Private-Public Line Gets Blurred for Senior Housing Partnerships

 

eecker | January 24, 2012 | Comments (0)

In a development climate that is still plagued with limited credit and sometimes-unconventional financing, some senior housing developers are starting to look into individual projects that combine public benefits and private capital for a mutually-favorable deal.
The deals often present solutions that result in senior housing developments or rehabs, but they can require the participation of several entities. For the right partnerships, the capacity to combine a public property or facility with financing or operations from a private company can provide a positive outcome for all parties, even if the opportunities are not yet commonplace.
“The mix between public and private is getting blurred,” says Marc Cabrera, Managing Director and head of Healthcare Investment Banking at Morgan Joseph TriArtisan.
But that combination of private and public capital that can sometimes change the importance of the tax structure of the deals, as there are often there are public tax incentives, but they come with restrictions.
In the case of some publicly-funded hospitals, Cabrera says, capital is part of the equation, but there are other considerations as well.
“What is the mission of the larger organization?” he says. “It’s still important, but it’s not the only decision.”
The deals aren’t exactly commonplace in the senior housing sector, but some companies have seen success in this particular type of senior housing development partnership.
“It’s a minor trend in the space,” says Dan Hermann, senior managing director and head of investment banking for Chicago-based Ziegler, noting that Ziegler has not yet been active in private/public projects, but is doing research in the space. “It’s usually in a crowded urban market or an area that needs moderate to affordable senior housing.” It might involve working with a municipality, Hermann says, or finding a publicly designated parcel of land for the building type.
Several developers are seeing success in the projects, Hermann says, but it may be too soon to call the developments a “trend.”
“A lot of people are trying to figure out these tax credit deals,” Hermann says, noting that they’re almost always affordable housing units in urban areas. “Cities are motivated to keep seniors and get creative.”
Written by Elizabeth Ecker

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Assisted Living and Health Center for Elderly

Seniors Guide Online Unveils Social Media Resources For Seniors and Marketing Professionals
PRWeb Thu, 12 May 2011 06:13 AM PDT
Seniors Guide Online, the leading online and print resource for senior retirement housing options, home health care, senior products and services is now participating in several social media platforms. Baby boomers and seniors alike will find Seniors Guideâs Twitter @SeniorsGuide , Facebook.com/SeniorsGuideOnline and YouTube.com/SeniorsGuideOnline fun to follow and watch. (PRWeb May 12, 2011 ...





San Francisco Senior Center Receives Grant to Help Local Seniors
Marketwire Wed, 11 May 2011 14:09 PM PDT
SAN FRANCISCO, CA--(Marketwire - May 11, 2011) - As part of a $10,000 grant from The Home Instead Senior Care Foundation, San Francisco Senior Center will support its Homecoming Transitional Care Program (HTCP). Each year, the HTCP provides services to more than 200 low-income, isolated seniors and people with disabilities who need hospital-to-home transitional care that includes case management ...















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McFadden Manor Nursing Home

PrintCouncil denies retirement for McFadden staff
By Francis Brown / Correspondent
Thu Jul 02, 2009, 04:45 PM EDT
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Malden - Employees at the soon-to-be shut down McFadden Manor will not be able to receive early retirement as the City Council’s vote on Tuesday night was deadlocked at 5, and thus, the motion of whether or not to send the paper to the state legislature failed.

During the Ordinance Committee meeting prior to the council meeting, committee members listened to reports on what the city would have to do and how many employees of McFadden Manor would be affected by the decision.

The issue has to do with those employees that are not yet 55 years of age, but who have worked at McFadden Manor for over 20 years. The six to nine people at McFadden Manor who meet this requirement would be able to receive early retirement, which the city would pay for.

While the numbers are not definite, if the council had voted in favor of the motion and the state legislature had passed the paper, the city would have to pay between $70,000 and $100,000 a year over 20 years or between $140,000 and $200,000 over 10 years.

This uncertainty over what financial impact the decision to grant early retirement to the employees would have on the city is what kept many councilors from voting for the motion.

Ward 6 Councilor and Ordinance Committee Chairman Neil Kinnon voted against the motion citing this uncertainty.

“I am not against taking care of people,” said Kinnon during the meeting. “My challenge with this paper is that we do not understand the financial consequences of it.”

Fellow committee member and Ward 8 Councilor Judith Bucci echoed Kinnon’s concerns.

