Design for Developing an Innovative Adult Day Center Program in the Metro Salt Lake City Area.

Transcription

1 Design for Developing an Innovative Adult Day Center Program in the Metro Salt Lake City Area. By Corey Fairholm A nonthesis project submitted to the faculty of The University of Utah partial fulfillment o f the requirements for the degree of Master of Science in Gerontology College of Nursing The University o f Utah April 2001 Supervisory Committee Michael Caserta, PhD, Chair Scott Wright, PhD A. Kimberly Dansie, MBA

2 Copyright 2001 by Corey Fairholm All rights reserved

3 T a b le o f C o n te n ts A bstract... ii Executive Sum m ary... 1 Introduction Demographics Trends in Aging... 4 Caregiving... 5 Adult Day C enters... 7 The Service Product Specification Mission Statem ent Objective Company Strategy Management Structure The Service M arketing Marketing Strategy Economics Conditions Distribution Channels Com petition Marketing Proforma Start-up Budget Finance Financial P lan Sources of Financing Financial Requirements Sourcing Material and Production Requirements Labor Requirements Structure References C ite d Exhibits... Exhibits 1A-8 Appendix... Concluding pages

4 A bstract The purpose of this project was to develop an innovative adult day center model. The proposed center will combine the features of an adult day center, health and wellness education and a senior center. Choices of activities will be given to each individual client. When an individual is treated like an adult, given choices in their lives, they tend to respond more positively. Erik Erikson s psychosocial model shows that the developmental stages of personality are affected by the social environment. Individuals do make choices regarding the responses to common lives changes. Erikson focused on the eight stages of development of the ego throughout life, with the final stage occurring in mature adulthood. In his book, The Life Cycle Completed. Erikson and his wife, Joan discuss the stage of Gerotranscendence, involvement vs. withdrawal, in which individuals derive importance and meaning in their lives from a sense of accomplishment. Life satisfaction, or the feeling that life is worth living, may be achieved through tasks in ones life, accepting one s mortality, sharing experiences with the younger generation and leaving a legacy to future generations. Guided by Erickson s principles, the proposed adult day center will offer opportunities and activities to the clients that help them fulfill their need to be involved, to continue learning, and to foster self-concept and self-esteem. The center will encourage clients to socialize, develop enduring friendships and provide supportive interaction among the staff, clients, families, and the community.

5 EXECUTIVE SUM M ARY The proposed center is an unique concept developed by Corey Fairholm, as her masters project toward fulfilling the requirements of a master of science degree in Gerontology at the University of Utah. The center combines the features of an adult day center, health and wellness program, and a senior center. The center will offer a safe, supportive environment for those individuals needing constant supervision. Recreational activities will include entertainment, cultural enrichment, music and dance therapy, socialization, simultaneous activities promoting quality o f life and stimulation. The educational component o f the center s programming will feature lectures on important health topics, fine art lectures, intergenerational programs, and college courses. The health and wellness component will include medication management, personal care services, physical, occupational and speech therapy, special assistance with memory loss and cognitive disorders, and health counseling and assessment. Transportation, nutritious meals and snacks, and support groups will be other services offered to the senior clients and their caregivers. The staff will be highly qualified to work with each client and meet each of their special needs. The hours o f operation will be 7:30 a.m. to 6:00 p.m., Monday through Friday. The center also will provide respite care for the caregiver to receive a much needed break. Features of the proposed center that distinguish it from other adult day care models include the physical facility lay-out, and the variety o f offered services. The location of the center will be in the southern part o f the Salt Lake Valley in the Sandy/Draper area primarily serving northern Utah County and the southern Salt Lake county. 1

6 An increasing senior population is resulting in a growing need for adult day care both nationally and locally. The 65+ age group of will be the largest growing segment of the population by By the year 2030, over 75 million people will be over the age of 65 years. The proposed center s marketing strategy will primarily emphasize the variety of services and programs available to potential clientele, as well target caregivers, children, and professionals working with the geriatric population. The marketing plan also will utilize a public education campaign that educates the community on the benefits of adult day services. The demands o f the aging society will have to be met by providing more quality services. Adult day care is a more economical choice for many seniors and their caregivers. The services will cost on an average, $10,000 a year compared to $50,000-$80,000 a year for long term care. Because a growing number of seniors have saved for retirement, more will be able to pay for adult day services. A direct sales force will be the distribution channel for the proposed center. The administrator will be the main sales/marketing director with an administrative assistant responsible for mailings, answering inquiries, and enrolling customers. The center will use direct mailings, newspaper ads, and magazines ads as ways to advertise to the public. The administrator will market to gerontology professionals, clubs, corporations, and other businesses who will need the services of adult day care. The base price of the services will be $39.00 a day, including activities and meals. Extra fees will be added for additional services, including medication management, personal care services, transportation, and other amenities. Overall, the cost to the senior individual will be less compared to other services like long term care facilities, assisted living, and home health care. 2

