Exiting the workforce at a “traditional” age is no longer the norm for many older adults, and senior living communities are learning that in order to keep their residents happy and provide a comprehensively convenient environment, they may have to accommodate a variety of interests—including residents who still work in some capacity.
Some retirement communities make a point of including business centers at all or most of their locations, and while it’s a relatively small percentage of senior living residents who are still working, that number is growing, says John Spooner, Greystone Communities’ executive vice president.
Traditionally, people may have planned on retiring at about 62, then perhaps take up a hobby or pursue a leisurely lifestyle, but recent studies show that attitudes toward retirement are changing.
“The changes in the workplace have made the retirement more gray,” says Troy Bourne, the vice president of planning and development at Continuing Life Communities, a California-based CCRC chain. “People used to retire [at a younger age], but now, not so much. People quasi-retire.”
These days, it’s more likely for someone to continue working well into “traditional” retirement age. That could look like simply scaling back the number of hours worked, volunteering at a church or for some other cause, or even switching careers altogether, Spooner says.
Business centers have always been included in CLC communities, Bourne says. They have about a dozen computers along with other equipment, like fax or copy machines, are are free for residents to use.
“They’re like a mini [FedEx] Kinko’s,” he says. “It’s access to all of those things, without having to leave the community.”
For Continuing Life Communities residents, most of those who still work in some capacity are self-employed or work as a consultant, Bourne continues. They may still be doing work that’s similar to their original career, but they’re doing it from a home office.
“The workplace has just become a little more fluid that way,” he says.
That’s similar to what Spooner has seen at Greystone communities, most of which have a business center (some are even starting to include adjacent board rooms or meeting rooms).
“Many of our residents, both male and female, were the owners of family businesses and play an ongoing role in that business,” he says.
Looking ahead to the aging boomer population, Spooner says senior living providers will need to accommodate that generation’s attitudes toward work and retirement, and that’s what Greystone is trying to do.
“Boomers are still far away from entering a retirement community, but tremendously high percentages say they’ll never stop working,” he says. “We’ve seen these statistics, and we’ll adapt and implement and complement whatever their values are.”
Entering a senior living community shouldn’t automatically mean retirement, Spooner and Bourne agree, adding that their companies seek to accommodate a longer work life and the desire of people to remain in the workforce longer.
Written by Alyssa Gerace
Prudential Closes $13.7 Million Construction Take-Out Loan for Ohio Community
Prudential Mortgage Capital Company, the commercial mortgage lending business of Prudential Financial, Inc. (NYSE:PRU), recently closed a $13.7 million construction take-out loan for an Ohio senior living community. Parker Place is a three-story, 124-unit independent living complex located in Mentor, Ohio. The loan term is for 20 years; the community opened in 2009 and is close to fully occupied. Karen McGinnity, a director with Prudential Mortgage Capital Company, was the lead on this transaction.
Sabra Originates $11 Million Mortgage Loan with Purchase Option for Meridian Equity Investors-Owned SNF
Sabra Health Care REIT, Inc. (NYSE:SBRA) announced on Tuesday if had originated an $11 million mortgage loan, following an $11 million mortgage loan agreement it entered on June 22 with with affiliates of Median Equity Investors, L.P., secured by a first trust deed on a 125-bed skilled nursing facility in Texas.
The loan has a five-year term with an fixed interest rate of 8.5% a year, and cannot be prepaid during the first three years of the loan term.
Sabra also has the option to purchase, and the borrowers have the right to sell, the Texas skilled nursing facility securing the loan between July 1, 2013 and the time the loan is repaid, for between $12.5 million and $14.5 million, depending on the annualized EBITDAR of the facility for the three months leading up to the exercise option date.
Meridian Equity Investors can’t require Sabra to purchase the property, however, if the three-month annualized EBITDAR is below $1.7 million.
The skilled nursing facility was built in 2010 and is operated by Senior Care Centers.
“The Onion Creek Mortgage Loan is yet another example of repeat business with a relationship we have developed in the last year,” said Rick Matros, CEO and Chairman of Sabra. “Like our previous deal with Meridian, this is an investment that should generate an attractive yield for our shareholders while providing us with the flexibility to purchase the property and add to our increasing list of operator relationships. We are excited to continue growing our relationship with the Meridian and SCC teams.”
