The Fundamentals of Underwriting Senior Housing and Care Certificate Program is a comprehensive, 90-day program, which is offered online in a self-paced, asynchronous format to maximize convenience for learners. The program is available multiple times a year and not only saves you time but also money by bundling relevant courses together.

This certificate program stands out as the industry’s premier certification program designed to train investment and finance professionals. Upon completing the program’s six courses, graduates will earn a certificate in the Fundamentals of Underwriting Senior Housing & Care and the professional designation of “CSHIP” — Certified Senior Housing Investment Professional. 

In the senior housing and care industry, the significance of hiring is growing due to shifting demographics in the United States, evolving consumer preferences, the introduction of innovative technologies, and the increasing demand for novel housing solutions. Hiring and retaining skilled, well-trained employees will be imperative as the industry prepares for expansion.

Traditionally, the senior housing and care industry, known for its niche and unique nature, has relied on on-the-job training (OJT) methods to onboard new hires in real estate or investment-based roles within the sector. While OJT methods have their advantages, they also come with various challenges. For instance, many OJT training methods lack standardization of quality control, offer limited exposure, and often result in a loss of productivity among teams responsible for managing new hires. These challenges prompted the NIC Academy team to reconsider how best to prepare the next generation of industry professionals, ensuring they are equipped with all the tools for success.

NIC Academy’s Fundamentals of Underwriting Senior Housing and Care Certificate Program provides a viable solution by enhancing the training and onboarding process and acting as a strong supplement or replacement for OJT training methods.

I recently had the opportunity to speak with Zach Bowyer, MAI, Senior Managing Director at Cushman & Wakefield. As an executive in the senior housing and care industry, he effectively balances the demands of his executive role with the essential task of training new hires.

“Attracting top talent and equipping them with the necessary expertise as swiftly as possible has always been a top priority for us,” Bowyer explained. “I’m excited to learn about NIC Academy’s Fundamentals of Underwriting Senior Housing & Care Certificate Program, and I am confident it will be a game-changer in this regard.”

Properly training new hires is vital for the growth, success and long-term sustainability of any organization. It not only equips employees with the necessary skills and knowledge but also fosters a positive work environment and a professional culture, ultimately leading to improved business outcomes.

Promoting the pursuit of professional designations will help the senior housing and care industry grow by ensuring standardization, credibility, quality and ethical standards, and by facilitating career advancement and increased collaboration. Professional designations benefit professionals by fostering a culture of excellence and continuous improvement. 

The NIC Academy team is confident that the CSHIP designation will establish a new “gold standard” for the senior housing and care industry moving forward, becoming the foundational requirement for hiring and training new employees. This designation offers new industry entrants and career changers an equal opportunity to succeed in the ever-evolving senior housing and care industry.

Serena Lipton serves as Programming Curation Manager at the National Investment Center for Senior Housing & Care (NIC). In this role, Ms. Lipton collaborates with senior living industry leaders to develop educational platforms and content to service the industry. Before joining NIC, Ms. Lipton served as an Associate with Artemis Real Estate Partners’ healthcare business and was responsible for supporting asset management activities across the healthcare platform with a focus on seniors housing, in addition to prior years spent as an analyst for JLL and CBRE’s Senior Housing Valuation & Advisory Services.

The opinions expressed in McKnight’s Long-Term Care News guest submissions are the author’s and are not necessarily those of McKnight’s Long-Term Care News or its editors.

Have a column idea? See our submission guidelines here.

We currently find ourselves in an uncertain market where a large number of companies are looking to raise capital as they look to survive in the current environment. 

While there is capital on the sidelines, it is being more selective about the opportunities it pursues. Although some groups are in the capital allocation business, others are focused on being value-add to the companies in which they invest, bringing not only capital but taking the time to offer their expertise and finding ways to leverage relationships or other skills that may benefit the company. Meanwhile, founders work hard to ensure their companies shine and stand out in order to attract a well-rounded investor base.

Once a company has engaged with strategic investors, what sets apart the ones who succeed from the ones who struggle? What’s the best way for a founder to make the most of this opportunity and achieve the best outcome? 

Counter to what many younger founders may think, the answer isn’t the tired “fake it ’til you make it!” maxim. As someone with decades of experience investing in private equity and venture capital, the number one piece of advice I would give all companies is to have open, honest, two-way communication with investors.

