Download presentation
Presentation is loading. Please wait.
Published byCarter Bivens Modified over 10 years ago
1
Steve Monroe Managing Editor and Partner Irving Levin Associates, Inc. monroe@levinassociates.com www.levinassociates.com
6
The SeniorCare Investor The Senior Care Acquisition Report
7
The SeniorCare Investor
11
HJ Sims Presentation Anthony Argondizza Senior Vice President and Chief Operating Officer
12
Organizational Growth - 2014 and Beyond Purpose Expand mission Lower overhead costs Improve revenue through management fees Serve new markets 12
13
New Construction Long lead times Entitlement approvals Financing Working capital Finally break-even Construction / Occupancy risk 13
14
Mergers / Affiliations Shortened lead time Zoning and approval issues easier Capital considerations Cash flow Operating efficiencies – staff, systems, leverage Access to capital and funding 14
15
Consideration Affiliation Merger Shared services agreement 15
16
Growth Considerations Geography Risk profile Mission Culture residents, trustees, staff 16
17
Springpoint Merger Activity Navesink Harbor – July 2006 Winchester Gardens – June 2013 Un-named CCRC 17
18
Case Study - The Atrium at Navesink Harbor Extremely challenged Small units Physical disrepair Deferred maintenance No cash Financial distress Weak board Partially occupied 18
19
Case Study - The Atrium at Navesink Harbor Repositioned: Façade replacement Total interior reconstruction Larger units (total unit count: from 213 to 138) Deck replacement New addition – 60 units External challenges 2008! Investment much larger than planned 19
20
Case Study - Winchester Gardens Challenges we all face in CCRCs: Heating and cooling upgrades Decorating Changes in space utilization Strengths: Very strong balance sheet Strong demographics CEO and Board of Trustees vision New marketplace for us Impossible entry otherwise 20
21
Summary Assumptions Projected Springpoint Savings Based on Preliminary Analysis – 2013: Administration$649,000 Dining$111,000 Marketing$250,000 Legal $53,000 Purchases and Insurance$264,000 Service Contracts$100,000 Refinancing$830,000 Forward Purchase Utility Contract$150,000 Total Projected Savings$2,400,700 21
22
Case Study - Unnamed CCRC Similarities/Fits: Geography Familiar organizational type Challenges: Declining occupancy (substantial) Capital needs ($10.0MM+) Decent demographics Very large debt burden Reputational risk Estimated 7-10 year fill 22
23
Clinical Decision Unit A new opportunity for growth of Skilled Nursing Home Services
24
Issues Facing Short Term stays.. Managed plans, “Medicare Advantage” Shorter Stays Decreased Reimbursement Part B Therapy Shrinking Narrowing Hospital Networks Short Term Beds are available, but not full!
25
The Opportunity A unique care opportunity Sought by managed care companies & “incentivized” primary care physicians A new ‘admission’ type to SNF Downstream impact to AL, Home Health etc. Alignment w/ a large primary care physician practice Alignment with Managed Care organizations Innovation is our mission ‘call’ Reduce the cost of care Add a new revenue stream to the CCRC Gain experience in “Incident of Care” risk based payments
26
What is a Clinical Decision Unit? Dedicated unit (5-10 bed) within a skilled nursing or short term rehabilitation facility Treat patients that don’t yet need hospital admission –Similar to a hospital Observation Unit Patients awaiting a “clinician’s decision” for care pathway Short length stays (3-10 days) Types of Diagnosis: –COPDPneumonia –CHFUncontrolled Blood Pressure –Failure to ThriveUncontrolled Blood Sugar Staffed by RN, (ratio 5 to 1) Supervised by “on site” Physician or Nurse Practioner
27
Proposed Clinical Structure Physicians will provide clinical support, on site and with EMR Patients will be “managed Medicare” ONLY!!! –Preapproved and Not Requiring the “3 day stay” Physicians will be initial referral stream: –From Observation Unit at Hospital and –Direct from Physician Offices Clinical Decision Unit will manage: –Transport from referral site –Lab and Imaging –Respiratory and Other therapy –IV Fluids –Pharmacy needs Patients will be monitored until Discharge (home or skilled unit)
28
Patient Flow AL, LTC, SNF Clinical Decision Unit Direct from Office COPC Patient Presents at ER Admit to Obs Unit Discharge to Home or Admitted Discharge to CDU DISHCHARGEDDISHCHARGED
