Care Homes Review SPRING I Accelerating success.

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1 Care Homes Review SPRING I 213 Accelerating success.

2 table OF CONTENTS Care Homes Review 3 Key Results Long-term Elderly Care and Specialist Care 4 Key Performance Indicators (KPIs) Nursing and Personal Care Sectors 5 Specialist Care Sectors 8 Conclusion 9 Research Methodology 11 p. 2 Colliers International

3 research and forecasting report care homes review Spring 213 From the analysis we carry out, more often than not, we see an allowance for annual staff training included in payroll costs. It will be interesting to see how the inevitable cost increases, incurred as a result of new compulsory staff training, will impact on payroll costs and start to filter through to our KPI s. Whilst in the short term we may see a slight increase, the long term view must take precedence and, as we see standards of care and confidence in the sector improve further, so should profitability. This is something we will be monitoring going forward. Rachel McCarthy Director Healthcare Colliers International Care Homes Review This is the seventeenth in a regular series of research papers which provide an in-depth analysis of the healthcare property and business sector, focusing on long-term personal care and nursing care for both the elderly and specialist markets. Colliers International has reported on KPI s in the healthcare sector since 21. Our analysis is based on actual on data confidentially sourced from valuation and agency transactions conducted by the Colliers International Healthcare team. The database includes more than 4, records from the full spectrum of care providers, from national corporates to regional private companies through to operators of single homes. The sample of care homes varies in each six month period but typically has a corporate bias. This paper provides commentary on indicative trends in the healthcare market for the second half of 212 and more detailed data is available on many aspects of this paper. For further information, please contact us or visit our website: Care Homes Two main types of CQC registered care home are covered in this paper: Care Homes without Nursing Care (PC) Personal care homes offer either short- or long-term care. They provide accommodation, meals and personal care, such as help with bathing and eating. Care Homes with Nursing Care (NH) These homes are similar to residential homes but they also employ registered nurses who provide care for more complex health needs. Specialist Homes Specialist care homes (SP) generally provide care in the age categories, catering for people with long-term physical and learning disabilities. Source: Bucklesham Grange, Ipswich Colliers International p. 3

4 research and forecasting report care homes review Spring 213 Occupancy Rates % of available beds NH PC SP 212 H H H AVERAGE weekly FEES s per week NH PC SP 212 H , H , H ,445 payroll costs % of total revenue NH PC SP 212 H H H non-payroll costs % of total revenue NH PC SP Key Results Long-term Elderly Care and Specialist Care Our research focuses on the key drivers of the care home industry, covering occupancy rates, average weekly fees, payroll costs, non-payroll costs and profit margins (EBITDAR). These five measures have been adopted as the Colliers International Key Performance Indicators. Occupancy Rates: Occupancy rates in nursing homes have been hovering around 9% since the beginning of 211 and remain unchanged during the last six months of 212. However, occupancy rates in personal care homes and specialist care homes fell in the second half of 212, with specialist home occupancy falling by almost one percentage point and both now registering occupancy rates below 9%. Average Weekly Fees: Significantly, average weekly fees in both nursing and personal care homes have reduced when compared with H1 212, whereas specialist care homes evidenced an increase following a fall in the H1 212 dataset with an increase in average fees of more than 2%, reaching 1,462 per resident per week. Payroll Costs: The personal care sector continues to show period on period reductions in the payroll KPI, edging down in H2 212 to 51.5%. By contrast the KPI s indicate that for nursing and specialist homes the percentage of revenue spent on the payroll continues to increase. Non-Payroll Costs: Non-payroll costs, expressed as a percentage of total revenue, have continued to rise in nursing and personal care homes, but reduced marginally in H2 212 in specialist homes, down to 12.9%. EBITDAR: Our research shows that profit margins (making no allowance for central head office corporate costs) in the personal care sector have remained unchanged over the last six months at 31% of revenue. However, EBITDAR margins for nursing homes and specialist homes have slipped, after remaining relatively stable since H H H Profit Margin (EBITDAR) % of total revenue NH PC SP 212 H H H Source: Bucklesham Grange, Ipswich p. 4 Colliers International

