Document Douglas_doc_4272e7d512

CONVERSE COUNTY LONG-TERM CARE MARKET ANALYSIS Final Report (March 2014) Community Builders, Inc. www.consultCBI.com 873 Esterbrook Road [EMAIL REDACTED] Douglas, WY 82633 (307) 359-3311 ---PAGE BREAK--- Converse County Long-Term Care Market Analysis Page 2 of 60 A c k n o w l e d g e m e n t s Community Builders, Inc. (CBI) would like to acknowledge the support and participation of the following people and organizations: Converse County Long-Term Care Advisory Committee: Gay Bolln, Member, Memorial Hospital of Converse County Board Rick Grant, County Commissioner, Converse County Bob Kayser, Chairman, Memorial Hospital of Converse County Board Dave Kreycik, CPA, Citizen Chuck Lyford, Citizen Denise Lyons, Director, Converse County Hospital Foundation Jan Pope, Retired Nurse, Private Citizen Ryan Smith, CEO, Memorial Hospital of Converse County Converse County Residents and Property Owners Converse County Service Providers Douglas and Glenrock Senior Centers Memorial Hospital of Converse County Converse County Commissioners ---PAGE BREAK--- Converse County Long-Term Care Market Analysis Page 3 of 60 T a b l e o f C o n t e n t s Topic Page Executive Summary 4 Introduction 7 Community Engagement Process 11 Review of Long-Term Care Industry 14 Nursing Homes – U.S. 17 Nursing Homes – Wyoming 17 Assisted Living Facilities – U.S. 20 Assisted Living Facilities – Wyoming 20 Memory Care – U.S. 26 Memory Care – Wyoming 27 Current Long-Term Care Services 28 Description of Market Area 29 Demographics 30 Age 30 Income 32 Housing 32 Target Market Analysis 33 Demographics 34 Limitations with ADLs and 35 Income and Housing 38 The Unmet Need 40 Ownership and Management 43 Location/Site Selection Options 44 Economic Feasibility 47 Construction Funding 53 Conclusion 59 APPENDICES 60 ---PAGE BREAK--- Converse County Long-Term Care Market Analysis Page 4 of 60 E x e c u t i v e S u m m a r y The Converse County Board of County Commissioners and Memorial Hospital of Converse County retained Douglas-based Community Builders, Inc. (CBI) to help evaluate current and projected senior long-term care housing needs in Converse County, Wyoming. This market and financial feasibility study examines long-term care needs, market demand, growth potential and competition in Converse County, with special emphasis on the need for assisted living services in the county. An assisted living facility, by definition, is a group living arrangement providing help for residents with activities of daily living such as eating, bathing, using the bathroom, taking medicine, and getting to appointments as needed. Assisted living facility residents often live in their own room or apartment within a building or group of buildings and have some or all of their meals together. CBI worked with an Advisory Committee composed of representatives from Converse County, Memorial Hospital of Converse County and the communities of Glenrock and Douglas. The goals and general parameters of the project set by the Advisory Team were:  To allow residents to age in their own communities rather than having to go outside of the community for long-term care  To provide an affordable model with high quality of care  To consider non-profit models for ownership and/or management of long-term care services CBI developed a public engagement process to evaluate the long-term care needs and desires of the Converse County community. Public and stakeholder input was obtained using a variety of methods. Additionally, CBI developed an objective market analysis, based on demographic trends, industry best practices, and government data. CBI has examined population and other demographic trends in Converse County and, more generally, east-central Wyoming. CBI has also analyzed existing and planned development of long-term care facilities in these areas. Existing long-term care facilities in Converse County include:  Douglas Care Center LLC, a licensed nursing care facility  Dream Catcher Adult Day Care, a licensed adult day care facility located in Douglas  Ann's Best Care LLC, a licensed home health agency Currently, there are no licensed assisted living facilities, boarding homes, or hospice facilities in Converse County. A recent announcement by the Douglas Care Center indicates that the owners of that nursing home are now proposing to build a 30-unit assisted living facility on the same site as the existing nursing home in Douglas. Objective demographic observations include the following:  There is a growing population of seniors age 65 or older ---PAGE BREAK--- Converse County Long-Term Care Market Analysis Page 5 of 60  Wyoming’s elderly population is the fastest growing segment of the state’s population  People are living longer, but with more limitations in their abilities to perform activities of daily living (ADLs)  The rural nature and low density of population in Wyoming makes it difficult to identify strong market demand anywhere (for any kind of services) Following this examination and analysis, CBI identified Converse County’s unmet needs for nursing home facilities, assisted living facilities, and memory care units. Those findings are summarized in the table below: Market Growth Forecast, by Market Area and Year DEMAND FOR NURSING HOME UNITS Market Area Primary Market Primary Market Secondary Market ALL AREAS Year Glenrock Area Douglas Area State of Wyoming United States Total 2012 25 -17 -148 -32,577 -32,717 2013 27 -15 10 -6,271 -6,249 2014 29 -13 169 20,034 20,220 2015 32 -10 327 46,340 46,688 2016 34 -8 486 72,645 73,157 2017 36 -6 644 98,951 99,625 DEMAND FOR ASSISTED LIVING FACILITY UNITS Market Area Primary Market Primary Market Secondary Market ALL AREAS Year Glenrock Area Douglas Area State of Wyoming United States Total 2012 15 24 272 148,392 148,704 2013 17 25 368 163,963 164,373 2014 18 27 463 179,534 180,042 2015 19 28 559 195,106 195,712 2016 20 29 654 210,677 211,381 2017 22 30 750 226,248 227,050 DEMAND FOR MEMORY CARE UNITS Market Area Primary Market Primary Market Secondary Market ALL AREAS Year Glenrock Area Douglas Area State of Wyoming United States Total 2012 14 -5 1,254 757,021 758,284 2013 15 -4 1,346 798,861 800,218 2014 16 -3 1,438 840,701 842,152 2015 18 -3 1,530 882,540 884,085 2016 19 -2 1,622 924,380 926,019 2017 20 -1 1,714 966,220 967,953 Based on these findings, it appears there may be a growing need for additional nursing home units and/or memory care units in Glenrock. Development of assisted living units is needed in both Glenrock and Douglas to meet current demand in Converse County. Given consumer ---PAGE BREAK--- Converse County Long-Term Care Market Analysis Page 6 of 60 preferences and operational efficiencies, the community should consider development of two assisted living facilities – one in Glenrock and one in Douglas. Those two facilities should be jointly managed. Additionally, in light of the community’s desire for high quality, and the County’s large percentage of low-income households, it may be necessary to engage local government involvement (to secure grant funding), as well as seek/develop a nonprofit operating company (to keep base rates as low as possible). If the Douglas Care Center moves forward with their proposal, this analysis should be revisited. It would be difficult for the Converse County market to adequately support two ALFs in Douglas. Further, if the goal is to meet the community’s strong desire for quality and affordability, a nonprofit model may need to be pursued. CBI estimates that the average base cost per resident could be reduced from a high of $3,817 using conventional debt service financing to construct and operate the facility, compared to a base cost of $2,412 with no debt service to be recovered. Finally, it should be noted that Douglas Care Center has already indicated that it will be pricing its base rates using the prevailing market costs of doing business in Douglas (and thus is not in a position to offer low-income subsidies), nor does it plan to develop an ALF in Glenrock. Accordingly, if the needs of those populations are to be met (including their desire to remain in their own community during their golden years), the community as a whole should carefully consider its alternatives. ---PAGE BREAK--- Converse County Long-Term Care Market Analysis Page 7 of 60 I n t r o d u c t i o n America is an aging country. Americans are living longer, and unprecedented numbers of older citizens are choosing (or of necessity needing), to live in long-term care facilities. The number of people using nursing facilities, alternative residential care places, or home care services is projected to increase from 15 million in 2000 to 27 million in 2050. Most of this increase will be due to growth of the older adult population. Caring Magazine reports that there will be a shortage of family caregivers for a number of reasons:  Fewer children to provide care the Baby Boom generation families, or “Boomers,” have had only two children, compared to today's elders’ average of four children)  Family members may not live nearby, due to increased mobility and relocations  Escalating numbers of singles without a spouse to care for them  Highest rates - ever - of both middle-aged men and women working (and therefore are unavailable to care for their parents). The largest generation of Americans ever – Boomers – is now reaching retirement age. The Boomer generation is wealthier than previous generations, and so today’s elderly citizens can afford to demand higher levels of privacy, safety, and quality from service providers. Consequently, market demand is strong for new long-term care facilities that offer private rooms, high quality services, and special amenities. Previous generations of Americans struggled with the concept of long-term care. For the most part, the elderly lived with their children during their later years. The last 50 years have been marked by just one type of long-term care facility: nursing homes, or skilled nursing facilities. Most of these facilities have operated with an institutional mindset, focused entirely on the health needs of “patients,” and not on the social or personal relationship needs of these residents. For these institutional facilities, cost efficiency and Medicare/Medicaid reimbursement rates are, increasingly, the focus for facility managers. Yet, today’s elderly have many other long-term care choices. In fact, many communities offer a continuum of long-term care services and supports, including transportation, meals, home- health care, independent living, boarding homes, assisted living facilities, skilled nursing homes, and hospice facilities. Wyoming's aging population is larger (on a percentage basis) than the nation’s. In fact, the state is actually aging faster than national averages. As can be seen in the following chart, Wyoming's population projections for its older population are staggering, especially for the 85+ age range: ---PAGE BREAK--- Converse County Long-Term Care Market Analysis Page 8 of 60 Source: AARP Public Policy Institute. The levels of care and alternatives to traditional nursing home facilities have not yet been as fully developed in Wyoming as they have elsewhere. Accordingly, many Wyoming communities have recently been evaluating their long-term care needs, and they are identifying new opportunities for providing services to their elderly citizens. In Wyoming, only 11 seniors per 1,000 are using assisted living services (also known as Residential Care), which is significantly below the national usage rate (15 per 1,000 seniors), as seen in the figure below. Source: National Center for Health Statistics, Long-Term Care Services in the United States: 2013 Overview. ---PAGE BREAK--- Converse County Long-Term Care Market Analysis Page 9 of 60 Accordingly, this study reviews national and regional long-term care trends, and compares those findings to the market area under consideration (Converse County). Population demographics, disability statistics, housing, and income data are evaluated to determine market demand. Wyoming-licensed long-term care facilities are reviewed to determine the existing supply in the market area. Finally, calculations are made to estimate the unmet need for long-term care in Converse County. The draft City of Douglas Comprehensive Plan also supports the need for additional facilities. This document includes a section on Senior Housing options and needs. This document (completed by Logan-Simpson in 2013), notes a range of housing options needed to accommodate seniors:  Owner or renter-occupied housing for seniors requiring little or no care;  More affordable, independent living units for persons who are unable to care for larger properties and have lower household incomes, including townhomes, duplexes, patio homes, and other options;  Assisted-living housing units  Nursing homes that provide skilled nursing care The lack of an assisted living facility represents an unfilled gap between available senior housing at Irwin Towers, Riverside Plaza I and II, Barber Apartments and available skilled nursing care and rehabilitative services at the Douglas Care Center. ---PAGE BREAK--- Converse County Long-Term Care Market Analysis Page 10 of 60 Map of Wyoming, with Converse County highlighted. C o m m u n i t y P r o f i l e Converse County is located in east-Central Wyoming. Elevations in Converse County range from a high of more than 10,200 feet (Laramie Peak) to a low of about 5,000 feet. Its terrain includes mountains, grasslands, and the North Platte River. Converse County contains 4,265 square miles. As of July 1, 2012, the County population is estimated to include 14,008 residents. The county includes four incorporated municipalities: Douglas, Glenrock, Lost Springs, and Rolling Hills. Additionally, there are several non-incorporated communities including Bill, Esterbrook, Orin Junction, and Shawnee. Each community is important to the County in its own way:  Douglas, the county seat and largest community in Converse County, with an estimated population of 6,280 is surrounded by several livestock ranches and is a family-centered community. Key industries in the area include coal mining, oil and gas extraction, uranium mining, railroad, and local government (including schools). The population of the “Douglas Area,” which is the east portion of Converse County, in 2012 is estimated to include 9,296 residents.  Glenrock, population 2,583, is home to the Dave Johnson coal-fired power plant and, more recently, has experienced development of significant wind energy farms. Oil and gas extraction and uranium mining are key industries. The population of the “Glenrock Area,” which is the west portion of Converse County, in 2012 is estimated to include 4,483 residents.  Lost Springs, population 4, is a quaint community along the Union Pacific Railroad, east of Douglas. It is included in the “Douglas Area” market.  Rolling Hills is a relatively new community (incorporated in 1984), with a population of 441 residents. It is included in the “Glenrock Area” market.  All of the unincorporated communities identified above Bill, Esterbrook, Orin Junction, and Shawnee) are included in the “Douglas Area” market. Location Converse County is served by several major highways, including Interstate 25, Wyoming's only north-south interstate, and U.S. Highway 18-20-26. In addition, Wyoming State Highway 59 runs from Douglas to Interstate 90 in Gillette. Distances to major population centers on these roads include: ---PAGE BREAK--- Converse County Long-Term Care Market Analysis Page 11 of 60  Glenrock to Douglas = 25 miles  Glenrock to Casper = 20 miles  Douglas to Cheyenne = 129 miles  Douglas to Denver = 230 miles  Douglas to Rapid City (SD) = 210 miles The four communities are roughly four hours from Denver International Airport, one of the nation's busiest commercial airports. The smaller, regional commercial airport in Casper is an hour or less away by automobile. C o m m u n i t y E n g a g e m e n t P r o c e s s Support for a project can only come from people and organizations that are involved because they understand the importance of the project and their relationship to it. It was also important for this study to reach out to both sides of Converse County to generate consensus for any plan that ultimately develops. Additionally, many funding agencies require that community and economic development recipients inform and educate the public to the greatest extent possible about a proposed development project, utilizing a variety of techniques and media. For these reasons, a Converse County Long-Term Care Feasibility Study Public Participation Plan was developed and is attached to this document as Appendix A. As the long-term care study unfolded, the public engagement process was designed to provide the greatest possibility of successful implementation of project goals. Special efforts were made to hear the thoughts and opinions of senior citizens who currently receive or who may in the future receive long-term care residential services. The public forums at the end of the survey process were held in the Senior Citizen Centers in Glenrock and Douglas. Public Input Surveys A community survey was developed and circulated throughout the community to get the general public's input on long-term care needs. The survey was not intended to be a statistically valid instrument; rather it was intended to gauge the pulse of the interested community. Surveys were made available at various community centers in Glenrock and Douglas that are frequented by senior citizens and the general public; a Survey Monkey Internet link was created and advertised in the newspaper, on Facebook, and on community websites; and letters encouraging survey completion were sent to advisory committee members and key stakeholders for their constituents. A separate survey for stakeholders service providers) was also conducted. Sample surveys are included in Appendix A (Public Participation Plan) and complete results of those surveys are attached as Appendix B. A total of ---PAGE BREAK--- Converse County Long-Term Care Market Analysis Page 12 of 60 275 community surveys were received and compiled, with 22 of those coming from identified stakeholders in the community. The percentage of respondents from each community roughly paralleled the actual population demographics of Converse County. Key findings of the surveys include:  Respondents receive many of the services traditionally provided by a community for its senior citizens. However, 45% reported that they receive "none of the listed services," and yet they indicated strong support for needed long-term care facilities.  95% of all community survey respondents (and 100% of identified stakeholders), stated that there is a need for more long-term care services in the community.  An Assisted Living Facility topped the list of needed additional services, as seen in the following chart summarizing the survey responses for this topic.  Affordability of care, the ability to stay in their hometown, and the quality of care, are the community’s most important factors when making a long-term care choice.  95.1% of all respondents report that they would use an assisted living facility if they could afford it.  Many survey respondents reported knowing someone who moved away from the community to live in an assisted living facility or nursing home in another location.  The main reason the individuals had moved away was that services were not available in Converse County, following by concerns about the quality of care at the local facility.  Grants and special purpose taxes topped the list of potential ways to pay for an assisted living facility, in the opinion of survey respondents. 0% 20% 40% 60% 80% 100% Respite Care Boarding Home Facility Assisted Living Facility Memory Care Facility Nursing Care Facility Home Health Care Senior Independent Living In-home Hospice Care Hospice Care Facility Other (please specify) What additional services are needed in Converse County? Community Stakeholders ---PAGE BREAK--- Converse County Long-Term Care Market Analysis Page 13 of 60  Survey respondents’ overwhelming desire to spend their "golden years" in their own community is obvious in the following chart. Public Forums The public was invited to two separate public forums to report initial findings - one in Glenrock and one in Douglas. Advertisements were placed in the Douglas Budget and Glenrock Independent, and flyers distributed to public gathering places inviting people to the public forums with press releases providing additional media and radio coverage. Individual letters were sent to stakeholders, advisory committee members, governmental agencies, non-profits, community service providers, health/senior care providers, senior independent housing providers, and other identified stakeholders. Each meeting was attended by 35-40 individuals, and 31 attendees signed in at the Glenrock evening meeting (28 signed at the Douglas public forum, in spite of a snowstorm that evening). News Coverage The local newspapers (Douglas Budget and Glenrock Independent), provided coverage of the study's progress, and Advisory Committee members were interviewed by the local radio station about the project as well. 0% 20% 40% 60% 80% 100% In my own community Within Converse County, but not necessarily the community I live in Somewhere else in Wyoming Near family or friends in another state It doesn't matter to me Other (please specify) Where would you most want to spend your "golden" years? Community Stakeholders ---PAGE BREAK--- Converse County Long-Term Care Market Analysis Page 14 of 60 R e v i e w o f L o n g - T e r m C a r e I n d u s t r y As we age, many people lose some of their abilities to care for themselves. Many elderly citizens develop difficulties in completing activities of daily living (ADLs). ADLs are the things we normally do in life, including any daily activity we perform for self-care (such as feeding ourselves, bathing, dressing, grooming), work, homemaking, and leisure. The ability (or inability) to perform ADLs is often used to measure one’s ability/disability for many health conditions. Similarly, some citizens struggle with instrumental activities of daily living (IADLs), which are the activities often performed by a person who is living independently in a community setting. IADLs would include activities such as managing money, shopping, telephone use, travel, housekeeping, preparing meals, and taking medications correctly. Limitations in performing ADLs and IADLs may result in the need for long-term care. The vast majority of people needing long-term care receive it from their own family members and/or friends. Only a small portion of the population needing long-term care actually receive it from paid caregivers, and an even smaller percentage (about of the elderly population receive needed services at a long-term care facility. Yet, this segment of our population is very large, growing exponentially, and increasingly needs long-term care services. Typically, elderly persons with the highest levels of need are the ones who seek care in a long-term care facility, especially if they do not have the appropriate support services they need to stay in their own home. The number of people using nursing facilities, residential care facilities, or home care services is projected to increase from 15 million in 2000 to 27 million in 2050. Most of this increase will be due to growth in the older adult population who need such services. Caring Magazine reports that there will be a shortage of family caregivers for a number of reasons:  Fewer children to provide care Boomers have had only two children, compared to today's elders’ average of four children)  Family members may not live nearby, due to increased mobility and relocations  Escalating numbers of singles without a spouse to care for them  Highest rates - ever - of both middle-aged men and women working (and therefore are unavailable to care for their parents). ---PAGE BREAK--- Converse County Long-Term Care Market Analysis Page 15 of 60 In 2012, about 58,500 paid, regulated long-term care services providers served about 8 million people in the United States. Long-term care services were provided by 4,800 adult day services centers, 12,200 home health agencies, 3,700 hospices, 15,700 nursing homes, and 22,200 assisted living and similar residential care communities. Each day in 2012, there were 273,200 participants enrolled in adult day services centers, 1,383,700 residents in nursing homes, and 713,300 residents in residential care communities (assisted living facilities and the like). In 2011, about 4,742,500 patients received services from home health agencies, and 1,244,500 patients received services from hospices. Long-term Care Services and Supports The concept of long-term care (LTC) in the United States has traditionally meant sending elderly citizens to institutionalized nursing homes. Those institutions, called “Skilled Nursing Facilities” or SNFs, currently house about 1.4 million elderly Americans. Yet, much has changed in the last 20 years! Today, there is a wide range of LTC options available, including:  Community-based Services – Many communities provide services and programs to help seniors and people with disabilities with a variety of personal activities. These services include Meals-on-Wheels, transportation services, personal care, chore services, adult day care, and a variety of activities in senior centers. These services are usually free or at low cost to individuals who qualify. Local organizations typically coordinate these services to promote the independence and dignity of older adults.  Home Health Care – Some elders receive care in their own home. Such services can include skilled nursing care, homemaker/health aides, personal care aides, respite care, medical equipment, home repair and modification, and hospice.  Senior Independent Living – Typically, a cluster of multi-family units (duplexes) or condominium units that are designed for seniors who pay for some services (such as housekeeping, transportation, or meals) as part of a fee, and who require little, if any, assistance with Activities of Daily Living. Independent living units are not normally licensed for health care, although residents may receive home health care services in their own unit.  In-law Apartments – An in-law apartment is a separate housing arrangement within a single-family home or lot. It may also be referred to as a second unit, accessory apartment, or accessory dwelling unit. An in-law apartment is a complete living space and includes a private kitchen and bath. An in-law apartment may provide living space for a caretaker or may be rented to provide additional income.  Subsidized Senior Housing – The federal government and most states have programs that help pay for housing for older people with low or moderate incomes (less than $46,000 if single or $53,000 if married). Some of these housing programs also offer help with meals and other activities like housekeeping, shopping, and doing the laundry. Residents typically live in their own apartments in the complex. Usually a Federal or ---PAGE BREAK--- Converse County Long-Term Care Market Analysis Page 16 of 60 State agency will review income and expenses for eligibility for this type of housing. Rent payments are usually a percentage of income.  Boarding Homes – This group living arrangement provides help with activities of daily living such as eating, bathing, and using the bathroom for people who cannot live on their own but do not need nursing home services. These are sometimes called "group homes". In some cases, private long-term care insurance and other types of assistance programs may help pay for this type of living arrangement. Many of these homes do not receive payment from Medicare or Medicaid and are not strictly monitored. The charge is usually a percentage of income.  Assisted Living Facilities (ALFs) – This group living arrangement provides help with activities of daily living such as eating, bathing, and using the bathroom, taking medicine, and getting to appointments as needed. Residents often live in their own room or apartment within a building or group of buildings and have some or all of their meals together. Social and recreational activities are usually provided. Some assisted living facilities have health services on site. Costs for assisted living facilities can vary widely depending on the size of the living areas, services provided, type of help needed, and where the building is located. Residents usually pay a rent and then pay additional fees for the services that they get.  Continuing Care Retirement Community (CCRC) – These housing communities have different levels of care based on residents’ needs. Where one lives depends on the level of care needed. In the same community, there may be individual homes or apartments for residents who still live on their own, an assisted living facility for people who need some help with daily care, and a nursing home for those who require higher levels of care. Residents move from one level of care to another based on their needs but still stay in the CCRC.  Skilled Nursing Facilities (Nursing Homes) –These facilities provide care to people who cannot be cared for at home or in the community. Nursing homes provide a wide range of personal care and health services. For most people, this care generally is to assist people with support services such as dressing, bathing, and using the bathroom, for people who cannot take care of themselves due to physical, emotional, or mental problems.  