Nursing Homes sector across EMEA

You've come to the right place to understand Nursing Homes services in Europe and Emerging Markets. Here is how we can help you:
  • Detailed research report on Nursing Homes services with marketshare and growth rates for 19 countries and information on a further 305 (HBI Intelligence)
  • Database of 305 Nursing Homes service providers, including profile and major external investors (HBI Intelligence)
  • Merger and acquisition (M&A) intelligence showing likelihood of sale (HBI Intelligence)
  • News stories and interviews with Nursing Homes operators (HBI Deals and Insights)
  • Events that cover healthcare services globally including Nursing Homes (HBI 2020)
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Sector Report
Nursing Homes Sector

Updated: May 2020

Executive Summary

Detailed research overview on the private nursing homes sector
 
Impact of Covid-19 
 
We are in the process of analyzing the impact of Covid on the care sector and we should have updates for every country’s growth forecasts for 2020 and 2021 by end of May. There has been a strong short-term impact with costs rising and demand falling which we have already reported in news. A serious recession may further hit demand and tariffs and leave many investors breaking their bank covenants.
 
EXECUTIVE SUMMARY
The current trend in for-profit nursing homes is for commercial operators to increasingly gain market share, even in traditionally public markets. As demographic changes put pressure on public health and social care systems, laws and regulations are being passed that invite commercial providers to share a bigger piece of the pie.
Europe's licenced markets have two of the highest ratios of beds per capita, alongside Finland, at 0.42 per population over 85 (Switzerland, Belgium) while countries with the largest for-profit sectors come next (Germany with 0.39 and the UK with 0.38). Countries where provision is mostly public or not-for-profit have smaller ratios, with around a third of citizens over 85 able to access a bed (Denmark, the Netherlands). The underserved South has yet to catch up with the concept of nursing homes to the same extent as North Western Europe, with ratios of between 0.02 (Greece) and 0.25 (Spain) of elderly citizens over 85 able to access a bed. 
The for-profit sector plays in four ways:
 
1. Outsourced model – This is where the home continues to be owned by the municipality but is then run on a long-term contract by a for-profit operator.
2. Unlicensed building and running homes for publicly paid for residents –This is known as the unlicensed model because any developer who gets planning permission can build a home and then compete for local customers who are part or mainly funded by municipalities.
3. Licenced building and running homes for publicly paid for residents – In this model homes can only be constructed if a government authority has licensed them. In other words, the authority assesses demand and will only allow construction if it is deemed necessary.
4. Building and running homes for privately paid for residents – This is a major sector in the UK where general levels of care and comfort in the publicly funded sector are low. Similar but much smaller sectors exist in the Netherlands, Scandinavia and in Eastern Europe.
The for-profit sector has developed very differently in different countries reflecting payor attitudes and behaviour and secondly the ability of individuals to pay for residential care.
See the full report for further details.
How then has the sector developed across Europe?

The last decade has been marked by several developments:
1. French Pan-European operators
Faced by a dearth of new opportunities in France, Orpea followed by Korian and other French operators such as Domus Vi, Maisons de Familie and the merger of Colisee and Armonea have built international businesses. Having first moved into “safe” licenced markets like Belgium and Switzerland, Orpea and Korian have now moved into Germany, Spain and Italy. Orpea is active in Poland and Czechia and Korian’s shareholders are active in the Baltic States.
See the report for further details on development in the nursing home market in Europe. See the table of contents for further information on what you can expect in the report.
Growth over the next decade
Here we first look at growth drivers and then at forces which may limit growth. We then come to a conclusion on what sort of growth level we expect to see. This process is an art, rather than a science. Anyone who says they know the answer is lying. It is also the case that big nursing home groups, investors and their advisors all have a vested interest in creating a picture based on demographics which is as expansive as possible!
Below is a sample extract. See the report for further details on growth and limitations in the nursing home sector, including data and graphs. See the table of contents for details on what you can expect to see in the report.
Growth drivers: Alzheimers and dementia
Currently, in the big five European economies there are some 5,615,300 Alzheimer sufferers and 9,453,000 people over 85. As the number of over-85s continues to grow, so the number of dementia patients will increase. This is likely to lead to a big increase in demand. Whilst telemonitoring may enable early-stage Alzheimer patients to live at home longer, it is hard to see how the rise will not translate into a need for more beds. But it is not clear whether these Alzheimer numbers will continue to rise at the same rate.
Nonetheless, treatment options and prevention (more exercise/better diet) should flatten numbers somewhat.
Growth forecasts: our view
To determine this, we need to answer three unanswerable questions:
1)    What will be overall demand growth in a context where the state wants to limit the right to a nursing home bed?
2)    How far will supply shift from the public and not-for-profit sectors to the profit sector?
3)    How much ceiling for consolidation is left within the for-profit sector?
1) What will overall demand growth be in a context where the state wants to limit the right to a bed? 
A good way of looking at demand is to consider what percentage of the population over 85 has access to a bed today. This figure varies dramatically from .42 beds per inhabitant in Finland to around .33 in the UK and Austria and down to 0.18 in Italy and just 0.05 in Poland. These stats have their failings. Exactly what is meant by a bed will vary from country to country and there are cultural reasons why demand in conservative Catholic Poland will stay relatively low compared to the Nordics, where liberated middle age women have careers to pursue and faith in publicly funded services.
If we ask what the essential ratio should be for elderly people, it seems likely that anything over .33 could be categorised as over-bedded. Indeed, the founder of Orpea told HBI some years back that only 10-15% of all over-85s had to have beds.
The converse is that in many countries with very limited bed provision acute hospitals are essentially taking up the strain. These beds will be much cheaper in nursing homes.
We see in the graphics below that with this ratio, numbers could be reduced by as much as 119,000 beds in Spain. Still, CEE countries such as Poland and Czechia will need to grow by at least 15,000 and 226,000 respectively.
See the full report for our view on the other two questions, including data and graphs.
So, who will be the winners?
Looking at the past decade, the failures have been those who have mismanaged staff, failed to put the elderly first and who have used ambitious financial deals to over expand. So we think the winners over the next decade in what is a profoundly conservative sector, will be those who do three things right:
  1. Build a corporate culture which really does put the patient first
  2. Conservative M&A competently executed
  3. Hire the right manager
See the report for full details.
Sample report pages and data
 
