LONG TERM CARE MARKET ANALYSIS · 2019-07-19 · Platte County Long‐Term Care Market Analysis...

LONG‐TERMCAREMARKETANALYSIS

PlatteCountyHospitalDistrict

November2010

CommunityBuilders,Inc. www.consultCBI.com873EsterbrookRoad [email protected],WY82633 (307)359‐1640

PlatteCountyLong‐TermCareMarketAnalysis Page2of51

TableofContentsExecutiveSummary..............................................................................................................................3 Introduction............................................................................................................................................4 CommunityProfile................................................................................................................................5 PublicParticipationPlan....................................................................................................................6 ReviewofLong‐TermCareIndustry...............................................................................................8

NursingHomes–U.S.............................................................................................................................11 NursingHomes–Wyoming................................................................................................................12 AssistedLivingFacilities–U.S..........................................................................................................14 AssistedLivingFacilities–Wyoming.............................................................................................15 MemoryCare–U.S.................................................................................................................................21 MemoryCare–Wyoming....................................................................................................................22

DescriptionofMarketArea.............................................................................................................23 Demographics...........................................................................................................................................24 Income.........................................................................................................................................................28 Housing.......................................................................................................................................................29

TargetMarketAnalysis.....................................................................................................................30 Demographics...........................................................................................................................................31 LimitationswithADLsandIADLs....................................................................................................33 IncomeandHousing..............................................................................................................................38 CompetitionandSupportServices..................................................................................................43 TheUnmetNeed......................................................................................................................................45 SeniorIndependentLivingHousingDemand.............................................................................48

Conclusion.............................................................................................................................................50 APPENDIX...............................................................................................................................................51


ExecutiveSummaryPlatte CountyHospital District has retained Community Builders, Inc. (CBI) to study thelong‐termcaremarket in theWheatland,Wyomingregion. CBIhasexaminedpopulationandotherdemographic trends inPlatteCountyand,moregenerally,SoutheastWyoming.CBI has also analyzed existing and planned development of long‐term care facilities intheseareas.Followingthisexaminationandanalysis,CBIidentifiedtheregion’sneedsfornursinghomefacilities,assistedlivingfacilities,andmemorycareunits.Thosefindingsaresummarizedinthetablebelow:

MarketGrowthForecast,byMarketAreaandYear

DEMANDFORNURSINGHOMEUNITSMarketArea PRIMARY SECONDARY TERTIARY ALLAREAS

Year PlatteCounty SEWyoming StateofWyoming UnitedStates TOTAL2010 7 ‐4 ‐9 ‐2 ‐92011 7 ‐3 ‐7 ‐2 ‐52012 8 ‐2 ‐5 ‐1 ‐12013 8 ‐1 ‐4 ‐1 32014 9 0 ‐2 ‐1 72015 10 2 0 0 11

DEMANDFORASSISTEDLIVINGFACILITYUNITSMarketArea PRIMARY SECONDARY TERTIARY ALLAREAS

Year PlatteCounty SEWyoming StateofWyoming UnitedStates TOTAL2010 20 6 1 1 272011 20 7 1 1 292012 21 7 1 1 312013 21 8 1 2 322014 22 9 2 2 342015 22 10 2 2 36

DEMANDFORMEMORYCAREUNITSMarketArea PRIMARY SECONDARY TERTIARY ALLAREAS

Year PlatteCounty SEWyoming StateofWyoming UnitedStates TOTAL2010 2 ‐2 3 0 32011 2 ‐2 3 0 32012 2 ‐2 3 0 42013 2 ‐1 3 0 42014 2 ‐1 3 0 42015 2 ‐1 3 0 5

Basedonthesefindings, itappearsthatconstructionofadditionalnursingfacilityunitsisneededtomeetcurrentdemandinthePrimaryMarketarea(PlatteCounty).Additionally,construction of a new assisted living facility will be needed to meet current and futuredemand.Considerationshouldbegiventooptionsforaccommodatingthismarketdemandwhen reviewing the costs and opportunities of remodeling the existing nursing home.However,givenconsumerpreferencesandconstructionefficiencies,thecommunityshouldalsoconsiderdevelopmentofanentirelynewlong‐termcare“campus,”wherebothtypesofresidentialfacilitieswouldbebuilt,andanticipatetheneedforexpandingallservicesforthenext40‐50years.


IntroductionAmericaisanagingcountry.Americansarelivinglonger,andunprecedentednumbersofolder citizens are choosing to live in long‐term care facilities. The largest generation ofAmericans–the“BabyBoom”generation–isnowreachingretirementage. TheBoomergenerationiswealthierthanpreviousgenerations,andsotoday’selderlycitizenscanaffordto demand higher levels of privacy, safety and quality from service providers.Consequently,marketdemandisstrongfornewlong‐termcarefacilitiesthatofferprivaterooms,highqualityservices,andspecialamenities.PreviousgenerationsofAmericansstruggledwiththeconceptof long‐termcare. Forthemostpart,theelderlylivedwiththeirchildrenduringtheirlateryears.Thelast50yearshavebeenmarkedby just one type of long‐term care facility: nursinghomes, or skillednursing facilities. Most of these facilities have operated with an institutional mindset,focusedentirelyonthehealthneedsandnotonthesocialorpersonalrelationshipneedsofresidents.Today’s elderly have many long‐term care choices. In fact, most communities offer acontinuumofcare includingsupportservices(e.g., transportationormeals),home‐healthcare, independent living,boardinghomes,assisted living facilities, skillednursinghomes,andhospicefacilities.Wyoming's agingpopulation is similar to thenation’s. In fact, the state is actually agingfasterthannationalaverages.However,perhapsbecauseofitsruralnature,Wyominghasnotyetdevelopeda fullrangeof long‐termcareoptions inmostof itscommunities. ThelevelsofcareandalternativestotraditionalnursinghomefacilitieshavenotyetbeenfullydevelopedinWyoming,astheyhaveelsewhere.Accordingly,someWyomingcommunitiesarecurrentlyevaluatingtheirlong‐termcareneedsandidentifyingnewopportunitiesforprovidingservicestotheirregion’selderlycitizens.This study reviews national and regional long‐term care trends, and compares thosefindingstomarketareaunderconsideration.Populationdemographics,disabilitystatistics,housing,andincomedataareevaluatedtodeterminemarketdemand.Wyoming‐licensedlong‐termcarefacilitiesarereviewedtodeterminecompetitivesupplyinthemarketarea.Finally, calculations aremade to estimate the net, unmet need for long‐term care in themarketarea.


CommunityProfilePlatteCountyislocatedinsoutheasternWyoming.ElevationsinPlatteCountyrangefromahighofabout7,000feetinthesouthwesttoalowof4,300feet,intheextremeeasternpartofthecounty.PlatteCounty,roughly60milesfromnorthtosouthand30milesfromeasttowest,covers2,111squaremiles.The county includes five incorporated municipalities ‐ Chugwater, Glendo, Guernsey,Hartville,andWheatland.

Wheatland, the county seat and largest town in Platte County with an estimatedpopulationof3548,issetamidirrigatedfarmsandranchesandisafamily‐centeredcommunity. Primarilyanagriculturalcommunity,Wheatlandboastsa large,cleanindustrialpowerplant.

PicturesqueHartville (population ‐76), isoneof theoldest incorporatedtowns inWyomingestablished in1884. It is located inEurekaCanyon‐asmallcommunitysixmilesnorthofGuernseyonhighway270.

ThetownofGuernsey(population1147),liesdirectlyontheoldOregonTrail.Thetownwasincorporatedin1902andisaccessedalongU.S.Highway26.

Chugwater is a small community of 244 located adjacent to Interstate 25 at thesouthernedgeofPlatteCounty.

GlendoisthenorthernmostcommunityinPlatteCountyandislocatedonI‐25nearGlendoReservoirandStatePark.Glendo'spopulationis229.

Transportation‐Rail,AirandRoadServicePlatteCountyisservedbyseveralmajorhighways,includingInterstate25,Wyoming'sonlynorth‐southinterstateandU.S.Highway26,amajoreast‐westartery.Inaddition,WyomingStateHighway34runsfromcentralPlatteCountytoU.S.Highway30,justnorthofLaramie,and Wyoming State Highway 270 connects Guernsey and Hartville with U.S. Highway18/20,anothermajoreast‐westhighway.Distances fromWheatland tomajorpopulationcentersinWyomingandneighboringstatesinclude:

Laramie‐85miles Denver:177miles Cheyenne‐70miles RapidCity,SouthDakota‐275miles

ThefivecommunitiesareroughlythreehoursfromDenverInternationalairport,oneofthenation'sbusiestcommercialairports,andsmaller regionalairports inCheyenne,LaramieandCasperareroughlyanhourbyautomobile.The Burlington Northern Santa Fe Railroad provides freight, coal and other commercialservicethroughPlatteCounty.ElectricityThe vast majority of Platte County’s 8,300 residents receive their power from theWheatland Rural Electric Association (Wheatland R.E.A.).Established in 1936, the


Wheatland R.E.A. has expanded dramatically over the years to provide even the mostremote parts of Platte County, and several neighboring counties as well, with reliable,reasonably priced electricity.Today the R.E.A. provides electric power for agriculturalpurposes such as irrigation wells and pivot sprinklers, domestic use, and business andindustriesthattendtobelocatedinmoreruralareas.WaterTheTownofWheatlandalsosupplieswaterfordomestic,business,andindustrialuses,aswellassewerandsanitationpickupforitsresidents.NaturalGasResidents,businessesand industry in andnear theCityofWheatland canaccessnaturalgas,providedandmaintainedlocallybySourceGasofWyoming.TelecommunicationsQWEST is the provider of landline telephone service in Wheatland and much of PlatteCounty. Cell phone service is presently provided by Verizon, Alltel and UnionWireless.WirelessInternetserviceisprovidedlocallybyWyomingWireless.

PublicParticipationPlanIn compliance with the Wyoming Business Council's requirement to community andeconomic development recipients to "inform and educate the public and businesscommunity to the greatest extent possible about the proposed economic developmentproject utilizing a variety of techniques and media," the Platte County Long‐Term CarePublic Participation Action Plan was developed and is attached to this document asAppendixA.Asthelong‐termcareplanunfoldsinthecommunity,thepublicengagementprocesswillprovide the greatest possibility of successful implementation of project goals. Specialeffortsarebeingmadetohearthethoughtsandopinionsofseniorcitizenswhocurrentlyormayinthefuturereceivelong‐termcareresidentialservices.

CommunitySurveysAcommunitysurveywasdevelopedandcirculated throughout thecommunity toget thepublic's inputon long‐termcareneeds. Thesurveywasnot intendedtobeastatisticallyvalid instrument; rather itwas intended togauge thepulseof the interestedcommunity.Surveysweremadeavailableatvariouscommunitycentersfrequentedbyseniorcitizens;aSurvey Monkey Internet link was created and advertised in the newspaper; and lettersencouraging survey completion were sent to advisory committee members for theirconstituents. A separate survey for advisory committee members was also conducted.SamplesurveysandcompleteresultsofthosesurveysareattachedasAppendixB.


