Case 1: Cottage Senior Living
Continue analyzing the situation your case study’s healthcare organization faces. In this milestone, you will evaluate the impact of policies and policy changes on the healthcare organization’s strategic plan. You will also consider the role that the healthcare manager and other organizational stakeholders have in strategic planning.
In a short paper, address the policies of the healthcare organization. Be sure to address the following:
Provide a brief summary of the organization’scurrentpolicies with regard to the issue it is facing.
To what extent do you feel current organizational policies address theinfluence of the identified environmental or external factors? Be sure to justify your rationale.
What internal policy changes or new policies do you feel will need to be implemented to more effectively address the issue? Be sure to justify your response.
To what extent do the identified key stakeholders influence the strategic planning process in terms of policy change or development?
Cottage Senior Living
The leadership of Cottage Senior Living (CSL) assembled at a strategic
planning retreat away from their headquarters in Huntsville, Alabama to prepare a
plan to move the business “to the next level.” For the president of the company,
Cliff White, the goal of reaching the next level involved growth that focused on
identifying locations for acquisition and development. In addition to White,
attending the retreat were: Sandy Brackin Vice President of Operations, Cheryl
Westlake, Director of Operations; Alan Hangartner, Vice President of Marketing
and Sales; Greg Dykes, Regional Managing Director – South; Selena Jackson,
Regional Managing Director – North; and Holly Mitchell, Senior Accountant.
To begin the retreat, White articulated Cottage Senior Living’s vision as the
“development of housing and service offerings that attract empty nesters who
choose to live an active, vibrant, and engaged lifestyle.” He further explained,
“Our product is differentiated from the traditional markets for independent living
(IL), assisted living (AL), memory care (MC), and skilled nursing facility (SNF)
by focusing on non-subsidized, private-pay customers in tertiary markets.”
White continued, “Moving toward the goals of the retreat, our task today is
to answer three questions: 1) How to grow? 2) Where to grow? and 3) Do we have
the organizational capacity to grow? Answering the ‘how to grow’ question
involves assessing additions to existing capacity, offering services we presently do
not, and expanding our same product into other geographic markets (horizontal
integration). The ‘where to grow’ question involves the consideration of new cities
and perhaps new states. And both questions, how to grow and where to grow,
require us to examine our organizational capacity to grow.”
The Cottage Story
Cottage Senior Living, also known as “the Cottages,” was headquartered in
Huntsville, Alabama. The founders of Cottage Senior Living, Peg Thompson and
Wade White, met in Doylestown, Pennsylvania in 1980 while consulting as turnaround specialists focused on continuing care retirement communities (CCRCs)
and more specifically, the Pine Run Community, a for-profit CCRC. The Pine Run
Community opened in 1976, and was one of the first retirement communities to be
developed and the only one at that time with a full service, 200-bed regional health
center devoted to senior care.1 Thompson and White married and spent the
remainder of the 1980s creating the assisted living service model, something that
did not exist prior to 1980. Thompson and White sought distressed retirement
communities, especially religiously-affiliated CCRCs and spent the mid-1980s
1
through the mid-1990s making deals. Their first venture was a management
contract to operate the “Regency” Community in Huntsville, Alabama. The
Regency Community became the company’s headquarters. During the 1990s,
Cottage Senior Living developed CCRCs in Florence, Alabama; Russellville,
Alabama; Corinth, Mississippi; Lawrenceburg, Tennessee; Mountain Brook,
Alabama; and acquired CCRCs in Hoover, Alabama; Decatur, Alabama; Hartselle,
Alabama; and Huntsville, Alabama (see Exhibit 1 for Cottage Senior Living’s
market area).
Exhibit 1. Cottage Senior Living Service Area
Cliff White, Wade and Peg’s eldest child, returned to the family business in
2009 after completing an MBA at the American University in Washington, DC.
Beginning in 2011, White served as president of Cottage Senior Living, LLC.
Among Cliff White’s accomplishments was the development of The Commons, a
54-unit active adult community in Huntsville, Alabama where he implemented
several information technology (IT) projects to improve operational efficiency and
management reporting. White focused much attention on innovating assisted
living. He was a member of the Urban Land Institute Senior Housing Council and
the American Seniors Housing Association and was a Certified Public Accountant.