Recent Lancaster Pollard Financing Transactions (For-Profit & Non-Profit):
Lancaster Pollard Closes $8.1 Million in Loans for Two Ohio Nursing Homes
Lancaster Pollard recently announced the closing of two loans totaling $8.1 million for Suburban Nursing Homes in Cincinnati, Ohio. Kass Matt, senior vice president located at the firm’s headquarters in Columbus, was the lead banker on the transaction. The loans were insured through HUD’s Section 232/223(f) program and resulted in low fixed-interest rates over the loans 35-year terms and produced significant debt service savings for the borrower. The loans refinanced two of Suburban’s skilled nursing facilities: The Residences at Huntington Court and Home at Taylor’s Pointe.
Lancaster Pollard Obtains $7.7 Million Loan to Refinance Ohio SNF’s Term Notes
Lancaster Pollard recently closed a $7.7 million loan with mortgage insurance through the FHA Section 232/223(f) program for Cardinal Woods Skilled Nursing and Rehabilitation Center, located in Madison, Ohio. The loan will refinance three separate term notes the borrower had with a major bank. The refinancing resulted in a low interest rate with a 35-year term and will generate significant debt service savings and fund a sizable replacement reserve for future capital needs. Kass Matt, senior vice president located at the firm’s headquarters in Columbus, Ohio, was the lead banker on the deal.
Lancaster Pollard Refinances Two Ohio Senior Care Properties With $11.2 Million Loan
Lancaster Pollard recently refinanced two properties operated by Health Care Management Group: Clovernook Health Care Pavilion and Loveland Health Care Nursing & Rehab Center, both located in the greater Cincinnati, Ohio area. The firm, led by Kass Matt out of the home office in Columbus, Ohio, utilized the FHA Section 223(a)(7) program for both transactions. The total loan amount was $11.2 million and the borrower will achieve nearly $200,000 in annual debt service savings.
Lancaster Pollard Helps Kansas Senior Care Facility Refinance Debt With $3.8 Million Loan
Lancaster Pollard recently assisted Hillside Village of De Soto, located in De Soto, Kan., with refinancing its existing debt using the FHA Sec. 232/223(f) program. The site was originally built as a skilled nursing facility in 1976. In 2003, the skilled nursing facility was completely renovated and 38 assisted living units were added. Facing a balloon payment in December 2012, Lancaster Pollard, led by Bill Wilson out of the firm’s Lawrence, Kan., office, worked with the ownership team to secure a non-recourse funding structure, while locking in a 35-year term loan of $3.8 million with a low interest rate.
Lancaster Pollard Obtains $19.2 Million Refinancing Loan for Mo. CCRC
Lancaster Pollard recently assisted with the refinance of The Groves, a 447-bed continuing care retirement community located in Independence, Mo. The borrower acquired the facility in 2010 and substantially improved its operations and financial viability. The borrower then sought to refinance an existing seller note and bank debt associated with the acquisition. Using the FHA Sec. 232/223(f) mortgage insurance program, Lancaster Pollard was able to obtain a long term and low rate for a $19.2 million loan. In addition to substantial debt service savings, the loan will fund nearly $600,000 in improvements to the community without an equity requirement from the borrower. Steve Kennedy, out of the firm’s headquarters in Columbus, Ohio, was the lead banker on the deal.
Lancaster Pollard Provides $19.7 Million in Financing Through Bond Placement for NCR
National Church Residences (NCR), one of the nation’s largest nonprofit providers of senior housing, recently closed a series 2012 bond issue for its Traditions Healthcare Obligated Group. Lancaster Pollard competitively bid the direct placement of $19.7 million in Series 2012 tax-exempt, variable-rate bonds.
Formed in 2005, the obligated group originally consisted of five health-care campuses throughout the state of Ohio. As part of the financing, NCR and Lancaster Pollard added two new health-care entities to the group, Legacy Village and Heritage Day Health Centers. The bond proceeds refunded the bridge note related to the acquisition of Legacy Village and the Series 2002 and 2007 Heritage Day Health Centers bonds. Further, the bonds will fund several projects, including the expansion and renovation of the Mill Run campus, a new rehabilitation-only skilled nursing facility on the Legacy Village Campus and the expansion of the Chillicothe campus. Ultimately, the Series 2012 bonds also serve NCR’s long-term goal of maintaining an appropriate balance of variable-rate and fixed-rate exposure for its obligated group. Lancaster Pollard was represented by Kass Matt and Brendan Healy from its Columbus office.
