RESEARCH & FORECASTING UK CARE HOMES REVIEW

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1 AUTUMN 20 CARE HOMES REVIEW RESEARCH & FORECASTING UK CARE HOMES REVIEW Whilst for some domiciliary care will be the right option it is hardly a panacea for effective elderly care. As the population ages and more and more of us think of how we want to be cared for in our old age, political pressure will increase to provide adequately funded care homes for the elderly. Max Broadbent Director Healthcare Colliers International This is the sixteenth in a regular series of papers that provides in-depth analysis of the healthcare property and business sector, focusing on long-term residential and nursing care for the elderly. Our analysis is based on live data that supports valuations conducted by the Colliers International Healthcare team and includes more than 4,000 records across the full spectrum of care providers, from national corporates to regional private companies through to single home operators. 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 first half of 20. More detailed data is available on many aspects of this paper. Please contact us for further information or visit our website: International investors may begin to impact with private equity funds and US REITs looking for opportunities. Dr Walter Boettcher Director Research & Forecasting Colliers International CARE HOMES Two main types of CQC registered care home are covered in this paper: Care Homes without Nursing Care (PC) Residential 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. Source: Lakeside Manor Care Home, courtesy of Barchester

2 Research Commentary This half s figures show a mixed picture. Occupancy continues to fall but with signs that the decline may be slowing down. Fees are marginally up compared to the last half of 20 but still remain relatively flat in real terms having plateaued around 20. Payroll costs have come down as a percentage of turnover, but there are some doubts over the sustainability of this. This is because of the increasing care requirements of those coming into care homes, putting pressure on care home operators to increase staffing levels, which may not be met with increased fees. Then there has been some stabilisation of non-payroll costs, although operators are possibly deferring some non-fixed costs. On this last point Amanda Sherlock, then the Director of Operations for CQC, commented in the June 20 CQC Market Report on Adult Social care that: Over the last year, inspectors have noticed deterioration in the physical state of some care homes they inspect... it is increasingly likely that failure to address these kinds of problems is linked to increasing economic pressure within the system. For some operators there is more to be positive about, particularly those in affluent areas with homes geared towards the private sector that continue to get above inflation fee increases. In some cases we have heard of 5% year on year increases for privately funded residents. Other operators, particularly those relying more on the local authority funded residents, still have a gloomy face on, as one commentator put it. A clear message received when speaking to many operators is that where possible they are seeking to ensure that their homes (by asset, amenity and care delivery standards) are able to attract higher fee paying private funded clients, thereby offsetting some of the negative impact of local authority funding constraints. Arguably this mirrors the coalition government s hope of the private sector being able to pick up the slack in the economy. There is much debate at the moment about what the true cost of care is. Operators in many regions appear to be joining forces to highlight the fact that if UK PLC requires good quality care to be provided by robust operators within good quality environments then the government and local authorities will have to dig deeper into their pockets to offer fee levels that meet the real costs of the service provided. Whilst in affluent parts of the country privately funded care effectively subsidises those being funded by local authorities, this clearly leaves out huge swathes of the country. The report, Bridging the Gap, recently published by BUPA highlights this point. Taking into account inflation and rising costs there has been a real term reduction in local authority fees of 4.8% across the UK (5.1% England) over the last three years 20/, 20/ and 20/13. Focusing on England they suggest average weekly local authority fees need to increase 5% to 8% per year for the next three years and probably well beyond. This will require 1.8 billion in extra funding. Many local authorities have pushed domiciliary care and left it later and later before placing people in care homes. Whilst for some domiciliary care will be the right option it is hardly a panacea for effective elderly care and this has been highlighted in media reports during the year. More and more people require full time 24 hour care and to be left sitting at home waiting for maybe a couple of visits a day is often inadequate. As the population ages and more and more of us think of how we want to be cared for in our old age, political pressure will increase to provide adequately funded care homes for the elderly. In the current economic environment there is unlikely to be a quick fix. Operators need to effectively engage in their local communities to make themselves the home of choice. As has always been the case, some homes will cease to trade, but for most, offering high standards of care in good quality environments there is every opportunity to trade successfully. Max Broadbent Director Healthcare Colliers International Source: Worplesdon View Care Home, courtesy of Barchester P. 2 COLLIERS INTERNATIONAL

