Need help re-writing a MBA Healthcare Management final paper
I have a final paper that was written by a friend. They received an A on it and I am in a crunch to finish my paper on the same subject matter. I need someone who can re-write this paper so that it is not word for word the same. Also updating any numbers or dates since this paper was written last year. I have attached the paper and need this done by 11:59pm on Friday March 3rd. Many thanks in advance!
BROOKDALE SENIOR LIVING SOLUTIONS
Project Synthesis: Strategic Management Plan for Assisted Living Facilities
James Smith
MBA 6271- Strategic Management of Health Care Systems
Table of Contents
EXECUTIVE SUMMARY…………………………………………………………………………………………………………………………………………………….3
ENVIRONMENTAL ANALYSIS 3
INTERNAL ENVIRONMENT 4
EXTERNAL ENVIRONMENT………………………………………………………………………………………………………………………………4
SWOT ANALYSIS 5
VISION 6
MISSION 6
VALUES…………………………………………………………………………………………………………………………………………………………..6
STRATEGIC OBJECTIVES……………………………………………………………………………………………………………………………………………7
INITIATIVES……………………………………………………………………………………………………………………………………………………………..7
HEALTH CARE TRENDS AND POLICIES………………………………………………………………………………………………………………7
ECONOMIC AND BUSINESS FORCES………………………………………………………………………………………………………………….9
MANANGEMENT AND POLICY ANALYSIS…………………………………………………………………………………………………………11
SUPPLY AND DEMAND…………………………………………………………………………………………………………………………………….11
FINANCIALS…………………………………………………………………………………………………………………………………………………………..12
MISSION AND FINANCES…………………………………………………………………………………………………………………………………..12
OPERATIONS AND MOVING FORWARD……………………………………………………………………………………………………………14
ORGANIZAITONAL STRUCTURE…………………………………………………………………………………………………………………………….16
ORGANIZATIONAL CHART……………………………………………………………………………………………………………………………………17
CHALLENGES FOR NEXT 5 YEARS…………………………………………………………………………………………………………………………17
CONCLUSION………………………………………………………………………………………………………………………………………………………19
EXECUTIVE SUMMARY
When we retire or our loved family members, the choices we have to make on where we can live become overwhelming. Sometimes the ability to live completely independent is not an option due to limitations. This does not mean our lives need to be put into the hands of others solely. This topic usually means we are talking of nursing home placement, not in this case, there is another option available that is becoming more popular. For those elderly individuals that are looking for a residence that offers services of medical monitoring and minor medical care; Assisted Living Facilities (ALF) offers this plus personal freedom and privacy. (AssistedLivingFacilities, 2014) Although as we age the thought to do it peacefully in their own home begins to fade when the ability to perform daily activities become difficult or unsafe. “An assisted living facility is a senior living option for those with minimal needs for assistance with daily living and care.” (2014)
Furthermore, assisted living facilities are a necessity to our aging population that cannot live at home and do not want to be in a nursing home. However, there are still issues that make these transitions difficult. Addressing the concerns must be done soon with the increasing 77 million baby boomers planning to retire in the next twenty years. (Dugas, 2009)
ENVIRONMENTAL ANALYSIS
“Evaluation of the possible or probable effects of external forces and conditions on an organization’s survival and growth strategies.” (Business Dictionary, 2014) Organizations cannot afford to be surprised so this analysis seeks to eliminate external and internal surprises. (Ginter, Duncan, & Swayne, 2013)
Internal Environment
The situational analysis for Alf’s will determine that cost to the residents affect where they seek to live out the remainder of their years. The cost for residents to afford assisted living facilities needs to be addressed during a situational analysis. The current economic climate has resulted in the industry’s growth rate to dwindle, although an estimated 2 million Americans will reside in assisted living facilities. Housing values dropped, losses in stock prices and 401(k) drops, is resulting in American’s that a nearing their retirement to lose a good portion of their planned retirement income. Many of these baby boomers may be faced to postpone their retirements. An average month residency at an assisted living facilities costs anywhere from $3,000 to $4,500. Only those who have higher incomes are able to afford assisted living facilities due to the price tag and the current economy. (Ortiz, 2014) In order to make these facilities available to those of all incomes and needs, costs must be analyzed and monitored within the organization.
