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Fund-raising through grants.

Both non-profit and for-profit facilities may be eligible for grants to explore new service opportunities

In looking for funding, administrators of nonprofit nursing homes can look to help from charitable foundations in exploring new approaches to care or expanded services. While this avenue is obviously closed off to proprietary nursing homes, they may find it possible, and well worth the effort, to apply for and negotiate funding from a federal agency interested in geriatric-related research.

The proposal needn't be an "earth-shaking, never been done before" innovation. Today, the federal government has joined many of the nation's leading charitable foundations in a general search for solutions to the needs of the elderly. Indeed, more grant and contract money is being directed to healthcare programs and services for the elderly than ever before.

Programs and projects being supported range from innovative demonstration programs to testing new financing mechanisms.

Here is a representative list of the kinds of programs or services being funded today:

* Respite Services * Adult Day Care * Long-term Care at Home * Alzheimer's Disease Services * Long-term Care Insurance * Quality Assurance * Aging in Place * Training * "Seed Money" for New Projects * Program Planning Efforts * Community-Based Services * Programs Dealing with Elder Abuse * Hospice * Financing Long-term Care * Support for Living-at-Home

Because spending on nursing home services increased from $980 million in 1960 to $53.1 billion in 1990, an average annual rate of increase of 14.2 percent, and because many government officials and professionals believe more of the elderly can be cared for in the community, there are a number of grantmakers currently funding community-based services programs.

Although the average busy nursing home administrator is not about to take on a burdensome research project, it may make sense to explore collaborating with a university-based researcher interested in working with a nursing home to study a specific problem in access to geriatric health care. An upshot of this could be that you may either find your facility broadening its services to the elderly, or firmly establishing itself as part of the community's network of geriatric health care services.

Before you entertain the idea of "writing a grant," it is important to get a sense of how and for what reasons grants are currently being awarded.

Federal grants are being awarded to conduct research forecasting life and health expectancy in older populations and for programs developing and testing interventions increasing or maintaining older persons' abilities to live independently. The National Institute on Aging (NIA), for instance, is awarding these grants to various healthcare organizations -- public and private, profit and nonprofit.

As an example, grants are being awarded to organizations to develop Claude D. Pepper Older Americans Independence Centers (OAIC), as established by the Public Health Services Act of 1990.

Organizations that develop methods and models to improve life and active life expectancy for older populations will receive priority in receiving the NIA's life and health expectancy grants. The OAIC centers should also seek to train researchers to help the elderly and conduct studies on issues concerning them.

Clinical Research Topics

"The Geriatric Syndrome." Falls and fractures, delirium, malnutrition, inactivity and deconditioning, the overall impact of various geriatric syndromes on the health of Americans and on the costs of medical care -- research interest in all of these is intensifying as the number of Americans between 75 and 84 years of age rises by more than a third to 12.3 million, and the number those 85 or older -- known as the frail elderly -- almost doubles to 4.9 million, by the turn of the century. This grouping of disorders and disabilities has become so common that some experts have dubbed it the "geriatric syndrome."

As an example of the extent of the problem posed by various aspects of the "syndrome," injury from falls and fractures alone is the sixth leading cause of death in persons over age 65, and most fatal injuries in this age group result from falls which each year kill 9,500 elderly persons.

Alzheimer's Disease. Clinical studies that test interventions for secondary symptoms exhibited by patients with Alzheimer's disease and related disorders can receive grants from the National Center for Nursing Research, as well as the NIA. Secondary symptoms of Alzheimer's disease of special concern include, but are not limited to, wandering, disturbed sleep, pacing, agitation, feeding and dressing difficulties, incontinence and toileting difficulties, screaming and other vocalizations, aggression and violence, and inappropriate sexual behavior. Although the primary focus is on nonpharmacological interventions, research is also needed on pharmacological approaches.

