NUR 621: Financial and Operational Management in
Healthcare
Assignment: Designing a Staffing Model for a 30-Bed SNF
Proposal for Maplewood Gardens Rehabilitation & Skilled Care
I. ASSIGNMENT INSTRUCTIONS
Your Role
You have been engaged as a healthcare operations consultant by Maplewood Gardens
Rehabilitation & Skilled Care, a 30-bed for-profit Skilled Nursing Facility (SNF) located in
a suburban Midwestern community. The facility's leadership team—comprising the
Administrator, Director of Nursing (DON), and Chief Financial Officer (CFO)—faces a
critical operational inflection point. Despite stable census, the facility struggles with
workforce instability, quality variability, and unsustainable labor costs that threaten its
competitive position and regulatory standing.
Your mandate is to analyze the provided operational data and deliver a comprehensive,
evidence-based staffing proposal that achieves three concurrent objectives:
1. Regulatory Compliance: Meet or exceed all state and federal staffing
requirements
2. Financial Sustainability: Reduce total nursing labor costs by 5% while eliminating
dependency on premium agency labor
3. Quality Improvement: Establish staffing levels and mix that demonstrably support
reduction in falls and pressure ulcer incidence
This assignment requires you to function as both analyst (working with complex data)
and strategist (crafting implementable solutions). Your deliverables must be
,presentation-ready for an executive audience with limited clinical background but
sophisticated financial acumen.
II. FACILITY PROFILE: MAPLEWOOD GARDENS
Comprehensive Data Packet for Analysis
A. Organizational Context
TableCopy
Attribute Data
Facility Name Maplewood Gardens Rehabilitation & Skilled Care
Licensed Beds 30 (all skilled nursing)
Average Daily Census
28 residents (93.3% occupancy)
(ADC)
Ownership For-profit, regional chain (3 facilities)
Medicare Certification Yes
Medicaid Certification Yes
Medicare: 35% / Managed Care: 25% / Medicaid: 30% / Private Pay:
Payer Mix
10%
, Average Length of Stay 28 days (short-term rehab: 65%; long-term care: 35%)
B. Resident Acuity Profile
TableCopy
Acuity
Current State Benchmark/Goal
Indicator
Average Acuity Target: Maintain with improved
3.2 on 5-point scale
Score outcomes
Case Mix
1.15 State average: 1.08
Index (CMI)
ADL
40% extensive assistance High acuity population
Dependency
Clinical 60% post-surgical ortho, 25% cardiac, 15% Increasing medical complexity
Complexity complex medical trend
Behavioral Requires specialized staffing
20% with dementia behaviors
Health considerations
Acuity Scoring System (5-Point Scale Used by Facility):
● 1 = Minimal assistance, stable medical condition
● 2 = Moderate assistance, predictable care needs
● 3 = Extensive assistance, multiple comorbidities
● 4 = Maximum assistance, unstable conditions
● 5 = Total dependence, critical care needs (typically not appropriate for SNF)
Healthcare
Assignment: Designing a Staffing Model for a 30-Bed SNF
Proposal for Maplewood Gardens Rehabilitation & Skilled Care
I. ASSIGNMENT INSTRUCTIONS
Your Role
You have been engaged as a healthcare operations consultant by Maplewood Gardens
Rehabilitation & Skilled Care, a 30-bed for-profit Skilled Nursing Facility (SNF) located in
a suburban Midwestern community. The facility's leadership team—comprising the
Administrator, Director of Nursing (DON), and Chief Financial Officer (CFO)—faces a
critical operational inflection point. Despite stable census, the facility struggles with
workforce instability, quality variability, and unsustainable labor costs that threaten its
competitive position and regulatory standing.
Your mandate is to analyze the provided operational data and deliver a comprehensive,
evidence-based staffing proposal that achieves three concurrent objectives:
1. Regulatory Compliance: Meet or exceed all state and federal staffing
requirements
2. Financial Sustainability: Reduce total nursing labor costs by 5% while eliminating
dependency on premium agency labor
3. Quality Improvement: Establish staffing levels and mix that demonstrably support
reduction in falls and pressure ulcer incidence
This assignment requires you to function as both analyst (working with complex data)
and strategist (crafting implementable solutions). Your deliverables must be
,presentation-ready for an executive audience with limited clinical background but
sophisticated financial acumen.
II. FACILITY PROFILE: MAPLEWOOD GARDENS
Comprehensive Data Packet for Analysis
A. Organizational Context
TableCopy
Attribute Data
Facility Name Maplewood Gardens Rehabilitation & Skilled Care
Licensed Beds 30 (all skilled nursing)
Average Daily Census
28 residents (93.3% occupancy)
(ADC)
Ownership For-profit, regional chain (3 facilities)
Medicare Certification Yes
Medicaid Certification Yes
Medicare: 35% / Managed Care: 25% / Medicaid: 30% / Private Pay:
Payer Mix
10%
, Average Length of Stay 28 days (short-term rehab: 65%; long-term care: 35%)
B. Resident Acuity Profile
TableCopy
Acuity
Current State Benchmark/Goal
Indicator
Average Acuity Target: Maintain with improved
3.2 on 5-point scale
Score outcomes
Case Mix
1.15 State average: 1.08
Index (CMI)
ADL
40% extensive assistance High acuity population
Dependency
Clinical 60% post-surgical ortho, 25% cardiac, 15% Increasing medical complexity
Complexity complex medical trend
Behavioral Requires specialized staffing
20% with dementia behaviors
Health considerations
Acuity Scoring System (5-Point Scale Used by Facility):
● 1 = Minimal assistance, stable medical condition
● 2 = Moderate assistance, predictable care needs
● 3 = Extensive assistance, multiple comorbidities
● 4 = Maximum assistance, unstable conditions
● 5 = Total dependence, critical care needs (typically not appropriate for SNF)
