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Operations Management

In addition to our accounting services and consultation, we can also assume full responsibility for a long-term care operation. From single institutions to established chains of nursing homes, we provide expert management at all levels, increasing profits and representing the interests of the facility in a professional, ethical manner.

Controlling the product is our forte. Our market plans, outreach programs, sales courses, and quality standards are specifically tailored to increase revenues without increasing overhead. Our cost control programs and timely review of fiscal results make a noticeable and welcome difference in profit margins.

Of course, we are aware that our programs and policies are only as effective as their reception by middle managers. Therefore, all new procedures are sensitively introduced and carefully explained. All of our executives enthusiastically participate in transition activities and facility operations – training, coaching, and leading the entire staff to successful implementation.

Whether our services are secured through contract or receivership, once established, we continue to improve and upgrade management services. Working closely with a top health care law firm, we receive daily updates on all pertinent operational and clinical requirements – from certificate of need issues and cost reimbursement procedures to state and federal regulation and facility contract obligation. These contemporary standards of performance are immediately implemented to assure compliance with licensure requirements, maximization of reimbursement, and capture of optimum market share.

Accountability is introduced at every level of the facility organization. Our quality assurance program spells success, not just in clinical excellence, but just as importantly, in fiscal control. The staff is trained on published standards of performance and regularly audited in the areas of:

  • Administration
  • Adult Recreation
  • Business Office Services
  • Dietary Services
  • Environmental Services
  • Inservice
  • Marketing and Admissions
  • MDS
  • Nursing Services
  • Personnel Management
  • Social Services
  • Special Care Units

Detailed budgets are developed and monitored for compliance in all facility departments. Comprehensive operational and marketing plans are developed and implemented.

Staff development and training are the foundation of our success. From an assortment of long-term care training modalities developed by our experts to educational programs developed to meet specific needs at a single facility, our training expertise is one of our greatest strengths. Our extensive lending library of health-related publications is available free-of-charge to all clients.

The implementation of new revenue-producing products is part of our repertoire. We have developed such services and specialties as units for those persons with cognitive impairments, Ventilator Units, Sub-Acute Units, and wound and rehab specialties. Sage has worked with long-term care centers offering psychiatric care for the elderly, as well as assisted living services. We have also guided centers through Joint Commission accreditation.

And finally, we maintain excellent working relationships with the prime vendors used by health care institutions. From pills to pumps, we can procure the necessary materials to efficiently operate a health care center.

Regulatory Compliance

Achieving regulatory compliance is becoming more difficult with every passing year. Federal regulations are more stringent and reimbursement is declining. Avoiding deficient practices during a survey that place your facility in jeopardy of fines and denial of payment for new admissions is vital to your facility’s financial health.

Our clinical experts can help you resolve the regulatory problems you may be encountering. We can review your facility’s statement of deficiencies and make recommendations to improve your clinical systems that will ensure continued regulatory compliance.

Based upon your facility’s Quality Indicator results, our clinical staff can assist you in developing a Quality Assurance/Quality Improvement program. This program will provide your facility’s clinical team with consistent auditing results upon which regular improvements can be made. Thus, your center can consistently assure compliance and customer satisfaction.

We are available for on-site visits to assist you in solving immediate problems, or we are ready to provide consultative oversight to your team for long-term results.


The key to a successful turnaround is early intervention. But many times management waits too long to call in professional help. For 19 years, Sage Health Services of Indiana, Inc. has provided turnaround expertise to owners, investors, lenders, bondholders, and indentured trustees. Our turnaround professionals have the ability to provide efficient and effective solutions to challenging situations.

Through strategic and tactical evaluations, we isolate points of difficulty, identify strategic options, and work with the facility’s personnel to initiate change and improve returns on invested capital. In most instances, a substantial change in operating philosophy is necessary to effect a change in financial performance. Debt restructuring, recapitalization, divestiture, or reorganization are often used as preferred courses of action.

We believe that companies can achieve superior financial performance through the successful implementation of a focused business strategy. Opportunities to enhance performance result from the following:

  • New Programmatic Clinical Approaches
  • Dynamic Marketing Outreach
  • Proactive Training Programs
  • Detailed Reviews of Personnel, Salary Structure, and Staffing Levels

In order to select the optimum course of action, Sage evaluates the critical questions. We ascertain the strategic impact on cash flow, the amount of capital needed to revitalize the business, and where and how that capital should be invested. We design our strategy with the understanding and experience that all parties must be accepting of the proposals for change. Finally, if divestiture is warranted, we develop the plan and identify the likely buyers.

Establishing realistic, objective expectations is the basis for each assignment. Conventional accounting measures such as earning per share and ROI do not provide the whole financial analysis because they ignore pivotal factors such as quality assurance, licensure, and cost of capital.

Sage approaches each assignment by focusing on the cash flow implications of a chosen business strategy. We are specialists in the financial and operational aspects of long-term care company restructuring. We initiate change.

To learn more about how Sage Health Services can assist your troubled nursing facility or protect your interest in a long-term care company, contact our turnaround professionals at 812-422-7774.

Receivership Services

Is receivership a good option to gain control? Lenders are often desirous of taking possession of a health care facility, but are reluctant of the exposure that operation brings. When this is the case, receivership may be the answer.

More and more lenders are pursuing the court appointment of a receiver. Although statutes vary from state to state, there are a few common aspects of which one should be aware. In regard to health facilities, there are two separate types of receiverships:

A Health Receivership is a legal term applied to receiverships granted at the behest of State Health Departments. These cases are usually the result of serious health deficiencies, but may be sought for weak financial conditions. The state petitions the court to appoint a qualified individual licensed to operate the facility. Most state agencies already have individuals who routinely take these assignments.

A lender should not view a Health Receivership favorably. Typically, the receiver will have a set pattern of operation that is unilaterally slanted toward quality of care. Fiscal concerns will usually not be part of the strategic plan. Additionally, the receiver’s commitment, while always first to the court, is second to the state agency. Lenders will rarely be kept informed of the facility’s status. Debt service is often ignored during the pending of the case, which can last for several years.

Most importantly, a divestiture of the property is often difficult to accomplish during a Health Receivership since the receivership is not discharged at the time of sale. The state agency is the only entity that can move for closure of the receivership and this is never done until all deficiencies are deemed corrected. It is difficult, if not impossible, to sell a property with that contingency darkening the buyer’s due diligence.

The second type of receivership common for a health care facility is a Civil Receivership. This may be a very good option for lenders who find themselves in difficult circumstances. Such a move provides the lender with oversight control without liability.

Many individuals and organizations qualify as a civil receiver. However, in a case involving a health care facility, one should be aware that if the receiver were not qualified to operate a facility in the state, he would need to hire a qualified operator.

A Civil Receivership works very well when the lender proposes a qualified operator to the court. Just as in a Health Receivership, the receiver’s first obligation is to the court, but secondarily, their interests are aligned with the lender.

Such receiverships facilitate divestiture. Once the operation has been stabilized, the civil receiver will identify potential buyers and petition the court for liquidation. Although there are several divestiture methods, the most efficient is sealed bid. A minimum price is established, bid packages are sent to prospective buyers, and advertising is placed. When the bids are submitted, the receiver, lender and owner have an opportunity to review them. The receiver makes a recommendation to the court and all interested parties have an opportunity to comment.

During the pending period of the receivership, usually less than one year, the lender is given periodic reports and debt service either accrues or is paid. At sale, the debt service is senior to any other claims on the real estate.

Sage Health Services of Indiana, Inc. is experienced as both a Health and a Civil Receiver. Call us today at 812-422-7774 for additional information on how we might help you with gaining control of a health care facility.