External Environment
No matter what method is chosen it must be a clear picture and the assessment of the external environment must be given. As a highly competitive industry, assisted living facilities (Brookdale Senior Living) plan on continuing at the top. In our efforts to acquire and operate senior living communities, Brookdale and the industry has and will continue to experience competition. Additionally, as the decline in new construction in recent years, competition is still there. “Consequently, we may encounter competition that could limit our ability to attract residents or expand our business, which could have a material adverse effect on our revenues and earnings.” (Brookdale- Form 10-k) Brookdale must determine and evaluate the factors that may be drawing either prospective residents or current residents to consider their rivals. The ability to reflect on managements understanding of competitive treats needs to have intense monitoring. “The database will be used to confirm or disconfirm the trend dilemma, or possibility of an event and to determine the rate of change taking place within the environment.” (Ginter, Duncan, & Swayne, 2013)
TOOLS FOR COMPARISION ANALYSIS
SWOT analysis
Strengths:
• Well-designed facility
• Accommodation layouts easy for residents to live independently
• Comfort in mind
• Specialized are for memory loss, dementia and Alzheimer’s disease
Weaknesses
• Capital access can constrain growth
• Expenses can drain revenue such as for liability insurance keep from being cost-effective
• Lack of trained professionals (pay more for training or importing professionals) increases costs and communication barriers
Opportunities
• Economic forces put Brookdale in a strong position
• Demand growth is faster but the supply is not
• Well targeted marketing campaign to increase awareness
• Adding new services (on-site pharmacy and medical personnel)
Threats
• Increased regulation could raise costs (could be a barrier to entry)
• Rapidly adding new facilities can lead to untrained staff and unpreparedness
• Lawsuits could be in the future due to cost-cutting emphasis
• Economic downturn eliminates large chunk of market
(Berman, 2014)
STRATEGIC PLAN
Vision
Assisted Living Facilities have a vision to be an affordable first choice of continual living care providers and supportive partners with the community, alongside the loving families.
Mission
“Enriching the lives of those we serve with compassion, respect excellence and integrity.” (Brookdale Senior Living Solutions, 2014)
The purpose of Assisted Living Facilities is to provide outstanding care for our elderly community that is safe, private, and comfortable. By putting focus on developing a supportive and encouraging environment with a goal to enable our residents opportunities to participate in activities that are meaningful and secure. Ultimately providing independence, health, and social interaction with their peers.
