Grace’s House

Erin Buell

Concordia University

Issues in Human Service Administration

HS 550

Angela Kollbaum

October 20, 2013

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Grace’s House

Week 8

BACKGROUND:

Grace’s House is my hypothetical organization that is inspired by my mother’s real life

journey with Alzheimer’s and the effects that this disease had on my family.

The Administration on Aging reports that the population of people over the age of 65 was

nearly 4O million in 2009, which was about 12% of the population. This number is expected to

reach 19%, or over 70 million by 2030 (“Aging Statistics,” 2013).

While many issues deserve attention for our elderly population, I see a particular lack of

understanding, resources, community education and care for those who have, or care for

someone who has, Alzheimer’s or dementia (A/D). An estimated 5 million people suffer from

Alzheimer’s and it is the sixth leading cause of death in the U.S (“Alzheimer’s facts and figures,”

2013). However, it takes an autopsy to conclusively diagnose Alzheimer’s, so this number is

likely to under represent fact.

In an interview with Carolyn Nystrom, director of our local hospice and palliative care

organization, I learned that 19% of the carepatients of their program have dementia, up from 4%

in 2010. They currently have about 150 patients in hospice and palliative care in our county,

which translates to nearly 30 A/D patients that they see. In our small community, this is

significant. Furthermore, Carolyn’s opinion is that it is likely that the number of A/D patients

that live within our county is actually twice that number. When asked what the primary un-met

need is of A/D patients, families and caregivers, Carolyn said that affordable caretaking is a large

gap for families.

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Grace’s House will provide free day care service for A/D patients and will offer support

and education to families.

THE ENVIRONMENT:

Our clients and stakeholders will be A/D day care attendees, as well as families,

caregivers, community members and regional partners.

Grace’s House will have a modern element. We will look at music, entertainment,

activities, décor, lifestyles, etc. that are relevant, current and meaningful to our clients. We will

have a social environment that is respectful, modern, clean, caring and personal without

condescension.

Our economic environment is largely dependent on grants, contracts and fundraising. An

endowment has helped us in our start-up costs. Medicare, Medicaid and private insurance

options were explored, but the family financial implications are, in our view, negatively affected

when there is a fee for this type of service. Swiftsure Ranch, a local non-profit that provides

equine therapy for disabled children and adults has been our model for a no-fee program

(Swiftsureranch.org). Our organization will offer respite for the caregiver and a safe environment

for the A/D client. Our criteria for admission to the day care is that the client has dementia, has

adequate self-care or outside assistance beyond our day care hours of operation, and does not

have current acute medical needs. In addition, either the A/D client or the primary caregiver

needs to be a resident of Blaine County.

Our technological environment will, in part, be focusing on the development of a

compelling website for promotion and support. Furthermore, a significant effort will be made to

develop tracking and logging methods for our evaluative tools.

PLANNING

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Mission: “To provide compassionate care for people in our region who have

Alzheimer’s or dementia; to provide education, support and respite for their families and

caregivers, and to advocate for research funding and understanding of memory loss

disabilities.”

Initial planning included expanding my knowledge and understanding of the current and

projected needs in our community for A/D patients and their caregivers, as well as existing

resources. Furthermore, there has been a big learning curve to understand the local, state, and

Federal mandates for an adult day care setting. Health codes, building codes, accreditations,

policy, licensure and insurance, and staffing regulations will be necessary, yet costly and time

extensive. I am building a strong board of directors that includes expertise in, and connections to,

non-profit organizational skills, policy and law, grant writing and funding, physical and mental

health care, elderly care and financial planning.

One of our biggest planning considerations was the venue. We have arranged to remodel

an existing portion of the senior center, which strengthens our partnership with that agency, cuts

our budget for some of the utility and insurance costs, and expands on the community’s

recognition of existing services.

Further operational goals are:

1) To provide current and relevant education and support to families and caregivers of A/D

patients.

2) To provide frequent and relevant staff training to align the care of our guests and their

caregivers with dignity, humor, grace, and knowledge.

3) To provide safe, caring and affordable care for A/D client and to foster respite for

caregivers.

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A community needs assessment was produced through St. Luke’s Wood River Medical Center

that has helped us identify needs of our target population.