7 There are three licensed adult day centers in the Salt Lake Valley. Nursing homes and assisted living facilities offer adult day care as part of their services but have to meet the regulations and requirements established by the Utah Department of Human Services, Office o f Licensing. The adult day centers serve a variety of seniors with several activities but do not have the room available to offer a variety of stimulating programs that meet the needs of every client. The proposed center s physical design will allow for higher quality activities, meeting the needs of most clients. The center is a new innovative program model combining adult day care, health and wellness services and the senior center programming. The estimated start-up cost is $950,000, including construction, marketing, operating deficit reserve, and fixtures, furniture and equipment. During the first year, the total expenses will be approximately $305,900 with a net operating income of $16, 135. Once the business is established, the center s expenditures will be $340, 934, and its net operating income will increase to $167, 962 per year. 3

8 INTRODUCTION Demographic Trends in Aging Those over the age of 60, comprise the fastest growing segment of Utah s population. The elderly population in Utah will increase by 65% between the years of 1990 and 2010, compared to a growth of 49% for the remainder of the population (Salt Lake County Aging Services, 2000). Trends indicate that this age category will continue to increase until the year The older population in the United States is becoming increasingly older. The number of older Americans increased by 3.2 million or 10.1% since 1990, compared to an increase o f 8.1% for the under 65 population (AARP, 1999). The average age of the elderly population also is increasing with the oldest-old, those 85 years and older representing the fastest growing segment o f America s older population (Administration on Aging, 2000). The problems of the older population tend to be more severe and complex and often require more expensive and complicated solutions (S.L. County Aging Services, 1999). The large growth of the older segments of the population provides great opportunity for businesses. The older population in 1998 numbered 34.4 million; (12.7%, of the U.S. population) but by the year 2030, that number will double to 70 million older persons, representing about one in every five Americans (AARP, Profile of Older Americans, 1999). The 85+ age group, the fastest growing segment of America s population, will increase from 3.9 to 8.5 million by the year 2030 (AARP, 1999). Nationally, the state of Utah ranks fourth in life expectancy( 72.4 years for men and 79.2 for women). The life expectancy in the United States has increased due to breakthroughs in science and technology that have lead to the extension o f the life-span. By the 4

9 year 2008, Utah will have over 500,000 individuals over the age of 65 (Utah Governors Office of Planning and Budget, Demographics and Economic Analysis Section, 1998). Salt Lake County alone faces a challenge: the growth of the frail elderly population which by the year 2020 will be over 200,000 people (Salt Lake County Aging Statistics, 1999). The impact of the growth in the older population will not be limited to public agencies who serve the elderly, but also will be experienced by hospitals, nursing homes, home health agencies, and other community agencies (S.L.County Aging Services, 1999). Caregiving Caregiving in America presents many challenges and difficulties but can be rewarding as well for the caregiver and the older individual who receives the care. Eighty percent of the help the elderly need are provided by family, friends, church and community group (Lund & Wright, 2000) and three-fourths o f these individuals receive their assistance entirely from informal sources (Kosloski, 1995). Fifity-four percent of the elderly population live with their spouse, 2.2% live with non-relatives, and 12.6% live with other relatives, suggesting that the majority of seniors live with someone who could potentially be a caregiver (AARP, 1999). Each day in the United States, more than five million older individuals receive some kind of assistance from family members, friends, and neighbors allowing them to live in their own homes (AoA, 1997). Only one in five older persons needing long-term care lives in a nursing home, the remainder are able to live in their own communities due to the support of informal caregivers who assist with a range o f activities (AOA, 1997). Informal caregiving is defined as unpaid care provided to a person aged 65 or older who has an impairment that limits that person s independence and requires some level o f ongoing 5