Values
Involve family and friends
Freedom of choice
Dignity preservation
Individuality
Independence focused
Promoting privacy
Community living/ Socialization
STRATEGIC OBJECTIVES
Several main goals of assisted living facilities is to encourage quality of life, aging in one comfortable home, and amplifying function. It will be critical to attend to nursing shortages and turnover rates, which will impact identifying acute medical problems in time to manage. “While every state has different nursing staff regulations, every state requires ‘sufficient staffing’ to meet resident’s ‘scheduled and unscheduled’ needs on a 24hour basis.” (SeniorHomes.com, 2014)
INITIATIVES
Health Care Industry Trends and Policies
Although the Affordable Care Act is in our headlines, there are more health trends that are involved in this legislation other than just insurance coverage. “It has ushered in new competitors, services and business practices, where are in turn generating substantial industry shifts that affect all players along with health care’s value chain.” (DeVore, 2014) One of the top trends for 2014 is that providers are quickly moving to establish accountable care organizations (ACOs). Which is projected to double in 2014. A more intense focus on the biggest health care consumers: those who have multiple chronic conditions; providers are improving their way to shared savings payments. The management of this population will be the sweet spot to pull these savings, which will be fundamental for ACOs. Ambulatory Intensive Care Units or medical homes are needed to be accomplished by the providers of assisted living facilities that will better manage chronic medical care for their residents. The ultimate goal will be to decrease hospital utilization, admissions, readmissions, emergency room visits, inpatient stays, and the length of those stays. (DeVore, 2014)
In 2014, the health care employment of health coaches will be essential to the industry instead of nurses and doctors to handle the rise in chronic medical problems in patients especially in our elderly population. These health coaches will be functioning to listen, challenge, motivate, and inspire these patients to live the best independent lives and healthy lives possible. They work alongside providers to guide them through medical plans or any issues that the resident does not disclose to their medical professional but will to the coaches. Health coaches can be hired out of a diversity of settings because the profession does not need a medical degree. (DeVore, 2014)
One big trend circulating the health care industry is data liberation (Big Data). “From electronic health records to clinical measures and decision support tools, providers are inundated with new technologies that enable them to automate processes and capture new types of clinical data.” (DeVore, 2014) However, since the system does not function with others and the data will be held prisoner behind proprietary walls not allowing the system to function at the highest potential it will be a challenge. Additionally, providers can make application programming interfaces open source tools so that those who chose and can develop application so that all the data may be functional. Some vendors who recognize this trend are making more systems such as Big Data open to new innovation. (DeVore, 2014)
A concentration on employee health will be an important trend for 2014. Financial incentives and free health tools are being offered to employees to push wellness on the job. An increase of private insurance costs and employees ability capability to increase incentives for wellness to 30% from 20% has been spurred by the ACA. (DeVore, 2014)
To increase the quality of patient care a program call Hospital at Home provides acute care to those with chronic medical conditions that would normally be admitted to hospitals. When a patient is a resident at an assisted living facility this program can assist them without the added costs of a hospital setting and they are in the comfort of their own homes. It also will decrease costs by 30% and solve access to care for patients issues. Additionally, it prevents a gap in medical care resulting from distance, geography or other reasons that one cannot be seen for at a face-to-face appointment. (DeVore, 2014)
Economic and business forces that drive change at Brookdale Senior Living
Although assisted living facilities have experienced slow growth, the industry has withstood the economic downturn, better than most in the industries. The value that these facilities provide to seniors and their children could explain this, with the increasing dementia and Alzheimer’s diagnosis these services are necessary. (Ortiz, 2014) Brookdale offers specific services for these diseases called Memory Care, “consist of specially designed living spaces and supporting environments for those who are living with cognitive challenges brought on by Alzheimer’s and dementia.” (Brookdale Senior Living Solutions, 2013-2014) For any long-term care community economics and resident-centered philosophies are driving forces. The leaders at Brookdale are obligated to consider any quality improvement investments that would benefit the company’s bottom line. Culture change is necessary to build the company’s reputation, through word of mouth, there will be more residents resulting in an increase in revenue. (Long-Term Care Improvement Guide, n.d.)
Furthermore, cuts to Medicare decreases the spending rate for the Affordable Care Act and it will have an impact on assisted living facilities. Retirees will continue to see small increases to their premiums of Medicare part A and B through 2017. Assisted living facilities count on the individuals that can afford their facilities since almost all of these organizations do not accept insurances. This can be a blessing for families and also a hindrance. Residents do not have to deal with filing claims or waiting for approvals. However, this only leaves a selected community that will be able to reside based on financial standings. Many assisted living providers argue that allowing to accept payments from Medicare would allow for a strings attached policy that must follow stricter regulations. The attractive setting that has appealed to the elderly community may be jeopardized. (Carder, Wright, & Jenkens, 2005) At the beginning there was endless financing for those who wanted to be a resident at ALF’s but over time this has created an issue for the industry. The industry was overbuilt and occupancy was lacking at the facilities.
