RE-CREATING HEALTHCARE Project Goal Next Steps February 27, 2019
Project Goal Project Goal Re- create healthcare at Saint John’s in a way that respects resident needs and desires, incorporates best practice, supports ongoing innovation, and responds to the desire to provide employees an opportunity to deliver excellence.
Continuum of Care at Saint John’s Project Goal Current State • Skilled Nursing – Windsor & Stratford Courts : (50 rooms – licensed at 50) • Assisted Living – Canterbury Court : (24 rooms – licensed at 24) • Independent Living – Central & South Towers : (200 apartments)
External Challenges Project Goal • Occupancy in skilled nursing trending down – Fewer Medicare referrals as patients go directly home from the hospital – Fewer private pay direct admissions as consumers seek lower cost alternative – Increased number of high acuity assisted living options available in marketplace – Medicaid recipients not attractive option as funding has not kept pace with cost of care
External Challenges Project Goal • Cost to provide skilled nursing escalating – Increased Federal regulation – Tight labor market driving up wages and benefits • Difficult to fill RN and LPN positions – Work not as challenging as in acute care settings – Resident contact diluted by increasing paperwork demands
Internal Challenges Project Goal • More time required by skilled nursing regulation negatively impacting person first culture • Increased cost associated with provision of skilled nursing negatively impacting cost of Life Care • Difficult to meet individual resident needs and desires as currently structured
Opportunities Project Goal • Honor resident and prospect requests for memory care • Align care needs with staff specialization • Respond to resident requests to live together as couples • Advantage flexibility afforded by assisted living regulations • Reduce labor costs associated with more regulated environment
Continuum of Care at Saint John’s Project Goal Proposed Future State • Skilled Nursing – Windsor Court : (25 rooms – licensed at 30 to accommodate the potential of couples sharing one room) • Assisted Living – Stratford and Canterbury Courts : (50 rooms – licensed at 60 to accommodate the potential of couples sharing one room) • Assisted Living – York Court : (16 apartments with a capacity of 20 residents to accommodate couples) • Independent Living – Central, South & North Towers (279 apartments)
Windsor Court – Skilled Nursing WI Project Goal Resident Profile • Requires the availability of licensed nurses 24/7 • Complex wound care management • Complex pain management • Behaviors associated with dementia that require nurse oversight and intervention • Short-term rehabilitation under Medicare A • Hospice Care
Stratford Court – Assisted Living WI Project Goal Resident Profile – Frail Elderly • Requires daily oversight of licensed nurses • Care needs are primarily physical (may also have mild cognitive impairment) – Mobility: uses walker or wheelchair independently or with assist of one staff person for transfers – ADL’s: requires the assist of one person for bathing, dressing and personal grooming – Nutrition: may require assistance with eating (ex. Use of adaptive equipment) – Toileting: requires staff assist to meet toileting needs (includes managing incontinence). • Hospice Care
Canterbury Court – Assisted Living WI Project Goal Resident Profile – Memory Care • Requires daily oversight of licensed nurses. • Care needs are primarily cognitive (may also have mild physical impairment). – May require verbal cuing for mobility, performing activities of daily living, eating, and toileting – Requires assistance to structure the day • Hospice Care
York Court – Assisted Living WI Project Goal Resident Profile • Requires oversight of licensed nurses • Care needs do not exceed 4 hours/day and may include: – Standby assistance or supervision/cueing for mobility, performing activities of daily living, eating and toileting – Benefits from more convenient access to others for socialization – Resident is able to structure his/her day with minimal assistance. May benefit from reminders for day to day events • Hospice Care
Towers – Independent Living WI Project Goal Resident Profile • Is generally independent with all aspects of daily living • May receive scheduled supportive services – not to exceed 4 hours/day - including: – Medication management – Standby assistance with bathing & dressing – Meal support (pick-up from Bistro) – Grocery shopping, managing medical appointments, transportation – Hospice Care
The Continuum of Care Project Goal Tower Apt Windsor York Resident Stratford Canterbury
Stratford: SNF to CBRF Financial Impact Project Goal Scenario A Scenario B Scenario C Total Expense Reduction $ 498,000 $ 498,000 $ 498,000 Reduction in Revenue $(375,000) $(311,000) $(167,000) Net Favorable P&L Impact $ 123,000 $ 187,000 $ 331,000 Revenue Payor Mix Assumptions: Eight (8) existing SNF Lifecare residents deemed appropriate for assisted living transferred to CBRF, with mix of additional new admissions to CBRF on Lifecare assumed to be: 79% (current IL payor mix) Scenario A: 54% (current AL payor mix) Scenario B: Scenario C: 0% (least conservative assumption)
Recommendation Project Goal Management recommends converting one floor of skilled nursing to assisted living licensed as a Community Based Residential Facility (CBRF). Specifically: • Reducing the skilled nursing facility license from 50 single occupancy rooms to 20 single occupancy and 5 double occupancy rooms • Increasing the CBRF license from 24 single occupancy rooms to 40 single occupancy and 10 double occupancy rooms.
Timing Project Goal • Concurrent with occupancy of new building, currently anticipated by year-end • Allows for single relocation to align resident care needs with program of floor • Goal: Seamless to resident
Next Steps Project Goal • Meet with State officials to explain request and ascertain requirements • Apply for City Zoning Appeal needed to increase number of CBRF beds • Communicate to residents and staff • Provide CBRF required training to additional staff
WI Project Goal
Anticipated Questions Project Goal • Might this result in more moves within the continuum? • Does this mean we’ll be laying off staff? • Would we be able to increase skilled beds in the future? • Downside?
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