4.7.3Segment

Assisted Living Facilities

Assisted living communities providing supportive residential care and personal assistance to seniors with moderate needs.

4
Verticals

Overview

Assisted Living Facilities provide supportive residential care and personal assistance to seniors with moderate needs. It is a predominantly private-pay segment — Brookdale, Atria, Sunrise, and many regional operators — that is better positioned than skilled nursing given its consumer-pay model and lower clinical intensity.

Occupancy fell during the pandemic and has been recovering, and the segment is poised to benefit from the coming surge in the senior population. Operations and real estate are often split (REIT-owned property), and consolidation is active across both.

Market snapshot

Market size
~$48B
Growth
~4.8%CAGR (2017–22, nominal)
Companies
~18,567 firms
Firms by employee count

70.8% of firms have fewer than 20 employees: 13,147 micro-businesses, below most mandates.

The investable universe5,420 firms with 20+ employees
20–99
3,98373%
100–499
90017%
500+
53710%

Predominantly private-pay senior housing — ~18,600 firms, mostly small (71% under 20 staff) — that recovered faster than skilled nursing because it isn't tied to Medicaid rates. Occupancy is climbing back toward the demographic surge (~4.8%/yr growth); operations and REIT-owned real estate are often split, and PE/REIT capital keeps consolidating the space. The count leans partly on a broad 'other residential care' bucket.

NAICS 623312, 623990. U.S. Census Bureau — 2022 Statistics of U.S. Businesses; U.S. Census Bureau — 2022 Economic Census.

Business model & economics

Revenue model

Primarily private-pay monthly resident fees

Key economics

Revenue per firm
$2,586,481
Revenue per employee
$80,516
Employees per firm
33.4
Recurring revenue
High

recurring monthly occupancy

EBITDA margin
Occupancy- and labor-sensitive; better than SNF
Capex intensity
High

Characteristics

  • Balanced cost base — payroll is 41% of revenue, leaving room to scale margin without cutting staff
  • Deep strategic-buyer pool — 537 firms exceed 500 employees, so a scaled asset has trade buyers
  • Predominantly private-pay — better positioned than SNF.
  • Occupancy recovering toward the demographic surge.
  • Operations and REIT-owned real estate often split.

NAICS 623312, 623990. U.S. Census Bureau — 2022 Statistics of U.S. Businesses; U.S. Census Bureau — 2022 Economic Census.

Geographic concentration

AlabamaArizonaColoradoFloridaGeorgiaIndianaKansasMaineMassachusettsMinnesotaNew JerseyNorth CarolinaNorth DakotaOklahomaPennsylvaniaSouth DakotaTexasWyomingConnecticutMissouriWest VirginiaIllinoisNew MexicoArkansasCaliforniaDelawareDistrict of ColumbiaHawaiiIowaKentuckyMarylandMichiganMississippiMontanaNew HampshireNew YorkOhioTennesseeUtahVirginiaNebraskaSouth CarolinaIdahoNevadaVermontLouisianaRhode IslandAlaskaOregonWashingtonWisconsin

Assisted living concentrates in the Pacific Northwest and Upper Midwest — Oregon, Washington, Alaska, and Wisconsin — where the assisted-living model is most established relative to nursing homes.

OregonWashingtonAlaskaWisconsin

U.S. Census Bureau — 2022 Statistics of U.S. Businesses (firms by state), NAICS 623312/623990. Concentration shown by location quotient.

M&A deal context

Deal activityHigh

Who’s acquiring

  • Senior-living operators
  • Healthcare REITs & real-estate investors
  • PE-backed platforms

What’s driving deals

  • Occupancy recovery and demographic tailwind.
  • Operations/real-estate transactions and REIT activity.
  • Consolidation of regional operators.

Verticals in this segment

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