Questions No 4 and 6. I already found answers to other questions.

MAKING THE CONNECTION INTEGRATIVE EXERCISES Part 4 Chapters 16-20 Sabrina Hoffman is founder and CEO of Golden Care, Inc., which owns and operates several assisted- living facilities. The facilities are apartment-style buildings with 25 to 30 one or two bedroom apart- ments. While each apartment has its own complete kitchen, in every building Golden Care offers communal dining options and an on-site nurse who is available 24 hours a day. Residents can choose monthly meal options that include one or two meals per day in the dining room Residents who require nursing services (o..., blood pressure monitoring and injections) can receive those services from the nurse. However, Golden Care facilities are not nursing homes, all residents are ambulatory, and custo- dial care is not an option. In the five years it has been in operation, the company has expanded from one facility to five, located in southwestern cities. The income statement for last year tuliows Golden Care, Inc. Income Statement for Last Year Revenue $2,880,000 Cost of services 2,016,00C Gross profit $ 864,000 Marketing and administrative expenses 500,000 Operating income S 364,000 Sabrina originally got into the business because she had trouble finding adequate facilities for her mother. The concept worked well, and income over the past five years had grown nicely at 20 percent per year. However, Sabrina sensed clouds on the horizon. She knew that the population was aging and that her current clients would be moving to more traditional forms of nursing care. As a result, Sabrina wanted to consider adding one or more nursing homes to Golden Care. These nursing homes would be staffed around the clock with RNs and LPNs. The residents would likely have more severe medical problems and would be confined to beds or wheelchairs. Sabrina knew that quality care of this type was needed. So, she contacted Peter Verdon, her marketing manager, and Bernadette Masters, her accountant for a brainstorming session. Peter: "Sabrina, I really like the concept. As you know, several of our facilities have faced seeing their long-term residents move out to local nursing homes. Not only are these homes of lower quality than what we could provide, but losing a resident is heartrending for the staff, as well as for the remaining residents. I like the idea of providing a transition from less care to more." Bernadette: "I agree with you, Peter. But let's not forget the differences between assisted-living and full-time, nursing home-type care. Our expenses will really increase." Sabrina: "That's why I wanted to talk with both of you. As you know, Golden Care's mission statement emphasizes the need to make a profit . We can't continue to serve our residents and provide high- quality care if we don't make enough money to pay our staff a living wage and earn enough of a profit to smooth over the rough patches and continue to improve our business. Could the two of you look into this idea, and get back to me in a week or so?" Throughout the following week, the three communicated by e-mail. By the end of the week, a number of possibilities had surfaced, and these were summarized in a message from Bernadette to the others. hoboch/ Scanned with CamScanner 4. 5. TO: sabrina.hoffman@goldencare.com, peter verdon@goldencare.com FROM: bernadette.masters@goldencare.com MESSAGE: I've compiled the ideas from all of our e-mails into the following list. This may be a good starting point for our meeting tomorrow, 1. Buy an existing nursing home in one of Golden Care's current locations 2. Buy an existing nursing home in another city 3. Build a new nursing home facility in one of Golden Care's current locations. Build a new nursing home facility in another city. Build a wing on to an existing Golden Care facility. The Apache Junction facility has sufficient open land for an addition The next day, Sabrina, Peter, and Bemadette met again in Sabrina's office. Sabrina: "I didn't realize there were so many possibilities. Are we going to have to work up numbers on each of them?" Bernadette: "No, I think we can eliminate a few of them pretty quickly. For example, building a new facility would cost more than the other options, and it would involve the most risk." Peter: "I agree, and I also think we might eliminate the purchase of an existing nursing home for the same reasons. Also, existing homes would not give us the option of building a facility that is state of the art and meets our needs, and it would lock us into a preexisting patient mix." Sabrina: "I like that thinking. Let's restrict our attention to Option 5." Bernadette: "I thought you might like that option, so Peter and I sketched out two alternatives for an extension of the Apache Junction building. We call the alternatives Basic Care and Lifestyle Care." Peter: "There are different markets for each type of care. If we want to concentrate on Medicare and Medicaid