Purpose: Board members and real estate managers (decision makers) play an important role in the decision-making process in nursing home organisations. This study aims to provide an understanding of underlying attributes and benefits sought by decision makers when making nursing home real estate decisions. Design/methodology/approach: Decision makers from seven different nursing home organisations in The Netherlands were interviewed using the laddering technique to determine the individual requirements, the considerations of the decision alternatives, the relevant attributes and benefits and their mutual relationships. Findings: This study details the motivations behind real estate management decisions in nursing home organisations. The findings show that apart from financial considerations, decision makers strive to enhance the quality of life and satisfaction of users with their real estate decisions and seek to include residents and employees in the process. These benefits are connected to the goals of well-being and innovation in health care. Furthermore, functionality, physical and functional flexibility and technology are key considerations when undertaking corporate real estate (CRE) decisions, to ensure that real estate management aligns with the strategic goals of the nursing home organisation. Practical implications: The insights of this study can support decision makers in healthcare facilities to create strategic value with their real estate. Understanding how to obtain certain benefits from nursing home real estate may result in a better realisation of organisational objectives and user needs. Originality/value: This study reveals the decision-making process in a nursing home context. Moreover, the laddering technique is used as a new method to explore and gain a deep understanding of CRE decision-making processes.