A move to 'assist' facilities

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As freestanding nursing homes struggle to stay afloat, some providers are adding assisted living to boost occupancy and attract private-pay residents. Experts believe this model is predominantly popping up in smaller communities, which have traditionally been underserved by the assisted living market.

"While nursing care remains an integral part of the continuum, more and more seniors are seeking out assisted living," said Bradley Schurman, advocacy project manager for the American Association of Homes and Services for the Aging, Washington. "It's a way for (nursing facilities) to tap into a lucrative, private-pay market that can help sustain their business model."
About two years ago, Harvard Rest Haven in Harvard, NE, converted nine of its double-occupancy rooms into four assisted living apartments and added a newly constructed wing with 13 studios. Overall, it now comprises 17 assisted-living units and 37 nursing beds.
The facility was one of more than 70 Nebraska nursing homes that took part in a state-funded conversion program, which required participants to devote 40% of their assisted living units to Medicaid-eligible residents. Similar efforts are underway in neighboring states.
"Over the years, we had seen a decline in occupancy because people were staying in their homes longer," said Administrator Ron Crosby. "Without the assisted living, we would have found it more and more difficult to operate."
From a marketing standpoint, Crosby has worked hard to create a separate identity for the assisted living component of his facility. Harvard House Assisted Living has its own name, its own manager and apartments that feature the same design and amenities that residents could expect to find in freestanding assisted living.


Keeping separate, yet related


Crosby believes the combination model has been very beneficial to the community.
"It gives residents a choice in care levels without having to pick up and move," he said. "We have assisted living residents who eventually go into our nursing home, and we also have people come back from a hospital stay, spend a few days in the nursing home, and then go back into assisted living."
Dave Kyllo, executive director of the National Center for Assisted Living, Washington is quick to point out, though, that adding a level of care is no small undertaking.
"You can't just hang a sign saying that you're assisted living," he said. "You need to reconfigure the physical plant and have a different look and feel of your decor. You want to have different quality assurance programs in place and make sure that staff is trained in the assisted living philosophy."
Getting staff acclimated to assisted living can be a challenge, explains Bev Schnell, the administrator of Kimball County Manor, which underwent the conversion a few years ago.
"Our nursing home staff are wonderful caregivers, and they were used to jumping at every chance to help," she said. "With assisted living, we had to educate them to let residents be more independent."
Despite initial adjustments, Schnell feels the change has been well worth the effort. By sharing resources such as laundry, kitchen and transportation services, Kimball County Manor has been able to operate both components more economically.


Market may dictate


Jan Thayer, CEO of Excel Development Group, has consulted on more than a dozen conversion projects. She is a strong believer in the model, but cautions that success is often market specific. Detailed market research and financial forecasting are necessary.
"It can sometimes be difficult for a facility to free itself from the fact that people in the community have known it as a nursing home and may not think of it as their first choice for assisted living," she said. "There is the challenge to demonstrate that you're delivering an entirely separate kind of service."
There are also some other issues that are unique to combination projects.
"If you share any services with the nursing home, for instance, you have to be very careful with your accounting," she said. "It's important to make sure you're not charging Medicare or Medicaid for time, supplies or utilities that are being used in assisted living."
Providers can face challenges when it comes to renovations as well.
"There are some states where the buildin