More Than a Home
From the outside, the Four Seasons Home looks no different from any single-family residence in the quiet upper-middle class neighborhood.
On the inside too, the board-and-care facility apparently lives up to its billing: “A place where you’ll experience the comforts of home, but none of the work and worry.”
Behind the scenes, however, the six-bedroom, three-bath, 2,600-square-foot house on Hiawatha Street differs from other residences.
This home is a business--one with heavy regulations, stiff competition for clients, and the same challenges in keeping customers satisfied that all service industries face.
Susanna Denes opened the home for the elderly in 1996 after quitting her job as a financial analyst.
“I was tired of working for other people,” she said.
Just after moving to the U.S. from Hungary in the late 1980s, Denes was hired to provide companionship for an elderly woman. Recalling the rewards she felt in that position, Denes decided to invest in a home she could convert into a six-unit residential care facility for the elderly (also known as a board-and-care or assisted-living facility).
Her background put her at an immediate disadvantage. “Most owners in this industry are nurses, or at least have connections in the medical field,” Denes said. “It’s much easier to get clients when you have connections.”
The business is volatile, with board-and-cares often serving as temporary quarters for elderly individuals who don’t require medical assistance but have begun having trouble with activities of daily living. Since a residential care facility is unable to provide any health care, clients must move on once their condition deteriorates to the point where they need nursing home care.
Denes figures the average length of stay at the home is two years. In an effort to fill vacancies, she distributes her brochure to social workers and various referral services. But there is considerable competition from large and small residential care facilities and nursing homes.
From both a business and a compassion standpoint, she says it’s difficult to watch some clients forced to move on to nursing homes before they want or need to, simply because their insurance will pay supplemental coverage for a nursing home but not for a board-and-care.
Denes admits she isn’t as aggressive as she should be in recruiting residents. It’s been a year and a half since she’s been at capacity. Nonetheless, she’s turning a profit.
“When I have three residents, I’m breaking even,” she said. “When the house is filled, I can make a good income.”
Her overhead costs read much like a private homeowner’s--mortgage, property taxes, insurance, maintenance, utilities, plus outlays for advertising, substantial cleaning and food bills, and salaries for the two-member staff.
The home charges $2,000 to $2,600 a month, depending on the occupant’s needs. Residents get a private room--one has a private bath and walk-in closet--along with meals, transportation, entertainment, recreation and assistance with tasks such as bathing, dressing, grooming and medication reminders.
Most clients are in various stages of dementia. “I have two ladies now who are mentally quite all right, but need constant observation because they tend to become confused,” Denes said.
Another woman, who has Alzheimer’s disease, does well with daily activities such as bathing and grooming but forgets things moments after they are told to her.
The larger assisted-living facilities tend to be less expensive than the Four Seasons Home, but Denes contends that her facility offers more personalized attention, with the owner and her two staffers overseeing up to six residents.
The home offers entertainment for residents, though three of the four in the current group prefer to sit in the spacious backyard or watch movies from a well-stocked video collection.
“It really depends on the residents,” Denes said. “In the past, I had people who wanted to go somewhere every day. We have one woman now who likes to go to the movies and out to lunch, but the others want to be left alone.” Nonetheless, the group does enjoy celebrations for birthdays, holidays, and other special occasions, when families are invited to join in the festivities.
Family members are always welcome, Denes emphasized. Occasionally, they are needed to help solve problems when a resident becomes disgruntled. Keeping clients with diverse needs and interests content is no easy task, Denes noted.
“People who come to live in a facility such as ours are often not happy,” she said. “There might be one person who complains, and, especially if the other people have dementia, they will repeat that person’s complaints.”
Denes has learned about the needs of her clients both on the job and through a 40-hour certification program required of owner-administrators, who then provide in-house training for staff. Once a week, Denes meets with her staff to discuss the residents and how to keep them comfortable and content.
“A lot of what they’re doing is manual labor,” she said. “But it’s also very important that they be loving and compassionate.”
Given the potential for abuse or exploitation, the state Department of Social Services keeps close watch on residential care facilities for the elderly. Criminal background checks are required of all employees.
Once a year, facilities are inspected by the department’s Community Care Licensing branch. “They always find something,” Denes said. The facility was cited for minor infractions in 1999 and 2000, but the problems were properly remedied, a spokesman for the state Department of Social Services said.
To meet fire safety codes, Denes had to widen bedroom doors to accommodate nonambulatory residents. She also was required to invest in a manual pull station that can sound an alarm in an emergency.
“It can be quite expensive if you’re starting this business from nothing,” Denes said. “But once you have invested in the property and construction costs, it can be very profitable, particularly if you open more than one facility and can keep them full.”
“It’s a lot of headache. It’s not a 9-to-5 business, because your clients are always there and there is always some kind of problem to deal with. On the other hand, you work for yourself, and you’re helping people. That part of it is satisfying.”
