MONTICELLOAM, LLC Senior Managing Director Karina Davydov sits with Bluma Broner, Talya Nevo-Hacohen, Amy Heller, and Jennifer Meyers to discuss their team’s approach when evaluating seniors housing and healthcare opportunities.
Discover the panel’s insights as they share their perspective on how industry capital partners and operators are currently finding opportunities while balancing clinical, financial, and operational priorities.
Moderator
Sr. Managing Director, MONTICELLOAM,LLC
Karina Davydov is a Senior Managing Director on MONTICELLOAM’s Seniors Housing and Healthcare bridge lending team, where she plays a pivotal role in driving the firm’s success. She is actively involved in every stage of the origination process—including sourcing, structuring, closing, and relationship management—ensuring seamless execution and long-term client partnerships. Beyond transactions, Karina is a key force behind the company’s growth initiatives, leveraging her industry expertise and strategic vision to expand MONTICELLOAM’s reach in the seniors housing and healthcare sectors.
In addition to her duties at MONTICELLOAM, Karina serves as head of Business Development for Trustwell Senior Living. Where she helps lead the team’s expansion efforts including asset acquisitions and third party management contracts.
Managing Director, Healthcare, CIBC Bank USA
Bluma Broner is a Managing Director and Head of Healthcare for CIBC Bank USA. The Healthcare group has 38 lenders with a nationwide platform with a focus on providers in the skilled nursing and seniors housing sector. Bluma has over 25 years of banking experience and has spent the past 22 years as a lender to the healthcare industry. Prior to joining CIBC in 2007, Bluma served as Vice President in healthcare at LaSalle Bank. She started her banking career at Bank Leumi in Israel in 1995 and has held a variety of banking positions with a focus on middle market entrepreneurial businesses. Bluma is a current board member of Shalva (a not-for profit that supports Jewish women experiencing domestic abuse, through counseling, supportive services, and community education), the OU, JUF and JWE of Chicago. She is a Fellow with Leadership Greater Chicago. Bluma holds a B.A. in Economics from Hebrew University in Jerusalem, Israel.
Senior Managing Director, Meridian Capital
Amy Heller serves as the Senior Managing Director of Meridian Capital’s senior housing and healthcare group, focusing on healthcare related debt brokerage. She most recently founded and served as the President and co-Chief Lending Officer of the Healthcare and Housing and Urban Development lending divisions at Forbright Bank. Prior to Forbright, Heller held leadership roles at Healthcare Financial Partners, Heller Financial and CapitalSource Finance, overseeing portfolios, managing complex workouts and restructurings, establishing diligence teams, managing new loan origination, and underwriting.
Managing Director, Marwood Group
Jennifer Meyers has over 20 years of experience advising senior corporate executives, private equity firms, and other institutional investors on healthcare investments, including senior housing. She leads client relationships and has worked on thousands of assignments across healthcare, providing strategy consulting and diligence services. Prior to Marwood, Ms. Meyers was a Principal at Bank of America Merrill Lynch, serving as a senior member of the M&A Group focusing on healthcare. Previously, she held positions at JPMorgan Securities and Prestwick Scientific Capital, among others. Ms. Meyers received a B.S. cum laude in Business Administration from the University of North Carolina at Chapel Hill and an MBA from Vanderbilt University.
Chief Investment Officer, Sabra Health Care REIT
Talya Nevo-Hacohen has served as Sabra’s Chief Investment Officer, Treasurer and Executive Vice President since November 2010. She has served as an advisor to private and public real estate organizations after senior roles in private equity and a health care REIT. Previously, Ms. Nevo-Hacohen worked for Goldman, Sachs & Co. where she was a Vice President, prior to which she practiced architecture in New York. Ms. Nevo-Hacohen is a trustee of Seritage Growth Properties, President of the Board of Trustees of South Coast Repertory, Chairman of the Board of U.S. Friends of Dror Israel, and serves on the board of several more organizations.
Talya Nevo-Hacohen (TNH): Our approach at Sabra Health Care REIT focuses on (1) the market, present and future, for residents and labor; (ii) the community itself, such as unit count, layout, and efficiency; (iii) the manager and their familiarity with the asset type and market; and (iv) environmental risk. Regulatory risk has emerged in seniors housing in a handful of states, but remains limited, so far.
Bluma Broner (BB): Our team puts a lot of emphasis on the borrower team when we evaluate a potential opportunity. We’re looking at their results by quarter, their clinical, market expertise, and overall strength.
Jennifer Meyers (JM): That’s very similar to how we’re looking at things. We’re constantly examining market fundamentals and operator strength, especially when it comes to independent living and assisted living.
On the SNF side, we’re closely monitoring the discussions in DC on potential changes to the federal Medicaid program and how these changes may impact state Medicaid budgets going forward.
Amy Heller (AH): I’ve always said first and foremost, it’s not what you lend on, it’s who you lend to. Market fundamentals, regulatory risk, asset class, etc. are certainly important, but my experience is if the parties on both sides of the table have a common goal, you can work through even the most complex situations.
My advice is to truly consider who you’re working with and borrowing from.
KD: How do you model the financial impact of potential regulatory changes in your underwriting and portfolio planning while mitigating risks related to those potential changes?
