A. Home for Mom Cash-Strapped:
Nursing Home Failing Bond Covenants

What’s to know here? 
A community-owned senior living campus was failing its bond covenants on a construction loan for a new assisted living complex.  This option had recently been added to the nursing home and independent living campus. 

The organization had already drained considerable community foundation cash for operating expenses.

Contract management that had been overseeing the senior living campus for several years had ended most management services.

What happened?
Solutions leadership assessed the organization, educating the board on the status of management, operational issues, and go-forward options.

Then Solutions staff effectively worked as a chief restructuring officer turning operations to achieve a positive operations cash flow.   

Much of the improvement work involved billing and marketing.  Filling all beds/units and correcting use of the billing system strengthened revenues.  Stabilization of clinical staff also began reducing costs for temporary/traveling staff.

In collaboration with the team, leadership gaps were filled with excellent area recruitments.

This senior living campus is recovering financially and is well on its way to meeting its loan obligations.  It will continue to serve its community in providing a caring home for its senior citizens. 


B. State Inspectors Making Frequent Unannounced Visits to Nursing Home

What’s the scoop?
When the Solutions team arrived, the nursing home was undergoing frequent (two to three per week) unannounced visits from State Inspectors highlighting quality of care issues.  The pressure was on!

Wow… Where to Start?
The organization had brought in an expert on quality of care.  While this was a great start to identify priorities, the consultant did not have the ability to implement necessary changes. 

Solutions leadership assisted in interviewing candidates for an Interim Nursing Home Director position, guiding to the hiring of the strong change agent needed in this situation.

How Did This Go?
Within a few months, Solutions brought the nursing home back into substantial compliance with quality-of-care regulations. 
Is there anything else to know?

Returning to substantial compliance with regulations was a yeoman effort by the entire organization which included a large rural hospital. 

Solutions facilitated bringing necessary resources to the effort, including maintenance, food services, nursing, the pharmacy, and housekeeping.  It was important that everyone on the team came to a belief in what was needed to operate the nursing home as well as was the hospital.

C. Nursing Home Losing Money

What’s the scoop?
The new Nursing Director had brought the quality of care up to a stellar level the last couple of years at this nursing home associated with the local hospital.

BUT….prices had not been adjusted…for forever!  No adjustment for staffing improvements.  No increase for the phenomenal quality of care.  No recognition of inflation or improved market position.

Everyone was worried that if the nursing home rates were raised, many of the residents would leave.  Yet the nursing home had been losing money for years. 

What Did Solutions Do?
Solutions management carefully studied regional nursing home quality and price rates.  The team determined that with a market-based price increase, residents would still find this nursing home to be a great value as a “home for Mom.”

So What Happened?
Only one family moved its relative…  sadly, to a low quality facility that later closed under the weight of its poor management and services. 

Residents and their families remained satisfied and supportive of the nursing home, regular rate increases were instituted to avoid another large adjustment, and the nursing home remains a great “home for Mom.”

Is there anything else to know?
With its improved cash position, the hospital connected with this nursing home was able to acquire refinancing and build new facilities, supporting the community members and the economy.  
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