By Alex Spanko |
Developing new post-acute and long-term care infrastructure during normal times isn’t always easy — in fact, for one Illinois company, the phased opening of three new skilled nursing facilities this year represented the culmination of more than five years of work.
But as COVID-19 continues to reveal the fatal shortcomings of outdated nursing home design, calls for newer facilities with private rooms and a higher level of care have already grown louder, and the team at Innovative Health believes they’ve made the right bet on what seniors and hospital partners will want in a post-pandemic world.
“Time will tell our success, but I think the model is so different that people are really willing to give us an opportunity to show them how different it is,” Innovative Health chief strategy officer Charles Ross told SNN.
The company is two-thirds of the way through opening a trio of new skilled nursing facilities in the western Chicago suburbs of Mundelein, Lisle, and Aurora, Ill., all branded under the Thrive name. The former two are currently open and operational, with the third set to open later this year.
The Mundelein project, Thrive of Lake County, replaced a county-run facility that Innovative Health initially applied to take over on an interim basis around six years ago. The other two, Thrive of Lisle and Thrive of Fox Valley, represent completely new developments, with a total price tag of about $80 million for all three.
Thrive of Lake County’s status as a replacement for an existing nursing home helped to ease the project through Illinois’s certificate of need (CON) process; like many other states, Illinois limits the number of skilled nursing beds that can legally operate in an attempt to prevent oversaturation and, in theory, maintain a high standard of quality.
In this case, the new facility clocks in at 185 beds, compared to the old property’s 224.
“Essentially, we were de-bedding the market by 39 beds, so the CON board obviously understood what we were trying to accomplish,” Innovative Health principal owner Brad Haber said.
That doesn’t mean the road was easy: Even with that advantage, it took the the Innovative Health team a year to secure the CON approval on the replacement building, while facing challenges on the CONs for the remaining two facilities.
The Lisle facility also saw delays with receiving formal certification for Medicare and Medicaid residents from the state of Illinois, despite serving residents covered under private insurance plans, according to Brian Cloch, principal of Innovative Health partner Transitional Care Management.
Thrive’s experience is indicative of the inherent challenges in designing and building new skilled nursing inventory in many markets. Aside from CON rules, which often do not allow the creation of new nursing home beds without contraction somewhere else, investors aren’t always willing to place a bet on new construction in a space perceived as particularly susceptible to abrupt changes in government reimbursements.
Some companies have seen preliminary success with the high-end “medical resort” model, with real estate investment trusts (REITs) and other investors putting up tens of millions to construct luxurious properties that cater to younger seniors who want a hotel-like experience while recovering from surgeries and other acute events.
But on the whole, investment in new nursing homes has been limited, contributing to a landscape where operators in the space generally have the oldest physical plants in the greater senior care spectrum. The average nursing home still features shared rooms and narrow corridors that consumers and their families don’t prefer — and which serve as particularly virulent breeding grounds for COVID-19.
In Massachusetts, for instance, state health officials have noted that rules requiring new nursing facilities to have single-occupancy rooms have been on the books since the early 2000s — but because so many older facilities were grandfathered in through waivers, a lack of substantial new construction means that the state still has a primarily old stock of nursing home real estate.
The pandemic has thus brought nursing home design into the greater public consciousness, with the Green House model of small-home design emerging as a particular area of focus for big-picture thinkers in long-term care.
But Thrive’s strategy of lower bed counts and ground-up design could also position the buildings for life amid a pandemic with no end in sight.
“What makes us different is that we have made the commitment to the design of the building and to the care delivery model,” Cloch said.
The Thrive buildings have all the trappings of the higher-end medical resorts that have spurred investor excitement, such as a kitchen with a professional pizza oven and lobbies that look more like boutique hotels than nursing homes.
But the luxury design touches belie a wider strategy. The Mundelein campus, for instance, features three separate buildings for each of its main care models — short-term rehab, long-term care, and skilled memory care — connected in the center by a shared kitchen. Each of the buildings has its own separate entrance, dining area, therapy gym, and other amenities, according to Cloch.
