Continuing Care Retirement Communities and Assisted Living Facilities for the Elderly (U.S.) — NAICS 62331

A Histometrics rollup primer for public-market and private investors. This level combines two child industries — CCRCs (623311) and assisted living (623312) — into the residential, non-hospital end of senior housing.

1. Overview

NAICS (North American Industry Classification System) code 62331 is the part of the U.S. seniors-housing economy where older adults live and receive personal care — help with the activities of daily living (ADLs — bathing, dressing, medication, mobility), meals, housekeeping, and supervision — as opposed to the acute, hospital-style setting of a skilled-nursing facility (which sits in a separate code, 623110). It bundles two related but economically distinct businesses: Continuing Care Retirement Communities (CCRCs), campuses that pair independent- and assisted-living housing with on-site nursing, and Assisted Living Facilities, communities that provide the same personal care without on-site nursing.[1]

Why it matters: at roughly $80 billion in annual operating revenue and about 964,000 workers in the federal statistics (Section 3), 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. It is also structurally unusual for investors, because the two halves are almost mirror images of each other. One half (CCRCs) is roughly 80% tax-exempt nonprofit and financed largely with six-figure entrance fees and municipal bonds; the other half (assisted living) is for-profit and private-equity-dominated, financed like real estate and paid for out-of-pocket month to month.[2][3] Understanding 62331 as an investment means understanding that contrast.

Two things unite the whole level. First, almost all the operating activity is local and privately held — national brands operating hundreds of communities exist, but they are a minority of a fragmented long tail. Second, the real estate is usually owned separately from the business that runs the community (the "opco/propco" split), which is what makes the sector investable from both a real-estate angle and an operating angle. Public-market investors mostly reach it through REITs (real estate investment trusts — landlords that own the buildings), a handful of listed operators, and — uniquely for the CCRC half — tax-exempt municipal bonds.

2. What's inside — the two child industries and how they differ

The level splits cleanly into two child industries. The single most important fact for an investor is that they are similar in revenue but opposite in almost everything else — ownership, unit economics, financing, regulation, and how you buy in.

How to read the split. CCRCs earn about half the level's revenue from only a fifth of its establishments, because a CCRC is a large, capital-intensive campus. Assisted living earns the other half from four-fifths of the establishments, each about a third the size. So if you are counting buildings, the level looks like assisted living; if you are counting dollars, it is a near-even split; and if you are counting nonprofit mission-driven capital, it is mostly the CCRC half. The two also carve residents out of each other: assisted living delivered inside a CCRC campus is counted in 623311, not 623312 — one reason neither federal count matches trade-group community counts (Section 3).

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

Ground-truth U.S. federal figures for NAICS 62331. Reference years differ: establishments, employment, and payroll are County Business Patterns (CBP) 2023; receipts, firm count, and concentration are the 2022 Economic Census; the SBA threshold is 2023. Do not divide receipts (2022) by employees (2023) to derive margins.

The children reconcile to the level. The two child industries add up almost exactly: 5,639 + 20,884 = 26,523 establishments, and 455,640 + 508,230 = 963,870 employees — an exact match on both counts. Receipts (~$41.1B + ~$38.9B ≈ $80B) and payroll (~$17.6B + ~$17.7B ≈ $35.3B) match to rounding. Firm counts do not add up cleanly (3,694 + 14,674 = 18,368 vs. the level's 18,102) because some firms operate in both industries and are counted once at the parent level — a small, expected overlap.

Concentration: a fragmented national industry. With a top-4 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"), this is one of the more fragmented large industries in the economy. The level's HHI sits between its two children — the assisted-living half (HHI 86.7) is somewhat more concentrated at the top than the CCRC half (35.5) — but by any normal standard no operator dominates nationally. Competition is local (Section 8).

Averages. The figures imply about 36 employees per establishment and an average wage near $36,700 — a labor-intensive, service-wage business, consistent with both children. (The level average sits between the CCRCs' larger campuses and assisted living's smaller homes.)

