戴德梁行+投资者调查及趋势报告：美国老年人生活及护理-英_市场营销策划_重点报告202301202_.docx

INVESTORSURVEYANDTRENDSREPORTU.S.SENIORLIVING&CARENOVEMBER2023PhotoprovidedbyNationalDevelopmentInthisreportOlKeyFindings02PropertyMarkets03CapitalMarkets04ValuationIndex05InvestorSurveyResults06SeniorsHousingOutlook/UlKEYFINDINGS U.S.seniorshousingpropertymarketfundamentalscontinuetoimprove.Stabilizedoccupancytrendedupwardovertheprior10quarters,reaching86%,asrentgrowthremainedintactat5%throughthethirdquarterof2023.Cushman&Wakefieldexpectstoseecontinuedimprovementinpropertymarketfundamentals. Northeastmarketsareexpectedtoshowthestrongestnear-termperformance.MarketsintheSouthwestandSoutheastareexpectedtoexperiencedownwardpressureonoccupancyandrentgrowthintheneartermasnewsupplyisintroduced. Seculartailwindsarestrongerthanever,asconstructionstartstoslowtothelowestlevelssincetheGreatFinancialCrisis(GFC).Tomeetdemandatpeaklevels,supplygrowthmustincreaseby35,(XX)unitsperyear,beginningtoday. Affordabilityremainsunsolved.Withthenumberofmiddle-incomeseniorsprojectedtodoubleby2029,overhalfofthissegmentwillnothaveadequatefinancestoaffordtraditionalassistedliving. Operatorswilllearntoscale,andpartnershipsbetweenoperatingcompany(OpCo)andpropertycompany(PropCo)willevolve.Accelerationoftrendsandinnovationsintechnology;integratedcareandcaredeliverymodels;infrastructure;anddesignwithgreaterbranddiversificationarebeginningtoemerge. Thecostofdebtisstressingshort-termvaluations,withseniorlivingtransactionvolumedown51%year-over-year(YOY)zandthepriceperUn什，at$111,000,downnearly54%frompeakpricing.MostownersW计hwell-locatedpropertiesandhealthyoperatingperformanceareoptingnottosellduetothemarketdislocation.Skillednursingvolumewasdownonly17%,withthepriceperbedreachinganall-timehighof$109,500inthefirsthalfof2023.,Impendingloanmaturitiestotaling$16billion-expectedwithinthecoming24months,alongwithfund-lifeexpirations,willcatalyzetransactionactivitywithincreasedinvestmentsfromthosewhoarewellcapitalizedandlessreliantonleverage. Cushman&Wakefield'svaluationindexreportson$32billioninaggregatethird-partyvaluationscompletedoverthepast12months.Same-storeindicesextractedfromthisdatasetindicateaYOYincreaseincapitalizationratesforseniorliving,rangingfrom75to125basispoints(bps),withvaluationsdecliningby12%to18%onaverage. Ofthemorethan90peoplewhoparticipatedinCushman&WakefieId1Sinvestorsurvey,68%expecttoseeacontinuedincreaseincapitalizationratesoverthenext12months,withdebtmarketliquiditybeingthetopconcernof51%oftherespondents. Mostinvestors(49%)aretargetingcore-plusinvestmentstrategies,followedbyassistedlivingat33%andactiveadultat23%.Nearly34%ofrespondentsarefocusedonopportunisticordistressedinvestmentstrategies. Marketparticipantsareunderwritingnegativeleverage:uptooneyearfor44%ofrespondentsanduptotwoyearsfor31%ofrespondents.Still,19%ofsurveyrespondentsarenotwillingtounderwritenegativeleverageaspartoftheirinvestmentstrategy.Someinvestorsareelectingtopurchaseonanunleveredbasisasdebttermsforopportunisticbuysaredilutivetoreturns. Basispointspreadsbetweenthegoingincapitalizationrate,thediscountrateandterminalcapitalizationratehavecompressed,indicatingthatmarketparticipantsareexpectingtoseeimprovementinthecurrentinterestrateclimateoverafive-to10-yearholdingperiod. Environmental,socialandgovernance(ESG)considerationscontinuetogainnotorietyintheseniorshousingandcaresector,with59%ofsurveyrespondentsviewingESGinitiativesasbeingapositiveattribute,butonly9%willingtoprovideapremiumtopricingwhereESGisprevalent.UZPROPERTYMARKETSPRIMARY