The NIC Analytics team presented findings during a webinar with NIC MAP Vision clients on January 23rd to review key senior housing data trends during the fourth quarter and full year 2024. Additionally, Chris Bird, CEO of LCS, joined Lisa McCracken, NIC’s Head of Research, for a conversation on outlook, growth, and strategy for owners and operators in the senior housing industry in the year ahead.

Key takeaways included: 

Takeaway #1: Occupancy Rate Continued Climbing 

• The occupancy rate for the 31 NIC MAP Primary Markets rose 0.7 percentage points to 87.2% in the fourth quarter, gaining 2.2 percentage points for the full year 2024.
• Occupancy increases were driven by another year of robust demand as 2024 net absorption was roughly in line with 2022 and 2023 levels.
• Inventory growth in 2024 was slightly higher than 2023 but overall remained low and near levels last seen in 2013.

Takeaway #2: Occupied Units Reached New Record High

• The total number of occupied senior housing units hit another record high in 2024, rising to more than 618,000 units for the 31 Primary Markets in the fourth quarter.
• The Secondary Markets had a similar trend, reaching a record high of more than 335,000 units.
• These record highs speak to the robust consumer demand for senior housing units.

Takeaway #3: Senior Housing Units Under Construction Least Since 2014  

• In construction trends, for both Majority Independent Living and Majority Assisted Living properties, the number of units under construction in 2024 continued to decline, falling to levels last seen in 2014.
• This decline may reflect ongoing headwinds to development such as access to capital, cost of capital, and construction costs.

Takeaway #4: Construction Starts Declined for Third Consecutive Year 

• Senior housing construction starts also remained depressed in 2024, with the fewest units breaking ground in the 31 Primary Markets since 2009 during the depths of the Global Financial Crisis.

Takeaway #5: Increasing Number of Markets with No Projects Under Construction

• By metro area each quarter, this heat map shows which markets had the most construction activity shaded in red, and the least construction activity shaded in blue.
• In 2024, an increasing number of the 31 Primary Markets reported no projects underway, rising from one to four during the year.

Investors considering an acquisition always ask about the cap rate, the estimated rate of return on the property. But that calculation has never varied so much, according to Colleen Blumenthal, chief operating officer at HealthTrust LLC, a Sarasota-based firm that provides property appraisals and valuations.

“There’s a wide spectrum of risk right now,” said Blumenthal, who will lead a panel of industry pros in a discussion at the 2025 NIC Spring Conference on the complicated dynamics impacting today’s cap rates. “We’ve never had a market before where the cap rate is determined by so many different factors.”

While cap rates traditionally have been fairly predictable, brokers and investors say cap rates, especially those on less desirable projects, don’t make sense anymore. Cap rates today depend on who’s buying the property, the lender, the property’s age and location, and performance assumptions. “Every deal is different,” said Blumenthal. “There is no one answer.”

Blumenthal recently previewed what attendees can expect to take away from the wide-ranging, in-depth session in San Diego. Here are some of the factors impacting cap rates that will be explored:

Obsolete buildings. Communities built 25 years ago typically have several challenges. One example is too many studio apartments. The assumption has been that those properties can fill the needs of middle-income seniors, the so-called “Forgotten Middle,” first identified by NIC in 2019. “I’m not sure that’s true,” said Blumenthal. “Studio apartments are not popular.” She’s noticed in some markets that people still won’t lease the units even with very low rents.

Submarket trouble. Certain submarkets have specific problems. For example, New York City has had seven buildings open over the last few years. For a variety of reasons, mostly related to the pandemic, the buildings that opened more recently have had a better initial lease-up than the older buildings. But none of the buildings are doing as well as expected. “That will be cured with time,” said Blumenthal. “But no one is coming out as well off as they had hoped.”

Interest rates. The capital markets have been rocky since the Federal Reserve started increasing rates in early 2022. Deals began to fall apart later that year because not all the interest rate hikes had been factored into the pricing. Blumenthal doesn’t expect interest rates to go much lower than they are now. But cap rates will decline on stabilized, new properties with good operators. “The supply of desirable product is smaller than the demand,” she said. 

Failure to thrive. Newer buildings that haven’t filled are subject to high cap rates. One newer building traded at a cap rate close to 15%. The lender pushed the sale because the buyer had the ability to close the deal. “Buyers with cash are doing fine,” said Blumenthal.

