Continuing Care Retirement Communities and Assisted Living Facilities for the Elderly (U.S.) — NAICS 6233

A Histometrics rollup primer for public-market and private investors. This is a "pass-through" level: the industry group 6233 contains exactly one industry, 62331, so the two are effectively the same thing. This page gives the group-level ground-truth figures and points you to the 62331 primer for the full detail.

1. Overview

NAICS (North American Industry Classification System) code 6233 is the residential, non-hospital end of U.S. seniors housing — the part of the economy where older adults live and receive personal care with the activities of daily living (ADLs — bathing, dressing, medication, mobility, meals, supervision), as distinct from the acute, hospital-style setting of a skilled-nursing facility (which sits in a separate code, 623110).[1]

Because this four-digit industry group contains only one five-digit industry — 62331, Continuing Care Retirement Communities and Assisted Living Facilities for the Elderly — everything true of 62331 is true of 6233. For the full economic story, read the child primer; this page exists to give you the group-level federal figures and a map of what sits underneath.

2. What's inside — and why the level equals its one child

The group has a single child industry:

Since 62331 is the only industry in 6233, the group's revenue, employment, and establishment counts are identical to 62331's — there is nothing to add up and no other sibling to dilute it.

The economic diversity in this level sits one rung below, inside 62331, which itself splits into two six-digit industries that are similar in revenue but opposite in almost everything else:

• 623311 — Continuing Care Retirement Communities (CCRCs): large campuses pairing independent living, assisted living, and memory care with on-site skilled nursing under one contract ("Life Plan Communities"); ~80% nonprofit; financed with six-figure entrance fees and tax-exempt municipal bonds.[2]
• 623312 — Assisted Living Facilities: apartment + meals + help with ADLs + 24-hour non-medical supervision, without on-site nursing; for-profit and private-equity-dominated; financed like real estate and paid month-to-month out of pocket.[1][3]

That CCRC-vs-assisted-living contrast is the real substance of this level, and it is covered in full in the 62331 primer.

3. How big it is (the level's rollup figures)

Ground-truth U.S. federal figures for NAICS 6233, from stats-6233.md. Reference years differ: establishments, employment, and payroll are County Business Patterns (CBP) 2023; receipts, firm count, and concentration are the 2022 Economic Census. Do not divide receipts (2022) by employees (2023) to derive margins.

These are, by construction, the same figures reported for child 62331 — a group with one member cannot differ from that member. At roughly $80 billion in annual receipts and about 964,000 workers, this is one of the larger consumer-services industries in the country, and it sits directly in front of the fastest-growing age cohort in the United States.

Concentration: a fragmented national industry. With a top-4 revenue share of 9.2% and an HHI of 34.8 (the HHI runs to 10,000 for a monopoly; anything under 1,500 is "unconcentrated"), no operator dominates nationally. Competition is local.

The undercount caveat. CBP measures employer establishments with paid staff — it excludes nonemployer businesses, the self-employed, and most government facilities, and it counts locations, not beds or residents.[6] Because the assisted-living half runs down to tiny family-run "residential care homes," small and individually owned operators are genuinely under-captured; treat the establishment and employment counts as a floor for that tail. Trade sources count more communities (roughly 41,000+ assisted-living communities and ~1,900–2,000 marketed CCRCs) on broader definitions, and private "market-size" reports citing $45–115 billion generally use global or broader-senior-housing scope and are not comparable to the ~$80B federal receipts figure.[3]

4. Investable universe — where value concentrates

There is no large pure-play public company for this level. Public exposure concentrates in three buckets, spanning both halves of the child industry:

• Seniors-housing REITs (real estate investment trusts — the landlords that own the buildings) — the broadest public route, spanning both CCRCs and assisted living: Welltower (WELL), Ventas (VTR), Healthpeak (DOC), plus American Healthcare REIT (AHR), CareTrust (CTRE), Sabra (SBRA), NHI, LTC, and Omega (OHI).[7][8][9]
• Listed operators — thin, and concentrated in the assisted-living half: Brookdale Senior Living (BKD) and Sonida Senior Living (SNDA), plus diversified post-acute platform National HealthCare (NHC).[10][11][12]
• Tax-exempt municipal senior-living revenue bonds — the CCRC half's most direct public route, because ~80% of CCRCs are nonprofit with no equity to buy.

The marquee operating brands (LCS/Life Care Services, Erickson, Discovery, Atria; the LeadingAge Ziegler 200 nonprofit systems) are largely private.[13] For the full breakdown of where value sits across the two children, see the 62331 primer, Section 4.

