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A major Chicago-based long-term care insurer is being sued by an elderly group policyholder who says the company “abruptly” changed its policy and began denying her claims for assisted living care, according to Courthouse News Service. 

The company, CNA, provides group long-term care insurance and initially sought to hike premiums for a certain group of seniors by 45% in Connecticut, where lead plaintiff Marie Gardner, age 91, lives. The state ultimately approved a 30% premium increase for Gardner’s group.

“Defendants have engaged in an illegal course of conduct designed to reduce its exposure to costly long-term care claims by denying claims of elderly insureds through a scheme of fraud, deception, and manipulation of policy terms, while seeking massive premium increases at the expense of these same insureds,” Gardner says in a federal class action suit she’s bringing against CNA, Courthouse News reports.

Gardner claims her policy originally covered a range of assisted living communities but was changed by CNA to cover nursing home care, only. The plaintiff says she broker her hip in 2008—after paying into her insurance policy for 15 years—and subsequently moved into an assisted living community. CNA approved her claim and began paying out the monthly benefit, Courthouse News says. 

The payment benefits ended in February 2011 when Gardner was considered to have recovered. About one year later in April 2012, she fell and fractured her sacrum. However, CNA told her that in order to qualify for long-term care insurance benefits, the assisted living community where she lived would have to be staffed 24/7 by an on-premise nurse. 

That requirement differs from a settlement in a previous class action settlement against CNA requiring a nurse to be on call 24 hours a day, and a nurse to be on site for more than five hours a day, seven days a week. 

“(A)t the time the CNA reached an alleged ‘agreement’ with the Connecticut Insurance Department, CNA did not disclose to the Insurance Department that it had previously been covering stays at assisted living facilities under this same policy,” the lawsuit says, reports Courthouse News.

Because CNA is now denying new claims for assisted living community care despite a previous claim having been paid out at an assisted living community, Gardner claims the insurer used the remediation process in the previous class action as a way to invent new ways to avoid claim liability. 

Gardner is seeking class certification for her lawsuit, along with an injunction preventing CNA from excluding claims for Connecticut assisted living community stays. Additionally, she is seeking monetary damages for class members who have been denied stays based on the assisted living community definition or staffing levels. The class would include around 383 people in Connecticut and at least 20,000 nationwide, according to Gardner’s estimates. 

Read more at Courthouse News. 

Written by Alyssa Gerace

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In light of both an aging work force among baby boomers as well as new employees entering the senior living business, operators are developing new solutions to accommodate both populations along with their different learning styles and preferences when it comes to training and communications.

Largely, they find, training and communication with employees requires more than a single approach.

And for large providers, that may also mean a third party to help with resources.

“We take a layered approach,” says Natalie Cardenas, director of employee development for Senior Lifestyle Corp. “Very few trainings are one dimensional.”

For Senior Lifestyle Corp., that means approaching the company’s 6,200 employees through multiple channels and always having some form of back-up training in place. The company does some training online, for example, and keeps a hard copy option in place in the event that an employee either isn’t comfortable with the technology or has other problems with a web-based platform.

“We couple [online training] with a hard copy document,” Cardenas says. “The onus is then on the executive director or human resources person to enter the employee’s information into a computer.”

In some cases, Senior Lifestyle Corp. will also help the employee develop the skills needed to complete the online training on a computer.

“If folks are going to continue to be successful, they’re going to have to get familiar with the system in addition to back end training to get the basic computer skills needed,” Cardenas says.

Third party training providers are also noting the multi-generational approach that senior living providers require today, as some employees are more tech-savvy than others when it comes to working in senior living communities.

“As the workforce is turning over, we’re still trying to train [current] clinicians, but now we have the younger Gen X and Gen Y employees,” says Eric Masters, Relias Learning vice president of marketing. “We need to provide relevant content.” To cross generations, that may involve requiring a lunch to discuss training material or creating a book club around a mandatory training, he says.

The younger generation also presents some challenges from a training standpoint, though not generally in terms of technology adoption.

“The older generation may take more time to get the information, but rarely fails to meet requirements. They get it done completely and accurately. With the younger generation, we often have to remind them,” Cardenas says.

Reminders may take the form of email or even text messages, which the company employs regular to communicate with its workforce. Yet still there is room to improve when it comes to adopting technology in a business that historically, has not been on the forefront of going high-tech.

“Because we’re in a bit of an antiquated business, some of our mindsets are different,” Cardenas says. “We depend on our employees to keep us current.”

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As needs rise across the residents of senior living communities, providers are focusing in on training among their staffs, both clinical and non-clinical. Increasingly, that may mean looking to a third-party training provider that can stay up to speed on the ever changing landscape of regulations and other requirements. 

