Description Case 1: Cottage Senior Living Now that you have selected and carefully reviewed your c ...
Description Case 1: Cottage Senior Living Now that you have selected and carefully reviewed your case study, it is time to begin analyzing the situation the healthcare organization faces. In this milestone, you will evaluate the issue it faces in light of its mission, vision, and values. Develop an analysis of the organization's strategic planning approaches. Be sure to address the following: Based on its mission and vision statements, what can you discern about the organization's approach to strategic planning? Be sure to provide specific examples to justify your response. What is the prevailing issue in question in the case study you selected? What do you see as the overall strategic planning concerns for the healthcare organization with regard to this issue? What role do you feel the healthcare manager plays in terms of strategic planning around this issue? Be sure to substantiate your claims. Who are the key stakeholders affected by or involved in this issue, and what role do they serve in strategic planning within the organization? 2 attachments Slide 1 of 2 attachment_1 attachment_1 attachment_2 attachment_2 UNFORMATTED ATTACHMENT PREVIEW Cottage Senior Living The leadership of Cottage Senior Living (CSL) assembled at a strategic planning retreat away from their headquarters in Huntsville, Alabama to prepare a plan to move the business “to the next level.” For the president of the company, Cliff White, the goal of reaching the next level involved growth that focused on identifying locations for acquisition and development. In addition to White, attending the retreat were: Sandy Brackin Vice President of Operations, Cheryl Westlake, Director of Operations; Alan Hangartner, Vice President of Marketing and Sales; Greg Dykes, Regional Managing Director – South; Selena Jackson, Regional Managing Director – North; and Holly Mitchell, Senior Accountant. To begin the retreat, White articulated Cottage Senior Living’s vision as the “development of housing and service offerings that attract empty nesters who choose to live an active, vibrant, and engaged lifestyle.” He further explained, “Our product is differentiated from the traditional markets for independent living (IL), assisted living (AL), memory care (MC), and skilled nursing facility (SNF) by focusing on non-subsidized, private-pay customers in tertiary markets.” White continued, “Moving toward the goals of the retreat, our task today is to answer three questions: 1) How to grow? 2) Where to grow? and 3) Do we have the organizational capacity to grow? Answering the ‘how to grow’ question involves assessing additions to existing capacity, offering services we presently do not, and expanding our same product into other geographic markets (horizontal integration). The ‘where to grow’ question involves the consideration of new cities and perhaps new states. And both questions, how to grow and where to grow, require us to examine our organizational capacity to grow.” The Cottage Story Cottage Senior Living, also known as “the Cottages,” was headquartered in Huntsville, Alabama. The founders of Cottage Senior Living, Peg Thompson and Wade White, met in Doylestown, Pennsylvania in 1980 while consulting as turnaround specialists focused on continuing care retirement communities (CCRCs) and more specifically, the Pine Run Community, a for-profit CCRC. The Pine Run Community opened in 1976, and was one of the first retirement communities to be developed and the only one at that time with a full service, 200-bed regional health center devoted to senior care.1 Thompson and White married and spent the remainder of the 1980s creating the assisted living service model, something that did not exist prior to 1980. Thompson and White sought distressed retirement communities, especially religiously-affiliated CCRCs and spent the mid-1980s 1 through the mid-1990s making deals. Their first venture was a management contract to operate the “Regency” Community in Huntsville, Alabama. The Regency Community became the company’s headquarters. During the 1990s, Cottage Senior Living developed CCRCs in Florence, Alabama; Russellville, Alabama; Corinth, Mississippi; Lawrenceburg, Tennessee; Mountain Brook, Alabama; and acquired CCRCs in Hoover, Alabama; Decatur, Alabama; Hartselle, Alabama; and Huntsville, Alabama (see Exhibit 1 for Cottage Senior Living’s market area). Exhibit 1. Cottage Senior Living Service Area Cliff White, Wade and Peg’s eldest child, returned to the family business in 2009 after completing an MBA at the American University in Washington, DC. Beginning in 