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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 of the requirements for the degree of
Master of Science
in
Gerontology
College of Nursing
The University of Utah
April 2001
Supervisory Committee
Michael Caserta, PhD, Chair
Scott Wright, PhD
A. Kimberly Dansie, MBA
Copyright 2001 by Corey Fairholm
All rights reserved
T abl e of Contents
Abstract.................................................................................................................... ii
Executive Summary............................................................................................... 1
I ntroduction
Demographics Trends in Aging............................................................................ 4
Caregiving............................................................................................................... 5
Adult Day Centers.................................................................................................. 7
The Service
Product Specification............................................................................................ 14
Mission Statement.................................................................................................. 16
Objective................................................................................................................. 17
Company Strategy.................................................................................................. 17
Management Structure.......................................................................................... 17
The Service............................................................................................................. 18
Marketing
Marketing Strategy................................................................................................. 26
Economics Conditions.......................................................................................... 28
Distribution Channels........................................................................................... 29
Competition............................................................................................................. 31
Marketing Proforma Start-up Budget.................................................................. 36
Finance
Financial Plan........................................................................................................... 37
Sources of Financing................................................................................................ 38
Financial Requirements........................................................................................... 38
Sourcing..................................................................................................................... 38
Material and Production Requirements................................................................. 39
Labor Requirements.................................................................................................. 39
Structure..................................................................................................................... 39
References Cited...................................................................................................... 40
Exhibits........................................................................................................................ Exhibits 1A-8
Appendix..................................................................................................................... Concluding
pages
Abstract
The purpose of 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 an
individual 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 occurring in mature adulthood. In his book, The Life Cycle
Completed. Erikson and his wife, J oan discuss the stage of Gerotranscendence, involvement vs.
withdrawal, in which individuals derive importance and meaning in their lives from a sense of
accomplishment. Life satisfaction, or the feeling that life is worth living, may be achieved
through tasks in ones life, accepting one’s mortality, sharing experiences with the younger
generation and leaving a legacy to future generations.
Guided by Erickson’s 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.
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 of 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 center’s 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 of their special needs. The hours of 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 of the proposed center that distinguish it from other adult day care
models include the physical facility lay-out, and the variety of offered services. The location of
the center will be in the southern part of the Salt Lake Valley in the Sandy/Draper area primarily
serving northern Utah County and the southern Salt Lake county.
1
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 of 65 years.
The proposed center’s 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 of 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 compared to $50,000-$80,000 a year for long term care.
Because a growing number of 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 of adult day care. The base price of 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.
2
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 of Human Services, Office of
Licensing. The adult day centers serve a variety of 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 center’s 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 center 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 center’s expenditures will be $340, 934, and its net operating income will
increase to $167, 962 per year.
3
INTRODUCTION
Demographic Trends in Aging
Those over the age of 60, comprise the fastest growing segment of Utah’s population.
The elderly population in Utah will increase by 65% between the years of 1990 and 2010,
compared to a growth of 49% for the remainder of 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 million or 10.1% since 1990, compared to an increase of 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 of America’s 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 of the older segments of 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 America’s population, will increase from 3.9 to 8.5 million by the year
2030 (AARP, 1999). Nationally, the state of 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 of the life-span. By the
4
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 of these individuals receive their assistance entirely from informal
sources (Kosloski, 1995). Fifity-four percent of 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 of 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 person’s independence and requires some level of ongoing
5
assistance (AoA, Caregiving Compassion in Action, 1997). The majority of the seniors needing
assistance live with a family member, many of 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 of 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, lost productivity, greater stress, and the potential stress, and the potential loss of
skilled employees are among the more significant impacts that businesses will face as the
number of elderly continues to grow” (Salt Lake County Needs of the Elderly, 1999, p.2). The
demands and constraints of caregiving can become overwhelming. Many working caregivers
find that the demands of their jobs and their caregiving responsibilities are in conflict. In fact,
an increasing number of companies and government 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 of their employees. Emphasis is
now being placed 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
6
younger and older disabled persons and their families prefer to receive services in their own
homes and communities, 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 Alzheimer’s 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 of rest or
relief while the loved one receives care from qualified individuals. An evaluation of a respite
program found that 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 of 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 of 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 of adult day care is borrowed from the child care model but
targets a much narrower segment of the population; individuals experiencing significant mental,
physical, and/or social impairments (Travis, 1993). The service was introduced to the United
7
States in the late 1960's by an English physician who originally used day treatment as a means of
accelerating the return of aging, hospitalized 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 of dementia populations through an individual plan of care
(National Adult Day Services Association, 1997). These plans may require a combination of
physical, mental, and social activities that are provided by the center’s staff; special therapies,
and health monitoring and medical treatments (only if the center qualifies as a medical adult day
care) (Travis, 1993). Adult day centers promise the opportunity to maintain individual worth and
dignity, promote independence, and potentially delay admission into a long term care facility.
