Keeping Pace with the Keeping Pace with the Keeping Pace with the Keeping Pace with the EverEver--changing Needs changing Needs

and Preferences of and Preferences of ResidentsResidentsResidentsResidents

Tim Phillippe, Ph.D. President

Christian Homes, Inc.

1 How many are LTC providers?1. How many are LTC providers? 2. SNF construction since 2009? 3 U f d l i SNF3. Use of new models in SNFs:

• Single rooms with private baths• Short-stay rooms & units are

different? New therapy gyms? • Neighborhood models?• Resident-centered care?

• Demand: Annual declines in census &• Demand: Annual declines in census & private pay census in the states

• New models for SNFs & ALs• New models for SNFs & ALs• Medicare revenue must offset

Medicaid lossesMedicaid losses• Result: facility renovations &

construction for good payers areconstruction for good payers are necessary

1. Faith-based, not-for-profit (NFP)1. Faith based, not for profit (NFP)2. Over 3,300 units on 16 campuses in

5 states5 states3. Not a typical NFP

• Heavily focused on skilled nursing• Heavily focused on skilled nursing, unusual for a NFP

• Mostly in small communities (5 000• Mostly in small communities (5,000 to 90,000)

• Affordable living for avg people• Affordable living for avg. people

Ch d t fi t i• Change does not occur first in small Midwestern communities

• Demand today for new products and services even in small communities

• No town is too small for an Assisted Living Facility

Pi t f id• Picture of pyramid

D t ti l id t d iDoes our potential resident drive change? Mostly not.

Dramatic changes are taking placeDramatic changes are taking place.

• Fewer SNF beds and facilities will be required R id t t ill b diff t G t A it &• Resident types will be very different: Greater Acuity & Clinically Complex

• Other models of housing & services are substituted for traditional SNF carefor traditional SNF care

• Quality report cards, pay-for-performance, & managed care are increasingly prevalent.

• The role of states in managing LTC are changing as• The role of states in managing LTC are changing as they contract with managed care & move to expanded consumer choice models.

• Stress to state budgets: Medicaid reductionsStress to state budgets: Medicaid reductions How will we prepare for this new era of accountability &

responsibility?

45.7 45.2 4544.4 43.945

47

40.4

43.4

39.6 39.0 37.939

41

43

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eds

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34.7

36.5

35.535

37

39

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tifie

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331995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007

March 15 of Each Year

15

Source: Larson Allen Study of Minnesota

Th Fl id ti t d tThe Florida estimated use rate by 2030 for SNF beds/1000 population 65+ declines from about 24 beds to 13 beds.

This decline in beds/1000 population 65+ would be substantially lower thansubstantially lower than Oregon’s use rate, which is the lowest in the country at 17.9 and lower than Scandinavian countries which are at about 17 beds/1000 65+.

M q estion for o r emplo ees• My question for our employees.• How about you?

O b ildi diff t• Our new buildings are very different.• What customers drive changes in our

d t d i ? Th ?products and services? The payers? The regulators? The referral sources?

• Everyone is different: Two lessons in• Everyone is different: Two lessons in small versus large.

• What would you & I want?What would you & I want? The Ultimate: Receive LTC care in our

home or a very nice, three bedroom apartment with a personal cook & permanent staffing.

• Everything else is a compromise• Everything else is a compromise

• Residential Look & PrivacyResidential Look & Privacy• Many choices: dining &

activities & more space • Dedicated units: by clinical

need D th f th L T• Death of the Long Term Care Facility as we knew it? (except for dementia care)(except for dementia care)

• As with acuity, preferences moving downstream! SNF gstudios & 1-2 bedroom AL

• Private rooms with private baths• Private rooms with private baths • Residential look, not institutional

“N t th h it l f 1975”“Not the hospital of 1975” • Eliminate large common rooms• Small, informal dining rooms • Several small common areas, for

social interactions, and activities• The perception of choicesp p• Large, first class therapy gym

Six Case Studies:Six Case Studies:Six Case Studies:Six Case Studies:Changing Facilities to Changing Facilities to M t th D d f M t th D d f Meet the Demands of Meet the Demands of

Today’s SeniorsToday’s Seniors2008 2008 -- 20122012

• Acquisition in working class• Acquisition in working class suburb of Chicago

• Pre acquisition: 223 licensed• Pre-acquisition: 223 licensed beds on five units with private rooms only licensed for Medicaidrooms, only licensed for Medicaid

• Badly needed renovation and updatesupdates

• Medicare wing with semi-private rooms and small therapy gymrooms and small therapy gym

• Remodeled two units to create a residential look and feel P i t t di t t C t d• Private studio apartments: Carpeted, flat-panel TVs, telephones, microwaves, and refrigeratorsand refrigerators

• Private Baths • Separate dining and common areas• Separate dining and common areas • Separate entrance, if desired