5 research and forecasting report care homes review Spring 213 Key Performance Indicators (KPIs) Nursing and Personal Care Sectors Occupancy Rates: The occupancy rate is calculated by the total number of residents at the time of valuation/transaction divided by the number of available beds. For this period, occupancy rates in personal care fell marginally to 88.3%; but nursing home occupancy rates remained unchanged in 212 at 9.1% (see Figure 1). Whilst only marginal changes are reported in this period, there are two main factors that will continue to have an impact on occupancy levels going forward; government policy and, increasingly, capacity levels in the market from high end, quality care homes. Government and local authorities continue to favour the provision of care at home for the elderly for as long as possible, with the decision to refer into a registered care environment often a financial/budget consideration rather than relating solely to care needs. Overall occupancy levels in the long-term elderly sector have been consistently edging downward since H2 25 and have now reached their lowest levels since we began collecting our data. However, demographic pressure will see the need for more care home places to be available over the next two decades and, depending on the rate of new developments, this demand could result in improved occupancy within well-located and presented homes offering cost effective care. Average Weekly Fees: Over the last two years we have been tracking the relationship between nominal fees and real fees (weekly fees with inflation taken into account) and have found that, although nominal fees were increasing in both the nursing and personal care sectors, real fees were much lower and exerting significant pressure on operators. Analysing this data for H2 212, we see that nominal fees and real fees have fallen for the first time in 212 (see Figure 2), albeit by 1% and 2% respectively. Based on our analysis, the personal care sector appears to be faring better than the nursing sector in terms of fees. Figure 1: Average Occupancy: (2yr rolling average) Occupancy % H2 3 H1 4 H2 4 H1 5 H2 5 H1 6 H2 6 H1 7 H2 7 H1 8 H2 8 H1 9 H2 9 H1 1 H2 1 H1 11 H2 11 H1 12 H2 12 Source: Colliers International Figure 2: Average Weekly Fees in Nominal and Real Terms s Source: Colliers International PC NH 1YR Data Period Average NH Average Weekly Fees NH Real Fees PC Average Weekly Fees PC Real Fees 2 H2 3 H1 4 H2 4 H1 5 H2 5 H1 6 H2 6 H1 7 H2 7 H1 8 H2 8 H1 9 H2 9 H1 1 H2 1 H1 11 H2 11 H1 12 H2 12 Figure 3: Payroll Costs as a % of Total Revenue (2yr rolling average) % of Total Revenue PC Payroll Costs Nursing Payroll Costs H2 3 H1 4 H2 4 H1 5 H2 5 H1 6 H2 6 H1 7 H2 7 H1 8 H2 8 H1 9 H2 9 H1 1 H2 1 H1 11 H2 11 H1 12 H2 12 Source: Colliers International Colliers International p. 5

