Finance 101 For Assisted Living Facilities

I’m really excited to speak at the Wisconsin Assisted Living Association’s spring conference this week. I know that I will get to see many past and current clients, and old friends. But I will also have an opportunity to share some of what I have learned about financial management of assisted living facilities.

This is a big topic. And I have about an hour to give my presentation. So the presentation will really be just an overview of important issues that any assisted living provider should consider.

 

finance101

Big Mistakes and Best Practices

Since I became involved in assisted living in 1988, I have had the opportunity to learn a lot about financial management.  For 12 years, our family business developed, owned and operated assisted living facilities and I was the CFO.  Then, after the sale of our 21 facilities, I have had the privilege of helping dozens of clients start, grow and sell their assisted living business, too.

I’m sure that I learned most of what I know from the mistakes that I made.  Tuition is what I call costly mistakes.  Lessons that come with a price.

Many of my clients have made mistakes, too.  I see them everyday.  But I also get to see great ideas and best practices.

In this post, I want to share with you a list of the biggest mistakes and the corresponding best practices in financial management by small and large assisted living providers.

 

Mistake #1 – Not Understanding the Valuation Equation

What is the valuation equation?  It’s the income approach to value used by appraisers, lenders and buyers of assisted living facilities and just about any other piece of income producing real estate.  It is really simple math once you understand it.

Value = Net Operating Income / Capitalization Rate

You can learn more about about the valuation equation in another post written a while ago called What’s My Facility Worth.

Here’s a very simple explanation of the valuation equation.  The Net Operating Income (NOI) is the cash flow your facility generates annually before you pay mortgage payments or any other costs of financing or take non-cash deductions such as depreciation.  The Capitalization Rate (the cap rate) is basically the rate of return your facility would generate without mortgage financing.  When you divide the NOI by the cap rate, the result is the value of the property.

Now there is almost always more to it than this simple formula, but this is the foundation of calculating value for income property.

Keep this simple rule of thumb in mind:  Multiply your NOI times 10 to calculate the value.  Your facility may be better or worse than the average property for lots of reasons but many assisted living facilities are valued at about 10 times the NOI – your’s may be 11 or even 12 times NOI, or maybe just 8 or 9 time NOI.  But keep 10 times NOI in your mind for simple and frequent calculations of value to track progress toward your goals.

Best practice:  Understand the Valuation Equation.

 

Mistake #2 – Not Separating Business and Personal Expenses

I’ve seen it many times.  Personal expenses find their way into the business checkbook and onto the income statement and tax return.  It happens.  For some more than others.

Many think that they are saving money by having their business cover personal expenses.  Perhaps.

But in the long run, what’s the real cost of the business paying personal expenses?  A lot.

Let’s say that your business spends $1,000 over the course of a year for groceries and supplies that don’t go to your facility but go home.  If your total federal and state income rate is 35%, then you may have saved $350 in income taxes by “mistakenly” allowing those personal expenses to be a deduction.  $350 – remember that number.

On the other hand, let’s say that you are planning to refinance or sell your facility in the next year or two.  Using what we just learned about the Valuation Equation, how will that $1,000 in expense affect the value of our facility?  Let’s do the math.  $1,000 times 10 is…..$10,000.

So you saved $350 in taxes and lost $10,000 in value!  How expensive were those groceries now??

Best practice:  Always keep accurate books and report actual income and expenses.

 

Mistake #3 – Not Outsourcing Accounting and Payroll

You don’t have to do it all.

Many assisted living providers are entrepreneurs, starting their own business for the first time.  And one of the biggest mistakes that I see many entrepreneurs make (including myself) is thinking that you have to do it all yourself.

But unloading certain duties to an employee or to a freelancer or professional can save you money by making sure things are done right the first time and by freeing you up to do what you do best.