Higher acuity residents are driving the need to ramp up training whether inside the company or outside, with many relying on third-parties to keep abreast of regulatory changes on the federal and state levels that are impacting providers’ staffs on an ongoing basis. 

“There is almost a panic in some markets,” says Traci Bild, president and CEO of Bild & Company. ”Skilled nursing is off the charts. First, because the business is changing so rapidly due to pent up demand during the recession. Training has come to the forefront because of what has happened with higher acuity residents.”

Many prospective residents waited through the recession rather than moving, so they are arriving with greater needs, Bild says, especially in assisted living communities. 

Supply is rising to meet this new demand, with assisted living and memory care communities being built from the ground up in many of the nation’s metros, according to data from the National Investment Centers for the Senior Housing and Care Industry.

Training, too, is rising to the occasion. 

“The key thing resonating with customers has been focusing on senior care and how assisted living is different from skilled nursing,” says Mike Mutka, Relias Learning Chief of Strategy and Corporate Development. “We’re focusing on training as a business process that has been broken. People are doing it manually, their management staff is thin, they have high turnover and increasing regulations mandating training.”

Relias offers tools that cater to a mobile and shift-based workforce, with an online foundation and specific courses that are administered in person. 

“More and more people are looking at online training,” Mutka says. “Some people take the courses but also use us to track live training or live webinars. Or, if there’s a policy or procedure, they can embed a document and test on it.” 

Some courses simply can’t be taught online, however. For those, in-person training is still a mainstay. 

“If there are topics that need to be person to person, do that in the classroom,” Mutka says. “The tool acts as a background for a blended learning approach. Even if a provider wants to do a decent amount of live training, there are still some areas where it makes sense to do it online, and they still want to use an online tool to track it all.”

Tracking and accountability is a feature in high demand, with metrics available via training resources to measure, chart, and drive efficiencies across training activities. 

But it doesn’t stop with technical teaching in the current environment, Bild says.

“Turnover is so dramatic, [many providers are] working on culture,” she says. “Companies need to look at defining who they are. Culture attracts talent.”

It can ultimately impact the bottom line. 

Relias cites research that companies that invest in training can recoup the costs in two to three months, with the primary areas of saving being the reduction of time spent tracking and reporting for managers by 75%. The time saved can be used elsewhere, Relias says. 

“One client has put a lot of emphasis into an effective hospitality model and delivery of down home care,” says Eric Masters, Relias vice president of marketing. “Because they’re able to manage training, folks have had more time to develop that program. Another client has been able to save time in order to help enhance dining programs. If I could give you 20 hours of time this month, what would you do?”

Written by Elizabeth Ecker

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When it comes to issues that keep senior living providers up at night, training is at the top of the list, agreed executives at the 2013 annual NIC conference, especially as it’s tied so closely to care. 

A huge component of quality care is staff training, the participating executives said, and many providers are already developing and finessing their own training programs. 

Capital Senior Living (NYSE:CSU) has employees attend what’s called the Capital Senior Living University in Dallas for a comprehensive, three to four day training program. Regional directors play a big role in training, says CEO Larry Cohen.

“Our philosophy is to empower communities to operate at autonomous businesses. It’s based on a very strong regional infrastructure,” he said during the NIC session. 

Capital Senior Living used to primarily own and operate independent living communities but in the last few years has transformed its portfolio to almost 50% assisted living units through acquisitions and unit conversions. 

As a result, the company has been forced to take a much closer look at the clinical, safety, and risk management sides of the business, Cohen said, using both in-house and third parties to train staff in communities along with webinars. 

“We have mechanisms where we grade our communities,” said Cohen. The company is seeking ways to measure outcomes, too, as part of its core philosophy to improve the quality of care to residents.

Each community is graded on a regular basis on categories such as mitigation management, documentation, dietary, activity programs, and quality of staff. The company then creates action plans for any community with grades beneath 90%.

Vi Living’s approach is very similar, according to company president Randy Richardson. The company has about 3,000 employees across its 10 CCRCs and plans to spend $2.5 million on training or training-related programs in 2014.

“That’s the level of commitment we’ve made in the organization,” Richardson said. “It’s as important as reinvesting capital into the asset.”

Turnover at Vi communities is at about 19%, he said, about half of which is voluntary on the part of the company. The retention rate for assisted living employees in 2011, meanwhile, was 73%, according to a survey conducted by the National Center for Assisted Living with collaboration from several other industry trade groups.

Richardson attributed the company’s lower turnover to its training and reinvestment policies. 