What we offer
 
-       Instant overview of the EMEA nursing homes market and players This report gives you visibility of this important, fast-growing market across 23 countries with market data on all as well as detailed profiles of the Top 50 players.
 
-       Ever green! Updated throughout your subscription As part of our HBI intelligence platform this report is updated throughout the period of your subscription. You will also receive additional news stories and interviews on nursing home services throughout the period.
 
-       Insights on business models The report is based on in-depth interviews with many operators. The report also looks at how nursing home services players can best build customer loyalty.
 
-       Identify national opportunities We assess opportunities at national level based on the regulatory environment and proposed reforms.
 
-       Size markets This report enables you to swiftly see market sizes and market shares
 
-       Save time and money This report will save you weeks researching these opaque markets and enable you to swiftly identify investment opportunities, new partners and markets.
 
 

Table of Contents

Table of Contents
EMEA overview
 
Datasets  
Size of EMEA market 2018
Marketshare of major EMEA players 2018
Comparison of market sizes 2018
Comparison of market growth rates 2016-2020
 
Introduction
 
The for-profit sector plays in four ways
 
                                    - Outsourced model
                                    - Unlicensed building and running homes for publicly paid for residents
                                    - Licenced building and running homes for publicly paid for residents
                                    - Building and running homes for privately paid for residents
                                     
How then has the sector developed across Europe?
 
                                    - French Pan-European operators
                                    - Major UK operators suffer
 
Growth over the next decade
 
                                    - Growth drivers
  • Alzheimers and dementia
  • The baby boomer generation
  • Step down
  • Shift away from the public sector
  • Consolidation
            - Growth limiters
  • More sophisticated homecare
  • Scapegoating the private sector
  • Consumer choice and the rise of assisted dying
  • Staffing issues
 
Growth forecasts: our view
So who will be the winners?
 
            - Build a corporate culture which really does put the patient first
                                    - Conservative M&A competently executed
                                    - Hire the right manager
 
 
Belgium
 
Data sets
For-profit /private market size and growth rates 2016-2020
Marketshare of major players 2018
 
Market description and trends.
 
Czech Republic
 
Data sets
For-profit /private market size and growth rates 2016-2020
Marketshare of major players 2018
 
Market description and trends.
 
Denmark
 
Data sets
For-profit /private market size and growth rates 2016-2020
Marketshare of major players 2018
 
Market description and trends.
 
Finland
 
Data sets
For-profit /private market size and growth rates 2016-2020
Marketshare of major players 2018
 
Market description and trends.
 
France
 
Data sets
For-profit /private market size and growth rates 2016-2020
Marketshare of major players 2018
 
Market description and trends.
 
Germany
 
Data sets
For-profit /private market size and growth rates 2016-2020
Marketshare of major players 2018
 
Market description and trends.
 
Greece
 
Data sets
For-profit /private market size and growth rates 2016-2020
Marketshare of major players 2018
 
Market description and trends. 
 
Ireland
 
Data sets
For-profit /private market size and growth rates 2016-2020
Marketshare of major players 2018
 
Market description and trends.
 
Italy
 
Data sets
For-profit /private market size and growth rates 2016-2020
Marketshare of major players 2018
 
Market description and trends.
 
Netherlands
 
Data sets
For-profit /private market size and growth rates 2016-2020
Marketshare of major players 2018
 
Market description and trends.
 
