J. Justin Hutchens
Executive Vice President Senior Housing at Ventas
Thank you, Debbie. I'll start by covering the third-quarter SHOP results and our year-over-year same-store pool. We are pleased to report another quarter that was consistent with our expectations while delivering strong year-over-year growth. NOI grew 13% year-over-year, which is above the midpoint of our SHOP guidance range led by the US at 17.4%, while Canada demonstrated positive growth again with 5.9%.
Same-store average occupancy grew year-over-year by 260 basis points to 84.7%. Same-store SHOP revenue in the third quarter grew ahead of expectations, increasing nearly 9% year-over-year due to continued acceleration in RevPOR growth and positive trends in occupancy. Pricing power has been impressive. At 5.4% year-over-year growth, RevPOR is the strongest we've seen in the last 10 years, primarily driven by in-house rent and care increases and re-leasing spreads that have improved to positive 1.4% in Q3 from negative double-digits during the low-point in the first-quarter of 2021. Underpinning the re-leasing spreads are improvements in street rates, which increased 11% year-over-year in the third quarter. This pricing power is being driven in a US portfolio that is only around 80% occupied, which is a real testament to the underlying demand for senior housing and bodes well for future pricing.
As expected, expenses were $3.8 million per day. Operating expenses remained elevated as contemplated in the Company's guidance for the third quarter, year-over-year same-store operating expenses grew 7.6%, driven primarily by occupancy growth and continued macro inflationary impacts throughout the quarter on labor, utilities, repair and maintenance, and food costs. Leading indicators in the US remained very strong as we experience leads as a percent of 2019 at 109%, move-ins at 107%, and outs at 98%.
Canada continues to deliver growth and high occupancy at 94%. We are benefiting from positive operating leverage. SHOP NOI margin expanded 90 basis points in the third quarter due to stronger-than-expected revenue growth that outpaced continued elevated expenses. I have to say a big thank you to our operating partners including Atria, Le Groupe Maurice, Sunrise, and our regional operators who are delivering great results.
Now, I will cover Q4 SHOP guidance and our expanded same-store year-over-year pool, which includes 478 communities. We are pleased that our strong year-over-year growth expectations are reflected in this much larger pool which represents 87% of our SHOP portfolio. This larger pool includes assets that have transitioned from triple-net, transitioned from other operators, and acquisitions made in the prior year.
Both the legacy same-store communities and the new entrants to that pool are expected to contribute attractive growth, with the pre-existing pool showing the strongest performance. SHOP same-store cash NOI is expected to accelerate from 13% growth in the third quarter to grow in the range of 15% to 21% year-over-year in the fourth quarter. We anticipate year-over-year revenue growth of approximately 8% at the midpoint of the same-store cash NOI guidance range, driven by continued strong rate growth and occupancy growth of 100 basis points and 250 basis points.
Year-over-year revenue growth is expected to be partially mitigated by continued broad inflationary expenses. At the guidance midpoint, operating expenses are expected to be consistent on a per-day basis with a third guard [Phonetic] quarter in 2022. The bottom and top ends of the NOI range are principally driven by variability in operating expenses. Our guidance assumes attractive margin expansion.
Moving on to asset management. Ventas OI which is our approach to a collaborative oversight where we leverage our operating expertise and best-in-class data analytics to the benefit of our operating partners continues to differentiate our platform and is creating tangible value in our senior housing business. I'm pleased to report that we had a very productive third quarter, engaging with our operators on the underlying fundamentals and two important deep-dive topics: rate increases and recruiting.
Rate increases this coming year will be our highest on record. We started our process early and collaborated with our operators to develop recommendations down to the unit and resident level. These customized rate -- recommendations are grounded in data, should limit controllable move-outs, and will be a huge contributor to revenue growth. It's really important to note that pricing power is greatly enhanced when we are delivering care and services resulting in highly satisfied residents and families.
Historically, we have seen around 5% in-house rent increases in the US. We saw 8% in 2022, and we expect over 10% in 2023. Certain operators, notably Sunrise, have already implemented early in-place rent increases and the results are positive and a good preview of what should be a successful execution in the first quarter and beyond.
We continue to address labor challenges in innovative ways. Our recent focus has been on community-level staff recruiting to help our operators compete for talent more effectively. In doing so, we see [Indecipherable] over 50 job titles across 15 different operators to evaluate reputation, career websites, the application process, and application follow-up. While I was pleased to see that our operator scored well relative to industry benchmarks, we came away with several actionable recommendations to attract fresh talent to our communities.
Ventas OI also continues to be a powerful tool in the capital allocation process. Our asset management teams are leveraging access to extensive industry and market-specific data to help drive decision-making around revenue-generating capex projects. Portfolios are evaluated on an asset-by-asset basis with communities prioritized based on near-term occupancy and rate upside as well as long-term supply-and-demand outlook. A significant investment of time and capital into this process has resulted in over 100 individual renovation projects currently underway within our SHOP portfolio, with a material number of those completing in the next several months.
I'll conclude by highlighting my continued confidence in the growth opportunity in our senior housing business. There are very encouraging facts that continue to support this view. The supply-demand outlook remains very strong, the growth rate of the 80-plus population will be the highest on record as we've noted before, and 99% of Ventas' senior housing markets are free from competitive new starts, we have had positive net move-ins for 18 months of the past 19 months, and pricing power is consistently demonstrated through in-house rents and street rate increases, all working together to drive NOI growth.
Now, I hand the call over to Bob.
