Specialist care home finance
We arrange commercial finance for operators, buyers and investors in specialist and high-acuity care. This is business lending against a trading specialist service, not help with paying care fees.
Funding specialist care
Specialist and high-acuity care covers homes registered for complex needs such as neurological care, acquired brain injury, complex physical disability, end-of-life and other intensive clinical pathways. Fees per bed are high, much of the income is commissioned by the NHS and local authorities, and the operator's clinical capability is central.
Specialist care home finance, as we use it, is the commercial mortgage, going-concern or development loan used to buy, build or refinance a specialist service as a trading business. Lot sizes are often smaller than mainstream elderly care, but fee-per-bed is higher and income is frequently underpinned by long-term commissioned placements.
Lenders treat specialist care as a higher-skill, higher-reward niche. They look hard at the operator covenant, the CQC rating, the commissioning relationships and the durability of the clinical model, because the asset is harder to re-let if the operator fails.
We present the clinical and commissioning story so specialist-aware lenders can underwrite it, and we run the market rather than relying on a single relationship.
What we fund
- Neurological and acquired brain injury care
- Complex physical disability and continuing care
- High-acuity nursing and end-of-life care
- Step-down and rehabilitation services
- Behaviour-that-challenges and complex needs units
- Single-occupancy high-dependency placements
Indicative terms
- Commercial mortgage LTVUp to 70 to 75% of value
- Going-concern basisTo around 70% of going-concern value
- Term15 to 25 years
- Indicative rateFrom around 7.5 to 9%
- Lot sizeOften smaller, higher fee per bed
- Key testsCovenant, CQC rating, commissioned income, clinical model
- IncomeOften NHS and local-authority commissioned
Indicative only. Terms vary by lender, operator and home and are not an offer of finance.
How we fund specialist and high-acuity care
We fund specialist services on maintainable trading earnings and the durability of their commissioned income. For an acquisition or refinance we build the EBITDARM, examine the commissioning relationships and the operator's clinical capability, and arrange a commercial mortgage to around 70 to 75% of value over 15 to 25 years, or a going-concern facility to roughly 70% of going-concern value. Because lot sizes are often smaller and fee-per-bed higher, the lending can be intensive relative to the headline price. For new or reconfigured specialist schemes we arrange development finance to about 60 to 70% of loan-to-cost. Specialist lenders price the higher skill and re-let risk, so terms sit at the firmer end; we present every figure as indicative, never an offer.
Lender appetite for specialist and high-acuity care
Specialist care is a narrower lending field, but appetite is real for credible operators. Shawbrook and OakNorth both fund complex-care and high-acuity operators through their healthcare teams, valuing the higher fee-per-bed and commissioned income. Assetz Capital and Allica Bank support owner-operator specialist acquisitions, while Puma Property Finance and Ortus feature on purpose-built or reconfigured specialist schemes. Atom Bank and Paragon are more selective on high-acuity stock. As a broker without an exclusive tie, we match the clinical model and commissioning profile to the lenders genuinely comfortable with specialist risk; specialist lenders can be firmer on price, which is the trade-off for funding a higher-skill niche.
The specialist and high-acuity care market
Specialist care sits on the resilient, commissioned end of the market. Knight Frank reports the sector EBITDARM margin at 30.1% of income for FY2024/25 and occupancy at 88.7%, while nursing fees, the nearest published proxy for high-acuity care, run at £1,420 a week and reach £1,638 private. Specialist fee-per-bed typically exceeds these mainstream levels because of the clinical intensity involved. Knight Frank records healthcare investment of £3.2bn in FY2024 against a five-year average of £2.4bn, with sector total returns of 5.8%, evidence of deep institutional interest in well-run healthcare assets including specialist services. For lenders, a specialist home with durable commissioned income and a strong CQC rating is a defensible income asset, though one they underwrite with care.
Finance that suits this setting
- Care home purchase and investment financeAcquires a trading specialist service or adds high-acuity stock to a portfolio.
- Going-concern and operator financeLends on EBITDARM where a clinically capable operator takes on a specialist business.
- Care home development financeFunds purpose-built or reconfigured specialist schemes through to stabilisation.
- Mezzanine and equityBridges the gap on capital-intensive specialist schemes where senior debt stops short.
Fund a specialist care home
A view on fundability within one working day.
What drives a specialist care home's numbers
Specialist and high-acuity services run on high fee-per-bed and largely commissioned income, so the economics are about clinical intensity and income durability rather than headline occupancy alone. Knight Frank reports the sector EBITDARM margin at 30.1% of income for FY2024/25 and staff costs at 55.3%, and specialist fee-per-bed typically exceeds the £1,420 a week nursing benchmark because of the clinical staffing involved. The decisive factors are the durability of NHS and local-authority commissioned placements, the operator's clinical capability and the re-let risk if the operator failed. Because lot sizes are often small but earnings strong, lenders size lending on trading as much as the property. We model maintainable EBITDARM and stress the concentration of commissioned income.
Indicative specialist care home leverage and rates
Indicatively we arrange specialist commercial mortgages to around 70 to 75% of value, or going-concern lending to roughly 70% of going-concern value, over 15 to 25 years, with pricing from around 7.5 to 9%. Specialist lenders price the higher clinical and re-let risk, so terms sit at the firmer end, the trade-off for funding a higher fee-per-bed niche. Durable commissioned income and a strong CQC rating earn the keener end. Purpose-built or reconfigured development runs to about 60 to 70% of loan-to-cost, with mezzanine or equity available where senior debt stops short. These are market-typical, indicative figures and never an offer; the terms depend on the service's accounts, rating and commissioning.
Frequently asked questions
Are specialist care lenders more expensive?
They can be firmer on price than mainstream elderly-care lenders, because high-acuity assets are harder to re-let and the clinical risk is greater. The trade-off is access to higher fee-per-bed income that mainstream homes do not earn. We present indicative pricing from around 7.5 to 9% and run the market to keep it as keen as the risk allows.
Can commissioned NHS and local-authority income support a loan?
Yes, and lenders often value it. Durable commissioned placements add income visibility, which can support a stronger covenant case. Lenders assess how long the commissioning relationships have run and how concentrated the income is. We present the full income picture so the covenant is understood.
Why are specialist care lot sizes smaller?
Specialist services often run fewer beds at much higher fee-per-bed than mainstream elderly care, so the property value can be modest even where the trading earnings are strong. Lending is therefore sized on the trading performance as much as the bricks and mortar.
What is specialist care home finance, exactly?
It is commercial lending used to buy, build or refinance a specialist or high-acuity care service as a trading business, sized on its earnings, covenant and CQC rating. It is not help with paying for an individual's specialist care; that is a consumer matter we do not advise on.
Can finance fund a new specialist scheme?
Yes. We arrange development finance to around 60 to 70% of loan-to-cost for purpose-built or reconfigured specialist services, and where senior debt stops short of the capital need we can layer in mezzanine or equity, with a term exit once the service stabilises.
Funding a specialist care home?
Tell us about the home and the operator and we will come back with a view on fundability and likely terms.