How to Buy or Sell a Care Business in Europe: A Practical Guide for UK Operators

How to Buy or Sell a Care Business in Europe: A Practical Guide for UK Operators

James Dixey — Founder and Managing Director    ·    9 min read    ·    James Dixey Limited

Continental European care groups have become serious acquirers of UK assets, and UK operators are increasingly looking at Continental deal flow as either acquirers, joint venture partners, or — for the more ambitious — sellers into a European platform play. This guide walks through what is genuinely different about cross-border care deals.

EXECUTIVE SUMMARY

•  The dominant European care groups — Korian (France/Belgium/Italy), Orpea (rebranded as emeis, France/Germany/Spain), Domus Vi (France/Spain), DomusVi (Germany via Cosmo), Colisée (France/Italy/Belgium) — together operate the largest cross-border care platforms in Europe. None has historically been deeply present in the UK, but several are now actively evaluating UK acquisitions.

•  On the buyer side, listed European healthcare REITs (Aedifica, Cofinimmo — now combined into a c.€12bn platform — plus Healthcare Activos, AEDAS Healthcare) are the most visible institutional capital. They follow a real-estate-first acquisition logic, much like the US REITs that have arrived in the UK over 2024–2025.

•  For UK sellers, the European REIT capital pool genuinely competes with US REIT capital at scale, and increasingly enters mid-market processes alongside UK operator consolidators. For UK buyers, Continental targets offer meaningful diversification but require management capacity that most UK owner-managers do not have without a JV partner.

•  Cross-border care deals are slower than domestic ones — typically two to three months longer for legal due diligence, regulatory pre-notification, FX hedging and cross-border tax structuring. Currency, communication norms and tax timing all need to be managed proactively.

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Why the European care market matters to UK operators

Five years ago, most UK care operators thought of "Europe" as a tangentially relevant market — interesting if you wanted to spend a week looking at Scandinavian dementia design, less obviously relevant to the operating economics of a Sussex care home. That has changed. The European care market is now a serious source of acquisition capital for UK sellers and — for the more ambitious UK operators — a serious source of acquisition targets in their own right.

Three forces have driven this. First, the cross-border consolidation of the larger European care groups (Korian, emeis (formerly Orpea), DomusVi, Colisée) has reached the point where their operational and capital models genuinely scale across multiple jurisdictions, and the UK is one of the most obvious next markets. Second, the European listed REITs — Aedifica, Cofinimmo, Healthcare Activos — have built the analytical capacity to underwrite UK assets at scale, with the recently completed Aedifica/Cofinimmo combination creating Europe's largest healthcare REIT (c.€12bn combined GAV). Third, the unwinding of some of the historic UK PE platforms over 2023–2025 has created assets that don't fit cleanly into UK consolidator hands and where European capital has been the cleaner buyer.

The cross-border buyer universe for UK assets

Three distinct types of European buyer regularly enter UK processes.

European listed healthcare REITs

The most active institutional category. Aedifica (Belgian, now the largest European healthcare REIT post the Cofinimmo combination) has been the most visible UK acquirer at scale; Healthcare Activos and AEDAS Healthcare from Spain have evaluated UK opportunities; smaller listed and unlisted vehicles from Germany and Italy occasionally appear at the upper end of mid-market processes. They follow a real-estate-first acquisition model: long-lease structures with operating partners, a focus on freehold quality, and a willingness to pay institutional multiples for portfolios that match the long-duration income profile.

Pan-European operator groups

Less visible in UK processes historically, but increasingly present at the bid-list stage. Korian (France/Belgium/Italy), emeis (the rebranded Orpea, with operations across France, Germany, Spain, Switzerland), DomusVi (France, Spain, Germany via Cosmo), Colisée (France, Italy, Belgium). For these groups, UK entry is typically platform-acquisition led rather than single-asset; they tend to look at portfolios of fifteen-plus homes with management depth that allows them to plug into existing UK operating infrastructure without building a new central function.

Continental private equity

Less common as direct UK buyers but increasingly present as JV partners with UK acquirers, or as secondary buyers of UK PE-backed platforms. PAI Partners, Antin Infrastructure Partners, EQT Healthcare, IK Partners and a handful of others have evaluated UK care assets over 2024–2025; some have direct portfolio companies that are themselves potential UK acquirers.

