Our services
Audit & Tax
Our firm is efficient and cost-effective, minimizing staff disruption while delivering expert services in senior living, including HUD, Medicaid & Medicare, benefit plans, and foundations. As a midsize firm, we focus on higher wages for our professionals rather than corporate overhead, resulting in lower fees, more experienced staff, and consistent staffing for your engagement. Our financial audits are thorough, and we provide valuable benchmarking on staffing, overhead, and reimbursement trends. We specialize in HUD audits, with experience in over 300 audits across various programs, including Section 223(f), Section 8, Section 232, and Section 202/811. Our CPA team also handles benefit plan audits and Form 5500 filings for over 70 clients nationwide, including Hawaii and Alaska. With deep expertise, we deliver efficient, high-quality services that save time and money. We stay current with IRS priorities, ensuring your 990 filings are less likely to be flagged for review. Our compilations for resident tax memos are reliable and compliant with the latest IRS rulings.
Economic Projections & Project Management
Making decisions with long-term implications requires a clear understanding of likely outcomes. Whether it’s launching a new product like lifecare at home, expanding your footprint, or creating a short-term recovery/rehab center, having insight into the key drivers is critical to developing solid financial projections. We can assist in formulating and implementing comprehensive project and operational plans. As part of this service, we’ll provide you with our robust five-year forecast model. This model, built at a monthly level, includes user-friendly input and output tables that allow you to easily assess how changes in assumptions affect desired outcomes. Our clients find this tool invaluable for scenario modeling and annual planning.
Divestitures, Acquisitions and Strategic Alliances
Our associates bring extensive experience, having participated in over 100 transactions, including strategic alliances. We understand that "fit" is crucial—aligning operational, cultural, and strategic goals is key to success. We offer comprehensive services, including target identification, due diligence, deal structuring, and post-transaction integration or separation. Our deep expertise in financial, operational, and cultural considerations helps clients make informed decisions and optimize value. We also help assess the strategic alignment of potential alliances, ensuring that new partnerships support long-term business goals. With our experience and tailored approach, we enable clients to navigate complex transactions with confidence, positioning them for sustainable growth and success.
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.
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.
Contract Services – Resident Agreements
Many CCRCs are recognizing that the upcoming generation of retirees has diverse needs and expectations regarding the 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.
Strategic Planning Facilitation
We’ve facilitated numerous strategic planning sessions with management teams and boards, playing an active role in the research needed to ensure the plan is both actionable and relevant. All too often, strategic plans lack the focus and direction to drive meaningful change. When done correctly, translating a plan into clear, measurable actions can have a substantial, positive impact. It’s important to review and, if necessary, recalibrate the plan annually to ensure it continues to meet the organization's evolving needs.
Governance Optimization – Board Operations and Education
An advisory board and its committees can bring substantial value when properly aligned with management teams. Clear and attainable expectations between the board and management are essential. Often, there is a perception of alignment, but in reality, the two are not fully in sync. A broad goal like becoming a “center of clinical excellence” must be clearly defined with specific attributes before meaningful progress can be made. Achieving this alignment requires education and communication.
Operational Reviews
Many organizations believe they are excellent, but even great ones can become complacent, assuming success means no further improvement is needed. Our operational reviews identify both your strengths and areas for growth. We then partner with you to design and implement the changes necessary to achieve and sustain true excellence.
Consulting and Other Services
With former senior living executives on our team, we bring a unique perspective to the challenges faced by "C" level leaders. Having been in your shoes, we understand your needs from the "inside looking out." Our experience spans a wide range of areas, including facility expansion and planning, new product feasibility studies and economic projections, strategic alliance identification and structuring, team building and performance management, software systems selection and implementation, in-source/outsource decisions, vendor selection and contract negotiation (including performance criteria), market studies, secret shopper analysis, and strategic plan facilitation.
Brand Development
As customer expectations rise, it’s critical that senior care living providers fully understand the market: the needs and expectations of their customers; how competitors are improving their offerings; and how to differentiate themselves in order to establish a unique position in the market. We help by strategically developing your brand, enhancing your market position and driving vision achievement.
New Revenue Streams
Constructing new services or expanding existing ones into new markets is essential for diversification and growth. While this process may seem complex and risky, we believe complexity consists of simple, manageable components. Our approach is to break down the overall objective into its most basic elements and understand the interdependencies of each.
Performance Management – Teams & Process
Our approach goes beyond financial and operational reviews to include the design and development of high-functioning teams. We not only identify operational opportunities but also help you implement the programs and processes needed to unlock their full potential, including training and KPI implementation. Successful senior living providers—those that are both economically efficient and high quality—achieve this through the creation of effective teams across all levels of care. This environment also fosters the next generation of leaders within the organization. Ultimately, a senior living campus is only as strong as its people and programs. A team’s ability to communicate effectively, resolve conflicts, and foster personal growth is crucial for both resident and employee satisfaction. Additionally, measurement is key to driving continuous improvement.
Executive Search
Our process of identifying and matching a client’s current and future needs to a candidate’s profile—encompassing competencies, motivators, and communication style—is unmatched in the industry. We take a thorough, data-driven approach to ensure a strong fit, evaluating not just technical skills but also the interpersonal qualities and leadership potential that will drive long-term success. By understanding the nuances of both the client’s organizational culture and the candidate’s unique strengths, we provide a tailored solution that goes beyond traditional matching. This ensures that each placement not only meets immediate needs but also contributes to sustainable growth and alignment with strategic goals.