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.
Skilled nursing is census-and-acuity underwriting under the industry's heaviest regulatory and reimbursement frame: certificate-of-need posture where applicable, state Medicaid rates that set the floor for most beds, Medicare post-acute volume that carries the margin, and a staffing mandate environment that has repriced the expense base. The study sizes demand from the 75-plus population and hospital-discharge patterns, models the payer mix bed by bed, and tests the labor build against the market's actual wages and the ratio requirements in force — because in this category the expense side fails projects more often than the census does.
Census modeling from demographic and referral data, payer-mix yield with Medicaid, Medicare, and managed-care rates stated separately, labor builds at mandated ratios and market wages with agency-staffing reality included, and survey-history review of the operator as core management diligence.
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. The category spans HUD-insured, USDA, and conventional structures; operator capability and regulatory standing weigh decisively in every program's review.
The firm's senior-care record — assisted living, memory care, and CCRC analysis — extends directly into the skilled-nursing reimbursement frame. 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 skilled nursing facility feasibility study is not a repurposed senior-housing template. The scope is built around the reimbursement architecture that governs SNF economics: a bed-by-bed payer-mix model, a staffing build that reflects mandated nurse-to-resident ratios, and a survey-history review that treats the operator's regulatory record as a credit variable. The narrative addresses certificate-of-need status where the state requires it, because CON posture determines whether new beds can be licensed at all — a threshold question that precedes every financial projection.
Each element is integrated into a single bound narrative so the lender reads one coherent document, not a collection of appendices.
Demand for skilled nursing beds is not read from a single population table. The analysis triangulates three distinct data streams: demographic aging curves, hospital-discharge volumes, and competitive-supply counts — and each stream requires its own sourcing discipline.
Demographic data draws from the Census Bureau's American Community Survey and county-level population projections published by state demography offices, isolating the 75-plus cohort because that age band drives the overwhelming share of post-acute admissions. Hospital-discharge patterns are sourced from state all-payer claims databases and Medicare Provider Analysis and Review files where accessible, identifying the volume of short-stay post-acute discharges originating within the facility's defined draw area.
Competitive-supply work uses state health department licensing registries to enumerate every licensed SNF bed within the primary and secondary service areas, including beds that are licensed but not staffed — a distinction that matters because unlicensed capacity can re-enter the market without a CON proceeding. State CON office dockets and public-comment filings are reviewed for pending applications that would add supply before the subject facility reaches stabilized occupancy. Medicaid cost reports filed with CMS provide occupancy and payer-mix benchmarks for existing operators. The synthesis produces a net-available-bed count and an absorption schedule that the financial model consumes directly, so the demand assumption and the revenue projection are arithmetically connected rather than stated separately.
In skilled nursing underwriting, the expense side fails projects more often than the census does — a pattern that distinguishes this asset class from most other healthcare real estate. Four inputs move the coverage ratio decisively, and each is tested under explicit stress scenarios rather than held at a single point estimate.
Every assumption is documented with its source so a reviewing agency can audit the input, not just the output.
SBA, USDA, and conventional lenders each bring a distinct review lens to skilled nursing transactions, but they share one concern: the reimbursement frame is set by government programs that can change rates, add conditions, or suspend payments without the borrower's consent. The feasibility study must demonstrate that the project survives plausible adverse scenarios in each program, not merely that it pencils at today's rates.
SBA engagements prepared to SOP 50 10 8 must demonstrate 1.15x operating debt-service coverage and 1.00x global coverage. For SNFs, the SBA analyst will scrutinize whether the Medicaid rate assumption is current and whether the labor build reflects the actual wage environment — not a pre-pandemic baseline. USDA Business & Industry and Community Facilities engagements under 7 CFR Part 5001 place additional weight on community need, which in a SNF context is documented through bed-need analysis and hospital-discharge data. USDA also examines operator experience and financial capacity as conditions of guarantee eligibility.
