Senior living
Skilled nursing
Skilled nursing facility (SNF) financing is commercial real estate debt secured by a licensed nursing home that provides 24-hour nursing and rehabilitation care. Because most revenue comes from Medicaid and Medicare, lenders underwrite payer mix, reimbursement and regulatory standing as closely as the building.
Key facts
Figures as of 2026-10-31. Program rules change by notice, so an advisor confirms current terms with lenders before you rely on any figure.
| Item | Figure | Source and date |
|---|---|---|
| HUD 232/223(f): term | Up to 35-year fixed | HUD Handbook 4232.1 and prior MIP schedule; as of 2026-10-31 |
| HUD 232/223(f): max LTV / DSCR | 80% / 1.45x | HUD Handbook 4232.1 and prior MIP schedule; as of 2026-10-31 |
| Annual MIP (refinance) | 0.65% | HUD Handbook 4232.1 and prior MIP schedule; as of 2026-10-31 |
| Annual CPA audit | About $20,000 per year | Corin sizing estimate; as of 2026-10-31 |
| Bridge: max LTV | 75% | Corin sizing estimate; as of 2026-10-31 |
What lenders review
Skilled nursing underwriting centers on the operator. Lenders review state survey and inspection history, star ratings, staffing, payer mix and reimbursement rates, and the lease or ownership structure between the real estate owner and the operating entity.
- Payer mix: Medicaid, Medicare, managed care and private pay
- Regulatory standing and any corrective-action history
- Operating-lease coverage when owner and operator are separate
- Capital needs and physical plant condition
Why HUD is common for SNFs
HUD 232 gives SNF owners long fixed amortization and non-recourse terms that conventional lenders rarely match, which is why it is a leading takeout for bridge-financed acquisitions. A CPA-audited financial package is required each year.
Frequently asked questions
Can a skilled nursing facility with low occupancy get HUD financing?
HUD looks for stabilized operations. A facility below that mark usually starts with a bridge loan or a lender willing to underwrite the turnaround.
What documents does a skilled nursing lender ask for?
Expect state licenses and survey reports, trailing operating statements and cost reports, payer-mix and census detail, the ownership and operating structure, and operator resumes.
Does reimbursement risk affect pricing?
Yes. Heavy Medicaid dependence and rate changes are reflected in lender underwriting, coverage requirements and pricing.
Related programs
- HUD Section 232FHA-insured, long-term, non-recourse debt for licensed healthcare real estate.
- HUD 232/223(f) refinanceRefinance or acquire an existing, stabilized senior housing facility with HUD-insured fixed-rate debt.
- Bridge-to-HUDShort-term floating debt to stabilize a facility before a HUD 232/223(f) takeout.
- Assisted livingCompare HUD, SBA, bank and bridge options for assisted living communities.
- Senior living financingHUD, SBA, bridge and bank options for senior living owners.
Talk through your deal with an advisor
Send the basics and a licensed Corin advisor reviews which programs and lenders may fit, or size the loan yourself first.