This can feel especially tough when a company encounters hurdles. Especially in the current market, founders are facing a variety of different challenges, and a natural response is to attempt to sugarcoat or mask those problems as a company works to move through them. In short, many founders falsely view admitting problems as a sign of weakness.

The reality is that investors not only know there will be challenges for any growing company — they fully expect them. Things often don’t go according to plans, and recognizing and being willing to discuss challenges is a clear sign of strength in a leader.

In fact, because hills and valleys are a normal part of growing any company, it can be concerning to an investor to only hear good news. Investor-founder relationships thrive on candor and transparency — open discussions about how a company is approaching challenges and being receptive to advice and counsel.

That last part is key. In addition to falling into the trap of thinking that all news must be good news, another pitfall that founders find themselves in is believing they must always be the smartest person in the room. Investors love innovative and forward-thinking founders who seek out creative ways to solve problems, but we also love working with leaders who are excited to take advantage of the experience and perspective we have to offer. 

In my role, we seek out companies that are actively working to solve problems. Once we pinpoint the right company, we never expect them to go it alone. Our goal is to work with them to identify any struggles that are preventing them from moving to the next level. 

The goal of establishing these problems isn’t to cast judgment on them; it’s to have open discussions and offer expertise on moving around or beyond them. As an investor, we are always fully aligned with the founder in working to achieve the best possible outcome. 

We have a virtual treasure trove of resources — from leaders with expertise in relevant fields, experience guiding founders who have faced similar challenges, and relationships that we can draw upon to help achieve solutions. In fact, founders should insist on working with investors who have more than cash to offer; utilizing the unique skills and networks an investor brings to the table is equally valuable. 

It’s a really great time to be a founder. Once you’ve found the right investor, work hard to build a strong relationship with them. By working together in a way that’s open, honest and receptive to new ideas, you’ll be able to celebrate shared success.  

Steve Lebowitz is a Senior Managing Director at Two Bridge Capital. With over 20 years of real estate and senior housing investment experience, Lebowitz has been involved in over $1B of acquisitions, complex financing projects (traditional and HUD) and asset management.

The opinions expressed in McKnight’s Long-Term Care News guest submissions are the author’s and are not necessarily those of McKnight’s Long-Term Care News or its editors.

The “new normal” for those who operate skilled nursing facilities is not so new anymore. 

Staffing and labor shortages that at one time would have been labeled as unthinkable are now the everyday operating reality.  For over two years now, the forces and fallout from the pandemic have shaken up what was already a vulnerable industry, leaving an impact that’s unlikely to change for quite some time without substantial and dynamic shifts in the sector.

Staggering staffing statistics 

A June 2022 American Health Care Association (AHCA) survey presented alarming facts that have become all too familiar across the industry: a majority of nursing home providers are facing staffing and labor shortages, and experiencing difficulty hiring.

Most of these facilities rely on overtime, extra shifts and temporary staff in an attempt to relieve the problem.

Hiring permanent staff poses its own unique set of issues. Seventy-one percent of AHCA survey respondents said their top obstacle is the inability to find interested or qualified candidates, in part due to a lack of funding to offer competitive wages to attract new staff. 

It’s a circular situation — the labor situation impacts the financial situation, which impacts the most important aspect of the SNF: the ability to provide quality care to the residents they serve. 

Working proactively with operators

Historically, many owners/investors do not typically involve themselves or interact with their operators beyond standard financial reviews, legal issues or significant regulatory concerns. 

However, in the spirit of what we can call “proactive asset management,” it is critical that those with a financial stake take a much more proactive approach to understanding the  “outside-the-box” thinking to drive the operational and financial stability of the building. With the industry facing statistics that are so dire, it is time to throw out all historical paradigms and collaborate in new ways amongst all key stakeholders for the common goal of a facility’s survival. 

The key is not for investors to approach operators in a punitive, “checking up,” disciplinary type of approach but rather in a collaborative and idea-sharing style that fosters a team approach to allowing the facility to provide the best possible resident care, which in turn leads to and facility sustainability. 

Nontraditional ways to ensure good care and financial growth

Here are some ways beyond traditional census and staffing mitigation to ensure best-in-class care and financial growth of SNFs.

Value-based programs 

These include hospitals monetizing current SNF assets, partnering with specialized SNF operators or focusing on increased investment in next-generation SNFs (“super SNFs”) that can accommodate higher acuity patients in a more comfortable and appropriate care environment.

