Starting a Boarding Home

truern · Dec 31, 2008

GoLytely, I have a friend (a fellow nurse) that has been trying to get a home for autistic kids opened for almost two years now. The red tape is unbelievable!! Not sure what the requirements would be for opening an assisted living home, but if any home depends on funding there are all kinds of hoops to jump. Your best bet is finding out locally what the requirements are to see if you're still even interested.

Good luck :)

GeriatrxRN · Dec 31, 2008

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.

antidote · Dec 31, 2008

Wow, I can only imagine what type of work and dedication this would take. Kudos to you for willing to hop in the boat!

What I would do, personally is search around for a decent lawyer that you are comfortable with enough to have through the entire process. Normally one of these fellows will find out what it is you need and assist with you with getting it done. It wouldn't hurt to see if you can find some sponsors, maybe even a friend in the field as well to represent your idea with you.

Jo Dirt · Dec 31, 2008

Thanks. I know operating a business is a 24 hour ordeal. I love old people, but truthfully, they are a huge liability. My father-in-law stayed in a boarding home until he kept falling and they refused to take him back. I know that the owner of this boarding home was having trouble finding elderly residents so she started taking in mental patients who were halfway house material. This caused a lot of problems because they made the old people who were there very uncomfortable.

There is one very small operation in this town and a larger operation (a facility) run by a pharmacist and his wife.

My husband keeps stating all the negatives and being a negative thinker myself, I've about talked myself out of it. Then again, I'm stubborn, maybe too stubborn for my own good.

You'd think with all the old people business wouldn't be so hard to find. I guess most of them are either in a position where they may as well go to a nursing home or their family could get by cheaper hiring a sitter.

I know, too, that unless the potential to make good money is there I wouldn't be interested. It wouldn't be worth the trouble to make 30 or 40k a year after expenses. Not long-term, anyway. I would have to expect to start making real money.

GeriatrxRN · Dec 31, 2008

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:))

Jo Dirt · Dec 31, 2008

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:))

I have some questions, I hope you don't mind.

I know the assisted living facility here charges by what "tier" the person is, ambulatory is tier 1, walker + 1 person assist with goes up to tier 2...etc...they basically told us if we could walk my father-in-law through the door whether he could come in with a walker or if we had to carry him with one on each side..they would keep him until the end. But with the shape he was in (catheter, max assist with just about everything) the rate was $3500/month for the basics (washing clothes, hand feeding him, etc.). The first facility charged $1900/month but when he kept falling they wouldn't keep him anymore.

Did you have an attorney draw up the legal paperwork, or can the state give you the forms you need?

Did you have to get an accountant to figure your expenses? Or is it pretty straightforward?

Did you receive state funding for anything?

I'm in a pretty laid back area for the time being. It is also considered somewhat of a vacation spot because it is right near a big lake.

I actually enjoy preparing meals and helping with baths, washing clothes...I just don't know how much I'd enjoy being a slave to it day in and day out. It would seem I could build up the business and maybe sell it and make a pretty decent profit...maybe I'm living on Fantasy Island. I would think I could keep it up several years, 5,6, 7 years. I'm always looking up and keeping the bigger picture in mind, it seems like.

I would also hesistate to advertise there is an RN on call 24/7...what if I wanted to take a week long trip to the beach and couldn't find a nurse? Do people really consider it a plus to have a nurse on call 24/7?

GeriatrxRN · Dec 31, 2008

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!

rph3664 · Dec 31, 2008

I know a woman whose sister has severe MR, and her parents, who are quite wealthy, were always determined to keep her out of an institution. When the house next door came up for sale, and they knew the day was fast approaching where they could no longer look after her at home, they bought the house and had it converted into a DD/MR group home.

And this is where she lives.

Now, they have reached a point where they cannot look after themselves, and they recently moved to our city (several hundred miles away ) and live in an assisted-living facility. I know that leaving their disabled daughter behind was more painful for them than losing their own independence.

There's a house down the street from my parents where several total-care quadriplegics - all men - live, and people take turns coming in to take care of them. I don't know the story behind that one.

I have no idea who pays for those people to stay in these facilities.

GeriatrxRN · Dec 31, 2008

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:)!!

CHATSDALE · Dec 31, 2008

i don't know about the expenses but with four bedrooms you would be in a bind unless you had all four filled pretty much all the time

you would might be required to have licensed care [rn/lpn] --you would count for one shift--insurance, an accounting service, diet supervision, transport to md etc,

don't want to be a wet blanket but this sounds like an expensive undertaking

maybe if your house was large enough for a few more it might be more profitable

GeriatrxRN · Dec 31, 2008

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.:)