GeriatrxRN

Best bet is to hire several live-in staff and they can alternate their days off; much cheaper. Also, you will have to consider if you need two staff per shift or one (depends on residents' level of care needs, including if two person transfer etc).

I wonder if people are realizing that this post is 4 yrs old; some people are still answering the post/giving advice as if it was posted recently. Also wonder what happened to the op and if he found another job or what...he never posted after the original post.

I am also interested in this...

What state are you in ?

I used to own one a few yrs ago. Few things to consider prior to opening it: 1. Referral source 2. Competition (from other small group homes like yourself and larger ALF) 3. Location (nice suburbs preferably) 4. Good staff (they make all the difference) Also, double check w/your state licensing whether or not you can provide nursing care to the residents; in my state you can't. But you can get around that by working for a skilled care agency and providing skilled nursing for the cert period , just like you would for any other home care patient. Good Luck!

In michigan medicaid recently approved a program that supplements what a person with low income can afford to pay ( ie using their ssi check). Check what programs your state has. I work as an RN assessor for Area Agency on Aging which is why i know this. Also what kind of figures were you using where this wouldn't be lucrative?

It sounds kind of low to me. I'm a home care RN, and I get paid $55 for revisits (the one unit you were talking about) and $85 for initial visits (the 2 units). No milage reinbursment though, but no oncall either. But don't forget , when they pay you per visit that means the paperwork that goes with it, (which takes a while, esp the initial visits).

I'm also interested in becoming a geriatric case manager and was wondering if you knew if insurances or other modes of payment (other than private pay) would pay for this type of service. Also, if you don't mind , what type of rates were you thinking of charging the client. I've heard that some case managers charge by the hour and others by the case. Thanks in advance for your response and good luck in your venture!

I work in home care, not hospice, but was wondering where/how you would generate your clients, since you would be competing with medicare, a free service.

I've read several posts where RN's want to bill medicare for home visits but can't since you would need to have an established home care agency. It's something that has interested me as well, so I was wondering if it wouldn't be easier to just open a staffing agency, where you could refer yourself to a home care agency and ask for a certain amount per visit. Of course it would be higher than they would normally pay since you would be bringing in your own clients. Any thoughts on this? Are there any medicare rules/reg pertaining to staffing agencies? I currently work for both a staffing agency and a home care agency. I have the possibility to generate medicare clients (from established connections with dr's, assisted living, etc), but don't want to work as a marketer. I would prefer to be compensated for both bringing in clients as well as making the home visits. I also know that its illegal to get compensated for referring clients (ie per head), so I'm trying to find a good medium (and legal way) for doing this. Thanks in advance for your comments/advice:)

How much do home care agencies get paid by medicare for RN visits? I noticed on the medicare website that for 2009 skilled nursing visits were listed as $109 and for 1010 as $111. Is this just a base rate and increases as patient complexity/increase in skilled nursing care is needed or is it a flat rate? Thanks in advance for your response:)

Hi, I recently graduated with my BSN degree and love working in the geriatrics field (have been doing it for the past 10 years). My question is: Should I go for the GNP or , as so many have recommended, go for the ANP? My dilemma is that I would like to only work with the geriatric population, but fear that I wouldn't be able to get a GNP job (since there's not that many out there). Also, I love the idea of the GNP program where it would be specific to the population I'm interested in, whereas the ANP will include adolescence which doesn't interest me. My goal is to work full-time and go to grad school part-time, thus finishing in aprox 5 yrs and getting some nursing experience in the meantime. I'd love to hear thoughts from both GNP's and ANP's. The two GNP's I've spoken with also have their ANP, so that didn't help much. Also, would you recommend that I work in a skilled nursing home vs a hospital to get the max experience/exposure to this population? Thanks in advance for your comments!

I'm sure a lot of us new grads would like to know what city you live in. LOL. I'm in Troy, Michigan (northern suburb of Detroit) and I've been told by a hospital nurse recruiter that although there's a nursing shortage she said that there is a hiring bubble right now. She stated that they're not hiring due to the fact that nurses are not retiring because of the state of the economy plus nurses that were working part-time are now picking up extra shifts or switching to full time due to the fact that their husbands are out of a job from the automotive industry. She also stated that she's not sure how long this bubble will last, but as soon as these nurses retire there will be a big nursing shortage. (Maybe that's what she meant by nursing shortage). She also said that MI state health dept called her and requested that when they are hiring again to contact them since they are having a problem with the fact that a lot of MI nurses are leaving the state. I'm not sure if this is unique to our state because of the layoffs from the auto industry, but from reading other posts it seems like a lot of other states are having the same hiring issues.

