Our initial study of the Adult Home beds in Montgomery County concluded that there is definite need for Assisted Living beds or for regular Adult Home beds that can be assisted through a Licensed Limited Home Health Care Agency.

There are three major need areas for Assisted Living or Licensed Limited Home Health Care Agency beds. In order of importance, they are:

• Dementia, including behavioral
• Rehabilitation
• Frail elderly, the PA, PB, and CA Nursing Home residents.

Additionally, there is a resident peace of mind aspect that is satisfied and addressed if the Adult Home and Nursing Home are located on the same campus, or within the same facility. The facility becomes a "home" to the residents who live there. The residents make friendships that they don’t want to lose. Being close by the other facility lessens the trauma of such a move, when there is a medical need in order to provide proper care. This is particularly true for a married couple.

We have seen the benefits of this "same campus" multi-level care facility at Green Manor in Ghent, New York, and at the Methodist Home in Johnson City, New York.

It is of even greater benefit to the resident when these multi-level services are provided in the same facility, such as at Canterbury Place in Pittsburgh, Pennsylvania. Canterbury Place is part of the University of Pittsburgh Medical Center. Canterbury has a Skilled Nursing floor, a Dementia floor, and three floors for Adult Home residents.

Often, married couples require different levels of care, and even though the husband and wife must stay in separate rooms, they are still able to visit and even eat some of their meals together. Family members can come together with both Mom and Dad at the same time, and continue to celebrate their family life as nearly normally as possible. This is what happens at a facility such as Canterbury, and this is the type of facility that Montgomery Meadows envisions, which to the best of our knowledge does not exist anywhere in New York State. To not provide these types of care services in the same facility causes a "medically mandated divorce".

The following is a list of the existing Adult Homes, including specialty services, in Montgomery County (provided by Montgomery County Department of Social Services):

The total number of Adult Home beds in Montgomery County is 242 beds.

The 2000 Census data provided by the Montgomery County Department of Planning and Development lists an elderly population (65+) of 9,537 for the entire county. The 1980 Census was 9,077 and the 1990 Census was 10,085.

We have heard comments that the elderly population in Montgomery County is declining. However, the available Census data seems to indicate more of a fluctuation averaging around 9,600, or approximately the current census.

Our general "rule of thumb" is that for every 1,000 people over the age of 65 it would support 21 non-medical model Adult Home beds. This would mean that the county would only support about 200 beds, when in fact it is supporting 242 beds at the present time. The 40 ALP beds at Hillcrest Spring seem to resolve this apparent discrepancy.

There is still an unmet need for medical model Adult Home beds, as Montgomery Meadows has discovered. They have not been able to adequately place their PA, PB, and CA residents. Additionally, the need for Adult home dementia beds is not being addressed in Montgomery County.

From our discussions with Montgomery Meadows admissions personnel and Montgomery County Department of Social Services and from our review of admission inquiries, there appears to be a need for approximately 25 dementia beds.

We have found it difficult to adequately address the need for behavioral dementia beds, particularly from the standpoint of being in an adult home, as there is a definite avoidance of such resident admissions by both adult homes and nursing homes due to the problems associated with violence toward other residents and the likelihood of receiving deficiency write-ups.

Our discussions with the administrator of Gardens of Western Reserve of Streetsboro, Ohio, indicated that they have had success admitting behavioral residents into their Assisted Living dementia unit. Such residents have been first stabilized in a hospital psychiatric unit with medication before being admitted. The residential atmosphere and all private rooms has had a further calming effect on these residents resulting in few problems. If properly addressed, this group represents a potential increase in the number of dementia beds needed.

In our discussions with the physical and occupational therapy departments, there appeared to be a need for 20 to 25 beds for intermediate level of therapy prior to being discharged to their homes. They also suggested a need for one or two bedrooms with a standard (non-handicapped) kitchenette where rehabilitation residents could practice doing their own cooking and bathing unassisted for a day or two prior to discharge.

Such a rehabilitation program would allow short term rehab residents to be admitted from a hospital for a few weeks of intensive therapy. These residents would then be discharged to the adult home rehab unit for less intensive therapy until they are capable of living on their own. The average total time in both the Nursing Home and the Adult Home would be six to eight weeks.