Memory Care – These are secure units designed for people with significant cognitive impairment as a result of having Alzheimer’s disease or some other dementia. In Wyoming, there are additional licensure requirements for Memory Care beds. Source: Adapted from U.S. Department of Health and Human Services/Medicare. The Converse County Board of County Commissioners and Memorial Hospital of Converse County retained Community Builders, Inc. (CBI) to study the long-term care market in Converse ---PAGE BREAK--- Converse County Long-Term Care Market Analysis Page 17 of 60 County, Wyoming. A complete examination of the full continuum of all long-term care options would go beyond the scope of this study. Instead, this study will focus on market demand for three primary types of long-term care: Nursing Homes, Assisted Living Facilities, and secure Memory Care units. Nursing Homes – U.S. Nursing homes provide the most intense long-term care services in the United States. Services at a nursing home meet a wide range of medical, personal, rehabilitative, and long-term needs for residents. The most distinguishing characteristic of these facilities is the skilled nursing care that is available to nursing home residents 24-hours a day. Thus, unlike many other types of long-term care facilities, government-funded programs (Medicare and Medicaid) typically pay the cost for nursing home care. According to the U.S. Department of Health and Human Services, there were 1,389,241 residents living in 15,702 certified nursing facilities during 2011 (most recent data available). Those same facilities contained 1,703,846 licensed beds, resulting in an overall occupancy rate of 81.6%. Source: Health, United States, 2012, prepared by the U.S. Department of Health and Human Service. At that time (2011), the U.S. Census Bureau estimated that there were 39.2 million residents aged 65 or older living in the United States. Thus, in 2011, 3.6% of all persons aged 65 or older were living in certified nursing facilities in the United States. While the cost of residing at a nursing home is typically paid by Medicare or Medicaid, most nursing homes are privately owned and operated. One other source of payment is derived from long-term care insurance, so long-term care costs are annually tracked by major insurance companies that provide such coverage. According to the Genworth 2013 Cost of Care Survey, the national median rate for nursing homes in 2012 was $6,235 for a semi-private room, and $6,965 for a private room. The accuracy of the Genworth Survey is validated by the U.S. Department of Health & Human Services who now uses the Genworth Survey’s figures to advise consumers of the costs for long-term care (http://longtermcare.gov). In order to build a new nursing home or expand an existing facility, many states require the developer to obtain a Certificate of Need (CON). The justification for CON programs is to control health care facility costs and allow coordinated planning of new facilities. The idea is that new or expanded facilities should be approved only when there is a genuine need. Statutory criteria help licensing agencies decide what is necessary for a given location. By reviewing occupancy levels of existing facilities, the agencies make judgments about whether there is a need for additional beds. Once that need is established, the licensing agency will grant the developer permission to begin a project. Nursing Homes – Wyoming According to the U.S. Department of Health and Human Services, there were 2,401 residents living in 38 certified nursing facilities in Wyoming during 2011. Those same facilities contained 2,969 licensed beds, resulting in an overall occupancy rate of 80.9%. Source: Health, United States, 2012, prepared by the U.S. Department of Health and Human Services. ---PAGE BREAK--- Converse County Long-Term Care Market Analysis Page 18 of 60 The Wyoming Department of Health, Office of Healthcare Licensing and Surveys, conducts annual surveys of every nursing home in the state. According to data on their website (http://wdh.state.wy.us/ohls/index.html), there are currently (2014) 2,958 licensed beds in 38 nursing facilities in Wyoming. The census of residents taken during the annual surveys (the timing of which is different for each facility) is 2,416 people, resulting in a statewide occupancy of 81.7%. Because the federal government measures data from facilities that maintain federal Medicare and Medicaid certificates not the same as a state license), and because of timing differences for state licensing annual surveys, data from the two sources is different. According to the Genworth 2013 Cost of Care Survey cited above, Wyoming’s median daily rate for nursing homes was $6,038 for a semi-private room, and $6,327 for a private room. Wyoming is not a CON state. However, before the State will award a license to a developer for a new or expanded nursing home, the Office of Healthcare Licensing and Surveys considers occupancy levels (from its most recent surveys) for the construction area. Wyoming Statute 35- 2-901(a)(v) defines the “construction area” to include all nursing homes within a 30-mile drive from the proposed site. By law, nursing home occupancies in the construction area must exceed 85% in order to secure a license to build more nursing home beds (Wyoming Statute 35- 2-906(b)). However, that same statute allows existing nursing homes to increase their licensed bed capacity by ten percent up to ten beds, in any two-year period. Currently licensed nursing home facilities in the State of Wyoming, including their location, number of licensed beds, and occupancy level, are identified in the table below. ---PAGE BREAK--- Converse County Long-Term Care Market Analysis Page 19 of 60 Nursing Home Community Licensed Beds Occupancy Star Valley Care Center Afton 24 97% Bonnie Bluejacket Memorial Nursing Home Basin 37 78% Wyoming Retirement Center Basin 90 71% Johnson County Healthcare Center Buffalo 50 82% Life Care Center of Casper Casper 120 93% Shepherd of the Valley Healthcare Center Casper 192 90% Poplar Living Center Casper 120 85% Life Care Center of Cheyenne Cheyenne 160 89% Cheyenne Regional Medical Center Transitional Care Unit Cheyenne 16 91% Kindred Transitional Care and Rehabilitation - Cheyenne Cheyenne 146 77% Cheyenne Healthcare Center Cheyenne 105 85% West Park Long Term Care Center Cody 94 77% Douglas Care Center LLC Douglas 60 87% Rocky Mountain Care Evanston 60 67% Morning Star Care Center Fort Washakie 45 78% Pioneer Manor Nursing Home Gillette 150 77% Castle Rock Convalescent Center Green River 59 94% St John's Nursing Home Jackson 60 86% South Lincoln Nursing Center Kemmerer 24 83% Westward Heights Care Center Lander 60 93% Ivinson Memorial Hospital Extended Care Facility Laramie 10 42% Laramie Care Center Laramie 105 72% New Horizons Care Center Lovell 85 88% Weston County Health Services Newcastle 54 97% Sublette Center Pinedale 50 67% Powell Valley Care Center Powell 100 86% Kindred Nursing and Rehabilitation-Rawlins Rawlins 62 87% Kindred Nursing and Rehabilitation - Wind River Riverton 81 88% Deseret Health & Rehab at Rock Springs, LLC Rock Springs 82 72% Deseret Health & Rehab at Saratoga, LLC Saratoga 46 64% Green House Living for Sheridan Sheridan 48 52% Sheridan Manor Sheridan 128 64% Westview Health Care Center Sheridan 102 72% Crook County Medical Service District Long Term Care Sundance 32 76% Thermopolis Health Care Inc Thermopolis 60 77% Goshen Care Center Torrington 103 95% Platte County Memorial Nursing Home Wheatland 43 88% Worland Healthcare and Rehabilitation Center Worland 87 69% Total - Wyoming Nursing Homes 2,950 81% Source: Wyoming Department of Health, Healthcare Licensing and Surveys, Wyoming Healthcare Facility Directory, as of February 24, 2014. ---PAGE BREAK--- Converse County Long-Term Care Market Analysis Page 20 of 60 Assisted Living Facilities – U.S. Traditionally, long-term care in the United States has been resisted by the elderly because of a stigma attached to nursing homes as a place for “old folks” or a “place to die.” Today, however, many elders are choosing to move to a non-institutionalized alternative, called assisted living, or residential care communities. Assisted Living Facilities (ALFs) focus on providing necessary services in a home-type environment. ALFs have been the fastest growing segment of the long- term care market in the United States during the last 20 years. In 2012, the national daily use of residential care communities was 15 residents per 1,000 persons aged 65 and over. In 2012, (the year with the most recent estimates), the National Center for Health Statistics reported that there were about 22,200 Residential Care Facilities (ALFs) in the United States, with about 713,300 residents. Source: Long-Term Care Services in the United States: 2013 Overview. That report estimated that about 1.542% of the nation’s population of people aged 65 and over were living in ALFs. According to the Genworth 2013 Cost of Care Survey, the national median rate for assisted living in 2012 was $3,293 for a one-bedroom unit. Assisted Living Facilities – Wyoming The National Center for Health Statistics found that, in 2012, about 1.139% of Wyoming’s residents aged 65 and over were living in ALFs. That percentage is significantly lower than the national average, and even lower than the regional average for states that surround Wyoming. Wyoming’s low rate of use is especially evident in the following map, which shows the states that are significantly higher or lower than the national average. Source: National Center for Health, Long-Term Care Services in the United States: 2013 Overview. ---PAGE BREAK--- Converse County Long-Term Care Market Analysis Page 21 of 60 Current licensed assisted living facilities in the State of Wyoming, including their location, number of licensed beds, and occupancy level, are identified in the table below. Assisted Living Facility Community Licensed Beds Occupancy Beyond Home Inc Afton 13 74% Agape Manor Inc Buffalo 26 72% Beehive Home of Buffalo Buffalo 15 53% Veterans' Home of Wyoming Buffalo 117 73% Casper Assisted Living LLC Casper 50 86% Meadow Wind Assisted Living Community Casper 167 43% Mountain Plaza Assisted Living Casper 62 na Park Place Assisted Living Community Casper 116 52% Primrose Retirement Community of Casper Casper 42 80% Aspen Wind Assisted Living Community Cheyenne 94 62% Pointe Frontier Retirement Community Cheyenne 50 86% Primrose Retirement Community of Cheyenne Cheyenne 45 na Sierra Hills Assisted Living Community Cheyenne 100 68% Emeritus At Absaroka Cody, 51 89% Warm Valley Lodge Dubois 25 na Bee Hive Homes of Evanston Evanston 16 86% Tender Heart Assisted Living Evanston 16 75% Primrose Retirement Community of Gillette Gillette 45 42% River Rock Lodge Assisted Living Community Jackson 65 65% Showboat Retirement Center Lander 50 88% Spring Wind Assisted Living Community Laramie 117 51% New Horizons Assisted Living Facility Lovell 9 70% Mondell Heights Retirement Community Newcastle 23 74% The Heartland Powell 24 96% Deer Trail Assisted Living Rock Springs 62 30% Homestead Assisted Living Riverton 49 72% Emeritus at Sugarland Ridge Sheridan, 65 81% Sundance Assisted Care Sundance 15 76% Legacy Homes Assisted Living Thayne 16 79% Wyoming Pioneer Home Thermopolis 64 62% Total - Wyoming Assisted Living Facilities 1,609 59% It should be noted that the number of licensed beds often exceeds the actual number of beds that an operator seeks to fill, for a variety of reasons. Some have recently expanded and have not yet caught up to their current licensing levels. Additionally, several of the ALFs listed above are new, and have not yet stabilized their occupancy level. Two of the facilities are publicly owned/operated (Veterans’ Home of Wyoming and Wyoming Pioneer Home), and may not have the same marketing effort behind them. Finally, the number of licensed beds and the occupancy levels noted above are those found on the Wyoming Department of Health website, which reports those numbers as they exist on the date of their annual survey. Accordingly, the number of licensed beds listed above is actually higher than the actual number available, and the occupancy level is grossly understated. CBI surveyed all facilities and was able to obtain updated occupancy data from the majority of the licensed ALF's in the state. That information appears on the following page. ---PAGE BREAK--- Converse County Long-Term Care Market Analysis Page 22 of 60 For comparison purposes, this study will primarily examine other private pay ALFs, excluding the government-owned facilities. Assisted Living Facilities in Wyoming are licensed as either Level I or Level II, which is a secure unit memory care license. Wyoming had 26 non-state owned facilities in operation in 2013. These facilities have 1,383 licensed beds with approximately 122 of those being Level II, or Memory Care licensed beds. CBI phone surveys of those private pay assisted living facilities establish an average base cost of $2,933 for a studio unit, $3,263 for a 1 bedroom unit and $3,816 for a 2-bedroom unit. Currently, there are 772 residents in Level I facilities, resulting in a statewide private ALF occupancy level of 74%, compared to the 59% figure on the Healthcare Licensing website, as seen in the following table. ---PAGE BREAK--- Converse County Long-Term Care Market Analysis Page 23 of 60 WYOMING LICENSED ASSISTED LIVING FACILITIES (NON-GOVERNMENT OWNED) Community Total Licensed Beds Level I Capacity Current Occupancy Level I Current Level I % occupancy Level II Capacity Current Occupancy Level II Current Level II % occupancy Beyond Home Inc. Afton 13 11 9 82% Agape Manor Assisted Living Buffalo 26 25 10 40% 2 Beehive Home of Buffalo - Level II Buffalo 15 15 0 n/a 12 9 75% Garden Square of Casper Casper 50 48 44 92% Meadow Wind Assisted Living Community Casper 167 81 66 81% 17 17 100% Mountain Plaza Assisted Living Casper 62 50 na na 12 Park Place Assisted Living Community Casper 116 61 65 107% Primrose Retirement Community of Casper Casper 42 35 31 89% Aspen Wind Assisted Living Community Cheyenne 94 32 32 100% 39 39 100% Pointe Frontier Retirement Community Cheyenne 50 50 43 86% Sierra Hills Assisted Living Community Cheyenne 100 90 73 81% Emeritus at Absaroka Cody 51 51 45 89% Warm Valley Lodge Dubois 25 25 11 44% Bee Hive Homes of Evanston Evanston 16 8 7 88% 8 8 100% Tender Heart Assisted Living Facility Evanston 16 16 13 81% Primrose Retirement Community of Gillette Gillette 45 45 33 73% River Rock Lodge Assisted Living Community Jackson 65 57 23 40% Showboat Retirement Center Lander 50 35 27 77% Spring Wind Assisted Living Community Laramie 117 96 57 59% 21 15 71% New Horizons Assisted Living Facility Lovell 9 9 7 78% Mondell Heights Retirement Community Newcastle 23 20 20 100% The Heartland Powell 24 23 23 100% Homestead Assisted Living Riverton 49 43 40 93% Deer Trail Assisted Living Rock Springs 62 44 19 43% 13 7 54% Emeritus at Sugarland Ridge Sheridan 65 65 53 81% Sundance Assisted Care Sundance 15 15 11 76% Legacy Homes Assisted Living Thayne 16 13 10 77% 0 Total - Wyoming ALFs (non-government) 1,383 1,063 772 74% 122 97 83% Source: Wyoming Department of Health/Office of Healthcare Licensing and Surveys. Some data updated by CBI via emails and phone calls to facilities. ---PAGE BREAK--- Converse County Long-Term Care Market Analysis Page 24 of 60 As identified in the table above, Wyoming’s private Level 1 ALFs are currently operating at 74% of their design capacity. This number has decreased from 80% occupancy during the course of the previous 12 months, mirroring national trends. Finally, it should be noted that – unlike nursing homes – the State does not require proof that construction of an ALF is warranted by high occupancy rates in the area. Instead, recognizing that ALFs are primarily funded by private-pay residents, the government allows development of new or expanded ALFs to be determined by market demands. Therefore, this study will particularly explore the market areas level of demand and supply of ALFs. The chart on the following page compares ownership type, management structure, and base fees for types of rooms for each of the Wyoming Assisted Living Facilities who responded to the survey. As noted, the vast majority of assisted living facilities are private for-profit and are either owner-operated or operated by a contract senior housing management company. ---PAGE BREAK--- Converse County Long-Term Care Market Analysis Page 25 of 60 WYOMING LICENSED ASSISTED LIVING FACILITIES (NON-GOVERNMENT OWNED) Level I Level II Community Ownership Management Base Fee Base Fee Base Fee Payment Type Structure Studio 1 BR 2 BR Source Beyond Home Inc. X Afton Private for-profit Owner Operated $2,400 MW/PP Agape Manor Assisted Living X Buffalo private for-profit Mgt. Company $2,675 $3,465 $4,005 Private Pay Beehive Home of Buffalo - Level II X Buffalo private for-profit Owner Operated $4,375 $4,120 MW/PP Garden Square of Casper X Casper private for-profit Mgt. Company $3,295 MW/PP Meadow Wind Assisted Living Community X X Casper Private for-profit Mgt. Company $3,295 $4,195 MW/PP/VA Mountain Plaza Assisted Living X X Casper Park Place Assisted Living Community X Casper private for-profit Mgt. Company $3,700 $4,000 MW/PP Primrose Retirement Community of Casper X Casper private for-profit Owner-Operated $3,690 $4,075 Private Pay Aspen Wind Assisted Living Community X X Cheyenne private for-profit Mgt. Company MW/PP Pointe Frontier Retirement Community X Cheyenne Sierra Hills Assisted Living Community X Cheyenne private for-profit Mgt. Company $2,800 $3,100 $3,500 MW/PP Emeritus at Absaroka X Cody Warm Valley Lodge X Dubois Non-profit Owner operated $2,200 $2,800 $2,950 Private Pay Bee Hive Homes of Evanston X X Evanston private for-profit Owner Operated $2,500 MW/PP Tender Heart Assisted Living Facility X Evanston Private for-profit Owner Operated $2,350 $2,350 MW/PP Primrose Retirement Community of Gillette X Gillette Owner operated $4,500 $4,200 Private Pay River Rock Lodge Assisted Living Community X Jackson private for-profit Mgt. Company $3,792 $4,336 $4,882 MW/PP Showboat Retirement Center X Lander private for-profit Owner operated $1,700 $2,000 MW/PP Spring Wind Assisted Living Community X X Laramie private for-profit Mgt. Company $4,150 $4,500 Govt operated New Horizons Assisted Living Facility X Lovell Non-profit Owner operated $1,654 $1,645 Private Pay Mondell Heights Retirement Community X Newcastle private for-profit Owner-operated $2,500 $2,700 Private Pay The Heartland X Powell private for-profit Hospital district; private for-profit $2,844 Private Pay Homestead Assisted Living X Riverton private for-profit Owner-operated Deer Trail Assisted Living X X Rock Springs private for-profit Owner-Operated $3,500 $4,640 Private Pay Emeritus at Sugarland Ridge X Sheridan Sundance Assisted Care X Sundance Legacy Homes Assisted Living X X Thayne private for-profit Owner Operated $2,000 MW/PP Average - Wyoming ALFs (non-government) $2,933 $3,263 $3,816 Source: Wyoming Department of Health/Office of Healthcare Licensing and Surveys. Some data updated by CBI via emails and phone calls to facilities. MW-Medicaid Waiver PP - Private Pay ---PAGE BREAK--- Converse County Long-Term Care Market Analysis Page 26 of 60 In Wyoming, it is common to find that most ALF residents came from the same community where the ALF is located. However, there is a small percentage of other residents from outside the community, as seen in the following table. WYOMING LICENSED Where do residents come from? ASSISTED LIVING FACILITIES Community Local Community Within 50 Miles Other Wyoming Outside Wyoming Beyond Home Inc. Afton 90-100% Agape Manor Assisted Living Buffalo 80-89% 20-29% Beehive Home of Buffalo - Level II Buffalo 80-89% 20-29% Garden Square of Casper Casper 50-59% 20-29% 30-39% Meadow Wind Assisted Living Community Casper 90-100% 80-89% 70-79% <10% Mountain Plaza Assisted Living Casper Park Place Assisted Living Community Casper 70-79% 10-19% 80-89 <10% Primrose Retirement Community of Casper Casper 80-89% 10--19% Aspen Wind Assisted Living Community Cheyenne 50-59% 30-39% 10-19% <10% Pointe Frontier Retirement Community Cheyenne Sierra Hills Assisted Living Community Cheyenne 50-59% 30-39% 10-19% Emeritus at Absaroka Cody Warm Valley Lodge Dubois 80-89% 40-49% <10% Bee Hive Homes of Evanston Evanston 70-79% 10-19% <10% Tender Heart Assisted Living Facility Evanston 90-100% <10% Primrose Retirement Community of Gillette Gillette 80-89% 10-19% <10% River Rock Lodge Assisted Living Community Jackson 30-39% 20-29% 50-59% Showboat Retirement Center Lander 20-29% 80-89% Spring Wind Assisted Living Community Laramie 50-59% 20-29% 10-19% <10% New Horizons Assisted Living Facility Lovell 90-100% 10-19% <10% Mondell Heights Retirement Community Newcastle 90-100% 10-19% <10% The Heartland Powell 90-100% Homestead Assisted Living Riverton Deer Trail Assisted Living Rock Springs 80-89% <10% Emeritus at Sugarland Ridge Sheridan Sundance Assisted Care Sundance Legacy Homes Assisted Living Thayne 70-79% 20-29% Source: Wyoming Department of Health/Office of Healthcare Licensing and Surveys. Some data updated by CBI via emails and phone calls to facilities. Memory Care – U.S. In addition to limitations in physical abilities, many Americans have additional needs related to their mental abilities. For example, an estimated 5.2 million Americans of all ages have Alzheimer’s disease. This figure includes 5 million people aged 65 and older. About one in nine people aged 65 and older (11%) have Alzheimer’s disease. Estimates from various studies indicated that 45-67 percent of residents of assisted living facilities have Alzheimer’s disease or some other form of dementia. Yet, only 5% of assisted living beds are in Alzheimer’s special care units (as of June 2009, according to the most recent data available). Thus, it is clear that the great majority of nursing home residents with Alzheimer’s and other dementias are not in Alzheimer’s special care units. Source: Alzheimer’s Association, Alzheimer’s Disease Facts and Figures, 2013. ---PAGE BREAK--- Converse County Long-Term Care Market Analysis Page 27 of 60 According to the MetLife Market Survey of Long-Term Care Costs, the average assisted living base fee for Alzheimer’s and Dementia Care in 2012 is $4,807 per month. Memory Care – Wyoming The lack of memory care is profound in Wyoming. The state has more than 10,000 elderly residents with Alzheimer’s disease or some other form of dementia, but has only seven licensed Level II (Memory Care) assisted living facilities (with about 122 beds). Until recently, few Wyoming-licensed nursing facilities had secure memory care units. The Wyoming Department of Health does not track designated memory care units within skilled nursing facilities in the state. However, Goshen Care Center in Torrington opened a 28-bed secure memory care unit in the summer of 2010, and Douglas Care Center in Douglas opened a 20-bed memory care unit in December 2010. Based on a review of literature and interviews with existing ALF operators, there are several reasons for this lack of secure/memory care: Cumbersome regulations; relative cost of providing 24-hour LPN or RN care (versus CNA coverage); high demand for existing ALF services; and the high cost of providing (and paying for) dementia care services. Since there are so few established licensed assisted living memory care units in Wyoming (and thus little reliable data), the national median base cost will be used for this study. This assumption is reasonable, given that Wyoming average costs for long-term care in general is quite similar to national costs. ---PAGE BREAK--- Converse County Long-Term Care Market Analysis Page 28 of 60 C u r r e n t L o n g - T e r m C a r e S e r v i c e s This study notes that there are other long-term care services in all of the market areas. Because a broad continuum of care provides elders with a choice of where to live, it is important to note all the known services in the market. Within Converse County, the only nursing home is the Douglas Care Center. There are no assisted living facilities or boarding homes. There are nearly 100 senior residential apartment units in Douglas: Irwin Towers has 38 1-bed units and 12 2-bed apartments. Riverside Plaza I and II have 48 1-bed units. All three facilities have waiting lists. Glenrock’s Barber apartments have 21 apartments consisting of four 2-bed apartments, 16 1-bed apartments and 1 studio apartment. They also have a waiting list. The secondary market areas also have a number of long-term care facilities, as noted above. The total number of licensed beds in each market will offset any demand for long-term care in each respective market. There are a number of support services for seniors available in Converse County. These include:  Ann's Best Care LLC  Converse County Public Health Department  Douglas Senior Citizen Center  Dream Catcher Adult Day Care  Glenrock Health Clinic  Glenrock Senior Citizen Center  Memorial Hospital of Converse County  North Platte Physical Therapy  Wyoming Dept. of Family Services  Wyoming Independent Living ---PAGE BREAK--- Converse County Long-Term Care Market Analysis Page 29 of 60 D e s c r i p t i o n o f M a r k e t A r e a For this study, Converse County was designated as the primary market area to be studied. However, within the County, there are two areas designated by the U.S. Census Bureau as County Census Districts (CCDs). Conveniently, these two areas coincide with what many local residents know to be the “Glenrock area” and the “Douglas area.” These CCD’s have been separately as Primary Market areas in this study. The maps below show the two Primary Market areas. Glenrock Area Douglas Area Because the long-term care market can be fluid, and because many long-term care facilities draw residents from outside the immediate area, the State of Wyoming and the rest of the country are considered to be the Secondary Market for purposes of this feasibility study. ---PAGE BREAK--- Converse County Long-Term Care Market Analysis Page 30 of 60 D e m o g r a p h i c s Age The percentage of the population in age groups 45-64 and 65+ in the Primary Market area is greater than the state or country, as seen in the following graph. Source: Data from U.S. Census Bureau. Consequently, the Primary Market area will continue to have a relatively high percentage of elderly residents for the next 40-50 years. According to the most recent estimates from the U.S. Census Bureau, Converse County contained 14,008 residents as of July 1, 2012. The Wyoming Division of Economic Analysis forecasts the County to grow to 15,440 residents in the next five years (2017), and 16,260 in the next ten years (2022). By 2030, Converse County’s population is expected to grow to 17,270 residents (24.8% growth since 2010). The remarkable change during this time, though, is that the population of residents who are 65 years or older will more than double (from 1,776 to 3,707), rising from 12.8% to 21.5% of the County’s population. This remarkable growth rate is obvious in the following graph. 0% 5% 10% 15% 20% 25% 30% Under 18 18-24 25-44 45-64 65+ Population by Age Groups (2010 Census) USA Wyoming Converse Co. ---PAGE BREAK--- Converse County Long-Term Care Market Analysis Page 31 of 60 Source: Data from Wyoming Department of Administration and Information, Economic Analysis Division. Note that the growth of elderly residents in Converse County comes at a time that the prime working population those who are age 45-64 years) is actually shrinking. According to the 2010 Census, the median age of residents in the Douglas Area is 38.1 years, and the Glenrock Area is 41.3 year. Secondary Market residents are younger (36.8 years in Wyoming and 37.2 years in the United States). Moreover, because of the remarkable growth in the population of residents who are 65 years old or older, the median age of residents will rise much faster than in other areas. The population demographic analysis above supports the direction that community leaders in Converse County are now going to study the need for appropriate senior housing for local residents. 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Converse County Population Estimates by Age Group % (2010 - 2030) 65+ 45-64 25-44 18-24 Under 18 ---PAGE BREAK--- Converse County Long-Term Care Market Analysis Page 32 of 60 Income As the residents of the Primary Market area have aged, their income and their home values have grown. The Douglas Area market experienced a slight downturn in 2011, but is now growing much faster than state and national income levels, as seen in the following graph. Source: Data from U.S. Census Bureau, American Community Survey. Housing Median Home Values in the Primary Market area have generally increased, but not as evenly as income levels. As of 2012, the Median Home Value in the Douglas Area market was $189,400, and in the Glenrock Area market it was $170,300. From 2010 to 2012, the markets in the USA and Glenrock have been more volatile, as seen in the following graph. Source: Data from U.S. Census Bureau, American Community Survey. $0 $10,000 $20,000 $30,000 $40,000 $50,000 $60,000 $70,000 2010 2011 2012 Median Household Income (2010 - 2012) USA Wyoming Douglas Area Glenrock Area $150,000 $160,000 $170,000 $180,000 $190,000 2010 2011 2012 Median Home Values (2010 - 2012) United States Wyoming Douglas Area Glenrock Area ---PAGE BREAK--- Converse County Long-Term Care Market Analysis Page 33 of 60 T a r g e t M a r k e t A n a l y s i s The previous Section of this study conducted a demographic analysis of the Primary and Secondary Market Areas, and made the following key observations: 1. The target population of seniors aged 65 and older is growing. 2. The Primary Market Area target population is aging more quickly than the other areas. 3. As of 2010, the Converse County population aged 65 and older included 1,776 residents (12.8% of the total population). 4. By 2030, Converse County’s elderly population (age 65 and older) will have grown to 21.5% of the total County population 3,707 residents will be 65 or older). Likewise, the first section of this Study reviewed the long-term industry in Wyoming and the United States, and discovered important facts: 1. Of the nation’s population of seniors aged 65 and older, approximately 2.605% reside in a nursing home, and 1.542% reside in an assisted living facility. 2. National occupancies of long-term care facilities are high, but have dropped in the last few years. Nursing Homes are at 82.9% occupancy, and ALFs are currently operating at 90.5% occupancy (no accurate occupancy data exist for memory care units). 3. National and local surveys demonstrate that seniors will primarily seek privacy single-occupancy rooms) and quality of services when choosing long-term care (the exception: dementia care units). 4. Wyoming has 38 nursing homes licensed for 2,950 beds, operating at 80.9% occupancy. 5. Wyoming has 28 ALFs (public and private) licensed for 1,564 beds which are currently operating at 70% occupancy. 