I have a long list of stories about small businesses that got behind in payroll taxes, or didn’t set aside money for income taxes, or had a large amount of disallowed expenses  on their cost report.  Each of these stories ended badly, with pain and suffering that could have been prevented by having an experienced person helping with accounting and payroll.

Best practice:  Hire experienced accounting and payroll help, or outsource.

 

Mistake #4 – Not Maximizing Revenue

What’s the second biggest expense in most assisted living facilities?

Answer:  vacancy expense.

Payroll is by far the biggest expense at any assisted living facility.  But the next largest expense, vacancy, is something that many don’t even consider an expense.  It is not uncommon for vacancy rates to run 10% – 20% at many assisted living facilities, and that’s a BIG expense.

During my days in the family business operating assisted living facilities, we had a saying that went something like this “a full facility hides a lot of expenses”.  In other words, when our administrators ran a bit over their activity budget or their staffing budget, it was much easier to let it slip a little when they consistently kept their building full and met their goal on the bottom line.  If they were running with a 10% vacancy expense, then scrutiny of other expenses was a lot more important.

So one of the financial mistakes that assisted living providers make it not considering vacancy expense and not making marketing, sales and high occupancy a priority.

Occupancy rates are just part of the revenue formula.  A high occupancy rate with residents fees that are too low will also lead to trouble.

Many assisted living providers are reluctant to charge what they need to survive.  But it is essential that both base rates and charges for levels of care are updated regularly to keep pace with expenses and the market.

Revenue on the books is good but revenue in the bank is better.  Make sure that accounts receivable don’t grow too large.  An effective collections policy should make sure that money earned is received on time.

Best practice:  Minimize vacancy to maximize revenue, and raise rates when able to stay in the black.

 

Mistake #5 – Not Knowing Key Financial Indicators

Managing expenses is important.  But some expenses are more important and more controllable than others.

We just covered vacancy expense above.  That’s important.

Some other important, large expenses are fixed over longer periods of time.  Examples include insurance, property taxes and service contracts.  Day to day and month to month management of these expenses isn’t a priority, as long as you try to find ways to trim these items at least every year.

There are two other expenses that require continuous management:  payroll and food expense.

You need to prioritize your time and manage those expenses that matter the most.  Payroll is always the first priority and food is not far behind.

Managing these expenses and all expenses can be done using these key financial indicators:

  1. Operating expense ratio – the percentage of revenue used to pay all operating expenses.  This is a good measure of the overall efficiency of an assisted living facility.
  2. Payroll expense ratio – the percentage of revenue used to pay all payroll expenses.  As revenue goes down, payroll may need to go down too.  This is a great way to measure how well you’re managing staffing costs.
  3. Food per resident day – the raw food costs to serve each resident for a day.  Quality and resident satisfaction are the first priorities but the next priority for kitchen staff should be keeping costs in line.

Key financial indicators should also include other critical items, including:

  1. Occupancy rate – this can be measured very simply as a snapshot of units filled vs units available at the end of the month, or more accurately measured by counting the number of resident days for the month.
  2. Revenue – perhaps THE key financial indicator, it is critical to know if revenue is strong and steady or weak and declining.
  3. Net operating income – when your accounting system is set up properly, this is the easiest number to find and track over time, as well as to gauge positive and negative trends.
  4. Days cash on hand – divide your month-end cash balance by your daily operating expenses for the month and find how much cushion you have for surprises.

There are other measures that assisted living providers use, and some of these are more important and more useful than others.  Don’t get in a trap of spending too much time calculating key financial indicators.  Try to set up a system so that these numbers are generated automatically and tracked monthly.

Assisted living providers that have a system to track these key financial indicators monthly will be operating with the information they need to manage their facility.

Best practice:  Have a system to generate and monitor key financial indicators monthly.

 

 Mistake #6 – Not Having (and Living By) a Budget

This mistake may seem so obvious but it’s so common, too.  We have all heard that you need a map to get where you want to go.  And the budget is the financial map to help make sure we reach our financial goals.

