Initial Planning of starting an Adult Day Care facility

Initial Planning

1.      Research  Information

a.      Have you reviewed the state adult day regulations?

b.      Have you reviewed the requirements of the funding sources for adult day services?

c.       Have you visited existing adult day centers to observe the program in action?

d.      Have you visited the websites of the National Adult Day Services Association www.nadsa.org  and other professional adult day organizations?

e.      Do you plan to be accredited by the Commission on Accreditation Rehabilitation Facilities?  

2.      Assess Your Community’s Need

a.      Are there existing adult day centers in the area where you wish to open your program?

b.      Have you spoken with or interviewed local agencies? (i.e. Alzheimer’s Association,

c.       Area Agencies on Aging, Discharge Planners, etc.)

3.      Target Population

a.      What population(s) is the center planning to serve? (i.e. individuals with a dementia related disease such as Alzheimer’s, individuals with physical disabilities, individuals with developmental disabilities, etc.)

b.      Have you studied the demographics of the target population?

4.      General Business Plan

a.      What is the center’s philosophy?

b.      What services would the center offer? (i.e. bathing, medication administration, physical therapy, occupational therapy, counseling, etc)

c.       Have you completed a market analysis?

d.      Does the center have a marketing plan? 

co-housing New Trend

GOODBYE NURSING HOMES!  THE NEW TREND IS CO-HOUSING WITH FRIENDS

Their homes would be “future-proofed”, allowing them to make mobility adaptations in later years if they needed to and thus to live independently for as long as possible. But crucially – unlike standard sheltered housing – the development would be designed and managed by the community itself, and the residents would choose each other.

Schemes like this have been an established option in parts of mainland Europe since the 1970s – there are 200 senior cohousing schemes in the Netherlands alone, according to the UK Cohousing Network – but no one has successfully imported the model to the Britain until now. When Ratcliffe and the other members of the Older Women’s Co-housing group (Owch) move into their properties next year, they will become Britain’s first cohousing scheme specifically designed for and by older people.

It is an option that the charity Age UK would like to see available much more widely to people moving into old age, according to policy adviser Joe Oldman. “We think it makes sense, especially for people who are friends or have things in common, to be able to come together and to support each other. We think [cohousing] could have a really important role.”

“I think the problem has been with the practicalities of actually setting up cohousing schemes,” says Oldman, and in the case of the Owch development, that is quite an understatement. The project was first conceived 15 years ago, since when the group has explored numerous potential sites and development partners before finally securing the Barnet land in association with the developer Hanover.

Maria Brenton, trustee of the UK Cohousing Network, said delays to these kind of projects were due to sky-high land prices, councils that don’t always understand the co-housing model or which prioritise housing for younger age groups,and the difficulty of securing developer or housing association partners.

Co-housing is such a lot of work, it's not for the fainthearted

Maria Brenton

“Cohousing is such a lot of work, it’s not for the fainthearted,” she says. “But certainly there are older people clamouring for it.”

On a small, steep plot of land on the outskirts of Colchester in Essex, another group of enterprising older adults are making plans for their own cohousing scheme – one of a dozen or so similar projects in development across the country. Unlike Owch, the London Countryside Housing Group (LoCo) is open to men and women, andis being developed without the help of a housing association, meaning that its members have had to privately buy their site, on the grounds of a historic wooden-clad mill, in open competition against commercial developers.

The group started, says Anne Thorne, with friends who took regular walks together: “All of us were looking after our decrepit parents and thinking, ‘Oh God, there must be a better way’.”

Thorne, an architect, has designed 23 low energy houses and flats they hope to build in the grounds of the mill building, which will be used as a communal house with shared kitchen, lounge and guest bedroom facilities. Her designs will be submitted to the local council for planning approval next week.

The LoCo group, too, has been working for almost a decade to get the scheme off the ground.It is “madness”, agrees Thorne, that setting up a scheme like this should be so difficult. She hopes the government-backed self-build and custom house-building bill, which seeks to increase the self-build housing market and is passing through parliament, could encourage cohousing developments, by requiring councils to create a register of people interested in building locally and to take that into account when allocating land. There is no guarantee, however, that the bill will be passed before the election.

Some suggest that more could be done to encourage a range of different housing options for older people, given the shortage of suitable homes. Retirement home builder McCarthy and Stone is calling for “a national strategy led by government that looks constructively at the needs of older people”.

“Our position is that different people want different things from their housing, and cohousing is one thing that should be available to them. But it might not suit everybody,” says Oldman. “The point is to have a range of things that will give people choices.”

With building work finally about to begin on her home, Ratcliffe, who is 81, admits she is “desperately keen” to get on with her new, collective life.

“People don’t have to be bosom pals, but there will be social activities if you want to join in, maybe once a week we’ll cook a meal together, we might employ someone to do our cleaning. There are a lot of decisions to be made. But the important thing is, they will be our decisions, and there won’t be anybody imposing them on us.”

