Originally posted 6/10/19. Updated 2/16/20.
One of the more common questions I’ve been asked, both when I was with licensing, and now as an independent consultant is, “How do I find residents?” My advice has always been to start thinking about your strategy to market your adult foster home from the very start of the process, and use a multi-pronged approach to getting your business noticed.
To better assist my clients now, I continuing to seek out beneficial resources and partnerships that will allow them to most effectively get the word out about their vacancies to the right people. That is key. To the right people. You want to go where people are looking for the care you provide. Don’t simply cast the marketing net wide, but instead be deliberate and strategic in your approach.
There are a several avenues for finding potential residents, both private pay and Medicaid consumers. The list below is not comprehensive, but is a start. The options listed below provide similar services, yet are targeted to different audiences. Just like your stock options, you want to diversify. I’d like to tell you a bit more about each option.
Placement agencies: These agencies receive a fee from the adult foster home provider for successful placement. Generally the fee is between 75 – 100% of the resident’s payment for the first month. Their target market is individuals and families looking for placement in a long-term care facility, including adult foster homes. A good resource to connect with a referral agent is the Oregon Senior Referral Agency Association(OSRAA), which also has a page to post your vacancies.
Posting Websites: The target market for vacancy websites is individuals and families looking for placement in an adult foster home. Laria Care Finder is a local business that allows you to post detailed information about your home, about yourself as a provider, and about your vacancies. You can also add your business to the Alzheimer’s Association Community Resource Finder.
Discharge planners, care managers, and social workers: Get to know discharge planners, care managers, and social workers at your local hospitals and skilled nursing facilities. Contact the facilities to introduce yourself and let them know what level of care your provide.
State diversion/transition program: The State has a program specifically to move Medicaid consumers from nursing facilities to community-based facilities, such as adult foster homes. You can locate the local diversion/transition (D/T) programs by contacting your local licensing authority (LLA), also know as your local licensing office.
As you can see, there is no single avenue to find residents. What it takes is a solid, strategic plan, and being both proactive and persistent. Put yourself out there and develop professional relationships with others so they both know and trust you, and the care you provide.
Most hospitals and skilled nursing facilities adopted electronic medical records years ago. Now, larger community-based facilities, such as assisted living and residential care, are slowly adopting electronic health records; however, the adult care home industry has yet to jump on the electronic records bandwagon.
This lag in adoption is likely due to several factors. Adopting electronic records can be more challenging for adult care home providers without electronic record experience who may initially believe they lack the money, staffing, and infrastructure to implement this change. Fortunately, these potential barriers are not insurmountable.
As larger facilities migrate to electronic record-keeping, it is simply a matter of time before more and more providers in Oregon start implementing electronic record-keeping systems in their adult care homes.
One trailblazer in the area of electronic record use in adult care homes is Shannon Carskadon. Shannon owns and operates Silver Cloud Adult Family Homes in Forest Grove and has been in the business for 25 years. I recently had the opportunity to sit down with Shannon to talk about her experience transitioning to an electronic records system earlier this year.
The system Shannon uses is supported through Beaverton-based company Care Facility Management Systems, LLC, which works with individual adult care home providers to “cost-effectively transition their business operations from paper to electronic records.” Owners Gueipin Xi and Elaine Hartman bring over twenty years of experience providing technical support and security to health care clients.
Interview with provider Shannon Carskadon(Interview has been edited for brevity and clarity)
Have you used electronic records for your homes before?
I used Excel files, which I printed out for licensing, but I had no system set up.
What made you decide to transition to electronic records?
There were current issues [with the hard copy records]. At licensing inspections, the books would be torn apart and nothing got put back correctly. There was too much repetition and similar mistakes. There was a huge potential for medication errors.
Elaine [with Care Facility Management Systems, LLC] called me and asked if I’d be interested in helping build this program for use in other adult foster homes. The company takes care of online security with a private network, and provides training and support to use the system. I was all for it.
Tell me about the process of transitioning your paper records to the electronic records? How long did it take?
Gueipin and Elaine provided me with the hardware and software, set up, and training. They also provide the system security, and ongoing technical support for the electronic records system. The support is amazing. Often, providers are isolated. For me, it feels like a professional system with support and cohesion.
The support is amazing.
