What the referral side costs to fill eleven assisted living beds in seven months

The retainer is the piece worth turning over. At 18 of 18 the owner is paying you $2,700 a month to maintain a wait list. What does the renewal conversation look like in month nine when nothing has moved? Expect the retainer to be the first line cut, and then you're back to per-head only, which is lumpy. Have you had that conversation yet, or are you still in the honeymoon?

What is a care assessment exactly? Is that a nurse visiting the person, or is it paperwork? I've read this thread twice and I can't tell whether you do it or the home does.

Three homes is one person's phone. For most operators the number where things break is four, because that is where holding every unit in your head stops working. Your source tags will save you at six homes and your calendar will not. Who covers the Saturday tour when you are at a funeral?

The licensing question is real and it isn't settled the same way everywhere. Some states regulate senior placement referral agents and require disclosure of the fee arrangement to the family, some don't touch it at all. I looked into it in mine while working on my own license and got two different answers from two different people at the same agency, so get it in writing from a lawyer who does health care licensing there. Lantern, did you ever get a written opinion or did you just get the agreements drafted?

How do you screen for money? Private pay at $5,400 plus care levels means a family is burning maybe $70k a year, and I'd want to know whether the runway is three years or fourteen months before I move someone in and then have to move them out. Is that part of your eight questions or is that the owner's job?

Those rates do not exist in every market. In plenty of counties the best licensed home is $3,100 private and $2,400 shared, and half the census is on a state waiver program that pays less than that. Same demographic wave, completely different economics. The referral fee model breaks when first month's rent is $2,400 and the home's margin per bed is a couple hundred dollars.

Missing number is length of stay. Eleven move-ins in seven months against 18 beds tells me almost nothing until I know your average stay, and in assisted living it's commonly measured in months rather than years because people arrive later and sicker than they used to. If average stay is 16 months you're refilling roughly 13 beds a year across three homes forever, and your $1,200 per head is a permanent operating cost, not a lease-up cost. Do you have the actual number yet or is seven months too short?

Did any home change physically to take the higher-acuity leads that were being turned away? Widened doorways, a roll-in shower, a ceiling lift track or grab bar reinforcement. On the construction side, a ceiling lift into an existing joist layout in a residential house is more than a weekend job, and it can pull you into a permit conversation that reopens whatever the fire marshal signed off on.

The double claim on one resident is the interesting failure here. Agency agreements typically put the fee with whoever first introduced the resident, then define introduction as a dated written notice to the home, with a tail of six or twelve months running from that notice. If both agencies had a tail running and neither notice was dated in writing, the home owed twice and had no defense. Lantern, whose paper governs now, yours or theirs? Because if the owner is still signing agency agreements with a twelve month tail behind your back, nothing has actually been fixed.

What does financing look like for a business shaped like this? There is no asset. Three contracts that can be terminated and a phone is not collateral a lender can take.

What this thread makes clear is that 100 percent occupancy in senior care and 100 percent occupancy in a fourplex are different animals. A fourplex turn is paint and a lock change. A turn in your homes is a death or a hospitalization and a family that needs a call back the same day.

Anyone coming into this room hoping the passive version exists should sit with lantern's month four. The hospital takes two residents and census goes backwards. That is a second job with a pager.

Sideways question. Two of your three homes, were they already licensed when the owner bought them or did he convert? I keep looking at residential lots and houses and I can't work out whether the zoning fight or the license is the longer pole.

How does someone find the homes that need this work? A state licensing directory shows which facilities exist, but it does not show census. Is it a matter of calling and asking how many beds are open, and do they tell the truth?

Bramble, they tell you something. Whether it is true depends on whether they take you for a family or a competitor.

I hit my own ceiling at deal number five and it was the same shape as anchor's question. Once you're full you're worth less to the client than you were when they were empty, and the retainer is the tell. The way out is either owning a piece of the census upside or owning the homes. Lantern, has anybody offered you a percentage of revenue instead of a retainer, and would you take it?

Disagree with keystone on the revenue share. Tying compensation to a client's top line tends to inherit their bad decisions. They raise rates, census dips, the number moves for the service provider with no vote in the decision. Flat retainer plus per-event is the cleaner deal, and lantern's 30-day clawback is doing exactly the right work. A tier so the retainer steps down at full census instead of getting cancelled outright would help. Cancellation is binary and it always happens on a bad month.

Girder, on the bathroom side, gutting one hall bath to a curbless roll-in with a proper linear drain in an existing slab house ran a client of mine around eleven thousand by the time the tile and the grab bar blocking were done. In a crawlspace house it's cheaper. Not the ceiling lift, just the shower.

Worth seeing the funnel. Inquiries, tours, assessments passed, move ins. Conversion moving from a third to 60 percent could mean tour to move-in or inquiry to move-in, and those are wildly different businesses. Analysis stalls for months for exactly this reason, usually because a ratio arrives without a denominator.

The structural question is whether census-building should ever be outsourced. If demand is as strong as the demographics say, the operator who owns his own referral relationships keeps that margin permanently, and the ones renting it are paying a tax on a tailwind. Lantern, are you the bridge until the owner builds it in-house, and does he know that's the plan?

What did it cost you to start? I'm trying to work out first-deal numbers on everything I look at and a service business is the one where I have no idea whether the answer is $2,000 or $40,000.

Take a case where a clawback like that would matter: a resident moves in, the agency invoices, and the resident passes at day 41. The agency's paperwork sets the fee at 30 days so it holds, the family asks for a prorated refund of the room rate, and the operator ends up covering both ends of the same month. Nobody involved did anything wrong, and it can still run close to $4,900.

From a lender's view, a small care home's cash flow is census times rate minus a payroll line that does not shrink when census does. Underwriters typically apply a haircut to any census that ramped fast, and a marketing contract cancellable on 30 days notice is not a credit enhancement. If an owner in this position ever refinances, expect somebody to ask what happens to occupancy the day the referral relationship walks away.

Is this a sales job at heart? I'm circling the service side and I can't tell if what you did is a marketing skill or a clinical judgment skill, because the eight questions sound clinical.

So who pays the referral fee, the family or the home? I assumed the family was paying somebody and the whole time it's the home?

Compass, the home pays, which is exactly why the free placement services are free to families. Lantern, the piece I want is discharge planners. Getting on a hospital's list is the whole game as far as I can tell and I've never heard anyone explain how you get on it without already being on it.

Take a case like this: three homes, 18 licensed beds, occupancy climbing from 7 to full over seven months with four names on a wait list, worth calling two-thirds real. Underwriting a purchase of those homes today, the wait list should be discounted to zero and the trailing three months of census used, not the current number. Eleven move-ins in seven months with a paid marketer attached means the census has a cost of acquisition embedded in it, and a seller's pro forma will often show it as a one-time lease-up expense. It isn't one-time if the length-of-stay math holds up. A retainer plus per-move-in fee that nets out to something like $32,100 over seven months on 18 beds works out to roughly $255 per bed per month of pure census cost. That belongs in the expense line permanently until proven otherwise.

This thread is the first one that made me want to pick up a phone instead of open a spreadsheet. Sextant's $255 a bed is the number I'm writing down.