Healthcare and senior living are moving towards the mainstream of institutional real estate investment, supported by a structural imbalance between an ageing population and the supply of suitable accommodation and care. Yet translating that need into a viable investment market remains a complex undertaking, requiring a closer integration of property, operations and social infrastructure.
These were central themes of an Investor Talk conducted by Iberian Property at BARCELONA CATALONIA stand during Expo Real, bringing together Prof. Scott L. Eckstein, Managing Director at Active Living International, and Yeliz Bicici, Chief Operating Officer at Aedifica, to examine the evolution of senior living in Europe and whether Catalonia could become a benchmark market for the sector in Southern Europe.
The scale of the challenge is particularly apparent in Spain, where the country faces a shortfall of nearly 100,000 care beds. Demand extends beyond traditional nursing homes to include assisted living, retirement communities and housing that allows older people to retain their independence for longer. For investors, this creates the prospect of a long-term development pipeline, but one that requires careful alignment between local needs, affordability and the capacity to operate facilities effectively.
Professor Eckstein, who began developing assisted-living accommodation in Brooklyn in 1996, brought a perspective shaped by the evolution of the US market. His central warning was that developers must understand their future residents before designing a project. Without that understanding, the result can be a mismatch between the building, the price point, the needs of the target population and the capabilities of the operator. In a sector where the quality of the service is inseparable from the quality of the accommodation, an unsuitable building or an inadequate operating partner can undermine the investment regardless of demographic demand.
Yeliz Bicici drew attention to the institutionalisation of healthcare real estate in Europe, where Aedifica has built a substantial specialist platform. Following its merger with Cofinimmo, completed in 2026, the combined group has approximately €12 billion in assets under management, reflecting the scale that the sector has achieved at the European level. In Spain, Aedifica’s portfolio could reach around €650 million in assets by the end of 2026, subject to some of the company’s completions being realised still during the last quarter.
However, the maturity of the market varies considerably across Europe. Established healthcare investment markets such as the UK, France and Germany can offer longer lease structures, in some cases extending to 30 years, while Spanish agreements typically fall closer to 15 years. This difference matters for investors seeking long-term income visibility and confidence that an asset can be maintained and adapted throughout its lifecycle.
Bicici stressed that underwriting a healthcare property requires a detailed assessment of the operator’s experience, financial stability and ability to deliver the service. The physical building remains important, but the operational business is often the more decisive factor, "which I understand can be odd to advocate so strongly given that we do not operate the assets ourselves...still, in the previous years leading Cofinimmo activity I would personally visit each asset before handing over the keys to the operator". Staffing, fees and affordability can determine whether a facility succeeds, particularly outside more affluent areas. A market may have a clear need for additional beds, but that need does not automatically translate into sufficient purchasing power or a sustainable operating model.
The relationship between real estate and operations also has implications for building design. Eckstein highlighted the importance of considering how facilities can make care easier to deliver, from layouts that support staff and residents to technology that improves safety and day-to-day management. Temperature monitoring, fall-detection systems, devices that monitor residents’ vital signs or even sensors that prevent taps from causing flooding were all highlighted examples of how they can all form part of a more responsive environment. Such measures need to be considered alongside the needs of residents and staff, rather than introduced as technology from a pure premium valuation measure.
There is also a reputational dimension that distinguishes senior living from many other property sectors. Residents and families are placing their trust in an environment that must provide both accommodation and care. This makes the quality of the operator, staff training and the suitability of the building central to the long-term performance of an investment. Bicici also emphasised the need for a long-term ownership perspective, allowing investors to allocate capital expenditure over time and prevent properties from becoming obsolete as standards and care requirements evolve.
That question of obsolescence is particularly relevant in Barcelona, where land scarcity makes the redevelopment of existing buildings an important consideration. Yet Eckstein cautioned against assuming that refurbishment is always the best solution. Depending on the location and condition of an asset, demolition and new construction may provide a more appropriate environment for residents and operators than trying to adapt a building that was never designed for this purpose.
For the sector to develop at scale, however, better buildings and stronger operators will not be enough. Eckstein argued for independent and transparent sources of market intelligence and benchmarking, drawing on the model of the US National Investment Center for Seniors Housing & Care. More consistent data on operational performance and resident outcomes would help investors and policymakers distinguish between business models that work and those that struggle, reducing uncertainty in a market where comparable information remains limited.
Financing and regulation also influence how quickly markets can mature. As Bicici noted, the availability and structure of funding, including the way care services are financed, vary between countries and affect the pace at which business models consolidate. Greater regulatory clarity, stronger operator platforms and deeper institutional liquidity would help create a more scalable investment environment, particularly in markets where demand is evident but the supporting ecosystem is still developing.
For Catalonia, the healthcare sector is especially relevant given that a new biomedical hub forms part of the major transformation plans taking place at the region: the Campus Clínic project will relocate and expand the historic hospital complex into a much larger biomedical district designed to host hospitals, research centres and innovation companies. The first development phase will transform approximately 10 hectares, while the broader project could extend across up to 60 hectares spanning three municipalities within the metropolitan area. An international architectural competition will soon define the design of the campus, with construction expected to begin around 2030 and completion targeted for 2035.
Ultimately, the discussion at Expo Real pointed to a sector whose investment case extends beyond the conventional relationship between supply and demand. Senior living requires patient capital, specialist operators, suitable buildings and a more transparent understanding of operational performance. As Europe’s population ages, the need for these environments will become more pressing. The opportunity for investors lies in building models that can meet that need sustainably, rather than treating demographic growth as a guarantee of returns.
