TENSGThe Ensign Group, Inc.

Ensign Group runs nursing homes and buys the ones that are performing badly.

The model is unusual for the industry: each home is run by an independent administrator empowered to decide almost everything, while the centre supplies capital, training and shared services. The premise is that care quality depends on the particular manager more than on a manual, and the results bear that out.

Growth comes from buying loss-making homes and turning them around: raising occupancy, shifting the patient mix toward better-reimbursed care, putting costs in order. That takes time and skill, but the properties come cheap. Risks: government programme reimbursement, clinical staff shortages and care quality complaints. The dividend is token.