1. family and parenting
2. eldercare

Senior Care Integrated Planning (SCIP)
SCIP through the Golden Years
Business Plan
Chesapeake, Virginia
Team Chesapeake
Heidi Kulberg, MD, MPH, Chesapeake Health Department
Stacie Walls-Beegle, ACCESS AIDS Care
Elizabeth Reitz, MS, Chesapeake Regional Medical Center
Ann Myers, MS, Chesapeake Public Schools (retired)
Management Academy for Public Health
Year 12, Cohort 25
April 1, 2011
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SENIOR CARE INTEGRATED PLANNING (SCIP)
Table of Contents
Executive Summary………………………………………………………..………………1
Definition of Plan…………………………………………………………..……………….2
Project Operations and Management……………………………….. …………………4
Target Market/Research………………………….……………………. …………………5
Marketing Strategy…………………………………………………………………….…...7
Industry Analysis…………………………………………………………………...………9
Partners/Competitors…………………………………………………………………….12
Risks………………………………………………………………………………………...14
Timeline………………………………………………………………………………….....16
Financials/5-Year Projections…………………………………………………………..17
Appendices
A. Home Care Services Community Resource List………………...….21
B. Stakeholder Forum Results…………………………………………….24
C. Certified Geriatric Care Manager Criteria and Ethics Pledge….....26
D. Letter of Support……………………………………………………...…..29
E. Break-Even Analysis……………………………………………………..30
F. References and Resources………………………………………...…...32
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SENIOR CARE INTEGRATED PLANNING (SCIP)
Executive Summary
America is graying at a very rapid pace and this is having a profound impact on
communities and the services required by a senior population. Eldercare coordination
is becoming an urgent need. Senior Care Integrated Planning (SCIP) will address this
need by serving seniors, connecting caregivers and educating employers.
Baby boomers began turning 65 years old on January 1, 2010 and every day 10,000
more Americans become senior citizens. Two-thirds of this population will require
long-term care at some point in their lives. In prior decades, this care was provided in
nursing homes or assisted living facilities. In the past decade an explosion of services
aimed at assisting seniors in their home emerged and nursing home utilization has
actually decreased. With these new services, it has become confusing for seniors
and their caregivers to evaluate which services are relevant and appropriate.
Senior Care Integrated Planning (SCIP) will employ Certified Geriatric Care
Managers to assist seniors with comprehensive assessments, individualized care
plans, and coordination of services. SCIP will help seniors and their caregivers
navigate the maze of eldercare. The program will initially focus on seniors living in
Chesapeake, Virginia. In Chesapeake alone, the senior population is anticipated to
triple between 2000 and 2030 to over 56,000 people. SCIP will exist under the
auspices of the Home Care Services department of Chesapeake Regional Medical
Center, a recognized leader in community health care. Home Care Services does not
currently offer a geriatric case management program. Throughout the surrounding
metropolitan area of 1 million people, only two geriatric care management businesses
currently exist. SCIP will greatly expand city residents’ access to services necessary
for helping seniors to make the best choice for their living condition.
A relatively new focus in the eldercare arena is that of the working caregiver. Studies
reveal that 30% of employees have responsibilities for a parent. Caregiver
responsibilities impact businesses with increased absenteeism and poorer health of
the caregivers themselves. This results in business losing up to $47 billion a year.
There is an opportunity for case management organizations to partner with
employers to reduce caregiver stress. SCIP will educate employers and work with
employees to create care plans in advance of a crisis. Access to eldercare services
may become as important to employees in the future as child care is today.
Revenue generation will be achieved through a private pay model for case
management to include fees for the services of assessment of need, individualized
care plan creation and implementation, and continuous care management. With
initial in-kind support from Chesapeake Regional Medical Center and fee for service
revenue, SCIP will become financially self-sustaining by the end of year three.
It is rare to talk with someone who has not been affected by an aging family
member’s health challenges. SCIP will help seniors and families understand, plan,
and manage eldercare services. SCIP will help seniors live as independently as they
choose.
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Definition of Plan
SCIP will utilize Certified Geriatric Care Managers (GCM) who will assist families with
the understanding, planning and managing of health, social, and legal services for
their elder family members. Coordinating care and quickly alerting families to
problems will help decrease crisis and will also reduce the stress family members
experience when trying to navigate a difficult system. Working with area employers,
SCIP will provide educational seminars on the importance of long term care planning
to help avoid crisis management.
With rapid growth in the senior population, our local citizens are facing a need for
additional senior services and help with navigating the maze of paperwork, explain
unfamiliar terminology, and define the various levels of care. A navigation system
will prepare seniors and their families for their future, ensuring that their children and
those caring for them are informed and educated about this complex system.
Through a team of three Geriatric Care Managers, SCIP will assist Chesapeake and
surrounding area residents with elder care issues. A GCM is an expert in the field of
geriatrics and understands the complex nature and interaction of medical, emotional,
social and financial aspects of a senior’s health. Ultimately, the GCM will work with
families and seniors who are either experiencing a crisis at the time or who are
planning for future care.
Services that will be provided or assessed for referral:
 Assessment-Assess the senior’s physical, medical, social, functional,
psychological, and financial status.
 Planning-Develop a comprehensive plan for the client to include goal setting,
care planning, service initiation, and resource allocation.
 Service Coordination-Referral service including modification of service delivery
as needed. Communication with various service providers and coordinating
services of physicians, pharmacists, social workers, discharge planners, home
health agencies, and other services agencies.
 Monitoring-Client status, reassessment, service quality, and crisis
management.
 Personal Care Services-referring to personal care services that will provide
companionship, light housekeeping, and personal service like bathing,
dressing and feeding.
 Education-Educational seminars on the importance of pre-planning for
eldercare.
SCIP will be housed under the Chesapeake Regional Home Care Services, an
affiliate of Chesapeake Regional Medical Center. Chesapeake Regional is a 310-bed
acute care community hospital with more than 600 primary and specialty care
physicians and 2500 employees. CRMC Home Care Services is located off-site from
CRMC and currently offers: skilled nursing services, diabetes services, IV therapy,
rehabilitative services, palliative care services, and pain management services. They
also administer the Lifeline program, which identifies seniors who are at risk. Home
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SENIOR CARE INTEGRATED PLANNING (SCIP)
Care Services utilizes a network of community resources (Appendix A); however,
neither the Lifeline nor Home Care Services as a department have the capacity to
follow through with the needed eldercare planning for their clients despite their
identification of risk. At CRMC Home Care Services there is no program currently
available to focus on the comprehensive approach to serving seniors and no
personal care or activities of daily living services. Through discussions with the
Home Care Director, other ancillary providers and input from a community
stakeholder forum (Appendix B), SCIP has been identified as the missing piece that
the health care staff and families need. The SCIP Geriatric Care Managers will work
closely with other Home Care agencies to provide the experience and sensitivity to
guide seniors and their families through the maze of financial, legal and medical
issues.
Three Geriatric Care Managers will be hired the first year. In the beginning their
focus will be to market the program and educate the hospital staff, physicians,
seniors, and businesses on the services offered by SCIP. The GCMs will have an
office in the Home Care Services Department but the majority of their clients will be
seen in the comfort of their own home. Each GCM will utilize a laptop for
convenience to complete assessments and questionnaires while interviewing the
client in the community setting. When a client is enrolled in SCIP, a comprehensive
assessment will be completed by the GCM. Based on the need, a GCM may be
hired for a single task, such as arranging all aspects of placement in an assisted
living facility, or SCIP can take on long-term services of a client. For example, they
can oversee the personal care service for a long-distance family member and be
available in the event of an emergency. The average caseload for each Geriatric
Care Manager will be 15-25 clients; depending on level of need of each client.
One of the Geriatric Care Managers will dually serve as the Program Manager. This
individual will be responsible for the administrative duties which include hiring and
supervision of the staff, financial and performance reports, and marketing activities in
addition to working with clients. This position will report to the Director of Home Care
Services. The other two GCMs will see clients and work closely with referral
agencies, case managers and hospital staff. They will follow up on referrals made for
their clients and they will conduct new intakes as they enroll in the program. Finally,
they will assist in conducting educational seminars to businesses to further generate
referrals to SCIP.