6. Wyoming has 122 memory care beds associated with assisted living facilities, including one Level II only facility in Buffalo, and a number of existing memory care beds located within existing skilled nursing facilities. ---PAGE BREAK--- Converse County Long-Term Care Market Analysis Page 34 of 60 Demographics A brief comparison of key 2012 demographics for each of the relevant Market Areas is contained the table below. Comparison of Market Areas (2012) Data Primary Market Primary Market Secondary Market Glenrock Area Douglas Area Wyoming USA Total Population 4,483 9,296 576,626 313,873,685 Aged 65 and older 648 1,169 70,372 40,671,441 Aged 65 and older % 14.5% 12.6% 12.2% 13.0% Aged 85 and older 65 125 8,705 5,512,132 Aged 85 and older % 1.4% 1.3% 1.5% 1.8% Median Age 38.0 40.7 36.9 37.2 Median Household Income $64,730 $61,364 $56,573 $53,046 Median Home Value $170,300 $189,400 $184,400 $181,400 Source: Data from U.S. Census Bureau and American Community Survey. In addition to the demographics above, two other factors are relevant to an analysis of the assisted living facility market: 1. The number of elderly who are considered “frail” or otherwise in need of services; and 2. The number of elderly who have sufficient income and/or assets to be able to afford the “private pay only” costs of the ALF. Analysis of those two items follows in the next section. ---PAGE BREAK--- Converse County Long-Term Care Market Analysis Page 35 of 60 Limitations with ADLs and IADLs As discussed above, “frail” elderly can be identified by evaluating abilities to perform certain functions, commonly called “activities of daily living” (ADLs). ADLs are the things normally done in life, including any daily activity performed for self-care (such as eating, bathing, dressing, or grooming), work, homemaking, and leisure. The ability or inability to perform ADLs is a very practical measure of ability/disability in many disorders. Those elderly citizens who have one or more limitations in performing ADLs are considered prime candidates for assisted living. Similarly, some elderly citizens struggle with so-called “instrumental activities of daily living” (IADLs), which are the activities often performed by a person who has been living independently in a community setting. IADLs would include activities such as managing money, shopping, telephone use, travel, housekeeping, preparing meals, and taking medications correctly. Surveys of persons with limitations in ADLs and IADLs have been conducted for many years by the Centers for Disease Control and Prevention (CDC). According to the CDC, the most recent data (2012) from the National Health Interview Surveys reveal these limitations, by age group, as seen in the table below. Limitations with ADLs and IADLs, by Age Group (2012) Age Group Limitation with: 1 or more ADL 1 or more IADL 18 - 44 years 0.64% 1.41% 45 - 64 years 1.89% 3.66% 65 - 74 years 3.26% 5.98% 75 years and over 10.47% 19.54% Source: Centers for Disease Control and Prevention, "Summary Health Statistics for the U.S. Population: National Health Interview Survey, 2012.” [Note: the population of persons with limitations in ADLs may overlap with the population of persons with limitations in IADLs. In other words, the two populations are not necessarily mutually exclusive.] According to the CDC, their surveys draw from large enough samples as to produce reliable estimates of the percentages of people with limitations in ADLs and IADLs, by age group. This study assumes that the 2012 distribution (percentages) of persons with limitations in performing ADLs and IADLs remains the same for the current analysis. With that assumption, application of the CDC’s findings to the relevant age group population in 2012 for each Market Area appears in the table below. The reality is that the limitations with ADLs and IADLs for elderly residents in Converse County happens at a higher rate than the national average. According to the Centers for Disease Control and Prevention, such rates are higher for Western states (such as Wyoming), and for people living outside of large metropolitan areas (such as rural Converse County). ---PAGE BREAK--- Converse County Long-Term Care Market Analysis Page 36 of 60 Persons with Limitations in ADLs and IADLs, by Market Area and by Age Group (2012) Market Area Percentage and Number of Persons 65-74 75+ Total 65+ PRIMARY Glenrock Area: 7.78% 6.67% 14.45% # in age group 349 299 648 Limitation in ADL % 3.26% 10.47% 6.59% Limitation in ADL # 11 31 43 Limitation in IADL % 5.98% 19.54% 12.24% Limitation in IADL # 21 58 79 PRIMARY Douglas Area: 7.37% 5.21% 12.58% # in age group 685 484 1,169 Limitation in ADL % 3.26% 10.47% 6.24% Limitation in ADL # 22 51 73 Limitation in IADL % 5.98% 19.54% 11.59% Limitation in IADL # 41 95 136 SECONDARY State of Wyoming: 6.89% 5.29% 12.18% # in age group [net of Markets above] 38,779 29,776 68,555 Limitation in ADL % 3.26% 10.47% 6.39% Limitation in ADL # 1,263 3,118 4,381 Limitation in IADL % 5.98% 19.54% 11.87% Limitation in IADL # 2,320 5,818 8,138 United States: 7.01% 5.95% 12.96% # in age group [net of Markets above] 21,972,248 18,628,821 40,601,069 Limitation in ADL % 3.26% 10.47% 6.57% Limitation in ADL # 715,431 1,950,786 2,666,217 Limitation in IADL % 5.98% 19.54% 12.20% Limitation in IADL # 1,314,397 3,639,818 4,954,216 Total [all Areas] 22,012,061 18,659,380 40,671,441 Source: Data from U.S. Census Bureau, American Community Survey, and Centers for Disease Control and Prevention. Using this analysis, the Primary Market-Glenrock Area contains 648 persons who are aged 65 or older. Of those 648 residents, 43 have limitations with at least one ADL and 79 are limited in IADLs. Similarly, the Primary Market-Douglas Area contains another 1,169 persons who are aged 65 or older. Of those 1,169 residents, 73 are limited with at least one ADL and 136 are limited with IADLs. The Secondary Market Area in the table above contains the Primary Market Areas above it, so the numbers of persons in the Secondary Market Area have been adjusted to exclude the population of the Primary Market Areas no person is counted more than once in any particular group). Accordingly, one would add the total numbers of persons in each Market Area to determine the total target population. To determine the total target population of residents who are aged 65 or older in the Primary Market Areas, one would add them together and find that there are 1,817 residents aged 65 or older in those two combined areas, with 116 residents limited with ADLs and 215 limited with IADLs. ---PAGE BREAK--- Converse County Long-Term Care Market Analysis Page 37 of 60 Additionally, the entire population of adults all persons aged 18 and older) could be included the table above According to the Centers for Disease Control, the adult population in the Glenrock Area with limitations performing ADLs is probably around 69 people, and around 147 in the Douglas Area. All such adults could be considered to be a part of the target market, since assisted living facilities are licensed and capable of meeting the needs of any adult who has limitations in ADLs, not just those who are aged 65 and older. However, the majority of persons with limitations in ADLs are those who are 65 and older, and the Primary Market areas’ residents are clearly focused on housing for seniors. This calculation of residents who have limitations with ADLs and IADLs is current as of 2012, which is used as a base year in this analysis because there is good data available for all areas and for all analytical factors. However, it is important to consider whether future demographic trends justify the development of new long-term care facilities. Using Census Bureau population projections for 2017, the relevant age group populations in 2017 for each Market Area would be as follows. Persons with Limitations in ADLs and IADLs, by Market Area and by Age Group (2017) Market Area Percentage and Number of Persons 65-74 75+ Total 65+ PRIMARY Glenrock Area: 7.78% 6.67% 20.77% # in age group 547 384 931 Limitation in ADL % 3.26% 10.47% 6.23% Limitation in ADL # 18 40 58 Limitation in IADL % 5.98% 19.54% 11.57% Limitation in IADL # 33 75 108 PRIMARY Douglas Area: 10.22% 6.17% 16.39% # in age group 950 574 1,524 Limitation in ADL % 3.26% 10.47% 5.97% Limitation in ADL # 31 60 91 Limitation in IADL % 5.98% 19.54% 11.09% Limitation in IADL # 57 112 169 SECONDARY State of Wyoming: 10.03% 6.28% 16.31% # in age group [net of Markets above] 56,461 35,350 91,811 Limitation in ADL % 3.26% 10.47% 6.03% Limitation in ADL # 1,838 3,702 5,540 Limitation in IADL % 5.98% 19.54% 11.20% Limitation in IADL # 3,378 6,907 10,284 United States: 7.01% 5.95% 12.96% # in age group [net of Markets above] 21,972,248 18,628,821 40,601,069 Limitation in ADL % 3.26% 10.47% 6.57% Limitation in ADL # 715,431 1,950,786 2,666,217 Limitation in IADL % 5.98% 19.54% 12.20% Limitation in IADL # 1,314,397 3,639,818 4,954,216 Total [all Areas] 22,030,206 18,665,129 40,695,335 Source: Data from U.S. Census Bureau, American Community Survey, Wyoming Division of Economic Analysis, and Centers for Disease Control and Prevention. ---PAGE BREAK--- Converse County Long-Term Care Market Analysis Page 38 of 60 Using the same analysis as earlier – but with the projected population growth for 2017 – the Primary Market Area is projected to contain 2,455 persons who are aged 65 or older. Of those 2,455 residents, the projection is that there will be 149 residents limited with at least one ADL and 277 limited in IADLs. In other words, the target population of “frail” elderly citizens is projected to grow significantly in the near (and long term) future. In fact, the local population aged 65 and older is projected to grow 35% from 2012 to 2017, while the total local population is growing just 12% during that same time! Income and Housing According to the sources cited above, the median cost of nursing home care in Wyoming is $6,038 for semi-private rooms and $6,327 for private rooms. The median cost for a private single bedroom unit in an assisted living facility in Wyoming is $3,300 per month. The rates are higher in Casper, Wyoming (which is the closest large community for Converse Country). The median nursing home rate in Casper is $6,418 for a semi-private room and $6,874 for a private room. The median assisted living facility rate in Casper is $4,100 per month. There are no known national surveys that provide state-level detail for Alzheimer’s and Dementia Care. However, according to the most recent MetLife Market Survey of Long-Term Care Costs, the average nursing home rate for Alzheimer’s and dementia care is $7,939 (private room) and $6,996 for a semi-private room. That same study found that the national average base rate for Alzheimer’s and dementia care in an assisted living facility is $4,807. Recognizing that payment of those long-term costs comes from a variety of sources (private pay, long-term care insurance, Medicaid, and Medicare, etc.), prospective residents must have appropriate levels of income to pay these costs. Of course, when moving into any form of long- term care facility, many elderly people will sell their home and/or have other personal assets to pay the costs of their care. Still others will be assisted by their family or have private long-term healthcare insurance. Given the average costs and sources of payment noted above, this study assumes that future nursing home residents will likely need to have income of at least $15,000; future assisted living facility residents will need income of at least $35,000; and future residents of memory care units will need annual income of at least $50,000. To complete the market analysis, then, one must examine Household Income levels, as the following chart demonstrates. ---PAGE BREAK--- Converse County Long-Term Care Market Analysis Page 39 of 60 Householders Aged 65+ Income Bracket Percentages Income bracket for Householders 65 years and over Primary Market Primary Market Secondary Market Glenrock Area Douglas Area State of Wyoming United States Percent Percent Percent Percent Less than $10,000 8.7% 8.8% 5.8% 7.5% $10,000 to $14,999 7.7% 14.4% 9.7% 9.7% $15,000 to $19,999 5.5% 7.9% 10.3% 9.2% $20,000 to $24,999 13.5% 9.2% 8.3% 8.3% $25,000 to $29,999 1.6% 7.0% 7.7% 7.5% $30,000 to $34,999 12.1% 11.1% 6.7% 6.5% $35,000 to $39,999 7.9% 7.6% 6.0% 5.8% $40,000 to $44,999 2.4% 8.2% 6.1% 5.1% $45,000 to $49,999 1.6% 3.5% 5.0% 4.5% $50,000 to $59,999 2.1% 2.2% 7.4% 7.5% $60,000 to $74,999 15.8% 3.9% 8.9% 8.2% $75,000 to $99,999 11.3% 9.4% 7.9% 8.2% $100,000 to $124,999 4.7% 4.0% 4.0% 4.5% $125,000 to $149,999 5.0% 1.3% 2.5% 2.5% $150,000 to $199,999 0.0% 0.0% 1.5% 2.4% $200,000 or more 0.0% 1.6% 2.1% 2.6% $15,000 or more 83.6% 76.8% 84.5% 82.9% $35,000 or more 50.9% 41.7% 51.5% 51.4% $50,000 or more 39.1% 22.3% 34.3% 36.0% Source: Data from U.S. Census Bureau and American Community Survey.  In the Glenrock Market Area: o 83.6% of those who are aged 65 or older could afford nursing home care o 50.9% could afford assisted living o 39.1% could afford memory care. o  In the Douglas Market Area: o 76.8% of those who are aged 65 or older could afford nursing home care o 41.7% could afford assisted living o 22.3% could afford memory care ---PAGE BREAK--- Converse County Long-Term Care Market Analysis Page 40 of 60 T h e U n m e t N e e d The next step in the analysis is to compare average long-term care use rates facilities, with the more specific analysis of the numbers of persons in each market who have limitations in performing ADLs AND have sufficient income to pay for services. By calculating the midpoint of these two methods, and subtracting the current supply of services in each market, one can calculate the net unmet need for long-term care. The following table shows those calculations for nursing home care. Analysis to Determine Nursing Home Market Feasibility (2012) MARKET AREA Primary Market Primary Market Secondary Market ALL AREAS Glenrock Area Douglas Area State of Wyoming United States Total # Residents Aged 65 or older 648 1,169 68,555 40,601,069 40,671,441 Wyoming Average # Nursing Home Beds 16 30 1,782 1,057,657 1,478,015 # Limited in ADLs 43 73 4,381 2,666,217 2,670,714 % with Financial Resources 83.6% 76.8% 84.5% 82.9% 82.9% # with ADLs & Resources 36 56 3,702 2,209,490 2,213,283 Midpoint of above estimates 26 43 2,742 1,633,573 1,636,384 Current # of Nursing Home Beds in Area 0 60 2,890 1,666,150 1,703,846 Net Unmet Need in Area beds) 25 -17 -148 -32,577 -67,462 Thus, by this measure of market feasibility, there are 25 persons in the Glenrock area who may need nursing home care AND can afford to pay for that care, but are not currently receiving services locally. However, much of that local need is likely provided in the Douglas area, since the net need there is actually negative. Similar methodology is used to calculate the unmet need for assisted living, as shown in the following table. ---PAGE BREAK--- Converse County Long-Term Care Market Analysis Page 41 of 60 Accordingly, there are 15 persons in the Glenrock area and 24 persons in the Douglas area who may need assisted living AND can afford to pay for that care. Since there are no assisted living facilities in Converse County, none of these people are getting the services they need. Because all memory care residents suffer from Alzheimer’s disease or some other form of dementia, they all have significant limitations in their ability to perform ADL’s. Accordingly, a simplified approach can be taken to calculate the unmet need, as follows. Analysis to Determine Memory Care Market Feasibility (2012) MARKET AREA Primary Market Primary Market Secondary Market ALL AREAS Glenrock Area Douglas Area State of Wyoming United States Total # Residents Aged 65 or older 648 1,169 68,555 40,601,069 40,671,441 US estimate (11%) with Dementia 71 129 7,541 4,466,118 4,473,859 US Average (1.65%) in dedicated units 1 2 124 73,753 73,881 US estimate (11%) with Dementia 71 129 7,541 4,466,118 4,473,859 % with Financial Resources 39.1% 22.3% 34.3% 36.0% 36.0% # with ADLs & Resources 28 29 2,589 1,608,487 1,611,133 Midpoint of above estimates 14 15 1,357 841,120 842,507 Current # of dedicated Dementia Care units in Area 0 20 102 84,099 84,221 Net Unmet Need in Area beds) 14 -5 1,254 757,021 758,285 With this analysis, it appears that there are 14 persons in the Glenrock area who have some form of dementia AND can afford to pay for memory care. However, given the proximity of Douglas (where there are more services than locally demanded), the Converse County market for dementia care may currently be sufficiently met. Summary of Analysis to Determine Assisted Living Facility Market Feasibility (2012) MARKET AREA Primary Market Primary Market Secondary Market ALL AREAS Glenrock Area Douglas Area State of Wyoming United States Total # Residents Aged 65 or older 648 1,169 68,555 40,601,069 40,671,441 US Average (1.54% of 65+) # in ALFs 9 18 1,057 626,068 627,152 # Limited in ADLs 43 73 4,381 2,666,217 2,670,714 % with Financial Resources 50.9% 41.7% 51.5% 51.4% 51.4% # with ADLs & Resources 22 30 2,255 1,370,750 1,373,057 Midpoint of above estimates 15 24 1,656 998,409 1,000,104 Current # of ALF Beds in Area 0 0 1,383 850,017 851,400 Net Unmet Need in Area beds) 15 24 272 148,392 148,704 ---PAGE BREAK--- Converse County Long-Term Care Market Analysis Page 42 of 60 Pulling together all of the information and analysis above, this study concludes that there is growing market demand for long-term care services in Converse County. In fact, extending the above analysis out to 2017, the market demand will continue to grow, as seen in the following table. Market Growth Forecast, by Market Area and Year DEMAND FOR NURSING HOME UNITS Market Area Primary Market Primary Market Secondary Market ALL AREAS Year Glenrock Area Douglas Area State of Wyoming United States Total 2012 25 -17 -148 -32,577 -32,717 2013 27 -15 10 -6,271 -6,249 2014 29 -13 169 20,034 20,220 2015 32 -10 327 46,340 46,688 2016 34 -8 486 72,645 73,157 2017 36 -6 644 98,951 99,625 DEMAND FOR ASSISTED LIVING FACILITY UNITS Market Area Primary Market Primary Market Secondary Market ALL AREAS Year Glenrock Area Douglas Area State of Wyoming United States Total 2012 15 24 272 148,392 148,704 2013 17 25 368 163,963 164,373 2014 18 27 463 179,534 180,042 2015 19 28 559 195,106 195,712 2016 20 29 654 210,677 211,381 2017 22 30 750 226,248 227,050 DEMAND FOR MEMORY CARE UNITS Market Area Primary Market Primary Market Secondary Market ALL AREAS Year Glenrock Area Douglas Area State of Wyoming United States Total 2012 14 -5 1,254 757,021 758,284 2013 15 -4 1,346 798,861 800,218 2014 16 -3 1,438 840,701 842,152 2015 18 -3 1,530 882,540 884,085 2016 19 -2 1,622 924,380 926,019 2017 20 -1 1,714 966,220 967,953 ---PAGE BREAK--- Converse County Long-Term Care Market Analysis Page 43 of 60 O w n e r s h i p a n d M a n a g e m e n t There are many possible ownership vehicles for one or more assisted living facilities (ALFs) in Converse County, depending on final development decisions. As an overview, the following possibilities exist: Private Owners – The most common type of ALF ownership is private, for-profit entities. Because ALF services typically generate positive cash flow, they are attractive investments. Many ALFs are owned by national chains and publicly traded companies. This ownership model emphasizes bottom line profits, and generally focuses on the high-end of private paying customers (not Medicaid or other low-income financing). Non-Profit Organization – Some ALFs are owned by local not-for-profit organizations. This type of ownership emphasizes local control, responsiveness to community concerns, and an inclusive sales approach. Residents from all levels of income are welcome, including those who rely on public assistance such as Medicaid. Government Owners – Very few ALFs are owned by government entities. Those that are publicly owned are often associated with a county hospital/nursing home or a federal- funded program (such as the Veterans Administration). Hybrid Model – It is possible to mix different ownerships of an ALF by splitting the ownership of the facility from the operation or management of ALF services. For example, given the Converse County community’s clear desire to have affordable, high quality ALF services, it may be best for the facility (or facilities) to be developed and owned by a governmental entity, which would open a door for seeking state and federal grant funds to help pay construction costs. A municipality, the County, the Hospital District, or a joint powers board would be eligible to apply for grants. After construction, the governmental entity could then contract with a non-profit organization (or even a for-profit company) to manage the ALF. A non-profit organization would be able to conduct fundraising to help reduce capital construction costs, and it could also help to lower operational costs. Ultimately, the decision about ownership of any proposed ALF will be determined by those who commit to constructing and operating it. In conjunction with ownership of the ALF, many management decisions regarding the proposed facility (or facilities) must be made. Many of these decisions will impact the quality of construction, size or rooms, amount and terms of debt service (if any), quality of care, efficiency of operations, cost to residents, profit (if any), and other key factors. As noted in a previous section, in Wyoming, only two of the 26 non-government licensed Assisted Living Facilities (Warm Valley Lodge in Dubois and New Horizons ALF in Lovell) operate ---PAGE BREAK--- Converse County Long-Term Care Market Analysis Page 44 of 60 under the auspices of a non-profit entity. Approximately half of those who responded to the survey conducted by CBI are owner-operated and half utilize the services of a long-term care management company such as Edgewood Senior Living (Casper, Cheyenne and Laramie), or Rural Health Development, a Healthcare Consulting and Management Company based in Nebraska (Platte County Nursing Home and to-be-constructed Assisted Living Facility). L o c a t i o n / S i t e S e l e c t i o n O p t i o n s The ideal site within each community will be in a neighborhood complemented by the addition of an assisted living facility (ALF). It will have ample space for the expansion of independent housing units or additional ALF's on the property. Compatible zoning, accessible utilities, stable, well drained soils, and excellent street and pedestrian access are other important factors to consider. The ideal ALF will be removed from undesirable industrial activity and traffic hazards, but convenient to important public facilities and/or recreational areas. Land availability, land use, public sentiment and other community issues can have an important influence on site selection. A complete Site Selection Matrix is beyond the scope of this long- term care study. However, there are several factors that should be taken into consideration in determining the best location in either Douglas or Glenrock for a new Assisted Living Facility. A Sample Site Selection Matrix could include the following criteria: Sample Site Evaluation Matrix Weight Factor Douglas Sites Glenrock Sites Site 1 Site 2 Site 3 Site 4 Site 1 Site 2 Site 3 Social and Land Use Factors Current zoning and/or need for rezone or conditional use permit Proximity to key existing facilities (healthcare, recreation, shopping, etc.) Proximity to future expansion of community Accessibility (design capacity of streets - speed, volume, width, etc.) Proximity to Emergency Vehicle Response (police, fire, ambulance) Site Topography Aesthetic Value Site Availability (free of legal encumbrances, platted and surveyed, identifiable owner, etc.) Noise (vehicle traffic, industrial uses, air traffic, etc.) Environmental Review (wetlands, hazards, sensitive areas, etc.) ---PAGE BREAK--- Converse County Long-Term Care Market Analysis Page 45 of 60 Sample Site Evaluation Matrix Weight Factor Douglas Sites Glenrock Sites Site 1 Site 2 Site 3 Site 4 Site 1 Site 2 Site 3 Construction Cost Factors Site Soils Availability of water and sewer utilities Availability of electricity, natural gas, telephone, internet, CATV Other Infrastructure Site Cost Existing site development (vacant, undeveloped; demolition needs, etc.) Operational and Maintenance Cost Factors Site Drainage Sun Orientation Proximity to Natural Hazards Size of Site Building footprint Service Area (dumpsters, loading and access for food and supplies) Vehicle Parking (employee and resident) Visitor Parking Walkways Landscape area Outdoor Recreation area Summary Weight Factor Douglas Sites Glenrock Sites Site 1 Site 2 Site 3 Site 4 Site 1 Site 2 Site 3 Social and Land Use Factors Construction Cost Factors Operational and Maintenance Cost Factors Size of Site TOTAL Several locations have been proposed in Glenrock and Douglas for an ALF. In Glenrock, the following sites have been suggested:  Recently vacated property owned by Converse County. This was the site of the county shop. ---PAGE BREAK--- Converse County Long-Term Care Market Analysis Page 46 of 60 o Zoned General Business. o Building would need to be demolished. o Utilities are on-site.  Lincoln Building, owned by the Town of Glenrock. Upstairs was designed for apartments and could be remodeled to support this effort. o Zoned Central Business District. o Building has been determined structurally sound. o There is some asbestos abatement required.  Land owned by the Glenrock Hospital District, west and south of the existing Glenrock Health Clinic. o Zoned Single Family Residential – undeveloped. o Water and sewer would need to be extended.  Land owned by the Town of Glenrock west of Barber Apartments. o Zoned Single Family Residential – undeveloped. o Water and sewer are available to the property. In Douglas, the following general zoning code provisions apply:  Assisted Living Facilities require a conditional use permit in any R-1 (single-family residential) or R-2 (duplex or townhome) zone. They are an allowed use in R-3 (multi- family residential) and above zones (excluding Industrial zones, which do not allow any residential uses).  The City Council may make the granting of a conditional use permit subject to reasonable limitations or conditions as it may deem necessary to enhance the appearance of the property, to reduce the adverse effects on nearby property, to preserve the character of the area, or to make the conditional use more acceptable in other ways. The following Douglas sites have been suggested:  John Lambert Subdivision (Douglas Raceway Property - East Richards) o Current Zoning - B-2 (allowable use) o Unplatted o Completely undeveloped, and will need substantial upgrades for utility extensions and other infrastructure. o Current Owner - Converse County o Advantage - owned by Converse County; public ownership  Current EWC Building (6th and Walnut) o Current Zoning - R-1 o Platted and currently occupied o Would require extensive design/remodel and/or demolition o Current Owner - Converse County School District #1 o Advantage - near MHCC and downtown; public ownership now ---PAGE BREAK--- Converse County Long-Term Care Market Analysis Page 47 of 60  East of Current EWC Building (7th and Walnut) o Current Zoning - R-1 o Platted; former football field/track o Would require extensive earthwork to bring to grade o Current Owner - Converse County School District #1 o Advantage - near MHCC and downtown; public ownership  East of Medical Office Building - between Center and Walnut Street o Current Zoning - R-1 o School Maintenance Building and private residences o Current Owner(s) - Converse County School District 31; Rodney York o Advantage - adjacent to MHCC Medical Building  Douglas Business Park o Current Zoning - Planned Light Industrial o May be covenants restricting residential use o Current Owner - Granite Peak Properties, LLC  Northeast of Williams Street o Vacant; unplatted parcel o Zoning - R-1 o Access issues to this subdivision o Current Owner - Gay Bolln Family Trust  Douglas Care Center - 12th and Birch o Expansion to current Douglas Care Center Nursing Home o Current Zoning - R-1 o Current Owner - Douglas Care Center, LLC o This site could only be developed by the current owner(s) o Advantage - current owner is proceeding with possible ALF development  Northeast of Logsden Lane (east of Douglas High School football field) o Currently outside of City Limits o No zoning o Current Owner - Victor E. Garber o Would need annexation, subdivision and platting, extension of all utilities and infrastructure After ownership and management decisions are made, potential locations can be better assessed using the proposed site selection matrix. It is possible that some sites would help to lower the overall development cost, while others would increase it. E c o n o m i c F e a s i b i l i t y Like any business, an assisted living facility (ALF) must be well managed to succeed. However, if a proposed ALF is managed according to industry-specific best practices, it can generally earn a ---PAGE BREAK--- Converse County Long-Term Care Market Analysis Page 48 of 60 fair profit. To that end, this analysis uses national medians (based on the number of ALF residents) to determine appropriate staffing levels and non-wage costs. ALF Size The national median for size of assisted living facilities is to construct 388 square feet of common area for each resident (who rents 536 square feet of living space). Thus, the national median for ALFs includes 923 square feet for each ALF resident. Of course, with all projects, there will be local constraints and preferences that deviate from national medians. However, national medians nonetheless provide a good perspective for feasibility studies such as this planning project. Availability and Cost of Labor Wyoming wages lag behind national averages. Median wages in Wyoming for key occupations is provided in the following table. Wyoming Median Wages by Occupation (Sep. 2013) Occupation Median Hourly Wage Administrative: Medical and Health Services Managers $38.43 Office & Administrative Support $15.11 Dietary: Cooks, Institution and Cafeteria $12.55 Housekeeping: Maids & Housekeeping Cleaners $9.18 Maintenance: Maintenance & Repair Workers $18.60 Skilled Nursing (RN): Registered Nurses $29.40 Nursing Aids (CNA): Nursing Assistants $13.50 Other: Healthcare Social Workers $23.95 Sales Reps, Services $28.78 All occupations in Wyoming $18.06 Source: Source: Wyoming Department of Workforce Services, Wyoming Wage Survey, May 2012 estimates updated to September 2013. These wages can be used to determine base wage costs to help determine the economic feasibility of an ALF. For purposes of this study, national medians for staffing level (per resident) are used to estimate the number of full-time equivalent (FTE) employees who will be hired to operate the facility. Those national median FTE staffing levels are provided in the following table. ---PAGE BREAK--- Converse County Long-Term Care Market Analysis Page 49 of 60 ALF Staff (Full Time Equivalent): National Median FTE % FTE Per bed Administrative FTE 8% 0.04 Dietary 20% 0.10 Housekeeping 6% 0.03 Maintenance 4% 0.02 Marketing 2% 0.01 Assisted Living/CNAs 56% 0.28 Skilled Nursing 8% 0.04 Other 4% 0.02 TOTAL 100% 0.50 Source: National Investment Center (NIC), et al, State of Seniors Housing (2010). These staffing ratios are built into a model that can estimate total FTE by occupation (along with other costs – see below). It should be noted that, for many years, most Wyoming communities (including Converse County) have endured a shortage of employees, particularly in the healthcare industries. Therefore, before proceeding with this project, a detailed business plan should be prepared for this project, taking into consideration local wages and staffing supply. Non-Wage Costs National medians for non-wage costs have been calculated by the ALF industry. These costs are provided in the following table. Non-Wage Expenses National Median Cost $ per resident Food $1,706 Housekeeping $92 Insurance - Liability $107 Insurance - Property $411 Marketing/Advertising $480 Repairs & Maintenance $1,061 Taxes - Property $988 Utilities $1,520 Other $2,101 TOTAL $8,466 Most non-wage expenses for ALFs in Wyoming are comparable to the national median, with two exceptions: food and utilities. Food costs in Wyoming are often higher than the rest of the nation. However, those costs are offset by lower utility costs. Utilities in Wyoming are among the lowest in the nation. Abundant natural resources in the area, as well as efficient utilities, translate to relatively low operating costs in most areas of the state (including Converse County). Local electric rates for small businesses (such as an ALF) are about $0.11 per kilowatt (kWh), and local gas rates are about $7.00 per dekatherm (1 million BTU). Larger business ---PAGE BREAK--- Converse County Long-Term Care Market Analysis Page 50 of 60 operations are often able to negotiate lower utility rates. There is abundant capacity in Converse County for considerable growth, and so a new ALF can be accommodated with ease. Financial Feasibility A basic model to calculate financial feasibility, using the national and Wyoming median costs for wages and other items, suggests that an ALF may struggle financially, especially if it must carry significant debt. As a starting point, this study makes the following assumptions: 1. An ALF is to be built and operated according to national and Wyoming medians, including wages and non-wage operating costs. 2. Construction costs for a new ALF will be $200 per square foot. 3. Land, utilities, and all other pre-development costs will be donated or otherwise provided at no additional cost. 4. Construction/permanent loans can be arranged for a 30-year term at 6% interest per annum. 5. An operating reserve equal to 1-year of all operating costs is necessary during the first two years of operation, since it will take up to two years to fill the ALF to capacity. 