“These are the most difficult decisions to make,” said Bucci. “But based on the fact that we don’t have the actual numbers on this, I can’t put my arms around it.”

Bucci also had reservations about giving early retirement to the employees of McFadden Manor while those who have been laid off in recent months were not given this opportunity.

This comes on the heels of the city’s decision not to give $1.2 million to McFadden Manor last month, essentially shutting down the nursing home. This decision was still fresh in the minds of some councilors when it came time to vote on Tuesday.

Ward 7 Councilor and Ordinance Committee member Neal Anderson stated that he was aware of the financial uncertainty, but was still in favor of the motion.

“We do have uncertainties about the financial impact, but we owe it to them to do what we can to help them through this transition,” said Anderson.

Ward 3 Councilor Paul DiPietro, also on the Ordinance Committee, called out the city to provide for the employees before the vote.

“I believe it’s incumbent upon the city to be a responsible employer,” said DiPietro.

One of the main reasons for shutting down the nursing home was the poor condition that it is currently in. However, while the conditions have not been up to par, the care of the patients by the employees has been top-notch. Still, it came back to the financial uncertainty that the city would face during a time when its budget was just cut by $6 million.

“I understand that they’ve done a tremendous job for the community over the years,” said Ward 2 Councilor Paul Condon of the efforts of the employees at McFadden Manor, “but I can’t vote for the unknown.”

This decision brought much disappointment to the employees of McFadden Manor who were in attendance. Kathleen MacDonald is one of the few employees that would have been able to opt for the early retirement plan had it been passed as she is not yet 55 years of age but has been employed at McFadden for 25 years.

“I’m very disappointed with the council’s vote,” said MacDonald, who spoke to the Ordinance Committee about the hardships she currently faces caring for a disabled son and a husband who recently had surgery.

“There were inaccuracies stated,” she added, citing the comment that there are other employees in the city that are in the same position as the employees of McFadden Manor. “There’s a big difference,” she said, referring to the comment.

She said that she appreciated the support from the councilors who voted in favor of the motion, but was disappointed that there was not a public forum for proponents of the early retirement plan to voice their opinions in front the entire council.

Mc Fadden Manor Closinng

a sad day in Malden Ma when the City Council would not vote appropriation cto keep the facility open and the Mayor closed it cleaning out the 28 patients calling it home are to be displaced.

Pace Program

The Program of All-Inclusive Care for the Elderly (PACE) is a capitated benefit authorized by the Balanced Budget Act of 1997 (BBA) that features a comprehensive service delivery system and integrated Medicare and Medicaid financing. The program is modeled on the system of acute and long term care services developed by On Lok Senior Health Services in San Francisco, California. The model was tested through CMS (then HCFA) demonstration projects that began in the mid-1980s. The PACE model was developed to address the needs of long-term care clients, providers, and payers. For most participants, the comprehensive service package permits them to continue living at home while receiving services rather than be institutionalized. Capitated financing allows providers to deliver all services participants need rather than be limited to those reimbursable under the Medicare and Medicaid fee-for-service systems.

The BBA established the PACE model of care as a permanent entity within the Medicare program and enables States to provide PACE services to Medicaid beneficiaries as a State option. The State plan must include PACE as an optional Medicaid benefit before the State and the Secretary of the Department of Health and Human Services (DHHS) can enter into program agreements with PACE providers.

Participants must be at least 55 years old, live in the PACE service area, and be certified as eligible for nursing home care by the appropriate State agency. The PACE program becomes the sole source of services for Medicare and Medicaid eligible enrollees.

An interdisciplinary team, consisting of professional and paraprofessional staff, assesses participants' needs, develops care plans, and delivers all services (including acute care services and when necessary, nursing facility services) which are integrated for a seamless provision of total care. PACE programs provide social and medical services primarily in an adult day health center, supplemented by in-home and referral services in accordance with the participant's needs. The PACE service package must include all Medicare and Medicaid covered services, and other services determined necessary by the interdisciplinary team for the care of the PACE participant.

PACE providers receive monthly Medicare and Medicaid capitation payments for each eligible enrollee. Medicare eligible participants who are not eligible for Medicaid pay monthly premiums equal to the Medicaid capitation amount, but no deductibles, coinsurance, or other type of Medicare or Medicaid cost-sharing applies. PACE providers assume full financial risk for participants' care without limits on amount, duration, or scope of services.