In the first year, SCIP plans to complete at least 60 initial screening assessments and
enroll 50% of these clients into the program. Providing educational seminars on the
importance of pre-planning for eldercare to 12 Chesapeake businesses will be one of
the major annual objectives as well as a marketing tool. Working closing with CRMC,
another objective is to decrease the number of non-urgent visits by our senior
population to the emergency department by 50% thus reducing health care costs. A
GCM is able to check on their senior clients and make sure they have the support,
medicine, and care they need to stay healthy and avoid a crisis that requires hospital
care. The GCM can provide this service for less than the cost of an ER visit or
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hospital stay. More importantly, the GCM can help prevent hospital readmissions,
creating a tremendous savings to the hospital.
In year three, a personal care component may be added. Personal care provides the
assistance with daily activities that a senior needs in order to stay in their home.
These services range from light house work to bathing or assisting with meals.
Personal care would be staffed with certified nurse’s aides that have been thoroughly
screened, trained, insured and bonded. Staffing would be based on demand and
may range from a few hours a week to comprehensive 24-hour care. While
conducting our research for SCIP, a focus group with stakeholders was facilitated. It
was determined personal care services is necessary for this population and staffing
for that service can be a barrier to providing quality services. We will consider adding
personal care services to our project, but at this point, we will work through referrals
with other providers who are currently providing the services.
Listed below are our measures of success: (these are annual figures)
130 screening assessments by three Geriatric Care Managers (by year four)
50% of those screened, enrolled in SCIP
90% good to excellent satisfaction rating (as reported by SCIP clients/families)
12 employers educated per year on the importance of long term care planning
25% decrease in geriatric hospital re-admissions of SCIP enrolled clients
50% decrease in non-urgent ER visits by seniors of SCIP enrolled clients
Revenue generation will be achieved through a fee for services; including
assessment of need, care plan development and continuous care management.
With initial in-kind administrative support from Chesapeake Regional Medical Center
and fee for service, we will develop an on-going and sustainable program. It is
expected recruitment and marketing will be a priority for the first several months,
therefore, program revenue will be limited. By Year 4, no in-kind expenses from
CRMC are factored into the budget.
SCIP is a service which will help families and seniors understand the medical and
health related options available to them. There is an emphasis on pre-planning which
will decrease the alternative of making choices under pressure during a crisis.
Project Operations and Management
The program will have the benefit of operating under an existing program, therefore
start up costs and program implementation requirements will be minimized. For
example, an IT system is already in existence, and while a SCIP specific program will
need to be set up, it can be developed within the existing system. The same is true
for patient billing. Home Care Services already has a system, but SCIP services will
be added. This must all be done before services can begin. Daily operations will
flow within the existing Home Care Services of CRMC. Existing systems are already
in place for services that are compatible with SCIP. The first hire of the program will
serve as a Certified Geriatric Care Manager/Program Manager. This person will be
responsible for coordinating the integration of SCIP into existing systems (IT, billing,
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etc). This staff member will be higher level and report directly to the Director of
Home Care Services, who will manage the supervision of the entire SCIP program.
Ancillary administrative support will be provided by the receptionist and other existing
staff in Home Care Services.
Referrals for SCIP will be made by hospital social workers/discharge planners,
Chesapeake Dept of Human Service Adult Protective Services, Home Care Services
staff, physician’s offices and self-referrals. All referrals will be coordinated through
the GCM Program Manager. An initial screening will be completed and, if
appropriate, the client will be assigned to a GCM and a comprehensive assessment
will be completed. All tracking of referrals, assessments and intakes will be
documented electronically. Tracking referrals into SCIP will help identify where the
referrals are initiated and where they are not. Focus on additional networking or
marketing efforts could then be re-directed to reach a larger audience.
A benefit of co-locating SCIP at Home Care Services will encourage the staff to work
as a team as the senior’s needs change levels of care. SCIP will become its own
cost-center within Home Care Services, but it is expected the flow of patient services
would be seamless to ensure a client no longer experiences a gap in service when
there is a change in level of care. The information systems already in place can be
adapted to ensure SCIP is able to electronically document client status and services.
Quality improvement activities will be in accordance with existing systems already in
place at the Home Care Services. Patient chart reviews will be completed at regular
intervals. The supervisor will meet with each GCM regularly to provide review of the
client files and feedback to the GCM regarding services that are provided. Billing
reports will be compared to client file documentation to ensure consistency in
appropriate documentation for client billing.
To ensure the highest quality of services are provided by our personnel, the program
requirements for SCIP GCMs will be a minimum of a baccalaureate degree, with a
preference for a Master’s Degree in Social Work or Nursing or closely related
discipline. We will require a minimum of five years experience with the
geriatric/senior services. Through our research for this project, we identified there
are only three Certified Geriatric Care Managers present in the entire region and
none in Chesapeake. Therefore, it’s unlikely we will be able to recruit individuals who
are already certified by the National Association of Professional Geriatric Care
Managers (NAPGCM). The program will assist the staff in obtaining appropriate
training and licensure to obtain the certification of Geriatric Care Managers.
Target Market Definition / Research
In 2008, the Chesapeake Health Department (CHD) completed a community-wide
strategic planning process to identify resources and prioritize issues that the public
health system can, and should, address. The tool used to guide this process was
called MAPP - Mobilizing for Action through Planning and Partnerships. This
assessment determined there was a need to improve linking people to needed
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SENIOR CARE INTEGRATED PLANNING (SCIP)
personal health services. Another needs assessment completed by the Chesapeake
Task Force on Aging also found that knowledge of community services was limited.
Educating our senior population on the availability of services in our community and
linking them to these services is a need that SCIP will be addressing.
An age wave of graying Americans is flooding the United States. In 2030 the senior
population is projected to be twice as large as in 2000, growing from 35 million to 72
million. This represents 20 percent of the total U.S. population. In the state of
Virginia, persons age 65 and older make up 12.2% of the population. In
Chesapeake, the proportion of individuals over 65 years will double between 2000
and 2030, from 9% to 18%, while the actual number will more than triple, from 17,844
to 56,015. In the past 6 months, CRMC discharged 517 patients to nursing homes
and skilled nursing placements. CRMC Home Care Services have over 300 Lifeline
units in homes of at risk seniors.
The average life expectancy in the US in 1900 was 47.3 and in 2000 it rose to 76.9.
People are living longer and healthier lives; this creates a major social and healthcare
challenge. Heart disease, cancer and stroke are the leading causes of death among
older adults. About 80 percent of seniors have at least one chronic health condition
and 50 percent have at least two. Diseases like hypertension, arthritis and diabetes
are the leading causes of activity limitations among the senior population.
Care for our senior population is changing. In the late 1960’s and early 1970’s longterm care choices were mainly limited to nursing homes which were modeled after
hospitals. Over the past 10 years, the focus has changed to less institutional kinds of
residential care, assisted living and home-based care. From 1987 to 1996, there was
actually a drop in nursing home occupancy rates suggesting that the older population
needs are being met outside of nursing homes. Traditional nursing homes now focus
on caring for the oldest and frailest seniors. Between 1998 and 2003 there was an
80% increase in spending on home care and community-based services. Assisted
living provides more privacy and independence but is not covered by Medicare and
tends to focus on a higher economical status.
The majority of older adults vehemently state that they do not want to end up in a
nursing home. For many seniors, a nursing home may be seen as the only option.
The changing face of eldercare and its financial implications represent a significant
societal issue with the aging of the senior population. Ken Dychtwald, president and
CEO of Age Wave, author of 16 books on aging, and a leading thinker in the field,
recently completed a study for Genworth Financial that looked at America’s readiness
for long life. Only 36% of the people surveyed think they will ever need long-term
care. Current care usage demonstrates that 67% of the over-65 population will need
long-term care at some point in their lives. This suggests that all of us need to do
some serious planning and saving.
Many seniors feel pushed into nursing homes due to lack of education concerning
their knowledge of options, lack of finances for home care services, and limited family
support. Many adult children, known as the “sandwich generation,” are unable
physically or financially to care for their parents at home because they have to work
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to support their families and also care for their own children. With the increase
expected in the senior population, more will need to be done.
