Welcome to Citi's 2025 Global Property CEO Conference. I'm Nick Joseph, here with Michael Griffin. I'm a Citi researcher. I'm pleased to have with us Ventas and CEO Debra Cafaro. This session is for Citi clients only, and disclosures have been made available at the corporate access desk. To ask a question, you can raise your hand or go to LiveQA.com and enter code GPC25 to submit any questions. Debbie, I'll turn it over to you to introduce the company and team and provide any opening remarks, and then we can get into Q&A.
All right, well, thank you on behalf of my Ventas colleagues and I. It's a pleasure to be here with Citi and with the investors today, so let me start off with a few high-level remarks, and we'll take it from there. So first of all, Ventas is a $44 billion enterprise value REIT focused on the longevity economy, and because of the incredible secular demand in our space, we have been delivering and hope to deliver in the foreseeable future outsize FFO, same store, and Senior Housing Operating Portfolio or SHOP NOI growth, and of course, TSR for our investors, and we've been doing that really based on a simple one, two, three strategy. And that strategy is really taking advantage of the unprecedented multi-year growth opportunity in Senior Housing.
We believe 2025 will be the fourth year in a row of double-digit same store NOI growth generated by our large and growing SHOP portfolio. The second prong of our strategy, which we executed to the tune of about $2 billion in 2024, is external growth focused on Senior Housing. There's a compelling private-to-public arbitrage opportunity that's very rare in my decades of experience in the REIT sector that's enabling us to have immediate accretion, drive enterprise growth, and accelerate deleveraging at Ventas, and we would expect from a combination of internal SHOP growth and external opportunities in 2025 that by year-end, over 50% of our NOI will come from our Senior Housing Operating Portfolio, and of course, number three is to drive the rest of our portfolio to the maximum extent of performance, so we have great momentum coming into 2025.
We recently added a dividend increase as kind of the cherry on top of this momentum that we have, and as a result, again, we're producing superior business results, growth at the top of the REIT space in both same store company growth and TSR, and we're very excited about the future as a team and ready to go after it.
Terrific. Well, we're starting off all these sessions with the same opening question. So why should someone buy Ventas stock today?
First of all, we believe that given the compelling opportunity that we have an attractive valuation, i.e., our growth prospects compared to our multiple, so we believe there's continued TSR opportunities really from that cash flow growth and from multiple. The second is really looking ahead. There is this multi-year NOI growth opportunity that is driven by compelling secular demand from a large and growing aging population, coupled with historically low deliveries and starts, and so that gives us a long runway for growth, and the third is really the advantage platform and team that gives us an incredible competitive advantage in both driving performance, making external acquisitions. We're really well positioned to succeed with experience, data, relationships, and scale.
All right. Well, I think we'll want to get into all of those, but maybe we'll start with the question I feel like we get most frequently. I think we've written before that we think Senior Housing is the best supply-demand dynamics over the next few years. We can talk about the aging demographics, the lack of supply, all of that. And the growth has been very strong. So at what point does supply become kind of the topic we're discussing right now? When does capital re-enter the space from a new construction standpoint and kind of compete away some of that growth that we're expecting over the next few years?
Yeah, sure. So this is Justin. I'm going to start by reinforcing your first point, which is the compelling supply and demand, and focus on our markets, which we've put a lot of work in over the last few years through 170 acquisitions and 100 dispositions to make sure that we're well positioned in the right markets that have 1,000 basis points of net absorption projection over the next few years. And on top of that, have over 1,500 basis points of net demand projection. So that means that certain markets would be projected to go 100% occupied. And that is going to create a compelling opportunity, not just for occupancy growth, given the fact that our U.S. portfolio is at 84% occupied, but also rate growth over time. So those fundamentals are certainly compelling. So the question around new development is the right one.
But we know today that starts at our all-time low. We have less than 1% starts in any of our markets. So we also know that the window from the time you start to finish is around three years. So if you had starts today, that would push you all the way out to 2027. We don't. So you would think it's going to come later than that. So it seems like it's more like a four or five-year window, at least. And then the follow-up question is, why is that the case? So the reason that's the case is because of a few things. One is it's just expensive to build. And even low-barrier markets such as Texas and Florida have had very high increases in land costs since the land costs are up, materials, labor, and then debt availability and costs have been high as well.
