Download Affordable Assisted Living in Alaska - Alaska Department of Health PDF

TitleAffordable Assisted Living in Alaska - Alaska Department of Health
Author
LanguageEnglish
File Size2.2 MB
Total Pages100
Document Text Contents
Page 1

Affordable Assisted Living in Alaska

Honoring Traditions by Keeping Our Elders Close to Home

Financial Feasibility Analysis
and

Business Plan Guidebook

State of Alaska
Department of Health and Social Services

Senior and Disabilities Services

Page 2

Financial Feasibility Analysis and Business Plan Guidebook

Affordable Assisted Living in Alaska

Affordable Assisted Living in Alaska

Financial Feasibility Analysis
and

Business Plan Guidebook

Published and Funded By

State of Alaska
Department of Health and Social Services

Senior and Disabilities Services

Robert Wood Johnson Foundation
Coming Home Program

Alaska Housing Finance Corporation

Project Steering Committee

Alaska Department of Commerce and Economic Development
Alaska Department of Health and Social Services

Alaska Housing Finance Corporation
Alaska Native Tribal Health Consortium

Denali Commission
HUD Office of Native American Programs

Rasmuson Foundation
USDA Rural Development

Written By

Patricia Atkinson
Senior and Disabilities Services

Terri Sult
Vista Senior Living

Robert Jenkens
NCB Development Corporation

Graphic Design

David Singyke

April 2004
Revised February 2008

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Financial Feasibility Analysis and Business Plan Guidebook | 46

Affordable Assisted Living in Alaska

A similar example would be a male, 44, with advanced Multiple Sclerosis. He has a wife and three
children in the community, but they are no longer able to care for him at home due to his high
care needs and their other responsibilities. Requires maximum assistance with all ADLs and has
some paralysis and seizure disorder. Resident is on antidepressant medication and has frequent
mood swings that make it difficult to care for him.

MAXIMUM ASSISTED LIVING HOME RESIDENT WITH DEMENTIA
Female, 92, in the advanced stages of Alzheimer’s disease. This client has family in the communi-
ty, but is no longer able to recognize them. She is able to ambulate and has few other physical
health problems. She has a poor appetite, is unable to chew and has difficulty swallowing. All food
must be pureed and she needs physical assistance to swallow. She is incontinent of bowel and blad-
der and is afraid of bathing. She is often agitated and can be verbally abusive. She has difficulty
sleeping and often gets up in the night and wanders around, trying to get out of the house.

MINIMUM ASSISTED LIVING HOME RESIDENT
Male, 76, with high blood pressure and coronary artery disease, past history of mild strokes. He
has never been married, and has only a few friends that visit infrequently. He has some right side
paralysis that inhibits his ability to perform his ADLs without supervision. He is able to eat on his
own, but cannot prepare meals. He is still able to handle his own financial affairs and makes his
own medical appointments. His primary needs from the assisted living home are supervision and
cueing.

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Affordable Assisted Living in Alaska

F. Description of Home and Community Based Services

Care Coordination – A service that helps clients to gain access to needed medical and social serv-
ices. A care coordinator will assess clients’ medical and social needs and work with other agencies
to provide for those needs.

Information and Referral – Provide seniors with information about where they can obtain needed
services (medical, social, legal, etc.) to continue to live independently.

Congregate and Home Delivered Meals – Meals for seniors provided in a senior center, village
school or other community setting where seniors can eat together and visit. Meals can also be deliv-
ered to a senior’s home if they are unable to attend. Funded through the Older Americans Act.

Transportation – Van service offered to transport seniors to congregate meals, medical appoint-
ments, shopping, etc. Funded in part by the Older Americans Act.

Respite Care – Short-term relief for primary care providers in the form of alternate caregivers.
Respite can be provided in the client’s home or another location.

Adult Day Centers – Supervised care in a social setting that can include a variety of health and
social support services. Centers offer structured activities throughout the day, and attend to clients’
personal care needs.

Homemaker and Chore Services – Housekeeping and other activities to maintain a client’s home
in a clean, safe, sanitary condition.

Home Modifications – Physical adaptations to a home that enable seniors to function with greater
independence and ensure a safe home environment. Home modifications include grab bars, shower
seats, enlarging doorways, installing ramps, etc.

Personal Care Services – Assistance with the activities of daily living in a client’s home provided
by a Personal Care Attendant to enable seniors to remain in the community.

Assisted Living Homes – A licensed congregate residential setting that provides for personal and
health care needs of residents 24 hours a day.

Home Health – Health related services provided by a Nurse or Certified Nursing Assistant in a
client’s home.

Hospice/End of Life Programs – Palliative care for individuals with a terminal illness. Programs
include nursing care and support, training for family and friends, and pain management.

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Affordable Assisted Living in Alaska

Alaska has a nurse delegation act that permits RNs to delegate to unlicensed staff at assisted living
homes, nursing tasks that would otherwise need to be performed by a licensed nurse. Thus, use of
an RN can significantly increase the ability of a home to provide a higher level of care more effi-
ciently and at a decreased cost.

