MBA Panelists Talk Changes in Nursing Facilities
Not only has staffing guidelines changed, but the qualitative measures that nursing homes are being judged on has been revised and updated which might be difficult for underwriters in the next six months, say panelists.
SAN DIEGO—How are changes in lifestyle trends, health and technology for working seniors contributing to the challenge of providing highly sought after residential healthcare facilities and seniors housing? Panelists at Monday morning’s Trends in Healthcare and Seniors Housing panel discussed the question at the MBA CREF/Multifamily Housing Convention and Expo 2019. They also discussed how developers and loan originators are responding to these changes while managing regulatory compliance issues and operational complexities.
Moderated by Raelee Jones, managing director and FHA chief underwriter at Wells Fargo Bank, N.A., talked about the change happening in the industry. “Our industry is undergoing a great deal of change and that isn’t a bad thing.”
Brad Granger, VP of operational and clinical underwriting at Orix Real Estate Capital dba Lancaster Pollard Mortgage Co., talked about skilled nursing facilities specifically, and pointed out that “right now, the industry is going through a tremendous about of change.” He pointed out that nursing homes are required to have inspections at least once a year, but all of the care tags that a home can be cited on have been changed to better reflect resident rights and better care.
“There is a lot of focus on doing root cause analysis on issues at the facility,” he said. “There has also been a lot of changes in staff regulations across the country such as new staffing guidelines for example.”
According to Granger, another thing going on is that there are 16 quality measures that nursing homes are being judged on through the five-star system that have been updated and revised. “This has been an overwhelming amount of work for the nursing homes to deal with right now. It is a lot of change. The other thing is readmissions.” He also talked about the hospitals and referral sources and how they get penalized if they are referred to a nursing home and go back to a hospital. “Those readmission rates are now getting measured and tracked.”
The last major change he discussed was a comprehensive change in the reimbursement system for Medicare. “The old system was very focused on therapy delivery.”
Up next was Stephen J. Ervin, SVP at Berkadia, who talked about PDPM and how it will make underwriting for these kinds of facilities very difficult. “In effect, nursing homes will be required to access every resident on five metrics and then based on where that resident comes in, sets the reimbursement rate. Over the course of time, that reimbursement rate goes down.”
Just like any other industry, there will be some who get it right and some nursing homes who get it wrong, explained Erwin. “We talk to operators who say this model will be good. But I don’t envy anyone who is an underwriter. Ultimately the goal will be to work toward patient outcomes, but the next six months will be hard.”
Roger Lukoff, office of healthcare programs at the US Department of Housing and Urban Development, talked a bit about the shutdown and what lenders can do to help. “During the production process for sure, when you do submit applications, clean applications make it through the process much quicker,” he said. “The more that can happen, the quicker we can move through the queue.” He also encouraged young people to look at employment options with HUD.
Check back with GlobeSt.com for more coverage from MBA’s CREF/Multifamily Housing Convention and Expo 2019.