Adult day care center.pdf

8/11/2019 Adult day care center.pdf

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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 U niversity o f Utah

April 2001

Supervisory Committee

Michael Caserta, PhD, ChairScott Wright, PhD

A. Kimberly Dansie, MBA


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Copyright 2001 by Corey Fairholm

All rights reserved


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T a b l e o f C o n t e n t s

A bstra ct .................................................................................................................... ii

Executive Sum m ar y............................................................................................... 1

IntroductionDemographics Trends in Aging ............................................................................ 4

Caregiving............................................................................................................... 5

Adult Day C ente rs .................................................................................................. 7

The Service

Product Spe cifica tio n............................................................................................ 14

Mission Sta tem en t.................................................................................................. 16

Object iv e................................................................................................................. 17

Company Strateg y.................................................................................................. 17

Managem ent Struc tu re .......................................................................................... 17

The Service............................................................................................................. 18

Marketing

Marketing Strateg y................................................................................................. 26

Economics Cond ition s.......................................................................................... 28

Distribution Channe ls ........................................................................................... 29

Com pe tit ion............................................................................................................. 31

Marketing Proforma Start-up Bud get .................................................................. 36

Finance

Financial P lan ........................................................................................................... 37

Sources of Finan cing................................................................................................ 38

Financial Requirem en ts........................................................................................... 38

Sourcing..................................................................................................................... 38Material and Production Requirem ents................................................................. 39

Labor Req uirem en ts.................................................................................................. 39

Structure..................................................................................................................... 39

References C ite d ...................................................................................................... 40

Exhib its........................................................................................................................ Exhibits 1A-8

Appendix..................................................................................................................... Concluding

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Abstract

The purpose o f 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 anindividual 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 occurr ing 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 o f

accomplishment. Life satisfaction, or the feeling that life is worth living, may be achieved

through tasks in ones life, accepting ones mortality, sharing experiences with the younger

generation and leaving a legacy to future generations.Guided by Ericksons 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.


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EXECUTIVE SUMMARY

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 o f 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 of life and stimulation. The educational component of the centers 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 o f 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 o f 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.

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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 2005. By the year 2030, over 75 million people will be over the age o f 65 years.

The proposed centers 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 com pared to $50,000-$80,000 a year for long term care.

Because a growing number o f 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 o f adult day care. The base price o f 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.

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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 o f Human Services, Office of

Licensing. The adult day centers serve a variety o f 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 centers 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 cen ter 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 centers expenditures will be $340, 934, and its net operating income will

increase to $167, 962 per year.

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INTRODUCTION

Dem ographic Trends in Aging

Those over the age of 60, comprise the fastest growing segment of Utahs population.

The elderly population in Utah will increase by 65% between the years of 1990 and 2010,

compared to a growth o f 49% for the rem ainder o f the population (Salt Lake County Aging

Services, 2000). Trends indicate that this age category will continue to increase until the year

2020. The older population in the United States is becoming increasingly older. The number of

older Americans increased by 3.2 m illion 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 Americas 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 o f the older segments o f 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 Americas population, will increase from 3.9 to 8.5 million by the year

2030 (AARP, 1999). Nationally, the state o f 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

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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 o f 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 persons independence and requires some level o f ongoing

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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, los t productivity, greater stress, and the poten tial stress, and the potential loss o f

skilled employees are among the more significant impacts that businesses will face as the

number of elderly continues to grow (Salt Lake County Needs o f the Elderly, 1999, p.2). The

demands and constraints o f caregiving can become overwhelming. Many working caregivers

find that the demands o f their jobs and the ir caregiving responsibilities are in conflict. In fact,

an increasing number o f companies and governm ent 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 o f their employees. Emphasis is

now being p laced 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

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younger and older disabled persons and their families prefer to receive services in their own

homes and communitie s, 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 Alzheimers Association (2000) as a short time of

rest or relief from the responsibility of 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

relie f while the loved one receives care from qualified individuals. An evaluation of a respite

program found tha t 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 o f 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 o f 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 impairm ents (Travis, 1993). The service was introduced to the United

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States in the late 1960's by an English physician who originally used day treatment as a means of

accelera ting the return o f aging, hospita lized 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 of family respite and caregiver support (Travis, 1993).