10 assistance (AoA, Caregiving Compassion in Action, 1997). The majority of the seniors needing assistance live with a family member, many o f whom have competing demands but remain highly committed to caring for dependent, older family members (AoA, Caregiving Compassion in Action, 1997). Caregivers include the spouses of older people, who often are elderly themselves, as well as their siblings, children, grandchildren and other family members (AoA, 1997). The average age of family caregivers in the United States is 46 years (Administration on Aging, 2000), with many o f them having to continue to participate in the work force, and take care of their own children as well as their parents. Recent studies have found that between 6% and 30% of all employees are also caregivers for an older relative or spouse. Increased absenteeism, lost productivity, greater stress, and the potential stress, and the potential loss of skilled employees are among the more significant impacts that businesses will face as the number of elderly continues to grow (Salt Lake County Needs of the Elderly, 1999, p.2). The demands and constraints of caregiving can become overwhelming. Many working caregivers find that the demands o f their jobs and their caregiving responsibilities are in conflict. In fact, an increasing number of companies and government agencies at all levels are offering flex-time, job-sharing or rearranging of work schedules to help minimize the strain on caregivers (AoA, 1997), In early 1993, President Clinton signed the Family and Medical Leave Act into law to ensure that businesses address the elder and kindercare needs of their employees. Emphasis is now being placed on expanding these efforts (AoA, 1997). Caregivers play a critical role in maintaining the quality of life of their older family member, and they need to be supported in their efforts as much as possible. Surveys show that 6

11 younger and older disabled persons and their families prefer to receive services in their own homes and communities, rather in an institutional setting (AoA, 1997). With the increase in individuals 75 years and older, who are more likely to have more chronic impairments requiring assistance; respite care services will need to be in place to provide intermittent formal support to care givers. Respite care is defined by the Alzheimer s Association (2000) as a short time of rest or relief from the responsibility o f providing care. Respite care services generally allow some time for caregivers to catch up on other responsibilities and have a short time o f rest or relief while the loved one receives care from qualified individuals. An evaluation of a respite program found that it reduced depression, health problems, and relationship strains among those caring for a loved one (Cox, 1997). Each community usually has a variety of respite services available to the caregiver, ranging from in-home respite care, adult day care, assisted living, and others. Adult Dav Centers Adult day centers offer structured, comprehensive health, social, and related support services in a protective setting during any part o f the day for three or more adults 18 years of age and over for at least four but less than 24 hours a day. The purpose of the care is to meet the needs of functionally impaired adults through a comprehensive program that provides a variety of health, social, recreational, and related support services in a protective setting usually during normal business hours, five days a week (Utah Department of Human Services, Office of Licensing, 2001). The concept of adult day care is borrowed from the child care model but targets a much narrower segment o f the population; individuals experiencing significant mental, physical, and/or social impairments (Travis, 1993). The service was introduced to the United 7

12 States in the late 1960's by an English physician who originally used day treatment as a means of accelerating the return of aging, hospitalized patients to life at home (Travis, 1993). In the 1980's, with the passage of Omnibus Budget Reconciliation Act (OBRA) of 1981, adult day care was recognized as a legitimate option in the array of community-based, long-term care services that serve as a source o f family respite and caregiver support (Travis, 1993). Most programs are community-based and are effective models for meeting the physical, psychological and cognitive needs of dementia populations through an individual plan of care (National Adult Day Services Association, 1997). These plans may require a combination o f physical, mental, and social activities that are provided by the center s staff; special therapies, and health monitoring and medical treatments (only if the center qualifies as a medical adult day care) (Travis, 1993). Adult day centers promise the opportunity to maintain individual worth and dignity, promote independence, and potentially delay admission into a long term care facility. An adult day care program may focus on one or a combination o f activity programming, designed to engage the individual according to the person s capabilities and changes in their functional levels. A program should consist o f several aspects including: mental health programming, which emphasizes counseling services for adult day care participant as well as the caregiver and family members; health care programming, which provides a way to manage, monitor and treat medical and rehabilitative needs of the participant; and mobile programming, which provides activities for seniors in more than one setting (Alzheimer s Association, 1999), Other services may include transportation, social services, meals, nursing care, personal care, counseling, therapeutic activities, and rehabilitation therapies. A well-designed study by National Adult Day Services Association in 1998 demonstrated both short-term and long-term 8

13 benefits o f adult day care use in decreasing caregiver stress and enhancing psychological wellbeing (National Adult Day Services Association, 1997). The study also showed that the adult day centers maintain the client s present level of functioning and promote the maximum level of independence. Many older clients in the study were able to function at the highest possible level after participating in the adult day center s activities. Adult day centers can be either a medical or a social model, depending on clientele, staffing, services, and costs. Social day centers provide social outlets for mental and physical stimulation through the use o f therapeutic and recreational activities (Salari, 1999). These centers can be quite informal and are considered an organized program with services that support frail, impaired elderly or younger, disabled adults (Savage, 1990). The purpose o f the program is to foster the personal independence o f the participants and promote their social, physical, and emotional well-being through individual plans of care (Savage, 1990) Centers using the medical model serve the more severely impaired, and are staffed by an array of medical professionals, including on-site registered nurses, speech, occupational, and physical therapists, social workers, and registered dietitians. The medical centers provide preventive, diagnostic, therapeutic, rehabilitative services under medical supervision (Savage, 1990). It is estimated that more than 4,000 adult day centers are currently operating in the United States (National Adult Day Services Association, 2000). Ninety percent of the adult day centers are non-profit or publically funded, and many are affiliated with larger organizations like home health care agencies, skilled nursing facilities, medical centers, or multi-purpose senior centers (National Adult Day Services Association, 2000). In fact, many home health agencies, hospitals, and assisted living facilities are offering adult day services as part o f a continuum of 9