Additionally, because 77 million baby boomers will be entering retirement years the shortage of doctors will affect care under the new law. One third of the current health doctors will also be entering retirement age which will also increase the shortage. The nation’s providers want to place new or additional limits on accepting Medicare patients. To sustain most practices to reimbursement for Medicare was about 80% by 2013 but dropped to 55%, if it continues to drop it will cost providers money to accept these patients at assisted living facilities. (Hawkins, 2001-2011) Brookdale’s plans to improve their growth revenue with the idea of controlling costs will ultimately produce cash flow growth significantly. (Brookdale Senior Living, 2014)
The entry and exit of major firms will be a driving force to assisted living facilities. When competitors enter the industry it will take residents and revenue from Brookdale. It will be the company’s job to offer the brand that the residents will want to be a part of. There are many developers who are attempting to make ways that assisted living more affordable, but this is still a daunting and challenging task. Brookdale has the opportunity for long-term growth opportunities with an increase in occupancy and rates. (Brookdale, 2014) Assisted living organization management teams require development of skills among staff to address and handle changes. When changes are warranted the staff must be able to think of new ways, engage in new behaviors, and form new partnerships internally and externally.
Health care management and policy analysis of Brookdale
“Policy-makers at all levels will face increasingly difficult decisions with respect to the design, regulation, and financing of assisted living, particularly regarding the extent to which assisted living should provide medical services to the frail elderly.” (Manard & Cameron, 1997) When it comes to opening up the communication on a sensitive issue of entering assisted living facilities, Brookdale introduces a National ad Campaign to facilitate communication regarding these choices before it is necessary. Additionally, educational programs for staff will only be effective if they are guided by adult education principles but also supported by the environment. Changes are more likely to be successful and sustainable when Brookdale’s structures and process are aligned to support any economic and business or adapt to health care trends.
Supply and demand at Brookdale Senior Living
When it addresses developers of real estate assisted living facilities will experience a surge in demand of U.S. housing. This surge is expected due to the population of senior citizens doubling in the next 35 years. However, the demand for U.S. housing for the elderly may peak to fast that these developers may not be able to deliver. Additionally, Brookdale Senior Living Solutions, may have problems because the jump in supply is predicting a cut growth in senior-housing net operating income to 1.8% in 2015 and in 2016 1.4 % from the current year of 3.3%. “Nationally, the inventory of senior-living units is at the highest since at least the fourth quarter of 2005, according to the National Investment Center.” (Louis, 2014) The demand for these units are there in the long-term sense, but supply is becoming a concern for the future with the demographic wave and baby boomers entering retirement. Assisted living services are expected to increase in demand due to these boomers which will also open up opportunities for entrepreneurs. (Louis, 2014)
Financial Components
Financial components for Brookdale Senior Living Solutions in RI uses income statements, cash flow statements, and the balance sheet; they are accounting systems that must follow GAAP regulations. Assisted living facilities such as Brookdale use the accrual system of accounting which, “provides recognition to all revenues in the time period they are actually earned, and to all expenses when they are actually incurred.” (Yee-Melichar, Boyle, & Flores, 2010) Additionally Brookdale also uses a non-GAAP regulation statement, called CFFO that measures operating performance. It provides the company with a day-to-day trend performance that shows management indicators of progress in achieving their optimal performance. The balance sheet of Brookdale defines whether or not the company you are investing in is capable of generating real value for their shareholders. It will also determine if the company has enough cash to fund their growth or if they will have debt, issue debt, or have to issue more stocks to stay afloat.
Mission and Finances
With the mission of enriching lives of the seniors in the community. We promise that our resident’s quality of life and independence will not be compromised as we expand our initiative to expand. Through Brookdale’s goals to renovate and upgrade communities we promise that our services will not lack from our mission. Additionally, by growing our communities, we promise to continue to enrich our senior’s lives. To follow our mission statement, staffing concerns and shortages in the industry must be addressed. Staffing the current 438 assisted living communities along with the other communities that Brookdale operate takes a lot of manpower and resources. The staffing needs of the administrative department, recreational activities department, medical and nursing professionals, all forms of therapists, and maintenance for the facilities can add up fast.
