Extendicare Inc
TSX:EXE

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Earnings Call Transcript

Earnings Call Transcript
2018-Q3

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Operator

Good morning, ladies and gentlemen. Welcome to Extendicare Inc. Third Quarter Conference Call. Please be advised that this call is being recorded. I would now like to turn it over to Ms. Jillian Fountain. Please go ahead, Ms. Fountain.

J
Jillian E. Fountain
Vice President of Investor Relations

Thank you, Rick. Good morning, everyone, and welcome to Extendicare's 2018 third quarter results conference call. With me today is your new President and Chief Executive Officer, Dr. Michael Guerriere; and Elaine Everson, your Vice President and Chief Financial Officer.Our 2018 third quarter results were disseminated yesterday and are available on our website along with the supplemental information package. The audio webcast of today's call is also available on our website along with an accompanying slide presentation, which viewers may advance themselves.A replay of the call will be available from noon today until midnight on November 23. The replay numbers and passcode have been provided in our press release and an archived recording of this call will also be available on our website.Before we get started, please be reminded that today's call may include forward-looking statements regarding our future operations. Such statements involve known and unknown risks and uncertainties that may cause actual results to differ materially from those expressed or implied today. We have identified such factors in our public filings with the Securities Commission and suggest that you refer to those filings. As we discuss our performance, please bear in mind that all figures are in Canadian dollars unless otherwise noted.With that, I'll turn the call over to Michael.

