When proposing an idea aimed at helping or caring for the elderly, there are literally thousands of considerations to be made in every arena of the venture. The purpose and goal of this proposed assisted living community for the elderly is to make aging an adventure and to allow seniors to have as much independence as possible while still providing the most intensive and committed care. What should separate this proposed assisted living center from others is a determination to create an atmosphere that allows the medical, palliative care, and lifestyle decisions made to intermingle seamlessly. By providing residents at this projected assisted living facility with expert physicians around the clock, well-trained and experienced elderly care professionals, an efficient and knowledgeable in-house pharmacy staff, and well-maintained living and recreation quarters, it is hoped that this operation will be a rewarding experience for all parties involved.
The assisted living industry is steadily growing as an increasing number of “baby boomers” are reaching retirement age. As they grow older, naturally there will be increased need for not only beds and qualified staff in every division, but for the industry as a whole. Competition is fierce, particularly after the mid-1990s boom in such facilities being built. In order to stay competitive and provide the best possible care an efficient, realistic, and manageable business model covering all aspects of the industry is absolutely vital. This proposal will outline the amenities of the assisted living community along with the practical financial and other considerations necessary to helping it thrive amidst stiff competition. As a final note, this vision statement’s main goal is to express a desire to work to appeal to potential residents. This is a “double-bonus” because we are not only going to be able to provide a number of incentives to prospective residents, but because with more actual residents our community can grow as a unit and hopefully attain financial success—even after insurance, staffing, and other cost considerations are factored into the equation.
There are a number of options in the elderly care industry, including traditional nursing homes that are more directed toward those who are ailing or are significantly disabled or otherwise impaired in old age. As it stands, however, those who are reaching retirement age have voiced their opinions for a number of studies about their future options. For instance, in one study, “Of pre-retirees ages 50 to 65, 91% responded that they want to live in their own home in retirement. Of that group, 49% want to stay in their current home, and 38% say they want to move to a new home, with the remainder not sure” (Timmerman 2006). It should be pointed out that none of their alternatives involved any kind of assisted living or palliative care, nursing home or otherwise. Unfortunately, the fact remains that many of these respondents will end up requiring some kind of physical or mental care as they further age. The point of these data is that there is a strong sense of independence they desire and none of them even wish to consider the possibilities of managed care. Interestingly, however, the same study of these respondents was asked to answer a questionnaire regarding which of the elderly care service types they would most prefer if they were forced to choose. In concurrence with the data showing that the majority wished for independence and the ability to associate with others, “Forty-seven percent chose an active adult community, 37% a life care community, 34% a clustered living community, and 22% a new home to share” (Timmerman 2006). In terms of this proposed assisted living care, it is clear that potential resident’s desires lean toward an independent lifestyle near others. They wish to remain active and perhaps would rather not dwell on the potential medical issues that will most certainly arise as they further age. Using data such as this, it is known that our assisted living facility will offer as much independence as possible (while providing, of course, expert medical care) and will provide residents with the opportunity to be active members of the community. By combining all of their stated desires we can strive to match them as closely as possible given the constraints of being a facility.
Staying active is an important part of a healthy social, emotional, and physical lifestyle and since we want residents to be in the best shape possible, our recreation facility will offer a large area that can be devoted to any number of activities. “Even with the United States population rapidly aging, a smaller proportion of elderly and disabled people live in nursing homes today compared to 1990. Instead, far more depend on assisted living residences or receive care in their homes” (Stavros 2005). Part of the reason this shift has occurred is because more and more elderly people enjoy remaining active as long as possible and with other people their age. Given the fact that space is limited (since we will need to construct as many beds/rooms as possible within the allotted space in order to maximize our efficiency) we will not provide large facilities such as tennis courts. Instead, we will maximize space by building a safe, well lit, and smoothly paved track along the outer perimeter of the facility. This will allow small groups or couples to walk side by side at their own pace while enjoying one another’s company and staying fit and active. The lighting will be bright enough so that the chances of falls or slips would be reduced and the paving will be as smooth as possible to minimize incidents of tripping and falling. In addition to this, the indoor area will have sections devoted to particular activities such as movie-watching, quilting, card and chess playing, or space for community-based clubs to meet. This area will be built in the middle of the facility and will be surrounded by lookout areas where staff can discreetly ensure the safety and well begin of residents without being overbearing, thus allowing them to maintain the sense of independence. Other activities will include gardening where each resident will have a small plot, as well as scheduled activities that may or may not involve the staff. Having staff that interacts well with the residents is a must and this will certainly be one of the criteria during the probationary period all potential full-time staff members must undergo. Again, as stated in the vision statement and elsewhere, we want to provide a caring environment but also one that caters to the desire for independence.