AdvisoryCommitteeSurveySummaryIn general, most Advisory Committee respondents reported knowing someonewho hadmovedawayfromthecommunitytoreceivelong‐termcareservices.Mostoftheseformerresidentsmoved to nursing homes orAlzheimer (memory care) units. Overwhelmingly,the reason given for leaving the community for these long‐term care services was thatserviceswerenotavailableinPlatteCounty.When asked if there is a need for additional long‐term care services in the community,most advisory committee respondents listed memory care, skilled nursing facility, orassisted living facilityasneeds. Clearly, theopinionexists that thecurrentPlatteCountyMemorial Nursing Home does not adequately meet the needs of the community for avarietyofreasons,mostnotablytheneedformoreroomsandmoreprivacy,handicappedaccessiblebathrooms,andmemorycare.CommunitySurveyTheAdvisoryCommitteeresponsesweremirroredby theCommunitySurveyresults. Ofthe60 respondents, 23%ormore reported receivingnursinghome care, transportation,publichealthservicesand/oradultdaycareservices. By far, themost importantreasongivenwhenseekingout long‐termcarehousing isqualityofcare, followedbyadesiretostayinthearea,andthenprivacy.HalfoftherespondentsreportedknowingsomeonewhohadmovedoutofthecommunitytoanAlzheimerormemorycarefacility.Aclosesecond(28respondents)knowsomeonewhomovedtoanursinghome.Themajorreasonthesepeoplemoveawaywasbecausetheserviceis(orwas)notavailableinPlatteCounty.Nearly all (90%) of the community survey respondents indicated a need for additionallong‐termcareservicesinthecommunity‐commonresponseswereaneedforanAssistedLiving Facility, Alzheimer or Memory Care and Skilled Nursing Care in a larger facility.Desired improvements include more and larger rooms, modern updates, larger privatebathroomsandimprovedkitchenservices.TheoverwhelmingmajorityofthosecommunitymemberswhoreturnedsurveysindicatedthattheywouldusetheNursingHomeifitcouldberemodeledtomeettheirneeds.Ahighpercentage(86%)ofrespondentsalsosaidtheywouldbelikelytouseanAssistedLivingFacilityifitwereconstructed.Accordingtotherespondents,thebestwaytogatherinputfromthecommunitymemberswhoneedorwillneed long‐termcarecenteroncommunity‐basedmethods: face‐to‐facecontact, informational meetings, newspaper or radio announcements and variouscommunitygrouppresentations.


ReviewofLong‐TermCareIndustryAsweage,manypeople losesomeof theirabilities tocarefor themselves. Manyelderlycitizens develop difficulties in completing activities of daily living (ADLs). ADLs are thethingswenormallydoinlife,includinganydailyactivityweperformforself‐care(suchasfeeding ourselves, bathing, dressing, grooming), work, homemaking, and leisure. Theability or inability to perform ADLs can be used as a very practical measure ofability/disabilityinmanydisorders.Similarly,somecitizensstrugglewithinstrumentalactivitiesofdailyliving(IADLs),whicharetheactivitiesoftenperformedbyapersonwhoislivingindependentlyinacommunitysetting.IADLswouldincludeactivitiessuchasmanagingmoney,shopping,telephoneuse,travel,housekeeping,preparingmeals,andtakingmedicationscorrectly.LimitationsinperformingADLsandIADLsmayresultintheneedforlong‐termcare.Thevastmajorityofpeopleneedinglong‐termcarereceiveitfromtheirownfamilymembersand/or friends. Only a small portion of the population needing long‐term care actuallyreceiveitfrompaidcaregivers,andanevensmallerpercentage(about6%)oftheelderlypopulation receiveneeded services at a long‐term care facility. Yet, this segment of ourpopulation is very large, growing exponentially, and increasingly needs long‐term careservices.Typically,elderlypersonswiththehighest levelsofneedaretheoneswhoseekcareinalong‐termcarefacility.Theconceptof long‐termcare(LTC) intheUnitedStateshastraditionallymeantsendingelderly citizens to institutionalized nursing homes. Those institutions, called “SkilledNursingFacilities”orSNFs,currentlyhouseabout1.6millionelderlyAmericans.Yet,muchhas changed in the last20years! Today, there is awide rangeofLTCoptions available,including:

Community‐basedServices–Manycommunitiesprovideservicesandprogramstohelpseniorsandpeoplewithdisabilitieswithavarietyofpersonalactivities.Theseservices include Meals‐on‐Wheels, transportation services, personal care, choreservices,adultdaycare,andavarietyofactivitiesinseniorcenters.Theseservicesareusuallyfreeoratlowcosttoindividualswhoqualify.Localorganizations,calledAreaAgenciesonAging,coordinatetheseservicestopromotetheindependenceanddignityofolderadults.

HomeHealthCare–Someeldersreceivecareintheirownhome.Suchservicescan

includeskillednursingcare,homemaker/healthaides,personalcareaides, respitecare,medicalequipment,homerepairandmodification,andhospice.

SeniorIndependentLiving–Typically,aclusterofmulti‐familyunits(duplexes)orcondominiumunitsthataredesignedforseniorswhopayforsomeservices(suchashousekeeping, transportation,ormeals)aspartofamonthlyfee,andwhorequirelittle,ifany,assistancewithActivitiesofDailyLiving. Independentlivingunitsare


notnormally licensedforhealthcare,althoughresidentsmayreceivehomehealthcareservicesintheirownunit.

In‐law Apartments – An in‐law apartment is a separate housing arrangement

within a single‐family home or lot. It may also be referred to as a second unit,accessoryapartment,oraccessorydwellingunit.Anin‐lawapartmentisacompleteliving space and includes a private kitchen and bath. An in‐law apartment mayprovidelivingspaceforacaretakerormayberentedtoprovideadditionalincome.

Subsidized Senior Housing – The federal government and most states have

programsthathelppayforhousingforolderpeoplewithlowormoderateincomes(lessthan$46,000ifsingleor$53,000ifmarried).Someofthesehousingprogramsalso offer help with meals and other activities like housekeeping, shopping, anddoingthelaundry.Residentstypicallyliveintheirownapartmentsinthecomplex.Usually a Federal or State agency will review monthly income and expenses foreligibility for this type of housing. Rent payments are usually a percentage ofincome.

BoardingHomes–Thisgroup livingarrangementprovideshelpwithactivitiesof

dailylivingsuchaseating,bathing,andusingthebathroomforpeoplewhocannotlive on their own but do not need nursing home services. These are sometimescalled "grouphomes". In some cases, private long‐term care insuranceandothertypes of assistance programs may help pay for this type of living arrangement.Manyof thesehomesdonot receivepayment fromMedicareorMedicaidandarenotstrictlymonitored.Themonthlychargeisusuallyapercentageofincome.

Assisted Living Facilities (ALFs) – This group living arrangement provides help

withactivitiesofdailylivingsuchaseating,bathing,andusingthebathroom,takingmedicine,andgettingtoappointmentsasneeded.Residentsoftenliveintheirownroomorapartmentwithinabuildingorgroupofbuildingsandhavesomeoralloftheirmealstogether.Socialandrecreationalactivitiesareusuallyprovided.Someassisted living facilities have health services on site. Costs for assisted livingfacilitiescanvarywidelydependingonthesizeofthelivingareas,servicesprovided,type of help needed, and where the building is located. Residents usually pay amonthlyrentandthenpayadditionalfeesfortheservicesthattheyget.

Continuing Care Retirement Community (CCRC) – These housing communities

havedifferentlevelsofcarebasedonresidents’needs.Whereonelivesdependsonthelevelofcareneeded.Inthesamecommunity,theremaybeindividualhomesorapartments for residentswho still live on their own, an assisted living facility forpeople who need some help with daily care, and a nursing home for those whorequire higher levels of care. Residents move from one level of care to anotherbasedontheirneedsbutstillstayintheCCRC.


NursingHomes–Thesefacilitiesprovidecaretopeoplewhocannotbecaredforathomeor inthecommunity. Nursinghomesprovideawiderangeofpersonalcareand health services. Formost people, this care generally is to assist peoplewithsupportservicessuchasdressing,bathing,andusingthebathroom,forpeoplewhocannottakecareofthemselvesduetophysical,emotional,ormentalproblems.

Memory Care – These are secure units designed for people with significantcognitive impairment as a result of having Alzheimer’s disease or some otherdementia. InWyoming, there are additional licensure requirements for MemoryCarebeds.

Source:AdaptedfromU.S.DepartmentofHealthandHumanServices/Medicare.ReviewedontheInternetonFebruary20,2010,at:http://www.medicare.gov/LongTermCare/Static/TypesOverview.asp.

Platte CountyHospital District has retained Community Builders, Inc. (CBI) to study thelong‐termcaremarket inthePlatteCounty,Wyomingregion. Acompleteexaminationofthefullcontinuumofall long‐termcareoptionswouldgobeyondthescopeofthisstudy.Instead, this studywill focusonmarketdemand for threeprimary types long‐termcare:NursingHomes,AssistedLivingFacilities,andsecureMemoryCareunits.


NursingHomes–U.S.Nursing homes provide the most intense long‐term care services in the United States.Servicesatanursinghomemeetawiderangeofmedical,personal,rehabilitativeandlong‐termneeds for residents. Themostdistinguishing characteristic of these facilities is theskilled nursing care that is available to nursing home residents 24‐hours a day. Thus,unlike many other types of long‐term care facilities, government‐funded programs(MedicareandMedicaid)typicallypaythecostfornursinghomecare.According to the U.S. Department of Health and Human Services, there were 1,412,540residents living in 15,730 certified nursing facilities during 2008 (most recent dataavailable).Thosesamefacilitiescontained1,703,846licensedbeds,resultinginanoveralloccupancy rate of 82.9%. Source: Health, United States, 2009, prepared by the U.S.Department ofHealth andHuman Services, downloaded from the Internet onOctober 28,2010 at http://www.cdc.gov/nchs/hus/older.htm. At that time (2008), the U.S. CensusBureau estimated that there were 38,869,716 residents aged 65 or older living in theUnitedStates.Thus,in2008,3.63%ofallpersonsaged65orolderwerelivingincertifiednursing facilities in the United States. Source: U.S.CensusBureau,downloaded from theInternet on October 28, 2010 at http://www.census.gov/popest/national/asrh/NC‐EST2009/NC‐EST2009‐02.xls.WhilethecostofresidingatanursinghomeistypicallypaidbyMedicareorMedicaid,mostnursinghomesareprivatelyownedandoperated.Oneothersourceofpaymentisderivedfromlong‐termcareinsurance,andsolong‐termcarecostsareannuallytrackedbymajorinsurancecompaniesthatprovidesuchcoverage.AccordingtoGenworthFinancial’s2010CostofCareSurvey,thenationalmediandailyratefornursinghomeswas$185forasemi‐private room, or $206 for a private room. Those daily rates translate into $5,627 and$6,266,respectively,permonth,and$67,525and$75,190,respectively,peryear.Inordertobuildanewnursinghomeorexpandanexistingfacility,manystatesrequirethedeveloper toobtainaCertificateofNeed(CON). The justification forCONprogramsis tocontrolhealthcarefacilitycostsandallowcoordinatedplanningofnewfacilities.Theideais thatneworexpandedfacilitiesshouldbeapprovedonlywhenthere isagenuineneed.Statutorycriteriahelplicensingagenciesdecidewhatisnecessaryforagivenlocation.Byreviewing occupancy levels of existing facilities, theagencies make judgments aboutwhether there is a need for additional beds. Once that need is established, the licensingagencywillgrantthedeveloperpermissiontobeginaproject.


