ParenteBeard Senior Living Services

Providers Look to Offset Cuts in Medicaid
with Operational Improvements

March 2011

As the Great Recession and the not-so-great recovery have rolled from 2009 and 2010 into 2011, state governments across the country have faced tremendous budget pressures from falling tax revenues and rising costs to operate. The results in many cases, large and growing deficits, have forced governors to look for places to cut their state budgets. The obvious target is often one of the largest lines in the state budget: Medicaid. Over the past few weeks, across the country both newly elected governors and those finishing out their terms have been consistent in announcing cuts to the Medicaid program.

For the senior living providers, cuts in Medicaid during the past year and proposed cuts in the 2011 budgets are adding to the same woes that have hit state governments: higher labor costs, higher insurance costs, higher fuel costs, and generally higher costs to operate. However, it is incumbent upon long term care organizations experiencing cuts to their revenue streams to continue to find ways to provide high quality care to the frail elders living within their walls.

Nursing homes, home health and home care providers, and adult day health care programs are all looking for ways to cut costs without sacrificing quality in the services they provide. Freezing salaries and reducing staffing are merely stopgap measures that may have limited long term financial impacts because they often begin to negatively impact care or employee morale. Instead, a number of providers have been successful in reaping the fiscal rewards associated with improvements in operational efficiencies and clinical outcomes in serving their residents.

The positive fiscal impacts begin with an assessment of current operations. After first obtaining specific data and information regarding financial results and ongoing operational processes, analysis can be undertaken that target specific areas where there may be opportunity for improvement. Interviews of selected senior staff and other personnel help to provide additional information about the operation of the facility or facilities, to understand operational processes, and to gain a more in-depth understanding of the operating philosophy.

For providers to realize optimal results, it is important to determine how certain key elements of operations compare to industry benchmarks and to measure them against “best practices” seen across a wide range of senior living providers.

For more information, please contact the following member of the ParenteBeard Senior Living Group

Jennifer Schwalm, Partner

Contact Us

For Senior Living Consulting Services:

Jeff Boland, Partner

Jennifer Schwalm, Partner

For Senior Living Assurance and Tax Services:

Mark Ross, Partner and Practice Leader, Senior Living Services Practice

Mike Frey, Partner

Brian Gabriel, Partner

Ben Jarmul, Partner

Julius Green, Partner


ParenteBeard's Senior Living Services specialists will be speaking at or attending the following upcoming conferences:

Apr 11-13

LeadingAge (formerly AAHSA) Spring

"Adapting to An Altered Senior Living Landscape"
Frank Mandy

"Benchmarks: Are We Measuring Up?"
Jeff Boland, Bruce Hartshorne of Tel Hai Retirement Community, Jefferson Kaighn, PA Region ACTS Retirement Communities, Inc., and Brian Williamson of Standard & Poors

Washington, DC
Apr 13-14 Spectrum Seminar 2011 Charlotte, NC
Apr 14-15 AANAC Spring - American Association
Of Nurse Assessment Coordinators
Atlanta, GA
April 27-29

Ziegler LeadingAge National Seminar Senior Living CFO Workshop

"Accounting Practices Under the Spotlight"
Mark Ross

Chicago, IL
May 2


"Change Management"
Pamela Richmond

New Orleans, LA
May 3-5 Lifespan Baltimore, MD
May 18-19

Aging Services of Maine and New Hampshire

"Pricing Your Residences for Marketing and Financial Success"
Jarrod Leo and Rob Love of Love and Company

South Portland, ME
May 31-June 1

LeadingAge New Jersey (formerly NJAHSA)

"Marketing and Operations: Partnering Together to Improve Census and the Bottom Line for Healthcare"
Allyson Preston and Sophie Campbell

Somerset, NJ
June 5-8 VANHA - Virginia Association of Nonprofit
Homes for the Aging
Norfolk, VA
June 6-8

PICPA - PA Institute of Certified Public Accountants

"Long Term Care: Clinical Update – Medicare and Medicaid"
Stephanie Kessler and Mark Baron

Harrisburg, PA
June 10-11

PANAC - PA Association of Nurse Assessment Coordinators

"MDS Interview Accuracy"
Sophie Campbell

General Session on 6/10: "RUGs IV" &
Breakout Session 6/10 from 2:30- 3:45 pm: "Medicare Basics"
Stephanie Kessler and Tracy Montag

State College, PA
June 15-17


"Expanding into Home and Community-Based Services: Financial Considerations"
Pamela Richmond and Denise Harris of D.K. Harris Consulting

"Repositioning and Reinvention: Planning for the Recovery"
Frank Mandy, Vernon Feather of SFCS Inc., and James Pieffer of Presbyterian SeniorCare

"Investment Management Best Practices"
Jeff Boland, Steve Backus of MBO Cleary Advisors, and Aaron Rulnick of Herbert J. Sims & Co.

Hershey, PA
July 13 - 15 NAHC Financial Management San Diego, CA
Sept 7-9 LeadingAge Ohio (formerly AOPHA) Columbus, OH
Sept 22-24 NADSA - National Adult Day Services Association Milwaukee, WI
Oct 16 - 19 LeadingAge (formerly AAHSA) Washington, DC

About Us

If you would like to learn more about ParenteBeard use the following links:

Business Advisors With Administrators, former CFO’s, licensed CPA’s and RN’s on staff, we offer a wide range of services, including strategic planning, market feasibility, operations assessment, review and improvement, development and finance solutions, and clinical advisory services.

Audit, Cost Report and Tax Solutions We perform audit and tax services for a number of state aging associations and approximately 250 continuing care retirement communities, skilled nursing, assisted living facilities, and subsidized housing projects for the elderly.  Our team periodically advises Leading Age (formerly AAHSA) on 990 and other tax matters. We also prepare approximately 300 Medical Assistance and Medicare cost reports on an annual basis.