2010 Largest Assisted Living Providers

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While stormy economic conditions buffeted the business last year, indicators now point to smoother navigation ahead. As businesses in nearly every U.S. Sector struggled to stay afloat last year, assisted living was the buoy in the choppy waters. Steady query for quality services helped keep fellowships stable-even if accompanied by a hiatus from major mergers and acquisitions.

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As businesses in nearly every U.S. Sector struggled to stay afloat last year, assisted living was the buoy in the choppy waters. Steady query for quality services helped keep fellowships stable-even if accompanied by a hiatus from major mergers and acquisitions.

Now, as economic forecasters allude to the end of the "Great Recession," fellowships like this year's Largest Providers are poised for growth, some of which is already underway. Forty-two of those fellowships (60%) that made the 2010 list report increases in licensed assisted living resident capacity-though much of that growth was in single-digit percentages. Another 16 of the top 70 fellowships maintained their size, while just 12 reported losses.

Here's a look at Assisted Living Executive's 2010 Largest Providers, and the business environment, transactions, and trends that landed each business a spot.

Top Players Hold Steady

In 2009, no assisted living providers merged nor acquired any other complete company. However, while most deals were small, the year did furnish a few large folder acquisitions and critical reshuffling. The biggest gains and losses were among the biggest players and occurred straight through straightforward sales and acquisitions.

For the first time since Assisted Living executive began compiling this annual Largest Providers list, Sunrise Senior Living, based in McLean, Virginia, no longer sits at No. 1. The company, now No. 2, had no new building starts and sold off about 9 percent of its assisted living capacity (about 2,896 units) last year. Its biggest transaction was a folder of 21 communities in 11 states to Milwaukee, Wisconsin-based Brookdale Senior Living for 4 million, but Sunrise also sold smaller portfolios to regional providers, such as Baltimore-based Brightview Senior Living (The security Group), which purchased two of Sunrise's New Jersey communities.

The Sunrise downsize has made Seattle-based Emeritus Senior Living the nation's largest assisted living provider. Emeritus acquired 2,221 new licensed assisted living units and grew by 7 percent in the past year, and it's very likely that Emeritus will not only articulate the top spot next year, but strengthen significantly in 2011. The company's partner, Blackstone Real Estate Advisors, is pursuing the purchase of 134 communities operated by Sunwest Management, which is in chapter 11 bankruptcy. Under a introductory agreement, Emeritus would manage the properties with the selection to invest up to 10 percent of the equity in a joint investment with Blackstone and Columbia Pacific Management, an entity controlled by Dan Baty, Emeritus chairman and co-Ceo.

Brookdale Senior Living maintained its No. 3 ranking, but also grew by 3,808 residents, or 15 percent, in 2009. Sunwest Management, last year's No. 4 company, comes in at No. 7 this year with 9,186 assisted living residents, a 43 percent drop. The business will disappear completely from the 2011 list if Blackstone or Another entity receives court approval to buy the remainder of Sunwest's portfolio.

In terms of percentage growth, the clear winner is Solana Beach, California-based Senior reserved supply Group, Another beneficiary of Sunwest's financial woes. The business picked up supervision contracts for 41 properties in 11 states, under the name LaVida Communities, when institutional investor Lone Star Funds of Dallas acquired the properties in the first big deal of 2009. Senior reserved supply Group catapults from No. 55 to No. 11, having grown its assisted living resident capacity more than 500 percent, to 4,897.

Big Movers

For the next Largest Providers percentage spike, look to Crl Senior Living Communities, which enters the list at No. 57, thanks to more than doubling its assisted living capacity from 502 to 1,019. Also on the growth path, Frontier supervision wide by 64 percent, from 828 to 1,358 licensed assisted living units, thanks to seven new supervision contracts and two new buildings. Frontier supervision jumps 15 spots from No. 57 to No. 42. Watch this Western regional provider to grow supplementary next year as some more new buildings open.

The fourth-largest list jumper is Carmichael, California-based Eskaton Senior Residences and Services, rising 12 spots to No. 56. The business reports 1,036 licensed assisted living units (up from 732 last year) due to whether expansions or applications for supplementary assisted living licensing.

Only seven other providers report gains of 20 percent or more in the past year, and among them is Bradley, Illinois- based Bma Management. Because of its focus on the affordable market, the business continues to advantage from accessible financing sources not available to primary providers. Bma Management's assisted living resident capacity jumped 27 percent in the past year as the business opened six new communities. In 2010, the business moves up the list by three spots, arrival in at No. 21.

