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Substance Use Disorder Treatment Facilities Attracting Investors

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With funding support from the federal government and the growing need for mental health facilities nationwide, this niche commercial real estate sector is evolving and emerging as a viable investment opportunity, including drawing the attention of REITs.

The Substance Abuse and Mental Health Services Administration noted in a 2021 survey that nearly 1 in 4 adults 18 and older, and 1 in 3 among adults aged 18 to 25, had a mental illness in the past year.

“The fastest growing sector in this asset class has primarily been the substance use disorder treatment facilities,” writes Justin Butler, leader of the Healthcare Valuation Practice Group for Colliers.

Most facilities that treat substance abuse disorder are not purpose-built, according to Butler, and many are adaptive reuses of nursing homes, assisted living facilities, hospitals, schools, large homes, and sometimes even apartments and office buildings.

 “The behavioral health industry is currently riding a hot wave in terms of funding from the federal government,” Doug King, Vice President and Healthcare Sector Lead at Project Management Advisors, tells GlobeSt.com. “While this could always turn around if the political winds shift, it’s great to see so many behavioral health and addiction centers opening in communities across the country right now.”

Unlike other medical facilities, which often require specialized technology and higher power needs, behavioral health clinics have about the same requirements as the average office, albeit with the addition of specialized anti-ligature devices and additional surveillance for patients of higher acuity, according to King.

“When looking to lease space for behavioral health centers, the ideal clinic should be located in a centralized place that’s easy to get to on public transportation,” King said. “Especially for behavioral health clinics that focus on addiction, it’s important to find a property with space for socialization, which can be essential for recovery. That’s why we see a lot of behavioral health clinics feature outdoor areas (as many patients are smokers), cafes, and even diners where patients can mingle with each other before and after treatment.They also need to be designed with mental health in mind — lots of natural light, comfortable seating and biophilia, and an array of private areas to accommodate different kinds of patients.”

When it comes to adaptive reuse, one area of opportunity for the CRE industry is the conversion of former retail properties in strip malls and downtown areas into behavioral health centers, King said.

“Not only are these spaces already sufficiently embedded into the community, but they also have enough space for clinics to expand and partner with other community organizations, such as medical nonprofits and housing programs,” said King.

Avison Young’s Brooks Hauf tells GlobeSt.com he has seen an increase in the demand for behavioral health services nationwide.

“The largest challenge for the sector is staffing related as the supply for talent is more specialized and not as deep as other labor sectors,” Hauf said. “With demand for behavioral health services expected to continue, staffing will remain very competitive and will drive decision-making on specific locations that have deeper talent pools.”

Butler said the costs for purpose-built facilities compared to adaptive reuse are considerable, and the increased cost often doesn’t provide comparable increased utility. However, there have been purpose-built facilities in operation.

Sale leaseback transactions generally see year-one yields in the 8% to 10% range, Butler said, but this can vary above and below that based on rent levels, tenant strength, quality of the real estate, and location. Rents are commonly in the $30 to $40 PSF NNN range, and many operators can afford rent at these levels, according to Butler.

“We would expect to see more purpose-built facilities, as well as larger operators with national networks and in-network insurance relationships,” Butler said. “There already have been some publicly traded healthcare and net lease REITs that have been purchased these facilities, “and we would expect that to continue.”

 

Source: GlobeSt.

2019 Medical Office Building Transaction Volumes 50% Higher Than Pre-Recession

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Increasing interest from institutional investors has helped to push the medical office sector to hefty transaction volumes and steady occupancy despite record construction in the second quarter.

A new report from CBRE notes that US transaction volumes this year for medical office properties are 50% higher than their pre-recession levels. Meanwhile, medical-office capitalization rates – a measure of a property’s income as a percentage of its price – have pulled even with those of conventional offices after years of registering higher.

Much of the market’s momentum comes from demographic trends toward longer lifespans and more healthcare consumption as well as a medical-industry shift toward more outpatient care. CBRE defines medical offices as office buildings in which at least half of leasable space is occupied by medical uses such as dental, surgical or special practitioners and services.

GlobeSt.com caught up with Ian Anderson, CBRE’s head of Americas Office Research, for an exclusive interview about the report’s findings on the medical office sector. Here are excerpts from that conversation.

GlobeSt.com: What about the medical office sector is most appealing to institutional investors and why are they jumping into the sector now rather than years earlier?

Ian Anderson: Medical office buildings have been an attractive target for institutional investors for many years, but this current cycle has been unique in accelerating that trend. The current expansion has seen a dramatic transformation in the way commercial real estate is being used, and that sometimes has negatively affected demand for space. That’s particular true for conventional offices, for which demand is influenced by workplace strategies and densification, and for retail space, which is adapting to e-commerce. As a result, many institutional investors have been forced to seek new opportunities that offer attractive returns. This has caused a surge of interest into alternative commercial real estate investments where growth is more robust, such as life sciences lab space, self-storage, and co-living, among others.

Aside from the ‘push’ by investors into emerging, alternative commercial real estate investments, the ‘pull’ of deeply entrenched and highly attractive demand drivers is what is really driving demand for medical office space. Any investor seeking to capitalize on the demographic and consumption trends unfolding in the United States wants to have a position in medical offices. Underlying these megatrends, though, is the continued shift by healthcare systems to provide services in a lower cost setting that is more convenient to the consumer. In other words, allowing consumers to obtain healthcare services near to their home, rather than venturing to the main hospital of a healthcare system. Finally, though, medical office investment is driven by the income derived from these properties, which are frequently supported by a variety of tenants with abundant demand and a reluctance to move upon the expiration of their lease.

