When buyers value a skilled nursing facility, or any senior living property, it is always the absolute level of cash flow (NOI) that matters, not the operating margin or expense ratio. Buyers are purchasing a stream of net cash flow, and that net cash flow is going to provide the returns to capital providers. As long as cap rates remain stable, which they certainly have in the skilled nursing sector, when cash flow increases, the prices paid increase.
From 2008 to 2015, the average cash flow per bed of SNFs sold increased by 63% (peaking in 2015 at $9,600 per bed), and this was driving the five straight years of record average prices for skilled nursing facilities, according to the 23rd Edition of The Senior Care Acquisition Report. Although there was a small dip from 2015 to 2016 to $8,800 per bed, just as the average price per bed peaked in 2016, the simple average does not always tell the story. In 2017, there was a very small decrease in the average NOI per bed for SNFs sold (a 3% drop to $8,500 per bed), but the average price per bed plunged by 18%.
The reason is that when we recalculated the statistics on a weighted average basis, the NOI per bed sold dropped from $12,100 in 2016 to $9,450 in 2017, representing a nearly 22% decline. This clearly explains the 18% drop in average prices, given average cap rates were almost identical in both years. The $12,100 figure also explains why the average price per bed peaked in 2016.