Lancaster Pollard Closes $5.9 Million Refinancing Loan for Georgia ALF
The Gardens at Calvary, a 78-unit assisted living facility in Columbus, Ga., is owned by Calvary Baptist Church and managed by Friendswood, Tex.-headquartered TrinityCare. The nonprofit organization wanted a long-term, fixed-rate financing structure to refund its existing tax-exempt bonds, release funds trapped in trustee-held escrows and obtain capital funding for repairs. Lancaster Pollard structured and closed a $5.9-million loan issued by the FHA Sec. 232/223(f) program. The refinancing will generate more than $ 1.7 million in debt-service savings and fund a sizable replacement reserve for future capital needs. Lancaster Pollard’s team was led by Jim Neil and Scott Blount from the firm’s Austin, Tex., office.
Affordable Housing Program Grant Allows Dallas CCRC to Move into Final Construction Phase
A $500,000 Affordable Housing Program grant awarded by Amegy Bank of Texas and the Federal Home Loan Bank of Dallas (FHLB Dallas) will allow the construction of a Dallas-area senior living community to move forward into its third and final phase.
The last leg of a new senior housing development is expected to break ground in July 2012. The project, Lake West Assisted Living, will consist of 130 assisted living units designated for low-income seniors, and will expand the senior living community’s services to include a full continuum of care.
The Dallas Housing Authority and StoneGate Senior Living, a Lewisville, Tex.-based senior living and care management company are leading the project, which has already completed its first two phases. The Village at Lake West and the Lakewest Rehabilitation and Skilled Care center are already in full operation, opening in November 2009 and April 2011, respectively.
The Village, an affordable independent living community, has 360 units for 55+ adults and reached 100% occupancy within one year of opening. The rehabilitation center offers post-acute healthcare services and has capacity to care for up to 118 patients.
The AHP grant will help StoneGate with related construction costs for the final phase of development. The new assisted living apartment complex will give its residents access to long-term supportive services and will offer onsite meal plans through its dining program, along with laundry services, a recreation center, and daily activities.
The Medicaid program as envisioned through the Affordable Care Act’s expansion provision has been “transformed” and isn’t even the same program anymore, said the Supreme Court Justices today in their momentous healthcare reform ruling, so it’s not constitutional for the government to threaten states with losing their existing Medicaid funding if they choose not to comply with the expansion.
“The original program was designed to cover medical services for particular categories of vulnerable individuals. Under the Affordable Care Act, Medicaid is transformed into a program to meet the health care needs of the entire nonelderly population with income below 133 percent of the poverty level,” the Justices noted in the syllabus of their massive decision.
They argue that states could have “hardly anticipated” that when Congress reserved the right to “alter” or “amend” the Medicaid program, it would also have the power to “transform it so dramatically.”
Click here to read about how the Medicaid expansion could affect the long-term care industry.
Medicaid is a voluntary program that all states currently choose to participate in. Each state Medicaid program is allotted a certain amount of matched federal funding, depending on the demographics of that state’s residents. However, part of Obamacare gives the Department of Health and Human Services the authority to penalize states that choose not to participate in the expansion, by taking away their existing Medicaid funding.
States depend heavily on that matching funding, though, so most states, despite the voluntary nature of the program, would essentially be forced to go all-in with the expansion—or risk losing everything.
But “depriving a state of all of its Medicaid funding for refusing to agree to the new expansion would exceed Congress’s power under the Spending Clause,” writes the SCOTUSblog of three of the Justices’ position on the provision.
“Although Congress may attach conditions to federal funds, they concluded, it may not coerce states into accepting those conditions,” SCOTUSblog says. “And in this case, taking away all the states’ funds for the entirety of its Medicaid program just because it disagreed with a piece of the program would be coercive.”
The bottom line is that while expanding Medicaid is constitutional, it’s unconstitutional for the federal government to cut off all funding for states who choose not to comply with the expansion, the article continues.
“The result is that states can choose to participate in the expansion, [and] must comply with the conditions attached to the new expansion funds if they take that new money, but states can also choose to continue to participate only in the unexpanded version of the program, if they want,” it says.