MARKETSInventory GrowthAbsorption Stabilized OccupancyOCCUPANCYSeniorshousingperformancecontinuestoacceleratewithstabilizedoccupancytrendingupwardforthetenthconsecutivequarter.TheNationalInvestmentCenterforSeniorsHousing&Care(NIC)reportedstabilizedoccupancyat86%forprimarymarketsand87%forsecondarymarketsforthethirdquarterof2023.Thoughtrendinginapositivedirection,theselevelsremainwellbelowpre-pandemicaveragesof90%and90.2%,respectively.ASKINGRENTALTRENDSTherateofannualrentgrowthreachedanall-timehighinthesecondquarterof2023,at5.9%inprimarymarketsand5.9%insecondarymarkets,whichtaperedslightlyinthethirdquarterto5.4%and5.6%respectively.Assistedlivingmarkedthehighestrentgrowthat6.4%,withrentgrowthforindependentlivingaveraging5.2%.RecentvaluationsconductedbyCushman&Wakefieldhaveidentifiedannualrentgrowthinthe7%to9%rangeinkeymarketsthroughouttheU.S.S±UJ。,JoqEn10,OOO5,00-5,000MHMBJ*kMmULllLbfeMlbfi-10,000AQUOdnOOOPaZ三qasCccccc§8-§8-ZoZoeLoo-Oeoe00088-60Nco6-020-8一。Com58-zo09一。臂9三CxlO-SON0COSLOSOLFoeoeFOmL8oeggo0Z-OZ:0coZ-c-Source:Cushmon&VVakefieJdResearch.NICMAP¼sronzQ32023SECONDARYMARKETSs*uJQ-lquJN£0306HOSoSOeoe0coOzo30L6oeco6oe0L8一OeoeogNONOCOZOCSI0L9oNg9-0oLSLooeS-OSeLq5eoeg5eoe20aeoNOcodo-ABSORPTIONAbsorptionhasoutpacedinventorygrowthfornineconsecutivequartersasthenumberofoccupiedunitsreachedanall-timehighinthethirdquarterof2023.Duringthisperiod,absorptionhasoutpacedinventorygrowthbynearly3x.Theannualrateofabsorption,whichsubsidedinthethirdquarterof2023to4.3%inprimarymarketsand3.9%insecondarymarkets,stillwellabovehistoricalaverages.Demandisanticipatedtocontinuethroughtheremainderof2023andinto2024.Withconstructionstartscontinuingtosubside,favorableoccupancyandrentgrowthtrendsareexpectedtocontinue-acriticalcomponentofoffsettingtheincreasedoperatingexpensescausedbythelaborshortageandincreasedinsurancepremiumscomingoutofthepandemic.Fromapropertymarketsstandpointthesectorwillonceagainproveitsrecessionaryresilientreputation.CONSTRUCTIONTRENDSSlowingconstructionstartsrepresentasilverliningforowners.Despiteanincreaseindevelopmentappetiteandarobustneedforadditionalsupplyinmostmajormarkets,thelackofliquidityandcostofdebthasrestrictedconstructionstartstothelowestlevelinoveradecade.Thisdeclineinconstructionstartswillonlymagnifysupplyshortagesasourpopulationcontinuestoage.Valuationchallengesvarybyregion,duetolimitedtransactionaldatapointsandshiftingpropertymarketfundamentals.Marketswithhighoccupancyandlowconstructionvs.inventorywillexperiencethegreatestrentgrowth.Onaverage,northeastmarketspresentthestrongestmarketfundamentals.QUARTERLYCONSTRUCTIONSTARTS-PRIMARY&SECONDARYMARKETS一£00INozgIeweIUIoooIMMO-I6_03gI6-0c-II20oIIo-I二0舄Iz-ozo-I9-0ZgI9-03。-Is-ooIg-0Zo-IBP-OZgIHagI8-OZDe20Zo一de-StabilizedOccupancyMARKETLEVELPERFORMANCEAnnualRentGrowth(%)Constructionvs.Inventory(%)Source;Cushman&WakefieldResearch.NICMAPVision,Q32023LONG-TERMDEMANDTRENDSPOINTTOSIGNIFICANTSUPPLYSHORTAGEConsumerdemandisexpectedtoOVerWhelmthemarketW计hinthenextfiveyears,atalllevels,withnetdemandprojectedtoturnpositiveasearlyas2025.Theaverageageatmove-inforseniorlivingpropertieswillrangefrom75foractiveadultto83yearsofageforassistedliving,accordingtotheAmericanSeniorsHousingAssociation(ASHA).Thispopulationsegmentwillexpandsignificantlyoverthenextdecade.1.ookingattheover-80demographic,demandwascalculatedbasedonamarket-extractedpenetrationrateof7.9%from2016,whenstabilizedoccupancywas91%.Supplygrowthwasestimatedbasedonatrailingfive-yearaverageof80+LONGTERMDEMANDOUTLOOKapproximately26,000unitsperyear,withcurrentlevelsmuchlowerasconstructionstartsdecline.Tomeetdemandatpeaklevelsfortheover-80populationsegmentestimatedfor2045,thesectormustincreaseannualsupplygrowthby35,000unitsperyear,beginningnow.AFFORDABILITYREMAINSLARGELYUNSOLVEDThenumberofmiddle-incomeseniorswillnearlydoubleby2029,astheover-80populationincreases.AccordingtotheNationalInvestmentCenterforSeniorsHousing&Care,60%ofthispopulationsegmentwillhavemobilitylimitations,with20%requiringhighhealthcareorfunctionalneeds.Demand(80+)Supply(Avg.)Population(80+)Equilibriumsuo三工353025201510SUo三一16qoe等0NNqoe4Oe。(N寸寸。CN*0NWOeWeOqoe6COOeoCMZeoS9co0NSeONkcoo(NWoeNSOeOcoe6eoN8N0eNeoS9eo(NSeoeqeoCN30NeeoNOeoo<N6e85ZZ5N9cxl50.Source:Cushman&WakefieldResearch.NlCMAPVision,Q32023Withanadditional35Zooounitsinnewconstructionannuallyrequiredtomeetpeakdemand,overhalfofmiddle-incomeseniorswillnothaveadequatefinancestoaffordassistedliving./U3CAPITALMARKETSINVESTMENTTRENDSSeniorshousingandcareinvestmentactivitystalledtonearly$3.2billioninthefirsthalfof2023,markinganapproximate51%declineYOYanddown71%fromthesecondhalfof2022.Second-quartertransactionvolumeforseniorshousingtotaled$400million,thelowestreportedsincetheGFC,highlightingthemarketdislocationbetweenthestrengtheningmarketfundamentalsforthesectorandthechallengingdebtmarkets.Transactionactivityfornursingcarefaredslightlybetter,withafirst-halftotalvolumeof$1.5billion,downonly17%YOY.VALUATIONTRENDSPricedislocationandanelevatedinterestrateenvironmentcontinuedtohindervaluations,asevidencedbythedeclineinpriceperunitpaidforseniorshousingtothelowestlevelsincetheGFC.Theaveragepriceperunitwasreportedat$111,000inthesecondquarterof2023,downnearly54%frompeakpricingrealizedinthefirstquarterof2022.Duringthisperiod,ownerswhowerenotabletoachievetheirtargetedexitpricesimplywerenotsellers,ortheyex计edatadiscountduetoanincreasedcostofdebt-atrendthatwilllikelycontinueinthenear-term.Thegapbetweenbuyersandsellershasyettoclose,asevidencedbythelimitedvolumeoftradesduringthefirsthalfoftheyear.Cushman&Wakefieldisstillseeingvaluationsabove$650,000perunitthoughdealslikethishaven'thitthemarket.Nursingcarevaluationssuggestadifferentnarrative,W计htheaveragepriceperbedof$110,000downslightlyfromthepriorquarter,butup5%YOY.Onatrailingfour-quarterbasis,theaveragepriceperbedfornursingcarereachedanall-timehighof$109,500.SENIORLIVING&CAREROLLINGFOUR-QUARTERTRANSACTIONVOLUMENursing Care RollingSeniors Housing RollingllllMhI 加 IlIlIlhInh 邮Q 5 0 5 c> 5 ， $3C$2$2$1$1$ $SUO=SHoeOco Oeozoe Owg 6eos 650 8-0ec*> 0oL Zoeoco ZLOeOL 9 L Oeoe 980 90Noco nooe 5Oeo- So&co 65eo- doco eoe。一 Loe0co -oeo- ooN0fo 0-02。一 6NOC9 60Oeo- 8Z0CO 800<N。一Source:Cushman&WakefieldResearch.NICMAPVision,Q32023SENIORLIVING&CAREROLLINGFOUR-QUARTERPRICING$200$150$100$50PricePerUnit-SeniorsPricePerBed-NursingCareeeoze330o-SeSgo-Ooeo6Oss-60Cg6-0eHB-OsogHOL40cc*>ZUKg9oeg9-020-S-O20gS-Oso-oeocoEo2oo20-e-oogZ-Oso-二oe二Oeo-00NeS20-60OeOg68e0Leooeoe§8-$0INVESTMENTYIELDSTotalannualizedreturnsforseniorshousingfellinrecentquarters,primarilydrivenbytheincreasingcostofdebt,achallenginglabormarketandanincreaseincostsofotherkeyoperatingexpenses.Asoperatingexpensesbegintopullbacktomorenormalizedlevels,thecostofcapitalremainsaloomingconcernasinvestorspreadsbetweencapitalizationratesandthe10-yearTreasurycompresstothelowestlevelsinoveradecade.TheFederalReservebeganraisinginterestratesinMarch2022,with11hikestakingplacesince.Inthethirdquarterof2023,the10-yeartreasury(IOY)averaged4.38%,markingnearlya300basispointincreaseduringthisperiod.Thelasttimethe10Ywasatthislevelwas2002andthe10Ywasat3.97%,Duringthisperiod,theaveragecapraterecordedforseniorhousingwas8.1%andmovedupto9.3%.1.ookingattheaveragespreadbetweenthe1OYandcapitalizationratesoverthepasttenyears,seniorshousinghasaverageda465basispointspreadwithacurrentspreadofonly212basispoints.Thiswouldindicatecontinuedupwardpressureoncapitalizationratesasthemarketcontinuestoadjusttothehighercostofcapital.Short-termreturnswillbechallengedthrough2025,primarilydrivenbycapitalreturns,asoccupancyandrentgrowthcontinuetoimproveandoperatorsfindwaystoreduceoperatingexpenses.CAPITALFLOWCclP计Qlsourcesareshiftingasinvestorsseekrisk-adjustedreturns.Riskpremiumsareadaptingtothelackofliquidityandcurrentpricinginthedebtmarkets,andassuch,arereconsideringwhichpropertytypesarelikelytodeliverthebestrisk-adjustedreturns.2023hasproventobetheyearofportfoliooptimizationforseniorshousinginvestors,asthemarketadjuststothecurrenteconomicclimateandvaluationsreset.Privateequityisselectivelyactivebutislargelyin'wait-and-see'*mode,giventhecostoffinancingandthepotentialforassetpricereductions.PubliclylistedREITshaveacquirednearly$4.6billioninseniorshousingpropertiesyeartodate,representing60%oftotalinvestmentdollarsinthesector.However,thesameREITshavedivestednearly$4.5billionoverthesameperiod.Privatecapitalthesecond-largestinvestorinseniorshousingyeartodate,hasacquirednearly$2.7billion,with$2.5billionindivesturesoverthesameperiod.Cross-borderinvestmentwasalmostnonexistentinthefirsthalfof2023,withinstitutionalinvestorsbeingthelargestsellersofseniorshousingrealestate,divestingnearly$560millionyeartodate.NETACQUISITIONSBYBUYERTYPE(BILLIONS)$8PrivateREIT/ListedInstitutionalCross-BorderSource:RCAandCushmon&VVokefieWResearchCAPITALIZATIONRATESVS.10YEARTREASURY(BASISPOINTS)Avg. Spread - SeniorsSpread-SeniorsSpread-Apts.,Avg.Spread-Apts.850Source:CUshmCrC&WakefieldResearch.NICMAPVision,Q32023U4VALUATIONINDEXTheCushman&Wakefieldvaluationindexrepresentsanaggregationofmark-to-marketvaluationconclusionsfromnearly2,200U.S.propertiesthatwerevaluedwithinthepast12months.Theaggregatemarketvalueofthisproprietarydatasettotalsapproximately$32billion,or6.8%ofthetotalestimatedmarketcapitalizationof$470billioninstitutionalseniorshousingandcaresupply.MajorityActiveAdultLowerDecileLowerQuartileAverageUpperQuartileUpperDecileStabilizedOccupancy(%)8587909396EffectiveMonthlyRentperRevenueUnit($)1,3161,9712,2452,4943,266ExpenseRatio(%)3741434853CapitalizationRate(%)4.95.25.86.36.8StabilizedMarketValueperRevenueUnit($)11Z412175,912291,354391,921498,969MajorityIndependentLivingLowerDecileLowerQuartlleAverageUpperQuartileUpperDecileStabilizedOccupancy(%)8687929395EffectiveMonthlyRentperRevenueUnit($)2,5233,2213,9544,8886,239ExpenseRatio(%)5860666976CapitalizationRate(%)5.97.26.36.87.8StabilizedMarketValueperRevenueUnit($)86,870162,924283z242386,111511,232MajorityAssistedLivingLowerDecileLowerQuartileAverageUpperQuartileUpperDecileStabilizedOccupancy(%)8689929395EffectiveMonthlyRentperRevenueUn什($)3,1563,7775J755,9917,834ExpenseRatio(%)6669727880CapitalizationRate(%)66.57.27.98.3StabilizedMarketValueperRevenueUnit($)99,088152,256283,223346,281562,616MajorityMemoryCareLowerDecileLowerQuartileAverageUpperQuartileUpperDecileStabilizedOccupancy(%)8284899092EffectiveMonthlyRentperRevenueUnit($)3,2013,71447225,3766,789ExpenseRatio(%)5561757882CapitalizationRate(%)7.27.98.28.78.9StabilizedMarketValueperRevenueUnit($)89,672121,46518L697241,572355,401MajorityNursingCareLowerDecileLowerQuar