leading age 2015 presentation repositioning roi synergy in design, care, and finance
TRANSCRIPT
Repositioning ROI: Synergy in Design, Care and Finance
LeadingAge Annual MeetingNovember 1st, 2015
3:15 – 4:45 PMPresenters:Rebecca Donato, Chief Operating Officer, North HillAdam Goldman, Director of Operations, Marquis Health ServicesMark Moeller, AIA LEED AP, Principal, JSA ArchitectsChristine Rancourt, Project Manager, JSA Architects
Provider Number: G318Course # 119040A
Credit(s) earned on completion of this course will be reported to AIA CES for AIA members. Certificates of Completion for both AIA members and non-AIA
members are available upon request.
This course is registered with AIA CES for continuing professional education. As such, it does not include content that may be deemed or construed to be an approval or endorsement by the AIA of any material of construction or any
method or manner ofhandling, using, distributing, or
dealing in any material or product.
Questions related to specific materials, methods, and services will be addressed at the conclusion of this presentation.
This presentation is protected by US and International Copyright laws. Reproduction, distribution, display and use of the presentation without written
permission of the speaker is prohibited.
© JSA and North Hill 2015
Copyright Materials
True North is the latest chapter in the story of North Hill, the leader in Massachusetts continuing care retirement communities and a major initiative that has transformed their campus into a vibrant community. A few years ago North Hill’s outlook was not so bright. Occupancy was at an all-time low, and the need to change and evolve was evident. They embarked on a new repositioning journey that would transform their campus visually, culturally, and financially.
From a design standpoint, they will discuss how the design team partnered with North Hill to help them improve campus amenities, transition to a “Small House” model of care, and reestablish themselves in the Senior Living community. Operationally, speakers will present the challenges of culture change for both the residents and the staff at North Hill. This will be explored from the initial stages through post occupancy. Speakers will discuss their evolution from a traditional standard of care to the “small house” model. Finally, speakers will look at the return on investment holistically– from a design, care, and financial standpoint. The session will conclude with a presentation on the overall impact of this initiative. How did the repositioning project fulfill its original goal of revitalizing this community? What was learned during the process? Presenters will explore and analyze the data from the project as a whole.
CourseDescription
LearningObjectives
1. Hear about a repositioning initiative that transformed a tired campus into a revitalized community.
2. Discuss the multiple phases of design and construction to improve campus amenities and transition to a small house model of care.
3. Explore the return on investment to the organization from a design, care and financial standpoint.
4. Realize how embracing innovation resulted in better meeting resident need, as well as aligning with the preferences of new consumers in the marketplace.
At the end of the this course, participants will be able to:
North Hill Overview• Single site CCRC 12 miles West of Boston• Roots of Innovation
– Babson College Connection– Creation of the 90% refund
• Extraordinary success 20+ years– 2nd CCRC in Massachusetts– Decades with 100+ wait list– In 2006, largest single site portfolio
2006 Scenario
• Solid occupancy, but board knew change needed• New CEO recruited• Conducted Strategic Planning Retreat• Outcome: Recognized that existing campus /
product in dire need of change
Marketing & Product Challenges• Physical plant – no changes since 1984• 65 units < 600SF• Undesirable and limited common areas• No assisted living or memory care• Semi-private SNF• Very frail population in IL• Home health services given away
• Increasing competition• Weakened economy / housing market• Inadequate marketing program/investment• Tarnished brand
–“the nursing home for rich people”• FY 2010 - 44 deaths (14% of IL) and 7 sales
Marketing & Product Challenges
Mission Challenges
• Frail Residents becoming isolated• Residents dreaded semi-private rooms,
postponed SNF moves until very sick• Healthy residents disturbed by increasing frailty• Memory impaired residents req’d other facilities• Home Health used by some, subsidized by all• Embraced holistic wellness but few amenities• Dark, depressing environment
• Antiquated systems• Silo mentality• Service creep• Cultural barriers
–Superiority–Complacency–Resistance to change
Operational Challenges
Strategic Objectives
Secure long-term sustainability of North HillRebrand / reposition in the marketplace Defend our marketIncrease the value of our Lifecare PromiseRestructure the business modelRe-infuse spirit of innovation
14
Master Planning Process• Evaluate market perceptions• Understand future market desires• Understand current resident desires• Assess marketing priorities • Estimate the investment needed• Determine the optimal sequence• Develop financial model
15
Primary Market Area Map
Competitive environment
changed dramatically
between 1984 and 2007
Still attractive room to grow
Conduct Market Analysis
16
Resident Input
17
• Focus Groups with all residents–27 page report
• Identified top 5 priorities• Significant resistance• First change in 22 years of history• Board Member served as “Ombudsman”
Resident Priorities
• Add assisted living and memory care• Modernize skilled nursing• Ensure physical connectivity to Health Care • Sustain service during construction• Minimize disruption• Provide open communication channels
18
Guideposts for Our Journey
20
Creating platforms and being partners to residents in the fulfillment and ongoing
discovery of their passions
Team Selection Process
Extensive design “charrette” and team
selection process
Board and management engaged a team of senior living and
development experts
22
The Project True North initiative is designed to evolve North Hill’s living accommodations, common spaces and programs so that the
community more closely resembles what would be
standard if North Hill were being built today.
