6,500 — — — 3,245 45 John Sevo & Jeffrey Kraus Managing Directors Denver, CO spectrumretirement.com
24 Grace Management, Inc. 6,275 2,206 3,617 452 2,958 60 Guy Geller President Maple Grove, MN gracemanagement.com
25 Senior Resource Group 6,161 3,169 2,565 427 3,855 32 Michael Grust President and CEO Solana Beach, CA srgseniorliving.com
26 Civitas Senior Living 5,641 2,881 1,625 1,135 — 51 Wayne Powell Co-founder and CEO Fort Worth, TX civitasseniorliving.com
27 Gardant Management Solutions, Inc. 5,629 5,369 81 179 2,841 57 Rod Burkett CEO Bourbonnais, IL gardant.com
28 Benchmark 5,537 3,258 713 1,566 6,458 61 Tom Grape Founder, Chairman, and CEO Waltham, MA benchmarkseniorliving.com
29 Brightview Senior Living 5,381 2,276 2,105 1,000 4,522 41 Marilynn Duker CEO Baltimore, MD brightviewseniorliving.com
30 Sagora Senior Living 5,295 1,930 2,504 861 2,447 39 Bryan McCaleb President Fort Worth, TX sagora.com
31 Pinnacle Senior Living 1
5,107 3,665 1,044 398 2,060 57 Brian Hulse President Tempe, AZ pinnaclesl.com
32 Century Park Associates 4,772 2,384 2,388 — — 42 Forrest L. Preston Owner and President Cleveland, TN centurypa.com
33 The Arbor Company 4,721 2,057 1,694 970 3,839 43 Judd Harper President Atlanta, GA arborcompany.com
34 Heritage Operations Group, LLC 4,511 — — — — 54 Benjamin Hart President and CEO Bloomington, IL heritageofcare.com
35 JEA Senior Living 4,200 200 200 3,950 4,400 59 W. Cody Erwin CEO Vancouver, WA jeaseniorliving.com
36 Kisco Senior Living 4,177 1,479 2,415 283 2,268 22 Andy Kohlberg President and CEO Carlsbad, CA kiscoseniorliving.com
37 Belmont Village Senior Living 4,164 2,751 333 1,080 4,000 29 Patricia Will Founder and CEO Houston, TX belmontvillage.com
NOTES: AL: Assisted Living; IL: Independent Living; MC: Memory Care. All data, unless otherwise noted, was voluntarily self-reported and represents U.S. data as of December 31, 2019. Data for skilled nursing units is not included. Only for-profit communities are included in this list. Several companies that would make the list did not respond to our request for data. 1Bridgestone Senior Living is now
Pinnacle Senior Living, but did not respond to requests for information. The data here is from 2019. 2Data is from 2019 Largest Providers Report, as of March 31, 2019. 3The Waters Senior Living AL and IL units are dually licensed. 4Wickshire Senior Living information is drawn from the company’s website.
2020 LARGEST PROVIDERS REPORT 4
2020 LARGEST PROVIDERS
TOTAL TOTAL TOTAL TOTAL TOTAL U.S.
RANK PROVIDER CHIEF EXECUTIVE TITLE CITY/STATE WEBSITE
UNITS AL UNITS IL UNITS MC UNITS EMPLOYEES PROPERTIES
38 Pegasus Senior Living 4,053 2,560 921 572 3,500 37 Steven Vick Co-Founder and Vice Chair Dallas, TX pegasusseniorliving.com
39 Bridge Senior Living 4,043 1,548 1,762 733 2,543 26 David Grady Chief Asset Officer Orlando, FL bridgeig.com
40 Capri Communities, LLC 3,960 586 1,394 173 700 25 James Tarantino CEO Waukesha, WI capricommunities.com
41 Vi 3,636 333 3,150 153 3,300 10 Randy Richardson President Chicago, IL viliving.com
42 MBK Senior Living 3,583 2,121 924 538 2,352 33 Jeff Fischer President Irvine, CA mbkseniorliving.com
43 Aegis Living 3,500 1,627 n/a 864 2,462 32 Dwayne J. Clark Founder and CEO Bellevue, WA aegisliving.com
44 Northstar Senior Living 3,438 2,189 320 929 2,579 47 Rick Jensen President and CEO Redding, CA northstarseniorliving.com
45 Elegance Living 3,410 1,800 1,200 330 2,700 37 Joshua “Josh” Krull CEO Baltimore, MD elegance-living.com
46 Priority Life Care 3,318 2,034 — 467 1,057 27 Severine Petras Wells CEO Fort Wayne, IN prioritylc.com
47 Genesis HealthCare 3,312 3,312 n/a n/a — 47 George V. Hager, Jr. CEO Kennett Square, MA genesishcc.com
48 Harbor Retirement Associates 3,184 1,818 367 999 2,893 31 Sarabeth Hanson President and CEO Vero Beach, FL hraseniorliving.com, harborchase.com
49 Legend Senior Living 3,122 2,077 279 766 2,195 40 Tim Buchanan CEO Wichita, KS legendseniorliving.com
50 MorningStar Senior Living 3,119 1,504 896 719 1,848 26 Ken Jaeger Founder and CEO Denver, CO morningstarseniorliving.com
51 Cascade Living Group 2
3,070 1,515 946 609 1,854 32 Tom Stanley & Bill Shorten Co-Founders Bothell, WA cascadeliving.com
52 Koelsch Communities 3,049 843 539 1,667 2,227 34 Aaron E. Koelsch President and CEO Olympia, WA koelschcommunities.com
53 Oakmont Senior Living 3,039 2,155 n/a 884 2,500 31 Courtney Siegel President and CEO Windsor, CA oakmontseniorliving.com
54 Avamere Living 3,035 1,893 548 594 2,071 33 Rick Miller CEO Wilsonville, OR avamere.com
55 Americare Senior Living 3,018 2,231 161 626 2,033 81 Clay Crosson President and CEO Sikeston, MO americareusa.net
56 Prestige Care 2,888 2,182 281 425 5,405 43 Harold Delamarter Founding Partner and CEO Vancouver, WA prestigecare.com
57 Brandywine Living 2,744 1,943 55 746 2,077 29 Brenda J. Bacon President and CEO Mount Laurel, NJ brandycare.com
58 Senior Living Communities 2,683 703 1,701 279 2,815 15 Donald O. Thompson, Jr. CEO Charlotte, NC senior-living-communities.com
59 Coordinated Services Management 2,667 1,295 1,122 250 1,554 22 Robert McNichols CEO Roanoke, VA csmmanagement.com
60 Arrow Senior Living 2,646 1,276 918 452 1,378 22 Stephanie Harris CEO Saint Charles, MO arrowseniorliving.com
61 Pathway To Living 2,638 1,841 617 180 1,200 29 Jerome E. Finis CEO Chicago, IL pathwaysl.com
62 Traditions Management 2,602 1,476 576 550 1,780 19 Tom Smith CEO Indianapolis, IN traditionsmgmt.net
63 New Perspective 2,496 1,075 598 823 1,700 24 Ryan Novaczyk CEO Minnetonka, MN npseniorliving.com
64 The Goodman Group 2
2,476 1,886 181 409 1,857 19 Craig Edinger CEO Chaska, MN thegoodmangroup.com
65 Commonwealth Senior Living 2,475 1,480 258 737 2,000 35 Richard J. Brewer CEO Charlottesville, VA commonwealthsl.com
