Bigger Doesn’t Have to Mean

Creating a MegaCenter

by Amber B. Sheely, BA

This article is the second of several articles to be published addressing the issue of expansion.

 

Imagine for a moment that you are out of town on vacation and you need some cash.  Where do you go for help?  Most of us would go to an ATM machine and get some cash--your bank and a local bank or business with an ATM working in partnership to serve you.

 

It would be rare that you would open a savings account while you were away.  Making deposits in existing accounts wouldn’t even be possible unless you accessed a branch of your bank.  For most people, the majority of their banking business is usually handled nearest their home or office.  The bank serves you according to where you are--not by what you need.

 

The bank provides the service you need, but the service location is not contingent on the need.  Like banking, adult day centers must meet their customers where they are.  Whether you are just starting to think about opening your first center or you have an existing center, expansion will likely become a consideration.  Can expansion only be accomplished through moving into bigger space with a bigger transportation system with a bigger group of staff and participants under one roof?  No.  For Total Life Centers in Wake County, North Carolina, what started as execution of a mission statement has evolved into a critical success factor.

 

The Total Life Centers are operated by a not-for-profit multi-service parent organization, Resources for Seniors (RFS).  The mission of  RFS is to assist older adults and their families in maintaining the most independent lifestyles possible while remaining in their communities.  We find it critical to our success to serve clients according to where they feel comfortable and safe, not by need or diagnosis.

 

Besides location, another consideration for expanding into multiple sites is to segment by diagnosis.  Whether you choose location or diagnosis as criteria for expansion, there are pros and cons to consider.  Obviously, our approach of multiple sites is not for everyone.  It is successful for our centers.

 

The area we serve, Wake County, is made up of one city with five distinct areas, six towns and lots of suburbs.  Wake County population is 600,000; the metropolitan area is one million.  When RFS decided to expand from one center to two in 1980, the Board went back to the mission statement "in their community" to decide where to expand.  They looked at where the enrolled participants lived and expanded into the community that had the second largest population of enrolled clients.

 

Our expansion process and criteria proceeded and evolved in much the same fashion for our subsequent sites.  Our ‘niche’ has become small, truly community-based centers.  Once we establish a continued average daily attendance of about 25 participants, we expand.

 

When I meet an adult day service professional and we share our ‘center stories,’ the first comment I hear is "How do you manage five centers?"  This question opens discussion on pros and cons of operating multiple sites.

 

Controls:  Training, Empowering, Quantifying

It is hard to manage all aspects of a center when the person ‘in charge’ is not on-site.  When ‘the boss’ is not there, s/he cannot personally control every situation. 

 

We addressed this challenge by establishing systems so that the on-site staff became knowledgeable and empowered to control every situation themselves.  In times of stress, we revert to habit.  We manage and control by training and empowering staff so that it is habit for them to make the right decision.  We divide our controls into three categories:  training controls, empowering controls, quantifying controls.

 

Training and empowering the staff are essential to their controlling situations.  Quantifying makes it possible for the off-site director to ‘control the controlling.’  Both the staff and the director know when the staff are not in control of their situations.  The by-product created by this triangle is that our team members--our most important product--are positioned to be 100% consumer responsive.

 

Marketing & Promotion

A problem that has arisen with marketing multiple sites is that referral sources and users don’t realize that all the sites are part of the same operation.  Just like each community is different, so is each center.  Therefore, we face the challenge of promoting the centers by returning to the idea of community--we promote the individual centers on a community level.

 

Transportation

Transportation is actually another reason we operate multiple sites.  We do not operate our own transportation routes; we contract it out.  By using the ‘neighborhood’ approach and opening multiple sites, the need for transportation is decreased.  Only 14% of our clients use the system.  One of our centers has no transportation.  Because of this, control over transportation and accessibility to transportation for activities is a challenge we must continually address.

 

Environment

With multiple sites, we cannot afford to be in state-of-the-art buildings that we own.  We use church space for  most of our locations.  Therefore, we have moderate to little control over our environment.

       In facing this challenge, we are very selective in our choice of churches.  We utilize a very specific format for our facility use agreements, defining our control with the church liaisons.  While there are certainly days I long for one large center under one roof, I am reminded of the overriding positive factors of operating multiple sites.

 

Consumer Responsiveness

Our customers have repeatedly commented that they feel safe, secure and comfortable using a service that is in their community.  It seems more natural for participants to go to a place that is down the street and around the corner.  The individual programs offer smaller settings so participants are not overwhelmed by a large number of people.  Utilizing services in existing community facilities like churches is also less threatening and more appealing for most of our customers because it doesn’t appear institutional.

 

Community involvement has been a real asset to Total Life Centers.  Volunteers have commented that they feel like they are giving back to their immediate communities.  Donors are very inclined to give when they know the money is being used for their immediate community--that the center is down the street from their child’s high school.  Ultimately, our caregivers and volunteers, all from the neighborhood, become our walking advertisements.

 

Are there pros and cons to managing multiple sites?

¨ Yes--control is an issue, from financial to systems and the flow of information.

¨ Maybe--if the area and population are not appropriate, multiple sites may not be appropriate.

¨ No--all the negatives are seen as challenges.  The by-products created as we rise to meet the challenges increase our consumer responsiveness and ultimately increase the quality of our program.¥

Amber Sheely was Director of the Total Life Centers in Raleigh, North Carolina when she authored this article.  To learn more log on to www.resourcesforseniors.com.

 

Reprinted from The Information Source for Adult Day Centers®, December 1997