Downloads
PACE Fact Sheet [PDF 65 KB]

Fact Sheet for Beneficiaries [PDF, 60KB]

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McFadden Manor Geriatric Authority

SENATE, No. 2844
By Mr. Tisei, a petition (accompanied by bill, Senate, No. 2844) of Richard R. Tisei, Christopher G. Fallon and Paul J. Donato (with the approval of the Mayor and City Council) for legislation to authorize the establishment of the Geriatric Authority of Malden and providing for the
financing thereof. Municipalities and Regional Government. {Local approval received.}

Version with line numbers




The Commonwealth of Massachusetts


--------------------------------------------------------------------------------

In the Year Two Thousand and Eight.

--------------------------------------------------------------------------------

AN ACT AUTHORIZING THE ESTABLISHMENT OF THE GERIATRIC AUTHORITY OF MALDEN AND PROVIDING FOR THE FINANCING THEREOF.
Be it enacted by the Senate and House of Representatives in General Court assembled, and by the authority of the same, as follows:

SECTION 1. It is hereby declared that the establishment of a Geriatric Authority in the city of Malden to shelter and protect and provide service to the aging and infirmed who can continue to reside in the community but may be in need of activities and services provided for at or by the McFadden Memorial Manor Nursing Home and such social welfare and health programs in the community relating to the care of the aging is a public purpose. It is further declared that the lack of properly constructed dwelling units designed specifically to meet the needs of elderly and infirmed persons aggravates those diseases peculiar to the elderly.

SECTION 2. There politic to be known as the authority, which shall lease, own, maintain and operate the McFadden Manor Nursing Home and any other facilities which may be established by the authority in accordance with the powers conferred by this act. The exercise by the authority of the powers conferred by this act shall be deemed and held to be the performance of essential governmental functions.

SECTION 3. Said authority shall consist of seven members. The Director of Public Health shall serve as a member by virtue of said position. The Director of Human Services shall serve as a member by virtue of said position. Five members shall be appointed by the city council and shall serve for a term of three years. Of the members first appointed by the city council, two shall serve for a term of one year, two for a term of two years, and one for a term of three years unless removed from office by vote of the city council for cause. The authority shall hold at least ten meetings in every calendar year and a majority of the members shall constitute a quorum for each meeting.

SECTION 4. The authority shall have the general management and control of the McFadden Memorial Manor Nursing Home and any branches thereof which have been or which may hereafter be established, and of the expenditure of the money appropriated for the operation thereof. The authority may appoint an administrator with such assistant and subordinate, officers and other employees as it may deem necessary or expedient. The authority shall have jurisdiction of its affairs and of the property under its control. The authority shall establish and enforce all necessary rules and regulations for the administration, admission, government and removal of residents in the McFadden Memorial Manor Nursing Home and any other such facility which it may control. The authority shall reimburse said city annually the amount of principal and interest paid by said city after the effective date of this act, on bonds and notes issued by said town pursuant to section ten A.

SECTION 5. The members of the authority shall elect a chairman, a vice-chairman, secretary and treasurer who shall serve for a term of one year, or until their successors are elected. Said election shall be held annually during the month of July.

SECTION 6. The following standing committees shall be appointed by the chairman with the approval of the members: budget and finance, medical, personnel, social and volunteer service. The chairman shall be a member ex-officio of all committees.

SECTION 7. The chairman shall preside at all meetings of the authority. He shall appoint the chairman of all standing and special committees and shall maintain general supervision over all the affairs of the authority. He shall, together with the treasurer, execute and deliver for, on behalf and in the name of the authority, all instruments which may be required for the proper prosecution of its business. In the absence or inability of the chairman to perform his duties, his duties shall be performed by the vice-chairman. The secretary shall attend all meetings of the authority.

The Treasurer shall have custody of the funds of the authority and shall keep and maintain complete records of all financial transactions and shall carry a complete record of all accounts. The treasurer shall cause books to be kept containing a detailed account of all funds received and expended, and shall make quarterly reports to the city controller of funds received and expended.