NursingHomes–WyomingAccording to the U.S. Department of Health and Human Services, there were 2,431residents living in 39 certified nursing facilities inWyoming during 2008. Those samefacilities contained 2,993 licensed beds, resulting in an overall occupancy rate of 81.2%.Source: Health,UnitedStates,2009,preparedbytheU.S.DepartmentofHealthandHumanServices, downloaded from the Internet on October 28, 2010 athttp://www.cdc.gov/nchs/hus/older.htm.TheWyomingDepartmentofHealth,OfficeofHealthcareLicensingandSurveysconductsannual surveys of every nursing home in the state. According to data on their website(http://wdh.state.wy.us/ohls/index.html), there are currently 2,958 licensed beds in 38nursing facilities inWyoming. The census of residents taken during the annual surveys(thetimingofwhichisdifferentforeachfacility)is2,416people,resultinginastatewideoccupancyof81.7%.Because the federal government measures data from facilities that maintain federalMedicareandMedicaidcertificates(notthesameasastatelicense),andbecauseoftimingdifferences for state licensing annual surveys, data from the two sources is slightlydifferent.According to Genworth Financial’s 2010 Cost of Care Survey cited above, Wyoming’smedian daily rate for nursing homes was $188 for a semi‐private room, or $200 for aprivateroom.Thosedailyratestranslateinto$5,718and$6,083,respectively,permonth,and$68,620and$72,818,respectively,peryear.WyomingisnotaCONstate.However,beforetheStatewillawardalicensetoadeveloperfor a new or expanded nursing home, the Office of Healthcare Licensing and Surveysconsiders occupancy levels (from its most recent surveys) for the construction area.Wyoming Statute 35‐2‐901(a)(v) defines the “construction area” to include all nursinghomeswithina30‐miledrivefromtheproposedsite.Bylaw,nursinghomeoccupanciesintheconstructionareamustexceed85%inordertosecurealicensetobuildmorenursinghome beds (Wyoming Statute 35‐2‐906(b)). However, that same statute allows existingnursinghomestoincreasetheirlicensedbedcapacitybytenpercent(10%),uptotenbeds,inanytwo‐yearperiod.CurrentlylicensednursinghomefacilitiesintheStateofWyomingareidentifiedbelowinTable1,alongwiththeiroccupancystatus.


Table1:WyomingLicensedNursingHomeFacilities

NursingHomeFacility#of

LicensedBeds#

OccupiedOccupancy

%City

StarValleyCareCenter 24 22 91% AftonBonnieBluejacketMemorialNursingHome 37 31 85% BasinWyomingRetirementCenter 90 55 61% BasinAmieHoltCareCenter 50 45 90% BuffaloLifeCareCenterofCasper 120 113 94% CasperShepherdoftheValleyCareCenter 192 182 95% CasperSSCCasperOperatingCompanyLLC 120 110 92% CasperWyomingMedicalCenterTransitionalCareUnit 15 12 78% CasperLifeCareCenterofCheyenne 160 150 94% CheyenneMemorialHospitalofLaramieCo 16 10 63% CheyenneMountainTowersHealthcare&RehabilitationCenter 146 130 89% CheyenneSSCCheyenneOperatingCoLLC 105 93 89% CheyenneWestParkLongTermCareCenter 128 74 58% CodyDouglasCareCenterLLC 60 41 68% DouglasRockyMountainCare‐Evanston 60 43 71% EvanstonMorningStarCareCenter 45 40 89% FtWashakiePioneerManorNursingHome 150 123 82% GilletteCastleRockConvalescentCenter 59 56 95% GreenRiverStJohn'sNursingHome 60 41 69% JacksonSouthLincolnNursingCenter 24 24 98% KemmererWestwardHeightsCareCenter 60 56 94% LanderAlbanyCoHospitalDistrict 10 7 72% LaramieLaramieCareCenter 105 75 71% LaramieNewHorizonsCareCenter 85 69 81% LovellWestonCountyHealthServices 54 52 97% NewcastleSubletteCenter 50 30 60% PinedalePowellValleyCareCenter 100 94 94% PowellSouthCentralWyomingHealthcare&RehabilitationCenter 62 29 47% RawlinsWindRiverHealthcare&RehabilitationCenter 88 77 87% RivertonSageViewCareCenter 82 52 63% RockSprgsValleyViewCare&RehabilitationCenter 46 34 74% SaratogaSSCSheridanOperatingCompanyLLC 128 95 74% SheridanWestviewHealthCareCenter 102 83 81% SheridanCrookCoMedicalServiceDistrictLongTermCare 32 30 94% SundanceThermopolisRehabilitation&CareCenter 60 47 78% ThermopolisGoshenCareCenter 103 101 98% TorringtonPlatteCountyMemorialNursingHome 43 26 60% WheatlandWorlandHealthcare&RehabilitationCenter 87 64 74% Worland

TOTAL 2,958 2,416 81.7%

Source: Wyoming Department of Health/Office of Healthcare Licensing and Surveys,Healthcare Facility Directory, downloaded from the Internet on October 28, 2010 athttp://www.health.wyo.gov/ohls/facilitiesdirectory.html.


AssistedLivingFacilities–U.S.Traditionally,long‐termcareintheUnitedStateshasbeenresistedbytheelderlybecauseofastigmaattachedtonursinghomesasaplacefor“oldfolks”ora“placetodie.”Today,however,many elders are choosing tomove to anon‐institutionalized alternative, calledassistedliving.TheseAssistedLivingFacilities(ALFs)havefocusedonprovidingnecessaryservicesinahome‐typeenvironment.ALFshavebeenthefastinggrowingsegmentofthelong‐termcaremarketintheUnitedStatesduringthelast20years.In 2007 (the year with the most recent estimates), the U.S. Department of Health andHumanServicesreportedthattherewere38,373licensedALFsintheUnitedStates,with974,585 units/beds. Source: Residential Care and Assisted Living Compendium: 2007.DownloadedfromtheInternetathttp://aspe.hhs.gov/daltcp/reports/2007/07alcom.htm. Atthat time, anestimated37,887,958 residents in theUnitedStateswereaged65yearsorolder. Source:PopulationDivision,U.S.CensusBureau;Table1:EstimatesofthePopulationbySelectedAgeGroupsforJuly1,2007. ReleaseDate: May1,2008. DownloadedfromtheInternet on February 13, 2010 at http://www.census.gov/popest/states/asrh/tables/SC‐EST2007‐01.xls. Accordingly, in 2007, approximately 2.572% of the entire nation’spopulationofpeopleaged65orolderwerelivinginALFs(974,585/37,887,958=2.57%).According to those same sources, in 2004, there were 935,634 residents living in ALFsnationwide,when the total population of people aged 65 or olderwas estimated by theCensusBureau tobe36,301,469,meaning that therewas then2.576%of thatagegroupliving in ALFs. Similarly, according to the same federal sources, there were 908,488residentsinALFsin2002,atwhichtimetherewasapopulationof35,591,009peopleaged65orolderintheUnitedStates;thus2.553%ofthatselectagegroupchosetoliveinALFs.The data for each of these years (2002, 2004, and 2007) are remarkably consistent;demonstratingthatthepercentageofpersonsaged65andolderwholiveinALFshasbeenrelativelyconstantforthepastfiveyears.Accordingtothe2009OverviewofAssistedLiving,themediancost(i.e.,thecostpointatwhichthebaseratesfor50%ofallunitsishigher,and50%islower)forasingleoccupancyassisted living unit is $2,864 permonth, and themean average is $3,022 permonth. Amore recent study, The State of Seniors Housing 2010 cited above, reported that themedian total cost (i.e., includes costs that are charged in addition to the base rate) forassistedlivingresidencesunitsis$3,352permonth.


AssistedLivingFacilities–WyomingGiven the relative constancyof thepercentageofAmericanswho choose to live inALFs,andconsideringthatthenationalstatisticsabovetakeintoaccounteverystate–largeandsmall–andeverykindofcommunity–ruralandurban–thisstudymakestheassumptionthat the same percentage (2.57%) of Wyoming residents, including the Primary andSecondaryMarketArearesidents,willmakethesamedecisiontoliveinanALF.Onemightargue that theaboveassumption isover‐generalized. Forexample,onecouldtheorizethatmanyretireesmovetothesouth,toawarmerclimateand“morecomfortable”lifestyle.Yet,onapercentagebasis,theassumptionholdstrue.Consider,forexample,thetoptenstateswiththehighestpercentagesofelderly(aged65orolder)livinginALFs,aspresentedinTable2below.

Table2:TopTenStateswithHighestPercentageofALFresidents(2007)

Nat’lRank State

TotalPopulation(1)

65yearsandover(1)

65yearsandover% Units/Beds(2)

Units/Bedsperperson65yearsandover(%)

1 Oregon 3,747,455 488,936 13.05% 22,130 4.53%2 Maine 1,317,207 194,986 14.80% 8,703 4.46%3 Wisconsin 5,601,640 736,301 13.14% 31,782 4.32%4 Nebraska 1,774,571 236,648 13.34% 10,063 4.25%5 California 36,553,215 4,003,593 10.95% 161,586 4.04%6 Alaska 683,478 47,935 7.01% 1,912 3.99%7 Idaho 1,499,402 174,946 11.67% 6,819 3.90%8 Pennsylvania 12,432,792 1,889,660 15.20% 71,831 3.80%9 NorthCarolina 9,061,032 1,103,413 12.18% 41,642 3.77%10 NorthDakota 639,715 93,285 14.58% 3,472 3.72% Top10States 73,310,507 8,969,703 12.24% 359,940 4.01%

Source(1):PopulationDivision,U.S.CensusBureau;Table1:EstimatesofthePopulationbySelectedAgeGroupsforJuly1,2007. ReleaseDate: May1,2008. DownloadedonFebruary13, 2010 at http://www.census.gov/popest/states/asrh/tables/SC‐EST2007‐01.xls. Source(2):U.S.Department ofHealth andHuman Services. Residential Care andAssisted LivingCompendium:2007.Downloadedathttp://aspe.hhs.gov/daltcp/reports/2007/07alcom.htm.WiththeexceptionsofCaliforniaandNorthCarolina,thesetopstatesarealllocatedinthenorthernpartofthenation.Thereare,ofcourse,averylargenumberofretireeslivinginsouthern states such as Florida but, on a percentage basis, those states tend to drag thenationalaveragedownward,notupward.Similarly,onemaysuggestthatWyoming’spercentageofelderly livinginALFsshouldbelessthanthenationalaverage,giventhestate’srural,westernculturewherefamilies“takecareoftheirown”andareproudlyindependent.However,ananalysisofthesixstatesthatareimmediatelyadjacenttoWyomingsuggestsjusttheopposite,asseeninTable3below.