5. How the money works

Both halves of the level share a labor-heavy, occupancy-levered cost base (labor ~55–60% of operating cost); once a building is staffed and open, costs are largely fixed, so occupancy is the earnings lever.[3] They diverge on revenue:

• CCRCs earn a six-figure entrance fee (avg ~$400,000, often partly refundable and booked as deferred revenue and a liability) plus a monthly fee, and Type A "Life Care" contracts carry insurance-like actuarial risk.[2]
• Assisted living earns occupancy × monthly rate — overwhelmingly private-pay (median ~$6,200/month per the CareScout 2025 survey), with only about one in six residents on Medicaid for the service portion.[3][14]

Across both, real estate is usually owned separately from the operating business (the "opco/propco" split), so a REIT landlord earns either fixed rent (triple-net lease) or the property's net operating income (a SHOP / seniors-housing operating portfolio structure, enabled by RIDEA — the REIT Investment Diversification and Empowerment Act), while the operator earns the operating profit or a management fee. Full detail in the child primer, Section 5.

6. Demand drivers

The demographic engine is unusually strong and predictable. The U.S. population aged 65+ reached 61.2 million (18.0%) in 2024, all baby boomers will be 65+ by 2030, and the core 80+ customer cohort is projected to grow roughly 27–28% between 2025 and 2030.[15][16] New construction sits near the lowest rate of the century, so demand is running ahead of supply — favoring existing, filled communities with pricing power.[8][17] Rising dementia prevalence (roughly 40% of assisted-living residents live with Alzheimer's or another dementia) lifts acuity and memory-care pricing; because most entrants fund a move by selling a home, move-in volume also tracks the housing market.[3]

7. Regulation

The two halves inside this level are regulated on different tracks:

• Assisted living is state-licensed with no federal regime — each state sets its own rules, so operators face 50-plus regimes; federal influence is indirect, mainly through Medicaid HCBS (Home and Community-Based Services) waivers.[18]
• CCRCs face an insurance/financial track for the Life Care contract (about 38 states, often via the Department of Insurance) plus a federal health-care track — CMS (Centers for Medicare & Medicaid Services) — for the skilled-nursing beds.[19][20]

Do not apply nursing-facility (623110) certification and reimbursement rules to this level wholesale — only the CCRC nursing beds carry them.

8. Consolidation

Nationally fragmented (CR4 9.2%, HHI 34.8) and locally competitive; barriers to entry are high (capital, entitlement, licensing, years of fill-up).[5] Consolidation runs on capital and looks different in each half: REIT roll-ups and private-equity/operator M&A in assisted living (Welltower announced ~$23 billion of transactions in 2025; LCS combined with Vi in May 2026), versus nonprofit affiliation in the CCRC half.[7][8][13] Emerging substitutes include rental "active-adult" housing and "CCRC-without-walls" home-based continuing care.

9. Risks

The level's risks are 62331's risks: labor cost and staffing (the number-one operating risk); occupancy and housing-market sensitivity (COVID-19 drove severe 2020–21 damage); the CCRC entrance-fee model's fragility (at least 16 CCRCs have filed Chapter 11 since March 2020, and residents owed refunds usually rank as unsecured creditors behind bondholders); an affordability ceiling that excludes many middle-income seniors; interest-rate and capital-intensity exposure across this real-estate-heavy level; and quality/liability risk.[3][21]

10. How to invest, and outlook

Public routes: seniors-housing REITs (WELL, VTR, DOC, plus AHR/CTRE/SBRA/NHI/LTC/OHI) for the broadest exposure spanning both children; listed operators (BKD, SNDA, NHC) for leveraged operating exposure to the occupancy-and-rate recovery; and tax-exempt CCRC revenue bonds for the nonprofit half — a credit-selection game (analyze debt-service coverage, liquidity, entrance-fee liabilities, and covenants).[7][8][10][11] Private routes: buying and operating an existing community, ground-up development (judged on development yield versus market cap rate), net-lease or SHOP/RIDEA joint ventures, private credit, and LP stakes in seniors-housing funds; the SBA classifies assisted-living firms up to $23.5M and CCRCs up to $34M as small businesses, so direct ownership is within reach.[22] Underwrite each local market, not the national demographic average.

Outlook: the demographic case is unusually strong — an 80+ population growing ~27–28% by 2030 against a development pipeline near record lows should support occupancy, rate growth, and entrance-fee pricing for incumbents through the decade.[8][17] But demographics support demand, not margins or returns; the binding constraints are labor availability and cost, the affordability ceiling, the path of interest rates, and — for the CCRC half — whether the bankruptcy overhang dents trust in the entrance-fee model. Expect a strengthening demand backdrop favoring well-capitalized operators and high-quality real estate, with a persistent tail of fragile single-site communities — making credit, operator, and local-market selection decisive. For the complete analysis, see the 62331 primer.

