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Miserable useless burden, is perhaps my best description of most of the rules and regulations that accompany receiving government payments for senior care (assisted living, skilled nursing) . That being said Occasionally these programs can provide some unexpected benefits for seniors and those who serve them. Last week I spent some time talking with Mark Cimino, the CEO of Cimino Care a Sacramento area based regional assisted living provider. Here is the story he told me.
He was offered the chance to lease River Fountains of Lodi a 52 room assisted living community. Lodi is located in the California Central Valley and is famous for growing wine grapes and a Creedence Clearwater Revival song. At the time Cimino Care assumed operation of the community it had an occupancy of around 70%. This does not tell the whole story though because 33 of the residents were receiving Supplemental Security Income (SSI) benefits which paid the community just $980 per month. The 10 private pay residents were paying rates of less than $1,500 per month. It gets even worse though, because the community was under targeted supervision by the state.
Finally, because of the low monthly revenue stream physical plant was in disrepair.
The first task was to get right with state licensing. This required a substantial investment in the physical plant and a significant number of staffing changes. As important as the staffing changes was a significant commitment to staff training. The next step was to implement a fresh marketing program, telling a highly skeptical and distrustful community that things have changed. This involved more than just telling the story, it required getting to know the community and inviting them come and experience the new River Fountains. As they began to tell and demonstrate their story, additional private pay residents began to trickle in.
The Magic Bullet – Medical Waiver Program
Mark knew going in, that River Fountains was an ideal candidate for the California State Waiver program. Under this program, residents who require intermittent nursing care that would have historically “forced” them into skilled nursing at a cost to the state of around $150 per day are allowed to be admitted into an assisted living community that provides the required nursing services. Under this program the community receives an additional $50-$80 per day saving the state typically $100 or more per day. In order to participate in the program several things had to happen.
1. They were committed to not evicting any of the existing residents in order to make room for higher paying residents (not a requirement by a philosophy).
2. They then had to go 12 months without a single serious licensing infraction. They were able to accomplish this in 14 months.
3. The application process took another 3 months. Today the community is above 90% occupancy and it’s reputation in the local community is continuing to improve. This is not a program for every troubled community. The community needs to be in the right state and in the right county.
Even then, many communities have an operating cost structure that exceeds the $2,500- $3,500 per month that River Fountains receives. All that being said, there are communities where this program and programs like it can make a real difference for both the residents and community owners.
Finally, I am extremely cynical about the effectiveness of the government to do much of anything, including providing senior care. This is one case where they have done something that is very creative and benefits everyone. Do you have other examples where revenue can be enhanced to make a difference in lives of residents and the communities they live in?
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Finally: If you know anyone who is looking at emergency call systems I would appreciate the opportunity to talk with them about Vigil Health Solutions.
From LinkedIn Groups
I have an elderly care facility and have been trying to find way to have long term care insurance pay for residents care in small facilities. Any idea.?
Posted by Adriana Aguayo
From LinkedIn Groups
I read the article with interest since I have care homes in CA and a 38bed assisted living facility in Nevada. I am very familiar with the Medicaid Waiver program in Nevada since I have 12 medicaid waiver residents. I am not familiar nor aware of the program in CA.
As far as the program in Nevada is concerned, documentation and audits may be the additional issues for compliance (Medicaid) in addition to the regular licensing requirements. So far the system keeps my beds full. I have been a Medicaid provider for over five years now.
Question: What or how is the system in CA initiated? Is it available for all counties? I thought there was a trial program in Northern CA about three years ago. Who is the agency in CA responsible for the Medicaid Waiver?
Just an additional comment: Some of my residents are either recipients of VA subsidy or Medicaid waivers or long term care insurance. Private funded residents are also around but can only affort for a certain period of time then there funds are gone. We need to cater to the monetary status of society and the availability of “insurance” for aging.
Posted by Daisy Lopoz
From LinkedIn Group
I am glad you are having a good experience with it in Nevada. I expect that Mark will respond to your specific questions in the comments section of the blog where I have reposted your thoughts. I think right now there are 7 counties that are participating but I understand that a couple of more counties are in pipeline.
To participate in the California program, you need to follow the instructions found on the website. Your facility must not have any A citations for at least a year. Your first application goes to the ALW program, then they send it to your local licensing agency for approval, then it goes back to the ALW for final Medi-Cal approval. The program was first started in California several years ago as a pilot program in only three counties: LA, San Joaquin, and Sacramento. After the 5-year pilot, it became “vested” as a permanent program in March of 2009 and at that time, the program was expanded to 7 counties. We understand that they will be adding on 2 or 3 more counties in the near future. Just today we attended a conference on the Medi-Cal Managed Care program where we confirmed that there is a possibility that the Assisted Living Medi-Cal (Medicaid) program may be run under the “Managed Care” program. So lots to follow in the near future. Here is the link to the direct office who currently oversees the program for California and on their website you can see the counties currently in the program: http://www.dhcs.ca.gov/services/ltc/pages/alwpp.aspx
My company has an assisted living community (ALC) in Kerrville, Texas. We have Medicaid contract its called Community Based Alternative (CBA) that pays no more than $1,500 per month. Initially they gave us only 16 beds, but they are allowing us to increase our CBA contract to 44 double occupancy although operational wise, I could only do single occupancy.
The CBA is helping us survive the low census in this location. The financial demographic in this location is high but what we found out that, people are house rich, but cash poor. Next time I should know better.
Any New York recommendations ? Thanks
From LinkedIn Groups
Thank you for sharing. Does the medical rate vary by county? Do you know of other states that have this program?
Posted by Kellie Gundling
As for California, interestingly, unlike Skilled Nursing Homes, the Medi-Cal Assisted Living Waiver program pays the same rates in each of the counties…this should probably change…Mark
Oh, and 30+ states have such a program ….
I did a quick web search and it looks like New York May have a waiver program. Take a look at this page under home and community service waivers.
Dear Mr. Cimano:
After having spent about ten years of my working life in an “assisted living/skilled nursing” facility I commend anyone that has a vested interest in maintaining such an enterprise. Although I was a union member, and rightly so because of the conditions that unlicensed staff had to tolerate, it is a very costly enterprise and good staff is hard to train, recruit, and keep. Again, I wish you the best of luck.
Bill at LinkedIn.com
How about NC recommendations?