# REIT Investments in Nursing Homes and the Quality of End of Life Care for Residents with Alzheimer's Disease and Related Dementias

> **NIH NIH RF1** · WEILL MEDICAL COLL OF CORNELL UNIV · 2024 · $1,306,862

## Abstract

PROJECT SUMMARY/ABSTRACT
Alzheimer's disease and related dementias (ADRD) affect 5.5 million people in the US and account for $305 billion in
health care spending annually. Nearly half of all Medicare decedents have an ADRD diagnosis prior to death. Nursing
homes play an important role in end-of-life (EOL) care for individuals with ADRD. Among the 1.4 million nursing home
residents in the US, 68% have some degree of ADRD, with the prevalence expected to increase. More than two-thirds of all
ADRD-related deaths occur in nursing homes. Nursing home ownership has been associated with the quality of EOL care
for residents with ADRD. Among US nursing homes, 12% have investment from real estate investment trusts (REITs). It
is not known whether REIT investments in nursing homes are associated with the quality of EOL care. The prevalence and
increasing rates of these corporate investments have raised concerns among policymakers and oversight agencies including
the Government Accountability Office, MedPAC, the House Ways and Means Committee, the Senate Finance Committee,
and The White House. The Centers for Medicare and Medicaid Services have proposed a new rule that would require public
reporting of REIT investments in nursing homes. REITs are for-profit public or private corporations that invest in income-
producing properties. They are “pass-through entities” which qualify for tax exemptions if they satisfy requirements related
to sources of income and assets, including disbursing 90% of their taxable income to shareholders as dividends. These
corporations purchase a nursing home's property and lease it back to the nursing home operator. Under this arrangement,
the operator pays all of the expenses of the property, including real estate taxes, building insurance, and maintenance. These
expenses are in addition to the cost of rent and utilities that are paid to the REIT by the operator. REITs are not directly
involved in nursing home operations, though they may provide guidance to help the operator achieve profitability goals.
Selling a nursing home's property to a REIT provides the operator with an infusion of capital that can conceivably be used
for facility improvements and/or to provide more resources for resident care. However, annual rent escalations that are
typically included in the leases may make rent unaffordable for nursing home operators over time and potentially lead to
reductions in staffing, supplies, or equipment that negatively impact the quality of EOL care. Preliminary analyses indicate
that registered nurse staffing levels in nursing homes are often reduced following REIT investment. For this project, a
nationally representative database of nursing home residents with ADRD will be constructed from Medicare claims and
Minimum Data Set assessments and merged with a novel database of REIT investments in nursing homes for the period
2012-2022. This will be the first study of the relationships between REIT investments in nursing homes a...

## Key facts

- **NIH application ID:** 10807383
- **Project number:** 1RF1AG082059-01A1
- **Recipient organization:** WEILL MEDICAL COLL OF CORNELL UNIV
- **Principal Investigator:** Robert Tyler Braun
- **Activity code:** RF1 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $1,306,862
- **Award type:** 1
- **Project period:** 2024-08-15 → 2027-07-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10807383

## Citation

> US National Institutes of Health, RePORTER application 10807383, REIT Investments in Nursing Homes and the Quality of End of Life Care for Residents with Alzheimer's Disease and Related Dementias (1RF1AG082059-01A1). Retrieved via AI Analytics 2026-05-26 from https://api.ai-analytics.org/grant/nih/10807383. Licensed CC0.

---

*[NIH grants dataset](/datasets/nih-grants) · CC0 1.0*