Solving Challenges with Collaboration: Catholic Senior Living + Women Religious Congregations

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1 Solving Challenges with Collaboration: Catholic Senior Living + Women Religious Congregations October 27th, 2018 / 1:30 PM Sponsored by

2 Facilitator: Nancy Hooks VP of State Partnerships LeadingAge

3 Presenter: John Barnum SVP & CFO Liberty Lutheran

4 Presenter: Sr. Sandra Schmidt SBS Councilor Sisters of the Blessed Sacrament

5 Liberty Lutheran 7002 Butler Pike Ambler, PA Incorporated in Pennsylvania 2001 Parent company and sole member that provides oversight and management services to Affiliates Budgeted revenue $82,500, Independent Living apartments 18 Independent Living cottages 238 Personal Care beds 217 Skilled Nursing beds 80 Assisted Living apartments 978 Total Active employees approximately 1,200 1

6 Paul s Run 9896 Bustleton Ave Philadelphia, PA Incorporated in PA 1977 Life plan community 223 Independent Living apartments 100 Personal Care beds 120 Skilled Nursing beds Active employees 399 Artman 250 N Bethlehem Pike Ambler, PA Incorporated in PA 1916 Life plan community 126 Personal Care beds (includes 19 Memory Care beds) 61 Skilled Nursing beds Active employees 253 Mary J Drexel Home d/b/a The Hearth at Drexel 238 Belmont Avenue Bala Cynwyd, PA Incorporated in PA 1887 Acquired January Assisted Living beds (including 20 Memory Care beds) 20 beds Memory Care Active employees 95 2

7 Liberty Lutheran Housing & Development Corp d/b/a The Village at Penn State 260 Lions Hill Road State College, PA Incorporated in PA 2002 Acquired June 2012 Life plan community 138 Independent Living apmts. 18 Independent Living cottages 12 Personal Care beds 36 Skilled Nursing beds Active employees 160 Liberty Village d/b/a The Manor at York Town 2010 York Road Jamison PA Incorporated in PA 2015 Acquired October Independent Living apartments Active employees 50 Liberty Community Services d/b/a Liberty at Home 250 N Bethlehem Pike Ambler, PA Incorporated in PA 2005 Home Health, Home Care, and Hospice Services Active employees 124 3

8 LCFS 7002 Butler Pike Ambler PA Incorporated in PA 1966 Agency that provides services to senior citizens through the West Philadelphia Senior Center and In Home Support Program Lutheran Congregational Services 1923 Hanover Ave Allentown, PA Incorporated in PA 1973 Acquired July 2010 A social ministry organization providing education and facilitation of ministries Liberty Lutheran Foundation 250 N Bethlehem Pike Ambler, PA Incorporated in PA 1991 Responsible for the implementation and administration of fund development and investment management Active employees 23 Active employees 2 Active employees 3 4

9 Liberty s Experience in Collaboration with Realm Group July 2016 Sisters of the Society of the Holy Child Jesus Agreement still active Initial move-in of approximately 6 sisters to The Hearth at Drexel, assisted living Additional move-ins ongoing as needed and available for the future January 2017 Sisters of the Blessed Sacrament Agreement still active Initial move-in of approximately 50 sisters to Paul s Run, all levels of care Additional move-ins ongoing as needed and available for the future 5

10 Highlights of the Coordination Process Preliminary Planning Internal congregational processing Tours of a variety of communities Final selection of community Consultant Assistance Oversite of process Realm Group Movers Room design / Furniture assistance 6

11 Highlights of the Coordination Process Detailed Agreement Rates Services and Community Life Third party reimbursement (Medicaid process) Level of care determination / Assessments Transition of Sisters Executive Director, Katrina Wise, and Realm direct day-to-day involvement Controlling available units Staff / Prior care givers / Job fair 6

12 Presenter: Mary Alice Ryan President & CEO St. Andrews Resources for Senior System

13 St. Andrew s Resources for Seniors System Faith based NFP affiliated with Giddings Lovejoy Presbytery, Episcopal Diocese of St. Louis, & the United Church of Christ s regional Missouri Mid-South Conference 20+ communities in Mo and IL Home and Community Based Services Serves 10,000 seniors and their caregivers a year

14 I. The Sarah Community St. Louis

15 Our Journey began in 1996 Franciscan Sisters of Mary convened a meeting of local religious women congregations, (1) describing a common need to relocate the care given to their senior and infirm sisters and (2) to explore the possibility of working together towards a solution. Reasons to relocate included (1) an increase number of Sisters needing a higher level of care, (2) increased staffing costs, and (3) the sale of property. 5 leadership representatives from 4 congregations were present at first meeting. Listed various needs & how they might work together in addressing them.

16 The Sarah Community Founding Members The Daughters of Charity of St. Vincent de Paul, Franciscan Sisters of Mary, Society of the Sacred Heart, School Sisters of Notre Dame, and Sisters of Loretto.

17 Year One Established committee structure: Legal, Research, Facilities, & Financing and Services Potential grants were discussed. Each committee discussed what information they needed to proceed. Attorney present -- legal challenges. Discussion with SSM DePaul Hospital on facilities and land available.

18 Year One (continued) Education on the development process and what it involved An exercise with the interested members: what they are envisioning, what do they want to accomplish, how they see moving forward, what are the challenges and opportunities, what time and money is available, and how to organize the group.

19 Year One (continued) Over the next months Looked at legal models. Discussed financing potential/models & financial input from group. Reviewed state and federal regulations. Hired actuarial study on potential usage by orders. Reviewed information from Intercommunity project in Chicago. Looked at potential sites. Began timeline.

