5 unchanged sentences
Risks Relating to Our Operations
−Removed: COVID-19 and other pandemics, epidemics, or outbreaks of a contagious illness may adversely affect our operating results, cash flows and financial condition.
−Removed: The COVID-19 pandemic had a negative impact on our business and results of operations.
−Removed: COVID-19 and other pandemics, epidemics, or outbreaks of a contagious illness, and similar events, may cause harm to us, our partners (employees), our patients, our vendors and supply chain partners, and financial institutions, which could have a material adverse effect on our results of operations, financial condition and cash flows.
−Removed: The impacts may include, but would not be limited to:
−Removed: Disruption to operations due to the unavailability of partners due to illness, quarantines, risk of illness, travel restrictions or factors that limit our existing or potential workforce.
−Removed: Increased costs and staffing requirements related to additional CDC protocols, federal and state workforce protection and related isolation procedures, including obligations to test patients and staff.
−Removed: Decreased availability and increased cost of supplies due to increased demand around essential personal protective equipment (“PPE”), sanitizers and cleaning supplies including disinfecting agents, and food and food-related products due to increased global demand and disruptions along the global supply chains of these manufactures and distributors.
−Removed: Decreased census across all our operations, which could negatively impact our operating cash flows and financial condition.
−Removed: Elevated partner turnover which may increase payroll expense, increase third party agency nurse staffing, and recruiting-related expenses.
−Removed: Increased risk of litigation and related liabilities arising in connection with patient or partner illness, hospitalization and/or death.
−Removed: Significant disruption of the global financial markets, which could have a negative impact on our ability to access capital in the future.
−Removed: The further spread of COVID-19, and the measures taken by federal and state governments and local health authorities intended to limit the spread of the virus, could impact the resources required to carry out our business as usual and may have a material adverse effect on our results of operations, financial condition and cash flows.
−Removed: The extent to which the COVID-19 pandemic will impact our business and our financial results will depend on future developments, which are highly uncertain and cannot be predicted.
−Removed: Such developments may include the ongoing geographic spread of the virus, the timing, availability and effectiveness of medical treatments and vaccines (including additional doses of vaccines), the impact of any mutations of the virus, and the type, duration and efficacy of actions that may be taken by various governmental authorities to contain the virus or treat its impact, among others.
−Removed: Any of these developments, individually or in aggregate, could materially impact our business and our financial results and condition.
We depend on reimbursement from Medicare, Medicaid and other third – party payors, and reimbursement rates from such payors may be reduced.
4 unchanged sentences
CMS began imposing a 2% reduction on Medicare claims in 2013, and these reductions have been extended through 2030.
−Removed: The CARES Act and related legislation temporarily suspended this 2% reduction through March 31, 2022, and reduced the sequestration adjustment from 2% to 1% from April 1 through June 30, 2022.
−Removed: The full 2% reduction took effect July 1, 2022.
Net revenue realizable under third–party payor agreements can change after examination and retroactive adjustment by payors during the claims settlement processes or as a result of post–payment audits.
19 unchanged sentences
Data collected in each performance year will impact Medicare payments two years later.
−Removed: Calendar year 2023 is the first performance year under the expanded HHVBP Model that will affect payments.
+Added: Calendar year 2023 was the first performance year under the expanded HHVBP Model.
Other initiatives aimed at improving the cost of care include alternative payment models, such as ACOs and bundled payment arrangements.
31 unchanged sentences
The staffing level required to receive a 5-star rating in the CMS Nursing Home Five Star Quality Rating System is determined based on analysis of the relationship between staffing levels and measures of nursing home quality.
+Added: CMS continues to increase its quality measure thresholds, which is regularly increased every six months, making it more difficult to achieve upward and five-star ratings.
+Added: CMS increased its quality measure thresholds in 2022, making it more difficult for facilities to obtain or maintain four-and-five-star ratings.
CMS places a strong emphasis on registered nurse (“RN”) staffing.
7 unchanged sentences
The loss of the services of any of these persons could have a material adverse effect upon us.
+Added: Federal minimum staffing mandates may adversely affect our labor costs, ability to maintain desired levels of patient census and profitability.
+Added: In April 2024, CMS issued the Staffing Rule, establishing minimum staffing standards for SNFs.
+Added: The Staffing Rule contains three primary staffing requirements which are phased in over the next several years.
+Added: Due to pending legislation in both the House of Representatives and the Senate, industry litigation filed to dispute the Staffing Rule's validity and enforceability, as well as the long phase-in of the requirements, the exact effects of the Staffing Rule cannot be determined.
+Added: Future developments may significantly alter or even halt the implementation of the Staffing Rule.
+Added: However, we expect that the Staffing Rule in its current form will have adverse financial consequences upon our business.
Disasters and similar events, which may increase as a result of climate change, may seriously harm our business.
25 unchanged sentences
The failure to obtain any required license or certificate of need could impair our ability to operate or expand our business.
