In honor of Women’s History Month, MONTICELLOAM, LLC’s Karina Davydov sat down with BHI‘s Tami Antebi, BLUEPRINT‘s Amy Sitzman, and Polsinelli‘s Lisa Katz to discuss the challenges and opportunities shaping the seniors housing and healthcare industry.
Their perspectives are a must-read as they cover the trends shaping the industry—from the impact of interest rates on deal flow to the availability of debt and equity.
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.
Sr. Vice President, BHI
As Senior Vice President, Head of the National Healthcare lending platform for BHI, the US Operation of Bank Hapoalim, Tami has led her team with a current portfolio under management of over $1 Billion in financing. Tami is a seasoned banker with 26 years of banking experience, in which she’s been with BHI since 2010. Prior to BHI, Tami spent 10 years at JPMorgan Chase as a Senior Credit Underwriter in their Commercial Bank for C&I loans. Tami has a Bachelor’s Degree from New York University’s Stern School of Business in Accounting and Marketing.
Shareholder, Polsinelli
Lisa Katz uses her passion for law to bring a unique hybrid skill set to both the health care transactional and regulatory compliance spaces, as well as the financial services industry. She has extensive experience representing lenders in financing transactions for acute care, long-term care and senior housing, home health, hospice and behavioral health providers, among others, across the country. Lisa’s bifurcated practice provides many opportunities for her to make valuable introductions between lenders and healthcare providers all around the country, in order to meet the needs of all parties involved.
Executive Managing Director, Blueprint Healthcare Real Estate Advisors
Amy Sitzman joined Blueprint in 2017 and is a partner at the firm. Amy has been involved in approximately $1 billion in transactions to date holding an active real estate broker’s license in Arizona, California, and Texas. As an Executive Managing Director and Arizona native currently residing in California, she utilizes her Southwest market knowledge to advise on existing assets and to provide guidance on all aspects of a transaction to ensure a smooth experience for all parties. She began her career in healthcare, selling capital imaging equipment. Prior to joining Blueprint, Amy served as Vice President of Sales in Senior Housing and Healthcare, specializing in title and escrow, which marked her first exposure to senior housing and care a decade ago.
Tami Antebi (TA): At BHI, we are continuing to see a lot of M&A as confidence in the sector remains high. Additionally, we are seeing a lot of refinance requests, which include cash outs and equity recapture requests, as owner/operators are trying to capitalize on the rate increases that occurred over the last year that created a lot of value. With those cash out requests, we sometimes structure delayed funding earn-outs for the operator to exhibit strong, seasoned and sustainable cash flows.
Amy Sitzman(AS): A variety of deals are being struck too, including stabilized and non-cash-flowing assets. Core and core-plus assets are coming to market into 2025, and non-performing assets remain available at compelling pricing.
We find time and time again that truly knowing your buildings and markets, both on the sale and the financing side of things, helps to mitigate any risk that a deal doesn’t trade. This includes providing clear and actionable pricing on the front end and making certain the right buyer is selected through a process.
Lisa Katz (LK): There have still been promising healthcare real estate investment opportunities emerging. Particularly in high quality properties. This means newer properties, with full occupancy, strong lease rates & upcoming renewals, and minimal deferred maintenance.
TA: A lot more momentum needs to pick up to meet this growing need.
To help achieve this, developers will need to be more creative in identifying locations, costs and capital. The cost of doing business likely won’t be cheap, so projects will still need to have a strong thesis and execution to succeed. The ongoing hope is that policymakers will recognize this as a going concern and hopefully assist in alleviating some of these challenges.
LK: The industry has been addressing the growing demand via alternative real estate solutions, such as office and retail spaces near patients or hospital. The site selection process is becoming more intricate as well. Involving analysis of patient data, community demographics, care gaps, population growth, insurance coverage, referral networks, and competitor proximity.
KD: Amy, can you talk about what you’re seeing in existing assets in established markets?
AS: With construction stalling for a while, significant opportunity exists in acquiring existing assets in viable markets and investing in a capex plan. We’re seeing this approach, in some instances combined with a renewed focus on operations, as a logical formula to arrive at a resilient asset in a given market.
AS: Overall, people are approaching opportunities with a more conservative mindset, considering their current exit cap rates compared to potential future values.
Lenders are still seeking some level of credit enhancement on non-stabilized deals. Additionally, the strength of the sponsor and borrowers’ and operators’ track record in a certain geography or asset profile is subject to more scrutiny than the years pre-COVID.
KD: I think we’ll continue to see lenders exercising caution as the sector navigates a complex landscape, but with signs of rate stabilization, there is renewed optimism in our space which has coincided with an increase in deal activity.
We reviewed over $14B in healthcare transactions in 2024, with opportunities ranging from value-add acquisitions to dispositions of performing assets. We evaluate opportunities with a disciplined approach, acknowledging the sector’s growth potential while remaining vigilant about risks.
LK: They still see senior housing and healthcare real estate financing as viable income streams. Shifts in demographics are a major driver of that. The US population aged 65 and older is projected to reach 20% by 2030. This is up from 16% in 2020.
TA: It’s important to hover on that point a beat longer: we’ve been conditioned over our lives to mentally associate the phrase ‘by 2030’ as some far-flung date in the future. But it’s 2025, and a lot more momentum needs to pick up to meet this growing need. I think there will be more non-traditional lenders that start lending for new construction as they will see a niche opportunity.
AS: Development has been slow and challenging, mainly because of the difficulty in getting capital (both debt and equity) comfortable committing to transactions. Lenders have reservations given their general experiences through COVID to current.
What typically stalls development more are barriers to entry, lack of access to viable capital, and construction costs.
TA: Agreed, higher overall costs across the board due to inflation have made a noticeable impact, with some lenders becoming more reticent to significantly increase their construction lending portfolio. This has and will continue to exacerbate the imbalance between supply and demand as more and more baby boomers are aging into the demographic of needing senior housing and inventory issues still persist.
KD: Without a doubt, macroeconomic factors have had a huge impact on the seniors housing sector. Rising insurance rates continue to be a pressure point, but we’ve seen some moderation in labor related expenses and cost of goods. Lisa, in your practice, are you seeing operators’ advocacy efforts shift to address the changing regulatory landscape?
LK: Heading into 2025, the Administration’s policy agenda was expected to focus on immigration, tax reform, housing, and healthcare. Within that sphere, industry leaders aim to advocate for workforce development: pushing for workforce solutions that include an immigration approach supporting the needs of senior living providers.
In summary, there was general agreement among the roundtable that 2025 presents a dynamic landscape for the senior housing space. Debt and equity markets reflect a combination of cautious optimism and strategic realignment. The outlook is generally positive despite economic challenges.
Strong investor interest, operational improvements, and demographics tailwinds continue to provide long term support for the sector. With $10 billion of loan maturities estimated in 2025, operators and other stakeholders can utilize MONTICELLOAM’s suite of capital and advisory solutions to achieve their goals.