“Big Family” House. Family- style affordable alternative for Nursing Home. (part 2: chapters 6-10 of 19).

6. Residents Profiles

To assure the cost-effective and high-quality management of “Big Family House” we developed a system of profiling of residents.

To create the typical profile we’ve used the GIR evaluation system and several additional characteristics:

1. Family situation,
2. Clinical history,
3. Documented needs,
4. Characteristics of mobility.

The Summary and Care plan version is presented for 5 profiles: Barbara, Doris, Carl, Albert, Emma.

6.1. Barbara. Average résident. GIR4.

Female, age 78, widow, one adult son who lives in England. She has lived in Latvia most of her adult life and chooses to remain instead of relocating nearer to her son.

She has diabetes, heart and respiratory illnesses (chronic heart failure and chronic obstructive pulmonary disease). She suffers from mild depression and short-term memory loss. She was hospitalized recently for uncontrolled diabetes and is no longer able to live alone. Poor circulation from the diabetes has caused some gait problems and she currently uses a walker to ambulate. She has occasional incontinence due to the inability to walk quickly.

6.2. DORIS. Maximum level of Care in BFH. GIR2.

Female, 67, lived for the last several year in family of elder daughter who is burnt out after the last hospitalisation of her mother.

Dorys has a history of severe respiratory illnesses with recurrent bouts of pneumonia that require hospitalization.

She is high risk for bed sores, frequent turning and skin monitoring necessary. She is incontinent of bowel and bladder.

6.3. CARL. With Dementia. GIR2.

Carl, Male, 92, in the advanced stages of Alzheimer’s disease. This client has family in the community, but is no longer able to recognize them.

He is able to move around in wheelchair and has few other physical health problems. He has a poor appetite, is unable to chew and has difficulty swallowing. All food must be pureed and he needs physical assistance to swallow. He is incontinent of bowel and bladder and is afraid of bathing. He is often agitated and can be verbally abusive. He has difficulty sleeping and often gets up in the night and wanders around, trying to get out of the house.

6.4. Albert. Minimum level of care BFH. GIR5.

Male, 76, with high blood pressure and coronary artery disease, past history of mild strokes. He has never been married, and has only a few friends that visit infrequently. He has some right side paralysis that inhibits his ability to perform his ADLs without supervision. He is able to eat on his own, but cannot prepare meals. He is still able to handle his own financial affairs and makes his own medical appointments. His primary needs from the assisted living home are supervision and cueing.

6.5. EMMA. Palliative care. GIR1.

In Emma’s case, it is no longer considered important that she be stimulated to contribute to movement and become active. In some cases, such as residents/patients in the terminal stages of cancer or Alzheimer’s dementia, this active contribution may even have to be avoided or may be undesirable.

7. Social stimulation and Care plan approaches specific for each of the profiles.

7.1. Direct Individual, Direct Grouped and Indirect operations.

We distinguish 3 main types of operations:

7.1.1. Direct Individual operations

Operations that imply the ONE-to-ONE communication of resident and carer. (Like accompanied shower, or feeding)

7.1.2. Direct Grouped

Operations that imply the direct communication of ONE carer with several residents. (Like reading books, or singing songs)

7.1.3. Indirect

Operations that don’t require the participation of resident. (Like cleaning, laundry or cooking).

7.2. Defining  the timeframes and types of each of the subgroups of operations.

Based on our experience and on publically available results of recently performed chronometrage of the French market of home aged-care, we can define the necessary time for the performance of the Direct and Indirect operations of each sub-group.

Also we must divide all the operations into two groups: Guaranteed (basic package) and Additional.

Finally we can present the table of Direct care.

And we can mention that the total time of Indirect Operations in the Basic Package is 2:35:00 per 24H.

Based on performed calculations we can present the Social Stimulation and Care Plan approaches for each of the profiles:

7.3. Albert’s social stimulation and & Care plan approach

This resident/patient is able to perform daily activities independently without assistance from another person.

The resident/patient may require social aids or appliances. Generally, there is no risk of physically overloading the caregiver. Albert requires careful monitoring.

7.4. Barbara’s Social Stimulation & Care Plan approach.

Barbara is partly capable of performing daily activities independently and the assistance she requires is not generally physically demanding for the caregiver.

Assistance will consist of verbal social support, feedback or indications, but light physical assistance may also be necessary. This assistance will be provided in combination with minor aids (walking aids, support or grips and handles) in adapted resident environment. Barbara’s remaining capacities will be stimulated.

7.5. Carl’s Social stimulation and & Care plan approach

Carl is incapable of performing daily activities without assistance, but is able to contribute to the action or perform part of the action independently when he is not agitated.

The transportation  equipment should be used to prevent the caregiver from being exposed to unsafe load levels and wandering warning signalisation used to prevent the unauthorised leaving of the living place.

However, these residents are able to actively contribute to their movement and it is important that they maintain or improve this capacity as far as possible. The assistance provided for Carl might include transfers using a standing and raising aid. It is important to stimulate Carl's remaining capacity and slow down the deterioration of the cognitive abilities.

7.6. Doris’ Social stimulation & Care plan approach

Doris is bed and wheelchair bound, maximum assistance required with all ADLs, including Hoyer lift for transferring from bed to wheelchair and bath.

Doris is incapable of performing daily activities independently or actively contributing in any substantial or reliable way.