Unlike some other new developments, the Thrive facility in Mundelein also accepts Medicaid, allowing residents to remain at the facility long-term if they end up needing more than the 100 days of Medicare-covered post-acute care, Cloch noted.
The other two properties, which will both feature 60 beds and serve only post-acute residents, were designed with the potential for reconfiguration in mind, Ross aid.
“The way the different centers are designed if we should ever need to separate suites because of COVID or clinical programming or really any other reason … we’ve got multiple units that can be closed off and work independently from each other,” Ross said. “So it gives us a lot of flexibility.”
The Thrive team has focused on showing the buildings’ worth to hospital partners, which have been forced to reconsider their own post-acute strategies amid a sharp drop in elective surgeries and patient concern about going to an institutional setting after witnessing tens of thousands of COVID-19 deaths in American nursing homes.
While Ross acknowledged that health systems in Thrive’s markets have accelerated their push to send more people directly home, he noted that they still recognize the need for institutional care for some portion of the population — and that providing something different, with private rooms and bathroom facilities, can help set operators apart.
“They’re still finding there’s a core population that just isn’t going to do well at home, and it’s going to need transitional care, and need our products,” Ross said.
READ ORIGINALLY PUBLISHED STORY HERE
By Lyndee Yamshon |
Despite a general lack of new construction in the skilled nursing space, one owner/operator stands out for building three brand-new skilled nursing facilities in the Chicagoland area.
And when many companies are paring down staff and consolidating, Brad Haber, principal owner and operator at Innovative Health, LLC, is midway through spearheading three SNF construction projects in Mundelein, Lisle, and Aurora for about $80 million in total.
Innovative Health, a short-term transitional and post-acute health care company based in Northbrook, Ill., will replace Winchester House and bring existing staff to the new Mundelein facility and a new set of staffers to the Lisle and Aurora buildings — adding 200 employees, concentrated mostly in nurses with at least 15 new therapists.
The new Winchester House skilled nursing facility being built on Route 45 southeast of Route 83 in Mundelein is more than halfway home, with its opening planned for mid-2020.
When complete, the 185-bed facility on a former driving range will end any remaining Lake County government connection with Winchester House, which opened in 1847 as a poor farm and evolved into a long-term, 24-hour skilled nursing facility.
"We're almost completely under the roof at this point," said Brad Haber, a principal with facility developer and owner Innovative Health LLC. "We're in pretty good shape."
One of the Lake County Board's last expected actions regarding the new Winchester House will ensure the comfort of its residents by allowing wider beds and mattresses than currently in use.
But that will be a while, as work progresses to replace the existing five-story Winchester building at Milwaukee Avenue at Winchester Road that has been a highly visible fixture for generations on the Lake County government campus in Libertyville.
County involvement in the nursing home began to change as revenues fell and deficits rose when its resident population began to decline. In 2011, the county hired an outside firm to manage Winchester House. Eventually, officials reluctantly decided to get out of the nursing home business altogether.
Traditional Care of Lake County, an entity of Rosemont-based Innovative Health LLC, has operated Winchester House since Aug. 1, 2015.
After county officials decided they didn't want to sink significant money into aging mechanical systems at the existing facility, they reached an agreement with Transitional Care clearing the way for a new, privately owned and operated Winchester House.
Under the deal, all residents living in the existing Winchester House will be able to live at the new facility, which may get a new name.
"Whatever it's called, we'll have all the care and characteristics of what's here," Haber said. "It's still the same reputation (for care). We're bringing over all the people."
Originally, the $30 million new Winchester House was to have been completed in the fall of 2018. However, financing-related issues delayed the groundbreaking until last December.
Besides skilled, long-term care for conditions including dementia, 79 of the beds at the new facility will be for patients undergoing short-term rehabilitation after procedures like hip replacements.