The Industry
The long-term care industry was composed of health-service, social service,
and residential service organizations that provided rehabilitative, restorative, and
ongoing skilled nursing care to disabled and elderly patients who required
assistance with daily living.2 The assisted living industry was comprised of a
variety of senior care services; generally divided into two major subcategories: (1)
2
continuing care retirement communities and (2) homes for the elderly. The
primary difference between the two subcategories was the presence of nursing
care. Continuing care retirement communities provided on-site nursing facilities
whereas homes for the elderly did not. Future growth of the industry would be
spurred by 77 million Baby Boomers and the increasing life expectancy of the
elderly population. Approximately 1 million Americans lived in senior care
facilities and the number was expected to double by 2030.
Competition in the assisted living industry was intense. The four largest
providers in the industry (Brookdale Senior Living, Sunrise Senior Living,
Emeritus Corporation, and Atria Senior Living Group) controlled only about 13
percent of the market share. The remaining 87 percent was comprised of a variety
of not-for-profit and for-profit enterprises. The largest source of revenue for
providers came from private payers representing almost two-thirds of total
revenue. Medicaid provided about 10.5 percent, Medicare about 6.2 percent, and
private insurance about 3 percent. The remaining 14 percent came from a variety
of sources including other government programs and assigned Social Security.
Great variety occurred in the demographic make-up of retirement communities.
Approximately 69 percent of residents were female and 31 percent were male. The
typical resident of a senior living community was an 85-year-old female.
Individuals over the age of 85 made up the largest percentage of residents in senior
living facilities.3 More specifically, the industry was comprised of a variety of
facilities differentiated by the intensity of care provided as summarized in Exhibit
2.
Exhibit 2. Senior Living Communities in Order of Increasing Intensity of Care
Type of
Community
Age
Range or
Average
Age of
Residents
Regulation
Senior
Apartments
55 plus
Not regulated Occasional
Independent
Living
82
average
Not regulated Scheduled
Assisted
Living
Facilities
85 plus
and need
driven
Regulated by
state
government
Scheduled and
required by
regulation
Memory
Care – a
85 plus
and need
Regulated by
state
Scheduled and
required by
Transportation
Activities
Daily, but
not
required
Daily, but
not
required
2
Services
A la carte
Housekeeping
(included*), nursing
call system3,4
Housekeeping
Scheduled 6 (included); nursing
call system; food
times per
service (3 times/day,
day;
scheduled);
(schedule
required by medication assistance
regulation) – all required by
regulation
Scheduled 6 Housekeeping
times per
(included), nursing
3
Specialty
driven
Care Assisted
Living
Facility
(SCALF)
government
regulation
Skilled
Nursing
Facility
(SNF)
Regulated by
state and
federal
governments
Scheduled and
required by
regulation
Adolescent
and older
*
day;
(schedule
required by
regulation)
call system, food
service (3 times/day,
scheduled), nurse
administered
medication, monthly
RN assessments- all
required by regulation
Housekeeping
(included); nurse
Scheduled, 6
calling system; food
times per
service (3 times/day,
day;
scheduled); nurse
(schedule
administered
required by
medication; monthly
regulation)
RN assessments – all
required by regulation
Included means incorporated into the residential fee-for-service structure
Independent living settings were adult communities that usually imposed
age restrictions, offered social activities, provided security, offered access to
transportation services, but did not provide medical services. Although no
uniformly accepted definition of assisted living facilities (ALFs) existed, ALFs
were considered “multi-family properties with personalized support services for
seniors.”4 A relatively new development in the long-term care industry was the
Continuing Care Residential Community or CCRC. CCRCs attracted private-pay
residents5 “of high socioeconomic status, who were independent upon entering the
CCRC.”6 CCRCs offered a variety of services providing a progression of care
from independent living to nursing facilities in a single campus setting focusing on
wellness activities and amenities.7,8,9 The progression of services offered by
CCRCs acknowledged the inevitable decline of independent older adults during
the last few years of life, making CCRCs the “final station” of an older adult’s
life.10 A skilled nursing facility (SNF) was defined by the Social Security Act as
an institution (or a distinct part of an institution) that was primarily engaged in
providing skilled nursing care and related services for residents who required
medical or nursing care, or rehab services for the rehabilitation of injured,
disabled, or sick persons, and was not primarily for the care and treatment of
mental diseases; and had in effect, a transfer agreement with one or more
hospitals. Nursing facilities offered the most intense level of long term care and
were for individuals requiring around the clock care.11 Memory care facilities
catered to the needs of individuals with Alzheimer’s disease or a related disorder
(ADRD)12 and was an emerging development within CCRCs.13 Memory care and
skilled nursing facilities were categorized as Specialty Care Assisted Living
Facilities or SCALFs.