Developers are just not getting projects off the ground. And that's been slowing the start activity. And like I said, once they get started, there's a window. And then when we get to that period of 2027 and 2028, 2029, 2030, you're at a place where the step function in demand doubles again. We're adding around 400,000 a year of 80-plus-year-olds now. That will double to 800,000, 900,000 a year starting in 2027. So we are certainly well positioned from a supply-demand standpoint.
Justin, just on if development were to pencil, I mean, where would pro forma rents have to be relative to where they are now for a developer to justify that cost?
We've been talking about a range of between 20% and 50%. This is really just focused on markets where we've made acquisitions over the past year. There's quite a ways to go before the rents will be where they need to be to justify the new development.
Maybe we can turn.
The range that we've underwritten in the markets where we've made investments in 2024 was somewhere between 20 and 50 as a range, but call it 20 to 30 on average of rent growth in order to justify a 9% return.
Maybe that's a good segue to kind of our next topic, external growth opportunities. You were very acquisitive toward the end of last year with about $2 billion of deals. Guidance for 2025 includes a line of sight to an additional $1 billion in the first half of the year. Maybe just talk about the competitive set and opportunities that you're looking at from an acquisition standpoint. Justin, it seems like these are properties with occupancy in the low 90s, but really you have a lot of pricing power and operating leverage as that occupancy increases.
Yeah, so starting with what we're buying, we're buying properties that are over 100 units in size. We've been averaging about 130 units on average. They're in markets that have strong net absorption and strong affordability. Usually, the operator's staying in place because we're buying a high-performing asset that's a proven market leader with a strong track record and in markets that have a tailwind that supports more occupancy growth and pricing power and in an asset that's already established with a positive track record, and we were able to, with that criteria in mind, plus buying below replacement cost, complete $2 billion of acquisitions last year. We have line of sight on another $1 billion that are front half of the year loaded, same criteria. 7 to 8-year one unlevered IRRs are low to mid-teens.
So the returns have been attractive, and it's a unique opportunity, like Debbie described, where we can have high yield and growth, and we're buying assets that will deliver growth. There's a long way between 90% and 100% occupied, and the pricing power is compelling as well as the occupancies get higher. The pipeline has been busier throughout last year and into this year. So we have plenty of opportunities under review.
Maybe can you talk a little bit about the competitive set, who you might be competing with on deals, who buyers or prospective sellers are? Anything on the transaction side there would be helpful.
Right. I mean, go ahead.
Well, I do want to emphasize that we have many significant competitive advantages in the investment market. And those include some I mentioned before: the experience team, the scale, the operator relationships, the data. And so we're using those competitive advantages where we see an asset that's right for us and our shareholders and delivers the kind of financial and operational qualities that Justin described. And in those cases, I would say our success rate is very, very high. So we have the flexibility, the capital access, etc., to be able to win those deals that we think are appropriate to win. So why don't you just talk about kind of what?
Some of the food groups.
Some of the food groups who are selling.
Some examples. A good question, kind of related question is, with the fundamentals are so good and these assets are delivering such good results, why would you sell it? There's several reasons. One is that maybe the holder had a three-year to five-year time horizon in mind to hit their targeted returns. It could have been slowed down by the pandemic era. They've been ready to sell, but they've been waiting for NOIs to get to a level where they can get out at a reasonably good price. That's created a good opportunity for us because we're hitting their mark, but we're hitting a yield and a growth opportunity for us that's really attractive. Other examples would be the fact that there's been a lot of debt maturities. We have a debt maturity peak in 2025. It was high in 2024.
It's peaking in 2025. It's also high the next two years. And although it's not a stress asset class, and although lenders have been friendly and working with operators and owners, it does create a decision. And the decision is, do we recap, refi, do we sell the asset? So that's generating activity. Sometimes there's an owner-operator that they've grown their company through friends and family equity, and they'll have a variety of different capital stacks in each asset. And when we get to a certain scale, they're ready to clean that up. And a buyer like us can help do that. And that's been an opportunity. And then just the classic, I mean, certain PE sellers are actually spot on where they want to be. They're three years in, they're four years in, and they're ready to exit. And that's another example.
On the other side, when we're competing for acquisitions, like Debbie said, I mean, we have a high success rate of delivering on opportunities that we think are right for us. Pipeline was $18 billion in senior housing last year. We pursued $5 billion. We landed $2 billion of that, and where we're not delivering, sometimes there's, I mean, it's PE, sovereign wealth, it's insurance. I mean, it's the classic food groups you would expect to see targeting the space.
