Investing Across the Healthcare Continuum: Specialized Real Estate in a Changing Care Landscape
Anchor Viewpoints: Q1, 2026
By Steen Watson, President, Anchor Health Capital
Healthcare delivery continues to evolve toward more specialized, distributed, and patient-centric models of care. In turn, the real estate supporting it is expanding beyond traditional formats to include a broader range of purpose-built facilities serving distinct roles.
At Anchor, we view these specialized care settings as an increasingly important part of the healthcare real estate market. The healthcare facilities emerging within this landscape often support essential services, are occupied by experienced healthcare operators, and are positioned to benefit from long-term shifts in how and where care is delivered.
Anchor Health Properties has been developing healthcare facilities for more than forty years, working alongside providers to bring needed care settings to growing communities. Now, through Anchor Health Capital, we are building on that development and operating expertise with a dedicated capital platform. As a fully integrated healthcare real estate firm, we believe this combination of sector knowledge, execution capability, and investment discipline is a meaningful advantage.
Specialized healthcare facilities share some common traits that can be attractive to investors. The facilities are typically leased on a long-term basis by a single tenant. Rental rates escalate annually. And leases are typically absolute net with the tenant responsible for all operating and capital costs along with property management.
In this edition of Anchor Viewpoints, we examine several specialized healthcare real estate property types that are increasingly relevant in today’s market: inpatient rehabilitation facilities, ambulatory surgery centers, micro hospitals, freestanding emergency departments, behavioral health facilities, and the Program of All-Inclusive-Care for the Elderly (PACE). Together, these sectors reflect the ongoing evolution of healthcare delivery and the growing role of specialized real estate in supporting it.
A Deeper Look at Inpatient Rehabilitation Facilities
Among the sectors highlighted in this report, inpatient rehabilitation facilities (IRFs) represent a particularly important segment of the healthcare real estate landscape.
IRFs are post-acute hospitals that provide intensive, interdisciplinary rehabilitation services for patients recovering from serious medical events, including stroke, traumatic brain injury, spinal cord conditions, orthopedic surgery, and other complex illnesses or injuries. These facilities serve patients who continue to require a hospital-based level of care, including full-time nursing and coordinated therapy delivered by a multidisciplinary team that may include physicians, rehabilitation nurses, physical therapists, occupational therapists, speech-language pathologists, psychologists, and case managers. The clinical objective is to help patients regain function and transition safely back home whenever possible.
IRFs occupy a distinct position within the broader healthcare continuum. They serve patients whose recovery needs are too complex for lower-acuity post-acute settings, placing them between acute-care hospitalization and discharge to the home. They differ meaningfully from skilled nursing facilities and long-term acute care hospitals in both the intensity of therapy provided and the complexity of the patients they serve. IRF patients are typically in a transitional stage of recovery rather than long-term residence, with an average length of stay generally ranging from 10 to 20 days.
The facilities themselves are highly specialized, reflecting the clinical and operational demands of inpatient rehabilitation. They are often purpose-built to support a highly specific clinical model, with design and operational requirements that make them difficult to replicate and important to the operator’s long-term presence in a market. IRFs are frequently operated by health systems, national post-acute providers, or joint ventures, and are typically leased on a long-term basis to tenants for whom the facility is both licensed and mission-critical.
The sector is also supported by several durable long-term fundamentals. An aging population, sustained demand for post-acute recovery services, improved survival rates following trauma and stroke, and continued pressure on the healthcare system to manage patient flow more efficiently all reinforce the role of inpatient rehabilitation. At the same time, supply can remain constrained in many markets, particularly for newer facilities developed to meet the standards of established operators. Taken together, these factors position IRFs as a specialized and increasingly important component of the healthcare real estate market.
Beyond IRFs, Anchor’s focus includes five additional specialized healthcare property types that support essential services across a range of care settings.
Ambulatory Surgery Centers (ASCs)
Ambulatory surgery centers (ASCs) are freestanding outpatient facilities that provide same-day surgical, diagnostic, and preventive procedures without requiring an overnight hospital stay. Common services include orthopedic, ophthalmologic, gastrointestinal, ENT, and pain management procedures.
ASCs have become an increasingly important part of outpatient care because they can often deliver procedures more efficiently and at lower cost than traditional hospital settings. Many are owned or operated by physician groups, physician-health system joint ventures, or specialized operating platforms. Their specialized buildouts, recurring procedural volumes, and long-term operator commitment underscore their value to investors seeking exposure to specialized healthcare facilities.
Micro Hospitals
Micro hospitals are small-format acute-care facilities designed to extend a health system’s presence into growing or underserved markets. These facilities typically offer 24/7 emergency care, diagnostic imaging, laboratory services, and a limited number of inpatient beds, allowing them to provide essential hospital-level services in a more compact format.
For health systems, micro hospitals can serve as strategic access points within broader care networks. They are often developed as purpose-built, single-tenant facilities and are closely aligned with the operator’s long-term presence and care delivery strategy in a given market, typically at a distance from the health systems’ main campus.
Freestanding Emergency Departments
Freestanding emergency departments (FSEDs) provide emergency care in facilities that are physically separate from a traditional hospital campus. Staffed around the clock by emergency-trained physicians and nurses, they typically include advanced imaging, laboratory services, and other capabilities associated with hospital-based emergency departments.
These facilities help expand access to emergency care, particularly in suburban and rural markets. In many cases, they are purpose-built for a single operator and serve an important role in extending emergency services beyond the main hospital campus.
Behavioral Health Facilities
Behavioral health facilities include a range of settings that treat mental health disorders, substance use disorders, or both. These may include outpatient clinics, residential treatment centers, and inpatient psychiatric hospitals, depending on the acuity of care being delivered.
Demand for behavioral health services has grown in recent years due to increased awareness, reduced stigma, and broader recognition of unmet care needs. Because the category spans multiple care settings, facility types vary as well, with outpatient services often located in multi-tenant environments, and higher-acuity care more commonly delivered in specialized standalone buildings.
Program of All-Inclusive Care for the Elderly (PACE)
The Program of All-Inclusive Care for the Elderly (PACE) is a care model designed to help older adults with significant care needs remain in their homes and communities rather than transition into institutional settings. PACE centers coordinate preventive, primary, acute, and long-term care services through an interdisciplinary model that integrates medical care with social support.
PACE centers serve as centralized hubs for this coordinated model of care. The format is closely aligned with demographic trends and growing interest in care settings that support aging in place while reducing reliance on more institutional forms of long-term care.
Conclusion
Healthcare delivery is becoming increasingly specialized, distributed, and responsive to patient needs, and the real estate that supports it is evolving accordingly. Facilities such as inpatient rehabilitation hospitals, ambulatory surgery centers, micro hospitals, freestanding emergency departments, behavioral health facilities, and Program of All-Inclusive Care for the Elderly centers each serve important functions within the broader continuum of care.
At Anchor, we view these sectors as an important part of the healthcare real estate landscape. Through the combined capabilities of Anchor Health Properties and Anchor Health Capital, we remain focused on healthcare real estate that is aligned with experienced operators, responsive to changing care models, and positioned to serve communities over the long term.
Sources
Newmark, U.S. Healthcare Capital Markets. Sector Spotlight Series: Inpatient Rehabilitation Facilities (2026).
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