3 OCCUPANCY RATES Key Results % NURSING PC AVERAGE WEEKLY FEES s PER WEEK NURSING PC 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: Nursing and residential care home average occupancy rates have edged down slightly on 20 by 0.3 percentage points over the six months to June 20. Average Weekly Fees: Average weekly fees in both sectors have increased in 20. The nursing and residential care sectors saw increases of more than 1%. Payroll Costs: Payroll costs as a % of total revenue decreased by 1.7 percentage points in the nursing sector and by 1.1 percentage points for residential wage costs. Non-Payroll Costs: Non-payroll costs as a proportion of total revenue decreased slightly in the first half of 20 for nursing to 14%; whereas, residential care non-payroll costs increased marginally during the same period to 16.5%. EBITDAR: EBITDAR levels in the residential sector saw marginal increases in the first half of 20; after consecutive declines in profit margins since the beginning of 20. Profit margins in the nursing sector continued to fall; down marginally to 29.3%. Nursing sector EBITDAR levels have remained below the eight year average of 31% since the beginning of 20. PAYROLL COSTS % TOTAL REVENUE NURSING PC NON-PAYROLL COSTS % TOTAL REVENUE NURSING PC PROFIT MARGIN (EBITDAR) % TOTAL REVENUE NURSING PC Source: Hurstwood View Care Home, courtesy of Barchester COLLIERS INTERNATIONAL P. 3

4 Colliers International Key Performance Indicators (KPIs) OCCUPANCY RATES Our KPI analysis has shown occupancy levels consistently edging downward since 20. Occupancy rates in both the nursing and residential sectors are still at an all-time low. The trend in occupancy levels for the long-term elderly care sector shows a consistent downward decline in occupancy and is now in line with the levels seen in the nursing care sector in the first half of 20 (see Figure 1). As expected, given the mature corporate homes that make up a significant proportion of our data set this half, occupancy levels in the larger corporate homes (55+ beds) were much higher in the nursing sector, with an average occupancy rate of 92%; in line with the long-term average. The residential sector homes with less than thirty beds saw occupancy levels around 90%. Although mid-sized homes (30-54 beds) registered an average of 87% occupancy in both nursing and residential care, there are more homes in this category in the nursing sector with an average of 42 beds per home. AVERAGE WEEKLY FEES Nominal average weekly fees (before inflation) in the long-term elderly care sectors continued to climb in the six months to June 20. Nominal average weekly fees reached 670 (nursing) and 534 (residential). Since the beginning of 20, real average weekly fees (after inflation) have decreased slightly below inflation. However in, fees have increased marginally above the level of inflation (see Figure 2). Small (<30 beds) to mid (30-54 beds) sized nursing homes are achieving the highest average weekly fees in 20, 781 and 689 respectively. Residential care homes with between beds achieved average weekly fees of 573 and homes with <30 beds achieved 532. The nominal fee increases we are seeing in our analysis of the KPIs are in line with the long-term elderly care market where private fees have increased by 4-5%. FIGURE 1: AVERAGE OCCUPANCY: (2 YR ROLLING AVERAGE) FIGURE 2: AVERAGE WEEKLY FEES IN NOMINAL AND REAL TERMS OCCUPANCY RATES PC 8 Year Data Period Average Combined NH & PC Trend % NURSING PC PC Nominal PC Real Nursing Nominal Nursing Real NH AVERAGE WEEKLY FEES s PER WEEK NURSING PC The occupancy rate is calculated by the total number of residents at the time of valuation divided by the number of registered beds. Average fees are calculated by taking the average of weekly fees being paid by residents. P. 4 COLLIERS INTERNATIONAL