Doris is unable to substantially contribute to movement. Equipment should be used to eliminate this risk of physically overloading the caregiver.

However, wherever and whenever possible, it is important to activate and stimulate her own abilities. The assistance provided for Doris might include transfers with a Hoyer lift. One extra point to remember is prevention, when it comes to the problems associated with immobility, e.g. provide good skincare.

It is important to slow down the deterioration of her mobility.

7.7. Emma’s Care plan approach.

This resident/patient is incapable of performing daily activities independently or actively contributing to them

8. Equipment

To assure a safe way of living of residents and the efficient work of carers the different equipment is to be used in BFH.

8.1. Security & Medication

8.1.1. Bed and chair leaving detectors (pads and motion detectors)

According to our Family- style concept the security control should be unobtrusive and the proposed help also. So we don’t install the panic buttons close to beds, but equip the beds and wheelchairs with detectors that will allow the caregiver to know if the resident has left the bed or wheelchair and to react in case the resident has not come back after initially defined period of time.

8.1.2. Wandering control.

This “Smart” system functions with door monitor and a resident wristband. When a resident wearing a wristband attempts to wander too close or through the doorway, the “Daughter” is warned through pager.

8.1.3. Fall detectors (cogvis)

Specialized fall- detectors don’t transfer the images, but analyses them. They warn the caregiver in case the person takes the horizontal position somewhere besides the bed.

8.1.4. Panic Pull-cord systems

Panic Pull- cord systems are installed in bathrooms and toilets- where the resident while alone can have other problems besides falls that need the intervention of a carer.

8.1.5. Connecting to the external care center

For any case we assume the reserve system of transmission of alerting signal to the central reaction point of our contracted partner- such as “White Cross”.

8.1.6. Medication

The medication is assured by use of automated distributing machines. These machines are charged and programmed by the subcontracted pharmacy.

8.2. Care

The ADL care is definitely the most time and energy consuming group of operations. We use a variety of equipment, as necessary, for all the profiles of residents.

8.2.1. Assessment - software

The profiling is performed with help of special software, which makes the process fast and assures the storage of information and the distant control of the procedure.

8.2.2. Medical Beds & Bedside tables

For resident of profiles Doris and Carl we will supply the medical beds and bedside tables.

8.2.3. Movable shower chairs

Shower chairs help carers to perform accompanied showers for dependent residents. In BFH the shower room is specially adapted to be used with help of movable shower chairs

8.2.4. Hoyer lifts

This devices assures that it takes only one carer to lift the resident from the bed and into a wheelchair or washing chair.

8.3. Social Stimulation

8.3.1. Uniforms

We put really serious attention into maintaining the family spirit in BFH. One of the important tools for fast integration of the representatives of subcontracted companies, who help our carers is the family- style uniform. This uniform is specially designed by one of the world’s 100 best clothing designers, Madame Lumelsky, for our project.

8.4. Housing & Feeding

8.4.1. Clean Stations

The specialised station for preparation of the cleaning solutions insures the quality and the reasonable cost of professional cleaning.

8.4.2. Trash racks

Movable trash containers help significantly in assuring cleanliness.

8.4.3. Cleaning Carts

As a part of the indirect operations group, the daughter  will perform everyday cleaning with help of mini, family- size cleaning trolley

8.4.4. Another equipment

Definitely the additional services will need additional equipment which will be supplied as necessary.

All the equipment will belong to the operator.

9. GR.

The relations with states and municipalities have two connotations. First of all we should satisfy the applied requirements, second- we should get some reimbursement

9.1. Requirements from state.

According to the criteria used currently in Baltic states (in Latvia for instance) for issuing a social-care license (and being included on the register of suppliers of social services), what is essential for the TVA non-taxation of supplied services, the average surface for one person should not be less than 6 sq meters per one resident. We meet these criteria. Other requirements were also analyzed and taken into account.

9.2. Financing for revenue from municipalities

In Riga, Vilnius and Tallinn the reimbursement for the residents whose level of dependency exceeds approximately GIR3 varies from 100 to 500 euros.

The municipalities plan to increase it.

In our interviewing of future customers we’ve based our question on the 250€ basis.

10. Operation/ Legal structure

The Big Family House project is organised in form of Proprietor/Operator structure. The Operator is responsible for the filling, management of the BFH and for paying of the rent to the proprietor.

In our case the rent is paid already free from

• Utilities
• Real Estate related taxes
• Small annual maintenance

The proprietor is responsible for major renovation and for insurance. This ‘double net’ rent structure differentiates us from traditional for New Europe RE lease market. There the Real Estate taxes are usually paid by owner.

The private or legal person can act as a proprietor. Operator should be a legal person, who has the social care license of the country of operations. In Latvia, for instance, it should be listed in the register of suppliers of social services.

To be continued.

DISCLAIMERS:

• For our profiles gallery we've used the publicly available images of Arjo.
• All the mathematics can be found here: https://docs.google.com/spreadsheets/d/1tDpWwQ00Kf9GKrIU-VDJokg0Yxu0A1DQVKB6Uwz7hDo/edit?usp=sharing
• Etude des prestations d’aide et d’accompagnement à domicile et des facteurs explicatifs de leurs co?ts ici: https://drive.google.com/file/d/0B85Ck0P2tyqQY1loQkQ2TGZzRjA/view?usp=sharing