How much Money do you need to start an assisted living

So, how much money do you need to start an assisted living facility?

The amount you need will depend on a many factors.  What is the cost of real estate in your area?  How many changes, if any, are needed to your property?  Will you be working in the facility, or hiring staff or managers to do all the work?

The exact amount is something you need to calculate for your own circumstances.  But here is a list of things to keep in mind when you do the math.

• Down Payment.  You may be buying, building or converting your new assisted living facility.  In either case, you will probably be financing most of the price.  Lenders will normally require a down payment equal to 20% to 25% of the cost.  Yes, there are many ways to reduce that percentage but this is what most will need.

• Start Up Costs.  So now that you have your building, it’s going to need furniture, equipment, supplies.  Some estimate this amount to be $3,000 to $5,000 per unit after accounting for both resident unit and common space furnishings.   Your facility may be more or less based on its size and on both the quantity and quality of the furnishings you provide.

• Working Capital.  This is an area where many undershoot their estimate.  Working capital is basically the cash you have in your checkbook to fund operations after you’ve bought, furnished and supplied your facility.  If you’re buying an existing facility that is producing positive cash flow, it will be much easier to estimate the amount you need:  often that’s 30 to 60 days of operating expenses, including all payroll, mortgage payments and all other costs.  If you’re starting from scratch with no residents in a facility that you build or convert, then it gets more complicated:  how long will it take to lease up? when will you reach break-even? will the rates you expect to receive turn out to be those you do?  You will learn more on this site soon about estimating your working capital needs during a start-up, but for now plan to fund operations for at least three to six months before reaching break-even and maybe longer for larger facilities.

Let’s look at the following example.

Jane is buying a 40 unit assisted living facility at a cost of $4 million.  The facility generates $120,000 a month in revenue but expenses and debt service amount to $90,000 a month.

First, Jane will need at least a 20% down payment of $800,000.  Second,  since the facility is already operating and comes with furnishings, she only plans to make about $50,000in improvements to the furnishings and equipment.  And third, with expenses running at $90,000 per month, Jane sets aside $180,000 for working capital to make sure she isn’t stressed financially.

That’s a grand total of $1,030,000 needed for Jane to get started in her own assisted living facility.

Using Medicaid to pay for Assisted Living

From the consumer perspective, there are pros and cons to each of these approaches. Waivers usually allow participants to have much higher income eligibility limits than regular / State Plan Medicaid. In 2016, Waivers usually allow monthly income limits of $2,199 while Medicaid State Plans may limit income to $733 / month. Note these are very general numbers, they vary by state, marital status and with other factors. Waivers are almost always enrollment capped. They have a limited number of “slots” available and waiting lists are common. Regular / State Plan Medicaid is an entitlement and therefore these programs cannot limit enrollment. Finally, Waivers almost always require the participant to have “nursing home level of care needs”. Regular Medicaid can be less restrictive with the care requirements of program participants.

Forty-six states now provide some level of financial assistance to individuals in assisted living. However, the term "assisted living" is not used consistently across these states, nor are their definitions or benefits the same. Other terms which are used include: residential care, adult foster care, personal care homes, supported living and several other variations. Some states pay only for personal care services received in assisted living, others include nursing services. Coverage for medication administration, chore and homemaker services even recreational activities varies by state. No state is permitted to pay for room and board costs in assisted living, but states have other means of controlling these costs such as by capping the amounts the residences can charge, offering Medicaid eligible individuals supplemental assistance (from general state funds) to cover room and board and paying for meal preparation and serving but not actual food costs.

The past ten years have seen a dramatic increase in the number of states whose Medicaid's programs provide financial assistance for assisted living residents. We expect this trend to continue until all 50 states and D.C. are included.

long-tem care numbers

At least 60% of home health agencies, hospices, nursing homes, and residential care communities were for profit, while about 40% of adult day services centers were for profit (Figure 4). The majority of nursing homes and residential care communities were chain-affiliated, while the majority of adult day services centers were not chain-affiliated  

Hacking into Secure Healthcare Files

In 2017, healthcare organizations are predicted to be one of the top targets for cyber security threats. Historically, healthcare has ranked in the top of the list, but this year it has moved to the front of the line. Security breaches involving more than 500 records have increased 300% in the last three years. The recent announcement from CMS at https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Downloads/Survey-and-Cert-Letter-17-17.pdf confirms just how serious everyone needs to treat this issue.

ASSISTED LIVING SMALL BUSINESS PACKAGE

If you are starting an assisted living for no more than 17-24 beds, this package was designed for you.

It all has the essentials for starting your project. A Business Plan, A Senior Living Demographic Study to find the perfect location for your facility, Administrative Guidelines to guide you in all the right directions with the operations, Basic Operating Procedures and job descriptions for all staff, And The Complete Guide to Operations, Marketing and Management.  It's a package designed to assisted you in starting your own Assisted Living Facility.  Call with questions or how we can customize this package to suit your needs.