American Healthcare REIT Projects Another Year of Growth

American Healthcare REIT, Inc. ((AHR)) has held its Q4 earnings call. Read on for the main highlights of the call.

American Healthcare REIT’s latest earnings call struck an upbeat tone, highlighting powerful same-store NOI growth, robust NFFO gains and disciplined capital deployment through 2025. Management acknowledged some deceleration embedded in 2026 guidance and several execution risks, but stressed that strong occupancy trends, margin expansion and limited new supply create durable tailwinds for the platform.

Same-Store NOI Keeps Momentum

Total portfolio same-store NOI rose 11.8% in Q4 2025 and 14.2% for the full year, marking a second straight year of double-digit growth. Management framed this as evidence that the post-pandemic recovery has shifted into a more durable, operationally driven upcycle rather than a one-off rebound.

Trilogy Segment Delivers High-Quality Growth

The Trilogy segment posted same-store NOI growth of 14.0% in Q4 and 18.4% for 2025, with occupancy reaching about 90.6%, roughly 275 basis points higher year on year. A healthier Medicare and Medicare Advantage mix improved quality mix by about 220 basis points, supporting both revenue and margin gains in these higher-acuity settings.

SHOP Portfolio Leads the Pack

The senior housing operating portfolio (SHOP) was the standout performer, with same-store NOI up 24.6% in Q4 and 25.2% for 2025. Same-store occupancy climbed to roughly 90.6%, about 290 basis points higher year on year, and management expects SHOP to remain the main growth engine heading into 2026.

Margin Expansion Underlines Operating Leverage

NOI margins expanded meaningfully as occupancy pushed toward 90%, showcasing the sector’s operating leverage. Trilogy margins widened by about 130 basis points while SHOP margins expanded by roughly 280 basis points in 2025 versus 2024, reinforcing the earnings power of relatively small occupancy gains.

Strong NFFO Performance and Outlook

Normalized FFO reached $0.46 per diluted share in Q4 and $1.72 for 2025, representing about 22% year-over-year growth in NFFO per share. For 2026, the company guided to NFFO of $1.99–$2.05 per share, signaling another year of double-digit growth even off a strong 2025 base.

2026 Same-Store Growth Slows but Stays Solid

For 2026, management forecasts total portfolio same-store NOI growth of 7%–11%, a step down from 2025’s 14.2% but still healthy by REIT standards. Segment guidance calls for Trilogy at 8%–12%, SHOP at 15%–19%, outpatient medical at 0%–2% and triple-net leased assets at 2%–3%, reflecting a maturing recovery.

Accretive Capital Deployment Continues

The company closed more than $950 million of investments in 2025, including roughly $665 million in Q4 alone, underscoring an aggressive but targeted acquisition strategy. Early 2026 has already seen about $117.5 million of closings and a pipeline exceeding $230 million, largely focused on higher-acuity, newer properties sourced through relationships.

Balance Sheet Strength and Market Access

Leverage metrics improved notably in 2025, with debt-to-EBITDA better by nearly a full turn and net debt-to-EBITDA at 3.4x entering 2026, excluding unsettled forward equity. The REIT tapped equity markets through ATM issuance and a follow-on offering, using proceeds to fund acquisitions and developments while preserving balance sheet flexibility.

Platform Scale and Development Edge

The operating portfolio, combining Trilogy and SHOP, now provides roughly 76.9% of consolidated cash NOI, anchoring results in operator-controlled assets. Management is prioritizing Trilogy development and expansion projects that can deliver attractive incremental yields with limited market risk, supported by historically low new supply of under 1%.

Revenue Management and Operator Alignment

American Healthcare REIT is piloting revenue management tools, originally developed with Trilogy, across its SHOP operators to sharpen pricing and increase revenue per occupied room. Leadership is also pushing alignment through long-term incentive plans and equity-based structures, aiming to share the benefits of platform improvements with operating partners.

Leadership Transition Adds a Note of Uncertainty

The company is navigating a leadership transition with founder Jeff Hanson stepping in as interim CEO while the prior CEO is on medical leave. While management emphasized strategic continuity and noted that the absent CEO remains engaged, investors must factor in some short-term headline risk until the leadership picture fully stabilizes.

Growth Guidance Reflects Controlled Deceleration

Management’s 2026 guidance acknowledges a natural cooling from the breakneck pace of 2025, notably in same-store NOI growth. Even so, the projected ranges still imply robust double-digit NFFO per share growth and mid-to-high teens gains in the SHOP segment, suggesting that the core growth story remains intact.

Early-Stage Revenue Initiatives and Competition Risks

The revenue management rollout remains in pilot mode, with no quantified portfolio-wide impact yet, leaving upside potential but also uncertainty. At the same time, management flagged intensifying competition from other REITs and private equity for SHOP deals, with acquisition cap rates compressing into the high-5% to low-6% range on entry.

Execution Risk on Value-Add Acquisitions

A meaningful slice of recent investments involves underoccupied or undermanaged assets that require operational turnarounds to realize targeted returns. Success hinges on operators lifting occupancy and margins on schedule, making execution and timing key swing factors for future performance.

Leverage Metrics Mask Forward Equity Overhang

The reported 3.4x net debt-to-EBITDA ratio does not include roughly $287 million of unsettled forward equity. Until these agreements are fully settled, leverage optics may appear slightly better than the company’s eventual, fully funded capital structure.

Seasonality, Public Health and Policy Risks

Management reminded investors that last year’s first quarter was hit by elevated flu-related move-outs, illustrating how seasonal and public-health factors can temporarily pressure occupancy. Reimbursement uncertainty, particularly around Medicare and Medicare Advantage, and variable hospital coverage in parts of the triple-net portfolio add further external risks to monitor.

Guidance and Outlook Emphasize Continued Growth

Looking ahead to 2026, American Healthcare REIT expects NFFO of $1.99–$2.05 per share and same-store NOI growth of 7%–11%, based only on acquisitions closed so far this year. With net debt-to-EBITDA at 3.4x and a sizable awarded pipeline not yet embedded in the numbers, management framed the outlook as both conservative and supportive of continued double-digit earnings expansion.

American Healthcare REIT’s earnings call painted a picture of a healthcare REIT in a strong uptrend, powered by occupancy gains, margin expansion and disciplined capital allocation. While growth is expected to moderate from 2025’s exceptional levels and several execution and macro risks remain, the underlying fundamentals and guidance suggest the story still has room to run for investors focused on healthcare real estate income and growth.