Justin, you touched on kind of lender appetite and debt maturities upcoming. Is there more interest from debt capital in Senior Housing? Are lenders more willing to lend on it, or are they still pretty apprehensive?
Lenders are typically a lagging indicator, and so I would say it's going to take some time before lenders really get super active in the market for anything other than primo-primo deals that clearly cover and have been very stabilized for a long time, so that's going to take a little bit, even on operating assets, let alone development.
Maybe we can switch over to internal growth opportunities. You've been able to leverage your Ventas OI platform, whether it's through data analytics, best practices with your operators to help improve and increase NOI margin expansion and ultimately drive earnings growth. So Justin, maybe you can walk us through some of the processes you use in order to optimize the portfolio and really get the benefit from this internal growth that we're seeing right now.
Right, so the Ventas OI , broadly focuses in three areas. The first area is markets. I described that earlier, ensuring that we are in the right markets. And we've had a lot of actions around on the asset management side to position the platform. And when we're making decisions around transitioning, for instance, from triple-net to SHOP, the market is a critical aspect of that decision. The analytics help us to get down to a very granular level to make that determination that it's going to be a market that's going to deliver near, mid, and long-term for us. The next area is really the asset, and the asset within the market needs to be well positioned. That's led to investment into the assets over time. We've had 230 that we've completed at the end of the year.
We have another 50 or so that we're going to complete before the key selling season this year. And if you can get those two right with all the analytics supporting and experience supporting those decisions, the market and the asset, then the operating side is going to be a lot easier to deliver. And the next really big decision we make is who should operate. And that decision is a lot easier when you have something like an acquisition that has a high-performing asset. A lot of times when we've been transitioning from one structure to the other, from the triple- net to SHOP, we've been changing the operator. We have a lot of experience with this now as we've transitioned over 150 communities to new operators. So we know who can deliver in which markets and which asset classes, and we have a lot of confidence around that.
So that's the big broad strokes. And then when you get into some of the examples around overseeing the operating platform, we're particularly strong in a few areas. One is market analysis. And that's giving insights into some of which I described, just where to invest and when, and also the competitive set within the markets. And the next area is pricing. And this is in a sector that has very little to no price transparency, but is certainly price sensitive. So having all the different data sources we have to get to the community level, by unit, and within a market, to be able to give advice to our managers in terms of where to set pricing and where the opportunity is to really drive price and volume together because occupancy is leading the way, and we have price opportunity as well.
So we're trying to move the two together through our analytics. And analytics are one thing, but you also have to have the platform to deliver on those. And that's a real powerful aspect of this where we have operating experience within our team, and we have boots on the ground in our communities actually delivering on our insights. We've had 150+ site visits already year to date in our communities. And that's really designed to be a collaborative partner with our operators to take action. And we walk in the door with answers, not questions, in terms of where we see the opportunity. And then we help to guide the strategic direction of the communities and with our operators.
Justin, how do you balance the prospect of pushing on renewals versus worrying about maybe pushing too aggressively? And then is there more of a mark-to-market opportunity as a new resident comes in with that turnover versus on the renewal side?
Well, so all of our pricing is underpinned by our analytics. And so we have a good feel for the marketplace. We get down to the particular unit level and what the price history has been in that unit over time. We know the market pricing. We know vacancy timing. We know everything you could possibly know about the unit when we're making a decision. And we've had good success in actually delivering increases. We've been around 7% on a blended basis each of the last two years. And there's been a different inflationary environment that the two years we're facing. So I think we've delivered good results in terms of in-house pricing. And that's with an occupancy that's still relatively low because of all the actions we've taken to bring in lower-occupied communities into our portfolio.
And then from the street rate standpoint, we have really good data to make sure that as we make decisions, that we're not making a decision around price that slows down volume. We want volume and price to move together. And we're having success there. And I think what you'll see over time as occupancies grow and demand picks up in our markets is that there'll be rev core opportunity over time over the upcoming years because we'll have a stronger connection between in-house and street rate growth. And that's a big area of focus for us.
Is there a worry that changes in immigration policy could impact your business from a labor or wage pressure perspective?
All of our business uses documented workers. From a direct standpoint, we would expect to have virtually no impact on our operating business. It's very early to see how the new policies are going to ripple through the economy, but we would believe that there are other sectors, both inside and outside of real estate, that would have a much bigger impact because they use a relatively high proportion of undocumented workers like construction or certain restaurant businesses, for example. The labor market right now has been very constructive in our business.
