St. Dismas Assisted Living Facility—1 St. Dismas Medical Center, an urban, nonpr

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St. Dismas Assisted Living Facility—1

St. Dismas Medical Center, an urban, nonprofit, 450 bed rehabilitation hospital began tosee a significant decline in admissions. St. Dismas' mission focuses on inpatient andoutpatient rehabilitation of the severely injured and catastrophically ill. While the patientcensus varied from month to month, it appeared to the St. Dismas Board of Trustees that the inpatient population was slowly but steadily declining. The hospital's market researchers reported that fewer people were being severely injured due to the popularity of seat belts and bicycle/motorcycle helmets. In order to get a handle on the future of the organization, the Board, and the CEO, Fred Splient M.D. called for a major strategic planning effort to take place.

In January 1999, St. Dismas held a planning retreat to identify future opportunities. The outcome of the retreat was that the Medical Center needed to focus its efforts around two major strategic initiatives. The first, a short run initiative, was to be more cost effective in the delivery of inpatient care. The second, a long-run strategy, was to develop new programs and services that would capitalize on the existing, highly competent rehabilitation therapy staff and St. Dismas's excellent reputation in the region.

At the time of the retreat, Fred Splient's parents were living with him and his family. Fred was an active member of the “sandwich generation.” His parents were aging and developing many problems common to the geriatric populace. Their increased medical needs were beginning to wear on Fred and his family. It crossed Fred's mind that life might be more pleasant if the hospital Board approved an expansion of the Medical Center's campus to include an assisted living facility.

In March 1999, Fred had his Business Development team prepare a rough estimate of the potential return on investment of an assisted living facility. He asked the team to identify different options for facility construction and the associated costs. The team also did a complete competitive analysis and examined the options for services to be offered based on St. Dismas's potential population base and catchment area. The Business Development team visited several facilities across the country. The team also interviewed companies that could oversee the design, building, and operation of the facility for St. Dismas. The development team produced a preliminary business plan based on the recommended structure for the facility, estimated capital expenditure needs, estimated income from

operation of the facility, as well as projected revenues to other Medical Center programs resulting from the facility's population.

The plan was presented at the May 1999 meeting of the Board of Trustees. Fred Splientand his team introduced the Board to the concept of opening an assisted living facility onSt. Dismas's campus. The facility would be set up as a for-profit subsidiary of the Medical Center so that it could generate a profit and not be subjected to the strict guidelines of the hospital's accrediting agencies. As a subsidiary organization, however, the Board would still have control. The chosen facility design was a freestanding apartment-like facility with a sheltered connection to the Hospital for access to the kitchen and hospital services. The facility would have 100 units with 15 to 30 of the units classified as “heavy-assisted” and built to code to house the physically and medically disabled. The rest of the units would be “light-assisted,” larger apartments. The population would be approximately 110 to 150residents, with most being single occupants rather than couples.

The light-assisted apartments could hold residents who required only minor medical andsocialinterventions. The residents of the heavy-assisted section would have more medicalneeds and would require assistance getting around. The Business Development teamrecommended this type of programming model, because many assisted living facilitieswere erected across the country, but few had a medical focus and offered the types ofservices that St. Dismas could offer—physical and occupational therapy programs, andbehavior management programs to name a few.

The Board was assured that the facility would meet the strategic initiative of a growingbusiness. The business plan projected an immediate increase in the number of referrals tothe outpatient therapy programs. Another projected deliverable of the project was toenable St. Dismas to strengthen its focus on reimbursable preventive and wellnessprograms for the healthier geriatric population. The project's longer term goal was toincrease the census in the hospital's inpatient units by having a location where peoplecould age in place until they were in need of hospitalization, and then such a facilitywould be right next door.

Depending on the exact size of the apartments, their equipment, and the actual ratio ofheavy-to light-assisted units, Fred estimated that the entire project would cost between $8,500,000 and $11,000,000 for the facility construction. That estimate included the costof land, furnishings, and a sheltered connection to the hospital. When up and running, itwas estimated that the net income would range between $9,000 and $12,000 per unit per year. The team estimated the net cash flow for the entire project to be around $1,500,000per year.

