Elder Care

BUSINESS PLAN

SUMMER GARDENS RESIDENTIAL CARE FACILITY FOR THE AMBULATORY ELDERLY

472 Gull Flight Ave.
Freemont Hills, CA 56789

February 14, 1993

Summer Gardens is a living facility providing food preparation, laundry, housekeeping, and personal care services to its senior residents. Run by a professional nurse, the facility hopes to provide an alternative to traditional nursing homes.

• product profile
• market
• location
• competition
• distribution
• sales
• key personnel
• organization
• reference list
• addenda
• floor plan
• cash flow statement

PRODUCT PROFILE

According to an article published in the Executive Female, "Companies offering alternatives to the nursing home are taking off." Residential Care Facilities for the Elderly (RCFE) are a recognized, cost-effective alternative to the nursing home. Summer Gardens Residential Care Facility for the Ambulatory Elderly will be a community-based living and care giving facility established to serve the needs of our rapidly increasing elderly population.

Residential care facilities have existed in various forms for decades. Over the past twenty years, most states have developed licensure requirements as a means of standardizing the quality of these facilities. RCFE's operating in the state of California must be licensed and must operate under the comprehensive Code of California Regulations.

Summer Gardens will comply with all licensure and Title 22 requirements. The facility will focus on providing services which promote independence in a safe and pleasant environment. As the elderly struggle to stay out of nursing homes and hospitals, they seek help with food preparation, laundry, and housekeeping. As an alternative to nursing home placement, Summer Gardens will provide housing and assistance to its residents, including meal preparation (general and special diets), laundry, linen, housekeeping, and personal care. Appropriate staff will assist in recreational activities. Staff will also arrange physician appointments and coordinate transportation.

Elderly men and women frequently express a desire for basic companionship or the need for assistance, but prefer not to impose on family members. Concerned family members may be forced to acknowledge that it has become increasingly difficult for loved ones to take care of themselves and their homes. Summer Gardens will provide needed services to adults 60 years of age and older who require assistance to remain safely independent. Summer Gardens will be able to accommodate eight residents, 24 hours a day, seven days a week. The facility will be staffed 24 hours a day with qualified employees who are trained to respect the individuality and promote the dignity of every resident.

While there are other residential care facilities in the area, Summer Gardens is the only one owned and operated by a Masters-prepared Registered Professional Nurse. My fifteen years of nursing experience include the start-up and management of a Medicare-certified home health agency, and the management of a private home health services branch office. Additionally, I have been on the staff of Andrews Hospice as an on-call advisory nurse for two years. Both relatives and residents will feel confident that the appropriate level of care will be provided, along with monitoring and supervision. As a professional nurse, I am a credible and competent link to the physician. I am qualified to make nursing assessments and able to communicate findings to physicians as appropriate.

The elderly population in this country is increasing. In Aaron County, the population aged 62 and older has increased from 8% of the population in 1980 to 14.9% in 1990 (See Addendum A). The elderly are living longer and requiring alternative living arrangements. RCFE's are fulfilling a need. Qualified owner/administrators of care facilities are in demand.

A loan in the amount of $25,000 will facilitate the acquisition of property to house this community-based RCFE. The loan will also provide beginning capital for lease deposit, leasehold improvements, insurance and furniture.

MARKET

The residents at Summer Gardens and their families will live in the San Francisco Bay area; most will live in Aaron County. The Aaron County location chosen for Summer Gardens is important because the elderly will want to continue to live in an area familiar to them and families will want their loved ones close enough to visit regularly.

The primary users of residential care services are men and women who cannot live safely in their own homes, but do not require the full-time skilled nursing care provided by convalescent hospitals. The targeted client market for the services provided at Summer Gardens RCFE is comprised of people who are 60 years of age and older. According to the Continuing Care Resources newsletter, the average age of residents of RCFE's is mid-to-late eighties. Of the 34,240 people in Aaron county aged 62 and older, 6,177 are already aged 80 and older, with the other 28,063 nearing age 80. Many of these elderly adults are single or widowed individuals who may have outlived other relatives and friends. If they are left alone at home, confusion or forgetfulness may render them unsafe and may affect their ability to care for themselves. However, with supervision and minimal assistance, these elderly will be able to maintain dignity, remain safe and independent, and conserve needed funds for future medical care. In addition, state and federal funds need not be used to provide care for these elderly at a level much higher and much more costly then they require.