“We decided we want to be a learning organization,” he said, adding that he’s a “champion” of investing in his employees. “When you reinvest in your people, they don’t leave. They tend to stay. I found training as a mechanism, a way to reinforce the culture of what we want to deliver in our communities.” 

What senior living providers deliver is service and care, said Richardson. 

“It’s a great investment, and it’s a great return on investment to make that kind of commitment to the employees and the organization.” 

 Written by Alyssa Gerace

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The senior living industry and continuing care retirement communities in particular are gaining momentum as a career option for hospitality students as compelling demographics help increase awareness about the sector. 

In early October, a group of senior living professionals gave a presentation on the industry to more than 200 students enrolled in Pennsylvania State University’s colloquium course for its hotel, restaurant, and institutional management program.

“It’s timely, because as the baby boomer generation are retiring, there are more and more opportunities for senior living,” says Professor A. L. “Bart” Bartlett, MBA, PH.D., associate professor and associate director of PSU’s School of Hospitality Management.

The demographic push is coinciding with the university’s recent efforts to make its hospitality students aware of those opportunities, he adds, at the request of a benefactor and alumnus who left a successful career at ARAMARK to be an executive director at a Connecticut CCRC. The alum, Joe Venucci, attributed his continued success at East Hill Woods, Inc. to his hospitality orientation, Bartlett says, and encouraged PSU to look into similar opportunities for its students. 

The demonstrated success of two presenters who are executive directors with hospitality backgrounds served to bolster already compelling 65+ demographic projections, says Jim Glynn, owner of marketing and advertising firm GlynnDevins, citing resident satisfaction surveys. 

“The move toward hospitality is very much going to enhance the marketing and sales of communities,” he says. “It will be more and more a place where people know they want to go, because the hospitality is good, instead of thinking ‘I’m not ready for that yet, I’ll wait til something happens.’” 

Between 150 to 200 students graduate each year from PSU’s hospitality program, with about 250 currently taking the colloquium class. While Bartlett expects the majority will continue going to well-known hotel and restaurant employers such as Marriott, Hilton, and Darden, a growing number are expected to look to senior living as an alternative career track. 

“Senior living will likely always be a niche in our student body,” he says. “But it’s definitely on a positive trajectory. It’s just at the beginning stages.”  

PSU’s hospitality program offers “Hospitality in Senior Living” once a year, mostly concentrating on the management of continuing care retirement communities. 

The first time the class was offered, it was titled “Managing CCRCs,” recounts Bartlett, and only 22 students enrolled, in large part because they didn’t know what a CCRC was. The class is being offered again under the hospitality heading, and Bartlett is counting on at least 40 students taking the course.

“I’m optimistic we can have some real positive momentum,” says Bartlett, calling CCRC residents a “very rewarding clientele” who are regularly coming to dinner, ordering from a menu, and know and appreciate quality service and food. 

“As a hotel manager, you try to make a guest’s day, and have them leave feeling better than when they checked in. At a CCRC, you’re not making peoples’ day–you’re making their life,” he says. “You can really make a difference in terms of peoples’ lives while doing all the things you like to with food, services, and lodging. That message has resonated with undergraduates.” 

The approximately 40,000 hotels around the country vastly outnumber CCRCs, of which there are around 2,000, according to LeadingAge, the Penn State professor points out. But according to trade group the Assisted Living Federation of America, there are around 36,000 assisted living communities, often described as the intersection of hospitality and healthcare. 

“We wanted to get across to [the students] the importance of hospitality to attract new residents,” Glynn says. “I think we opened up their eyes to what senior living is about. They have an awareness as to the health side, by it was a real eye opener to see that many residents arrive with no health problems, and successfully age in place.”

Written by Alyssa Gerace 

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Assisted living for seniors can happen in many forms and settings, from the home to a community, and there’s no one-size-fits-all plan, writes a senior care specialist in a New York Times Q&A column.  

More than one hundred readers wrote in with questions and comments, including one touting assisted living communities for providing residents with more freedom than they could enjoy in their own homes.

But there’s no one size fits all plan, counters Debra Drelich, a geriatric care specialist, licensed social worker in New York, and founder of New York Elder Care Consultants. 

“There is no one ‘right’ plan for all elders. Many elders prefer not being ‘trapped’ in their homes with a stranger or hired caregiver, yet they need services,” Drelich writes. “Having the services they need throughout the day provided by the overall facility staff helps to enhance their privacy as well. Yet others will do anything to remain at home, and might come to cherish their caregivers.” 

Another reader questions the concept of “aging gracefully in place,” citing a disabled friend who just moved into an assisted living community where she can participate in physical therapy and fitness classes and other group activities, as opposed to being “marooned” in her home. 