ORGANIZATIONAL DESIGN:

The design of Grace’s House has a strong foundation with the board of directors bringing

expertise of agency management, financial planning, quality control and policy. The executive

director, or ED, will directly oversee the staff and operations, be a conduit between the board and

the staff, and be responsible for hiring and overseeing daily operations. The organizational

design will primarily follow the theory of universal management principles, but will hold

elements of bureaucracy theory as well. There will be a balance of leadership providing guidance

and quality control, with staff participation, communication, creativity and energy.

The ED will be responsible for planning, organizing commanding, coordinating and

controlling, as per the universal management principles described in Management of Human

Service Programs (Lewis, Packard and Lewis, 2012, p. 82). The ED will be in a position of

leadership for the staff to look toward for guidance, while at the same time following the

mandates and expertise of the board. This model will also encourage face to face interactions

between all staff members as an effort to bring in creativity and accountability in the care of, and

partnerships with, our stakeholders. Weekly staff meetings, appropriate training, continuing

education, inter-staff collaborations in activity planning, and community outreach are essential to

the organization. Lewis, et al., describe the gangplank as an image of every individual in the

agency being encouraged to communicate directly with any other staff (p. 82); this will work

well in our agency.

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Bureaucracy will also be an important organizational structure. This will help us follow

local, state and federal guidelines, and manage the areas that require standardization of practice

(Lewis, Packard and Lewis, 2012; p. 82, 83).

Staff job descriptions include:

Day Care Coordinator: Attending and coordinating care for the day care clients through

direct service (ie., personal care and interaction, coordination of food service, activities,

and transportation), and indirect support (ie., medical/clinical support), and maintaining

daily client logs and updates.

Care Giver/Family Support Coordinator: Responsible for education and outreach for

caregivers and community. Works closely with Day Care Coordinator.

Volunteer Coordinator: Responsible for recruitment, training, oversight and support for

our volunteer corps.

Facilities Coordinator: Responsible for housekeeping and building maintenance.

Activities Planning: This is now absorbed into the Coordinators’ roles, and is further

supported by the volunteers. Activities planning and reporting is part of our weekly staff

meeting. In the first year of operation, we are not hiring additional supportive staff, but

have a place holder in the organizational chart for future planning.

Finance Coordinator: Manage and coordinate budgets, accounts, payroll, and income.

Will meet with staff at least once per quarter.

As our client needs will vary and at times be quite complex, we will have 10 minute staff check-

ins each morning to preview the daily schedule, client specifics and staff needs. Our facility is

small, so staff will be expected to be able to assist in areas outside of their own department.

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JOBS AND SUPERVISION:

In this small organization it is crucial that I hire exceptional staff. In addition to clearly defined

job descriptions, I need to put a staff together that can collectively fit together to meet the needs

and the mission of the organization. The positions of coordinators, administration, marketing and

public relations, finance and the coordinators will be quite prominent. I am hoping that the

expertise of the board will cover the legal, policy and financial pieces, but there is budgeting

allotted for contractual help in these matters.

As an example, the person hired for the position of day care coordinator (DCC) will

benefit from having experience in being a team leader. I will be looking for someone that is

compassionate, smart, willing to take direction and able to lead others. As the overseer of the

clients who are affected by dementia, it will be beneficial for this person to have some

experience working with, or caring for, A/D or elderly people. However, it is more important

that these person is willing to learn and to be able to provide relevant, vibrant and respectful care

of the client who has very limited ability to stand up for his or her own dignity. In addition, the

DCC will need to interface with the clients’ caregivers and, at times, medical professionals. The

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DCC will be able to maintain compliance of client/staff ratio as per the state of Idaho

(“Regulatory Review of adult day care,” 20006, section 2-Idaho) by giving appropriate directives

to supporting staff as necessary. A Bachelor’s degree plus some relevant experience will be

required. Furthermore, this candidate must be able to lift 50 pounds, have basic computer

literacy, a professional and personable demeanor, a willingness to do all tasks involved in the

day care setting including, but not limited to, feeding, incontinence care, and managing

behavioral issues. This person must be willing and able to participate in reasonable and

appropriate continuing education opportunities, be able to work the designated schedule of hours

and days in relation to the agency’s hours of operation, within reason, and attend meetings and

educational elements.