6. Profit (or operating margin) of 10% is desired. If those assumptions are made, development of new ALF services in Converse County can be accomplished if ALF resident costs are set high enough to cover 100% of all costs. Initial calculations suggest that ALF residential costs must be set at or above $3,817/month ($45,802/year) with these assumptions. If construction costs were eliminated the developer successfully secured grants and/or contributions to pay for all construction costs), then ALF rates could be reduced to $2,412/month, or $28,940/year. [Note: Appendix D includes several financial feasibility scenarios for ALFs that include 12, 20, or 32 units, with and without debt. This study earlier made the assumption that ALFs could be built and operated in Converse County based on charging the median rent paid in Wyoming for ALF services at about $3,330/month, there is a unmet need in Glenrock of 15-22 ALF units and, in Douglas, 24-30 ALF units, from 2012 to 2017). Obviously, it is critical to consider the impact of debt service on any proposed project. The calculations above, based on the assumptions listed above, strongly suggest that any ALF in Converse County will be strongly influenced by the amount of debt that must be serviced. If, for example, the calculation of unmet need for local ALF services were based on lower rates (such as $30,000 per year), then the market grows appreciably, as seen in the following table. ---PAGE BREAK--- Converse County Long-Term Care Market Analysis Page 51 of 60 DEMAND FOR ASSISTED LIVING FACILITY UNITS ($30,000+) Market Area Primary Market Primary Market Secondary Market ALL AREAS Year Glenrock Area Douglas Area State of Wyoming United States Total 2012 18 28 419 235,002 235,467 2013 19 30 522 250,573 251,145 2014 21 31 626 266,144 266,822 2015 22 33 729 281,716 282,500 2016 24 34 833 297,287 298,177 2017 25 36 936 312,858 313,855 Similarly, if debt service forces the ALF operator to increase costs to $45,000 per year, then the unmet need shrinks considerably, as seen in the following table. DEMAND FOR ASSISTED LIVING FACILITY UNITS ($45,000+) Market Area Primary Market Primary Market Secondary Market ALL AREAS Year Glenrock Area Douglas Area State of Wyoming United States Total 2012 13 18 6 2,999 3,037 2013 14 19 87 18,570 18,691 2014 15 20 169 34,142 34,346 2015 17 21 250 49,713 50,001 2016 18 22 332 65,285 65,656 2017 19 23 413 80,856 81,311 Accordingly, a determination of ALF size should be made in conjunction with final business decisions about capital needs and costs. Overall Economic Impact of Project If a 12-unit ALF is built in Glenrock, and a 20-unit facility ALF is built in Douglas, significant economic impacts will be generated, including jobs and taxes. The U.S. Bureau of Economic Analysis’ Regional Input-Output Modeling System, more commonly known as RIMS II, is a helpful tool to calculate economic impacts. RIMS II multipliers are used to estimate economic impacts. They quantify the cumulative effects on total industry output, earnings, employment, and value added that result from a change in final demand. The multipliers are derived from two sources: A national input-output table—an accounting framework that shows the distribution of the inputs purchased and outputs sold—and regional data, which are used to adjust the national input-output table to reflect the a region’s industrial structure and trading patterns. Jobs impacts estimated using the final-demand and direct-effect employment multipliers include both part-time and full-time employees. The RIMS II model is a well- respected resource for measuring total economic impacts, is easily accessible, relatively inexpensive, and customizable to the county level. For this analysis, the most recent RIMS II annual data for the State of Wyoming is used. Type II multipliers are used because they include induced effects. The construction phase is based on ---PAGE BREAK--- Converse County Long-Term Care Market Analysis Page 52 of 60 construction industry multipliers; the business operations phase uses the particular industry multipliers the “Nursing and residential care facilities” industry sector. All multipliers are used to estimate impacts based on the “demand” of each phase. For construction, demand is the total building cost. Demand produced annually per employee is based on multipliers of the direct jobs that are created for each ALF. RIMS II reports two different employment multipliers — total employment and direct-effect multipliers — that are used to estimate final demand per employee. For example, using the national medians for size, a 20-unit ALF in Douglas would require construction of an 18,469 square foot facility. At $200 per square foot, such a facility would cost nearly $3.7 million to construct. Construction of the facility would create 52 jobs and a total economic output of $6.4 million. Subsequent business operations at the ALF would create 13 jobs and nearly $1 million of economic output each year. Additionally, new excise and property taxes of $46,540 would be generated, as seen in the following table. 20-unit Assisted Living Facility (Douglas, WY) Construction Phase Multipliers Base Cost Total Impact Total Employment 14.1577 $3,693,891 52 Total Earnings 0.5893 $3,693,891 $2,176,810 Total Output 1.7276 $3,693,891 $6,381,566 Local Sales Tax Generated 3.500% $3,693,891 $76,188 State Tax Generated 2.500% $3,693,891 $54,420 Business Operations Multipliers Base Demand Annual Impact Total Employment 21.7712 10 13 Total Earnings 0.6454 $601,483 $388,197 Total Output 1.5799 $601,483 $950,283 Local Sales Tax Generated 3.5% $601,483 $13,587 State Tax Generated 2.5% $601,483 $9,705 Property Tax Generated 0.629375 $3,693,891 $23,248 Total Annual Tax Impacts $46,540 Over the course of thirty (30) years, this 20-unit ALF could be expected to generate $1.4 million in taxes (not adjusted for inflation). Likewise, a 12-unit ALF in Glenrock would require construction of an 11,082 square foot facility. At $200 per square foot, such a facility would cost more than $2.2 million to construct. Construction of the facility would create 31 jobs and a total economic output of $3.8 million. Subsequent operations would create 8 jobs and nearly $570,170 of economic output each year. Additionally, new sales and property taxes of $29,661 would be generated, as seen in the following table. ---PAGE BREAK--- Converse County Long-Term Care Market Analysis Page 53 of 60 12-unit Assisted Living Facility (Glenrock, WY) Construction Phase Multipliers Base Cost Total Impact Total Employment 14.1577 $2,216,335 31 Total Earnings 0.5893 $2,216,335 $1,306,086 Total Output 1.7276 $2,216,335 $3,828,940 Local Sales Tax Generated 3.500% $2,216,335 $45,713 State Tax Generated 2.500% $2,216,335 $32,652 Business Operations Multipliers Base Demand Annual Impact Total Employment 21.7712 6 8 Total Earnings 0.6454 $360,890 $232,918 Total Output 1.5799 $360,890 $570,170 Local Sales Tax Generated 3.5% $360,890 $8,152 State Tax Generated 2.5% $360,890 $5,823 Property Tax Generated 0.70775 $2,216,335 $15,686 Total Annual Tax Impacts $29,661 Over the course of thirty (30) years, this 12-unit ALF could be expected to generate nearly $900,000 in taxes (not adjusted for inflation). Together, both ALF units would create 21 jobs, $1.5 million in economic output, and $2.3 million in taxes each year (plus inflation). C o n s t r u c t i o n F u n d i n g There are several sources of funding available for the construction of a new assisted living facility (ALF) in Converse County:  General Obligation  Revenue Bonds  Hospital District Mill Levy  Capital Facility Tax (special purpose excise tax)  State Loan & Investment Board (SLIB) Consensus and/or Mineral Royalty grants  U.S. Department of Agriculture/Rural Development programs  Wyoming Business Council/Business Ready Community Grant & Loan program  Local fundraising  Private grants Each of these potential funding sources has certain attributes to be considered, including their respective costs, uses, and likelihood of availability. They will each be discussed below. ---PAGE BREAK--- Converse County Long-Term Care Market Analysis Page 54 of 60 General Obligation Bonds General obligation bonds pledge the "full faith and credit" of the issuing local government, which would either be Converse County or the Converse County Hospital District. The entity pledging its assets then agrees to use tax money to repay the debt. There are statutory limits to the total mills that can be assessed on property tax valuation in the issuance of general obligation bonds. General obligation bonds cannot be issued unless a majority of the voters approves the assessment. Wyoming Statute 35-2-415 provides the authorization for the hospital district board (or Converse County itself) to issue general obligation bonds. Bonds may be issued in an amount not to exceed 5% of the district’s assessed valuation. The board of the hospital district would have to obtain the approval of the county commissioners and submit the question of whether the hospital district board could issue general obligation bonds to the electorate. The maximum term of the bonds cannot exceed 25 years. The purposes include purchase of real property, for the construction or purchase of improvements and for equipment for hospital or related purposes. If the electorate approves the issuance of general obligation bonds, the bonds would be repaid from a property tax levy, but not from the mills already levied for the hospital district. General obligation bonds also cannot be repaid from the hospital or ALF revenues. Revenue Bonds Wyoming Statute 35-2-424 provides authorization for the trustees of a hospital district to issue revenue bonds. Revenue bonds may be issued for the purposes of acquiring, erecting, constructing, reconstructing, improving, furnishing, and equipping hospitals and related facilities, and acquiring a site or sites for those purposes. Revenue bonds are repaid from revenues the project itself generates. These work best for projects with a defined user fee stream, such as water and sewer projects or higher volume revenue producers such as hospitals. Revenue from the proposed assisted living facility could theoretically be pledged as security for a revenue bond but are unlikely to generate sufficient excess revenue to realistically pay off such amounts. Revenue bonds do not require voter approval unless certain federal programs are used to acquire the bonds. The revenues of the hospital district would have to be sufficient to provide for the payment of the project’s operations, maintenance, and payment of the debt. The maximum maturity for revenue bonds is 50 years. By state law, county indebtedness may be created and county bonds authorized and issued for the construction, acquisition and equipment of a hospital (or nursing home in this case), just like it can for the construction of a courthouse or jail. Once a facility has ---PAGE BREAK--- Converse County Long-Term Care Market Analysis Page 55 of 60 been constructed or acquired and equipped, the county is required to annually levy a sufficient tax to provide for the maintenance of the facility. Hospital District Mill Levy Wyoming law allows for the creation of Hospital and Health Special Districts to provide funding for the maintenance and construction of health facilities including hospitals, mental hospitals, and clinics (including nursing homes). It is further divided into Hospital Special Districts (Wyoming Statute 35-2-401 and related statutes) and Rural Healthcare Districts (Wyoming Statute 35-2-701 and related statutes). Converse County Hospital District is a Hospital Special District as provided for under Wyoming State Statute Title 18, Chapter 8, and is limited to a 3-mill levy for operations without a vote of the people. This 3-mill levy can be requested each year from the County Commissioners. Wyoming Statute 35-2-414(c) authorizes another three mill levy for “operation and maintenance” provided it is approved by the electorate. Capital Facility Tax Counties have the ability to levy optional sales and use taxes with a special purpose local option tax. A special purpose tax, (also known as a capital facilities tax), is an excise tax of not more than 2% levied with all other sales and use taxes collected in the county. It must be approved by a popular vote. The revenues from the specific purpose local option tax must be used to pay for specific capital needs indentified in the ballot proposition. To put a capital facility tax on the ballot, the board of county commissioners and two-thirds of incorporated municipalities in the county must first pass a resolution authorizing a ballot issue. There are four municipalities in Converse County (Douglas, Glenrock, Lost Springs, and Rolling Hills); meaning three of those municipalities must approve any ballot resolution. Projects must be approved when the tax is approved, and the tax ends when the amount of money approved has been collected. Unlike mill levy assessments that are to be used only for operation and maintenance, specific purpose taxes cannot be used for operating expenses. This method is a good one to utilize to raise matching funds and to provide evidence of support by the community for the project. Converse County approved a 1% capital facilities tax in 2012 for new libraries ($22 million) and for a new Douglas campus of Eastern Wyoming College ($9.7 million). Because of Converse County’s booming economy, collection of that tax is expected to reach the full voter-approved amount sometime in late 2015. A 1% capital facilities tax generates about $1 million of revenue The County could ask that the tax be continued by placing a new ballot proposition on the November 2014 ballot. However, local governments will be asking for a 4-year continuation of the so-called fifth penny tax on that same ballot. Thus, it may be imprudent (and a significant concern for local government leaders) to seek voter approval of two taxes at one time. ---PAGE BREAK--- Converse County Long-Term Care Market Analysis Page 56 of 60 In order to get the project underway while collecting the tax revenues, the community may want to consider issuing revenue bonds to allow for construction of the facility. There are a number of quality firms within the State of Wyoming who, in anticipation of selling the bonds once the question passes, provide election assistance developing promotional brochures, framing the question and helping generate support for the project. George K. Baum and Associates in Cheyenne is one such firm. CBI would also recommend that developers seek special bond counsel advice in the development of any capital financing that would result in the issuance of bonds. State Land and Investment Board The State Land and Investment Board (SLIB) provides Federal Mineral Royalty Grant (MRG) funds. The MRG revenue stream is funded by the royalties from federal leases on public lands in Wyoming. The amount varies from year to year and is subject to legislative appropriation based on revenues received by the state from the federal government. Eligible entities are Counties, Municipalities, Joint Powers Boards and certain special districts, including Hospital Districts. The funds are provided in the form of grants ranging from 50% to 75% of eligible project costs. Municipalities with a population less than 1,300 or that are in a county where the three-year average of state sales and use tax is less than 70% of statewide average are eligible for 75% grant funding, larger municipalities are limited to 50%. The SLIB Board reviews applications and prioritizes them by urgency. Emergency situations that pose an immediate threat to health, safety, and welfare get top priority. The second priority is compliance with federal or state mandates, and the third priority is to provide an essential public service. A new ALF would likely be included in the lowest level of priorities. USDA Rural Development Programs Community Facilities Grants The USDA Rural Development provides grants and loans to assist in the development of essential community facilities in rural areas and towns of up to 20,000 in population. Grants are authorized on a graduated scale, and typically represent a very small portion of the total amount of funding from USDA. Applicants located in small communities with low populations and low incomes will receive a higher percentage of grants. Grants are available to public entities such as municipalities, counties, and special- purpose districts, as well as non-profit corporations and tribal governments. Grant funds can be used to construct, enlarge, or improve community facilities for health care, public safety, and community and public services. This can include the purchase of equipment required for a facility's operation. The amount of grant assistance for project costs depends upon the median household income and the population in the community where the project is located and the availability of grant ---PAGE BREAK--- Converse County Long-Term Care Market Analysis Page 57 of 60 funds. In most instances, projects which receive grant assistance have a high priority and are highly leveraged with other loan and grant awards. Grant assistance may be available for up to 75% of project costs but is typically limited to either $50,000 or 50% of a State's annual allocations, whichever is greater. Grant funding limitations are based on population and income, economic feasibility, and availability of funds. Converse County’s population and other demographics would allow it to score high in terms of community need. Applicants must be unable to obtain needed funds from commercial sources at reasonable rates and terms and are typically provided to supplement Community Facility Loans or Community Programs Guaranteed Loans. Community Facilities Loans Loans are available to qualified borrowers who are unable to obtain needed funds from other sources at reasonable rates and terms. The project is based on taxes, assessments, revenues, fees or other satisfactory sources of money sufficient for operation, maintenance and reserve, as well as to retire the debt. ALFs are specifically listed as an allowable project. Funds may also be used for necessary equipment for the operation of these facilities. Community Facilities Guaranteed Loans Under this federally funded loan program, guarantees may be up to a maximum of 90% of the loan amount. The actual guarantee percentage is determined by Rural Development. There are no down payment or minimum equity requirements. Interest rates are negotiated between the Lender and Borrower. They may be fixed or variable and repayment term is limited to a maximum of 40 years or the useful life of the security, whichever is less. Wyoming Business Council Business Ready Communities (BRC) program This grant and loan program can fund construction of a facility and/or infrastructure to facilitate the start up or expansion of a senior care facility. For this type of project, the maximum award is $1 million. A 15% match is required. BRC grants can only be made to governmental bodies (city, town, county or joint powers board). The next BRC grant application deadline for senior care facilities will be in early 2015, with funding decisions expected to be made in mid-2015. The Wyoming Business Council is more likely to provide grant funds if the land, the cash reserve, and the debt portion of project costs are already identified by that time. Local Fundraising ---PAGE BREAK--- Converse County Long-Term Care Market Analysis Page 58 of 60 Many communities find it necessary to conduct some sort of local fundraising activities in order to support projects. Such efforts can also provide a helpful gauge to the level of overall community support for a particular project. Community leaders can raise funds locally on their own, or by hiring a professional fundraiser. The advantage of using a professional is that they can be quick, they make the sales pitch to collect funds, and they have specialized methods for what they do. The disadvantages of using a professional include a relatively high cost, and a lack of connection to or understanding of the community (which can lead to poor reception and, ultimately, failure). To target those households that are most likely to contribute, it would be wise to establish a fundraising team. Team members should be well known in the community and be able to demonstrate passion for the project. Private Grants There are many grant opportunities available to help build a new assisted living facility. However, there are far more communities and organizations competing than there funds available. However, it is important to screen these opportunities to make good use of the time it will take to submit applications. For example, the following funding sources should be carefully considered:  Anadarko Petroleum Corporate Contributions Program  ConocoPhillips Corporate Contributions Program  First Interstate Foundation  Gertrude Kamps Memorial Foundation  Martin Family Foundation  McMurry Foundation  Safeway Foundation  Walter Scott Foundation  Wells Fargo Charitable Contributions Program  Wyoming Community Foundation ---PAGE BREAK--- Converse County Long-Term Care Market Analysis Page 59 of 60 C o n c l u s i o n Based on these findings, it appears that construction of additional nursing facility units is needed to meet current demand in Converse County, particularly in the Glenrock area. Construction of assisted living units is needed to meet current and future demand in both the Douglas and the Glenrock areas. Given consumer preferences, special efforts should be made to insure high quality service and affordable prices. ---PAGE BREAK--- Converse County Long-Term Care Market Analysis Page 60 of 60 A P P E N D I C E S Appendix A – Converse County Public Participation Plan Appendix B – Stakeholder and Community Survey Results Appendix C – Warm Valley Lodge model Appendix D – Assisted Living Facility (ALF) Estimator – Examples for 12, 20, and 32 unit ALF Facilities, with and without debt ---PAGE BREAK--- A p p e n d i x A CONVERSE COUNTY PUBLIC PARTICIPATION PLAN ---PAGE BREAK--- 1 Memorial Hospital of Converse County and Converse County Long-Term Care Feasibility Study Public Participation Plan Why is Public Participation Important? A good listening process is critical, as it will lead to a more accurate description and understanding of local needs, the proposed long-term care project and its potential partners. Support can only come from people and organizations that are involved because they understand the importance of the project and their relationship to it. Effective public engagement is always important, but it also is becoming a legal requirement to secure resources. For example, The Wyoming Business Council requires community and economic development grant applicants to "inform and educate the public and business community to the greatest extent possible about the proposed economic development project utilizing a variety of techniques and media." A successful public engagement process will include multiple ways to assess and collect input from the population and will be: • Results-focused - The plan process needs to stick to a schedule. The end goal should always be kept front and center. ---PAGE BREAK--- 2 • Informative - The process should help educate people about choices and implications, building on an understanding of the project. • Transparent - The process needs to be open and accessible to the public so that people can safely express themselves and see how their ideas are integrated. • Engaging for people - The process needs to be interactive and interesting to the entire community • Find the Champions - It is vital to identify the champions in the community who are trusted to carry the vision. This group includes those with influence, interest, intelligence or who are impacted in some way by the issue. What Is the Project? To help evaluate current and projected senior long-term care housing needs in the community, Converse County and Memorial Hospital of Converse County jointly came together to fund a market and financial feasibility study for long-term care in Converse County. Part of the feasibility study process will be to complete an analysis of projected long-term care needs, market demand, growth potential and competition in Converse County, with special emphasis on the need for one or more Assisted Living Facilities in the county. Community Builders, Inc. (CBI), was hired to do the Feasibility Study. Stakeholders or Providers that Need to Be Involved 1) Initial Advisory Committee a. MHCC - Ryan Smith, CEO b. MHCC - Bob Kayser, Board Chairman c. Converse County - Rick Grant, Commissioner d. Chuck Lyford - Glenrock resident e. Gay Bolln - Douglas resident f. David Kreycik - Douglas resident 2) Elected and appointed officials a. Converse County Commissioners - Jim Willox, Mike Colling, Major Brown, Tony Lehner, Rick Grant b. Niobrara County Commissioners - Richard Ladwig c. Platte County Commissioners - Chris Kanwischer, County Clerk d. City/Town Councils - i. Douglas - Bruce Jones, Mayor ii. Glenrock - Sue Dills, Mayor iii. Rolling Hills - Devonie Mueller, Mayor iv. Lost Springs - Leda Price, Mayor v. Manville - Richard Schroeder, Mayor vi. Lusk - Patricia Smith, Mayor ---PAGE BREAK--- 3 vii. Glendo - Susan Juschka, Mayor e. Hospital District Board - Bob Kayser, Chairman f. MHCC Foundation - Denise Lyons, Executive Director g. Glenrock Hospital District Board of Directors - Jeanne Ehlebract h. State Elected Officials - i. Senator Jim Anderson ii. Senator John Hines iii. Representative Dan Kirkbride iv. Representative Richard Cannady 3) Health/Senior Care Providers a. Glenrock Senior Center - Carolyn Yeaman b. Douglas Senior Center - Carolyn Yeaman c. Dream Catchers Adult Day Care - Carolyn Yeaman d. North Platte Physical Therapy - Chuck Mangus e. Ann's Best Care LLC - Ann Rex f. Home Health Agency - Lisa Mellott g. Converse County Agency - in-home services - Bernie Davis h. Interim Home Health - Leslie Fowler i. CNA Instructor - Vickie Winnie, RN j. Converse County Public Health - Melissa Ohnstad k. Douglas Care Center - Kelli Rogge l. Glenrock Health Clinic - Melanie Cielinski m. Private Physician - Dr. John Thalken n. Private Physician - Dr. Jim Morgan 4) Staff a. Memorial Hospital of Converse County - Ryan Smith b. City of Douglas - Tony Tolstead, City Administrator c. Town of Glenrock - Donna Geho, Clerk/Treasurer d. Town of Rolling Hills - Teresa Montgomery, Clerk/Treasurer e. Douglas Community Development - Harmit Bedi, Director f. Converse County Economic Development - Cindy Porter g. Glenrock Economic Development Corp - Kathy Patceg 5) Housing/Developers a. Converse County Senior Housing (Riverside I&II) - Stephanie Hagemann b. Douglas Housing Authority - Irwin Towers - Kathy Johnson c. Cozy Corner Inn - Boarding Home - Keenan d. Glenrock Housing Authority (Barber Apartments) - Della Best e. Douglas Care Center - Joe Rude f. K&R Construction - Ron McNare g. Landowners - Vic & Jane Garber ---PAGE BREAK--- 4 6) Community a. Sharon & Palmer Aust b. Nancy Fink c. Jan Pope d. The Gathering - Frank Wiederrecht 7) Consultants/Outside Entities a. Community Builders, Inc. (CBI) - Joe Coyne, Bobbe Fitzhugh, Kathy Patceg b. State Department of Health Licensing Board c. Wyoming Senior Citizens, Inc. - Jeannie Mitchell, Assistant Ombudsman d. Wyoming Independent Living - Rick Geringer e. Department of Family Services - Deanna McLean f. Converse County Tripartite Board - Bob Shinmori 8) Media/Community Outreach a. Douglas Budget - Matt Adelman b. Glenrock Independent - Matt Adelman c. KKTY Radio AM/FM - Dennis Switzer d. Glenrock Area Chamber of Commerce - Mary Kay Kindt e. Douglas Area Chamber of Commerce - Helga Bull General Public Engagement Process It will be important to reach out on both sides of Converse County to generate consensus for any plan that ultimately develops. Goals in this process will include education, fact-finding, identifying alternatives, obtaining buy-in and identifying community champions. Key players in the completion in the feasibility study include: CBI will work with the Advisory Committee and will consider the development of expanded advisory committees in Glenrock and Douglas to make certain that both sides of the county are included in the planning process. The Advisory Committee will provide ongoing advice and feedback throughout the planning process. This committee includes representatives of the hospital and county who are funding the feasibility study, as well as key stakeholders who support long-term care in the community. Advisory Committee CBI will develop a list of stakeholders and providers of senior services in Converse County. A survey will be conducted using Survey Monkey to get responses to several key questions: Stakeholders/Providers 1) Have people moved from the community to receive long-term care services and if so, why? 2) Is there a need for other types of long-term care in the community, such as independent living, assisted living or memory care units? ---PAGE BREAK--- 5 3) What is the sense of general community support for the existing nursing home? 4) What is the best way to get seniors' input and perspective? In addition to stakeholders and providers, it will be necessary to talk to those within the community who anticipate needing long-term care housing for themselves or others. Seniors as well as the general community will be surveyed through a variety of methods (written surveys, focus groups, interviews), to gauge community support and the need for additional long-term care opportunities. Community It will be important to report to the community on the progress of the study. A positive relationship with the media will enhance these efforts. CBI will publish results of meetings to get feedback from the public. Advisory committee members will play a key role in acting as a sounding board and feedback loop for their respective constituencies and clients. Media/Outreach Results of Advisory Committee recommendations will be presented to the public in a variety of ways. Public Presentations Proposed public outreach methods 1) Advertise to the community a. Written survey for targeted populations - i. Stakeholder/Provider Survey - email link with follow-up phone calls to nonresponsive ii. Community Survey - distributed to advisory committee to hand out; also available on web - Survey Monkey - b. Email notification, postcards, existing websites, Facebook i. CBI ii. Converse County iii. MHCC iv. Chambers of Commerce c. Brochures, flyers at locations that provide care and services to seniors as well as the general public d. Newspaper articles, newsletters, websites, radio station i. Douglas Budget ---PAGE BREAK--- 6 ii. Glenrock Independent iii. Radio station - KKTY 2) Hold community meetings to share thoughts, ideas and concerns about the project and to provide new information to strengthen it. a. Focus Groups - hold a series of focus groups in Glenrock and Douglas b. Public Forums - larger community meetings to present alternatives, survey results c. Senior Centers (Glenrock and Douglas) d. Service Clubs (Rotary, etc.) e. Churches Schedule All project tasks are scheduled to be completed by January, 2014. Appendix • Stakeholder List - Converse County LTC Planning Process • Survey cover letters • Press Releases • Sample Survey - Stakeholders/Providers • Sample Community Survey • Public Forums ---PAGE BREAK--- 7 Stakeholder List - Converse County LTC Planning Process Contact Person Title Advisory Committee Memorial Hospital of Converse County Ryan Smith CEO Converse County Hospital Foundation Denise Lyons Director Converse County Rick Grant County Commissioner Citizen Chuck Lyford MHCC Gay Bolln Board Member Citizen Dave Kreycik CPA Memorial Hospital of Converse County Board Bob Kayser Chairman Private Citizen Jan Pope Retired Nurse Government Agencies City of Douglas Tony Tolstead City Administrator City of Douglas Bruce Jones Mayor Harmit Bedi Community Development Director Town of Glenrock Donna Geho Clerk/Treasurer Town of Glenrock Sue Dills Mayor Town of Rolling Hills Devonie Mueller Mayor Town of Rolling Hills Teresa Montgomery Clerk/Treasurer Town of Lost Springs Leda Price Mayor Town of Lusk Patricia Smith Mayor Town of Manville Richard Schroeder Mayor Town of Glendo Susan Juschka Mayor Converse County Rick Grant County Commissioner Converse County Jim Willox County Commissioner Converse County Mike Colling County Commissioner Converse County Major Brown County Commissioner Converse County Tony Lehner County Commissioner Niobrara County Richard Ladwig County Commissioner Chairman Platte County Chris Kanwischer Clerk Department of Family Services - Douglas Mary Ann Maidl Social Services Supervisor Converse County Tripartite Board Bob Shinmori Wyoming State Legislator Jim Anderson Senate District 2 Wyoming State Legislator Dan Kirkbride House District 4 Wyoming State Legislator Richard Cannady House District 6 Wyoming State Legislator ---PAGE BREAK--- 8 Non-Profits Wyoming Independent Living Rick Geringer Independent Living Specialist Wyoming Senior Citizens, Inc. Jeannie Mitchell Ombudsman Community Service Providers Glenrock Senior Center Nancie Fink Office Manager Douglas Senior Center Bernie Davis LPN, Access Care Coordinator Dream Catchers Adult Day Care Carolyn Yeaman Health/Senior Care Providers Memorial Hospital of Converse County Nancy Probert Administrative North Platte Physical Therapy Chuck Mangus Ann's Best Care LLC Ann Rex Owner/Manager Interim Home Health Kary Pickett Administrator Interim Home Health Rob Lempka Business Development Rep. EWC Douglas Campus Vicki Winney, RN Health Technology Instructor Public Health Department - Douglas Melissa Ohnstad County Nurse Manager Public Health Department - Douglas Leslie Fowler Public Health Nurse Public Health Department - Glenrock Pat Reiter RN Staff Nurse Douglas Care Center Kelli Rogge Administrator The Home Health Agency LLC Lisa Mellott Administrator Glenrock Health Clinic Melanie Cielinski Administrator Glenrock Hospital District Board of Directors Jeanne Ehlebract President Precision Prosthetics & Orthotics Kamil Leman Owner/Practitioner Private Physician Dr. John Thalken Private Physician Dr. Jim Morgan Sr. Independent Housing Converse County Senior Housing (Riverside Plaza) Stephanie Hagemann Housing Director Douglas Housing Authority - Irwin Towers Kathy Johnson Executive Director Cozy Corner Inn - Boarding Home Keenan Glenrock Housing Authority (Barber Apartments) Della Best Manager ---PAGE BREAK--- 9 Other Glenrock Economic Development Corp. Kathy Patceg CANDO Cindy Porter Douglas Care Center Joe Rude Owner Landowners Vic & Jane Garber Private Citizens Sharon & Palmer Aust Private Citizens Jim & Jenne Twiford K&R Construction Ron McNare Developer Private Citizen Scott Howe Citizen The Gathering Frank Wiederrecht Pastor KKTY Dennis Switzer Radio Station Owner Douglas Budget Matt Adelman Editor/Publisher Glenrock Area Chamber of Commerce Mary Kay Kindt Director Douglas Area Chamber of Commerce Helga Bull Director ---PAGE BREAK--- 10 we need your input! converse county Long-Term Care Survey please complete by nov. 20th! ---PAGE BREAK--- 11 Advisory Committee Agendas Steering Committee Meeting Agenda Converse County Long-Term Care Plan October 23, 2013 MHCC Conference Room 1) Public Participation Plan a) Review overall plan b) Add/correct Stakeholder List 2) Surveys a) Stakeholder/Provider Survey review b) Community Survey review c) Survey of Existing LTC Facilities statewide 3) Advisory Committee formation a) Identify Glenrock and Douglas "Community Champions" for Project b) Set Advisory Committee date(s) 4) Community Outreach a) Press Release on process b) Who signs letters on behalf of Steering Committee? c) Websites - whose? d) Facebook page? e) Focus Groups - Douglas and Glenrock 5) Set next meeting date ---PAGE BREAK--- 12 Steering Committee Meeting Agenda Converse County Long-Term Care Plan December 11, 2013 MHCC Conference Room 6) Surveys a) Stakeholder/Provider Survey Results review b) Community Survey Results review c) Survey of Existing LTC Facilities statewide - overview of current complexion 7) Community Focus Groups a) Identify Glenrock and Douglas "Community Champions" for Project b) Set Community Focus Group date(s) - January 2014 8) Define Market Areas (Primary, Secondary, Tertiary) 9) Continuum of Care Options to Consider a) Congregate Living b) Assisted Living c) Memory Care 10) Management Structure Options a) Private non-profit b) Joint Powers c) Private for-profit management company 11) Location options a) Co-locate with other facilities/campus concept? b) Douglas i) Douglas Care Center ii) Near MHCC Physician Clinic iii) Private Property iv) Other? c) Glenrock i) Glenrock Hospital District property ii) Other public property iii) Private property iv) Other? 