RiverSpring Health is working on New York City’s first continuing care retirement community (CCRC) as it expands beyond its Hebrew Home at Riverdale nursing facility. And CEO Daniel Reingold is optimistic about it — particularly as the skilled nursing industry convulses in a series of transformations.

“It’s a dinosaur,” he told Skilled Nursing News of the industry during an interview on the sidelines of LeadingAge’s annual conference and expo in Philadelphia, where he received the organization’s Award of Honor for his leadership in the field of aging.  “Skilled nursing, in my opinion, is going to end up serving three populations. It’s going to be advanced dementia, memory care. It’s going to be hospice and palliative care. And it’s going to be post-acute care.”

In this environment, more and more people will be going to home care and into CCRCs, Reingold believes. But because baby boomers have done a poor job saving for retirement, the question of who will pay for long-term care for them is looming large, he said.

While Medicare covers 100 days of skilled nursing care in the wake of a qualifying hospital stay, seniors who require longer-term care frequently must rely on their own assets — often spending down all of their cash and then qualifying for Medicaid, the largest payor for nursing home services nationwide.

“There’s going to be two very distinct classes of older adults,” he said. “A small percentage that have saved up enough money and a much larger portion that are dependent on the government and other resources as they age.”

The Riverdale, N.Y.-based RiverSpring already has home care services, in addition to affordable housing services and middle-income independent living, as well as Medicaid assisted living, he noted. And with the planned CCRC in an affluent neighborhood of the Bronx — the first and only one in New York City — it will be moving into an upper-income population, Reingold said. The hurdle will be getting people to understand what the CCRC model offers, particularly since New York City is not an area familiar with the concept and the varying level of care it offers.

Still, in a city with 8 million people, Reingold believes there will be at least some interest.

“There are now some companies coming in to build some high-end independent living buildings in Manhattan,” he told SNN; Omega Healthcare Investors (NYSE: OHI) and Maplewood Senior Living, for example, have teamed up to build a 23-story assisted living facility on the city’s upscale Upper East Side. “But nobody’s building a CCRC. So I think as soon as people can understand the economic model, I think they’re going to grab it, and I think it fills up very quickly. Then we have to maintain and sustain it.”

Currently the non-profit RiverSpring has 735 skilled beds, though when the CCRC is built, that number will drop to 610, since a building is being demolished to make room for the new community. The CCRC will have 386 independent living beds and 70 assisted living beds, making use of the existing skilled care at RiverSpring — which was one of the reasons the state of New York likes the project, according to Reingold.

The plan for the facility recently received approval from the City Council’s Subcommittee on Zoning and Franchises, Crain’s New York reported. The project was started in earnest in 2013, Reingold told SNN, and is projected to break ground at the end of 2020; in the state of New York, 20% of the units must be pre-sold before a project can get financing approval, Reingold noted, so that process is currently in progress.

The move comes as RiverSpring Health is working to ensure that it has a variety of programs and services. Operators of both for- and non-profit facilities are facing razor-thin margins — in some cases, as low as zero. Reingold has many concerns about non-profit SNFs, particularly those in New York, as they are increasingly  bought out and converted into for-profit homes. And many of the programs at RiverSpring have been made with the goal of not being dependent on skilled nursing, despite the fact that skilled care represents the organization’s core mission, he told SNN.

“In our case, I wanted to make sure that we had enough programs and services that are generating surpluses that will be subsidizing the nursing home,” Reingold said. “We’ve adopted a strategic plan that anticipates the nursing home will lose money.”

Written by Maggie Flynn