Member Article

Amid the unprecedented changes wracking the business world in 2020, one certainty remains: many industries will look very different in future years as strategic responses to COVID-19 gain traction and become permanent. In the healthcare REIT sector, we are beginning to see trends that may shape industry norms long after the dust has settled from the chaos of 2020.

1. Conservative Balance Sheets/Liquidity Emphasis

The 2020 pandemic dramatically illustrates the need for corporate resilience. When an unexpected major detriment occurs, a strategic or financial “safety net” can mean the difference between a company’s survival and its demise. Companies that entered 2020 with strong, conservative balance sheets and ample liquidity are poised to weather the storm of business closures, lost rents, increased costs and other pandemic-related crises.

Some publicly traded healthcare REITs have reported taking steps to build liquidity, cut costs and/or reduce leverage in order to build cash reserves.^[1]These strategies enhance nimbleness and flexibility, thereby maximizing options for responding to unforeseen events and sudden detriments. As healthcare REIT executives and investors internalize the lessons of 2020, this general conservatism may expand not only in the fiscal realm, but also in healthcare REIT documents and transactions. For example, it seems likely that leases will contain more specific, detailed force majeure clauses, that transactions will involve more extensive diligence, reps, warranties, indemnities and protections for wary buyers, and perhaps that pandemic insurance (or business interruption insurance specifically covering pandemic-related losses) will become more widespread.

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2020’s new abundance of caution may also lead investors and/or regulators to demand more extensive disclosure and greater transparency regarding health and safety measures.

2. Occupancy Rate Shifts

Demand for all types of healthcare real estate is widely expected to change as telemedicine expands and more people work from home. While some experts opine that these factors will diminish demand, others believe that will be somewhat offset by tenants who want larger (if fewer) spaces in order to facilitate social distancing. Although the direction and the extent of occupancy rate changes are uncertain at present, many healthcare real estate leaders are confident that past occupancy trends will take downward trajectories in coming years. These uncertainties are another reason why companies are likely to stick with 2020’s trend of caution and conservatism as discussed above.

With respect to occupancy rate changes and shifts in demand, different subsectors of healthcare real estate -- and different geographic markets -- will sustain different effects. For example, some healthcare REIT leaders have noted that the medical office sector has continued to be a more “steady Eddie” asset class than more historically tumultuous property types like skilled nursing during the first half of 2020. Others predict that denser metropolitan areas may sustain greater long-term drops in demand than secondary markets as remote working and social distancing become ingrained in everyday work and life habits.

3. New Hot Markets

In addition to new demographic patterns that may lead people (and businesses) away from dense markets in the wake of COVID-19, new state and local regulations adopted in reaction to the novel coronavirus will vary. Regulatory differences across the country will -- and already do -- create a patchwork of laws, making business operations in some markets more difficult and costly than in other markets. Although regulations may become more consistent over time as different jurisdictions discover what works well and what doesn’t, it will likely take several years for legislation to become somewhat more uniform, and it is probable that many state and local variations will remain indefinitely because of differing demographics, political composition and market specifics. Some healthcare REIT experts anticipate heightened interest in small-city markets, continued growth in off-campus facilities, and perhaps rejuvenation of transactional activity in rural markets.

4. Changes In Portfolio Composition

Investors are watching public healthcare REIT filings closely for red flags and subtle (or explicit) indications of impending difficulties. A number of publicly traded healthcare REITs have been proactive in disclosing information to reassure investors, and the picture they paint seems brighter overall than the outlook for the hardest-hit REIT sectors (e.g., retail and hospitality). Some industry leaders have pointed out the continued reliability and desirability of the MOB subsector. The life science subsector also has shown indications of continued strong demand and stable rent collection.

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