Table3:ALFPercentagesforStatesAdjacenttoWyoming(2007)

Nat’lRank

StateTotal

Population(1)65yearsandover(1)

65yearsandover%

Units/Beds(2)


19 Colorado 4,861,515 492,685 10.13% 14,237 2.89%7 Idaho 1,499,402 174,946 11.67% 6,819 3.90%15 Montana 957,861 133,578 13.95% 4,351 3.26%4 Nebraska 1,774,571 236,648 13.34% 10,063 4.25%16 SouthDakota 796,214 113,555 14.26% 3,578 3.15%30 Utah 2,645,330 233,982 8.85% 5,256 2.25% AdjacentStates 12,534,893 1,385,394 11.05% 44,304 3.20%

Source(1):PopulationDivision,U.S.CensusBureau;Table1:EstimatesofthePopulationbySelectedAgeGroupsforJuly1,2007. ReleaseDate: May1,2008. DownloadedonFebruary13, 2010 at http://www.census.gov/popest/states/asrh/tables/SC‐EST2007‐01.xls. Source(2):U.S.Department ofHealth andHuman Services. Residential Care andAssisted LivingCompendium:2007.Downloadedathttp://aspe.hhs.gov/daltcp/reports/2007/07alcom.htm.As Table 3 above demonstrates, the states adjacent toWyoming actually have a higherpercentage(3.2%)ofelderlypersonsaged65orolderlivinginALFsthandoesthenationasawhole(2.57%).Wyoming’spopulationofelderlyaged65ormorein2007was63,901people.IfWyomingprovidedthesamerateofALFbedsto itscitizensas thenation(2.57%)oras theregioncomprisedof adjoining states (3.2%), thenWyomingneeds tohave a supply of 1,642or2,045ALFunits,respectively.However,asof2007,Wyominghadjust1,436ALFbeds,asseeninTable4below.Table4:ComparisonofALFPercentagesforUnitedStates,WyominganditsAdjacentStates(2007)

Nat’lRank State

TotalPopulation(1)

65yearsandover(1)

65yearsand

over%Units/Beds(2)


UnitedStates 301,621,157 37,887,958 12.56% 974,585 2.57% AdjacentStates 12,534,893 1,385,394 11.05% 44,304 3.20%29 Wyoming 522,830 63,901 12.22% 1,436 2.25%Source(1):PopulationDivision,U.S.CensusBureau;Table1:EstimatesofthePopulationbySelectedAgeGroupsforJuly1,2007. ReleaseDate: May1,2008. DownloadedonFebruary13, 2010 at http://www.census.gov/popest/states/asrh/tables/SC‐EST2007‐01.xls. Source(2):U.S.Department ofHealth andHuman Services. Residential Care andAssisted LivingCompendium: 2007. Downloaded from the Internet on February 13, 2010 athttp://aspe.hhs.gov/daltcp/reports/2007/07alcom.htm.Given the number ofWyoming residentswho are 65 years or older, and the number oflicensedALFs,thereisashortfallofALFbedsnomatterwhichaverageisused.Ifoneuses


thenationalaverage(2.57%)ofelderlypeople(65orolder)whoare living inALFs, thenWyominghadashortfallin2007of206beds;andifoneusestheregionalaverage(3.2%)thenWyominghadashortfall in2007of609beds. Forthesakeofargumentandtoriskerringonlyontheconservativeside, thisstudywillusethe lower,nationalpercentageofelderlylivinginALFs(2.57%)fortherestofthisstudy.The shortfall of ALF beds actually has worsened in Wyoming since 2007. As of 2010,Wyoming’s elderly population (age 65 and older) has grown to 69,485 residents,generatingevenmoredemandforALFs.Source:ESRIBusinessAnalystOnline,basedonU.S.Bureau of theCensus,2000Census ofPopulationandHousing,andESRI. Downloaded onOctober1,2010athttp://www.esri.com/bao. Atthesametime,thenumberofALFbedsinWyoming has not grown to accommodate the rising demand. As of September 2010,Wyominghadjust1,234licensedbeds,whichwouldincreasetheshortfallbyanother202beds.In2010,then,ifthenationalaverageof2.57%ofWyoming’selderlywereresidinginALFs,thenWyomingwouldneed1,786ALFbeds.However,accordingtolicensingdatafromtheWyoming Department of Health (see Table 5 below), there currently are 20 privatelylicensedALFsinWyoming(oneofwhichisanewstart‐upinearly2010thatisnotyetfullyoperational), plus two government‐operated ALFs. Theoretically, if Wyoming’s targetpopulation were to abandon their values for privacy and quality of services, then theexistingALFsinthestatecouldpossiblymeet69%ofthemarketdemand(i.e.,1,234bedsarecurrentlyavailable,leavinganunmetneedofatleast552beds).However,Wyoming’sALFoperatorsclaimthatWyoming’sseniorsplaceahighvalueonprivacyandqualityofALF services. Accordingly,mostWyomingALFoperatorsareable to sell services to justoneoccupantperunit,regardlessofthenumberofbedslicensedforthatroom.Thetypicalexceptiontothisrule–andtheonlytimethatunitsactuallyhousetworesidents–iswhenmarriedcouples/partnersorsiblingsdesiretolivetogether.OnemustbeclearaboutthedifferencebetweenALFlicensed“units”and“beds.”Unitsareroomsinwhichresidentsmaylive;bedsarethenumberofresidentsthatarelicensedtobeplaced in all rooms. The design and construction of the ALF determines the number ofunits(rooms)intheALF.Incontrast,theWyomingDepartmentofHealthdeterminesandlicensesthenumberof“beds”thatcouldbeplacedintheALF,basedonthesquarefootageof each room at the time of initial facility licensing. However, according to the 2009OverviewofAssistedLiving,manyother reports cited in this study, andCBI’s telephoneinterviewswithWyomingALFs,mostALFresidentswillnotsharearoomunlessitiswiththeirspouse.Privacyisoneofthemostcommondecision‐makingcriteriaidentifiedbyALFresidents when choosing where they will live (quality of services is the other majorcriteria), according to the 2009 Overview of Assisted Living. Accordingly, whenconsidering the occupancy level of any ALF, it is most appropriate to consider thepercentageofunits that are occupied, not thenumber of beds. Source:2009OverviewofAssistedLiving,a collaborative researchprojectof theAmericanAssociationofHomesandServices for the Aging (AAHSA), the American Seniors Housing Association (ASHA), theAssistedLivingFederationofAmerica(ALFA),theNationalCenterforAssistedLiving(NCAL),andtheNationalInvestmentCenterfortheSeniorsHousing&CareIndustry(NIC).Published


byStrattonPublishing&Marketing,Inc.(August2009).[Note: Thenational organizationsthat collaborate in this reports preparation consider it to be “the singlemost importanteffort to provide core national metrics about the assisted living customer” and an“invaluable statistical resource for senior housing providers, policymakers, regulators,consumers,consumeradvocates,andhealthcareprofessionals.”]

Accordingly,ifoneassumes(asdoesthisstudy)thatthemostappropriatemeasureofALFusageisthenumberofunits,thenWyominghasamuchlargershortfall.IftheactualneedinWyoming is for 1,786units (not beds), then there is a current need for 817newALFunits (i.e.,differencebetweencurrentdemand for1,786unitsandcurrent supplyof969units).ThisstatewideshortageisevenmoreacuteatsomelocalitieswithinWyoming,andisalikelyreasonthatelderlyresidentsareleavingcommunitieslikeWheatlandandPlatteCounty.For comparison purposes, this study will primarily examine other private pay ALFs,excludingthegovernment‐ownedfacilities.Also,becausetheAgapeManorALFinBuffalo,Wyoming,hasbeenopenlessthanoneyear,ithasnotyetreachedfulloperationalcapacity,and so that facility’s occupancy is not a good comparison. The 19 remainingWyomingALFs–allprivatepayfacilitiesthathavebeenoperationalformorethanoneyear,contain768 units. CBI phone surveys of those private pay assisted living facilities establish anaveragemonthlybasecostof$3,011.Currently,thereare655residentsinthosefacilities,resultinginastatewideprivateALFoccupancylevelof85%,asseeninTable5below.


Table5:WyomingLicensedAssistedLivingFacilities

AssistedLivingFacility#of

LicensedBeds

#Units#

ResidentsOccupancy

% CITY

AgapeManorAssistedLiving 26 24 Buffalo

GardenSquareofCasper 50 48 43 90% Casper

MeadowWindAssistedLivingCommunity 75 53 48 91% Casper

ParkPlaceAssistedLivingCommunity 116 61 56 91% Casper

PrimroseRetirementCommunityofCasper 42 32 31 74% Casper

AspenWindAssistedLivingCommunity 100 77 72 94% Cheyenne

PointeFrontierRetirementCommunity 50 45 41 92% Cheyenne

SierraHillsAssistedLivingCommunity 100 80 63 79% Cheyenne

AbsarokaAssistedLivingCommunity 51 46 44 95% Cody

BeeHiveHomesofEvanston 16 12 8 69% Evanston

TenderHeartAssistedLivingFacility 16 14 11 77% Evanston

RiverRockLodgeAssistedLivingCommunity 65 57 38 66% Jackson

ShowboatRetirementCenter 50 32 27 84% Lander

SpringWindAssistedLivingCommunity 75 53 37 69% Laramie

NewHorizonsAssistedLivingFacility 9 7 5 75% Lovell

TheHeartland 24 24 23 95% Powell

HomesteadAssistedLiving 48 45 32 71% Riverton

SugarlandRidgeSeniorAssistedLivingCommunity 65 55 52 94% Sheridan

SundanceAssistedCare 15 14 13 95% Sundance

LegacyHomesAssistedLiving 16 13 11 81% Thayne

Averageoccupancy‐non‐statefacilities 1009 792 655 83%

PRIVATEALFs,LESSBUFFALO 983 768 655 85%

Veterans'HomeofWyoming 117 117 91 78% Buffalo

WyomingPioneerHome 108 60 30 50% Thermopolis

TOTALPRIVATEANDPUBLICLYOPERATEDALFs 1,234 969 776 80%

Source: Wyoming Department of Health/Office of Healthcare Licensing and Surveys,Directory ofWyomingAssistedLivingFacilities,downloaded from the Internet onMay22,2010athttp://www.health.wyo.gov/ohls/facilitiesdirectory.html. Dataupdated byCBI viaemailsandphonecallstofacilities.AsidentifiedinTable5above,Wyoming’sprivateALFsarecurrentlyoperatingat85%oftheirunitcapacity.Thisnumberhasdecreasedfrom90%occupancyduringthecourseofthelast12months. Facilityadministratorscitedtheeconomicdownturnasakeyreasonfor higher than normal vacancy rates. By comparison, median occupancy for ALFsnationwide is 90.5%. Source: The State of Seniors Housing 2010, a joint publicationproduced by the American Association of Homes and Services for the Aging (AAHSA),AmericanSeniorsHousingAssociation(ASHA),AssistedLivingFederationofAmerica(ALFA),


National Investment Center for the Seniors Housing & Care Industry (NIC), and NationalCenterforAssistedLiving(NCAL).Accordingtothe2009OverviewofAssistedLivingcitedabove, thereareseveralreasonsthatsomeALFsdonotoperateatfulloccupancy.SomeALFsfaceoperationallimitations,such as limitedworkforce, older structures, and local competition. However, the largestfactoronoccupancyisconsumerchoice,primarilyledbytwodecisionpoints:Privacyandquality. According to this study, the elderlymarketwill avoid ALF units that have onlysemi‐private rooms (i.e., units shared by two residents). Additionally, today’s elderlyconsumer seeks to avoid ALFs that appear to be institutionalized or that lack quality ofservices.Accordingly,manyofWyoming’scurrentALFsdonotmeetwiththeexpectationsanddemandsoftoday’sconsumer.The findings of the 2009 Overview of Assisted Living study seem particularly on pointwhenoneconsiderstheALFslocatedinWyoming’slargermarkets,CheyenneandCasper.There,withineachmarket,onecanfindanALFthatmeetsorexceedsthatnationalmedianoccupancyrate.Yet,inthatsamemarket,onefindsotherALFswhoseoccupancyisfarless.Suchdiscrepanciescannotbeexplainedbythesizeofmarket,marketdemand,oranythingotherthanconsumerchoice.Finally, itshouldbenotedthat–unlikenursinghomes–theStatedoesnotrequireproofthat construction of an ALF is warranted by high occupancy rates in the area. Instead,recognizing that ALFs are primarily funded by private‐pay residents, the governmentallows development of new or expanded ALFs to be determined by market demands.Therefore,thisstudywillparticularlyexplorethemarketareaslevelofdemandandsupplyofALFs.