An adult day care program may focus on one or a combination of activity programming,
designed to engage the individual according to the person’s capabilities and changes in their
functional levels. A program should consist of several aspects including: mental health
programming, which emphasizes counseling 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 (Alzheimer’s 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 Adult Day Services Association in 1998 demonstrated both short-term and long-term
8
benefits of 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 client’s present level of 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 center’s activities.
Adult day centers can be either a medical or a social model, depending on clientele,
staffing, services, and costs. Social day centers provide social outlets for mental and physical
stimulation through the use of 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 of the participants and promote their social,
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 of
9
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 of the consumers are women, one-fourth live alone, three-fourths live with a spouse, adult
children or other family member. Fifty-seven percent of 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
for Adult 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 of Adult Day Care (NIAD) permit tremendous flexibility in the qualifications of
individuals who direct the daily operations of adult day programs (Travis, 1993).
The fees for adult day services vary depending upon the region of the country and the
range of 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 of 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
10
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% of 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 of 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
11
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 Alzheimer’s 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 center (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 of the Older Americans Act funds
12
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 of care, individual care plans, be part of 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 of the impaired older adult, as well as provide
needed respite for their family caregiver. Adult day services supplement home health and other
long-term community-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.
13
THE SERVICE
Product Specification
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 of 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 Erikson’s psychosocial model of human development maintains that one’s
personality is affected by their social environment (Hooyman, 1996). The process of aging
entails numerous life changes which places demands on the older person’s abilities to cope with
and adapt to new life situations. Personality characteristics influence coping responses. This
14
center will provide more of an adult-oriented setting, age appropriate activities and privacy and
autonomy for each client. Activities and the atmosphere of 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 of 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 staff 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
15
(Salari, 1999). The environment of the proposed center will be a comfortable, home-like
setting. Each individual’s 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 of the center will be that the client needs to be treated to the highest level of
their cognitive functioning and encouraged to allow expressions of 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
environment 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 center’s 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 staff of the proposed center will
provide the clients with an opportunity to maintain their individual worth, dignity, and their
independence. The center will provide caregivers with needed respite from full-time caregiving
16
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 of family members needing respite care in the South Salt Lake
valley (primarily Draper and Sandy) and northern Utah County.
2. Market the unique features of 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 of 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
17
oversee the financial, marketing, and management operations of the business. A program
supervisor will be on staff 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 of 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 of operation to provide assistance to clients with activities of daily living.
THE SERVICE
The center will combine health and wellness educational programs with the traditional
adult day programs as well as activities of a senior 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.
18
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 senior’s 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 of 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 maintain their individual worth and dignity, maintain
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 center will have a stimulating combination of 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 about 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
19
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. I f 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.
20
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 Erikson’s
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 of service within the center.
Each participant will be encouraged to participate in the activities of 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 of Human
Services, Office of 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.
Nutritious 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 staff 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 client’s service
record.
The nursing staff also will administer medications to the clients as needed. The client
needs to provide the medicine, with a detailed explanation of how the medication needs to be
21
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 client’s 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 of 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 of the center is the design of 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 half 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-
22
appropriate. Activities should focus on socialization, building self-esteem and a sense of
accomplishment 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 of 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 of 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 center’s leadership and
planning. An activities’ committee 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 of the center’s 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 of the family/caregivers.
The center’s 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
23
will be set to help meet the needs of each client. Team building in-service meetings for the staff
will be held monthly. Staff 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
center’s physical lay out allows for opportunities for solitude or to become involved in the
activities. Studies by many researchers show detrimental effects of “infantilization” or societal
treatment of 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 of their choice and will not
be forced to participate if they are not interested. Client autonomy (right of self-determination)
and client privacy will be an essential in the center’s 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 director of the proposed center feels that the concept of this adult day programing
24
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 of the broad range of offered services
and the emphasis on client autonomy. The center’s emphasis on health and wellness also will
set it apart from others in the area. The director 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 become 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.