patients, the reimbursement is lower, and we would want to offer the Basic Care option. Pri vate insurance and private-pay patients could afford more services; if we are marketing to these patients, we could offer the Lifestyle Care option. Both alternatives provide high-quality nursing care. Basic Care concentrates on the quality nursing and maintenance activities. For example, the addition would have 25 double rooms, two nursing stations, two recreation rooms, a treatment room, and an office. The Lifestyle Care option adds physical and recreational therapy with a specially equipped gym and pool. That addition would have 30 single rooms, two nursing stations, a recreation room, a swim- ming pool, a hydrotherapy spa and gym, a treatment room, and an office. In each case, there would be cable TV and telephone hookups in each room and a buffer area between the nursing home and the apartments." Sabrina: "Why the buffer area? Won't that add unnecessary cost?" Peter: "It adds cost, but it will be well worth it. Sabrina, you must remember that the nursing home patients are different from the apartment residents. Some of the patients will have advanced dementia. We'll lose apartment residents in a hurry if they have to be reminded every day of what might be in store for them later on." Sabrina: "I see your point. Bernadette, what will these two plans cost? I'll tell you right now that I like the Lifestyle Care option better. It fits with our history of doing whatever we can to make life better for our residents." Bernadette: "I've checked into the costs of putting on a new wing and operating both alternatives. Here's a listing." Basic Care Lifestyle Care Construction $1,500,000 Construction $2,000,000 Annual operating expenses: Annual operating expenses: Staff: Staff: RNs (3 x $30,000) 90,000 RNS (3 x $30,000) 90,000 LPNs (6 x $22,000) 132,000 LPNs (6 x $22,000) 132,000 Aides (6 x $20,000) 120,000 Aides (6 * $20,000) 120,000 Basic Care Lifestyle Care Cooks (2 x $15,000) 30,000 50,000 Physical and recreational therapists (2 x $25,000) Janitors (2 x $18,000) 36,000 Cooks (1.5 x $15,000) 22,500 Other (60% variable) 300,000 Janitors (2 x $18,000) 36,000 Debt service 150,000 Other (60% variable) 360,000 75,000 Depreciation (over 20 years) 200,000 Debt service Depreciation (over 20 years) 100,000 Other includes supplies, utilities, food, and so on. "In both cases, total administrative costs for Golden Care would increase by $30,000 per year. This seems high, but the increased legal and insurance requirements will add significantly more paperwork and accounting." Sabrina: "All this sounds reasonable, but why is nbursement such an important factor? Peter: "Well, if you admit Medicaid patients, the state will reimburse at most $30,000 per year Private insurance policies will pay roughly $46,000 per year. We can charge up to about 565.000 for private patients, but this type of care is so expensive that many of these patients exhaust their funds and go on Medicaid. The nice aspect of Medicaid is that we can be virtually assured that we will operate at capacity." Sabrina: "Can we cross that bridge when we come to it?" Peter: "No, not really. Once the patient is a resident of our facility, it is hard to evict him or her. Also, while it is legal to force patients out before they go on Medicaid and to refuse to accept Medicaid patients, once we do accept Medicaid patients, we are prevented by law from evicting them-no matter how high our costs go." Sabrina: "OK, it looks as if we have some hard work ahead of us to decide whether or not to get into this line of business." Required 1. How did Sabrina, Bernadette, and Peter use the tactical decision-making model of Chapter 17? 2. Categorize each of the expenses for the Basic Care and Lifestyle Care options as flexible or com- mitted. Further categorize the committed expenses as committed fixed or committed step costs. 3. Calculate the break-even number of patients in total and for each type of reimbursement) for each of the following scenarios: Basic Care option, 20 percent private insurance, and 80 percent Medicaid b. Basic Care option, no Medicaid Lifestyle Care option, no Medicaid, 75 percent private insurance, and 25 percent private pay d. Lifestyle Care option, all insurance reimbursement 4. What is the markup percent of cost of services charged on the assisted-living expenses? What would the price per month for a Basic Care patient be if the same markup were used? For a Life- style Care patient? (Assume in both cases that occupancy is at 80 percent of capacity.) 5. What is the payback period for the new addition? 