Graying demographics spur assisted living
Ineffective pricing creeps into private duty contracts
A growing population of the frail elderly and a need for less costly ways to care for them is feeding the growth in assisted living. And as assisted living communities continue to grow, so do the opportunities for private duty home care providers, says Molly Miceli, CEO and founder of the Chicago-based LifeStyle Options, which specializes in providing personal care services to older adults.
The $12 billion-a-year industry is expected to grow to $30 billion by the year 2000, says Whitney Redding, director of media and public relations for the Assisted Living Federation of America in Fairfax, VA. Up to 1.5 million Americans live in an estimated 30,000 to 40,000 assisted living communities. The key to capturing this market is understanding the concept of assisted living communities and to determine what the gaps are in the care they provide. (For more statistics on assisted living communities, see p. 43.)
Assisted living offers residents help with daily living, but avoids the regimentation of medical settings. Its based on a residential model rather than a medical or institutional model, Redding says.
Although no single blueprint exists for what assisted living communities should look like or how they should be run, Redding says, they do share a philosophy that promotes independence and dignity.
Find your niche
Nancy Cobb, vice president of the Atlanta-based Arbor Co., which develops and manages assisted living residences in the Southeast, says assisted living communities use one of three models to provide activities of daily living:
• Set up their own home care agency to capture additional revenue.
Few assisted living communities do this, Cobb says, leaving the window of opportunity open for private duty.
• Hire their own staff.
This is more prevalent, especially among the larger communities. But even within this model, there are gaps in care that a private duty home care provider can fill.
The staffing is not set up in assisted living to provide one-on-one care, says Cobb. A resident coming out of the hospital, for example, might need a sitter or personal attendant around the clock for the short term.
Although the resident or the resident’s family has the final word on who will be hired, sometimes the assisted living community keeps a preferred agency list.
It’s important, therefore, to talk to administrators and listen carefully to determine their needs, Miceli says.
• Contract with a home care agency.
"Its a trend in the industry; actually, it’s a trend in business, in general, to outsource," says Mary Brickel, vice president of development and employee training at Constellation Senior Services, an Arlington, VA-based company that manages 2,000 units, some of which are assisted living.
For agencies who want to contract with assisted living facilities, it’s very important to get involved in the developmental phase, Cobb says.
How do you know when a development is going up? Here are some signs:
• Look for signage at new building sites.
Usually signage goes up before ground is broken.
• Investigate building permits.
Check with the governmental agency that issues these permits. The information is public record.
• Network with agencies on aging.
They usually know about new developments for the elderly.
• Visit assisted living communities.
Ask if they are planning on expanding locally. Even if that assisted living community hires its own staff, the new community might opt for out sourcing, says Cobb.
Communicate constantly
When a home care agency contracts its services to an assisted living community, warns Cobb, it has to be a strong partnership.
Miceli suggests talking about philosophies up front. Because her company’s philosophy to keep older adults independent as long as possible is compatible with the concept of assisted living, the partnership was a natural fit. The assisted living market now accounts for 50% of her company's business.
"We want to make sure there’s a match philosophically between ourselves and that home health agency if we use them," adds Brickel. "That tells how they are going to deliver the care."
Here are other important aspects of the private duty/assisted living relationship:
• Consistency and training.
Miceli’s staff undergoes extensive orientation and training before placement at an assisted living community.
"A lot of the folks we hire are certified CNAs, so we obviously look for [agencies] that have the ability to provide that training or keep that certified nurse assistant updated," says Brickel. "It’s a way of gauging the expertise of the individual."
Brickel also says she looks at the inservices the agencies provide, such as sessions on safety practices and understanding the geriatric patient.
• Maintain the same staff.
"How would you like a stranger coming into your home every day?" Miceli asks.
• Be adaptable.
Agencies must be adaptable to the needs of different types of assisted living communities, Brickel says. "They have to be adaptable in terms of how they train in our environment."
• Quality of care.
You have to have the clinical skills, but you also need to know how to word it, how to communicate it, and to have that residential feel and approach to caregiving in an assisted living community, says Brickel.
• Policies and procedures.
"We make sure there is a match between their policies and procedures and ours," says Brickel.
Miceli cautions, though, that providing services to assisted living communities is not as easy as it sounds. "We see it again and again that people get in over their heads," she says.
The biggest pitfall that potential health care providers face is ineffective pricing for their services. Usually, assisted living communities pay "X" amount of money per resident per month for a predetermined package of services. Many people get into trouble if they don’t anticipate overhead or if they forget that every resident requires different services, Miceli says.
Home care agencies should find out how many residents they’ll be serving, what type of services each resident requires, and how long it takes to provide those services.
Not doing your homework can have consequences: The half hour estimated for Mrs. Jones’ bath is now taking an hour. And, the 15 minutes to escort her to the dining room turns into 30 minutes. Although it takes twice as long to perform those services, the agency still earns the same amount of money.
"We learned the hard way. Now, we track our costs really aggressively," Miceli says.
Another caveat for potential providers: Stay informed about changes in reimbursements and states’ moves to regulate assisted living. According to Redding, 31 states either have or are establishing policies for assisted living, while 13 others are studying the issue.
[Editor’s note: For more information about the Assisted Living Federation of America in Fairfax, VA, call (703) 691-8100.]
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