24
Project Changes - Campus Occupancy• 1984
• Original IL 341• Skilled Nursing 72*
*12 beds added in 1992
Phase One Design Priorities
Create an arrival experienceImprove wayfindingMake the entrance visible Redesign landscaping
Make room on campus for expansionRelocate maintenance buildingRedesign loading dockRedesign traffic flow and parking plan
28
Enhance existing buildingExpand lifestyle amenitiesModernize common area interiorsCreate “social gathering” spaces
Phase One Design Priorities
29
Bring IL apt finish levels to market standardsModernize the 1984 finishes
Adjust unit mix to be competitiveCombine small aptsRebuild the mix by constructing new large apts
30
Phase One Design Priorities
Phase One Design Themes• Support multi-dimensional wellness• Provide central spaces that elicit socialization• Generate engagement through spaces • Increase visual connectivity
Phase One Design Themes• Allow for more natural light• Incorporate more elements from nature• Create more expansive interiors • Add grandeur • Create a contemporary feel
34
PHASE One - 2011 & 2012New Arrival – Town Green
Site RedesignNew Maintenance Bldg
Amenities Additions/Redesign (25)Apt Redesign (285)
Window Replacement (978)
Greatest Resident Resistance • Adding staircases• Relocating the library• Building a new lobby• Contemporary interior finishes• Cost
Project Changes - Campus Occupancy• 1984
• Original IL 341• Skilled Nursing 72*
*12 beds added in 1992
• 2016• IL Existing (full renovation) 285• IL Under Construction (new) 45• EIL /MC Addition 45
• Skilled Nursing (replace) 72
375
Phase Two Priorities
Complete continuum of health care servicesAdd enhanced living and memory care
Rebuild health center to be fully privateCreate appropriate rehabilitation spaceSeparate long-term and short-term needs
Incorporate same feel as ILPhysically connect all levels of care
71
Phase Two Priorities
Small House / Home /Non InstitutionalMinimize Move Anxiety / Smooth TransitionsMinimize Stigma / Encourage Moving
72
Health Care Design• Evaluated extensively
– Small House concept• Extended same Design Priorities as IL
Health Care Design• Land constraints req’d vertical house stacking • Small House model embraced for all services
– Enhanced Living – Memory Care– Skilled Nursing
Phase Two - 2013/2014• Enhanced Living Households
• Memory Care Household• New Health Center
(For Short-Term Rehabilitation and Long-Term Care Services)
Private Residences & Suites
75
• Enhanced Living - 4 Houses on 2 Levels– 3 Traditional Houses
• Variety of Studios - 2-Beds – 1 Memory Care House
• All Studios• Goal: More like IL than SNF
Health Care Design
Health Care Design• Nursing Care – 7 Houses over 4 Levels
– Grand Entrance – Winter Garden and Mezzanine– 6 Long Term Care Houses
• All rooms private bed and shower (10/house)– 1 Rehab House
• All rooms private bed and shower (12/house)
Communicating with DPH• Massachusetts DPH process
– Challenge to comply with Skilled Nursing requirements while still maintaining a residential Small House community
• JSA Relationship/Strategy
Communicating with DPH• Operational Plan• Waivers -Required space vs. Functional space
– 19 Waivers requested and approved including:• Central Resident Toilet Rooms (105 CMR 151.370)• Bedroom Door Width (105 CMR 151.630A)• Drinking Fountain (105CMR 151.310)• Shower stall size (105 CMR 151.370B)• Public Telephone (105 CMR 151.860)• Bathing Facilities – Freestanding tub requirement (105 CMR 151.370A)• Medication Storage (105 CMR 151.008D)• Nurse Station location (105 CMR 151.340A)• Linen Closet (105 CMR 151.370C)• Medicine Room (105 CMR 151.350)• Main Entrance/Lobby (105 CMR 153.030A)• Soiled Utility Room (105 CMR 151.390C)• Exam/treatment room (105 CMR 151.520)• Dietician’s Office (105 CMR 151.560)• Access to central dishwashing area (105 CMR 151.560F)• Freestanding tub location (105 CMR 151.370A)• Consultant’s Office (105 CMR 151.530B)• Consolidating service and clinical sinks in soiled utility (105 CMR 151.390)
Key Transformations
• Resident Centered Care Vs Task Oriented• Universal Worker –
