Industry Participants in the Seniors Housing & Care Property Market and Their Business Models

 

Industry Participants in the Seniors Housing & Care Property Market and Their Business Models

  • What are the ownership and operating structures/models?
  • Who are the capital sources for seniors housing and care properties?
  • Who are the operators and managers for seniors housing and care properties?
  • Who are the developers of seniors housing and care properties?
  • Who are the appraisers and consultants for seniors housing and care properties?
  • What government programs affect seniors housing and care properties?

 

What are the ownership and operating structures/models?

Properties may be owned and operated by a single company care provider, managed as a fee-based service by a care provider with capital backing, or leased by a manager/operator from a financial institution. Larger companies may use each of these operating structures in varying situations, depending upon financing, although many companies simply pick one of the operating models for all assets

 

Who are the capital sources for seniors housing and care properties?

Capital for seniors housing and care properties comes from three primary sources: debt, equity, and lease capital. Traditional sources of debt capital include:

  • Government sponsored enterprises (GSEs), such as Fannie Mae, Freddie Mac and HUD.
  • Commercial banks.
  • Commercial finance companies and mezzanine/preferred equity providers.
  • Life insurance companies.
  • Federal Housing Administration (FHA) and tax‐exempt bonds.

Leverage typically ranges from 60% to 80% for secured debt instruments but does vary depending upon the point of the economic cycle and capital market conditions.

Equity financing comes from both public and private real estate investment companies and participates in both majority and minority equity positions. Property operators and managers may also own a significant portion of their communities, often with passive investment support from financing entities. Private equity firms, both small and large, also play a significant role in the capital stack, and may seek shorter term investments.

Lease financing is typically provided by relatively passive investment companies such as public and private Real Estate Investment Trusts (REITs). Because lease financing is normally capitalized at the corporate level through the capital markets, properties financed with leases are often considered as having 100% financing, though lease risk security measures are common. Lease financing often has longer-term expectations.

Some REITs use a partnership structure under the REIT Investment and Diversification and Empowerment Act (RIDEA) of 2007, which allows REITs to keep a share of the building’s operating income and not just the lease payments.

A more detailed explanation of each common financing source can be found in the NIC Investment Guide, Fifth Edition.

 

Who are the operators and managers for seniors housing and care properties?

Operators and managers range in size from large, publicly traded companies to single facility and family-oriented owner-operators. Lists of the largest seniors housing, nursing care, and CCRC operators can be found in the exhibits 1.l, 1.m, and 1.n respectively, of the NIC Investment Guide, Fifth Edition. Operators’ and managers’ business models are often closely correlated to their respective, chosen financing model.

 

What is the development of seniors housing and care properties like?

Compared to other major real estate classes, developing seniors housing is most closely related to developing multifamily property, and multifamily developers often take part in seniors housing development. Independent living and assisted living are typically somewhat more capital‐intensive than multifamily, while nursing care is less capital‐intensive. Each also faces unique entitlement challenges. Section 8 of the NIC Investment Guide, Fifth Edition provides a detailed analysis of typical seniors housing and care development projects.

 

Who are the appraisers and consultants for seniors housing and care properties?

As is the case with other real estate classes, appraisers provide project valuation and description services to lenders, buyers, and investors, typically in conjunction with sale of an asset. Marketing and sales consultants provide consultation to owners and operators regarding effectiveness of sales and marketing programs, both at the company-strategic and property-specific levels. Market study and feasibility consultants provide various parties with fee-based services, which may include market definition and analysis, project sizing and scoping, and demographic analyses.

 

What government programs affect seniors housing and care properties?

Any government program, legislation, or initiative that affects health care reform, reimbursement, and regulation has a significant impact on seniors housing and care properties. Medicaid and Medicare are important components in the industry revenue structure, especially in skilled nursing and, to a lesser extent, in assisted living. As a result, any governmental initiative to modify these entitlement programs can have considerable effects throughout the industry. Many states have defined governing or oversight agencies that oversee property licensing, regulation, and inspection to include need-based certifications to operate properties’ units or beds. Additionally, tax credit and incentive-based financing programs may be affected by changes in respective governmental programs.

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