About 80% of Winchester House residents rely on Medicaid, a federal-state health insurance program for low-income people. That means residents who move will be paying the same amount.
Transitional Care's agreement also included the county's providing a subsidy of up to $6.7 million for the new facility. The county board last week agreed to increase that amount by $175,000 to provide better beds and mattresses at the new facility, but that additional money will come from a Winchester House donation fund.
"It's not county money. It's not taxpayer money," said Lake County Board member Steve Carlson, chairman of the board's health and community services committee.
Following many years of work and partnerships between Lake County, the Winchester House Advisory Board, Transitional Care Management, Innovative Health, and the Village of Mundelein, representatives of the public/private partnership celebrated the official ground-breaking of the highly anticipated new Transitional Care of Lake County. The new care center, to be located at 850 East Route 45, will replace the existing county-owned Winchester House that will relocate and open as a new state-of-the-art healthcare center that is owned and operated by Transitional Care of Lake County.
After 150 years of owning and operating Winchester House, the Lake County Board sought a partner that could help the County facilitate a smooth transition to private ownership and management of the county-owned and operated Winchester House skilled nursing center. Primary goals included:
building upon the strong Winchester House legacy of quality care
maintaining and enhancing services to residents and families
and planning for a new state-of-the-art community for current residents and their families, as well as future people in need of skilled nursing or memory care, to call home.
Innovative Health and Transitional Care Management offered what turned out to be an ideal solution for the County’s needs, and, in addition, presented incorporating a model, known as Transitional Care, which helps patients bridge the distance between hospital and home by providing a new and highly specialized, short-term recovery option. Construction for the new center begins this month.
“The new Transitional Care of Lake County will offer new innovation in resident-centered senior care and continue the tradition of providing compassionate, high quality skilled nursing and memory care to current residents of Winchester House and Lake County residents who require services in the years to come,” said Denise Norman, President of Transitional Care Management.
Breaking ground for the new Transitional Care of Lake County, a public/private partnership initiated by the Lake County Board in partnership with Innovative Health and Transitional Care Management to best serve area older adults and their families are (from left to right):Mayor Steve Lentz, Village of Mundelein; Julie Mayer, Winchester House Advisory Board Chair; Steve Carlson, Lake County Board Member (District 7); Brad Haber, Principal, Innovative Health; Denise Norman, the President of Transitional Care Management; Michael Knight, Lake County United, Winchester House Advisory Board; Sandy Hart, Lake County Board Chair; Brian Cloch, Principal, Innovative Health, CEO, Transitional Care Management
Great Place to Work Institute, an independent research and consulting firm, honored Transitional Care Management and two of its managed care centers, Transitional Care of Arlington Heights and Winchester House, with certification as a Great Place to Work.
The two care centers earned the distinction following the evaluation of more than 60 elements of team members’ experiences on the job, like employee pride in the organization’s community impact and feeling that their work has special meaning.
"Earning the 'Great Place to Work' distinction is such a privilege,” says Denise Norman, President of Transitional Care Management. "We value our Crew and all they do to make our guests and residents feel comfortable and help them heal. Workplace satisfaction directly contributes to a better patient experience and improved results, making our centers not only great places to work, but better places to recover and live."What employees say:
“I can be myself around here.” 86%
“I feel I make a difference here.” 84%
“My work has special meaning: This is not just a job.” 84%
“I’m proud to tell others I work here.” 83%
“When I look at what we accomplish, I feel a sense of pride.” 83%
This review is based on 196 employee surveys, with a 90% confidence level and a margin of error of ± 4.20. It was published on Jun 14, 2018.
Therapists and clinicians take pride in identifying successful outcomes, but how do referral sources and potential customers in today’s competitive marketplace learn about and understand the great work they are doing? Charles Ross, Chief Strategy Officer with Transitional Care Management, a featured conference speaker on marketing techniques for new therapy models at The National Association of Rehabilitation Providers and Agencies (NARA) fall conference, says:
“In an increasingly data-driven, results-based world, we have great stories to tell! Providers must creatively position their outcomes in a way that translates into increased referrals and more opportunities from both professionals and consumers.”
