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Item S1 JUL-01-2003 TUE 12:43 PM HTA -'PRESIDENT FAX NO, 3052959070 Ii II I~ ii p, 02 E:dwin O. Swift, III suite 224 20 I front street key west, fi 33040 (305) 294-4142 June 30,2003 James L. Roberts, County Admin. Monroe County 1100 Simonton Street, Suite #205 Key West, PI. 33040 .~I~\:1 A~? ,,:~~;~~r i';:;\I~.:::Y The Florida Keys Assisted Care coalition wi~he~, ' Commission on July 15, 2003 at their 2,,:pM ~'. ,,;;,:,,:;:;i~:\::';:' Dear Mr. Roberts: Edwin O. SJ Assisted Living in Monroe County, Florida History: At one time, there were four assisted living homes for elders in the County, three privately owned and one (Bayshore Manor) operated by Monroe County. All ofthe private homes have closed due to the high cost of doing business in the County and the recently burgeoning liability insurance rates for assisted living. Bayshore Manor is licensed for 16 residents. Bayshore Manor has always been the only assisted living residence available for low-income seniors. There are currently twelve people on the waiting list for Bayshore Manor. This could represent three to four years of waiting time. This does not include the approximately 12 inquiries per year which Bayshore Manor receives from people who opt not to go on the long waiting list. Current Situation: . Bayshore Manor is the only assisted living residence for elders for all of Monroe County. It was built in 1946 and has been continuously in operation since that time, first as a "poor house", then an adult congregate living facility and at present as an assisted living facility since such facilities have been licensed by the State. Actually, since the late 19th century, Monroe County has maintained residences for indigent elders. . The Private paying rate is $2,138. per month. Eight individuals currently pay that fee. Four residents pay the Optional State Supplemental rate of $720.00 (these are the SSI residents) and the remaining four pay something between the OSS rate and private. . Income for Bayshore Manor FY 2001 was $370,000.00. Direct operating cost were $513,328. This includes no land or building cost or sinking fund. . The current budget for Bayshore Manor is $558,000. In order to break even, each resident would need to pay $2,906.00 per month for services. Very few elders could afford these rates. The addition of land and building cost would make the rates prohibitive. . Costs per resident to operate assisted living services far outpace other areas in the State, indeed the nation. Competition for health care and personal care workers is tight. Starting pay for an attendant is $12.83/hr. Without this wage and the accompanying benefits, positions cannot be filled. In addition, the small size of the residence does not allow for efficiency in operations in terms of minimal staffing standards. . There are currently no extended congregate care, limited nursing or Alzheimer's facilities in the County. Since Bayshore Manor cannot even serve the number of elders who need basic assisted living, it has elected not to obtain these additional licenses. In addition, it would not be cost efficient to operate these services to such a small number of residents. This means that those individuals needing these services are faced with either leaving the area or opting for nursing home care. Statistics of Importance . The average age of a Bayshore Manor resident is 86 years. . The averafe length of stay in an assisted living residence nationally was 28 months for 2001. The average length of stay for residents at Bayshore Manor is 50.40 months. Monroe County has the distinction of being the highest cost of living area in Florida since 1973. For the year 2000, Monroe price level index wasll0.47 vs. 100.0 for Florida.2 The housing index is even more disparate. Average housing price in Florida in 1997 was $95,800. The same figure for Monroe County was an astonishing $195,00Q!3 Residential land prices in Monroe County have risen over 300% in the last 20 years vs. 110 % for Florida.4 Key West land prices have even outpaced Monroe County as a whole.) 15.5% of the population of Monroe County is over 65.5 Median age for Monroe County is 41.2 years vs. 39.3 for Florida. 6 For Monroe County, there are 11,648 individuals age 65 and over. Ofthese 3,893 are between 75 and 84 and 976 are over 85 years.? For Key West, there are 2,990 residents over 65 years. Of these 1080 are between 75 and 84 and 310 are 85 and over. 8 For the over 65 years population, there are 280 persons receiving SSI, 11,500 receiving Social Security,1O 683 receiving public assistance and 5,674 receiving other . . 10 retirement Income. Average retirement income in Monroe County in 1999 was $1,463.00 per month. I I Bayshore Manor is staffed to meet minimum staffing requirements promulgated by the State of Florida. The staffing plan is as follows: 1. One FTE Administrator 2. One FTE Administrative Assistant 3. One FTE Custodian (housekeeper) 4. Two .5FTE respite workers 5. 