14 care. Most adult day centers serve the frail elderly and persons with Alzheimer's disease and other dementing illnesses (National Adult Day Services Association, 2000). Several centers also provide services to persons who are mentally disabled or have chronic mental illness; HIV/AIDS, multiple sclerosis, head trauma, or brain injury (National Adult Day Services Association, 2000). Only 7.3% of the senior population report using adult day services (National Adult Day Services Association, 2000). According to the National Adult Day Care Services Association (1997), the average age of the adult day care consumer is 76 years. Twothirds of the consumers are women, one-fourth live alone, three-fourths live with a spouse, adult children or other family member. Fifty-seven percent o f adult day clients require assistance with two or more activities of daily living and forty-one percent require assistance in three or more areas. Adult day service regulations differ from state to state. The Standards and Guidelines fo r Adult Day Care developed by the National Adult Day Services Association (2000) provides the benchmarks for states to regulate their center. Staffing standards developed by the National Institute of Adult Day Care (NIAD) permit tremendous flexibility in the qualifications of individuals who direct the daily operations o f adult day programs (Travis, 1993). The fees for adult day services vary depending upon the region of the country and the range of available services provided by the center. Daily fees can be as high as $185 per day, depending upon the services provided and reimbursement levels (National Adult Day Services Association, 1999). Day care programs are a relatively inexpensive part o f the continuum of community- based services for frail and impaired elders. The price of a nursing home ranges from $3000 to $6000 a month, $100-$200 a daily, or $40,000-70,000 annually (A Place for Mom 10

15 and Dad.com). Skilled nursing facilities provide round the clock skilled, rehabilitative nursing care by licensed nurses. The primary purpose is to facilitate injury or illness recovery or to provide care to those diagnosed with complex medical conditions. Payment sources include private pay, medicaid, and medicare (A Place for Mom and Dad.com). Assisted Living communities are designed for seniors who are not completely independent but could function adequately with assistance with daily living activities, meals, and housekeeping. Staff are available 24 hours per day and licensed nursing services are provided several hours a day. Payment is usually private pay and some take Medicaid. The cost ranges from $1600 to $3500 per month depending on the size of the apartment and the level of assistance required (A Place for Mom and Dad.com). Home Health agencies charge $40-$60 per hour for a home health service, providing services ranging from companionship, bathing, meal preparation, medication administration, and transportation (A Place for Mom and Dad.com). Depending on the area, adult day services could be a considerably less expensive option for those needing assistance during the day, saving over $40,000 a year. Only 24% o f the population net worth is under $25,000 a year. The median income of older person in 1998 was $18,166 for males and $10,054 for females (AARP, 1999). Only 13.7% of families with an older head of household had incomes less than $15,000 compared to 44.6% households that had incomes of $35,000 or more (AARP, 1999). According to the Social Security Administration, the major sources of income for older persons in 1996 were Social Security (91%), income from assets (63%), public and private pensions (43%), earnings (21%), and public assistance (6%) (AARP-Profile of Older Americans, 1999). Adult day services are a more affordable option many seniors can choose while still living at home. As the oldest segment of the 11

16 population continue to grow, and the risk of increased health care expenditures also rises, these centers will be a serious alternative for clients and families who need long-term health care (Savage, 1990). Funding by Medicare and Medicaid have not yet been approved to cover adult day services in Utah. Medicaid will cover some adult day center expenses, usually the medical day care settings, but some quasi-medicaid funds can be obtained through the State-Wide Respite program, an Alzheimer s grant, and the Community Care Program for the Elderly and Disabled (National Adult Day Services Association, 1997). Medicaid rates depend upon the setting: nursing home based centers receive 45% of their Medicaid rate, free-standing centers receive the average of all centers throughout the state (approximately $50/day), and hospital based centers receive the same amount as the highest nursing facility based center (National Adult Day Services Association, 1997). Some states cover adult day services under a Medicaid waiver for qualified low-income elderly, or those who are mentally, and/or functionally impaired. Medicare does not cover adult day services, but discussions have been occurring on a national level that may change this. Part B of Medicare will cover out-patient mental health services by licensed clinical social workers or psychologists for assessment and psychotherapeutic treatment (National Adult Day Services Association, 1997), Many insurance companies offer adult day care coverage as part of their new long-term care policies (National Adult Day Services Association, 1997)), In some Medicare Health Maintenance Organizations (HMO), Social Health Maintenance Organizations (SHMO), Preferred Provider Organizations (PPO), and Health Alliance Networks, adult day services are available as a covered service (National Adult Day Services Association, 1997). Title III o f the Older Americans Act funds 12