From an industry perspective, Medicaid was the primary payer of long term
care services inasmuch as more than 60 percent of the patients in nursing homes
4
were Medicaid recipients and that Medicaid patients comprised almost 20 percent
of residents in assisted living facilities.14 The Cottages did not market to or admit
Medicaid recipients.
The CSL Regulatory Environment
The Cottages operated three types of facilities – Assisted Living, Memory
Care, and Active Adult as “group” facilities or “congregate” facilities. The word
congregate used as an adjective to describe long-term-care facilities is a synonym
of the word group and thus appeared to refer to the same thing;15 however, state
regulations distinguish between the terms as they applied to health care facilities.
Because the Cottages operated facilities in three states, agencies in each state
regulated the facilities; however, the majority of the Cottages’ facilities were
located in Alabama and as a result the company was profoundly affected by
regulations of the Alabama Department of Public Health (ADPH). ADPH
regulations differentiated between group assisted living and congregate assisted
living facilities. Group assisted living facilities were authorized to care for three to
sixteen adults. Congregate assisted living facilities were authorized to care for 17
or more adults. Regulations addressed staffing requirements and the qualification
of key members of the staff. The key regulatory parameters, shown in Exhibit 3,
indicate that in general, ALFs had fewer staffing requirements than SCALFs and
both ALFs and SCALFs had similar building requirements.
5
Exhibit 3. Key Regulation Parameters within the Cottages Footprint
15
ALF
SCALF
Staffing
General requirement: sufficient staff on duty General requirement: sufficient staff on duty to
to provide the care needs of all residents
provide the care needs of all residents twenty-four
twenty-four hours per day, seven-days per
hours per day, seven-days per week.
week.
Staff requirement: based on resident population and
time of day:
Residents by Time Period
Staff
7am-3pm 3pm-11pm
11pm-7am
2
1-16
1-16
1-16
3
17-24
17-36
17-48
4
25-32
37-48
49-64
Staff requirement: based on resident
5
33-40
49-60
65-80
population and time of day; no set, specific
requirement.
6
41-48
61-72
81-96
7
49-56
73-84
97-112
8
57-64
85-96
113-128
9
65-72
97-108
129-144
10
73-80
109-120
145-160
11
81-88
120-132
161-176
+1 per
8
12
16
Specific professional licensed staff:
Specific professional licensed staff:
Administrator
Administrator
Medical Director – licensed physician
Dietician – could be full-time, part-time, or
Registered Professional Nurse
consultant
Coordinator – an administrator who was an RN
Dietician – could be full-time, part-time, or consultant
Building Requirements
Dining separate from kitchen
Dining separate from kitchen
Separate rooms for administrative and office
Separate rooms for administrative and office purposes
purposes
Centrally located staff station with call for
Centrally located staff station with call for assistance
assistance and fire alarm communication
and fire alarm communication system
system
Grab bars conforming to current building
Grab bars conforming to current building code
code
Commercial exhaust food system
Commercial exhaust food system
Institutional grade range with double oven
Institutional grade range with double oven
Bedrooms individually and consecutively
Institutional grade refrigerator
numbered
Hand washing lavatory in kitchen with soap
Hand washing lavatory in kitchen with soap dispenser,
dispenser, supply of soap, disposable towels,
supply of soap, disposable towels, and hot and cold
and hot and cold running water running
running water running through a mixing valve or
through a mixing valve or combination faucet combination faucet
Commercial grade dishwashing equipment
Three-compartment sink with a booster heater or
with a booster water heater
chemical sanitizing system
Laundry rooms shall not open directly into
Doors of resident bathrooms swing into the bedroom
resident rooms or food service areas
6
ALF
Utility rooms on each floor
A sign bearing the word “EXIT” at each exit
SCALF
Bedroom doors at least three feet wide
A sign bearing the word “EXIT” at each exit
The CSL Market and Product Lines
Sandy Brackin, Vice President of Operations, distributed information on
occupancy by facility. Exhibit 4 shows the number, type of unit, and occupancy of
each location in the Cottages portfolio of facilities. All units were single
occupancy, meaning each unit housed one resident. Brackin stated, “As you may
note, our occupancy is highest at one of our smaller facilities – Russellville and
lowest at our largest facility – Huntsville.” Brackin continued, “Average
occupancy for five years for all facilities was 87 percent.”