-on working with Care Facility Management Systems, LLC
At first, it was about 10-15 hours of work at the first of the month. I first started with medications only [eMAR], and it took as long as it takes to enter medication orders. The eMAR is a no fail system. For example, with a PRN, caregivers have to write the result in the record, or they cannot close the entry. Also, I can easily track narcotics using the system.
There was a learning curve, but my caregivers picked it up quickly. We worked on it piece-by-piece until they were comfortable with each section.
Elaine then came to my home with a large scanner. I scanned all resident records into the system and they’re saved in a secure folder. All the [paper] records I have left are in two binders.
What are some other benefits of the system?
I can send and receive [electronic] faxes to the doctor, and I can have legal representatives electronically sign documents.
We also use the system to document resident activities and facility records, such as smoke detector testing. I can add reminders and tasks for staff. Caregivers log in with an individual login and see the reminders and tasks. I can run reports and look at tasks that were done. I can also see when caregivers read an email I sent.
My data is secure and consistently updated, and I can access the information securely and remotely. If we have a fire or earthquake, I can get into the system remotely and I don’t have to worry about losing records.
Tell me about your renewal inspection after you started using an electronic records system.
It saved a lot of time. The inspection at my first home was in January (2019), and the renewal inspection of my second home was in March. I learned from the first inspection, and had everything ready to go for my second inspection. The licensor was in-and-out in two hours and got everything [the licensor] needed. I had no medication violations.
The licensor was in-and-out in two hours….I had no medication violations.
What advice do you have for other providers who are considering the transition to electronic records, but are concerned about either cost, the challenge of transitioning, licensing, or other issues?
Take the time to learn the program. It’s especially beneficial for multiple homes. I can run compliance reports, and I can check on caregivers remotely and run audits to see who logged in, when, and what actions they took. The program is customized so it meets licensing requirements. If you do your due diligence, the system helps you be compliant.
Finally, the cost is worth it. It’s less than ink and paper, and that doesn’t include the time saved. We’ve been thrilled with this. I can’t say enough positive about it.
Today, March 8th, is International Women’s Day. March is Women’s History Month. Every day should be a day to celebrate the lives, strengths, and accomplishments of women.
It’s no secret that women make up the majority of caregivers for both seniors and children. It has been researched and written about for years. In families, of course, the care burden is primarily placed on the shoulders of female spouses and daughters. According to the Alzheimer’s Association, “Approximately two-thirds of caregivers are women…and one-third of dementia caregivers are daughters.”
If we look at the numbers for adult care homes, we can see there isn’t a significant difference between family and professional caregivers, in this regard. There are almost 1,600 adult care homes in Oregon, and based on a quick sampling of the State’s provider list, it is plain to see the majority are owned by women.
I think we’re starting to see a slow paradigm shift where there is less expectation that caregiving is “women’s work,” and where more men are proudly taking on caregiving roles. Anecdotally, I’ve seen a significant increase in the number of men opening adult care homes over the past few years and being the primary caregivers, or working along side their female partners. This is a good thing.
The adult care home business provides women with the opportunity to be their own bosses yet also care for children or aging parents while working at home and making a solid income. What other business truly provides this opportunity for women?
Even with this slow shift taking place, the majority of caregivers are still women. According to a 2018 Portland State University report on adult foster homes in Oregon, 88% of providers live in the adult care home, and a third had children under 17 living at home. From this, we can conclude that many women are both providing care for residents and their children. This is both a benefit and a challenge. It really is more of a benefit, though, if we consider these women would be caring for children, or having to find care for children, regardless of where they worked.
In this regard, one significant benefit of owning an adult care home is that parents can stay home with their children while working. The adult care home business provides women with the opportunity to be their own bosses yet also care for children or aging parents while working at home and making a solid income. What other business truly provides this opportunity for women?
So, on this International Women’s Day, let’s take the opportunity to recognize and appreciate the work of women around the world, and also here at home. Let’s continue to recognize the important work of adult care home providers and support those providers who are making an important contribution to both the older generations, and the next.
I've spent the majority of my career providing program service delivery, regulatory leadership, training development, and program coordination and management in government and not-for-profit organizations. I am now an independent consultant and training specialist who helps current and future adult care home providers in Oregon successfully navigate the licensing process and provide quality care to seniors.