The benefits of seniors aging at home are numerous. The older adults feel more
independent and a sense of control. They are exposed to less contagious diseases
and sleep better in their own homes. There is also a substantial cost difference. The
annual cost of a nursing home in Chesapeake is $79,000 which is about $213 per
day. Home care costs are less costly because it is paid by the hour and not around
the clock.
Seniors and their family members/caregivers are our major target audience. MetLife
Mature Market Institute and the National Alliance for Caregiving have conducted a
number of studies on the impact of family care giving on the workforce. Sixty-two
million people (26.8%) in the US have served as an unpaid family caregiver to an
adult. Up to 30% of employees have responsibilities for their parent/s. Sixty three
percent of caregivers between the ages 51-63 are working and most full-time. The
majority of the caregivers are working middle-aged women. Met Life found that
companies lose up to $33.6 billion per year due to employee’s absenteeism,
workplace disruptions and reduced work status of working family caregivers.
Additionally, there is an 8% differential in increased health care costs between care
giving and non-care giving employees, costing employers an extra $13.4 billion per
year. Caregivers are more likely to report depression, hypertension, diabetes and
pulmonary disease.
In 2009 a survey determined caregivers want more information regarding:
 Keeping a recipient safe at home= 37% (up from 2004, 30%)
 Talking to doctors/professionals 24%
 Choosing a home care agency= 23% (up from 2004 13%)
 Choosing an assisted living facility= 19% (up from 2004, 13%)
 Choosing a nursing home= 17% (up from 2004, 8%)
SCIP will educate employers regarding the critical nature of long-term care preplanning. SCIP will effectively reach the caregivers through their employers due to
the impact this issue has on businesses. Access to eldercare services may become
as important to employees in the future as child care is today.
Marketing Strategy
This program will target the seniors, their caregivers and employers and as such the
marketing strategies must also target all three aspects.
Direct one on one encounters or personal presentations will occur at several different
levels:
 To reach seniors directly, we will approach senior groups or places where
seniors gather (support groups, social clubs, health fairs, community events,
etc) to conduct presentations and information sharing sessions.
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

To reach caregivers, we will approach employers who may be struggling with
loss of personnel hours due to caregiver responsibilities. We will present
information through group level presentations (through human resources and
through “lunch & learn” type presentations).
To reach both seniors and caregivers, we will approach professional
organizations serving seniors (physician’s offices, hospitals, rehabilitation
centers, social service organizations, etc). This will facilitate third party
referrals to SCIP.
There are 15,599 companies in Chesapeake, Virginia; 12 employ 500 to 999 persons
and three employ 1,000 to 4,999 persons.
We will utilize traditional marketing strategies as well as the technology of today.
Seniors themselves may not utilize the internet or other social marketing outlets, but
it’s likely their caregivers or other family members do. Internet and mobile marketing
efforts will be targeted towards caregivers and employers. Traditional print
(brochures) and media marketing (television and internet) will be utilized. SCIP
representatives will seek to publish free print articles in the following:
 Clipper: Chesapeake specific publication that is included in the regional
newspaper, the Virginian-Pilot and has a distribution of 137,880. The Virginian
Pilot has a regional distribution of 542,471 weekly.
 The Shopper: distribution of 84,896 and is delivered with regular mail to all
single dwelling homes in Chesapeake.
 Doctor to Doctor: a newsletter published quarterly and is mailed to 8,500
doctors, dentists, and medically related businesses.
 Vital Sign: a medical magazine distributed online by the Marketing
Department of Chesapeake Regional Medical Center, with distribution to
4,600 email addresses.
 Doctor’s Page: newsletter with receiving audience of 523 physicians serving
the Chesapeake Regional Medical Center.
Brochures will be distributed at all speaking engagements. For organizations in
which we have no existing relationship, a brochure will be mailed and followed up
with a phone call or personal visit to request a presentation.
SCIP will involve the faith community by making a presentation at the Hampton
Roads Ministerial Association. Bulletin announcements will be sent to 500
institutions in the faith community to be reprinted in their bulletins and newsletters.
Two speaking engagements will be requested on Chesapeake’s cable Channel 48
television. Existing shows Health Matters and Thinking Out Loud each reach an
audience of 100,000. There is no advertisement fee involved for these public service
programs.
In an overt effort to reach the caregivers during their transit time to and from work, an
advertisement will be placed on five outdoor billboards in strategic locations reaching
over 200,000 commuters each day.
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Industry Analysis
Case management has been defined as a systematic process of assessment,
planning, service coordination and/or referral, and monitoring through which the
multiple service needs of a client are met. Five essential features comprise case
management:
 identification of eligible patients
 assessment
 development of an individual care plan
 implementation of the care plan
 monitoring of outcomes
For individuals at high risk of adverse outcomes and excessive healthcare utilization,
case management is an important intervention. Case management has been shown
to decrease glucose levels in diabetics, reduce infant mortality in maternal-child
health patients, and decrease emergency room use utilization, as well as increase
days of life, in geriatric patients. In 1993, geriatric care management was declared
the way to decrease unnecessary hospital costs. Geriatric care management has
been defined as a service that assess an individual’s medical and social service
needs, then coordinates assistance from paid service providers and unpaid help from
family and friends to enable persons with disabilities to live with as much
independence as possible.
The long-term care continuum includes case management for seniors and their
families. Nursing homes and publicly funded programs have traditionally been the
primary provider of this management. In the mid-1980’s “private” providers of case
management began to emerge; practitioners who charged for case management as a
separate service, not usually reimbursable by Medicare or Medicaid or other public
programs. According to Marcie Parker, a research associate with InterStudy, a
Center for Aging and Long-Term Care, this distinctive industry resulted from
numerous factors including: “(a) converging growth trends in the older population; (b)
increasing concern over the costs of services; (c) growth in the number and types of
services targeted at the elderly and thus the complexity of the system; (d) the
entrepreneurial spirit of human service professionals; and (e) a realization that public
programs cannot meet the care coordination needs of all older persons and their
families.” Surveys conducted in both 1988 (Parker) and 2000 (AARP) revealed that
more than two-thirds of geriatric case management firms were independent and selfmanaged; those with affiliations were located within hospital, social service or nursing
home systems. Regarding payment sources, 91% of firms report at least some of the
payment comes from the client out-of-pocket, while 77% receive some out-of-pocket
payments from the family/caregiver; only 17% receive any payment from insurance.
The National Association of Professional Geriatric Care Managers (NAPGCM)
defines the profession of geriatric care management as “a human service specialty
provided by professionals from diverse background and academic preparations to a
vulnerable and often frail population.” In 2000, the vast majority (75%) of the case
managers held post-graduate degrees; additionally, two-thirds of the case managers
were licensed, 37% in social work and 30% in nursing. In an attempt to provide high
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quality standardization to the practice of care management for seniors, to ensure
clients are getting the best care, the NAPGCM, in January of 2010, began requiring
its active members to meet stringent criteria to be professionally recognized as a
“Certified Geriatric Care Manager (GCM)” (Appendix C). The criterion include a
minimum of a Baccalaureate degree with 2-3 years of supervised experience as well
as certification in one of four vetted case management programs: Care Manager
Certified, Certified Case Manager, Certified Advanced Social Worker in Case
Management, Certified Social Work Case Manager.
In addition to the core case management services, many private geriatric
organizations began offering direct services such as counseling and nursing home
placement. Over time, the addition of companion, homemaker, and home health aide
services became integrated in many geriatric case management organizations. Two
nationally recognized at-home, senior care organizations are SeniorBridge and
LivHOME. Founded in 2000 and with 33 locations in 10 states, SeniorBridge is
considered a leader in elder care. LivHOME, with 23 branches in 7 states was
founded in 1999 “to enable older adults to remain in their home for as long as
possible.” Both of these organizations tout Certified Geriatric Care Managers who
oversee the assessment, care and coordination of services for the client. Additionally,
both offer personal care, or caregiving, services to assist the client with activities of
daily living. Neither of these organizations provides care in southeastern Virginia.
