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Surviving and Thriving in a Belt-Tightened Economy. Oklahoma Association of Homes and Services for the Aging (OKAHSA) 15 th Annual Meeting, Educational Seminars & Exhibition March 10, 2010. Reality Check.

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Surviving and thriving in a belt tightened economy

Surviving and Thriving in a Belt-Tightened Economy

Oklahoma Association of Homes

and Services for the Aging (OKAHSA)

15th Annual Meeting,

Educational Seminars & Exhibition

March 10, 2010


Reality check
Reality Check

  • Front door is essentially closed—CDS predicts IL occupancy at most CCRCs will decrease over the next 3 to 5 years

EXCEPTION:

creative, equity-based models where developers are willing to buy residents’

homes


Reality check1
Reality Check

  • Moving through the traditional “continuum of care” may not be the best strategy moving forward

Moved

OPPORTUNITY:

Aging in place (lengthening each resident’s stay) and establishing your own home care services. One equity-based CCRC generates $2M in revenues annually through home care.



Client vision

Set goal to provide seniors the RIGHT:

SERVICES (maximize my independence)

PLACE (my own home)

TIME (before I lose function)

PRICE (what I can afford)

Client Vision


Organization vision

Be the leading innovator in developing and operating comprehensive services for older adults regardless of economic or functional status

Organization Vision


Rationale
Rationale comprehensive services for older adults regardless of economic or functional status


Mission
Mission comprehensive services for older adults regardless of economic or functional status

  • Holistic

  • Addresses unmet needs

  • Partners with the community

  • Compassion expressed through choice


Market
Market comprehensive services for older adults regardless of economic or functional status

  • Community continuum targets 100%

  • Strategy breeds community support

  • Driven by community education—not selling


Business
Business comprehensive services for older adults regardless of economic or functional status

  • Creates the structure to take risk

  • Provides new funding for the most expensive

  • Reduces fragmentation and waste


Six tipping points for financial success
Six Tipping Points for comprehensive services for older adults regardless of economic or functional statusFinancial Success

  • Maximizing Occupancy (Market Share)—May not be possible

  • Premium Pricing (Value)—Mayhave to discount

  • Lean Organizational Structure

  • Effective Capital Management

  • Optimizing Information Systems

  • Efficient Staffing


Best practices lost revenue reporting
Best Practices comprehensive services for older adults regardless of economic or functional statusLost Revenue Reporting

Definition—determines maximum revenue at full occupancy (100%) and identifies reasons for the vacancy (unit not ready for occupancy or Resident temporarily in another care level).

Purpose—focuses management on financial advantage of small increases in occupancy.


Best practices
Best Practices comprehensive services for older adults regardless of economic or functional status

  • Consider alternate forms of fee increases (e.g., percentage versus per person dollar amount)

  • Concentrate on superb resident communications

    • Total costs of operations

    • Market value of services

    • Extra charges


Best practices1
Best Practices comprehensive services for older adults regardless of economic or functional status

  • Implement an effective POS system

  • Consider flexible dining plans that minimize meal credits

  • Implement level of care pricing in Assisted Living


Best practices2
Best Practices comprehensive services for older adults regardless of economic or functional status

  • Centralize Facility Operations to include Maintenance, Grounds, Housekeeping, Laundry, Security and Transportation.

  • Schedule Kitchen staff so that cooks open and close.

  • Empower Charge Nurses to lead Care Teams to serve specific Residents and consider returning nurse leadership to direct patient care on the floors.


Best practices capital management
Best Practices comprehensive services for older adults regardless of economic or functional statusCapital Management

  • Boards should require that management provide annual reporting on projects against projections until stabilized.

  • Repositioning should first focus on programming improvements prior to capital expenses (only when unavoidable).


Best practices optimize information systems
Best Practices comprehensive services for older adults regardless of economic or functional statusOptimize Information Systems

Wireless call systems which signal a pager

POS system integrated with receivables

Electronic medical record combined with service tracking system (i.e. CareTracker or DaRT Chart) , which helps maximize reimbursement under Medicare and case-mix Medicaid

Eliminate time-consuming manual processes


Overall staffing targets
Overall Staffing Targets comprehensive services for older adults regardless of economic or functional status

Target salaries and benefits to be around 40-45% of net revenues


Ftes by level of service
FTEs by Level of Service comprehensive services for older adults regardless of economic or functional status


Facility operations
Facility Operations comprehensive services for older adults regardless of economic or functional status

