(from the Diaries -- I described the journey of Bill's organization in this story earlier this year -- joe)

We have begun to develop the neighborhood concept on all three of our 41 bed units.  Only one of our neighborhoods is Medicare certified, so we typically have true short term rehab residents intermingled with long term residents that have just been admitted and are utilizing their Medicare benefits on the certified neighborhood.  Once their Medicare coverage has ended, and it is decided that they are indeed staying long term, we typically ask them to move to another neighborhood (provided there is a bed available.)  Obviously, this isn't the best situation, as the resident has to adjust to a new neighborhood, new neighbors, and a new caregiver.  Often times, residents refuse to move, which in turn limits our ability to admit new residents, which leads to lower revenue, etc.  

One solution would be to certify the entire building for Medicare residents. Our accountants have continually cautioned me against doing that, in fear of a return to a cost based methodology for Medicare payment, as well as fear of not having all the Medicare charting done by nurses that are comfortable with the increased number and level of documentation requirements.  For those of you out there that have taken this approach, how has it worked out? Would you do it again?

We had a discussion today about not truly instituting the neighborhood concept on the short-term unit.  All of the leaders of the facility are mindful of the issues that affect both sides of this coin.  We want our short term rehab residents to get as much therapy as possible, so we don't want them to sleep late, or become so comfortable that they decide they want to stay on that short term unit.  At the same time, we don't want to limit or take away those residents rights or abilities to make their own decisions.  I would think that other facilities have had similar issues, and am wondering how they were dealt with.