Yeah, we've actually had, I mean, I'd say it's probably the best we've seen in terms of just positive hiring. We've had, I mean, two years in a row of strong positive net hiring. And the conditions on the ground are very favorable right now from a labor standpoint.
Are you seeing any changes in turnover on the labor front, obviously from your operators, but I feel like we're getting a lot of questions outside of Senior Housing, but just broadly on what's happening in the economy and on maybe the lower-skilled labor side and that side of the consumer? Is there anything that you're hearing from the operators that is different than what you've seen over the last 12-24 months?
Yeah. And I would point to the conditions being good from a macro standpoint. So the employers are in a stronger position because we have people at our doorstep interested in jobs. And so that means that it's more competitive. The labor market's more competitive. But there's another area I'll point to as well. And that is that over the past few years, our operators have had this incredible internal focus on operations. And the reason for that was help with the external environment. There's not a lot of activity. Like we've talked about before, there's not new developments. Operators are expanding, but usually it's been capital player-driven like us as we've brought in new managers from time to time. And so therefore, the operating best practices has been an area of fo cus, I think, with a level of intensity that I've never seen in my career.
And what that's led to is enhancing the use of tech in our settings, including on the care delivery side and from the standpoint of just managing sales and revenue management. And then particularly on employee relations focus as well. So in that hiring practices is a big focus. Employee retention has always been a focus. And the operational excellence has been improving. And I think a lot of that's a result of the conditions and the area of focus that the operators have had.
I think in your investor presentation, you announced a pending sale of some Pennsylvania SNF assets for around $150 million, which I think lowers exposure, I guess, or creates exposure over 99% to non-SNF. So can you just, I know you've exited that business before. This is kind of the final exit. Can you just talk about kind of that decision, the pricing you're getting there, and how that sets up Ventas going forward?
Yes. And I would tell you that we're really just doing what we said. I mean, our strategy starting in 2016 was to exit SNFs. I think there are some peers who do a very good job with the asset class. However, in my experience, I always say SNFs ebb and flow, but they flow a lot less than they ebb. And so it's just a business that we think is better left to others. And right now, of course, there's federal policy risk around that asset class. So whenever we occasionally get a SNF over the transom, as we did a couple of years ago, we work to optimize the disposition of those assets. And in this case, we've disposed of $300 and something million at a gain and about a 10% cap. And we're really focused on the SHOP business, both internally and externally.
That's really going to be the dominant theme in our company.
What's left there?
What's left?
Yeah. It said 99%. I mean, I know that's everything, but what's left?
A little bit of Genesis.
Okay. And that will eventually be.
There's maybe a few others.
Okay. And then.
About 1%.
And then you mentioned, obviously, the government role in there. You have the R&I platform. I know there's some potential changes with how grants exist, particularly on the higher education side, trying to cap out the percent of the grant that, I guess, does not go directly to the work being done. How does that impact your R&I business, potentially?
Yep. So the U.S. is a global leader in biomedical research. And I would say to all of us, we want to keep being that. And at Ventas, maybe mid-single digits of our NOI on a consolidated basis come from our research portfolio. And it is really a top-flight portfolio anchored with the leading educational and research institutions in the United States. The WALT, or Weighted Average Lease Term for the leases with our university partners in those businesses, is over 10 years. So it really gives us a nice bridge as we look to whether there could be any NIH impact from the executive order, which so far has been stopped and halted, right, because the dollars are still flowing. These institutions are committed to doing cutting-edge research. I think they're going to continue to be so committed.
And in most of the cases, you would see these universities having extraordinarily large multi-billion-dollar research spends per year. And typically, the NIH grants are a minority of that overall budget. And within that, if there's a cap on indirect costs, that's a minority of a minority. So at the end of the day, while it would be, we believe, manageable for most of those institutions, and there could be upside in a sense that most of these leading research universities want to build buildings. And that's very expensive, as you know. So I've really challenged the team to really start thinking about how we could instead go to these universities to lease space, which is a less costly alternative while this uncertainty exists. So it could turn out to be an opportunity for us.
Mostly, I just would advocate for continued federal funding of this very, very important part of the U.S. economy.
You mentioned the excitement is on the Senior Housing, the SHOP side. Is that where every incremental dollar really should go right now? Is R&I interesting? Are MOBs interesting? Or is it all about Senior Housing?
