[fusion_builder_container type=”flex” hundred_percent=”no” hundred_percent_height=”no” min_height=”” hundred_percent_height_scroll=”no” align_content=”stretch” flex_align_items=”flex-start” flex_justify_content=”flex-start” flex_column_spacing=”” hundred_percent_height_center_content=”yes” equal_height_columns=”no” container_tag=”div” menu_anchor=”” hide_on_mobile=”small-visibility,medium-visibility,large-visibility” status=”published” publish_date=”” class=”” id=”” link_color=”” link_hover_color=”” border_sizes_top=”” border_sizes_right=”” border_sizes_bottom=”” border_sizes_left=”” border_color=”” border_style=”solid” margin_top_medium=”” margin_bottom_medium=”” margin_top_small=”” margin_bottom_small=”” margin_top=”” margin_bottom=”” padding_top_medium=”” padding_right_medium=”” padding_bottom_medium=”” padding_left_medium=”” padding_top_small=”” padding_right_small=”” padding_bottom_small=”” padding_left_small=”” padding_top=”” padding_right=”” padding_bottom=”” padding_left=”” box_shadow=”no” box_shadow_vertical=”” box_shadow_horizontal=”” box_shadow_blur=”0″ box_shadow_spread=”0″ box_shadow_color=”” box_shadow_style=”” z_index=”” overflow=”” gradient_start_color=”” gradient_end_color=”” gradient_start_position=”0″ gradient_end_position=”100″ gradient_type=”linear” radial_direction=”center center” linear_angle=”180″ background_color=”” background_image=”” background_position=”center center” background_repeat=”no-repeat” fade=”no” background_parallax=”none” enable_mobile=”no” parallax_speed=”0.3″ background_blend_mode=”none” video_mp4=”” video_webm=”” video_ogv=”” video_url=”” video_aspect_ratio=”16:9″ video_loop=”yes” video_mute=”yes” video_preview_image=”” absolute=”off” absolute_devices=”small,medium,large” sticky=”off” sticky_devices=”small-visibility,medium-visibility,large-visibility” sticky_background_color=”” sticky_height=”” sticky_offset=”” sticky_transition_offset=”0″ scroll_offset=”0″ animation_type=”” animation_direction=”left” animation_speed=”0.3″ animation_offset=”” filter_hue=”0″ filter_saturation=”100″ filter_brightness=”100″ filter_contrast=”100″ filter_invert=”0″ filter_sepia=”0″ filter_opacity=”100″ filter_blur=”0″ filter_hue_hover=”0″ filter_saturation_hover=”100″ filter_brightness_hover=”100″ filter_contrast_hover=”100″ filter_invert_hover=”0″ filter_sepia_hover=”0″ filter_opacity_hover=”100″ filter_blur_hover=”0″][fusion_builder_row][fusion_builder_column type=”1_2″ layout=”1_2″ align_self=”auto” content_layout=”column” align_content=”flex-start” content_wrap=”wrap” spacing=”” center_content=”no” link=”” target=”_self” min_height=”” hide_on_mobile=”small-visibility,medium-visibility,large-visibility” sticky_display=”normal,sticky” class=”” id=”” type_medium=”” type_small=”” order_medium=”0″ order_small=”0″ dimension_spacing_medium=”” dimension_spacing_small=”” dimension_spacing=”” dimension_margin_medium=”” dimension_margin_small=”” margin_top=”” margin_bottom=”” padding_medium=”” padding_small=”” padding_top=”” padding_right=”” padding_bottom=”” padding_left=”” hover_type=”none” border_sizes=”” border_color=”” border_style=”solid” border_radius=”” box_shadow=”no” dimension_box_shadow=”” box_shadow_blur=”0″ box_shadow_spread=”0″ box_shadow_color=”” box_shadow_style=”” background_type=”single” gradient_start_color=”” gradient_end_color=”” gradient_start_position=”0″ gradient_end_position=”100″ gradient_type=”linear” radial_direction=”center center” linear_angle=”180″ background_color=”” background_image=”” background_image_id=”” background_position=”left top” background_repeat=”no-repeat” background_blend_mode=”none” animation_type=”” animation_direction=”left” animation_speed=”0.3″ animation_offset=”” filter_type=”regular” filter_hue=”0″ filter_saturation=”100″ filter_brightness=”100″ filter_contrast=”100″ filter_invert=”0″ filter_sepia=”0″ filter_opacity=”100″ filter_blur=”0″ filter_hue_hover=”0″ filter_saturation_hover=”100″ filter_brightness_hover=”100″ filter_contrast_hover=”100″ filter_invert_hover=”0″ filter_sepia_hover=”0″ filter_opacity_hover=”100″ filter_blur_hover=”0″ last=”false” border_position=”all” first=”true” spacing_right=””][fusion_text columns=”” column_min_width=”” column_spacing=”” rule_style=”default” rule_size=”” rule_color=”” content_alignment_medium=”” content_alignment_small=”” content_alignment=”” hide_on_mobile=”small-visibility,medium-visibility,large-visibility” sticky_display=”normal,sticky” class=”” id=”” font_size=”” fusion_font_family_text_font=”” fusion_font_variant_text_font=”” line_height=”” letter_spacing=”” text_color=”” animation_type=”” animation_direction=”left” animation_speed=”0.3″ animation_offset=””]
The corona crisis has not yet got a grip on the healthcare real estate market and the investment segment also appears to remain attractive for the coming years. The investment cycle is in an upward trend and it is expected that rents will often continue to develop in line with inflation. The reasons for this are the increasing aging of the population and the persistent health care real estate shortage.