12) Set next meeting date ---PAGE BREAK--- 13 Steering Committee Meeting Agenda Converse County Long-Term Care Plan January 14, 2014 1:00 p.m. MHCC Conference Room 13) Report on Meeting with County Commissioners - January 7th 14) Community Focus Groups a) Glenrock - Wednesday, January 29th - 6:30 p.m. - Glenrock Senior Center b) Douglas - Thursday, January 30th - 6:30 p.m. - Douglas Senior Center c) Proposed Presentation (attached as pdf) d) Outreach and publicity 15) Models to Consider a) Facilities visited b) Management Structure Options i) Private non-profit ii) Joint Powers iii) Private for-profit management company 16) Location options a) Co-locate with other facilities/campus concept b) Douglas c) Glenrock 17) Funding Discussion 18) Request for Contract Extension to March 14, 2014 19) Set next meeting date ---PAGE BREAK--- 14 Steering Committee Meeting Agenda Converse County Long-Term Care Feasibility Study February 25, 2014, 1:00 p.m. MHCC Board Room 20) Report on Progress Reports/Public Forums Jan. 29-30 a) News coverage 21) Draft report – overview 22) Management recommendation: Develop two facilities operated by a single management company. That manager could be: a) Private non-profit b) Joint Powers Board c) Private for-profit management company d) Other/hybrid 23) Location recommendation: Construct two facilities (Glenrock and Douglas) in the most favorable cost/operating locations. Alternatives: a) Co-locate with other facilities/campus site TBD near a Senior Center, hospital, other senior living) b) Glenrock: i) Private site TBD c) Douglas: i) At former Converse County airport site ii) Current EWC building or adjacent to iii) Next to Medical Building iv) Douglas Care Center site v) Other private site TBD 24) Ownership recommendation: Public entity (or entities?) could secure substantial grant financing if they owned the facilities, which would also allow substantial public input in operations. Alternatives: a) Nonprofit ownership – best for fundraising, but eliminates profits b) For profit ownership – pushes risk/reward to entrepreneurs 25) Funding recommendation: Pursue BRC grants from Wyoming Business Council, raise funds locally via the Hospital Foundation, and seek a government-guaranteed loan to cover the balance of construction costs and start up expenses. 26) Next Steps 27) Set next meeting date ---PAGE BREAK--- 15 Survey Introduction - Community CONVERSE COUNTY LONG-TERM CARE STEERING COMMITTEE We need your help! Your input and insight is needed to help evaluate current and projected senior housing and other long-term care needs in the community. Converse County's Long-Term Care Steering Committee is currently evaluating the county's long-term care needs and identifying new opportunities for providing services to our elderly citizens. Today’s elderly have many long-term care choices. In fact, most communities offer a continuum of care including support services transportation or meals), home-health care, independent living, boarding homes, assisted living facilities, skilled nursing homes, and hospice facilities. Converse County has many high quality services for seniors, but there appears to be a need for additional pieces of that continuum of care model. To help evaluate current and projected senior long-term care housing needs in the community, Converse County and Memorial Hospital of Converse County jointly came together to fund a market and financial feasibility study for long-term care in Converse County. Part of the feasibility study process will be to complete an analysis of projected long-term care needs, market demand, growth potential and competition in Converse County, with special emphasis on the need for one or more Assisted Living Facilities in the county. Community Builders, Inc. (CBI), was hired to do the Feasibility Study. Please complete this survey so that we can evaluate how residents in Converse County view long-term care needs in our community. Please complete the survey before November 15, 2013. You can drop your completed survey off at any of the following locations: • Glenrock Health Center • Glenrock Town Hall • Oregon Trail Clinic • Glenrock Senior Center • MHCC Ambassador Desk • Douglas Sr. Center • Converse County Courthouse - Clerk's Office • Frontier Drug If you prefer to complete the survey online, it can be accessed at the following link: Thank you on behalf of the entire Converse County Long-term Care Steering Committee: ---PAGE BREAK--- 16 Rick Grant, County Commissioner Bob Kayser, MHCC Chairman, Board of Directors Gay Bolln, MHCC Board of Directors Dr. Charles Lyford, MHCC Board of Directors Ryan Smith, MHCC CEO Denise Lyons, MHCC Foundation Executive Director Jan Pope, Glenrock Citizen David Kreycik, Douglas Citizen ---PAGE BREAK--- 17 News Releases NEWS RELEASE IMMEDIATE RELEASE****** Contacts: Bobbe Fitzhugh, [PHONE REDACTED], [EMAIL REDACTED] DOUGLAS, Wyo. – Does Converse County need an assisted living center? Are there other types of long term housing care in the community, such as memory care units or more independent living units that would improve our ability to meet the needs of an aging population? CONVERSE COUNTY LONG-TERM CARE PLAN These were just two of the questions posed to the Converse County Long-Term Care Steering Committee at a kick-off meeting on October 23, 2013. Today’s elderly have many long-term care choices. In fact, most communities offer a continuum of care including support services transportation or meals), home-health care, independent living, boarding homes, assisted living facilities, skilled nursing homes, and hospice facilities. Converse County has many high quality services for seniors, but there appears to be a need for additional pieces of that continuum of care model. To help evaluate current and projected senior long-term care housing needs in the community, Converse County and Memorial Hospital of Converse County jointly came together to fund a market and financial feasibility study for long-term care. Part of the feasibility study process will be to complete an analysis of projected long-term care needs, market demand, growth potential and competition in Converse County, with special emphasis on the need for one or more Assisted Living Facilities. "We have retained Community Builders, Inc., a Converse County-based consulting firm, to prepare this study," said Converse County Commissioner Rick Grant. "CBI will analyze the appropriateness, gaps and need for each of the types of long-term care in the Converse County area, such as, independent living, assisted living, adult day care, memory loss care, nursing care, personal care, or low-income apartments. "A key part of the planning process is to engage the public," CBI Consultant Bobbe Fitzhugh stressed. "A Stakeholder and Community Survey is being circulated throughout the community ---PAGE BREAK--- 18 to get the public's input. Once the survey results are analyzed, presentations to the public will be scheduled." Residents are encouraged to complete the survey on line at Paper copies of surveys are also available at the following Douglas locations: Memorial Hospital of Converse County (Information Desk); Douglas Senior Center; Frontier Drug; and the Converse County Clerk's Office. Glenrock locations with community surveys are: Glenrock Town Hall; Glenrock Senior Center; Oregon Trail Clinic; and the Glenrock Health Center. Survey links will also be available on the Converse County, Memorial Hospital of Converse County, Town of Glenrock, and CBI websites. Residents are asked to complete surveys by November 20th, 2013 and drop them off at any of the listed locations. The initial Steering Committee members include: Rick Grant, County Commissioner Bob Kayser, MHCC Chairman, Board of Directors Gay Bolln, MHCC Board of Directors Dr. Charles Lyford, MHCC Board of Directors Ryan Smith, MHCC CEO Denise Lyons, Converse County Hospital Foundation Executive Director Jan Pope, Glenrock Citizen David Kreycik, Douglas Citizen Photo below may be used in any news story: Shown from l-r - CBI consultant Bobbe Fitzhugh, CBI consultant Joe Coyne, Glenrock citizen Jan Pope and MCHH Board Chair Bob Kayser, discussing community input process for long-term care needs assessment. ---PAGE BREAK--- 19 NEWS RELEASE IMMEDIATE RELEASE****** Contacts: Bobbe Fitzhugh, [PHONE REDACTED], [EMAIL REDACTED] CONVERSE COUNTY ASSISTED LIVING FACILITY STUDY DOUGLAS, Wyo. – 95% of those responding to a recent community survey in Converse County agree that there is a need for more long-term care services in their community and a similar percentage want that long-term care to be an Assisted Living Facility. Quality of care, ability to stay in the city or town they live in and affordability topped the factors important for making long-term care decisions. These are some of the key findings in a recently completed Community Survey completed for Converse County. The long-term care study concluded that there is a demand for between 41 and 63 assisted living facility units in Converse County. SURVEY SHOWS STRONG SUPPORT FOR ASSISTED LIVING IN CONVERSE COUNTY Converse County residents will have an opportunity to hear details of these findings and provide input on possible locations and management structure for one or more facilities. Two meetings are scheduled so that both sides of the county can conveniently attend - Glenrock's meeting will be held at 6:30 p.m. on Wednesday, January 29th at the Glenrock Senior Center and on Thursday, January 30th, the Douglas Senior Center will host a public forum at 6:30. At the public meetings, consultants Bobbe Fitzhugh, Joe Coyne and Kathy Patceg will review the planning process and key findings. Their consulting firm, Community Builders, Inc. was retained by Converse County and Memorial Hospital of Converse County to complete the study. According to Coyne, "Americans are living longer, and growing numbers of older citizens are choosing to live in assisted living facilities. Wyoming's average age is higher than the rest of the nation and inching upward, and local market demand is strong for new long-term care facilities that offer high quality services and affordability. The Boomer generation will continue to drive this demand for the next 20-30 years." Fitzhugh adds, "Long-term care is a wide spectrum of services and facilities in a community that includes community-based services such as Meals on Wheels, Adult Day Care, and Senior Centers at the basic level. Home-Health Care provides in-home medical services and Nursing Homes providing skilled nursing care are at the far end of the scale. In the middle of the long- term care continuum are the apparent gaps in Converse County - a need for more independent senior housing facilities and assisted living facilities. ---PAGE BREAK--- 20 Fitzhugh continues that "The definition of assisted living needs to be clearly understood by the community. This group living arrangement provides help with activities of daily living such as eating, bathing, and using the bathroom, taking medicine, and getting to appointments as needed. Residents often live in their own room or apartment within a building or group of buildings and have some or all of their meals together. Social and recreational activities are usually provided. Some assisted living facilities have health services on site. Costs for assisted living facilities can vary widely depending on the size of the living areas, services provided, type of help needed, and where the building is located. Residents usually pay a rent and then pay additional fees for the services that they get." Community surveys and input from the Converse County Long-Term Care Advisory Committee emphasize that how one or more assisted living facilities are funded in Converse County is an important factor. There seems to be some support based on survey results for special purpose sales and use tax (the method used to fund the EWC and Library facilities). Funding will drive decisions on whether the facility or facilities should operate as private or public non-profits, or private, for-profit entities or a hybrid of the two. Affordability and a strong desire to make certain that, if possible, facilities can be constructed in both Douglas and Glenrock was stressed by the Advisory Committee. According to Advisory Committee member and MHCC Board Member Gay Bolln, "the public is encouraged to attend one or both of these meetings to listen to the findings and provide input. We are excited about this opportunity to better serve the long-term needs of Converse County residents, and we need public input and support before proceeding any further.” For more information about the proposed project or to obtain a copy of the survey results, contact CBI Consultant Bobbe Fitzhugh at (307) 359-3311. ---PAGE BREAK--- 21 PLAN TO ATTEND! Converse County Assisted Living Public Forums PROGRESS REPORT TO THE COMMUNITIES Wed, Jan 29 - 6:30 P.M. Glenrock Senior Center and Thurs, Jan 30 - 6:30 P.M. Douglas Senior Center Assisted Living, Home-Health Care, Senior Independent Living, Continuing Care Options What do you want to see in your community? Study sponsored by Converse County and MHCC ---PAGE BREAK--- 22 CONVERSE COUNTY LONG-TERM CARE STEERING COMMITTEE January 15, 2014 Dear Interested Stakeholder: It's time to hear about the progress made on the Assisted Living (and other long-term care needs) Study underway in Converse County! Please come to a public forum to hear details of these findings and provide input on possible locations and management structure for one or more assisted living facilities. Two meetings are scheduled so that both sides of the county can conveniently attend - Glenrock's meeting will be held at 6:30 p.m. on Wednesday, January 29th at the Glenrock Senior Center and on Thursday, January 30th, the Douglas Senior Center will host a public forum at 6:30. At the public meetings, our initial Advisory Committee will review the planning process and key findings. 95% of those responding to a recent community survey in Converse County agree that there is a need for more long-term care services in their community and a similar percentage want that long-term care to be an Assisted Living Facility. Quality of care, ability to stay in the city or town they live in and affordability topped the factors important for making long-term care decisions. The long-term care study concluded that there is a demand for between 41 and 63 assisted living facility units in Converse County. Long-term care is a wide spectrum of services and facilities in a community that includes community-based services such as Meals on Wheels, Adult Day Care, and Senior Centers at the basic level. Home-Health Care provides in-home medical services and Nursing Homes providing skilled nursing care are at the far end of the scale. In the middle of the long-term care continuum are the apparent gaps in Converse County - a need for more independent senior housing facilities and assisted living facilities. The definition of assisted living needs to be clearly understood by the community. This group living arrangement provides help with activities of daily living such as eating, bathing, and using the bathroom, taking medicine, and getting to appointments as needed. Residents often live in their own room or apartment within a building or group of buildings and have some or all of their meals together. Social and recreational activities are usually provided. Some assisted living facilities have health services on site. Costs for assisted living facilities can vary widely depending on the size of the living areas, services provided, type of help needed, and where the building is located. Residents usually pay a rent and then pay additional fees for the services that they get. ---PAGE BREAK--- 23 Community surveys and input from the Converse County Long-Term Care Advisory Committee emphasize that how one or more assisted living facilities are funded in Converse County is an important factor. There seems to be some support based on survey results for special purpose sales and use tax (the method used to fund the EWC and Library facilities). Funding will drive decisions on whether the facility or facilities should operate as private or public non-profits, or private, for-profit entities or a hybrid of the two. Affordability and a strong desire to make certain that, if possible, facilities can be constructed in both Douglas and Glenrock was stressed by the Advisory Committee. You are encouraged to attend one or both of these meetings to listen to the findings and provide input and hopefully join the effort to see a project through to fruition! Thank you on behalf of the entire Steering Committee: Rick Grant, County Commissioner Bob Kayser, MHCC Chairman, Board of Directors Gay Bolln, MHCC Board of Directors Dr. Charles Lyford, MHCC Board of Directors Ryan Smith, MHCC CEO Denise Lyons, Converse County Hospital Foundation Executive Director Jan Pope, Glenrock Citizen David Kreycik, Douglas Citizen ---PAGE BREAK--- Page 1 Community Survey: Converse County Long-Term Care Community Survey: Converse County Long-Term Care Community Survey: Converse County Long-Term Care Community Survey: Converse County Long-Term Care We need your help! Your input and insight is needed to help evaluate current and projected senior housing and other long­term care needs in the community. Converse County's Long­Term Care Steering Committee is currently evaluating the county's long­term care needs and identifying new opportunities for providing services to our elderly citizens. Today’s elderly have many long­term care choices. In fact, most communities offer a continuum of care including support services transportation or meals), home­health care, independent living, boarding homes, assisted living facilities, skilled nursing homes, and hospice facilities. Converse County has many high quality services for seniors, but there appears to be a need for additional pieces of that continuum of care model. To help evaluate current and projected senior long­term care housing needs in the community, Converse County and Memorial Hospital of Converse County jointly came together to fund a market and financial feasibility study for long­term care in Converse County. Part of the feasibility study process will be to complete an analysis of projected long­term care needs, market demand, growth potential and competition in Converse County, with special emphasis on the need for one or more Assisted Living Facilities in the county. Community Builders, Inc. (CBI), was hired to complete the Feasibility Study. Please complete this survey so that we can evaluate how residents in Converse County view long­term care needs in our community. Please complete the survey before November 20, 2013. You can drop your completed survey off at any of the following locations: • Glenrock Health Center • Glenrock Town Hall • Oregon Trail Clinic • Glenrock Senior Center • Memorial Hospital of Converse County/Ambassador Desk • Douglas Senior Center • Converse County Courthouse ­ Clerk's Office • Frontier Drug If you prefer to complete the survey online, it can be accessed at the following link: Thank you on behalf of the entire Converse County Long­term Care Steering Committee: Rick Grant, County Commissioner Bob Kayser, MHCC Chairman, Board of Directors Gay Bolln, MHCC Board of Directors Dr. Charles Lyford, MHCC Board of Directors Ryan Smith, MHCC CEO Denise Lyons, Converse County Hospital Foundation Executive Director Jan Pope, Glenrock Citizen David Kreycik, Douglas Citizen ---PAGE BREAK--- Page 2 Community Survey: Converse County Long-Term Care Community Survey: Converse County Long-Term Care Community Survey: Converse County Long-Term Care Community Survey: Converse County Long-Term Care 1. Where do you live? 2. Which of the following services, if any, do you currently receive? (select all that apply) 3. Long­term care includes a continuum of care to assist the elderly or disabled in completing activities of daily living. It includes home health care, subsidized senior housing, boarding homes, assisted living facilities, and nursing homes. Is there a need for more of these services in the community? Douglas area n m l k j Glenrock area n m l k j Rolling Hills area n m l k j Lost Springs area n m l k j Rural Converse County n m l k j Niobrara County n m l k j Platte County n m l k j Other (please specify) n m l k j Meals or Nutrition Services g f e d c Medical Services g f e d c Pharmacy Services g f e d c Services for the Disabled g f e d c Home Health Care g f e d c Public Health Services g f e d c Senior Center Services g f e d c Physical or Rehabilitative Therapy g f e d c Mental Health Services g f e d c Adult Day Care g f e d c Respite Care g f e d c Transportation g f e d c Live in Independent Living Facility g f e d c Live in Boarding Home Facility g f e d c Live in Nursing Home g f e d c None of the Above g f e d c Other (please specify) g f e d c 5 5 6 6 No n m l k j Yes n m l k j ---PAGE BREAK--- Page 3 Community Survey: Converse County Long-Term Care Community Survey: Converse County Long-Term Care Community Survey: Converse County Long-Term Care Community Survey: Converse County Long-Term Care 4. If your response to the previous question was yes, what additional services are needed in Converse County? (select all that apply) 5. If you were to seek out long­term care housing for you or a family member, what factors would be important to you? (select all that apply) 6. If a new Assisted Living Facility were to be built in the area, and assuming that you can afford the cost, would you or a family member be willing and likely to use it in the future? Respite Care g f e d c Boarding Home Facility g f e d c Assisted Living Facility g f e d c Memory Care Facility g f e d c Nursing Care Facility g f e d c Home Health Care g f e d c Senior Independent Living g f e d c In­home Hospice Care g f e d c Hospice Care Facility g f e d c Other (please specify) g f e d c Ability to stay in Wyoming g f e d c Ability to stay in the city or town I live in g f e d c Desire to relocate to be near family or friends g f e d c Ability to live with partner or spouse g f e d c Quality of care g f e d c More "resident­centered" vs. "institutional" facility g f e d c Amenities and support services g f e d c Choices of meals, activities, etc. g f e d c Location within community g f e d c Private room g f e d c Affordability g f e d c Memory Care g f e d c Other (please specify) g f e d c 5 5 6 6 Yes n m l k j No n m l k j ---PAGE BREAK--- Page 4 Community Survey: Converse County Long-Term Care Community Survey: Converse County Long-Term Care Community Survey: Converse County Long-Term Care Community Survey: Converse County Long-Term Care 7. Do you know of anyone who has moved away from Converse County to receive long­ term care services elsewhere? (select all that apply) 8. If you know of someone who has moved away from the community to receive long­term care services, please indicate their reason(s) for moving, if you know: (select all that apply) No g f e d c Yes, they moved to be with or to be near their family g f e d c Yes, they moved to a Nursing Home g f e d c Yes, they moved to an Alzheimer or Memory Care facility g f e d c Yes, they moved to an Assisted Living Facility g f e d c Yes, they moved to a Hospice facility g f e d c Yes, they moved to some Other type of facility (please specify) g f e d c 5 5 6 6 Service not available in Converse County g f e d c To be closer to family or special friends g f e d c Affordability g f e d c Quality of care of facility g f e d c Quality of "bricks and mortar" of facility g f e d c Amenities and support services at facility g f e d c Other (please specify) g f e d c 5 5 6 6 ---PAGE BREAK--- Page 5 Community Survey: Converse County Long-Term Care Community Survey: Converse County Long-Term Care Community Survey: Converse County Long-Term Care Community Survey: Converse County Long-Term Care 9. If an Assisted Living Facility (or other long­term care facility) is considered for Converse County, what would be the best way to fund the capital construction of said facility? (choose all that apply) 10. As you personally age and may need to consider a long­term care facility, where would you most want to spend your "golden" years? 11. What is the best way to gather input from community members who need (or will need) long­term care? 5 5 6 6 General Obligation Bonds g f e d c Special Purpose Sales and Use Tax (method used to fund the EWC and Library construction projects) g f e d c Government Grants g f e d c Low­interest loans g f e d c Local fundraising g f e d c Private grants g f e d c Revenue from the new assisted living facility to retire debt g f e d c Other (please specify) g f e d c 5 5 6 6 In my own community n m l k j Within Converse County, but not necessarily the community I live in n m l k j Somewhere else in Wyoming n m l k j Near family or friends in another state n m l k j It doesn't matter to me n m l k j Other (please specify) n m l k j 5 5 6 6 ---PAGE BREAK--- Page 6 Community Survey: Converse County Long-Term Care Community Survey: Converse County Long-Term Care Community Survey: Converse County Long-Term Care Community Survey: Converse County Long-Term Care 12. Please share any other information you think should be considered for this long­term care plan. 5 5 6 6 ---PAGE BREAK--- Page 1 Converse County Long-Term Care Stakeholder Survey Converse County Long-Term Care Stakeholder Survey Converse County Long-Term Care Stakeholder Survey Converse County Long-Term Care Stakeholder Survey We need your help! As a key stakeholder and/or provider of senior housing or services in Converse County, your input and insight is needed to help evaluate current and projected senior housing and other long­term care needs in the community. Wyoming's aging population is similar to the nation’s. However, perhaps because of its rural nature, Wyoming has not yet developed a full range of long­term care options in most of its communities, including Converse County. Converse County's Long­Term Care Steering Committee is currently evaluating the county's long­term care needs and identifying new opportunities for providing services to our elderly citizens. Today’s elderly have many long­term care choices. In fact, most communities offer a continuum of care including support services transportation or meals), home­health care, independent living, boarding homes, assisted living facilities, skilled nursing homes, and hospice facilities. Converse County has many high quality services for seniors, but there appears to be a need for additional pieces of that continuum of care model. To help evaluate current and projected senior long­term care housing needs in the community, Converse County and Memorial Hospital of Converse County jointly came together to fund a market and financial feasibility study for long­term care in Converse County. Part of the feasibility study process will be to complete an analysis of projected long­term care needs, market demand, growth potential and competition in Converse County, with special emphasis on the need for one or more Assisted Living Facilities in the county. Community Builders, Inc. (CBI), was hired to complete the Feasibility Study. Please complete this survey so that we can evaluate how stakeholders in Converse County view long­term care needs in our community. Please complete the survey before November 20, 2013. If you need additional information, or would like to offer your assistance to this process, please contact CBI consultant Bobbe Fitzhugh at 307­359­3311 or [EMAIL REDACTED]. Or, you may contact any of the Steering Committee members listed below. The survey can be accessed at the following link: Thank you on behalf of the entire Steering Committee: Rick Grant, County Commissioner Bob Kayser, MHCC Chairman, Board of Directors Gay Bolln, MHCC Board of Directors Dr. Charles Lyford, MHCC Board of Directors Ryan Smith, MHCC CEO Denise Lyons, Converse County Hospital Foundation Executive Director Jan Pope, Glenrock Citizen David Kreycik, Douglas Citizen 1. Name of Agency/Organization you represent (if applicable): ---PAGE BREAK--- Page 2 Converse County Long-Term Care Stakeholder Survey Converse County Long-Term Care Stakeholder Survey Converse County Long-Term Care Stakeholder Survey Converse County Long-Term Care Stakeholder Survey 2. Contact Information 3. What services does your company/agency currently provide? (select all that apply) Name Title Mailing Address City Zip Phone Number Email Meals and Nutrition Services g f e d c Medical Services g f e d c Pharmacy Services g f e d c Services for the Disabled g f e d c Home Health Care g f e d c Public Health Services g f e d c Referrals to Other Agencies g f e d c Senior Services g f e d c Physical or Rehabilitative Therapy g f e d c Mental Health Services g f e d c Adult Day Care g f e d c Respite Care g f e d c Transportation g f e d c In­home Hospice Care g f e d c Memory Care g f e d c Independent Living g f e d c Boarding Home g f e d c Assisted Living Facility g f e d c Nursing Home g f e d c Other (please specify) g f e d c 5 5 6 6 ---PAGE BREAK--- Page 3 Converse County Long-Term Care Stakeholder Survey Converse County Long-Term Care Stakeholder Survey Converse County Long-Term Care Stakeholder Survey Converse County Long-Term Care Stakeholder Survey 4. What services do your clients or patients receive from other agencies or providers in the community? (select all that apply) 5. Long­term care includes a continuum of care to assist the elderly or disabled in completing activities of daily living. It includes home health care, subsidized senior housing, boarding homes, assisted living facilities, and nursing homes. Do you feel that there is a need for more of these services or facilities in the community? Meal and Nutrition Services g f e d c Medical Services g f e d c Pharmacy Services g f e d c Services for the Disabled g f e d c Home Health Care g f e d c Public Health Services g f e d c Referrals to other Agencies g f e d c Senior Services g f e d c Physical or Rehabilitative Therapy g f e d c Mental Health Services g f e d c Adult Day Care g f e d c Respite Care g f e d c Transportation g f e d c In­home Hospice Care g f e d c Memory Care g f e d c Independent Living g f e d c Boarding Home g f e d c Assisted Living Facility g f e d c Nursing Home g f e d c Other (please specify) g f e d c 5 5 6 6 No n m l k j Yes n m l k j ---PAGE BREAK--- Page 4 Converse County Long-Term Care Stakeholder Survey Converse County Long-Term Care Stakeholder Survey Converse County Long-Term Care Stakeholder Survey Converse County Long-Term Care Stakeholder Survey 6. If your response to the previous question was yes, what additional services or facilities are needed in Converse County? (Check all that apply) 7. Do you know of anyone who has moved away from the community to receive long­term care services? (select all that apply) Respite Care g f e d c Boarding Home Facility g f e d c Assisted Living Facility g f e d c Memory Care Facility g f e d c Nursing Care Facility g f e d c Home Health Care g f e d c Senior Independent Living g f e d c In­home Hospice Care g f e d c Hospice Care Facility g f e d c Other (please specify) g f e d c No g f e d c Yes, they moved to be with or to be near their family g f e d c Yes, they moved to a Nursing Home g f e d c Yes, they moved to an Alzheimer or Memory Care facility g f e d c Yes, they moved to an Assisted Living Facility g f e d c Yes, they moved to a Hospice­care facility g f e d c Yes, they moved to some Other type of facility (please specify) g f e d c 5 5 6 6 ---PAGE BREAK--- Page 5 Converse County Long-Term Care Stakeholder Survey Converse County Long-Term Care Stakeholder Survey Converse County Long-Term Care Stakeholder Survey Converse County Long-Term Care Stakeholder Survey 8. If you know of someone who has moved away from the community to receive long­term care services, please indicate their reason(s) for moving, if you know: (select all that apply) 9. If a new Assisted Living Facility were to be built in the area, what impact would that have on your services? 