17 transportation to adult day centers as well as some social, recreational, educational and nutritional services that they provide (National Adult Day Services Association, 1997). The Child and Adult Care Food Program (CACFP) reimburses non-residential adult day centers designed to meet the needs of the frail elderly and functionally impaired adults for nutritious meals and snacks. The agency must have standards of care, individual care plans, be part o f a county government agency or be approved by the state (National Adult Day Services Association, 1997). Usually private pay is the primary funding source for adult day services for most older individuals. As the older population grows, so will the need for adequate services. Adult day centers will continued to assume a vital role in the lives of the impaired older adult, as well as provide needed respite for their family caregiver. Adult day services supplement home health and other long-term community-based care for older adults who are no longer completely independent, and also provides transitional care for individuals who eventually will need nursing home placement (Savage, 1990). Adult day services, therefore, will continue to be within the longterm care continuum. 13

18 THE SERVICE Product Specification This proposed adult day center will be different from the traditional adult day center models. It will be a new innovative idea, using the concept of a health and wellness model as opposed to a medical or social model. A comprehensive program of health and wellness education as well as nutritional, recreational, and socialization activities will help the individual remain independent. Health assessments also will be performed monthly to monitor the progress of the individual. The philosophy of the center will be to give individuals the experience they will need to help them remain independent by giving them opportunities for decision making and autonomy. Successful aging defined as the ability to maintain three key behaviors or characteristics: 1. low risk of disease and disease-related disability; 2. high mental and physical function; and 3. active engagement with life including maintaining relationships with other people and performing activities will give meaning and excitement to life (Rowe & Kahn, 1998). The health and wellness concept of the proposed adult day center will focus on all three aspects of the successful aging behaviors. Erik Erikson s psychosocial model of human development maintains that one s personality is affected by their social environment (Hooyman, 1996). The process o f aging entails numerous life changes which places demands on the older person s abilities to cope with and adapt to new life situations. Personality characteristics influence coping responses. This 14

19 center will provide more of an adult-oriented setting, age appropriate activities and privacy and autonomy for each client. Activities and the atmosphere of the center will encourage individuals to be able to choose for themselves, providing the opportunity to engage in meaningful activity. This center will provide their clients the opportunity to be involved, to continue learning, to socialize, develop friendships, and feel like they are still able to function in their community with meaning and dignity. Infantilization is defined as the societal treatment of old age as a second childhood (Salari, 1999). The effects o f infantilization in the day care setting are similar to those of selfmortification where a person can experience a loss of identity, lowered status, decreased sense of self-efficacy, social marginalization, and humiliation (Salari, 1999). The cumulative effects o f the conceptual linkage between old age and childhood can lead to social responses such as withdrawal, aggressive behaviors, adoption of lowered sense of responsibility and even childlike behaviors (Salari, 1999). Each individual client will be treated as an adult, encouraged to do what they want to do during the day, choose what they want to be involved in, and choose those with whom they would like to associate. The staff at the proposed center will work together to assist the older clients cope with the changes in their lives and encourage them to discuss their feelings about these changes. Each individual will be encouraged to share their life experiences with others, including children, to foster positive self-concept and self-esteem. Staff members will be trained to treat the client as an adult with life experiences and to avoid infantilization, Social processes are influenced by the environment as well as people (Salari, 1999). Individuals are embedded in their environment and the relationship between the individual and the environment is dynamic, in which a change in one necessitates a response from the other 15

20 (Salari, 1999). The environment of the proposed center will be a comfortable, home-like setting. Each individual s privacy will be respected. Clients will be able to enjoy the outdoors as well, if they prefer. The overall feeling of being at home will be an important feature of the adult day center. The center will attract the clientele who are in need of constant supervision but will be different from the other adult day centers in the area because it will provide the clients with an opportunity to continue living and learning within the limits o f their own functional capacity. The philosophy o f the center will be that the client needs to be treated to the highest level of their cognitive functioning and encouraged to allow expressions of autonomy, independence, privacy regulation and friendship formation (Salari, 1999). The adult day service will fill the gap for those who are not able attend the senior center activities and those needing 24 hour care of an assisted living. MISSION STATEMENT This is an adult day facility where clients receive quality care in a safe, supportive environment while providing respite services to caregivers. The center will offer a comprehensive program of health and wellness counseling and education as well as nutritious meals and recreational and socialization activities. The center s goal will be to preserve the dignity and maintain the quality of life for many seniors with Alzheimers disease, dementia, brain injuries, and others needing care during the day. The staff of the proposed center will provide the clients with an opportunity to maintain their individual worth, dignity, and their independence. The center will provide caregivers with needed respite from full-time caregiving 16