25
MARKETING
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 of Medicaid are looking toward other alternatives to slow the growth of 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 of 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 life of 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
26
simultaneously caring for their aging family member, friend, or neighbor.
The proposed center will be located in the southern part of the Salt Lake Valley, serving
Sandy, Draper, South J ordan, 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
of $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
27
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 for the elderly individual. Once again direct mail advertising will
be used to market to the professionals and providers. Education is an important aspect of
marketing to the professionals, to help them understand the purpose of adult day services and
how they will benefit their clients. St. Mark’s Hospital and Intermountain Health Care have
Senior Clinics as part of their services offered for seniors. The center will begin marketing 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 of the older population is also increasing (AARP, 1999).
28
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 of 65 (Governors Office of 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 of the elderly population.
The number of nursing home residents age 85 and above will increase by the year 2040 to a level
two to three times the current number of 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 of $ 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 of the wealthiest segments of the population. Only 24% of the population’s 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
29
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 of 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 education component of 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 of seniors as well as to caregivers. The
administrator will schedule meetings with different groups ranging from Lion Clubs, church
groups, corporation CEO’s, independent living facilities, physician groups, and civic groups. The
business will be a member of the Chamber of 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.
30
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 of 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 of
their services but must meet the licensing requirements and regulations established through the
Office of Licensing for the State of Utah Department of 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 J ordan 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 of Excellence, Life Care Inc., a national provider of long term care
facilities. Garden Terrace Adult Day Program specializes only in Alzheimers disease and other
31
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 staff 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 of 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. J oseph 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 J anuary 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 of 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
32
administrator and program director, both trained as certified recreation therapists. One daily
activity is tailored to the client’s 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. J oseph 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
children’s 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 center 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 if 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 of speaking toward older persons (Salari,
33
1999). The staff at the center will be trained on the aspects of the aging process and how to
work with the clientele, avoiding infantilization of the aged individual.
3. Neighborhood House Senior Day Program is a nonprofit business with two facilities
in northern Salt Lake City. The rates consist of 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 center’s administrator feels that it is important to meet the needs of each client and
34
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 of 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.
35
Marketing Proforma Start-up Budget
This is an estimated start-up budget for the marketing of 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 of a proforma (projected) marketing budget for a start-up
business, for one year.
36
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.
* Construction 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 of the business. The director will work mainly with marketing while the building is
under construction, promoting the concept 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, stationary for $1,500 and the pre-opening marketing expenses will
be $10,000. Pre-opening budget will be necessary for business licensing and zoning charges,
outside sign, purchase or initial payment of vehicle, outside sign, fixtures, furniture and
equipment. The total start-up costs will be about $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 of 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.
37
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 of the center. It is proposed that the family
will come up with 20% of the cash necessary and to guarantee the loan, receiving 45% of 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 time aides 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 director’s 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% of our total expenses operating at 95%
38
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 staff during most of 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 of a van for transportation, 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 Vi part-time employees. The director will be in the only manager who
will report directly to the chief operating officer, who is the founder and owner.
Structure
The structure of 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.
39
REFERENCES CITED
1. Alzheimer Association. (1999). Respite Care Manual. Chicago: Alzheimer Association.
2. Cox, C. DSW. (1997) Findings From a Statewide Program of Respite Care: A Comparison of
Service Users, Stoppers, and Nonusers. The Gerontologist, 371pp. 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 of 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 of Aged
Person: Observation in Two Adult Day Care Centers. International J ournal of Aging and Human
Development, 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.
40
EXHIBITS
For Exhibits 1A-8, pages 42-48
Please contact Corey Fairhoim
314 E. Eaglebrook Dr.
Sandy, Utah 84070
(801)567-9497
APPENDIX
OUR MISSION
-unset Mountain Adult
Day Program provides
quality care in a safe,
upportive environment
for seniors while
roviding respite services^
for care-givers. A
omprehensive program
of health and wellness
counseling and education
combined with meals,
ansportation,
screational and
Dcialization activities that
/ill enhance the quality of
ife and prevent premature
placement in a long term
^are facility.