“‘Aging gracefully in place’ can be beautiful. However, there is no ‘one size fits all’ best plan for everyone,” says Drelich. “Each situation has to be individually planned for. As the writer mentions, aging in place can mean isolation and uncertainty for some, yet be perfectly suitable for others.

“Living in a group setting does not guarantee that people will achieve a social life, if they have never been social in the past. At the same time freed from the responsibilities of maintaining a private house or apartment, many people, from my experience, blossom and benefit from the supportive services and social milieu of a supportive housing environment.”

Other topics addressed include options for married couples who need different levels of care; group homes; assisted living licensing; and memory care.

Read the full column

Written by Alyssa Gerace

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Senior living providers must expand outside the bricks and mortar and create a full care continuum if they want to be successful, long-term, in a changing healthcare system that’s substantially shifting where care is provided. 

Entitlement reform is poised to have a huge impact on post-acute providers, including those in senior living, agreed Scott Gottlieb, MD, a resident fellow at the American Enterprise Institute, and Gov. Howard Dean, MD, former presidential candidate and DNC chairman, both panelists of the National Investment Center (NIC) for the Seniors Housing & Care Industry’s 2013 Annual Conference. 

Programs introduced in the Affordable Care Act are testing bundled payment and managed care systems as opposed to the current fee-for-service payment model.

“I think we need to get rid of fee-for-service medicine,” Dean said. “Every incentive in the medical system right now is when people are really sick. If you paid by the patient, the whole system would be about taking care of problems early.” 

That would directly affect the long-term care environment, panel moderator Dan Mendelson, founder and CEO of Avalere Health, LLC, pointed out, as its revenue stream comes from a fee-for-service model that the nation’s healthcare system is going down the path of abolishing. 

The biggest piece of advice Gottlieb had for post-acute care providers in light of entitlement reforms: offer a continuum of care.

“Have a suite of options,” he said.

“We have to understand that institutional care is going to be reduced,” Dean said. “We have to get into home care; we have to get into hospice care; we have to get into assisted living. We need some federal changes.”

Those changes, he said, need to occur in what care settings federal programs cover.

“We need some of the programs that will only pay for beds [in a hospital or nursing home] be willing to pay for other things,” said Dean.

Hospice is an “enormous” growth area that senior living providers should figure out how to harness, Dean and Gottlieb agreed. 

“I think hospice is going to grow very rapidly, not because it makes money—although it does—but because it is time to turn the dying process back to the families and the patient,” Dean said, calling the industry the “wild, wild west.” 

Between 2005 and 2011, Medicare spending on hospice care for residents in nursing homes skyrocketed 70%, according to a 2011 annual report from the Department of Health and Human Services, and the industry has drawn increased scrutiny as a federal fraud task force has cracked down on some hospice providers accused of defrauding Medicare. 

“It could get hurt in Washington, because of the perception it’s been gamed,” Gottlieb said. 

But despite a potential “rough patch,” Dean said, there’s plenty of room in private pay hospice. 

Dean also said he sees opportunities for companies in “high end care,” and he predicts some large companies will get into the retirement home business, even though its penetration rate is a “relatively limited portion of the population.”

Even though there’s a movement toward shifting patients downstream, institutional facilities will be far from obsolete as there will always be people who need them. Federal payment structures often force people into bricks and mortar options as Medicaid is less available for home care, he added. 

“The growth strategy has to be to expand services to encompass the full spectrum,” Dean said. “It’s not just going to be bricks and mortar; you have to offer a different range of services.”

The companies who get that balance right are going to be the ones who make “plenty of money,” he said, and the companies that don’t are going to be the ones who get absorbed into someone else.

Additional benefits of ancillary services can be found it the marketing proposition it contains, allowing providers to extend into the community and potentially “convert” home care patients as they transition into bricks and mortar.

“If you’re admitting someone at the lowest level—home care—you’ve got that patient in your system,” Dean said. 

Written by Alyssa Gerace

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Two Assisted Living Homes Sell for $19 Million 

Senior Living Investment Brokerage, Inc., facilitated the sale of two assisted living properties for $19.1 million located in Ellijay and Canton, Georgia. 

The personal care homes sold in the deal, Cameron Hall Canton and Cameron Hall Ellijay, comprise 153 units of assisted living and memory care services, with a price per unit in the transaction being $124,837. 

Both facilities are located approximately 40 miles from one another, and the buyer was a national owner/operator with a strong presence in Georgia. —JO

Aviv Closes $13 Million Acquisition of 3 ALFs

Aviv REIT, Inc. (NYSE: AVIV) acquires three assisted living facilities in Florida for $13 million. 