Other fellowships that increased their licensed assisted living capacity consist of Capital Senior Living Corporation (No. 20), which grew by 25 percent, and Bonaventure Senior Living (No. 23), whose assisted living capacity surged by 21 percent to 2,595. Assisted living capacity for Carlsbad, California-based Integral Senior Living (No. 24) rose 24 percent. Benedictine health theory (No. 41) grew by 20 percent, and Brightview Senior Living (No. 52, up from No. 62 last year) wide by 29 percent, thanks to the Sunrise deal, which added 240 residents. Another chart-jumper was freedom Living Management, which vaulted nine places from No. 58 in 2009 to No. 49 this year simply by adding 200 residents (22 percent).

The vast majority of expanding providers, however, had gains of less than 10 percent. But a minute growth can go a long way when nearly 60 percent of fellowships on the Largest Providers list have fewer than 2,000 assisted living residents.

In Another indication of assisted living growth, Independent Healthcare Properties, the smallest business on the list at No. 70, only kept its 2009 rank thanks to an 18 percent capacity gain from 706 to 833. Most of the 2009-ranked fellowships that did not make this year's list whether maintained capacity or had very small gains. Another calculate for higher numbers at the bottom of the list is attributed to data from five providers not previously listed-Spectrum seclusion Communities (No. 28), Mountain View seclusion (No. 50), Crl Senior Living Communities (No. 57), Welcome Home supervision business (No. 64), and Elder Care Alliance (No. 66).

Other than Sunwest, the business with the most dramatic drop in licensed assisted living capacity was Northstar Senior Living, which shed 1,068 residents, or 55 percent of its 2009 capacity, falling from No. 28 to No. 67. Again, because of modest farranging numbers, decreases were most famed toward the bottom of the top 70 list. Grace supervision saw a 30 percent decline from 1,399 to 979 and dropped from No. 37 in 2009 to No. 61 this year. Carillon Assisted Living, No. 49 in 2009, decreased its capacity by 24 percent from 1,024 to 775, removing it from the list altogether.

Several fellowships that didn't make this year's list but may show up in 2011 consist of Trinity Lifestyles Management, which nearly doubled in size to 480 assisted living residents after picking up three Atlanta-area EdenCare properties, once operated by Sunrise Senior Living. Wichita, Kansas-based Legend Senior Living has been raising its assisted living component steadily with new construction, expanding Another 18 percent to 692 in 2010. And finally, AdCare health Systems, based in Springfield, Ohio, remains a smaller provider at 231, but that reflects a 38 percent growth over the prior year, and the business recently announced raising .5 million to fund acquisitions.

More carport Times Ahead

"The fact that we'll be able to point to this time period-the worst economic downturn in our lifetimes-and say that our manufactures weathered it pretty well and even continued to grow is significant," says Granger Cobb, president and co- Ceo of Emeritus Senior Living.

The past two recessions hit assisted living hard, and many providers at the start of 2009 were involved that the stalled housing market, depleted stock store earnings, and high unemployment among the adult children of inherent residents could cause occupancy rates to plummet. Instead, after modest 2008 rate declines and a rent growth slowdown to 2 percent from 2.9 percent in 2008 and 4 percent in 2007, the needs-based component of assisted living seemed to trump economic concerns. Move-ins could be postponed but only for so long.

By second quarter 2009, signs of stabilization began to emerge, followed by a slow but upward trend, says Robert G. Kramer, president of the Annapolis, Maryland-based National investment center for the Seniors Housing & Care manufactures (Nic). While national unemployment still hovered at a troubling 10 percent in January, Kramer says he's cautiously optimistic about the future, especially since the manufactures saw its largest absorption rate in the third quarter of 2009 since the first quarter of 2006- 1,400 assisted living units in the top 30 urban markets and slightly stronger in the top 100 markets.

Those statistics propose that the farranging photo is much rosier for assisted living than for other real estate sectors, including multifamily, hotels, and offices, Kramer notes. "Basically, we are finding operators keeping the line with regard to rates," he adds. "We nothing else but are finding more concessions out there, but at the same time, those concessions tend to be very much market-specific, property-specific, or even unit-specific."