ISNPs/REACH ACOs

Medicare Institutional Special Needs Plans, or ISNPs, enable nursing home operators to increase residents’ access to health and wellness resources, with nurse care managers helping coordinate members’ healthcare at no additional cost to the facility. Meanwhile, REACH ACOs provide partial and full capitation payments to physician groups to spur greater coordinated care.

Preparing for PDPM and RAC audits 

It’s important for SNFs to get ahead of PDPM audits, specifically targeting top areas of payment focus. Providers receive reimbursement for physical therapy, occupational therapy, speech-language pathology, non-therapy ancillary (NTA), and nursing. This makes it essential for operators to keep good documentation of areas within those categories (the special care high subcomponent of the nursing category, for example) that could be the target of audits by the government. Preparation is also the solution to defend against RAC audits — having a proactive, real-time compliance structure is the most effective solution to ensuring that all claims filed are accurate.

Market ancillary initiatives

Ancillary services — including therapeutic, care delivery and diagnostic services — are vital parts of care for patients in today’s world and can help ensure the appropriate functioning of the organization, including care delivery and clinical services.

Contract negotiations

Improving contract terms with MCOs and vendors is another area where investors can support operators in overcoming challenges. Because MCOs dictate the types of services a healthcare provider can offer patients, they have a major effect on the day-to-day decision-making processes of healthcare providers. 

Investors must be educated regarding such negotiations to help the providers get fair terms for their services. Operators historically have not been viewed as the best negotiators and could use the assistance of business-savvy investors when negotiating.

Develop strategies for improving Five-Star Quality Rating

Improving the Five-Star Quality Rating of a facility can lead to better census, more effective touch points on internet searches and improved reputations in the marketplace. Increased focus on these CMS-driven ratings factors can be hugely valuable. 

Like every other industry, as the world around them changes and information becomes more readily available, investors, although never getting involved in actual care, can provide insight, assistance and understanding to operations as they search for non-traditional ways to improve their financials without sacrificing care.

Alex S. Paley, MPH, is Senior Managing Director of Two Bridge. Mr. Paley has 30+ years of executive-level experience managing and overseeing all aspects of companies delivering complex healthcare services, having been responsible for all operational activities, revenue & business development, M&A activity, as well as quality control for multi-tiered national healthcare companies. He has served as the operational liaison to financial institution representatives and investors and has provided oversight, training and education to healthcare operations professionals industry-wide.

The opinions expressed in McKnight’s Long-Term Care News guest submissions are the author’s and are not necessarily those of McKnight’s Long-Term Care News or its editors.

The U.S. District Court of Rhode Island issued the ruling in favor of Omnicare’s parent company late last week. The decision was first reported by Bloomberg Law. 

A request for comment from CVS Health by McKnight’s Long-Term Care News was not answered by production deadline. 

Investors accused the company of actively putting out false and misleading information in its financial announcements between 2015 and 2018, the period between the Omnicare acquisition and Aetna merger. Plaintiffs argued CVS was “motivated by the desire to hide its struggling LTC business to ensure that the Aetna purchase would [succeed] and on terms preferable” to the company. 

“They allege that although CVS acquired Omnicare with the idea of taking over what was at the time a healthy distribution network of pharmaceuticals in the LTC market, mismanagement ultimately spurred substantial client losses. In addition to false and misleading reports designed to hide the problem from investors, the Plaintiffs point to CVS’s decision to ‘fold’ the LTC business into its front-store retail operations in its financial reports to make it impossible for investors to see the drain,” court documents detailed. 

District Judge Mary S. McElroy in her ruling noted that Omnicare was “by virtue” a leader in the LTC industry at the time of the acquisition and the statement was more of a declaration of “optimism, or perhaps wishful thinking, than anything an investor would rely on.” 

In denying the plaintiff’s argument, McElroy wrote that “as a characterization, these first set of statements may have been overly optimistic. But absent assertions supported by fact that CVS Health at that time had only a small fraction of the market, or was barely a ‘player,’ the labeling of CVS as a “leader” can hardly be termed objectively false. 

“And, indeed, one of the failings of the amended complaint is that it does not draw a clear timeline of customer losses; thus, while there is an ample demonstration of customer loss, there is no comparative basis for concluding that the customer base had fallen so far behind what it was pre-acquisition as to make the ‘leadership’ label cross from exaggeration into falsehood,” she added.