29
Steps to CDU Opening Development of Financial Structures –Billing Status for Medicare –Avoidance of out-of-pocket costs for patients classified as observation –Contracts with Medigold and other payors partnered with COPC in risk management contracts Development of Clinical Pathways Staff Hiring and Training Projected opening date 6/1/14
30
2014 HJ Sims Conference The 4 P’s of Marketing 1.Product. The right product. 2.Price. The right product offered at the right price. 3.Place. The right product at the right price available in the right place 4.Promotion. Informing prospects of the availability of the product, its price and its place. Todd Swortzel President and CEO
31
2014 HJ Sims Conference
32
Product Rehabilitation / Physician Practice Business Pilot CMS Bundled Payment Project with Illinois Bone and Joint Institute Product/Catered Living for Independent Living (All IADL’s)
33
2014 HJ Sims Conference Pricing
34
2014 HJ Sims Conference Promotion
35
Let’s Hear from the Leaders Senior Living Trends March 6, 2014
36
AGENDA 36 Welcome Occupancy / Rate Trends Construction Activity Transaction Activity Trends in Acuity Regulatory Trends Impact of the Internet Technology March 6, 2014
37
Assisted Living occupancy strengthened in 2013 37 Note: Represents majority AL and MC, excludes IL and SNF March 6, 2014
38
Annual rent growth slows slightly in late 2013 1/10/2012 38 Note: Represents majority AL and MC, excludes IL and SNF Source: NIC MAP Data and Analysis Services March 6, 2014
39
Construction pace slows as completions outpace starts and inventory increases 39 March 6, 2014
40
40 Public buyers, generally REITs, continue to be the most active buyers, however the private sector regained momentum after a lull in 2011 March 6, 2014
41
Trends in Acuity 41 Average age of our residents is 88, compared to 82 ten years ago 53% of our residents are on a care package which means they need assistance with Activities of Daily Living Today’s residents move-in with 3-5 ADL needs, where previously residents moved in for socialization 65% of our residents are receiving assistance with medications 72% of our residents take 3 or more medications, this number has more than doubled since 2010 In 2013, 43% of our residents moved out due to death Move-outs due to death in <1 year length of stay has increased 54% The Top 5 diagnosis for our resident population are: Hypertension, Dementia, Depression, Congestive Heart Failure, Diabetes March 6, 2014
42
Regulatory Trends Do current State Regulations Support Caring For Frail Residents? Basic assisted living, or create a second tier for providers who can offer “enhanced” services? Skilled nursing services within assisted living? Alzheimer’s Care: Training requirements, Safety precautions (such as “Silver Alerts”), Specialized Programs, Research Funding Prevention of Elder Abuse and Financial Exploitation: increasing emphasis on mandated reporting, prosecution Increased Consumer Disclosure requirements to clarify and manage expectations Medicaid & Assisted Living: Recent CMS regulation clarifies AL’s role in the Home & Community Based Waiver program Review of Life Safety Code issues 42 March 6, 2014
43
Impact of the Internet on Senior Living 43 60% of our leads come through the internet, both directly from our website and through paid internet sources (A Place for Mom, SeniorLiving.Net, Caring.com) Leads are coming to us much more educated from doing research online. Paid internet lead sources provide qualified leads to communities but there are numerous drawbacks Very costly – 70%-100% of one month’s rent/care - with residents coming in more frail and with shorter lengths of stay we are paying more and getting less. Internet sources pass along information to numerous communities Leads don’t always understand what is going to happen when they fill out a form and it can be a very overwhelming and frustrating experience and often makes the process more confusing Social Media is becoming a player in the marketing of senior living Facebook enhances the customer experience for residents and family members, engages associates and captures the true essence of a community for prospective residents and their families Online review sites are impacting the research and decision making process March 6, 2014
Similar presentations
© 2025 SlidePlayer.com Inc.
All rights reserved.