Still, move-in delays due to economic factors have amplified a trend already developing pre-recession-residents tend to be older and frailer, says Jim Moore, president of Moore Diversified Services and author of "Strategic Forecast," published in Assisted Living Executive's January/February 2010 issue. The corollary is heightened occasion in dementia care, which is even more needs-based than assisted living, he adds. Indeed, a whole of top 70 operators reported having converted independent units to assisted living or assisted living to memory care.

As for new construction, buildings already in the pipeline continued to open, but few fellowships launched new developments, and by January 2010, the whole of new building starts had fallen to the bottom point since Nic started tracking senior housing trends. No fellowships went social in 2009.

Forecast for 2010

Access to capital will remain the primary challenge for amelioration in 2010, although new properties financed before the retreat will continue to open straight through the third quarter of 2010. But the lack of new properties isn't necessarily bad news for assisted living.

"We're going to go straight through a period of very minute new stock arrival online, but if that coincides with pent-up query and a salvage in the economy, all should bode well for occupancies and rent growth in assisted living," Kramer says. "Outside of external economic factors that we don't have any operate over, the most risk to assisted living is overbuilding."

Fannie Mae and Freddie Mac will continue to be trustworthy sources of permanent 10-year financing, but when it comes to building loans, developers have few options. Some very minute Hud 232 financing will be available, but more likely, the few projects that launch will do so because of relationships with local lenders.

Indeed, The Arbor Company, based in Atlanta, lacks the cash to make properties on its own, but thanks to a partnership with Formation Capital, Arbor will manage two new properties scheduled to break ground this fall, says Coo Judd Harper. "We feel much stronger and more optimistic about the assisted living occupancies in today's slowly recovering economy, but are optimistic about independent living's rebound in the future," he adds. "As population get jobs, they no longer are going to be able to care for a parent at home."

A keen spot in the acquisitions arena, hidden equity entities are beginning to eye assisted living as a desirable sector again, and the major Reits in senior housing are well-positioned to invest again, Kramer notes. Emeritus will be a business to watch thanks to the Blackstone deal, and while it only plans one new building in 2010, the business actively will be finding for other acquisition opportunities at keen prices.

"If a business has liquidity, cash flow, and a reasonably salutary balance sheet, it will be in a great position because there are opportunities right now," Cobb says. That advantage isn't just for big fellowships like Emeritus, but also for regional and even small mom-and-pop players with targeted expansion plans, he adds, noting that "interest rates have not changed that much over the last concentrate of years, but the whole of equity and coverage ratios you have to have in place has become more stringent, as well as the underwriting."

Fanwood, New Jersey-based Chelsea Senior Living leveraged a strong association with a local lender to purchase a previous Sunwest property in New Jersey last fall and is actively finding for more deals, says Roger Bernier, president and Coo. "Some population are likely to see their debt maturing and be unable to refinance," he forecasts. "Ultimately we'd like to grow by two communities per year, but it has to be the right deal for us to take a look."

Much of the acquisitions activity in 2010 is likely to remain with distressed properties, however, and no one expects lots of high-end properties to come on the store this year, says Steve Monroe of Senior Care Investor. "High-performing properties are only going to sell if owners can get a good price, although that may start to change later in 2010."

Still, wise operators should not be blinded by keen price tags so much that they forget to think how well the acquisition fits into their existing folder and evolving demands of seniors and their families, Moore cautions. "Senior psychographics are changing," he adds. "It's not so much the World War Ii homemaker widow as 80-year-olds who have been in the professional workforce."

Another area of occasion in 2010 may be new supervision contracts for owners and lenders who may be unhappy with their current management, Moore suggests. And for many companies, the wisest move in 2010 may be just to sharpen internal operations, he says.

Although Greensboro, North Carolina- based Bell Senior Living is open to the right deal within the mid-Atlantic states in which it already operates, the latter strategy will be the company's prime priority this year, says President Steve Morton. "I'd say it's a time to focus on operations, enhance operating results including supervision and revenue streams, and put together the critical tools to maximize and run communities in the most sufficient manner possible," he says. "This is something we can do because we don't have five acquisitions or amelioration deals."

Finally, unstable financial markets still make it unlikely that any business will go social in 2010, but if conditions improve, Moore says, the two fellowships to watch continue to be Atria Senior Living Group (No. 4) and Hcr ManorCare (No. 10).

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