BB: Stress tests! Every deal we look at, we test on both an interest rate basis and cash flow basis. We’re absolutely monitoring the possible changes to Medicaid, but other factors like clinical care issues, potential fines, lower star ratings, and DPNA’s are a more immediate risk to revenue that we’re tracking.
TNH: While there’s a lot up in the air regarding Medicaid, we’re running scenarios to understand the range of possible impact since it is nearly impossible to accurately assess how the risk impacts our skilled nursing portfolio.
It’s interesting to note that we are currently seeing more opportunities in senior housing than skilled nursing, which is a convenient mitigant for incremental Medicaid risk in the short term.
AH: Many years ago, I asked a former reimbursement consultant (now skilled nursing operator) how I should factor regulatory and reimbursement changes into my underwriting, he told me that the only constant in reimbursement is change. When we model, we take into account the known while carefully evaluating the unknowns, leading to an as informed as possible decision.
JM: It’s difficult to avoid Medicaid risk given that it is the largest payor within the SNF sector, accounting for the stays of about 60% of national nursing facility patients.
SNF operators will need to attract enough post-acute patients to balance out Medicaid residents in SNFs as they also contend with a decline in average length of stay from post-acute Medicare Advantage patients.
KD: Deal flow has shifted meaningfully in 2025, driven by a wave of loan maturities and market volatility. We’ve reviewed over $11B in inquiries year-to-date, with more than $1B signed—nearly double 2024 levels.
We emphasize sponsor quality, with portfolio performance, market fundamentals and loan structure aiding to guide our decisions. Our asset management team conducts real time monitoring on everything from star ratings to occupancy levels to expense deviations.
KD: With rising healthcare costs, how are operators evolving their care delivery to address affordability while ensuring equitable access to quality care?
JM: With improvements in treatments and technology, SNFs may have higher acuity patients going forward, so having a combination of internal staff and outsourced providers that can provide care to their residents is essential. We’ve seen an increased use of outsourced providers, notably primary care and specialty providers, so that SNFs can focus on delivering quality care and affordability.
Talya, when evaluating operations, have you noticed any type of care provider becoming increasingly popular?
TNH: From our point-of-view, accountable care organizations (ACOs) are emerging as a health care service provider that presents seniors housing residents the affordable, coordinated, and consistent delivery of care that enables them to age in place.
The idea is to retain residents after they’ve moved in by extending their “health span”, which can be appealing to residents who want to make one decision to plan for their later years.
BB: We’ve seen technology become vital to ensure they’re delivering appropriate care while containing costs. A client was using sensors over beds that wirelessly monitor heart rate, temperature, blood pressure, among other things, that I thought was really savvy.
While SNF construction activity remains low, what’s currently being built is more single and double occupancy rooms and less triples or quads.
AH: With fewer new builds, many owners are focused on existing product. They are working on retrofitting older vintage facilities because reimbursement typically isn’t there for new construction.
We’re finally seeing some of the older assisted living facilities successfully converted into Medicaid or lower-cost options for the “forgotten middle” which will be increasingly important into the future.
KD: How can capital partners better align with operators’ goals to improve care delivery?
AH: As a lender, it’s paramount to align yourself with providers who believe in outcomes and aren’t chasing after the last dollar, because providing good care ultimately leads to better clinical outcomes, and profitability is a byproduct of that. The responsibility lies with owners and operators to select the ideal partners as well.
The alignment is essential because it’s the experience of the partnership that will weather difficult cycles and have a mutual understanding of the nuances in seniors housing and healthcare.
BB: That’s a great point. For capital partners and owners, they are sort of seeing each other through the looking glass. Capital partners primarily prioritize financial risk mitigation, while on the other side, operators have deeper focus on the clinical and operational risks.
An answer to align the financial, clinical, and operational interests is to get more clarity on the rates being paid by the government and insurance companies.
All my clients want to deliver top quality care but want to understand how to do that within the context of the rates being paid.
JM: Having a greater understanding of future payment models and regulatory impacts (e.g., staffing requirements) are key in helping capital providers and operators achieve goal alignment.
As the movement towards more value-based care in SNFs increases, operators will need the right capabilities and tools that enable VBC in order to be successful, but it will require buy-in and investment.
TNH: Technology is an area where healthcare has historically lagged. Capital can be deployed into cutting-edge tech by owners and operators in order to improve care while using staff more effectively and efficiently.
It’s an exciting period in the sector as tools like AI can be utilized to automate redundant tasks for operators while they focus on care and the “human touch”.
Conclusion
If there’s one takeaway from this discussion, it’s that seniors housing and skilled nursing deals aren’t just about the real estate—they’re about the people behind the operations.
Our panelists agree: the strength of the operator, the local market, and the ability to adapt to changing regulations all play a huge role in whether a deal makes sense. Medicaid and Medicare risk is real, but so is the opportunity to innovate—whether it’s through new care models, retrofitting older facilities, or using smart tech to improve care while managing costs.
For stakeholders in the space, it’s not just about chasing yield. It’s about partnering with those who care about outcomes and have a plan to deliver. When everyone at the table is aligned, the results tend to follow.