Hampton Roads is a metropolitan region of SE Virginia boosting a population of over
1 million people. However, only three certified GCMs, working in two separate
organizations, serve this area. Marilyn Fall is a certified GCM and founder and COO
of Elder Care at Home, Inc. which provides case management and personal care
services for an average of 50 clients at any one time. Mrs. Fall has chosen to limit her
case load. Family Care Solutions employs two certified GCMs and over 200 other
personnel to provide a broad spectrum of services including Geriatric Care
Management, Home Health Services, Personal Services, Home Maintenance
Services and Personal Monitoring Systems. Other long-term in-home care models in
the area are run by managers without specific health training. Seniorcorp, a Virginia
company dedicated to “changing the way America ages,” was founded by a business
entrepreneur with the designation of a Certified Senior Advisor (CSA). There are no
minimum educational or experience criteria to obtain the certification of CSA. Anyone
who chooses “to enhance their ability to serve the senior community more effectively”
can gain this certificate per the Society for CSA website; health care experience or
education is not necessary. Another organization that has an office in Hampton
Roads, Home Instead Senior Care, was created in 1994 by a man concerned about
the care of his elderly grandmother. Home Instead provides companionship services,
personal services and home helper services and the organization now boosts over
900 franchises in 14 countries. Only Home Instead is located in Chesapeake,
Virginia.
A relatively new focus in the elder care arena is that of the working caregiver. With
up to 30% of employees have responsibilities for their parent/s and businesses losing
up to $47 billion a year as a result, employers need to learn how to help their
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employees. There is a niche for case management organizations to partner with
employers to develop employer-sponsored geriatric care management programs.
Keys to success for long-term care stem from the vulnerable nature of the individuals
requiring the services, the senior. For the case management component of long-term
care, certification as a Geriatric Care Manager is the highest degree of expertise that
can be conferred to ensure quality assessment, coordination of care, and monitoring
of the client. Ease of accessibility, strong communication skills, and access to the
target market are also determining factors in the success of a geriatric care
management industry. When adding personal care services to an organization,
personnel that are trust-worthy, reliable, and well-trained are crucial to the success of
an organization. The aides must undergo thorough background, criminal, and
reference checks as well as pre-employment screening and drug testing. The
organization and employees must be licensed, bonded and insured. The coordinator
should take care to selectively screen and match each client with an appropriate
health aide. The addition of continued training and education as well as a benefits
package decreases turn-over in the care aide work force.
A political trend that supports new industry in long-term care sprouts from the recent
passage of the Patient Protection and Affordable Care Act in March 2010.
Coordination of care is being emphasized in multiple provisions of the new law
including the Community Care Transitions Program, which went into effect on
January 1, 2011 and aims to coordinate care and connect Medicare recipients to
needed services upon discharge from the hospital. Additionally, the Medicare
Independence at Home demonstration project will be launched in 2012 to determine
whether chronically ill clients will benefit from coordinated primary care in their home.
The Community Living Assistance Services and Supports program (CLASS) provides
the most important boost for in-home care service entities by creating a federally
administered insurance program for individuals to purchase non-medical long-term
services and support.
Payment for case management services and lack of knowledge about the benefits of,
and the need for, geriatric care management emerge as the two key stumbling blocks
for this burgeoning industry. Regarding finances, long-term care has historically been
paid for by the consumer or their family out-of-pocket. Long-term care (LTC)
insurance policies cover skilled, intermediate, and custodial care in nursing homes
and usually cover home care services. Many LTC policies are beginning to cover
“alternative care”, including case management. Some LTC insurance requires an
assessment of activities of daily living and/or of cognitive impairment, assessments
that may be carried out by GCMs. An emerging trend in payment for long-term care
comes from the employment sector via Employee Assistance Programs. A few
employers are adding benefits that cover the cost of long-term care for the family
member who needs care thereby allowing the employee to focus on their work.
Regarding knowledge, an AARP survey of GCM professionals found that their
“biggest challenge is lack of public awareness that geriatric care management even
exists and what is can do for the consumer.” Another study revealed that between ¼
and ½ of the GCMs time was consumed by educating clients and family/caregivers
11
SENIOR CARE INTEGRATED PLANNING (SCIP)
about their services. Additionally, many care givers, nurses and other case managers
who work with seniors are used to Medicare and/or Medicaid providing nursing home
and medical home health care services to their elder patients. They often do not think
patients would be willing, or able, to pay out of pocket for care coordination services;
consequently, they do not refer patients. Education to nursing and hospital staff and
to employers is every bit as valuable as educating the clients and their
caregivers/family.
Partners / Competitors
Despite a population of over 1 million people in the Hampton Roads region, only
three GCMs are known to practice in the area. Multiple organizations within
Chesapeake provide services or resources to the elder population; however, none
specifically provide eldercare planning services and care management to assist the
senior and their family members.
Many partners have been identified as assisting the senior population on different
levels. The goal of SCIP is to help seniors live as independently as possible while in
a safe environment to meet their needs. When partnering with these organizations,
cooperative strategies offer many potential advantages to the participant. A partner’s
specific knowledge of the local market can be invaluable and open doors for
additional assistance. SCIP has complimentary goals and objectives as the partners
listed below.
 Chesapeake Regional Medical Center provides comprehensive medical
services to people throughout Hampton Roads, including many seniors.
Their Home Care Services provide medical services; however, they do not
provide long-term planning, comprehensive care management or personal
care services. They accept Medicare, Medicaid, Tricare and private
insurance.
 Chesapeake Human Services offers a number of service and benefit
programs for senior adults including Adult Protective Services, companion
assistance, assessment for alternative living arrangements, and
entitlement programs such as food stamps and Medicaid.
 Chesapeake Health Department conducts nursing home screenings and
facilitates a caregiver support group.
 Chesapeake Task Force on Aging is dedicated to the well-being and
overall concerns of the elderly. They work to identify the needs of the
elderly population and investigate new and invigorating ways in which to
enrich their lives.
 Chesapeake Parks and Recreation provides Senior Programs and
activities at two senior centers.
 AARP Foundation Senior Services is a senior citizen service organization
addressing senior activities and weekly clubs and volunteer opportunities.
 Senior Services of Southeastern Virginia (SSSEVA) is the Area Agency on
Aging serving residents of Chesapeake and Hampton Roads. They support
and enrich the lives of older Virginians and their families through advocacy,
education, information products and comprehensive services. They
12
SENIOR CARE INTEGRATED PLANNING (SCIP)

receive funding from federal, state, municipal, and private sources. Many
of their services are free and they charge for others on a sliding scale
based on income.
Oast and Hook, “the experts in Elder Law” for Hampton Roads, is a legal
service which has the potential for referrals to, and from, SCIP.
It is expected these partners will serve as referral sources for the program. We will
work together in a collaborative environment enabling each other to provide the
needed services for the client. Workshops and seminars will be conducted with
organizations with the tools and knowledge to help clients and will assist by raising
awareness of senior issues. The partnership with CRMC adds significant validity to
SCIP due to the quality reputation they already have established in the region.
Competitors include organizations in Hampton Roads currently providing eldercare
services. Only one senior personal care service provider is located in Chesapeake
and they are limited to companionship services, home helper services and personal
services: therefore, many residents travel to the other cities of Hampton Roads
seeking these services. With the increasing population, additional service providers
will be necessary to meet the demand. A focus group held with community agencies
(including some competitors), identified a need for geriatric care management service
in Chesapeake.
The following companies are considered to be the competitors for SCIP.
 Elder Care at Home, Inc. is located in Virginia Beach. Founded in 1990 under
the direction of Marilyn Fall, the president and COO, they provide professional
geriatric care management including comprehensive assessment of needs,
personalized care planning, coordinated services, short and long term care
supervision, counseling and education, legal and financial service referrals,
medication monitoring, and household management. The proprietor of Elder
Care at Home, Inc. is actually a competitor turned alliance. The team met with
the owner to discuss services and local needs.
 Family Care Senior Solutions, Inc. is located in Portsmouth, VA and has been
in business since 1983. They advertise that they are the Virginia leader in
healthcare and home services for families with a staff of 200 screened,
bonded and insured employees. Their services include geriatric care
management, home health services, personal services, home maintenance
services, and personal monitoring services.