  • Target 50,000 square feet per maintenance FTE

  • Target square feet per housekeeper

    • ILU = 30,000

    • Assisted living = 20,000

    • Health center = 8,000

  • 60 pounds of laundry cleaned per productive hour


Facility operations1
Facility Operations comprehensive services for older adults regardless of economic or functional status

  • Blend security and 24-hour maintenance

  • Create a balance between technical, skilled and general staff

  • Regularly evaluate contracted versus internalizing services


Dining services
Dining Services comprehensive services for older adults regardless of economic or functional status

  • Target meals per labor hour

    • Health care = 5

    • Assisted living = 4

    • ILU = 2 to 3, depending on type of service

  • 40% of labor should be part-time


Dining services1
Dining Services comprehensive services for older adults regardless of economic or functional status

  • Dining staff should clean all dining rooms and kitchens

  • Nourishment costs should be charged to health care

  • Implement Liberalized Geriatric Diet Manual


Environmental services
Environmental Services comprehensive services for older adults regardless of economic or functional status

  • Create schedules so that:

    • There is only one housekeeper per apartment

    • Housekeepers clean units on same floor or in the same area (villas/cottages) on the same day

    • Detailed cleanings are incorporated into regularly scheduled cleaning times


Laundry
Laundry comprehensive services for older adults regardless of economic or functional status

  • Create drying capacity that is 150% of washing capacity

  • Establish cart exchange system

  • Maintain 5 turns of linen

  • Close laundry on weekends


Hours of care per resident day
Hours of Care per Resident Day comprehensive services for older adults regardless of economic or functional status


Best practices resident centered staffing
Best Practices comprehensive services for older adults regardless of economic or functional statusResident Centered Staffing

  • Assisted living and health care—12-hours shifts (7 days in 2 weeks).

    • Benefits

      • Minimizes number of shift changes.

      • Eliminates shift overlap for CNAs.

      • Staffs the same number of people.

      • Provides consistency of staff.

      • Prefers full-time staff.


Best practice resident centered staffing sample schedule
Best Practice comprehensive services for older adults regardless of economic or functional statusResident Centered Staffing Sample Schedule


Operations facility benefits
Operations comprehensive services for older adults regardless of economic or functional statusFacility Benefits

Reporting to the same people at the beginning and end of shifts

Residents served by the same nursing staff increases consistency of care

CNAs and nurses are on the same team and have the same days off, which reduces call-offs due to peer pressure


Operations facility benefits1
Operations comprehensive services for older adults regardless of economic or functional statusFacility Benefits

  • Improved recruitment

  • More staff to feed evening meals and return residents to bed

  • Less shift-to-shift complaints—problems are easier to resolve with only two shifts

  • Less wasted time for reporting with only two shifts—units are quieter at 3p


Operations facility benefits2
Operations comprehensive services for older adults regardless of economic or functional statusFacility Benefits

  • Scheduling is simple—just fill in names each month and adjust for vacations and/or holidays

  • Less complaints

    • Working long stretches

    • Too many weekends—12-hour shifts gives off every other weekend (Fri/Sat/Sun)


Employee buy in time off
Employee Buy-In comprehensive services for older adults regardless of economic or functional statusTime Off

  • More days off in a two-week pay period (e.g., 7 days versus 4 days)

  • Never work more than 3 days without 2 days off—3 day stretch is only once every two weeks

  • Employees have a long weekend (Fri/Sat/Sun) every other week


Employee buy in increase control
Employee Buy-In comprehensive services for older adults regardless of economic or functional statusIncrease Control

Can plan their schedules since the days off are known in advance

Only need to use 24 hours of PTO to be off for 7 days at a time

Feels more like working part-time with full-time benefits


Employee buy in improved resident care
Employee Buy-In comprehensive services for older adults regardless of economic or functional statusImproved Resident Care

  • Consistent full time staff

  • Residents receive care from the same 4 CNAs and 4 nurses

  • Increases productive hours of care due to elimination of shift change


Sample operational goals
Sample Operational Goals comprehensive services for older adults regardless of economic or functional status


Partner merge affiliate
Partner/Merge/Affiliate comprehensive services for older adults regardless of economic or functional status

  • Stand alone, non-profit, long-term care will be even tougher

  • Dress the Pig for Sale—including Lipstick

  • Challenged organizations seek debt capacity, economy of scale, and management

  • Strong systems seek strategic advantage and ROI


Questions
Questions comprehensive services for older adults regardless of economic or functional status

1501 Greer Lane

Signal Mountain, TN 37377

423.517.0567 ▪ 423.517.0568 Fax

[email protected]

www.consulting-cds.com


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