Exhibit 4. The Cottages Portfolio
Location
Assisted
Living Units
Memory
Care Units
Active Adult
Units
Corinth, MS
Decatur, AL
Florence, AL
Hoover, AL
Huntsville, AL
Lawrenceburg, TN
Montgomery, AL
Mountain Brook, AL
Russellville, AL
Hartselle, AL
27
32
47
16
48
27
40
44
27
10
0
0
0
32
0
0
32
0
0
32
0
0
0
0
54
0
0
0
0
0
Facility
Occupancy
Rate (%)16
92
95
93
70
65
98
88
77
97
96
White offered a brief review of the financing of the Cottages Portfolio.
White noted, “Our properties were financed by a roughly 50/50 relationship of
equity and debt. The debt was in the form of conventional mortgages and HUD
232 loans.”17 Exhibit 5 indicates the distribution of conventional and HUD 232
loans18 used in financing the Cottages facilities. White continued, “The average
original loan per unit was $39,400 with a standard deviation of about $16,000.”
Exhibit 5. Source of Debt Financing by Location
Location
Corinth, MS
Decatur, AL
Florence, AL
Hoover, AL
Huntsville, AL
Type of Debt Financing
Conventional
Conventional
HUD 232
HUD 232
Conventional
7
Lawrenceburg, TN
Montgomery, AL
Mountain Brook, AL
Russellville, AL
Hartselle, AL
Conventional
HUD 232
HUD 232
Conventional
Conventional
Prior to the retreat, White had directed Holly Mitchell to prepare a
simplified income statement for a set of representative properties for the most
recent three years. Mitchell’s work product is shown in Exhibit 6. Mitchell
distributed the income statement and commented, “The representative properties
selected were 1) the average of Florence and Mountain Brook – assisted living
facilities with the same number of units, 2) Russellville -small assisted living, 3)
Hartselle – small assisted living plus memory care, and 4) Decatur – assisted
living.” Mitchell continued, “A typical Cottages property produces average
operating revenue per occupied unit of $32,848 per year and operating expenses
average $26,181 producing an operating margin of about $7,000 per occupied unit
per year. The fixed expenses per occupied unit include depreciation, amortization,
and interest expense.”
Exhibit 6. Income Statement per Occupied Apartment
Revenue
Other Revenue
Total Revenue
Operating Expenses
Administrative & General
Resident Services
Marketing
Food Service
Maintenance
Total Operating Expenses
Other Income/Expenses
Fixed Expenses
Net Income
FLO/MBK
38,056
1,589
39,645
RCL
27,899
1,153
29,052
HAR
34,418
1,443
35,861
DEC
30,492
1,224
31,716
AVG
32,848
1,365
34,212
-10,841
-8,503
-2,505
-3,538
-2,444
-27,831
-2,043
-2,321
7,450
-10,315
-7,743
-1,111
-3,314
-2,017
-24,500
-1,318
-1,717
1,517
-9,886
-8,614
-1,603
-3,693
-2,765
-26,562
-2,820
-2,346
4,132
-9,483
-8,691
-1,576
-3,688
-2,755
-26,191
-1,094
-1,416
3,015
-10,293
-8,264
-1,747
-3,499
-2,378
-26,181
-1,742
-1,976
4,313
EBITDA (earnings before interest, taxes, depreciation, and amortization)
was a general estimate of cash flow.19 Mitchell distributed a schedule that showed
EBITDA generated per occupied unit (shown in Exhibit 7). She added, “Average
annual cash flow per occupied unit was $6,298 with a range from approximately
$4,000 per unit to almost $9,700.” She reminded the attendees that taxes were not
included in the calculation of EBITDA since the Cottages was organized as a
Limited Liability Company or LLC, and concluded, “LLCs are pass-through
8
entities for tax purposes that do not incur income tax liabilities as an enterprise,
rather tax liabilities are passed to the enterprise’s owners in proportion to their
ownership, similar to partnerships and Subchapter S corporations.”20
Exhibit 7. EBITDA per Occupied Apartment
FLO/MBK
7,450
RCL
1,517
HAR
4,132
DEC
3,015
ALL
4,313
2,321
1,641
1,717
1,041
2,346
2,820
1,416
933
1,976
1,477
254
-1,982
236
-1,453
235
-1,793
234
-1,586
242
-1,711
EBITDA
9,683
3,058
Legend:
FLO/MBK = facilities in Florence, AL and Mountain Brook, AL
RCL = facility in Russellville, AL
HAR = facility in Hartselle, AL
DEC = facility in Decatur, AL
7,741
4,012
6,298
Net Income
Add: Fixed Expenses
Add: Interest Expense
Add: Other
Less: Standard Management Fee
