Overview:
The purpose of this extended seminar is to provide an overview of the issues that propel nursing home value. It will couple reading and discussion with abbreviated case-study problems to illustrate the material. The material will be presented in an order that follows the steps of a self-contained appraisal report. While spreadsheet applications are used to make certain calculations in the material, use of computers is not essential to the understanding of the principles and problem-solving results presented in this course. To perform the calculations for the case studies, a financial calculator should suffice. This seminar will count for seven or nine hours of CE for states, and nine hours of CE for AI members.


Syllabus:
Module 1: Types of Long-Term Care Facilities
Module 2: History of the Nursing Home Industry
Module 3: Ownership and Interest Appraised Issues
Module 4: Regional and Neighborhood Analyses
Module 5: Property Data
Module 6: Market Analysis - Supply and Demand Factors
Module 7: Market Analysis - Payor Mix Analysis and HBU
Module 8: Revenue Development - Private Medicaid
Module 9: Revenue Development - Medicare and Managed Care
Module 10: Income Approach - Operating Expense Analysis
Module 11: Income Approach - Capitalization
Module 12: Sales Comparison Approach
Module 13: Cost Approach and Allocation of Value

Learning Objectives:

• Develop an understanding for the history of the nursing home industry as it goes through dramatic shifts in a short period of time, driven by government health care programs and changes in family and social structures.
  
• Identify various types of nursing home facilities, and the kinds of services that are provided in each type.
• Identify issues in ownership and interest appraised in nursing homes.
• Recognize the importance of the regional and neighborhood aspects that impact nursing home valuation issues.
• Identify specific physical characteristics in a nursing home property and learn how physical qualities affect competition for patients, management of operating costs, and Medicaid and Medicare reimbursements.
• Discover techniques to identify and estimate supply and demand factors that impact the competitive market and current or future occupancy, payer mix, and rates of the appraised facility.
• Examine issues relating to the income capitalization approach, including the variance between Medicaid and Medicare reimbursement issues, ancillary revenue, operating expenses, and capitalization techniques.
• Use the sales comparison analysis to measure the economic aspects of a facility, and examine factors such as differences in payer mixes, occupancy levels, and reimbursement rates to develop objective value indications from comparable sales.
• Recognize issues concerning the cost approach relating to obsolescence and allocation of real estate value.