CFO services for senior living and assisted living operators.
Senior living is hospitality, healthcare, and real estate in one building. Occupancy and rate set the top line; labor and food per resident-day set the margin; the lender sets the rules. We bring finance leadership that runs all three at once.
The finance problems that define this segment.
Occupancy and rate are managed separately from cost.
Census, move-ins and move-outs, and rate increases are tracked by sales; labor and food per resident-day by operations; nobody owns the margin that results.
Care-level pricing lags acuity.
Residents' care needs rise over their stay; assessments and level-of-care charges lag, so the community delivers more care than it bills.
Labor is 60 percent of cost and scheduled to templates.
Caregiver, nursing, dining, and housekeeping hours per resident-day, agency usage, and overtime decide margin; staffing to census and acuity is rare.
Real estate and operations are entangled.
Owner-operators mix property returns with operating returns; operators with third-party owners face management-fee and incentive structures that need clean operating numbers.
Lender covenants and reporting are demanding.
Debt service coverage, occupancy covenants, and reserve requirements tested quarterly, with breaches that trigger cash sweeps.
Move-in economics are unmeasured.
Cost per move-in by referral channel, length of stay, and lifetime revenue per resident are seldom calculated.
Regulatory cost is rising.
Licensing, staffing minimums, survey readiness, and memory care requirements each carry cost that must be budgeted, not absorbed.
How we run finance here.
- Occupancy, rate, and margin together — revenue per occupied unit, care revenue capture, and cost per resident-day in one monthly view.
- Acuity and care-level revenue — assessment timeliness, level-of-care charge capture against care delivered.
- Labor to census and acuity — hours per resident-day by department, agency and overtime as percent of wages, staffing templates rebuilt to the census curve.
- Food and supplies per resident-day against benchmarks.
- Real estate separation — operating profit and loss distinct from property; market rent or management fee structures modeled; clean numbers for owners and lenders.
- Lender covenant model two quarters ahead; lender and owner reporting owned.
- Move-in economics — cost per move-in by channel, length of stay, lifetime revenue.
- Accrual close, 13-week cash, and owner or sponsor pack.
Key metrics we build and report.
| Metric | What it tells you |
|---|---|
| Occupancy and revenue per occupied unit | Top-line health |
| Care revenue capture vs. assessed acuity | Whether care delivered is billed |
| Labor hours and cost per resident-day, by department | The largest cost lever |
| Agency and overtime as percent of wages | Staffing stability |
| Food and supplies per resident-day | Variable cost control |
| Net operating income margin | Operating performance |
| Debt service coverage and occupancy covenant headroom | Lender position |
| Move-ins, move-outs, and average length of stay | Census dynamics |
| Cost per move-in by referral channel | Sales efficiency |
Worked example.
A 96-unit assisted living and memory care community, $7.4M revenue, owner-operated with real estate debt.
The plan: assessment cadence and care-level billing capture; staffing templates rebuilt to census with an agency reduction target; dining cost program; move-in channel shift toward direct; a covenant plan and lender conversation before the test date; operating and real estate numbers separated for the owners.
Where we’ve done this.
Owner-operators of single communities and small portfolios; operators managing third-party-owned communities; memory care specialists; sponsor-backed senior living platforms. Pattern-level only.
We are full but not profitable. Where do we look?
Care revenue capture against acuity, and labor per resident-day against census — the two places full communities leak.
Can you help with our lender?
Yes — covenant forecasting, the reporting package, and the conversation ahead of a test the community may miss.
Should the real estate be separated from operations?
Usually yes; we model the structure with your counsel and tax advisor and produce clean operating numbers either way.
Do you work with third-party management arrangements?
Yes, including management-fee and incentive structures and owner reporting.
Further reading.
Lender Readiness: How a Behavioral Health Group Gets — and Keeps — a Line of Credit
What banks look for when lending to a behavioral health practice, how to size a line of credit against the receivables cycle, covenant traps, and a worked sizing example.
Read article → InsightLease or Buy? The Real Estate Decision for a Behavioral Health Practice
How a behavioral health group should weigh leasing against buying clinic space — occupancy cost per session, flexibility, financing, a worked comparison, and the separation of real estate from operations.
Read article → InsightThe Monthly Management Report for a Behavioral Health Group: What Belongs In It
The metrics, statements, and commentary a behavioral health practice's monthly report should contain, with a sample page-one — and the order that makes it useful to owners and boards.
Read article →Insights for this vertical.
Tell us about the organization.
One conversation about where the numbers stand and what the next stage needs from finance. We will tell you where we can help, where you need someone else, and what it would cost.
The information on this page is provided for general informational purposes and does not constitute accounting, tax, legal, or investment advice. Reimbursement, licensing, and compliance matters in healthcare depend on payer contracts, state rules, and the specific facts of the organization and change frequently. Figures in examples are illustrative. See our full Legal Disclaimer.