Basically, the Court decided to limit the financial pressure the Department of Health and Human Services could apply to states to force them to accept the terms of the Medicaid expansion. But while some states are now more able to choose to reject the expansion, that doesn’t mean all—or even any—will, the Justices note.
Written by Alyssa Gerace
While the Supreme Court upheld the Affordable Care Act, it struck a provision that said states would lose their Medicaid funding if they don’t comply with the planned expansion.The ruling means progressive action on maximizing Medicaid reimbursement is still needed, a top long-term care advocate told McKnight’s.
Many senior living providers are changing course on pet policies, a Sun-Sentinel article this week reports. That’s the way residents want it, according to the article, which follows other recent reports indicating that those senior living communities that say “no” to pets have the potential to lose out when it comes to new residents.
The Sun-Sentinel reports:
It’s a real zoo these days inside assisted living centers and nursing homes. Cats napping on the beds, dogs padding through the hallways. And that’s just the way the residents want it.
An increasing number of senior care centers, places that once wouldn’t let anything with fur in the front door, now welcome companion animals. Many facilities have a house pet, and some allow seniors, like Georgia Pritchard, to room with their four-legged friends.
“He almost talks. He knows what I’m saying,” said Pritchard, an 88-year-old widow with no children. She’s talking about O’Reily, a black and white cat she shares a room with at John Knox Village in Pompano Beach.
Because research has shown some seniors benefit from regular contact with animals, such privileges are expanding to assisted living and nursing units where elders have mild to serious medical conditions.
Read the original article.
Written by Elizabeth Ecker
In what some are calling the “decision of a century,” the Supreme Court ruled today to uphold some key portions of the Affordable Care Act, including the provision that is arguably the most relevant to the skilled nursing industry: Medicaid expansion.
The health care reform provision to expand Medicaid eligibility and coverage is probably the biggest aspect of how health care reform will directly impact the skilled nursing industry, says Greg Crist, vice president of public policy at trade group the American Health Care Association (AHCA).
Eligibility for participation in the Medicaid program has been expanded to cover nearly all non-disabled adults younger than age 65 with household incomes at or beneath 133% of the federal poverty level—for about 17 million new beneficiaries—starting in January of 2014.
Medicaid has been expanded before, but under the ACA, funding was going to be slightly different, says Kaiser Health News: “The ACA provides that the federal government will not cover its normal share, but rather 100% of the states’ costs of the coverage expansion from 2014 through 2016, gradually decreasing to 90% in 2020 and thereafter.”
The issue was, starting in 2017 states will be responsible 10% of those extra coverage costs, but most states have not, so far, made any indication they’d be putting more funds toward their Medicaid programs, says Crist. That means the existing Medicaid funds would have to be split even more ways than before—and it could spell more cuts for nursing homes.
Led by Florida, 26 states filed a lawsuit against the Department of Health and Human Services challenging the ACA’s Medicaid expansion provision, saying it was “unconstitutionally coercive of states,” says the Kaiser Health News brief.
If states are unhappy with the direction Medicaid is headed in, they can just opt out—it’s a voluntary program. For many, though, it’s not that easy. All states currently participate, and they depend on the federal matching funds to cover the costs of services to eligible individuals, including about 60% of the nursing home population.
Simply disregarding the expanded eligibility provision isn’t really an option, either: non-compliance with federal requirements can result in states losing their federal funding.
Leading up to the Supreme Court ruling on the ACA, AHCA was considering what could happen pending either decision.
“If it’s not struck down, it could have potentially negative repercussions,” Crist had said prior to the ruling. ”That’s the concern: It’ll be more groups competing for the same fixed amount.”
With the Court’s decision, providers will have to take action.
It was difficult to make any sort of preparation in advance of the ruling, Crist had said.
“There [was] no real clear path [on which to proceed],” he had said.
Now the hard work begins, he says, to make sure lawmakers are educated on the skilled nursing industry’s needs now that the expansion has, in part, been upheld.
On June 28, the U.S. Supreme Court issued its opinion on the Patient Protection and Affordable Care Act. “Regardless of opinions about the ACA, it elevated debate over fundamental themes that have great resonance for the field of long-term services and supports,” says LeadingAge President Larry Minnix. Check out the rest of his response to the ruling.