The facilities are triple-net leased to new Aviv operator Better Senior Living Consulting, which is an operator of nine assisted living facilities in Florida. 

The triple-net lease has an initial cash yield of 10%, initial lease term of 10 years and annual compounded escalators based on CPI. 

With this transaction, Aviv has now completed $106 million of investments in 2013, according to Craig M. Bernfield, chairman and CEO of Aviv REIT. 

“We are pleased to add another new operator relationship and to further diversify our portfolio by opportunistically adding three assisted living facilities,” Bernfield said. 

Better Senior Living was referred to Aviv by one of the REIT’s existing operator relationships, Bernfield added. 

“Our strong relationships with our operators continue to provide us with attractive acquisitions opportunities to grow the company and diversity the portfolio,” he said.” —JO

Cornerstone Core REIT Acquires 3 Meridian ALFs for $15.3 Million

Irvine, Calif.-based Cornerstone Core Properties REIT acquired three North Carolina assisted living communities for a total of $15.3 million on October 4. 

The communities were acquired through a sale/leaseback transaction with wholly-owned subsidiaries of Meridian Senior Living, which will continue to operate the communities pursuant to 15-year triple net leases. 

The communities include Carteret House in Newport, N.C., a 29,570 square foot facility with 64 beds built in 1994; Hamlet House in Hamlet, N.C., a 34,638 square foot facility with 60 beds built in 1999; and Shelby House in Shelby, N.C., a 23,074 square foot facility with 64 beds built in 1991.

“Cornerstone and Meridian both bring a commitment to excellence and a history of success to our relationship,” said Kent Eikanas, President and Chief Operating Officer of Cornerstone Core Properties REIT. “The folks at Cornerstone are among the best in their industry, and we are looking forward to working with these outstanding professionals.”

Since its launch in 2006, Core REIT has acquired 23 properties for a total purchase price of $209.5 million. Since 2011, 12 of those properties have been sold. — EE

NHI Acquires Florida Independent Living Community for $12 Million, to be Managed by Discovery

Following a recent National Health Investors Inc. acquisition of a Rainbow City, Alabama independent living community for $12 million, the company has entered into an agreement with Discovery Senior Living to manage the property. 

The 120-unit community, Regency Pointe, will be leased to Discovery for an initial 15-year term with options to extend. The units comprise 72 rental independent living units, 36 assisted living units and 12 memory care units. 

The community was built in 2003. 

“Our new association with NHI provides us a solid foundation for further expansion opportunities not only in Florida, but in adjoining states,” said Discovery Senior Living Founder Thomas Harrison. “We are very excited about our continued growth with Regency Pointe, like all of our communities that cater to seniors who enjoy being active and independent in beautiful surroundings.” — EE

Private Investor Buys County Nursing Home for $16.5 Million

A Chautauqua County nursing home has been sold to a private investor for $16.5 million, reports WGRZ.com.

VestraCare deposited a $1.65 million downpayment in early October after finalizing the acquisition contract the previous day. —AG

Solterra Senior Living Buys Ariz. Rehab Facility for $357k

Scottsdale, Ariz.-based Solterra Senior Living recently purchased a Phoenix medical facility out of bankruptcy for $357,000, reports AZCentral.com.

The senior living management company plans to form a new division using the former Capri at the Pointe Rehab facility to operate Solterra Subacute Services.

The 35,000-square-foot rehabilitation facility has 106 beds and is accessible to three major hospital systems in the area: Banner Health, Dignity Health, and John C. Lincoln Network. 

“It was an opportunity to have a skilled nursing presence in Arizona,” Steve Jorgenson, Solterra’s CEO, told AZCentral.com. “We felt that (the rehab facility) was not reaching its potential for patient care, and it was a great asset for the north-central Phoenix market.”

 Solterra’s new business division will provide subacute services including physical, speech, and occupational therapy, wound care, and hemodialysis. 

“Our objective is to do a better job of bridging the gap for the patients between the hospital and their home,”Jorgenson says in the article. “This will enable us to provide better outcomes for the patient and allow them to be back in their home sooner.” —AG

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Mainstreet is counting on baby boomers to revolt against existing nursing home options for short-term skilled nursing or rehabilitation stays, and bolstered by a recent survey’s results, it continues to develop a high-end, hotel-inspired product. 

Since 2002, the investment company has built, acquired, or is in the process of developing nearly 50 hospitality-infused, high-end assisted living and rehab facilities across the country and in Canada. Mainstreet, affiliated with HealthLease Properties REIT (TSX.UN:HLP), recently got confirmation for its hotel-inspired strategy after surveying boomers on their retirement living expectations and preferences. 