6 research and forecasting report care homes review Spring 213 Personal care nominal fees have seen a 64% increase since H2 23; in real terms we ve only seen an increase in fees by 22% over the same period. Since H2 21, real term fees in the residential sector have fallen by 4%. Looking at nursing homes, nominal fees have increased 48% since H2 23 reaching 665 per person per week, but have increased in real terms only by 11% over the same period. Real fees in the nursing sector for H2 212 are no better than those seen in H2 28. Nick White, Senior Surveyor in the Colliers International Healthcare team adds, In our experience there continues to be a large variation between the privately funded market, where operators are still reporting fee increases of around 4% per annum, and the publically funded market, where increases (if there have been any) have generally been below the rate of inflation. Payroll Costs: Payroll costs include wages and NIC costs and are taken from the accounts at the time of valuation/ transaction. Payroll costs as a proportion of total revenue marginally declined in the personal care sector to 51.5%; whereas, in the nursing home sector wage costs have edged up slightly to 56.6% (see Figure 3). Payroll costs in specialist care homes continue to increase and are now at their highest level in two years, at 52.3% of revenue. Rachel McCarthy, Director in the Healthcare team adds, From the analysis we carry out, more often than not, we see an allowance for annual staff training included in payroll costs. It will be interesting to see how the inevitable cost increases, incurred as a result of new compulsory staff training, will impact on payroll costs and start to filter through to our KPI s. Whilst in the short term we may see a slight increase, the long term view must take precedence and, as we see standards of care and confidence in the sector improve further, so should profitability. This is something we will be monitoring going forward. More specifically, in the nursing sector, the introduction of the new nursing training standards will require all student nurses to work as healthcare assistants before beginning their official studies. There is the potential for homes to offset any increase in costs through employing cost effective pre-student nurses who are gaining hands on experience prior to entering their formal training. Figure 4: Non-Payroll Costs as a % of Total Revenue (2yr rolling average) % H2 3 H1 4 H2 4 H1 5 H2 5 H1 6 H2 6 H1 7 H2 7 H1 8 H2 8 H1 9 H2 9 H1 1 H2 1 H1 11 H2 11 H1 12 H2 12 Source: Colliers International Non-Payroll Costs: PC Nursing Figure 5: personal care Average Food Costs per Person per Week s Per Person Per Week Source: Colliers International Avg Food Costs Per Person Per Week RPI (All Items) Figure 6: PERSonal care Average Heating & Lighting Costs per Person per Week s Per Person Per Week Avg Heating & Lighting Costs Per Person Per Week Source: Colliers International, Haver Analytics RPI (Heating & Lighting) Non-payroll costs are calculated by dividing total costs, excluding wages and NIC, by total revenue. Both figures are taken from the accounts at the time of valuation/transaction. Non-payroll costs incurred by a care home comprise both fixed costs, such as council tax, accountancy and insurance and variable costs, such as provisions, utilities and motor RPI (All Items) RPI (Heating & Lighting) p. 6 Colliers International

7 research and forecasting report care homes review Spring 213 costs. Figure 4 illustrates the proportion of total revenue apportioned to non-payroll costs from 23 until 212. Non-payroll costs for the personal care sector increased by less than one percentage point, reaching 17.3% of total revenue. Nursing non-payroll costs saw marginal increases in H2 212, to 14.5% of total revenue. Within the non-payroll costs we have also analysed food costs per person per week ( pppw ) as well as heating and lighting costs pppw against the Retail Price Index ( RPI ). In the personal care sector, average food costs per resident have increased above RPI since 22. Food costs, on average, were 27.2 pppw in 212; the highest on record. Average food costs pppw in the nursing sector have also historically risen above RPI until 211 and 212. Heating costs pppw, on the other hand, have increased below inflation for both the personal care and nursing sectors, which implies that operators are controlling costs well, especially given rising utility charges. Adrian Ilott, Director in the Healthcare team observes, Operators have been forced to closely control costs due to the pressure placed on fees. (See Figures 5, 6, 7, 8). EBITDAR (Profit Margin): Profit margin is calculated at the EBITDAR level (Earnings Before Interest Tax Depreciation, Amortisation And Rent), having taken the data at the time of valuation/transaction. Profit margins across the long-term elderly sector continue to be under pressure due to lower occupancy levels and continued cost constraints. Profitability in the personal care sector remains unchanged over 212 at 31.%. Adrian Ilott comments, The picture for personal care homes remains stable, with relatively static fee and occupancy levels. Operators have worked hard to maintain levels of profitability by countering non-wage cost increases with savings in wage costs. (See Figure 9). Nursing home sector profit margins dipped slightly by.7 percentage points to 28.6% after remaining relatively stable since H2 21 (see Figure 9). Adrian Ilott adds, The nursing home sector is facing more challenges than the care sector. Whilst income levels have remained static, non-wage costs have increased. Whilst the personal care sector has been able to Figure 7: Nursing Home Average Food Costs per Person per Week s Per Person Per Week Source: Colliers International, Haver Analytics Figure 8: Nursing Home Heating & Lighting Costs per Person per Week s Per Person Per Week Source: Colliers International, Haver Analytics Figure 9: EBITDAR as a % of Total Revenue (2yr rolling average) % of Total Revenue Avg Food Costs Per Person Per Week Avg Heat & Light Costs Per Person Per Week Source: Colliers International, Haver Analytics RPI (All Items) RPI (Heating & Lighting) PC Nursing 1YR Data Period Average H2 3 H1 4 H2 4 H1 5 H2 5 H1 6 H2 6 H1 7 H2 7 H1 8 H2 8 H1 9 H2 9 H1 1 H2 1 H1 11 H2 11 H1 12 H2 12 counter this increase with staff cost savings, nursing homes have seen wages increase, resulting in falling levels of profitability. It appears that the more constrained staffing environment, combined with inflationary pressure on nurses rates of pay, has limited operators ability to protect profitability RPI (All Items) RPI (Heating & Lighting) Colliers International p. 7

