RE-CREATING HEALTHCARE Project Goal Next Steps February 27, 2019 - - PowerPoint PPT Presentation

Project Goal

Next Steps February 27, 2019

RE-CREATING HEALTHCARE

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

• pportunity to deliver excellence.

Project Goal

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)

Continuum of Care at Saint John’s

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

• ptions 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

External Challenges

Project Goal

• More time required by skilled nursing

regulation negatively impacting person first culture

• Increased cost associated with provision
• f skilled nursing negatively impacting

cost of Life Care

• Difficult to meet individual resident

needs and desires as currently structured Internal Challenges

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

Opportunities

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
• f 20 residents to accommodate couples)
• Independent Living – Central, South & North Towers

(279 apartments)

Continuum of Care at Saint John’s

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

Windsor Court – Skilled Nursing

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

• ne 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

Stratford 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

Canterbury 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

York Court – Assisted 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

Towers – Independent Living

Project Goal

Tower Apt York Canterbury Stratford Windsor

The Continuum of Care

Resident

Project Goal

Stratford: SNF to CBRF Financial Impact

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: Scenario A: 79% (current IL payor mix) Scenario B: 54% (current AL payor mix) Scenario C: 0% (least conservative assumption)

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

• ccupancy and 5 double occupancy rooms
• Increasing the CBRF license from 24 single
• ccupancy rooms to 40 single occupancy and 10

double occupancy rooms.

Recommendation

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

Timing

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

Next Steps

WI Project Goal

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?

Anticipated Questions