MemoryCare–U.S.In addition to limitations in physical abilities, many Americans have additional needsrelated to theirmental abilities. For example, an estimated 5.3millionAmericans of allageshaveAlzheimer’sdisease. Thisfigureincludes5.1millionpeopleaged65andolder.Aboutoneineightpeopleaged65andolder(12.6%)haveAlzheimer’sdisease.Estimatesfromvarious studies indicated that45‐67percentof residentsofassisted living facilitieshaveAlzheimer’sdiseaseorsomeotherformofdementia. Yet,only5%ofassistedlivingbedsare inAlzheimer’s special careunits (asof June2009,according to themost recentdata available). Thus, it is clear that the greatmajority of nursing home residentswithAlzheimer’s and other dementias are not in Alzheimer’s special care units. Source:Alzheimer’sAssociation,Alzheimer’sDiseaseFactsandFigures,2010.Accordingtothe2009OverviewofAssistedLiving,themediancost(i.e.,thecostpointatwhich the base rates for 50% of all units is higher, and 50% is lower) for dedicatedAlzheimer’sunit is$4,200permonth,and themeanaverage is$4,504permonth. Morerecentdata,reportedinTheStateofSeniorsHousing2010citedabove,indicatesthatthemedian total cost (i.e., includes costs that are charged in addition to the base rate) forassistedlivingresidenceswithAlzheimer’sunitsis$4,900permonth.


MemoryCare–WyomingThe lack of memory care is profound in Wyoming. The state has about 7,600 elderlyresidentswithAlzheimer’sdiseaseorsomeotherdementia,butdoesnothaveanylicensedLevelII(MemoryCare)assistedlivingunits.Untilrecently,fewWyoming‐licensednursingfacilities had secure memory care units. TheWyoming Department of Health does nottrackdesignatedmemorycareunitswithin skillednursing facilities in thestate. GoshenCare Center in Torrington opened a 28‐bed SecureMemory CareUnit in the summer of2010, and Douglas Care Center in Douglas will open its 20‐bed Memory Care Unit inDecember2010.Based on a review of literature and interviews with existing ALF operators, there areseveral reasons for this lackofcare: Cumbersomeregulations;relativecostofproviding24‐hourLPNorRNcare(versusCNAcoverage);highdemandforexistingALFservices;andthehighcostofproviding(andpayingfor)dementiacareservices.SincetherearenoestablishedlicensedassistedlivingmemorycareunitsinWyoming(andthus no reliable data), the national median base cost will be used for this study. Thisassumptionisreasonable,giventhatWyomingaveragecostsforlong‐termcareingeneralisquitesimilartonationalcosts.


DescriptionofMarketAreaTypically, feasibility studies will define markets as that area enclosed within a certainradiusofaproposedsite(forexample,a50‐mileradius).However,inWyoming,giventheuniquegeographyandlongdistancesseparatingruralcommunities,itismoreappropriatetoconsidermarketsastheyareactuallyestablishedbycommunityshopping,workingandlivingpatterns.Accordingly,forthisstudy,PlatteCountywillbetheprimarymarketareatobestudied.Inthemapbelow,thisareaisenclosedbythebluemarkings.WhiletheWheatlandareaisrelativelyrural,thisareaisakeypartofamuchlargerregion.Infact,mostpeoplefromtheareaidentifythemselvesasbeingfrom“SoutheastWyoming,”or, more broadly, “Wyoming.” Many residents of Wheatland shop and/or work inCheyenne,andsoitisnotunusualforarearesidentstofrequentlycommutemorethananhourtoandfromCheyenne. Giventhispattern, theareathat iscommonlyreferredtoas“SoutheastWyoming”(i.e.,theareaenclosedbyDouglasandLusktothenorth,TorringtonandPineBluffstotheeast,DouglasandLaramietothewest,andWyoming/Coloradostatelinetothesouth)willbeconsideredastheSecondaryMarketforpurposesofthisfeasibilitystudy.Thatmarketareaisshowninredonthemapbelow.

Finally,becausemostexistinglong‐termcarefacilitiesdrawalimitednumberofresidentsfromextendedstateandnationalmarkets, thisstudywill consider theStateofWyomingandtheentireUnitedStatesasatertiarymarketarea.

Map:PrimaryandSecondaryMarketAreas


DemographicsWheatlandisthecountyseatofPlatteCounty,locatedinsoutheasternWyoming.In2000,PlatteCountycontained8,807residents.Sincethen,itisestimatedtohaveshrunktoabout8,494people.Itisforecasttocontinuelosingpopulationthrough2015,whenitisforecastto have 8,256 residents. The Secondary Market area (Southeast Wyoming) contained142,105residentsin2000,hasgrownto152,847peopletoday,andisexpectedtogrowto158,672 residents by 2015. The population of the Secondary Market area is heavilyinfluencedbytheCityofCheyenne,whichis70milessouthofWheatland.TheresidentsinthePrimaryMarketareaaremucholder(41.1yearsoldin2000)thaninotherpartsofWyomingandtheUnitedStates.TheSecondaryMarketresidentsareslightlyyounger(34.2in2000)thanWyoming(36.1in2000)andtheUnitedStates(35.3in2000).Moreover,PrimaryMarketarearesidentsareagingmorequicklythantheotherareas,asseenGraph1below.

Source: ESRIBusinessAnalystOnline, based onU.S.Bureau of the Census, 2000 Census ofPopulation and Housing, and ESRI forecasts for 2010 and 2015. Downloaded from theInternetonOctober1,2010athttp://www.esri.com/bao.Whilealltheareasidentifiedaboveareaging,thePrimaryMarketareaisagingsignificantlyfaster than the others. A series of population comparisons of the market areas clearly

0

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2000 2010 2015

Graph1:MedianAge,byAreaandYear


demonstratesthepreponderanceofolderresidentslivinginthisregion,asseeninTable6below.

Table6:MedianAge,byMarketAreaandYearMarketArea 2000 2010 2015PlatteCounty 41.1 44.5 45.1SEWyoming 34.2 35.9 36.5StateofWyoming 36.1 38.0 38.4UnitedStates 35.3 37.0 37.3

Further,asrevealedbyGraph2below,thepercentageofthepopulationineveryagegroup55 or older in 2000 in the PrimaryMarket area was greater than the state or country.Consequently,thePrimaryMarketareawillcontinuetohavearelativelyhighpercentageofelderlyresidentsforthenext40‐50years.

Source: ESRIBusinessAnalystOnline, based onU.S.Bureau of the Census, 2000 Census ofPopulation and Housing, and ESRI forecasts for 2010 and 2015. Downloaded from theInternetonOctober1,2010athttp://www.esri.com/bao.

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Graph2:2000PopulationbyAgeGroupandArea

PlatteCounty SEWyoming StateofWyoming UnitedStates


Through2010,therelativelylargepercentageofresidentsaged55ormoreinthePrimaryMarketarearemainssignificantlygreaterthanthestateorthecountry,asseeninGraph3below.


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Thisagingtrendisabouttobecomeevenmoreacute.The“babyboom”generationthatisjustnowreachingretirementage(i.e.,thatgroupofpeoplewhowillbe55to74yearsoldin2015)isforecasttobecomeamuchlargerpercentageofthetotalpopulation,asseeninGraph4below.Infact,by2015,37.3%oftheresidentsinthePrimaryMarketareawillbe55orolder.Bycomparison,just26.8%ofthenation’spopulationwillbethatold.

Source: ESRIBusinessAnalystOnline, based onU.S.Bureau of the Census, 2000 Census ofPopulation and Housing, and ESRI forecasts for 2010 and 2015. Downloaded from theInternetonOctober1,2010athttp://www.esri.com/bao.ThepopulationdemographicanalysisabovesupportsthedirectionthatcommunityleadersinPlatteCountyarenowgoingtodevelopappropriateseniorhousingforlocalresidents.

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IncomeAstheresidentsofthePrimaryMarketareahaveaged,theirincomeandtheirhomevalueshavegrown.Yet,growthratesforMedianHouseholdIncome,AverageHouseholdIncome,and Per Capita Income in the PrimaryMarket have been slower than state and nationalgrowth rates. In particular, the local area’s Median Household Income has risen muchslowerthanthestateornation,assuggestedinGraph5below.


$0

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2000 2010 2015

Graph5:MedianHouseholdIncome



HousingMedianHomeValuesinthePrimaryMarketareahaveincreasedalso,butnotasquicklyastheotherareas.Asof2010,theMedianHomeValueinthePrimaryMarketwas$132,929.The State of Wyoming as a whole ‐ driven by an energy development boom ‐ hasexperiencedmuch faster growth than the local region or the nation, as seen in Graph 6below.


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2000 2010 2015

Graph6:MedianHomeValue



TargetMarketAnalysis

ThepreviousSectionof this studyconductedademographicanalysisof thePrimaryandSecondary Market Areas, the State of Wyoming, and the United States, and made thefollowingkeyobservations:

1. Thetargetpopulationofseniorsaged65andolderisgrowing;2. ThePrimaryMarketAreatargetpopulationisagingmorequicklythantheother

areas;3. As of 2010, Wyoming’s elderly population (age 65 and older) has grown to

69,485residents, includingabout7,600residentswithsomeformofdementia;and

4. By2015,Wyoming’s elderlypopulation (age65andolder)willhavegrown to84,509residents–orapproximately14.5%oftheentirestatepopulation.

Likewise, thefirstsectionofthisStudyreviewedthe long‐termindustry inWyomingandtheUnitedStates,anddiscoveredimportantfacts:

1. Of thenation’s population of seniors aged 65 and older, approximately 3.63%

resideinanursinghome;2.57%resideinanassistedlivingfacility;and0.21%liveinamemorycareunit;

2. Nationaloccupanciesoflong‐termcarefacilitiesarehigh:NursingHomesareat82.9% occupancy, and ALFs are currently operating at 90.5% occupancy; noaccurateoccupancydataexistformemorycareunits;

3. Nationalandlocalsurveysdemonstratethatseniorswillprimarilyseekprivacy(i.e., single‐occupancyrooms)andqualityofserviceswhenchoosing long‐termcare(theexception:dementiacareunits);

4. Wyoming has 38 nursing homes licensed for 2,958 beds, operating at 81.7%occupancy.

5. Wyominghas22ALFs(publicandprivate)licensedfor1,234bedslocatedwith969units,whicharecurrentlyoperatingat80%unitoccupancy;

6. Wyoming’s established private pay ALFs (i.e., non‐government ownedALFs inoperationmorethanoneyear)arecurrentlyoperatingat85%occupancy;and

7. Wyoming has (orwill soon have) 48 newmemory care units associatedwithnursinghomefacilities,arelativelysmallnumberofexistingmemorycarebedslocatedwithinexistingskillednursing facilities, andno licensedassisted livingfacilitiesthathavedementiacareunits.


