Companion files

Senior Living and Healthcare Real Estate

A Practitioner's Guide to Rent Cover, Payor Mix, EBITDARM and What an Operating Asset Is Actually Worth

Someone will tell you this home is worth £16.8 million and someone else will tell you it is worth £14.2 million, and they are looking at the same roof. One is pricing a trade and the other is pricing a lease, and the two only agree at one particular rent cover: 1.52x. The lease in front of you is written at 1.80x.

These are the workbooks the book was written from. Every figure the book prints is reproduced by a live formula, and each workbook ends with a sheet that compares the two line by line.

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Senior Living and Healthcare Real Estate

A Practitioner's Guide to Rent Cover, Payor Mix, EBITDARM and What an Operating Asset Is Actually Worth — Julian R. Sterling. One home underwritten completely: the resident flow, the payor conversion, the rota, the lease, the regulator and the bid. 1,287 controls run over the model behind it.

EbookKindle, Apple Books, Google Play

Paperback102 pages

Hardcover102 pages

How to use them

Blue on pale blue is an input you may edit. A yellow fill is the carrying assumption of the sheet — the one to argue about first. Black is a formula. Nothing is locked, protected or watermarked. There are no macros and no external links.

Each workbook ends with a sheet called Checks: the figure as the book prints it, the figure the workbook computes, the variance and a status. If a line ever reads “to check”, the workbook and the book have drifted apart — and the workbook is right.

Three numbers to compute on your own home

  1. The true average length of stay. Twelve months of admissions, twelve months of average occupied beds, divide. Here it is 22.5 months. It will not match the figure the home quotes, because homes compute it over residents who have left — which excludes the long-stay residents who are still there.
  2. The private-pay share of occupied bed-weeks. Not of admissions. On this home the two differ by 18.6 points: 55 per cent of admissions arrive self-funding and 36.4 per cent of the beds still are, because capital runs out and the council takes over at £273 a week less.
  3. Care hours per resident per day, from the payroll. Not from the rota, and not from a percentage. Then divide the hours by 1,694 hours rather than by a contracted year, because leave and absence have to be covered by somebody who is also paid.

One warning, because it decides the answer

Three ratios get quoted about every care home transaction: the multiple of EBITDARM the trade is worth, the yield the investor requires on the rent, and the rent cover the lender insists on. They are not three judgements. Cover × yield × multiple = 1, exactly, so any two of them fix the third. At 11.00x and 6.0 per cent the implied cover is 1.52x — not the 1.80x in the term sheet. An investor who insists on 1.80x at that yield is not applying a prudential standard; he is naming a price, and the price is 9.26x of EBITDARM. Multiply the three numbers in any memorandum you are handed. If the product is not one, somebody is holding a difference they have not been told about.

And one risk with no analogue anywhere else in property

A regulatory rating drops and admissions stop. Nothing else changes — no fee falls, no wage rises, no resident leaves who was not going to leave anyway. The home empties at the rate people die, bottoms at 69.6 per cent occupancy in month 6, and takes 4.0 years to recover. The cost is £1.4 million, which is 0.92x of a year's EBITDARM, and it outweighs every operating lever in the book put together. It is the reason this asset class is priced on an operator and not on a building.

Articles on this book

Also by Julian R. Sterling