Despite a tempestuous year for the real estate industry, most experts agree that the seniors housing sector has thus far weathered the economic storm relatively well. Some encouraging fundamentals from the National Investment Center for the Seniors Housing & Care Industry (NIC) appear to bolster this view: Mean occupancy rates for assisted living, skilled nursing, and continuing care retirement communities, for example, held steady from the third to the fourth quarters in 2008.
What’s more, loan performance deterioration during the fourth quarter of 2008 was still well below the 10 to 15 percent levels of nonperforming loans that the industry experienced during the last downturn six to seven years ago, according to Lawrence Horan, NIC’s financial research and analysis director.
While most experts agree that the outlook for the next 12 months is sunnier, there is a dark cloud on the horizon: the specter of some $390 million in cuts to Medicare skilled nursing facility funding for next year.
On the following pages is Provider’s annual ranking of the top 50 nursing facility companies, by the number of nursing beds, as of Dec. 31, 2008. The data indicate the 50 leading companies’ 2008 revenue, occupancy rates, and extent of regionalism.

Reflections Of The Economy

This year’s ranking perhaps reflects the economic turmoil of the past 12 months, with a total bed count reduction of 14,827 compared to last year.

Only three of the top 10 companies reported gains this year—Genesis Healthcare Corp., Skilled Healthcare, and National HealthCare Corp. expanded by a total of 5,561 beds—while the remaining seven had modest dips in bed counts.  

Otherwise, HCR ManorCare retained its status this year as the leader of the pack, while all of the top four companies held steady. Golden Living, Life Care Centers of America, and Kindred Healthcare remained at Nos. 2, 3, and 4, respectively.

Genesis HealthCare grabbed the No. 5 spot from Sun Healthcare Group, which inched down to No. 6.
Extendicare Health Services slid one space up from last year, to No. 7, filling the spot left open by SavaSenior-Care, who did not participate in the rankings this year.

The remaining three top 10 companies were jostled slightly, with Evangelical Lutheran Good Samaritan Society moving up from No. 9 to No. 8 and Skilled Healthcare Group holding at No. 10.

National HealthCare slid past Skilled Healthcare to take up the No. 9 slot this year with a bed count gain of over 600.

Two companies, Trilogy Health Services and Americare, made notable jumps in the rankings this year through acquisitions of more than 1,600 beds combined. Trilogy leaped 10 slots, from No. 28 to 18, with 1,280 new beds, while Americare rose seven slots with an additional 463 beds, from No. 50 to No. 43 this year.

There is one newcomer to this year’s ranking: Stonegate Senior Care of Lewisville, Texas, who joins the list at No. 26 with 3,590 beds.

Companies Up Services

Renovation activity remains steady among the top 50, with nearly all respondents indicating they would either begin or complete renovations of some facilities this year. More than 36 companies are adding rehabilitation suites or units, and 16 are planning to add new services such as Alzheimer’s care, secured units, or respite rooms.

Two companies have added home care to their menu of business units, while 24 companies now offer hospice.

Up from last year are the number of companies offering ventilator services: 23 providers this year, compared to 19 last year.

The information in these rankings was collected through e-mail, Web sites, phone interviews, and faxed surveys. Only partial data were obtained for a number of private companies, which are not required to make public certain information.

Click here to download the 2009 Top 50 list.