Just FYI, this is the way I found it to work for me...I'm not sure what they would consider it to be the "correct" way to put on stockings for your CNA skills. You might want to ask your instructor.

I usually start by laying the stocking on the bed normal (not inside out) then folding it in half so that it is inside out half way...and then put it on like you would a normal stocking. Keep it folded in half while you are putting it on, and as seam-less as possible. When you get it to around the calf area (which should be the top of your folded stocking) unfold it and pull it up. I found that this way, it really cuts down on the tightness around the foot caused by bunched up stockings and helps you maneuver them more easily. Good Luck!

I'm currently a UT student in my last semester of the BSN program at UT. I'm not sure if you are aware of the fact that BG doesn't have a nursing program, instead their student come to the program at UT (but it's still thru BG). I chose to apply to UT (and transfered my prereq from a univ in MI) instead of BG because tuition is cheaper at UT. Our GPA cutoff, in 2007 was 3.4. Good luck!

GoLytely, I would really encourage you to find out the laws that pertain to your state regarding board and care homes. They really are different in each state. For example, comparing licensing regulation for Domiciliary Care/Family AFC Homes in MI to PA (in the post by NRSKARENRN) you are allowed to have up to 6 residents in MI vs only 3 in PA. The quote below is from the following MI website http://www.mfia.state.mi.us/olmweb/ex/ASM/376.pdf Also, in MI the amout of residents (6 or less) you can have in a Family AFC home is based on two things: the square footage of your bedrooms/house and the total number of people living in the house (that includes you, your spouse, children, residents). I just wanted to point out that there are big differences in licensing between the states. Two of my friends have a board and care home in diff states, one in CA and another in OR and their regualtions are very diff than MI (much more stringent than MI). I'd be more than happy to answer any questions you have regarding board and care homes, since this seems to be my only area of expertise on this board:). I'm graduating in May 2009 with a BSN and have no clinical exerience so I can't contribute too much on practical advice in nursing:) But in terms of rules and reguations, your state licensing office is your best bet. Good luck and take care! Daniela

The idea of building the business, keeping it for a few years, and then selling is actually a very good idea and you can make a very good profit from it. Especially if you are filled to the max capacity. A friend that's selling her business now, told me that there's actually a formula as to how much you can ask for it based on how much money the business generates and how many residents you have. I didn't sell my busines but left it to my mother, since she was laid off from her job and had a hard time finding another one (chemical engineering). Although it wasn't in her field of work she caught on pretty quick and has been doing a really good job. She has a very good heart and loves old people. k, if you have any other questions , feel free to ask.:)

In response to your questions: You, as the owner, determine how much you want to charge the resident, (ie by how much care he/she needs, a set rate no matter what, etc). Majority that I know, have a base rate and then increase the rate as more care is needed, much like the tier you described. Based on the care that your father-in-law needs, I probably would have charged the same if not a little more, maybe $4,000 (of course, if the family could afford it. No use in charging more if the family can't afford it. You usually get a feel for how much the family can afford. They're usually pretty open about it). 2) You can get the forms either online or mailed to you (depends on your state licensing office). I didn't get a lawyer. They're pretty straight forward. In MI, there is a big difference if you open a Family Home (where you live in the home that's licensed) or a Group Home (don't live there). Group home requirements are more and much more specific. What I did was open a Family Home and then convert it to a Group home after a few years. It's easier, especially at the beginning and if you're not sure if this is going to work out for you or not. 3). I used an accountant and would recommend it. They know what you can deduct better than you. Also, remember diff state, diff laws. They know the laws for that state. 4). I did not get state funding. I'm assuming you're refering to medicaid. In order to accept residents on medicaid, you have to be approved for that thru medicaid office (I believe)...which is separate from your board and care license. I've heard from others that were approved for medicaid that it's really a pain in the behind. There are twice as many visits from the licensing dept and requirements are a lot more stringint (in terms of physical enviromnent, reporting, etc). Plus, pay-wise, it's not worth it. In MI, I think they only pay like $1,000/mo or so. A lot of the board and care that accept dev delayed, mentally impaired, traumatically brain injured will accept medicaid. Not many that speciallize in elderly though. 5). YES!!! I would most definitely advertise that you have a nurse on call. BUT like you said, you have to make sure that you have someone to cover you while you are away. It's a BIG PLUS, in terms of advertising. Think of assisted living facilities that don't have nurses on call. You can offer that, they can't. Also, when families know that there's a nurse on call, it gives them peace of mind, knowing that there is professional care available in case their loved one needs it. Ok, I'll post this and respond to your other questions in another post...This is gettting really long and I type so slow:)!!