Norway
 
Data sets
For-profit /private market size and growth rates 2016-2020
Marketshare of major players 2018
 
Market description and trends.
 
Poland
 
Data sets
For-profit /private market size and growth rates 2016-2020
Marketshare of major players 2018
 
Market description and trends.
 
Romania
 
Data sets
For-profit /private market size and growth rates 2016-2020
 
Market description and trends.
 
Russia
 
Data sets
For-profit /private market size and growth rates 2016-2020
Marketshare of major players 2018
 
Market description and trends.
 
Spain
 
Data sets
For-profit /private market size and growth rates 2016-2020
Marketshare of major players 2018
 
Market description and trends.
 
Sweden
 
Data sets
For-profit /private market size and growth rates 2016-2020
Marketshare of major players 2018
 
Market description and trends.
 
Switzerland
 
Data sets
For-profit /private market size and growth rates 2016-2020
Marketshare of major players 2018
 
Market description and trends.
 
United Kingdom
 
Data sets
For-profit /private market size and growth rates 2016-2020
Marketshare of major players 2018
 
Market description and trends.
 
 

Nursing Homes News & Interviews

Our indepth stories dig deep and cover profit multiples, revenue, EBITDA and CEO thinking.

620 news stories on Nursing Homes.

Elderly care post-Covid: HBI Big Picture Seminar 44h ago

How has Covid affected the elderly care sector across EMEA? To find out, HBI-365, the new global digital platform, brought together a panel of three: Fredrik Gren, CEO and president, Ambea, a sophisticated and large Pan-Scandinavian care group, Alexei Sidnev, ...

Gren quits Ambea: "There are many Covid turnaround opportunities" 5d ago

After 9 years at the helm, Fredrik Gren, 52, has stepped down as President and CEO of Scandinavian care group Ambea. We talk to him about next steps....

PATRIZIA deal suggests healthcare real estate remains resilient, despite COVID 4w ago

Global real-estate investor PATRIZIA AG has acquired a portfolio of seven healthcare assets in Germany specialising in assisted living and specialist care in a sale & leaseback deal. Is this a good time to be investing in this sector in the light of the corona...

Dutch insurers to pay for empty beds to keep nursing homes afloat 4w ago

Dutch insurers say they will pay for empty beds in nursing homes to prevent them falling into bankruptcy, as COVID-19 has hit the sector hard. HBI talks to an Arnhem-based consultant to find out more....

Attendo divests its Norwegian assets 4w ago

Listed Nordic care group Attendo is divesting its Norwegian operations to a not-for-profit company, assessing that long-term opportunities for private companies to develop sustainable operations for elderly care in the country are limited....

COVID-19 and Emerging Market healthcare 2mo ago

We talk to two of the world's largest investors in emerging market health care about Covid's likely impact. Despite so far much lower death rates, the initial effect on health care operators has been worse than in Europe. Covid is set to destroy several motors f...

Who is raising money? 2mo ago

Making sense of the money markets isn't easy right now. But some big players - Ramsay, Zur Rose and TPG are still raising money and some sectors such as German outpatient are still seeing M&A consolidation....

Russia's care homes and hospitals hit hard while labs offset impact with B2C 2mo ago

Russia's lab market is likely to be boosted by the country's equivalent to Google setting up a courier network for B2C COVID-19 tests but the virus is "running rampant" through hospitals and elderly care....

Norwegians hand care homes to the state 2mo ago

Nordic care groups Unicare and Norlandia are handing their for-profit nursing homes in Norway to not-for-profits or municipalities because the latter refuses to work with the private sector....

Database of 305 Nursing Homes service providers

HBI has built a unique database of the Top 3,700 operators globally in health care services. As part of this, we have identified the top 305 Nursing Homes operators in Europe and will soon add the major players in Emerging Markets.

Profiles include revenue/sales data as well as EBITDA and other profit margins where known. They also cover private equity ownership with dates and mergers and acquisitions.

Mergers & Acquisition (M&A) Intelligence

Our deal pipeline shows how likely all private equity and some privately companies are to sell based on algorithms and journalistic know-how.

HBI 2020 – the only CEO-level conference to cover healthcare services globally

HBI 2020 – the only CEO-level conference to cover healthcare services globally
 
In 2019 this event brought together 700 delegates from over 40 countries. Over 60% are CEO level and they included 150 specialist investors in health care services. HBI 2020 includes three sessions on nursing homes, of which two are on elderly care, as well as a session on medicalised homecare. One session will tackle the challenges that the nursing home sector faces, with a panel of CEOs. The session will be led by Victor Chua, Partner at Mansfield Advisors.
 
Other sessions look at trends in the investment and merger and acquisition, digital health and telehealth.  
 
 
Contact us in the UK on 0207 183 3779 for more information.