Angela did not really realize what she was in for when she set out to house people with certain medical issues in her Midwest assisted living residence. As a nurse she focused on the non-behavioral populations who were managing issues with pulmonary concerns, diabetes, obesity and hypertension, including survivors of stroke.
She disdained the atmosphere surrounding funds that reimbursed homes which served the mentally ill, labeling the systems that oversees these funds as laced with improper politics and the kind of constant budget cuts that made quality care impossible. Without knowing it, Angela was onto something big, and she spent $30,000.00 on television advertisement to tell the world about it. She had developed the small-scale “Medical House”, an assisted living revolution still in short supply in comparison to what is really needed throughout America.
Charging from $3,000.00 to $6,000.00 per month depending upon the needs of the prospective resident after a thorough assessment, Angela’s Medical House still costs much less than the average monthly fee in a nursing home for the same patient which ranges $8000.00 to $10,000.00 per month. The routine in the home is an impressive one.
Each resident receives what is called the “morning quarter”, which is 15 minutes per morning devoted to nothing but observation of a resident’s mood and behavior in comparison to the day before or multiple previous days which helps staff to better plan a routine for the day. Often a specific 3 questions are asked of each resident.
The “morning quarter” is then used to help plan a more person-centered and meaningful regimen that considers energy levels, response to new medications, mood swings, sorrows, sleeplessness, new personal events, appetite changes and much more.
Support staff who may work partial shifts during the day then utilize the notes made by the early morning staffer allowing all to come together until bedtime to enhance the assisted living experience on each and every day. During this process an on-line case management system is updated and messages sent to applicable nurses, pharmacists, physicians including psychiatrists, guardians and other interested parties who can receive this information without privacy violations in real-time. There are two, (2) staff on duty during the morning quarters so that one can focus on observation, documentation and reporting while the other tends to morning personal care, medications and housekeeping.
The result? Even people with special needs which includes the medically fragile elderly and those with catastrophic injuries can live in their own communities in more dignified, non-institutional settings and avoid the stigma and depersonalization which can often come with the nursing home environment.
These 6-bed environments require the right staffing, ownership that is open-minded to change and innovation, professional relationships with a competent, experienced nurse and the regular involvement of a visiting physician whose practice is aimed at the population being served including a physical medicine and rehabilitation and wound care focused doctor.
The “Medical House” would typically be licensed based upon the requirements of your state of operation. They serve a valuable purpose and provide a meaningful, effective alternative to nursing home care for many and can spare lots of pain from Medicaid budgets once bureaucrats accept with action the need to develop a national standard and provide a fee for service system for this clinically competent assisted living model.
Such a reimbursement model must be a direct bill type system without the requirements associated with contracting with an agent of Medicaid waivers. Accreditation bodies must be involved and while these businesses cannot be skilled settings along the lines of a nursing home, they can be a close cousin in terms of quality medical oversight with lots more personal attention.
How urgent that America come together so thousands more neighborhoods develop and take pride in a real family booster, “”The Medical House” for those who need someone else to be their keeper.