Cap rate creep. For 30 years, skilled nursing cap rates were 12-14%. But cap rates are creeping up for skilled nursing properties. Mom and pop operators, exhausted from the pandemic, are cashing out. Operators need command of healthcare data to show they can provide good outcomes. Sophisticated operators with cash are buying skilled properties.

Blumenthal noted that the panelists in the upcoming 2025 NIC Spring Conference session represent a broad perspective of private, public and workout firms as well as a broker. “The session will be very spontaneous and worth your time,” said Blumenthal. “It won’t be your grandfather’s valuation panel discussion.”

Learn more and register.

As we look ahead in 2025, the senior living industry is poised for significant transformation, with value-based care (VBC) at the forefront of this evolution. The Centers for Medicare & Medicaid Services (CMS) has set an ambitious goal to have all Medicare beneficiaries in some form of value-based care arrangement by 2030, and the industry is making strides toward this objective.  

The transition to value-based care has been gaining momentum, particularly within the Medicare population. In 2024, KFF reported that 54% of eligible Medicare beneficiaries were enrolled in a Medicare Advantage (MA) plan as opposed to the traditional fee-for-service plan. Enrollment in MA plans has been rising steadily each year and CMS projects increased enrollment numbers again in 2025. As an alternative, several operators have entered into risk-bearing arrangements where they either own their own plan or participate in a joint venture with an existing payer. We anticipate continued growth in these provider-led plans in 2025 as operators aim to have greater control over reimbursement and quality decisions for those they care for.  

Growing Revenue Streams 

The recently announced CMS GUIDE Model (Guiding an Improved Dementia Experience)  presents a promising opportunity for senior living operators to participate in value-based care while generating additional revenue. GUIDE is not a shared savings or capitated model but is a condition-specific care model designed to be compatible with other models and programs like ACOs that aim to provide opportunities to improve care and reduce overall healthcare spend. Specifically, this model aims to help older adults with dementia stay healthy at home longer and introduces a new payment structure for participating providers. 

Key aspects of the GUIDE model include: 

• Reimbursement for care assessments 

• Compensation for care planning 

• Payments for educating caregivers 

Many senior living operators are already performing these tasks, making the GUIDE model a natural fit for their existing operations. As the CMS Innovation Center continues to explore alternative payment models, it is anticipated that there may be additional opportunities for senior living organizations to be reimbursed for value provided.  

Enhancing Data Sophistication 

As an industry, we need to become more sophisticated in our data tracking, reporting, and implementation. This is an imperative for the industry and something that is absolutely critical in making progress towards not only value-based care arrangements, but in improving outcomes and communicating the evidence of value provided. The adoption of platforms that enable operators to accurately track key metrics on residents, to access information in real-time, and to support proactive interventions are paramount. We are optimistic that the sector will continue to improve in its data collection and reporting efforts in 2025 and will move toward greater standardization of key performance metrics.     

As we enter the new year, the senior living industry is at a critical juncture in its journey toward value-based care. While progress has been made, there is still considerable work to do. The transition to value-based care represents not just a change in payment models, but a fundamental shift in how we approach senior care. By focusing on outcomes rather than services rendered, the industry has the potential to significantly improve the quality of life for seniors while also enhancing operational efficiency and financial sustainability. With innovative models like GUIDE and increasing awareness of value-based care benefits, we can expect more senior living operators to explore and adopt value-based care arrangements in the coming year. 

As the senior housing market emerges from a three-year pandemic-induced occupancy recovery, it finds itself at a critical juncture. Strengthening demand and occupancy rates steadily approaching 90% signal a powerful opportunity for growth, driven by the natural alignment between the industry’s mission and the needs of an aging population. 

While labor pressures continue and operational expenses remain elevated, the senior housing market fundamentals in 2025 will be strong, robust demand is expected to drive continued strong momentum in the absorption-to-inventory velocity (AIV) ratio over the next two years. As detailed in the spring 2024 SHARK report, this trend could set new occupancy records, with most regions projected to achieve occupancy rates in the 90% range by 2026.  

Simultaneously, rent growth has proven to be a double-edged sword. While rising rents have supported operating margins amid higher expenses, affordability challenges for middle-income older adults persist. Luxury senior housing properties may have successfully justified premium rents with high-end amenities and services, but mid-tier and lower-tier operators will likely need to balance pricing and discount strategies with occupancy to remain competitive. 