2011, White served as president of Cottage Senior Living, LLC. Among Cliff White’s accomplishments was the development of The Commons, a 54-unit active adult community in Huntsville, Alabama where he implemented several information technology (IT) projects to improve operational efficiency and management reporting. White focused much attention on innovating assisted living. He was a member of the Urban Land Institute Senior Housing Council and the American Seniors Housing Association and was a Certified Public Accountant. The Industry The long-term care industry was composed of health-service, social service, and residential service organizations that provided rehabilitative, restorative, and ongoing skilled nursing care to disabled and elderly patients who required assistance with daily living.2 The assisted living industry was comprised of a variety of senior care services; generally divided into two major subcategories: (1) 2 continuing care retirement communities and (2) homes for the elderly. The primary difference between the two subcategories was the presence of nursing care. Continuing care retirement communities provided on-site nursing facilities whereas homes for the elderly did not. Future growth of the industry would be spurred by 77 million Baby Boomers and the increasing life expectancy of the elderly population. Approximately 1 million Americans lived in senior care facilities and the number was expected to double by 2030. Competition in the assisted living industry was intense. The four largest providers in the industry (Brookdale Senior Living, Sunrise Senior Living, Emeritus Corporation, and Atria Senior Living Group) controlled only about 13 percent of the market share. The remaining 87 percent was comprised of a variety of not-for-profit and for-profit enterprises. The largest source of revenue for providers came from private payers representing almost two-thirds of total revenue. Medicaid provided about 10.5 percent, Medicare about 6.2 percent, and private insurance about 3 percent. The remaining 14 percent came from a variety of sources including other government programs and assigned Social Security. Great variety occurred in the demographic make-up of retirement communities. Approximately 69 percent of residents were female and 31 percent were male. The typical resident of a senior living community was an 85-year-old female. Individuals over the age of 85 made up the largest percentage of residents in senior living facilities.3 More specifically, the industry was comprised of a variety of facilities differentiated by the intensity of care provided as summarized in Exhibit 2. Exhibit 2. Senior Living Communities in Order of Increasing Intensity of Care Type of Community Age Range or Average Age of Residents Regulation Senior Apartments 55 plus Not regulated Occasional Independent Living 82 average Not regulated Scheduled Assisted Living Facilities 85 plus and need driven Regulated by state government Scheduled and required by regulation Memory Care – a 85 plus and need Regulated by state Scheduled and required by Transportation Activities Daily, but not required Daily, but not required 2 Services A la carte Housekeeping (included*), nursing call system3,4 Housekeeping Scheduled 6 (included); nursing call system; food times per service (3 times/day, day; scheduled); (schedule required by medication assistance regulation) – all required by regulation Scheduled 6 Housekeeping times per (included), nursing 3 Specialty driven Care Assisted Living Facility (SCALF) government regulation Skilled Nursing Facility (SNF) Regulated by state and federal governments Scheduled and required by regulation Adolescent and older * day; (schedule required by regulation) call system, food service (3 times/day, scheduled), nurse administered medication, monthly RN assessments- all required by regulation Housekeeping (included); nurse Scheduled, 6 calling system; food times per service (3 times/day, day; scheduled); nurse (schedule administered required by medication; monthly regulation) RN assessments – all required by regulation Included means incorporated into the residential fee-for-service structure Independent living settings were adult communities that usually imposed age restrictions, offered social activities, provided security, offered access to transportation services, but did not provide medical services. Although no uniformly accepted definition of assisted living facilities (ALFs) existed, ALFs were considered “multi-family properties with personalized support services for seniors.”4 A relatively new development in the long-term care industry was the Continuing Care Residential Community or