Most programs are community-based and are effective models for meeting the physical,

psychological and cognitive needs o f dem entia 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 centers staff; special therapies,

and hea lth monitoring and medical treatments (only if the center qualifies as a medical adult day

care) (Travis, 1993). Adult day centers promise the opportunity to main tain individual worth and

dignity, prom ote independence, and potentially delay admission into a long term care facility.

An ad ult day care program may focus on one or a combination o f activity programming,

designed to engage the individual according to the persons capabilities and changes in their

functional levels. A program should consist o f several aspects including: mental health

programming, which emphasizes counsel ing 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 (Alzheimers 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 A dult Day Services Association in 1998 demonstra ted both short-term and long-term

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benefits o f adult day care use in decreasing caregiver stress and enhancing psychological well

being (National Adult Day Services Association, 1997). The study also showed that the adult

day centers maintain the clien ts present level o f 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 cente rs activities.

Adult day centers can be either a m edical o r 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 of the

program is to foster the personal independence o f the participants and promote their socia l,

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 of a continuum o f

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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. Two-

thirds o f 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 Adu lt 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 o f Adult Day Care (NIAD) permit tremendous flexibility in the qualifications o f

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 o f 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

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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 o f 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

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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 Alzhe imers 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 cen ter (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

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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 o f 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 o f the impaired older adult, as well as provide

needed respite for their family caregiver. Adult day services supplement home health and other

long-term comm unity-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 long

term care continuum.

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THE SERVICE

Product S pecification

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 o f 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 Eriksons psychosocial model of human development maintains that ones

personality is affected by their social environment (Hooyman, 1996). The process o f aging

entails numerous life changes which places demands on the older persons abilities to cope with

and adapt to new life situations. Personality characteristics influence coping responses. This

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center will provide more o f an adult-oriented setting, age appropriate activities and privacy and

autonomy for each client. Activities and the atmosphere o f 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 self-

mortification 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

of 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 s taf f 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

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(Salari, 1999). The environment of the proposed center will be a comfortable, home-like

setting. Each ind ividuals 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 of their own functional capacity.

The philosophy o f the center will be that the client needs to be treated to the highest level o f

their cognitive functioning and encouraged to allow expressions o f 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

environm ent 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 centers 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 sta ff of the proposed center will

provide the clients with an opportunity to main tain their individual worth, dignity, and their

independence. The center will provide caregivers with needed respite from full-time caregiving

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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 o f family members needing respite care in the South Salt Lake

valley (primarily Draper and Sandy) and northern Utah County.

2. Market the unique features o f 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 o f much needed respite by using the adult day center.

as well as support from professionals and peers.

MANAGEMENT STRUCTURE

The management team of the adult day center will be lead by a chief operating officer who will

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oversee the financial, marketing, and management operations of the business. A program

supervisor will be on sta ff 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 o f 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 w ith 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 sen ior 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.

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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 seniors 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 o f 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 mainta in the ir individual worth and dignity, mainta in

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 cen ter will have a stimulating combination o f 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 abou t 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

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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.

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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 Eriksons

psychosocial stages (Hooyman, 1996).

Special needs will be met at the center through an interdisciplinaiy team consisting of 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 o f 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 o f Human

Services, Office o f 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.

Nutrit ious 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 staf f 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 clients service

record.

The nursing sta ff also will administer medications to the clients as needed. The client

needs to provide the medicine, w ith a detailed explanation of how the medication needs to be

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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 clients 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 of help and learn coping strategies to deal with the

stress associated with caring for a loved one.