M
Michael R. Guerriere
CEO, President & Director

Thank you, Jillian, and good morning, everyone. As you know, Extendicare operates across the spectrum of seniors' care in Canada to meet the needs of the growing seniors population. As you can see on Slide 3, our services are provided under various brands that together, cover the continuum of seniors' care. It is becoming increasingly clear that the growing needs of seniors are placing significant pressure on public sector health budgets. We won't be able to meet their needs by using the same approaches we always have. We will need some innovative approaches that leverage new technology to help seniors thrive in their own homes longer before needing assisted living or long-term care.I believe Extendicare is uniquely positioned to bring innovative solutions to the market that cover the full spectrum, from home care to retirement to long-term care. And given the steady expansion in its market given by demographic fundamentals, I believe there's a substantial opportunity to build shareholder value.On Slide 4, you can see that our results in the quarter were mixed across our various divisions. Growth from our retirement, management consulting and group purchasing divisions were strong, offset somewhat by declines in our long-term care and home health care operations.Net operating income from Canadian operations was up 2.5% from the same quarter last year. This kept pace with revenue growth, maintaining a margin of 12.7%. AFFO, however, was down 14.5% this quarter to $13.4 million. This was negatively impacted by higher lump-sum compensation costs, maintenance CapEx and current taxes.Let's look at the details in each of our divisions. Revenue in our home care division declined 2.4% from the year earlier quarter. This was due to insufficient staff in some of our Ontario districts outside the GTA, where we found it very difficult to find enough care providers to meet all the demand coming from the liens.In order to address this, we've been beefing up our recruiting activity, adding training resources and investing in new IT infrastructure. Our new computer system went live in the quarter and is being used in 3 of our districts, which account for about 20% of our home care volumes. It will take most of fiscal 2019 to complete the implementation.During this time, we are still shouldering the costs of operating 3 legacy systems, which will be decommissioned by the end of 2019. We are also investing in significant onetime training and implementation resources. Implementation is disruptive, causing a transient slowdown in activity in each office that we implement.Taken together, these factors will result in profitability headwinds for the next 4 quarters. In Q3, NOI was down 19.8% due to the volume drop and onetime costs related to the IT implementation and WSIB surcharges. As we continue with the system deployment, we expect performance will pick up in those districts that are already live on the system. We should start seeing volume increases that help to offset the onetime costs as we enter the new year.We are actively looking at ways to increase the speed of our implementation efforts. We're also working hard to improve engagement with our team in the field. The level of staff turnover has improved by 50% in the quarter, a huge improvement on a chronic issue in our home care division.We are optimistic that the measures we are taking on the people front will put this division back on a path to significant annual growth. Let's turn to long-term care on Slide 6... Although revenue growth was 3% over the prior year quarter, NOI was flat. Spending beyond our government funding envelopes, labor-related accruals and a prior year revenue pickup were responsible for a drop in NOI margin from 13% to 12.7%. Average occupancy continued to improve incrementally this quarter from the beginning of 2018, although it remains slightly below the same 2017 period.On the long-term care redevelopment front, as previously announced, we received approval for 2 of our redevelopment applications. One in Stittsville, a growing suburb of Ottawa, and the other in Sudbury. Both are 256-bed centers, and we are optimistic that we will be breaking ground on them early in 2019.We were granted 158 new long-term care beds in connection with the redevelopment of 3 of our other projects in Sault Ste. Marie, Sudbury and Peterborough, which are still in the government's review process. We continue to be encouraged by the emphasis the new Ontario government has put on new long-term care beds to reduce alternative level of care pressure in acute care hospitals. We will continue to apply for allocations of new beds to leverage the redevelopment of our older centers and to initiate new campus of care opportunities. In all, we have 21 long-term care centers in Ontario to redevelop, and we continue to work collaboratively with the Ministry of Health to move all our projects through the approval process.Turning to our Esprit Lifestyle division on Slide 7. Revenue was up 78% over the prior year quarter, and net operating income is up 294% due to higher occupancy in both our existing properties and our new communities. Our stabilized properties reached 94.8% occupancy by the end of the quarter, and our lease-up properties, of which there are 4: Yorkton Crossing and West Park Crossing in Saskatchewan, Cedar Crossing and Douglas Crossing in Ontario, reached 82.4% occupancy by the end of the quarter.We are very pleased with the continued growth of our retirement operations through acquisition and development. As previously mentioned, our new 103-suite Douglas Crossing community has outperformed our expectations and is already at 93% occupancy after only a year of opening. And this week, we are welcoming our first residents to the 47-suite addition. Interest in the addition has been robust with 46 deposits on-hand and 11 move-ins already scheduled before the end of this year. The total retirement community of 150 suites at Douglas Crossing has an expected NOI yield of 8.6%.The 2 development projects we have under construction in Bolton and Barrie are anticipated to deliver NOI yields of 7.6% and 8%, respectively. You can see these on Slide 8. These sites are on target to accept residents in early 2019 for Bolton and in Q3 2019 for the Barrieview.We are using the Barrieview retirement community to develop a smart retirement home concept, which we intend to be a prototype for future projects. We are exploring technologies that will enable independence by helping connect our residents with the information they need to stay well longer as well as offering them technologies that will help them connect more effectively with their health care providers. We anticipate we will be able to use the same technology platform in our home care division to support seniors in their own homes as well.Following completion of these 2 communities, our Esprit platform, which we launched 2.5 years ago, will have 11 communities with 1,052 suites. We are working on additional projects, 2 of which are expansions of existing communities. We are doubling the size of Empire Crossing in Port Hope. If all goes well, we will begin construction on the expansion in the summer of 2019. We are also pursuing expansion of Lynde Creek, which features 3.7 acres of surplus land ideal for an independent living development.On the next slide, you can see that revenue from our Extendicare Assist Management and Consulting Services team and our SGP Purchasing Partner Network increased 24.3% over the prior year quarter. Margins improved from 56.6% to 62.9%. The growth in these business units resulted in record high revenue and profit in Q3.Assist added 3 new centers, bringing 416 beds to its managed facility portfolio for a total of 53 senior care centers with capacity for 6,632 residents. The new contracts thus far in 2018 for SGP represent over 5,800 residents, bringing third-party residents served by SGP to over 51,000.We continue to experience increased demand for our day-to-day management services and clients are contracting with us for assistance with their redevelopment efforts while we provide analysis, application support and development services. In fact, Extendicare Assist recently secured a contract to provide consulting services in connection with Lakeside LTC Center, part of the University Health Network.So with that, I'll turn it over to Elaine to provide more details on the financial results. Elaine?

