LeadingAge Magazine · September/October 2013 • Volume 03 • Number 05

Small Providers With Big Ideas

August 30, 2013 | by Dianne Molvig

“Expanding the Possibilities” isn’t just for large organizations with a lot of resources. Here’s a look at three smaller providers who are thinking big to overcome obstacles to serving seniors.

Opportunities and challenges represent flipsides of the same coin. It’s a fact of life that small aging-services organizations know well.

On the one hand, their smaller size allows them to be more flexible and to respond more quickly to the needs of their residents and communities. On the other, compared to larger organizations, they may have to make do with fewer resources.

Still, many small providers seem to have an enormous supply of what matters most: heart, creativity and innovative ideas.

Until two years ago, Dan Shuman had set foot in Kansas only once. “That was by accident,” he says. Years before, his family was on a road trip from Texas to Oklahoma and took a wrong turn that landed them in Kansas.

In 2011, Shuman left behind a thriving practice in Austin, TX, and headed for southwest Kansas to practice medicine at the Ashland Health Center (AHC) in Ashland, population 800, located 160 miles west of Wichita.

What drew him to Ashland was the health center’s mission-focused culture. “That’s what attracted me here,” he says, “and what’s keeping me here.”

The mission-focused culture is the brainchild of AHC’s former CEO, Benjamin Anderson. When Anderson arrived in 2009, AHC faced problems common to remote rural hospitals across the country. Having had no administrator for the previous six months and no doctor for eight months, it faced the dismal prospect of having to close its doors. If it did, all of AHC’s services—the hospital, clinic, nursing home, home health care and senior independent living—would vanish.

Anderson’s research into solutions led to an idea: to recruit health professionals who had done mission work. What makes such people tick is a strong desire to be of service to people in need. They’d want to work in a remote community where the needs were great.

The mission-focused culture fits the bill for Shuman. Before coming to AHC, he’d done mission work in Haiti, Mexico and South America. And he can continue to do so. A key component of the AHC culture is that staff members get up to eight weeks off per year to do mission work anywhere they choose. That provision was key in attracting Shuman.

“But it’s not just a recruitment model,” he emphasizes. “It’s how we do things here. It’s about cultural change. The idea is that work has significance and meaning. Our goals are larger than ourselves.”

The community and region have reaped additional benefits from having a thriving health center in their midst. AHC provides telemedicine services for wound care patients, mostly elderly, who have chronic conditions such as diabetes. That saves them long trips to Wichita. In some cases, diabetics unwilling to travel long distances could neglect their wounds and eventually undergo amputations.

AHC is also one of the 170 hospitals belonging to the Children’s Miracle Network. And some years ago, Anderson started the WEPAC “Hoops for Hope” basketball games—involving high school, college and professional female players—to raise funds for women’s cancer screenings in the area.

Anderson recently left AHC to lead another rural Kansas hospital. As of August, new CEO Roger Barnhart—who has a background in both health care administration and long-term care administration—was in his third week on the job. The mission focus had a great deal to do with attracting him here from Kansas City. “I was immediately amazed to see the level of caring among staff,” he says. “This is not just what they do; it’s who they are.”

What do you do when you’re a senior housing organization that needs to expand to serve more people in your community, but your 17-acre site is hemmed in on all sides?

That was the quandary facing Spanish Cove Retirement Village, Yukon, OK, several years ago. “We were landlocked,” says CEO/executive administrator Don Blose. “We had no room to grow.”

The Spanish Cove board and former CEO/executive administrator Sherman Huff came up with a solution. As houses on a neighboring street went up for sale, Spanish Cove bought them, converted them into cottages and sold them to older adults looking for an independent living option that’s roomier than Spanish Cove’s apartments.

“Some people are ready to downsize,” Blose says, “but they may not want to downsize to a one- or two-bedroom apartment. They want a little more room.”

Spanish Cove purchased the first house in 2002, starting on one street. “We purchased homes as they became available through the normal market,” Blose says. “For us, it was a good strategy to start slow. That fit our budget well.”

Demand for cottages swelled and to meet the demand, Spanish Cove began buying houses on a second street as those became available on the market. To date, the organization has purchased 21 houses, of which 18 have been converted to cottages and then sold to seniors. Spanish Cove has managed to do all this without incurring debt for either home purchases or renovations.

