Want to open a care facility?

Operators and funding bodies of care facilities, politicians and representatives from nursing care insurance companies and their advisory body the Medical Service of the Central Organisation for Medical Insurers (MDS), as well as investors, gathered in November for the two-day Euroforum Conference.

With a focus on the future of care facilities, it became clear that current structures are no longer line up with patients’ demands, and that new concepts – particularly structural – are needed.

Determining trends in demand
Anyone wishing to develop or take over a care facility should initially check the market to avoid bad investment:
• What is the demand level of future residents? What is the local demographic structure?
• Is this market already saturated?
• What, depending on the population structure, should be offered for future residents to accept the facility?
• Is access to public transport and nearby shops good enough for their needs?
• What do future residents demand from a care facility, so that they find it an acceptable residence? The (often enforced) move to a retirement home/care facility is a significant step in people’s lives; it often happens too quickly, even if anticipated; it entails a reduction in previous living space, as well as loss of autonomy.
What services are required?
Categories expected by future residents:
• Assisted Living, allowing a seamless, individually customised transition to the next categories…
• In-patient geriatric care
• Care for mentally and physically disabled residents
• Long-term care
• Hospice care if required
They must also be able to afford these.
What does ‘trends in demand’ mean?
To avoid over capacities, a future care facility must orient itself around the respective birth rates from about 70 years ago, i.e. they must consider the lowered birth rates after the economic crisis of 1929 and during World War II. Additionally, after WWII, due to the late return of war prisoners, the birth rate only began to rise again in about 1956.
Moreover, due to improved care structures in out-patient services, people who need care can remain in their own homes for longer. The average time spent in care facilities has dropped from 280 days to 180 days. Hospice spaces are in greater demand. The future, calculated needs up to 2030 is expected to be around 200,000 beds, which equates with 2,000 new facilities if one looks at a usage/life expectancy of buildings of about 25 years.
What should be done?
Care facilities with a future should orientate around the concrete needs of current or future target groups. They should offer all service categories. However, they should still be manageable and their size should not deter future residents. Rural areas in particular have many small facilities with about 30-50 beds, which may be pleasant for residents but not economically viable. One possibility may be ‘satellite models’, i.e. having a central office hat deals with administration for all facilities belonging to the organisation in a 50km radius. The facilities are relatively small (50-100 beds) and can – through franchising, for example – be let out to different operators. Administration, apart from purely administrative tasks, could also include management of catering, bed and laundry. Personnel costs would be borne by the funding body.
The residents have apartments with a small kitchen and a washing machine, to retain their autonomy as far as and long as possible. When needing nursing and out-patient care, the cooperation of partners of the funding body is involved. Nowadays, carers are so well trained that they make it possible for those living alone and needing terminal care to remain in their own homes, helped by the social services, relatives or voluntary carers, although these obviously are not used to replace the professional carers.
Coping with temporary over or under capacity
To meet demand, smaller facilities can quickly be converted into, for example, hospices. They do not need to be closed. Existing structures could also be utilised for completely new target groups; this is something that will result from a demand analysis.
Summary – Internationally, the care market is subject to constant changes, including socio-economic. If their facilities are to have a future, operators, funding authorities and investors must recognise a change at an early stage, and react to it adequately.


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