Return Address
SUNSET
MOUNTAIN
SENIOR DAY
PROGRAM
(PICTURE)
Sunset Mountain
is an
Adult Day
Program
specializing in the
care of individuals
with Alzheimer,
dementia,
mental illness,
traumatic brain
injury,
and others.
picture
Services
Recreational Activities
Educational Lectures
Wellness Lectures and
Health Screenings
Nutritious meals and
snacks
Physical, occupational,
& Speech therapy
Care giver support
groups
Special activities for
Alzheimers, dementia
and stroke clients
Transportation
Volunteer opportunities
Freedom of Choice
- , i to o l £
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•gjtal IM
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RDOH
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LIBRARY
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Our unique facility
will allow our client
to enjoy their privacy
while under the care
of our staff or our
client can enjoy the
socialization while
attending our
recreational activities.
picture
Paul & Corey Fairholm
314 E. Eaglebrook Dr.
Sandy, Utah 84070
December 18, 2000
Sandy City
Community Development Department
10000 Centennial 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 of Utah’s 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 of health, social, recreational, and related
support 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 Care’s 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 Housing
Developments 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 City’s Staff need any further information, please contact us at 567-9497.
Sincerely,
Paul and Corey Fairholm
Sunset Mountain
Adult Day Care Services
Client Information
Date:
General Information:
Client’s 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:
Physician’s Address:___
Telephone #:
Telephone #:
Telephone #:
City/State: Zip:
General Correspondence Address:
Name:
Address:
City/State: Zip:
Background Information:
Marital Status: ____Married ______Single ______Widowed ______Divorced ______Other
Spouse’s Name:__________________________________ Deceased?________
Number of Children:_______ Grandchildren:_______ Great Grandchildren:
Children’s Names
Name Location Age Name Location Age
Number of Brothers and Sisters:
Name Location Name Location
Preferred Language:__________________________ Other Languages Spoken:
Level of Education and Location:______________________________________
Religious Preference:__________________ Organizational Membership:___
Lifetime Occupation:________________________________________________
..iset Mountain
T rtDay Care
Client Service Plan
Date:
Assessment Activities or Services
Provided
How Activity or Service
will be Provided
Who will
Provide the
Service
Method
of
Evaluation
-
ce Plan Developer’s Signature:________________
. ;viewed with Client and/or Responsible Person: Client or Responsible Person’s Signature:
Date:
Sunset Mountain
Resuscitation Status
Client’s Name
Client’s Name
Advanced Directive desire is:
DNR (do not resuscitate, NO CPR)
And supporting documentation of the
client’s proxy’s request for such is in the
chart.
CPR
Physician
Date
Client/Responsible Person’s Signature
Date
Client’s 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 juice soda
Afternoon Snack ■ milk coffee tea Decaf juice soda
Food Likes
Food Dislikes
Food Allergies___________________________________________________
Reason for altered texture___________________________ ______________
Food Consistency: Regular Mech. Soft Pureed
Serving Size: Regular Small Large Double
Meat Consistency: Regular Chopped Ground Puree
Teeth/Denture Condition:__________________________________________
Sunset Mountain
Consent to Photograph
I ,_________________________________________, a client of Sunset Mountain hereby
authorize the attending physician or other designated persons to take:
1. Photograph me for identification purposes. _YES ______NO
2. Photographs of appropriate parts of my ___YES _____ NO
body in order to provide supporting
documentation of my medical condition.
I understand that any photographs taken
will be placed in and remain part of my
medical records.
3. Photographs involved in Sunset Mountain _YES _____NO
activities.
