Ciena Healthcare, owner and operator of 83 nursing homes in five states, is breaking into the healthcare “resort” category with the opening of a 95,000 square foot, $32 million building in the Detroit suburbs.
With private rooms, an upscale therapy gym with expanded capabilities, a spa and microgreens garden, Regency at Troy’s extra amenities are designed to attract post-acute patients and help drive higher reimbursement in an ever-more competitive market.
“Health and wellness is such a huge focus for people, especially on the preventive side,” Senior Vice President Amy La Fleur told McKnight’s Long-Term Care News. “How do you think about a traditional skilled nursing home, versus some of the short-stay folks that we presume would be in this building? We wanted to incorporate healthier lifestyle choices as part of the stay, but then also after you leave the stay. Where do we fit in that continuum?”
With the opening of its last new-construction building in Ohio pre-pandemic, Ciena had already ventured into private rooms. But the company is doing more to brand around that luxury and the others available at Regency at Troy. While the building is projected to be about 50% long-stay patients, there is a focus on short-term rehab and recovery.
And those Medicare-backed patients will be necessary to cover the construction and operational costs of what is now slated to be a 154-bed facility split over three floors.
Plans to recruit congestive heart failure and COPD referrals will demand higher staffing levels, as will the multi-level design.
La Fleur said recruitment has gone well so far, with the first patients expected by year’s end and full licensing coming early in 2024. Ciena tapped a former administrator in training to serve as the building’s administrator and transferred an existing director of nursing to help guide a smooth opening.
The right staffing recipe
Now comes the “art and science” of calculating and adjusting direct care staff as patient acuity comes into full view, La Fleur said. Ciena is using a staff planning tool to run varying census scenarios, which could require adjusting staff daily as the building moves beyond its initial opening.
“Everybody loves a new building, so we’ve been able to rehire and hire,” La Fleur said.
But ahead of a potential federal staffing mandate, and with no Medicaid rate add-on in Michigan for private rooms, she acknowledged that the financial pressures will be very real.
“I think the numbers are gonna be tight because of the inflationary costs that drove the project to $32 million mark,” said La Fleur, noting that the cost was set to be significantly lower when it was first pitched in 2018. “I think we’re gonna have some challenges. Certainly, the staffing rates have gone up since a pro forma was done. So I could foresee where we would realistically add another 30 beds to manage that service and really be able to have the volume that we’re going to need. But it’s not going to be an easy one.”
And La Fleur said finding enough staff, potentially 200 full- and part-time workers, could be a challenge. Michigan officials earlier this year awarded Ciena a $26 million workforce grant, which the company has been using on expanded training and apprenticeship opportunities.
“But you can’t even get people to get into them. I mean, we’re putting all kinds of stuff into workforce development, but you still have to have the people to do it,” she said.
Of course, without adequate staff, the new Troy building could find itself struggling to admit enough residents to turn a profit. It might be in good company in the state; the Health Care Association of Michigan has projected the proposed mandate would force an estimated 4,000 skilled nursing beds out of service.
Dialysis a key
One feature that La Fleur expects to help with volume is a dialysis den that will be built on the building’s second floor. It meets an existing need in the Troy market, where Ciena already has a significant presence.
The company has been adding dialysis service to many of its existing facilities, which La Fleur posits as a major contributor to patient quality of life.
“Relying on transportation to get patients to dialysis was not easy during a pandemic, and the quality of the experience for somebody that has dialysis to be gone from a facility for six or eight hours a day,” she said. “We can do it in-house and make their overall quality, their meal quality, the caregiver contact, better. So we’ve been putting a strong emphasis on that. … We’re raising the bar, the level of expectation if you are a dialysis recipient.”
Regardless of their specific needs, patients will find themselves in a building with more technology and other interventions supported by new payer partners.
Last month, Ciena announced it was expanding its partnership with Curana Health on an Institutional Special Needs Plan. The plan will be available to long-stay patients in the building, which like all in the I-SNP, offers enhanced Medicare benefits and onsite preventative clinical care for residents.
The plan also supports building staff and offers financial rewards if facilities hit targets for reducing resident hospitalizations. In a similar push, Ciena is working to finalize its participation in the ACO Reach model.
“As far as value-based payment arrangements go, it always boils down to scope [of services] and return to hospital,” La Fleur said. “Having the ability to treat in-house with telehealth, having early warning signs for changes and conditions, having a lot of practitioners available, all of that will be key for us. That’s necessarily different for a new building, but it is part of our overall approach. The advantage of a new building is sort of getting it right from the onset. You have a little bit of a blank slate there.