Assisted living in my home? Assisted living in my home? | allnurses

Assisted living in my home?

  1. 1 After a very long, exhausting week and half a bottle of wine this idea occurred to me, and I wanted to see how complicated it would be to do.

    I am an RN in Georgia right now, with experience in med-surg, highly geriatric patient population. I am currently working in home health.

    The idea popped into my head of purchasing a house with like 7-8 bedrooms (3-4 for me and my family). I could then set up the other rooms for people requiring assisted living. I don't mean nursing home type patients. Just people who don't feel safe/comfortable living alone and need some help. I thought we could provide a private bedroom with furniture if they need it. We would also provide 3 meals per day, and a private phone line for each room. As a nurse, I could prepare weekly pill box. We could have a live-in CNA for assistance.

    I was told about nursing homes charging upwards of 5000$ per month for services. I thought that 3000-4000$ could cover whatever care was needed. I would max out at 4 rooms, and would give a special price for couples (ie instead of 3-4 thousand per month for one person, could do like 4500-5000 for 2 people since they would be sharing a room anyways).

    My question is how feasible is this? Could this work? Are prices too high? What kind of licensing would be needed? Does a private, home based assisted living setting require JAHCO approval and all that?

    I would appreciate any kind of input! Could be on here or private message, whatever you prefer.
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  2. 14 Comments

  3. Visit  somenurse profile page
    #1 1
    Interesting.
    I don't know anything about this, but, it's an interesting concept. I do NOT know this, but, i wonder-------, if you are private pay only,
    mayyyybe you might not need to bother with JAHCO, doctor's orders (for diet, activity, etc,)
    NPI numbers, HIPAA forms,
    but
    you still might need a Federal employer identification number (EIN) etc. And a "business" license.

    If you are going to try for third party payors, oh yeah, i can imagine you now have tons and tons of requirement to be met, but, that is just a guess.

    I bet some of these answers, will vary state to state.

    Will you be doing any "skilled" nursing care for these people?
    Or just food, ADLs and general supervision?

    Do you plan to have employees?

    Do you ever take vacations? If so, who watches these people while you are gone?

    If patient declines, and you 'miss' noticing it, how hard will you be sued? I think you'd need a lot of legal advice for this project. If your home caught fire, and all 5 oldsers don't get evacuated, i think there's a liability there, too.

    If you are busy with oldsters #1 -#4, while 5th oldster is trying to sneak into basement and falls, or drinking drano, i think you mihgt be the one who is responsible.

    I see a lot of ways you could end up sued....Might be easier and safer to take in severely disabled, immobile foster kids who often come with many hours of their own nurses, therapists, etc. and all of their medical supplies are paid for, (you still get paid)
    than
    to take in 4 or 5 walking talking semi-helpless oldsters, who will only be getting MORE helpless with each passing year,
    but, i don't know.

    Either way, foster kids, or oldsters, is a ton of work, imo.

    I'd get liability insurance and malpractice insurance, and red your home-owner's insurance policy reeeeal carefully with a lawyer next to you.
    And i'd see a lawyer, about if you should become an LLC or incorporate yourself. (me, i'd see several lawyers on this, lawyers who specialize in nursing law, etc)


    I'm also guessing you'd need a real good accountant to help you with your taxes.
    Last edit by somenurse on Jan 31, '13
  4. Visit  uRNmyway profile page
    #2 1
    My idea was kind of to stay with private pay. I just figured it would be less complicated, and like you, figured that might make a difference as far as JAHCO and all that. I also did anticipate that I would need a business licence.
    I definitely COULD do skilled nursing care if needed. That was one of the things I thought would appeal to the residents, is if there is an RN on site. I guess my main idea was for ADLs but if there is wound care, or one of the residents goes to hospital for whatever reason, need IV antibiotics, tube feeding, etc.. you get my drift. I would be able to provide that. The only employee I thought to have is a CNA, live-in, like I mentioned in the OP. I considered maybe getting someone for night shift, or something like that, to relieve ME, but not sure about that. I suppose it would depend on the dependence levels of the residence.
    As far as vacations, see, things like that are why I wanted to bring it up on here. Vacations hadn't occurred to me. I suppose I could hire a temp from an agency or something to cover. That would definitely increase the cost of my vacation, but, I guess thats what happens when you have your own business.
    I am sure that I would require some pretty substantial coverage as far as home/business insurance, liability, malpractice, all things the attorneys you mentioned could inform me on.
    I hadn't thought about disabled kids, much less severely disabled ones. I thought that would probably be a LOT more work, as well as risk. IE, child with CP, immobile, requires q2h repositioning, but gets a pressure ulcer anyways? And with that, might be harder to find private pay, no? I mean, might be harder to find residents who fit that bill, and are STILL private pay.

