Outsourced accounting and fractional CFO for skilled nursing and assisted living

Our clients in this space are owner-led operators: a single skilled nursing facility, an assisted living community, or a group of buildings run under one ownership with an entity for each. What they have in common is that the business has become more complicated than the finance function behind it.

• The books close weeks after month-end, so census, staffing and spending decisions are made on numbers that are already history.
• Each building has its own entity, and nobody can say with confidence which one is carrying the others.
• Payroll is the biggest cost and the least visible one: agency staff, overtime and shift differentials land in one line instead of the building and department that used them.
• A lender, an investor or a buyer wants reporting that the current setup cannot produce.
• One person in the office handles everything, and the books stop when they are out.

An outsourced CFO, often called a fractional CFO, is a senior finance lead who works on your company part-time instead of as a full-time executive. In a care facility, that means someone who owns the numbers behind the care: what each building actually earns per resident day, what labor really costs once it is allocated correctly, and how much cash will be in the bank on the next payroll day.

Most operators already have someone recording transactions. What is missing is the layer above the books: a monthly close you can rely on, reporting that connects occupancy to margin, and someone who asks why a number moved. At River Edge Advisors the CFO does not work alone. A CPA-led team of 75+ keeps the books, reconciles every payroll run, enters and pays vendor bills and closes the month on a fixed date. The CFO works from those numbers, so the advice rests on books that tie, not on estimates.

What that looks like month to month

• Close and review. The books close on a fixed date, and the CFO walks you through each building’s P&L, not just the consolidated total.
• Census and occupancy. Census, occupancy and revenue per resident day reported next to the financials, by building, instead of in a separate spreadsheet.
• Labor. Every payroll run reconciled to the books, with labor cost allocated to the right building and department, so you can see staffing cost per resident day.
• Payor mix. Private pay versus benefit revenue, and how each mix affects margin and the timing of cash.
• Cash. A 13-week cash forecast that shows the squeeze before payroll day, while you still have options.
• Decisions. Budgets, lender and investor reporting, and the financials behind an acquisition or a new building.

A good monthly package for a skilled nursing facility or assisted living community is short, consistent and arrives on the same day each month. It should answer the questions you would otherwise ask your administrator by phone. Ours is built around these pieces:

1. A P&L for each building, with shared and management costs allocated on a stated basis, plus the consolidated view.
2. Census and occupancy for the month and the trend, so a drop in revenue can be traced to occupancy, rate or mix.
3. Cost per resident day, split into labor and other operating costs, by building.
4. Labor detail: overtime and agency use by department, reconciled to payroll.
5. Payor mix: private pay versus benefit revenue, and how long each takes to turn into cash.
6. A balance sheet that ties: bank accounts, payables, accruals and any resident funds reconciled.
7. A 13-week cash forecast built from your payroll calendar and collection history.

If you want to see what a close on a fixed calendar looks like day by day, our free monthly close checklist lays it out.

These are the problems operators describe most often, and what changes when the finance function is set up properly.

“Payroll goes out every two weeks. The money for those days arrives much later.”

A 13-week cash forecast built from your payroll calendar and your collection history, so the gap is planned for weeks ahead instead of discovered the week of payroll.

“I can’t tell which building actually makes money.”

A P&L for every building, with payroll and shared costs allocated to the right place and reviewed with you each month, so margin by building is real.

“Our books close weeks after month-end.”

A close on a fixed date, every month. We bring reconciliations current first, then hold the calendar.

“Labor cost keeps rising and I can’t see where.”

Every payroll run reconciled to the books, with overtime and agency cost reported by building and department, next to census.

“A lender wants reporting I can’t produce.”

Lender and investor reporting, budgets and the financials behind an acquisition, prepared by a CPA-led team and reviewed by your CFO.

Multi-facility operators usually run each building as its own entity. That is exactly where the close slows down: twelve sets of books, intercompany charges, shared payroll and one consolidated view that nobody trusts until weeks after month-end.

The same approach applies to a single skilled nursing facility or a group of assisted living communities: one calendar for every entity, every account reconciled, and a package that lands on the same day each month. See all case studies.

From a first look at your books to a monthly rhythm, in four steps.

1. Review. Request a free review of last month’s books. We tell you which documents would help, review them, and walk you through what stands out: where cash is going, what doesn’t tie and what we’d fix first.
2. Scope. If it makes sense to go further, we set out what an engagement would cover: books, payroll reconciliation, payables, reporting and CFO time. You decide. No obligation either way.
3. Catch-up and setup. Your dedicated team takes over access, brings reconciliations current and organizes reporting by building and department.
4. Monthly cadence. The books close on a fixed date every month. Your CFO reviews the results with you, updates the cash forecast and works on the decisions in front of you.

We work alongside your billing team or billing company. We don’t replace them; we make sure what they collect shows up correctly in your numbers.