Ne Therap G mNew Therapy GymRenovated activity wing into a 2,800 sq. ft. therapy gymtherapy gym

R ltResult:1. Mock home areas, nice waiting area 2 P i t l ti ith i d2. Prominent location with windows 3. Private treatment areas

• Census: from 115 to 165 • Medicare/Managed Care census: g

from 12 to 50• Medicare Rate: 20% increaseMedicare Rate: 20% increase • Eliminated agency

Annual employee turnover:• Annual employee turnover:from 80% to 38%

N th t I di• Northwest Indiana• Old model: licensed Residential

Care with semi-private rooms • Converted to studio apartmentsp• Assisted Living appearance • Appearance: Private dining room• Appearance: Private dining room,

private baths, carpet, TVs & telephonestelephones

O t ith 49 AL• On current campus with 49 AL units & 50 Garden Homes

• Neighborhood model• No large common areas, except a g p

3,000 sq. ft. therapy gym• Private rooms, 190 sq. ftPrivate rooms, 190 sq. ft • Private baths

R id t t d i• Resident-centered care service model

Photos HPCV SNF

Photos HPCV SNF

P l d i i th k t• Popular and unique in the market • Originally all short-stay residents • Currently 25% are private pay at

80% above market rates• Very different from traditional long-

term careterm care• Quiet, residential look with

satisfied patientssatisfied patients

The CampusThe Campus• 155-bed SNF & 50 Garden Homes• Great census & case mixGreat census & case mix• Needed an Assisted Living option • New competition coming for the SNF• New competition coming for the SNFAdditions1 Small Assisted Living Villas1. Small Assisted Living Villas 2. Ten Studios per Villa – 265 sq. ft.3. New Skilled Wing (19 private rooms) &

Therapy Gym (2800 sq. ft.)

Resident FactorsResident Factors• Flexibility: Resident-centered • Choices: Meals and activities• Empowerment: Allows residents and family

to help.

Business Factors• Less riskLess risk• Popular• Local and state regulations are an issueg• Market-driven• Best land use

Vill f ll ith iti li t• Villas are full with waiting lists• The Memory Care Villa is the most

popular option• Rates are above typical Assisting yp g

Living rates

R i i #1 i k t i• Remaining #1 in a market is a moving target

• Changes: New facilities coming, demand for private rooms, therapy gym was too small

• Added a unit with 19 private rooms pto create 38 private rooms

• Needed a separate short-stay unitNeeded a separate short stay unit

E tl th th d i f• Exactly the same as the design of the new skilled nursing facility

• Construction overlapped for efficiencies

P l d f ll• Popular and full • Changes the attitude of g

hospital leaders about long-term careterm care

• Peaceful environment is very diff t th t diti ldifferent than traditional facilities

• Helps sell the total facility

58 b d t t 486• 58 one-bedroom apartments: 486 sq. ft.

• 70% low income • Medicaid waiver programp g• Nursing care qualified • Called the “Future of Long Term• Called the Future of Long-Term

Care” by some state officials

When one door closes, another door opens; but we so oftendoor opens; but we so often look so long and so regretfully upon the closed door that weupon the closed door, that we do not see the ones which are open for sopen for us.

Alexander Graham BellScientist and Inventor

Keeping Pace with the Keeping Pace with the Keeping Pace with the Keeping Pace with the EverEver--changing Needs changing Needs

and Preferences of and Preferences of ResidentsResidentsResidentsResidents

Tim Phillippe, Ph.D. President

Christian Homes, Inc.

Building a CustomerBuilding a Customer--Oriented Oriented Culture: Two IdeasCulture: Two IdeasCulture: Two IdeasCulture: Two Ideas

Developing the Leaders p gfor the Future

• How to ensure that employeesHow to ensure that employees behavior is consistent with the expectations of residents?expectations of residents?

• Two crucial groups: The directors and supervisorsand supervisors

Our Approach1 C i i f1. Corporate orientation program for

key leaders and supervisors2. Leadership development program

Th d t th• Three-day program at the corporate office

• For all Directors/VPs at corporate & five key leaders at campuses

• Three times per year • Sessions led by the senior leadersSessions led by the senior leaders

of the organization • Instill values mission and best• Instill values, mission, and best

practices

P t d ith Li l Ch i ti• Partnered with Lincoln Christian University

• Eight sessions over two years • One-day session with pre-session y p

and post-session readings and papers p p

• Can be taken for graduate credit• Starting the second cycle 2013-• Starting the second cycle, 2013-

2014

Keeping Pace with Changing Preferences:

• Very hard to do! • Serious costsSerious costs• Resources are tight

E t ti b k t• Expectations vary by market• People will choose places that

meet their expectations & pay for it

Keeping Pace with the EverKeeping Pace with the Ever--Keeping Pace with the EverKeeping Pace with the Ever--Changing Needs Changing Needs

and Preferences of and Preferences of ResidentsResidentsResidentsResidents

Comments & Questions