Dining/Engagement/Housekeeping• The Dining Experience• Electronic Medical Record• Polypharmacy Reduction• Team Member Commitment / Job Descriptions /
Job Titles
Preparing the Team• Began 18 Months Prior to
Opening• Commitment to Change• Frequent Meetings• Team Member
Input/Feedback• Resident Engagement• Dining / ServSafe Training• Schedule/Hours Changes
Staffing Up• Traditional Economies of Scale Vs Small House
Teams
7-3 3-11 11-7 Hrs/DayTotal
Hrs/Day
Old SNF UMs/Nurses 6 5 3 112Aides 10 8 4 165 277
New Small House Nurses 4 5 5 112
CarePartners 14 14 7 262.5 374.5
Challenges
• Training / Philosophy of Care Change• Team Member Envisioning of Space• Operational Plan Development• Hiring New Team Members• Construction Schedule/DPH Engagement/Move
Planning• Family Anxiety/Concerns
Impact on Independent Living
• Market responded quickly to Phase One • Refueled Sales!• Design was right on target
–Apt combinations–Apt finishes/redesigns–25 new or renovated amenities– Improved arrival experience
5,000+ Leads Generated
481
1223
1436
1015882
0
200
400
600
800
1000
1200
1400
1600
FY11 FY12 FY13 FY14 FY15
98
> 50% of all IL Inventory Resold Since Project Launch
99
7
22
32
3934
28
20
0
5
10
15
20
25
30
35
40
45
FY 2010 FY 2011 FY 2012 FY 2013 FY 2014 FY 2015 FY 2016 (6 mo)
IL Closings
Phas
e 1
Laun
ch
Phas
e 1
Com
plet
ePh
ase
2 La
unch
Phas
e 2
Com
plet
e
New IL Sales
100
In Fiscal Year 2015, in addition to 28 IL closings,
our sales team took 44 of 45 potential deposits
on Phase 3 construction of new luxury IL units
IN 6 WEEKS.
Year End Occupancy
76% 81%87% 92% 88%
0%
20%
40%
60%
80%
100%
FY11 FY12 FY13 FY14 FY15
101
The reason for FY 2015 dip = 18 IL Residents moved to new Enhanced Living last 5 months
• Added value to Lifecare contracts• More engagement of compromised residents• Met dire need for memory support• Added private pay revenue pool• Expanded EF pool
Impact of Adding Enhanced Living
• Created a more dignified living experience–Home environment, not hospital like–Peacefulness - no call bells, alarms–Privacy–Access to outdoors–Long term and short term residents separated
Impact of New Skilled Nursing
• Improved Occupancy and Private Pay revenue• Expanded referral network into SNF• Increased referrals to Home Health agency
Impact of New Skilled Nursing
FY 2013 - 2015 Average
FY 2016 to Date (April - Sept 2015)
Private Pay % 19% 24%SNF Occupancy 90% 95%
Impact Since Opening of New SNF January 2015
• Historically, annual operational losses were funded by investment portfolio
• Restructured model = self-funding ops• Potential EF pool increased by 30%• Eliminate ($1.5M) yearly loss of in-home support• Productivity initiative to reduce expenses $1M
• Projected breakeven end of FY2017
Projected Long TermFinancial Impact of Project
Other Project True North Fun Facts• Renovated or constructed 475,000SF• Existing apartments reno’d to date 170• New apt constructed (45 IL+45 EIL+72 SNF) 162 • Sliders and windows replaced 978• Courses & Events attendees since Nov 2011 3860• National awards won 10
106
Overall Results
Enhanced resident quality of lifeIncreased value of Lifecare contractSuccessfully repositioned in market Secured future of community
107
What Would We Do Differently?
• Not wait for competitive crisis to change• Better supplement ops team bandwidth• From day 1
– Hire an Owner’s Rep– Manage Apartment Renovations internally
• Select a CM with senior living experience
What Would We Do Differently?
• Before Design Development –Engage the small house ops consultant–Build entire small house ops plan
• Dining and low voltage systems–Don’t assume another models work for you
What Were the Biggest Successes?
• “True North” marketing strategy• Impact of experiential marketing on rebranding• Design priorities hit the mark!• Immediacy of demand returning after apt renos
began and Commons project was complete
• Smoothness of SNF relocation• Final DPH architectural and clinical approvals• Increased engagement of SNF residents in
household model• Eagerness of residents to move to EIL• Preservation of a “one-community” feel
What Were the Biggest Successes?