ALL = all CSL facilities
The CSL Operations and Staffing
Model
As White continued to facilitate the retreat, he recognized Brackin who
explained, “Concerning organizational capacity, one of our strengths is that the
Cottages operates its facilities in a franchise type arrangement – each facility is
established as a legal entity for purposes of owning real estate; then we as the
parent company – the Cottages – provide branding, a standardized staffing plan,
and a standardized operating plan.21 Each facility pays the Cottages a management
fee that is five percent of gross revenue. Each facility’s staff members are
employees of the Cottage’s and we administer payroll and employee benefits. I
believe we certainly should continue this model since it has served the company
well since its inception.”
The staffing model specified the credential and experience requirements for
facility administrators. For ALFs, an administrator was required to have a high
school diploma and relevant work experience.22 The staffing model implemented
the regulatory framework (presented previously in Exhibit 3). For example, a
Licensed Practical Nurse (LPN) or Registered Nurse (RN) was required as a staff
member for the administration of medications and an RN was required to perform
intake assessments and monthly assessments in all SCALF facilities. The standard
procedures model might be modified based on the physical plant differences
9
among facilities. For example, if a facility had three buildings, then the one foodservice staff member transported food between buildings rather than simply
plating food in a single facility.
Mitchell distributed a handout (see Exhibit 8) that showed the overall
staffing plan for CSL as well as the functions and the number of full-time
equivalents for each function. Mitchell noted, “For facilities that did not show the
function of housekeeping, residential services personnel are assigned the tasks.”
10
Exhibit 8. CSL Management Structure by Location
Headquarters
Function
President
Accounting
Information Technology
Marketing and Sales
Operations
Function
Managing Director
Food Service
Maintenance
Residential Services
Function
Managing Director
Admissions
Food Service
Maintenance
Residential Services
Function
Managing Director
Food Service
Maintenance
Residential Services
Function
Managing Director
Admissions
Food Service
Maintenance
Residential Services
Executive*
1
0
1**
1
1
Corinth, MS
Executive*
1
0
0
0
Decatur, AL
*
Executive
1
0
0
0
0
Florence, AL
Executive*
1
0
0
0
Hartselle, AL
Executive
1
0
0
0
0
*
FTEs
Managers
0
1
1
1
3
Staff
0
2
1
2
3
FTEs
Managers
0
1
1
1
Staff
0
0
0
6
FTEs
Managers
0
1
1
1
1
Staff
0
0
1
0
12
FTEs
Managers
0
1
1
1
Staff
0
1
0
12
FTEs
Managers
0
1
1
1
2
Staff
0
0
1
0
15
FTEs
Managers
0
1
1
1
Staff
0
0
1
0
Hoover, AL
Function
Managing Director
Admissions
Food Service
Maintenance
Executive*
1
0
0
0
11
Residential Services
Function
Managing Director
Admissions
Food Service
Housekeeping
Maintenance
Residential Services
Function
Managing Director
Food Service
Maintenance
Residential Services
Function
Managing Director
Admissions
Food Service
Health Services
Housekeeping
Maintenance
Residential Services
Function
Managing Director
Food Service
Maintenance
Residential Services
Function
Managing Director
Food Service
Maintenance
Residential Services
*
0
Huntsville, AL
Executive*
1
0
0
0
0
0
Lawrenceburg, TN
Executive*
1
0
0
0
Montgomery, AL
*
Executive
1
0
0
0
0
0
0
Mountain Brook, AL
Executive*
1
0
0
0
Russellville, AL
Executive*
1
0
0
0
2
15
FTEs
Managers
0
1
1
1
1
1
Staff
0
1
1
0
0
15
FTEs
Managers
0
1
1
1
Staff
0
0
0
6
FTEs
Managers
0
1
1
1
1
1
1
Staff
0
1
1
0
0
0
15
FTEs
Managers
0
1
1
2
Staff
0
1
0
12
FTEs
Managers
0
1
1
1
Staff
0
0
0
6
For headquarters – Vice President and above, for facilities, Managing Director and above
The president oversees all information technology functions
**
12
Developing a Growth Plan
White distributed a document summarizing the market selection criteria
that had proven successful for the company.