    I am so conflicted though. Ever since this popped into my head it's been floating around in there. I would anticipate a lot of work, and it is definitely a risk, just like any 'business' is. But then again, a nurse in LTC typically has what, 30-40 patients in her charge? I think to have 4-5 would be do-able. And the CNA who gets hired for that would probably be pretty happy too I would think!

    I appreciate the response and input JeanMarie!


    Quote from Jean Marie46514
    Interesting.
    I don't know anything about this, but, it's an interesting concept. I do NOT know this, but, i wonder-------, if you are private pay only,
    mayyyybe you might not need to bother with JAHCO, doctor's orders (for diet, activity, etc,)
    NPI numbers, HIPAA forms,
    but
    you still might need a Federal employer identification number (EIN) etc. And a "business" license.

    If you are going to try for third party payors, oh yeah, i can imagine you now have tons and tons of requirement to be met, but, that is just a guess.

    I bet some of these answers, will vary state to state.

    Will you be doing any "skilled" nursing care for these people?
    Or just food, ADLs and general supervision?

    Do you plan to have employees?

    Do you ever take vacations? If so, who watches these people while you are gone?

    If patient declines, and you 'miss' noticing it, how hard will you be sued? I think you'd need a lot of legal advice for this project. If your home caught fire, and all 5 oldsers don't get evacuated, i think there's a liability there, too.

    If you are busy with oldsters #1 -#4, while 5th oldster is trying to sneak into basement and falls, or drinking drano, i think you mihgt be the one who is responsible.

    I see a lot of ways you could end up sued....Might be easier and safer to take in severely disabled, immobile foster kids who often come with many hours of their own nurses, therapists, etc. and all of their medical supplies are paid for, (you still get paid)
    than
    to take in 4 or 5 walking talking semi-helpless oldsters, who will only be getting MORE helpless with each passing year,
    but, i don't know.

    Either way, foster kids, or oldsters, is a ton of work, imo.

    I'd get liability insurance and malpractice insurance, and red your home-owner's insurance policy reeeeal carefully with a lawyer next to you.
    And i'd see a lawyer, about if you should become an LLC or incorporate yourself. (me, i'd see several lawyers on this, lawyers who specialize in nursing law, etc)


    I'm also guessing you'd need a real good accountant to help you with your taxes.
  5. Visit  somenurse profile page
    #3 0
    I hope someone who knows more about this than i do,
    will see this thread and give you better ideas of things to consider.

    Re: the kids. No, that wouldn't be private pay at all. Severely handicapped kids, often immobile, often barely responsive, are NOT not not not private pay,
    but, the homes i have been to as a nurse, often had multiple children like that. And such children do have all their medical equipment payed for by govt, and govt pays for private duty nurses, often many hours per week. Often, multiple nurses in the home (paid for by govt) not just me.

    The foster parent or parents
    do receive stipends for each and every child, though.
    It used to be $1,000s of dollars per month,
    per child,
    but, i have no idea what todays stipends are nowadays, but, i used to do some of this kind of nursing on the side,
    and the homes i went to,
    were ordinary homes, but, no doubt, some type of inspection must have been done to be able to qualify for this. and no doubt, a thorough investigation into your background would be req'd, or, at least, i hope it would be req'd.

    but, so far as i know, JAHCO is not involved in that kind of home, at all, so far as i know, but, admittedly, i do not know. Usually, a nurse is VERY aware of the presence of JAHCO, cuz you hear stuff "Jahco is coming next week" etc etc, but, i never heard a word about jayco, ever,
    but ohhh my, did i ever hear about medicare or medicaid, so my charting would be following criteria for them. But jayco, nope, dont' recall hearing about them.