GlobeSt.com: What has fueled demand for medical office space in markets where it is strongest, namely Chicago, Atlanta, New Jersey and Nashville?

Ian Anerson: Demand for medical office space varies from market to market due to several reasons. In some instances, we observe higher net absorption – demand – simply as a result of the delivery of new medical office buildings in markets where it is easier to build. For example, there are more medical offices under construction and waiting to be occupied in the Inland Empire than Los Angeles, where it is more difficult to build. In other instances, there are local trends in the healthcare industry, such as a merger between healthcare systems, that may affect demand for space. But generally speaking, higher demand for medical office space by market results from a combination of favorable demographics, either in the form of a growing total population or an existing, abundant elderly population, supported by attractive and growing incomes.

GlobeSt.com: Given the strong trends driving the sector, why aren’t we seeing more construction of medical office buildings? Does the pipeline include more deliveries on par with the record set in this year’s second quarter?

Ian Anderson: Like most types of commercial real estate today, construction of medical offices has remained in check with demand. Not surprisingly, the vacancy rate of US medical offices hasn’t budged by more than 20 basis points in the last two years. In the second half of 2018, we saw construction volume of medical offices drop significantly, which should help boost rent growth for investors in the near-term. Then construction activity picked up in 2019 to levels consistent with the average since 2010, but still well-below the peak of construction in 2016.

 

Source: GlobeSt

Case For Investing In Healthcare Real Estate Remains Strong: Panel Discusses Pros And Cons Of Sector

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As brick and mortar retail stores flounder and pricing for industrial and multi-family properties continues to soar, many investors in recent years have started to look to “niche” commercial real estate (CRE) sectors to round out their portfolios.

One of the more newly discovered niche property types are medical office buildings (MOBs) and healthcare real estate (HRE) facilities, which aren’t exactly very “niche” anymore.

“It just seems like all investors are talking about these sectors now — student housing, self-storage, life science, medical —  whereas before all the news was about office, retail, multi-family and industrial,” said Elizabeth Thomas, managing director with Boston-based Bain Capital Real Estate, which is a relatively new investor in the HRE sector.

Nicholas Buss, senior director of research for Atlanta-based Invesco Real Estate (NYSE: IVZ), agreed with Ms. Thomas, adding “The firm “broke away from its shell about two years ago and started looking at sectors around the edge as well. We like the secular (non-cyclical) drivers behind medical real estate and the durability of the property type that seems to continue through economic cycles and gives us some diversification in our portfolio.”

“Even though the amount of MOB square footage, at 3 billion square feet, represents only about 5 percent of the overall commercial real estate (CRE) sector, the space is very attractive and has been the focus of many new investors in recent years,” according to Daniel Klein, senior VP of investments and deputy chief investment officer with Milwaukee-based Physicians Realty Trust (NYSE: DOC).

Mr. Klein moderated an HRE investment panel session that included Ms. Thomas and Mr. Buss at the fifth annual Revista Medical Real Estate Investment Forum, which was held Feb. 6-7 in San Diego. The session was titled “The Case for Investing in HRE” and also included as panelists Peter Martin, managing director with San Francisco-based JMP Securities, and Charles Campbell, managing partner and CEO of Charlotte, N.C.-based Flagship Healthcare Properties, which also manages a private real estate investment trust (REIT) that owns MOBs.

The focus of the panel was to hear from investors – both those who have been in the space for years as well as newcomers – as to why HRE is currently so attractive and whether it will be for the long haul. While the focus was mostly on MOBs, the panelists also talked about other HRE facility types, such as senior housing and post-acute care.

“We like the fact that the property type is not a GDP (gross domestic product) dependent property type,” Ms. Thomas noted. “We like the strength of the demographics that will depend on senior housing, and we like the fact that clinical care is migrating from the hospitals out to where the patients are. In addition, the MOB sector is not fraught with speculative development when we’re looking to invest in other sectors we really have to monitor the amount of spec development taking place.”

“JMP Securities entered the HRE space in a number of different ways, including as an investment bank providing equity growth capital for operators, and then we moved into the REITs, funding apartment REITs before moving over the healthcare REITs,” Mr. Martin told the audience. “We’ve taken a value-add approach on the investment side, as our work on the healthcare side is focused on the dislocation created by different reimbursement changes. In the last five years, we’ve been building things and selling them back to the healthcare systems, who have been slow to realize they need more outposts to service their beneficiaries.”

“The company made a commitment to HRE a decade ago and is all in, with no discussion on whether we should allocate capital to other spaces,” Mr. Campbell of Flagship Healthcare Properties said. “The company started a private REIT in recent years that is largely funded by high net-worth individuals and family offices, including some foreign investors. When we sit down with our investors, they keep coming back to us about the stability, the risk-adjusted yields and the predictability of the sector. A lot of it comes down to our access to deal flow, and in our world there is a premium to having relationships with good operators to work with. Flagship REIT is a longer-term holder of its MOB assets, and we tell our investors we say we like to own for a minimum of five years. Unless you’re a ground-up developer or a value-add buyer, that’s how you benefit from the inherent stability of the product type. And, it’s also a good way to build relationships with the health systems, as they prefer ownership stability as well.”

 

Source: HREI