CASE STUDY

This 100 unit ALF was developed in 2003 under a tax free bond with the purpose of expanding the supply of affordable assisted living in underserved communities. The vision of this program is to provide, within private apartments, assisted living services using 24-hour staff to seniors with modest incomes in affordable yet luxurious settings. The project was designated as a Robert Wood Johnson Coming Home Program.

This 100 unit ALF is licensed and has 75 units targeted to Medicaid-eligible individuals or veterans through the Veteran’s Administration Aid & Attendance program and the other 25 units are targeted towards private pay individuals. This 100 unit ALF is a stand-alone facility (i.e. not part of a larger campus), located in a residential neighborhood in Pinellas Park, Florida.

Mia Senior Living was involved in the financing and design of the 100 unit ALF, but Mia Senior Living Solutions did not manage the facility during its first five years. In 2007, the operation found itself in serious deficit when the owners considered selling it. The owners could not secure the proper permissions from HUD to sell the facility, which is why in 2008 Mia Senior Living was hired to turn around the operation.

This 100 unit ALF is a one-story residential building configured in a honeycomb with the dining room overlooking landscaped courtyards. The facility includes a mix of studio, one-bedroom, and two-bedroom units. Each private apartment includes a kitchenette with a refrigerator and microwave; walk-in closet; and a bathroom with a large roll-in shower. In addition, each unit has individually controlled heating and air conditioning, cable television, telephone availability, and a personal emergency response system.

Common areas include a family room, wellness center, chapel, library/ technology space with computers, and several sitting rooms and areas. Other spaces include the main dining room and a large activity room, a beauty/ barber shop, two resident care stations, commercial kitchen, administrative offices, and laundry facilities.

The following services are available at this 100 unit ALF:

• Supportive services – meals, housekeeping in resident units, laundry services, and arranging access to medical services

• Personal services – daily assistance with all activities of daily living including dressing, eating, bathing, grooming, toileting, transferring and ambulation or mobility; and medication management

• Building services – property repair and maintenance and building regulation adherence

• Business office services – expense and capital budgeting and management, accounts payables and receivables, vendor contracting and group purchasing

• Government service funding – assist with the securing of service funding, including Medicaid, for eligible residents, bill government for services provided, claim dispute and resolution

The assisted living fees at this 100 unit ALF are based on a flat rate for a basic service package with additional services available on an a-la-carte basis. Service fees for eligible residents are reimbursed by either the local Medicaid agents/providers or the Veteran’s Administration with the remaining residents paying privately. The strong relationships that the 100 unit ALF has developed through Mia Senior Living Solutions aging network have been critical to the success of the project. Mia Senior Living expertise in admission of residents that qualify for government funding has ensured facility profitability.

The average age of the residents are 85 years of age and seventy percent of the residents have a mobility need. Of the current assisted living residents, 90% receive assistance with medications, 30% receive assistance with one or more Activity of Daily Living (ADL), and 70% receive assistance with three or more ADLs. A number of the 100 unit ALF’s residents were successfully relocated from nursing homes.

When first contracted in 2008, Mia Senior Living conducted an audit of the operation and submitted a lengthy plan of correction within a week that was subsequently approved. Two of the largest problems at the facility were its occupancy rate of 80% and only 20% of the residents had government service funding, even though most of them were eligible for the funding. In addition, the facility had high expenses and a demoralized workforce.

One of the 100 unit ALF client executives wrote “Mia not only implemented a conversion plan but offered successful strategies to improve it and worked with the State to facilitate the release of the freeze on Medicaid waiver funding. This remarkable accomplishment along with their suggestions for new and better ways to operate the facility have resulted in a breakeven year in 2008, and the prospect of ending 2009 with a positive cash flow. Mia’s professional handling and expert knowledge of the complicated billing process is unsurpassed.”

Within six months of getting the contract, Mia Senior Living secured government funding for all eligible residents, increased the number of private pay residents, drastically cut expenses and developed detailed expense and capital budgets. In 12 months, with Mia Senior Living as operational management, the 100 unit ALF went from an operational income loss to consistent monthly profits of approximately 12% of revenue. Mia Senior Living improved employee relations through strong training, benefits and reward and recognition programs and instituted a successful marketing plan. In 2010, the 100 unit ALF was designated a Medicaid model for the state.

Most families who have had a parent or grandparent in a nursing home know that individuals usually prefer residential alternatives to institutions when unable to remain at home. Unfortunately, with rates averaging more than $100 per day, most assisted living facilities are not an affordable option for the majority of older Americans. Mia Senior Living was developed to fill this gap, creating models of assisted living that serve seniors with modest incomes.

Mia Senior Living has contributed to the development of more than 1,000 affordable assisted living units. Mia Senior Living has provided direct technical assistance to organizations and extensive resource development (including manuals and best practice guidelines). In addition, Mia Senior Living is working with states and federal agencies to implement or modify policies and programs essential to the creation of affordable assisted living facilities.