CCRC. CCRCs attracted private-pay residents5 “of high socioeconomic status, who were independent upon entering the CCRC.”6 CCRCs offered a variety of services providing a progression of care from independent living to nursing facilities in a single campus setting focusing on wellness activities and amenities.7,8,9 The progression of services offered by CCRCs acknowledged the inevitable decline of independent older adults during the last few years of life, making CCRCs the “final station” of an older adult’s life.10 A skilled nursing facility (SNF) was defined by the Social Security Act as an institution (or a distinct part of an institution) that was primarily engaged in providing skilled nursing care and related services for residents who required medical or nursing care, or rehab services for the rehabilitation of injured, disabled, or sick persons, and was not primarily for the care and treatment of mental diseases; and had in effect, a transfer agreement with one or more hospitals. Nursing facilities offered the most intense level of long term care and were for individuals requiring around the clock care.11 Memory care facilities catered to the needs of individuals with Alzheimer’s disease or a related disorder (ADRD)12 and was an emerging development within CCRCs.13 Memory care and skilled nursing facilities were categorized as Specialty Care Assisted Living Facilities or SCALFs. From an industry perspective, Medicaid was the primary payer of long term care services inasmuch as more than 60 percent of the patients in nursing homes 4 were Medicaid recipients and that Medicaid patients comprised almost 20 percent of residents in assisted living facilities.14 The Cottages did not market to or admit Medicaid recipients. The CSL Regulatory Environment The Cottages operated three types of facilities – Assisted Living, Memory Care, and Active Adult as “group” facilities or “congregate” facilities. The word congregate used as an adjective to describe long-term-care facilities is a synonym of the word group and thus appeared to refer to the same thing;15 however, state regulations distinguish between the terms as they applied to health care facilities. Because the Cottages operated facilities in three states, agencies in each state regulated the facilities; however, the majority of the Cottages’ facilities were located in Alabama and as a result the company was profoundly affected by regulations of the Alabama Department of Public Health (ADPH). ADPH regulations differentiated between group assisted living and congregate assisted living facilities. Group assisted living facilities were authorized to care for three to sixteen adults. Congregate assisted living facilities were authorized to care for 17 or more adults. Regulations addressed staffing requirements and the qualification of key members of the staff. The key regulatory parameters, shown in Exhibit 3, indicate that in general, ALFs had fewer staffing requirements than SCALFs and both ALFs and SCALFs had similar building requirements. 5 Exhibit 3. Key Regulation Parameters within the Cottages Footprint 15 ALF SCALF Staffing General requirement: sufficient staff on duty General requirement: sufficient staff on duty to to provide the care needs of all residents provide the care needs of all residents twenty-four twenty-four hours per day, seven-days per hours per day, seven-days per week. week. Staff requirement: based on resident population and time of day: Residents by Time Period Staff 7am-3pm 3pm-11pm 11pm-7am 2 1-16 1-16 1-16 3 17-24 17-36 17-48 4 25-32 37-48 49-64 Staff requirement: based on resident 5 33-40 49-60 65-80 population and time of day; no set, specific requirement. 6 41-48 61-72 81-96 7 49-56 73-84 97-112 8 57-64 85-96 113-128 9 65-72 97-108 129-144 10 73-80 109-120 145-160 11 81-88 120-132 161-176 +1 per 8 12 16 Specific professional licensed staff: Specific professional licensed staff: Administrator Administrator Medical Director – licensed physician Dietician – could be full-time, part-time, or Registered Professional Nurse consultant Coordinator – an administrator who was an RN Dietician – could be full-time, part-time, or consultant Building Requirements Dining separate from kitchen Dining separate from kitchen Separate rooms for administrative and office Separate rooms for administrative and office purposes purposes Centrally located staff station with call for Centrally located staff station with call for assistance assistance and fire alarm communication and fire alarm communication system system Grab bars conforming to current building Grab bars conforming to current building code code Commercial exhaust food system Commercial