The undercount and definitional caveats. Three cautions, and they cut in opposite directions:

1. CBP undercounts the long tail. County Business Patterns measures employer establishments with paid staff — it excludes nonemployer businesses, the self-employed, and most government facilities, and it counts locations, not beds, residents, or occupancy.[16] Because the assisted-living half runs down to tiny family-run "residential care homes," small and individually owned operators are genuinely under-captured here; treat the establishment and employment counts as a floor for that tail.
2. The code boundaries move residents around. Assisted living inside a CCRC is booked in 623311; a home that adds on-site nursing gets reclassified to 623110 (skilled nursing) and leaves this level entirely. So the federal totals are a clean measure of the industry as defined, not of "everywhere seniors receive residential care."
3. Trade counts are broader and larger. Industry sources count roughly 41,000+ assisted-living communities with 1M+ licensed beds (AHCA/NCAL) and ~1,900–2,000 marketed CCRCs (the CCRC establishment count is higher than that because 623311 nets in any combined-care-plus-nursing site, not just marketed campuses).[3][17] Private "market-size" reports citing $45–115 billion generally use global scope or a broader senior-housing definition and are not comparable to the ~$80B federal receipts figure — read the federal number as the anchor for the narrowly defined U.S. industry.

4. The investable universe — where value concentrates

There is no large pure-play public company for either child industry, and none for the level. Public exposure concentrates in three buckets, and which bucket carries the value differs between the two halves.

Seniors-housing REITs (the real-estate landlords) — the broadest public exposure. These own the buildings across both children and increasingly capture operating profit directly (Section 5). They are the single most important public bucket for the level:

Listed operators — thin, and concentrated in the assisted-living half. The assisted-living side has two genuine listed owner-operators; the CCRC side has none of scale:

Tax-exempt municipal bonds — the CCRC half's most direct public route. Because ~80% of CCRCs are nonprofit with no equity shareholders, the largest pool of investable CCRC securities is senior-living revenue bonds issued by those nonprofits — a fixed-income route open to institutions and individuals alike. There is no equivalent for assisted living, which is financed as private real estate.

Where the operating scale actually is (mostly private). The biggest operators by unit count are largely private and private-equity-backed. Argentum's 2025 ranking put LCS (Life Care Services), Erickson Senior Living, Discovery, Brookdale, and Atria among the largest, with reported AL-unit counts on the order of ~15,000–24,000 each.[24] On the CCRC/nonprofit side, the LeadingAge Ziegler 200 nonprofit systems together run 300,000+ units across ~1,600 communities, with the 10 largest holding ~30% of nonprofit units.[25] Provider scale does not equal property ownership: LCS, for instance, is primarily a manager running buildings owned by REITs and nonprofits, and closed its acquisition of Vi in May 2026 to become a larger combined platform.[24][26]

Bottom line: to own the level publicly you are mostly buying a REIT landlord (real-estate cash flows and dividends, spanning both children), one of two AL operators (operating leverage), a diversified post-acute platform, or nonprofit CCRC bonds (tax-advantaged credit). The marquee operating brands are largely in private hands.

5. How the money works

The two halves share a cost structure and diverge on revenue.

Shared: a labor-heavy, occupancy-levered cost base. Both are service businesses where labor is the swing factor — roughly 55–60% of operating cost — followed by food, insurance, utilities, maintenance, property costs, marketing, and compliance.[10][11] Costs are largely fixed once a building is staffed and open, so occupancy is the earnings lever: each additional filled unit drops a large share of its revenue to profit, and a weak lease-up produces outsized losses. Assisted-living occupancy in the NIC (National Investment Center for Seniors Housing & Care) primary markets reached ~87.7% in Q4 2025; entrance-fee CCRCs ran higher at ~91.6% in Q1 2025.[11][12]

Diverging revenue engine #1 — CCRCs: entrance fee + monthly fee + a balance sheet. New independent-living residents pay a lump-sum entrance fee — commonly $100,000 to $1M+, averaging ~$400,000 — plus a monthly service fee (~$3,900–$4,300 in 2025).[10] The entrance fee is not immediate profit: it is deferred revenue amortized over the resident's stay and, where refundable (contracts run up to 90–100% refundable), a liability owed back to the resident's estate. It funds construction and pays down the (usually tax-exempt municipal) debt, and it turns over as units vacate and refill — so entrance-fee sales velocity and turnover are core metrics. Type A "Life Care" contracts additionally promise higher care at little fee increase, meaning the community has effectively sold long-term-care insurance and must reserve actuarially against residents living longer or needing more care than priced.[9]