5 PAYROLL COSTS Salary and national insurance costs as a proportion of total revenue marginally declined in both the nursing and residential care sectors. Nursing sector wage costs edged down slightly in 20, down to 56.1%. Residential care staff wages also fell but less so than in nursing with only a one percentage point decrease to 52.2% (see Figure 3). Looking more closely at our payroll costs figures, we analysed payroll costs per resident per week. Not surprisingly, the analysis shows that smaller nursing homes with less than thirty beds have the highest average payroll costs per resident per week ( 486). Residential care homes with beds saw the highest average payroll costs per resident per week ( 276) followed closely by smaller residential care homes with less than thirty beds where payroll costs per resident per week reached 274 on average. As average weekly fees have increased in the first six months of 20, it is understandable that payroll costs have decreased. The decreases are an indication that the operator, and not the state, is dictating the level of care by employing more flexible staffing arrangements. FIGURE 3: PAYROLL COSTS AS A % OF REVENUE (2YR ROLLING AVERAGE) PC Nursing 8 Year Data Period Average FIGURE 4: NON-PAYROLL WEIGHTED AND ACTUAL (NON-WEIGHTED) KPIs PC Actual PC (non-weighted) Nursing Actual NH (non-weighted) NON-PAYROLL COSTS Non-payroll costs incurred by a care home include fixed costs such as food, fuel and utility costs. Figure 4 illustrates the proportion of total revenue allocated to non-payroll costs from 20 until 20. Fixed costs for the longterm elderly care sector indicate more of a mixed picture. There are marginal decreases in the nursing sector (14%); whereas, the residential sector registered marginal increases to reach 16.5%. When looking at our actual (non-weighted) non-payroll cost KPIs, the story is very different. We are seeing increases in fixed costs for 20 in both the nursing and residential sectors. Residential care homes saw the largest actual non-payroll cost increases at 1.6 percentage points and smaller increases (0.4 percentage points) for nursing care homes. The actual (non-weighted) data suggests that increases in fixed costs, such as utilities and food, are having a bigger impact on the sector than our reported KPIs are suggesting PAYROLL COSTS % OF TOTAL REVENUE NURSING PC Payroll costs are calculated by dividing wage and NIC costs by total revenue. Both figures are taken from the accounts at the time of valuation. NON-PAYROLL COSTS % OF TOTAL REVENUE NURSING PC 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. COLLIERS INTERNATIONAL P. 5

6 PROFIT MARGIN (EBITDAR) FIGURE 5: EBITDAR AS A % OF REVENUE (2 YR ROLLING AVERAGE) % OF TOTAL REVENUE NURSING PC Profit margin is calculated by dividing the profit EBITDAR (Earnings Before Interest Tax Depreciation, Amortisation And Rent) by total revenue. Both figures taken from the accounts at the time of valuation PC Nursing 8 Year Data Period Average EBITDAR (PROFIT MARGIN) EBITDAR levels have remained relatively stable since the beginning of 20. During the first half of 20, we have seen a marginal uptick in residential care EBITDAR levels reaching 31%; whereas profit margins in the nursing homes have edged down slightly to 29.3%; remaining below the long-term average of 31% which it has done since 20. Conclusion Our 20 KPI analysis shows that pressures in the wider economy continue to influence the performance of the long-term elderly care sector. Occupancy rates continue to fall to all-time low levels. Increases in nominal fees (those before inflation) are in line with private fee increases seen in the wider market (4%-5%). Although we are seeing above inflation increases in fees in real terms (after inflation) the overall picture shows lower fee increases are putting pressure on operators. Decreases in payroll costs indicate the levels of influence that operators are having on the level of care in their respective homes. In addition, although non-payroll costs are not consistent; they are a gauge on how well operators are able to control the rising costs of food and utilities. EBITDAR levels are also mixed; with sustained market pressures on operational EBITDAR, operators will continue to feel the pressure on their bottom lines a little longer. 20 The Care Home Investment Market By volume, investment transactions in the UK care home market over the last six months has been limited mostly to market churn of smaller assets with values of between 3m to 5m. Bespoke care home funds were the only real actors. What evidence there is suggests that prime yields on quality corporate homes ranged from 6.75% to 7.25%, hence little movement in pricing since the beginning of the year, although there is a notable softness in the market, given the general lack of funding. Corporate operators are not acquisitive given the lack of finance. Consolidation of holdings is a major theme with large operators working existing portfolios to maximise return. Limited funds are being used for capital expenditure projects for refurbishments and extensions; increasingly operators are looking for, and finding, developers willing to enter joint venture arrangements to undertake redevelopment. International investors may begin to impact with private equity funds and US REITs looking for opportunities. Will they be looking at the UK? Some evidence suggests this may be the case, especially in the care village market segment. The notable exception to the trend was the Terra Firma purchase of Four Seasons Healthcare through an equity injection and acquisition of debt which has taken the operator from what some saw as another market disaster in the making to a market darling where operations are properly structured and financed with the stability necessary to push the business further. Four Seasons operates some 445 homes with 22,364 beds including 61 specialist homes with 1,601 beds. Dr Walter Boettcher Director Research & Forecasting Colliers International P. 6 COLLIERS INTERNATIONAL