SECTION 8. The authority shall have the following powers and duties:

(a) To adopt a seal, and the engraved or printed facsimile of such seal appearing on any bond, note, or other instrument of the authority shall have the same effect as though such seal were impressed thereon.
(b) To sue and be sued, but only to the same extent and upon the same conditions that a non-profit organized pursuant to Massachusetts General Laws.
(c) With its own funds, or with the appropriation of necessary funds by the city of Malden, to acquire within said city, by purchase or gift, or eminent domain under chapter seventy-nine, chapter seventy-nine A, or chapter eighty A of the General Laws, or by lease or otherwise, any land or buildings or interests in land, air or water for the purposes of the authority, and to plan, design, acquire, construct, reconstruct, improve, extend, equip, repair, maintain, and operate geriatric facilities, which may include, but not be limited to, hospital, nursing home and sheltered living facilities, as such terms are defined in section one of chapter one hundred and twenty-one B of the General Laws, and community facilities designed to meet the need of the elderly, to acquire personal property necessary in connection with the foregoing, and to lease geriatric facilities, either as lessee or lessor, provided: that any lease agreements shall be subject to approval by vote of the city council of the city, that any major construction, reconstruction, or extension, totaling one hundred thousand dollars or more, not requiring the issuance of bonds or notes shall be subject to approval by two-thirds vote of said city council, and that any acquisition of real property shall be subject to approval of two-thirds vote of the said city council.
(d) To dispose of any real or personal property of the authority which is no longer needed for its purposes by sale or otherwise provided that no real property shall be disposed of by the authority without approval of two-thirds vote of said city council.
(e) To maintain an office at such place or places within said town as it may determine.
(f) To receive and apply any grants or gifts for its purposes.
(g) To make and enforce such rules and regulations as may, in the judgment of the authority, be necessary or desirable for the efficient operation of any geriatric facility or geriatric system within its jurisdiction, control, and supervision, and for accomplishing the purposes of this act.
(h) To issue temporary notes, from time to time, in the name and upon the full faith and credit of the authority in anticipation of revenue to be received from any source in an amount not to exceed two hundred thousand dollars outstanding at any time and in such greater amount as may be approved from time to time by a two-thirds vote of the city council, provided that the aggregate amount of notes outstanding at any time under this section shall not exceed one-half of the authority's ordinary operating revenues of the previous fiscal year. The proceeds of such notes shall be used to pay current operating expenses only but no purchaser of such notes shall be in any way responsible for the proper application of such proceeds. Each such loan shall be payable no later than five years from its date. Temporary notes issued under this clause for shorter periods than permitted hereby may be refunded from time to time by the issue of other temporary notes maturing within the required period. Temporary notes may be issued pursuant to this clause by the chairman and the treasurer whenever they are so authorized by the authority, and said chairman and treasurer shall determine the form, interest rate and other details of such notes and shall sign such notes.
(i) To employ and fix the compensation of such consulting and other engineers, attorneys, accountants, construction and financial experts, superintendents, managers and such other employees and agents as it may deem necessary or incidental to the performance of its duties and the execution of its powers under this act.
(j) When authorized by a vote of the board of the city council of said city, in its own name or in the name of the city, to enter into agreement with the federal government relative to the acceptance of grants or borrowing of funds for any project which the authority is authorized to undertake, and containing such covenants, terms and conditions as the authority, with like approval, may deem desirable and, pursuant to any such agreement, to borrow funds from the federal government or from any qualified lender under a federally funded, guaranteed or insured lending program, upon the security of its bonds, notes or other evidences of indebtedness, and to secure the same by mortgages upon property held or to be held by it, or by pledge of its revenues.
(k) To call upon the various departments, authorities, boards, and commissions of said city for the purposes of assistance in making investigations and in effecting design, construction, and operation of geriatric facilities and the authority shall arrange for payment for such services and expenses of said agencies in connection therewith.
(l) To organize and control the activities of such nonprofit corporations as may be necessary and appropriate to receive loans and grants from the federal or state government or from any nonprofit agency for the purposes of this act, provided that the trustees of any such nonprofit corporation shall be the same persons who hold office as members of the authority. The organization of any such nonprofit corporation shall require approval by two-thirds vote of the city council of said city and any action of such nonprofit corporation which if taken by the authority would require approval under this act shall require like approval.
(m) To do all acts and things necessary or convenient to carry out the provisions of this act.