66 Allegro Senior Living 2,455 854 1,267 334 1,250 18 Laurence Schiffer Chairman and CEO St. Louis, MO allegroliving.com
67 Sunshine Retirement Living 2
2,444 129 2,236 79 1,500 30 Luis Serrano President and CEO Bend, OR sunshineretirementliving.com
68 The Springs Living 2,374 817 1,158 399 1,673 17 Fee Stubblefield CEO and Founder McMinnville, OR thespringsliving.com
69 Country Meadows Retirement Communities 2,338 1,213 707 418 1,983 11 G. Michael Leader President and CEO Hershey, PA countrymeadows.com
70 LCB Senior Living, LLC 2,264 1,560 162 542 2,177 28 Michael Stoller CEO Norwood, MA lcbseniorliving.com
71 Midwest Health 2,254 1,572 425 257 2,399 53 Jim Klausman President and CEO Topeka, KS midwest-health.com
72 Senior Star 2,193 537 1,415 241 — 14 Anja Rogers CEO Tulsa, OK seniorstar.com
73 Dial Retirement Communities 2,173 840 1,040 293 1,175 24 Ted Lowndes President Omaha, NE dialretirementcommunities.com
74 Compass Senior Living 2,172 1,379 441 352 1,380 32 Dennis Garboden President Eugene, OR compass-living.com
75 Keystone Senior, LLC 2,152 1,215 629 308 1,285 44 Dave Kingen Managing Member Indianapolis, IN keystonesenior.com
NOTES: AL: Assisted Living; IL: Independent Living; MC: Memory Care. All data, unless otherwise noted, was voluntarily self-reported and represents U.S. data as of December 31, 2019. Data for skilled nursing units is not included. Only for-profit communities are included in this list. Several companies that would make the list did not respond to our request for data. 1Bridgestone Senior Living is now
Pinnacle Senior Living, but did not respond to requests for information. The data here is from 2019. 2Data is from 2019 Largest Providers Report, as of March 31, 2019. 3The Waters Senior Living AL and IL units are dually licensed. 4Wickshire Senior Living information is drawn from the company’s website.
2020 LARGEST PROVIDERS REPORT 5
2020 LARGEST PROVIDERS
TOTAL TOTAL TOTAL TOTAL TOTAL U.S.
RANK PROVIDER CHIEF EXECUTIVE TITLE CITY/STATE WEBSITE
UNITS AL UNITS IL UNITS MC UNITS EMPLOYEES PROPERTIES
76 Western States Lodging and Management 2,078 1,341 283 454 1,571 16 Paul Fairholm Owner and CEO Taylorsville, UT wslm.biz
77 Heritage Senior Living 2,029 397 1,079 553 604 32 Milo Pinkerton President and CEO West Allis, WI heritagesenior.com
Scott Goldberg & Wyman
78 Atlas Senior Living 2,021 740 846 435 1,100 21 President/President Birmingham, AL atlasseniorliving.com
Hamilton
79 Chelsea Senior Living 1,973 1,401 160 412 1,462 21 Roger Bernier President and Chief Operating Officer Fanwood, NJ chelseaseniorliving.com
80 Waltonwood 1,951 678 1,059 214 1,485 12 Gurmale S. Grewal CEO West Bloomfield, MI waltonwood.com
81 Solvere Senior Living 1,946 903 384 659 798 22 Kristin Kutac Ward CEO St. Petersburg, FL solutionsadvisorsgroup.com
82 Morning Pointe Senior Living 1,884 1,235 n/a 649 2,198 33 Greg A. Vital President Chattanooga, TN morningpointe.com
83 Hearth Management, LLC 1,852 1,362 — 490 1,482 15 Kevin Hunter COO Camillus, NY thehearth.net
84 Generations, LLC 1,835 784 763 288 900 7 Melody Gabriel CEO Portland, OR generationsllc.com
85 Danbury Senior Living 1,806 1,039 364 403 — 18 William Lemmon/Brian Spring CEO/President North Canton, OH danburyseniorliving.com
86 Cadence Living 1,738 935 363 440 — 19 Rob Leinbach Principal Scottsdale, AZ cadence.com
87 Tutera Senior Living 1,685 850 675 160 — 17 Randall Bloom CEO and Presidenet Kansas City, MO tutera.com
88 Thrive Senior Living 2
1,676 979 6 691 1,000 20 Jeramy Ragsdale Founder Atlanta, GA thrivesl.com
89 HHHunt Senior Living 1,637 1,311 n/a 506 1,564 23 Buck Hunt Vice Chairman and CEO Raleigh, NC hhhunt.com
90 Northbridge Companies 1,414 722 106 586 1,428 18 James Coughlin CEO Burlington, MA northbridgecos.com
91 Carlton Senior Living 1,398 1,016 152 230 — 11 David Coluzzi President Concord, CA carltonseniorliving.com
92 Stellar Senior Living 1,381 1,166 — 215 1,021 11 Evrett Benton CEO Salt Lake City, UT stellarliving.com
93 Justus Rental Properties, Inc. 1,367 257 1,073 37 366 4 Walter E. Justus President Indianapolis, IN justus.net
94 The Waters Senior Living 3
1,359 1,053 1,053 306 950 11 Tami Kozikowski CEO Minneapolis, MN thewatersseniorliving.com
95 Kaplan Development Group, LLC 1,340 830 280 230 1,253 18 Glenn Kaplan CEO Jericho, NY kapdev.com
96 Agemark Corp. 1,332 741 60 531 900 21 Richard Westin CEO Orinda, CA agemark.com
97 Watercrest Senior Living Group 1,324 730 72 522 373 11 Marc Vorkapich Principal and CEO Vero Beach, FL watercrestseniorliving.com
98 The Laureate Group 1,303 656 559 88 — 8 Beth Anderson Executive Vice President Waukesha, WI laureategroup.com
99 Premier Senior Living, LLC 1,256 846 12 398 1,200 23 Wayne Kaplan Co-Founder and Managing Member New York, NY pslgroupllc.com
100 Vitality Living 1,253 595 132 526 820 15 Chris Guay CEO and Founder Brentwood, TN vitalityseniorliving.com
101 Bristol Care, Inc. 1,250 — — — — 63 David Furnell President Sedalia, MO bristol-manor.com
102 Era Living 2
1,242 312 904 26 1,095 8 Eli Almo Co-founder and CEO Seattle, WA eraliving.com
103 Silverado 1,241 n/a n/a 1,241 2,166 19 Loren Shook President, CEO, and Chairman Irvine, CA silverado.com
104 Charter Senior Living, LLC 1,215 658 44 513 956 18 Keven J. Bennema CEO and President Naperville, IL charterseniorliving.com
105 SAL Management Group 1,210 867 74 269 975 33 Scott Monson Partner and Director of Operations Logan, UT salmg.com
106 Leisure Living Management 1,194 784 64 346 1,155 25 Neil Kraay President and CEO Grand Rapids, MI leisure-living.com
107 Radiant Senior Living 1,173 530 239 404 913 19 James T. Guffee President and CEO Portland, OR radiantseniorliving.com
108 Juniper Communities 1,160 324 270 — 1,500 18 Lynne S. Katzmann Founder and CEO Bloomfield, NJ junipercommunities.com