6. Research Assignment: In 1999, Congress passed a law restricting the ability of nursing homes to evict Medicaid patients. What led to the passing of these laws? Why would nursing homes accept Medicaid patients and later evict them? Is eviction of Medicaid patients still a problem? Discuss the legal and ethical issues in a nursing home's decision on whether to accept Medicaid patients. a. MAKING THE CONNECTION INTEGRATIVE EXERCISES Part 4 Chapters 16-20 Sabrina Hoffman is founder and CEO of Golden Care, Inc., which owns and operates several assisted- living facilities. The facilities are apartment-style buildings with 25 to 30 one or two bedroom apart- ments. While each apartment has its own complete kitchen, in every building Golden Care offers communal dining options and an on-site nurse who is available 24 hours a day. Residents can choose monthly meal options that include one or two meals per day in the dining room Residents who require nursing services (o..., blood pressure monitoring and injections) can receive those services from the nurse. However, Golden Care facilities are not nursing homes, all residents are ambulatory, and custo- dial care is not an option. In the five years it has been in operation, the company has expanded from one facility to five, located in southwestern cities. The income statement for last year tuliows Golden Care, Inc. Income Statement for Last Year Revenue $2,880,000 Cost of services 2,016,00C Gross profit $ 864,000 Marketing and administrative expenses 500,000 Operating income S 364,000 Sabrina originally got into the business because she had trouble finding adequate facilities for her mother. The concept worked well, and income over the past five years had grown nicely at 20 percent per year. However, Sabrina sensed clouds on the horizon. She knew that the population was aging and that her current clients would be moving to more traditional forms of nursing care. As a result, Sabrina wanted to consider adding one or more nursing homes to Golden Care. These nursing homes would be staffed around the clock with RNs and LPNs. The residents would likely have more severe medical problems and would be confined to beds or wheelchairs. Sabrina knew that quality care of this type was needed. So, she contacted Peter Verdon, her marketing manager, and Bernadette Masters, her accountant for a brainstorming session. Peter: "Sabrina, I really like the concept. As you know, several of our facilities have faced seeing their long-term residents move out to local nursing homes. Not only are these homes of lower quality than what we could provide, but losing a resident is heartrending for the staff, as well as for the remaining residents. I like the idea of providing a transition from less care to more." Bernadette: "I agree with you, Peter. But let's not forget the differences between assisted-living and full-time, nursing home-type care. Our expenses will really increase." Sabrina: "That's why I wanted to talk with both of you. As you know, Golden Care's mission statement emphasizes the need to make a profit . We can't continue to serve our residents and provide high- quality care if we don't make enough money to pay our staff a living wage and earn enough of a profit to smooth over the rough patches and continue to improve our business. Could the two of you look into this idea, and get back to me in a week or so?" Throughout the following week, the three communicated by e-mail. By the end of the week, a number of possibilities had surfaced, and these were summarized in a message from Bernadette to the others. hoboch/ Scanned with CamScanner 4. 5. TO: sabrina.hoffman@goldencare.com, peter verdon@goldencare.com FROM: bernadette.masters@goldencare.com MESSAGE: I've compiled the ideas from all of our e-mails into the following list. This may be a good starting point for our meeting tomorrow, 1. Buy an existing nursing home in one of Golden Care's current locations 2. Buy an existing nursing home in another city 3. Build a new nursing home facility in one of Golden Care's current locations. Build a new nursing home facility in another city. Build a wing on to an existing Golden Care facility. The Apache Junction facility has sufficient open land for an addition The next day, Sabrina, Peter, and Bemadette met again in Sabrina's office. Sabrina: "I didn't realize there were so many possibilities. Are we going to have to work up numbers on each of them?" Bernadette: "No, I think we can eliminate a few of them pretty quickly. For example, building a new facility would cost more than the other options, and it would involve the most risk." Peter: "I agree, and I also think we might eliminate the purchase of an existing nursing home for the same reasons. Also, existing homes would not give us the option of building a facility that is state of the art and meets our needs, and it would lock us into a preexisting patient mix." Sabrina: "I like that thinking. Let's restrict our attention to Option 5." Bernadette: "I thought you might like that option, so Peter and I sketched out two alternatives for an extension of the Apache Junction building. We call the alternatives Basic Care and Lifestyle Care." Peter: "There are different markets for each type of care. If we want to concentrate on Medicare and Medicaid patients, the reimbursement is