SECTION 9. Any bonds, notes, or certificates of indebtedness of the authority, in the absence of an express recital to the contrary of the face thereof, shall constitute negotiable instruments for all purposes. They may be payable from the income of the authority or constitute a general obligation thereof, may be sold at not less than par, at public or private sale, may mature at such time or times, may be secured in such manner, may provide for such rights and remedies upon their default, may contain such other covenants, terms and conditions not inconsistent with law, may be executed by such officers, and may be issued with or without the corporate seal, all as may be authorized either by vote of the authority or by the officers to whom the power to determine any or all the matters set forth in this sentence may, be expressly delegated by vote of the authority. The engraved or printed facsimile of the seal of the authority on its bonds, notes, or certificates of indebtedness shall have the same validity and effect as if such seal were impressed thereon. Whenever a bond, note or certificate of indebtedness is required to bear the signatures; provided, that each officer whose facsimile signature appears on such instrument has, by a writing bearing his written signature and filed in the office of the secretary of the authority, authorized the officer whose written signature appears on such instrument to cause such facsimile to be placed thereon. The facsimile signature of any officer so engraved, printed or stamped thereon shall have the same validity and effect as his written signature. In case any officer whose signature or a facsimile thereof appears on any notes, bonds, or coupons shall cease to be such officer before the delivery of such notes or bonds, such signature or facsimile shall nevertheless be valid and sufficient for all purposes as if he remained in office until such delivery.

The bonds, notes, and certificates of indebtedness of the authority issued under this act including temporary notes issued under clause (i) of section eight their transfer and the income therefrom, including any profit made on the sale thereof, shall at all times be free from taxation within the Commonwealth. The bonds of the authority issued under this act shall be legal investments for the deposits and the income derived therefrom of savings banks, for the trust funds of trust companies, for the capital and other funds of insurance companies and for funds over which the commonwealth has exclusive control.

SECTION 10. The employment of any employees of the authority shall be included in the term "employment" as used in sections one to eleven, inclusive, of chapter one hundred and fifty-one A of the General Laws, and the authority is authorized to become liable for payments instead of contributions and otherwise to comply with the provisions of section fourteen of said chapter. Employees of the authority are hereby made eligible to participate in the contributory retirement system under chapter thirty-two of the General Laws. Notwithstanding any general or special law or rule or regulation to the contrary, the authority shall be required to pay to the Malden retirement system quarterly in of each fiscal year, an amount of money equal to the quarterly total amount paid by said retirement system to retired employees of the McFadden Memorial Manor Nursing Home. Such payment shall be in lieu of any other payment, charge or assessment required of the authority pursuant to chapter thirty-two of the General Laws. Employee contributions shall be withheld from the wages of eligible employees and paid to the Malden Retirement system, as required by law.

SECTION 10A. For the purposes of this act, the city may from time to time issue bonds or notes to an amount not exceeding, in the aggregate, ten million dollars. Such bonds or notes shall bear on their face the words McFadden Memorial Manor Nursing Home Loan, Act of 2008. Each authorized issue shall constitute a separate loan, and such loans shall be paid in not more than twenty years from their dates. Indebtedness incurred from time to time under this act shall be outside the statutory limit of indebtedness described in section ten of chapter forty-four, exclusive of the limitation contained in the first paragraph of section seven thereof. The proceeds of such bonds or notes shall be paid over to the treasurer of the authority, to be used for the purposes of this act, upon such terms and conditions as said city and the authority shall mutually agree.

SECTION 10B. The city shall not assess any tax upon the geriatric facility or geriatric system or part thereof, or upon the income therefrom. Nothing contained in this act shall exempt any lessee or person in possession of a geriatric facility or part thereof, or the property leased or possessed from taxes or assessments payable under the General Laws.

SECTION 10C. This act shall be construed in all respects to meet constitutional requirements. If any provision is held invalid in any circumstances, such invalidity shall not affect any other provision or circumstance. In carrying out this act, all things shall be done which are necessary to meet constitutional requirements whether or not such things are otherwise required by statute.

SECTION 10D. For the purpose of chapter 30B of the General Laws, the authority shall not be a municipal agency. For purposes of chapter two hundred and sixty-eight A of the General Laws, the authority shall be a municipal agency and without limiting the power of the city council of said city to classify additional special municipal employees pursuant to said chapter, each member of the authority and any person who performs professional services for the authority in a part-time intermittent or consultant basis, shall be considered a special municipal employee.

SECTION 11. Upon the passage of the within act and the date transfer of licenses and possession of the premises from the city to the Authority, the Authority shall be absolved and released from any contractual obligations and claims as their may be against the McFadden Memorial Manor Nursing Home.

SECTION 12. This act shall take effect upon its passage.