Again, the research interest is explained by the magnitude of the problem. Total direct costs of caring for a person with Alzheimer's disease are estimated in the area of $38 to $42 billion per year. "Individual, familial and societal burdens of care are well documented," noted the National Institutes of Health (NIH) in a recent report, adding significantly that the dollar figures "represent only a small fraction of caregiving burdens."

As a result, the NIH has invited qualified researchers to submit applications for research and research training grants which focus on the broad area of caregiving for patients with Alzheimer's disease and related disorders. The major goal of the program is to understand the nature of caregiving and how this affects and is affected by the special features of the disease.

Non-Profits' Opportunities

As already indicated, foundations are highly active in awarding grants to non-proprietary institutions and agencies studying geriatric health care issues. Funding for aging projects from 1983 to 1987 increased from $39 million to $68 million, a 51 percent increase after inflation, according to a new report by The Florence V. Burden Foundation. The number of grantmakers that reported significant grants awarded in the field jumped from 209 to 263.

Health programs accounted for 55 percent, $161 million, of the grants awarded in the elderly field, according to Aging: The Burden Study on Foundation Grantmaking Trends. Nearly 90 percent of all funding was distributed in three areas: 43 percent, $127.2 million, to direct service agencies; 24 percent, $70.9 million, to educational institutions; and 20 percent, $59.8 million, to hospitals and medical facilities.

The study predicts that the financing of long-term care and the access to and quality of healthcare will rank among the most pressing concerns in the 1990s; grantmakers will give highest priority to community-based support services and health programs; and the special population groups of the frail elderly and caregivers will receive particular attention from grantmakers.

An example is the support by the John A. Hartford Foundation of a project in Monroe County, New York to explore various long-term care financing alternatives. The grant was given to service providers, county officials and local employers to work on plans to develop a comprehensive system to meet the long-term care needs of their community's elderly, with $239,753 supporting an analysis of financing alternatives for such a system. The analysis should be of "utility to many other communities developing similar programs," said the Foundation.

The Foundation also awarded a 30-month grant of nearly $598,000 to the Huntington Memorial Hospital, Pasadena, CA, to develop and test a model partnership of physicians and community services care coordinators. The program will seek to improve physician identification of older patients who need long-term care services and facilitate their access to them. The project will develop several components to link physician offices with community-based care resources, including: a screening tool that physicians can use to identify patients who would benefit from care coordination interventions; and a system to provide physicians and their patients with easy access to continuity of care with community-based resources (such as long-term care facilities) and coordinated care programs.

Meanwhile, the Robert Wood Johnson Foundation, the nation's largest grant maker in the field of health, has been funding programs that aim to develop and strengthen innovative adult day care programs and respite services. The latest round of grants for the "Partners in Caregiving" program was $2.5 million.

The foundation plans to make 36-month grants of up to $150,000 for development of new day centers and 24-month grants of up to $100,000 for existing centers. Foundation funds must be matched by funds from local sources, with $1 in local funds matching each $2 from the foundation. Some 50 sites are expected to be selected for the program.

Centers participating in the program will be expected to: identify services desired by participants and caregivers; develop or enhance day programs, other respite services, and ancillary services for people with dementia and other chronic disorders; develop a case-coordinated plan for each participant and caregiver to assure access to requested services, which will require maintaining links with community health and social service agencies and diagnostic and treatment facilities; provide or arrange training for caregivers, workers, and volunteers providing respite care in the day center or in the home; implement a marketing and promotional plan; and, develop mechanisms for organizing and financing services through a variety of funding sources, in order to establish and sustain the center's viability.

It Takes Work

Whether non-profit or for-profit, to be successful in winning grants or contracts for your nursing home requires determination, painstaking research into the funding interests of those awarding the money, diligence in putting your proposal package together and much patience. Only a small percentage of grants submitted are actually funded. Obviously, the more closely your proposal matches the agency's priorities, the better the chance of being funded.

Here are some thoughts to help you increase your odds:

* Clearly define your objectives at the outset. Thoroughly research your funding source. Identify government agencies or foundations most likely to support projects or programs similar to yours.