Outcomes are, without a doubt, increasingly the name of the game. Determining the most effective data for measuring success and finding the best way to present it for maximum results, are the keys to success in an increasingly data-driven marketplace.
To find out more about positioning your skilled nursing or post-acute rehab center for success, contact Charles at CRoss@tc-mgmt.com.
“The roles of the therapist, rehab director and middle manager are critical not only in caring for patients but in managing resources and getting paid for what we do,” says Filippo. “Understanding fundamentals in accounting and finance are key to delivering quality care in our ever-changing industry.”
Charles Ross, Chief Strategy Officer with Transitional Care Management (TCM), is a featured presenter at the national PointClickCare Summit on November 6-9 in Orlando, Florida. Charles will discuss the role of the “virtual CCRC” in helping improve outcomes and increase census.
By creating successful partnerships at various care levels, residential care centers can offer a “virtual” CCRC experience. For example, partnering with a post-acute transitional care center presents an opportunity to develop and fine-tune mutually agreed upon pathways and protocols that help residents transition through various levels of post-acute care more efficiently and effectively.
“Virtual CCRC partnerships ultimately make for a better user experience and improve clinical outcomes,” says Ross. “Plus they can also assist each provider market their own services while ensuring residents are directed to the most appropriate setting in a timely manner.”
Participants will learn what a virtual CCRC “looks” like, and how it can create a smooth and consistent transition for residents who are in need of services, either upstream or downstream along the continuum of care, in a coordinated effective way.
For more information about the PointClickCare Summit or to register visit summit.pointclickcare.com.
Michelle Stuercke, RN, MSN, DNP, MPH, LNHA, Chief Clinical Officer with Transitional Care Management (TCM), is a featured presenter at the national PointClickCare Summit on November 6-9 in Orlando, Florida. Michelle and a panel of experts will discuss positively impacting re-hospitalization rates by fostering interdisciplinary communication and physician engagement.
Hospital readmissions continue to be a focus at all levels of care. The current rate of returning to hospitals from post-acute care facilities is approximately 23%. The cost of re-hospitalizations to Medicare is approximately 17.5 billion dollars. The effect of re-hospitalizations is not only monetary, but physical and emotional as well. Research shows that approximately 45% of these hospitalizations are avoidable.
The centers to be profiled in this session are post-acute care centers that specialize in high acuity. At the beginning of 2016 the centers were not using the PointClickCare INTERACT™ tools or Physician Engagement solution. The return-to-hospital rate was running as high as 50%. By the end of 2016, after the implementation of both the Change of Condition forms, QI tools and Physician Engagement tools, the return-to-hospital rate decreased to as low as 16%.
The use of the Change of Condition form for effective communication, as well the physicians’ use of the Physician Engagement tool to review labs, medications, vital signs and progress notes, allowed for a more comprehensive evaluation and treatment that resulted in the prevention of unnecessary hospitalizations.
For more information about the PointClickCare Summit or to register visit summit.pointclickcare.com.
Transitional care facilities move ahead in Lisle, Aurora
Rosemont-based Innovative Health said Monday it will break ground this summer on new short-term rehab centers in Lisle and Aurora, after winning court decisions against local competitors attempting to stop them.
Innovative Health, which also plans to build more facilities in the region, already acquired the land on Ogden Avenue in Lisle and on New York Avenue in Aurora for about $1 million each. The company plans to spend another $40 million to construct the two 68-bed facilities, which will add about 200 jobs by next year.
"We're very confident that we'll fill these facilities after we did the research prior to picking the locations," said Brad Haber, principal and co-founder of Innovative Health. "These areas demonstrate a need with a lot of growth expected."
The state approved both projects last May, and zoning permits were provided by Lisle and Aurora officials. Read More