E
Elaine E. Everson
VP & CFO

Thank you, Michael, and good morning, everyone. I'll provide you with an overview of our consolidated results beginning with the NOI contributions of each of our business segments.Turning to Slide 11. Our NOI generated from Canadian operations was up 2.5% to $35.5 million this quarter with a margin of 12.7%, unchanged from Q3 of 2017. As you can see on the slide, this was driven from growth of $2 million from our retirement living operation, both organically and as a result of the acquisition completed earlier this year as well as the increased contribution from our management consulting and group purchasing operation.Conversely, our LTC operations were flat this quarter and our home health care NOI was lower by $2.2 million, experienced lower volumes due to the labor capacity challenges that Michael's just spoken about. Similar factors impacted the NOI from Canadian operations for the 9 months, where we experienced a $3.7 million or 3.8% increase over the prior year.As outlined on the slide, the 3 operations contributed an additional $5.3 million, of which $2.2 million was non same-store and Extendicare Assist and SGP contributed an additional $2.5 million. On a year-to-date basis, the home health care contribution was lower by $2.8 million and long-term care was lower by $1.3 million, impacted by timing of spending under the flow-through envelopes as well as higher cost of resident care and a favorable prior period revenue adjustment received last year.Turning to Slide 12, our consolidated NOI, EBITDA and AFFO. The improvement in our consolidated NOI this quarter was partially offset by a slight increase in our admin and lease costs, bringing the increase in our adjusted EBITDA to $400,000 over the same period of 2017 with a margin of 8.7%.For the 9 months, the consolidated NOI reflects the improved metrics discussed from our Canadian operations as well as lower investment income from our remaining U.S. operation. The investment income relates to income earned on the investment in our Captive that are held to settle self-insured liabilities remaining from those former operations.The earnings of the Captive do not impact our AFFO as any settled claims are funded by its cash and investments. Lower administrative and lease cost of $800,000 in the 9-month period due primarily to share-based compensation and professional fees brought the improvement in our adjusted EBITDA to $1.7 million and a margin unchanged at 8.6%.AFFO this quarter was $13.4 million or $0.151 per basic share and included a charge for our former CEO departure of $2.1 million on an after-tax basis or $0.025 per share. In comparison to Q3 of 2017, AFFO was down $2.2 million, reflecting the increase in adjusted EBITDA, the exclusion of the impact of lower noncash share-based compensation included therein and an increase in our current taxes and maintenance CapEx spending quarter-over-quarter.For the 9-month, AFFO improved by $2.4 million, reflecting the improvement in adjusted EBITDA and the lower current income taxes, partially offset by an increase in the amount of maintenance CapEx spending over the same period last year. We anticipate our effective tax rate on FFO will be in the range of 13% to 15% for the 2018 year.Our maintenance CapEx spend was $8.5 million year-to-date, and we expect it to be in the range of $11 million to $12 million for the year. Our payout ratio for the first 9 months this year was 70% compared to 75% in 2017.Now turning to our financial position on Slide 13. Our total long-term debt at September 30 was flat $540 million and relatively unchanged from year-end with debt repayments offset by construction loan draws and a new mortgage on one of our retirement communities. At September 30, our weighted average interest rate was 4.8% and the weighted average term to maturity on our debt was 8 years. Our debt to GBV was 46.6% and EBITDA interest coverage was relatively unchanged at 3.4x.We ended the quarter with cash on hand of $67.4 million, representing a decrease of $60 million from the end of last year, primarily attributable to the acquisition of Lynde Creek in the second quarter; growth capital expenditures; purchases of common shares under our normal course issuer bid; and costs incurred in connection with the refinancing of our convertible debenture.As Michael mentioned, one of our priorities is the redevelopment of our long-term care centers over the next few years, which will necessitate raising funds through debt financing and capital markets. We expect to be in a position to share more around our capital plans with you in the new year.With respect to our Captive, our provision for self-insured liabilities was USD 35 million at September 30, with 62 million of investments held to service those liabilities. And in October, we've repatriated USD 7.5 million of that cash from the Captive, bringing the total repatriated since the sale in 2015 to USD 28.5 million.With that, I'd like to turn it back over to Michael for his concluding remarks.