Another unique feature o f the cen ter 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 ha lf 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-

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appropriate. Activities should focus on socialization, building self-esteem and a sense of

accom plishment and friendships (Alzheimer Association Respite Manual, 1998). Activities will

include crafts, painting, sewing, games, lectures, outside trips, entertainment, exercise. See

Exhibit 1A, page 42 for an example o f 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 o f 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 centers leadership and

planning. An ac tiv ities com mittee 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 o f the centers 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 centers 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

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will be set to help meet the needs of each client. Team building in-service meetings for the staff

will be held monthly. Sta ff 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

centers physical lay out allows for opportunities for solitude or to become involved in the

activities. Studies by many researchers show detrimental effects o f infantilization or societal

treatment o f 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 o f their choice and will not

be forced to participate if they are not interested. Client autonomy (right o f self-determination)

and client privacy will be an essential in the cen ters 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 d irector o f the proposed center feels tha t the concept o f this adult day programing

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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 o f the broad range of offered services

and the emphasis on client autonomy. The cente rs emphasis on health and wellness also will

set it apart from others in the area. The direc tor 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 becom e as vital as child day care. The projected growth of

the over 85 age group, a greater consumption of 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.

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M A R K E T I N 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 o f 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 lifeo f 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

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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 45-65 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

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caring for an aging individual.

3. The third market segment includes many professionals who work with the senior

population: geriatric physicians, discharge planners, financial planners, social workers, and

geriatric care managers. Many seniors and their family members rely on these professionals for

expert advice because they are trained in aging issues and they can provide valuable information

that can assist family members making decisions about the care of their loved one. For

example, a physician might indicate to a caregiver that the parent is unable to be by themselves

during the day while the caregiver is at work, and they would refer them to an adult day center to

provide a safe environment fo r the elderly individual. Once again direct mail advertising will

be used to market to the professionals and providers. Education is an important aspect o f

marketing to the professionals, to help them understand the purpose o f adult day services and

how they will benefit their clients. St. Marks Hospital and Intermountain Health Care have

Senior Clinics as part of their services offered for seniors. The center will begin marke ting to

those clinics to inform the physicians and nurses about the program.

Economic Conditions

The senior population in the United States is booming. Projections show by year 2030,

1/3 of the U.S. population will be 55 years and older (AARP, 1999), In the year 2000, the older

population reached more than 35 million people and by the year 2030 that number will increase

to more than 70 million people. The overall population in the United States is becoming

increasingly older, and the average age o f the older population is also increasing (AARP, 1999).

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Utah is experiencing a burgeoning senior population as well. Between the years of

1990 and 1998 in Utah, individuals 65 years and older increased by 22%. By the year of 2008,

Utah will have more than 500,000 individuals over the age o f 65 (Governors Office o f Planning

and Budget, Demographics and Economic Analysis Section, 1999). Salt Lake County alone

faces a challenge because the frail elderly population in that county will be more than 200,000

by the year 2020 (Salt Lake County Aging Statistics, 2000). Needless to say, the population is

aging and many more services will be needed to meet the demands o f the elderly population.

The number o f nursing home residents age 85 and above will increase by the year 2040 to a level

two to three times the current number o f person 85 and older in nursing homes (AARP, 1999).

The purpose of adult day care is to delay admission into long term care facilities and

could provide a less expensive alternative for frail and impaired elders. It also provides respite

care, a temporary break for caregivers, by sharing the care of a loved one with other

professionals. The center will charge $39 a day with additional charge for extra services. The

yearly cost o f $ 10,000, translates into a savings of more than $40,000 a year compared to

assisted living or nursing home care.

