4.7.4Segment

Continuing Care Retirement Communities

Continuing care retirement communities providing a full continuum of care from independent living through skilled nursing.

4
Verticals

Overview

Continuing Care Retirement Communities (CCRCs, or life-plan communities) provide a full continuum of care — independent living through assisted living and skilled nursing — on a single campus, often under an entrance-fee model. The sector is heavily nonprofit and serves residents seeking aging-in-place security.

The entrance-fee model creates distinctive economics and balance-sheet considerations, and demand is supported by the aging population's desire for a guaranteed care continuum. It is a fragmented, largely nonprofit segment with selective for-profit and consolidation activity.

Market snapshot

Market size
~$41B
Growth
~3.5%CAGR (2017–22, nominal)
Companies
~3,731 firms
Firms by employee count

31.8% of firms have fewer than 20 employees: 1,188 micro-businesses, below most mandates.

The investable universe2,543 firms with 20+ employees
20–99
1,35953%
100–499
85634%
500+
32813%

heavily nonprofit.

NAICS 623311. U.S. Census Bureau — 2022 Statistics of U.S. Businesses; U.S. Census Bureau — 2022 Economic Census.

Business model & economics

Revenue model

Entrance fees plus monthly fees across the care continuum

Key economics

Revenue per firm
$11,011,146
Revenue per employee
$93,445
Employees per firm
118.8
Recurring revenue
High

long-term resident relationships

EBITDA margin
Nonprofit surplus and entrance-fee economics
Capex intensity
High

Characteristics

  • Balanced cost base — payroll is 40% of revenue, leaving room to scale margin without cutting staff
  • Deep strategic-buyer pool — 328 firms exceed 500 employees, so a scaled asset has trade buyers
  • Full care continuum on a single campus.
  • Entrance-fee model creates distinctive economics.
  • Heavily nonprofit; aging-in-place security demand.

NAICS 623311. U.S. Census Bureau — 2022 Statistics of U.S. Businesses; U.S. Census Bureau — 2022 Economic Census.

Geographic concentration

AlabamaAlaskaArizonaColoradoFloridaGeorgiaIndianaMaineMassachusettsNew JerseyNorth CarolinaNorth DakotaOklahomaSouth DakotaTexasWyomingConnecticutMissouriWest VirginiaIllinoisNew MexicoArkansasCaliforniaDelawareDistrict of ColumbiaHawaiiKentuckyMarylandMichiganMississippiMontanaNew HampshireNew YorkOhioOregonTennesseeUtahVirginiaWashingtonWisconsinNebraskaSouth CarolinaIdahoNevadaVermontLouisianaRhode IslandKansasMinnesotaPennsylvaniaIowa

Continuing-care retirement communities concentrate in the Upper Midwest and Mid-Atlantic — Iowa, Kansas, Pennsylvania, and Minnesota — reflecting strong nonprofit and faith-based CCRC traditions.

IowaKansasPennsylvaniaMinnesota

U.S. Census Bureau — 2022 County Business Patterns (employment by state), NAICS 623311. Concentration shown by location quotient.

M&A deal context

Deal activityModerate

Who’s acquiring

  • Senior-living operators
  • Nonprofit affiliations & sponsors
  • Real-estate investors

What’s driving deals

  • Selective consolidation in a nonprofit-heavy segment.
  • Aging-in-place continuum demand.
  • Entrance-fee and balance-sheet dynamics.

Verticals in this segment

Find Continuing Care Retirement Communities acquisition targets

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