Diverging revenue engine #2 — assisted living: occupancy × rate, private-pay. Revenue is a bundled monthly fee — a base apartment charge plus tiered "acuity" charges that rise with a resident's needs. The sector's rate metric is RevPOR (revenue per occupied room); the CareScout 2025 survey put the national median assisted-living price at ~$6,200/month (~$74,400/year), up ~5% year-over-year.[27] It is overwhelmingly private-pay — residents pay from income, savings, home-sale proceeds, or long-term-care insurance; only about one in six relies on Medicaid, and only for the service (not room-and-board) portion, through state HCBS (Home and Community-Based Services) waivers that pay below private rates.[3] Medicare does not cover custodial care in either child industry, though licensed CCRC nursing beds can bill Medicare/Medicaid for qualifying stays.

Shared: two profit engines, one asset (opco/propco). Because operations and real estate are usually split, the property owner earns either fixed rent under a triple-net lease (operator-tenant pays rent, taxes, insurance, maintenance) or the actual property net operating income (NOI) under a SHOP (seniors-housing operating portfolio) structure — enabled by RIDEA (the REIT Investment Diversification and Empowerment Act), which lets a REIT capture operating upside and downside rather than just collect rent. The biggest REITs have been shifting from triple-net toward SHOP to capture the occupancy-and-rate recovery directly.[18][19] The operator earns the operating profit or a management fee.

Two different capital stories. For the nonprofit CCRC majority there are no equity shareholders — "profit" is an operating surplus reinvested in the mission, and the capital-market participants are bondholders who watch debt-service coverage ratio (DSCR), days cash on hand, and entrance-fee liabilities. For for-profits and REITs (all of assisted living and the minority of CCRCs), the money is property-level: NOI, rent coverage, cap rates, and funds from operations (FFO).

6. What drives demand

Both children run on the same demographic engine, which is unusually strong and unusually predictable.

• The age wave. The U.S. population aged 65+ reached 61.2 million (18.0% of the population) in 2024, and all baby boomers will be at least 65 by 2030.[28][29] The core customer is older still — the 80+ cohort, which NIC projects will grow roughly 27–28% between 2025 and 2030 (about 4 million more people) and keep climbing toward ~23 million by 2035.[30] The first boomers turn 80 in 2026. This is the strongest single tailwind in the sector.
• A supply shortfall. New construction sits near the lowest rate of the century, throttled by high interest rates and construction costs, while NIC estimates the country needs hundreds of thousands of additional units by 2030 to hold current penetration — favoring existing, filled communities with pricing power.[11][30]
• Rising acuity and dementia. Residents skew to the "oldest old"; roughly 40% of assisted-living residents live with Alzheimer's or another dementia, and national Alzheimer's prevalence (~6.7 million today) is projected to rise toward ~14 million by 2060 — filling units and lifting rates through memory-care pricing.[3][31]
• Fewer family caregivers, and the housing market. Demand rises when adult children can't provide full-time care. And because most entrants fund a move (an entrance fee or a monthly rate) by selling a home, move-in volume tracks home prices, home-sale liquidity, and consumer confidence — a frozen housing market slows fill-up directly.

Demand is not automatic: many older adults prefer to age in place, and the level's price points exclude households without substantial assets (the underserved "middle market" is a well-known gap).

7. Regulation

The two halves are regulated on different tracks, and a CCRC campus answers to both at once.

• Assisted living: state-licensed, no federal regime. Unlike nursing homes, assisted living has no federal licensing equivalent — each state (plus D.C.) sets its own rules for licensure, staffing, training, medication, dementia care, disclosure, inspection, and admission/discharge, so operators face 50-plus regimes.[15] Federal influence is indirect, mainly through Medicaid HCBS-waiver requirements where states help pay for AL services (44 states cover some AL services; 29 use HCBS waivers).[32] This light-touch structure is part of why private capital finds the sector attractive.
• CCRCs: an insurance track plus a health-care track. About 38 states regulate the continuing-care contract, often through the state Department of Insurance or Financial Services (because the Life Care promise is insurance-like), with filed disclosure statements, reserve/escrow rules, and actuarial studies.[13] Separately, the skilled-nursing component is federally regulated by CMS (Centers for Medicare & Medicaid Services) where it participates in Medicare/Medicaid — certification, survey/inspection, and staffing rules under 42 CFR Part 483 — while the AL and memory-care components are state-licensed.[14] So one CCRC campus can answer to an insurance regulator for its contract and to CMS for its beds.
• Consumer protection and tightening oversight. A wave of CCRC bankruptcies has pushed states to add early-intervention powers, quarterly financial reporting, and refund-timing rules; residents owed entrance-fee refunds are represented by groups such as NaCCRA (National Continuing Care Residents Association).[13] On the AL side, private-equity ownership has drawn policymaker attention, with several states advancing 2025 legislation on healthcare consolidation.[33]

Do not apply nursing-facility (623110) certification and reimbursement rules automatically to this level — only the CCRC nursing beds carry them; the assisted-living and independent-living components do not.

