ElderHealth: Good pay, benefits mean good workers for its clients

This is the second and final column about ElderHealth Northwest, a Seattle nonprofit — offering adult day services, assisted living and home care — that's part of my occasional series on innovators in eldercare.

One of the factors that makes ElderHealth stand out in the care business is its philosophy toward its employees: It treats them fairly, intelligently, respectfully.

This is no small feat. Historically, long-term care providers — retirement communities, adult family homes, home care, nursing homes — have been lousy employers, even those serving the wealthy.

What makes ElderHealth's story all the more remarkable is that it serves some of the poorest — those on Medicaid.

"We try to care for our employees in the same way we care for our clients," says Nora Gibson, ElderHealth's executive director, "because they're the backbone of what we do." However, state policies often make that difficult.

The state now allows clients on Medicaid more choices when they need care — not just nursing homes (which is all many states still offer), but care in the community — at home, adult day centers, assisted living and adult family homes. However, this care must cost significantly less than a nursing home.

"Which means the taxpayers save money when people receive care in the community," says Gibson, "but it comes at the expense of the people who provide it." Because Medicaid rates are so low, caregivers have historically received $7 to $8 an hour, without benefits. "Many caregivers will probably end up themselves on Medicaid someday," says Gibson.

In contrast, ElderHealth starts its caregivers at $9 to $10 an hour, plus benefits.

"We took a page from Starbucks," explains Gibson, noting the coffee company's reputation for productive, loyal workers. Starbucks has high expectations of its staff and trains them in its philosophy and mission. Part of that philosophy recognizes their contributions by offering full benefits, even for those who work part-time.

"Once we saw the link between good benefits and good workers," Gibson says, "we provided benefits to all our staff who work at least 22 hours a week." This includes a retirement plan (to which ElderHealth contributes), health and dental insurance, an employee-assistance program, a section 125 flexible spending plan (allows employees to set aside pre-tax earnings to spend on health, dental and child-care needs), an extended family-leave pool for employees in crisis or very ill and generous days off.

How ElderHealth does this, in part, is by bringing in revenue from multiple services — adult day, residential, and home care (also offering more work opportunities for staff). With one overhead, she says, the dollars from both private-pay and Medicaid clients can be used more efficiently. Plus ElderHealth fills the gaps by fund-raising — about $500,000 a year out of a budget of $5 million.

It's paid off. Turnover among aides in the long-term care industry is around 85 percent. At ElderHealth, it's typically below 20 percent. Even people who volunteer sometimes apply to work there, and several who've worked at ElderHealth while attending college have returned after graduation. Surveys of client families and referral sources consistently bring accolades for the competency, compassion and commitment of ElderHealth's staff.

But last year, ElderHealth came close to closing its doors.

Last Monday, I told you about two small assisted-living facilities that ElderHealth began to develop in 2001 — Gaffney House, an old, elegant mansion on Capitol Hill, and Buchanan Place, a newly constructed two-story home in Southeast Seattle.

Both offer several key, innovative features. They're small enough — 12 to 14 residents — to feel like a real home, with a kitchen, short halls and the smell of dinner cooking.

Residents have access to additional daily activities, plus nurses, therapists and other professionals, by attending ElderHealth's adult day centers. Each is set up to care for residents until they die, including those with advanced dementia. And, ElderHealth offers the same excellent care to both private-pay and Medicaid clients.

In June 2003, construction was finished, and they were ready to open — but first the Department of Social and Health Services (DSHS) had to license them.

In the meantime, a large assisted-living corporation purchased a number of facilities in our state from another company, and each had to be re-licensed by DSHS before inspectors could or would turn their attention to ElderHealth.

Buchanan Place sat empty for 11 months and Gaffney House for eight months while ElderHealth paid their mortgages — with no clients and no revenues. The loss that year came to $324,000, says Gibson. They laid off staff and almost couldn't make payroll.

At the same time, DSHS slowed the access of people on Medicaid attending adult day centers, further crippling ElderHealth's revenues. Only by refinancing the mansion did it survive.

ElderHealth endured — but at what cost to potential clients? There's almost no assisted-living facility in King County that cares for severely demented or disabled people on Medicaid. DSHS pays lip service to wanting providers to do this — then cuts the legs out from under the one that does.

You can read more about ElderHealth at www.ElderHealth.org or call 206-528-5315.

Liz Taylor's column runs Mondays in the Northwest Life section. A specialist on aging and long-term care, she consults with individuals and teaches workshops on how to plan for one's aging — and aging parents.

You can see all of her columns at www.seattletimes.com/growingolder/.