Waterloo, Illinois
Government, division of Monroe County
130-bed skilled nursing facility
50-unit affordable assistedl living
Fixed price, heavily regulated environment
Affiliations: None

Background

Growing rural community southeast of Saint Louis, Missouri. Quality of nursing care is excellent. Long history of operating income deficits. Dependent on non-operating revenue and county subsidies. Significant morale issues between management and line staff. Poor communication between Administrator and County Commissioners. Significant decrease in census over the previous 12- month period. Consistently low census on the Alzheimer’s unit. Public perception of substandard care on the Alzheimer’s unit. Existing 211-bed facility in need of replacement.

Results under MPA leadership

• Returned to profitability from operations within 10 months
• Overall census up by 7%; Medicare rehab census up by 71%; 100% occupancy rate on the Alzheimer’s unit
• Facility replaced and re-positioned for delivering new services— expanded dementia services and supportive living
  

Key Moves

• Provided interim management and began turnaround; MPA subsequently retained as permanent Manager
• Revised operating budget
• Renegotiated all vendor contracts
• Implemented marketing program to emphasize the Medicare rehabilitation program
• Revamped service delivery on Alzheimer’s unit; added Director and additional activity aides
• Increased activities programming to eight hours per day, every day
  

Leadership Strategy

• Instituted a forward-looking culture
• Established accountabilities between Management and County Commissioners, and between Administrator and Department Managers
• Implemented consistent enforcement of policies and procedures
• Improved organizational communication
• Adapted service offerings to what the community could support