4. Photographs of me for the purpose of _____YES _____ NO
(specify):
Client’s Name Date
Responsible Party Signature Date
Relationship to Client
Employee Signature and Title Date
(To be completed by the physician within 30 days of admission to Sunset Mountain)
Name: _________________________________________ Date:_____________________
Address: _______________________________________________________________
DOB: / / Age:_____________ Gender:__ Male_____Female
Social Security and Medicare Number:
Soc. Sec.#______/______/______ Medicare # _______/________/______-____
Responsible party name, address and phone numbers:________________________________
Diagnosis:________________________________________________________________________
Sunset Mountain___________________________Physician Assessment
Medications:
Diabetes: ___ Type I ___Type II
____ Insulin:__________________________
____ Diet control:______________________
____ Oral control:______________________
Hyperglycemia:__________________
Hypoglycemia:___________________
____ Self-care:_________________________
Prior Medical History (Please attach an H&P):
Allergies:___________________________________________________
Vital Signs: T:___________ P:_____________ Resp:_____________BP:__________ Wt:_______
Diet:______________ Eating pattern:___________good ______ fair ______poor Anorexic
Dentures:____Top ____Bottom_____Both ____Partial
Comments:___________________________________________________________________
Activity limitations:______________________________________________________________
Neurological:
Memory Recall: (Able to recall)___Person ____Place Time _____Situation
Memory loss in:____Short term Long term _____Forgetful
_____Agitated____Vertigo Impaired decision making_____Slurred speech
Comments:_____ ____________________________________________________________
Psychosocial:
____Angry ____Discouraged _____Difficulty Coping _____Denial of Problems
____Depressed
Comments:____ ____
Functional:
Locomotion: Cane _____Wheelchair _____Walker _____Motorized cart
Range of Motion:_____No limitations _____Limited on one side_____Limited on both sides
Comments:___________________________________________________________________________
Behavioral:
______Wandering ______Verbally abusive ______Repetitive questions____Lost of interest
______Reduced Social Interaction
Comments: _______________________________________________________________
Skin Problems:
______Abrasions ______Rashes ______Skin tears ______ Open lesion(s)
Comments: ___________________________________________________________________
Hearing:
_____HOH ______Difficulty Making Self Understood ______ Able to Understand Others
_____Deaf R / L _____ Hearing Aid R / L _____ Tinnitus ______Vertigo
Comments: ___________________________________________________________________
Hygiene (bathing):
___Independent ____Needs assistance
Comments:___________________________________________________________________________
Continence:
____Continent ___ Incontinent at Night___ Wears Brief____ Independent Care
____Needs Assistance
Bowel Elimination:
____Control Regular Bowel Movement ____Constipation ____Diarrhea
____Independent Care____Needs Assistance
Comments:
Sight:
Wears glasses Cataracts Contacts R L Glaucoma
Comments:
Genitalia:
Menopause Hysterectomy Mastectomy R / L Date:
Prostate Problems:
Comments:
This person is free of a communicable disease in a communicable form.
____ Has received a recent T.B. test Date: ____/______/______
__ This person has a negative T.B. test.
____ Has a history of T.B. and received proper medical treatment and is not contagious.
_____Physician Order: Physical Therapy to evaluate and report back to me.
According to my assessment I feel that__________________________________ is
appropriate for Adult Day Care at Sunset Mountain.
Physician:________
Address and Phone#:
Date:
SUNSET MOUNTAIN
ADULT DAY PROGRAM INTAKE ASSESSMENT
CLIENT INFORMATION:
Name ______________ __________________________________ Age________Date o f Birth
Address _____________________________ City________________ Zip
Telephone #_____________________ Gender____________ Marital Status
RESPONSIBLE PARTY: (Billing Address)
Name __________________________________________Relationship______
Address_______________________________________ City______________ Zip_
Telephone # (Home)________________________ Telephone # (Work)__________
ADDRESS WHERE FACILITY INFORMATION SHOULD BE SENT: (Calendar, etc.)
Name____________________________________________________________
Address_______________________________________City__________________ Zip_____
IN CASE OF EMERGENCY:
1. Name Phone
2, Name______________________________________________________ Phone
Primary Physician_____________________________________________ Phone
Address_____________________________________________ City______________ Zip_
********************************************************************************
CIRCLE AS APPROPRIATE THE DAY AND TIME YOU WISH TO USE:
Dav: Monday Tuesday Wednesday Thursday Friday
Time: 1 */* 1% 1lA 1 '/* 1 */*
1= Whole Day lA = Half Day
********************************************************************************
LIMITATIONS: List Limitations and special conditions__________________________________
PIET: List Special Dietary Needs
TOILETING: (Mark all that apply)
____ Independent ____Independent-Uses Pads _____Needs reminding to toilet
____Needs assist to toilet ____ Lacks bladder control _____Lacks bowel control
____Behavioral problems relating to toilet
BEHAVIORS: (Mark all that apply)
____Sociable ____Cooperative ____Wandering/Pacing ____ Agitation
____Social Withdrawal ____ Verbally Aggressive ____ Physically Aggressive ____ Confusion
____Talkative ____Other (Explain)___________________________________________
What works with these behaviors?_________________________________________________
What doesn’t work? ________________________________________________________
Needs assistance walking?____________________ Needs assistance standing?___________
Does the applicant require outside services, ie: physical therapy, speech therapy, etc?
