Ground-up, acquisition, lease-up and census ramp, and bridge to a HUD 232 takeout.
Healthcare real estate is underwritten as an operating business with a building attached. Census, payor mix, staffing and licensure drive the credit as much as the dirt, which is why generalist desks pass and why the lenders who write it are specialists. Assisted living, memory care, independent living, skilled nursing and behavioral health, plus medical office and ambulatory care.
13 programs placed on this asset class, with the published size range on each. Everything here is business purpose, written to an entity, non-owner-occupied.
| Program | What it covers | Size |
|---|---|---|
| Healthcare & Senior Housing | Assisted living, memory care, independent living, skilled nursing and behavioral health, plus medical office and ambulatory care. Ground-up construction, acquisition and recapitalization, lease-up and census ramp capital, bridge-to-HUD for a 232 takeout, and operations capital for the operating company. | $2M to $100M+ |
| ALF / Memory Care Ground-Up | Ground-up assisted living and memory care. Senior construction debt with funded interest and operating deficit reserves, milestone draws, and completion guaranty structures. | $5M to $100M+ |
| Senior Housing Acquisition & Recap | Single asset and portfolio acquisition, partner buyout, and recapitalization across independent living, assisted living, memory care, and skilled nursing. | $2M to $200M+ |
| ALF / Memory Care Bridge | Assisted living and memory care acquisitions, turnarounds, and stabilization. Lenders who understand the healthcare space inside and out. | $500K to $30M+ |
| SNF / Skilled Nursing | Skilled nursing facilities. Bridge financing into HUD 232 for 35 year fixed, non-recourse permanent debt. | $1M to $100M+ |
| Healthcare Operations Capital | Not real estate. Working capital for healthcare operators to cover payroll, accounts payable, insurance, and operational expenses while waiting on reimbursement. Keeps the facility running while the business plan executes. | $25K to $5M+ |
| Medical Office & Ambulatory Care | Medical office buildings, ambulatory surgery centers, dialysis, imaging, urgent care and dental. Acquisition, refinance, cash-out and tenant improvement capital. Placed with lenders who read tenant credit, referral base and lease term instead of treating the building as generic office. | $1M to $100M+ |
| Senior Housing Construction & Gap Capital | Construction, mezzanine and preferred equity for memory care, assisted living and independent living alongside a licensed operator, including land loans for future facilities. | $5M to $60M |
| Bridge-to-HUD (232 Takeout) | Bridge underwritten to a stressed HUD 232 takeout at stabilization, so the exit is engineered at origination rather than assumed. | $2M to $150M+ |
| FHA / HUD (232, 223f, 221d4) | Stabilized multifamily and senior housing. 35 to 40 year fixed terms at the lowest permanent rates available. Longer timeline but unbeatable pricing. | $2M to $500M+ |
| Lease-Up & Census Ramp Capital | Facilities open but pre-stabilization. Interest reserves and working capital lines funded alongside the real estate for operators carrying an operating shortfall. | $2M to $75M+ |
| Construction Completion Loans | Projects 65 to 99 percent built that ran out of money: cost overruns, a construction lender that stopped funding, contractor liens, or a partner who walked. Proceeds finish the building and retire the existing construction loan. | $1M to $100M+ |
| Sale-Leaseback for Operators | Sell the real estate, stay in place on a long-term net lease, and take the equity in cash. Common for fuel and convenience, car washes, auto service, dealerships, restaurants, early education, medical and multi-unit operators. | $1M to $100M+ |
What healthcare property types do you finance?
Assisted living, memory care, independent living, skilled nursing and behavioral health, plus medical office and ambulatory surgical. Ground-up construction, acquisition and recapitalization, lease-up and census ramp capital, bridge-to-HUD for a 232 takeout, and operations capital for the operating company. $500,000 to $200,000,000.
What is a bridge to HUD?
A bridge loan underwritten to a HUD 232 takeout at stabilization, so the permanent exit is priced at the front of the transaction rather than underwritten again a year later. It is the standard path for a senior housing asset that is not yet stabilized enough for HUD.
How much leverage on ground-up assisted living or memory care?
Up to 80 percent of total project cost on ALF and memory care ground-up, with the interest reserve funded at closing and draws advanced against inspected work.
Do you finance a facility that is still filling up?
Yes. Lease-up and census ramp capital is sized into the loan, underwritten to the stabilized census rather than to trailing performance.
Is the operator underwritten as well as the real estate?
Yes. Census, payor mix, staffing, licensure and the management agreement are underwritten alongside the property. Operations capital for the operating company is available separately.
What does a healthcare file need to be priced?
Location, licensed beds or units, current census and payor mix, trailing 12 operating statements, the operator and management agreement, licensure and CON status, loan amount requested, project cost or purchase price, existing debt and maturity, and the exit.
An offering memorandum, budget or term sheet in hand is the fastest way to start. Anything you do not have yet can be left blank.