CSL’s desired market characteristics included:
Strong demographics – age and income qualified customers (market
penetration in the 5 to 10 percent range) and population growth
exceeding 2 percent year-over-year;
Towns and communities undergoing re-urbanization (“main street
living”) – communities with re-urbanization plans that were being
executed; and
Reasonably priced land near the main street area.
He then presented a single PowerPoint slide showing a regional map with
two circles (see Exhibit 9). White narrated, “The inner circle represents the market
area for CSL as a circle centered on our headquarters in Huntsville with a radius
that includes all of the CSL facilities, the most distant being Montgomery. What if
we extended the radius of the circle by about fifty miles? Our reach would be to
five states – Alabama, Georgia, South Carolina, North Carolina, Tennessee,
Kentucky, and Mississippi.”
Alan Hangartner, CSL VP of Marketing and Sales, “Cliff, as I look at the
map, something strikes me as interesting. . . Look at all the college towns in the
larger circle – Auburn, Clemson, Knoxville, Nashville, Starkville, and Oxford.”
He continued, “I recall reading that college towns are attractive to retirees.”23
Several nodded their heads in agreement.
Selena Jackson, Regional Managing Director – North, reacting to
Hangartner’s comment stated, “Alan, college towns would be interesting ‘where to
grow’ places, but do they meet all three elements of our market characteristics: age
and income qualified customers, main-street living, and reasonably priced land
near the main street area? College towns may meet the first two requirements, but
I am concerned about the third – the availability of reasonably priced land.”
Hangartner responded, “You may be right, but we should consider towns near
these college towns. An example is Opelika, Alabama near Auburn, Alabama,
home of Auburn University.”
“That wouldn’t work for Clemson!” laughed Greg Dykes, Regional
Managing Director – South. He continued, “Plus, I think that South Carolina and
especially North Carolina have significant CON (certificate of need) laws. North
Carolina is quite willing to add more Assisted Living, Memory Care, and SNF
facilities in rural areas, but the metro areas – Charlotte, Raleigh, Greensboro,
13
Durham, Winston Salem and Fayetteville all with more than 200,000 in population
– are challenging.”
The group began identifying potential growth strategies – horizontal
integration, vertical integration, product expansion such as more specialty care
offerings, new payers, and geographic expansion. They knew they had to keep in
mind the regulatory barriers of entering new states, the demographics of potential
new cities, and important considerations such as company’s demographics – size,
personnel capabilities, span of management, geographic limitations; and
competitive variables including employment markets, potential competitors, and
pricing.
White replied, “As we consider the possibilities, we need to focus on the
three questions:
How to grow?
Where to grow?
Do we have the organizational capacity to grow?”
He continued, “Let’s break for lunch and when we reconvene, we can each
identify a strategy that we believe will best enable us to grow the organization.”
14
Exhibit 9. Examining SCL’s Service Area*
*Current Cottage locations are in red.
References
1
About Pine Run. retrieved from: http://pinerun.org/independent-living/ )
2
Warren Greenberg, “Long-Term Care Industry,” The Health Care Marketplace (New York:
Springer, 1998), pp. 91-102.
3
J. Ortiz, Assisted Living Facilities Business Report. U.S. Small Business Administration, April,
(2014). Small Business Market Research Reports, available at:
http://www.sbdcnet.org/small-business-research-reports/assisted-living-facilities .
4
Lynn David and Tim Wang, “The US Senior Housing Opportunity: Investment Strategies,”
Real Estate Issues 33, no. 2 (2008), pp. 33-51.
5
Michael D. Barnett, “Future Expectations among Older Adults in Independent Living
Retirement Communities” (University of Houston, 2010).
6
I. Doron, and E. Lightman, “Assisted-living for Older People in Israel: Market Control or
Government Regulation?” Aging and Society 23, no. 6 (2003), pp. 779-795.