Some have budgets but miss out on the power and usefulness that budgets provide.  Here is how to get the most out of your budget:

  1. Use the budget to do a “what-if” analysis.  Test different occupancy rates.  Test different staffing schedules.  Test different resident fees.  Find the impact on your bottom line for your best case, worst case and most likely cases.  Find what is possible, both positive and negative, to protect against setbacks and to set big goals.
  2. Use the budget for comparison to actual.  Temporary variation is one thing.  But consistently missing the budget is a reason to dig deeper and find whether there is inefficiency or unrealistic expectation.
  3. Budget your key financial indicators, not just revenue and expense.  Set a goal for each of your key financial indicators and measure your performance against those goals monthly
  4. Forecast your cash balances as part of the budget.  You made a profit – great.  But that doesn’t mean much if you run out of cash and can’t make payroll.  Forecast cash flow as part of the budgeting process and take into account things like major repairs and replacements, tax payments, insurance deposits and other non-recurring expenditures.

Best practice:  Create a budget and use monthly it as a management tool.

 

Mistake #7 – Not Keeping it Simple

Everything that I’ve said so far may seem a bit complicated.  It’s certainly not intended to be.

In fact, one of the keys to effective financial management for most assisted living providers is keeping it simple.  There are several reasons why this is important and key ways to prevent over-complication.

  • When financial management becomes complicated, too time consuming or too tedious, it eventually is just ignored.  Most assisted living providers are wearing many hats.  Financial management is just one of the hats they wear  and, on many days, probably not the most important one.
  • When your financial system is simple, it’s easier to delegate many of the simple tasks.  Time to pay bills?  Pay bills online and show an assistant how to make the payments.
  • Starting with a good system helps keep it simple.  If you’ve never done this before, find someone who has for help and set up your system right from the start.
  • Take advantage of many tools available today.  Quickbooks Online can be a big time saver allowing you and your bookkeeper to work on the finances whenever and wherever.  Online banking and bill pay can speed up the process and bring added levels of security.

Best practice:  Implement an effective but simple accounting and financial management system.

 

Mistake #8 – Not Protecting Your Assets

While it doesn’t happen often, it still does.  Someone you trust with your facility’s finances turns out to be not trustworthy.  The result could be minor or catastrophic.

Smaller providers have limited options to segregate duties, which is a concept of having multiple staff involved in financial transactions to minimize the risk of embezzlement or other misuse of funds.  If you outsource any financial duties to an employee or contractor, have a system of checks and balances to protect your assets.

Best practice:  Maintain strong internal controls and proper segregation of duties to protect your assets and reputation.

 

Mistake #9 – Not Having the Right Financing

Whether your facility is small or large, every assisted living facility is expensive.  Assisted living providers almost always need to borrow a lot of money to buy or build their facility.  So having the right financing is important.

What is the right financing?

  • Financing that matches your ability to pay.  While most lenders or investors won’t give you more than you can afford, some will.  Or, your circumstances may change and your ability to pay may change.  Consider those possibilities when deciding how much you can afford.
  • Financing that doesn’t create more risk than necessary.  Most financing requires the borrower to personally guarantee the debt.  But there are times when that’s not required.  Take advantage of opportunities to have non-recourse debt.
  • Financing that matches your long-term plans.  Financing comes in many different terms.  Long-term debt can be a blessing, but it can become a curse if your long-term plans change.
  • Financing the right asset at the right price.  Yes, you can borrow enough to buy that facility.  But should you?  Sometimes owners of assisted living facilities end up under water because they overbuilt or overpaid for a facility.

Best practice:  Secure financing based on conservative assumptions with terms that match your long-term plans.

 

These are some of many mistakes that we all make operating assisted living facilities.  I hope that the best practices on this list  help give you peace of mind and success in operating your assisted living facility.

 

Thanks to my friend Susan for some of these ideas and for the opportunity to present this information on Finance 101.