 Care Connect of Hampton Roads, established in 2007, is located in Virginia
Beach, Virginia 23462. Under the direction of Christina Boyd, a Certified
Senior Advisor (not a GCM), they claim to be a full service geriatric care
management firm. They offer health care, finance, legal, Medicare, Medicaid,
assisted living, home care, and nursing care.
 Seniorcorp, Inc. located in Norfolk, Virginia. They provide a personal care
coordinator (not a GCM) who oversees advocacy for the client. It is a private
pay establishment that offers basic services to seniors based on the level of
need and the amount of time needed during the week to provide personal
services.
13
SENIOR CARE INTEGRATED PLANNING (SCIP)


Senior Helpers (Caring In-Home Companions), founded in Baltimore in 2001,
is located in Virginia Beach, Virginia and offers a full complement of services
to ensure a continuum of care including companion care services and
personal care services. They do not have a GCM.
Home Instead Senior Care, founded in 1994, is located in Chesapeake, VA.
They offer companionship services, home helper services and personal
services. A Geriatric Care Manager is not employed and they are led by
individuals who live, work and have a desire to impact aging related issues in
their community.
SCIP will offer a distinctive service from what is available in the city of Chesapeake.
SCIP will offer an additional choice to the limited array of GCMs regionally. Because
of the growing elderly population and booming market, we do not expect to take
clients away from our competitors. Additionally, no other program is focusing on the
employer aspect of elder care; therefore, it is anticipated SCIP will recruit new clients
who are not currently utilizing any senior services.
As we look at threats and future competition, companies that are interested in
acquiring the professional practices of experienced, or entrepreneurial, private firms’
surface. LivHome has launched a franchise program and was named in the Inc.
5000 List of fastest growing private companies for the 4th straight year. They employ
a credentialed care manager (not a GCM) with a specialty in social work, nursing or
mental health. Another company, SeniorBridge Care wants to merge with or buy care
management practices or home care companies. They are a geriatric care
management team of nurses, social workers, and certified caregivers located
throughout Florida and other states and with a national office in Baltimore, Maryland.
Risks
Creating a new business includes numerous risks; for SCIP, financial, staff, and
organizational risks pose the major threats to the organization.
The financial risk takes into account both expense and revenue sources. Regarding
expenses, SCIP depends on integration, as a cost center, under Chesapeake
Regional Medical Center’s Home Care department for its initial creation and start-up.
The Director of Home Care shares the vision of SCIP and has written a letter of
support (Appendix D). CRMC’s Senior Executive Team was educated about the
benefits of SCIP, not only to the community but to their bottom-line, during a
presentation of SCIP’s business plan. Specific metrics targeting reduction in hospital
readmissions and unnecessary emergency room visits were cited. If CRMC decided
not to integrate SCIP under its umbrella, the business plan could be re-written to
create an independent, non-profit entity.
Regarding risk and revenue, concern has been voiced about patients’ ability and
willingness to pay out-of-pocket for case management and personal care services.
Chesapeake’s indigent population is lower than the state average; additionally, the
14
SENIOR CARE INTEGRATED PLANNING (SCIP)
senior population was the only age demographic category to reduce their rate of
poverty last year. With home care costing less than nursing homes, it is a viable
alternative to many seniors. Educating seniors and their families about the benefits of
care coordination and contrasting the costs of nursing homes with in-home care will
help enable seniors to make decisions that are best for them. Furthermore, many
studies demonstrate that private care is often financed, in whole or in part, by family
members or caregivers. Marketing will target these populations, especially through
their employers. SCIP will educate employers about caregivers in the workplace,
explaining the stressors on the individuals as well as the resultant toll on the business
and will offer ways to reduce the burden including adding long-term care benefits for
not only the employee but their family members.
Staff risk involves service providers. The inability to hire a certified Geriatric Care
Manager could be devastating to SCIP’s success. To prevent this obstacle from
occurring, SCIP will focus on hiring professional care managers with experience in
the field of gerontology and will pay for their certification and recognition by the
NAPGCM. Provision of competition wages with benefits will help entice high quality
staff.
CRMC will be expected to provide organizational support through name recognition
and by access to potential clients, namely hospitalized seniors. Lack of support in
these areas could results in the inability to create and maintain a sufficient client
base. Integration into the discharge planning cycle would facilitate internal support.
Cooperation with emergency room staff will assist with the introduction of SCIP’s
services at the onset of a perceived crisis. An additional barrier is the mentality of
health and social service staff who perceive the senior patient as unwilling or
financially unable to acquire private services. Education for these staff about the
benefits of geriatric care management programs, not only for the patients but also for
the hospital, could help shift the paradigm regarding referrals to private pay entities.
Marketing support from CRMC is also important as brand recognition associated with
our community hospital will provide SCIP with enhanced community acceptance.
Regarding regulatory restrictions, as SCIP will not be billing Medicaid or Medicare, it
will not be beholden to the numerous restrictions and documentation challenges that
come with these payor sources. SCIP will hire licensed case managers and will be
insured and bonded under the auspice of CRMC.
The long-term development plan involves expansion of services and education.
Initially, SCIP will begin as a geriatric care management service under the umbrella
of Home Care Services at CRMC. Within three years, SCIP will consider offering
personal care services. Simultaneously, SCIP will educate local businesses about
geriatric care coordination and encourage the integration of these services as a
benefit to their employees and their family members.
An exit plan could come in three main forms: merger, acquisition, or dissolution. SCIP
could fully merge with the Home Care Services by dropping its independence as a
cost center. This would entail regulatory changes as Home Care Services does bill
15
SENIOR CARE INTEGRATED PLANNING (SCIP)
Medicaid services. Secondly, CRMC could choose to release SCIP. This would free it
up to be acquired by a national geriatric care management firm such as LivHome or
SeniorBridge. Both of these organizations have been actively purchasing small,
independent firms. Lastly, in the event that SCIP is not financially viable, it would
need to dissolve. Resources, such as space and equipment, would be absorbed by
CRMC. Case management staff may be integrated into the Home Care Services
staff. Most importantly, SCIP would work diligently with the patients and their families
to ensure a smooth transition of care to one of the two existing geriatric care
management organizations within Hampton Roads.
Timeline
Time Period
March-September 2011
October-December 2011
January-March 2012
April-June 2012
July –September 2012
October 2012 and on-going
Action
1. Present plan to Chesapeake Regional Medical Center.
2. Apply to local foundations for funding (Hampton Roads
Community Foundation, Chesapeake Foundation, etc).
1. Recruit and Hire Program Manager to start January 2012.
1. Develop policies, strategies (billing, computer services,
personnel, standards of care).
2. Design marketing materials (brochures, web presence).
3. Training and certification for Certification for Geriatric Care
Manager/Program Manager.
1. Stakeholder engagement activities.
2. Distribute marketing materials, implement networking
strategies (face to face appointments with employers,
physician’s offices, hospital staff, etc)
3. Continued development of policies, procedures, program
guidelines.
4. Recruit and hire 2 Geriatric Care Managers to begin July
2012.
5. Initiate employer education programs.
1. Training and orientation for Geriatric Care Managers.
2. Screen and enroll clients into SCIP.
3. Continue employer education program.
4. Continue marketing strategies (outreach to senior groups,
community partners, stakeholders, etc).
1. Continue community education through presentations at
community groups, employers, hospitals, etc.
2. Continue screening and enroll clients into SCIP.
16
SENIOR CARE INTEGRATED PLANNING (SCIP)
Budget Narrative
SCIP strives to be financially sustainable by the end of year three through revenue
generation by fee-for-service initial and comprehensive geriatric assessments, plan
creation and case management. Expenses in the initial three years will be subsidized
by a start-up grant from the Hampton Roads Community Foundation and by in-kind
donations from CRMC for salaries, fringe benefits, management fees, and
rent/utilities. By year four, no further outside support will be necessary.
Assumptions: Revenue
Client assessment will being in month seven. A conservative estimate suggests 4
initial consults in month seven and enrollment into service of 50% of the consults. By
the end of year one, 60 initial consults will have been conducted with 30 clients
enrolled. The maximum number of clients a single full-time GCM can carry is 25. The
supervising GCM will have a maximum of 15 clients, to allow for her .6 FTE status.