21 as well as support from professionals and peers. Objective: In the next five years, the center will become a major adult day provider in the Salt Lake City area. The company will develop a successful prototype of an adult day center that will serve as a model for larger companies to develop on-site adult day centers. COMPANY STRATEGY 1. Market to the caregivers of family members needing respite care in the South Salt Lake valley (primarily Draper and Sandy) and northern Utah County. 2. Market the unique features of the proposed center including: larger facility with more choice in activities, emphasis on health and wellness programming and educational and recreational/social activities. 3. Provide services to large corporations and organizations for employees who need to continue working but have the role of caregivers for a family member. 4. Exit strategy includes a five year holding period at the end of which we will look to sell the prototype to a larger company. 5. The proposed center will educate the public about the benefits of adult day centers and how caregivers will be able to take advantage of much needed respite by using the adult day center. MANAGEMENT STRUCTURE The management team o f the adult day center will be lead by a chief operating officer who will 17

22 oversee the financial, marketing, and management operations of the business. A program supervisor will be on staff to oversee and organize the activities and services for the clients. An administrative assistant will assist the director with sales calls, answer phone calls, and assist where needed in the program. Program assistants, certified as recreation therapists, will conduct the activities during the hours of operation. A bus driver will be hired to provide morning and afternoon door-to-door transportation service, provide private transportation to medical appointments, and to off property activities. A certified nursing assistant also will be on staff during the hours o f operation to provide assistance to clients with activities o f daily living. THE SERVICE The center will combine health and wellness educational programs with the traditional adult day programs as well as activities o f a senior center. The proposed adult day center will offer opportunities and activities for the clients to fulfill their need to be involved, to continue learning, and to develop friendships. The concept of the senior center, where seniors go for services and activities which enhance their dignity, support their independence and encourage their involvement in their community is an idea that could be carried over to the development of an adult day center. Senior centers do not provide the personal care services that many individuals need but they will be able to receive these services at an adult day center. When individuals are given choices in their lives, they are more committed to their well-being and health. But when the decisions are made for them, choices are taken away from them, the individual seems to give in and their self-esteem decreases. Activity programming at the center will offer the opportunity to the individual to be able to choose for themselves. 18

23 The developer, Corey Fairholm believes that a service that combines the programs of an adult day center, senior center, and a health and wellness program is a unique and innovative business in the rapidly growing senior s market. A comprehensive program of health and wellness counseling and education combined with nutritional, recreational and socialization activities will preserve the dignity and enhance the quality of life for many seniors with Alzheimers disease, dementia, brain injuries and other limitations, including physical handicaps. The center will provide support, supervision and a safe environment for those individuals who are in need of constant supervision during the day while their primary caregivers are involved in work, child care, or other normal activities. The proposed adult day center will provide the elderly with an opportunity to maintain their individual worth and dignity, maintain their independence, and delay possible admissions into a long term care facility. Many individuals will still have desires and ability to participate in a senior center activity but through physical limitations are not able, the proposed adult day center will be able to provide the services and activities for these individuals. The center provides family caregivers with essential and needed respite from full-time caregiving as well as support from senior professionals and others in similar circumstances. The center will have a stimulating combination of recreational, educational and wellness programming for many groups of seniors. Recreational activities will include entertainment, cultural enrichment, music/dance/art therapy, day trips, and socialization. Educational services will include lectures about common health concerns and issues among the elderly today. Each month a health issue affecting seniors will be addressed including the medical aspect, how to live with the disease, and ways to minimize the effects. Other educational lectures will include 19

24 topics like bereavement, fine arts lectures and educational tours, including trips to museums, colleges, government offices, and historical sites. College level classes also will be offered to help the clients continue learning while attending the facility. Wellness programs will include supervision, monitoring, and medication management, personal care services, physical occupational and speech therapy, special assistance with memory loss and disorders, health counseling and assessments, and dietary counseling. Other services and amenities will include assistance with bathing, nutritious meals and snacks, private and group transportation, and support groups for caregivers. Each group (i.e.: Alzheimers disease, Dementia, Brain Injury, disabled, stroke) will have activities that they will be able to choose from that will meet their special needs. A unique factor of the center will be simultaneous activities to meet the needs of each client. Choices in simultaneous activities will be offered to allow the clients the opportunity to choose for themselves. If the individual declines the invitation to attend an activity, the staff will honor that request and will not push the client further. Volunteer opportunities will be offered to the clients to help them serve the community as well as other individuals. Intergenerational educational programs allowing seniors the opportunity to use their skills to teach children or give companionship to children will be planned to provide volunteer opportunities for the clients. The clients also will be encouraged to serve in the community at various functions. Volunteer projects will be ongoing in the center at all times to provide opportunities for those individuals who enjoy serving their community. Each day daily service activities will be offered to those clients who are interested in helping out the center, including dishwashing, setting the table, and cleaning up. By providing these opportunities clients will be able to feel needed and will feel like they have a purpose. 20