10. If an Assisted Living Facility (or other long­term care facility) is considered for Converse County, what would be the best way to fund the capital construction of said facility? (select all that apply) Service not available in Converse County g f e d c To be closer to family or special friends g f e d c Affordability g f e d c Quality of care at facility g f e d c Quality of "bricks and mortar" of facility g f e d c Amenities and support services at facility g f e d c Other (please specify) g f e d c 5 5 6 6 No impact n m l k j Yes, it would impact: n m l k j General Obligation Bonds g f e d c Special Purpose Excise (sales and use) Tax ­ the method used to fund the EWC and library construction projects g f e d c Government Grants g f e d c Low­interest loans g f e d c Local fundraising g f e d c Private grants g f e d c Revenue from the new assisted living facility to retire debt g f e d c Other (please specify) g f e d c ---PAGE BREAK--- ---PAGE BREAK--- ---PAGE BREAK--- ---PAGE BREAK--- ---PAGE BREAK--- ---PAGE BREAK--- ---PAGE BREAK--- ---PAGE BREAK--- ---PAGE BREAK--- ---PAGE BREAK--- ---PAGE BREAK--- ---PAGE BREAK--- ---PAGE BREAK--- ---PAGE BREAK--- ---PAGE BREAK--- ---PAGE BREAK--- 1/7/2014 1 Progress Report to Converse County Commissioners Converse County Commissioners January 7, 2014 Conduct market analysis of the county’s needs and desires for long-term care; especially assisted living Background Review Solicit public and stakeholder input Solicit public and stakeholder input Market analysis Analysis of projected long-term care needs Market need and demand Growth potential Extent of competition Determination of appropriate services and Determination of appropriate services and facility size, number of units, proposed services Inventory of existing facilities Location analysis Fundraising analysis 30% 40% 50% 60% Community Survey Respondents vs. Actual Population 0% 10% 20% 30% Douglas area Glenrock area Rolling Hills area Lost Springs area Rural Converse County Survey Actual 13.3% 31.1% 28.0% 2.3% 2.7% 9.8% 26.5% 8.3% 1 9% Meals or Nutrition Services Medical Services Pharmacy Services Services for the Disabled Home Health Care Public Health Services Senior Center Services Physical or Rehabilitative Therapy Mental Health Services 1.9% 0.8% 1.1% 5.7% 3.0% 0.8% 0.8% 45.1% 3.4% 0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 50% Mental Health Services Adult Day Care Respite Care Transportation Live in Independent Living Facility Live in Boarding Home Facility Live in Nursing Home None of the Above Other (please specify) ---PAGE BREAK--- 1/7/2014 2 4.9% Community Is there a need for more long-term care services in the community? 0.0% Stakeholders 95.1% No Yes 100.0% No Yes Respite Care Boarding Home Facility Assisted Living Facility Memory Care Facility Nursing Care Facility 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Home Health Care Senior Independent Living In-home Hospice Care Hospice Care Facility Other (please specify) Community Stakeholders Ability to stay in Wyoming Ability to stay in the city or town I live in Desire to relocate to be near family or friends Ability to live with partner or spouse Quality of care More "resident-centered" vs. "institutional" … Amenities and support services 0% 50% 100% Amenities and support services Choices of meals, activities, etc. Location within community Private room Affordability Memory Care Other (please specify) 4.9% Yes If new ALF is build, and assume If new ALF is build, and assume you can afford it, would you or you can afford it, would you or your family use it? your family use it? 95.1% Yes No Know anyone who has Know anyone who has moved moved away for LTC reasons? away for LTC reasons? Y h d Al h i Yes, they moved to an Assisted Living Facility Yes, they moved to a Hospice facility Yes, they moved to some Other type of facility (please specify) 0% 20% 40% 60% 80% 100% No Yes, they moved to be with or to be near their family Yes, they moved to a Nursing Home Yes, they moved to an Alzheimer or Memory Care facility Community Stakeholders Why did they move away Why did they move away? Service not available in Converse County To be closer to family or special friends Affordability Quality of care of facility 0% 20% 40% 60% 80% 100% Quality of "bricks and mortar" of facility Amenities and support services at facility Other (please specify) Community Stakeholders ---PAGE BREAK--- 1/7/2014 3 If we build, how do we pay for it If we build, how do we pay for it? General Obligation Bonds Special Purpose Sales and Use Tax (method used to fund the EWC and … Government Grants Low-interest loans 0% 20% 40% 60% 80% 100% Local fundraising Private grants Revenue from the new assisted living facility to retire debt Other (please specify) Community Stakeholders Where do you want to spend Where do you want to spend your “golden years”? your “golden years”? In my own community Within Converse County, but not necessarily the community I live in Somewhere else in Wyoming 0% 20% 40% 60% 80% 100% Near family or friends in another state It doesn't matter to me Other (please specify) Community Stakeholders Target population of seniors age 65+ is growing Wyoming’s elderly population has grown to almost 70,000 By 2015 Wyoming’s elderly population will By 2015, Wyoming s elderly population will be 84,500 – 14.5% of entire state population Preliminary Analysis to Determine Assisted Living Facility Market Feasibility (ACS 2008-2012) LOW - HIGH END Primary Market Primary Market Secondary Market ALL ESTIMATES Glenrock Area Douglas Area WY USA Total Private Pay Market Demand 12 - 20 25 - 37 2 - 3 2 - 3 41 - 63 Douglas Glenrock ---PAGE BREAK--- 1/7/2014 4 Glenrock Area Douglas Area Community-based Services (Meals on Wheels, adult day care, senior centers, etc.) Home Health Care Subsidized Senior Housing B di H Boarding Homes Assisted Living Facilities Continuing Care Retirement Community Nursing Homes Converse County ◦Douglas Care Center Nursing Home ◦Dream Catcher Adult Day Care ◦Ann’s Best Care LLC ◦No ALFs, BHs , Statewide Market ◦26 Private ALFs; 7 with Level II ◦2 State Facility ALFs ◦9 Boarding Homes ◦38 Nursing Homes ◦23 Hospice programs Management Structure ◦Private non-Profit ◦Joint Powers ◦Private for-profit Location Options ◦Douglas ◦Glenrock Community Builders, Inc. Douglas, Wyoming Bobbe Fitzhugh and Joe Coyne www.consultCBI.com ---PAGE BREAK--- Page 1 2013 Wyoming Licensed ALF/BH Survey 2013 Wyoming Licensed ALF/BH Survey 2013 Wyoming Licensed ALF/BH Survey 2013 Wyoming Licensed ALF/BH Survey Community Builders, Inc., a Wyoming­based consulting firm, is currently under contract to develop a Long­Term Care Needs Assessment and Feasibility Study in East­Central Wyoming. We want our data to be as accurate as possible and would like to verify the information available on the Wyoming Healthcare Licensing website. Would you please complete this short survey about your facility, so that our information is as accurate as possible? Please contact CBI with any questions or additional information at [EMAIL REDACTED], or (307) 359­3311. We will be happy to provide you with a copy of the completed survey results when the survey is completed. THANK YOU! 1. Information about your facility. 2. Please indicate your license and Level (if applicable). 3. What is the number of residents you consider to be full capacity for your facility? (This may not be the same as the number of licensed beds which is determined by the WDH based on the square footage of each room). Name of Facility City County Contact Person email phone Number of Level I residents Number of Level II residents Number of Nursing Home residents Nursing Home n m l k j Nursing Home with dedicated Dementia Care Unit n m l k j Assisted Living Facility ­ Level I only n m l k j Assisted Living Facility ­ Level II only n m l k j Assisted Living Facility ­ Levels I and II n m l k j Boarding Home n m l k j Other (please specify) n m l k j ---PAGE BREAK--- Page 2 2013 Wyoming Licensed ALF/BH Survey 2013 Wyoming Licensed ALF/BH Survey 2013 Wyoming Licensed ALF/BH Survey 2013 Wyoming Licensed ALF/BH Survey 4. How many residents do you currently have occupying your facility? 5. What is the configuration of your facility? 6. What is the current average rate for each of the types of room configurations (if applicable)? 7. What type of payment do you accept? 8. How many years have you been in operation? Level I residents Level II residents Nursing Home residents Number of studio units Number of one­bedroom units Number of two­bedroom units Number of dementia care beds Other Studio unit One­bedroom unit Two­bedroom unit Semi­private room Other Private Pay Only n m l k j Accept Medicaid Waiver/Private Pay n m l k j Government­operated facility n m l k j Other (please specify) Less than 2 years n m l k j 2­5 years n m l k j 6­10 years n m l k j 11­20 years n m l k j Over 20 years n m l k j ---PAGE BREAK--- Page 3 2013 Wyoming Licensed ALF/BH Survey 2013 Wyoming Licensed ALF/BH Survey 2013 Wyoming Licensed ALF/BH Survey 2013 Wyoming Licensed ALF/BH Survey 9. Describe the ownership of your facility. 10. Please indicate the response that best describes your management structure? 11. Please indicate the approximate percentage of residents you typically have who come to your facility: 12. Would you like a copy of these survey results when they are completed? Directly from community From within 50 mile radius From Wyoming From Outside Wyoming 90­100% n m l k j n m l k j n m l k j n m l k j 80­89% n m l k j n m l k j n m l k j n m l k j 70­79% n m l k j n m l k j n m l k j n m l k j 60­69% n m l k j n m l k j n m l k j n m l k j 50­59% n m l k j n m l k j n m l k j n m l k j 40­49% n m l k j n m l k j n m l k j n m l k j 30­39% n m l k j n m l k j n m l k j n m l k j 20­29% n m l k j n m l k j n m l k j n m l k j 10­19% n m l k j n m l k j n m l k j n m l k j Less than 10% n m l k j n m l k j n m l k j n m l k j None n m l k j n m l k j n m l k j n m l k j Non­profit g f e d c Government­owned and operated g f e d c Private for­profit g f e d c Other (please specify) We are an Owner­Operated Facility n m l k j We are operated by a Government or Non­Profit Entity n m l k j We contract with a Senior Living Management Company n m l k j Name of Management Company, if applicable: Yes, please g f e d c No, thank you g f e d c Email address ---PAGE BREAK--- A p p e n d i x B STAKEHOLDER AND COMMUNITY SURVEY RESULTS ---PAGE BREAK--- 1 of 30 Community Survey: Converse County Long-Term Care 1. Where do you live? Response Percent Response Count Douglas area 56.6% 154 Glenrock area 23.5% 64 Rolling Hills area 2.6% 7 Lost Springs area 0.4% 1 Rural Converse County 14.7% 40 Niobrara County 0.4% 1 Platte County 1.1% 3 Other (please specify) 0.7% 2 answered question 272 skipped question 3 ---PAGE BREAK--- 2 of 30 2. Which of the following services, if any, do you currently receive? (select all that apply) Response Percent Response Count Meals or Nutrition Services 13.3% 35 Medical Services 31.1% 82 Pharmacy Services 28.0% 74 Services for the Disabled 2.3% 6 Home Health Care 2.7% 7 Public Health Services 9.8% 26 Senior Center Services 26.5% 70 Physical or Rehabilitative Therapy 8.3% 22 Mental Health Services 1.9% 5 Adult Day Care 0.8% 2 Respite Care 1.1% 3 Transportation 5.7% 15 Live in Independent Living Facility 3.0% 8 Live in Boarding Home Facility 0.8% 2 Live in Nursing Home 0.8% 2 None of the Above 45.1% 119 Other (please specify) 3.4% 9 answered question 264 skipped question 11 ---PAGE BREAK--- 3 of 30 3. Long-term care includes a continuum of care to assist the elderly or disabled in completing activities of daily living. It includes home health care, subsidized senior housing, boarding homes, assisted living facilities, and nursing homes. Is there a need for more of these services in the community? Response Percent Response Count No 4.9% 13 Yes 95.1% 253 answered question 266 skipped question 9 4. If your response to the previous question was yes, what additional services are needed in Converse County? (select all that apply) Response Percent Response Count Respite Care 34.4% 88 Boarding Home Facility 20.7% 53 Assisted Living Facility 92.2% 236 Memory Care Facility 29.7% 76 Nursing Care Facility 28.9% 74 Home Health Care 42.6% 109 Senior Independent Living 61.7% 158 In-home Hospice Care 42.2% 108 Hospice Care Facility 40.2% 103 Other (please specify) 4.7% 12 answered question 256 skipped question 19 ---PAGE BREAK--- 4 of 30 5. If you were to seek out long-term care housing for you or a family member, what factors would be important to you? (select all that apply) Response Percent Response Count Ability to stay in Wyoming 56.6% 154 Ability to stay in the city or town I live in 84.6% 230 Desire to relocate to be near family or friends 17.3% 47 Ability to live with partner or spouse 56.6% 154 Quality of care 81.3% 221 More "resident-centered" vs. "institutional" facility 66.9% 182 Amenities and support services 52.2% 142 Choices of meals, activities, etc. 58.8% 160 Location within community 43.4% 118 Private room 56.3% 153 Affordability 83.8% 228 Memory Care 33.8% 92 Other (please specify) 1.5% 4 answered question 272 skipped question 3 ---PAGE BREAK--- 5 of 30 6. If a new Assisted Living Facility were to be built in the area, and assuming that you can afford the cost, would you or a family member be willing and likely to use it in the future? Response Percent Response Count Yes 95.1% 255 No 4.9% 13 answered question 268 skipped question 7 7. Do you know of anyone who has moved away from Converse County to receive long-term care services elsewhere? (select all that apply) Response Percent Response Count No 21.2% 57 Yes, they moved to be with or to be near their family 33.1% 89 Yes, they moved to a Nursing Home 38.3% 103 Yes, they moved to an Alzheimer or Memory Care facility 20.8% 56 Yes, they moved to an Assisted Living Facility 56.5% 152 Yes, they moved to a Hospice facility 31.6% 85 Yes, they moved to some Other type of facility (please specify) 3.7% 10 answered question 269 skipped question 6 ---PAGE BREAK--- 6 of 30 8. If you know of someone who has moved away from the community to receive long-term care services, please indicate their reason(s) for moving, if you know: (select all that apply) Response Percent Response Count Service not available in Converse County 74.6% 159 To be closer to family or special friends 30.5% 65 Affordability 28.6% 61 Quality of care of facility 42.3% 90 Quality of "bricks and mortar" of facility 9.9% 21 Amenities and support services at facility 25.4% 54 Other (please specify) 3.3% 7 answered question 213 skipped question 62 ---PAGE BREAK--- 7 of 30 9. If an Assisted Living Facility (or other long-term care facility) is considered for Converse County, what would be the best way to fund the capital construction of said facility? (choose all that apply) Response Percent Response Count General Obligation Bonds 24.5% 62 Special Purpose Sales and Use Tax (method used to fund the EWC and Library construction projects) 54.2% 137 Government Grants 62.5% 158 Low-interest loans 39.1% 99 Local fundraising 36.8% 93 Private grants 47.4% 120 Revenue from the new assisted living facility to retire debt 43.1% 109 Other (please specify) 7.9% 20 answered question 253 skipped question 22 ---PAGE BREAK--- 8 of 30 10. As you personally age and may need to consider a long-term care facility, where would you most want to spend your "golden" years? Response Percent Response Count In my own community 73.1% 198 Within Converse County, but not necessarily the community I live in 8.5% 23 Somewhere else in Wyoming 1.5% 4 Near family or friends in another state 9.6% 26 It doesn't matter to me 2.6% 7 Other (please specify) 4.8% 13 answered question 271 skipped question 4 11. What is the best way to gather input from community members who need (or will need) long-term care? Response Count 142 answered question 142 skipped question 133 ---PAGE BREAK--- 9 of 30 12. Please share any other information you think should be considered for this long-term care plan. Response Count 77 answered question 77 skipped question 198 ---PAGE BREAK--- 10 of 30 Q1. Where do you live? 1 Natrona - all family lives in Converse Nov 20, 2013 9:49 PM 2 AFTON, WY Nov 7, 2013 5:47 PM Q2. Which of the following services, if any, do you currently receive? (select all that apply) 1 Work with all of the above Dec 9, 2013 9:05 AM 2 I work at the Glenrock Senior Center Nov 22, 2013 7:16 PM 3 Eat at the senior center. Nov 22, 2013 7:38 AM 4 We eat at the center 2 or 3 times a week and play grocery bingo on Mondays. I play piano at Adult Day Care and sing with fun singers on Thursdays. Nov 22, 2013 7:25 AM 5 I worked with cardio-therapy Nov 20, 2013 10:24 PM 6 none Nov 20, 2013 3:19 PM 7 Our mother recently suffered a stroke. She could live on her own physically but mentally requires help with medications. Douglas does not provide a place to bring her close to us. Nov 14, 2013 10:54 AM 8 Massage therapy Nov 9, 2013 2:47 PM 9 elderly parent lives with me Oct 31, 2013 4:55 PM ---PAGE BREAK--- 11 of 30 Q4. If your response to the previous question was yes, what additional services are needed in Converse County? (select all that apply) 1 Medium Income apartments Dec 9, 2013 9:36 AM 2 Majorly!!!! Our seniors (my friends), are having to leave Douglas due to NO room at Care Center or assisted living which there is really none. So sad! Dec 9, 2013 9:13 AM 3 Senior Companion Program Dec 9, 2013 9:01 AM 4 More options for transporation for health care ie. kidney issues. Nov 21, 2013 9:28 AM 5 Glenrock is in need of all these areas, It seems like we rely on Casper for these services. Nov 18, 2013 11:26 AM 6 Independent smaller housing for people who are living in large family homes. Independent apartments that they are cimfortable in so they can have space to entertain their friends. The housing we have now are not friendly to people who are used to regular homes. Nov 16, 2013 10:17 PM 7 #1 is an Assisted Living Facility Nov 9, 2013 2:47 PM 8 If we think outside the box we could do both in one facility Nov 2, 2013 8:06 AM 9 daycare workers willing to go into homes in the country Oct 31, 2013 4:55 PM 10 Green Homes Oct 31, 2013 4:05 PM 11 Moderate Income Independent Living for Middle-Aged with less mobility, etc... Oct 31, 2013 9:06 AM 12 Don't know how many services are in Glenrock now Oct 30, 2013 3:38 PM Q5. If you were to seek out long-term care housing for you or a family member, what factors would be important to you? (select all that apply) 1 I have no intention of going to such a facility, but, moving the senior I know there would meet their needs. Nov 21, 2013 9:12 AM 2 Combination independent senior living, assisted living and maybe memory care - the one I am familiar with works very well. Nov 20, 2013 9:58 PM 3 Recreational opportunities (may be under support services) and educational opportunities geared towards clients abilities Nov 1, 2013 2:36 PM 4 Most people go to either Douglas or Casper for Assisted Living services. Casper would be ok for me if I needed help. Oct 30, 2013 3:38 PM ---PAGE BREAK--- 12 of 30 Q7. Do you know of anyone who has moved away from Converse County to receive long-term care services elsewhere? (select all that apply) 1 Assisted living. Nov 22, 2013 8:24 AM 2 No comment Nov 21, 2013 9:46 AM 3 Day Hal Services Nov 21, 2013 9:16 AM 4 Veterans adm - support for facility. Nov 21, 2013 8:49 AM 5 They moved to an independent senior housing complex have their own apartment and close support services Nov 19, 2013 7:15 PM 6 Move to facility with both Senior Living & Assisted Living Facility. Nov 19, 2013 12:21 PM 7 The housing is more like an apartment where they can have house guests but a dinning room that is more like a resturant with tables. Nov 16, 2013 10:17 PM 8 My mother currently resides with her daughter. However, it is a situation that can't continue due to the daughter's health. Nov 14, 2013 10:54 AM 9 They moved to a board and care facility in Casper because there was nothing comparable in Douglas. Nov 7, 2013 12:14 PM 10 Severe mental health related. Oct 31, 2013 9:06 AM Q8. If you know of someone who has moved away from the community to receive long-term care services, please indicate their reason(s) for moving, if you know: (select all that apply) 1 Religious affiliation Dec 9, 2013 9:36 AM 2 Unknown Nov 22, 2013 7:24 PM 3 No service for their needs. Nov 22, 2013 8:24 AM 4 Assisted living not available Nov 21, 2013 9:35 PM 5 Did not want to leave Glenrock, but had no choice. Nov 17, 2013 9:01 PM 6 Don't really know Nov 2, 2013 8:06 AM 7 They moved to Casper to be in an assisted living facility and close to children. I hear that most people who live in Glenrock go to Casper for services. Oct 30, 2013 3:38 PM ---PAGE BREAK--- 13 of 30 ---PAGE BREAK--- 14 of 30 Q9. If an Assisted Living Facility (or other long-term care facility) is considered for Converse County, what would be the best way to fund the capital construction of said facility? (choose all that apply) 1 State obligation Dec 9, 2013 9:36 AM 2 Any way Dec 9, 2013 9:28 AM 3 All of the above Dec 9, 2013 9:26 AM 4 Don't give Egypt and Afghanistan billions. Dec 9, 2013 9:24 AM 5 Don't know Nov 22, 2013 8:06 AM 6 I am not sure. Nov 22, 2013 7:44 AM 7 I don't know all the possibilities - but a county this wealthy could certainly afford to do one, but not one of the for-profit mega-business. Look at "Frontline" explosion "assisted living facilities for-profit. Nov 21, 2013 9:12 AM 8 1% sales tax Nov 20, 2013 10:28 PM 9 A conglomerate so one area is not hit too hard for funding. Nov 20, 2013 10:01 PM 10 Combination of several Nov 20, 2013 9:58 PM 11 Any way to make it possible Nov 20, 2013 9:41 PM 12 I don't really know because I don't know what monies are available already. Nov 18, 2013 12:46 PM 13 Although I checked Special Purpose Sales Tax, I believe it would be extremely difficult to get a vote passed to do that. Most don't worry about a need for assisted care until they or someone they know needs it. At one time Douglas had an assisted care facility. Nov 14, 2013 10:54 AM 14 I think there are opportunities using multiple sources. Nov 8, 2013 2:22 PM 15 WHATEVER IT TAKES TO MAKE IT HAPPEN. Nov 7, 2013 12:14 PM 16 When Mac and Theo McComb had their assisted living facility they could answer ALL these questions. My suggestion is to consult with Theo McComb and her clients' families and go from there. Nov 2, 2013 8:06 AM 17 I don't know enough about funding a long-term care facility to make a choice Nov 1, 2013 2:36 PM 18 money left over from last assisted living endeavor Oct 31, 2013 4:05 PM 19 Don't know what would be best Oct 30, 2013 5:12 PM 20 5th cent tax Oct 30, 2013 12:53 PM ---PAGE BREAK--- 15 of 30 Q10. As you personally age and may need to consider a long-term care facility, where would you most want to spend your "golden" years? 1 If nothing available in own community. All my finances would then end up in another state. Dec 9, 2013 9:36 AM 2 At home. Nov 22, 2013 7:58 AM 3 As I said I have no intention of going into a facility of this nature. But I have many friends who would love such an alternative. When I can no longer take care of myself - it's really okay. I am a Do Not Resuscitate absolutely. Nov 21, 2013 9:12 AM 4 Depends on where my children are. Nov 21, 2013 8:44 AM 5 Jerusalem, Israel Nov 20, 2013 10:28 PM 6 Not in Glenrock Nov 20, 2013 10:15 PM 7 With my spouse and family. Nov 19, 2013 2:44 PM 8 Somwhere warm Nov 18, 2013 11:29 AM 9 Out of state Nov 17, 2013 9:14 PM 10 Preferably in my own community (Douglas) but possibly near family in another state or Wyoming community. Nov 9, 2013 2:47 PM 11 All these decisions depend on how much family I have when the need arises, and where I live at that time. Nov 2, 2013 8:06 AM 12 Near family is my first choice but I don't know where they will be living at the time I may need long-term care. Nov 1, 2013 2:36 PM 13 Probably Casper or even in another State where I grew up because of all the amenities there including shopping & restaurants etc depending on what kind of services I would need. Oct 30, 2013 3:38 PM ---PAGE BREAK--- 16 of 30 ---PAGE BREAK--- 17 of 30 Q11. What is the best way to gather input from community members who need (or will need) long-term care? 1 Workers in each community call on their neighbors who are middle aged or older - or have responsibility to care for aging family Dec 9, 2013 9:39 AM 2 Build it and it will be filled! Dec 9, 2013 9:36 AM 3 Surveys like this to help for those unable to go on line Dec 9, 2013 9:30 AM 4 Senior Center and mail Dec 9, 2013 9:28 AM 5 Any available Dec 9, 2013 9:26 AM 6 Visit them Dec 9, 2013 9:24 AM 7 Surveys such as this if they are considered Dec 9, 2013 9:23 AM 8 survey Dec 9, 2013 9:20 AM 9 Put these forms in newspapers Dec 9, 2013 9:19 AM 10 This worked well for myself and husband. He is 69 and I am 66 - so we're aging fast and wondering where we'll be soon. Dec 9, 2013 9:13 AM 11 This first effort has been valuable. Keep trying. Dec 9, 2013 9:07 AM 12 A survey like this. Meeting with older people at places like the Senior Center, Senior apartments and Douglas Care Center Dec 9, 2013 9:01 AM 13 This is it! Dec 9, 2013 8:49 AM 14 Open forum Nov 22, 2013 7:22 PM 15 Open meetings, visit churches and senior centers, phone survey. Nov 22, 2013 7:20 PM 16 Survey Nov 22, 2013 7:18 PM 17 Senior centers Nov 22, 2013 7:16 PM 18 In person town meetings. Nov 22, 2013 8:26 AM 19 Visit senior center and senior housing facilities. Nov 22, 2013 8:24 AM 20 This is a good start Nov 22, 2013 8:18 AM 21 As is. Nov 22, 2013 8:16 AM 22 More information on what is available and a perceived projection t what future needs will be addressed in future planning. Nov 22, 2013 8:04 AM 23 Senior center. Nov 22, 2013 7:58 AM 24 Town meetings. Nov 22, 2013 7:56 AM 25 Fill out these forms - have talks about this at our center. Nov 22, 2013 7:44 AM ---PAGE BREAK--- 18 of 30 Q11. What is the best way to gather input from community members who need (or will need) long-term care? 26 Put in newspaper. Nov 22, 2013 7:41 AM 27 Meetings with public. Nov 22, 2013 7:39 AM 28 Surveys, written or online - town meetings. Nov 22, 2013 7:32 AM 29 Senior Center - Local doctors - public health agencies and churches. Nov 22, 2013 7:29 AM 30 Talk to people here. Nov 22, 2013 7:25 AM 31 A survey like this with assistance from a helper if need (those who cannot write) Nov 21, 2013 9:39 PM 32 Personal letters Nov 21, 2013 9:37 PM 33 Meetings - paper trail - news Nov 21, 2013 9:35 PM 34 Talk to citizens in Converse County (all ages). Put surveys out. Do talks or presentations I towns. Nov 21, 2013 9:28 PM 35 through the senior center, newspaper and radio. Nov 21, 2013 9:23 PM 36 Town meeting, informational meeting - seminar Nov 21, 2013 9:12 PM 37 Informational meeting Nov 21, 2013 9:10 PM 38 Meetings and surveys Nov 21, 2013 9:05 PM 39 Senior community and their families. Nov 21, 2013 9:03 PM 40 First, identify current community members facing this decision. Then use them as an additional source for identifying others in or getting close to the same situation. Medical providers in Converse County are NOT the only source of who may need this type of care. A significant number of county residents get their care in Casper or from the Veterans Administration in Cheyenne or Sheridan, WY or in Hot Springs, SD. Second, enlist the aide of other community organizations such as the membership of the HRC groups in BOTH communities as well as using your local libraries and churches to solicit information. Nov 21, 2013 3:09 PM 41 Town hall meetings - Q & A's Nov 21, 2013 9:52 AM 42 Town meetings Nov 21, 2013 9:51 AM 43 Community meetings Nov 21, 2013 9:49 AM 44 Physician's offices. Nov 21, 2013 9:44 AM 45 Newspaper - word of mouth. Nov 21, 2013 9:43 AM 46 Senior Center Nov 21, 2013 9:40 AM 47 Surveys Nov 21, 2013 9:39 AM 48 Survey or use outside source to gather information. Nov 21, 2013 9:37 AM ---PAGE BREAK--- 19 of 30 Q11. What is the best way to gather input from community members who need (or will need) long-term care? 49 How ever necessary. Nov 21, 2013 9:35 AM 50 Distribute flyers, surveys, and other info a the Douglas and Glenrock Senior Centers. Nov 21, 2013 9:33 AM 51 Town meetings, Hospice, hospital and public health facility. Nov 21, 2013 9:28 AM 52 Home visits, central meeting at senior center, referrals from family and physician, senior advocate. Nov 21, 2013 9:25 AM 53 Information and advertising in local paper and community meetings. Nov 21, 2013 9:22 AM 54 Personal letters, personal meetings, public meetings, as always, radio and newspaper announcements. Nov 21, 2013 9:16 AM 55 Senior Center - organize meetings - Gay Bolln is a good presenter and pro- active advocate. Have to forms and go over them individually with the seniors. Many seniors get confused when so many options they don't understand Nov 21, 2013 9:12 AM 56 Word of mouth. Nov 21, 2013 8:56 AM 57 Mail, computer-based surveys - public meetings. Nov 21, 2013 8:53 AM 58 Public meetings (more than one or two), word of mouth, senior center, current nursing home folds, newspaper, radio and TV. Nov 21, 2013 8:49 AM 59 Personal interviews Nov 21, 2013 8:44 AM 60 Hold public meetings and talk to people in the community. Nov 21, 2013 8:40 AM 61 See where elders are now housed by cost needs to be a factor (reasonable) Ask care givers, family and friends. Nov 21, 2013 8:36 AM 62 This way Nov 20, 2013 10:30 PM 63 I don't know Nov 20, 2013 10:28 PM 64 With public meetings and advertising on radio, TV and paper. Nov 20, 2013 10:22 PM 65 Survey like this Nov 20, 2013 10:15 PM 66 Surveys, public meetings, on-line blogs Nov 20, 2013 10:11 PM 67 Getting into community, advertising, availability of surveys, reaching "non- traditional" areas such as health care and senior centers - seek out younger people who may need to assist parents/elders. Nov 20, 2013 10:05 PM 68 Use the web - surveys at the library and nursing home along with the senior center to get family members now using services for their elders. Nov 20, 2013 10:01 PM 69 This way should be good unless you make personal calls, help fill out and visit with them. Maybe personal stop at senior center while they are eating. Nov 20, 2013 9:58 PM 70 Publicity - make sure everyone knows about survey. Nov 20, 2013 9:49 PM ---PAGE BREAK--- 20 of 30 Q11. What is the best way to gather input from community members who need (or will need) long-term care? 71 This survey is good. Community open meetins Nov 20, 2013 9:46 PM 72 Town hall meetings, any way to gather information Nov 20, 2013 9:41 PM 73 Newspaper - meetings Nov 20, 2013 9:38 PM 74 Meetings Nov 20, 2013 9:36 PM 75 Talk with them in person or by phone. Nov 20, 2013 9:31 PM 76 Through surveys, focus groups, interviews Nov 20, 2013 9:28 PM 77 Visit people at the sr center. Nov 20, 2013 5:37 PM 78 newspaper, public meeting Nov 20, 2013 3:19 PM 79 Through the mail or faith community Nov 20, 2013 1:31 PM 80 As most of them don't use the online way like this, I say do a door to door (after a phone call or letter of introduction) questionnaire visiting with people currently receiving in home help who may be looking to transition to assisted living int he near future. Nov 20, 2013 10:41 AM 81 Surveys like this--thanks for supplying it on Facebook. Nov 20, 2013 12:17 AM 82 Surveys at senior center, grocery stores and medical service offices. Nov 19, 2013 7:15 PM 83 Interviews Nov 19, 2013 3:37 PM 84 Ask their family members through surveys, newspaper, maybe a drop box at an easily accessible location. Nov 19, 2013 2:44 PM 85 A survey such as this addresses what seniors think as well as those who may be caring for seniors now or in the near future. A pubic meeting may be beneficial as well as this can be an e xchange of ideas where one person builds on another when answering alone one is not aware of some hurdles. Nov 19, 2013 1:36 PM 86 Survey, but be more aggressive in soliciting response, ie leave stacks of survey in public locations, such as library, post office, and stores Nov 19, 2013 12:19 PM 87 Surveys but I feel that they would need to be handled in a more personal way to gain the input from older members of the community. Nov 19, 2013 11:27 AM 88 Go to the Senior Centers Nov 19, 2013 8:51 AM 89 Senior Centers, mailing out surveys to senior citizens Nov 19, 2013 7:03 AM 90 Survey letters sent to households to send back in the mail or a certain drop off place in Douglas. Nov 19, 2013 2:00 AM 91 Talk to them Nov 18, 2013 10:52 PM 92 You might consider hosting a few "Morning Coffee" events around the county. Folks usually show up for a cup of coffee and a cookie or two, and retired Nov 18, 2013 10:20 PM ---PAGE BREAK--- 21 of 30 Q11. What is the best way to gather input from community members who need (or will need) long-term care? persons may be available at that time of day. I would also attempt to get in touch with younger folks who will be helping to make decisions about the care of their parents. 