109 Retirement Unlimited, Inc. 1,145 915 — 230 1,231 9 William Fralin CEO Roanoke, VA rui.net
110 Maplewood Senior Living 2
1,136 486 98 552 1,401 14 Gregory D. Smith President and CEO Westport, CT maplewoodseniorliving.com
111 Senior Services of America 1,135 — — — 673 15 Lee Field CEO and President Tacoma, WA seniorservicesofamerica.com
112 Inspirit Senior Living 1,120 821 2 297 910 15 David McHarg President and CEO McLean, VA Inspiritseniorliving.com
NOTES: AL: Assisted Living; IL: Independent Living; MC: Memory Care. All data, unless otherwise noted, was voluntarily self-reported and represents U.S. data as of December 31, 2019. Data for skilled nursing units is not included. Only for-profit communities are included in this list. Several companies that would make the list did not respond to our request for data. 1Bridgestone Senior Living is now
Pinnacle Senior Living, but did not respond to requests for information. The data here is from 2019. 2Data is from 2019 Largest Providers Report, as of March 31, 2019. 3The Waters Senior Living AL and IL units are dually licensed. 4Wickshire Senior Living information is drawn from the company’s website.
2020 LARGEST PROVIDERS REPORT 6
2020 LARGEST PROVIDERS
TOTAL TOTAL TOTAL TOTAL TOTAL U.S.
RANK PROVIDER CHIEF EXECUTIVE TITLE CITY/STATE WEBSITE
UNITS AL UNITS IL UNITS MC UNITS EMPLOYEES PROPERTIES
113 12 Oaks Senior Living 1,115 280 647 188 666 10 Richard Blaylock President and CEO Dallas, TX 12oaks.com
114 Provision Living2 1,107 530 239 404 1,011 19 Todd Spittal Principal St. Louis, MO provisionliving.com
115 Ridge Care, Inc. 1,082 483 334 265 n/a 16 Jeff Dickerson CEO Kernersville ridgecare.com
116 Randall Residence 1,064 525 192 347 789 13 Christopher C. Randall CEO and Managing Member Lawton, MI randallresidence.com
117 Franklin Companies 1,028 374 431 223 650 8 Aubra Franklin Chairman and CEO San Antonio, TX franklinpark.org
118 Holbrook Life Management 938 359 453 126 625 6 Al Holbrook Chairman and CEO Alpharetta, GA holbrooklife.com
119 IntegraCare 932 581 164 187 600 11 Rick Irwin CEO Wexford, PA integracare.com
120 Retirement Living Associates, Inc. 920 212 659 49 880 5 David W. Ammons Owner and Principal Raleigh, NC rlainc.com
121 Sonata Senior Living 899 556 80 263 610 11 Stuart J. Beebe CEO Orlando, FL sonataseniorliving.com
122 Solera Senior Living 895 513 107 275 230 8 Adam J. Kaplan Founder and CEO Greenwood Village, CO soleraseniorliving.com
123 The Plaza Assisted Living 879 — — — 550 6 Tricia Medeiros COO Honolulu, HI plazaassistedliving.com
124 Anthem Memory Care 834 n/a n/a 834 720 11 Isaac Scott & Lewis McCoy Principals Lake Oswego, OR anthemmemorycare.com
125 Claiborne Senior Living 826 386 256 184 343 8 Tim Dunne President and COO Hattiesburg, MS theclaiborne.com
126 EPOCH Senior Living 769 52 174 543 1,018 12 Laurence Gerber President and CEO Waltham, MA epochsl.com
127 Avalon Health Care 757 515 100 142 575 10 Randy Kirton Owner and CEO Salt Lake City, UT avalonhealthcare.com
128 LifeWell Senior Living 734 530 n/a 204 450 9 Kimberly Erickson President/COO Houston, TX lifewellsl.com
129 Ridgeline Management Co. 677 520 45 112 325 12 John R. Safrans CEO West Linn, OR ridgelinemc.com
130 Chancellor Health Care, Inc. 671 147 124 400 — 15 Michel Augsburger CEO Windsor, CA chancellorhealthcare.com
131 Woodlands Senior Living 668 260 349 60 400 14 Lon Walters Founder, President, and CEO Waterville, ME woodlandsmaine.com
132 Cardinal Senior Management 651 525 18 108 395 12 Joe Pohlen & Chuck Gray Principals Grand Rapids, MI livecardinal.com
133 Legacy Retirement Communities 619 134 453 32 500 4 Greg C. Joyce CEO Lincoln, NE legacyretirement.com
134 Welbrook Senior Living 618 307 109 202 524 10 Doug Brawn Principal El Segundo, CA welbrook.com
135 Liv Communities 609 196 327 86 — 4 Scott McCutcheon COO Grand Haven, MI livcommunities.com
136 Surpass Senior Living 585 413 n/a 172 314 7 Matt Johnson President and Founder Dallas, TX surpassliving.com
137 Kensington Senior Living 554 252 61 241 950 6 Tiffany Tomasso Founding Partner Reston, VA kensingtonseniorliving.com
138 American Senior Communities 516 333 61 122 — 4 Donna Kelsey CEO Indianapolis, IN ASCseniorcare.com
139 Platinum Communities 515 — — — 350 8 John Teresinski Managing Director West Allis, WI platinum-communities.com
140 Wickshire Senior Living 4
500 — — — — 7 Staci Lynn COO Brentwood, TN wickshireseniorliving.com
141 Terrace Communities 495 328 n/a 147 343 7 Kate Heaton CEO and Owner Manchester, VT terracecommunities.com
142 Omega Communities, LLC 478 340 — 138 385 4 Pat Trammell, Jr. Chairman and CEO Birmingham, AL omegacommunities.com
143 Mustang Creek Estates 445 304 n/a 141 250 5 Reneé Ramsey CEO Plano, TX mustangcreekestates.com
144 New Forum 426 n/a 426 n/a 30 3 Tyler Steele COO Charlotte, NC newforum.net
145 Greenfield Senior Living 392 232 n/a 160 307 7 Matt Peponis CEO Falls Church, VA greenfieldseniorliving.com
146 WestShore Senior Living 391 126 — 265 — 5 Melissa Caldwell Principal Valparaiso, IN westshorellc.com
147 Insignia Senior Living 340 214 — 126 303 7 Milton L. Cruz CEO San Juan, PR insigniaseniorliving.com
148 GoodLife Senior Living and Memory Care 320 45 n/a 275 269 13 Dallen Skelly CEO Ruidoso, NM goodlifeseniorliving.com
149 The Abbey at Westminster Plaza 269 92 141 36 75 1 Jeny Knight Executive Director Tyler, TX abbeywp.com
150 Clearwater Living 245 54 136 — 171 2 Tony Ferrero CEO Newport Beach, CA clearwaterliving.com
NOTES: AL: Assisted Living; IL: Independent Living; MC: Memory Care. All data, unless otherwise noted, was voluntarily self-reported and represents U.S. data as of December 31, 2019. Data for skilled nursing units is not included. Only for-profit communities are included in this list. Several companies that would make the list did not respond to our request for data. 1Bridgestone Senior Living is now
