Traditional skilled nursing environments remain highly institutional, characterized by visible nurses’ stations, medical equipment and hospital-like layouts. Peter van Kalkeren, COO of Skokie, Presbyterian Living, wants to change that.
As Presbyterian Living prepares for measured growth while strengthening its existing operations, the Skokie, Illinois-based organization is updating its buildings to adapt its skilled nursing facilities into models that feel more homelike.
“We’re really going to focus on what is the healthcare model going to look like in the future because in its current format, it’s so institutional,” van Kalkeren, COO of Skokie, Illinois-based Presbyterian Living told Skilled Nursing News. “How can we make changes in that operational model so that all of those pieces are still there, but they might not be as visible, or there’s a different layout to support a different operational model?” he said.
Van Kalkeren, who sat down with SNN to discuss the organization’s growth strategy, workforce priorities and technology initiatives impacting post-acute care, said Presbyterian Living is also closely evaluating its healthcare footprint to better align capacity with demand and future care models.
The organization is preparing for potential affiliations or acquisitions by refining its operating model and establishing a framework for evaluating growth opportunities, van Kalkeren said.
All of Presbyterian Living’s facilities enjoy a 5-Star rating on Care Compare, and with occupancy levels in the 90% range, the organization is currently focused on waitlist management, resident and employee experience and retention.
In a wide-ranging interview, van Kalkeren also discussed challenges facing post-acute care providers with Medicare Advantage contracts – his organization manages negotiation through being a part of a regional provider network, the Illinois Aging Services Network (ILASN). He also shed light on technology adoption.
Presbyterian Living owns and operates three Life Plan Communities, also known as Continuing Care Retirement Communities (CCRCs), and one independent living rental community. Its healthcare operations include skilled nursing services, including one community with 250 licensed skilled nursing beds.
Previously known as Presbyterian Homes, Presbyterian Living underwent rebranding about a year ago.
The following interview has been edited for length and clarity.
SNN: What is your vision for the next three to five years?
Van Kalkeren: Well, we’re definitely looking for the right opportunity to grow. We are lining everything up so that our business model and all the elements are scalable, and that we are ready when that right opportunity presents itself.
Besides having everything scalable, we’re also really shifting our focus to the employee and the resident experience.
What are Presbyterian Living’s growth plans?
There is not much same store growth, just a few things here and there. We really need to redevelop one of the communities because they have some aging buildings that are just no longer with the times. So that’s what we’re working on, and then the remainder of the growth strategy would really be getting everything lined up when the right opportunity presents itself.
Which kind of facilities or assets fit your model?
We’ve done a lot of work on making sure that we have a framework in which we can see or for which we can make a determination that it is something that works for us. We’re looking at a certain mileage radius for new opportunities. We’re evaluating if we will be open to acquiring distressed [communities]? All of those types of things is what we work with our board to be fully aligned so that when an opportunity presents itself, we can see if it fits with what we’re doing.
We’re probably not looking at distressed opportunities. More kind of like affiliations, but our our operational model we’re fine-tuning right now so that it’s truly scalable. We identified a few areas where it’s not totally scalable.
Geographically, we’re open to looking at a slightly larger radius, even out of state, but it’s not like the whole country.
Do you have a strategy for keeping occupancy levels strong?
Our occupancy is high. We’re in the 90s.
We’re shifting a little bit because of the high census to waitlist management.
Other than that, we’re always investing [our communities], in making sure that we don’t really have a lot of deferred maintenance. We do need to right size our healthcare at our communities because it’s just too large of a footprint.
At one community, we have 250 licensed SNF beds, and that’s just way too many.
How Presbyterian living is positioning itself to leverage value-based care opportunities?
We’re in a fortunate situation where we don’t have [reliance on] Medicaid, and our Medicare is limited. What we are really focused on is transforming our vendor relationships into partnerships. So if you’re looking at our [electronic medical records], to ensure that whatever we’re working on aligns with the vendor.
With AI, things are coming at us so fast, but we don’t yet have the ability to absorb them or even have the awareness of what’s coming – and that’s what we’re really changing.
On Medicare Advantage burdens, how is Presbyterian Living dealing with burdens from MA?
Our footprint is growing, so we have to really start looking at what’s the contribution value. Is that going to work for us, or do we need to, you know, really look at that as to which contracts make sense? And for some we can’t even get certain contracts.
Are there certain pain points that you’re still seeing within managed care, from prior authorizations and having to deal with administrative burdens from that?
Oh yes! Denials in claims, in getting authorizations, all those things.
How much reimbursement are you getting from MA compared to Medicare rates?
We are part of a larger entity – ILSN — that negotiates those contracts for us. Anytime a contract comes up for renewal, is when we really like to see if the contract is right for us or not?
It’s an Illinois-based group so that all a lot of senior living organizations in Illinois are part of that, so that you have more bargaining power.
What do you see as the biggest challenges facing Presbyterian living in 2026, and how is the company preparing to address them while sustaining growth in quality standards?
Challenges are always lurking everywhere. I don’t think we really have like any major challenges that we you know see in 2026. It’s making sure that we keep up with our maintenance, making sure that we you know have the right product out there, making sure that we keep census because if you don’t have a strong census, it’ll suck the oxygen out of any room, and from there, we’re just up for growth.
Any compliance or payment policies that present particular hurdles?
Compliance is always a challenge because the whole model Is broken basically – it’s not so accessible for many people. So, from that perspective, it’s a challenge.
All of our surveys are going well. We’ve got a good system in place.
How is the staffing climate?
I mean, staffing is an interesting conundrum these days. It’s constantly changing, and we constantly have to adjust to it.
Overall, we’re pretty stable, but we’re very much focused on retention, so that our residents see the familiar faces that they, you know, come to expect. And what is it that we need to do to ensure that our employees want to be with us and do not feel that they need to go elsewhere.
Any staffing initiatives, leadership development programs, tuition funding programs for staff?
We have a scholarship program. We also have tuition reimbursement, and as we are going into growth mode, we’re doing a larger focus on succession planning.
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