5.0 FTE Attendants (Universal workers) 6. Two relief workers/occasional help Included in this plan are staff to operate the facility-based day respite program. There is currently no other facility-based daytime respite care nor day care program in the County. A maximum of 10 persons daily can be served by this program at the current location. It should be noted that economies of scale to be gained can be dramatic in increasing the size of the community. For example, you need an administrator for a sixteen bed facility. That same administrator could operate a substantially larger facility. . . . . . . . . . . . . The target population for assisted living is seniors age 75 and older. 12 . The need for assisted living increases from 20.9 % of the 75 to 84 years to 50.2% of the over 85 age group. 13 2 The Need . A minimum of 40-50 units oflow and median rate assisted living for elders with a contiguous property of 15-20 independent housing units for elders with median mcome. . Co-located respite, daytime respite and/or day care for seniors . Co-located market rate independent housing and assisted living units for elders . Option for seniors in independent housing to purchase services from the assisted living community (medication supervision, respite, meals, housekeeping, etc.) or to purchase home based and/or services from a local home health agency/hospice provider. . An extended congregate care license for the assisted living community so that elders could age in place and, generally, avoid progression to nursing home. . End-of-life care for both independent living and assisted living communities. This would fill the needs of the Lower Keys only and could be developed as a model project for rural areas which could be duplicated in other locales as well as for other areas of the Keys. The plight of seniors in Monroe County begs cooperation and assistance from public, private and charitable organization sectors. Nationally, 84% of elders cannot afford assisted living.14 For Key West and Monroe County, this figure is even higher because the cost of operating an assisted living facility in this locale greatly surpasses the average across the nation. Elders are living longer and becoming more frail. Many of the elders who are forced into nursing homes could do well in a supported and/or assisted living environment. In 1970, when the U.S. Naval Station closed, Monroe County lost the greatest economic engine that had driven the local economy since the 1930's. In the 1970's, 80's and 90's, Key West and the Florida Keys repositioned themselves as tourist driven economies. Further, in 1974, Florida declared Monroe County to be " an area of critical concern". This ongoing designation has resulted in progressive environmental protection of vacant lands in the County, with an eye on reducing growth possibilities, This has yielded fewer and fewer construction permits each year. In the 1980's, a rapidly progressive trend began wherein wealthy retirees and others seeking part-time or second or third residences in a warm climate with tourist driven amenities began purchasing many homes and gentrifying many neighborhoods in Key West. These three conditions have driven up the cost of land and have caused rapid increase in the cost of living in the Key West area. 3 The economies of scale for a project as described above make it very difficult to attract a private provider of these services. The elders of the Keys are not alone in this plight. Elders in rural communities across our nation are faced with similar problems, albeit exaggerated in tourist driven and environmentally sensitive economies such as ours. We have a sterling opportunity to develop a model project, which could be duplicated in other under served areas. Will we have the dedication, the spirit of cooperation and commitment to accomplish this unique project? We can, if all levels of government, private sources and charitable organizations can come together to create... An attractive model housing community of 60-70 units, conveniently located in the Key West area, in harmony with the environment, serving elders of all income levels across the continuum of care from independent living to assisted living through end- of-life care. 4 Contact Information: Anita Brackett Lucie Adams Louis Latorre Liz Kern Molly Shallow Nancy Jameson Dixie M. Spehar Betty Behrens Theo Tamborlane Ed Swift Joan Higgs Peter Batty 292-5257 FAX 296-4411 292-4517 294-9348 FAX 296-9597 FAX 294-1589 292-3466 FAX 292-3440 PHONE 295-2752 908/276-4926 FAX 908/276-4967 PHONE 295-9070 FAX 294-4142 PHONE Bayshore@monroecounty-fl.com 292-4533 PHONE 292-4477 FAX 292-3203 FAX 292-1031 PHONE Catholic Charities Kevsbuck<W,aol.com MCSS Lzkern<W,bellsouth.net wshallow<W,kevsdie:ital.com Observer BOCC BTBEHRENS<W,msn,com 5