Census Aging America Trends and Projection (1991) (Table 1A) states that older adults

comprise one o f the wealthiest segments of the population. Only 24% o f the populations net

worth is less than $25,000 a year. Senior individuals will save several thousand dollars by

choosing adult day services over nursing homes, assisted living, or home health care,

Distribution Channels

The distribution channels for the center will be a direct sales force. The chief operating

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officer/administrator will be the main marketing/sales director for the business. If the business

grows, the business will consider hiring a marketing/sales manager to help with the marketing of

the business.

An administrative assistant will be hired at $8.50-9.00/hr., to manage the sales/marketing

office. The duties o f the administrative assistant will include: the direct mailings, answering

inquiries, coordinating tours, managing waiting lists, and providing information to the public

about the adult day center. An incentive program will be offered to the administrative assistant,

encouraging the assistant to make call-backs, schedule tours and enroll people in the program.

One of the most important duties of the administrator will be to sell and market the adult

day services to the community. A public educa tion component o f the marketing department will

need to be in place to help educate the public on ways to use the services of adult day care and

who could benefit from the services.

The administrator will market to groups o f seniors as well as to caregivers. The

administrator will schedule meetings with different groups ranging from Lion Clubs, church

groups, corporation CEOs, independent living facilities, physician groups, and civic groups. The

business will be a member o f the Chamber o f Commerce. The administrator must understand

the personality traits of people the center needs to target and know how to ask for a commitment

from the family and individual. The key to success for the company will be the confidence the

administrator has in the product and how well she can persuade and influence the customer to

decide to use the service. The administrator must be able to persuade and influence the

customer to choose adult day services as away to meet their needs as a caregiver. Enrollment

goals will be set each month as an incentive for the sales staff.

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Direct mail advertisements, newspaper ads, ads in magazines targeting senior audiences

will be ways that the company will market to the public. Newspaper ads will target the

caregivers of seniors, addressing their need for respite care to meet the demands of their lives.

Other ads will also target the needs o f the elderly through the activities and events happening at

the center. Sales and marketing is the essential to the success of the business.

Competition

Within the state of Utah, fourteen licensed adult day facilities are serving the elderly

population. Many nursing homes and assisted living facilities offer adult day services as part o f

their services but must meet the licensing requirements and regulations established through the

Office o f Licensing for the State of Utah Department o f Health Services. Three licensed

facilities serve the senior population living in the northern Salt Lake County. One facility in

Davis County, serves several counties in Northern Utah and is expected to expand services to

Bountiful, while another is providing services in Logan. The proposed center plans to be

located in the southern part of the Salt Lake Valley, serving Draper, Sandy, South Jordan and

northern Utah County. At the present time, no adult day center primarily provides service to

these areas. The facilities in north Salt Lake receive many calls from those in the southern part

of the county but have to deny services because they are unable to provide transportation across

that distance. The three licensed facilities in Salt Lake City are the following centers:

1. Garden Terrace Adult Day Program is integrated into a larger facility owned by

Garden Terrace Center o f Excellence, Life Care Inc., a national provider of long term care

facilities. Garden Terrace Adult Day Program specializes only in Alzheimers disease and other

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similar dementias. The facility is licensed for 15 clients due to the small square footage of the

building. Services that are provided include: transportation, nutritious meals and snacks, and

activities including dance, music, and art therapy. The cost per day is $37. Transportation

(within 8 mile radius) is provided and medications are dispensed for an extra charge. The

program is administered by three staf f members, including a recreation therapist and two

assistants. The whole program is overseen by the administrator of the Garden Terrace Center of

Excellence. The adult day program is small and does not provide a variety of programs for the

participants. The plan for this proposed center is to provide a choice o f activities for its clients.

It will have several different rooms for resting, art and crafts, a library and a general use room.

This will allow for simultaneous activities that take place where the clients can choose what

activity they will attend.

2. St. Joseph Villa Adult Day Care Center is a nonprofit business managed by the Sisters

of Charity of the Incarnate Word. The center relocated to a new building in January 2000,

offering an intergenerational day program. They are licensed for thirty-eight clients, charging

$35 a day and $39 a day for those individuals needing extra attention and care, including

feeding, changing briefs, assisting with walking, one-on-one care, and agitation management.

