Prepared for lenders, CDCs, and federal agencies to SBA SOP 50 10 8, USDA 7 CFR Part 5001, and conventional underwriting standards. Fiduciary duty runs to the lender and the agency, never the borrower. 4,000+ engagements since 1998 covering $41.2 billion in evaluated project value. So far in 2026: 41 engagements and $1.54 billion evaluated — 17 SBA, 11 USDA.
Healthcare feasibility joins clinical demand to reimbursement reality. For assisted living and memory care, the study quantifies age- and income-qualified households within the realistic draw area, existing licensed bed supply and occupancy, and the private-pay versus Medicaid waiver mix that determines achievable monthly rates. For clinics, surgery centers, and outpatient facilities, the analysis evaluates provider supply, procedure volume migration to outpatient settings, payer contracting, and the certificate-of-need environment where one exists. In every case the operating model — staffing ratios, acuity creep, and labor availability — is tested as rigorously as the demand side, because healthcare projects fail on operations more often than on demand.
The analysis uses CMS provider and utilization files, state licensing and survey data, Census age-cohort projections, Genworth cost-of-care benchmarks for senior product, and BLS healthcare wage data for the staffing model. Financial projections carry rate, occupancy, and payroll sensitivity consistent with the firm's standard stress discipline, tested against the program's coverage minimums.
Every Wert-Berater financial model is fully linked with no hardcoded values, so any reviewer can stress any input. Deliverables comprise a complete narrative report and the linked Excel model, with ten-year pro forma, sensitivity analysis at ±5, 10, and 15 percent, interest-rate stress from +0.5 to +3.0 percent, and ratio analysis benchmarked against RMA and IBISWorld data.
SBA engagements are prepared to SOP 50 10 8, including its debt-service-coverage minimums of 1.15x operating and 1.00x global. USDA engagements follow RD Staff Instruction 5001 across the Business & Industry, Community Facilities, REAP, and Value-Added Producer Grant programs. Conventional engagements are built to the lender's stated coverage standard, typically 1.20x. Healthcare engagements arrive through USDA B&I and Community Facilities for rural facilities, SBA programs for physician- and operator-owned projects, and conventional lending for larger senior housing; the study is structured to the evidentiary standard of the reviewing agency in each case.
Representative work includes a USDA B&I assisted living engagement in Cortez, Colorado and physician-equity ambulatory surgery analysis in Florida. Independence is non-negotiable: determinations follow the evidence and are not revised under pressure, and studies are built to pass lender, agency, and third-party review without exception items.
A healthcare & assisted living feasibility study is not a market overview stapled to a pro forma. It is a structured evidentiary record that answers the specific questions a credit officer, SBA loan officer, or USDA program director must resolve before a commitment can be issued. The scope is built around the project type: a memory care facility raises different questions than an ambulatory surgery center, and the study is organized accordingly.
Demand for senior housing and healthcare services is not estimated from regional population totals. It is built from the bottom up, starting with the smallest geographic unit for which reliable age-cohort data exist, then aggregated to a draw area defined by realistic travel time and competitive gravity rather than arbitrary radius.
The age-cohort base comes from Census Bureau decennial data, American Community Survey five-year estimates, and the Bureau’s population projections, applied at the tract or county level. Income and asset qualification rates are derived from ACS household income tables and, where available, state-level Medicaid eligibility thresholds that define the boundary between private-pay and waiver-funded residents.
Competitive supply is built from state health department licensing registries, CMS Nursing Home Care Compare and Home Health Compare files, and state long-term care ombudsman reports. Each competing property is mapped, its licensed capacity recorded, and its estimated occupancy triangulated from cost-report data and, where accessible, state survey findings. For outpatient and clinic projects, CMS provider utilization files, state certificate-of-need filings, and physician group practice location data inform the provider-supply side. Labor market conditions are assessed using BLS Occupational Employment and Wage Statistics at the metropolitan or nonmetropolitan area level, because a facility that cannot staff to ratio cannot operate regardless of demand.
Licensed acute-care facilities are analyzed under a separate framework, because inpatient demand, physician admitter relationships and payer mix behave differently from residential and outpatient care. Hospital projects are addressed in the firm’s hospital feasibility study consultant practice.
Coverage ratios in healthcare and senior housing projects are sensitive to a small number of operating variables. Identifying those variables and testing each one systematically is the analytical work that separates a credible feasibility study from a document that simply confirms the sponsor’s projections.
Each assumption is stress-tested at the firm’s standard intervals so the lender can see exactly where coverage breaks.