Older adults—even those with memory impairments—living in senior care facilities still have a right to have sex, says a paper published in the Journal of Medical Ethics in June, but many are prevented from doing so by prohibitive policies or environments.
“Sexual self-determination is considered a fundamental human right by most of us living in Western societies. While we must abide by laws regarding consent and coercion, in general we expect to be able to engage in sexual behaviour whenever, and with whomever, we choose,” write the paper’s authors.
But for seniors with dementia, it’s not so simple.
It can be hard for staff to balance a resident’s rights with their care and the safety and care of others living in the facility. Pair that with generally negative (or avoided) views on sexuality in older adults, and, the authors say, this can lead to ”residents’ sexual expression being overlooked, ignored, or even discouraged.”
The big issue is consent, and whether residents with memory or other cognitive impairments are able to safely agree to sexual activity or physically intimate relationships.
“While every effort should be made to ensure that no resident comes to harm, [senior care facilities] must respect the rights of residents with dementia to make decisions about their sexuality, intimacy, and physical relationships,” the paper says.
Some care facilities have restrictive policies toward sexual activity among residents, and even where policies may be absent, environments may not be conducive to pursuing intimate relationships. Whether it’s because of a lack of privacy or and absence of physical accommodations, that should change, the authors say.
“Since it has been well established that sexuality and intimacy continue to be important in later life and are central to an individual’s health and wellbeing, the lack of attention paid by aged care facilities to residents’ sexual needs is concerning,” the authors write.
When older residents with memory impairments pursue sexual relationships, it’s very important for care providers to make sure it’s consensual and understood, Frieda Pulkowski, owner of Cherry Tree Senior Care Consulting, has emphasized in a previous SHN article on senior sex.
Honoring and accommodating residents should be a priority—but so is keeping them safe, she says.
“It helps to identify what level of dementia the resident has—obviously residents with milder stages are more likely to meet the above criteria [of knowing the risks and benefits of their actions and having the ability to make informed decisions],” Pulkowski has previously said. “It also helps to identify whether or not the behavior in which the resident is now engaging is consistent with his or her historically held belief system.”
As more adults age, and the numbers of those with memory impairments increase, the topic of sexual activity among residents will become more relevant. For now, they conclude, most senior care facilities will likely ignore these issues and, instead, err on the side of caution.
Access the full paper.
Written by Alyssa Gerace
Developer to Turn Former Michigan School Into Senior Housing Facility
A developer is planning on buying a former elementary school in Grand Rapids, Michigan for $510,000 and turning it into an assisted living facility, reports MLive.com. Officials from the city of Grand Rapids signed off on the property getting rezoned for conversion; plans include around 50 living units, a dining hall, a recreation area, and offices.
G.A. Haan Development is the developer, and expects to close on the property by early July. The building is located on 7.5 acres and is currently 36,686 square feet, but G.A. Haan plans to add approximately 7,700-square-feet. To do the expansion, however, the developer would have to get permission again from the city.
North Dakota Nursing Home to Build New $25 Million Facility
Baptist Home, a nursing home in northeast Bismark, North Dakota, is planning to build a new $25 million facility, reports Aberdeen News. Construction will begin soon on the 140-bed skilled nursing center, and residents will be able to move in by fall of 2013. The building will have 108 single rooms and 16 shared rooms, along with a 24-bed short-term rehabilitative care unit. The existing nursing home has been operating since 1948.
Nuns to Invest $16 Million Mo. Senior Living Community Overhaul
Nazareth Living Center is planning a $16 million expansions project to add an independent living facility to its senior living community in the St. Louis, Mo. area, reports the local Business Journal. They are also planning to build a new dementia care facility, and replace its existing 150-unit assisted living building with a new structure.
To help finance the project, the nonprofit provider is issuing $8.2 million in bonds through St. Louis County’s Industrial Development Authority. Read more.
Construction: In the Process
The LaSalle Group Breaks Ground on Georgia Memory Care Community
Assisted living and memory care community developer The LaSalle Group celebrated groundbreaking yesterday for Autumn Leaves of Sugarloaf, located in Suwanee, Ga.
The LaSalle Group designs, develops, and constructs multiple memory care communities in a few market areas under the “Autumn Leaves” brand, which are operated by affiliate company Constant Family Management.
Each community is about 26,000 square feet and is staffed by trained and certified staff members who specialize in memory care needs.
