Greystone has a long history of financing healthcare projects, and we admire the commitment providers have for their communities. They face unique challenges, and we understand that from our experience working with owners and operators of skilled nursing, assisted living, independent living, supportive living, and memory care facilities. We are committed to providing our clients with optimal financing solutions so they can achieve their goals and focus on providing quality care for their residents.
The Greystone Advantage
Case Study
THE SITUATION
A modern Texas SNF had strong operations but was leaving significant HUD loan proceeds on the table until Greystone stepped in with both a financing solution and active policy advocacy.
This 104-bed skilled nursing facility in Texas built in 2019 and operated by Creative Solutions in Healthcare needed acquisition financing. The asset was modern, purpose-built, and performing well: occupancy was improving, expenses were stable, and revenue was supported in part by Texas' Quality Incentive Payment Program (QIPP).
The challenge: traditional HUD underwriting wasn't fully capturing the facility's QIPP income, which compressed proceeds and limited what the acquisition financing could achieve. The sponsor needed a lender who could deliver near-term execution certainty while positioning the asset for optimal long-term financing.
THE SOLUTION
Greystone originated a $17,000,000 bridge loan to finance the acquisition, structured specifically to facilitate a seamless transition to HUD-insured permanent financing under HUD 232.
Beyond the capital, Greystone engaged directly with HUD to advocate for updated QIPP underwriting treatment pushing for a methodology that more accurately reflects the revenue's consistency and quality-driven nature.
This bridge-to-HUD approach is central to Greystone's integrated lending platform: borrowers get near-term execution certainty and a clear, coordinated path to permanent financing without switching lenders mid-process.
THE RESULTS
| OUTCOME | DETAILS |
| Acquisition Financing Closed | $17.0M bridge loan |
| HUD Proceeds Increase | 20% higher than prior underwriting |
| Driver | Updated QIPP income recognition |
The updated QIPP underwriting is expected to increase HUD loan proceeds by approximately 20% unlocking meaningful additional capital for reinvestment in staff, operations, and continued quality of care.
For the operator, the outcome is a stronger capital stack, improved long-term financing terms, and a clear path to maximize the asset's value in a growing Texas market.
We saw a disconnect between how these assets were being underwritten and the real performance driven by QIPP. Our role was to advocate for a more accurate approach, one that reflects the stability and impact of these programs today. By working collaboratively with operators and HUD, we were able to help drive changes that increase proceeds and better align financing with the realities of the market. This is exactly the kind of strategic partnership we aim to bring to every client relationship.”
Christopher Clare
Senior Managing Director, Greystone
THE SITUATION
The borrower sought acquisition financing for a 210-bed skilled nursing facility in Virginia. The property offers specialized care services and modern amenities, positioning it as a high-quality healthcare asset in a competitive market. The borrower required a flexible financing structure to facilitate the purchase while preparing for a long-term HUD execution.
THE SOLUTION
Greystone provided a $33,900,000 bridge-to-HUD loan to support the acquisition. The interest-only financing carries a 24-month term with two 6-month extension options and a floating interest rate. An interest rate cap was secured to mitigate exposure to market volatility while maintaining flexibility during the bridge period.
Due to strong credit metrics and a longstanding relationship with a repeat borrower, Greystone was able to provide 97% loan-to-cost (LTC) financing. Furthermore, by assisting the borrower in renegotiating the purchase and sale agreement (PSA) with the seller and employing creative structuring, the borrower was able to acquire a second asset at a significant discount.
THE RESULTS
The bridge loan enabled the borrower to complete the acquisition quickly while maintaining a clear path to long-term HUD-insured financing. The structure provided the necessary capital to stabilize operations and optimize performance ahead of the planned permanent takeout. By combining speed, flexibility, and rate protection, the financing supported the borrower’s growth strategy in the skilled nursing sector and strengthened the facility’s position for future success.
This financing is a testament to Greystone’s commitment to delivering tailored solutions that support our clients’ growth strategies in the skilled nursing sector."
Christopher Clare
Senior Managing Director, Greystone
THE SITUATION
Our client recognized the need for quality Memory Care & Assisted Living services in the south shore of Long Island with a vision to repurpose the Gulden’s (Mustard) family summer homestead into a premier facility. They were in search of new construction financing to develop a project that would provide high leverage debt at low interest rates. The market dynamics posed a challenge as their timing unintentionally coincided with the covid pandemic outbreak in New York. As risk factors rose, construction lending became scarce with limited options.
THE SOLUTION
The FHA 232 loan was the solution for this project, providing construction-to-long-term permanent financing with favorable terms. It enabled the transformation of this historic site into an assisted living and memory care community that preserves the mansion’s architectural integrity and introduces 72 specialized rooms with innovative Montessori-based therapies. This approach provided funding for a state-of-the-art facility and ensures that residents enjoy a connection to the property’s rich history as well as a beautiful marina and oceanfront views just minutes away.
THE RESULTS
Netherbay is emerging as a landmark healthcare development project, redefining the landscape of senior care on Long Island’s beautiful Bay Shore. Greystone’s guidance in the application and financing process played a pivotal role in helping realize the client’s vision. The community will provide an exceptional care option that supports seniors with memory conditions in a facility designed to foster dignity, comfort, and a sense of belonging.
Our partnership with Greystone was instrumental in bringing our vision to life for Netherbay. Their expertise in securing HUD financing ensured we could transform a historic site into a state-of-the-art memory care community. Thanks to their guidance, we’re creating a landmark development that offers innovative care while preserving the architectural heritage.”
CHARLES FERRARO
BAYBERRY CAPITAL GROUP
Healthcare Loan Program Term Sheets
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