The cost includes a meal, two snacks and activities throughout the day. Other services offered

that require an extra fee include: bathing, transportation (will pick up and take home within a

radius of 5 miles from the building), physical and occupational therapy, a beauty salon and

laundry. The clientele consists o f individuals 65 years and older who are diagnosed with

Alzheimers disease, other dementias, stroke, and other cognitive impairments requiring constant

supervision. Some services are provided by certified nursing assistants, overseen by an

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administrator and program director, both trained as certified recreation therapists. One daily

activity is tailored to the clients level of impairment where they are organized into groups

according to their abilities. Activity that occurs in one large setting usually does not meet the

needs of the more incoherent individuals in the center. The proposed center will provide

simultaneous activities during each hour to ensure the needs of each participant are being meet.

At St. Joseph Villa, twice a day the children and the adults come together for activities. Usually

the activity focuses on the children as the adult clients watch.

Intergenerational programming in the day care setting has negative as well as positive

effects. Some of the positive outcomes of intergenerational day programs include 1) minimizing

childrens negative stereotypes toward aging (Salari, 1999), 2) increasing older clients social

interaction with others (Salari, 1999), and 3) maximizing efficiency in dependent care for

employee caregivers (Salari, 1999) Intergenerational programs at the center will include

opportunities for the elderly to use their skills in helping the children understand the older

generation, helping the children in their studies, and providing friendship among the elderly and

the children. The cen ter will have an adult-oriented environment, age appropriate activities,

and will provide privacy and autonomy for the clients. The clients will be allowed to decide for

themselves i f they will participate in the activities. When a center has a more adult-oriented

environment, with age appropriate activities, and more privacy and autonomy, there are greater

social contact and friendships among clients ( Salari, 1999). Infantilization or societal treatment

of old age as a second childhood which often occurs in institutions, community-based services,

and adult day centers include encouraging participation in childlike activities, use of pet names,

directing childlike remarks, gestures and patterns o f speaking toward older persons (Salari,

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1999). The s taff at the center will be trained on the aspects of the aging process and how to

work with the clientele, avoiding infantilization o f the aged individual.

3. Neighborhood House Senior Day Program is a nonprofit business with two facilities

in northern Salt Lake City. The rates consist o f a sliding fee schedule based on the clients

monthly income ranging from $11 to $36 a day. Following is the sliding scale:

$350 - $450/month - $11 per month

$451 - $550/month - $15 per month

$551 - $650/month - $19 per month

$651 - $750/month - $23 per month

$751 - $850/month - $27 per month

$851 - $950/month - $31 per month

$951 - and more - $36 per month

Neighborhood House provides licensed, supervised care for older frail or disabled

individuals. The services include: nutritious meals and snacks; medication supervision;

transportation (an extra fee, $4 each way); music and dance therapy; a beauty salon (extra fee);

physical, speech, and occupational therapy (extra fee); and caregiver support groups. Activities

are conducted by recreation assistants, with an administrator and program director who is

trained as a recreation therapist. The program director oversees the whole program. The

clientele include adults diagnosed with Alzheimers Disease and other dementias, strokes,

intellectual disabilities, traumatic brain injury, multiple sclerosis, and other diseases requiring

daily supervision. Activities are performed in one large room with every client participating.{*

The centers administrator feels that it is important to meet the needs of each client and

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encourages them to participate in each activity if they desire. The activities at the proposed

center will be planned to meet the interests of many groups and stimulate each client according

to their cognitive levels. Variety in the types of activities, promoting quality of life, self-esteem,

and promoting feelings of competence will be the focus at the center.