In recent years, the pace of new senior housing construction has slowed, driven by rising material costs, labor shortages, and economic uncertainty. This tempered supply growth has created opportunities for existing properties to capture demand as the market stabilizes. We expect this trend to continue through much of the year ahead.  

Yet, the industry faces a supply shortfall exacerbated by aging stocks and prolonged construction timelines. This will likely fuel a trend toward repurposing older buildings and increasing capital expenditures to enhance efficiency, competitiveness, and appeal to future residents. 

Investment and lending dynamics are also changing. Investors and lenders are seeking stable, long-term returns while assessing the risk profiles of new developments and repositioning older assets. Senior housing properties that can demonstrate strong lease-up performance, operational efficiency, and adaptability to market conditions will be better positioned to attract capital. 

Finally, one of the most critical lessons from recent years is the importance of clearly articulating the value proposition of senior housing. Today’s seniors and their families expect more than a place to live, they seek a property where they can thrive physically, emotionally, and socially.  Achieving this potential requires balancing affordability with quality while transitioning from the traditional one-size-fits-all model to more personalized offerings that cater to the diverse needs and preferences of the baby boomer generation – one of the largest and most diverse cohorts.  

The senior housing market is entering 2025 with both challenges and opportunities. The coming years will test the industry’s continued resilience and innovation as it strives to deliver on its mission and achieve sustainable growth. 

The future of senior housing is bright. Is the sector ready to transform today’s challenges into tomorrow’s opportunities? 

As we look ahead in 2025, the skilled nursing sector is poised for both opportunities and challenges. The year will likely be driven by many factors including evolving supply and demand fundamentals, workforce pressures, policy changes, and capital market trends. Below are the key trends to follow in 2025. 

Occupancy on the Rise 

Expect continued occupancy increases as the number of occupied units rise and operational bed inventory declines. The occupancy rate for nursing care rose 0.2 percentage points to 84.5% in the third quarter of 2024 for the 31 NIC MAP Primary Markets. This marked the fourteenth consecutive quarter of occupancy gains, driven by net absorption of nursing care beds outpacing the amount of new inventory. Inventory has been declining due to factors including closed properties and the migration toward more private than semi-private rooms. In addition, the total number of occupied nursing care beds continues to increase, rising to more than 467,000 beds for the 31 Primary Markets in the third quarter. 

Stable, but Uneven Reimbursement Rates 

Medicaid funding is expected to remain stable, with some states projecting rate increases of 3% to 4%. Supplemental payments tied to quality of care will continue to be a significant factor in reimbursement as states expand these programs throughout the country. The Centers for Medicare & Medicaid Services (CMS) finalized a 4.2% increase in Medicare payments to skilled nursing facilities (SNFs) for fiscal year 2025. This translates to approximately $1.4 billion in additional Medicare Part A payments. While this increase is welcome news for operators, it is important to note that it may be partially offset by other factors such as elevated operating costs. 

Active Acquisitions and Consolidation Cycle  

The industry is likely to see continued consolidation, with disciplined acquisition strategies presenting opportunities for growth in 2025. This trend is driven by the need for operational efficiencies and the potential for organic growth in newly acquired properties. Well-performing assets will command premiums, while distressed assets may see increased interest for turnaround opportunities or even sales for alternate uses. Much of the consolidation is expected to be driven by smaller and/or underperforming operators that need to exit the business. 

Expansion of Technology and Innovation 

The industry is likely to see continued adoption of technology solutions to address staffing challenges, improve care quality, and enhance operational efficiency. This may include increased use of telehealth, remote monitoring, and AI-assisted care planning. Many believe AI has the potential to reduce routine administrative burdens, guide clinicians to better outcomes, and improve the quality of care. 

More Favorable Regulatory Environment Possible 

The recent presidential election has led to expectations of a more favorable regulatory environment. The federal minimum staffing mandate was finalized in April of 2024. An analysis by KFF estimated that only 19% of nursing facilities would meet the minimum hours per resident day standards under full implementation of the final rule. Many in the industry are confident that the incoming administration, along with the Republican majority in the House and Senate, will likely reverse the mandate. However, workforce challenges including the availability of labor, especially direct care staff, will continue in 2025.   

Skilled nursing operators and investors must navigate a complex landscape in 2025 shaped by ongoing reimbursement changes, workforce shortages, and evolving care models. The winners will be those who prioritize operational efficiency, embrace technology, and strategically manage labor and regulatory challenges. The demographics provide long-term tailwinds, but success will hinge on adaptability and innovation in a constrained budget environment.