America’s Research Group conducted the survey, which tallied 1,000 qualified responses nationally that proportionally represented each region of the country. Boomers were polled on topics including health concerns, finances, retirement, and senior living. 

It’s no secret among the senior living and care industry that most older adults don’t want to go to a nursing home, and rather than change that mindset, Mainstreet is pursuing a strategy to build facilities that provide more enjoyable short-term stays.

“We know 90% of people want to be at home, as long as possible. Our entire model is focused on getting them well and sending them home,” says Zeke Turner, CEO of Mainstreet. “We know people will not downsize and won’t choose to move into a [senior living] property. Boomers want nothing to do with that. But when they have a need, they want to be taken care of, be rehabbed, and get sent home.” 

Only one in four respondents said they expected to move from their current home when they retire, and 81% said they didn’t want to go to a nursing home. Another 25% said they believed they would eventually be “forced” to live in a healthcare assisted living facility. 

However, 80% said they would consider a short-term stay in a hotel-like property for rehabilitation or therapy—Mainstreet’s wheelhouse. A vast majority of people utilizing Mainstreet facilities only stay for around 18-25 days before they move home, Turner says. Most units (around 90%) are private, with each building featuring hospitality-centered design, restaurant-style dining, social gathering areas such as movie theaters, pubs, and internet cafes, and therapy and wellness areas. 

More than one in three boomers surveyed named “loss of privacy” as the biggest barrier for them in considering senior living. Still, two in three indicated they’d like to retire and then live with others who have similar interests. 

Another preference highlighted in the survey: a desire among boomers to remain in their communities, something 30% of respondents said they would do if they had to move from their home. 

“We’re focused on where the baby boomers are today, where people want to get their care,” says Turner. “We’re making our properties part of communities, rather than isolating them.”

One of the biggest barriers to that, according to him, is the state regulatory environment and availability of certificates of need. 

“For some bizarre reason, states continue to restrict new development of senior care,” he says. “The biggest thing [is getting] licensed.”

Even though Mainstreet’s various facility designs could go in any location, whether rural, urban, or suburban, Turner says, only about half of states allow for new product in senior care. Of those, only about a quarter allow for new construction in the space without having to cut through “a ton” of red tape. 

“It has to change,” Turner says of skilled nursing product and the regulatory environment. “Consumers themselves will revolt. People are saying they won’t go to these [older] properties, and it’s the only option available… We haven’t hit the tipping point yet.” 

Written by Alyssa Gerace

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A California-based laboratory and radiology company will pay $17.5 million for falsely billing Medicare and Medi-Cal, the state’s Medicaid program, by charging skilled nursing facilities discounted rates for inpatient services in exchange for outpatient referrals. 

The payment will settle allegations that Kan-Di-Ki LLC, dba Diagnostic Laboratories and Radiology, violated federal and state False Claims Acts by paying kickbacks for referral of mobile lab and radiology services for which it sought federal and state reimbursement, says the Department of Justice. 

“This settlement demonstrates the Department of Justice’s continuing efforts to protect public funds,” said Stuart F. Delery, Assistant Attorney General for the Civil Division.  “We will continue to work with our state partners to recover misspent monies from companies that abuse government health care programs.”

Medicare reimburses inpatient and outpatient services differently, and Diagnostic Labs allegedly charged skilled nursing facilities in California discounted rates for inpatient services in exchange for those facilities to refer outpatient business to the lab and radiology company. 

Outpatient services are reimbursed on a per-episode basis by Medicare, while the federal program pays for inpatient services on a fixed rate based on the patient’s diagnosis, regardless of what services have been provided.

Diagnostic Labs’ scheme helped participating skilled nursing facilities to maximize the profit earned for providing inpatient services as they were being charged less for lab and radiology services. Then, Diagnostic Labs was able to access a “steady stream lucrative outpatient referrals,” says the Justice Department, that could be directly billed to Medicare and Medi-Cal. 

The nearly $18 million settlement resolves a lawsuit filed by former Diagnostic Lab employees, Jon Pasqua and Jeff Hauser, under the whistleblower provisions of the federal and state False Claims Acts. The two former employees will receive nearly $3.8 million as their share of the federal government’s recovery. 

Written by Alyssa Gerace

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A large majority of healthcare executives expect they’ll pursue mergers and acquisitions before the year is over, according to a recent GE Capital Healthcare Financial Services survey of healthcare services executives.

While 43% anticipate pursuing refinancing in the next few months, more than twice as many—88%—executives believe M&A is in their near-term future, according to the survey, which examined the expectations of more than 200 senior executives within the healthcare services industry in advance of its 2013 Healthcare Services Conference held last week in Washington, D.C. 