    While the nurses ARE there, the workload on the parent is very reduced,
    but,
    once all the nurse do leave, it is a lot of work. Many nurses and foster parents find the immobile child can be less work than the child who IS running about, and possibly, some people might find an immobile child, some of whom are barely responsive,
    less demanding or less work than a semi-helpless, walking talking oldster, too.
    Last edit by somenurse on Feb 1, '13
  6. Visit  somenurse profile page
    #4 0
    re: doing skilled nursing care, seems like you would need a doctor's order for those activities.

    but, in the foster homes i went to, the parents would be doing things often considered "skilled" nursing activities, such as giving tube feedings or suctioning trachs, even though parent was not a nurse. Still a doctor's order was around for the activity was written somewhere.
  7. Visit  LadyFree28 profile page
    #5 0
    Depends on the state...did you check your state's local health department?? In my state, live in caregiving is covered by Medicare, usually 3,000 per person, to be exact. A colleague of mine was interested in doing this as well, researched it and thought of contracting people she knew to pick up hours and rotate. This colleague knows a family of nurses that do this as well, and charges the insurance companies 3000-5000 dollars/month, depending on local, state, and federal guidelines. These nurses have been doing this for at least 3 years...Right now, my colleague has left it at the planning stage, so I don't know any more info...at least start with the state health department, and find out who regulates private group homes. Hope this helps!
  8. Visit  CapeCodMermaid profile page
    #6 0
    Liability. Malpractice...home owner's. What you want to charge seems quite high. Even in expensive Massachusetts you can find a nice assisted living for less than that.
  9. Visit  Glycerine82 profile page
    #7 0
    Yeah, I'm thinking there would be so many problems that could pop up. What if someone can't afford to pay anymore? Do you just throw them out? What if they die under your care, what if they fall and break a hip, what if your CNA gets sick, you get sick, seems like there would be a ton of hoops to jump through.

    "No day but today"
  10. Visit  Designer NP profile page
    #8 0
    Why not just open a group foster home? I have a cousin who does this. All of the kids are healthy, but just need a home and guidance.

    She used to take a few in her own home, but now has a bigger facility and is able to foster more.
  11. Visit  uRNmyway profile page
    #9 0
    Hmm, I don't know about the foster kids thing. My grandparents used to do this and they often had a very difficult time with the behavioral problems many of them had. Some got violent with them, and I don't think I would want to risk that with my toddler.
    Of course I realize the elderly can get confused and aggressive too, but that is why I was thinking of an assisted living as opposed to nursing home type home.
    As far as how much I was thinking of charging, I am flexible with that of course, to a certain degree. I had just heard of many places charging close to that amount in this area, but I would definitely need to do more research.
    And I realize there are many risks and hoops to jump through. I mean, isn't that what starting a business is though? You get all the different necessary insurances. You set up backups for staff and all. That is partly why I thought of keeping it small. Less residents means less need for staff, thus less staff to replace for sickness/vacation, etc.
  12. Visit  nurseprnRN profile page
    #10 1
    I would definitely contact your state board that regulates nursing homes, rest homes, and assisted living and get their definitions of what each one is, and the regulations for each. This may help you decide how many hoops you want to jump, what level of acuity you want to manage, setting criteria for when someone has to move out, etc.

    You will definitely need an EIN (employer ID number, even if you are the only employee), so contact a good tax accountant to help you with that aspect of your business. That person can also advise you on how to incorporate, what form to file with your state to do that, etc. Do not wait until later to do that. Do it first. If you will have employees (you're not going to work/take call 24/7, are you?) you'll need to look into tax withholding, paying into the state work comp fund, etc. If you are not medicare/medicaid certified you won't have to do CORI checks, bonding, insurance for malfeasance by your employees...but you may be personally liable if they steal or injure someone, etc. And cover no-shows yourself... Sure you want to take that on?

    Then you call your malpractice insurer and ask them what they think you need coverage for-- or what they won't cover you for. There's a lot you need to think about. It's not as easy as, "Gee, i can help old folks who need a little support in my house."
  13. Visit  nhgypc50 profile page
    #11 0
    I was the wellness director at an AL complex and worked with the homes that are used as assisted living 6 bed to 10 beds . Most states want you to follow the rules for the regular houses especially when it comes to having more than 3 people. You have to make sure meds are done correctly etc. You could look into independent hsing for seniors who are concerned about living along but do not need any assistance. So will be able to take care of their meds but they are past the ability to take care of meals, laundry and cleaning house, they also will need transportation etc. It could be per state for rules but I would call a small AL and pretend your looking for your parents and want to know what regulations cover them. Also check your state board of nursing for the rules that are there if your a nurse you are suppose to follow the state rules! PS loved the job was with the company for 4 yrs until a new state manager came in and ripped it out from under me. So I am also looking into something of my own. Good luck.
  14. Visit  Designer NP profile page
    #12 0
    Just to add on what Grn Tea said about your EIN number and what form you should take for your business..after you figure out whether to incorporate or do a limited liability, I advise using Legal Zoom. I haved used them to file for both of my businesses and it was a breeze.

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