A guest blog post by Brian Mailliard, CFO of St. Paul’s Senior Living Community
What does a community do with a prospective resident that is nursing home-eligible, does not need 24-hour care and yet can’t live independently? Up until now, the answer in western Pennsylvania has primarily been “personal care.” Unfortunately, Pennsylvania has many older adults who primarily live off of social security. These seniors do not have the assets to pay for personal care.
The problem is especially severe in rural western Pennsylvania. Here, the main industries of farming and manufacturing have taken a hard hit over the last 20 years. To make matters worse, affordable housing options for older adults are few and far between.
The good news is that, in the last five years, an alternative housing model has appeared. Share Care houses have been opening up in western Pennsylvania. This new housing bridges the gap for those with a low asset base who need assistance with activities of daily living.
A Neighborhood Solution
For-profit and nonprofit companies have been purchasing three-bedroom ranch homes in the community outside of their traditional campuses. The companies make small renovations, such as wheelchair ramps, wider doors and accessible bathrooms, to accommodate three residents. The residents utilize the Medicaid Home and Community-based Services waiver program, plus their social security, to cover the cost of care. Once the home has three residents, the community can typically recoup the cost of the real estate purchase, plus renovations, in a 4–5-year time frame. At this point, the model becomes profitable. Since there are not more than three residents receiving services under the same roof, this model does not fall under personal care regulations.
The waiver will pay for an individual to get up to eight hours of assistance per day in a home in the community. Housing three residents, each optioned for eight hours of care per day, under one roof allows a company to have a care partner in the home 24 hours per day, seven days per week. Staffing is provided though a company’s home and community-based service providers, which now have the ability to offer staff the set schedules that are typically offered in home care. What I have found is that, in these small homes in the community, the staff and residents become their own little family. They grow close by doing activities together, such as shopping and cooking.
New Share Care Homes Opening
St. Paul’s Senior Living Community has opened two of these Share Care houses in the last six months. Wesbury United Methodist Community in Meadville, Pennsylvania, is also involved in Share Care. In addition to providing care at its campus, Wesbury owns and operates eight Share Care homes in the Meadville area. I have toured two of these homes. I’ve also met with Wesbury’s chief financial officer to discuss the community’s successes and struggles with Share Care.
Wesbury identified the need for a level of care for lower-income individuals that are not nursing home-appropriate. It first heard about the Share Care model from a local home care agency that operated a home. The Share Care homes are contributing to the entity’s bottom line and are operating at a profit. The impact on the outside community has also been very positive for Wesbury, with residents and staff getting involved in the greater communities in which the houses are located. That community involvement is something I plan to take back to promote at the Share Care homes within my organization.
Lessons Learned About Share Care
Wesbury learned early on that, when making renovations, it is best to keep the house looking just like any other in the neighborhood. This way, neighbors do not get a sense that an outside organization is coming in and changing their neighborhood. One of the ways in which Wesbury combats this stigma is by putting the wheelchair access ramp inside the garage. That means the ramp is out of sight when people are driving through the neighborhood.
We have opened two of these homes in the last six months, and we are filling our second one with residents now. During this process, it has become obvious that, with any fewer than three residents, the costs outweigh the revenue. Because of this, filling the home has become a priority. When I asked Wesbury how it combats the cost of census turnover in its homes, I received a simple answer. Currently, they said, the only way to absorb the cost is by scale. The more houses you have to spread the costs of census turnover across, the better the model performs financially.
The Top Challenge Communities Face
What’s the number one struggle that Wesbury — and now St. Paul’s — has with this care model? It’s getting people approved for the waiver. Individuals who apply for the waiver wait, on average, six months for approval to be finalized. And, unlike the Medicaid benefit for the nursing home, there is no presumption of eligibility with the Home and Community-based Services Waiver. This means that someone in need of services cannot start receiving them until final approval is given.
As leaders in our communities, we have the ability to effect change. Organizations like ours and LeadingAge PA can advocate for change to the approval process for the waiver. Additionally, organizations such as mine that are just starting to offer Share Care can work with experienced organizations, like Wesbury, to learn how to navigate the current approval process. Share Care has proven that it can be an effective care model for low-income individuals who need help to live on their own. We just need to work together to make it easier to implement.