Overall, optimism was high, as 72% of executives believe their businesses will have a stronger upcoming performance as compared to the last few months. Only 4% are anticipating weaker performance, while nearly a quarter believe they will perform the same.

“We expect conditions to continue to be strong for the balance of this year into next year,” says Jim Seymour, senior managing director for GE Capital’s Healthcare Financial Services Real Estate segment. “Looking on the senior housing side, the demographics remain very strong. The improving economy is very good, particularly on the less-acute side of the [senior housing and care] continuum.” 

Still, there are some headwinds facing the industry stemming from economic performance, regulations, financing availability, and healthcare reform. 

Budget pressures and the looming possibility of a government shutdown are worrisome to 37% of executives surveyed, followed by Affordable Care Act changes as the reform law is implemented (30%) and regulatory scrutiny (26%). Only 8% of respondents are worried about their access to financing when it comes to the future of their organization. 

Anecdotally, while there’s been an “awful lot of uncertainty” on the skilled nursing side—particularly when it comes to reimbursements—the outlook has improved, says Seymour. 

“The reimbursement environment [for the sector] is in better shape now than any of the past three years,” he says, adding that this positive outlook is expected to continue through the rest of this year into 2014.

Another sector with a positive outlook, according to executives, is home health.

More than four in ten surveyed (41%) picked home health as the segment of healthcare services—out of hospice, hospitals, rehabilitation, home health, and assisted living/skilled nursing—they expect will see the most growth through the remainder of the year.

The hospital segment was a close second with 38% of executives in agreement, followed by assisted living and skilled nursing, at 28%. 

“As the survey points out, the trend of integration and consolidation is continuing across healthcare services,” said Darren Alcus, president and CEO of GE Capital, Healthcare Financial Services, in a statement. “Companies are seeking ways to grow in a challenging environment.  Decreased utilization, reimbursement rates under constant pressure and increased regulatory scrutiny have made it difficult to grow organically, so we’re continuing to see companies turn to M&A.”

Written by Alyssa Gerace

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A large majority of healthcare executives expect they’ll pursue mergers and acquisitions before the year is over, according to a recent GE Capital Healthcare Financial Services survey of healthcare services executives.

While 43% anticipate pursuing refinancing in the next few months, more than twice as many—88%—executives believe M&A is in their near-term future, according to the survey, which examined the expectations of more than 200 senior executives within the healthcare services industry in advance of its 2013 Healthcare Services Conference held last week in Washington, D.C. 

Overall, optimism was high, as 72% of executives believe their businesses will have a stronger upcoming performance as compared to the last few months. Only 4% are anticipating weaker performance, while nearly a quarter believe they will perform the same.

“We expect conditions to continue to be strong for the balance of this year into next year,” says Jim Seymour, senior managing director for GE Capital’s Healthcare Financial Services Real Estate segment. “Looking on the senior housing side, the demographics remain very strong. The improving economy is very good, particularly on the less-acute side of the [senior housing and care] continuum.” 

Still, there are some headwinds facing the industry stemming from economic performance, regulations, financing availability, and healthcare reform. 

Budget pressures and the looming possibility of a government shutdown are worrisome to 37% of executives surveyed, followed by Affordable Care Act changes as the reform law is implemented (30%) and regulatory scrutiny (26%). Only 8% of respondents are worried about their access to financing when it comes to the future of their organization. 

Anecdotally, while there’s been an “awful lot of uncertainty” on the skilled nursing side—particularly when it comes to reimbursements—the outlook has improved, says Seymour. 

“The reimbursement environment [for the sector] is in better shape now than any of the past three years,” he says, adding that this positive outlook is expected to continue through the rest of this year into 2014.

Another sector with a positive outlook, according to executives, is home health.

More than four in ten surveyed (41%) picked home health as the segment of healthcare services—out of hospice, hospitals, rehabilitation, home health, and assisted living/skilled nursing—they expect will see the most growth through the remainder of the year.

The hospital segment was a close second with 38% of executives in agreement, followed by assisted living and skilled nursing, at 28%. 

“As the survey points out, the trend of integration and consolidation is continuing across healthcare services,” said Darren Alcus, president and CEO of GE Capital, Healthcare Financial Services, in a statement. “Companies are seeking ways to grow in a challenging environment.  Decreased utilization, reimbursement rates under constant pressure and increased regulatory scrutiny have made it difficult to grow organically, so we’re continuing to see companies turn to M&A.”

Written by Alyssa Gerace

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A large majority of healthcare executives expect they’ll pursue mergers and acquisitions before the year is over, according to a recent GE Capital Healthcare Financial Services survey of healthcare services executives.