20 Decisions Made An inter-congregational endeavor. Open to the laity. Provide a continuum of care. Design would promote community life, including a chapel and common open space which would double as space for individual congregational gatherings. Clarified this was a collaboration of five religious congregations and not connected to the archdiocese; however did meet with the archbishop to communicate what we were doing and why.

21 Budgets. Year Two Certificate of Need process. Market feasibility study. RFP for architectural firms. Finalized legal structure. Continued financing discussions. Began plan for start up of operations and marketing. Finalized architectural plan, interior design, and construction documents.

22 Year Two (continued) Received cost estimates for all parts of project. Issued tax exempt and taxable bonds. Began construction and renovation. Visited with orders to explain project. Visited with employees of orders to talk about potential jobs. Worked closely with representatives of health system on how they would partner. Plan for moving in sisters.

23 Opened in January 1999

24 St. Andrew s Involvement Consultant throughout the process. Program design. Worked with congregations on their planning for informing their members about project, on how to meet the special needs of religious members, and on forming the NFP entity. Facility Design. Coordinating all team members (attorneys, architect, contractor, interior designer, etc.). Operational budgets. Assisted with planning and execution of financing (Tax Exempt Bonds).

25 St. Andrew s Involvement (continued) Retained as Management Company: Refined operational budgets. Planned and executed marketing campaign. including all marketing materials and ads. Worked with congregations on moves into the community. Hired and trained initial staff, including Executive Director. Worked with local discharge planners at hospitals. Set policies and procedures.

26 # of Sisters at The Sarah Community Today Anna (SNF) 44 of % Veronica (ALU) 43 of 98 44% Naomi (ILU) 26 of % Total 113 of % School Sisters of Notre Dame, Franciscan Sisters of Mary, and Daughters of Charity have the largest number of Sisters (in that order). In addition to those Sisters listed we currently have two Carmelite Sisters and a Sister of the Most Precious Blood.

27 II. St. Andrew s at Francis Place

28 St. Andrew s at Francis Place (cont.) Mr. Bernard Huger of Greensfelder, Hempker and Gale approached St. Andrew s with this opportunity. He had been in contact with the Franciscan Brothers. Franciscans built and operated Price Memorial nursing home in the city of Eureka, MO for over 30 years. Price Memorial was a Five Star Skilled Nursing Home. Only five brothers left in this Province, all of retirement age, and they were interested in finding the right sponsor to assume their mission. They were willing to give the facility to a not-for-profit organization that would keep its Catholic heritage.

29 St. Andrew s at Francis Place (cont.) Mr. Huger was also in contact with the Ursuline Sisters who were looking for a new location for their sisters who require skilled nursing home care (SNF). The Sisters were very interested in the opportunity but stated from the beginning that they did not operate or wish to operate licensed nursing homes.

30 Brothers gave facility to the Ursuline Sisters and St. Andrews in Sisters sponsorship met the requirement that this stay a Catholic affiliated community. Received canonical approval from the Archbishop of St. Louis. Financial: Details of the Arrangement Ursuline Sisters invested $$. St. Andrew s did all development consulting services as their contribution of sweat equity.

31 Legal: Sponsorship and Board Ursuline Sisters and St. Andrews each a Member sponsorship with certain reserve powers for each. Ones of most interest are: St. Andrew s makes decisions on the operation of the facility. Sisters make all decisions needed to keep it as a Catholic institution. The board members: 5-7 members. St. Andrew s will always have one more than the Sisters.

32 Arrangement with Franciscans Price Memorial requested that if the facility is sold within five years from the turnover (2014), they will recoup the money from the sale after repayment of any debt (Ursulines, St. Andrew s and any outstanding loans). The amount will be on a sliding scale basis, 20% declining every year. Brothers leased their home on campus for $1.

33

34 III. Navigator Program Health Navigator is a full time LPN who supports the coordination of health services for the 50+ age Sisters of a women s religious order. Services provided: Hands-on care is not provided but coordination and oversight of care needs. Conducts assessment to track baseline health issues and progression. Conducts in-home safety assessments.. Communicates changes to assigned liaison.

35 Navigator Program (continued) Individualized health care plans. Educational programs & activities for healthy lifestyle choices. Accompanies sisters to physician appointments. Visits, if in hospital, and acts as advocate. Conducts a holistic, systematic, ongoing and criterion-based evaluation of work being done.

36 Presenter: David Nolan Chief Operating Officer On Lok / PACE

37 What is PACE Comprehensive services for the frail elderly Preventive care Primary care Medications Acute care Transportation Meals Medical Specialists Dental Emergency Care Behavioral and mental health Long-term care, including nursing facility when needed

38 What is PACE (cont.) Capitation funding (per member per month): Combines Medicare, Medicaid and private payments Program has full financial risk Alignment of care needs and financial interests Monitors elders closely takes action early to restore health, and control cost

39 Who does PACE serve? Eligibility: 55 years or older Resident of PACE service area State-certified to need nursing home level care Can live safely in community at time of enrollment 39

40 Sisters of the Holy Family Fremont Seek out and advocate for the poor and needy especially families Dominican Sisters of Mission San Jose To stand in solidarity w/young, poor and vulnerable Both seeking solutions to aging population

41 Challenges Leadership Collaboration between orders Change management Physicians Transition to On Lok docs ADHC attendance 24/hour staffing Understanding each other s culture Bringing larger community onto the campus

42 Perspective This experience changed us Small population required adaptation Changing populations being served Behavioral health, substance use

43 Thank you. John Barnum SVP & CFO Liberty Lutheran Nancy Hooks VP of State Partnerships LeadingAge David Nolan Chief Operating Officer On Lok / PACE dnolan@onlok.org Mary Alice Ryan President & CEO St. Andrews Resources for Senior System mryan@standrews1.com Sr. Sandra Schmidt SBS Councilor Sisters of the Blessed Sacrament schmidtsl@aol.com

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