Types of care sector development financed
Care development finance covers the full range of registered care assets, from purpose-built new schemes to the refurbishment of de-registered homes. The common thread is that the completed facility must reach a CQC registration standard and generate income that supports a long-term exit.
- New-build residential care homes - purpose-built single-storey or multi-storey facilities, typically 20-60 beds for specialist care and dementia care
- New-build nursing homes - higher-dependency facilities with en-suite clinical rooms, wider corridors, and nurse call systems throughout
- Conversion and extension - residential property or commercial building converted to care home use, often with an extension to increase bed count
- De-registered home refurbishment - bringing a previously closed care home back to CQC registration standard
- Additional unit construction - adding beds to an existing registered care home to increase capacity and EBITDA
- Supported living development - smaller specialist facilities (4-12 beds) for adults with learning disabilities or mental health needs, often developed under a specialist housing association or registered provider structure
How care development finance is structured
Care home facilities are sized against five key factors. Unusually for development finance, the GDV is assessed on an investment value basis (capitalised EBITDA) rather than the vacant possession value of the building - which generally produces a higher GDV and is advantageous for the LTGDV calculation.
LTGDV: 55-65% of GDV for care home new builds. GDV for care homes is typically assessed on an investment value basis (capitalised EBITDA) rather than vacant possession value of the building. A 40-bed care home generating £400,000 EBITDA capitalised at 7% yield = £5,714,000 GDV.
EBITDA projection: lenders require a detailed EBITDA financial model for the completed care home - occupancy trajectory (year 1, 2, 3), fee income assumptions, staffing model, running costs, and EBITDA margin. Most lenders look for a stabilised EBITDA margin of 20-30%.
CQC registration: for operational care homes, CQC registration must be in place or in process for the completed facility before the development lender will advance. The CQC registration pathway must be clearly documented in the development finance application.
Monitoring and QS: a construction cost QS report is required for all care development schemes. A monitoring surveyor certifies each drawdown. Care home fit-out (nurse call, clinical wash rooms, fire systems, dementia-specific design features) adds significantly to build costs relative to standard residential.
Exit strategy: refinance onto a specialist care home commercial mortgage (20-25 year term). Lenders will want to see an illustrative exit mortgage scenario based on the projected stabilised EBITDA. Sale to a care group is an alternative exit, though lenders prefer the operator to remain.
A 40-bed care home generating £400,000 EBITDA capitalised at a 7% yield produces a GDV of £5,714,000. Because care GDV is assessed on capitalised EBITDA rather than bricks-and-mortar value, the resulting GDV is typically higher than a vacant possession valuation, which improves the LTGDV available.
Build cost considerations specific to care
Care fit-out is materially more expensive than standard residential. The clinical, safety, and dementia-design requirements that commissioning bodies expect all add cost, and lenders expect these to be reflected in the cost plan rather than discovered mid-build.
- Build costs for specialist care facilities are significantly higher than standard residential - typically £2,000-£3,500 per sq m for new-build care versus £1,200-£2,000 for standard residential
- En-suite wet rooms to all bedrooms add cost but are increasingly required by commissioning bodies and CCGs
- Hoisting systems, dementia-appropriate finishes (non-reflective flooring, colour contrast on doors), and secure gardens are standard in modern care homes
- Nurse call, CCTV, access control, and category 2 fire suppression systems are required for nursing homes and may be required for residential care
- Car parking provision requirements - commissioning bodies and CQC assessors consider staff and visitor parking in quality assessments
Case study: 40-bed dementia care new build, East Midlands
An established care operator with three existing CQC-registered homes developed a 40-bed specialist dementia care facility on a purchased greenfield site. Doulton structured a £3.64m development finance facility at 65% LTGDV with a specialist healthcare lender. The EBITDA model demonstrated stabilised income of £380,000 pa at 87% occupancy - sufficient to support refinance onto a 20-year care home mortgage.
CQC registration was applied for in Month 12 and granted in Month 19. Practical completion was reached in Month 22. First residents were admitted in Month 23. Stabilised occupancy of 87% was achieved by Month 30.
- Scheme: 40-bed specialist dementia care home, East Midlands
- Developer: experienced care operator - 3 existing CQC-registered homes (110 beds)
- GDV: £5,600,000 (investment value - 40 beds x £10,500 weekly fee x 90% occupancy, 7% yield)
- Build cost: £3,200,000 (£2,200/sqm x 1,455 sqm, single storey)
- Development facility: £3,640,000 (65% LTGDV)
- Rate: 8.5% pa rolled
- Term: 22 months
- Exit: specialist care commercial mortgage at Month 24, stabilised occupancy 87%