 

Want to learn more?  Click here and subscribe to my email list to receive special content and blog posts delivered to your inbox.

 

Comments

  1. May I simply say what a comfort to discover somebody who truly knows what
    they’re talking about online. You actually realize how to bring
    a problem to light and make it important. More people must read this and understand this side of the story.

    It’s surprising you aren’t more popular
    given that you most certainly have the gift.

  2. Great overview, Mike! Even if we know it all, sometimes we forget some of it.

  3. Victor Young says:

    I am a R.E. Developer and understand income properties very well. I purchased a 55,000 sq.ft. 4-story bldg. in Newnan, GA, a satellite city near Atlanta SMSA. I am converting it for two uses: one level will be a Childcare (15,000 Sq.Ft.) business, the remaining 3 floors will include some retail/business space and AL common area on one floor and the AL residential space on the remaining two floors housing 33 units. Would you have an interest in discussing a short term consulting contract with me which could be a combination of emails and telephone calls. Specifically, I need access to an accounting system, operating manual for the AL business, discussion on financing options, etc.
    Vic Young
    President
    Pointe Development Group, Inc.
    404-433-4113

    • Vic – I’m not taking new consulting clients at this time but I may be able to point you to some others who could help, or see if my schedule and yours could match up sometime soon. I’ll follow up in a separate email. Mike

  4. I have a question. Hope someone can answer. I bought a 14 bed facility (miami) ALF that has not been active for 3 years and presently going through the process of certification.. When i lease the facility monthly do I ask for cash for key? Meaning buying the business but i own the property? is that normal practice?

    • Marcus –

      That’s a great question. Many assisted living providers lease their facilities. Yes, it’s normal practice. The specific details of leases can vary widely, including the operator paying the cost of any business value acquired while also signing a lease to use the real estate. Up front cash can consist of a security deposit, first & last month’s rent, and escrows for taxes and insurance – but not always. There is endless flexibility in leases to meet the needs of lessors and lessees.


      Mike

  5. Ann-Marie Knight says:

    Good evening Mike,

    Your Finance 101 was right on time for me today. I AM one of those brand new enterpreneurs that you referenced in the early part of your article. I am a retired Navy Veteran who is about to execute my dream of opening an ALF. On Monday, we close on a commercial property that we will convert to a 14 bed (two-person shared rooms) ALF. I am a hospital administrator, while that skill is helpful it is not enough in of itself. I recognize some of the ratios you mention, but not all, so I absolutely appreciate them. I see you aren’t taking any consulting clients, I wouldn’t ask anyway, because you would be a luxury I can’t afford right now (smile). However, I welcome your mentorship if you have time (just like a Navy Vet to ask for someone’s wisdom without compensation (smile). Seriously though, I am in Jacksonville Florida and looking forward to the opportunity of helping some of our community elders and if there is a caution you would have, that isn’t listed above, what would that be? I am struggling with the decision about furniture. I could easily go to hotel furniture liquidators, but I feel like I need to make a bit of an investment for this important “curb appeal” element. At the same time, I want to ensure I am keeping my expenses manageable. My business plan was supported by a bank and I am happy to say that I garnered an SBA loan in which my hubby and I invested 28% of the financial plan, which includes; the real estate, renovation costs, working capital for salaries, furniture, marketing, other items and good ole construction contingency). I realize how busy you may be, but I would welcome your feedback on what I have outlined above. I am printing your article, making sure my hubby and son read it and, then, read it again, then I will post it in the office! Thanks so much, I found the article while searching for a suggestion on bookkeeping resources.

    Sincerely,
    Ann-Marie Knight, USN Retired

    • Ann-Marie –

      First of all, thanks for your service to our country! And in the spirit of serving others, you want to open an ALF – that is great. I would like to help you as much as I can, and your kind note is an inspiration to keep writing these articles to share what I’ve learned over the years and continue to learn working with assisted living operators from around the world.