The Excel document displays that Brookdale has a mission to increase revenue while upgrading their community with their facilities. This shows that as they add new communities the revenue is increasing, but they are still able to keep operating expenses low enough to have an increase in operating income.
Assisted Living 2013 2012
Revenue 1,051,868 1,013,337
Operating Expenses -271,392 -269,029
Operating Income 780,476 744,308
Additionally, in 2013, Brookdale for assisted living facilities had a total current asset of $294,862 with an operating costs of $271,392; it shows that the company had enough assets that can be converted into cash within a year to cover those operating costs. However, if in 2014 the current assets remained the same at $294,862 but the operating costs increased because of the increase of communities to $325,862; the result is $-31,000 not enough assets to cover these operating costs (United States Securities and Exchange Commission, 2013) This could result in the company not being able to pay back their creditors and ultimately may result in bankruptcy. It could also explain to their investors that they are not working efficiently. (Investopedia, 2014)
Operations and Moving Forward
Brookdale wants to grow their existing operations by increasing their revenues through combination of increasing their monthly service fees and occupancy growth. In 2014, Brookdale initiated a merger with Emeritus Senior Living Solutions to accomplish their goals. According to the balance sheet, Brookdale reported a net loss of 66.5 million dollars but in 2013 they reported a decrease to 3.6 million dollars. To drive their growth of occupancy the company plans to invest more significant capital expenditures. As they are doing this, their net loss will decrease over time due to bringing in more and significant fees for these residents of the communities. The organization merger will provide the opportunity to renovate and upgrade the communities that will drive this initiative. The merger with Emeritus has allowed the opportunity for the company to save costs on procurement goods and services. This will also decrease their net loss. By adding new communities to the organization and adding assets to the already set ones, the company plans to increase their revenues and cash flows. There are some weaknesses that will affect this merger and the financial situations of Brookdale. Declining economic conditions, inflation, commodity costs, fuel and other energy costs, and cost of labor will all impact the opening of new communities along with increasing fees for services and living. (Brookdale, 2013-2014)
By adding new level of services for their residents through the Program Mix initiative, Brookdale hopes to reposition the communities to meet the growing needs of the residents. They may also plan to purchase more already established living communities to increase their service needs and increase the net profit of the company. With the merger signed in July 31, 2014 Brookdale has become the first National Senior living solutions company which will open more funds to purchase and open new communities to the residents. (Brookdale, 2014) Brookdale also plans to expand their services to those that are not in their selected communities, to those in home, to increase cash flow, and with the goal of these clients entering their communities in the future.
However, and increase in state and local regulations will be a challenge for Brookdale because it will ultimately increase the cost of doing business. In the future, the increase in employment costs that include salaries, wages, and benefits (health care for employees), will negatively impact the financial results for Brookdale, especially because their plan to open up new communities that will need more staffing and supplies. Additionally, estate taxes, utilities, cost of food and insurances will also impact the financial statements of the company negatively. (United States Securities and Exchange Commission, 2013) Therefore, I would recommend that Brookdale try not to be too aggressive in expanding their company to more communities until the economic status of the area is in a position to support such a facility. If they are too aggressive, Brookdale will not continue to see an increase in their net profit but will start to reflect prior years of net loss.