* Contact the funding source before you submit your proposal. Talking with program officers often results in constructive changes in an application before the proposal is formally submitted.

* To avoid disappointment, determine funding cycles, application deadlines, and board review meeting dates.

* Prepare for meetings with foundation or funding agency officials. The best way to "rehearse" the meeting is in your office with those who will be visiting the office awarding the grant. Determine "who" will discuss "what" about your project.

* Bring to the meeting charts, sketches, or illustrations which will help you make your points. Feel free to refer to a summary of the proposal or to your notes to give accurate figures, costs, or statistics.

* Persistence pays when you're dealing with funding sources. Stick with it. If you are declined for a good reason -- assuming you meet the funder's program interests to begin with -- there is no reason why you can't re-approach the foundation or agency for the same project or for another project later. In fact, the president of one major foundation that gives important support to healthcare said he was amazed that grantseekers fail to come back after being turned down once. He could not understand why they did not try again. Consider the approach, and even the rejection, as part of the cultivation process.

There are several information sources to turn to for information on federal funding programs as well as private sector grants from charitable foundations.

For details on federal programs, begin with the Catalog of Federal Domestic Assistance which, as its name implies, inventories the various funding programs. Find out about grant and contract programs of the NIA and such health agencies as the Health Care Financing Administration (HCFA), which, since it is responsible for reimbursement mechanisms for Medicare, home health and hospice, is funding a number of demonstration programs.

For details on charitable foundations, start with the data readily available from The Foundation Center, a leading source of information on foundation and corporate philanthropy. The Center maintains libraries in New York City, Washington, D.C., Cleveland and San Francisco, as well as a network of cooperating library collections throughout the country (although the Foundation Center does not direct grantseekers to particular foundations or corporations). In addition to free access to information on philanthropy, the libraries also provide information to grantseekers on the funding process itself through free weekly orientation sessions and seminars featuring foundation representatives.

The Foundation Directory is the cornerstone of the Center's publications program; it is the standard reference text on the funding interests of the country's largest foundations. The Center also publishes indexes that classify recent foundation awards by subject and geographic focus, as well as guidebooks that introduce novice grantseekers to funding research and the elements of proposal writing. For those without access to one of the Center's libraries, computer searches are made on a fee-for-service basis through DIALOG Information Services. Write to: The Foundation Center, 79 Fifth Ave., New York, NY 10003. Phone: (212) 620-4230 or (800) 424-3076.

A Final Thought

Because the "very old" population (85 years and over) is the fastest growing age group -- it is expected to comprise 14.7 percent of the total elderly population in the United States by the year 2000 -- and because the number of elderly expected to live in nursing homes is projected to increase by 64% by the year 2000, it is obvious that much attention will be focused on this area of long-term care by government officials and health policy experts. This translates into grant and contract monies for projects that address these issues.

However, as a busy nursing home administrator, you have to ask yourself: Does it make economic sense to consider devoting the time that it takes to develop a grant proposal? The fast answer is, only if you are genuinely committed to continuing a program or service once the grant money runs out. There is no sense in creating future disruption and perhaps even ill will for the sake of short-term financial opportunity.

The longer-range answer is that, if you are of an entrepreneurial mindset, grants can open up new service opportunities and a chance to collaborate with alternative services already in place in your community. They can help your facility to not only survive, but grow.

If that makes sense to you, then go for it -- and good luck!

Robert K. Jenkins is editor-in-chief of Health Funds Development Letter, Elderly Health Services Letter, and The Health Funds Grant Resources Yearbook. He is also author of an introductory brochure titled "21 Steps to a Successful Grant Proposal."
COPYRIGHT 1993 Medquest Communications, LLC
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Copyright 1993, Gale Group. All rights reserved. Gale Group is a Thomson Corporation Company.

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Author:Jenkins, Robert K.
Publication:Nursing Homes
Date:Apr 1, 1993
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