      You asked if there is another caution that I would share with a start-up ALF operator. I think this one applies to any start-up business: watch your cash and keep some liquidity. In other words, don’t sink all of your available cash into the building, furnishings and other costs before opening, only to leave yourself squeaking by each week while trying to cover payroll. Many states require a certain amount of operating cash available to obtain and maintain a license to operate an ALF. Whether yours does or not, it’s just good business practice to plan ahead for the up’s and down’s of cash flow. One of my side gigs is volunteering at my church and helping coordinate the Financial Peace University class – if you’re not familiar, that’s Dave Ramsey’s program on personal finance. I’ve become a big proponent of financial peace, both personally and in business. While there may be times when certain steps may help maximize financial performance, I’m more often interested in reasonable financial performance in a way that doesn’t drive me crazy – I’ve been there before and I don’t want to go back. So, staying liquid with a reasonable cash reserve is the other caution that I’d add to that list.

      You also mentioned the furniture you’re buying. While it may seem that I’m contradicting myself given what I said above, I think that purchasing quality furnishings is important. If you’re operating an ALF, you want furniture that is functional, high enough quality to last a while, and will resist staining and other things that happen with ALF’s. I’ve made the mistake of buying cheap, only to buy cheap again so soon that I would have been better off buying quality to begin with.

      Ann Marie, I hope your ALF is a great success and please check back here when other questions come up.

      Mike

  6. I am in the middle of getting approval from the City of Miami for my ALF 14 bed facility. My intention is to lease it out to qualified medical professionals.

    • Mark – Good luck with your ALF in Miami. I’d love to visit sometime. We stared out our company leasing ALFs from investors and it worked well, although we learned a lot over time about what to do and what not to do when leasing. Now, we’re on the other side of the lease and leasing ALFs that we own to some great operators. Hope all goes well for you. Mike

      • Thank you Mike! Can you give me some examples of things not to do in leasing?

        Mark

        • Mark – That may be a great subject for a blog post and I’ll try to turn one around soon. For a quick answer and if you’re the landlord, I’d say don’t make the rent so high that your tenant struggles. I understand that you want to maximize your investment (I always do too) but sometimes a maximized investments doesn’t come from the highest possible initial monthly rent. If your tenant flames out after a few months or a few years, you’ll be stuck with a big problem. Make sure that the margins give you a good return and that the tenant can make a reasonable cash flow for the risk and work they put into it. I’ve seen tenants covering the lease payment but taking home no pay themselves – they burn out very quickly in that scenario and the property usually fails. Make sure it’s a win-win from the start, and it will help you maximize your investment for the long term. Mike

          • Mike thank you for your input. I do have a question which i am not sure you can answer. Is the property more valuable as a commercial/ALF as apposed to a residential ? The facility i have has all the hardware for a ALF such as indoor fire sprinkler throughout , fire bell and fire alarm system. I am looking for best long term investment.

          • Mark – I think that I understand your question to be whether the property will be more valuable as an ALF, or just left as a single family home – if I misunderstood, please let me know. And I wish I could answer your question with certainty but I’d need to know more.

            First, do you know what the market is for single family homes in that area and what your property might sell for? The assessed value is sometimes a good indicator but a better estimate may come from Zillow or speaking with a local residential real estate agent.

            Second, have you prepared a budget that indicates how much profit the property will generate as an ALF? That will help you determine value as an ALF. In my experience, a single family home is often a more stable long-term investment but an ALF normally produces a higher yield – and it should. An ALF has a lot more risk because of the business component that you won’t have from a SFH investment.

            So the answer would seem to be that the better rate of return will come from the property being used as an ALF, but make sure to consider the risk adjusted rate of return in your analysis.