8 research and forecasting report care homes review Spring 213 Key Performance Indicators (KPIs) Specialist Care Sector This section of the paper provides analysis of the specialist care property and business market, focusing on homes that cater for adults with long-term physical and learning disabilities. Analysis of our specialist care home KPIs indicates that we are finally seeing the cost pressures which have long been affecting the long-term elderly care sector feeding through into our specialist KPI analysis. Occupancy Rates: Occupancy rates are now below 9% in the specialist sector at 89.9%, after remaining virtually unchanged during H2 211 and H1 212 (see Figure 1). Since H1 211, occupancy rates have fallen by 1.7 percentage points. Average Weekly Fees: Average weekly fees for H2 212 increased to 1,462 in nominal terms, which is a 38% increase in fees since H2 23. When taking inflation into account, real average weekly fees have only increased by 3% over the same time period, considerably below the uplifts seen in the elderly personal care and nursing sectors of 22% and 11% respectively. This shows the pressure that is being put on levels of profitability (see Figure 11). Figure 1: average Occupancy in Specialist Care Homes (2yr rolling average) % H2 3 H1 4 H2 4 H1 5 H2 5 H1 6 H2 6 H2 7 H1 8 H2 8 H1 9 H2 9 H1 1 H2 1 H1 11 H2 11 H1 12 H2 12 Source: Colliers International, Haver Analytics Figure 11: Specialist Average Weekly Fees in Nominal and Real Terms: s 1,6 1,5 1,4 1,3 1,2 1,1 1, Source: Colliers International, Haver Analytics SP Specialist Nominal 1YR Data Period Average Specialist Real H2 3 H1 4 H2 4 H1 5 H2 5 H1 6 H2 6 H2 7 H1 8 H2 8 H1 9 H2 9 H1 1 H2 1 H1 11 H2 11 H1 12 H2 12 Source: Admiral Court, Leigh-on-Sea p. 8 Colliers International

9 research and forecasting report care homes review Spring 213 Payroll and Non-Payroll Costs: Payroll costs rose by over one percentage point to 52.3% in the last six months of 212, despite remaining relatively stable in 211 and H1 212 (see Figure 12). EBITDAR (Profit Margin): For the first time since H2 21, we are seeing a fall in profitability in the specialist sector. EBITDAR has fallen by one percentage point in H2 212 to 34.3%. We expect profit margins to continue to be under pressure in 213 as cost pressures continue to squeeze operators (see Figure 12). Nick White adds, As with the elderly care sectors, specialist operators have managed to broadly maintain income levels despite the challenges they are facing. However, as seen in the nursing sector, wage costs have increased due to the difficulties of maintaining staff costs in a more constrained staffing environment and where there are inflationary pressures on specialist staff rates of pay. Figure 12: Specialist Care EBITDAR under Pressure % of Total Revenue Payroll Costs as a % of Total Revenue EBITDAR as a % of Total Revenue Non-Payroll Costs as a % of Total Revenue H2 3 H1 4 H2 4 H1 5 H2 5 H1 6 H2 6 H2 7 H1 8 H2 8 H1 9 H2 9 H1 1 H2 1 H1 11 H2 11 H1 12 H2 12 Source: Colliers International Conclusion Our H2 212 KPI analysis shows that keeping costs down while continuing to deliver high standards of care is a continuing theme for both the long-term elderly and specialist sectors. Occupancy levels are down across the sector, due in part to government policy. Pay levels in the sector will continue to be an issue, with operators perhaps seeking to limit pay increases in line with the National Minimum Wage. This could be a false economy as staff, especially senior staff, have to be incentivised and rewarded for maintaining high care and amenity standards and effectively marketing the homes services. If a business in the healthcare sector loses its senior motivated staff, it typically results in deteriorating standards and profit. Thanks to Hallmark Care Homes for providing photographs of their award winning homes. Source: Admiral Court, Leigh-on-Sea Colliers International p. 9

