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While stormy economic conditions buffeted the business last year, indicators now point to smoother sailing 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 demand for quality services helped keep companies stable-even if accompanied by a hiatus from major mergers and acquisitions. As businesses in nearly every U.S. sector struggled to stay afloat last year, assisted living was the buoy in the choppy waters. Steady demand for quality services helped keep companies stableeven if accompanied by a hiatus from major mergers and acquisitions. Now, as economic forecasters allude to the end of the "Great Recession," companies like this year's Largest Providers are poised for growth, some of which is already underway. Forty-two of those companies (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 companies 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 company 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 produce a few large portfolio acquisitions and considerable reshuffling. The biggest gains and losses were among the biggest players and occurred through simple 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 portfolio of 21 communities in 11 states to Milwaukee, Wisconsin-based Brookdale Senior Living for $204 million, but Sunrise also sold smaller portfolios to regional providers, such as Baltimore-based Brightview Senior Living (The Shelter 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 maintain the top spot next year, but expand 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 preliminary agreement, Emeritus would manage the properties with the option to invest up to 10 percent of the equity in a joint venture 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 company 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 Resource Group, another beneficiary of Sunwest's financial woes. The company picked up management 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 Resource 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 Management expanded by 64 percent, from 828 to 1,358 licensed assisted living units, thanks to seven new management contracts and two new buildings. Frontier Management jumps 15 spots from No. 57 to No. 42. Watch this Western regional provider to grow further next year as several 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 company reports 1,036 licensed assisted living units (up from 732 last year) due to either expansions or applications for additional 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 company continues to benefit from accessible financing sources not available to traditional providers. BMA Management's assisted living resident capacity jumped 27 percent in the past year as the company opened six new communities. In 2010, the company moves up the list by three spots, coming in at No. 21. Other companies that increased their licensed assisted living capacity include 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 System (No. 41) grew by 20 percent, and Brightview Senior Living (No. 52, up from No. 62 last year) expanded by 29 percent, thanks to the Sunrise deal, which added 240 residents. Another chart-jumper was Leisure 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 little


growth can go a long way when nearly 60 percent of companies 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 company 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 companies that did not make this year's list either maintained capacity or had very small gains. Another reason for higher numbers at the bottom of the list is attributed to data from five providers not previously listed-Spectrum Retirement Communities (No. 28), Mountain View Retirement (No. 50), CRL Senior Living Communities (No. 57), Welcome Home Management Company (No. 64), and Elder Care Alliance (No. 66). Other than Sunwest, the company 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 overall numbers, decreases were most notable toward the bottom of the top 70 list. Grace Management 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 companies that didn't make this year's list but may show up in 2011 include Trinity Lifestyles Management, which nearly doubled in size to 480 assisted living residents after picking up three Atlanta-area EdenCare properties, formerly 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 increase over the prior year, and the company recently announced raising $2.5 million to fund acquisitions. More Stable 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 industry 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 concerned that the stalled housing market, depleted stock market earnings, and high unemployment among the adult children of potential 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 Industry (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 industry 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 suggest that the overall picture is much rosier for assisted living than for other real estate sectors, including multifamily, hotels, and offices, Kramer notes. "Basically, we are seeing operators holding the line with regard to rates," he adds. "We certainly are seeing more concessions out there, but at the same time, those concessions tend to be very much marketspecific, property-specific, or even unit-specific." Still, move-in delays due to economic factors have amplified a trend already developing prerecession-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 result is heightened opportunity in dementia care, which is even more needs-based than assisted living, he adds. Indeed, a number 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 companies launched new developments, and by January 2010, the number of new building starts had fallen to the lowest point since NIC started tracking senior housing trends. No companies went public in 2009. Forecast for 2010 Access to capital will remain the primary challenge for development in 2010, although new properties financed before the recession will continue to open 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 through a period of very little new product coming online, but if that coincides with pent-up demand and a recovery 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 control over, the greatest risk to assisted living is overbuilding." Fannie Mae and Freddie Mac will continue to be dependable sources of permanent 10-year financing, but when it comes to construction loans, developers have few options. Some very limited 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 develop 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 people get jobs, they no longer are going to be able to care for a parent at home." A bright spot in the acquisitions arena, private 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 company to watch thanks to the Blackstone deal, and while it only plans one new building in 2010, the company actively will be looking for other acquisition opportunities at attractive prices. "If a company has liquidity, cash flow, and a reasonably healthy balance sheet, it will be in a great


position because there are opportunities right now," Cobb says. That advantage isn't just for big companies 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 couple of years, but the amount 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 relationship with a local lender to purchase a former Sunwest property in New Jersey last fall and is actively looking for more deals, says Roger Bernier, president and COO. "Some people 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 action in 2010 is likely to remain with distressed properties, however, and no one expects lots of high-end properties to come on the market 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 attractive price tags so much that they forget to consider how well the acquisition fits into their existing portfolio 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 opportunity in 2010 may be new management 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, improve operating results including management and revenue streams, and put together the necessary tools to maximize and run communities in the most effective manner possible," he says. "This is something we can do because we don't have five acquisitions or development deals." Finally, unstable financial markets still make it unlikely that any company will go public in 2010, but if conditions improve, Moore says, the two companies to watch continue to be Atria Senior Living Group (No. 4) and HCR ManorCare (No. 10).

http://www.ALFA.org The Assisted Living Federation of America (ALFA) is the largest national association exclusively dedicated to professionally operated assisted living communities for seniors. ALFA's memberdriven programs promote business and operational excellence through national conferences, research, publications, and executive networks. ALFA works to influence public policy by advocating for informed choice, quality care, and accessibility for all Americans.


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