Much has improved since I began covering this field in 1990. Care capabilities have improved tremendously. Quality is no longer an afterthought. Operators have more data- and business-savvy than ever.

But, sadly, one discomforting reality remains. And if anything, it’s gotten worse. Simply put, far too many operators in this field keep getting into fiscal trouble.

To be fair, systemic flaws are at least partly to blame. For any way you slice it, providers must compete in an environment often beset by unrealistic oversight demands, dubious payment opportunities and unrealistic outcome expectations. On the best of days, this is a tough field to be in.

But there’s a deeper issue at play here. It’s one most in the field are loath to admit to, much less discuss: greed gone bad. This issue manifests itself in many ways. They include coding irregularities, bills for services never delivered, intentionally short-staffing, cheating workers out of earned wages, to name but a few. The list goes on. 

Why have greed-driven problems continued, decade after decade? Because operators must simultaneously do two things that are often at odds. The first is to provide residents with the best level of care possible. The second (with the exception of nonprofits, many of which play their own fiscal reindeer games) is to maximize profits.

Most long-term care businesses are either family owned or publicly traded. In each case, a return on the investment is expected. The higher, the better. That is not by and of itself a bad thing. In fact, it is the way most businesses are run.

But it’s too often the case in our field that care or profit must be sacrificed so the other can improve. And when it’s care that gets shortchanged, a lot of bad things can and do happen.

If only there were a model that could lend a hand to this perennial challenge? Well, as it happens, there might be. And it comes from the financial sector, of all places.

Ever hear of the Vanguard Group? 

The Malvern, PA-based investment firm now has more than $6 trillion in global assets under management. It has become the world’s largest mutual funds provider, and the second largest provider of exchange-traded funds.

When the late Jack Bogle founded Vanguard in 1975, he put an unusual structure in place. He made it a client-owned enterprise that would be run at cost. His aim was to charge only the minimum fees needed to cover operational expenses.

Because Vanguard is not under pressure to generate profit for its owners, it enjoys both a performance and cost advantage over competitors who are. That is to say, all of them.

To be clear, running an investment firm is very different than running a long-term care facility. But surely, there is enough brain power in this sector to figure out how Vanguard’s approach could be adapted.

Do I expect such a thing will be happening any time soon? Probably not.  It’s the rare operator who would be willing to embrace a client-owned strategy.

But imagine if this new approach took hold — and expanded on a large scale. It would certainly reduce the number of reports we keep reading about fraud and other fiscal abuses in this sector.

As an added bonus, it might also encourage others with larceny in their hearts to seek their fortunes elsewhere.

John O’Connor is Editorial Director for McKnight’s.

For more information, click here.

How these firms operate became a controversial issue inside and outside the field for several months, before eventually fading. And it’s beginning to look like private equity may be revived as a hot topic, thanks to Mitt Romney.

For those of you just arriving from another planet, Romney is the prohibitive Republican favorite in the Oval Office race. But despite his frontrunner status, he is taking a pounding for his private equity bona fides. Much of his wealth — which has been estimated to be in the neighborhood of around $270 million — was generated during his tenure at private equity firm Bain Capital.

Private equity may not grow crops, raise children or promote world peace. But when it works, private equity makes the economy run more efficiently. It also tends to handsomely reward investors. How handsomely? Consider that Carlyle Group’s three founders made $413 million in 2011. Not a bad year at the office.

However, critics remain less enamored with the concept. Their complaint is that many of the resulting efficiencies and profits constitute little more than a pink-slip harvest. Having a reputation as a job killer can have a distinct downside. That’s especially the case during an election year in which job growth has become, well, Job One.

According to the General Accounting Office, private equity firms acquired 1,876 nursing facilities between 1998 and 2008. And you can bet that businesses such as the Carlyle Group, Warburg Pincus, Formation, National Senior Care, Fillmore Capital Partners and others will be closely watching how this presidential campaign plays out as they ponder their next moves.

Under their breath, they may also be cursing Romney’s presence. For unlike the former governor of Massachusetts, these firms might have more to lose than a mere election. One possible casualty could be their special tax breaks — including carried interest  –—which allow them to treat profits like capital gains.

At this point, it’s too early to predict how things will play out. But it is safe to say this: One way or another, Mitt Romney will make this a memorable presidential election.