The type o f services that the proposed center will include will offer seniors more choices

and will fill a need that exists that the other programs cannot offer to seniors. The center is

going to offer variety in their programs, more services, as well as a higher quality of services

then the other adult day programs in the Salt Lake Valley offer. The location of the proposed

center in the Sandy-Draper area is an advantage that the center will have over the other facilities.

The center is going to provide a new product that is not currently available in the community, a

combination of adult day center and health and wellness program.

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Marketing Proforma Start-up Budget

This is an estimated start-up budget for the marketing o f the proposed center. It is based

on other local facilities start-up budget

Brochures $6,000

Graphic Design for Company Image $1,500

Advertising Development $1,000

Collateral and Give away $2,000

Stationary $1,500

Pre-opening Marketing Expenses $8,000

Total $20,000

Table 4A is an example o f a proforma (projected) marketing budget for a start-up

business, for one year.

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FINANCE

FINANCIAL PLAN

The start-up of a new adult day center will occur in three phases: first, the construction

and development phase; second, the pre-marketing and pre-opening phase; and finally, the ramp-

up phase.

* Con struc tion and Development - Exhibit 5 (page 45) shows a cost breakdown for the

construction of a new building to house the adult day center. The total cost is $850,000.

* Pre-Marketing and Pre-Opening - Marketing before the center opens will be crucial to the

success o f the business. The director will work mainly with marke ting while the building is

under construction, promoting the concep t of adult day services in the community. The pre

marketing start up cost will be $20,000. The costs will include brochures for $12,000, graphic

design for company image for $3,500, advertising development for $3,000, collateral and

promotional gifts for $5,000, stat ionary for $1,500 and the pre-opening marketing expenses will

be $10,000. Pre-opening budget will be necessary for business licensing an d zoning charges,

outside sign, purchase or initial payment of vehicle, outside sign, fixtures, furniture and

equipment. The total start-up costs will be abou t $985,000.

* Ramp-up- The ramp-up budget is the projected budget that will get the company through the

second year of operation. Ramp-up is a critical time in the start-up of an adult day care facility.

The majority o f the losses will take place during the first year. The operating deficit reserve is

estimated at $50,000 to cover the expenses for the first year of business.

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Exhibit 5 through 7 (pages 45-47) provide a detailed financial analysis of the adult day center

start-up budget and a stabilized budget following the first year of operation. The anticipated

total project cost, including the operating deficit reserve with a contingency of $985,500.

Sources of Financing

The owner of the proposed adult day center is considering a conventional business loan

and personal family funds to support the building o f the center. It is proposed that the family

will come up with 20% of the cash necessary and to guarantee the loan, receiving 45% o f the

company ownership.

Financial Requirements

Exhibit 6 (page 46) provides a detailed financial budget for the start-up year. The chief

operating officer is estimating that the center will not be at full capacity (40 clients) but is

expecting to have a 5% vacancy rate each month. Employees consist of four full times aides, 4.5

part t ime a ides and a driver. Expenses for the start-up year include recreational programs,

transportation, utilities, food services, and fixed expenses. The total expenses for the start-up

year will be estimated at $306,000. This will assist in purchasing all FF&E, kitchen, emergency

response and pre-opening equipment. The net operating income for the first year will be

estimated at $16, 135. Once the budget has stabilized, the expenses will increase to $341,000

due to the increase in the directors salary. The net operating income for the year once the

company stabilized will be estimated about $167, 962. (Exhibit 5, 6, 7, pages 45-47).

Sourcing

The largest cost associated with providing adult day services is the labor and the food

cost. Combined, these expenses represent roughly 73% o f our total expenses operating at 95%

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occupancy. These two expenses are mostly fixed. Adult day service is a service industry, and it

is a labor-intensive industry. The adult day service must have some licensed medical staff

people on sta ff during most o f the day.

Material and Production Requirements

Exhibit 5 (page 46) shows a cost breakdown for the construction estimate, the pre

marketing, operating deficit reserve, business licensing and zoning charges, outside sign,

purchase o f a van for t ransportation, and FF&E. These necessary costs are important for the

start-up of the adult day center, will be estimated at $985,000.

