Loans for seniors housing and care facilities

The level of care decides the program

Property	First call	Also price
Independent living, stabilized	Fannie Mae, Freddie Mac seniors housing	Life company, HUD 232
Assisted living and memory care, stabilized	Fannie Mae, Freddie Mac, HUD 232	Bank
Skilled nursing	HUD 232	Bank, healthcare bridge lender
Leasing up, a turnaround, or an operator change	Bridge, debt fund	Bank
New construction	Construction loan, HUD 232 new construction	C-PACE for qualifying systems
Additional proceeds on an existing agency loan	Agency supplemental

Terms side by side

Term	Fannie Mae seniors housing	Freddie Mac seniors housing	HUD 232 (existing, 223(f))
Max LTV	75% max LTV1	Independent living: 75% LTV at 1.30x (7-year+)4	80% (85% non-profit)2 for assisted living; 80% (85% non-profit)2 for skilled nursing
Min DSCR	1.30x if over 50% independent living1; 1.40x if over 50% assisted living and/or memory care1	Shown with leverage	1.45x (includes MIP); 1.11x for 223(a)(7) and 232(i)2
Term	Agency fixed or floating terms	Agency fixed or floating terms	Up to 35 years (or 75% of remaining economic life)3
Skilled nursing	Limited	skilled nursing capped at 20% of NOI4	Eligible
Cash out	Program and lender rules	Program and lender rules	No equity take-out on 232/223(f)3
Insurance premium	None	None	1.00% upfront, 0.65% annual5
Rate hold	Lender lock	quoted spreads held 75 days from signed application4	Locked through the HUD process

Programs ranked for a stabilized assisted living community

Rank	Program	Wins when	Loses when
1	Fannie Mae seniors housing	Experienced operator, private-pay residents, stabilized census	Heavy skilled nursing or Medicaid share
2	Freddie Mac seniors housing	Same profile; competitive on independent living	Skilled nursing over the cap
3	HUD 232	Long fixed rate, full amortization, skilled nursing eligible	Slow, no cash-out on refinance, higher premium
4	Life company	Independent living with strong sponsors, low leverage	Care-heavy properties
5	Bridge and debt fund	Lease-up, turnaround, operator transition	Floating rate, short term

What seniors housing underwriters focus on

• The operator. Track record, number of communities run, state survey history and turnover in leadership. Agency and HUD lenders underwrite the operator as much as the building.
• Census and occupancy trend. Monthly occupancy over the trailing period, move-ins and move-outs.
• Payor mix. Private pay, Medicaid waiver, Medicare and long-term care insurance. Government-pay concentration raises reimbursement risk.
• Level of care and acuity. The split between independent living, assisted living, memory care and skilled nursing sets both the program and the coverage requirement.
• Labor. Staffing ratios, agency staff use and wage pressure. Labor is usually the largest expense line.
• Licensing and surveys. State licenses, survey results and any enforcement actions.
• Ownership structure. Owner-operated, or a property company leasing to an operating company. Lenders read the operating lease and often require both entities in the loan.
• Physical plant. Age, unit size, life safety systems and the cost to keep the property competitive.

Sizing example (illustration)

An illustration, not a quote. A stabilized assisted living and memory care community valued at $30,000,000 with $2,100,000 of underwritten NOI (a 7.0% cap rate), owned by a for-profit owner.

Test	Fannie Mae (75%, 1.40x, 30-year, illustrative 6.50%)	HUD 232/223(f) (80%, 1.45x including premium, 35-year, illustrative 6.40% plus 0.65% annual premium)
LTV	$22,500,000	$24,000,000
Debt service the NOI supports	$2,100,000 / 1.40 = $1,500,000	$2,100,000 / 1.45 = $1,448,300
Loan constant	7.58%	7.17% plus 0.65% premium = 7.82%
DSCR test	$19,776,000	$18,526,000
Loan	$19,776,000 (66% LTV)	$18,526,000 (62% LTV)

Coverage binds both, and here the agency loan is larger, because HUD’s coverage test includes the premium and its premium on healthcare is higher than on apartments. HUD 232 wins on a different axis: a long fixed rate that fully amortizes, and eligibility for skilled nursing. The upfront premium (1.00% upfront, 0.65% annual) also adds to closing costs. Run your own coverage math in the DSCR calculator.

Market reading

Measure	Reading
Health care lending, by property type, Q2 2026 versus Q2 2025 (MBA)	Retail up 61%, office up 47%, hotel up 19%, multifamily up 8%, industrial up 6%, health care down 19%6
Share of each property type’s balances maturing in 2026 (MBA)	Hotel 30%, industrial 23%, office 17%, health care 15%, multifamily 13%7
FHA multifamily and health care delinquency, Q3 2026 (MBA)	0.90%, down from 1.06% in Q2 (MBA)8

Health care was the only property type where lending fell year over year in the MBA’s Q2 2026 survey, while a meaningful share of health care debt matures in 2026. Owners with maturing loans should start early and expect lenders to underwrite the operator closely.

Programs to avoid

• Freddie Mac Conventional Small. Excludes seniors housing.
• Agency loans on a mostly skilled nursing facility. Over the skilled nursing limit, the property needs HUD 232 or a healthcare lender.
• HUD 232 when you need equity out or a quick close. Use a bridge or conventional loan, then refinance into HUD later if the long fixed rate is the goal.