Pinnacle Senior Living, but did not respond to requests for information. The data here is from 2019. 2Data is from 2019 Largest Providers Report, as of March 31, 2019. 3The Waters Senior Living AL and IL units are dually licensed. 4Wickshire Senior Living information is drawn from the company’s website.
2020 LARGEST PROVIDERS REPORT 7
25% 50% 75% 100%
FAILURE FRAILTY FUNCTION FUN
E F E F E F E F
PUTTING THE FUNCTION IN
FUNCTIONAL RESERVE:
HELPING OLDER ADULTS THRIVE, LIVE, & LEARN
ANTHONY RUGGERI, DIRECTOR OF SENIOR LIVING PARTNERSHIPS | FOX REHABILITATION
Impacting Older Adults
Three years ago, my wife and I decided to sign up for our
The impor tance of functional reser ve for older adults
first half marathon. We had run a 5K and 10K the year
cannot be overstated. Most people who are familiar with
before, but 21K — the equivalent of 13.1 miles — seemed
the term think of it as intense aerobic exercise, such as
like quite the jump. It was going to be difficult, but with the
cycling or running. However, it applies to much more than
right training regimen, we were hoping to get ourselves
that. People have a set functional reserve for almost any
ready to tackle the challenge.
activity. For the majority, it is not something we need to
Have you ever noticed how difficult an initial workout can worry about because we have the necessary energy stored
be after taking some time off? It probably took a handful to complete the most common, everyday tasks. However,
of sessions before you became comfortable and willing to for the older adult population, the reality of not having
push yourself to the next level. enough energy to complete activities of daily living (ADLs)
For us, the more we trained, the easier it was to find the comes to fruition consistently every single day.
extra energy required to get through each run. As the In addition to helping one perform ADLs, perhaps the
distance gradually increased, we were able to keep up grander importance of functional reserve is the assistance
with the physical and mental demands. That extra energy it provides with strengthening the immune system. This
supply is a physiological phenomenon called functional helps the body fight against sometimes deadly illness, such
reserve. According to a study titled, Functional reserve as the flu, or recently, COVID-19.
in functionally independent elderly persons, functional
As one of the more vulnerable populations, older adults
reserve is defined as the difference between the maximum
need all the support they can get. Why not start by building
physical or mental capacity of a construct and the minimum
a strong foundation of abundant functional reser ve?
necessary to perform daily functioning.
8 2020 LARGEST PROVIDERS REPORT
In a 2005 article written by David F. Goldspink, he states
that “reserve capacity of the heart is a major determinant
of an individual’s ability to remain active and cope with “
daily stresses and illnesses. Long-term participation in
endurance-based activities helps to preser ve cardiac NOW, MORE THAN EVER, THE
reserve and has both direct and indirect beneficial effects
on vascular smooth muscle and health preservation within
ADEQUATE FUNCTIONAL RESERVE
the cardiovascular system.”
IS NECESSARY FOR ALL
This, of course, speaks to FR of the heart, but it certainly
impacts other organs and skeletal muscles in the body. OLDER ADULTS TO
David goes on to say, “in a culture where inactivity has
become an accepted part of life, we still need to explore in LIVE BETTER, LONGER.
greater detail the benefits of habitual physical activity and
use this information as a community-based educational tool ”
to help prevent or delay cardiovascular disease, obesity,
arthritis, and the frailty associated with old age.”
If residents are not participating in activities, events, or
exercise classes in the community, it is most likely not
because they would rather sit in their room and keep to
themselves—often, this behavior can be attributed to lack
of functional reserve. Not only is their physical ability and
functional well-being diminished, but also their confidence
and mental health to actively participate and try new things.
Putting Valuable Resources to Work
Now, more than ever, the adequate functional reserve
is necessary for all older adults to live better, longer. It is
the responsibility of family, caregivers, and professionals
to advocate for movement, exercise, and the utilization of
physical and occupational therapies to keep older adults
happy and healthy, allowing them to thrive in their living
environment and beyond.
Functional Reserve in Senior Living There are tools out there to help delay the deterioration
Surely, functional reserve may offer benefits in performing of functional reserve. They need to be put to use. Just as
ADLs, fighting illness, and improving one’s overall quality my wife and I tried a half-marathon for the first time, older
of life. The questions that senior living operators need to adults want opportunities to face new challenges. They,
ask is, “How and what can older adults do to build up FR? too, want to explore, learn, and live with purpose.
What are some activities or healthcare options that can
help lead them on a path to happier and healthier golden
years?” Most senior living communities have resources to
provide exercise classes for their residents. Taking regular
walks around the inside or outside of the community
certainly helps, but what if residents have difficulty walking,
or participating in classes? A medically-driven intervention REFERENCES
may prove to be a better option.
