1. Does PACE Make Sense for your Organization? Prepared by : AEC Consulting, St. Paul’s Senior Homes and Services, United Church Homes and Services, Volunteers of Americaa National Services David Reyes Lee Syria Wayne Olson Cheryl Wilson

2.  Develop an understanding of the strategic thinking process around developing PACE and why other providers may want to do consider the same.  Develop an understanding of the cost/benefit that the panelists encountered and why PACE worked so well for their organizations  Learn about “lessons learned, outcomes and rewards of this important strategic decision.

4.  1960 - St. Paul’s Episcopal Home established ◦ DBA St. Paul’s Senior Homes  Next 30 years slowly developed: ◦ Manor (HUD) ◦ Tower (HUD) ◦ Health Center (HUD)  From 1990 until present developed: ◦ Assisted Living ◦ Senior Day Care & Childcare (intergenerational) ◦ Secure memory care ◦ PACE ◦ Middle income multi-level facility* (under construction)  Now Serves: ◦ 260 in HUD supportive housing ◦ 465 in health care ◦ 100 HCBS ◦ *160 under construction

5.  Diversity  Finances  Growth into more low income HCBS

7.  Serving a diverse population ◦ Many mental health participants  Financial picture ◦ Doubled revenues ◦ Concern for too much government ◦ Reimbursement ◦ Corporate overhead contribution  Serve more low income HCBS ◦ More than accomplished

8.  PACE has lead to additional partnerships: ◦ Housing ◦ Healthcare

9.  YES!!!  But we will not expand any further: ◦ Too expensive to open a site ◦ Too much insecurity around reimbursement ◦ Additional reporting expenses

11. A Christian ministry committed to providing vibrant senior living opportunities, diverse programs of outreach and compassionate healthcare services. Enriching lives by providing the right services, at the right time, in the right setting.

12.  Three Continuing Care Retirement Communities: ◦ Abernethy Laurels, Newton, NC ◦ Lake Prince Woods, Suffolk, VA ◦ Piedmont Crossing, Thomasville, NC  Kids Only Childcare Program at Piedmont Crossing  Seven Affordable Housing communities: ◦ Carolina Senior Living, Lexington, NC ◦ Covenant Place, Chapel Hill, NC ◦ Emmanuel’s Place, Statesville, NC ◦ Matthew’s Place, Albermarle, NC ◦ NOAH, New Bern, NC ◦ Saint Joseph’s Place, Durham, NC ◦ The Willows, Burlington, NC  Program for All-inclusive Care for the Elderly (PACE) ◦ Carolina SeniorCare, Lexington, NC  UCHS Home Office  UCHS Foundation

14.  Serve over 2000 individuals annually  Employ approximately 800 team members  Projected Operating Revenue FY 15: $61 Million  Total Assets: $140 Million  Total Long Term Debt: $56 Million

15. #1 Reason: PACE programming fits our Mission, Vision and Strategic direction  Plus: ◦ Already Medicare/Medicaid provider ◦ Approximately 50% of our SNF residents in NC are Medicaid eligible ◦ Cost per individual served versus SNF ◦ Strong leadership team at home office with capacity for start up ◦ NC favorable to PACE expansion (at the time)

16. SNF Consolidation Cost (2011)  Stand alone transfer at 60 SNF beds to a CCRC  Cost to house 54 new beds = $7.5 million  Investment per bed/resident = $138,889 PACE Projected Start-Up Cost  4-County Service Area  400 Participants  $7.1 Million Start Up cost ◦ $3.8 Million Building/Improvements ◦ $900K FF&E ◦ $1.9 Million Cash Operations ◦ $500K Cash Reserves  Investment per participant = $17,750

17. Pro FormaActual or Budget Avg CensusRevenue Profit/ Loss Avg CensusRevenue Profit/ Loss Year 12013 54$3,491,910(1,526,754)40$3,262,665(654,519) Year 22014 126$8,898,969267,889110*$8,681,685*(156,347) Year 32015 198$14,389,5271,458,336161$10,966,495470,511 * 11 month actual

18.  Making a positive difference in people’s lives  1 st year of operations: Positive $209K variance  Positive operations by month 17 (pro forma – by month 18)  Census and enrollments were on track with pro form until April 2014 (State of NC = roadblock)

20. Carolina Senor Living  2011 awarded HUD 202 grant to develop a 30- apartment units (Carolina Senior Living)  Opened in July 2014, on property flanking the PACE program  9 participants were among first tenants

21.  Be prepared for: ◦ Start-up is not for faint of heart ◦ A complete mind shift – NF operations vs. PACE operations ◦ Changes in state level leadership ◦ Lots of advocacy work ◦ Making a favorable difference in people’s lives!