According to a 1989 report from the Association of Bay Area Governments, 60% of the heads of households in Aaron County aged 65 and older had an annual income of $25,000 or more. Less than 25% of the heads of households had an annual income of less than $15,000. Of the market targeted as potential residents of Summer Gardens, at least 60% will be able to afford the services offered and less than 25% will be dependent solely on SSI (see Addendum B).

The cost of a semi-private room at Summer Gardens will be $2500 per month, or $83.00 per day (less than the cost of a hotel room). Future residents and families who investigate available options will find that the cost of the average semi-private room in a convalescent or nursing home in Aaron County is $105 to $150 per day, and the cost to hire 24-hour unskilled home care is $205 per day (see Addendum C).

Residents and families who choose Summer Gardens will do so because of:

• The nursing experience and expertise of the owner
• The high quality of care provided
• The safe, comfortable, and home-like environment
• The locality, which makes visitation easy
• The peace of mind which comes from keeping loved ones out of nursing homes

Presently, the 36 residential care facilities located in the Aaron County area cannot meet the needs of that portion of the 34,240 elderly residents who are already age 62 or above and in need of some degree of assistance. There are waiting lists at most of these facilities. Reports from the County Conservator, Rehabilitation Hospital, and Acute Care Hospital discharge planners show that there are not enough residential options for people who are unable to live alone but not ready for convalescent home care.

LOCATION

Summer Gardens RCFE will be located in Freemont Hills, California. It is important that the facility be located in Aaron County because of its reputation for beauty, relative safety, affluence and proximity to desired clients and their families. The city of Freemont Hills was chosen because property is less expensive than any other city in Aaron County and has less restrictions (e.g. use of water).

Summer Gardens will be located in a large home in a quiet residential area of the city. Residents will be able to sit safely on the patio or take short walks in the neighborhood. The house itself will be built on one level. It will be large enough to accommodate 8 adults comfortably and will be brought into compliance with all state and local safety regulations. (See Floor Plan).

COMPETITION

There are six (6) other RCFE's located in Freemont Hills. Five (5) are of similar size and offer similar services. According to the California Code of Regulations, RCFE facilities cannot be located within 300 feet of another RCFE. The names and locations of the RCFE facilities located in Freemont Hills are:

Riverview Terrace

Administrator: Lee Smith
123 Bay St.
Freemont Hills, CA 56789

Seaside Residential Care

Administrator: Donna Jones
234 Mason Ave.
Freemont Hills, CA 56780

Pine Acres

Administrator: Thomas Beech
345 Pollyanna
Freemont Hills, CA 56789

Lyle B. Morton Care Facility

Administrator: Andrea Morton
4567 J St.
Freemont Hills, CA 56789

Shady Arbor

Administrator: Diane Brown
56789 Irving Lane
Freemont Hills, CA 56780

The similarities between RCFE facilities is due to the California Code of Regulations, Title 22, Division 6, Chapter 8. All facilities offering services to the elderly are strictly supervised and mandated by this Code. Despite the inherent similarities, I do not expect to need to take clients away from my competitors because of the growing elderly population. These businesses are very profitable and many owners (e.g. Andrea Morton) subsequently opened second and third facilities. Once eight residents are found, it may be 1-5 years before an opening exists for another resident.

DISTRIBUTION

I intend to contact individuals who will use my facility through professionals in the community who find appropriate accommodations for the elderly. These referral sources include the county conservators, hospital discharge planners, rehabilitation center discharge planners, day care centers, senior citizen centers, home care agencies, and independent case managers. I plan to mail a brochure describing Summer Gardens along with a cover letter announcing the opening of the new facility. I will follow up with a phone call and a request for referrals. I plan to place a continuous ad in the local "senior" newspaper and advertise in the yellow pages. I will gain access to many referral sources by taking advantage of the contacts made when I was in an administrative position at Miller Health Care Services, which was located in Aaron County.

SALES

I plan to open with one resident in January 1994, and expect to increase to three residents by February, six residents by March, and a full census of eight residents in April. Based on these projections, end of the year assets will be $83,728.