González, Paul Medina, Cofré, Rodrigo Muñoz, & Cabello,
Today, many senior living operators have modernized Máximo Escobar. (2016). Functional reserve in functionally
their wellness models to include physical, occupational, independent elderly persons: a calculation of gait speed
and speech therapy as a proactive component within and physiological cost. Revista Brasileira de Geriatria e
a resident’s continuum of care. If a resident is sedentary Gerontologia, 19(4), 577-589. https://doi.org/10.1590/1809-
due to deconditioning, or simply has a fear of falling 98232016019.150136
that prevents them from leaving their apartment, their
David F. Goldspink (2005) Ageing and activity: their effects
condition can continue to deteriorate without rehabilitation
on the functional reser ve capacities of the hear t and
intervening. It is an unfortunate cycle—one that I witnessed
vascular smooth and skeletal muscles, Ergonomics, 48:11-
with my grandfather, who refused therapy for years, until he
14, 1334-1351, DOI: 10.1080/00140130500101247
ended up relying on a motorized scooter for mobility even
within his apartment.
FOXRE HAB.ORG
Tim Fox, PT, DPT, GCS-Emeritus, CCI: Lic. #40QA00702100 / 2020-0324-D6
2020 LARGEST PROVIDERS REPORT 9
Looking for a partner to bring value to your community? FOX Rehabilitation is a leading provider of
Geriatric House Calls™, providing physical and occupational therapy, speech-language pathology,
and exercise physiology to older adults. We are a corporate partner of Argentum serving more than
600 senior living communities and are committed to abolishing ageism through these FOX programs:
FOX RESTORING BALANCE is a true FOX RESTORING LIFE provides individuals with
proactive, wellness-driven program, rather than a unique stage-specific approach to dementia with
a common illness-driven, reactive approach. prescribed interventions to increase the quality of
Through communication with the nursing team daily interactions and manage the challenges that
on-site, residents may be identified as high fall come with the diagnosis. Our team will teach you
risk by FOX using evidence-based functional to focus on what a person with dementia can do
outcome measures. — not what they can’t do.
FOR MORE INFO EMAIL US AT
SLC@FOXREHAB.ORG
10 2020 LARGEST PROVIDERS REPORT
T I M F O X , P T, D P T, G C S - E M E R I T U S , C C I | LI C # 4 0 Q A0 070210 0 | 7 CARNEGIE PLAZA | CHERRY HILL, NJ 08003 | 2020-0324-D6ASSISTED LIVING/INDEPENDENT LIVING
30 LARGEST ASSISTED LIVING PROVIDERS 30 LARGEST INDEPENDENT LIVING PROVIDERS
Assisted Independent
Rank Provider Rank Provider
Living Units Living Units
1 Brookdale Senior Living 34,572 1 Holiday Retirement 31,272
2 Sunrise Senior Living 14,550 2 Life Care Services (LCS) 27,910
3 Five Star Senior Living 12,885 3 Brookdale Senior Living 23,504
4 Enlivant 9,798 4 Erickson Living 20,221
5 Atria Senior Living 9,673 5 Five Star Senior Living 11,196
6 Trilogy Health Services 8,550 6 Atria Senior Living 9,272
7 Senior Lifestyle 7,931 7 Senior Lifestyle 7,099
8 ALG Senior 7,819 American House Senior Living
8 4,928
Communities
9 Life Care Services (LCS) 6,243
9 Leisure Care, LLC 4,861
10 Capital Senior Living 6,065
10 Integral Senior Living 4,659
11 Eclipse Senior Living 5,821
11 Watermark Retirement Communities 4,569
Gardant Management
12 5,369
Solutions, Inc. 12 Capital Senior Living 4,424
13 Discovery Senior Living 5,325 13 Grace Management, Inc. 3,617
14 Meridian Senior Living 4,563 14 Sunrise Senior Living 3,255
15 Merrill Gardens 3,853 15 Vi 3,150
16 Frontier Management, LLC 3,737 16 Discovery Senior Living 2,945
17 Pinnacle Senior Living* 3,665 17 Merrill Gardens 2,937
18 Pacifica Senior Living 3,614 18 Senior Resource Group 2,565
19 Leisure Care, LLC 3,570 19 Sagora Senior Living 2,504
20 Watermark Retirement Communities 3,465 20 Kisco Senior Living 2,415
21 Genesis HealthCare 3,312 21 Century Park Associates 2,388
22 Benchmark 3,258 22 Sunshine Retirement Living* 2,236
23 Senior Resource Group 3,169 23 Brightview Senior Living 2,105
24 Civitas Senior Living 2,881 24 ALG Senior 1,767
25 Belmont Village Senior Living 2,751 25 Bridge Senior Living 1,762
26 Pegasus Senior Living 2,560 26 Senior Living Communities 1,701
27 Century Park Associates 2,384 27 The Arbor Company 1,694
28 Brightview Senior Living 2,276 28 Eclipse Senior Living 1,638
29 Americare Senior Living 2,231 29 Civitas Senior Living 1,625
30 Integral Senior Living 2,212 30 Pacifica Senior Living 1,598
*Bridgestone Senior Living is now Pinnacle Senior Living, but did not respond to * Data is from 2019 Largest Providers Report, as of March 31, 2019
requests for information. The data here is as of March 31, 2019.