While 43% anticipate pursuing refinancing in the next few months, more than twice as many—88%—executives believe M&A is in their near-term future, according to the survey, which examined the expectations of more than 200 senior executives within the healthcare services industry in advance of its 2013 Healthcare Services Conference held last week in Washington, D.C. 

Overall, optimism was high, as 72% of executives believe their businesses will have a stronger upcoming performance as compared to the last few months. Only 4% are anticipating weaker performance, while nearly a quarter believe they will perform the same.

“We expect conditions to continue to be strong for the balance of this year into next year,” says Jim Seymour, senior managing director for GE Capital’s Healthcare Financial Services Real Estate segment. “Looking on the senior housing side, the demographics remain very strong. The improving economy is very good, particularly on the less-acute side of the [senior housing and care] continuum.” 

Still, there are some headwinds facing the industry stemming from economic performance, regulations, financing availability, and healthcare reform. 

Budget pressures and the looming possibility of a government shutdown are worrisome to 37% of executives surveyed, followed by Affordable Care Act changes as the reform law is implemented (30%) and regulatory scrutiny (26%). Only 8% of respondents are worried about their access to financing when it comes to the future of their organization. 

Anecdotally, while there’s been an “awful lot of uncertainty” on the skilled nursing side—particularly when it comes to reimbursements—the outlook has improved, says Seymour. 

“The reimbursement environment [for the sector] is in better shape now than any of the past three years,” he says, adding that this positive outlook is expected to continue through the rest of this year into 2014.

Another sector with a positive outlook, according to executives, is home health.

More than four in ten surveyed (41%) picked home health as the segment of healthcare services—out of hospice, hospitals, rehabilitation, home health, and assisted living/skilled nursing—they expect will see the most growth through the remainder of the year.

The hospital segment was a close second with 38% of executives in agreement, followed by assisted living and skilled nursing, at 28%. 

“As the survey points out, the trend of integration and consolidation is continuing across healthcare services,” said Darren Alcus, president and CEO of GE Capital, Healthcare Financial Services, in a statement. “Companies are seeking ways to grow in a challenging environment.  Decreased utilization, reimbursement rates under constant pressure and increased regulatory scrutiny have made it difficult to grow organically, so we’re continuing to see companies turn to M&A.”

Written by Alyssa Gerace

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Gentiva Health Services (NASDAQ:GTIV), national provider of home health care, said this week it has formed a partnership with a university-affiliated hospital in an effort toward creating a new post-acute care model for senior patients. 

Through a partnership with Wake Forest Baptist Medical Center, the company will operate Wake Forest Baptist Health Care at Home to provide solutions for seniors transitioning between hospitals and returning home. It will enable doctors and home health care providers to collaborate toward coordinated care, improved outcomes and reductions in hospital readmissions. 

“One of the major differences in this care model is the integration of physician leadership to provide continuity in overseeing each patient’s journey from the hospital to their home by helping manage the more complex, acute patients in partnership with home health professionals until their primary care team can resume care,” said Dr. Jeff Williamson, professor of geriatric medicine and clinical director of the Sticht Center at Wake Forest. 

The academic setting is also being touted as a contributor to the success of the partnership. 

“The partnership will provide better care for patients and is an example of how industry and academics can come together to promote health care improvements,” said Pamela Duncan, professor of neurology and director of Innovations and Transitional Outcomes at Wake Forest Baptist.

Written by Elizabeth Ecker

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Gentiva Health Services (NASDAQ:GTIV), national provider of home health care, said this week it has formed a partnership with a university-affiliated hospital in an effort toward creating a new post-acute care model for senior patients. 

Through a partnership with Wake Forest Baptist Medical Center, the company will operate Wake Forest Baptist Health Care at Home to provide solutions for seniors transitioning between hospitals and returning home. It will enable doctors and home health care providers to collaborate toward coordinated care, improved outcomes and reductions in hospital readmissions. 

“One of the major differences in this care model is the integration of physician leadership to provide continuity in overseeing each patient’s journey from the hospital to their home by helping manage the more complex, acute patients in partnership with home health professionals until their primary care team can resume care,” said Dr. Jeff Williamson, professor of geriatric medicine and clinical director of the Sticht Center at Wake Forest. 

The academic setting is also being touted as a contributor to the success of the partnership. 

“The partnership will provide better care for patients and is an example of how industry and academics can come together to promote health care improvements,” said Pamela Duncan, professor of neurology and director of Innovations and Transitional Outcomes at Wake Forest Baptist.

Written by Elizabeth Ecker

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