25 Volunteer opportunities will establish for the individual a sense of meaning in their life compared to feelings of despair or bitterness, this fulfills the eighth stage of Erikson s psychosocial stages (Hooyman, 1996). Special needs will be met at the center through an interdisciplinaiy team consisting o f a consulting nurse, contract nutritionist, recreation therapists, certified nursing assistants, licensed therapists, social workers, and a director working with each family member to provide the best care for each individual client. The program supervisor who is a certified recreation therapist, will coordinate the calendar, scheduling the activities for each area of service within the center. Each participant will be encouraged to participate in the activities o f their choice. Before admittance, a written assessment will be completed to evaluate current physical and mental health and medical history, legal status, social and psychological needs and, as appropriate, developmental, vocational, or educational factors (The Department of Human Services, Office of Licensing, 2000). Following the assessment, a treatment plan will be written that includes a program plan that is individualized to meet the needs of the client. The center staff will monitor and document the clients progress. Nutritious meals will include lunch and two snacks each day. Special diets will be available to address the dietary needs of each client. A registered dietitian will assess the meal plans, working with the staff to assure each dietary need is being met. As special dietary requirement as well as changes in diet will be monitored and entered into the client s service record. The nursing staff also will administer medications to the clients as needed. The client needs to provide the medicine, with a detailed explanation of how the medication needs to be 21

26 administered. The center also will provide additional services for an extra charge. Physical, occupational and speech therapy will be offered by licensed professionals to those needing the services. Other services including psychological counseling, dietary analysis, nursing assistant, bathing services also will be offered to the clients as needed. An extra charge will be assessed for transportation between the client s home and the center, as well as to and from medical appointments. Clients will be not be charged for transportation to group activities, however, beyond the cost of admission to an outside event. Caregiver support groups will be offered to the clients family members. The purpose o f these support groups will be to help caregiver identify their own needs, identify sources o f help and learn coping strategies to deal with the stress associated with caring for a loved one. Another unique feature of the center is the design o f the physical facilities. The developer has designed a lay out that will be beneficial for each participant. Activities will be continuously going on in several rooms: an arts and craft room, an activity room, a library/tv room, dining room and a living room. A track around the center of the building will provide those wandering individuals room to walk without disturbing other clients or activities. An outside courtyard and gardens with a walking path will provide an atmosphere for those individuals who enjoy the outside, or who enjoy gardening. Several resting rooms, away from the activities will be provided to those clients who need to nap during the day or need some privacy. Between the craft and activity room, an air wall will be in place to allow for larger space during activities. The whole building will have an open feeling with half walls around the walking track, skylights, and windows. (Exhibit 8, see page 48) Each day the clients will have the choice of participating in activities that are age- 22

27 appropriate. Activities should focus on socialization, building self-esteem and a sense of accomplishment and friendships (Alzheimer Association Respite Manual, 1998). Activities will include crafts, painting, sewing, games, lectures, outside trips, entertainment, exercise. See Exhibit 1 A, page 42 for an example of an activity calendar. The activities each day will have a routine, starting in the morning with current events, exercise, brunch and ending the day again with exercise. The clients will be given a list of alternatives. For instance, they can either go on an outing away from the premises or choose to attend an art class in the arts/crafts room. Providing the clients opportunity to choose activities for themselves help foster feelings of autonomy and control (Rodin & Timko, 1992). Each afternoon at 3:00, those clients needing transportation to their homes will depart the center. Clients who are able will be encouraged to be active in the center s leadership and planning. An activities committee will be formed where the clients will help plan, run and organize the activities. Also, the center will have a newsletter written by the clients informing the community, family members, and clients about the activities, the center, and any special events. A client association will be the leadership of the center s community, holding monthly meetings, working closely with the director and staff to help better serve the clients and assess their needs. Monthly conversations with the director will be held to help the clients express their concerns and requests, which could help the director know how to better serve the clients. Monthly, family/caregiver meetings (besides the caregiver support group) also will be held by the director to help the director address the concerns o f the family/caregivers. The center s staff will be trained to work with clients diagnosed with Alzheimers disease, dementia, as well as those who suffered a brain injury, stroke or have other disabilities. Goals 23

