The group home is viable. This care business model has saved families, kept communities united and assisted entrepreneurs with a focus on compassion to find fulfillment in service to the needs of others. Regardless of the costly mistakes made by current and previous owners who allowed greed to turn into substandard care, regulatory compliance breakdown and poor financial management, most group home owners have been a complement to the long-term care spectrum.
New entrepreneurs entering this business model have much to offer. With all of their energy, commitment and experience they stand to positively impact the lives of many. Yet, there are still a few areas these special people must be careful not to ignore.
A. Be Population Specific
While there can be diversity in populations served, its good not to take the “one size fits all” approach in community based care. In some cases serving the mentally ill may not be compatible with residential services to the medically fragile senior. Imagine serving a mentally ill person who is very physical and has to move often, who may also be very verbal which could make Grandpa Jones nervous and uncomfortable. Grandpa should not have to feel this way in the place he is supposed to call home.
So be sure your admissions process considers this. There is another concern too when it comes to populations. If your home takes on a specialized designation and you enter into a placement contract with a community mental health agency, you may be contractually restricted to serving only those residents this agency places there. This means that during periods of empty beds you cannot bring in residents from other referral or service purchase sources.
Generally this is that agency’s means of ensuring that the homes with whom they contract are always focused only on the needs of a specific population or diagnosis. After all this is what specialization is. So explore diversity in whom you can serve but be prepared for the potential incompatibility that may exist. Click Here for a special course on Person Centered Planning with a special focus on group home environments.
B. Show You Can Serve the Needs of Residents
From the program data you plan to discuss with licensing bodies to the creed of operation you develop for staff, there must be a focus on how you can serve the needs of those in your home. This could be as simplistic or logistical as ensuring you arrange the special diet and transportation required for an end-stage renal disease sufferer who has to take multiple trips weekly to dialysis or it may be more complex.
Perhaps you admit new residents who have been benefiting from group therapy discussions for months and now you have to lead these in the home during inclement weather. Whatever the issue, enter the business prepared to serve the needs of the population no matter how intricate and/or willing to obtain the training and direction you need to make the needs of your population a priority that you can attend to.
C. Embrace Regulatory Compliance
There is never a need to be negative when it comes to regulators. We just need to comply with written, established licensing standards. Never turn it into a personality game…”who is your licensing rep, I heard she’s tough, etc.” Obviously if you are convinced a regulator has approached you with a visible, provable bias you may have to respond to it. Barring that, view them as a resource for ensuring you maintain a level of compliance that keeps your operation above reproach and avoid the fluff.
Think of the approach Sgt. Joe Friday used in Dragnet: “Just the facts mam.” You too should stick with whats important, focus on compliance and self-refinement. One state employed licensing consultant in Oakland County, Michigan asked a client of ours: “Where did you get the money to go into business?” and I thought wow how invasive!! My client responded: “I just shut down my meth lab.” The AFC licensing applicant felt the question was out of line, maybe so! Bottomline is keep relationships professional and much of the small talk can be minimized. Don’t play the personality game.
D. Have a Tight System of Governance
Group living programs must have priorities. Among them is person-centeredness in how we relate to and cater to the needs of residents. This is not to be a “landlord-tenant” relationship.
Employees need to be trained based upon published licensing standards and requirements. Administrative staff need to prepared and criminally clear, regardless of whether or not you find it convenient to employ your cousin. Direct care staff must have a set of enforceable policies with published consequences for breaches. They also need a clear line of supervision and education on what constitutes an emergency and how to report incidents.
The same applies for the micro-assisted living or unlicensed model. Just because it may not be critiqued the same way a licensed model is, does not mean we do not need policies for:
- Care Delivery Protocol
- Visiting Hours
- Documentation of Daily Activity and Incidents
- Home Sanitation
- Resident Privacy
- Resident Medications
- Hiring, Preparing, Monitoring and Developing Staff
- Financial Procedures
- Basis for Admission
- Basis for Discharge
Policies must be clearly defined and staff must be fully aware of them regardless of how the business is state regulated.
Special Notes for Unlicensed Models:
a. Some referral sources will not refer prospective residents to an unlicensed model for fear of a lack of regulation
b. Some insurers may be reluctant to write liability coverage in some states for unlicensed models
c. Local governments may not offer the same protections and acknowledgments for unlicensed models as it relates to
zoning and building and safety issues
The right system of governance will shape your program to stand out as focused, professional and you will earn the reputation of a serious player in the long-term care spectrum.
E. Create Fulfilling Environment for Employees
Employees do not stay just because you want them to and they will not thrive just because you smile at them. Many mistakes must be avoided in managing employee relationships.
The group home owner may be well-educated and/or come from a highly motivating, fulfilling employment history. Your direct care staff may not be quite as motivated but can become real winners if you invest the time into their ongoing development. It really is up to the owner to set the stage for quality relationships and performance. If a condescending approach is taken, we will go beyond the limits of professional boundaries and cause employees to feel emotionally distant from us. At that point there are no winners!
F. Practice Good Time Management
Neither licensing, your liability insurance carrier, a contract placement agency, a resident family or guardian or judge will want to hear about why you cannot be available to oversee the operations of your home. Make time to govern! You need to establish priorities and personal routines that govern everything from family time, to auxiliary employment to sleep schedules to how you are paying attention to the group living facility. This includes ensuring you have quality management in place that is properly trained to respond to emergencies and reporting situations to you.
G. Show You are Serious Early
If your commitment to being an advocate for and provider of quality community based care is real, you will already be networking on www.linkedin.com on Facebook and in other venues announcing your new initiative. You will be gathering support for what makes you different. With the right mix of humility and confidence you will be sharpening your intellectual sword with the experience of others who have paved the way before you. This same commitment will go to how aggressively you are working to ensure the proper governance for your program is in place. If these items are not important to you both your confidence and motives will be questioned!
Yes we need group homes. They keep recently discharged patients medically stable in their own communities and help avoid premature institutionalization while also removing often improperly placed stigmas associated with the mentally ill. This need, however, must never be viewed as a basis for not approaching the business legitimately.
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