2020 LARGEST PROVIDERS REPORT 11MEMORY CARE/CCRCS/INTERNATIONAL
30 LARGEST MEMORY CARE PROVIDERS 10 LARGEST CONTINUING CARE
RETIREMENT COMMUNITY (CCRC) PROVIDERS
Rank Provider
Memory BY NUMBER OF COMMUNITIES
Care Units
1 Brookdale Senior Living 9,968 Rank Provider No. of CCRCs
2 Sunrise Senior Living 5,801
1 Life Care Services (LCS) 97
3 Frontier Management LLC 4,087
2 Five Star Senior Living 35
4 JEA Senior Living 3,950
3 Brookdale Senior Living 22
5 Five Star Senior Living 3,575
4 Erickson Living 19
6 ALG Senior 3,277
5 Senior Living Communities 11
7 Atria Senior Living 2,717
6 Vi 10
8 Senior Lifestyle 2,632
7 Senior Lifestyle 7
9 Life Care Services (LCS) 2,586
8 Sunrise Senior Living 6
10 Pacifica Senior Living 2,142
9 Oakmont Senior Living 5
11 Koelsch Communities 1,667
10 Kisco Senior Living 2
12 Benchmark 1,566
13 Meridian Senior Living 1,444
14 Merrill Gardens 1,405
15 Capital Senior Living 1,389
NO. OF INTERNATIONAL PROPERTIES
16 Watermark Retirement Communities 1,359 AMONG LARGEST PROVIDERS
17 Silverado 1,241
Number of
18 Eclipse Senior Living 1,235 Provider International Locations
19 Civitas Senior Living 1,135 Properties
20 Belmont Village Senior Living 1,080 Sunrise Senior Living 61 15 in Canada; 46 in UK
21 Discovery Senior Living 1,037 Atria Senior Living 29 Canada
22 Brightview Senior Living 1,000 Meridian Senior Living 26 China
23 Harbor Retirement Associates 999 Merrill Gardens 3 China
24 The Arbor Company 970 Belmont Village
1 Mexico
Senior Living
25 Integral Senior Living 935
Northstar Senior Living 1 Mexico
26 Northstar Senior Living 929
27 Enlivant 924
28 Oakmont Senior Living 884
29 Aegis Living 864
30 Sagora Senior Living 861
12 2020 LARGEST PROVIDERS REPORTOPERATIONAL CAPACITY
50 LARGEST PROVIDERS BY OPERATIONAL RESIDENT CAPACITY
Operational Operational
Rank Provider Resident Rank Provider Resident
Capacity Capacity
1 Brookdale Senior Living 72,267 26 Oakmont Senior Living 4,500
2 Life Care Services (LCS) 42,249 27 Bridge Senior Living 4,455
3 Holiday Retirement 31,313 28 Northstar Senior Living 3,958
4 Five Star Senior Living 27,656 29 Americare Senior Living 3,930
5 Sunrise Senior Living 27,507 30 Legend Senior Living 3,577
6 Atria Senior Living 23,716 31 Genesis HealthCare 3,312
7 Erickson Living 22,010 32 Priority Life Care 3,187
8 Senior Lifestyle 19,557 33 Arrow Senior Living 3,175
9 Trilogy Health Services 13,390 34 Brandywine Living 3,029
10 ALG Senior 12,863 35 Allegro Senior Living 2,946
11 Enlivant 10,798 36 Commonwealth Senior Living 2,932
12 Watermark Retirement Communities 10,250 37 New Perspective 2,700
13 Pacifica Senior Living 8,320 38 Heritage Senior Living 2,682
14 Integral Senior Living 7,992 39 The Goodman Group* 2,524
15 Meridian Senior Living 7,891 Western States Lodging
40 2,389
and Management
16 Senior Resource Group 7,393
17 Grace Management, Inc. 7,032 41 LCB Senior Living, LLC 2,358
18 Brightview Senior Living 5,919 42 Solvere Senior Living 2,186
43 Compass Senior Living 2,172
Gardant Management
19 5,749
Solutions, Inc. 44 Justus Rental Properties, Inc. 2,047
20 The Arbor Company 5,429 45 Morning Pointe Senior Living 1,930
21 Sagora Senior Living 5,295 46 Hearth Management, LLC 1,852
22 Vi 4,800 47 Northbridge Companies 1,581
23 Senior Living Communities 4,633 48 Danbury Senior Living 1,500
24 Kisco Senior Living 4,500 49 Vitality Living 1,500
25 Belmont Village Senior Living 4,500 50 Waltonwood 1,485
NOTES: This list includes only companies that responded to the request for operational resident capacity data. Operational capacity is defined as the total number
of residents communities can adequately serve on any given day. This data includes U.S. properties only and does NOT include skilled nursing. * Data is from 2019
Largest Provider Report.
2020 LARGEST PROVIDERS REPORT 13OUTLOOK ON REITS
CAUTIOUS MOVEMENT TO KEEP THE RIGHT BALANCE
By Sara Wildberger
Through 2019, the outlook for senior living was based on the Leadership changes at Healthpeak included Scott Brinker,
same factors as prior years: Demographic imperatives point to promoted to president as well as serving in his existing chief
greater need—more people, living longer—counteracted by investment officer role; Jeff Miller as executive vice president,
the increase in chronic diseases, which present challenges to senior housing, and Lisa Alonso as executive vice president
current models. Although it behaves differently than a chronic and chief human resources officer. In its 2020 second-quarter
disorder, COVID-19 may have a similar dampening effect and is earnings call, Healthpeak CEO Thomas Herzog stated that the
already raising operating expenses. company intenced “for the majority of our future growth to be
in life science and medical office.”
Midway through 2019, some saw 2021 as the year senior
housing would exhaust supply and head into growth mode; by National Health Investors (NHI), New Senior Investment Group,
second-quarter 2020, the decrease in move-ins and increased Sabra Health Care REIT, and LTC Properties, Inc., hovered
operating expenses put this in doubt, but it’s not off the table. around their same investment value as on last year’s list.
Senior Housing Properties Trust, $4.5 billion and number 4 on
last year’s list, changed its name to Diversified Healthcare Trust NEW ON THE LIST:
and Nasdaq ticker symbol to DHC on January 1, 2020. • Omega Healthcare Investors, whose portfolio at the end
of first quarter 2020 was 84 percent skilled nursing and 16
Healthpeak Properties (PEAK on NYSE) went through a percent senior housing, and which in May 2019 acquired
transformation as well, re-naming from HCP at the end of MedEquities Realty Trust, including 35 properties.
October 2019. Its senior living investment value in the last list,
spanning second quarter 2018 to end of first quarter 2019, was • CareTrust REIT, with 72 percent skilled nursing and 19
$6.9 billion. percent assisted and independent living, held a $150 million
share buyback at the end of first quarter 2020.
10 LARGEST REAL ESTATE INVESTMENT TRUSTS (REITs) BY SENIOR LIVING INVESTMENT VALUE
Trading Senior Living Total US Total US
Company Chief Executive/Title
Symbol Investment Value Units Properties
Welltower WELL $17.7 billion 66,253 655 Thomas J. DeRosa, Chairman and CEO
Ventas* VTR — 59,258 671 Debra A. Cafaro, Chairman and CEO
Jennifer Francis, President and COO/
Diversified Healthcare Trust DHC $4.2 billion 31,618 244
Richard Siedel, Jr., CFO and Treasurer
Healthpeak Properties PEAK $2.7 billion 13,176 115 Thomas Herzog, CEO
National Health Investors NHI $2.4 billion 14,517 157 Eric Mendelsohn, President and CEO
New Senior Investment Group SNR $2.1 billion 12,405 103 Susan Givens, CEO and President
Omega Healthcare Investors. OHI $1.6 billion 8,033 130 C. Taylor Pickett, CEO
Richard K. Matros, Chairman, President,
Sabra Health Care REIT SBRA $1.5 billion 8,629 108
and CEO
Wendy Simpson, Chairman, CEO,
LTC Properties Inc. LTC $0.9 billion 6,173 107
and President
CareTrust REIT CTRE $0.2 billion 3,409 41 Gregory Stapley, President and CEO
Updated listing as of August 27, 2020.