The number of nursing hours needed depends on the size of the facility and the level of acuity
in the building. The financial model utilizes a factor of .75 hours of nursing time per resident
per week, and assumes that the average acuity level in the project will be high – the level typical
for a nursing home alternative model. A nursing home alternative model is used because this is
the model that is required by the state Medicaid waiver program. If you expect to use a different
source of service reimbursement with lower acuity thresholds, the estimated hours of nursing
time built into the model can be modified to reflect a lower level of anticipated care needs.

Comparable wages for the nurse position may be found by surveying other assisted living facilities,
nursing homes, hospitals, and home health agencies. Other sources of wage information may be
industry surveys, help-wanted ads and web-based job postings.

Nurse On-Call. Nurses in assisted living homes are typically expected to be available on an on-call
basis for questions by staff regarding resident care. An additional fee may be paid to the nurse as
compensation for on-call time. This fee may range from $100 to $250 per month, depending on
the size of the facility.

Lead Cook/Food Services Director. In larger facilities, a lead cook/food services director is typi-
cally employed to oversee the day-to-day operations of the kitchen, including ordering food, ensur-
ing the cleanliness of the kitchen, and maintaining food costs within budgetary guidelines.
Depending on the size of the building, this individual may also be responsible for overseeing all
kitchen personnel (e.g., hiring, scheduling, supervising, etc.). The person in the lead cook/food
service director position typically also performs cooking duties and is usually budgeted at 40 hours
per week. This position may not be utilized at all in small homes if the home’s universal workers
are involved in meal preparation and service tasks.

The wage for the lead cook/food service director will vary depending upon the size of the building
and the location of the facility. Wage surveys may include other assisted living facilities, nursing
homes, hospitals, schools and/or restaurants. Help-wanted ads and job postings may also provide
useful information.

Cooks. Depending on the size of the facility, one or more cooks may be required in addition to the
lead cook/food service director, although in small homes universal workers typically perform all
cooking tasks. When dedicated cooking personnel are used, homes with less than 50 residents can
typically be staffed with 10 cook hours per day, supplemented as appropriate with assistance from
dietary aides.

The lead cook/food service director typically performs cooking tasks in addition to the administra-
tive duties within the 40 hours a week budgeted for this position. In larger buildings, the food serv-
ice director may need more hours for administrative duties, and thus may not be able to allocate

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Affordable Assisted Living in Alaska

the full 40 hours to cooking-related tasks. This has been factored into the cooking hours budgeted
for the model.

As with the lead cook/food service director, wage surveys should include other assisted living facili-
ties, nursing homes and hospitals, utilizing schools and restaurants if appropriate. Help-wanted ads
and job postings may also provide useful information.

Dietary Aide/Kitchen Assistant. In larger homes, dietary aides/kitchen assistants may be utilized
to provide assistance to the cooks. Duties may include food prep tasks, dish washing, cleaning of
food preparation areas, and dining room set-up/clean-up. The hours needed for this position will
vary depending on the size of the building and the number of cook hours budgeted. An appropri-
ate wage for this position may be obtained by surveying nursing homes, hospitals and restaurants.

Server. Most smaller assisted living homes and facilities designed to provide affordable assisted liv-
ing will utilize universal workers to serve meals to residents. However, dedicated servers may be
desirable in larger facilities with a high percentage of private pay units, especially those with a
higher-end rate structure. In some markets, the use of dedicated servers has become a standard
and is used to enhance the dining experience for residents. In such a case, it may be helpful to uti-
lize dedicated servers to compete effectively in the marketplace.

Housekeeper. In small homes, universal workers are usually responsible for the routine cleaning of
resident units and common areas. Larger facilities, however, typically utilize dedicated housekeep-
ers for the regular cleaning of resident apartments. Housekeepers may also be used by smaller
homes to provide deep cleaning tasks. If a dedicated housekeeper is used, the number of hours
required for this position will depend on the number of units in the project. A factor of 0.8 hours
per week for each unit is often used to budget the number of housekeeping hours needed.

The wage for a housekeeper is typically similar to that paid to universal workers. Wage surveys for
this position may include competing assisted living facilities, nursing homes, and motels.

Maintenance Person. Maintenance personnel are needed to keep the building in good condition
and perform preventative maintenance tasks as appropriate, even for new buildings. For larger facili-
ties, 0.5 hours per week per unit is generally an appropriate estimate of the time needed for this
position. Smaller homes will typically require a greater per-unit, per-week factor, as these homes are
not able to benefit from the economies of scale present in larger facilities. Older buildings and/or
buildings that have not been well maintained may require additional maintenance time.

The wage for a maintenance person will vary depending upon the location and size of the facility.
Wage surveys for this position can be conducted with other assisted living facilities, nursing homes,
and hospitals. Help-wanted ads and job postings may also provide helpful information.

Other Project-Specific Personnel. Some facilities have special needs that require additional staffing
not included in this model. For example, a project located in a high crime or urban setting may need
to employ security personnel, while a special-needs project that serves only hearing-impaired individu-
als might require the services of a translator to facilitate communication with residents.

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