Audit & Tax Services:

Our firm is both effective and efficient, minimizing cost and disruption to your staff’s time. We are highly experienced with all lifecare contract types, HUD, Medicaid & Medicare, benefit plans, and foundations within the context of senior living. Additionally, because we are a midsize firm, we do not have to “feed the mother ship” like many large firms who are constantly having to buy their firm from retiring partners. Instead, we put these funds into higher wages for our professionals. This translates into lower, more reasonable fees, more knowledgeable and experienced staff and consistent staffing for your engagement. Our financial audits are extremely effective and efficient…The result, more value for you. As a component of each audit engagement we provide benchmarking within the context of staffing levels, overhead costs as well as reimbursement trends.

We are also experts in HUD related audits and reviews. We have performed and have collective experience with over 300 different HUD audits, including Section 223(f) insured mortgage multifamily rental housing, Section 8 housing assistance payments (HAP), Section 232 mortgage insurance for nursing homes, Section 202 supportive housing for the elderly, Section 811 supportive housing for the disabled, Section 202 and 811 capital advance programs, Section 207/221(d)(4) multifamily rental housing for low income and moderate income families, project rental assistance (PRAC) for Section 202 and Section 811 capital advance projects, and cost certification audits.

We also have a team of CPA’s dedicated to benefit plan audits and reviews and the completion of related forms 5500. We currently perform these services for over 70 clients located throughout the US including the states of Hawaii and Alaska. As with all of our audit and tax services, because of the deep level of experience of our professional staff, we are both efficient and effective, saving your staff’s time and you money.

We remain abreast of the current focus being taken by the IRS, which helps to ensure your 990s are less likely to be selected for detail review. Our compilations for resident tax memos have withstood challenge and we keep abreast of all IRS rulings and advisories related to this dynamic topic.

Consulting and Other Services:

Since we have former senior living executives on staff we have a truly unique perspective on the challenges faced by “C” level leaders like you. Unlike most firms who are “on the outside looking in”, we have the ability to view your needs from the “inside looking out”. We have been extensively involved with issues such as facility expansion and planning, new product feasibility studies and related economic projections, strategic alliance identification and structure, teambuilding and performance management, software systems selection and implementation, “in-source/outsource” decisions, vendor selection and contract negotiation (inclusive of vendor performance criteria), market studies and “secret shopper” market analysis and the facilitation of strategic plans.

Performance Management – Teams & Process

This includes not only financial and operational reviews, but the design and creation of high functioning teams. We can not only identify your operational opportunities but help you identify and implement the programs and processes needed to realize the full value of these opportunities, this includes training and the implementation of KPI’s. Senior living providers who “win”, i.e. are economically efficient and of high quality, have done so through the creation and implementation of effective teams in all levels of care. This environment also becomes an “incubator” for the creation of the next generation of leaders for the organization. Any senior living campus is only as good as its people and programs. A team’s ability to effectively and constructively communicate and resolve conflicts is essential to both resident and employee satisfaction as well as personal growth. It is also very true that measurement is key to continual improvement.

It is interesting how often we see organizations using “accounting numbers” to measure and drive performance at departmental and operational levels. In our experience, there are typically no more than 7 things or “factors” which are controllable by a department or operational unit, and accounting numbers alone are generally are not up to the task.

Economic Projections & Project Management

Many of the decisions you make have long term consequences; a clear understanding of likely outcomes is essential to the ultimate success of these decisions. With all major decisions, whether it’s a new product (e.g. lifecare at home), expansion of your existing “footprint”, or the creation of a standalone short term recovery/rehab center, a sound understanding of the key drivers is essential to the formulation of a robust set of financial projections. We can assist with the formulation and implementation of project and operational plans….Does your staff have the bandwidth to run the business and manage your projects?...We can help.