8. Competitive dynamics and consolidation

• Nationally fragmented, locally competitive. The federal data (level CR4 9.2%, HHI 34.8) confirm no operator dominates.[5][6] Competition is local — a resident chooses among communities within a short drive of family — so reputation, referral networks, physical quality, staffing quality, care access, contract terms, and financial strength matter more than national share, and a strong local community can hold real pricing power.
• High barriers to entry. Both children are capital-intensive (land, buildings, years of fill-up before stabilization), require entitlement/zoning and licenses, and the CCRC adds the actuarial complexity of Life Care contracts. With new construction near record lows, incumbents with filled communities are advantaged.
• Consolidation runs on capital, and looks different in each half. In assisted living the engine is REIT roll-ups and PE/operator M&A — Welltower announced ~$23 billion of transactions and 900-plus communities in 2025; Ventas acquired 52; LCS combined with Vi (~130 communities, 45,000+ residents) in May 2026.[18][19][26] In the CCRC half, growth is more often nonprofit affiliation — smaller single-site communities merging into multi-site systems for scale and access to capital, plus distressed restructurings — rather than pure roll-up.[25]
• Emerging substitutes. Both halves face competition from rental / "active-adult" housing (no six-figure entrance fee, classified in 531110) and from "CCRC-without-walls" / Continuing Care at Home programs that deliver the continuum to seniors who stay in their own homes — targeting customers unwilling or unable to commit a large upfront fee.

Judgment: consolidation should continue, because fragmented ownership, demographic demand, and limited new development create opportunities to buy under-managed communities and lift occupancy — but the strongest platforms will be those with local density, reliable staffing, credible care outcomes, pricing power, and conservative leverage, not simply the biggest.

9. Risks

• Labor. Wage inflation, turnover, agency reliance, and staffing rules are the number-one operating risk across both children; with labor ~55–60% of cost, a wage spike directly compresses margins.[10][11]
• Occupancy and the housing market. Earnings are highly sensitive to occupancy; weak move-ins, a local building boom, delayed home sales, or a demand shock (COVID-19 drove severe occupancy and reputational damage in 2020–21) hit high-fixed-cost communities hard.
• The CCRC entrance-fee model's fragility. The model borrows against future move-ins; when new-resident sales slow, a leveraged nonprofit can run out of cash. Since March 2020, at least 16 CCRCs have filed Chapter 11, affecting 1,000+ families and ~$190 million in entrance fees — and in bankruptcy, residents owed refunds usually rank as unsecured creditors behind bondholders.[34] Type A contracts add longevity/actuarial risk.
• Affordability ceiling. At ~$74,400/year median for assisted living and six-figure entrance fees for CCRCs, the level is out of reach for many middle-income seniors, capping the addressable market and exposing operators to recessions and housing downturns.[27]
• Interest rates and capital intensity. This is a real-estate-heavy, debt-financed level: higher rates raise financing and refinancing costs, pressure REIT valuations, lift cap rates (cutting asset values), and strain nonprofit bond covenants.
• Quality, liability, and reimbursement. Falls, medication errors, neglect, and infection outbreaks create litigation and sanctions; the CCRC nursing beds carry Medicare/Medicaid rate exposure.
• Structural complexity and measurement. Campus owner, operator, bond obligor, landlord, and contract provider may be different entities, and NAICS, state licensing, and trade surveys classify mixed-care campuses differently — limiting comparability and complicating diligence.

