Launching a brand new nursing home business right now is not for the faint of heart. But for those with deep clinical and operational expertise – and a mission to help the industry evolve – it’s worth the struggle.

Kimberly Green, founder of Sage Integrated Health, aims to do just that, drawing from more than 30 years of industry experience, 13 of which were spent as COO for the Oklahoma-based Diakonos Group. Green’s transition from executive to owner was shaped by the post-COVID landscape, and the financial and emotional toll the pandemic took on the sector.

The winding road to nursing home ownership has had plenty of hurdles, she said, with a plan to purchase Diakonos facilities falling through while the sticker shock of price per bed for skilled nursing is setting the industry veteran on her heels. Green was set back six months in her plan for building up Sage, but patience, resilience and strong industry relationships have helped to secure funding and asset opportunities since then.

“I was very blessed over the last 30 years that I’ve created a lot of connections. It’s not just something that you leap into quickly,” said Green. “The unknown can be scary because it’s a totally different world, but don’t be afraid to leap. On the other side of fear is greatness. And don’t be afraid to fail, because in that failure, you’re going to find all those tools to dust yourself off and get up and go again and understand that within all those connections you’ve made in your career, there’s money to be found to help you get there.”

Green spoke with Skilled Nursing News about her new venture, and what it has been like to start a new nursing home business amid ongoing staffing shortages, shifting policy trends and an industry evolving in real time. Sage is set to close on a continuing care retirement community (CCRC) in September, its first asset, with two more facilities in the pipeline and 10 others being vetted.

The following transcript has been edited for length and clarity – our full interview with Green offers wide-ranging insights on Medicaid cuts, value-based care and the future of reimbursement programs. Listen on SoundCloud or iTunes/Apple Podcast.

SNN: Talk a bit more on founding Sage Integrated Health.

Green: This has been quite a journey. I would say it’s a career journey. It’s been 30-plus years getting here as I slowly climbed that ladder to different things, and I wasn’t quite sure that I wanted to be an owner, especially post-Covid.

I worked for the Diakonos Group. As many people know, I was their chief operating officer for 13 years, and post-COVID we opened two super SNFs, and that was a really, really difficult journey. During that time, the owner had decided that he was done. He was just tired and financially drained and told me he wanted to sell all the SNFs, and we did.

That put me on the path of thinking, what do I want my next step to be? As I interviewed with other companies inside and outside of the industry, they just never felt right. And so I had to stop, and I’m very spiritual so I prayed about it, and talked to my team and thought about where I really wanted to be. I kept coming back to the mission of helping to change the industry and change that narrative, which was only going to be through an owner’s seat. And so I started pursuing it that way,

SNN: Sounds like it was a winding road to ownership for your team.

Green: After I made the decision that I did want to pursue ownership, I talked to my owner, and it sounded like the plan going forward would be for me to buy the SNF side of Diakonos. That was really exciting. My team and I worked really hard to make that happen. The goal was that I would have between five and nine buildings to start out, which would have been a great portfolio. I already knew those buildings. I had my team, and those buildings were running within the culture that I had created over 13 years. That was the best case scenario.

I went to NIC and met some amazing people, and there was such interest in helping me do that. Unfortunately, when it came right down to it, a couple days before getting the signatures, things shifted … I didn’t end up getting the Diakonos buildings, but I am getting other buildings to add to our portfolio. It’s a smaller portfolio to start with, but it’s a very exciting one.

On the ownership journey, there’s a lot of pivoting, and I just had to pivot. And so here I am, and have some great things coming on board with some great team members that did make the change with me.

SNN: So what assets does Sage have currently?

Green: Those five to nine Diakonos facilities took another journey with another owner … that puts me about six months behind where I expected to be. My first building, a large CCRC campus, is scheduled to come on board on Sept. 1 – that’s our first asset. We’re very excited. And then I have two other facilities I’m working on, with about 10 others that we’re vetting right now.

SNN: Any advice for those considering ownership in the nursing home sector?

Green: The number one piece of advice is to be patient and to start creating those connections. I was very blessed over the last 30 years that I’ve created a lot of connections. It’s not just something that you leap into quickly. It’s going to take a lot of time and a lot of money. That doesn’t mean you have to have all the money yourself … the cost is scary. I think that the timeline can be scary.

SNN: What was your experience in netting investors?

Green: Whenever we went to NIC, my strategy was to be very transparent. I acknowledged that I knew that we had just a little bit of time. I gave them the rundown of exactly who I am and my perspectives that I bring to the table and the experience I have. I have been sitting in this seat on the bus for 13 years as COO. That seat on the bus doesn’t bring millions of dollars, but what it does bring is my team, and the experience I have. Some people did walk away, but we had four or five that reached out before we even left NIC and said, “We believe in you, and we think this is fantastic, and it’s so great to have people coming to the ownership realm that have lived it and breathed it and still want to do it through all of these difficulties that we’ve had.”

SNN: Any roadblocks to asset growth that are top of mind?

Green: I would hear that people were selling. There were owners, smaller regional owners or smaller state owners that you would think because they were small owners, they would want to sell to someone who was going to keep it local, or someone who was small. I had so many doors shut from owners not willing to talk because we weren’t going to pay the big money that they could get from some other New York or East Coast company, other large companies that are out there. I heard that over and over and over… I am a great provider. I’m clinical by background, I have operations expertise, I’m involved nationally and at state levels. I lecture all over the country, I have a great team.

That was shocking. I thought, everybody knows me, and they’re going to be so excited. Even if it’s $60,000 a bed, I can’t pay $120,000 a bed, but there’s plenty of people that will. It was much more difficult and humbling than I expected it to be.

I had hoped already to have a large portfolio. It’s really hard to have just one or two buildings. It’s scary because with health care, you really need to have a regional presence in order to survive the next five years.

And so, my goal is to just continue to create all these wonderful relationships that I’ve had over the years. That networking, that’s how I found this wonderful CCRC that’s coming on board. I’m going to continue to push through and really rely on my networking skills and the network I’ve already built to bring me some great buildings.

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