lower, and we would want to offer the Basic Care option. Pri vate insurance and private-pay patients could afford more services; if we are marketing to these patients, we could offer the Lifestyle Care option. Both alternatives provide high-quality nursing care. Basic Care concentrates on the quality nursing and maintenance activities. For example, the addition would have 25 double rooms, two nursing stations, two recreation rooms, a treatment room, and an office. The Lifestyle Care option adds physical and recreational therapy with a specially equipped gym and pool. That addition would have 30 single rooms, two nursing stations, a recreation room, a swim- ming pool, a hydrotherapy spa and gym, a treatment room, and an office. In each case, there would be cable TV and telephone hookups in each room and a buffer area between the nursing home and the apartments." Sabrina: "Why the buffer area? Won't that add unnecessary cost?" Peter: "It adds cost, but it will be well worth it. Sabrina, you must remember that the nursing home patients are different from the apartment residents. Some of the patients will have advanced dementia. We'll lose apartment residents in a hurry if they have to be reminded every day of what might be in store for them later on." Sabrina: "I see your point. Bernadette, what will these two plans cost? I'll tell you right now that I like the Lifestyle Care option better. It fits with our history of doing whatever we can to make life better for our residents." Bernadette: "I've checked into the costs of putting on a new wing and operating both alternatives. Here's a listing." Basic Care Lifestyle Care Construction $1,500,000 Construction $2,000,000 Annual operating expenses: Annual operating expenses: Staff: Staff: RNs (3 x $30,000) 90,000 RNS (3 x $30,000) 90,000 LPNs (6 x $22,000) 132,000 LPNs (6 x $22,000) 132,000 Aides (6 x $20,000) 120,000 Aides (6 * $20,000) 120,000 Basic Care Lifestyle Care Cooks (2 x $15,000) 30,000 50,000 Physical and recreational therapists (2 x $25,000) Janitors (2 x $18,000) 36,000 Cooks (1.5 x $15,000) 22,500 Other (60% variable) 300,000 Janitors (2 x $18,000) 36,000 Debt service 150,000 Other (60% variable) 360,000 75,000 Depreciation (over 20 years) 200,000 Debt service Depreciation (over 20 years) 100,000 Other includes supplies, utilities, food, and so on. "In both cases, total administrative costs for Golden Care would increase by $30,000 per year. This seems high, but the increased legal and insurance requirements will add significantly more paperwork and accounting." Sabrina: "All this sounds reasonable, but why is nbursement such an important factor? Peter: "Well, if you admit Medicaid patients, the state will reimburse at most $30,000 per year Private insurance policies will pay roughly $46,000 per year. We can charge up to about 565.000 for private patients, but this type of care is so expensive that many of these patients exhaust their funds and go on Medicaid. The nice aspect of Medicaid is that we can be virtually assured that we will operate at capacity." Sabrina: "Can we cross that bridge when we come to it?" Peter: "No, not really. Once the patient is a resident of our facility, it is hard to evict him or her. Also, while it is legal to force patients out before they go on Medicaid and to refuse to accept Medicaid patients, once we do accept Medicaid patients, we are prevented by law from evicting them-no matter how high our costs go." Sabrina: "OK, it looks as if we have some hard work ahead of us to decide whether or not to get into this line of business." Required 1. How did Sabrina, Bernadette, and Peter use the tactical decision-making model of Chapter 17? 2. Categorize each of the expenses for the Basic Care and Lifestyle Care options as flexible or com- mitted. Further categorize the committed expenses as committed fixed or committed step costs. 3. Calculate the break-even number of patients in total and for each type of reimbursement) for each of the following scenarios: Basic Care option, 20 percent private insurance, and 80 percent Medicaid b. Basic Care option, no Medicaid Lifestyle Care option, no Medicaid, 75 percent private insurance, and 25 percent private pay d. Lifestyle Care option, all insurance reimbursement 4. What is the markup percent of cost of services charged on the assisted-living expenses? What would the price per month for a Basic Care patient be if the same markup were used? For a Life- style Care patient? (Assume in both cases that occupancy is at 80 percent of capacity.) 5. What is the payback period for the new addition? 6. Research Assignment: In 1999, Congress passed a law restricting the ability of nursing homes to evict Medicaid patients. What led to the passing of these laws? Why would nursing homes accept Medicaid patients and later evict them? Is eviction of Medicaid patients still a problem? Discuss the legal and ethical issues in a nursing home's decision on whether to accept Medicaid patients. a