HEALTHCARE

Keypoints

  • Recovery in investment volumes still pending
  • Slight decline in initial yields continues
  • Positive valuations and total returns
  • WoON 2024: a mismatch in housing supply for the elderly
  • Pressure on institutional elderly care remains high

Recovery in investment volumes still pending

Investment volume in the first quarter of 2025 amounted to nearly €100 million, comparable to the same quarter in 2024. Although Q1 traditionally lags behind other quarters, a true recovery in transaction volume has yet to materialise. The decline in financing rates has led to a gradual return of investors reliant on external capital—such as private investors and property funds. Institutional investors accounted for 20% of the total investment volume. In contrast to 2024, the average investment size per transaction was higher in the first quarter. Approximately 80% of recorded transactions took place in the intramural and private elderly care segments. Notably, 100% of these transactions were carried out by Dutch investors. Given the expected further decline in financing rates in 2025 and increased market activity, we anticipate a rise in investment volume in the coming quarters. Due to the announced reduction in real estate transfer tax as of 2026, it is likely that some investments will be postponed from Q4 2025 to Q1 2026.

INVESTMENT VOLUME HEALTHCARE (€ BILLION)

Source: CBRE (2021), Capital Value (2025), edited by Achmea Real Estate

SHARE INVESTMENT VOLUME HEALTHCARE BY SEGMENT (%)

Source: Capital Value (2025), edited by Achmea Real Estate

Slight decline in prime initial yields continues

The slight decline in prime initial yields observed in recent quarters persisted into Q1 2025. However, quarter-on-quarter differences were minimal, partly due to the relatively low number of transactions. On an annual basis, the most notable yield compression occurred in the extramural and private elderly care segment. This trend is partly driven by rising residential property values and the growing popularity of private care homes. Despite this development, initial yields remain well below the 2022 peak. Forecasts for long-term interest rates, which indicate a modest upward trend, suggest that any further yield compression will be limited in the coming quarters. Stabilisation appears likely—unless the impact of the ongoing trade war causes capital market rates to rise more sharply than currently anticipated.

YIELDSHIFT Q1 2025 (%-POINT)

Source: Capital Value (2025), edited by Achmea Real Estate

TOTAL RETURN (%, ANNUALISED Q4 2024)

Source: MSCI Netherlands Quarterly Property Index (Unfrozen) (2025)

Positive valuations and total returns

At the end of 2024, the MSCI quarterly index reported positive total returns across all real estate segments. Healthcare real estate delivered a return of over 8% over the past four quarters. Extramural healthcare properties in particular benefited from value appreciation, driven by increasing vacant possession values—a trend that was also reflected in Q1 2025 valuations. Market rents across all healthcare segments are showing steady growth. In the private rental segment, rent increases can be relatively strong, partly due to limited supply and the regulatory constraints imposed by the Affordable Rent Act on the mid-market. For intramural care real estate, the indexation of the normative housing component is expected to have a positive impact. Additionally, above-average inflation continues to feed through into both contract and market rents in curative care real estate. Combined with a slight compression in yields, total annualised returns are expected to remain robust in the coming quarter.

WoON 2024: a mismatch in housing supply for the elderly

The recently published WoON 2024 survey reveals that the need for suitable housing for the elderly is more urgent than ever. The target group is growing rapidly: 40% of all households in the Netherlands now consist of single-person households, of which over one-third are aged 65 or older. The ageing post-war baby boomer generation—many of whom live in owner-occupied homes—holds a key position in unlocking housing mobility. While they often have substantial home equity, they are not sufficiently attracted by future-proof housing concepts.

The number of elderly people who moved in the past two years has dropped by 10%, mainly due to a mismatch between supply and demand. Among those aged 65 and over, the main barrier (25%) is the lack of suitable housing options in their own neighbourhood, followed by homes that do not match their preferences (14%). Although high housing prices are an issue for 20% of this group, affordability weighs even more heavily on younger and middle-aged households.

Notably, elderly households show a strong preference for rental apartments. In highly urbanised areas, no less than 72% of single-person 65+ households actively searching for a new home are looking for a rental apartment; in less urban areas, this figure still reaches 56%. These findings underscore the urgent need to develop more suitable, accessible, and appealing housing solutions for the ageing population.

Pressure on institutional elderly care remains high

Pressure on nursing home care remains structurally high: by early 2025, nearly 20,000 people were on the waiting list for elderly care. Although this marks a slight decline compared to previous quarters, it still reflects a significant shortage of appropriate care capacity. At the same time, the personal contribution for institutional care has increased to a maximum of €2,950 per month. This rise is driven by income increases in 2023—such as adjustments to the minimum wage and state pension—which now affect the 2025 contribution calculations. For many elderly individuals, this means a substantial portion of their pension is spent on residential care costs.

As a result, private extramural care concepts are gaining appeal. In these models, clients rent an apartment independently and receive home-based care via a Long-Term Care Act (Wlz) indication. The care component is reimbursed, but housing costs are paid out-of-pocket. Crucially, the lower personal contribution applies to extramural care (maximum €900 per month), meaning that the €2,000+ difference compared to intramural care can be allocated to rent and other living expenses. This makes high-quality and independent living with care more accessible—without being more expensive than a nursing home stay.

For investors, this presents an attractive proposition. Extramural care housing addresses both a societal need and financial feasibility. It offers potential for stable operations, aligns with the national “ageing in place” policy, and fits the structural trend of decoupling housing from care provision. Moreover, the risk of bankruptcies among care providers and tenants remains low, with the most recent quarter even showing a slight decline in insolvencies.

WAITING FOR LONG-TERM CARE HOUSING (2020 Q3 = 100)

Source: Zorginstituut Nederland (2025),edited by Achmea Real Estate

HEALTHCARE BANKTRUPTCIES (2 QUARTER MOVING AVERAGE)

Source: CBS (2025), edited by Achmea Real Estate

Outlook

The gradual recovery anticipated in the previous quarter has only partially materialised. Healthcare real estate continues to deliver attractive total returns, while the strength of the user market keeps upward pressure on market rents. The number of active investors is increasing, and we expect this to translate into a higher transaction volume as 2025 progresses. The end of 2025 may be affected by the announced reduction in real estate transfer tax as of 2026, which could lead to the postponement of some transactions to Q1 2026.

Initial yields are currently experiencing moderate downward pressure, a trend expected to persist into the next quarter. In the second half of 2025, we anticipate a stabilisation in yield levels. At the same time, international uncertainties—particularly the impact of the trade war on capital market interest rates—remain a risk. These factors could still weigh on market confidence and pricing dynamics.

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