Logistically speaking, the structure of the center is one of the most integral elements of these early planning stages. For instance, it has already been suggested that all space must be used wisely. In such a center, the more beds that we are able to put on the lot will allow for greater financial success of the center later. While we do not want to make the facility feel overcrowded, there are ways to maximize the usage of space. As stated, the recreation area will be in the center of the complex with the resident’s quarters in a concentric manner around the outside of it. This “ring” of private one-bedroom residences will also contain a row of quieter palliative and nursing care rooms that are located closer to the nurse’s station and doctor’s quarters. The outside of these units will be surrounded by individual garden plots for plants, flowers, or small vegetables and yet another outer ring will contain the walking path. By putting things in such a circular fashion with the recreation center at the center, there is a “center” for the residents to gather and if they chose to move to the “fringe” for a while, it is always a possibility. Overall, the structure of the facility itself lends to the idea of preserving the sense of community as well as is economically efficient since it maximizes space without sacrificing ambiance.
Just as the outer structure of the community is important, so too are the personnel who maintain and direct the daily functions. There will be a pyramid structure to the leadership paradigm with the owners and director and the top. The owners will manage the financial decisions solely and offer input into the daily proceedings of the facility and these directions will be passed down and mediated by the head director of the facility. Each division including nursing, physicians, cooks, janitorial, and other staff will all have a division manager who is responsible for making job-specific decisions and discussing and mediating issues and ideas with the director. For each person under the director there is an assistant manager who can handle other duties and stand in as a fill-in in the division is absent. This is a very traditional leadership structure that may change eventually, but for such a large facility and so many divisions that are vital to success, this is the best management solution and will allow for a more focused exchange of ideas, information, and issues.
Aside from the recreation as a focal point for potential and current residents, one of the most alluring aspects to this proposed center will be the 24 hour, 7 day per week availability of trained and certified physicians who specialize in geriatric care. Although the issue of independence and freedom from a “nursing home-like” feel is important, so is the fact that residents will at least rest assured that they will provided with in-house care at any given moment. This is especially important as the population of the assisted care center grows older within the facility. As one scholar notes:
The number of persons age eighty-five or older is projected to triple by 2040. This so-called older-old population tends to be less healthy and more socially isolated and is more likely to have two or more chronic conditions, more likely to have at least one functional limitation, and more likely to have mobility and social activity limitations than persons between ages sixty-five and eighty-four” (Gusmano 2004).
With any number of variable medical conditions, it is of vital importance that these physicians are trained in geriatrics. Many illnesses such as dementia and Alzheimer’s disease will require special attention and the doctor on call during his or her shift must be intimately familiar with each resident. In order to preserve continuity in care, these medical personnel must be paid as competitively as possible, even if it requires the price of a bed to rise significantly. This risk will be taken with the impression that many of potential residents will value the prospect of having a doctor whom they are very familiar and see around the community daily. In order to maintain these physicians for the long term, their salary must high. Consistency is key, especially when there are likely to be a number of palliative care and serious illnesses to contend with. Again, while this is a “selling point” of the community, it can also be a dangerous gamble if we are not careful to realize how to best fit such personnel into the business plan. It is even trickier when we consider later the problems and costs associated with insurance, but it may be well worth all of these risks in the end.