Fred requested the Board to approve the concept and allow his team to prepare a proforma plan to the Board for approval. The plan would include a recommended design forboth heavy-and light-assisted apartments. It would also include all costs of land,construction, furnishings, and staffing. Income estimates would be included and would beconservatively biased. A timetable would also be included.

The Board conducted several executive sessions, and by the middle of May voted toapprove the concept. They approved the architectural-construction-

management firm recommended by the team, and they requested Splient to proceed with developing a complete project plan. The Board appointed two Board members to sit on Fred's planning group.

In June, Dr. Splient gathered his executive team together and presented the projectmission, and scope. He reported that the board had approved a small budget to financethe planning process. The Board also stipulated that construction could not begin untilafter the November 1999 city elections because two of the Board Members were running in that election, one for a city council seat and one as a county commissioner. The Board

also stated that they would like a plan that would allow the facility to open by July 2000, as research has shown that many adult children find the summer the easiest time to assist their parents in finding an alternative to independent living arrangements. The CEO and executive team were now confident that they were ready to launch the project to plan, build, and open an assisted living facility at St. Dismas.

A few days later, Fred decided that it was time to set up the team that would take Responsibility for what he called the ALF project. He quickly decided to include the following staff at the launch meeting:

Chief Financial Officer (CFO)

Vice President of Business Development and Marketing

Rehab Services Medical Director

Construction Project Manager for capital facilities projects

Chief Operations Officer (COO) (nursing, facilities, food services, and

housekeeping)

Director of Information Services

Director of Support Services (central supply, purchasing, and security)

Two members of the Board of Trustees, one with construction experience and the

other a probable electee to the city council.

Even though the department directors from Support Services and Information Services would not be involved until later, Fred decided to include them from the beginning. Fred knew some members of his team had a tendency to become obstacles to progress if they

felt left out.

Fred named the group the ALF Project Steering Committee and held the first meeting. Fred presented his vision for the facility. He told the group that he personally would be managing this project. He led a discussion of all the major steps that must be included in

the project plan, and asked each team member to identify the areas for which they would accept responsibility. The hospital's Construction Project Manager took responsibility for the construction of the facility, and the COO volunteered to oversee the building design, as well as define the needs for food services, housekeeping, staffing, and policy and procedure development. The CFO agreed to develop the budgets for each area of the project as well as the operating budget for the facility. The CFO also agreed to create the payroll and accounting systems necessary to operate the facility.

The IS director accepted responsibility to define and set up all the telecommunications and information system needs of the facility. The VP of Business Development agreed to create a preliminary marketing plan, and a communication package for the community and hospital staff. In addition, she discussed organizing a major ground breaking event. The Medical Director said that he would design an assessment tool for determining residents' level of medical needs upon moving in to the facility. He felt this was the first step in defining what clinical services should be offered to residents. Fred told the team that he would develop the management structure for the new facility and work with in-house counsel to identify all governmental regulations as well as all industry standards

that pertain to an assisted living facility and govern the facility's practices. Splient gavethe team two months to come back with their detailed action plans for their areas ofresponsibility.

St. Dismas Assisted Living Facility case study. Think about the attributes of the St. Dismas project and how they may impact how the project is approached and managed.

Question: Describe your approach to creating the profile. Why did you choose that approach?

Explanation / Answer

St. Dismas Assisted Living Facility case study. Think about the attributes of the St. Dismas project and how they may impact how the project is approached and managed.

Question: Describe your approach to creating the profile. Why did you choose that approach?

We have used the waterfall process to creating this profile. The St Dismas care though located in urban and populated is catering to a diminishing need.

We need to create an alternate plan for creating a parallel profitable business unit primarily using same manpower and resources.

The entire process has been divided into small sequences which are implemented and approved step by step. It flows downwards as follows:

This approach is because:

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