The evidentiary standard varies by program, and a study that satisfies a conventional lender may not satisfy a USDA Community Facilities reviewer or an SBA loan officer applying SOP 50 10 8. The study is structured to the standard of the reviewing authority from the first draft, not retrofitted after submission.
For SBA engagements, the study must support a debt-service-coverage determination at the 1.15x operating and 1.00x global minimums required by SOP 50 10 8. The independence of the analyst and the absence of any contingent fee arrangement are material to SBA review; both conditions are satisfied as a matter of firm policy on every engagement.
USDA Business & Industry and Community Facilities programs serve rural markets where competing supply may be thin but where Medicaid waiver dependency is often higher and private-pay depth shallower. The study addresses rural labor market constraints directly, because USDA reviewers consistently flag staffing feasibility as a primary concern for rural healthcare projects. The analysis is prepared to RD Staff Instruction 5001 in all USDA engagements.
Conventional lenders underwriting senior housing typically apply a 1.20x coverage standard and place particular weight on the sponsor’s operating track record alongside the market study. The study documents competitive positioning, rate sustainability, and the payer-mix assumptions that drive net operating income, giving the credit officer the record needed to defend the underwriting to internal loan committee and, where applicable, to a secondary market purchaser.
The fee is fixed and quoted in writing within one business day of receiving a project description. No fee is contingent on the finding, and the determination is not revised because a sponsor or lender prefers a different conclusion. The quote covers the complete deliverable set: bound narrative report, ten-year pro forma, sensitivity tables, interest-rate stress analysis, ratio benchmarking against RMA and IBISWorld data, and the explicit statement of conditions.
Standard delivery is ten to fifteen business days from receipt of a complete data room. For healthcare and senior housing projects, a complete data room includes the site address and legal description, the proposed unit or bed count and product type, the operator’s proposed rate schedule, any existing market studies or appraisals, the proposed financing structure, and the lender’s program identification. Rush delivery is available and is quoted at the time of engagement.
Once the engagement is open, every document and the live financial model are published to a secure client portal. The Excel model remains live in the portal and recalculates when any input changes, so a lender who wants to run an alternative occupancy or rate scenario can do so without requesting a revised report. This is particularly useful in healthcare underwriting, where a credit committee may want to test payer-mix or wage-escalation scenarios that differ from the base case. The portal record also provides a clean audit trail if the study is reviewed by a second lender, an SBA center, or a USDA state office after initial submission.
The fee is fixed and quoted in writing within one business day of receiving a project description. It covers the full deliverable set—narrative report, ten-year pro forma, sensitivity tables, and the live Excel model—with no contingent or success-based component. Because scope varies by project type and program, a specific quote requires a brief project description rather than a published rate card.
Standard delivery is ten to fifteen business days from receipt of a complete data room. Rush delivery is available and is priced at the time of engagement. The most common cause of delay is an incomplete data room; providing the site address, proposed unit count, rate schedule, financing structure, and lender program at the outset keeps the engagement on the standard timeline.
Three factors create underwriting complexity that does not appear in conventional commercial real estate. First, revenue depends on a payer mix—private pay, Medicare, and Medicaid waiver—where each stream carries a different rate and a different collection risk. Second, staffing ratios are state-mandated minimums, not management choices, so labor cost is largely fixed and wage pressure flows directly to coverage. Third, acuity creep over time tends to push costs upward even when census holds steady.
No. A feasibility study is an independent analytical determination of whether the evidence supports the project as proposed. It does not bind any lender or agency, and no representation to that effect is made or implied. Loan approval depends on the full credit review conducted by the lender and, where applicable, the reviewing agency.
Generally, no. SBA engagements are prepared to SOP 50 10 8 and USDA engagements to RD Staff Instruction 5001; the evidentiary standards, coverage thresholds, and required disclosures differ between programs. If a project may be submitted to more than one program, that should be identified at the outset so the study is structured to address both standards from the first draft.
Competitive supply is built from state health department licensing registries, CMS provider files, and state long-term care ombudsman reports. In rural markets where licensed capacity is limited, the analysis also examines home- and community-based waiver utilization data and any certificate-of-need filings that indicate planned additions to supply. Labor market conditions are assessed using BLS occupational wage data for the relevant nonmetropolitan area.
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Wert-Berater, Inc. is an independent provider of feasibility studies and other related services. The firm does not provide financing or equity investment advice, and does not arrange, broker, or place debt or equity capital of any kind.
All appraisal assignments are performed by Bruce E. Jones, MAI, ASA-GC, BCA, CMEA, a member of the Appraisal Institute since 2006, a staff member of Wert-Berater, Inc. and owner of Special Purpose Realty Valuation.