Nursing Home Business Valuation
Skilled Nursing Facility Valuation Calculator & Exit Planning Built for Operators
We built one platform that tracks your SNF's value monthly, identifies exit gaps early, and ensures your personal finances align with your exit timeline.
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Most Nursing Home Operators Have No Idea What Their Facility is Actually Worth
Current Nursing Home / Skilled Nursing Valuation Multiples (2026)
Skilled nursing valuations depend on occupancy, quality metrics, and real estate. Here's the current market:
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What Actually Drives Skilled Nursing Facility Value
Licensed beds tell part of the story. Sophisticated buyers evaluate these factors that determine whether your SNF commands a premium:
Occupancy Rate
85%+ Occupancy
Occupancy is the heartbeat of any SNF. High, stable occupancy above 85% demonstrates market demand, effective referral relationships, and operational competence. It proves your facility has a reputation that drives admissions. Low or declining occupancy signals problems that buyers either avoid entirely or use to extract steep discounts.
Low occupancy = turnaround project
Quality Scores
4+ Star CMS Rating
Your CMS star rating isn't just a number on a website—it directly impacts referrals, reimbursement rates, and buyer confidence. Moving from 3 stars to 4+ stars can increase your value by 20-30% because buyers see reduced regulatory risk and better market positioning. Quality scores are increasingly tied to reimbursement, making them even more critical.
Low stars = reimbursement risk
Real Estate
Owned Facility
Real estate ownership adds substantial value and provides structuring flexibility. You can sell the operations and real estate together, sell operations and lease back the property, or sell to a healthcare REIT separately. Leased facilities face rent escalations and renewal risk that reduce operational value. If you own your building, it's likely your biggest asset.
Leased = reduced control
Payor Mix
Diversified Medicare/Medicaid/Private
Medicare skilled nursing days carry the best reimbursement, followed by private pay, then Medicaid. A facility heavily dependent on Medicaid faces margin pressure as state budgets fluctuate. Sophisticated operators work constantly to optimize payor mix—maximizing Medicare skilled days, attracting private pay residents, and managing Medicaid census strategically.
Medicaid-heavy = margin pressure
Staffing Stability
Low DON/Admin Turnover
SNF staffing is brutal—everyone knows it. But stable leadership at the Director of Nursing and Administrator level signals a healthy culture and competent management. High turnover in these positions creates immediate post-acquisition challenges that buyers dread. Demonstrating leadership stability (3+ years in role) significantly increases buyer confidence.
High turnover = red flag
Survey History
Clean Survey Record
State survey results follow your facility like a credit score. Clean surveys with minimal deficiencies signal compliance and quality care. Serious deficiencies—especially G-level or above—create buyer concerns about regulatory risk, potential fines, and operational problems. A pattern of issues can kill deals entirely. If you have survey problems, address them aggressively before going to market.
Survey issues = deal complications
How to Value a Skilled Nursing Facility
The U.S. skilled nursing industry includes approximately 15,000 facilities generating over $130 billion in annual revenue. Skilled nursing facility (SNF) valuations are complex, involving both operating performance and real estate considerations.
EBITDA and cap rate methods are both used. SNFs typically sell for 5.0x to 9.0x EBITDA including real estate, or at cap rates between 8% and 12% applied to stabilized NOI. Operating companies without real estate (OpCo) are valued at lower EBITDA multiples of 3.0x to 6.0x.
Revenue multiples are less common for SNFs, but price per bed is a widely used metric — typically $30,000 to $100,000 per licensed bed depending on state, occupancy, acuity mix, and facility condition.
The unique valuation factors for skilled nursing are the Medicaid/Medicare payer mix, star ratings, and regulatory standing. CMS Five-Star Quality Ratings directly impact referral volume and reimbursement eligibility. Facilities with 4+ star ratings, high Medicare census (which reimburses at significantly higher rates than Medicaid), clean survey histories, and strong discharge-to-home rates command premium valuations. Staffing levels, especially registered nurse hours per patient day, are increasingly scrutinized by both regulators and buyers.
The SNF market has been challenged by staffing shortages and Medicaid rate pressures, but well-run facilities in strong markets continue to attract buyer interest from REITs, PE firms, and regional operators. Use our free calculator above to get your instant estimate, then track your value monthly with YourExitValue.
Frequently Asked Questions
What multiple do nursing homes sell for?
Skilled nursing facilities typically sell for 6x – 10x EBITDA, often expressed per-bed ($30K – $80K+ per bed depending on market). Quality scores, occupancy, and real estate ownership significantly impact multiples.
How do CMS star ratings affect SNF value?
Dramatically. Higher star ratings improve referrals, reimbursement rates, and buyer confidence. Moving from 3 to 4+ stars can increase value by 20-30% because buyers see reduced regulatory risk.
Does real estate ownership affect nursing home valuation?
Significantly. Owned real estate adds substantial value and provides multiple structuring options (sell together, REIT sale-leaseback, etc.). Leased facilities trade at discounts due to rent risk and lease terms.
How does payor mix affect skilled nursing value?
Medicare skilled nursing days have the best margins, followed by private pay, then Medicaid. A facility heavily dependent on Medicaid faces margin pressure—buyers prefer balanced or Medicare-heavy mixes.
Who buys nursing homes?
Regional and national SNF operators, healthcare REITs (who buy the real estate), PE-backed platforms building regional networks, and occasionally hospital systems expanding post-acute capabilities.
What's the fastest way to increase my nursing home value?
Three focus areas: 1) Improve quality metrics and CMS star ratings, 2) Optimize payor mix toward Medicare skilled days, 3) Maintain clean survey history. These directly impact buyer confidence and multiples.