Trends in Reported Assisted Living Facility Acquisitions by Private Equity Firms From 2006-2023

TL;DR

This study tracks how private equity firms have increasingly acquired assisted living facilities in the U.S. from 2006 to 2023.

Contribution

The paper provides a novel dataset and analysis of private equity acquisitions in the assisted living sector.

Findings

Private equity acquisitions of assisted living facilities increased significantly, peaking in 2021.

Most transactions involved a single facility, with Florida, California, and Texas being top acquisition states.

The average value per facility acquisition ranged from $750,000 to $95.5 million.

Abstract

Assisted living (AL) facilities provide a supportive alternative to nursing homes for approximately 1 million older adults across 34,000 U.S. facilities. While private equity (PE) investment in nursing homes has grown, its impact on AL remains unclear. This research examines PE acquisitions of ALs from 2006-2023, analyzing transaction volume, value, and geographic trends. Using LevinAssociates databases amended with SEC reports, Pitchbook, S&P NetAdvantage, press releases, and company websites, we identified 254 PE transactions involving 711 AL facilities. Transactions ranged from 1 to 134 ALs, with 70.9% (n = 180) involving a single facility. ALs were located in 46 states, with Florida (n = 69), California (n = 62), and Texas (n = 46) comprising 25% of acquisitions. Transaction value was reported for 66.9% (n = 170) of deals (n = 558 ALs), ranging from $750,000 to $1.8 billion (median $29.1M, mean $79.6M). Average value per facility ranged from $750,000 to $95.5M (median $22.5M, mean $25.6M). Reported transactions increased over time, peaking at 35 in 2021, with 65.7% occurring between 2015-2021. AL acquisitions grew annually, from two in 2008 to a peak 184 in 2015. Reported PE investment in AL has risen significantly in the past decade. This study provides a novel dataset to understand PE trends in AL, offering insights into its growing role in this important sector of long-term care.