Autumn Leaves of Sugarloaf is expected to open in early 2013.
Construction Begins for KTGY-Designed, $15 Million Affordable Senior Housing Complex in California
Construction recently began on a KTGY Group-designed affordable senior housing complex in Santa Clara, Calif. El Camino Real Senior Apartments is a development by ROEM Corporation in collaboration with Pacific Housing, Inc. and the City of Santa Clara.
“Providing affordable housing for our community is a very important City Council priority, and we are happy to see this high quality project move forward,” said Santa Clara Mayor Jamie L. Matthews during the groundbreaking ceremony. “This project is an excellent example of what the private and public sectors can accomplish by working together to meet affordable housing needs. The City’s Housing Authority is proud to partner with ROEM and others to create these new senior apartments–housing that will be safe, affordable, have easy access to public transportation and shopping, and meet senior needs.”
The low-income senior housing project is scheduled to open in the summer of 2013, and will offer 48 one-bedroom apartments that are affordable to seniors with annual incomes at or below 60% of the county’s median income.
“We are very pleased to be implementing our award-winning affordable housing model in and with the City of Santa Clara,” said Jonathan Emami, Vice President of ROEM Corporation. “Through a collaborative process the City of Santa Clara has shown once again that developing affordable housing through public-private partnerships greatly benefits the residents and the community, who in turn will have a sustainable, high quality and affordable place to call home.”
The $15 million development was designed by KTGY Group, Inc. It will be a three-story, “C”-shaped building wrapped around an enclosed landscaped courtyard that will act as an outdoor extension of the community room, with pedestrian access to parking and entry spaces. The project’s architectural style will feature a mission-style, uniform color scheme with contrasting materials and details, with accent color found in its architectural features.
Amenities in the complex will include a community room, a computer room, a laundry facility, a courtyard with a barbecue, and community gardens. The development will be constructed using sustainable building methods, and will incorporate a number of ‘green’ features for better long-term energy efficiency and sustainability.
El Camino Real Senior Apartments is financed with 4% Low-Income Housing Tax Credits and tax-exempt bond financing through the Freddie Mac Credit Enhancement Program. ROEM and Pacific Housing, Inc. have partnered with the Citi Community Capital, AEGON USA Realty Advisors, and the City of Santa Clara for financial support on the project, for which the city invested $7 million.
Continuing Life Communities Breaks Ground on Calif. CCRC
Continuing Life Communities recently broke ground for the first phase of construction for Stoneridge Creek, a continuing care retirement community in Pleasanton, Calif. The community is located on 46 acres, and the first phase will include independent living units, the community clubhouse, and recreational buildings.
The community will offer more than 20 different floor plans, including single-story villas with attached garages and apartment-style homes. On-site amenities will include several restaurant venues ranging from casual to fine dining; a resident library; billiard and card rooms; a computer lab and business center; a spa and fitness center; an open-air pool and steam room; a performing arts theatre for musical and theatrical performances; a movie theatre; and an art studio and woodworking shop. Outdoor amenities include tennis courts, a short-game golf course; a dog park; walking and cycling trails; and bocce and croquet courts.
There will also be an adjacent health center at Stoneridge Creek with 68 assisted living apartments and a memory support area, along with 73 skilled nursing beds. The health center will be staffed 24/7 by nursing professionals and is licensed by the state’s Department of Health Services and Department of Social Services. It will be open to the public, along with Stoneridge Creek residents.
Stoneridge Creek is already more than 60% reserved, and CLC expects to complete construction during the second half of 2013.
Greystone Healthcare Management Opens Care Center at Fla. Retirement Community
Greystone Healthcare Management recently opened The Club Health and Rehabilitation Center in The Villages, Fla., to provide rehabilitation services in a resort-style atmosphere to the community’s 75,000 residents.
The 51,000-square-foot structure has 60 beds, all in private suites.
“The Club is all about rapid recovery and rehabilitation, getting the patient well and back home to a quality, active lifestyle,” states Connie Bessler, CEO of Greystone Healthcare Management. “By using many “Culture Change” initiatives, The Club will provide our patients a unique concierge healthcare experience in an exclusive setting with resort-like common and dining areas, spacious and artfully appointed private suites, state of the art rehabilitation gyms, a Wi-Fi café and lush courtyards with water features.”