DemographicsThe consideration of long‐term care facilities statewide is an important premise of thisstudy. WyomingGovernorMike Sullivan once said, “Wyoming is like a small townwithvery long streets.” Many people have subsequently used that phrase to explain several“realities”oflifeinWyoming:

Everyoneseemstoknoweveryone Wyoming residents share common values, in spite of the vast distances between

communities The needs of Wyoming residents are just like the needs of residents in more

populatedareas,andsoresourcesareneededtomeetthoseneeds Wyomingresidentsareaccustomedtotravelingmuchgreaterdistancestogetwhat

theywantthandoresidentsinotherpartsofthecountry–yetthesesameWyomingresidentsfeelthattheyareshopping/traveling/visitinglocally

GovernorSullivan’sinsightfulobservationwaspointon.Accordingly,thisstudyrecognizesthat Wyoming’s elderly population – regardless of where senior citizens may live –collectively needs more long‐term care living opportunities. Small municipalities inWyoming(suchasWheatlandorPlatteCounty)maynotbeabletojustifyconstructionofanew long‐term care facility based only on “local” market demand contained withinarbitrary linesonamapthatdefinemunicipalorcountyboundaries. Rather,Wyoming’selderlycitizenscollectivelydefineanddrivethestatewidemarketforlong‐termcare.Asexplainedabove,thereareculturalandrelationship‐basedboundariesthatdefinehowWyoming residents live. In order to secure dependable data, and to identify readilyrecognized and competitivemarkets, this study has defined the Primary and SecondaryMarketAreasaslocalresidentswoulddoso:PlatteCountyistheareawheretheyreside,paytaxes,andshop;SoutheastWyomingistheextendedareathattheycallhome.Further,consistentwith thediscussionabove, thisstudyhas foundthat there isastatewide long‐termcaremarket,andsotheStateofWyomingwillbetreatedasaTertiaryMarketArea.Finally,basedontheresourcescitedabove,andareviewofWyoming’scurrentlong‐termcare facility residents, this study concludes that a very small number of elderly personsfrom out‐of‐state have moved and will continue to move to Wyoming long‐term carefacilities. Of course, as the respectivemarket areas get bigger, this study assumes thatsmallerpercentagesofeachsuccessivelylargerarea’stargetpopulationwillactuallymovetothearea.A brief comparison of key 2010 demographics for each of the relevantMarket Areas iscontainedinTable7below.


Table7:ComparisonofMarketAreas(2010)

Data

PrimaryMarket

SecondaryMarket TertiaryMarket

PlatteCounty

SEWyoming

StateofWyoming

UnitedStates

TotalPopulation 8,494 152,847 548,154 311,212,863Aged65andolder 1,551 18,797 69,485 40,471,364Aged85andolder 230 2,720 9,383 6,070,110PerCapitaIncome $21,538 $23,627 $24,080 $26,739MedianHomeValue $132,929 $164,631 $171,316 $157,913

Source: ESRIBusinessAnalystOnline, based onU.S.Bureau of the Census, 2000 Census ofPopulation andHousing, andESRI. Downloaded from the Internet onOctober 1, 2010 athttp://www.esri.com/bao.Inadditiontothedemographicsabove,twootherfactorsarerelevanttoananalysisoftheassistedlivingfacilitymarket:

1. Thenumberofelderlywhoareconsidered“frail”orotherwiseinneedofservices;and

2. Thenumberofelderlywhohavesufficientincomeand/orassetstobeabletoaffordthe“privatepayonly”costsoftheALF.

Analysisofthosetwoitemsfollowsinthenextsection.


LimitationswithADLsandIADLsAs discussed above, “frail” elderly can be identified by evaluating abilities to performcertainfunctions,commonlycalled“activitiesofdailyliving”(ADLs). ADLsarethethingsnormallydone in life, includinganydailyactivityperformed forself‐care(suchaseating,bathing,dressing,orgrooming),work,homemaking,andleisure.TheabilityorinabilitytoperformADLs is a verypracticalmeasure of ability/disability inmanydisorders. Thoseelderly citizens who have one or more limitations in performing ADLs are consideredprimecandidatesforassistedliving.Similarly, some elderly citizens struggle with so‐called “instrumental activities of dailyliving”(IADLs),whicharetheactivitiesoftenperformedbyapersonwhohasbeenlivingindependently in a community setting. IADLswould includeactivities suchasmanagingmoney, shopping, telephone use, travel, housekeeping, preparing meals, and takingmedicationscorrectly.Surveys of persons with limitations in ADLs and IADLs have been conducted for manyyearsbytheCentersforDiseaseControlandPrevention(CDC).AccordingtotheCDC,themost recent data (2003‐2007) from the National Health Interview Surveys reveal theselimitations,byagegroup,asseeninTable8below.

Table8:PersonswithLimitationswithADLsandIADLs,byAgeGroup(2003‐2007)

AgeGroupLimitationwith:

1ormoreADL 1ormoreIADL

Alladults(age18+) 1.57% 3.63%

65‐74years 2.94% 6.23%

75‐84years 6.11% 13.76%

85+years 17.80% 35.29%

Source:CentersforDiseaseControlandPrevention,"LimitationsinActivitiesofDailyLivingandInstrumentalActivitiesofDailyLiving,2003‐2007,"downloadedonFebruary17,2010athttp://www.cdc.gov/nchs/health_policy/ADL_tables.htm. [Note: the population of personswith limitations inADLsmay overlapwith the population of personswith limitations inIADLs.Inotherwords,thetwopopulationsarenotnecessarilymutuallyexclusive.]According to the CDC, their surveys, taken over a period of five years, draw from largeenough samples as to produce reliable estimates of the percentages of people withlimitations in ADLs and IADLs, by age group. This study assumes that the 2003‐2007distribution (percentages) of persons with limitations in performing ADLs and IADLsremainsthesamefor2010.Withthatassumption,applicationoftheCDC’sfindingstotherelevantagegrouppopulationin2010foreachMarketAreaappearsinTable9below.


Table9:PersonswithLimitationsinADLsandIADLs,byMarketAreaandbyAgeGroup(2010)

MarketAreaPercentageandNumberofPersonsforeachMarketArea,byAgeGroup

All20+ 65‐74 75‐84 85+ Total65+

PRIMARY

PlatteCounty(1) 76.5% 9.9% 5.7% 2.7% 18.3%#inagegroup 6,499 841 480 230 1,551LimitationinADL%(2) 1.57% 2.94% 6.11% 17.80% 6.13%LimitationinADL# 102 25 29 41 95LimitationinIADL%(2) 3.63% 6.23% 13.76% 35.29% 12.87%

LimitationinIADL# 236 52 66 81 200

SECONDARY SEWyoming(1) 74.3% 6.3% 3.9% 1.7% 11.9%

#inagegroup[netofMarketabove] 107,245 9,112 5,644 2,490 17,246LimitationinADL%(2) 1.57% 2.94% 6.11% 17.80% 6.13%LimitationinADL# 1,680 268 345 443 1,057LimitationinIADL%(2) 3.63% 6.23% 13.76% 35.29% 12.89%

LimitationinIADL# 3,892 567 777 879 2,223

TERTIARY

StateofWyoming%ofpopulation(1) 75.5% 7.3% 4.1% 1.7% 13.1%

#inagegroup[netofMarketsabove] 291,996 28,239 15,786 6,663 50,688

LimitationinADL%(2) 1.57% 2.94% 6.11% 17.80% 5.88%

LimitationinADL# 4,574 831 965 1,186 2,982

LimitationinIADL%(2) 3.63% 6.23% 13.76% 35.29% 12.39%

LimitationinIADL# 10,598 1,758 2,172 2,351 6,281

UnitedStates%ofpopulation(1) 72.9% 6.8% 4.3% 2.0% 13.0%

#inagegroup[netofMarketsabove] 226,424,143 21,076,583 13,264,569 6,060,727 40,401,879


LimitationinADL# 3,546,727 620,532 811,109 1,078,604 2,510,245


LimitationinIADL# 8,217,847 1,312,403 1,824,995 2,138,531 5,275,928

Total[allAreas] 226,829,883 21,114,775 13,286,479 6,070,110 40,471,364

Source(1):ESRIBusinessAnalystOnline,basedonU.S.BureauoftheCensus,2000CensusofPopulation andHousing, andESRI. Downloaded from the Internet onOctober 1, 2010 athttp://www.esri.com/bao. Source (2): Centers for Disease Control and Prevention,"Limitations inActivities ofDaily Living and InstrumentalActivities ofDaily Living, 2003‐2007," downloaded from the Internet on February 17, 2010 athttp://www.cdc.gov/nchs/health_policy/ADL_tables.htm.Using thisanalysis, thePrimaryMarketAreacontains1,551personswhoareaged65orolder. Of those 1,551 residents, 95 have limitationswith at least one ADL and 200 arelimited in IADLs. Similarly, theSecondaryMarketAreacontainsanother17,246personswhoareaged65orolder. Of those17,246residents,1,057are limitedwithat leastoneADLand2,223arelimitedwithIADLs.EachsuccessiveMarketArea inTable9fullycontainstheMarketArea(s)aboveit,sothenumbers of persons in eachMarket Area excludes the population of theMarket Area(s)aboveit(i.e.,nopersoniscountedmorethanonceinanyparticulargroup). Accordingly,onewould add the totalnumbersofpersons in eachMarketArea todetermine the total


targetpopulation. Forexample, todetermine the total targetpopulation for thePrimaryandSecondaryMarketAreasaged65orolder,onewouldaddthemtogetherandfindthatthereare18,797persons inthosetwocombinedareas,with1,152residents limitedwithADLsand2,422limitedwithIADLs.Additionally,theentirepopulationofadults(i.e.,allpersonsaged20andolder)isincludedasthefirstagegroupinTable9.Allsuchadultsshouldbeconsideredapartofthetargetmarket,sinceassistedlivingfacilitiesarelicensedandcapableofmeetingtheneedsofanyadultwhohas limitations inADLs,not just thosewhoareaged65andolder. It is clear,though,thattheoverwhelmingmajorityofpersonswithlimitationsarethosewhoare65andolder.TheinformationcontainedinTable9aboveiscurrentasof2010.However,itisimportanttoconsiderwhetherfuturedemographictrendsjustifythedevelopmentofnewlong‐termcare facilities. Usingpopulationprojections for 2015, alongwith the samemethodologyfollowedabove,therelevantagegrouppopulationsin2015foreachMarketAreawouldbeasfollows,inTable10.