28 will be set to help meet the needs of each client. Team building in-service meetings for the staff will be held monthly. Staff will be given benefits and incentives to continue to work at the center. Previous experience and education in working with the elderly will be required of the staff when applying for a job at the center. The program will have an adult-oriented atmosphere including age-appropriate decorations and environment. The staff will be encouraged to treat the clients as adults. The center s physical lay out allows for opportunities for solitude or to become involved in the activities. Studies by many researchers show detrimental effects of infantilization or societal treatment of old age as a second childhood which often occurs in adult day centers (Salari, 1999). The clients will be given the option to participate in activities of their choice and will not be forced to participate if they are not interested. Client autonomy (right of self-determination) and client privacy will be an essential in the center s program. Clients who are typically given autonomy to participate or not in scheduled activities are provided with the freedom to develop friendships in smaller groups (Salari, 1999). The development of informal relationships among the clients will be encouraged in the center. Schedules overloaded with mandatory activities do not allow time for the clients to develop relationships or friendships with others (Salari, 1999). The physical facility design of the building is designed to facilitate these networking opportunities. For instance, it will be equally important for a client to choose to attend any on going activities or to go to the library to have a quiet conservation with a friend. Maintaining close relationships with others and remaining involved in activities that are meaningful and purposeful are important for well-being throughout the life course (Rowe & Kahn, 1998). The director o f the proposed center feels that the concept o f this adult day programing 24

29 will be different and set apart from the other adult day centers in the Salt Lake City area as well as throughout the state. The center will be unique because of the broad range of offered services and the emphasis on client autonomy. The center s emphasis on health and wellness also will set it apart from others in the area. The director feels that the present senior market is in need of an adult day center in the southern part of Salt Lake Valley. As the aging population increases, adult day services will become as vital as child day care. The projected growth of the over 85 age group, a greater consumption o f health care resources and an expected shortage of health care workers will render adult day centers as an important alternative for clients and families within the long-term care continuum. Older adults and their caregivers need to be informed about how adult day services can be a cost-effective resource available to them in the community. 25

30 M A R K E T IN G Marketing Strategy As the population ages, there will be a greater prevalence of more complex problems that will require more expensive and complicated solutions. The projected number of elderly needing nursing homes care will triple between the years 1990 and 2030 (AARP, 1999). The cost of nursing homes will force many seniors to expend their savings and rely on Medicaid. But according to the Administration on Aging, states and localities who are concerned about the escalating costs o f Medicaid are looking toward other alternatives to slow the growth o f long term care expenditures (AoA, 1997.) Older individuals and their families prefer to receive services in their own homes and communities, rather than in institutional settings (AoA, 1997). Consequently, many elderly will choose to live with caregivers and use the services like adult day services as an option that promotes independence and potentially delays admission to a nursing home. Adult day centers also provide respite care to family caregivers. More than 22 million individuals devote all or part of their day to assisting five million older family members who need help due to cognitive or functional impairments (AoA, 1997). The majority of caregivers have multiple responsibilities, including employment and caring for other family members, especially children. Caregivers are critical in the quality o f life of older impaired individuals and need support as they confront the many pressures of caring for a loved one. Without this support, caregivers would find it difficult to continue working and care for their children, while 26

31 simultaneously caring for their aging family member, friend, or neighbor. The proposed center will be located in the southern part o f the Salt Lake Valley, serving Sandy, Draper, South Jordan, and northern Utah County. The center is designed to primarily serve seniors with an annual income greater than $24,000. The marketing strategy for the center will be to target the following groups: 1. The Senior Market- the center will market to the 65+ age group, with annual income o f $24,000 or greater. The center will market to senior individuals who have physical limitations but are cognitively functional and would enjoy the senior center activities but would not be able to attend those activities. Marketing will be done through direct mail advertising, newspaper advertisements, and other publications that serve the senior population. Advertisements will feature statements encouraging participation in the program activities. In Salt Lake County, over 100,000 seniors are in need of services to meet their needs and promote their independence (Salt Lake County Aging Services, 2000). Services will be needed to help seniors with activities particularly during normal business daytime hours. 2. The second group to whom the center will market comprise of family caregivers, typically years of age, with an annual income of $45,000 or greater. Family caregivers are usually the decision makers for their parents or spouses concerning financial matters, living conditions, and daily activities. Many of them still are in the work force and will need someone else to provide care for their loved one while they are away during the day. The advertising materials sent to this the group will emphasize respite care as a way to obtain a break from caregiving duties in order to rest, pursue other activities or errands. The center also will advertise to corporations and private businesses, offering services to their employees who are 27