ORGANIZATIONAL STRUCTURE
The purpose of the organizational structure is to implement assisted living facilities strategy. “The fundamental building blocks of organizational structure are functional, divisional, and matrix designs as well.” (Ginter, Duncan, & Swayne, 2013) Brookdale Senior Living would be classified as multidivisional organizational structure. Since the company is nationwide in numerous communities with services including assisted living, nursing home, therapy care, memory care, etc.; this structure aligns the company according to individual divisions. For each community there is senior executives of each of the divisions that are assigned operational, financial, real estate, and human resource responsibilities for each division. “This organizational structure allows the adaptation of each division and its functional departments, such as sales, finance, and marketing, to the local market’s idiosyncrasies.” (Nordmeyer, 2014) Decision-making is at the responsibility of the division level and enhances the division’s responsiveness. Activity in the local operations are accountable to the senior managers of the divisions. However, a disadvantage of this structure is that functions may be duplicated; “which precludes the achievement of corporate-level economies of scale and increases operating costs.” (Nordmeyer, 2014) Additionally, Brookdale would be considered a large multidivisional structure and typically organized into three levels; corporate center (CEO, Owners), the divisions (Finances, human resources, real estate, assisted living, nursing, memory care, etc.) and individual business units (communities). (Grant, 2013)
ORGANIZATIONAL CHART
SENIOR MANAGERS OF EACH DIVISION
Each community has an organizational structure like this, and each one report to the senior executive.
CHALLENGES FOR NEXT 5 YEARS
In regards to the supply and demand of health care professionals, the expected growth of the U.S. of the older population over the next 50 years will have a tremendous impact on our numbers retire and/or reduce their working hours.” (Center of Health Workforce Studies, 2006) Between the years 2011 and 2029, the baby boomer generation will reach their 65 th birthdays. One in five Americans will meet this age by 2050, increasing the demand for assisted living facilities such as Brookdale Assisted Living Solutions. Additionally, those who reach the young age of 85 will have better safety, Medical care, and nutrition. These individuals will require more health care services than the younger generations, due to chronic illness that is not predominate to the older population.
There will be a more ethnically and racially diverse population than there is currently, which will require more multilingual and culturally competent health care workforce to service these residents. Poverty will be less likely for today’s adults and have higher incomes. As a result, this population will have income to use on services that Medicare will not cover; assisted living facilities would be one that they choose because it will improve and sustain their quality of life but they do not require major medical necessities. (Center of Health Workforce Studies, 2006)
Demands will be placed on the health care system in the future resulting from the baby boomers having different health care needs than that of the younger generations. “Older adults consumer more ambulatory care, hospital services, nursing home services, and home health care services than younger people.” (Center of Health Workforce Studies, 2006) Due to higher rates of cognitive and physical disabilities, limitations of performing daily living conditions; it will increase the demand and need for supply of assisted living facilities. Additionally, those baby boomers parents had fewer children, and they had fewer children than them, resulting in a smaller pool of caregivers; so as they enter retirement years they live alone and need facilities such as ALF’s.
Significant care and safety problems are a growing concern for assisted living facilities. Staff with minimal knowledge pose vulnerable elderly residents who have health care problems with safety and quality concerns. “When individuals with significant dementia reside in a congregate assisted living setting with inadequate staffing and supervision, there is a constant risk of neglect, serious injury, or adverse medical consequences.” (Center for Medicare Advocacy, n.d.)
The impact of the Affordable Care Act on the future of assisted living facilities will be instrumental to the industry. It will make changes on how senior citizens receive their health care. Obamacare will also increase patient demand but it will not address provider shortages at facilities such as assisted living facilities. (Assisted Living Facilities.org, 2014) Medicaid funding will be increased if they adopt home-based care programs and community-based care. However, long-term care organizations will face many challenges if this Medicaid money is being dispersed to other programs with the goal of keeping residents in their homes. “Expect that nursing home long-term care occupancy will decline while there will be an enhanced market opportunity for assisted living and home-based services.” (Merion Matters, 2013)
CONCLUSION
As a community and organization we must navigate assisted living facilities through tomorrow’s challenges. To accomplish this, ALF’s must meet some initiatives, such as to embrace emerging technology to improve overall care quality. Market share and the changing of it should be addressed so that it may be strengthened. Most all, staffing concerns must be brought to light with the increasing demand of these organizations. When there is a staffing shortage, the ability to maintain the customers quality of life functioning will suffer. For family members this is important so that their loved ones still maintain a sense of independence. (Agency for Healthcare Research and Quality, 2006) With this the development of a strategic management team that can formulate and implement success.
