Splient

St. Dismas Assisted Living Facility, Part 1

St. Dismas Medical Center, an urban, nonprofit, 450-bed rehabilitation hospital, began to see a significant decline in admissions. St. Dismas’s mission focuses on inpatient and outpatient rehabilitation of the severely injured and catastrophically ill. While the patient census varied from month to month, it appeared to the St. Dismas Board of Trustees that the inpatient population was slowly but steadily declining. The hospital’s market researchers reported that fewer people were being severely injured due to the popularity of seat belts and bicycle/motorcycle helmets. In order to get a handle on the future of the organization, the board of trustees and the chief executive officer (CEO) and president, Fred Splient, MD, called for a major strategic planning effort to take place.

In January 1999, St. Dismas held a planning retreat to identify future opportunities. The outcome of the retreat was that the medical center needed to focus its efforts around two major strategic initiatives. The first, a short-run initiative, was to be more cost effective in the delivery of inpatient care. The second, a long-run strategy, was to develop new programs and services that would capitalize on the existing, highly competent rehabilitation therapy staff and St. Dismas’s excellent reputation in the region.

At the time of the retreat, Fred Splient’s parents were living with him and his family. Fred was an active member of the “sandwich generation.” His parents were aging and developing many problems common to the geriatric populace. Their increased medical needs were beginning to wear on Fred and his family. It crossed Fred’s mind that life might be more pleasant if the hospital board approved an expansion of the medical center’s campus to include an assisted living facility.

In March 1999, Fred had his business development team prepare a rough estimate of the potential return on investment of an assisted living facility. He asked the team to identify different options for facility construction and the associated costs. The team also did a complete competitive analysis and examined the options for services to be offered based on St. Dismas’s potential population base and catchment area. The business development team visited several facilities across the country. The team also interviewed companies that could oversee the design, building, and operation of the facility for St. Dismas. The development team produced a preliminary business plan based on the recommended structure for the facility, estimated capital expenditure needs, estimated income from operation of the facility, as well as projected revenues to other St. Dismas Medical Center programs resulting from the facility’s population.

The plan was presented at the May 1999 meeting of the board of trustees. Fred Splient and his team introduced the board to the concept of opening an assisted living facility on St. Dismas’s campus. The facility would be set up as a for-profit subsidiary of the medical center, so that it could generate a profit and not be subjected to the strict guidelines of the hospital’s accrediting agencies. As a subsidiary organization, however, the board would still have control.

The chosen facility design was a freestanding apartment-like facility with a sheltered connection to the hospital for access to the kitchen and hospital services. The facility would have 100 units with 15–30 of the units classified as “heavy-assisted” and built to code to house the physically and medically disabled. The rest of the units would be “light-assisted,” larger apartments. The population would be approximately 110–150 residents, with most being single occupants rather than couples.

The light-assisted apartments could hold residents who required only minor medical and social interventions. The residents of the heavy-assisted section would have more medical needs and would require assistance getting around. The business development team recommended this type of programming model, because many assisted living facilities were erected across the country but few had a medical focus and offered the types of services that St. Dismas could offer—physical therapy programs, occupational therapy programs, and behavior management programs to name a few.

The board was assured that the facility would meet the strategic initiative of a growing business. The business plan projected an immediate increase in the number of referrals to the outpatient therapy programs. Another projected deliverable of the project was to enable St. Dismas to strengthen its focus on reimbursable preventive and wellness programs for the healthier geriatric population. The project’s longer-term goal was to increase the census in the hospital’s inpatient units by having a location where people could age in place until they were in need of hospitalization, and then such a facility would be right next door.

Depending on the exact size of the apartments, their equipment, and the actual ratio of heavy-to light-assisted units, Fred estimated that the entire project would cost between $8,500,000 and $11,000,000 for the facility construction. That estimate included the cost of land, furnishings, and a sheltered connection to the hospital. When up and running, it was estimated that the net income would range between $9,000 and $12,000 per unit per year. The team estimated the net cash flow for the entire project to be around $1,500,000 per year.

Fred requested the board approve the concept and allow his team to prepare a pro forma plan for board approval. The plan would include a recommended design for both heavy- and light-assisted apartments. It would also include all costs of land, construction, furnishings, and staffing. Income estimates would be included and would be conservatively based. A timetable would also be included.

The board conducted several executive sessions and, by the middle of May, voted to approve the concept. They approved the architectural-construction-management firm recommended by the team, and they requested Splient proceed with developing a complete project plan. The board appointed two board members to sit on Fred’s planning group.

In June, Dr. Splient gathered his executive team together and presented the project mission and scope. He reported that the board had approved a small budget to finance the planning process. The board also stipulated that construction could not begin until after the November 1999 city elections because two of the board members were running in that election, one for a city council seat and one as a county commissioner. The board also stated that they would like a plan that would allow the facility to open by July 2000, as research has shown that many adult children find the summer the easiest time to assist their parents in finding an alternative to independent living arrangements. The CEO and executive team were now confident that they were ready to launch the project to plan, build, and open an assisted living facility at St. Dismas.