In the interview process, I would plan careful questioning for all positions. I want a team

that can see the bigger picture around any task and that is cooperative, compassionate, honest

and hard-working. Questions would include:

Working with our clientele presents many challenging moments and many rewards.

What would be challenging for you? What would be rewarding? Why?

I can see from your resume that you have experience in relevant positions. What can you

tell me about yourself that is not about your work history that will make you a good

choice for this position?

One of the most important pieces to our mission here is to provide compassionate care.

What does that mean to you?

What experience do you have working in a situation where confidentiality is required?

How do you think confidentiality might factor into this position?

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Supervisory situations will occur for the day care coordinator and the caregiver/family support

coordinator. Daily logging is essential to track attendance, behavior, food intake and other

behaviors. I will rely on these two staff to adequately record these details, and to guide support

staff and volunteers to do the same; Furthermore, incidents that are complicated or present safety

or health issues will need to be reported to the ED or appropriate external professionals.

The ED will take a hands-on approach to the agency, showing willingness to do whatever

tasks are necessary; however guidance rather than micromanagement is important to allow each

staff confidence to perform well in his/her role.

BUDGET:

Below is a summary of the line-item budget. The budget was based on known costs, such

as rent, and estimations based on advice, research, and similar existing programs. Similarly,

income and resources were based on grants already awarded as well as estimations of income

goals from fundraising. I based my fundraising goal on Swiftsure Ranch, who sets a goal of 2/3

of income from fundraising efforts (swiftsureranch.org).

The Grace Richey Alzheimer’s and Memory Advocacy Fund (GRAMA) is a significant

annual endowment that will begin payment at the onset and will enable operating expenses to be

covered from the start, such as employee wages and benefits.

Several key in-kind services and donations came forward. An accounting and finance

agency helped us establish our non-profit tax status, accounting programs, and grant reporting. A

contractor and builders and supply stores contributed to our remodel addition to the senior

center.

Funding sources will have a significant relationship to the information systems that are

established. Statistical tracking will document the information that is required to sustain the

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various grant and contracts. For example, St. Luke’s Wood River Foundation is asking for total

client hours, which is a relatively easy, quantitative measure. However, the Foundation is also

asking for quarterly comparison reports that analyze the success of meeting needs based on a

prior needs assessment. They are looking for measurable increases in family support of A/D

patients, delayed admissions to in-patient care facilities, and decreased absenteeism in the work

force of family members within our community.

A thorough intake process will delineate the needs of the family and previous caregiving

practices used with the prospective A/D client. The intake will include item such as, date of A/D

daycare attendance; hours attended; care giver definition (ie., spouse, adult child, friend,

community service, etc.); home circumstances (ie., lives alone or with someone); current self-

sufficiency measures (ie., activities of daily living, mobility, verbal skills, dietary needs/habits);

emotional/behavioral concerns; safety concerns (ie., wandering, balance, abusive behavior); and

transportation needs.

In addition, the caregiver will complete intake information that includes primary reason

for seeking day care assistance (ie.,stress relief, A/D socialization, respite, incontinence issues,

safety concerns, caregiver employment needs); extenuating needs for A/D client (ie., mobility

needs, nutritional, clothing, medical or other bills); extenuating needs for caregiver (ie., financial,

emotional, education, mental or physical health, employment); current self-measure of stress,

health, and concern for A/D client.

A significant difference in measuring outcomes within Grace’s House in comparison to

other service organizations, is that the A/D clients will not actually get better. We will, however,

have incident reports that measure our A.D clients’ safety, behavior, activity participation,

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emotional identifiers, and mobility. We will offer transition support if it becomes necessary for

the A/D client to move to a facility with higher level of care.

Grace’s House will implement activities and educational opportunities for caregivers.

Throughputs will be documented to track the number of attendees and specific information of

each.