Along with the constant medical care available on site, another prominent feature of the community is the full-time presence of trained, certified, and experienced pharmacists. “Approximately 75% of residents in assisted living facilities are 80 to 95 years of age and routinely take an average of 6.2 medications per day. Overall, in the United States, individuals 65 years of age and older compromise 13% of the population and account for over 30% of prescription drug use” (Setter 2002). In a community such as the one proposed, it would be rare for any resident to be without a regime of daily prescription drugs. Instead of relying on outside providers for resident medication, it seemed best to bring them together with the full-time physicians on site so that the possibility of miscommunication could be greatly reduced. The pharmacy manager and managing physician will meet once per week to determine the course of the coming week and to discuss any relevant issues, a luxury that is not to be found at even the best hospitals for the most part. In essence, this will make our community very much like a small hospital since both the attending physician and pharmacist will be on site. As an added benefit, residents desiring to pick up their own medication could do so if they signed a form stating that was their desire. This would make them feel more independent, just like running out to the drugstore. As a safety precaution, however, staff would have a checklist of current prescribed medications that were due to be refilled and if a resident forgot his or her medication, they would notified and could have it delivered to their unit.
Aside from the initial cost of these outstanding services for residents, one of the most pressing issues concerns insurance. While the cost of building and maintaining the facility on a basic level is not difficult, especially with the wide variety of federal money for such ventures, the extras such as full time pharmacy and medical care will be taxing. Most of the reason for the cost is not just comprised of basic salary, but of insurance as well. Insurance for assisted living communities to cover the cost of damage such as fire, flood, and wind is skyrocketing and can make up over 30% of operating costs (Moore 2001). It is not a simple task to bring an assisted living community up to par with the demands of insurance companies and stricter new federal and state laws are making things more complicated and expensive. “Currently, state regulations of assisted living facilities use several strategies to ensure the health and safety of residents, such as mandatory physical plant requirements, requirements for staffing level and experience, criteria for clinical status of residents, or limitation on the scope and frequency of clinical services” (Kissam 2003). In the strategy for this community, there must be an allocation of over 40 percent of start-up resources for insurance purposes alone and this must extend through the first five years in such a manner. Once nearly all beds are filled to maximum capacity, the allocation may go down, depending on coverage, but this is by far one of the most daunting aspects of the enterprise for any assisted living or nursing home business, especially in the beginning stages.
This is obviously like a small city without shops. Food service, medical care, and a drugstore all lie in part of the circular area surrounding the center recreation center or “town square.” Residents will have private living quarters and can determine their personal level of participation and level of independence desired. While it will be possible to provide seclusion, we will encourage participation in activities to keep everyone as healthy and happy as possible. Staff will be well paid and will comprise 40 % of the facilities monthly budget (with insurance, at least at the beginning remaining anywhere from 30 to 40% of overall costs. Outside costs such as that of food, utilities, and other goods and services will comprise the remaining strictly-controlled 15% which leaves a slim 5% for the month as profit. Naturally, the costs will level out, but this is the most risk-free, realistic, and possibly overstated (since profit margins may turn out much higher) business plan. At all times it will be important to refer back to our vision stated at the beginning to help us remember that we are trying to provide the best possible care in a managed, well-maintained, and profitable assisted living community.
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Palliative Care: An Examination of Theory and Practice
Substance Abuse and the Aging Population
Sources
Gusmano MK. (2004). Review essay. Assisted living. Journal Of Health Politics, Policy And Law, 29(6), 1227.
Kissam. (2003). Ethics, Public Policy, and Medical Economics: Continued-Stay Criteria for Assisted Living Facilities. Journal of the American Geriatrics Society, 51(11), 1651.
Moore J. (2001). Affordable assisted living. Contemporary Longterm Care, 24(1), 27.
Setter, S.M. (2002). Managed Drug Use in Assisted Living and Home Care Settings: Who Benefits? Disease Management & Health Outcomes, 10(8), 469.
Stavros. (2005). Aging, but not in nursing homes. American Nurse, 37(5), 4.
Timmermann, Sandra. (2006). Housing and retiring living: Redefining the continuum.. Journal of Financial Service Professionals, 60(1), 23.
