Management Performance Associates

Oak Hill and Magnolia Terrace Waterloo, Illinois

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


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

Monroe Graph