Budget Summary:

COSTS START-UP COSTS MONTHLY ANNUAL

Wages and salaries

15,520 197,760

Benefits, taxes insurance

750 10,850

Building, utilities 17,000 2,160 23,960

Supplies, equipment, furnishings

25,100 2,375 1,150

Operational 10,650 400 35,800

Misc. Contractual

7,500 400 4,800

TOTAL EXPENSES

60250 21,2025 274,320

START-UP COSTS MONTHLY ANNUALRESOURCES AND INCOMEEndowment 60,000

Grants, Corporate donations and Contracts (11 total)

42,500 1,600 34,200(6 to renew annually, 1 as 5 yr; 3 as 2 yr, 1 projection)

Fundraising 5,000 177,000

In-Kind Donations 12,750 280 3,360

TOTAL RESOURCES

60,250 1,880 274,560

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EVALUATION:

Qualitative methods of evaluation will be drawn from questionnaires, intake information, daily

logs, focus groups and surveys that we implement throughout the year. We will also review

information that is available to us through community partnerships, such as Hospice and

Palliative Care of the Wood River Valley (HPCWRV), the home care department and the

community needs assessment from St. Luke’s, Region 5 Idaho Commission on Aging, and the

local senior center. Sufficient documentation of our observations, daily logs, intake and

transition forms will help us create a summative report of our agency and assess our strengths

and weaknesses that will guide us forward and encourage continued funding.

For at least the first year, we will commit to review all of our assessment tools on a

monthly basis. Observation and recording are essential in collecting data from our A/D clients as

they often are not able to relate thoughts and experiences cognitively or verbally. While this

information is useful to steer our programs and services to meet our direct client needs, there will

be gaps in the representation of a more global perspective of our aging population, specifically

our target clientele. Quantitative methods will help us gather data, statistics, attitudes and

behaviors from a broader range of population with dementia and family support issues.

Our goal will be to serve 10,000 A/D client hours for our first year and 1000 units (15

minutes each) of caregiver/family support. Marketing, public relations, community outreach, and

word of mouth are going to be important to reach this goal. Diligent and accurate tracking of our

client contacts will be essential in measuring our success rate.

Our method of tracking is an overlapping system of quantitative and qualitative methods

that include a coding process so that we can pull out data specific to a grant, a client, or any goal

or objective. Each of the staff with direct client contact will have a logging chart established.

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The chart delineates daily client behaviors, temperament, activities, level of mobility, safety

concerns, etc. Staff will also include sshort written statements to qualify the line item points.

The line items of the chart will vary with the duties of various staff. For example, the

administrative staff will log in the date, arrival and departure times, method of transportation and

caregiver assistance, if any, whereas the day care coordinator will log occurrences throughout the

day. These charts are viewed at Tuesday morning staff meetings, and the administrative staff will

then compile the information into a master chart in a shared drive in our computer system. In

addition, each A/D client has a file with a compilation of information from the intake forms,

family or caregiver information and participation, and daily logs.

One of our objectives is to “provide frequent and relevant staff training to align the care

of our guests and their families/caregivers with dignity, humor, grace and knowledge.” We have

a very small budget at this point for education, but in a partnership with HPCWRV, we will

provide 16 hours of administrative support for their organization each month and they will

provide 5 staff training seminars annually for us. Our day care coordinator, caregiver family

support staff and our volunteer coordinator will have trainings on elder care, and our nutrition

services staff will obtain training in a job shadow arrangement with an assisted living facility.

Our administrative assistant will receive intensive training at the onset. Weekly staff meetings

and quarterly ED-hosted staff activities and retreats will be scheduled. I will provide

opportunities in these meetings and on other occasions for the staff to brainstorm ideas, offer

suggestions for our programs and services, and have an opportunity to debrief experiences.

While we are looking for ways to streamline, improve efficiency and increase meaning to

our documentation, evaluative processes, programs, services and direct client care, I hope that

we have developed a well-rounded start to Grace’s House.

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References:

Aging statistics, (2013). Retrieved from http://www.aoa.gov/Aging.Statistics/

Alzheimer’s facts and figures, 2013. Retrieved, from

http://alz.org/alzheimers_disease_facts_and_figures.asp#quickFacts

Lewis, J. A., Packard, T. R., & Lewis, M. D. (2012). Management of human service programs

(5th ed.). Belmont, CA: Brooks/Cole.

Regulatory review of adult day care services: final report. section 2. state regulatory profiles,

(2006). Retrieved, from http://aspe.hhs.gov/daltcp/reports/adultday2htm#ID

Swiftsure ranch therapeutic equestrian center, www.swiftsurerance.org