M
Michael R. Guerriere
CEO, President & Director

Thanks, Elaine. In summary, we had strong results from Esprit, Assist and SGP, steady performance from LTC and a drop in volumes within the ParaMed division. Despite this, I'm very optimistic about where we are going with our home care operations. We have embarked on a modernization program focused on technology infrastructure that is approximately 20% complete. Improvements in our HR practices will increase the size of our team available for care delivery. Given the success of efforts made to date, I will be looking for ways to speed adoption across the rest of our home care business.We are building momentum in the redevelopment of our Ontario C beds and envision this to be the start of a multiyear, long-term care redevelopment and expansion phase for Extendicare across the province involving 21 centers and over 3,300 beds, augmented by additional beds allocated by the government to Extendicare.Furthermore, our market leadership in redevelopment is providing opportunities to leverage our consulting and design services through Extendicare Assist, and we anticipate more growth on this front in the future as well. We're delivering on our plans to enhance our nongovernment revenue through the growth in the Esprit Lifestyle's platform with additional organic development underway.In summary, our mission of helping people live better brings together a growing societal need and an enticing investment opportunity. Providing seniors with services across the spectrum of care is a key element of our strategy. At Extendicare, we are unique in having the foundational building blocks in place to deliver that vision. With the investments we are making now in technology platforms and human resources, we will be well positioned to meet the growing needs of seniors, whether or not they reside in one of our communities.In closing, I want to pay tribute to each one of our more than 23,000 people at Extendicare, who work hard every day to make a difference for seniors. The passion they have for our mission is nothing short of inspiring. The quality of care we provide and the quality of lives that our residents and clients enjoy is our #1 priority and gives purpose to everything we do. I feel fortunate to be part of a team that is pursuing a mission so vital for Canadian society.So that concludes our formal remarks. We'll now be happy to take any questions you may have.

Operator

[Operator Instructions] Your first question is from Lorne Kalmar from TD Securities.

L
Lorne Kalmar
Associate

Congratulations, Michael, on the new role.

M
Michael R. Guerriere
CEO, President & Director

Thank you.

L
Lorne Kalmar
Associate

Turning to home health, where do you guys see the margins going over the next couple of years?

M
Michael R. Guerriere
CEO, President & Director

Well, I mean, as we've talked about, we've got a significant investment program going on that involves significant onetime spending that will last for the better part of the next 4 quarters. So that's certainly going to be an impact from a margin perspective. But that will come to an end, and we'll be able to decommission some of the legacy systems and take advantage of the new capabilities that those systems will give us from an analytics perspective, from a scheduling perspective. So we'll be able to speed up the growth of that particular business line. So we don't expect the margins to change materially from what we've seen historically. What we expect to see change is our growth rate as a result of these investments. But there will be a transient period, where we're facing these onetime costs as well as the -- just the duplicated cost of supporting multiple computer systems until we've consolidated to one.

L
Lorne Kalmar
Associate

All right. And how much are you guys expecting to spend of the new system in 2019?

M
Michael R. Guerriere
CEO, President & Director

Lorne, that's a great question. We are looking at that pretty carefully right now. I think we'll be able to give you more visibility to that in the next quarter. But at the moment, I think the way to look at it is that it will be significantly different from what our investment pace has been to date.

L
Lorne Kalmar
Associate

Okay. So I guess, kind of 8%, 8.5% would represent a good NOI run rate for 2019?

M
Michael R. Guerriere
CEO, President & Director

I think that I expect the performance of that division to be about the same in Q4. But then, as we get into next year, the volume increases that we're anticipating will probably offset some of the onetime costs. So it just depends on the rate of those 2 things and how they combine to set the margin.

Operator

Our next question is from Chris Couprie from CIBC.

C
Chris Couprie
Analyst

I just wanted to follow up on Lorne's comments there. So you mentioned that there's some onetime expenses that you're seeing in home care right now. Could you maybe just elaborate on what you mean by that and quantify it if possible?

M
Michael R. Guerriere
CEO, President & Director

Yes, the onetime expenses are due to installing a new computer system across the home care division. So when we made the acquisitions in the past, we inherited different information systems with each acquisition. So we're running 3 different systems to operate that division. We're consolidating them all to actually a fourth system, a brand new system, that we feel is state-of-the-art in the industry. So the costs associated with that are implementation costs to install a system as well as training for our entire team. We're also, of course, still shouldering the cost of the 3 legacy systems, which we'll be able to turn off when the new system is completely implemented. So that's the nature of the onetime costs that we're facing.

C
Chris Couprie
Analyst

And the magnitude?

M
Michael R. Guerriere
CEO, President & Director

Well, the -- I think that -- just as we said in response to Lorne's question, we're looking at adding that up and being able to disclose more detail on that in the next quarter. So I don't have a number to share with you at the moment. But we will be able to give you more of a picture of what that investment looks like over the course of 2019. We'll also be letting you know how far along we are. So we've implemented 3 of our districts to date that represents about 20% of our home care volume. We'll report that on a quarterly basis so you can track our progress. And as we implement the system, those offices that are getting advantage of it are the ones that will start to see an improvement in operations. So we're just getting started. I mean, we just went live with the system. We're still measuring what the impacts are on our operations. We'll be able to give you more visibility as we get into the new year.

