CCRCs Gather on Future Growth, Facing “In or Out” Decision

In or out. It’s a decision that for many non-profit CCRCs, has not yet had to be addressed. 

But market factors over the last 10 to 20 years spanning technology changes, traditional innovation, consumer preference and financing vehicles are all leading to a turning point that many of those CCRCs today are facing. 

“The continuum as we know it has continued to be very successful, but it’s looking different than it has in years past,” says Lisa McCracken, senior vice president, senior living research and development for speciality investment bank Ziegler. 


The most pressing issues non-profit CCRCs today are facing are taking center stage at Ziegler’s 17th annual Senior Living Finance and Strategy conference in Asheville this month, September 10-12. Providers, parent organizations, industry professionals, capital market representatives and rating agencies will all gather to address the challenges—and opportunities—CCRCs are experiencing in today’s market. 

For some, as a near 20% decrease in skilled nursing residents has taken effect since 1980, that “in or out” decision has become pressing, McCracken says, and they are eager to figure out how to address it. 

“We know we are not seeing a great deal of growth in skilled care,” she says, noting factors such as cost of care and health care reform as influencers of the shift. “A lot of providers are saying: ‘Are we in or out? Can we compete? do we have strong enough outcomes?’”


Since 2000, Zielger has tracked growth among new construction non-profit CCRCs, noting that 75% of new development in the sector has come from multi-site organizations. 

“That brand new, standalone not-for-profit that just pops up from the ground up? That’s not happening,” McCracken says. Among the 25% of new construction that has come from standalone providers, they’re not exactly standalone either. In almost all cases they are affiliated with a hospital, or a faith-based organization, or have some benefactor or foundation backing the development, Ziegler has found. 

Further, there’s a “push-pull” phenomenon in the market whereas several decades ago developers coming together to build CCRC units, essentially putting them into a market they knew was ripe for move-ins, today the push is more internal on the development side.

But the good news is: financing is available and at today’s low rates, the landscape is prime for CCRC borrowers, McCracken says—another to-be-discussed during the conference. 

“The good news for providers is it’s a very good time to borrow,” she says. “There are many choices and interest rates have been great across the board. Beyond the last year, there’s speculation that short term interest rates will go up for the first time in 7 years. Now’s a good time before the rates go up.”

A panel of finance executives will share views with Ziegler conference attendees, among panels focused on technology, breaking into home and community based services, site development and expansion, planning and design and a host of other topics. 

The conference is based around a general theme of theme of: innovate, evolve, grow, McCracken says. 

“This includes continuing to grow through bricks and mortar and repositioning, but also continuing to expand beyond bricks and mortar,” she says. “We are trying to change and transform the sector based on the trends we are seeing.”

Written by Elizabeth Ecker