Labor Requirements

Management Summary: Proposed number of employees at 40 clients will be six full time

employees and four and Vipart-time employees. The director will be in the only manager who

will report directly to the ch ief operating officer, who is the founder and owner.

Structure

The structure o f the proposed adult day center will be a Limited Liability Company. This

structure was chosen because it provides many desirable liability traits similar to a corporation

while allowing the same favorable tax treatment enjoyed by partners in general and limited

partnerships. An LLC also gives the owner the option of being taxed as a corporation or as a

partnership.

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REFERENCES CITED

1. Alzheimer Association. (1999). Respite Care Manual. Chicago: Alzheim er Association.

2. Cox, C. DSW. (1997) Findings From a Statewide Program of Respite Care: A Comparison of

Service Users, Stoppers, and Nonusers. The Gerontologist, 371 pp. 511-517.

3. Hooyman, N., & Kiyak, H. (1996). Social Gerontology, A Multidisciplinary Perspective.

Boston: Allyn and Bacon, pp. 200-212.

4. Internet Service, www.aplaceformom.com. (2000). Learn about your housing options.

5. Kosloski, K., Ph.D, Rhonda J.V. ML, Ph.D.(1995). The Impact of Respite Use on Nursing

Home Placement. The Gerontologist, 35, pp. 67-74.

6. National Adult Day Services Association. (1999). Adult Day Services Fact Sheet.

Washington, D.C.: NADSA.

7. Rodin, J., & Timko, C. (1992). Sense o f control, aging, and health. In M.G. Ory, R.P.

Abeles, &P.D. Lipman (Eds.), Aging Health and Behavior (pp. 174-206). Newbury Park, CA:

Sage Publications.

8. Rowe, J., & Kahn, R. (1998). Successful Aging. New York: Pantheon Books, pp. 36-52.

9. Salari, S., Ph.D. & Rich, M,, M.S. (1999). Social and Environmental Infantilization o f Aged

Person: Observation in Two Adult Day Care Centers. International Journal o f Aging and HumanDevelopment, 52, pp. 1-29.

10. Salari, S., Ph.D. Intergenerational Partnerships in Aging Services: Avoiding Social_&

Environmental Infantilization of Elderly Clients ( Doctoral Dissertation, University of Utah,

September 2000).

11. Salt Lake County, Salt Lake County Aging Services. (1999), Needs of the Elderly. Salt

Lake City, Utah.

12. Salt Lake County, Salt Lake County Aging Services. (2000) Utah Association of Area

Agencies on Aging, Budget Requests. Salt Lake City, Utah.

13. Savage, E. & Madsen, N. (1990). Adult Day Care & Home Health, A Community

Partnership. Caring Magazine, pp. 36-40.

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EXHIBITS


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APPENDIX


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OUR MISSION

-unset Mountain AdultDay Program providesquality care in a safe,upportive environment

for seniors whileroviding respite services^

for care-givers. Aomprehensive program

of health and wellness

counseling and educationcombined with meals,

ansportation,screational and

Dcialization activities that/ill enhance the quality ofife and prevent premature

placement in a long term^are facility.


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Return Address SUNSET

MOUNTAIN

SENIOR DAYPROGRAM

(PICTURE)


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Paul & Corey Fairholm

314 E. Eaglebrook Dr.

Sandy, Utah 84070

December 18, 2000

Sandy City

Community Development Department

10000 C entennial Parkway

Sandy, Utah 84070

Dear Sirs:

We are requesting that Adult Day Care be included in the definitions of land uses within the City

and that the code be amended to include Adult Day Care as a conditional use in the Professional Office

zone. Currently, Adult Day Care is not included in any land use or zone within Sandy City.

