THE MARKET
Nursing care, defined as skilled nursing facilities, nursing homes, and hospice centers, is estimated at more than $128 billion.
Market analysts estimate the U.S. senior housing market at $60 billion, defined to include independent living facilities, assisted living facilities, and Mobile Home Parks.
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The National Center for Health Statistics estimates expenditures for “long-term care services” between
$210 and $306 billion, which include a variety of settings
in the home from a home health agency, adult day services centers, residential settings from assisted living communities, or in institutions from nursing homes. Others value the senior housing market at more than $300 billion.
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Despite a steady flow of mergers and acquisitions in recent years, the senior housing industry remains highly fragmented. According to one market share analysis, the top 25 independent living operators in the United States represent an estimated 24.5% of all units, while the top 25 assisted living operators only represent 37.7% of all units.
The top 25 nursing facility operators represent 22% of all beds. In another analysis, share of market was divided among non-REITs (21% share) and REITs (9%), with the remaining 70% of senior housing properties owned by “mom and pops” (i.e., defined as owners of 15 or fewer properties).
Large operators are looking to participate at each vertical across the continuum of care from independent living to assisted living to memory care and skilled nursing, as well as offer ancillary services which might include outpatient therapy, pharmacy, home health, and hospice, among others. It is estimated that more than 80% of the top 25 nursing facility operators also provide assisted living and more than two-thirds offer independent living. Other services offered include outpatient therapy (80%), pharmacy (40%), homecare (52%) and hospice (76%).