Table10:PersonswithLimitationsinADLsandIADLs,byMarketAreaandbyAgeGroup(2015)

MarketAreaPercentageandNumberofPersonsforeachMarketArea,byAgeGroup

All20+ 65‐74 75‐84 85+ Total65+

PRIMARY

PlatteCounty(1) 77.3% 12.2% 5.9% 2.6% 20.7%#inagegroup 6,382 1,010 484 218 1,712LimitationinADL%(2) 1.57% 2.94% 6.11% 17.80% 5.73%LimitationinADL# 100 30 30 39 98LimitationinIADL%(2) 3.63% 6.23% 13.76% 35.29% 12.06%

LimitationinIADL# 232 63 67 77 206

SECONDARY SEWyoming(1) 74.8% 7.9% 3.9% 1.7% 13.5%

#inagegroup[netofMarketabove] 112,437 11,845 5,878 2,544 20,267LimitationinADL%(2) 1.57% 2.94% 6.11% 17.80% 5.73%LimitationinADL# 1,761 349 359 453 1,161LimitationinIADL%(2) 3.63% 6.23% 13.76% 35.29% 12.06%

LimitationinIADL# 4,081 738 809 898 2,444

TERTIARY

StateofWyoming%ofpopulation(1) 75.7% 9.2% 4.1% 1.7% 15.0%

#inagegroup[netofMarketsabove] 314,623 38,294 17,078 7,158 62,530


LimitationinADL# 4,928 1,127 1,044 1,274 3,446


LimitationinIADL# 11,419 2,385 2,350 2,526 7,260

UnitedStates%ofpopulation(1) 73.4% 8.3% 4.2% 1.9% 14.4%

#inagegroup[netofMarketsabove] 236,622,035 26,776,215 13,523,675 6,274,315 46,574,205


LimitationinADL# 3,706,467 788,340 826,953 1,116,615 2,731,908


LimitationinIADL# 8,587,970 1,667,310 1,860,643 2,213,895 5,741,848

Total[allAreas] 237,055,477 26,827,364 13,547,115 6,284,235 46,658,714

Source(1):ESRIBusinessAnalystOnline,basedonU.S.BureauoftheCensus,2000CensusofPopulation andHousing, andESRI. Downloaded from the Internet onOctober 1, 2010 athttp://www.esri.com/bao. Source (2): Centers for Disease Control and Prevention,"Limitations inActivities ofDaily Living and InstrumentalActivities ofDaily Living, 2003‐2007," downloaded from the Internet on February 17, 2010 athttp://www.cdc.gov/nchs/health_policy/ADL_tables.htm.Usingthesameanalysis–butwiththeprojectedpopulationgrowthfor2015–thePrimaryMarketAreaisprojectedtocontain1,712personswhoareaged65orolder.Ofthose1,712residents,theprojectionisthattherewillbe98residentslimitedwithatleastoneADLand206 limited in IADLs. Similarly, the SecondaryMarketArea is projected to have 20,267additionalpersonswhoareaged65orolder. Of those20,267projectedresidents,1,161willbelimitedwithatleastoneADLand2,444willbelimitedwithIADLs.Inotherwords,thetargetpopulationof“frail”elderlycitizensisprojectedtogrowsignificantlyby2015.Infact, all the Market Areas will see significant, double‐digit growth of elderly residents


between2010and2015,eventhoughtheentirenationalpopulationisexpectedtogrowbylessthan4%duringthatsametime!


IncomeandHousingAccordingtothesourcescitedabove,theaveragecostofnursinghomecareinWyomingis$5,627forsemi‐privateroomsand$6,266forprivaterooms.Themediancostforassistedlivingfacilitiesisentry‐levelALFroomsinWyomingis$3,011permonth.SincetherearenoestablishedmemorycareunitsinWyoming,thisstudywillusethenationalmedianbasecostof$4,200permonth.Recognizing that payment of those long‐term costs comes from a variety of sources(privatepay,long‐termcareinsurance,Medicaid,andMedicare,etc.),prospectiveresidentsmusthaveappropriate levelsof incometopay thesecosts. Ofcourse,whenmoving intoany formof long‐termcare facility,manyelderlypeoplewillsell theirhomeand/orhaveotherpersonal assets topay the costsof their care. Still otherswill be assistedby theirfamilyorhaveprivatelong‐termhealthcareinsurance.Given the average costs and sources of payment noted above, this study assumes thatfuturenursinghomeresidentswill likelyneedtohave incomeofat least$15,000; futureassistedlivingfacilityresidentswillneedincomeofatleast$35,000;andfutureresidentsof memory care units will need annual income of at least $50,000. To complete thatanalysis,onemustexamineHouseholdIncomelevelsbyAgeGroup,ascompiledinTables11A,11B,and11Cbelow.[Note:EachtablerepresentsadifferentMarketArea.]

Table11A:HouseholdIncomeLevels,PrimaryMarketAreabyAgeGroup(2010)MARKETAREA/IncomeLevel 65‐74 75‐84 85+ Total65+ %65+

PRIMARYMARKET

PlatteCounty 540 338 145 1,023 100.0%

<$15,000 88 108 48 244 23.9%

$15,000‐$24,999 105 75 37 217 21.2%

$25,000‐$34,999 79 42 15 136 13.3%

$35,000‐$49,999 76 32 13 121 11.8%

$50,000‐$74,999 130 47 19 196 19.2%

$75,000‐$99,999 19 26 9 54 5.3%

$100,000‐$149,999 38 3 2 43 4.2%

$150,000‐$199,999 1 4 2 7 0.7%

$200,000‐$249,999 4 1 0 5 0.5%

$250,000‐$499,999 0 0 0 0 0.0%

$500,000+ 0 0 0 0 0.0%

$15,000ormore 452 230 97 779 76.1%

$35,000ormore 268 113 45 426 41.6%

$50,000ormore 192 81 32 305 29.8%

Source: ESRIBusinessAnalystOnline, based onU.S.Bureau of the Census, 2000 Census ofPopulation andHousing, andESRI. Downloaded from the Internet onOctober 1, 2010 athttp://www.esri.com/bao.


Thus, in the PrimaryMarket, among the population of residents aged 65 or older, thereappeartobe779householdswhocouldaffordnursinghomecare;426whocouldaffordassistedliving;and305whocouldaffordmemorycare.The percentage of households in the Secondary Market whose incomes are greater ishigher than the Primary Market, as seen in Table 11B below. There are 9,884 elderlyhouseholdsthathavesufficientincome($15,000)fornursinghomecare;6,186householdsthatcouldaffordassistedliving($35,000);and4,031householdsintheSecondaryMarketwhoseincomewas$50,000ormore,enablingthemtoaffordmemorycare.

Table11B:HouseholdIncomeLevels,SecondaryMarketAreabyAgeGroup(2010)MARKETAREA/IncomeLevel 65‐74 75‐84 85+ Total65+ %65+

SECONDARYMARKET

SEWyoming 6,233 4,214 1,699 12,146 100.0%

<$15,000 886 966 410 2,262 18.6%

$15,000‐$24,999 949 840 354 2,143 17.6%

$25,000‐$34,999 804 536 215 1,555 12.8%

$35,000‐$49,999 1,393 550 212 2,155 17.7%

$50,000‐$74,999 1,073 516 200 1,789 14.7%

$75,000‐$99,999 620 321 115 1,056 8.7%

$100,000‐$149,999 340 371 156 867 7.1%

$150,000‐$199,999 76 63 21 160 1.3%

$200,000‐$249,999 57 39 13 109 0.9%

$250,000‐$499,999 25 11 3 39 0.3%

$500,000+ 10 1 0 11 0.1%

$15,000ormore 5,347 3,248 1,289 9,884 81.4%

$35,000ormore 3,594 1,872 720 6,186 50.9%

$50,000ormore 2,201 1,322 508 4,031 33.2%

Source: ESRIBusinessAnalystOnline, based onU.S.Bureau of the Census, 2000 Census ofPopulation andHousing, andESRI. Downloaded from the Internet onOctober 1, 2010 athttp://www.esri.com/bao.


ThepercentageofresidentswithsufficientincomeishigherintheWyomingandnationalmarkets,asseeninTable11Cbelow.

Table11C:HouseholdIncomeLevels,TertiaryMarketAreasbyAgeGroup(2010)MARKETAREA/IncomeLevel 65‐74 75‐84 85+ Total65+ %65+

TERTIARYMARKETAREAS

StateofWyoming 23,943 14,695 5,843 44,481 100.0%

<$15,000 3,784 3,416 1,455 8,655 19.5%

$15,000‐$24,999 3,706 2,935 1,229 7,870 17.7%

$25,000‐$34,999 3,389 1,701 683 5,773 13.0%

$35,000‐$49,999 4,608 2,033 825 7,466 16.8%

$50,000‐$74,999 3,849 1,781 649 6,279 14.1%

$75,000‐$99,999 2,477 1,302 466 4,245 9.5%

$100,000‐$149,999 1,315 1,054 394 2,763 6.2%

$150,000‐$199,999 321 261 80 662 1.5%

$200,000‐$249,999 338 163 47 548 1.2%

$250,000‐$499,999 133 38 13 184 0.4%

$500,000+ 23 11 2 36 0.1%

$15,000ormore 20,159 11,279 4,388 35,826 80.5%

$35,000ormore 13,064 6,643 2,476 22,183 49.9%

$50,000ormore 8,456 4,610 1,651 14,717 33.1%

MARKETAREA/IncomeLevel 65‐74 75‐84 85+ Total65+ %65+

UnitedStates 12,837,056 8,482,617 3,584,983 24,904,656 100.0%

<$15,000 2,020,053 2,045,809 906,529 4,972,391 20.0%

$15,000‐$24,999 1,762,514 1,439,374 633,927 3,835,815 15.4%

$25,000‐$34,999 1,606,390 1,025,313 440,589 3,072,292 12.3%

$35,000‐$49,999 2,099,433 1,125,395 474,958 3,699,786 14.9%

$50,000‐$74,999 2,295,348 1,143,170 473,472 3,911,990 15.7%

$75,000‐$99,999 1,229,167 721,139 286,233 2,236,539 9.0%

$100,000‐$149,999 1,045,249 543,596 211,235 1,800,080 7.2%

$150,000‐$199,999 338,314 210,326 75,978 624,618 2.5%

$200,000‐$249,999 212,855 134,261 45,962 393,078 1.6%

$250,000‐$499,999 179,901 72,697 28,131 280,729 1.1%

$500,000+ 47,832 21,537 7,969 77,338 0.3%

$15,000ormore 10,817,003 6,436,808 2,678,454 19,932,265 80.0%

$35,000ormore 7,448,099 3,972,121 1,603,938 13,024,158 52.3%

$50,000ormore 5,348,666 2,846,726 1,128,980 9,324,372 37.4%

Source: ESRIBusinessAnalystOnline, based onU.S.Bureau of the Census, 2000 Census ofPopulation andHousing, andESRI. Downloaded from the Internet onOctober 1, 2010 athttp://www.esri.com/bao.GiventhefindingsintheTables11A,11B,and11C,thisstudyconcludesthat76.1%ofthePrimary Market, 81.4% of the Secondary Market, and about 80% of Tertiary Markethouseholdswillhavesufficient incometoaffordnursinghomecare. Similarly, thisstudyconcludes that41.6%of thePrimaryMarket, 50.9%of theSecondaryMarket, andabouthalf of Tertiary Market households will have sufficient income to afford assisted living


services. Finally, 29.8% of PrimaryMarket households and about one‐third of all othermarketareahouseholdscouldaffordmemorycare.AsimilaranalysishasbeenconductedbyCBI,usingprojectionsthrough2015.TheresultsofthatanalysisappearinTable15attheendofthisstudy,summarizingthegrowthofnetdemandforlong‐termcareservicesineachmarketarea.ThereisnocorrelationbetweenincomelevelsandlimitationsinADLs.Thisstudyassumesthatallpersons–regardlessofhouseholdincome–havesimilarlimitationsintheirabilitytoperformADLs.Therefore,fornursinghomesandassistedlivingfacilities,thepercentageofpersonswhohavesufficientresourcescanbemultipliedbythenumberofpersonswhohavelimitationsinperformingADLs,inordertodeterminethenumberofeligibleresidentswho could afford that type of long‐term care. SeeTables 12A and 12B, below for thesecalculations.

Table12A:CalculationofPersonswithADLsandwithFinancialResourcesforNursingHomes(2010)

MARKETAREA

PrimaryMarket

SecondaryMarket

TertiaryMarket ALLAREAS

PlatteCounty

SEWyoming

StateofWyoming

UnitedStates Total

#LimitedinADLs 95 1,057 2,982 2,510,245 2,514,379

%withFinancialResources 76.1% 81.4% 80.5% 80.0% 80.0%

#withADLs&Resources 72 860 2,402 2,009,057 2,012,391

Thus, by thismeasure ofmarket feasibility, there are 72 persons in the PrimaryMarketareawhoareeligiblefornursinghomecareANDcanaffordtopayforthatcare.