Conventional lenders typically require 1.20x coverage and give significant weight to the operator's Five-Star Quality Rating, survey history, and existing portfolio performance. HUD-insured structures add a separate layer of review through the Section 232 program, where the lender's feasibility study must align with HUD's own underwriting templates. In every program, operator regulatory standing — licensure, survey results, and any enforcement actions — weighs as decisively as the financial projections themselves.
The engagement begins with a fixed fee quoted within one business day of inquiry. No fee is contingent on the finding, and the determination is not revised under pressure — the fiduciary duty runs to the lender and the reviewing agency. The quote is based on project scope; there are no hourly overruns once the engagement is underway.
Delivery runs 10 to 15 business days from a complete data room. For SNF engagements, a complete data room includes the operator's most recent three years of audited or reviewed financial statements, the current state survey history and any enforcement correspondence, the proposed staffing plan with wage assumptions, executed or draft management and lease agreements, and the lender's term sheet or loan parameters. Rush delivery is available when the lending timeline requires it; the scope does not change, only the scheduling priority.
Upon completion, the bound narrative report and the fully linked Excel model are published to a secure client portal. The model remains live: a credit officer can change any input — occupancy rate, Medicaid rate, wage rate, interest rate — and every downstream output recalculates instantly. No values are hardcoded. This architecture matters in SNF underwriting because rate and staffing assumptions are frequently updated between the study date and loan closing, and the lender needs to confirm that the coverage ratio holds under revised inputs without commissioning a new study. The portal access persists through the lender's review cycle.
The fee is fixed and quoted within one business day of inquiry. It does not vary with the loan amount or the finding, and no portion is contingent on a positive determination. Because SNF studies require a payer-mix model, a staffing build at mandated ratios, and an operator regulatory review, the scope is more involved than a standard commercial real estate study; the quote reflects that additional work.
Standard delivery is 10 to 15 business days from receipt of a complete data room. Rush scheduling is available when a lending deadline requires it. The clock starts when the data room is complete — operator financials, survey history, staffing plan, and lender parameters — not when the engagement letter is signed. Incomplete submissions are the most common cause of delay.
Three factors combine in SNFs that do not appear together elsewhere: Medicaid sets the rate for most beds and can be changed by legislative action; federal and state staffing mandates establish a labor floor that cannot be reduced to improve coverage; and the operator's survey and enforcement history can trigger payment suspension independent of financial performance. The expense side fails SNF projects more often than the census does.
Yes, where applicable. Roughly half of states retain active CON programs for skilled nursing beds. A study prepared for a lender must address whether new beds can be licensed, whether competing applications are pending, and what the timeline to licensure is. In CON states, a favorable demand analysis is necessary but not sufficient — regulatory approval is a separate threshold the project must clear before construction financing closes.
At minimum: three years of audited or reviewed financial statements for the operating entity, the current state survey history including any Statement of Deficiencies and Plans of Correction, documentation of any Civil Money Penalties or enforcement actions, the proposed staffing plan with wage assumptions, and any executed management or lease agreements. Lender parameters — loan amount, structure, and coverage standard — are also required at the outset.
The fully linked Excel model is published to a secure client portal and remains live after delivery. A credit officer can revise any input — interest rate, Medicaid rate, wage rate, occupancy assumption — and every output recalculates without hardcoded overrides. If the scope of the underlying study changes materially, a supplemental engagement may be required; for parametric changes within the original assumptions, the live model handles the revision directly.
Qualify a project. Tell us about the project and the program. We will tell you the truth about it — scope, timeline, and fee confirmed before work begins.
Schedule a Zoom Call →Legal disclosure. Wert-Berater, Inc. offices are mailing addresses only. Following the COVID-19 pandemic the firm has elected to work remotely; its office locations receive mail and are not staffed for visitors or in-person meetings. Headquarters mailing address: 1968 South Coast Hwy, Ste 2382, Laguna Beach, CA 92651.
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.