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Inevitable competitors?

One might assume that the main business of Raffel HealthCare Group, owner/operator of three skilled nursing facilities for the past 20 years, is operating nursing homes. In fact, it is not.

Rather, when my mother started our family business 23 years ago, her goal was to take care of older people in Baltimore by focusing on their particular needs. Creating a caring nursing home was simply the best way to go about it.

Unfortunately, the industry that we entered and enjoyed so long ago is very different today. While nursing home patients typically have greater needs, the focus of the industry has been distracted by outside issues, such as stiff government oversight and the economic realities of Medicare and Medicaid. So, to keep our family's original philosophy and mission intact, we have started to expand into assisted living.

With its emphasis on maintaining residents' independence, privacy and dignity, the assisted living industry understandably has attracted many residents who otherwise would have no viable choice but to enter a nursing home. But contrary to the belief of many in the nursing home industry, the growth of the assisted living industry does not, in itself, constitute a threat.

In my home state of Maryland, I have watched as the nursing home industry has lobbied for legislation to protect their facilities at the expense, of consumers' ability to choose their own long-term care destination. For example, they are seeking a very strict, inflexible upper limit of care that may be provided in an assisted living residence, regardless of circumstances. If such regulations were adopted, residents with certain medical needs or conditions would be forced to move into a nursing home. In my opinion, this seriously undermines the concept of self-determination.

The nursing home lobby argues that its main concern is for the quality of care residents receive. If quality of care truly is the central concern of providers, then I support their concern. But I have been active in the nursing home industry long enough to know that the primary issue for many is fear of competition. Nursing homes are concerned that many assisted living residents are folks whom they could have cared for themselves, and they feel that assisted living should be subject to the same regulations as they, to foster a level playing field.

My feeling is that there is no need for a level playing field because we're really talking about two different products. Nor should quality of care be an issue to the point of proposing regulations for each other's industry. Would we, as nursing home operators, ever stand for having the hospital or subacute care industry propose standards and regulations for us? I think not.

In the case of our company, we conducted a detailed feasibility study of the area we serve. Despite the influx of new assisted living residences by some of that industry's largest players, we found that we could offer a depth of experience in working with the local Jewish community that our competition could not.

Based on these results, we sold our Seton Hill and Franklin Court nursing homes in 1996. Since then, we have expanded our remaining facility, Milford Manor, to a capacity of 119 residents, with space for a 20-slot adult day care center scheduled to open this spring. Last month, we opened our first assisted living community, Catered Living of Pikesville, Maryland, accommodating 70 residents.

Our mission, itself, has not changed at all. From the kosher dining to our choice in artwork and activities, both our nursing home and our assisted living residence offer a traditional Jewish environment that is haimische - a Yiddish word meaning cozy, warm and home-like. So far, about 20% of the inquiries for our assisted living community have come from residents of our competitors' facilities.

The transition, for me, did not come easily or overnight. My first brush with the industry was attending a conference sponsored by the Assisted Living Federation of America, the only trade association exclusively dedicated to serving that industry. There, I attended such a variety of sessions that I was able to get a very clear picture of what our mission needed to be. Since then, I have surrounded myself at my facility with people with an assisted living background, which has only helped our success.

For those who come from a nursing home background and have an interest in the assisted living industry, the window of opportunity is still open, although limited. The proliferation of assisted living facilities is perhaps unparalleled in any field. But there is no question that there is room for both models in the marketplace.

Consumers want to have choices, and any nursing home that can offer a flexible care model by incorporating or affiliating with an assisted living component will fare well. Such facilities can offer aging in place by allowing residents to remain within one company's family or philosophy of care options. By the same token, as long as an assisted living provider can utilize home health agencies to offer their residents the same healthcare services they could get in their own private homes, residents or responsible parties should be allowed to so choose.

Whether the model is skilled nursing, assisted living, independent living, subacute care or home health, taking our lead from consumers is in everybody's business interest.

Bruce Raffel is president of Raftel HealthCare Group in Baltimore, MD. He is vice-chairman of the Maryland Assisted Living Association, a state affiliate of the Assisted Living Federation of America.
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Title Annotation:the nursing home and assisted living industries
Author:Raffel, Bruce
Publication:Nursing Homes
Date:Feb 1, 1998
Words:914
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