Yeah. I mean, we are really leaning into the one, two, three strategy. It started a year and a half ago or more. We saw these unprecedented compelling opportunities. We would expect that our capital allocation priority is in Senior Housing because it provides the highest growth and returns on a multi-year basis going forward.
I think you mentioned, I think, in your opening remarks or maybe to the first question of why someone should buy your stock, you mentioned valuation. Part of that, obviously, is absolute. Part of that is probably relative to your most direct peer. Look, the stock has done very well last year. The stock has done well this year. Obviously, the growth has been there too. But as you maybe trade at a higher and higher valuation, how does that change what you do on the capital allocation side?
Sure. Well, I'll underscore the opportunity, which first and foremost, as we think about TSR, is earnings growth. So our guidance this year is 7% FFO growth. That if you rack and stack across REITs, is up there among the top tier of REITs. And that is a secular, durable trend, multi-year opportunity. You look at property growth, our total portfolio property growth led by SHOP last year was in the top four of all REITs in the fourth quarter. And again, we expect that to continue.
8%. Yeah.
Nearly 8%, right? So the earnings growth opportunity is a multi-year opportunity. When you look at the multiple relative to that growth and racked against other REITs, I would suggest the multiple opportunity is there as well. We are growing faster than other REITs at the same multiple. Therein lies an opportunity, and then finally, importantly, dividend as a contributor, we added 7% this year in terms of increase, so all three of the TSR components are there, and again, I think highly differentiated, so we're going to keep running the same strategy. It's working, and we see multi-year growth opportunity ahead.
I guess the question was, if you're trading at two turns, three turns higher than where you are right now, how would you operate the business differently? I mean, it's really an external growth question, but are there deals you're passing on because of your current valuation?
Look, we've been clear on what we want to buy, and so I think the short answer is no. It may open the aperture of more opportunity, but given the returns and the risk-reward trade-off, we're going to continue doing what we're doing.
We'll take the two or three turns, though.
Sure.
Bob, as you think about funding needs for external growth, obviously, you've done a good job with the balance sheet. The leverage level is in line with kind of where your sweet spot looks to be. But from a sources and uses standpoint, is equity still attractive right now? Would you look to raise debt if it made sense? How do you kind of weigh those opportunities versus the yield you get on acquisitions?
Right. Well, we've been able to use equity to fund investments while delivering accretion from the beginning, expanding our participation in Senior Housing and accelerating the growth through the enterprise and accelerating deleveraging. So all three things at the same time. That's a unique opportunity. While those conditions continue to exist, we're going to do that. We clearly are creating debt capacity the more we grow. And the organic growth opportunity is the engine of that. And so certainly, debt is on the table. But again, run the playbook. It's working.
And Debbie, I know you touched briefly on the regulatory environment and how it is shaping up for SNFs. Obviously, SHOP is not as regulated an environment as SNFs. But are there anything from a public policy perspective that you're keeping an eye on or engaging with key public stakeholders in various different ways?
As everyone knows, SHOP is a consumer-driven business. And residents pay sort of out of pocket. And the business is not federally regulated to the extent there is regulation. It's a state-by-state analysis. And so we're very conscious that we, in collaboration with our operators, are giving residents and their families good value for what they're paying and that we can justify the strong pricing power that we have. And more than some other sectors in the real estate space, we are careful about how we describe what we're doing, why we're doing it, how we approach the customer with significant year-over-year rent increases and so on. And so there's just a different culture around the description of rate growth and pricing power that we bring to bear. And we're very conscious, again, that we're bringing the value proposition to the resident and their families.
We're running up on time here. I've got a couple of rapid fires to end the session. First one, what is your expectation for same-store growth for the SHOP industry overall, so not Ventas specifically, in 2026?
I never answered that question, but this year, I've kind of already answered it. I will repeat. There is, for the foreseeable future, incredible tailwinds in Senior Housing from secular demand that's strong and getting stronger and historic lows in starts and deliveries. We see a great runway ahead.
Will there be more, fewer, or the same number of publicly traded healthcare REITs a year from now?
I would say the same because right now, this private-to-public arbitrage opportunity that is unique and powerful is in full swing, and I think that will be the priority for the companies.
A special one for you, Debbie. Over or under nine wins for the Steelers this season?
Never a losing season, said Mike Tomlin.
All right. Thank you so much.
Thank you very much.