Assisted Living in Cook County: What do we need and how do we get it?

Starting back in December the topic of Assisted Living services reared its head yet again in our community as a group of invested community members gathered with a potential vendor of "assisted living" services at the hospital.

If this sounds a little familiar, that is because a very similar conversation happened a little over 5 years ago, at which point a study for the need of these services was done and it was determined that there was not sufficient need for an additional facility to provide for our community.

So why are we looking at it again only 5 years later?

One of the reasons we are looking into it is that the scope for the original market study that was done 5 years ago was done with very few local considerations taken in to effect.  It did not take into effect the services that are currently being offered (nor did it talk to the people who are providing services currently) and it drew a small circle around Grand Marais (which doesn't match our reality of being the only city in Cook County... a city that sends several community members to Silver Bay or Duluth for these services).

Another reason we are looking at it again is that our community is aging.  You may have heard about the EDA's housing study's results that pointed out the fact that the Cook County population is rising, but it is also seeing its average age rise, something that we need to keep an eye on.  If people want to grow old in the community they love, there should be ways to make that possible for them.

Maybe we should go back a few steps... Let's talk about "assisted living" and where it fits into our current situation...

Assisted living can most plainly be explained by showing the progression of services available to elderly or infirm people:

-Independent Living-- You are on your own either in your own home or in an apartment.  You may receive outside help with daily activities, but it is not provided by your housing establishment... You arrange that yourself with your loved ones or social services.  Local example:  Sawtooth Ridges Apartments.

-Assisted Living--  You are not infirm, but are in need of help with daily activities such as meals, medication, bathing, dressing, and transportation, but you can manage yourself and feed yourself.  At assisted living facilities these things are standard along with 24 hour supervision and security.  Most assisted living facilities have a nurse on staff 24 hours a day as well for emergencies.  Memory care services and other medical services may be available based on the facility.  Local example: Silver Bay Carefree Living.

-Long-Term Medical Care-- You are infirm or have a medical situation that requires frequent professional attention.  This is a wide category that can go from short term rehabilitation to long term geriatric care or memory care, but stops before end of life planning or hospice care.  Local example: Cook County Care Center

-End of Life Planning or Hospice-- Focused on giving the patient the best quality of life as they approach the end of it, hospice care deals with not only the physical symptoms of late-stage illnesses, but the emotional challenges as well.  The nearest certified hospice to us in Grand Marais is Duluth, although Care Partners does offer many of the same services that a hospice program would.

-Other options-- We have a few unique care options in our community as well, one is Hillhaven Assisted Housing, which is not a licensed assisted living complex, but is able to offer similar services.  Hillhaven would fit in right between Independent Living and Assisted Living.

So you can see that we do have considerable resources available in our community, but there is a gap.  That gap comes in the area of assisted living.  How can we fill that need without compromising the systems that we already have though?  That is really the question and the one that we are seeking to answer right now.  In the past months I have met with a few of the members of the North Shore Health Care Foundation and have had numerous conversations on this topic with medical leaders in our community.  It was clear in these conversations that we need to look into assisted living, but we need to do it in a smart and thoughtful process.  This process includes the practitioners currently practicing in our community for feedback, it considers the majority of the residents of our county as they realistically would be the beneficiaries of such a facility, it includes considerations for our aging population (but not based on it... we hope to attract more young families to our area as well!), as well as other considerations that we have not yet figured out.

Our first step is to submit an RFP (request for proposal) to several of the companies we are aware of who can do a study such as this.  We are in the process of doing this right now.  Once we have heard back and know who can do this study for us, we will gather interested stakeholders together with the firm doing the study so that the people with something at stake can give feedback and input into the design of the study.  Once a thorough design is agreed upon, the firm will complete the study and will submit that back to the City.  It is then up to the City to invite assisted living providers to review the study and see if they would be able to successfully offer services in a community showing the characteristics that ours has.  *This study will most likely be paid for through a grant from the North Shore Healthcare Foundation, an organization that works for the betterment of healthcare on the North Shore.

What could happen out of this?

Scenario #1: The study comes back and shows a dramatic need for assisted living.  In this scenario, the City would extend invitations to assisted living providers to create a proposal for a facility in Grand Marais.  Based on the study and common sense, the City would then select a provider who would then build their facility (with their own money) and would go into business in our community.  The only investment that the City would have into this scenario would likely be infrastructure, which potentially could be off-set through IRRRB development grants...

Scenario #2: The study comes back and shows a minor need for assisted living.  In this scenario, the same process as #1 would be followed, but there may not be as many providers chomping at the bit to move into our community if the prospects for a strong business are not there.  We could end up with an assisted living facility in our community with this scenario, or we could, at least, know how to re-tool our current care options to better serve those in our community.

Scenario #3: The study comes back and shows a low or non-existent need for assisted living.  In this scenario, the City has done its due diligence and, although it is incredibly trying for families who have to move their loved ones away, there is not much that can be done for new services.  The study will show us where our weaknesses and strengths are in care services, so this could be a great opportunity to re-tool our current offerings to meet the needs of our community.

*Honestly I am not sure which of these scenarios is going to come to fruition, but I do know a few things about this whole process:
1. It will result in better care for our residents.  Either through the construction of a new facility or the re-tooling of our current offerings, this sounds like how we are going to get the information we need.
2. If assisted living comes to our community, it will mean several good jobs will come with it... Meaningful jobs working with the people that built up our community... this looks good to me.
3. The timing is right.  With the remodeling at the hospital occurring in the coming years, it is important to incorporate their expectations for their new facility, and think about how an assisted living facility can benefit them (keeping community members in the community longer...).

*Here are a few of my concerns about the process:
1. Assisted living will squeeze out or stress one of the other providers in our community.  We will do everything we can to prevent this through the structure of the study to the selection of an assisted living provider if that comes to pass.
2. Where will this facility be built if it is needed?  The City has some land that could be used, but would that mean that the City would be donating land to this project?  What kind of requirements would we put on the facility in that case?  In other words...
3. How do we protect the City if this thing fails?  I think that one is pretty self-evident...
4. How are we going to get workers for this facility?  Can we expect people to move up here to take jobs at this facility?  Where are those people going to live?  Will their salaries be enough to support them up here?  Do we have training opportunities for local residents to get certified to work at an assisted living facility?  I would love to see this be an opportunity for Cook County residents to find a meaningful career in our community, how can we make that happen?

In closing I would like to say that this process is going to be informed by our community's healthcare professionals and will move carefully through considering the next steps.  I am optimistic that we will get the information necessary to meet the needs of our community; I just don't know what that looks like yet...
As always, if you would like to discuss this, please let me know and I would love to find a time to talk with you about it.