10. How to invest, and the outlook

Public-market routes — separate the distinct exposures:

1. Seniors-housing REITs (the broadest route, spans both children). Welltower (WELL) and Ventas (VTR) for diversified large-cap exposure with dividend income; Healthpeak (DOC) for direct entrance-fee CCRC exposure (and its Janus Living spin-off); plus AHR, CTRE, SBRA, NHI, LTC, OHI. Watch occupancy, RevPOR, same-store NOI growth, FFO, lease coverage, leverage, and dividend sustainability — and don't lean on consolidated multiples when the senior-housing slice is small.[18][19][20]
2. Listed operators (mostly the AL half). Brookdale (BKD) and Sonida (SNDA) give leveraged exposure to the occupancy-and-rate recovery, with operating and balance-sheet risk; NHC is a diversified operator that discloses both AL units and CCRC-style contracts.[21][22][23]
3. Tax-exempt municipal senior-living revenue bonds (the CCRC half's most direct route). Tax-advantaged yield available to individuals, but credit quality varies sharply and defaults happen — analyze DSCR, unrestricted liquidity, entrance-fee liabilities, capital-renewal needs, and covenants. This is a credit-selection game, not set-and-forget.

Private routes. Direct ownership is well within reach — the SBA classifies assisted-living firms up to $23.5M in receipts (and CCRCs up to $34M) as small businesses.[35] Options: buy and operate an existing community; ground-up development (judged on development yield — stabilized NOI ÷ cost — versus market cap rate); net-lease or joint-venture ownership with a third-party operator (RIDEA/SHOP structures that share operating upside); private credit; and LP stakes in seniors-housing PE and real-estate funds. On the CCRC side, mission-driven capital participates through nonprofit bond purchases and board service. Underwrite each local market, not the national demographic average: competing capacity within the local radius; whether the property is stabilized, in lease-up, or losing residents; whether rates can rise without triggering move-outs; staffing cost, turnover, and agency use; the private-pay share; who owns the real estate and controls capital spending; and — for CCRCs — the resident-contract portfolio, refund schedule, actuarial assumptions, and bond documents of every obligated entity.

Outlook (forward-looking judgment). The demographic case is unusually strong and applies to both children: 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.[11][30] But demographics support demand — they do not guarantee margins or returns, and results will be uneven. The binding constraints sit on the supply and cost side: the availability and price of labor, the affordability ceiling for private-pay residents, the path of interest rates (which gate both REIT valuations and nonprofit financing costs), and, for the CCRC half, whether the bankruptcy overhang and tighter regulation dent consumer trust in the entrance-fee model. The likely shape is a strengthening demand backdrop favoring well-capitalized operators and high-quality real estate, with a persistent tail of financially fragile single-site communities — making credit, operator, and local-market selection the decisive factors in both the bond market and private deals. Near-term signals to watch: occupancy climbing toward 90%, rate growth versus wage growth, interest rates and construction starts, and continued REIT/PE consolidation of ownership.