exhaust food system Institutional grade range with double oven Institutional grade range with double oven Bedrooms individually and consecutively Institutional grade refrigerator numbered Hand washing lavatory in kitchen with soap Hand washing lavatory in kitchen with soap dispenser, dispenser, supply of soap, disposable towels, supply of soap, disposable towels, and hot and cold and hot and cold running water running running water running through a mixing valve or through a mixing valve or combination faucet combination faucet Commercial grade dishwashing equipment Three-compartment sink with a booster heater or with a booster water heater chemical sanitizing system Laundry rooms shall not open directly into Doors of resident bathrooms swing into the bedroom resident rooms or food service areas 6 ALF Utility rooms on each floor A sign bearing the word “EXIT” at each exit SCALF Bedroom doors at least three feet wide A sign bearing the word “EXIT” at each exit The CSL Market and Product Lines Sandy Brackin, Vice President of Operations, distributed information on occupancy by facility. Exhibit 4 shows the number, type of unit, and occupancy of each location in the Cottages portfolio of facilities. All units were single occupancy, meaning each unit housed one resident. Brackin stated, “As you may note, our occupancy is highest at one of our smaller facilities – Russellville and lowest at our largest facility – Huntsville.” Brackin continued, “Average occupancy for five years for all facilities was 87 percent.” Exhibit 4. The Cottages Portfolio Location Assisted Living Units Memory Care Units Active Adult Units Corinth, MS Decatur, AL Florence, AL Hoover, AL Huntsville, AL Lawrenceburg, TN Montgomery, AL Mountain Brook, AL Russellville, AL Hartselle, AL 27 32 47 16 48 27 40 44 27 10 0 0 0 32 0 0 32 0 0 32 0 0 0 0 54 0 0 0 0 0 Facility Occupancy Rate (%)16 92 95 93 70 65 98 88 77 97 96 White offered a brief review of the financing of the Cottages Portfolio. White noted, “Our properties were financed by a roughly 50/50 relationship of equity and debt. The debt was in the form of conventional mortgages and HUD 232 loans.”17 Exhibit 5 indicates the distribution of conventional and HUD 232 loans18 used in financing the Cottages facilities. White continued, “The average original loan per unit was $39,400 with a standard deviation of about $16,000.” Exhibit 5. Source of Debt Financing by Location Location Corinth, MS Decatur, AL Florence, AL Hoover, AL Huntsville, AL Type of Debt Financing Conventional Conventional HUD 232 HUD 232 Conventional 7 Lawrenceburg, TN Montgomery, AL Mountain Brook, AL Russellville, AL Hartselle, AL Conventional HUD 232 HUD 232 Conventional Conventional Prior to the retreat, White had directed Holly Mitchell to prepare a simplified income statement for a set of representative properties for the most recent three years. Mitchell’s work product is shown in Exhibit 6. Mitchell distributed the income statement and commented, “The representative properties selected were 1) the average of Florence and Mountain Brook - assisted living facilities with the same number of units, 2) Russellville -small assisted living, 3) Hartselle - small assisted living plus memory care, and 4) Decatur - assisted living.” Mitchell continued, “A typical Cottages property produces average operating revenue per occupied unit of $32,848 per year and operating expenses average $26,181 producing an operating margin of about $7,000 per occupied unit per year. The fixed expenses per occupied unit include depreciation, amortization, and interest expense.” Exhibit 6. Income Statement per Occupied Apartment Revenue Other Revenue Total Revenue Operating Expenses Administrative & General Resident Services Marketing Food Service Maintenance Total Operating Expenses Other Income/Expenses Fixed Expenses Net Income FLO/MBK 38,056 1,589 39,645 RCL 27,899 1,153 29,052 HAR 34,418 1,443 35,861 DEC 30,492 1,224 31,716 AVG 32,848 1,365 34,212 -10,841 -8,503 -2,505 -3,538 -2,444 -27,831 -2,043 -2,321 7,450 -10,315 -7,743 -1,111 -3,314 -2,017 -24,500 -1,318 -1,717 1,517 -9,886 -8,614 -1,603 -3,693 -2,765 -26,562 -2,820 -2,346 4,132 -9,483 -8,691 -1,576 -3,688 -2,755 -26,191 -1,094 -1,416 3,015 -10,293 -8,264 -1,747 -3,499 -2,378 -26,181 -1,742 -1,976 4,313 EBITDA (earnings before interest, taxes, depreciation, and amortization) was a general estimate of cash flow.19 Mitchell distributed a schedule that showed EBITDA generated per occupied unit (shown in Exhibit 7). She added, “Average annual cash flow per occupied unit was $6,298 with a range from approximately $4,000 per unit to almost $9,700.” She reminded the attendees that taxes were not