Texas’ largest skilled nursing operator expands with 18 real estate acquisitions and $218M in portfolio value, leveraging HUD-insured financing and striving to utilize the Fast-Track Approval Program to set the pace for long-term care consolidation.
At a time when many long-term care operators are retreating from the Texas market, Creative Solutions in Healthcare is charging ahead. The state’s largest skilled nursing operator has not only maintained its aggressive pace of operational acquisitions, but has also redefined what it means to grow strategically — now through real-estate acquisitions.
Over the past 18 months, Creative Solutions in Healthcare and its affiliates (hereafter collectively referred to as “Creative Solutions”), has closed or contracted the purchase of 18 nursing facilities representing more than 2,200 licensed beds. Across urban centers like Dallas, Fort Worth, and El Paso, as well as in smaller rural towns from Kirbyville to Nacogdoches, the company has constructed a statewide footprint with an appraised portfolio value of $218 million. By the end of next year, that portfolio is expected to be supported by more than $155 million in HUD-insured permanent financing.
This surge marks the rollout of a deliberate, disciplined buy-and-operate model allowing Creative Solutions to continue to be a leader in the skilled nursing sector. The deals already closed are the tip of the iceberg as the company continues to build momentum, with more facilities actively under contract and an expanding pipeline.
“We’re building a long-term, sustainable platform in Texas,” said Gary Blake, CEO of Creative Solutions in Healthcare. “Our portfolio is not a collection of buildings, it’s a network of care, built for permanence and sustained quality. Texas is our home, and we’re here to stay. We see HUD as a financial partner that helps us secure these facilities, but our true investment is in the residents who call them home.”
A Strategy Rooted in Quality
Historically, HUD financing has been a pathway for certain deals in the skilled nursing sector. But Creative Solutions is putting HUD at the center of its real estate strategy, using the federal agency’s long-term loan programs as both a financing vehicle and a quality benchmark.
The company’s HUD strategy is more than financing mechanics. It’s about reinforcing a fundamental operating philosophy: quality and compliance first, growth second. To use HUD funding, companies must meet key requirements, from debt service coverage and loan-to-value ratios to minimum two-star quality ratings, before being eligible for HUD conversion.
The entire company’s leadership is a part of defining this financial strategy. Auston Clanton, COO of Creative Solutions in Healthcare, shared his insight:
“Quality is the standard we operate by every day. From infection control and staffing to clinical governance and life-safety compliance, we have programs in place that ensure every facility not only meets but exceeds expectations. HUD’s requirements align closely with our own, and that synergy allows us to move quickly while still prioritizing excellence. More importantly, our investments are designed around people: the residents who deserve safe, compassionate care and the staff who make that possible. When we acquire a facility, our commitment is not just regulatory compliance, it’s building a culture of quality that families can trust for the long term.”
Multiple Pathways to Growth
Chris Eamiguel, CFO of Creative Solutions, shared some insight on the financial strategy and direction of the company, saying:
“Every transaction is structured to balance the seller’s expectations with our long-term objective: HUD conversion. This is intentional. By customizing pathways, whether through bridge loans, TPA assumptions, or straight-to-HUD financing, we preserve flexibility in the short term while securing permanence in the long term. HUD loans allow us to own these facilities outright under stable, predictable terms, and that ownership is the foundation of our long-term financial stability.”
Creative Solutions hasn’t relied on a one-size-fits-all model. Instead, acquisitions have been structured through three distinct pathways:
- Bridge-to-HUD Financing: The majority of facilities first secured short-term bridge loans, ranging from $2.3 million to $18.5 million, with full conversion to HUD debt already in process.
- Transfer of Physical Assets (TPA): In select transactions, the company assumed existing HUD-insured loans, creating seamless ownership transitions.
- Straight-to-HUD Acquisitions: Certain top-tier facilities were acquired with permanent HUD debt in place at close.
This flexibility has helped Creative Solutions close deals tailored to seller expectations while preserving its own long-term financing discipline. The approach has also strengthened ties with a diverse lending network, including Oxford, Berkadia, VIUM Capital, Greystone, Walker Dunlop, as well as One World Bank for a traditional loan.
Eamiguel continued saying, “We are deeply grateful to our lending partners, for HUD’s role as a partner, and for the efficiency programs Cassidy has put into place. These give us the ability to reinvest consistently, protect communities during market volatility, and continue to expand responsibly across Texas.”
A Pipeline That’s Still Expanding
The company’s current 18-deal slate represents only those acquisitions either closed or contracted under purchase agreements. Leadership acknowledges that additional facilities are in the pipeline — as part of a deliberate effort to accelerate toward opportunities.
“We see opportunities all around us,” said Eamiguel. “We have an expansive operating portfolio, really it comes down to which facilities will we prioritize first and what timeline makes the most sense.”
Sustainable, Long-Term Growth
From El Paso’s western desert to the pine forests of East Texas, Creative Solutions’ latest acquisitions underscore its ability to scale while maintaining a mission-driven focus. The company now operates over 164 nursing facilities statewide, making it the largest operator in Texas and one of the most HUD-aligned skilled nursing owners in the country.
In an era when many industry players buy, flip, and exit quickly, Creative Solutions is staking its reputation on permanence and longevity. With HUD’s 30-year loans, the message is clear, Creative Solutions intends to be in operation and ownership for decades.
By the Numbers: Creative Solutions’ HUD Strategy (2024–2025)
- 18 facilities closed or contracted
- 2,228 skilled nursing beds across Texas
- $218 million in appraised value
- $155 million HUD debt pipeline
- Acquisitions spanning North, East, and West Texas
The Big Picture
Creative Solutions’ HUD-centric strategy positions the company as a consolidator in a fragmented skilled nursing sector. While regulatory pressures and financial uncertainty have had several operators leave the industry or the state, Creative Solutions is leveraging long-term HUD-backed capital to remain a steady, expanding force in Texas healthcare.
And as Blake sees it, HUD’s strict standards are not obstacles — they’re accelerators. “Every approval brings us closer to a stronger, more resilient system of care,” he said. “This strategy isn’t just about building a portfolio — it’s about building a future for Texas healthcare.”
About Creative Solutions in Healthcare:
Founded in 2000 by Gary and Malisa Blake, Creative Solutions in Healthcare is a family-owned company headquartered in Fort Worth, TX. It started with the first acquisition of Granbury Care Center and has grown to operate 174 long-term care communities throughout the state of Texas. Each location still runs on the founding principle, 'a life lived for others is a life worthwhile'. Its mission is to provide the highest quality of care to aging adults, by investing in cutting-edge technology and embodying core values of Compassionate Clinical Care, Nutritious Meals, Enriching Lives, Valued Employees, and Unparalleled Cleanliness.
View source version on businesswire.com: https://www.businesswire.com/news/home/20250826463183/en/
"Our portfolio is not a collection of buildings, it’s a network of care, built for permanence and sustained quality." -Gary Blake, CEO
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