What this means for UK sellers

For a portfolio sale at scale — fifteen homes or more, with strong freeholds and management depth — the European REIT capital pool now genuinely competes with US REIT capital. Bringing one or two European REITs into a competitive process at the indicative-offer stage routinely lifts the price tension, and in some recent processes has been the dominant source of price uplift. The diligence requirements are different (greater emphasis on tenancy structure, longer cycle on regulatory pre-notification, more careful tax due diligence) but the process logic is the same.

For mid-market mandates (five to fourteen homes), European buyer interest is more selective. Pan-European operator groups will engage if the portfolio offers a credible platform play, but rarely at the same price discipline as a UK operator consolidator. The honest answer is that for most £3–15m EV care mandates, European buyers are a useful addition to the competitive process rather than the dominant likely acquirer — but their presence in the room sharpens the offers from the UK consolidators.

What this means for UK buyers looking at Europe

This is the less-trodden path, and the honest answer is that most UK owner-managers should not be looking at Continental acquisitions without a structured JV partner or an established local team. The operational complexity of running a care business across two regulatory regimes, two languages and two clinical-protocol environments is materially higher than running two UK sites, and the unit economics rarely justify the additional management overhead for a single-asset bolt-on.

The exception is a UK group with proven multi-jurisdiction management capacity (typically 50+ home UK operators with a head office team that can support a separate operating entity) where a strategic Continental acquisition fits a longer platform thesis. For most operators, the right Continental engagement is JV-led or partnership-led rather than direct acquisition.

The practical differences in a cross-border process

Cross-border care transactions are systematically slower than domestic UK ones — typically two to three months longer from instruction to completion. The reasons are predictable but worth planning for:

•   Regulatory pre-notification. CQC change-of-provider for UK target homes plus equivalent processes in the buyer's home jurisdiction. Allow three to four months minimum.

•   Legal due diligence. Two-jurisdiction work on entity structures, employment law, property arrangements and tax. Allow an additional four to six weeks beyond a domestic process.

•   Currency and FX hedging. Material for deals priced in EUR but completing in GBP or vice versa. Hedge mechanics should be agreed at heads-of-terms stage, not at completion.

•   Communication norms. Continental European processes are typically more committee-driven and slower-cycle than UK ones. Build the meeting cadence into the process plan rather than discovering it.

•   Cross-border tax structuring. Typically requires specialist input from a Big Four or sector-specialist tax practice in both jurisdictions. Get this lined up early.

Where the most active cross-border processes are happening

In our experience and across the published deal data, the most active cross-border care segments in 2025–2026 are: large-cap UK residential portfolios into European REIT capital (echoing the US REIT pattern at slightly smaller scale); specialist mental health and learning disability platforms into pan-European operator groups; and smaller domiciliary-care platforms with a digital-care-planning thesis into pan-European homecare consolidators (less mature, but emerging). Each of these has a distinct buyer-process logic and a distinct realistic price range — and the right next step for any owner evaluating cross-border interest is a confidential conversation that maps the genuine routes against the seller's underlying priorities.

Related: Who actually buys care homes in 2026? A tour of the buyer universe.  (/insights/who-actually-buys-care-homes-2026)

Considering a cross-border care transaction in 2026 or 2027?

Whether you're evaluating European buyer interest in a UK portfolio or considering Continental acquisitions yourself, the first conversation is always confidential and free.

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SOURCES

[1] Aedifica / Cofinimmo combination: agreed June 2025; Belgian Competition Authority cleared January 2026 with €300m Belgian asset divestment remedy; Aedifica secured 79.57% of Cofinimmo shares in acceptance period to 2 March 2026; combined Gross Asset Value c.€12.1bn, Europe's largest listed healthcare REIT.

[2] European care groups: Korian SA (CSE: KORI), emeis (formerly Orpea SA, EPA: EMEIS), DomusVi (Vesta Holding), Colisée (PAI Partners) — group operational footprints and UK evaluation activity 2024–2026.

[3] European listed healthcare REIT activity in UK: Aedifica UK portfolio coverage; Cofinimmo UK exposure (pre-combination); Healthcare Activos and AEDAS Healthcare UK evaluation activity 2024–2025.

James Dixey Limited — Specialist M&A for regulated, owner-managed businesses in Care, Education, Fire & Security and Other Regulated Services.