22. Health and Housing focus Division formed in 1970

23.  11 – Nursing Homes  7 – Assisted Living Sites  4 – Market Rate Senior Housing  1 – CCRC  HUD 202s  Adult Day Programs  Home Health Certified & HCBS  PACE  Minnesota  Colorado  Ohio  North Carolina  Florida  Arizona  Nevada

24. There are no limits to caring.® Montrose Delta Skilled Nursing Housing Meals Assisted Living Home Health PACE 70 Grand Junction 25 Colorado Springs Eckert

26.  Montrose County ◦ population33,400 ◦ population over 655,100 ◦ rural  Delta County ◦ population27,800 ◦ population over 655,500 ◦ very rural

27.  1980 – SNF  1984 – SNF  1995 – HUD 202  1998 – HUD 202  2000 – HUD 202  2001 – Home Health  2002 – Assisted Living  2003 – HUD 202 In 2007 operated:  220 low income apartments – 202 funded  170 SNF beds  60 unit Assisted Living  Home Health service base 60  Service 470 per day

28.  Solutions orientated – without anything new  Belief that change in healthcare funding and accountability would come  Continuum was heavy on housing and residential services but light and certainly not dominate in HCBS  Many competitors in the spaces of residential care – little differentiation

29.  Continued to focus on core business –always planned to be additive  Explored a variety of approaches to have a broader touch ◦ Technology ◦ HCBS ◦ PACE  Looked for way to build brand and relationships  Goal = RELAVANCE in our Market

30.  Years of observing PACE program development  Attended intro programs on the model  Explored states friendly to PACE  In 2006, notified of the Rural PACE opportunity  Applied and became one of the pilot programs

31. Creating a New Regional Culture  Region became more competitive with PACE ◦ Residents ◦ Staff ◦ Reputation  Leadership culture needed to evolve  A shared understanding of 1 + 1 + 1 + 1 = 6 for Referrals, Reputation, Staff Enrichment Mostly for Sustainability of Mission and Employment

32. Did we increase service volume? Did we fine a more stable financial model? Did we become more relevant in our market?

33. Operation 2007currentVariance SCC 0265 Valley 90 71 -19 Horizons 57 62 5 Homestead 44 47 3 HHWC 68164 96 Senior Apts202242 40 Total461851390

34. PACE Western Colorado has been VERY Successful with Strong Outcomes  30 % penetration rate  Clinical outcomes  Expense controls  Reputation/brand strengthening  Filled in continuum

35. 2007  $21,000,000 annual income  3.5% NI 2013  $36,000,000 annual income  6% NI  Increased management fee

37.  Find and create solutions for health care needs of the area ◦ West End – solutions needed ◦ Medicaid clinic options ◦ Post-acute Medicare stay reduction  Focus on human resources  Expand on brand and reputation  Reinvest in legacy programs physical plants  Invest in technology

38.  Someone else would have done it in Western Colorado ◦ If not us, we would be out of business  Change required continuity and focus  Needed to be ready to act when Rural PACE Grant developed  Board needed to be prepared for change, but not too impatient until we found our solutions  It wasn’t easy, cheap or risk free to pursue

39.  AEC Consulting ◦ David Reyes – dreyes@altitudeedge.comdreyes@altitudeedge.com  St. Paul’s Senior Homes and Services ◦ Cheryl Wilson - ceo@st.paulseniors.org,ceo@st.paulseniors.org  United Church Homes and Services ◦ Lee Syria – lsyria@uchas.orglsyria@uchas.org  Volunteers of America National Services ◦ Wayne Olson – wolson@voa.orgwolson@voa.org