*Ranking based on valuation data from 2019 Largest Providers Report, as of March 31, 2019. Total US Units and Total US Properties data is based on data as of
December 31, 2019.
14 2020 LARGEST PROVIDERS REPORTCOVID-19 AND THE SENIOR LIVING MARKET
PANDEMIC BRINGS NEW CHALLENGES AND INNOVATIONS
By Ken McDonald
John Means, PE, is a McKinsey & Company partner related topics. As you mentioned, this is very much
who serves on the company’s global real estate the crisis of our time. So I appreciate the chance to
executive committee and leads development talk to you about it.
services in North America. He has developed
inpatient, outpatient, and senior housing portfolios In the United States in particular, where we are
as well as major city center redevelopments, currently observing regional resurgence, we’ll
multifamily, office, and resorts. need to be prepared for addressing that and
seeing the impact economically and socially
Recently he served as moderator for one of across the country. What that means is this may be
Argentum’s member-only COVID-19 webinars, a longer and more fragmented economic recovery; John Means, PE
“Preparing for COVID-19’s Long-Term Business I’d say many business executives that we survey Partner
Impact.” As part of his analysis, he looked at are shifting in that direction. McKinsey & Company
companies that responded to past crises by
reimagining and re-forming their organizations, Our economic research suggests we could
dubbing these “Resilients.” They had in common experience a 10 percent to 12 percent drop in
focus on improving operating efficiency, divesting gross domestic product in second quarter 2020
for strength, acquiring for growth, “adopting a clear compared to 2019 fourth quarter, and that we’re
strategic intent and flexible resource re-allocation,” talking about probably the middle of 2023 to get
and “innovating their business model.” all the way back to the end-of-2019 levels.
Here, he looks at the toll of the pandemic tragedy, We’ve certainly modeled more drastic scenarios,
how to stay strategic and flexible in its face, and but for the most part, the economic stimulus in
how to emerge as a Resilient. the United States, we think, has done what it
was intended to do, which is to keep many of the
Excerpted from a longer interview and edited for economic engines of the country running and
clarity. supporting economic ecosystems. I think we’re in
a better place than we could have been.
Q: What is the outlook for where we’re standing
with the economic recovery for the next 12 But going back to this recovery question as a
months? What kinds of scenarios do you think humanitarian one—and as an individual watching
might be emerging? so many people in my community wrestling with
unemployment—I think we have to face that the
A: First and foremost, McKinsey is thinking about challenge in our own communities is quite serious.
this as a humanitarian crisis. We have several
hundred teams that have worked on COVID-19-
What has become clear in this crisis is that people are looking for actions
and features that help them feel more safe, secure, and connected. What
model can do that? If you can answer that question as an operator in
senior housing, you’re much more prepared to be resilient—and to meet
the needs of the residents, who are at the heart of your business.
2020 LARGEST PROVIDERS REPORT 15COVID-19 AND THE SENIOR LIVING MARKET
Q: Can we talk about the companies you’ve seen as resilient another residential environment in the next six to 12 months.
and what characteristics they tend to share? That number is much less if you haven’t had a COVID case,
closer to 30 percent.
A: Firms we called resilient were much more active in the
incoming days of a crisis in taking mediating actions: Improving As a senior housing operator, one potential shift could be
operational performance, managing cash, moving investments to deploy services that you might normally find in a senior
that might have pushed them toward bankruptcy out of their housing environment into home care or into a more traditional
portfolio. So it was really saying: How do we make sure that we multifamily environment. It might be a business-model shift.
are able to maintain the strongest posture with our employees
and our businesses during the downturn as we can? In the broader perspective of feeling secure, services like
regular wellness checks by a licensed nurse or demonstrated
We believe that they were also the fastest to act once their increased certification and infection control or “emergency
strategic paths became more clear. That would be things like response optimization” would be at the top of the feature sets
accelerating into growth and making bets about the future of that we measured.
their business. They had what we called a clear strategic intent
about what they were going to try to accomplish. Features like built-in telehealth systems within people’s units
and wearable health-tracking devices also jumped off the
Q: How does that dovetail with senior living? Will those same page—largely by the family members of residents, less so the
actions lead to resiliency in this crisis? residents. It reinforced for us the idea that we can much more
closely monitor our personal health and deliver the health care
A: Interestingly, through that period [around the Great that’s necessary, even in a remote setting or in a lockdown
Recession, 2007 to 2012], we used a metric of total return to setting.
shareholders. It didn’t necessarily measure other things around
broader sustainability objectives or employment. Another opportunity that I would highlight is the set of features
around community and connection, such as interactive
In this particular crisis, so many companies have taken experiences and socialization technology. Can you create an
sustainability and their responsibility to employees even more environment where residents can still interact with their local
seriously. We may come out measuring resilience and recovery community and also with their family members?
a little bit differently.
All of these things could together create a transformational
But I think the underlying philosophy that you take dramatic moment for senior housing. Each of these can be catalytic
steps quickly when you see the crisis coming, to preserve your for new business models and innovation that better serves
business and your employees, then take rapid steps with a residents through a period like this.
clear strategic intent as you’re moving out of the crisis—that is
still going to be fundamental. Many of these would have occurred naturally, but on a slower
timeframe. COVID-19 is ramping up the need.
Q: In reference to the senior living space, how important is
innovation? How hard is it to innovate when the walls are Q: When we look back at this time, are we going to look
coming down around you and you’re more likely to want to at COVID-19 and think that it was a blip on the screen or a
kind of hunker down? speed bump changing things in the senior living space?
A: I do think innovation and the business model is the most A: I think at the end of the day, we’re going to see this as a
important measure of success if you can get the other pieces pretty big speed bump that forced us to re-evaluate how we
in order. For senior housing owners and operators and their deliver care in a senior housing environment and as a catalyst
residents, what has become clear in this crisis is that people for many of the changes and innovations that were needed to
are looking for actions and features that help them feel more better serve residents.
safe, secure, and connected. What model can do that?
Those are going to be far more impactful over time than we
If you can answer that question as an operator in senior might have imagined—and probably of a much longer duration
housing, you’re much more prepared to be resilient—and to than people have been expecting.
meet the needs of the residents, who are at the heart of your
business. The McKinsey COVID Response Center offers data, leadership
insights, response tools, and public webinars on the crisis and
When we interviewed residents, their families, and prospective its effect on human lives, economies, and public health.
residents and their families, if they have had a COVID-19 case
in their building, nearly 60 percent of those individuals have Argentum members can download COVID-19 recorded
said they’re much more likely to move toward home health or webinars at argentum.org/covid19webinars.