C
Chris Couprie
Analyst

Okay. In terms of where these costs are kind of currently allocated, you called out the 92 and change percent of OpEx tied to labor. So is it basically -- is the costs of the systems and the implementation, are they appearing in the ex labor costs? Or is some of it in the labor cost as well?

E
Elaine E. Everson
VP & CFO

Chris, it's Elaine. There's a combination. The vast majority of the costs that we've seen to date are really around the implementation team and resources. There would be an impact within those labor costs as well as corporate lease trues up the infrastructure of our IT team. So we are aggregating and keeping them out, looking at opportunities as to how we can accelerate progress on that. And that's why we -- we're -- we expect to be in a position to be able to share a little more on a granular level over the next quarter.

C
Chris Couprie
Analyst

Okay, sure. And then just on the volume front. So the government last year said that they wanted to add 2.6 million hours of various types of home care service in the province. So in terms of the kind of submissions or requests for service from the government that you're seeing, would you say that the level of request that you're getting from the government is flat? Is it up? And it's just that your, for a lack of better word, your closing ratio is down?

M
Michael R. Guerriere
CEO, President & Director

Yes, it's definitely up. We've been turning down referrals, unfortunately, because of the lack of staff to fulfill those services in a number of districts outside of the GTA. In the GTA, we've been able to keep up. But other parts of the province of Ontario, we've had real difficulty with recruiting staff to be able to meet the demand. And just roughly speaking, we've turned down, over the past year, close to $100 million worth of referrals. So it's very significant demand. It's a fulfillment issue as to why the volume has dropped, not a demand issue.

C
Chris Couprie
Analyst

Okay. And just maybe big picture from change in government. Has there been any dialogue at all in terms of where the government stands with respect to LTCs funding home care and so on?

M
Michael R. Guerriere
CEO, President & Director

This government has indicated that they're continuing to look for ways to take pressure off the acute care health care system. The reduction of "hallway medicine", as they call it, has been a major focus for this government, and that will involve home care, long-term care, other community-based solutions in order to address that demand function within the acute care system. I made reference in my comments to ALC, or alternate-level-of-care, which is people who should be in the long-term care facilities that are in acute care beds in the acute care hospital system. And clearly, if they're there, then they're not able to admit new patients, and that's why we have so many people on stretchers in the hallways of emergency departments. So this is very high priority for this government. And so I expect to see continued support for expansion of long-term care and home care services over the course of this government's mandate.

C
Chris Couprie
Analyst

And where do you kind of sit on the private home care idea?

M
Michael R. Guerriere
CEO, President & Director

Well, we provide some private services. But as long as we're not fulfilling the referrals that we're getting from the public system, that will be our focus.

Operator

Our next question is from Michael Smith from RBC Capital Markets.

M
Michael Smith
Analyst

Michael, congratulations on your new position. I have a question, just again on home health care, and I know this was -- the major acquisition of the business was done before you were in management. So you're going from 3 systems to a fourth system. And I guess, the company's had a -- hired a consultant and you've been going through a process. Was that all part of the pro forma when the -- when you doubled the size of the business, so to speak? Or was that -- or is that basically something that's come out after you've tried to integrate the 2 businesses?

E
Elaine E. Everson
VP & CFO

Michael, it's Elaine. I was around at that time. And when we are -- when we acquired the home care business and doubled our size, we absolutely understood that there would be efforts to integrate and benefits of the synergies that we would get. So we were well aware they were running on 2 different platforms at that time as well as some -- another internal platform that we had on the scheduling inside. We're well aware that there would be initiative in order to bring those together. So considering it in the pro forma, I can't answer that level of granularity here. But absolutely, it was a factor that we were well aware we would be undertaking after we acquired them.

M
Michael Smith
Analyst

Sure. And Michael, have you made any changes since? I know it's early days since joining on the sort of the plan for the home care business.

M
Michael R. Guerriere
CEO, President & Director

Sorry, for the home care business?

M
Michael Smith
Analyst

Yes, home care business, yes.

