How a Chicago CCRC moved to mostly private rooms for the SNF wing as part of a $ 23 million renovation
Operators who want to stay in the long-term skilled nursing space see the need for private rooms moving forward after COVID, but for a skilled nursing wing in Chicago that modernization began in 2017.
Smith Village recently completed a $ 23 million renovation of its skilled nursing wing with infrastructure upgrades that include a new roof, all new electrical systems, HVAC and new windows.
The three-story building also has a therapy room on the first floor and dining rooms on the second and third floors.
Since its inception, the Smith Village Skilled Nursing Wing has housed 100 licensed beds, primarily designed for double occupancy, as well as common areas on each of the three floors. But research, focus groups and discussions with residents led the Smith Senior Living management team to see the need to convert double rooms to private suites.
“Gone are the days of semi-private bedrooms or more than two in a room,” said Kevin McGee, President and CEO of Smith Senior Living. “I wish I had something creative to say, but you have to find a way to the private rooms or else you are no longer part of the game.”
He spoke to Skilled Nursing News this week to discuss what drove the retiree community in continuing care – which includes independent and assisted living services, memory care, short-term rehabilitation and nursing skilled nurses – how to make such a large investment in his skilled nursing wing, how he was able to secure the funds for the renovation project and what advice he has for other operators looking to upgrade.
What Idid you decide to move to private rooms for qualified nursing residents in 2017?
We’ve always had a state-of-the-art, self-contained assisted living facility, but with our healthcare, for which we’ve always had a good reputation as a provider, amenities were not what consumers were looking for.
Over time we heard from residents and families that they wanted private rooms, to the point that sometimes we had an independent resident who was hospitalized and did not come to our house. They would go to a competitor with a less desirable reputation because the private room was important to them.
We held focus groups on the desired needs and from the focus groups it was clear that there was a desire for more private rooms and even more community space.
Now, private rooms are more than a simple preference, it is a need emerging from the pandemic.
Can you tell me how you were able to finance such a large investment in the installation?
We have placed corporate bonds with First Midwest Bank and Huntington Bank.
Our developer took construction costs, operating costs, and revenue into consideration and we were able to come up with a workable plan to reduce our beds from 100 to 78, of which 66 are private with 12 semi-private rooms.
The Illinois Department of Public Health and the Certificate of Need Board have been very supportive, as many skilled nursing facilities have not reinvested capital in their skilled care.
When we went through the CON process, they were very helpful in getting to private rooms and upgrading our amenities including new windows, new HVAC system. and all kinds of structural upgrades.
How? ‘Or’ What were bank investors open to working with you on this project?
We have long-term relationships with First Midwest and Huntington.
They know Smith Village very well and the bankers know us and the way we operate. They know our reputation in the community and have been excellent partners in the process and continue to be to this day.
What were the priorities in the overall construction project?
The first floor is where we will have 22 private rooms, all intended for rehabilitation. The rooms, which were once semi-private rooms, have been turned into private rooms. We have also installed a larger bathroom and a shower.
When you go to hospitals, they have private rooms and they have in-room showers. We mirrored the experience of a hospital up to the first floor of Smith Village.
We have added a 10,000 square foot addition, the main floor of which will be a full therapy gymnasium, for residents receiving therapy.
Do you have any other important features to mention?
First of all, the availability of private rooms.
We wanted to have an improved community space. The existing dining rooms on the second and third floors have been converted into community space located in the center of the first floor.
The second and third floors have a brand new dining room rather than being a therapy space.
What were some of the the challenges of being a non-profit organization and securing a $ 23 million investment to modernize the facility?
We have the financial strength of Smith Senior Living and have always operated with fiduciary responsibility, so securing the bank’s loans, I wouldn’t say it was easy, but it wasn’t as difficult as it might be. be for some.
We have always operated responsibly and the support of Smith Senior Village, I’m sure, was part of the reason the bank financed the debt for the Smith Village project.
Which makes Is Smith Village different from other senior care communities in Chicago?
We have received five stars since the Center for Medicare & Medicaid Services published the ratings.
We tend to have better staff ratios.
We also encourage people to move into Smith Village while they are independent so they have a plan in place. Many skilled nursing facilities accept people into their facility in the event of an emergency, which we do on occasion, but many of our skilled nursing residents are residents of our community so they have already set up a map. They know us and we know the families.
The transition to skilled care is obviously never easy, but when families and residents know the community well, I think it makes things a little easier than for a stand-alone skilled care facility.
How? ‘Or’ What do you think the push towards private rooms will impact the skilled nursing industry in the future?
COVID is obviously going to have an impact on skilled nursing care and that remains to be seen.
Those who haven’t moved into private rooms really need the push to do so, or they’re really going to be left behind.
I see skilled care beds continue to be phased out as there are other alternatives to assisted living or potential home care, but in my opinion there will always be a need for skilled care, and there will be probably fewer providers in the future.
Why Was the change from 100 to 78 beds important for this project? Aren’t you essentially losing profits?
Our Medicare census was probably an average of 15 [patients]. Now that we’ve raised it to 22, it really helped the ratios we needed in terms of paying down our debt service.
Then we went from semi-private rooms to private rooms and obviously the private rate of pay is increasing. But again, we are responding to market demand, so everything aligns with each other.
How? ‘Or’ What Does the installation fill up quickly?
We have received a lot of referrals from hospitals that we cannot accommodate because half of our beds are out of service.
We’ll likely see all 22 Medicare beds fill up by the end of December.
The only outlier is the endowment, [especially for] CNA. Depending on the number of CNAs we can hire, this will impact the number of residents we can accommodate.
How? ‘Or’ What is staff shortage hurting you the most?
At our Smith Village campus, for the most part, we are doing very well.
It has a bigger impact in our community in Orland Park. It is much more difficult in the suburbs.
Or are you with the vaccination mandate?
Our residents are approximately 97% vaccinated.
We have asked our staff to get vaccinated by November 1. To date, our staff are 75% vaccinated and people have signed up to be vaccinated so everything is encouraging, but you can call me on November 1 to see how it all goes.
How? ‘Or’ What Do you think some of the renovations will help rebuild hospital referrals for the skilled nursing wing?
We will have state-of-the-art equipment. We are a five star facility with CMS and acute care providers are looking for quality providers not only with new equipment but also providing good care so that they do not return to the emergency room. I think we have a great deal to do with not only a beautiful building but also the quality of care that we are able to provide.
I think organizations like ours will continue to monitor our five star rating as well as length of stay if we are to be competitive in the area of ââreferral to hospitals, medicare.
Have did you have to use agency staff in your facilities?
What have you encountered some of the challenges encountered in commissioning this facility?
We were fortunate to have locked in prices before the pandemic hit, so the skyrocketing prices didn’t really have an impact.
The biggest challenge was how to renovate a skilled care building that is currently in operation? Which units are you going to dismantle that are out of service and how are you going to proceed with the construction with the residents of the building?
It was more about working in an existing specialty care facility rather than a brand new building which was our biggest challenge of trying to bypass personal care.
Is there something you would like to see from the state or federal government reimbursement to help operators with these kinds of projects?
The state of Illinois has a very low Medicaid reimbursement rate.
In order for these facilities to have a high Medicaid enumeration to access private rooms, the state of Illinois is going to have to find a way to increase repayment or provide some kind of grant or some kind of government loan to help improve. the equipment. to offer to residents who are located primarily in Medicaid census buildings.