---

Sources

1. U.S. Census Bureau, "2022 NAICS Definitions: 62331 / 623311 / 623312" (and adjacent 623110, 531110, 621610). https://www.census.gov/naics/?details=62331&year=2022
2. myLifeSite, "A Closer Look: Examining the CCRC Market in the U.S." (~80% nonprofit; ~1,900–2,000 marketed CCRCs), 2018. https://mylifesite.net/blog/post/examining-ccrc-market-in-u-s
3. American Health Care Association / National Center for Assisted Living (AHCA/NCAL), "Assisted Living Facts & Figures" (communities, beds, residents, payer mix, dementia share), 2024–2025. https://www.ahcancal.org/Assisted-Living/Facts-and-Figures/
4. NIC (National Investment Center for Seniors Housing & Care), "Continuing Care Retirement Community (CCRC)," 2025. https://www.nic.org/senior-housing-care-research/senior-housing/continuing-care-retirement-community/
5. U.S. Census Bureau, 2022 Economic Census — Concentration of Largest Firms, NAICS 623311 (firms, receipts, CR4/CR8/CR20/CR50, HHI). https://api.census.gov/data/2022/ecnsize.html
6. U.S. Census Bureau, 2022 Economic Census — Concentration of Largest Firms, NAICS 623312 (firms, receipts, CR ratios, HHI). https://api.census.gov/data/2022/ecnsize/groups/EC2200SIZECONCEN.html
7. U.S. Census Bureau, County Business Patterns 2023, NAICS 623311 (establishments, employment, annual and Q1 payroll). https://www.census.gov/data/datasets/2023/econ/cbp/2023-cbp.html
8. U.S. Census Bureau, County Business Patterns 2023, NAICS 623312 (establishments, employment, annual and Q1 payroll). https://www.census.gov/data/datasets/2023/econ/cbp/2023-cbp.html
9. Acts Retirement–Life Communities, "CCRC Contract Types," 2025; Life Care Services, "CCRC Contracts Explained," 2025. https://www.actsretirement.org/resources-advice/retirement-communities/ccrc-types/
10. U.S. News & World Report, "How Much Do CCRCs Cost? 2026 Average Prices," 2026; National HealthCare Corp. Form 10-K (entrance-fee accounting, labor % of revenue), FY2025. https://health.usnews.com/best-senior-living/ccrc/articles/continuing-care-retirement-community-costs
11. NIC, "Occupancy Rate for Senior Living Communities Increased in 2025 as Construction Stalled" (AL occupancy ~87.7%, Q4 2025; supply). https://www.nic.org/news-press/occupancy-rate-for-senior-living-communities-increased-in-2025-as-construction-stalled/
12. NIC, "CCRC Performance 2Q 2025: Entrance Fee vs. Rental CCRCs" (occupancy, unit mix, entrance-fee price growth), 2025. https://www.nic.org/blog/ccrc-performance-2q-2025-entrance-fee-vs-rental-ccrcs/
13. 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
14. 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
15. U.S. Dept. of Health & Human Services, ASPE, "Compendium of Residential Care and Assisted Living Regulations and Policy" (state-by-state). https://aspe.hhs.gov/reports/compendium-residential-care-assisted-living-regulations-policy-2015-edition
16. 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
17. U.S. Census Bureau, "2022 NAICS Definition: 623311 Continuing Care Retirement Communities" (scope vs. marketed-CCRC count). https://www.census.gov/naics/?details=62311&year=2022
18. 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
19. Ventas, Inc., Form 10-K FY2025 (senior housing >50% of NOI; 52 communities acquired in 2025). https://www.sec.gov/Archives/edgar/data/740260/000074026026000006/vtr-20251231.htm
20. McKnight's Senior Living, "Healthpeak sees CCRCs as 'additive'" (2025) and "Healthpeak forms new senior housing REIT, Janus Living" (2026). https://www.mcknightsseniorliving.com/news/healthpeak-properties-forms-new-senior-housing-reit-janus-living/
21. 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
22. 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
23. National HealthCare Corporation, Form 10-K FY2025 (26 AL facilities/1,413 units; continuing-care contracts and entrance-fee liabilities). https://www.sec.gov/Archives/edgar/data/1047335/000143774926005910/nhc20251231_10k.htm
24. Argentum, "2025 Largest Providers Report" (voluntarily reported AL units as of Dec. 31, 2024), July 2025. https://www.argentum.org/wp-content/uploads/2025/07/2025-Largest-Providers.FINAL_.pdf
25. LeadingAge / Ziegler, "LeadingAge Ziegler 200 (LZ 200)," 2024–2025. https://leadingage.org/leadingage-ziegler-200/
26. LCS, "LCS Announces Successful Close of Vi Acquisition" (~130 communities, 27,000 employees, 45,000+ residents, 29 states), May 2026. https://www.lcsliving.com/resources/for-seniors/community-news/lcs-announces-successful-close-of-vi-acquisition/
27. CareScout (Genworth), "2025 Cost of Care Survey" (median assisted living $6,200/month); NIC asking-rate growth, 2025. https://www.carescout.com/cost-of-care
28. 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
29. 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
30. 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/
31. Centers for Disease Control and Prevention, "About Dementia" (6.7M with Alzheimer's, ~14M projected by 2060), 2024. https://www.cdc.gov/alzheimers-dementia/about/index.html
32. U.S. Government Accountability Office, "Assisted Living Facilities: Information on Federal Spending and Medicaid Coverage" (44 states cover AL services; 29 use HCBS waivers), 2026. https://www.gao.gov/products/gao-26-107884
33. McKnight's Senior Living, "Private equity, consolidation divide aging services sector…" (2025 state legislation), 2025. https://www.mcknights.com/news/private-equity-consolidation-divide-aging-services-sector-as-multi-agency-effort-gets-underway/
34. Cozen O'Connor, "Hundreds of Millions Lost by Seniors Due to CCRC Bankruptcies," 2025; McKnight's, "Lawmakers look to regulate CCRC refund process," 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
35. 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