A specialist advisory practice

Financial restructuring counsel for skilled nursing and senior living operators.

We work with operators navigating today's reimbursement, capital, and refinancing environment — quietly, and at the senior level.

Schedule a Confidential Conversation →

Direct: +1 480 253 7021 Intake: intake@fischerlarsondickson.com

Who we serve

We advise privately‑held and family‑controlled operators of skilled nursing and senior living facilities.

Our engagements often begin during covenant resets, refinancing windows, ownership transitions, or periods of meaningful change in reimbursement or operating cost structure.

Our clients typically own or manage 3 to 50 locations, with revenues ranging from $40 – $400MM.

Skilled Nursing Facilities
Assisted Living Facilities
Continuing Care Retirement Communities

Our practice

Four interlocking workstreams. Most engagements draw on two or three; some on one.

Capital Structure Review

A clear, lender‑ready picture of debt stack, covenants, and maturity ladder. We map flexibility before it is needed and identify the levers actually available given the operator's current performance.

Lender Negotiation Support

Counsel and presence in conversations with senior lenders, agents, and bondholders. We help operators prepare materials, anticipate positions, and negotiate amendments and waivers on terms that preserve operating discretion.

Operational Efficiency Diagnostics

A focused look at cost structure, staffing models, agency utilization, and revenue cycle. Diagnostics are short, specific, and oriented toward the two or three changes that materially improve liquidity within a quarter.

Refinancing Strategy

Sequencing, lender selection, and positioning ahead of a refinancing or recapitalization. We work alongside management and counsel to bring a coherent, well‑evidenced thesis to the market.

Our approach

A short, structured path from a first call to a defined engagement. The first two stages carry no commitment on either side.

01^·

Initial Conversation

A fifteen‑to‑thirty minute call with a partner. Context, current pressures, and time horizon. No materials requested in advance.

~ 30 min · No commitment

02^·

Confidential Diagnostic

Under mutual NDA, a focused review of capital structure, operating performance, and the two or three questions the operator most wants answered. Two to three weeks.

2 – 3 weeks · NDA

03^·

Engagement Proposal

A written proposal with scope, deliverables, partner involvement, and fees. Engagement only proceeds if there is a clear, mutual fit.

Written scope · Contingent fee

Our fee structure

We structure every engagement so the financial risk sits entirely with us. For the CFO carrying an over‑leveraged balance sheet, that makes this a rare decision with no downside — high reward, no risk.

— No win, no fee

We are paid only when we reduce your debt.

Our fee is contingent on results. If we do not achieve a reduction of at least 50% on the obligations we are engaged to restructure, we are not paid.

— No out‑of‑pocket cost

No retainers. No hourly billing. No upfront fees.

Engagements cost nothing to begin and nothing along the way. You commit no money out of pocket — the entire risk of the work rests with the firm.

— Aligned incentives

We only earn when you save.

Our fee is a share of the savings we negotiate on your behalf — paid out of money you would otherwise have owed your creditors, never out of your operating budget.

Selected results

Selected outcomes from the principals' restructuring work across healthcare and adjacent sectors. Client identities are confidential; figures are shown as negotiated reductions.

$37MM→$12MM

Multi‑facility nursing home operator

A 68% reduction across hundreds of healthcare creditors — more than $25MM in total savings.

$1.8MM→<$400K

Industrial / OEM parts distributor

Creditor exposure cut by over 75%, with structured payment plans negotiated across suppliers worldwide to preserve ongoing relationships.

$9.6MM→$3.4MM

Diagnostic imaging practice

More than $6MM saved, including significant reductions with major equipment lenders such as Siemens, Toshiba, and GE Capital.

Client identities are held in strict confidence. Operators rarely wish to make past financial pressure public, and we treat that discretion as fundamental to the work.

Why operators engage us

— Specialization

Sector specialization in long‑term care.

We work only with skilled nursing and senior living operators. Our reference points, lender relationships, and vocabulary are built around this segment.

— Discretion

Confidentiality before commitment.

Initial conversations are mutual diligence. Nothing is shared outside the firm without an executed engagement, and our client list is not public.

— Seniority

Senior‑led engagements only.

Partners run every engagement from first call through implementation. We do not staff with junior teams or hand work off after closing.

Leadership

Three partners, each with twenty‑plus years in healthcare restructuring and capital advisory.

Peter Fischer

Managing Partner

Twenty‑eight years advising healthcare operators on capital structure and refinancing. Founded the firm's long‑term‑care practice in 2014.

John Dickson

Partner / AI Engineer

Twenty‑two years in Software Development, Data Sciences and AI Engineering. Specializes in market research and financial analytics using agentic systems.

Layford Larson

Partner

Eighteen years in skilled‑nursing‑facility debt restructuring and capital advisory.

Begin a conversation

A first call is a conversation, not a commitment.

If the firm is on your list of advisors to consider, we are happy to spend half an hour on the phone with no expectation on either side. Outreach goes directly to a partner.

Schedule a Confidential Conversation →

Direct: +1 480 253 7021 Intake: intake@fischerlarsondickson.com