I have considered what could go wrong with this plan. The condition of the economy could affect the ability of the elderly to pay for their care with private funds. Regardless of the economy, there will be an elderly population. If funds run out and the elderly are placed on SSI, or if I would need to admit some residents whose only source of income was SSI, I would be guaranteed some payment from the State. In the unlikely event that this would occur to some of my clients, it would decrease the amount of profit, but would not result in a negative income.

KEY PERSONNEL

As the owner of Summer Gardens, I will be in charge of the business operations (See Resume for qualifications). I will have three employee care givers: two regular employees and one on-call or back-up person to handle sick calls, vacations, and holidays. Tracy Stevens and Samuel Jackson will be regular employees and Lucy Johnson will be on-call as needed.

Tracy Stevens is a Registered Nurse with five years experience in home care, hospice, and rehabilitation hospitals. Samuel Jackson is a Certified Home Health Care Aide with six years experience in acute care hospitals, convalescent hospitals, rehabilitation hospitals, and home care. Lucy Johnson is a Nurse Assistant with six years experience working with the elderly in their own homes. She has also worked in acute care hospitals and convalescent hospitals.

Employees will be responsible for providing personal care and related services for residents, providing companionship, and promoting mental alertness and physical well being. Please contact Marian Currey, the owner, for complete descriptions of employee qualifications and comprehensive job descriptions.

ORGANIZATION

This organization will be a sole proprietorship owned by Marian Currey. My short term goals are: l) to open Summer Gardens RChbin January 1994, 2) to have 8 residents by April 1994, and 3) to show a small profit by March 1994.

My long term goals are to purchase the leased property in January 1995 and to begin the process of opening a second RCFE in 1996.

REFERENCE LIST

• Between Home and Nursing Home, Down and Schnurr, Buffalo NY, 1992
• "More for Your Money," Inc. Magazine, September, 1992
• "Where the jobs are," Executive Female, July/August, 1991
• "Tips for Venture-Capital Seekers," Executive Female, July/August, 1992
• "The Weekly Cash Flow Planner," Inc. Magazine, June, 1992
• "How Much Should I Pay Myself," Inc. Magazine, June, 1992
• "How to Improve America's Medical Care," Mona Magazine, April, 1992
• "Your Business Starting It Growing It," Executive Female, March/April, 1992
• "Health Care Fraud," U.S. News and World Report, February 24, 1992
• "Banking and Capital," Inc. Magazine, June, 1991
• "How to Write a Personnel Manual," Small Business Success, June, 1991
• "How to Write a Business Plan," Small Business Success, June, 1991
• Summary Volume of the Aaron County Cities and CVP 1990
• Association of Bay Area Governments, Oakland, CA
• Aaron County Conservators Office
• Department of Social Services - Community Care Licensing Division

ADDENDUM A

ADDENDUM B

ADDENDUM C

FLOOR PLAN

A floor plan of the Summer Gardens facility is available through Simon Architecture, Inc., 100 Diamond Ave., Fremont Hills, CA 56780.

CASH FLOW STATEMENT

The Tribunal Accounting Firm has developed a spreadsheet to illustrate cash flow for Summer Gardens during the first year of operation. The statement includes data on cash receipts, investments, capital expenditures, operating expenses, loan payments, taxes, sales, and administrative tasks.

RESUME

A personal resume and references are available upon request.

Elder Care

The lives of slaves who were fortunate enough to survive to an elderly age were made worse by the fact that once they could no longer perform the arduous demands of physical labor, they were often left to take care of themselves after years of service to their masters. Frederick Douglass's (1817–1895) Narrative of the Life of Frederick Douglass provides some descriptive details of the trauma inflicted on those such as his grandmother, who reached an age where her masters did not know what to do with her. He writes about the plight of his grandmother:

If any one thing in my experience, more than another, served to deepen my conviction of the infernal character of slavery, and to fill me with unutterable loathing of slaveholders, it was their base ingratitude to my poor old grandmother. She had served my old master faithfully from youth to old age. She had been the source of all his wealth; she had peopled his plantation with slaves: she had become a great grandmother in his service … she was nevertheless a slave—a slave for life … and to cap the climax of their base ingratitude and fiendish barbarity, my grandmother who was now very old, having outlived my old master and all his children, having seen the beginning and end of all of them, and her present owners finding she was of but little value, her frame already racked with the pains of old age, and complete helplessness fast stealing over her once active limbs, they took her to the woods, built her a little hut, put up a little mud-chimney, and then made her welcome to the privilege of supporting herself there in perfect loneliness; thus virtually turning her out to die! ([1845] 1968, p. 944)