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he commercial real estate market is severely affected by the corona crisis. Based on figures from US bank Wells Fargo on recent appraisals of bundled mortgage bonds, the Financial Times states that commercial real estate in the United States has lost at least a quarter of its value. Hotel real estate owners in particular are seeing the value of their portfolios decline rapidly.
Closer to home, retail real estate giant Unibail-Rodamco-Westfield saw a large part of its rental income lost due to the lockdown. This has now somewhat recovered and URW received 70 percent of the rent in August.
Publicly traded healthcare real estate investors seem to be getting away with it for the time being. The Belgian Aedifica, which owns more than 450 healthcare real estate locations across six countries, saw rental income increase by 38 percent to 163 million euros between June 30, 2019 and June 30, 2020, while EPRA profit increased by 39 percent over the same period to 100 million euro. Care Property Invest, also Belgian, saw the fair value of the real estate portfolio increase by 24 percent to 796 million euros in the first half of this year.
The healthcare real estate investors also see that the corona crisis is creating uncertainty, but expect that growth will continue for the time being. Care Property Invest, for example, increased its forecast for ERPA earnings per share for the whole of 2020 from 0.93 euros per share to 0.96 euros per share.
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Real estate shortage
One of the main reasons for the optimism among healthcare real estate investors is that global aging is in full swing. Consultants from SiRM state that in 2017 in the Netherlands about 18 percent of the population was older than 65, 14 percent was between 65-80 years and 4 percent was older than 80 years. This puts the Netherlands just below the European average of 19 percent. It is expected that in the next ten years, especially more Dutch people will be added in the age categories 75-80 and 80-85.
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The aging of the population means that healthcare costs continue to rise and their affordability is under increasing pressure. Due to this cost pressure, the government is withdrawing further and further and tries to encourage longer living at home, a wish and need that also exists among healthcare consumers.
This rapidly growing group of elderly people is simultaneously creating pressure on the real estate market. Because the current stock of healthcare real estate is outdated and will have to be modernized in order to meet the requirements of the climate agreement and the housing requirements of residents.
According to the Social and Cultural Planning Office (SCP), there are currently 40,000 householders aged 65 and older who currently live in unsuitable housing. In the meantime, the waiting list for nursing home care has risen to over 15,000 in 2019, according to data from the National Health Care Institute. The expected demand for housing will be particularly high in the Randstad, with peaks in the cities of Amsterdam, Rotterdam, Utrecht and The Hague. Other cities where the expected demand for housing is high are Groningen, Apeldoorn, Nijmegen, Breda, Tilburg, Eindhoven and Maastricht.
As a result of these developments, Syntrus , among others, sees the healthcare real estate market as an attractive investment segment. Healthcare real estate that meets users’ future housing and care needs offers good investment opportunities. The low long-term interest rate, which was even negative in mid-2019, will result in an even higher demand for healthcare real estate among investors due to the relatively high spread compared to the risk-free return.
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Upward development
It appears that the healthcare sector is virtually insensitive to the economic cycle. As in previous years, the healthcare real estate market is predominantly in an upward development of the investment cycle. Partly for this reason, it is expected that healthcare real estate will remain a solid investment segment in the future due to room for yield declines, inflation-based rents and little vacancy.
Life-course-proof homes, in particular, currently often have low initial yields and above-inflation rental development. Yields and rents are expected to continue to rise in the coming years.
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In addition, intramural healthcare real estate still offers plenty of growth potential, especially real estate aimed at life-course-proof or regular homes in attractive locations.
Health centers, clinics and independent treatment centers have seen their returns increase in 2019 and have thus moved up the cycle. According to analysts, there is still limited room for growth for the most current real estate in this category.
The other healthcare real estate types are particularly interesting for investors who would like to capitalize on healthcare products with a so-called ‘cure stamp’. In the longer term, the extra risk premiums that are still present may disappear for most healthcare real estate.
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Press initial yield
As a result of the increasing interest in healthcare real estate, as well as the generally high investment pressure, the pressure on initial yields remains and is visible in almost all segments. The ‘waterbed effect’ of the highly priced cities towards the surrounding municipalities is clearly visible.
The initial yields for life-course-proof homes are expected to remain stable in the coming years. In municipalities where the waterbed effect is clearly visible, the yield shift will be limited.
For intramural care homes, a decrease in initial yields is expected. In addition to the increased interest in this type of healthcare real estate, this is also due to the increasing resemblance to the regular residential product. Risk premium spreads are expected to fall.
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Market rent expectations
Indexed leases with healthcare institutions and healthcare providers often form the basis of the rental price development of existing healthcare real estate. When real rents are taken into account at the start of the lease, it is expected that market rents will continue to develop in line with inflation. Healthcare institutions must normally pay the rent payments from the integrated rates.
Although health care costs are under pressure, it is expected that current health care real estate will contribute to high-quality and efficient health care provision and thus maintain rent levels. For life-course-proof homes and private residential care homes, the rent levels are determined by the market, so that the geographic location and physical properties of the home play a role in determining the rent level.
As a result of future scarcity, it is expected that market rent increases will be above inflation. For life-course residences and intramural real estate, the development of the market rent in the period 2020-2022 is expected to be higher than inflation.
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