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External pressures, such as lower reimbursement rates and an overall shift in policy by the Centers for Medicare and Medicaid Services (CMS) and state Medicaid agencies have put significant financial and operational pressure on skilled nursing and other senior living operators in the United States. Internal pressures, such as poor operational decision-making and a difficult, competitive environment for patients and employees, have combined to put some skilled nursing facility (SNF) owners and operators against the proverbial financial and operational wall. However, our recent experiences in the skilled nursing business indicate that all is not lost for owners and operators of SNFs and, in fact, with some fairly basic operational and financial improvements, these operators can not only recover but thrive in the current environment.

http://www.wallerlaw.com/portalresource/lookup/wosid/cp-base-4-132902/media.name=/HOW%20TO%20DE-STRESS%20A%20DISTRESSED%20SENIOR%20LIVING%20COMPANY.pdf