The description that Douglass paints of his grandmother illustrates the lack of regard accorded to elderly slaves. In her article Aging and Slavery: A Gerontological Perspective Leslie Pollard writes, "In Africa, the elderly performed special roles and functions that continued in slavery. They were the storytellers, the advisors, the links between the past and the present, and the historians of a non-literate people" (1981, p. 228).

While many plantation masters may have shown no feeling or care toward elderly slaves, slaves who were older were held in high esteem by the slave community. According to Pollard, "the mammy was often an old woman who had been on the plantation for several generations, and others, called 'aunties' and 'uncles' by their masters when 'boys' and 'girls' proved ridiculous, were also usually elderly slaves" (Pollard 1981, p. 229). But mammy sometimes referred to a slave's own mother and the term was also used to convey that. Pollard further notes that respected elderly slaves sometimes had the word Old juxtaposed before their given names such as Old Tom or Old Isom thus indicating the same deference for elders that their ancestors in Africa held for older family members (Pollard 1981, p. 229). Many slaves referred to their elder slaves as aunt or uncle often because they were, as Pollard related, but when the masters and mistresses of the plantation used these terms, they took on another meaning altogether. It was not uncommon for them to use aunt or uncle to refer to an older slave when they could no longer call them girl or boy. In the Unwritten History of Slavery, a project undertaken by the Social Science Institute at Fisk University, a former slave recalls, "I didn't do nothing but play and pick up chips for old Aunt Fanny. She fed us. They had these wooden bowls, and Aunt Fanny would take that and pour the licker in it, and put bread in it for the chillen to eat" (Unwritten History of Slavery 1945, p. 114). Aunt Fanny may well have been her biological aunt; however, the meaning differs when used by the mistress as evidenced by the following quote: "Mistress would say Go pick up some chips for old Aunt Fan to put on the lid" (Unwritten History of Slavery 1945, p. 114). Aunt or uncle were not terms of endearment and their elderly status did not keep older slaves from being whipped. The same woman remembers when her sister received a whipping for not keeping her dress clean and how her mother, whom she called mammy, protected her sister and how Aunt Fan herself endured beatings from the mistress:

Mammy got out of bed and went in there and throwed Aunt Fan out of the kitchen door, and they had to stop whipping Big Sis and come and see about Aunt Fan. You see, she would tell things on the others, trying to keep from getting whipped herself. I seed mistress crack her many a time over the head with a broom. (Unwritten History of Slavery 1945, p. 117)

Another woman recalled her mistress mistreating an elderly woman slave:

Honey, that sho' was a mean ole woman there. I remember when I went to bed that night the ole woman slave, the cook you know, was piddling 'round in the kitchen, and that ole woman was just actually driving her. I know that po' thing never went to sleep that night. Well, that ole woman had a parrot, one of these ole talking kind, and he was smart and talkative like me. The next morning the po' ole slave come out and say breakfast was ready; it was before six o'clock then…. I say shut yo' mouth, drat you … well, you know, course ole missy didn't git after me or nothin', but she tole me after a while Lucy, don't you say nothin' to that woman; you will make her whip that poor old slave; she is terrible mean. (Unwritten History of Slavery 1945, p. 19)

In keeping with Douglass's recollections of how his own grandmother was treated, another slave recounts:

Old Aunt Calline Fletcher was sold after she come out of the trade yard to old Dick Grinstead. He bought her, and after she had done all she could and yet she didn't suit old Dick's wife, they said she would have to go back to the trade yard. When his wife would get mad she would beat her as long as she wanted to, and she used to lead her around by the ears, and would put hot tongs on her ears and tell her that these were her earrings. (Unwritten History of Slavery 1945, p. 194)

Another horrifying picture of slavery and how the elderly were treated occurs in the beginning of Unwritten History of Slavery where an ex-slave retells how an old woman was beaten to death by her mistress:

She had one old woman and a boy and a girl; they come to her by her mother, and that was all the slaves he left her when he went off. She used to whip that old woman 'till she would run away, and they put a big iron bell on her and fixed it so she couldn't get to the clapper and put it on her neck with an iron collar … just before the war they sent her to the greenhouse to make the fire … well, she stayed so long in the greenhouse that the old lady got the cowhide and went out to see what the trouble was, and there was the old lady bending down just like she was making the fire and the old lady cut her lick with the cowhide, and lo and behold she was dead. (Unwritten History of Slavery 1945, p. 6)

There is evidence that still other plantation masters were not as cruel in how they treated elderly slaves. In their book, Time on the Cross: The Economics of American Negro Slavery, authors Robert Fogel and Stanley Engerman note "planters solved the problem of old age by varying tasks to capacities of slaves" (1974, p. 74). As Pollard suggests, the "agricultural nature of slavery" made it likely that elderly slaves could work in some capacity whether it was in the home sewing, cooking, taking care of the master's children or whatever other domestic skills were necessary to keep the plantation operating to full capacity (Pollard 1981, p. 231).

Whether elderly slaves were allowed to live out their years on the plantation or discarded and left on their own depended largely on their masters. In keeping with their roots, elderly slaves received the best treatment and care from the slave community itself. Pollard notes "in the slave community, that important network of social relationships away from the Big House, that the elderly gained status" (Pollard 1981, p. 232). Here, the elderly were afforded a buffer that helped them to survive the stresses and strains of aging and an escape from the precariousness of a nonproductive existence in a productionbased system (Pollard 1981).

In his book Medicine and Slavery, Todd Savitt says "according to the Virginia mortality census of 1850, and the death registers of four Virginia counties and towns between 1853 and 1860, more slaves than whites died of old age (1978, p. 201). The dilemma of what to do with slaves as they aged was a problem posed for masters and while some elderly fared better and were able to live out their days on the plantation in some capacity, many others as indicated by personal accounts did not. The fate of an elderly slave often depended on the wealth of the plantation owner. Those who could afford to take care of slaves as they aged sometimes did so, but those who could not would either avoid medical care or, in the case of a Mrs. Martha Southward, whose elderly slaves came down with smallpox and received treatment at the city hospital, petition the city council for release from payment of the hospital bill (Savitt 1978, p. 202). As indicated by Douglass, some owners simply left elderly slaves to take care of themselves in the rural areas by placing them in the woods with a rudimentary hut or in cities, by releasing them to wander on their own. There were several ways in which plantation owners handled the aging dilemma: (1) allowing slaves to perform other duties; (2) ignoring the fact that their slaves were aging and expecting the same level of work in excess of capabilities; (3) hiring them out for light work; and (4) allowing them to remain as part of the slave community and simply handing over the duties to younger slaves (Savitt 1978, p. 204). The available evidence indicates that most old people remained at home to be assisted by their children and the general slave community, thus indicating the tight bonds and esteemed held for their elderly and going back to traditional African roots where the elderly were revered (Savitt 1978). If slaves were fortunate enough to survive to an age where they were too old to do the work, then their fate lay in the hands of the plantation owners; however, within the slave community they were treated with much respect and admiration.

BIBLIOGRAPHY

Douglass, Frederick. Narrative of the Life of Frederick Douglass, An American Slave [1845]. Reprint, New York: Signet, 1968.

Fogel, Robert, and Stanley Engerman. Time on the Cross: The Economics of American Negro Slavery. Boston: Little, Brown, 1974.

Gutman, Herbert. The Black Family in Slavery and Freedom, 1750–1925. New York: Pantheon, 1976.

Pollard, Leslie J. "Aging and Slavery: A Gerontological Perspective." Journal of Negro History 66, no. 3 (Autumn 1981): 228-235.

Savitt, Todd L. Medicine and Slavery: The Diseases and Health Care of Blacks in Antebellum Virginia. Urbana: University of Illinois Press, 1978.

Unwritten History of Slavery, Autobiographical Account of Negro Ex-Slaves. Fisk University, Social Science Institute. Nashville, TN: Author, 1945.

                                        Yvonne Sims

Elder Care

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