Nursing Home Business Plan

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Organization Summary

Bright House is chartered as a nonprofit 501(C)(3) corporation in Middletown, CT, with the goal of providing holistic and respectful assisted living and skilled nursing home care to a small group of elderly residents. Our primary location is the old Wayfield Bed and Breakfast, on Farmer's Road, which we have spent the last five months converting into a two building nursing home facility in line with Eden Alternatives "Greenhouse" model for enlightened elder living. (See architectural drawing, attached.)

Our Medical Director, Doctor Mildred Johnson, M.D., M.S.W., of New Haven, is one of the most respected gerontologists in New England. She will be supported by four licensed practical nurses, and six Elder Assistants, who will perform all non-clinical duties such as daily assistance, laundry, cooking, and cleaning. Once a month, our contracted Nutritionist will visit the retreat to give cooking lessons and to review individual residents' dietary needs. The entire staff will meet with our Board of Directors three times a year to assess the staffing and other needs of the facility.

Our Financial operations will be overseen by Madeleine Morgan, who has managed nonprofit funding and payroll departments for 27 years (see attached resume). She will be supported by a full-time Medicare Liaison/Billing Specialist, and a part-time Development Officer.

2.1 What Makes Bright House Unique

Although the hospital model of care practiced in most nursing homes provides good results for Medicaid and Medicare billing purposes—that is, easily quantifiable lists of procedures and medicines administered, test results, and billable nursing hours—it does not provide good quality of life for residents (or "patients," as they are referred to in the hospital model).

At Bright House, we see a different way of assisting our elderly members through a new stage in their lives. Acknowledging that where they live is their home, and belongs to them, not to the medical staff, we have established a facility that not only meets their medical and physical needs, but one that also nourishes their social connections, individual dignity, and personal preferences. Each resident has a private room with bath, opening onto a central shared common area containing the kitchen, living room, and dining room, where all meals are shared communally at our 15 foot farm-style dining table.

Far more devastating than physical illness to our elders, is lack of purpose. Studies have shown over and over that seniors who are engaged in activities they find meaningful are far more likely to retain mental acuity, physical health, and emotional well-being. Although the hospital model tries to provide such stimulation, its "activities" are usually organized by staff, with little or no input from "patients," and become just one more set of required tasks for all involved. At Bright House, we have already begun working with prospective residents to identify areas of interest and methods of community involvement that will appeal to them.

Bright House is chartered as a nonprofit 501(C)(3) corporation in Middletown, CT. Its Board of Directors is drawn from the local medical and community-organization communities.

Board of Directors

  • President: Dr. Michael Medical, M.D.
  • Members: Laurie Law, Susie Social-Worker, M.P.H., John Leader.

2.3 Start-up Summary

Start-up Expenses

One of the largest items in our Start-up budget is a computerized medical records system. Preliminary designs of this system have already been constructed by DigInfoMedTel. In addition to the obvious benefit of allowing multiple care-team members to easily exchange information as they change shifts, this system will allow our residents and staff to keep track of chronic conditions, monitor gradual but serious changes in condition which might be overlooked in day-to-day interactions, and corroborate quantifiable medical data for our Medicare patients in the skilled nursing facility.

Start-up Assets

Current (Short-term) Assets include $6,000 of start-up inventory (bedding, cleaning and disposable medical supplies) and non-expensed, smaller medical equipment that will depreciate quickly, and will need to be replaced in year four or five.

Long-term assets include our existing location, the former Wayfield Bed and Breakfast, currently assessed at $400,000 including renovations. The location was willed to us by Evelyn and Jack Bright last February, with the condition that we include a small Medicare facility as part of the overall plan. This category includes new Long-term Assets needed as follows: $200,000 for (long-term, resalable) medical equipment, and $150,000 for initial furnishings, after the renovation.

Medical Equipment:

  • 1 Fully-loaded Crash Cart
  • Standard monitoring equipment (blood pressure, sugar, etc.)
  • Call-button system

Furnishings:

For the common areas of both buildings, we will need couches, self-lifting recliners, tables, and chairs suitable to our residents' needs. We have allocated $35,000 for furnishing the four common rooms.

Each private room will need a hospital-capable bed, linens, a dresser, and a phone, at the minimum. With the remaining funding, that leaves just over $6,000 per room. This budget will allow us to provide attractive, functional, and comfortable surroundings to our residents in their new homes. Each bedroom in the main building will have enough remaining space that residents can bring plenty of familiar furniture with them (up to two side tables and wingback/reclining chairs, and a second dressing table or its equivalent).

Funding

To fund these start-up costs, we have secured a low-interest loan for $210,000, and have collected donations and pledges in the amount of $291,500. We have also included the value ($400,000) of the Bright House property in the "donations collected" category to accurately reflect our assets. We must raise an additional $7,650 by January 1st to begin operations.

Start-up
Requirements
Start-up Expenses
Legal $500
Stationery etc. $200
Advertising $2,450
Insurance $8,000
Computerized Medical Records System $20,000
Expensed Medical Equipment $13,000
Staff Training $5,000
Total Start-up Expenses $49,150
Start-up Assets
Cash Required $78,000
Start-up Inventory $6,000
Other Current Assets $31,000
Long-term Assets $750,000
Total Assets $865,000
Total Requirements $914,150
Start-up Funding
Start-up Expenses to Fund $49,150
Start-up Assets to Fund $865,000
Total Funding Required $914,150
Assets
Non-cash Assets from Start-up $787,000
Cash Requirements from Start-up $78,000
Additional Cash Raised $0
Cash Balance on Starting Date $78,000
Total Assets $865,000
Liabilities and Capital
Liabilities
Current Borrowing $5,000
Long-term Liabilities $210,000
Accounts Payable (Outstanding Bills) $0
Other Current Liabilities (interest-free) $0
Total Liabilities $215,000
Capital
Planned Investment
Donations Collected $597,000
Donations Pledged $94,500
Needed $0
Additional Investment Requirement $7,650
Total Planned Investment $699,150
Loss at Start-up (Start-up Expenses) ($49,150)
Total Capital $650,000
Total Capital and Liabilities $865,000
Total Funding $914,150

2.4 Locations and Facilities

We have now nearly completed the five-month renovation of the former Wayfield Bed and Breakfast into our two main facilities. The main building will house our privately insured, assisted-living residents. The skilled nursing facility across the courtyard offers more intensive care for post-operative and recovering temporary residents, as well as providing a setting for increased care for our residents as needed.

Each resident in our assisted living retreat will have a private bedroom and bath, opening onto a central social area containing the living room, dining room, and kitchen. We have two larger rooms that can accommodate married couples who move in at the same time, for a total of 12 rooms, holding up to 14 residents. Each room is wheelchair accessible, and can accommodate maintenance machines such as oxygen.

The skilled nursing facility to the left of the main building can house up to eleven adults, and is the only area of the facilities which will house residents receiving Medicare or Medicaid payments. This part of Bright House has two purposes: as a short-term rehabilitation center for community members recovering from surgery or medical emergencies; and as a full-service nursing facility for residents who can no longer take care of their own needs sufficiently in the main building. The continuity of location, social contact, and quality of care ensures that our residents will remain in the best possible surroundings when their needs are greatest.

Middletown, where we are situated, is centrally located 25 minutes from Hartford, and 30 minutes from New Haven. Middletown is a small college town, with an ethnically and economically-varied population.