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Sources

1. U.S. Census Bureau, "2022 NAICS Definitions: 62331 / 623311 / 623312" (and adjacent 623110). https://www.census.gov/naics/?details=62331&year=2022
2. NIC (National Investment Center for Seniors Housing & Care), "Continuing Care Retirement Community (CCRC)," and Acts Retirement–Life Communities / Life Care Services, "CCRC Contract Types," 2025. https://www.nic.org/senior-housing-care-research/senior-housing/continuing-care-retirement-community/
3. American Health Care Association / National Center for Assisted Living (AHCA/NCAL), "Assisted Living Facts & Figures" (communities, beds, residents, payer mix, dementia share, labor % of cost), 2024–2025. https://www.ahcancal.org/Assisted-Living/Facts-and-Figures/
4. U.S. Census Bureau, County Business Patterns 2023, NAICS 6233 (establishments, employment, annual and Q1 payroll). https://www.census.gov/data/datasets/2023/econ/cbp/2023-cbp.html
5. U.S. Census Bureau, 2022 Economic Census — Concentration of Largest Firms, NAICS 62331 (firms, receipts, CR4/CR8/CR20/CR50, HHI). https://api.census.gov/data/2022/ecnsize.html
6. U.S. Census Bureau, "County Business Patterns Methodology" (employer-establishment scope; excludes nonemployers, self-employed, most government). https://www.census.gov/programs-surveys/cbp/technical-documentation/methodology.html
7. Welltower Inc., 2025 Annual Report and "Welltower Announces $23 Billion of Transactions…," Oct. 27, 2025. https://welltower.investorroom.com/2025-10-27-Welltower-Announces-23-Billion-of-Transactions-and-Intensified-Focus-on-Seniors-Housing
8. NIC, "Occupancy Rate for Senior Living Communities Increased in 2025 as Construction Stalled" (AL occupancy ~87.7%, Q4 2025; supply shortfall). https://www.nic.org/news-press/occupancy-rate-for-senior-living-communities-increased-in-2025-as-construction-stalled/
9. Ventas, Inc., Form 10-K FY2025 (senior housing >50% of NOI) and McKnight's Senior Living, "Healthpeak forms new senior housing REIT, Janus Living," 2026. https://www.sec.gov/Archives/edgar/data/740260/000074026026000006/vtr-20251231.htm
10. Brookdale Senior Living Inc., Form 10-K FY2025 (~584 communities, ~51,000 capacity; 15 CCRCs). https://www.sec.gov/Archives/edgar/data/1332349/000133234926000032/bkd-20251231.htm
11. Sonida Senior Living, Inc., Form 10-K FY2025 (~96 communities; CNL Healthcare Properties acquisition). https://www.sec.gov/Archives/edgar/data/1043000/000104300026000009/snda-20251231.htm
12. National HealthCare Corporation, Form 10-K FY2025 (AL units plus continuing-care contracts and entrance-fee liabilities). https://www.sec.gov/Archives/edgar/data/1047335/000143774926005910/nhc20251231_10k.htm
13. Argentum, "2025 Largest Providers Report," July 2025, and LeadingAge / Ziegler, "LeadingAge Ziegler 200 (LZ 200)," 2024–2025; LCS, "LCS Announces Successful Close of Vi Acquisition," May 2026. https://www.argentum.org/wp-content/uploads/2025/07/2025-Largest-Providers.FINAL_.pdf
14. CareScout (Genworth), "2025 Cost of Care Survey" (median assisted living $6,200/month). https://www.carescout.com/cost-of-care
15. U.S. Census Bureau, "Older Adults Outnumber Children in 11 States…" (65+ = 61.2M, 18.0% of population, 2024), 2025. https://www.census.gov/newsroom/press-releases/2025/older-adults-outnumber-children.html
16. U.S. Census Bureau, "By 2030, All Baby Boomers Will Be Age 65 or Older," 2019. https://www.census.gov/library/stories/2019/12/by-2030-all-baby-boomers-will-be-age-65-or-older.html
17. NIC MAP, "The Impending Age Wave" and NIC, "How Much Future Senior Housing Inventory is Needed…," 2025. https://www.nicmap.com/blog/the-impending-age-wave-navigating-the-urgent-need-for-senior-housing/
18. U.S. Dept. of Health & Human Services, ASPE, "Compendium of Residential Care and Assisted Living Regulations and Policy" (state-by-state), and U.S. GAO, "Assisted Living Facilities: Information on Federal Spending and Medicaid Coverage," 2026. https://aspe.hhs.gov/reports/compendium-residential-care-assisted-living-regulations-policy-2015-edition
19. National Continuing Care Residents Association (NaCCRA) and North Carolina Department of Insurance, "CCRC regulation and oversight," 2024–2025. https://www.ncdoi.gov/licensees/continuing-care-retirement-communities-ccrc
20. Centers for Medicare & Medicaid Services, "Nursing Homes" (42 CFR Part 483, survey/certification). https://www.cms.gov/medicare/health-safety-standards/certification-compliance/nursing-homes
21. Cozen O'Connor, "Hundreds of Millions Lost by Seniors Due to CCRC Bankruptcies," 2025. https://www.cozen.com/news-resources/publications/2025/hundreds-of-millions-lost-by-seniors-due-to-bankruptcies-filed-by-continuing-care-retirement-community-communities
22. U.S. Small Business Administration, "Table of Small Business Size Standards" (NAICS 623311 $34M; 623312 $23.5M), 2023. https://www.sba.gov/document/support-table-size-standards