Furthermore, the financial and operational components of any organization are necessary for a successful business. When there is a staffing shortage, the ability to maintain the customers quality of life functioning will suffer. For family members this is important so that their loved ones still maintain a sense of independence. (Agency for Healthcare Research and Quality, 2006) With this the development of a strategic management team that can formulate and implement success. In America, Brookdale is the largest, most diversified regional operator of senior living communities. The company worries for the future of their revenue because 85% of it comes from private pay customers. The ability of seniors and aging baby boomers to afford residency is at risk from the subprime crisis and ensuing credit crisis. This will ultimately has caused the concern that the company are unable to make debt payments and has to borrow money so that Brookdale can grow their business. (Wikinvest, 2014) Brookdale wants to grow their existing operations by increasing their revenues through combination of increasing their monthly service fees and occupancy growth. In 2014, Brookdale initiated a merger with Emeritus Senior Living Solutions to accomplish their goals. According to the balance sheet, Brookdale reported a net loss of 66.5 million dollars but in 2013 they reported a decrease to 3.6 million dollars. To drive their growth of occupancy the company plans to invest more significant capital expenditures. As they are doing this, their net loss will decrease over time due to bringing in more and significant fees for these residents of the communities. The organization merger will provide the opportunity to renovate and upgrade the communities that will drive this initiative.
Brookdale’s merger effected July 31, 2014 with Emeritus has grown in overall operating performance in the last six to eight years so there was not a consideration to raise salaries or open more spots for caregivers. With this merger, a shortage of providers for the residents will hopefully decrease and the quality of care and services will begin to be on the climb. Although, this would help the industry as a whole since there is a caregiver, nursing shortage in the United States. There are two goals for this organization: “to continue to service that demand of those seniors who are going to be looking for options as they age over the coming years, and also to play a more significant role in that post-acute care space. And figuring out — which we are working on but haven’t quite figured out yet — how to coordinate the care of our residents with the hospitals and the physicians.” (Cobb, 2013) A positive strength of Emeritus is that they continue to think of the customer first and look forward toward the overall vision of the organization. They are moving to implement EMR which will also provide a lot of opportunity for their business.Several main goals of assisted living facilities is to encourage quality of life, aging in one comfortable home, and amplifying function. It will be critical to attend to nursing shortages and turnover rates, which will impact identifying acute medical problems in time to manage. “While every state has different nursing staff regulations, every state requires ‘sufficient staffing’ to meet resident’s ‘scheduled and unscheduled’ needs on a 24hour basis.” (SeniorHomes.com, 2014)
Organizational structure displays how a facility will work to reach the company’s goals and missions. (Rhode Island Housing, n.d.) Assisted living facilities are considered social models because they combine health care with personal services in a place that replicates home. Furthermore, it is not only who does what and who they report to; but the ability for ALF’s to deliver its mission to their residents. When it comes to Brookdale Senior Living, who is a large company with many regions and communities, communicating their vision and philosophy becomes more complicated and harder to gain traction. With the merger with Emeritus, the organization is even larger and functions with more divisions. Each division has their own responsibilities and priorities but since they are all equal in the organizational structure, agreement must be unanimous or if there is not the course of action must be raised to the next level of management. However, if a disagreement happens everyone’s voice is heard because the levels of division are equal. Raymond Brandstorm, CFO of Emeritus Senior Living states that, “we have felt that this worked well for our company, empowering individuals at the community level within the organization, first, and trusting in their judgment with the involvement and oversight as necessary.” (Redding, 2013)
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