The model we use to formulate your five year forecast will be provided to you as a part of this service. Our model is robust and formulated at the monthly level. This in conjunction with our easy to use input (or key independent variables) and output tables (or key dependent variables), enables our clients to easily understand the sensitivities desired outcomes have to changes to assumptions. Our clients find this tool to be extremely useful to scenario modeling and annual planning.

Divestitures, Acquisitions and Strategic Alliances

Our associates have been involved with over 100 transactions, including strategic alliances. As with most things in life, “fit is everything”, within the context of the operational, cultural aspects and goals and attributes of an organization. Matching a third party organization to a set of your strategic objectives and then executing the integrative process in a timely and thoughtful manner is something that many firms get wrong…Don’t be one of them.

Debt Structure & Placement

HUD, Bond, and Bank – We have participated in debt placements ranging in size from $9 to $150 million within the context of fixed and variable rate transactions as well tax exempt and taxable structures. We have worked with many banks, bank groups, bond counsel and investment bankers to both minimize the cost of capital and reduce the burden of loan covenants. When making critical debt structuring and placement decisions, it is important to have a third party advisor who is truly independent.

Strategic Planning Facilitation

We have facilitated many strategic planning sessions with management teams and boards. We take an active role in performing the research needed to ensure the resulting plan is both actionable and relevant to your organization. All too often, an organization’s strategic plan becomes a “placeholder” rather than a plan which drives measurable change for the organization. Done well, translating the elements of a strategic plan into steps which are both actionable and measurable can make a very large and favorable impact. It is essential that a plan be critically reviewed and (if needed) recalibrated at least annually to ensure its continued relevance to the organization.

Governance Optimization – Board Operations and Education

An advisory board and its committees, when correctly aligned with management teams, add a lot of value to the organization. Board expectations of management and the organization must be very clear and obtainable. At times, we encounter boards and management teams who believe they are “on the same page” but in reality they are “thinking past each other”. A grand goal such as being a “center of clinical excellence” must be very well defined in terms of its key attributes before the organization can assume the task of making progress towards this objective. This is all about education and alignment. So is this relationship optimal for your team?…We can help.

Reimbursement Optimization

Optimizing Medicaid and Medicare reimbursements within the context of both therapy and nursing activities is essential to success. Our reviews of Medicaid CMI and Medicare RUGS scores have found that providers often do not realize their case-mix potential, in other words they are providing services which are not reflected in their scoring and thus reimbursement levels. Our reimbursement professionals can provide an in-depth review of your organization’s case-mix methodologies, procedures and trends, and provide an analysis of the causes of your organization’s understated CMI scores. We can provide CMI training for your organization and point out opportunities to appropriately optimize your Medicaid and Medicare reimbursement rates.

Interim & Part Time CFO and Controllership services

We have been CFO’s and Controllers in your industry, so we understand your challenges. Our professionals have a very broad and deep level of experience with all aspects of managing an organization within the context of nonprofit and for profit senior living organizations.

New Revenue Streams

Constructing new services or migrating existing services to new markets is key to diversification and growth. Many organizations see this as a very complex and risky task. Our view is that complexity is composed of “bundles” of simplicity. Key to each of these engagements for us is to break the overall objective down into its simplest elements and understand the interdependencies of each one. In this way, we make the seemingly complex, both simple and actionable.

Operational Reviews

Some organizations believe they are excellent….but are they really? At times great organizations can become complacent believing that they are great, a perspective that is anathema to continual improvement. Our operational reviews identify where you are great and where you can improve. We then partner with you to design and implement the changes needed to realize and maintain excellence.

Contract Services – Resident Agreements

Many CCRC’s are finding that the “Boomer” generation has a broad array of needs, desires and perspectives when it comes to the perceived value of their purchase. As such, many providers are beginning to broaden the array of contract types offered in order to enhance the appeal and competitive position of their product through increasing the array of contract types offered, e.g.

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Executive Search

Our process of identifying and matching a client’s current and prospective needs to a candidate’s profile in terms of competencies, motivators and communication style is unmatched in the industry