The remaining unsold houses are available for rent to anyone in the community-at-large. Keeping some houses on a rental status also gives Spanish Cove breathing space as the village undergoes changes in coming years. As its 24 apartment buildings, built back in the 1970s, need updating, displaced apartment dwellers can occupy the rental houses. “We have a place to relocate people temporarily when we need to,” Blose explains.

The go-slow house-buying process has met just one hurdle over the years. As word got around that Spanish Cove was looking for houses to purchase, sellers boosted their asking prices. To solve that problem, the board set a cap on how much it will pay for a house. “That’s helped to settle things down immensely,” Blose says.

When Spanish Cove buys a house, it invests a set amount in the cottage conversion. Cottage buyers have the option of putting some of their own money into the renovation to change it up a bit, and most do, Blose says.

Cottage owners have access to all of Spanish Cove’s amenities on the main campus. Many take their meals there, and they can choose from a wide range of activities, from using the fitness center to joining in a book discussion. One of the more unusual options is the dragon boat paddling team, which races in the Oklahoma City Regatta and Oklahoma Boat Festival.

The newest amenity at Spanish Cove, targeted to open Nov. 1, is an onsite medical clinic operated by INTEGRIS, the largest health care system and hospital network in Oklahoma. The clinic will be available to residents, residents’ guests, staff and staff’s family members. Blose says, “This partnership opens up doors of opportunity for both Spanish Cove and INTEGRIS.”

Camden, NJ, population 77,000, is one of the poorest, most crime-ridden cities in the country. Sitting in the midst of this urban area is Fair Share Northgate II, a high-rise apartment building providing a home and safe haven in 402 affordable housing units, of which 308 are for elderly or disabled residents. Northgate II is part of Fair Share Housing Development, a not-for-profit founded by Peter J. O’Connor, a public interest attorney who has been counsel to the plaintiffs since 1971 in the landmark Mount Laurel litigation which requires that all 566 municipalities in New Jersey provide their “fair share” of the regional need for affordable housing.

A few years ago, the Camden Coalition of Healthcare Providers (CCHP) designated Northgate II as a “hot spot”—that is, a location where residents had frequent hospitalizations and emergency room visits. As a result, their health care costs were extremely high. CCHP and Northgate II formed a partnership to find solutions.

“The idea was to marry health care, social services and housing to come up with something that would lower health care costs, improve health outcomes for our residents and also allow them to age in place,” says Marilyn Mock, director of support services for Northgate II. Many of the building’s older residents have lived there for decades.

Working together, CCHP and Northgate II hope to create a service model that could be used with high-risk, high-needs elderly and other Medicaid users in other cities across the country. The partnership has created New Jersey’s first Medicaid Accountable Care Organization (ACO).

The first piece put in place in 2011 was an on-site medical clinic, operated by Reliance Medical Group, which makes it easier for Northgate II residents to access primary care. Beyond that, the goal is for the Northgate II social services department to become a “care coordination hub” for residents returning from hospitalizations.

Northgate II has added several other components in the past couple of years to improve residents’ well-being. A survey and a residents’ advisory board give residents input into what the offerings ought to be. “Overwhelmingly, they’re interested in exercise, wellness and nutrition,” Mock says.

Thus, Northgate II offers Zumba dance and walking classes, and it launched Enhance®Wellness, a motivational behavior change program targeted to older adults with chronic conditions. “That’s supported by a community health worker,” Mock says, “who works with residents on an ongoing basis, one-on-one, to track their progress.” The same person also leads a “laughter clinic,” in both Spanish and English, to promote emotional health.

Northgate II partners with other local agencies to bring additional services to residents. For instance, the Food Bank of South Jersey delivers food once a month to residents age 60 and over, as does Camden Fellowship Housing.

Plans for more services are in the works. A chronic disease self-management class, offered in partnership with the Camden Area Health Education Center, will start this fall. Elderly residents soon will gain access to assisted living services to help them stay independent, through a partnership with Caring, Inc., which also will begin a social day program at the Northgate II community center to help combat social isolation.

Northgate II also hopes to make in-home counseling services available to residents, dependent on obtaining funding, and it intends to start a grief/loss support group. Says Mock, “That will address the emotional aspects of health and wellness.”