7 Colliers International View: The Innovators Never Stop The Colliers International Healthcare team was formed 18 years ago when the world was a very different place; Apartheid officially ended in South Africa, Nelson Mandela was inaugurated, Richard Nixon died, John Major was Prime Minister, Chancellor Kenneth Clark predicted national output would rise by 2.5% in 1994, Bank of England base rate was at 5.5% (having fallen from % at the beginning of the decade), Definitely Maybe was released in May and Wet Wet Wet were at number one in March of that year with Love is all Around. On the long-term care front there was much talk of the demographic time bomb, concern about how UK PLC could meet the cost of long-term care for the elderly, the level of fees being paid by the public sector and the real cost of delivering care, worries about how the regulators would limit the potential of the private sector to develop the real estate to serve the need (Ed: plus ça change plus c est la même chose) and very few names in the corporate operating market that we would recognise today. The Colliers International Healthcare team was innovative in 1994 and has continued with innovations and growing expertise to enable us to provide our clients with the support that valuations and consultancy in the sector demands and our experience and expertise gives. We showed innovation: I n 1994 with the development of the first dedicated (where all of the staff have a principle focus on healthcare real estate and businesses) Healthcare team within a national mainstream property consultancy; In 1994 with the first integrated valuation spreadsheet model (with changes in the team over the years we are aware that most UK healthcare valuation models trace their heritage back to this model); I n 1998 with the first Healthcare team within a national property consultancy where the team is 0% focused on healthcare; In 1998 with the first Healthcare team where all healthcare inspections for valuations are undertaken ONLY by experienced specialist healthcare valuers whatever the size of the portfolio or timescale limitations (we believe that we remain the only such large scale national service in the UK); In 2002 with the publication of our first research paper which reported on operational KPIs from real operators real profit and loss accounts this is now the 16th edition of that research; Increasingly from 20 with the internationalisation of the team which has delivered the widest possible expertise and knowledge of the market from which the UK healthcare sector can learn; In 20, with the introduction of the Manager Churn Index, which includes a great level of granularity including, for example, the typical age of a new long-term care home manager at the time of an internal promotion. FIGURE 6: PROMOTIONS BY AGE BRACKET Over <30 Internal Promotions External Promotions 0% % 20% 30% 40% 50% 60% 70% 80% 90% 0% The first edition of this data set is published in a stand-alone document available for the first time at our Autumn 20 launch event. Each innovation and the maintenance of a team 0% focused on the healthcare sector enables us to provide precise advice to our clients and to assist them in their business by offering data sets which can be used as operational benchmarks and headline statistics which can be utilised to drive businesses and profits forwards. The research presented in this document is literally the tip of the iceberg and reports only bundled KPIs; our data sets are comprehensive and are available for detailed interrogation (we are happy to quote for the delivery of bespoke reports) and if you wanted to know the average cost of catering supplies per resident per week in the UK long-term sector in 1998 we could provide the answer (the answer is 1998: (but the range was from.27 to 22.93) and make comparisons with food costs today, but we can also offer more focused advice on the UK regions, size of unit, type of unit etc. Watch this space for the next innovation from Colliers International. The Colliers International Healthcare team Jeremy Tasker Head of Healthcare Colliers International COLLIERS INTERNATIONAL P. 7

8 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, investment, agency, consultancy and litigation related services to a variety of clients, from multi-national healthcare and finance corporations to individual operators. This research is based on data drawn from evidence submitted to support valuations (see map), and is based on authentic, audited information. The data is treated confidentially and there are safeguards in place to protect the records of individual clients. This paper differs from existing research in the marketplace in that it is based not just on surveys but on actual, real valuation data. The research results, therefore, should be indicative of general trends AN ILLUSTRATIVE MAP OF THE LOCATION OF OPERATORS in the market. The data for this paper covers over 4,000 records across a range of different care providers, including corporates, single home units and consists of nursing and residential 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 June 20 ( 20) the data covers the period from 20 to 20. 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. Number of Sites > to to to to 20 to 15 0 to 520+ offices in 62 countries on 6 continents United States: 147 Canada: 37 Latin America: 19 Asia Pacific: 201 EMEA: 8 LONDON WEST END 9 Marylebone Lane London W1U 1HL RESEARCH & FORECASTING Lisa Dean Associate Director lisa.dean@colliers.com HEALTHCARE Jeremy Tasker Head of Healthcare jeremy.tasker@colliers.com We would like to extend our thanks to Barchester for providing the photographs for this publication. Views of the writer are not necessarily the views of Colliers International. Disclaimer: This report gives information based primarily on Colliers International data, which may be helpful in anticipating trends in the healthcare 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 this report and they must not be relied on for investment or any other purposes. This report does not constitute and must not be treated as investment or valuation advice or an offer to buy or sell property. October Colliers International is the licensed trading name of Colliers International Property Consultants Limited. Company registered in England & Wales no Registered office: 9 Marylebone Lane, London W1U 1HL Accelerating success.

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