included in the calculation of EBITDA since the Cottages was organized as a Limited Liability Company or LLC, and concluded, “LLCs are pass-through 8 entities for tax purposes that do not incur income tax liabilities as an enterprise, rather tax liabilities are passed to the enterprise’s owners in proportion to their ownership, similar to partnerships and Subchapter S corporations.”20 Exhibit 7. EBITDA per Occupied Apartment FLO/MBK 7,450 RCL 1,517 HAR 4,132 DEC 3,015 ALL 4,313 2,321 1,641 1,717 1,041 2,346 2,820 1,416 933 1,976 1,477 254 -1,982 236 -1,453 235 -1,793 234 -1,586 242 -1,711 EBITDA 9,683 3,058 Legend: FLO/MBK = facilities in Florence, AL and Mountain Brook, AL RCL = facility in Russellville, AL HAR = facility in Hartselle, AL DEC = facility in Decatur, AL 7,741 4,012 6,298 Net Income Add: Fixed Expenses Add: Interest Expense Add: Other Less: Standard Management Fee ALL = all CSL facilities The CSL Operations and Staffing Model As White continued to facilitate the retreat, he recognized Brackin who explained, “Concerning organizational capacity, one of our strengths is that the Cottages operates its facilities in a franchise type arrangement – each facility is established as a legal entity for purposes of owning real estate; then we as the parent company – the Cottages – provide branding, a standardized staffing plan, and a standardized operating plan.21 Each facility pays the Cottages a management fee that is five percent of gross revenue. Each facility’s staff members are employees of the Cottage’s and we administer payroll and employee benefits. I believe we certainly should continue this model since it has served the company well since its inception.” The staffing model specified the credential and experience requirements for facility administrators. For ALFs, an administrator was required to have a high school diploma and relevant work experience.22 The staffing model implemented the regulatory framework (presented previously in Exhibit 3). For example, a Licensed Practical Nurse (LPN) or Registered Nurse (RN) was required as a staff member for the administration of medications and an RN was required to perform intake assessments and monthly assessments in all SCALF facilities. The standard procedures model might be modified based on the physical plant differences 9 among facilities. For example, if a facility had three buildings, then the one foodservice staff member transported food between buildings rather than simply plating food in a single facility. Mitchell distributed a handout (see Exhibit 8) that showed the overall staffing plan for CSL as well as the functions and the number of full-time equivalents for each function. Mitchell noted, “For facilities that did not show the function of housekeeping, residential services personnel are assigned the tasks.” 10 Exhibit 8. CSL Management Structure by Location Headquarters Function President Accounting Information Technology Marketing and Sales Operations Function Managing Director Food Service Maintenance Residential Services Function Managing Director Admissions Food Service Maintenance Residential Services Function Managing Director Food Service Maintenance Residential Services Function Managing Director Admissions Food Service Maintenance Residential Services Executive* 1 0 1** 1 1 Corinth, MS Executive* 1 0 0 0 Decatur, AL * Executive 1 0 0 0 0 Florence, AL Executive* 1 0 0 0 Hartselle, AL Executive 1 0 0 0 0 * FTEs Managers 0 1 1 1 3 Staff 0 2 1 2 3 FTEs Managers 0 1 1 1 Staff 0 0 0 6 FTEs Managers 0 1 1 1 1 Staff 0 0 1 0 12 FTEs Managers 0 1 1 1 Staff 0 1 0 12 FTEs Managers 0 1 1 1 2 Staff 0 0 1 0 15 FTEs Managers 0 1 1 1 Staff 0 0 1 0 Hoover, AL Function Managing Director Admissions Food Service Maintenance Executive* 1 0 0 0 11 Residential Services Function Managing Director Admissions Food Service Housekeeping Maintenance Residential Services Function Managing Director Food Service Maintenance Residential Services Function Managing Director Admissions Food Service Health Services Housekeeping Maintenance Residential Services Function Managing Director Food Service Maintenance Residential Services Function Managing Director Food Service Maintenance Residential Services * 0 Huntsville, AL Executive* 1 0 0 0 0 0 Lawrenceburg, TN Executive* 1 0 0 0 Montgomery, AL * Executive 1 0 0 0 0 0 0 Mountain Brook, AL Executive* 1 0 0 0 Russellville, AL Executive* 1 0 0 0 2 15 FTEs Managers 0 1 1 1 1 1 Staff 0 1 1 0 0 15 FTEs Managers 0 1 1 1 Staff 0 0 0 6 FTEs Managers 0 1 1 1 1 1 1 Staff 0 1 1 0 0 0 15 FTEs Managers 0 1 1 2 Staff 0 1 0 12 FTEs Managers 0 1 1 1 Staff 0 0 0 6 For headquarters – Vice President and above, for facilities, Managing