Please specific:_________________________________________________________________
WHY DAY PROGRAM: Please explain why using Adult Day Care____________________
a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a
Signature of Person(s) Completing the Form:____________________________________________
Address________________________________________City__________________ Zip__________
Telephone # ________ ___________________________
Date:__________________________________
If other than the responsible person, what is your relationship to the client?__________________
Have you even wanted to
take a college course?
Now, you can from a college professor
at Sunset Mountain Adult Day Program!
Sunset Mountain has lectures weekly, covering subjects about
heath and wellness issues, educational topics, and cultural
enrichment activities.
Logo
(801)567-9497
Call or mail this coupon for information about Sunset Mountain
Name
Address
Phone
Mail to: Sunset Mountain, Adult Day Care Program
314 E. Eaglebrook Dr. Sandy, Utah 84070
Everyone Deserves a Vacation
Especially Care-givers.
Have you been putting off your break from caring for your mom or dad?
Sunset Mountain will give you a break you deserve and need. We’ll provide a
nutritious meal and snack, activities, and social stimulation in a safe and
supportive setting five days a week.
Call or mail in this coupon for information about Sunset Mountain
Name___________________________________________
Address
Phone
(801) 567 9497 Mail to: Sunset Mountain, Adult Day Care
314 East Eaglebrook Dr., Sandy, UT 84070
Corey Dawn Fairholm
314 E. Eaglebrook Drive
Sandy, Utah 84070
801-567-9497
CAREER SUMMARY
Experienced instructor in Cardio Pulmonary Resuscitation and First Aid instruction. Health
Promotion professional with several years experience in coordinating and planning health, wellness,
leisure and recreational programs for small and large groups of adults.
Provide health education and instruction to individuals and groups in the areas of CPR, First Aid,
community health awareness, lifestyle changes, fitness, and diet.
Responsible for planning and coordinating the social, recreational, cultural, and health programs for
a senior living community of more than 300 hundred clients. Programs included health fairs,
lectures on health issues, aerobics instructions, fitness testing, leisure time recreation, and social
events. Written and edited calendar and newsletter monthly advertising programs and promoting
health and wellness issues.
Activities Director September 1993 to May 1994
Ma r r i o t t Se n i o r Li v i n g Sh r v i c e s -Be d f o r d Co u r t He a l t h Ca r e Ce n t e r Si l v e r S p r i n g , MD
Planned and directed an activities program for 150 frail elderly adults. Developed recreational
programs that addressed the needs of groups and individuals. Served on an interdisciplinary team,
integrating professional treatments. Documented progress and significant events.
Certified Health Technici an May 1993 to September 1993
St a t e o f Ut a h -He a l t h y Ut a h Sa l t La k e C i t y , UT
Fitness tester for employees of the State of Utah. Performed blood pressures, determined body fat
percentages, conducted cardiovascular, flexibility, and strength testings. Developed personal fitness
programs. Educated employees on fitness, nutrition, and wellness. Tracked fitness improvement
and entered data on progress.
EMPLOYMENT
Health Educator January 1996 to Present
Sa l t La k e C i t y , UT
Recreation Director
Ma r r i o t t Se n i o r Li v i n g Se r v i c e s -Be d f o r d Co u r t
May 1994 to Jul y 1995
Si l v e r Sp r i n g , MD
EDUCATION
Master of Science
Un i v e r s i t y o f Ut a h
Gerontology
To Be Received May 2001
Sa l t La k e Ci t y , UT
Bachelors of Science
Br i g h a m y o u n g Un i v e r s i t y
1993
PROVO, UT
Major: Health Promotion
Mi nor Gerontology
Activities:
National Safety Council and American Heart Association Certified Instructor in CPR and First Aid.

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