If you don't mind my asking, what part of the country do you live in? From your posts it almost sounds rural...In which case, I'd venture to say that you'll probably have to charge less (than I did) for your services. Although, you might already have an idea of the monthly rates if your father-in-law was in a board and care home in the area. Since one of my greatest challenges was finding residents, I thought I'd share this with you too (in case you do decide to open the board and care home). My suggestion would be to find a case manager or discharge planner at a local hospital (try the ortho floor, med-surge floor) and let them know that you're planning to open a board and care home and ask if they would be willing to send some referrals your way. If you're a nurse maybe you can network with some friends this way. Also, you really need to sell your services. Tell them how your services compares to the larger assisted living or even the nursing homes (ie. resident to staff ratio, home cooked meals, no need to transfer to a nursing home if they need a wheelchair (if that's what you decide on), home-like environment, leisure activites, etc). Best of luck to you!

Sorry, I hit post before I finished my post. This is my first time posting on this board:)) I just wanted to mention the postive side of things too. 1. You do make a lot of money. I charged $2,500/month for my first few clients and then up to $3,500/mo depending on how much care they needed and/or how much they could afford to pay. Find out how much other board and care homes charge in your area (it really goes by the state and area you live). Your state office can also send you a list of board and care homes with the phone numbers in your area or you might be able to access that info online. 2. You have a lot of tax write offs, especially if you live in the house that's licensed. 3. Family can help out 4. With good help, you can make your own hours. The advice that I give my friends that ask me if I think it's worth opening a board and care home is, yes, but be ready for a lot of sacrifices, hard work (even if you have employees) and have a goal in terms of how long you want to do this for. The goal will help when you feel like you're about to burn out and you can't do this anymore. One other thing I wanted to mention (although this might be on the negative side again:) was the fact that you might be able to get residents that are ambulatory, but I'm sure that you're aware of the fact that the elderly can go downhill pretty fast in terms of mobility. So then you have to decide if you want to keep them or send them to a nursing home. Since it was pretty hard for me to get residents I usually kept them and, if the famiy could afford it, I raised their monthy charge a little. Also, I had to make sure that there were always two people on staff since some were two-person transfers. Okay, that's enough advice...:)) I hope this helped somewhat, and that it wasn't too pesimistic:))

Hi, I ran an Adult Foster Care Group (AFC) Home (the name for board and care here in MI) for a few years. You do need to be licensed and each state is different in terms of the requirements (physical property, paperwork: program statement, resident info, incident/accident reports, financial statement, etc etc). I would first contact your state office that deals with board and care and have them send you an application packet with the requirements. (In michgan, the office that deals with this is the Dept of Health and Human Services). In terms of hands-on stuff, I would be prepared for a LOT of that. You're right that good help is hard to find...and also there is a lot of burn out in this type of work. Additonally, workers then to slack off if you're not there to set an example as to how high your standards are. I found that if they see you working hard they will tend to do the same. If not, they slack off. Also, remember that this is very different than the 12 hr or 8 hr shifts at the nursing home/assisted living...vacation time has to be very well planned out and you need to have a manager left in charge that's responsible for the time when you are gone (there's certain requirements for managers per state licensing). I don't mean to scare or discourage you, I just wanted to get across that this job really is a 24 hr job and it really ties you down. I've had to miss weddings, vacation times, etc becasue I didn't have anyone to leave in charge. One other aspect to consider is, where will you get your residents from? Competition is pretty high with the assisted living facitlites and nursing homes. When I first opened my AFC home, I only had one resident for an entire year (I was licensed for 6). I recently talked to a licensing consultant here in MI for a friend that wanted to open one, and the consultant told me that the problem is not opening an AFC home, it's getting the residents.