M
Michael R. Guerriere
CEO, President & Director

Well, no. I'm on day 15. So it's been pretty early. But I can tell you that I've spent a lot of those 15 days focused on the home care business and understanding it. Just to top up on what Elaine said earlier, that the areas that are a bit of a surprise for us, if you look back over the last couple of years, are, one, the difficulty in finding people to fulfill the service. And the fact that our economy is performing so well means that it's hard to find people with the unemployment rate so low. And that, by the way, is not across the province. It's only in certain parts of the province where we're seeing that. As I said, in GTA, we've had no difficulty. It's been in other parts of the province. And then Bill 148 was a challenge as well. It caused significant compression in wage rates, and that has created more competition within the market from other sectors for people. So I think those things are -- have been surprising. But I think our nimbleness in being able to respond to those issues has been challenged by the fact that we were behind the 8 ball on the integration of these -- of the various businesses. So it's made things more difficult. In the midst of all of this, we're combining pay scales and computer systems and integrating the analytics that we have on each of our districts. So we'll get that sorted out in the next few quarters. And I think we'll be able to get back to the growth pace that we anticipated.

M
Michael Smith
Analyst

Okay. And just -- I'd like to try and get a sense. Again, I realized it's early days. You're only 15 days on the job. Like, from -- but you've been -- what do you -- like how do you -- what's the pecking order between LTC retirement and home care in terms of, like, the businesses that you really want to grow over the next 5 years? And where you see the most opportunity?

M
Michael R. Guerriere
CEO, President & Director

So yes, it's a great question, Michael. I think the way to look at it is, as opposed to a pecking order, is one of the synergies between those 3 businesses that we can achieve to create a more continuous set of services for seniors. So if you think about it as a progression, seniors go from needing some help to stay in their own homes to then moving to seniors living in assisted living and then moving through to requiring more residential care and nursing care in our long-term care facilities. Today, Extendicare is largely managing those 3 businesses as separate businesses just because of the history of those businesses. So a big part of our growth strategy is to look at ways that we can create combinations in synergies between those businesses. One, to get better operating results, but also to give our clients and residents a much better customer experience. And also, bringing technology to bear allows us to deliver care in different ways. So my focus is on getting growth out of all of our business lines, but finding ways that we can use each to provide synergy to the other in terms of improving our performance. I think the other thing that's important is the quality of our service and making sure that the customer experience is a positive one. And I'll be spending a lot of time on that aspect of it and creating a differentiated customer experience within the Extendicare community.

Operator

Our next question is from Yash Sankpal from Laurentian Bank.

Y
Yashwant Sankpal
Analyst of Real Estate Investment Trust

Yes, my first question is about your Douglas Crossing development. So you said the expected NOI is 8.6%. What is the market cap rate there right now? If you were to sell the property right now, assuming it is fully stabilized, what kind of cap rate would you get?

E
Elaine E. Everson
VP & CFO

I think that, that is a market area that I would think would demand a cap rate that is -- it's probably in the low 6s. But that's a speculative number, Yash, but it's a great community. It's got a great community. It's got a high demand in the market. It's a first-class building. So it's been a very big success story from our perspective.

Y
Yashwant Sankpal
Analyst of Real Estate Investment Trust

Right, okay. So roughly 40% upside just from value creation perspective. Okay. The second question is on home care. So when you say you're going to fix the problem of fulfillment and you're going to get your staff ready for the demand, does that mean, essentially, you're going to pay higher wages to your -- the people you're going to hire?

M
Michael R. Guerriere
CEO, President & Director

It's a good question. And I think it's going to involve a number of measures. One of the things that we're looking at very closely is the whole issue of scheduling services and how we fulfill the demand that we're getting for the market. Scheduling is a key part of it because it determines how many hours that we can give to every one of our care workers. And they're very focused on being able to get a sufficient number of hours in order to achieve a target total income. And we've been looking at this very carefully because a lot of our employees are not working full-time hours and many of them want to. So it's more about changing the relationship that we have with our team. And we're exploring ways to do that and offer more of our team a full-time status and being able to incorporate that into our scheduling systems to be able to optimize the way that we perform. So it's more a focus on that. It's also a focus on training and being able to offer people a very compelling career trajectory. So that's another place where we think we can leverage our continuum. We employ people in one of our three divisions. Giving people opportunities for more mobility between those divisions, I think will create more career opportunities for some of our people. So there are a lot of things that we can do that will substantially improve our employees' experience without necessarily changing the average hourly rates that we're having to pay.