15
7
Wassum, Ryan Michael, “Baby Boomer Living: Designing a Modern Continuing Care
Retirement Community,” Master’s Thesis, California Polytechnic State University, San
Luis Obispo, CA, (2013), available at: http://digitalcommons.calpoly.edu/theses/1070/ .
8
J. C. Hays, A. N. Galanos, T. A. Palmer, D. R. McQuoid, and E. P. Flint, “Preference for Place
of Death in a Continuing Care Retirement Community,” The Gerontologist 41, no. 1
(2001), pp. 123-128.
9
A. K. Smith, L. C. Walter, Y. Miao, W. J. Boscardin, and K. E. Covinsky, “Disability During
the Last Two Years of Life,” JAMA Internal Medicine 173, no. 16 (2013), pp. 1506-1513.
10
Services, C. O. M. M. “Skilled Nursing Facility” (SNF) Definition, 2017. Retrieved from
https://www.cms.gov/Outreach-and-Education/Medicare-Learning-NetworkMLN/MLNMattersArticles/downloads/SE0745.pdf
11
L. Ayalon, and O. Greed, “A Typology of New Residents’ Adjustment to Continuing Care
Retirement Communities,” The Gerontologist 56, no. 4 (2015), pp. 641-650.
12
S. G. Kelsey, S. B. Laditka, and J. N. Laditka, “Dementia and Transitioning from Assisted
Living to Memory Care Units: Perspectives of Administrators in Three Facility Type,”
The Gerontologist 50, no. 2 (2010), pp. 192-203.
13
J. Adler, Memory Care Facilities Fill a Growing Need. Chicago Tribune, (February 1, 2013).
Retrieved from http://articles.chicagotribune.com/2013-02-01/classified/ct-mre-0203memory-care-20130201_1_alzheimer-memory-loss-dementia .
14
https://www.ahcancal.org/advocacy/State LongTermPostAcute/Pages/default.
aspx#assistedliving
15
Congregate. In Merriam-Wwebster.com. Retrieved from https://www.merriamwebster.com/dictionary/congregate .
16
Adapted from Alabama Rules of Alabama State Board of Health Alabama Department of
Public Health Assisted Living Facilities (Ala. Code Chapter 420-5-4).
17
The Federal Housing Administration (FHA), part of the US Department of Housing and Urban
Development, provides mortgage insurance on loans made by FHA-approved lenders in
the US and its territories. The Section 232 loan program is administered by the Office of
Residential Care Facilities. The Section 232 loan program is known as HUD 232, “help
finance nursing home, assisted living facilities, and board and care facilities.” HUD 232
loans are offered only by FHA-approved lenders and the loans are insured or
underwritten by the US government. FHA Insurance and Section 232. (n.d.). Retrieved
March 27, 2017, from
https://portal.hud.gov/hudportal/HUD?src=%2Ffederal_housing_administration%2Fhealt
hcare_facilities%2Fresidential_care%2Ffha_insurance .
18
Multifamily Accelerated Processing (MAP) Approved Lenders. (n.d.) Retrieved March 27,
2017 from https://portal.hud.gov/hudportal/documents/huddoc?id=aprvlend.pdf .
19
B. Hamilton, “EBITDA: Still Crucial to Credit Analysis,” Commercial Lending Review 18, no.
5 (2003), pp. 47-48.
16
20
J. R. Macey, “The Limited Liability Company: Lessons for Corporate Law,” Wash. ULQ 73
(1995), p. 433.
21
S. W. Norton, “Franchising, Brand Name Capital, and the Entrepreneurial Capacity Problem,”
Strategic Management Journal 9, S1 (1988), pp. 105-114.
22
Alabama Board of Examiners of Assisted Living Administrators, Qualifications, available at:
http://www.boeala.alabama.gov/qualifications.aspx
23
T. Lewin, “Elderly Returning to Campus, This Time for Life as Retiree,” The New York Times
(February 19, 1990) retrieved from: http://www.nytimes.com/1990/02/19/us/elderlyreturning-to-campus-this-time-for-life-as-retirees.html
17
HCM 415 Milestone Four Guidelines and Rubric
Continue analyzing the situation your case study’s healthcare organization faces. In this milestone, you will evaluate the impact of policies and policy changes on
the healthcare organization’s strategic plan. You will also consider the role the healthcare manager and other organizational stakeholders have in strategic
planning.