10 research and forecasting report care homes review Spring 213 The Care Home Investment Market Investment activity in the care home segment of the healthcare sector was generally quiet with few large assets changing hands, although in the last few weeks, Target Healthcare REIT has activated their fund investment plans and acquired seven assets at yields between 7.25% and 7.5%. Private equity continues to circle the sector as operators continue to deal with finance restructurings and debt maturities as evidenced by Barchester s recent activities. Care home developers are finding some finance through JV deals with private equity and council referral forward commitments, but direct bank development finance remains thin, at best. In contrast, the primary care centre market has been very active with more consolidation and opportunistic purchases made, no doubt with an eye to changes in the NHS funding regime. MedicX is reported to have concluded deals worth 178m over the course of 212. Primary Health Properties has also been very active since our last report in Autumn 212, including the purchase of rival Apollo Medical Partners in December for 64.6m at a 5.9% cash yield. The purchase included 14 properties (11 developed in the last five years with three under construction). In March, PHP used its financial muscle to refinance the AMP portfolio improving its financial position by some 2 bps. This illustrates very aptly both the difficulties and opportunities across the healthcare market segments. Evidence would suggest that primary care facilities are trading at yields of around 5.75% to 6%. Debt opportunities have also been evident across hospital operators as the Moor Park acquisition of 12 Spire units for more than 7m might suggest. The deal is cited as evidence that sale and leaseback opportunities are of interest again, as is the increase in more complex and structured finance solutions. Dr Walter Boettcher Director Research and Forecasting Colliers International Source: Anisha Grange, Billericay p. 1 Colliers International

11 research and forecasting report Care homes review Spring 213 Research Methodology Colliers International specialises in all aspects of the healthcare property and business sector. The team is made up of experienced professionals and provides a wide range of valuation, agency, investment, consultancy and litigation related services to a variety of clients, from multi-national healthcare and finance corporations through to individual operators. This research is based on data drawn from both formal accounts and unaudited management accounts submitted to support valuations and agency activity (see map below). The data is treated confidentially and there are safeguards in place to protect the records of individual clients. This research paper, accordingly, differs from most other published data which typically relies on informal surveys and informed comments. All data used in this research report has, in addition, been diligently checked by the Colliers International Healthcare team in the course of our valuation and agency activity. The research results, therefore, are indicative of real trends in the market. The data for this paper covers over 4, records across a range of different care providers, including corporates, single home units and consists of nursing and personal care homes. The data also covers the whole of Great Britain and is therefore representative of the country as a whole. Unless otherwise stated, the data covers a moving two data period average, so for the most recent period ending at December 212 (H2 212) the data covers the period from H1 211 to H This two period rolling average has been adopted to eliminate any problems caused by outliers and helps to smooth any irregularities which may distort the true picture of what is happening in the marketplace. 48+ offices in 62 countries on 6 continents United States: 14 Canada: 42 Latin America: 2 Asia Pacific: 195 EMEA: 85 $2. billion in annual revenue 1.25 billion square feet under management 13,5 employees LONDON WEST END 5 George Street London W1U 7GA Research and Forecasting Lisa Dean Associate Director lisa.dean@colliers.com AN ILLUSTRATIVE MAP OF THE LOCATION OF OPERATORS Number of Sites > 4 31 to 4 26 to 3 21 to to 2 11 to 15 to 1 Healthcare Adam Lenton Head of Healthcare adam.lenton@colliers.com We would like to extend our thanks to Hallmark Care Homes for providing photographs of their award winning homes for this publication. Disclaimer: This report gives information based primarily on published data which may be helpful in anticipating trends in the property sector. However, no warranty is given as to the accuracy of, and no liability for negligence is accepted in relation to the forecasts, figures or conclusions contained in it and they must not be relied on for investment purposes. This report does not constitute and must not be treated as investment advice or an offer to buy or sell property. April Colliers International is the licensed trading name of Colliers International Property Consultants Limited. Company registered in England & Wales no Registered office: 5 George Street, London W1U 7GA. Colliers International p. 11

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