+Added: During 2024, we expanded our operations with the acquisition of the White Oak Senior Living portfolio.
+Added: This growth has placed and will continue to place significant demands on our management resources.
+Added: Our ability to manage our growth effectively and to successfully integrate this acquisition into our existing business will require us to expand our operation, financial and management information systems.
Upkeep of healthcare properties is capital intensive, requiring us to continually direct financial resources to the maintenance and enhancement of our physical plant and equipment.
−Removed: As of December 31, 2023, we leased or owned 60 skilled nursing facilities, 24 assisted living facilities, 3 behavioral health hospitals, and four independent living facilities.
+Added: As of December 31, 2024, we leased or owned 72 skilled nursing facilities, 24 assisted living facilities, three behavioral health hospitals, and eight independent living facilities.
Our ability to maintain and enhance our physical plant and equipment in a suitable condition to meet regulatory standards, operate efficiently and remain competitive in our markets requires us to commit a substantial portion of our free cash flow to continued investment in our physical plant and equipment.
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Our ability to contract with payors depends on our quality of service and reputation, as well as other factors of which we may have little or no control, such as state appropriations and changes in provider eligibility requirements.
+Added: The effects related to any potential future pandemic, epidemic, or infectious disease outbreak could adversely impact our business and future results of operations and financial condition.
+Added: Pandemics, epidemics, or outbreaks of contagious illnesses and similar events may cause harm to us, our partners (employees), our patents, our vendors and supply chain partners, and financial institutions, which could have a material adverse effect on our results of operations, financial condition and cash flows.
+Added: The impacts may include, but would not be limited to:
+Added: Disruption to operations due to the unavailability of partners due to illness, quarantines, risk of illness, travel restrictions or factors that limit our existing or potential workforce.
+Added: Increased costs and staffing requirements related to additional CDC protocols, federal and state workforce protection and related isolation procedures, including obligations to test patients and staff.
+Added: Decreased availability and increased cost of supplies due to increased demand around essential personal protective equipment (“PPE”), sanitizers and cleaning supplies including disinfecting agents, and food and food-related products due to increased global demand and disruptions along the global supply chains of these manufactures and distributors.
+Added: Decreased census across all our operations, which could negatively impact our operating cash flows and financial condition.
+Added: Elevated partner turnover which may increase payroll expense, increase third party agency nurse staffing, and recruiting-related expenses.
+Added: Increased risk of litigation and related liabilities arising in connection with patient or partner illness, hospitalization and/or death.
+Added: Significant disruption of the global financial markets, which could have a negative impact on our ability to access capital in the future.
+Added: Any such crisis could diminish public trust in healthcare providers, particularly those that are treating or have treated patients affected by contagious diseases.
+Added: Patient volumes may decline or volumes of uninsured patients may increase, depending on the economic circumstances surrounding the pandemic, epidemic or outbreak.
We are permitted to incur substantially more debt, which could further exacerbate the risks described above.
We and our subsidiaries may be able to incur substantial indebtedness in the future.
−Removed: If debt is added, the related risks that we now face could intensify.
+Added: If additional debt is added, the related risks that we now face could intensify.
Risks Related to Government Regulation
24 unchanged sentences
See Item 1, "Business – Government Regulation".
−Removed: We face uncertainty related to the COVID-19 public health emergency's ("PHE") expiration and wind-down, which could have a material adverse affect on our business, financial condition, results of operations and cash flows.
−Removed: The extent to which the COVID-19 PHE's termination will affect our operations will depend on future developments, which are highly uncertain and cannot be predicted.
−Removed: There remains uncertainty as to what changes will be made to the Health and Human Service’s emergency response requirements for our skilled nursing facilities and senior living facilities in order to better respond to the issues experienced during the COVID-19 PHE.
−Removed: To the extent COVID-19 is endemic in nature, we may face continued challenges from ongoing infection control and emergency preparedness requirements made part of state laws or regulations.
−Removed: Additionally, the long-term effects of the COVID-19 pandemic may include long-term decline in demand for care in skilled nursing facilities and senior living facilities.
Our business may be impacted by healthcare reform efforts.
3 unchanged sentences
The ACA has been subject to legislative and regulatory changes and court challenges.
−Removed: Although the current presidential administration has indicated that it generally intends to protect and strengthen the ACA, it is possible that there may be continued changes to the ACA, its implementation or its interpretation.
+Added: It is possible that there may be continued changes to the ACA, its implementation or its interpretation.
Changes by Congress or government agencies could eliminate or alter provisions beneficial to us, while leaving in place provisions reducing our reimbursement or otherwise negatively impacting our business.
143 unchanged sentences
Compared sentence by sentence after normalising whitespace, quotation marks, case and digits, so re-formatting and restated figures do not read as changed language. Wording changes appear as one removal and one addition. The current filing and the prior one are authoritative.