93 Visit areas that seniors congregate and ask them to participate in this survey e.g. Senior Centers, morning coffee areas, community activities for Seniors. Nov 18, 2013 8:05 PM 94 town mtgs, newspaper, surveys Nov 18, 2013 4:27 PM 95 Informaton should be shared at all the senior centers as this will be the population most impacted in the near future. Nov 18, 2013 2:47 PM 96 Through any medical facility they would frequent,drug stores - even in Casper, place of employment, rec center,churches Nov 18, 2013 2:45 PM 97 Perhaps put the survey in the local newspapers, libraries,restaurants, and other gathering places of the retired community members. Nov 18, 2013 12:46 PM 98 Send out a survey int he mail. Nov 18, 2013 12:23 PM 99 Go to senior facilities and ask. Look at demographics and age structure of community. Nov 18, 2013 11:58 AM 100 Public meetings and surveys Nov 18, 2013 11:29 AM 101 Open Public meetings at different meeting spots through out our town. Newspaper and mail Nov 18, 2013 11:26 AM 102 through the media and personal contat Nov 18, 2013 7:26 AM 103 Speak to the seniors at the Glenrock Senior Center, town meetings on the proposal. Nov 17, 2013 9:14 PM 104 Word of mouth/make it public knowledge/advertise door-to-door Nov 17, 2013 9:11 PM 105 1. Should have ramps 2. Pocket doors 3. Lever door and sink handles 4. High toilets Nov 17, 2013 9:06 PM 106 Meetings and surveys, more than one time. Nov 17, 2013 9:01 PM 107 Surveys such as this and public meetings Nov 17, 2013 8:57 PM 108 News paper - town meeting Nov 17, 2013 8:52 PM 109 Meeting over coffee and donuts. Nov 17, 2013 8:51 PM 110 Try to get everyone to fill these out. Advertise in Douglas and Glenrock news paper. Put a sample of this survey in ad or try to get volunteers to deliver door- to-door. I, for one would take my whole street - South 3rd Street - Glenrock - Mary Ann Davis - 630 S 3rd Street - 436-8829 Nov 17, 2013 8:30 PM 111 I think town meetings, letters, and emails are three ways to collect information. It would also be a good idea to access already-existing activities, such as the state fair and other public gatherings, to collect information from the attendees. Nov 17, 2013 6:02 PM ---PAGE BREAK--- 22 of 30 Q11. What is the best way to gather input from community members who need (or will need) long-term care? 112 Go to other retirement areas and observe how they do housing. Such as the areas where people go for the winter. There are some very nice smaller housing in Douglas, just not enough to go around. Nov 16, 2013 10:17 PM 113 talk with the folks at the senior centers Nov 15, 2013 6:14 PM 114 Contact/solicit information from residents that have been through the limited options that are currently available; gain input from their decisions, with reasons. Nov 15, 2013 3:15 PM 115 Survey with high percentage of participation from County residents Nov 15, 2013 12:32 PM 116 Talk to some of the elderly people in this town, and some of the home health nurses and aides that work in the community for them. Nov 15, 2013 10:08 AM 117 Senior Center activities. Leave survey forms at Douglas Grocery, Safeway, Shopko, Frontier Drug ask them if they will include a survey when sacking purchases. Unfortunate thing is that not one of knows if or when we will need long-term care. Nov 14, 2013 10:54 AM 118 Meetings. Internet, newspaper. Nov 12, 2013 2:43 PM 119 radio, mail, computer, post card Nov 12, 2013 10:14 AM 120 First of all, we have a long-term care facility in Douglas. My concern (and that of numerous family members) is that we really need an Assisted Living Facility to bridge the gap between such facilities as Irwin Towers and Riverside Plaza and the Douglas Care Center. Since, this option is not available at the present time, perhaps a series of public meeting forums would provide the best opportunity for input regarding the need for an Assisted Living Facility. Each of us has the potential for needing Assisted Living facility and those of us who are baby- boomers are getting closer and closer. Some in our communities have family members who are residents of Assisted Living Centers elsewhere in Wyoming and neighboring states. These individuals could provide great input on the need for a facility in Douglas (not Glenrock, please). There are also Douglas citizens who have lived most or all of their adult lives in Douglas/Converse County who are now residing in long-term care facilities elsewhere. Again, their families could provide great input at a public forum. Any public forum should also provide the opportunity for written input from those who are either unwilling, uncomfortable, or unable to speak publicly Nov 9, 2013 2:47 PM 121 Offer meetings, attend Sr. Centers. Nov 8, 2013 2:22 PM 122 Ask other communities how they approached this project. No need to reinvent the wheel. Use what they gleaned and modify it for Douglas and Glenrock. Nov 7, 2013 12:14 PM 123 one on one contact Nov 7, 2013 9:35 AM 124 Meeting at senior center Nov 6, 2013 9:34 PM 125 ask them Nov 6, 2013 3:20 PM 126 Provide on radio ads for desiring input from community and place questionnaires at gathering places such as churches, hospitals, care facilities, senior centers, voting centers and education facilities. Nov 6, 2013 3:13 PM ---PAGE BREAK--- 23 of 30 Q11. What is the best way to gather input from community members who need (or will need) long-term care? 127 surveys Nov 6, 2013 9:09 AM 128 It takes more than one effort--meetings, media articles, surveys, etc. Nov 5, 2013 1:38 PM 129 Have a team of community leaders give in-person presentations to service clubs, church congregations, the Senior Center, the ranching community and Social Service personnel. Public meetings after some data is collected. Nov 2, 2013 8:06 AM 130 By doing survey's like this asking people what their need's are Nov 1, 2013 4:35 PM 131 Have surveys available, they could be mailed, picked up at churches, the Senior Center, etc. Nov 1, 2013 2:36 PM 132 thru senior center - put up a bill board - mailing - door to door - probably a combination of all of those. And, contacting the churches, and other community leaders. Nov 1, 2013 12:37 PM 133 leave flyers with some leading questions in public places such as the library, court house, hospital, senior center Oct 31, 2013 4:55 PM 134 Go to where they have coffee groups, clubs, and other meetings and discuss in an informal format. Oct 31, 2013 4:20 PM 135 Public Meetings Oct 31, 2013 4:05 PM 136 Conduct a survey of the difficulties of the current senior living situation Oct 31, 2013 9:06 AM 137 Speak to individuals at the senior centers and have public meetings. Oct 31, 2013 7:40 AM 138 Oct 30, 2013 5:12 PM 139 Interview, face-to-face or perhaps via phone. Perhaps go to places where seniors spend time. Oct 30, 2013 4:32 PM 140 Probably this way. Oct 30, 2013 3:38 PM 141 Forums in the senior centers. Oct 30, 2013 3:00 PM 142 door-to-door. Elderly do not like to talk on phone, nor can they hear to understand a lot of the time. They are too proud to admit that they need help. Home visits would be more personable. Oct 30, 2013 12:43 PM ---PAGE BREAK--- 24 of 30 ---PAGE BREAK--- 25 of 30 Q12. Please share any other information you think should be considered for this long-term care plan. 1 We have a rich state compared to 46 other states. Our resources are being used up. A 1% tax on all industry who employs Douglas people then to be used to pay for LT Care facility to be built. Time for industry to give for the privilege of local workers who will be also offered a 1/2% discount. Dec 9, 2013 9:36 AM 2 You need qualified people to work and run the place. People who care..... Dec 9, 2013 9:32 AM 3 Frequent evaluations Dec 9, 2013 9:24 AM 4 We don't need another nursing home. Douglas Care Center seems to do a good job. My main concern with this survey is that 6 of the 8 on the steering committee are connected to the hospital in some form. We know from recent news that the hospital board chair is part owner of the hospital. We sure don't need any more hospital board involved in an assisted living place. I hope the comments you receive are considered. Dec 9, 2013 9:23 AM 5 or weekly checks by appropriate agencies; food service; elder abuse, etc. Dec 9, 2013 9:19 AM 6 Keep in mind that most of current residents who've been here all their lives or most of it, are not wealthy. Costs must be considered above all else when pricing these facilities for us. What is your plan for the charges? That will be a major question and then the care plan of quality. Thank you for your time in reading this survey. Sincerely, the Gillespie's Dec 9, 2013 9:13 AM 7 Location Availability of staff Cost Dec 9, 2013 9:01 AM 8 After tax increase passed for college and library it should pass for Long Term Care which is way more important. Nov 22, 2013 7:24 PM 9 Glenrock seniors have needs that are not being met. Nov 22, 2013 7:18 PM 10 Try to make cost affordable to older adults - money is very short these days with the high cost of living and medication, medical health needs. Facility does not need to be flashy, but comfortable and good care provided. This is very important to have we definitely need it in our community. Older adults are our heritage and deserve to have a good place to live in the later years of their lives. Nov 22, 2013 8:24 AM 11 Building should have in the floor heat. Nov 22, 2013 8:16 AM 12 Have things to do for seniors instead of them doing nothing and waiting to die. The mail should not be the highlight of their day. Nov 22, 2013 8:06 AM 13 Our long term population projections due to our large energy related systems. Nov 22, 2013 8:04 AM 14 You are going to do whatever you want anyway! Nov 22, 2013 7:58 AM 15 There are different stages in aging - requiring different needs as time progresses. Nov 22, 2013 7:56 AM 16 It should be affordable and have transportation and homelike. Nov 22, 2013 7:44 AM 17 I do believe that Douglas has a real need for an assisted living facility. Thank you for pursuing this much needed asset to our community. Nov 22, 2013 7:32 AM ---PAGE BREAK--- 26 of 30 Q12. Please share any other information you think should be considered for this long-term care plan. 18 I just know that there is a need for this! Nov 22, 2013 7:29 AM 19 My sister was in assisted living and husband in nursing home in They were next door to each other, so she just walked up the hall and to nursing home and could see him everyday and stay as song as she chose and they ate together in the dining room at the nursing home. Nov 22, 2013 7:25 AM 20 Movies, music, walking and swimming facilities. Nov 21, 2013 9:37 PM 21 Let's do it! Nov 21, 2013 9:28 PM 22 I have seen my neighbors grow very weary of having to drive to Casper or Douglas and put a strain on their own health. Nov 21, 2013 8:59 PM 23 Extremely needed in Douglas and Glenrock. Nov 21, 2013 9:49 AM 24 I truly feel that assisted living in Douglas is necessary. Nov 21, 2013 9:43 AM 25 Build it! Nov 21, 2013 9:37 AM 26 I would also direct attention to the families of those who already moved and would like to have them back in Douglas. Nov 21, 2013 9:16 AM 27 Hospice facility - I think you should work with the Central Wyoming Hospice In House Organization in Casper. As a concerned and interested member of the Douglas community I would be more than will to serve on a committee to share with others my ideas. Lucy Albertson - Irwin Towers. Nov 21, 2013 9:12 AM 28 The training and supervision need to be professional. Food preparation and service should be quality, indivualized and timely. Nov 21, 2013 8:53 AM 29 I believe private interests should be encouraged and zoning okayed. I also believe that MHCC should not be involved in tan assisted living facility as primary builder. Nov 21, 2013 8:49 AM 30 The best place to build this would be up at the old EWC building close to the doctors. This way those who could walk to their doctors appointment. There is plenty of room for it at the old EWC sight. Nov 21, 2013 8:40 AM 31 How it would be staffed and ability to have in town doctors. Who will mange and finance it. Nov 21, 2013 8:36 AM 32 I think Doctors salaries are too high. Nov 20, 2013 10:28 PM 33 Make it affordable to people or families so they can put their family members in a safe and comfortable place. Nov 20, 2013 10:22 PM 34 Don't like questions - they are geared toward only positive answers. Nov 20, 2013 10:17 PM 35 The need for an assisted living facility is definitely important for Douglas. Nov 20, 2013 10:15 PM 36 Check out the "Green House" projects and funding available for these - information can be obtained online. Nov 20, 2013 10:11 PM ---PAGE BREAK--- 27 of 30 Q12. Please share any other information you think should be considered for this long-term care plan. 37 I recently returned from a 3-week visit at a combination independent senior living mingled in so they don't have to move. Also, a connected memory wing. This seems to work very well, this company has 33 such facilities in the Minneapolis plus a brand new 5-story one opening very soon. It was so mice, people were pleasant, staff friendly and considerate. It was a happy place, probably some weren't but we didn't see them? If I can help please call - Jewell Reed 307-358- 2118 or [PHONE REDACTED] Nov 20, 2013 9:58 PM 38 Quality of facility and caregivers is important. Cost also but if care is excellent, cost would be less of a priority. Nov 20, 2013 9:46 PM 39 A family member was in Douglas Care Center eight years - we can tell you some sad stories. Nov 20, 2013 9:41 PM 40 We really need assisted living in Douglas. Too many have went somewhere else - they have had to leave family and friends. Douglas Senior Center does in home care. They se to do a very good job, but last few years they have gotten very bad and in the last 6 mos or so the food is really bad. Nov 20, 2013 9:36 PM 41 Information from current or past caregivers about the financial and emotional stress of being a caregiver is of having a place your loved one in an inappropriate or low quality long term facility. Nov 20, 2013 9:28 PM 42 There are several elderly people that I know that live in or near Douglas that would gladly move into an assisted living facility in Douglas. I certainly hope one becomes available in the near future. Nov 20, 2013 9:19 PM 43 I have a lot of friends that are seniors. Having to drive or find transportation out of town to receive services is a burden for them. We have a great senior center here in town but they can only do so much. I fully support a facility with memory care (as so many local seniors are dealing with memory related illness) in Glenrock. Nov 20, 2013 10:41 AM 44 The elderly in Douglas need another choice besides the Douglas Care Center, which is privately owned and could use improvement in SO MANY areas, especially in the management and the personal care of its residents. Nov 20, 2013 12:17 AM 45 Had a condo or townhouse complex been available for seniors to move into, I think many of the elderly would have sold their large and well landscaped homes during the previous boom easing the housing crunch for new families moving to Douglas as well as allowing the seniors to maintain their independence without all the burdens of home ownership. It can be a win-win for both elderly and young families. Nov 19, 2013 7:15 PM 46 Need for staff for these facilities. I know that there is a shortage of medical professionals everywhere, but it seems like our community could do something to make these professions more appealing and find a way to retain them. Nov 19, 2013 3:37 PM 47 One building in each city might be constructed to meet more than one need due to our county's relatively low population. Beginning with a senior housing wing for those who no longer are able to deal with taking care of a home. Bi-level homes of which there is an abundance in Glenrock are not well suited for the senior. The laundry is downstairs, the bathrooms are not wheelchair accessible, Nov 19, 2013 1:36 PM ---PAGE BREAK--- 28 of 30 Q12. Please share any other information you think should be considered for this long-term care plan. there can be too many steps, the kitchens are not designed properly. Thus you see there is little elder housing for safe self care. There could be a second wing that one could transfer to when the situation arose for example, more assistance with medications or personal care. With this group of people they could possibly share some of the same staff, activity rooms, barbershop etc. Nursing home could be upgraded to include special wing for Alheimers and another for hospice care, My experience with a family friend in the nursing home with end stage cancer was a nightmare. The staff was not knowledgeable in dealing with the pain. They, of course were geared to deal with different kinds of problems. It was too late for a transfer. I site this incident in the fact that the staff for one wing might not fit the other. Thanks for seeing that we have a problem that needs addresses. 48 As the baby boomers generation ages these types of facilities will be in high demand, so controlling the affordability will be very important. Nov 19, 2013 11:27 AM 49 Long term quality care. A place that you yourself wouldn't mind to live in. Nov 18, 2013 11:10 PM 50 I really think that if possible, facilities, at least for assisted living, should be built both in Glenrock and in Douglas. They are both great communities in which to live, but are different communities. Facilities in both communities would also create job opportunities in both communities. Nov 18, 2013 10:20 PM 51 not applicable Nov 18, 2013 4:27 PM 52 DO IT! Converse county needs an assisted living facility. Nov 18, 2013 11:58 AM 53 If at all possible there needs to be a facility in both Glenrock and Douglas operated jointly. Nov 18, 2013 7:26 AM 54 There are a large number of seniors in Glenrock and one is needed here. If it is just in Douglas, one may as well go to Casper. Nov 17, 2013 9:01 PM 55 Please consider "campus" facilities, combining temporary respite/therapeutic services with temporary housing, independent living senior housing, assisted living and dependent care buildings all on the same campus. It would be the most efficient use of land space and serve as a "community within a community" without the isolation that comes with relocating to an unfamiliar town. The project could be phased as part of a master plan, designed as a whole but built as finances allow, reducing architecture/engineering/site design costs Nov 15, 2013 3:15 PM 56 We were so please when we moved to Douglas in 1976. We saw senior housing at Irwin Towers that truthfully we had not seen in this area of the country and moved my Mom here while she waited for an apartment to open. It seems so strange that so many things were available earlier for Seniors that assisted care is not included in those services. It is like someone said build Irwin Towers, build Payne Plaza, build a new Senior Center and then put the brakes on with no thought as to what those people using those facilities would do next to remain a part of their community. And then we have the "younger" folks in need of help for so many reasons. Shouldn't there be something in their community that includes them as well? Nov 14, 2013 10:54 AM 57 more affordable care, assistance with setting up meds, regular well being checks Nov 12, 2013 10:14 AM ---PAGE BREAK--- 29 of 30 Q12. Please share any other information you think should be considered for this long-term care plan. by phone or home visits 58 Again, please don't confuse Assisted Living Facility with long-term care. Long- term care is the DFS terminology utilized for nursing homes. We MUST have an Assisted Living Facility to bridge the gap between either one's own residence or such housing as Irwin Towers/Riverside Plaza and a full-fledged nursing home. Nov 9, 2013 2:47 PM 59 Size - number of rooms Nov 8, 2013 2:22 PM 60 GET A PRIVATE INDIVIDUAL TO BUILD A SMALL ALF. Nov 7, 2013 5:47 PM 61 My husband and I have spent the last 10 years managing our parents' welfare through the aging and assisted-living stages. We desired to keep them in Douglas but there were no appropriate facilities in place here besides DCC. Out of necessity we arranged for them to receive care in Casper, starting with MGM, then SoV, Park Place, and finally back to SoV. Incidentally, at the point they required skilled nursing care, we looked into DCC and sought the opinions of residents' families. Regrettably, as a result, we chose to make arrangements for them to receive care at SoV. Nov 7, 2013 12:14 PM 62 We are an aging. Community and desperately need a long care facility Nov 6, 2013 9:34 PM 63 I have seen tiered care operations where independent living homes/housing coupled with assisted living centers and nursing care centers allow for individuals and couples to move into the level of care needed as needed. In an ideal world I think this would be desirable. Nov 6, 2013 3:13 PM 64 We just need long term. Nov 6, 2013 9:09 AM 65 Having had a bad experience with a family member in a nursing home facility, I hesitate to consider this in the future. Nov 5, 2013 1:38 PM 66 Let's visit with as many "positive-thinking" individuals representing men, women, businesses, Cando and the Chamber to form a committee of committed people with a good track record for getting things done. Jewel Reed, Helga Bull, Kerry Shatto, Mark Curtis, Kim Hiser, Butch, Troy and Blake Scott, Arlene & Mike Ernst, John Pexton, George Smith, Allen and Jackie Pierce... there are many many more! The first consideration should be that they have been, and are committed to a community dedicated to "quality of life, education and economic integrity." Nov 2, 2013 8:06 AM 67 Please let people know what is currently available in the area so they can take that into consideration when coming up with ideas of what is needed. Nov 1, 2013 2:36 PM 68 Service animals and sight assistance materials. Quality would be important - not just numbers in boxes, but qualified and caring staff. Nov 1, 2013 12:37 PM 69 For those not quite ready to leave their home, there needs to be more help available within that home, especially for homes that are isolated and in the country. Unfortunately, I am not sure where you will find the people to hire for such jobs because many service jobs are underfilled now. An in-home daycare for adults that a care person can call for occasional days, such as when the care giver has a personal doctor's appointment (out of county that requires being Oct 31, 2013 4:55 PM ---PAGE BREAK--- 30 of 30 Q12. Please share any other information you think should be considered for this long-term care plan. gone most of the day), would be wonderful, especially if their care recipient is handicapped, such as in a wheel chair. 70 What keeps a person from filling out this survey more than one time? These should be made in a hard copy in the event people do not use the internet. Oct 31, 2013 2:17 PM 71 The Hospital at one time had both a Home Health and Hospice it was sold down the river because "It needs to make money not just break even every department was expected to make money" That quote was from the last Hospital Director to my wife and I. After that the Hospital started advertising that they wanted to be our home town care. REALLY! Oct 31, 2013 1:32 PM 72 A transitional community would be ideal where residents could move from independent housing such as townhomes to assisted living similar to apartments with on site restaurant then to full care facilities. If this were in the same general location the moves would be less traumatic. Oct 31, 2013 9:18 AM 73 The current Independent Living facilities are wonderful. We do, however, need more accommodations for people who have disabilities, etc... that are not quite at the senior age status. Oct 31, 2013 9:06 AM 74 wondering if voters would go for another special purpose sales tax, or a bond, at this time, with EWC and Library expansions being done. Oct 30, 2013 5:12 PM 75 Services should be on a continuum from least restrictive to most restrictive. As long as the current management/ownership of the current long-term care facility is involved, I would be reluctant to take advantage of services. Oct 30, 2013 4:32 PM 76 I'm not familiar enough with long term care to know except I put my father in assisted living in another state and I interviewed 3 facilities and the one I chose was a small 12 bed facility and all were private rooms. The owners live at the facility and it's a friendly and caring atmosphere with great meals. It's very clean as well. The other 2 I interviewed of which one was a private home with 3-4 residents and it was much higher in cost than the facility I put him in and the other one was a newer facility with both skilled care and assisted care and although new it smelled of urine & the atmosphere was very cold and it was way higher than the others. Oct 30, 2013 3:38 PM 77 Something needs to be done to assist the elderly who can still live in their home but cannot afford the basic bills: utilities, groceries, day to day living expenses. If financial assistance can be found for utilities, they need it. More attention needs to be given to our elderly citizens. Oct 30, 2013 12:43 PM ---PAGE BREAK--- 1 of 27 Converse County Long-Term Care Stakeholder Survey 1. Name of Agency/Organization you represent (if applicable): Response Count 18 answered question 18 skipped question 4 2. Contact Information Response Percent Response Count Name 100.0% 22 Title 100.0% 22 Mailing Address 100.0% 22 City 100.0% 22 Zip 100.0% 22 Phone Number 100.0% 22 Email 100.0% 22 answered question 22 skipped question 0 ---PAGE BREAK--- 2 of 27 3. What services does your company/agency currently provide? (select all that apply) Response Percent Response Count Meals and Nutrition Services 20.0% 4 Medical Services 40.0% 8 Pharmacy Services 10.0% 2 Services for the Disabled 25.0% 5 Home Health Care 20.0% 4 Public Health Services 25.0% 5 Referrals to Other Agencies 40.0% 8 Senior Services 15.0% 3 Physical or Rehabilitative Therapy 15.0% 3 Mental Health Services 5.0% 1 Adult Day Care 5.0% 1 Respite Care 25.0% 5 Transportation 25.0% 5 In-home Hospice Care 0.0% 0 Memory Care 5.0% 1 Independent Living 5.0% 1 Boarding Home 0.0% 0 Assisted Living Facility 0.0% 0 Nursing Home 5.0% 1 Other (please specify) 40.0% 8 answered question 20 skipped question 2 ---PAGE BREAK--- 3 of 27 4. What services do your clients or patients receive from other agencies or providers in the community? (select all that apply) Response Percent Response Count Meal and Nutrition Services 68.4% 13 Medical Services 73.7% 14 Pharmacy Services 73.7% 14 Services for the Disabled 57.9% 11 Home Health Care 63.2% 12 Public Health Services 68.4% 13 Referrals to other Agencies 68.4% 13 Senior Services 63.2% 12 Physical or Rehabilitative Therapy 57.9% 11 Mental Health Services 63.2% 12 Adult Day Care 31.6% 6 Respite Care 42.1% 8 Transportation 52.6% 10 In-home Hospice Care 31.6% 6 Memory Care 10.5% 2 Independent Living 42.1% 8 Boarding Home 5.3% 1 Assisted Living Facility 10.5% 2 Nursing Home 36.8% 7 Other (please specify) 15.8% 3 answered question 19 skipped question 3 ---PAGE BREAK--- 4 of 27 5. Long-term care includes a continuum of care to assist the elderly or disabled in completing activities of daily living. It includes home health care, subsidized senior housing, boarding homes, assisted living facilities, and nursing homes. Do you feel that there is a need for more of these services or facilities in the community? Response Percent Response Count No 0.0% 0 Yes 100.0% 22 answered question 22 skipped question 0 ---PAGE BREAK--- 5 of 27 6. If your response to the previous question was yes, what additional services or facilities are needed in Converse County? (Check all that apply) Response Percent Response Count Respite Care 45.5% 10 Boarding Home Facility 45.5% 10 Assisted Living Facility 100.0% 22 Memory Care Facility 36.4% 8 Nursing Care Facility 31.8% 7 Home Health Care 40.9% 9 Senior Independent Living 54.5% 12 In-home Hospice Care 36.4% 8 Hospice Care Facility 50.0% 11 Other (please specify) 13.6% 3 answered question 22 skipped question 0 ---PAGE BREAK--- 6 of 27 7. Do you know of anyone who has moved away from the community to receive long-term care services? (select all that apply) Response Percent Response Count No 18.2% 4 Yes, they moved to be with or to be near their family 40.9% 9 Yes, they moved to a Nursing Home 59.1% 13 Yes, they moved to an Alzheimer or Memory Care facility 54.5% 12 Yes, they moved to an Assisted Living Facility 68.2% 15 Yes, they moved to a Hospice- care facility 40.9% 9 Yes, they moved to some Other type of facility (please specify) 13.6% 3 answered question 22 skipped question 0 ---PAGE BREAK--- 7 of 27 8. If you know of someone who has moved away from the community to receive long-term care services, please indicate their reason(s) for moving, if you know: (select all that apply) Response Percent Response Count Service not available in Converse County 66.7% 12 To be closer to family or special friends 27.8% 5 Affordability 5.6% 1 Quality of care at facility 44.4% 8 Quality of "bricks and mortar" of facility 16.7% 3 Amenities and support services at facility 33.3% 6 Other (please specify) 11.1% 2 answered question 18 skipped question 4 9. If a new Assisted Living Facility were to be built in the area, what impact would that have on your services? Response Percent Response Count No impact 54.5% 12 Yes, it would impact: 45.5% 10 answered question 22 skipped question 0 ---PAGE BREAK--- 8 of 27 10. If an Assisted Living Facility (or other long-term care facility) is considered for Converse County, what would be the best way to fund the capital construction of said facility? (select all that apply) Response Percent Response Count General Obligation Bonds 22.7% 5 Special Purpose Excise (sales and use) Tax - the method used to fund the EWC and library construction projects 54.5% 12 Government Grants 50.0% 11 Low-interest loans 40.9% 9 Local fundraising 36.4% 8 Private grants 45.5% 10 Revenue from the new assisted living facility to retire debt 36.4% 8 Other (please specify) 13.6% 3 answered question 22 skipped question 0 ---PAGE BREAK--- 9 of 27 11. As you personally age and may need to consider a long-term care facility, where would you most want to spend your "golden" years? Response Percent Response Count In my own community 68.2% 