Congregate Care / Skilled Nursing Homes in California

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May 20, 2024

by a searcher from The University of Chicago - Booth School of Business in Newport Beach, CA, USA

Looking at purchasing a group of congregate care homes in California. 6 to 12 beds per facility. Interested in speaking with people with knowledge/experience in this space. Trying to understand regulatory risks, insurance reimbursement, requirements for bank financing, etc.

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Reply by a searcher
from INSEAD in San Francisco, CA, USA
In general, the biggest issue will be quality staffing. One thing to consider is the new requirements for nurse ratios at long-term staffing:

https://www.cms.gov/newsroom/fact-sheets/medicare-and-medicaid-programs-minimum-staffing-standards-long-term-care-facilities-and-medicaid-0

This will drastically increase the demand for nurses.

From a due diligence perspective, the one I've heard come up is that you should ensure the facility isn't getting creative with their staffing. Most facilities should have a round-the-clock nurse and while it may look like that on paper, some places really only have a nurse there part-time. A lot of facilities do this because it's required for them to be profitable, but can be a legal grey area. Food is could be another area to look at for quality (e.g., are they being excessively cheap?).

I know some even some of the big nursing homes here in CA are still getting hammered, it's a tough market for sure.
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Reply by a professional
from Hofstra University in North Carolina, USA
If you go for private pay, it can work. If you haven't dealt with insurance reimbursements in the past, then you're in for a rude awakening - they dont get to be billion dollar companies (UHC/Aetna/BlueCross/Empire) by paying out reimbursements aha - so would definitely recommend you go into that with a partner that knows medical reimbursements and claims - happy to chat https://calendly.com/dealmavenpm/searcher-acquisitions-sync
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