            Finally, I have seen plenty of cases where a property was worth more as a SFH than an ALF – it just depends on the market. Back in 2006 and 2007, assisted living homes in the Phoenix market, for example, couldn’t be sold for any more than they would sell for as somebody’s single family home. And it was difficult to sell and ALF because the real estate costs were just so high that the business could barely generate enough income to justify the price of the property. Of course, that changed in a big way during the crash. Another example that I’ve seen is when a house has some unique features that don’t add much to its value as an ALF but are very appealing to someone buying it as a SFH – things like a pool in the back yard, extra land included, outbuildings, etc. – these are all things that homeowners might pay extra for but they won’t produce more income to the operator of an ALF, so they just don’t add value to the property when that’s the use.

            I hope this helps you think through your alternatives.

            Mike

  7. Hi Mike,

    Great article! I have developed senior living and consulted for near 20 years and agree with you.
    Let’s network.

    Joyce Clark
    CEO of Achievis Senior Living Associates
    Oklahoma City, OK (405) 812-9089
    joyce@achievisseniorliving.com
    http://www.achievisseniorliving.com

  8. Tim Ghorley says:

    Mike can you give me an idea of average operating expenses
    For a 25 bed facility approximately 10 years old. We are looking at purchasing an established facility and would like to try and determine an appropriate value.

    • Average operating expenses? Good question. It depends on your location to some degree, your vacancy to a larger degree, and the type of residents and their needs to an even greater degree. Staffing is always the largest expense. So, to the extent your residents have higher needs and you have more staff, your expenses could be much higher than another facility. In general, for the size facility you mentioned that is providing basic assisted living (i.e., not dedicated to memory care or other special needs), we find that operating expenses are often about 75% of revenue in a stabilized facility that is 90%+ occupied. This is a benchmark that is subject to much change based on many variables and the wide variety of assisted living facilities out there. But I hope that helps.

  9. What is your opinion of the Green Project and it’s related Eden Alternative developed by Dr Bill Thomas?

    • I have limited experience with the Green Project or the Eden Alternative. I have to start saying that I’m a big believer in innovation and experimentation in how long-term care and seniors housing is delivered. I’ve seen some great ideas that succeeded, and I’ve seen some terrible ideas that failed. But variety and consumer choice is a foundational principle of assisted living, in my opinion.

      I like the idea of smaller communities and personalized care – the first assisted living facility that our family developed in 1988 was an 8 unit facility based on a residential floor plan. It provided some great advantages but it also faced some serious challenges, with limitations that larger facilities didn’t have. Our next facilities were larger and our residents liked them, perhaps because we also designed in a way to keep the larger facility feeling small and home-like. We didn’t have a focus on making the facilities ‘green’ and our programming left something to be desired, so I would like to see more of the Green Project and Eden Alternative to better understand how they’re making a difference in their residents’ lives.

      As I said, I have limited experience with the Green Project or the Eden Alternative. But from what I have read about them, they’re a cutting edge option for assisted living residents, and those residents will ultimately decide whether they’re accepted and successful, or not.

  10. Hello,

    I have an ALF in Miami, 54 beds, usually full at 100 % capacity, but mostly Medicaid residents. Could you refer the reliable operators that could be interested in a long term lease/ management agreement?

    • Roger – Sorry for the slow reply. If you’re still in the market for an operator, please connect with me at Senior Care Realty. We offer a ‘match making’ service that may be able to help, or you may be interested in other advisory services to help you put a deal together. Mike

  11. Dorthelea williams says:

    Hello Mike,
    Do i have to buy? Or should I rent?
    I’m just getting started with this I’m in the beginning stages of this. It’s alot to consider and take in. But I’m super excited and I can do this!

    • Dorthelea – No, you don’t have to buy. Many people rent their assisted living facility. Renting is normally more expensive than owning but it is often the only option for those who may not have enough money for a down payment. It’s very important to maintain enough working capital when operating an assisted living facility, so you you can run into trouble (or at least some sleepless nights) when you use up most of your capital on a down payment to purchase the facility. Good luck! Mike

Speak Your Mind

*