Wednesday, March 9, 2011

Staffing and Profits for Assisted Living Communities

To be profitable, you simply need to keep your revenue greater than your expenses. In Assisted Living, income can be divided into three groups; property related, food costs, and staff costs - providing assisted living services. I will focus on staff, the largest of the three groups.

To relate resident fees to services, we need to use the common denominator of time. Regardless of the service (ADL Assist, bath, escort, etc.), it involves staff time. And resident's needs or preferences may require more or less staff time. For example, one resident may "want" (not need) a staff person to remain with them during a bath for reassurance, while another resident may only want assistance while stepping into the bath. The former situation may require 45 minutes of staff time, while the latter only require 15 minutes.

In addition to direct staff time for a service, we also need to add in administrative overhead, defined as costs related to payroll, staff hiring/training, supervision plus a little profit. By adding in these related costs, each staff person becomes a profit center.

Next we need to add in a cost for Shift Productivity. This is the difference between the total shift hours (8 hours) and the direct service hours (6 hours of direct care to residents) or 6/8 = 75% shift productivity. In this scenario, we need to add 2 hours to the cost of our staff person to get an accurate cost.

So if we pay our direct care staff $10 per hour, plus 35% administrative overhead plus shift productivity of 75% (leaving 25% to add into costs) we get a total cost of 10 + 3.50 + 2.50 = $16.00 / 4 = $4.00 per 15 minutes of direct care.

Now we need to assess each resident for the amount of time they need or want for a service and either sell them the service directly (Ala Carte), or combine a number of services into a package of care. For example, you might have a Basic Assisted Living Package of 3 hours per week; Package A provides 6 hours per week; and other packages depending on service time. Note how this model is both transparent and easily documented. We're not assessing "needs", which can be difficult to explain as it involves professional judgement, rather both resident/family and staff can agree to minutes of care. When a resident is documented as using additional hours of care a care conference is scheduled to explain the need to move to the appropriate level of care.

Managing staff is also simplified. The staff scheduler is given the "Shift Productivity" level and told to schedule accordingly. By monitoring the shift schedule, we ensure profits. In addition, if staff want more hours, they need to "create a customer" or sell their services, and if they provide more care than they document or report (service creep) they will find themselves overworked. If they complain about how hard they work, you show them the total direct care minutes for their shift assignments and ask them where the discrepancy is (who is getting more time than documented).

I think you will see staff morale improve under this system, as they are all working with the same shift-productivity ratio, another words, each shift has approximately the same number of direct care minutes. If someone want to work more hours, increase their shift from 4 to 6 hour for example, they only need to demonstrate the need (or create a customer for their time).

The entire process above can be supervised by management by reviewing the shift productivity schedule when the staff work schedule is released and ensuring that the actual daily schedule reflects the posted staff schedule.

Of course, PALs give you all the tools you need to setup the above. We have a service pricing tool which calculates the staff's hourly wages + Adm Overhead + Shift Productivity = Total Staff Cost per hour. PALs also has a resident assessment form to calculate resident costs (either ala carte or packages). PALs will create a weekly staff work schedule; daily shift assignment sheets; and monthly documentation sheets to record variations to the minutes of care. Finally, PALs will create a monthly invoice for resident care that is supported by a paper trail from Service Agreement to Service Documentation.

PALs can also be setup to record staff time and service documentation electronically. This way, a report is easily generated noting the variation in service minutes for each resident.

For a free trial of this "System of Care" go to our website, and download a free trial of PALs Executive.

Tuesday, March 1, 2011

DOH 4397 ALR Personal Data and Resident Evaluation - NY

It's done! We've added form 4397 for New York users to our assessment library.

This form, needed to look-like the form provided by the Department of Health. All eight pages were included, in two parts. Hence, Sections 1-2 and Sections 3-7 can be completed and printed separately.

To view this form, go to our website at and download the free trial of PALs Executive. When you call for an Activation Code, simply request that the New York assessment be emailed to you. Enjoy ~