Y
Yashwant Sankpal
Analyst of Real Estate Investment Trust

Right, okay. And just for my understanding, what happens when you are not able to cater to a particular patient or the government wants you to provide them care, but you don't have staff. So where does it go?

M
Michael R. Guerriere
CEO, President & Director

Those referrals would be offered to another company or another supplier.

Y
Yashwant Sankpal
Analyst of Real Estate Investment Trust

And does the government give the same, like -- same rate to those guys as you or they are different...

M
Michael R. Guerriere
CEO, President & Director

Yes. No, those are standard. They're absolutely standard.

Y
Yashwant Sankpal
Analyst of Real Estate Investment Trust

And so if you are not able to find enough people, say, outside the GTA, how are other guys able to do it? Just, like, on a broader scale. What do you think is happening?

M
Michael R. Guerriere
CEO, President & Director

Well, the details of the referral acceptance rates are not shared. So we don't have the information about how much of the care that we are unable to fulfill isn't fulfilled by other people. Anecdotally, we know that shortages of supply in certain parts of the province are a major problem, and that governments and agencies and hospitals are struggling to pick up the slack where we're not able to provide the care in people's homes. We're also looking at different models in terms of how we do it. So as you can imagine, in a home care situation, people are traveling quite a lot, a fair bit of their time is spent traveling from house to house. So we're exploring other models where when certain people are more mobile, that they may be able to come to the central office to get some of the services that they would have been able to get from a home care perspective. So there's a lot of different things that we're doing to try to figure out how to be more efficient and provide that -- fill that gap in care that we're seeing.

Y
Yashwant Sankpal
Analyst of Real Estate Investment Trust

Okay. So what I'm trying to understand is, if this situation persists, would the government step in at some point and say, "You know what, maybe we should provide more funding to this particular area to make sure that everybody gets the care that they need."

M
Michael R. Guerriere
CEO, President & Director

Some of the liens are already exploring that, but we don't have any decisions on that front that we can share with you at this point. But we'll see how that evolves.

Y
Yashwant Sankpal
Analyst of Real Estate Investment Trust

All right. And just one more question. You said that you're exploring various synergies that are possible between your divisions. Can you give us some examples?

M
Michael R. Guerriere
CEO, President & Director

At this point, I think it would be speculative for me to get ahead of the game on that front. So I think I'd rather defer the answer to that question until we have something definitive to announce.

Operator

Our next question is from Doug Loe from Echelon Wealth Partners.

D
Douglas W. Loe
Analyst of Healthcare and Biotech

Yes, my questions have been answered.

Operator

[Operator Instructions] Our next question is from Chris Couprie from CIBC.

C
Chris Couprie
Analyst

Just one follow-up for me, guys. How should we think about your cash position?

E
Elaine E. Everson
VP & CFO

On -- we -- our cash position ended the year, Chris, at about what, 60 -- $64 million. I think that our cash position and our cash from operations are comfortable. But as we grow, as we look at our -- as we activate our redevelopment, as we look at development opportunities, we will be looking for -- raising capital either through a combination of debt and the capital markets. And I think that we'll be in a better position to maybe share a little more of that with you early in the new year.

C
Chris Couprie
Analyst

Okay. So is it safe to say then that the cash you currently have on hand is more earmarked for development and redevelopment versus making acquisitions?

E
Elaine E. Everson
VP & CFO

No, it will be a transaction by transaction decision. I mean, there's a level of operating cash that needs to be there. The excess cash that is there can begin some of that. But with the amount of redevelopment that we have ahead of us and our growth plans, it'll go beyond what's on the balance sheet right now.

Operator

There are no further questions registered at this time. I would like to turn it back over to you, Ms. Fountain.

J
Jillian E. Fountain
Vice President of Investor Relations

Thank you, Rick. That concludes our call for today. This presentation is available on our website as are the call-in numbers for an archived recording. Please don't hesitate to give us a call if you have any further questions. Thank you again, everyone, for joining us. Goodbye, and have a good weekend.

Operator

Thank you. The conference call has now ended. Please disconnect your lines at this time, and we thank you for your participation.