You will develop a 2–3-page short paper addressing the policies of the healthcare organization. Be sure to address the following:
A. Provide a brief summary of the organization’s current policies with regard to the issue it is facing.
B. To what extent do you feel current organizational policies address the influence of the identified environmental or external factors? Be sure to justify
your rationale.
C. What internal policy changes or new policies do you feel will need to be implemented to more effectively address the issue? Be sure to justify your
response.
D. What role should the healthcare manager assume in terms of guiding strategic planning processes around policy revision or development? Why?
E. To what extent do the identified key stakeholders influence the strategic planning process in terms of policy change or development?
Guidelines for Submission: This short paper should be between 2 and 3 pages, not including cover page and references. This paper should be in APA format.
Instructor Feedback: This activity uses an integrated rubric in Blackboard. Students can view instructor feedback in the Grade Center. For more information,
review these instructions.
Critical Element
Summary
Exemplary (100%)
Meets “Proficient” criteria and
expertly balances brevity with
required detail
Proficient (90%)
Provides a brief summary of
the organization’s current
policies with regard to the issue
it is facing
Analysis: Current
Policies
Meets “Proficient” criteria and
demonstrates exceptional
insight into the relationship
between organizational policies
and environmental or external
factors
Logically assesses the extent to
which current organizational
policies address the influence
of identified environmental or
external factors, justifying
rationale
This study source was downloaded by 100000804400461 from CourseHero.com on 10-01-2023 03:27:45 GMT -05:00
Needs Improvement (75%)
Provides a brief summary of
the organization’s current
policies with regard to the issue
it is facing, but response is
verbose or has gaps in required
detail
Assesses the extent to which
current organizational policies
address the influence of
identified environmental or
external factors, justifying
rationale, but response has
gaps in logic, detail, or
justification
Not Evident (0%)
Does not provide a brief
summary of the organization’s
current policies with regard to
the issue it is facing
Value
5
Does not assess the extent to
which current organizational
policies address the influence
of identified environmental or
external factors
20
Analysis: Changes
Meets “Proficient” criteria and
demonstrates sophisticated
insight into the need to revise
or implement policies
Logically determines internal
policy changes or new policies
that will need to be
implemented to more
effectively address the issue,
justifying response
Analysis: Strategic
Planning
Meets “Proficient” criteria and
demonstrates exceptional
insight into the role of
healthcare managers in
strategic planning
Determines an appropriate role
for the healthcare manager to
play in guiding strategic
planning processes around
policy revision or development,
justifying determination
Analysis: Influence
Meets “Proficient” criteria and
demonstrates exceptional
insight into the role of
organizational stakeholders in
strategic planning
Articulation of
Response
Submission is free of errors
related to citations, grammar,
spelling, syntax, and
organization and is presented
in a professional and easy-toread format
Provides a logical explanation
of how identified key
stakeholders might influence
strategic planning process in
terms of policy change or
development
Submission has no major errors
related to citations, grammar,
spelling, syntax, or organization
This study source was downloaded by 100000804400461 from CourseHero.com on 10-01-2023 03:27:45 GMT -05:00
Powered by TCPDF (www.tcpdf.org)
Determines internal policy
changes or new policies that
will need to be implemented to
more effectively address the
issue, justifying response, but
with gaps in logic, detail, or
justification
Determines a role for the
healthcare manager to play in
guiding strategic planning
processes around policy
revision or development,
justifying determination, but
role is inappropriate for the
purpose or response has gaps
in detail or justification
Provides an explanation of how
identified key stakeholders
might influence strategic
planning process in terms of
policy change or development,
but with gaps in detail or logic
Submission has major errors
related to citations, grammar,
spelling, syntax, or organization
that negatively impact
readability and articulation of
main ideas
Does not determine internal
policy changes or new policies
that will need to be
implemented to more
effectively address the issue
20
Does not determine a role for
the healthcare manager to play
in guiding strategic planning
processes around policy
revision or development
25
Does not provide an
explanation of how identified
key stakeholders might
influence strategic planning
process in terms of policy
change or development
Submission has critical errors
related to citations, grammar,
spelling, syntax, or organization
that prevent understanding of
ideas
25
Total
100%
5
Order an Essay Now & Get These Features For Free:
Turnitin Report
Formatting
Title Page
Citation
Outline