Director and above The president oversees all information technology functions ** 12 Developing a Growth Plan White distributed a document summarizing the market selection criteria that had proven successful for the company. CSL’s desired market characteristics included: Strong demographics – age and income qualified customers (market penetration in the 5 to 10 percent range) and population growth exceeding 2 percent year-over-year; Towns and communities undergoing re-urbanization (“main street living”) – communities with re-urbanization plans that were being executed; and Reasonably priced land near the main street area. He then presented a single PowerPoint slide showing a regional map with two circles (see Exhibit 9). White narrated, “The inner circle represents the market area for CSL as a circle centered on our headquarters in Huntsville with a radius that includes all of the CSL facilities, the most distant being Montgomery. What if we extended the radius of the circle by about fifty miles? Our reach would be to five states – Alabama, Georgia, South Carolina, North Carolina, Tennessee, Kentucky, and Mississippi.” Alan Hangartner, CSL VP of Marketing and Sales, “Cliff, as I look at the map, something strikes me as interesting. . . Look at all the college towns in the larger circle – Auburn, Clemson, Knoxville, Nashville, Starkville, and Oxford.” He continued, “I recall reading that college towns are attractive to retirees.”23 Several nodded their heads in agreement. Selena Jackson, Regional Managing Director – North, reacting to Hangartner’s comment stated, “Alan, college towns would be interesting ‘where to grow’ places, but do they meet all three elements of our market characteristics: age and income qualified customers, main-street living, and reasonably priced land near the main street area? College towns may meet the first two requirements, but I am concerned about the third – the availability of reasonably priced land.” Hangartner responded, “You may be right, but we should consider towns near these college towns. An example is Opelika, Alabama near Auburn, Alabama, home of Auburn University.” “That wouldn’t work for Clemson!” laughed Greg Dykes, Regional Managing Director – South. He continued, “Plus, I think that South Carolina and especially North Carolina have significant CON (certificate of need) laws. North Carolina is quite willing to add more Assisted Living, Memory Care, and SNF facilities in rural areas, but the metro areas – Charlotte, Raleigh, Greensboro, 13 Durham, Winston Salem and Fayetteville all with more than 200,000 in population – are challenging.” The group began identifying potential growth strategies – horizontal integration, vertical integration, product expansion such as more specialty care offerings, new payers, and geographic expansion. They knew they had to keep in mind the regulatory barriers of entering new states, the demographics of potential new cities, and important considerations such as company’s demographics – size, personnel capabilities, span of management, geographic limitations; and competitive variables including employment markets, potential competitors, and pricing. White replied, “As we consider the possibilities, we need to focus on the three questions: How to grow? Where to grow? Do we have the organizational capacity to grow?” He continued, “Let’s break for lunch and when we reconvene, we can each identify a strategy that we believe will best enable us to grow the organization.” 14 Exhibit 9. Examining SCL’s Service Area* *Current Cottage locations are in red. References 1 About Pine Run. retrieved from: http://pinerun.org/independent-living/ ) 2 Warren Greenberg, “Long-Term Care Industry,” The Health Care Marketplace (New York: Springer, 1998), pp. 91-102. 3 J. Ortiz, Assisted Living Facilities Business Report. U.S. Small Business Administration, April, (2014). Small Business Market Research Reports, available at: http://www.sbdcnet.org/small-business-research-reports/assisted-living-facilities . 4 Lynn David and Tim Wang, “The US Senior Housing Opportunity: Investment Strategies,” Real Estate Issues 33, no. 2 (2008), pp. 33-51. 5 Michael D. Barnett, “Future Expectations among Older Adults in Independent Living Retirement Communities” (University of Houston, 2010). 6 I. Doron, and E. Lightman, “Assisted-living for Older People in Israel: Market Control or Government Regulation?” Aging and Society 23, no. 6 (2003), pp. 779-795. 15 7 Wassum, Ryan Michael, “Baby Boomer Living: Designing a Modern Continuing Care Retirement Community,” Master’s Thesis, California Polytechnic State University, San Luis Obispo, CA, (2013), available at: http://digitalcommons.calpoly.edu/theses/1070/ . 