Bright House

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Nursing Home Business Plan

Management Summary

Caregiving Management

Bright House offers a different management structure from that of the typical hospital-model nursing home. Our primary caregivers, the 6 Elder Assistants, work as a self-managed team, meeting with the Medical Director and the nurse on-call every morning to coordinate care for the coming day.

Although the Medical Director has the ultimate responsibility for the health and well-being of all residents and visitors, the nursing and caregiving staff, with their different kinds of knowledge about the residents' physical, social, and mental well-being, are expected to note, discuss, and recommend courses of action for all residents who, in their combined estimation, need help.

A 2001 study by the Robert Wood Johnson Foundation found that the small percentage of Chief Nursing Officers reporting no nursing shortages in their facilities at the time of the study cited formalized programs focused on the needs of, and professional recognition for, their nursing staffs as the reason for their adequate staffing. Our compensation packages, management structure, and caregiving requirements are designed to continually remind our LPNs and Elder Assistants how very valuable they are. 

Dr. Mildred Johnson is our Medical Director. Dr. Johnson has served as the head of Gerontology for six years at The Connecticut Hospital, and oversaw the creation, last year, of their Elder Assistant training program, which provides certification for Certified Nursing Assistants (CNA) to provide in-home hospice and respite care. Dr. Johnson has 20 years of experience working with elderly patients in this area, and has been integral in designing the physical layout, management structure, and priorities of Bright House.

The rest of our already-hired caregiving staff brings a whopping collective 75 years of professional experience in caring for elderly patients.

Financial Management:

Madeleine Morgan has been overseeing financial management of nonprofit organizations in Connecticut for 27 years. She became involved in our project when her mother developed a long-term care plan with Dr. Johnson which included home-based hospice care. "I wish everyone could have the same love and attention Dr. Johnson showed to my mother," Madeleine said. Ms. Morgan will be in charge of all financial operations at Bright House, overseeing billing, personnel payment and benefits, and development efforts.

Advertising and Marketing:

We are fortunate to have a skilled public relations officer in our group. Janice Ruthers is a retired ad executive living in Middletown with her husband (a professor at the university). She will be working 20 hours per week in our offices as a volunteer for the first two years of our plan, helping us design advertisements and brochures, and to plan events like our Open House in December to let the public see the results of our efforts.

5.1 Management Team Gaps

We still need to hire one swing-shift LPN, and one Elder Assistant. We are currently recruiting through Dr. Johnson's connections at The Connecticut Hospital, and expect to complete our team by mid-December, at the latest.

5.2 Caregiving Organizational Chart

5.3 Personnel Plan

One of the greatest stumbling blocks for traditional nursing homes is the dissatisfaction and high turnover rate of its staff. Given the current and foreseeable nursing shortages, this is an especially troubling tendency. Our Personnel Plan reflects our committment to offer employment that is not only meaningful, but compensates our employees fairly for their time, energy, and the emotional toll it takes to spend your days caring for others.

A study in 2000 by the Connecticut Legislative Program Review and Investigations Committee, the first to measure resident outcomes in relation to nursing staff levels, found residents were at increased risk for malnutrition, bedsores, dehydration, and preventable hospitalizations when nursing staff levels dropped beneath 2.75 hours per resident day (this includes Certified Nursing Assistants). In addition to its small size, which provides for individual attention, our Skilled Nursing Care Facility's personnel plan will provide no less than 5 hours per resident day of nursing attention.

Our assisted living retreat across the lawn will make use of these skilled nurses, but will rely for the most part on the care and attention of our Elder Assistants, nursing aides with special training for providing care in a holistic setting.

Our committment to fair, living wages is evident in our personnel plan. To ensure the best possible care for permanent and respite-care residents, all full-time staff positions include full health benefits, sick leave, and two weeks paid vacation time per year, increasing with seniority in years two and three. All benefits are included in the Personnel monthly payments. Our part-time positions (1 Medicare Holistic/Billing Specialist, and a Development officer) offer benefits with a higher employee contribution, and paid vacation in proportion to FTE (full-time equivalent) worked (.5 FTE = one week paid vacation/year, etc.). Our Development Officer already has a second part-time position with a local patients-rights advocacy group; we are working with them to coordinate her hours and provide her with a full benefits package.

To meet our staffing goals, we need the following medical and caretaking staff:

  • 1 full-time Medical Director (Dr. Johnson)
  • 2 full-time LPNs (alternating 30- and 40-hour weeks—9pm to 7am, switching 4 and 3 days/week) (hired—will start training December)
  • 1 swing-shift LPN (35 hrs/week, 5-10pm) (still seeking)
  • 6 full-time Elder Assistants (5 CNAs with CPR and First Aid training are currently taking part in our special Elder Care training; the sixth still needs to be hired)

We will also need administrative and development personnel:

  • 1 full-time Financial Manager (Madeleine Morgan)
  • 1 part-time (20 hours/week) Medicare Billing Specialist (Abby Hannah—currently helping to plan our computerized medical records system)
  • 1 part-time Development officer (Jessica Breindel)
Personnel Plan
Year 1 Year 2 Year 3
Medical/Clinical Personnel
Medical Director $66,000 $66,000 $67,000
LPNs - Full-time 35-40 hrs, night $117,000 $118,000 $119,000
LPNs - swing shift, 30 hours, day $34,125 $58,500 $59,000
Subtotal $217,125 $242,500 $245,000
Caretaking Personnel
Elder Assistants $221,520 $223,000 $255,000
Other $0 $0 $0
Subtotal $221,520 $223,000 $255,000
Administrative Personnel
Medicare Liason / Billing Specialist $33,600 $34,000 $34,500
Financial Manager $64,800 $65,000 $65,500
Janice Ruthers - Part-time Marketing $0 $0 $0
Subtotal $98,400 $99,000 $100,000
Fundraising Personnel
Development Officer - Part-time $14,400 $15,000 $15,500
Name or Title or Group $0 $0 $0
Name or Title or Group $0 $0 $0
Subtotal $14,400 $15,000 $15,500
Total People 14 14 14
Total Payroll $551,445 $579,500 $615,500