Due Diligence Guide · Memory Care Facility

Due Diligence Guide for Acquiring a Memory Care Facility

A structured checklist for buyers evaluating licensed memory care operations between $1M–$5M in revenue, covering regulatory compliance, census quality, staffing, and real estate.

Find Memory Care Facility Acquisition Targets

Acquiring a memory care facility requires deeper scrutiny than most lower middle market deals. Beyond standard financial review, buyers must assess state licensing status, survey deficiency history, dementia-specific staffing certifications, resident acuity levels, and physical plant safety compliance before committing capital.

Memory Care Facility Due Diligence Phases

01

Phase 1: Regulatory and Licensing Review

Validate the facility's legal right to operate and identify any compliance risks that could disrupt licensure, trigger sanctions, or affect Medicaid provider agreements post-close.

State Operating License and Survey Historycritical

Request current license, all state survey reports from the past five years, and any corrective action plans. Flag Class A deficiencies, immediate jeopardy citations, or pending enforcement actions.

Medicaid Provider Agreement Statuscritical

Confirm active Medicaid certification, provider number, and enrollment status. Determine whether a stock or asset purchase is required to preserve existing agreements without re-enrollment delays.

Certificate of Occupancy and Zoning Complianceimportant

Verify the facility holds a valid certificate of occupancy for memory care use and that local zoning permits continued residential care operations at the licensed bed count.

02

Phase 2: Financial and Census Analysis

Evaluate revenue quality, occupancy trends, and payer mix to confirm sustainable cash flow and assess exposure to Medicaid rate risk or census volatility.

Payer Mix and Average Daily Rate Breakdowncritical

Obtain monthly census reports showing occupancy, private-pay percentage, Medicaid census, and average daily rate by payer type for the trailing 24 months. Target 50%+ private pay.

Revenue and EBITDA Reconciliationcritical

Review three years of accrual-based financials with a detailed add-back schedule. Recast owner compensation, personal expenses, and one-time costs to confirm normalized EBITDA between $300K–$1.5M.

Move-In and Move-Out Trend Analysisimportant

Analyze monthly admission and discharge data to identify census stability, seasonal patterns, or accelerating move-outs that could signal care quality concerns or competitive displacement.

03

Phase 3: Operational and Physical Plant Assessment

Assess staffing quality, resident liability exposure, and facility condition to identify hidden capital requirements and transition risks before finalizing deal structure.

Staffing Ratios, Certifications, and Turnover Ratescritical

Review staff schedules, dementia-care certification records, and trailing 12-month turnover data. Identify any positions relying on agency labor, which inflates costs and signals retention problems.

Resident Care Agreements and Litigation Historycritical

Review all signed care agreements, rate schedules, and any resident or family complaints, grievances, or litigation filed in the past five years, including elopement or fall incidents.

Physical Plant Condition and Life Safety Complianceimportant

Commission an independent property inspection covering HVAC, sprinkler systems, emergency call systems, secured egress points, and dementia-specific safety features. Quantify any deferred maintenance or required capital expenditures.

Memory Care Facility-Specific Due Diligence Items

  • Confirm all dementia care programming materials, activity therapy schedules, and any proprietary cognitive engagement curricula transfer with the business at closing.
  • Verify that secured perimeter systems, wander guard technology, and elopement prevention protocols meet current state standards and have been tested within the past 12 months.
  • Assess the referral pipeline by reviewing admission source data, relationships with hospital discharge planners, neurologists, and elder law attorneys that drive consistent census growth.
  • Evaluate long-term care insurance billing procedures, outstanding claim reimbursements, and any payer disputes that may represent off-balance-sheet receivables or write-off risks.
  • Review administrator licensure, tenure, and willingness to remain post-acquisition, as state regulations require a licensed administrator on record and transitions can trigger regulatory scrutiny.

Frequently Asked Questions

Is a stock purchase or asset purchase better for acquiring a memory care facility?

Stock purchases preserve Medicaid provider agreements and existing state licenses but carry more liability. Asset purchases are cleaner but may require re-enrollment and new license applications, causing operational delays.

What occupancy rate should I require before making an offer on a memory care facility?

Target facilities with trailing 12-month occupancy consistently above 75%, ideally 85%+. Occupancy below 70% significantly compresses margins and may indicate referral pipeline, care quality, or market positioning problems.

Can I use SBA financing to acquire a memory care facility?

Yes. Memory care facilities are SBA 7(a) eligible when structured as an operating business acquisition. SBA financing can cover goodwill, equipment, and working capital, with sellers commonly carrying 10–15% to meet injection requirements.

How do state survey deficiencies affect my acquisition valuation?

Class B deficiencies with resolved corrective action plans have limited impact. Class A deficiencies, immediate jeopardy citations, or open enforcement actions materially reduce valuation and may make lender financing unavailable until fully resolved.

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