8 J. C. Hays, A. N. Galanos, T. A. Palmer, D. R. McQuoid, and E. P. Flint, “Preference for Place of Death in a Continuing Care Retirement Community,” The Gerontologist 41, no. 1 (2001), pp. 123-128. 9 A. K. Smith, L. C. Walter, Y. Miao, W. J. Boscardin, and K. E. Covinsky, “Disability During the Last Two Years of Life,” JAMA Internal Medicine 173, no. 16 (2013), pp. 1506-1513. 10 Services, C. O. M. M. "Skilled Nursing Facility" (SNF) Definition, 2017. Retrieved from https://www.cms.gov/Outreach-and-Education/Medicare-Learning-NetworkMLN/MLNMattersArticles/downloads/SE0745.pdf 11 L. Ayalon, and O. Greed, “A Typology of New Residents’ Adjustment to Continuing Care Retirement Communities,” The Gerontologist 56, no. 4 (2015), pp. 641-650. 12 S. G. Kelsey, S. B. Laditka, and J. N. Laditka, “Dementia and Transitioning from Assisted Living to Memory Care Units: Perspectives of Administrators in Three Facility Type,” The Gerontologist 50, no. 2 (2010), pp. 192-203. 13 J. Adler, Memory Care Facilities Fill a Growing Need. Chicago Tribune, (February 1, 2013). Retrieved from http://articles.chicagotribune.com/2013-02-01/classified/ct-mre-0203memory-care-20130201_1_alzheimer-memory-loss-dementia . 14 https://www.ahcancal.org/advocacy/State LongTermPostAcute/Pages/default. aspx#assistedliving 15 Congregate. In Merriam-Wwebster.com. Retrieved from https://www.merriamwebster.com/dictionary/congregate . 16 Adapted from Alabama Rules of Alabama State Board of Health Alabama Department of Public Health Assisted Living Facilities (Ala. Code Chapter 420-5-4). 17 The Federal Housing Administration (FHA), part of the US Department of Housing and Urban Development, provides mortgage insurance on loans made by FHA-approved lenders in the US and its territories. The Section 232 loan program is administered by the Office of Residential Care Facilities. The Section 232 loan program is known as HUD 232, “help finance nursing home, assisted living facilities, and board and care facilities.” HUD 232 loans are offered only by FHA-approved lenders and the loans are insured or underwritten by the US government. FHA Insurance and Section 232. (n.d.). Retrieved March 27, 2017, from https://portal.hud.gov/hudportal/HUD?src=%2Ffederal_housing_administration%2Fhealt hcare_facilities%2Fresidential_care%2Ffha_insurance . 18 Multifamily Accelerated Processing (MAP) Approved Lenders. (n.d.) Retrieved March 27, 2017 from https://portal.hud.gov/hudportal/documents/huddoc?id=aprvlend.pdf . 19 B. Hamilton, “EBITDA: Still Crucial to Credit Analysis,” Commercial Lending Review 18, no. 5 (2003), pp. 47-48. 16 20 J. R. Macey, “The Limited Liability Company: Lessons for Corporate Law,” Wash. ULQ 73 (1995), p. 433. 21 S. W. Norton, “Franchising, Brand Name Capital, and the Entrepreneurial Capacity Problem,” Strategic Management Journal 9, S1 (1988), pp. 105-114. 22 Alabama Board of Examiners of Assisted Living Administrators, Qualifications, available at: http://www.boeala.alabama.gov/qualifications.aspx 23 T. Lewin, “Elderly Returning to Campus, This Time for Life as Retiree,” The New York Times (February 19, 1990) retrieved from: http://www.nytimes.com/1990/02/19/us/elderlyreturning-to-campus-this-time-for-life-as-retirees.html 17 HCM 415 Milestone Two Guidelines and Rubric Now that you have selected and carefully reviewed your case study, it is time to begin analyzing the situation the healthcare organization faces. In this milestone, you will evaluate the issue it faces in light of its mission, vision, and values. You will write a 2–4-page analysis of the organization’s strategic planning approaches. Be sure to address the following: A. Based on its mission and vision statements, what can you discern about the organization’s approach to strategic planning? Be sure to provide specific examples to justify your response. B. What is the prevailing issue in question in the case study you selected? C. What do you see as the overall strategic planning concerns for the healthcare organization with regard to this issue? D. What role do you feel the healthcare manager plays in terms of strategic planning around this issue? Be sure to substantiate your claims. E. Who are the key stakeholders affected by or involved in this issue, and what role do they serve in strategic planning within the organization? Guidelines for Submission: This short paper should be between 2 and 4 pages, not including cover page and references. This paper should be in APA format. Instructor Feedback: This activity uses an integrated rubric in Blackboard. Students can view instructor feedback in the Grade Center. For more information, review these instruc