15 Within Converse County, but not necessarily the community I live in 4.5% 1 Somewhere else in Wyoming 0.0% 0 Near family or friends in another state 22.7% 5 It doesn't matter to me 0.0% 0 Other (please specify) 4.5% 1 answered question 22 skipped question 0 12. What is the best way to gather input from community members who need (or will need) long-term care? Response Count 18 answered question 18 skipped question 4 ---PAGE BREAK--- 10 of 27 13. Please share any other information you think should be considered for this long-term care plan. Response Count 11 answered question 11 skipped question 11 ---PAGE BREAK--- 11 of 27 ---PAGE BREAK--- 12 of 27 Q1. Name of Agency/Organization you represent (if applicable): 1 Douglas Care Center Nov 19, 2013 3:57 PM 2 Converse County Commission Nov 18, 2013 8:03 AM 3 Memorial Hospital of Converse County Nov 17, 2013 8:52 AM 4 Department of Family Services Nov 15, 2013 5:11 PM 5 Memorial Hospital of Converse County Nov 15, 2013 2:17 PM 6 City of Douglas Nov 15, 2013 1:10 PM 7 Glenrock Health Center Nov 15, 2013 11:55 AM 8 Converse County Hospital Foundation Nov 15, 2013 11:46 AM 9 Ann's Best Care, LLC Nov 14, 2013 9:28 AM 10 Interim HealthCare of Wyoming Nov 7, 2013 5:37 PM 11 Glenrock Senior Center Nov 5, 2013 3:59 PM 12 Douglas Senior Center Nov 5, 2013 11:43 AM 13 Interim HealthCare Nov 4, 2013 5:03 PM 14 Converse County Public Health-glenrock Div Nov 4, 2013 2:05 PM 15 Converse County Public Health Nov 4, 2013 11:41 AM 16 Precision Prosthetics & Orthotics Nov 1, 2013 4:41 PM 17 Converse County Public Health Oct 31, 2013 9:58 AM 18 Riverside Plaza I and Riverside Plaza II Oct 31, 2013 9:39 AM ---PAGE BREAK--- 13 of 27 ---PAGE BREAK--- 14 of 27 Q2. Contact Information Name 1 Kelli Rogge Nov 19, 2013 3:57 PM 2 Rick Grant Nov 18, 2013 8:03 AM 3 Gay Bolln Nov 17, 2013 8:52 AM 4 MAJOR L. BROWN Nov 16, 2013 7:03 PM 5 Mary Ann Maidl Nov 15, 2013 5:11 PM 6 Ryan Smith Nov 15, 2013 2:17 PM 7 Bruce Jones Nov 15, 2013 1:10 PM 8 Melanie Cielinski Nov 15, 2013 11:55 AM 9 Denise Lyons Nov 15, 2013 11:46 AM 10 Ann Rex, R.N. Nov 14, 2013 9:28 AM 11 Kary Pickett Nov 7, 2013 5:37 PM 12 Nancie Fink Nov 5, 2013 3:59 PM 13 Bernie Davis Nov 5, 2013 11:43 AM 14 Rob Lempka Nov 4, 2013 5:03 PM 15 Pat Reiter Nov 4, 2013 2:05 PM 16 Melissa Ohnstad Nov 4, 2013 11:41 AM 17 Kamil Leman Nov 1, 2013 4:41 PM 18 Scott Howe RN Nov 1, 2013 8:08 AM 19 Leslie Fowler, BSN, RN Oct 31, 2013 9:58 AM 20 Stephanie Hagemann Oct 31, 2013 9:39 AM 21 Vickie Winney Oct 30, 2013 4:23 PM 22 David Kreycik Oct 30, 2013 11:43 AM Title 1 NHA Nov 19, 2013 3:57 PM 2 Commissioner Nov 18, 2013 8:03 AM 3 Board Secretary Nov 17, 2013 8:52 AM ---PAGE BREAK--- 15 of 27 Q2. Contact Information 4 CONVERSE COUNTY COMMISSIONER Nov 16, 2013 7:03 PM 5 Social Services Supervisor Nov 15, 2013 5:11 PM 6 CEO Nov 15, 2013 2:17 PM 7 Mayor Nov 15, 2013 1:10 PM 8 Administrator Nov 15, 2013 11:55 AM 9 Executive Director Nov 15, 2013 11:46 AM 10 Owner/Manager Nov 14, 2013 9:28 AM 11 Administrator Nov 7, 2013 5:37 PM 12 Office Manager Nov 5, 2013 3:59 PM 13 LPN, Access Care Coordinatior Nov 5, 2013 11:43 AM 14 Business Development Representative Nov 4, 2013 5:03 PM 15 R.n Staff nurse Nov 4, 2013 2:05 PM 16 Nurse Manager Nov 4, 2013 11:41 AM 17 Owner/Practitioner Nov 1, 2013 4:41 PM 18 Citizen Nov 1, 2013 8:08 AM 19 Public Health Nurse Oct 31, 2013 9:58 AM 20 Housing Director Oct 31, 2013 9:39 AM 21 Registered Nurse Oct 30, 2013 4:23 PM 22 Owner Oct 30, 2013 11:43 AM Mailing Address 1 1108 Birch Street Nov 19, 2013 3:57 PM 2 199 Boxelder Rd. Nov 18, 2013 8:03 AM 3 664 Williams Nov 17, 2013 8:52 AM 4 P.O. BOX 1182 Nov 16, 2013 7:03 PM 5 219 North Russell Nov 15, 2013 5:11 PM 6 111 S. Fifth Street Nov 15, 2013 2:17 PM 7 1242 Frontier Drive Nov 15, 2013 1:10 PM ---PAGE BREAK--- 16 of 27 Q2. Contact Information 8 PO Box 786 Nov 15, 2013 11:55 AM 9 111 South 5th Nov 15, 2013 11:46 AM 10 214 North 5th Street Nov 14, 2013 9:28 AM 11 1010 E. 1st Street, Suite A Nov 7, 2013 5:37 PM 12 PO Box 783 Nov 5, 2013 3:59 PM 13 340 1st St West Nov 5, 2013 11:43 AM 14 1010 East 2nd Street, Suite A Nov 4, 2013 5:03 PM 15 PO Box 1842 Nov 4, 2013 2:05 PM 16 255 N. Russell Ave Nov 4, 2013 11:41 AM 17 5810 E. 2nd St., Ste. 300 Nov 1, 2013 4:41 PM 18 126 S. Monkey Mt. Nov 1, 2013 8:08 AM 19 255 N. Russell Oct 31, 2013 9:58 AM 20 405 West Grant Street Oct 31, 2013 9:39 AM 21 51 Red Rock Drive Oct 30, 2013 4:23 PM 22 PO Box 1043 Oct 30, 2013 11:43 AM City 1 Douglas Nov 19, 2013 3:57 PM 2 Glenrock, Wyo. Nov 18, 2013 8:03 AM 3 Douglas Nov 17, 2013 8:52 AM 4 DOUGLAS Nov 16, 2013 7:03 PM 5 Douglas Nov 15, 2013 5:11 PM 6 Douglas Nov 15, 2013 2:17 PM 7 Douglas Nov 15, 2013 1:10 PM 8 Glenrock Nov 15, 2013 11:55 AM 9 Douglas Nov 15, 2013 11:46 AM 10 Douglas Nov 14, 2013 9:28 AM 11 Casper Nov 7, 2013 5:37 PM ---PAGE BREAK--- 17 of 27 Q2. Contact Information 12 Glenrock Nov 5, 2013 3:59 PM 13 Douglas Nov 5, 2013 11:43 AM 14 Casper Nov 4, 2013 5:03 PM 15 Glenrock Nov 4, 2013 2:05 PM 16 Douglas Nov 4, 2013 11:41 AM 17 Casper Nov 1, 2013 4:41 PM 18 Glenrock Nov 1, 2013 8:08 AM 19 Douglas Oct 31, 2013 9:58 AM 20 Douglas Oct 31, 2013 9:39 AM 21 Douglas Oct 30, 2013 4:23 PM 22 Douglas Oct 30, 2013 11:43 AM Zip 1 82633 Nov 19, 2013 3:57 PM 2 82637 Nov 18, 2013 8:03 AM 3 Wyoming Nov 17, 2013 8:52 AM 4 82633 Nov 16, 2013 7:03 PM 5 82633 Nov 15, 2013 5:11 PM 6 82633 Nov 15, 2013 2:17 PM 7 82633 Nov 15, 2013 1:10 PM 8 82637 Nov 15, 2013 11:55 AM 9 82633 Nov 15, 2013 11:46 AM 10 82633 Nov 14, 2013 9:28 AM 11 82601 Nov 7, 2013 5:37 PM 12 82637 Nov 5, 2013 3:59 PM 13 82633 Nov 5, 2013 11:43 AM 14 82601 Nov 4, 2013 5:03 PM 15 82637 Nov 4, 2013 2:05 PM ---PAGE BREAK--- 18 of 27 Q2. Contact Information 16 82633 Nov 4, 2013 11:41 AM 17 82609 Nov 1, 2013 4:41 PM 18 82637 Nov 1, 2013 8:08 AM 19 82633 Oct 31, 2013 9:58 AM 20 82633 Oct 31, 2013 9:39 AM 21 82633 Oct 30, 2013 4:23 PM 22 82633 Oct 30, 2013 11:43 AM Phone Number 1 [PHONE REDACTED] Nov 19, 2013 3:57 PM 2 [PHONE REDACTED] Nov 18, 2013 8:03 AM 3 358 2177 Nov 17, 2013 8:52 AM 4 [PHONE REDACTED] Nov 16, 2013 7:03 PM 5 [PHONE REDACTED] Nov 15, 2013 5:11 PM 6 [PHONE REDACTED] Nov 15, 2013 2:17 PM 7 [PHONE REDACTED] Nov 15, 2013 1:10 PM 8 [PHONE REDACTED] Nov 15, 2013 11:55 AM 9 [PHONE REDACTED] Nov 15, 2013 11:46 AM 10 [PHONE REDACTED] Nov 14, 2013 9:28 AM 11 [PHONE REDACTED] Nov 7, 2013 5:37 PM 12 [PHONE REDACTED] Nov 5, 2013 3:59 PM 13 [PHONE REDACTED] Nov 5, 2013 11:43 AM 14 307-26601152 Nov 4, 2013 5:03 PM 15 [PHONE REDACTED] Nov 4, 2013 2:05 PM 16 [PHONE REDACTED] Nov 4, 2013 11:41 AM 17 [PHONE REDACTED] Nov 1, 2013 4:41 PM 18 436-8390 Nov 1, 2013 8:08 AM 19 [PHONE REDACTED] Oct 31, 2013 9:58 AM ---PAGE BREAK--- 19 of 27 Q2. Contact Information 20 [PHONE REDACTED] Oct 31, 2013 9:39 AM 21 [PHONE REDACTED] Oct 30, 2013 4:23 PM 22 [PHONE REDACTED] Oct 30, 2013 11:43 AM Email 1 Nov 19, 2013 3:57 PM 2 Nov 18, 2013 8:03 AM 3 lgbolln@yahoocom Nov 17, 2013 8:52 AM 4 [EMAIL REDACTED] Nov 16, 2013 7:03 PM 5 [EMAIL REDACTED] Nov 15, 2013 5:11 PM 6 Nov 15, 2013 2:17 PM 7 [EMAIL REDACTED] Nov 15, 2013 1:10 PM 8 [EMAIL REDACTED] Nov 15, 2013 11:55 AM 9 Nov 15, 2013 11:46 AM 10 [EMAIL REDACTED] Nov 14, 2013 9:28 AM 11 [EMAIL REDACTED] Nov 7, 2013 5:37 PM 12 [EMAIL REDACTED] Nov 5, 2013 3:59 PM 13 [EMAIL REDACTED] Nov 5, 2013 11:43 AM 14 [EMAIL REDACTED] Nov 4, 2013 5:03 PM 15 [EMAIL REDACTED] Nov 4, 2013 2:05 PM 16 [EMAIL REDACTED] Nov 4, 2013 11:41 AM 17 [EMAIL REDACTED] Nov 1, 2013 4:41 PM 18 [EMAIL REDACTED] Nov 1, 2013 8:08 AM 19 [EMAIL REDACTED] Oct 31, 2013 9:58 AM 20 [EMAIL REDACTED] Oct 31, 2013 9:39 AM 21 [EMAIL REDACTED] Oct 30, 2013 4:23 PM 22 [EMAIL REDACTED] Oct 30, 2013 11:43 AM ---PAGE BREAK--- 20 of 27 Q3. What services does your company/agency currently provide? (select all that apply) 1 The county provides funding for several agencies listed above Nov 18, 2013 8:03 AM 2 I work for the county Nov 16, 2013 7:03 PM 3 Adult Protective Services Nov 15, 2013 5:11 PM 4 City utilities Nov 15, 2013 1:10 PM 5 The foundation enhance the services, programs, and patient care provided to the community by Converse County hospitals and healthcare systems. It raises important funds for programs, services, and equipment not fully funded by healthcare dollars. Nov 15, 2013 11:46 AM 6 Private Pay Personal Care and Support Nov 7, 2013 5:37 PM 7 Orthotics & prosthetics Nov 1, 2013 4:41 PM 8 We provide a Service Coordinator who helps our residents find the services they need to remain independent living in their home for as long as possible. She assists with issues concerning Medicare, Medicare part D, Medicaid, Snap, and Social Security. She helps the resident keep their benefits current. Many times the resident needs assistance applying for benefits they qualify for. Oct 31, 2013 9:39 AM Q4. What services do your clients or patients receive from other agencies or providers in the community? (select all that apply) 1 We do not have clients Nov 18, 2013 8:03 AM 2 none Nov 16, 2013 7:03 PM 3 Dental Nov 15, 2013 11:55 AM Q6. If your response to the previous question was yes, what additional services or facilities are needed in Converse County? (Check all that apply) 1 Pharmacy in Glenrock Nov 15, 2013 11:55 AM 2 affordable housing Nov 5, 2013 11:43 AM 3 If our hospital has a busy ortho practice, an acute rehab unit might be a good option. I think options for long term care in our county would be good. There is state legislation to provide reimbursement for in facility hospice care Oct 30, 2013 4:23 PM ---PAGE BREAK--- 21 of 27 Q7. Do you know of anyone who has moved away from the community to receive long-term care services? (select all that apply) 1 Specializing in certain illnesses Nov 15, 2013 5:11 PM 2 Mental Health services Oct 31, 2013 9:58 AM 3 Rehab Oct 30, 2013 4:23 PM Q8. If you know of someone who has moved away from the community to receive long-term care services, please indicate their reason(s) for moving, if you know: (select all that apply) 1 Services not available in Glenrock, they choose Casper Nov 15, 2013 11:55 AM 2 ongoing staff shortages Nov 1, 2013 8:08 AM ---PAGE BREAK--- 22 of 27 Q9. If a new Assisted Living Facility were to be built in the area, what impact would that have on your services? 1 Continuation of care Nov 19, 2013 3:57 PM 2 Unsure at this time. Nov 15, 2013 5:11 PM 3 Would provide additional alternative for patients being discharged from the Hospital Nov 15, 2013 2:17 PM 4 Keep folks in the community to who we could provide medical services to Nov 15, 2013 11:55 AM 5 It is complimentary to our mission statement. Nov 15, 2013 11:46 AM 6 in a good way, to be able to continue services they need Nov 5, 2013 3:59 PM 7 It would be a positive impact on our business. We currently work closely with ALF, ILF and Memory Care facilities in Casper Nov 4, 2013 5:03 PM 8 ability to address multiple patients in one location Nov 1, 2013 4:41 PM 9 Referrals to the facility Oct 31, 2013 9:58 AM 10 It would give us a place to recommend to the resident when they need the next level of care that they cannot recieve in independent housing Oct 31, 2013 9:39 AM Q10. If an Assisted Living Facility (or other long-term care facility) is considered for Converse County, what would be the best way to fund the capital construction of said facility? (select all that apply) 1 Private Nov 19, 2013 3:57 PM 2 Private Entity Funding Nov 15, 2013 2:17 PM 3 I don't believe special purpose taxes should be used to pay for the facility because there is no state or federal money at this time to pay for assisted living, so it is all private pay. Not all long term care insurances cover assisted living. Oct 30, 2013 4:23 PM Q11. As you personally age and may need to consider a long-term care facility, where would you most want to spend your "golden" years? 1 I haven't thought about it Oct 30, 2013 4:23 PM ---PAGE BREAK--- 23 of 27 ---PAGE BREAK--- 24 of 27 Q12. What is the best way to gather input from community members who need (or will need) long-term care? 1 Through the media and talking to those that offer some sort of assistance to seniors. Nov 18, 2013 8:03 AM 2 Surveys--informational gatherings--websites---handoutspropose Nov 17, 2013 8:52 AM 3 Public Meetings, Piggy Backing off existing community events (ie: Health Fair, Senior Gatherings, Voting, State Fair, etc) Nov 15, 2013 5:11 PM 4 Open Community Forums Nov 15, 2013 2:17 PM 5 Ask them in person Nov 15, 2013 1:10 PM 6 On the spot surveys at local businesses, to both business employees and customers Nov 15, 2013 11:55 AM 7 Surveys, Town Hall Meeting. Nov 15, 2013 11:46 AM 8 Problem is, many people who NEED the facility will not admit to it. Hopefully this survey will be able to target family members who can have an input. Nov 5, 2013 3:59 PM 9 Presentations, ie Senior Center Nov 5, 2013 11:43 AM 10 Go to the seniors. Go to senior center and the elder care apartments in Converse Co. Nov 4, 2013 5:03 PM 11 forms similar to this but printed and left at all major facilities and deposited in a box at each facility Nov 4, 2013 2:05 PM 12 Public Meetings Meetings at Senior Housing and Irwin Towers Surveys- online or paper in agencies throughout the community Nov 4, 2013 11:41 AM 13 question family members Nov 1, 2013 4:41 PM 14 Community forums Nov 1, 2013 8:08 AM 15 A survey, such as this, that targets people over 30. Oct 31, 2013 9:58 AM 16 Send them a survey in the mail. Many of the residents use the computer; however, I think the best way is in the mail. The will read it and I believe respond to it. Oct 31, 2013 9:39 AM 17 I would go to the senior center and talk to them. I would also look at the Wysak data to see what is in there Oct 30, 2013 4:23 PM 18 surveys; public meetings; targeted mailings Oct 30, 2013 11:43 AM ---PAGE BREAK--- 25 of 27 ---PAGE BREAK--- 26 of 27 Q13. Please share any other information you think should be considered for this long-term care plan. 1 A facility needs to be built in Douglas and Glenrock operated jointly. Nov 18, 2013 8:03 AM 2 Proposed cost to senior when available. Unit design and size when available. Overall look and design of facility. Site choices. Keeping the community informed and involved, within reason, as the project evolves. Nov 17, 2013 8:52 AM 3 Assisted living is the highest priority for Converse County at this time. Nov 15, 2013 2:17 PM 4 Wish the 1 cent tax would have went to Assisted Living instead of businesses that are already existing. I don't think putting it on the ballot would work now. Nov 15, 2013 11:55 AM 5 Not have a facility in Glenrock over the last 6+ years I have been at the Senior Center has GREATLY affected our numbers. In that amount of time there has been over 100 clients who have left the community to go to either assisted living, nursing home, hospice, etc. Nov 5, 2013 3:59 PM 6 Taking Medicaid patients in the facility. There is help from the state and VA to help pay for ALF. Nov 4, 2013 5:03 PM 7 diabetes care should be specifically addressed, especially for home care and assisted living situations Nov 1, 2013 4:41 PM 8 Incentives to help with specialized education for care providers (CNA's and nurses) Nov 1, 2013 8:08 AM 9 In my experience, many people in both Glenrock & Douglas utilize assisted living and mental health services in Casper. Many Douglas residents have expressed to me that accessing services in Casper is a burden for them. I have also had a few Glenrock residents express this concern as well. It should be noted that many patients and family members of patients that access services in Casper also elect to do other business, such as shopping, while accessing health care services in Casper. Obviously, this takes revenue out of Douglas, Glenrock and Converse County as a whole. There are many, many at risk elderly adults, disabled adults, elderly adults with mental health issues and adults with mental health issues in the Douglas & Glenrock communities that would greatly benefit from being able to access support services such as assisted living and residential mental health services within the Douglas & Glenrock communities. When these at risk adults are taken out of the environment that is familiar to them, i.e. the Douglas & Glenrock communities, they often become disoriented, there conditions exacerbate and many of them lose the essential support of having friends & family in close proximity. I believe these adults would maintain a higher level of independent function if the Douglas & Glenrock communities offered greater support services such as assisted living and residential mental health services. Oct 31, 2013 9:58 AM 10 Long term care needs to be available to low income residents as well as moderate and high income residents. There is a need for all income levels. It would be nice if there was an assisted living facility in Converse County. Right now if our residents need just a little more care they move to the nursing home even though they may not need nursing care. Todays families are not able to care for a loved one at home. Many families must work so their loved one would be left home alone during the day putting them at the same risk they face living alone. Oct 31, 2013 9:39 AM ---PAGE BREAK--- 27 of 27 Q13. Please share any other information you think should be considered for this long-term care plan. 11 If you want to see examples that work in Wyoming, you should tour the Alzheimer's unit in Torrington. It is county owned, it has a culture of care like no other, and it has a waiting list. Another place to tour is Green House living in Sheridan. http://www.sheridangreenhouse.org/ It is a model project you can see information at thegreenhouseproject.org There may be grant money available to build that because it is supported by the Robert Wood Johnson Foundation Oct 30, 2013 4:23 PM ---PAGE BREAK--- A p p e n d i x C WARM VALLEY LODGE MODEL ---PAGE BREAK--- Warm Valley Lodge (Assisted Living Facility in Dubois, Wyoming) Community leaders and residents in Dubois, Wyoming worked diligently and with passion for seven years to study, plan and construct an assisted living facility. The Warm Valley Lodge, which opened the summer of 2013, is a 25-unit model of care, compassion and comfort. Located in a beautiful mountain setting, the Lodge offers a special combination of housing and personalized assistance with daily living needs, creating a balance between privacy and community. Community leaders in Dubois, Wyoming, noticed that many of their elderly friends in the community needed long-term care and support (LTC). There was no nursing home, assisted living, or other long- term care available. Consequently, some residents were forced to move away, while others suffered through a poor quality of life during their golden years. Originally, this group of volunteers worked under the auspices of the Dubois Community Project, Inc. (DCP), a 501(c)(3) nonprofit community development organization that has successfully completed a number of facilities in the community, most notably, The Headwaters Conference Center. That group then formed Dubois Assisted Living, Inc. (DAL), another 501(c)(3) nonprofit organization to complete the project. DAL will continue to operate the licensed assisted living facility as a 501(c)(3) non-profit entity on property originally donated from the Nature Conservancy. DCP took up the charge to explore options. They conducted a community survey, finding that nearly 100% of respondents would support development of an affordable, high-quality assisted living facility (ALF). DCP spent several years collecting private donations (about $400,000) and learning about LTC. Land ---PAGE BREAK--- located between the Wind River and Highway 26/287, at the south end of Dubois was donated by the Nature Conservancy,. A few years later, working with the Town of Dubois and various public funds, the site was upgraded with streets, sewer, and water. Dubois Assisted Living, another local nonprofit organization, was created to operate the proposed ALF. The Town secured a $1.5 million grant from the Wyoming Business Council to help construct a 25-bed ALF facility. Additional funding to complete the construction project was pieced together from donations, a large estate gift in excess of $1 million, and a large private loan arranged by a community leader. The dream became reality in spite of resistance from state and federal funding agencies. This dream was achieved because community champions who truly believed they could do this refused to take "no" for an answer, and found a way around the obstacles! The facility was designed to be a distinctive mountain lodge. It overlooks the Wind River and the walking path along the river. Because it has strong connections to the community, it often hosts events, such as the “happy hour” held every Friday. Including pre-development costs (such as site preparation and infrastructure, the facility cost more than $7 million to build. The Warm Valley Lodge is now fully constructed. It opened in mid-2013, and is well ahead of schedule on fillings its 25 rentable units by mid-2015. At that time, the proposed annual budget allows for debt service and minimal net income, as seen in the following table. Warm Valley Lodge - Operating at Capacity (2015) Proposed Annual Budget Estimate Operating Revenue Resident Fees (Average $3,382/month) $1,215,891 Less 15% Vacancy Factor -$182,384 Total Operating Revenue $1,033,507 Operating Expenses Personnel/Admin/Marketing $637,980 Dietary /Kitchen $54,773 Housekeeping $3,544 Resident Care/Activities $14,079 Utilities/Maintenance/Vehicle $95,587 Insurance $16,924 Total Operating Expenses $822,887 Less Debt Service -$199,217 Total Net Income $11,403 ---PAGE BREAK--- At full capacity 2015), the Warm Valley Lodge will employ 13.5 full-time equivalent employees (FTEs). To maintain a high quality of service, employees are expected to be well trained and experienced, thus their wages and benefits are above the median compensation rates in the region, as seen in table below. Warm Valley Lodge - Operating at Capacity (2015) Proposed Personnel FTE Estimated Salary + Benefits Management/Administration 2.00 $135,247 Technical/Professional 7.50 $285,817 Office/Clerical 1.00 $41,753 Other 3.00 $91,959 Total - All Personnel (2015) 13.50 $554,776 As the Warm Valley Lodge matures, DCP plans to work with the Town and DAL to shift any profits into development of senior independent living and/or a small nursing home. Those LTC facilities could be co-located on the same site as the Warm Valley Lodge, thereby creating a campus that could share certain management and operational functions. This plan will keep costs low, yet allow more elders to remain in the Dubois Community. Community Champions! ---PAGE BREAK--- A p p e n d i x D ASSISTED LIVING FACILITY (ALF) ESTIMATOR – EXAMPLES FOR 12, 20, AND 32 UNIT ALF FACILITIES, WITH AND WITHOUT DEBT ---PAGE BREAK--- 12 Proposed Proposed Cost/SF % Per bed Total SF $200.00 Common Area 42% 388 4,654 $930,861 Rentable Area 58% 536 6,427 $1,285,474 TOTAL SIZE 100% 923 11,082 $2,216,335 Debt Service* Interest Rate (APR): 6% *Assumes Total Facility Cost above Number of Years: 30 and a 1-year operating reserve of: $315,704 Payment: $15,329 Annual Debt Service* (12 Months): $183,950 Proposed Proposed Cost Per % Per bed Total WY Median Wages Administrative FTE 8% 0.04 0.48 $26,727 Dietary 20% 0.10 1.20 $31,325 Housekeeping 6% 0.03 0.36 $6,874 Maintenance 4% 0.02 0.24 $9,285 Marketing 2% 0.01 0.12 $7,183 Assisted Living/CNAs 56% 0.28 3.36 $94,349 Skilled Nursing 8% 0.04 0.48 $29,353 Other 4% 0.02 0.24 $9,016 TOTAL 100% 0.50 6.00 $214,112 ALF Size (Square Feet): ALF Staff (Full Time Equivalent): N W E National Median Total Non-Wage Expenses ASSISTED LIVING FACILITY (ALF) ESTIMATOR Enter Proposed number of ALF residents: National Median National Median Food Housekeeping Insurance - Liability Insurance - Property Marketing/Advertising Repairs & Maintenance Taxes - Property Utilities Other TOTAL SUMMARY: Per Month Per Year Debt Service $15,329 $183,950 Wages $17,843 $214,112 Non-Wage Expenses $8,466 $101,592 TOTAL $41,638 $499,654 Profit 10% $4,164 $49,965 Annual Average Cost Per Resident $3,817 $45,802 $2,101 $8,466 Non-Wage Expenses Highlighted cells indicate a variable value that can be changed. $101,592 Cost $ per resident $1,706 $92 $107 $411 $480 $1,061 $988 $1,520 $4,932 $5,760 $12,732 $11,856 $18,240 $25,212 National Median Total Non Wage Expenses For Proposed # of Residents $20,472 $1,104 $1,284 ---PAGE BREAK--- 12 Proposed Proposed Cost/SF % Per bed Total SF $200.00 Common Area 42% 388 4,654 $930,861 Rentable Area 58% 536 6,427 $1,285,474 TOTAL SIZE 100% 923 11,082 $2,216,335 Debt Service* Interest Rate (APR): NA *Assumes Total Facility Cost above Number of Years: NA and a 1-year operating reserve of: NA Payment: NA Annual Debt Service* (12 Months): NA Proposed Proposed Cost Per % Per bed Total WY Median Wages Administrative FTE 8% 0.04 0.48 $26,727 Dietary 20% 0.10 1.20 $31,325 Housekeeping 6% 0.03 0.36 $6,874 Maintenance 4% 0.02 0.24 $9,285 Marketing 2% 0.01 0.12 $7,183 Assisted Living/CNAs 56% 0.28 3.36 $94,349 Skilled Nursing 8% 0.04 0.48 $29,353 Other 4% 0.02 0.24 $9,016 TOTAL 100% 0.50 6.00 $214,112 ALF Size (Square Feet): ALF Staff (Full Time Equivalent): N W E National Median Total Non-Wage Expenses ASSISTED LIVING FACILITY (ALF) ESTIMATOR Enter Proposed number of ALF residents: National Median National Median Food Housekeeping Insurance - Liability Insurance - Property Marketing/Advertising Repairs & Maintenance Taxes - Property Utilities Other TOTAL SUMMARY: Per Month Per Year Debt Service (ASSUMES NONE) NA NA Wages $17,843 $214,112 Non-Wage Expenses $8,466 $101,592 TOTAL $26,309 $315,704 Profit 10% $2,631 $31,570 Annual Average Cost Per Resident $2,412 $28,940 $2,101 $8,466 Non-Wage Expenses Highlighted cells indicate a variable value that can be changed. $101,592 Cost $ per resident $1,706 $92 $107 $411 $480 $1,061 $988 $1,520 $4,932 $5,760 $12,732 $11,856 $18,240 $25,212 National Median Total Non Wage Expenses For Proposed # of Residents $20,472 $1,104 $1,284 ---PAGE BREAK--- 20 Proposed Proposed Cost/SF % Per bed Total SF $200.00 Common Area 42% 388 7,757 $1,551,434 Rentable Area 58% 536 10,712 $2,142,457 TOTAL SIZE 100% 923 18,469 $3,693,891 Debt Service* Interest Rate (APR): 6% *Assumes Total Facility Cost above Number of Years: 30 and a 1-year operating reserve of: $526,173 Payment: $25,549 Annual Debt Service* (12 Months): $306,583 Proposed Proposed Cost Per % Per bed Total WY Median Wages Administrative FTE 8% 0.04 0.80 $44,545 Dietary 20% 0.10 2.00 $52,208 Housekeeping 6% 0.03 0.60 $11,457 Maintenance 4% 0.02 0.40 $15,475 Marketing 2% 0.01 0.20 $11,972 Assisted Living/CNAs 56% 0.28 5.60 $157,248 Skilled Nursing 8% 0.04 0.80 $48,922 Other 4% 0.02 0.40 $15,026 TOTAL 100% 0.50 10.00 $356,853 ALF Size (Square Feet): ALF Staff (Full Time Equivalent): N W E National Median Total Non-Wage Expenses ASSISTED LIVING FACILITY (ALF) ESTIMATOR Enter Proposed number of ALF residents: National Median National Median Food Housekeeping Insurance - Liability Insurance - Property Marketing/Advertising Repairs & Maintenance Taxes - Property Utilities Other TOTAL SUMMARY: Per Month Per Year Debt Service $25,549 $306,583 Wages $29,738 $356,853 Non-Wage Expenses $14,110 $169,320 TOTAL $69,396 $832,756 Profit 10% $6,940 $83,276 Annual Average Cost Per Resident $3,817 $45,802 $2,101 $8,466 Non-Wage Expenses Highlighted cells indicate a variable value that can be changed. $169,320 Cost $ per resident $1,706 $92 $107 $411 $480 $1,061 $988 $1,520 $8,220 $9,600 $21,220 $19,760 $30,400 $42,020 National Median Total Non Wage Expenses For Proposed # of Residents $34,120 $1,840 $2,140 ---PAGE BREAK--- 20 Proposed Proposed Cost/SF % Per bed Total SF $200.00 Common Area 42% 388 7,757 $1,551,434 Rentable Area 58% 536 10,712 $2,142,457 TOTAL SIZE 100% 923 18,469 $3,693,891 Debt Service* Interest Rate (APR): NA *Assumes Total Facility Cost above Number of Years: NA and a 1-year operating reserve of: NA Payment: NA Annual Debt Service* (12 Months): NA Proposed Proposed Cost Per % Per bed Total WY Median Wages Administrative FTE 8% 0.04 0.80 $44,545 Dietary 20% 0.10 2.00 $52,208 Housekeeping 6% 0.03 0.60 $11,457 Maintenance 4% 0.02 0.40 $15,475 Marketing 2% 0.01 0.20 $11,972 Assisted Living/CNAs 56% 0.28 5.60 $157,248 Skilled Nursing 8% 0.04 0.80 $48,922 Other 4% 0.02 0.40 $15,026 TOTAL 100% 0.50 10.00 $356,853 ALF Size (Square Feet): ALF Staff (Full Time Equivalent): N W E National Median Total Non-Wage Expenses ASSISTED LIVING FACILITY (ALF) ESTIMATOR Enter Proposed number of ALF residents: National Median National Median Food Housekeeping Insurance - Liability Insurance - Property Marketing/Advertising Repairs & Maintenance Taxes - Property Utilities Other TOTAL SUMMARY: Per Month Per Year Debt Service (ASSUMES NONE) NA NA Wages $29,738 $356,853 Non-Wage Expenses $14,110 $169,320 TOTAL $43,848 $526,173 Profit 10% $4,385 $52,617 Annual Average Cost Per Resident $2,412 $28,940 $2,101 $8,466 Non-Wage Expenses Highlighted cells indicate a variable value that can be changed. $169,320 Cost $ per resident $1,706 $92 $107 $411 $480 $1,061 $988 $1,520 $8,220 $9,600 $21,220 $19,760 $30,400 $42,020 National Median Total Non Wage Expenses For Proposed # of Residents $34,120 $1,840 $2,140 ---PAGE BREAK--- 32 Proposed Proposed Cost/SF % Per bed Total SF $200.00 Common Area 42% 388 12,411 $2,482,295 Rentable Area 58% 536 17,140 $3,427,931 TOTAL SIZE 100% 923 29,551 $5,910,225 Debt Service* Interest Rate (APR): 6% *Assumes Total Facility Cost above Number of Years: 30 and a 1-year operating reserve of: $841,877 Payment: $40,878 Annual Debt Service* (12 Months): $490,533 Proposed Proposed Cost Per % Per bed Total WY Median Wages Administrative FTE 8% 0.04 1.28 $71,272 Dietary 20% 0.10 3.20 $83,533 Housekeeping 6% 0.03 0.96 $18,331 Maintenance 4% 0.02 0.64 $24,760 Marketing 2% 0.01 0.32 $19,156 Assisted Living/CNAs 56% 0.28 8.96 $251,597 Skilled Nursing 8% 0.04 1.28 $78,275 Other 4% 0.02 0.64 $24,041 TOTAL 100% 0.50 16.00 $570,965 ALF Size (Square Feet): ALF Staff (Full Time Equivalent): N W E National Median Total Non-Wage Expenses ASSISTED LIVING FACILITY (ALF) ESTIMATOR Enter Proposed number of ALF residents: National Median National Median Food Housekeeping Insurance - Liability Insurance - Property Marketing/Advertising Repairs & Maintenance Taxes - Property Utilities Other TOTAL SUMMARY: Per Month Per Year Debt Service $40,878 $490,533 Wages $47,580 $570,965 Non-Wage Expenses $22,576 $270,912 TOTAL $111,034 $1,332,410 Profit 10% $11,103 $133,241 Annual Average Cost Per Resident $3,817 $45,802 $2,101 $8,466 Non-Wage Expenses Highlighted cells indicate a variable value that can be changed. $270,912 Cost $ per resident $1,706 $92 $107 $411 $480 $1,061 $988 $1,520 $13,152 $15,360 $33,952 $31,616 $48,640 $67,232 National Median Total Non Wage Expenses For Proposed # of Residents $54,592 $2,944 $3,424 ---PAGE BREAK--- 32 Proposed Proposed Cost/SF % Per bed Total SF $200.00 Common Area 42% 388 12,411 $2,482,295 Rentable Area 58% 536 17,140 $3,427,931 TOTAL SIZE 100% 923 29,551 $5,910,225 Debt Service* Interest Rate (APR): NA *Assumes Total Facility Cost above Number of Years: NA and a 1-year operating reserve of: NA Payment: NA Annual Debt Service* (12 Months): NA Proposed Proposed Cost Per % Per bed Total WY Median Wages Administrative FTE 8% 0.04 1.28 $71,272 Dietary 20% 0.10 3.20 $83,533 Housekeeping 6% 0.03 0.96 $18,331 Maintenance 4% 0.02 0.64 $24,760 Marketing 2% 0.01 0.32 $19,156 Assisted Living/CNAs 56% 0.28 8.96 $251,597 Skilled Nursing 8% 0.04 1.28 $78,275 Other 4% 0.02 0.64 $24,041 TOTAL 100% 0.50 16.00 $570,965 ALF Size (Square Feet): ALF Staff (Full Time Equivalent): N W E National Median Total Non-Wage Expenses ASSISTED LIVING FACILITY (ALF) ESTIMATOR Enter Proposed number of ALF residents: National Median National Median Food Housekeeping Insurance - Liability Insurance - Property Marketing/Advertising Repairs & Maintenance Taxes - Property Utilities Other TOTAL SUMMARY: Per Month Per Year Debt Service (ASSUMES NONE) NA NA Wages $47,580 $570,965 Non-Wage Expenses $22,576 $270,912 TOTAL $70,156 $841,877 Profit 10% $7,016 $84,188 Annual Average Cost Per Resident $2,412 $28,940 $2,101 $8,466 Non-Wage Expenses Highlighted cells indicate a variable value that can be changed. $270,912 Cost $ per resident $1,706 $92 $107 $411 $480 $1,061 $988 $1,520 $13,152 $15,360 $33,952 $31,616 $48,640 $67,232 National Median Total Non Wage Expenses For Proposed # of Residents $54,592 $2,944 $3,424