16 2020 LARGEST PROVIDERS REPORTOUTLOOK ON PRIVATE EQUITY
INVESTMENT COOLED BUT CONTINUING
By Ken McDonald
Julie Ferguson, senior vice president and senior Q: We were also hearing concerns about
living sector leader at Ryan Companies, has a unrealistic expectations about what it takes to
20-year, $655-million-plus history in senior living. get into the space—could you speak to those?
At Ryan, she’s working to plan and execute the
strategic vision for the senior living sector. A: As more equity groups with inexperience in
this space got into senior housing, they came with
In this interview, she helps put the private equity some of their carry-over expectations from these
and overall senior living market in perspective other asset classes and attempted to apply those
from both sides of the crisis. same thought processes and expectations around Julie Ferguson
returns and exit timeframes. Senior vice president
Q: Could we look back to 2019 and compare that and senior living
to what we’re facing now? Senior housing is unique from the perspective sector leader
that the communities do take longer to lease up Ryan Companies
A: Private equity in senior housing has certainly and it is a very operationally driven business. It’s
accelerated in the past two to four years. The very much about what happens the day the doors
last statistic I’ve heard is that there was over $11 open, versus other asset types.
billion needing to be spent in this space in the
coming years. A lot of people have jumped into As an industry, we sometimes said: Okay, we can
this business that had not previously been in lease up in 18 months instead of 24. We can push
senior living—folks who traditionally had been, this margin. And it doesn’t help us to set unrealistic
maybe, multifamily developers. Our sector is very expectations, either.
attractive.
I hope that as an industry we have been able to
The amount of capital in the sector has also helped educate equity groups and explain why our returns
build credibility around our sector as an investment and timeframes are the way they are.
vehicle compared to your traditional real estate
classes like multifamily, industrial, hotel, office, or Q: Okay, then fast forward into where we are
retail. Institutions paying attention has certainly now, July 2020. Are you seeing senior living as
helped all of us open doors for more investment more or less appealing in light of COVID-19?
and more interest in the space.
A: I think we have to break that down into two
The construction starts over the last 18 to 24 separate segments: existing property acquisition
months show that as a sector, we are growing investment; and new developments. The feedback
rapidly. We’ve added a lot of products to the we’ve been seeing is that there continues to be
marketplace in a short period of time. I think this is appetite for development projects. The thought
the result of the interest equity players have been process is that new developments will open in 18
investing in this space.
Equity groups are looking for more of an operational story. The operators
have always been important, but today it feels like the operator is 90
percent of the story. During COVID, what the private equity groups are
looking at is: How did you keep your residents and employees safe?
What was your commitment to secure their health and well-being?
2020 LARGEST PROVIDERS REPORT 17OUTLOOK ON PRIVATE EQUITY
to 24 months, and COVID will hopefully be in the rear-view There’s still the desire for these groups to invest capital in
mirror. But they seem to have cooled a little bit on buying the space. The thinking is that this is a mid- or short-term
existing projects unless these are in a significantly distressed challenge, and that the long-term prospects of this industry
situation. haven’t changed. Certainly during COVID, we’re getting a
chance as an industry to prove our ability to take care of
The industry is experiencing pressure because of COVID and residents and people’s family members safely and securely in
not being able to maintain those occupancy levels. We have a senior housing community. That will certainly bode well for
this 12- to 18-month period of unusual but significant operating us later.
risks. Our costs are a little bit more unpredictable, because of
personal protective equipment, potential additional pay to our We’re finding we have a much bigger pool of job candidates.
employees, and paying for testing. It’s a great opportunity to attract new people to the senior
housing space at the community level.
We had it really good as an industry for several years, because
there was so much capital that it was easier to attract lots of We’re waiting to see if there will be some fallout from
people to look at your deal…you sort of got to drive the terms. hospitality or retail…that helps reduce some of the
Today, that’s changed a little bit. construction price pressure that we’ve been seeing for the
past several years.
The equity groups have emphasized that they want to focus
their attention and their dollars on people they have already COVID-19 has forced our industry to look at things that simply
transacted business with. It takes some of the relationship make sense when you’re dealing with a senior population:
risk out of it when you have somebody you have positive How you improve your infection control, air quality, air filtration
history with. systems, types of surfaces, cleaning protocol. Either using
technology or processes that have a positive benefit to our
I absolutely think they are taking a deeper dive when they look residents, regardless of whether it’s during COVID or just a
at a project than they have in the past. They’re digging into a regular period of time.
lot of the metrics and the staffing ratios and asking for plans
post-COVID for additional expenses. You know—and I can speak specifically to the groups that we
work with—they have been incredibly supportive of us telling
Today, pretty much every conversation I’m on is about how them what we need to best manage our communities during
Ryan’s portfolio is fairing in today’s COVID-19 world compared this crisis and have responded incredibly favorably to providing
to the rest of the industry.. What have your operators that support. They’ve approved budget changes, additional
been doing? What are you thinking of doing in your next costs, knowing that is incredibly important for us short-term
building that might help with this type of issue? How are you making our way through this, whether it has to do with
managing marketing? There are very detailed questions cleaning, whether it has to do with marketing, whether it has to
about how we are dealing with COVID-19 what operators are do with the building upgrades.
doing about it.
I would say every conversation that we have with an equity
One thing [equity groups] are looking for is more of an groups on the deals that we’re out raising capital, they want to
operational story. The operators have always been important, talk about what the company’s looking at as far as technology
but today it feels like the operator is 90 percent of the story. and building for future issues. I think they recognize there are
During COVID, what the private equity groups are looking at things that we could do that would perhaps take some of the
is: How did you manage that? What did you do? How did you risks off the table in a potential future virus situation.
react? How did you keep your residents and employees safe?
What was your commitment to their health and well-being? Capital markets recognize that we’ve been forced to do things
differently, and they’ve been supportive of how we do that.
Q: Are there positives in the picture? And I think they’re open to possibilities of how operations
might be different in the future.
A: I think we’ll certainly see some pent-up demand as
communities start providing tours and are able to provide more
normal activities and dining. We keep re-anchoring ourselves
as an industry and reminding ourselves that we all got into
this because of that demographic shift that’s happening in the
market, and that that’s not changing. The challenge is keeping
the fundamentals of our business throughout COVID-19.
18 2020 LARGEST PROVIDERS REPORTYou can also read