Thus, the maximum client case load for SCIP will be 65; it is expected to be achieved
by year four. It is assumed that a client will initially average six hours of case
management per month for the first three months and then will require 2-4 hours a
month thereafter. An average of 3.3 contact hours per client per month was
determined to be the break-even number of hours needed and will therefore be an
overall goal for hours of care management.
The simple fee schedule is as follows:
 Initial screening assessment = $ 80
 Admission to service
= $310
 Continuous care management = $125 per hour
Assumptions: Expenses
During the first month, the GCM who will be the Program Manager for SCIP as well
as a case manager will be hired with an annual salary of $60,000. In month seven,
the other 2 GCMs will be brought on board with an annual salary of $45,000. Fringe
is estimated at 30% of annual salary, based on CRMC data. Year 2-5 includes 2%
increase for Salary and Fringe. CRMC “management fees” include wages for
numerous shared positions including department supervisor, a receptionist, human
resources, marketing, billing, audit, housekeeping, and insurance. An annual cost of
$76,000 was provided by current CRMC staff. The figure for rent/utilities was also
provided by current CRMC staff. Regarding marketing, in month six, five billboards
will be purchased for a one month to lead up to the initial enrollment of clients; the
cost is $4,000 for this single activity. Other build-up marketing will occur in months
five and six. Travel reimbursement is set at $0.50 per mile and includes travel to
clients as well to employers and for promotional activities.
17
SCIP: YEAR ONE BUDGET
SENIOR CARE INTEGRATED PLANNING (SCIP)
REVENUE
Month 1
Month 2
Month 3
Month 4
Month 5
Month 6
Month 7
Month 8
Month 9
Month 10
Month 11
Month 12
Total
CRMC In-Kind support
Foundation grant
Patient Pay Fees CGM Services
Initial Consultation
Admission to Services
Continuous Care Mgmt.
14,533.33
15,000.00
14,533.33
14,533.34
14,533.33
14,533.33
14,533.34
16,783.33
16,783.33
16,783.34
16,783.33
16,783.33
16,783.34
187,900.00
15,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
320.00
620.00
1,500.00
640.00
1,240.00
4,500.00
800.00
1,550.00
8,250.00
960.00
1,860.00
12,075.00
960.00
1,860.00
15,225.00
1,120.00
2,170.00
18,787.50
4,800.00
9,300.00
60,337.50
Total revenue:
29,533.33
14,533.33
14,533.34
14,533.33
14,533.33
14,533.34
19,223.33
23,163.33
27,383.34
31,678.33
34,828.33
38,860.84
277,337.50
EXPENSES
Month 1
Month 2
Month 3
Month 4
Month 5
Month 6
Month 7
Month 8
Month 9
Month 10
Month 11
Month 12
$0.00
$0.00
0.00
16.67
350.00
70.00
200.00
100.00
0.00
0.00
0.00
$0.00
$0.00
500.00
16.67
0.00
70.00
160.00
200.00
10.00
0.00
0.00
$0.00
$0.00
250.00
16.66
0.00
70.00
160.00
250.00
10.00
0.00
0.00
$0.00
$0.00
250.00
16.67
0.00
70.00
160.00
250.00
10.00
0.00
0.00
$0.00
$0.00
500.00
16.67
0.00
70.00
160.00
250.00
30.00
0.00
0.00
$0.00
$0.00
5,000.00
16.66
0.00
70.00
160.00
250.00
200.00
0.00
0.00
7,500.00
$0.00
250.00
16.67
350.00
210.00
333.35
340.00
10.00
0.00
0.00
7,500.00
$0.00
250.00
16.67
0.00
210.00
333.33
580.00
10.00
0.00
0.00
7,500.00
$0.00
250.00
16.66
0.00
210.00
333.33
880.00
10.00
0.00
0.00
7,500.00
$0.00
250.00
16.67
0.00
210.00
333.33
1,200.00
10.00
0.00
0.00
7,500.00
$0.00
250.00
16.67
0.00
210.00
333.33
1,400.00
10.00
0.00
0.00
7,500.00
$0.00
250.00
16.66
0.00
210.00
333.33
1,800.00
10.00
0.00
0.00
45,000.00
0.00
8,000.00
200.00
700.00
1,680.00
3,000.00
7,500.00
320.00
0.00
0.00
2,700.00
350.00
100.00
2,500.00
6,386.67
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
956.67
0.00
756.66
0.00
756.67
0.00
1,026.67
0.00
5,696.66
4,400.00
650.00
200.00
0.00
14,260.02
0.00
8,900.00
0.00
9,199.99
0.00
9,520.00
0.00
9,720.00
0.00
10,119.99
7,100.00
1,000.00
300.00
2,500.00
77,300.00
Salaries: GCMs
Fringe Benefits: GCMs
Mgmt Fees
Rent/Utilities
Total In-Kind expenses:
5,000.00
1,500.00
6,333.33
1,700.00
14,533.33
5,000.00
1,500.00
6,333.33
1,700.00
14,533.33
5,000.00
1,500.00
6,333.34
1,700.00
14,533.34
5,000.00
1,500.00
6,333.33
1,700.00
14,533.33
5,000.00
1,500.00
6,333.33
1,700.00
14,533.33
5,000.00
1,500.00
6,333.34
1,700.00
14,533.34
5,000.00
3,750.00
6,333.33
1,700.00
16,783.33
5,000.00
3,750.00
6,333.33
1,700.00
16,783.33
5,000.00
3,750.00
6,333.34
1,700.00
16,783.34
5,000.00
3,750.00
6,333.33
1,700.00
16,783.33
5,000.00
3,750.00
6,333.33
1,700.00
16,783.33
5,000.00
3,750.00
6,333.34
1,700.00
16,783.34
60,000.00
31,500.00
76,000.00
20,400.00
187,900.00
SUMMARY
Month 1
Month 2
Month 3
Month 4
Month 5
Month 6
Month 7
Month 8
Month 9
Month 10
Month 11
Month 12
Total
Total revenue
29,533.33
14,533.33
14,533.34
14,533.33
14,533.33
14,533.34
19,223.33
23,163.33
27,383.34
31,678.33
34,828.33
38,860.84
277,337.50
Total expenses
Revenue less expenses:
20,920.00
15,490.00
15,290.00
15,290.00
15,560.00
20,230.00
31,043.35
25,683.33
25,983.33
26,303.33
26,503.33
26,903.33
265,200.00
8,613.33
-956.67
-756.66
-756.67
-1,026.67
-5,696.66
-11,820.02
-2,520.00
1,400.01
5,375.00
8,325.00
11,957.51
12,137.50
Salaries: GCMs
Fringe Benefits: GCMs
Marketing
IT - Computer support
Training
Cell Phones
Office Supplies
Travel Reimbursement
Postage
Mgmt Fees
Rent/Utilities
Start-up
Computer equipment
GCM certification/training
Phone
Furniture
Total expenses:
Total
In-Kind Expenses
CRMC -
18
SENIOR CARE INTEGRATED PLANNING (SCIP)
FINANCIALS
SCIP 5 Year projection
REVENUE
Year 1
Year 2
Year 3
CRMC In-Kind support
187,900.00
110,750.00
10,000.00
0.00
0.00
Foundation grant
Patient Pay Fees CGM
Services
15,000.00
6,400.00
9,600.00
10,400.00
10,400.00
4,800.00
Initial Consultation
Year 4
Year 5
9,300.00
12,400.00
18,600.00
20,150.00
20,150.00
60,337.50
198,000.00
297,000.00
321,750.00
321,750.00
Total revenue:
277,337.50
327,550.00
335,200.00
352,300.00
352,300.00
Admission to Services
Continuous Care Mgmt.