Adult Day Cares are regulated by the State o f Utahs Human Services Department which defines

Adult Day Care to mean continuous care and supervision for three or more adults 18 years of age and

over for at least four but less than 24 hours a day, that meets the needs of functionally impaired adults

through a comprehensive program that provides a variety o f health, social, recreational, and relatedsupport services in a protective setting. (Utah Administrative Code, Rule R501-13-3. Definition)

Adult Day Cares are similar in operation to a Child Day Care which is currently a defined land use

within the City and a conditional use within the Professional Office zone. A normal Adult Day Care

would be open Monday through Friday from about 7:00 a.m. to 6:00 p.m.. Transportation would be

provided to some clients, but the majority of the clients would be transported and dropped off by

families/care givers, similar to parents dropping off children at a Child Day Care. There is no over night

stays and provisions are required to make adult clients safe within the Adult Day Cares structure and/or

grounds.

Sandy City has already recognized the needs of a growing seniors population with the opening of

its Senior Center and the addition of several new Assisted Living Facilities and Senior HousingDevelopments over the last few years. However, Sandy residents who care for elderly parents have few

nonresidential, day programs that will meet the often difficult demands of their loved ones. An Adult Day

Care program is an important, economical alternative for Sandy residents who care for and need services

for their elderly parents during the day but wish to have them remain at home. It is a service which is not

currently available within the City and yet would greatly improve tire choices of its senior citizens and

their families

Your favorable review and recommendation to the City Council will be appreciated. If the

Planning Commission or the Citys Staff need any further information, please contact us at 567-9497.

Sincerely,

Paul and Corey Fairholm


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Sunset Mountain

Adult Day Care Services

Client Information

Date:

General Information:

Clients Name: Preferred Name:

Home Address:

Telephone # :__

City/State: Zip:

Social Security #:

Gender: F M Age:

Medicare #:

Date of Birth: _ _ _ /_ _ /_

Medicaid #:

Responsible Party Information:

(Billing Address)

Name: Relationship:

Address: City/State: Zip:

Home Telephone #: Work Telephone #:_

Emergency Contact In formation

l sl Contact Name: ___

Alternate Contact Name:

Primary Care Physician:

Physicians Address:___

Telephone #:

Telephone #:

Telephone #:

City/State: Zip:

General Correspondence Address:

Name:

Address: City/State: Zip:


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Background Information:

Marital Status: ____Married ______Single ______Widowed ______Divorced ______Other

Spouses Nam e:__________________________________ Deceased?________

Number of Children:_______ Grandchildren:_______ Great Grandchildren:

Childrens Names

Name Location Age Name Location Age

Number o f Brothers and Sisters:

Name Location Name Location

Preferred Language:__________________________ Other Languages Spoken:

Level of Education and Location:______________________________________

Religious Preference:__________________ Organizational Membersh ip:___

Lifetime Occupation:________________________________________________


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..iset Mountain

TrtD ay Care

Client Service P

Date:

Assessment Activities or Services

Provided

How Activity or Service

will be Provided

Who will

Provide the

Service

Method

of

Evaluation

-

ce Plan Developers Signature:________________

. ;viewe d with Client and/or Responsible Person: Client or Responsible P ersons Signature:

Date:


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Sunset Mountain Resuscitation Status

Clients Name

Clients Name

Advanced Directive desire is:

DNR (do not resuscitate, NO CPR)And supporting documentation o f the

clients proxys request for such is in the

chart.

CPR

Physician

Date

Client/Responsible Persons Signature

Date


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Clients Name

Sunset Mountain

__

_ Age____________

Dining Assessment

_______Male _______Female Diabetic Yes No

Admission diet order________________________________________________

_________________________________________________________ Date____

Beverage Preference

Morning Snack milk coffee tea Decaf juice

Lunch milk coffee tea Decaf ju ice soda

Afternoon Snack milk coffee tea Decaf juice soda

Food Likes

Food Dislikes

Food Allergies___________________________________________

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