EXPENSES
Year 1
Year 2
Year 3
Year 4
Year 5
Salaries: GCMs
45,000.00
153,000.00
156,060.00
159,180.00
162,364.00
0.00
31,550.00
46,818.00
47,754.00
48,709.00
8,000.00
8,000.00
8,000.00
8,000.00
8,000.00
200.00
210.00
220.00
230.00
240.00
Fringe Benefits: GCMs
Marketing
IT - Computer support
700.00
700.00
700.00
700.00
700.00
Cell Phones
1,680.00
2,520.00
2,520.00
2,520.00
2,520.00
Office Supplies
3,000.00
3,000.00
3,000.00
3,000.00
3,000.00
Travel Reimbursement
7,500.00
17,500.00
20,000.00
23,400.00
23,400.00
320.00
320.00
Training
350.00
350.00
350.00
Mgmt Fees
66,000.00
76,000.00
76,000.00
Rent/Utilities
20,400.00
20,400.00
20,400.00
324,068.00
341,534.00
345,683.00
0.00
0.00
Postage
Start-up
12,680.00
Total expenses:
79,080.00
216,800.00
In-Kind Expenses
CRMC Salaries: GCMs
60,000.00
Fringe Benefits: GCMs
31,500.00
14,350.00
Mgmt Fees
76,000.00
76,000.00
Rent/Utilities
20,400.00
20,400.00
Total In-Kind expenses:
187,900.00
110,750.00
10,000.00
10,000.00
SUMMARY
Year 1
Year 2
Year 3
Year 4
Year 5
Total revenue
277,337.50
327,550.00
335,200.00
352,300.00
352,300.00
Total expenses
266,980.00
327,550.00
334,068.00
341,534.00
345,683.00
10,357.50
0.00
1,132.00
10,766.00
6,617.00
Revenue less expenses:
19
SENIOR CARE INTEGRATED PLANNING (SCIP)
APPENDICES
20
SENIO
OR CARE IN
NTEGRATE
ED PLANNING (SCIP))
Appendix A: Health Care Services Com
mmunity Resource Listt
21
SENIO
OR CARE IN
NTEGRATE
ED PLANNING (SCIP))
Appendix A (contiinued)
22
SENIO
OR CARE IN
NTEGRATE
ED PLANNING (SCIP))
Appendix A (contiinued)
23
SENIOR CARE INTEGRATED PLANNING (SCIP)
Appendix B: Community Stakeholder Forum Results
On November 8, 2010 a community stakeholder forum was held with experts in health care,
senior services and finance. After a brief presentation about our concept of SCIP, we posed
many questions to the participants. What follows is a brief summary of the results.
1. What are the gaps in senior services in Chesapeake?
1. Adult Daycare
2. Transportation- (possibly the care assistances can assist with this component. Or
possibly use volunteers with stipends.
3. Homemaker services- Household chores, dishes, cleaning, laundry
4. Companion services- reduces isolationism
5. Supervision in the home environment.
6. Educate caregivers. Literally teaching them to take care of their spouse.
7. Caregivers support- education, respite. Make sure focus is on the caregiver in the
home.
8. Legal assistance before a person is compromised
9. Al a carte type services
10. Housing options.
2. How could we reach the people that need this service?
SENIORS
1. Word of mouth
2. Support groups
3. Churches
4. Chesapeake Redevelopment and Housing Authority
5. “Live a full continuum of life” Need eldercare to be considered as important as
childcare. Should be included in marketing materials.
CAREGIVERS
1. Churches
2. Support groups
3. Need to make sure you reach people who don’t identify as “caregivers”. Need to
teach them to self-identify.
EMPLOYERS/BUSINESSES
1. “Lunch & Learn” type of presentations. Discuss Return on Investment for this
service. “How to identify financial resources” as they age.
2. Veteran’s Administration (has a great program to look at
3. Ford- type of program to educate employees
4. Community Services Boards
24
SENIOR CARE INTEGRATED PLANNING (SCIP)
Appendix B (continued)
5.
6.
7.
8.
Advertising- Public Service Announcements.
Get ahead of the crisis with these families. Encourage PRE-PLANNING.
Business partnerships.
Get in the phone book
3. What makes a good company successful in the following services (Personal Care
and Case Management)?
CASE MANAGEMENT
1. Good evaluation systems so you can SELL your program to people who will buy
it….or buy into it. Even sell it to the insurance companies.
2. Evaluation from clients and care givers.
3. Employee satisfaction. Wage and benefits make it worthwhile to good staff.
4. Able to connect with the population (peer based services)
5. Knowledgeable of services.
PESONAL CARE
1. Competent, reliable staff,
2. “Likeable” staff
3. Competitive pay
4. Must be able to connect with population
5. Not intimidated or afraid of elderly.
4. Pitfalls
1. Doing too much in the beginning.
2. Possible lack of interest.
3. Lack of cash flow (Medicaid)…but being part of CRMC could assist with that
issue.
4. Not valuing employees. Make sure you train them and help them stay trained.
5. Need a niche’ and Certified Geriatric Care Managers can be it.
6. Lack of passion for the cause.
7. Auxiliary grants are not enough…..for those who need alternate housing options.
8. Commonwealth’s perspective on elder issues.
9. Advocacy of lack of advocacy for issues.
10. People who already work in the field that put up barriers because they don’t
“think” someone will take advantage of services (Lifeline example)
25
SENIOR CARE INTEGRATED PLANNING (SCIP)
Appendix C: Certified Geriatric Care Manager Criteria and Ethics Pledge
Certified Geriatric Care Manager (CGCM)
The National Association of Professional Geriatric Care Managers (NAPGCM) is an
organization of practitioners whose goal is the advancement of expert assistance to the
elderly and their families. NAPGCM is committed to maximizing the independence and
autonomy of elders and strives to ensure the highest quality and most cost-effective
health and human services. Through education, advocacy, counseling, and service
delivery, NAPGCM members assist older persons and their families to cope with the
challenges of aging.
NAPGCM promotes the highest standards of practice. Membership in NAPGCM as
a Certified Geriatric Care Manager is open only to qualified individuals with specialized
degrees and experience in human services, including social work, psychology,
gerontology or nursing, and who hold one of four NAPGCM-approved certifications.
Requirements for Certification
A. Education and Experience
1.
2.
A person who holds a Baccalaureate, Master's or Ph.D. degree with at least one
degree held in a field related to care management, i.e. counseling, nursing, mental
health, social work, psychology or gerontology;
--is primarily engaged in the direct practice, administration or supervision of clientcentered services to the elderly and their families; and
--has two years of supervised experience in the field of care management following
the completion of the degree. OR
Non-degreed RNs and other individuals with a Baccalaureate, Masters or Ph.D.
degree;
--are primarily engaged in the direct practice, administration or supervision of clientcentered services to the elderly and their families; and
--have three years supervised experience in the field of care management. AND
B. Additional certification
Certified Geriatric Care Managers must hold at least one of the four certifications listed below.
Care Manager Certified - CMC
National Academy of Certified Care Managers (NACCM)
Certified Case Manager - CCM
Commission for Case Manager Certification (CCMC)
Certified Social Work Case Manager (C-SWCM)*
National Association of Social Workers (NASW)
Certified Advanced Social Worker in Case Management (C-ASWCM)*
Membership Fee
Application Fee $25
Membership dues $345
26
SENIOR CARE INTEGRATED PLANNING (SCIP)
Appendix C (continued)
Pledge of Ethics For NAPGCM Members
PROVISION OF SERVICE
I will provide ongoing service to you only after I have assessed your needs and you, or a person
designated to act for you, understand and agree to a plan of service, the results that may be
expected from it, and the cost of service.
SELF-DETERMINATION
I will base my plan of service on goals you, or a person designated to act for you, have defined,
and which enhance the decisions you have made concerning your life.
LOYALTY
My first duty is loyalty to you. I will always provide services based on your best interest, even if
this conflicts with my interests or the interests of others.
TERMINATION OF SERVICE
I will end service to you only after reasonable notice. I will recommend a plan for you to continue
to receive the services as needed.
SUBSTITUTE JUDGMENT
I will not substitute my judgment for yours unless I am acting in the role of your guardian,
appointed by a Court of Law, or with your approval, or the approval of someone designated to act
for you.
CONFIDENTIALITY
I will hold in trust any confidence you give me, disclosing information to others only with your
permission, or if I am compelled to do so by a belief that you will be seriously harmed by my
silence, or if the laws of this State require me to do so.
REFERRALS/DISCLOSURE
I will refer you only to services and organizations I believe to be appropriate and of good quality. I
will fully explain to you any business relationship I have with any service I propose, and give you
information on alternatives, if at all possible, so that you, or a person designated to act for you,
can make an informed decision to accept or reject the services I recommend to you.
27
SENIOR CARE INTEGRATED PLANNING (SCIP)
Appendix C (continued)
COOPERATION
I will strive to ensure cooperation between all of the individuals involved in providing service and
care to you.
QUALIFICATIONS
I am fully qualified in my profession to provide the services I undertake. I continue to improve my
skills and knowledge by participating in professional development programs and maintaining
certification and licensing in my profession.
DISCRIMINATION
I will not promote or sanction any form of discrimination.
28
SENIO
OR CARE IN
NTEGRATE
ED PLANNING (SCIP))
Appendix D: Lette
er of Suppo
ort
March 16, 2011
om It May Concern:
C
To Who
Chesapeake Region
nal Home Caare Services is pleased too support thee Senior Carre Integratedd
Plannin
ng (SCIP) program propo
osed by Team
m Chesapeaake. We fullyy recognize the need forr
the coordination off care for a veery vulnerab
ble senior poopulation in tthis area.
ncy offers sk
killed home health
h
care sservices, hosspice care, paalliative caree
Currenttly, this agen
and LiffeLine® emeergency response system
m. We have aagreed to houuse, managee and assist w
with
the stafffing of SCIP
P, integrating
g it into the menu
m
of servvices alreadyy existing att the agency.
Please contact
c
me at
a Vickie.hun
nt@chesapeaakeregional..com or via ttelephone at (757) 3743227 iff you have an
ny questions regarding our
o participattion in SCIP
P.
Sincereely,
Vickie R. Hunt, R.N
N.
Directo
or of Home Care
C and Hosspice
29
SENIOR CARE INTEGRATED PLANNING (SCIP)
Appendix E: Break-Even Analysis
Break-Even Analysis: Billable Hours
TR = P * V = FC + (VC * V)
Total Revenue = Price * Volume = Fixed Costs + (Variable Costs * Volume)
Key question: How many hours (volume of hours) of continuous case management
need to be billed to “break-even”?
Total Revenue = (P1 * V1) + (P2 * V2) + (P3 * V3)
P1 = $80.00 for an initial screening evaluation
V1 = 130 clients screened
P2 = $310.00 for admission to service
V2 = 65 clients admitted
P3 = $125.00 per hour for continuous case management
V3 = The numbers of hours needed break-even
FC= $322,283 for year five
VC= $360 per client (the cost of mileage)
(P1 * V1) + (P2 * V2) + (P3 * V3)= FC + (VC*V2)
(80 * 310) + (310 * 65) + (125 * V3)= 322,283 + (360 * 65)
10,400 + 20,150 + (125 * V3) = 322,283 + 23,400
30,550 + 125V3 = 345,683
125V3 = 315,133
V3 = 2521.1 = total hours per year for all clients
Next, we need to determine the number of hour per client per month that is needed.
V3 / V2 (volume of clients) / 12 (months in a year)
2521.1/65/12 = 3.2 billable hours per client per month
To exceed the absolute minimum break-even number of hours, it was determined
that the GCMs of SCIP should strive for a minimum average of 3.3 contact hours per
client per month.
30
SENIOR CARE INTEGRATED PLANNING (SCIP)
Appendix E (continued)
Break-Even Analysis: Cost per Client and Billable Hours
TC = FC + (VC * V)
Total Cost = Fixed Cost + (Variable Cost * Volume)
Looking at different volumes of clients, how much does it cost to serve each client?
How many billable hours of case management would be needed?
50 clients:
TC= 322,283 + (360 * 50) = $ 340,283
Divided by 50 clients is 340,283 / 50 = $ 6,805.66 per client
V3 = (340,283 – 30,550) / 125 = 2477.86 total hours in a year
Billable hours per client per month = 2477.86 / 50 / 12 = 4.13 hours per client per
month
65 clients:
TC= 322,283 + (360 * 65) = $ 345,683
Divided by 65 clients is 345,683 / 65 = $ 5,318.20 per client
V3 = (345,683 – 30,550) / 125 = 2521.06 total hours in a year
Billable hours per client per month = 2521.06 / 65 / 12 = 3.23 hours per client per
month
75 clients:
TC= 322,283 + (360 * 75) = $ 349,283
Divided by 75 clients is 349,283 / 75 = $ 4,657.11 per client
V3 = (349,283 – 30,550) / 125 = 2549.86 total hours in a year
Billable hours per client per month = 2549.86 / 75 / 12 = 2.83 hours per client per
month
31
SENIOR CARE INTEGRATED PLANNING (SCIP)
Appendix F: References and Resources
“Best Practices in complex Chronic Care Management at Home”, a White Paper
presented by the Professional Advisory Board of SeniorBridge and a panel of leading
aging and chronic care experts. www.SeniorBridge.com Accessed 11/28/2010.
“Caregiving in the U.S.”, Executive Summary, November 30, 2009. Funded by
MetLife Foundation with AARP.
http://caregiving.org/data/CaregivingUSAllAgesExecSum.pdf Accessed 8/29/2010.
“Developing a Geriatric Care Management Business”, draft copy from Mary Kay
Krokowski, a GCM and Board Member of the NAPGCM. Additionally, conducted two
telephone interviews with her in September 2010.
Duke, Cheryl. “The Frail Elder Community-Based Case Management Project”,
Geriatric Nursing, Vol. 26, No. 2, p122-127, 2005.
Dychwald, Ken. Compilation of research found at http://phx.corporateir.net/phoenix.zhtml?c=175970&p=irol-newsArticle&ID=1490340&highlight=
“Geriatric Care Managers: A Profile of an Emerging Profession”, Data Digest, No. 82,
AARP, 2002. www.research.aarp.org/ppi. Accessed 8/29/2010.
“Guide to Long-Term Care Insurance”, a paper by America’s Health Insurance Plans
(AHIP). www.ahip.org.
Heiss, David W. “Geriatric Care Management Reduces Medicare Losses”,
Healthcare Financial Management, October 1, 1993.
“Hiring a Geriatric Care Manager”, Dynamic-Living. www.dynamic-living.com.
Accessed 8/30/2010.
“How Health Care Reform Affects Seniors”, a White Paper presented by the Society
of Certified Senior Advisors, 2010. www.society-csa.com Accessed 11/28/2010.
National Association of Professional Geriatric Care Managers.
http://caremanager.org/
Martin, Aya. “At A Certain Age”, Market Watch, December 10, 2009.
www.marketwatch.com/story/story/print?guid=C7559CE2-... Accessed 8/30/2010.
“Older Adult Survey Report”, Chesapeake Committee on Aging, September 1997.
Parker, Marcie & Secord, Laura J. “Private Geriatric Case Management: Providers,
Services, and Fees”, Nursing Economics, Vol.6, No. 4, p165-172 & 195, July-August
1988. http://web.ebscohost.com.chekov.evms.edu Accessed 12/3/2010.
32
SENIOR CARE INTEGRATED PLANNING (SCIP)
Appendix F (continued)
Picariello, Gloria et. al. “Impact of a Geriatric Case Management Program on Health
Plan Costs”, Population Health Management, Vol. 11, No. 4, 2008, p 209-215.
Appendix F (continued)
Scott, Lisa & Sharkey, Candace. “Putting the Pieces Together Private-Duty Home
Healthcare and Geriatric Care Management: One Home Health Agency’s Model”,
Home Healthcare Nurse, Vol. 25, No. 3, p167-172, March 2007. http://ovidsp.tx.ovid
Accessed 12/3/2010.
Sisk, Jennifer. “Home Sweet Home- Sizing up Senior Home Care,” Social Work
Today, Vol. 7, No. 1, p14.
Statistical Profile 2009. City of Chesapeake Department of Planning. Accessed on
8/29/2010 at www.chesapeake.va.us/services/depart/planning/pdf/2009StatisticalProfile.pdf
The MetLife Study of Working Caregivers and employer health care costs, MetLife
Mature Market Institute, Feb 2010, p1-33.
Whitlock, Angela. ”Why Should Employers Be Concerned With Eldercare?” Virginia
Pilot Newspaper, May 23, 2010.
www.payscale.com Accessed on 8/30/2010 for Geriatric Care Managers.
33