Table12B:CalculationofPersonswithADLsandwithFinancialResourcesAssistedLiving(2010)

MARKETAREA

PrimaryMarket

SecondaryMarket


30‐minuteDrive

90‐minuteDrive

StateofWyoming

UnitedStates Total

#LimitedinADLs 95 1,057 2,982 2,510,245 2,514,379

%withFinancialResources 48.3% 58.3% 57.4% 61.2% 52.3%


Similarly, there are 46 persons in the PrimaryMarket areawho are eligible for assistedlivingANDcanaffordtopayforthatcare.


BecauseallmemorycareresidentssufferfromAlzheimer’sdiseaseorsomeotherformofdementia,theyallhavesignificantlimitationsintheirabilitytoperformADL’s.Accordingly,theapproachtakenabovewouldbecalculatedasfollows,inTable12C.

Table12C:CalculationofPersonswithADLsandwithFinancialResourcesforMemoryCare(2010)

MARKETAREA

PrimaryMarket

SecondaryMarket


PlatteCounty

SEWyoming

StateofWyoming

UnitedStates Total

USestimate(12.6%)withDementia 195 2,173 6,387 5,091,244 5,100,000%withFinancialResources 29.8% 33.2% 33.1% 37.4% 37.4%


With this analysis, it appears that thereare58persons in thePrimaryMarket areawhohavesomeformofdementiaANDcanaffordtopayformemorycare.


CompetitionandSupportServicesThisstudynotesthatthereareotherlong‐termcareservicesinthePrimaryandSecondaryMarketAreas.Becauseabroadcontinuumofcareprovideselderswithachoiceofwheretolive,itisimportanttonotealltheknownservicesinthemarket.Within the Primary Market Area, the only nursing home is the Platte County MemorialNursingHome,andtherearenoassistedlivingfacilitiesormemorycareunits.ThereisalicensedBoardingHomeinWheatland(CountryClubLiving)thatprovides“room&board”careforseniors.However,thatfacilitydoesnotprovidethehigherlevelofcareprovidedatALFs,includingmedicalcare.WithintheSecondaryMarket,thereareseveralnursinghomes,summarizedinTable13Abelow.

Table13A:NursingHomesinSecondaryMarket

NameofFacility#ofLicensed

Beds#

OccupiedOccupancy

% CityLifeCareCenterofCheyenne 160 150 94% CheyenneMemorialHospitalofLaramieCo.CareUnit 16 10 63% CheyenneMountainTowersHealthcare&RehabilitationCenter 146 130 89% CheyenneSSCCheyenneOperatingCoLLC 105 93 89% CheyenneDouglasCareCenterLLC 60 41 68% DouglasAlbanyCoHospitalDistrict 10 7 72% LaramieLaramieCareCenter 105 75 71% LaramieGoshenCareCenter 103 101 98% Torrington

Totals 705 607 86%

Additionally, there are four assisted living facilities licensed to operate in the SecondaryMarket,aslistedinTable13Bbelow.

Table13B:AssistedLivingFacilitiesinSecondaryMarket

NameofFacility #ofLicensedBeds

#Units

#Occupied

Occupancy% City

AspenWindAssistedLivingCommunity 100 77 72 94% Cheyenne

PointeFrontierRetirementCommunity 50 45 41 92% Cheyenne

SierraHillsAssistedLivingCommunity 100 80 63 79% Cheyenne

SpringWindAssistedLivingCommunity 75 53 37 69% Laramie

Totals 325 255 214 84%

Finally, this study observes that there are (or will soon be) at least four memory carefacilitiesthatplantobeoperatingintheSecondarymarket,listedinTable13Cbelow.


Table13C:MemoryCareUnitsinSecondaryMarket

NameofFacility #ofSecureBeds #Occupied Occupancy% CitySierraHillsAssistedLivingCommunity(ALF) TBD NA NA CheyenneSpringWindAssistedLivingCommunity(ALF) TBD NA NA CheyenneDouglasCareCenterLLC(NursingHome) 20 NA NA DouglasGoshenCareCenter(NursingHome) 28 NA NA Torrington

Totals 48+TBD NA NA

TheTertiaryMarketareasalsohaveanumberoflong‐termcarefacilities,asnotedabove.Thetotalnumberoflicensedbedsineachmarketwilloffsetanydemandforlong‐termcareineachrespectivemarket,asseeninthenextsection.

ThereareanumberofsupportservicesforseniorsavailableinthePrimaryMarket.Theseinclude:

ServicesforSeniors‐theWheatlandSeniorCitizenCenter PlatteCountyHomeCare ForgetMeNotAdultDayCare PlatteCountyPublicHealth NorthPlattePhysicalTherapy

PlatteCountyishometothePlatteCountyMemorialHospitalfacility,a25‐bedacutecarefacilitydelivering24‐houremergencycare.PlatteCountyMemorialHospitalisoperatedbyBanner Health and underwent major renovations in 2008‐2009. The adjacent PlatteCountyMemorialNursingHome isoperatedby thePlatteCountyHospitalDistrictundercontractwithRuralHealthServices.BannerHealthprovidesmealsandlaundryserviceforthenursinghome.MedicalclinicsareavailableinWheatland,Chugwater,andGuernsey.


TheUnmetNeedPullingtogetheralloftheinformationandanalysisabove,thisstudyconcludesthatthereisgrowingmarketdemand for long‐termcareservices inallmarkets. Tables14A(nursinghomes),12B(assistedlivingfacilities),and12C(memorycare)belowcombinetherelevantdataandsummarizenetdemandforlong‐termcarefacilitiesinallmarketareas.Foreachmarketarea,CBIhasusedacapturerate(i.e.,apercentageoftheunmetneedthatislikelytoactuallyusealong‐termfacilityinthemarketarea).Captureratesdecreasedramaticallyasmarket size increases, reflecting the assumption thatmost peoplewill choose a long‐termfacilitythatisclosertohome.Ofcourse,othersmaychoosetomoveclosertofamilyortoaless(ormore)urbansetting,etc.

Table14A:SummaryofAnalysistoDetermineNursingHomesMarketFeasibility(2010)

MARKETAREA

PrimaryMarket

SecondaryMarket


PlatteCounty SEWyoming

StateofWyoming UnitedStates Total

#ResidentsAged65orolder 1,551 17,246 50,688 40,401,879 40,471,364

USAverage(3.63%)#NursingHomeBeds 56 626 1,842 1,468,219 1,470,744

#LimitedinADLs 95 1,057 2,982 2,510,245 2,514,379%withFinancialResources 76.1% 81.4% 80.5% 80.0% 80.0%

#withADLs&Resources 72 860 2,402 2,009,057 2,012,391 LowerofUSAvgor#withADLs&Resources 56 626 1,842 1,468,219 1,470,743Current#ofNursingHomeBedsinArea 43 705 2,210 1,700,888 1,703,846

NetUnmetNeedinArea 13 ‐79 ‐368 ‐232,669 ‐233,103 CaptureRate 50.00% 5.00% 2.50% 0.001% 14.38%

Targeted#ofResidents(BaseYear=2010) 7 ‐4 ‐9 ‐2 ‐9

Theanalysis inTable14Aabove indicates that,unlikeallothermarkets,PrimaryMarketdemandfornursinghomeshasalreadyoutgrowntheexistingsupply.Atleastsevenmoreunitscouldbeaddedtotheexistingnursinghometodaytomeetthatlocaldemand.


ThePrimaryMarketalsohasverystrongdemandforassistedlivingunits.TherealsoarenotenoughassistedlivingfacilitiesintheSecondaryMarket,asseeninTable14Bbelow.

Table14B:SummaryofAnalysistoDetermineAssistedLivingFacilityMarketFeasibility(2010)

MARKETAREA

PrimaryMarket

SecondaryMarket


PlatteCounty SEWyoming


#ResidentsAged65orolder 1,551 17,246 50,688 40,401,879 40,471,364

USAverage(2.57%)#inALFs 39 443 1,303 1,039,250 1,041,035

#LimitedinADLs 95 1,057 2,982 2,510,245 2,514,379%withFinancialResources 41.6% 50.9% 49.9% 52.3% 52.3%

#withADLs&Resources 40 538 1,487 1,312,760 1,314,825 LowerofUSAvgor#withADLs&Resources 39 443 1,303 1,039,250 1,041,035Current#ofALFBedsinArea 0 325 909 973,351 974,585

NetUnmetNeedinArea 39 118 394 65,899 66,450 CaptureRate 50.00% 5.00% 0.25% 0.001% 13.85%

Targeted#ofResidents(BaseYear=2010) 20 6 1 1 27

Ironically,theredoesnotseemtobesupportforasignificantnumberofmemorycareunits,asseeninTable14Cbelow.Thisconclusionismostlydrivenbytheoddfactthattheonlylicensedmemorycareunits that exist (or soonwill exist) inWyomingare located in theSecondaryMarket,therebydiminishingthenetunmetdemandinthearea.

Table14C:SummaryofAnalysistoDetermineMemoryCareMarketFeasibility(2010)

MARKETAREA

PrimaryMarket

SecondaryMarket


PlatteCounty

SEWyoming


#ResidentsAged65orolder 1,551 17,246 50,688 40,401,879 40,471,364USestimate(12.6%)withDementia 195 2,173 6,387 5,091,244 5,100,000

USAverage(1.65%)withDementiaindedicatedunits 3 35 105 84,076 84,221

USestimate(12.6%)withDementia 195 2,173 6,387 5,091,244 5,100,000%withFinancialResources 29.8% 33.2% 33.1% 37.4% 37.4%

#withADLs&Resources 58 721 2,113 1,906,176 1,909,069 LowerofUSAvgor#withDementia&Resources 3 35 105 84,076 84,219Current#ofdedicatedDementiaCareunitsinArea 0 48 0 84,221 84,269

NetUnmetNeedinArea 3 ‐13 105 ‐145 ‐50 CaptureRate 75.00% 15.00% 2.50% 0.001% 23.13%

Targeted#ofResidents(BaseYear=2010) 2 ‐2 3 0 3


Using thedemographicprojections trendsdiscussedearlier, this study further concludesthatdemandwillcontinuetogrowthrough2015,assuggestedbyTable15below.

Table15:MarketGrowthForecast,byMarketAreaandYear

DEMANDFORNURSINGHOMEUNITSMarketArea PRIMARY SECONDARY TERTIARY ALLAREAS

Year PlatteCounty SEWyoming StateofWyoming UnitedStates TOTAL2010 7 ‐4 ‐9 ‐2 ‐92011 7 ‐3 ‐7 ‐2 ‐52012 8 ‐2 ‐5 ‐1 ‐12013 8 ‐1 ‐4 ‐1 32014 9 0 ‐2 ‐1 72015 10 2 0 0 11

DEMANDFORASSISTEDLIVINGFACILITYUNITSMarketArea PRIMARY SECONDARY TERTIARY ALLAREAS

Year PlatteCounty SEWyoming StateofWyoming UnitedStates TOTAL2010 20 6 1 1 272011 20 7 1 1 292012 21 7 1 1 312013 21 8 1 2 322014 22 9 2 2 342015 22 10 2 2 36

DEMANDFORMEMORYCAREUNITSMarketArea PRIMARY SECONDARY TERTIARY ALLAREAS

Year PlatteCounty SEWyoming StateofWyoming UnitedStates TOTAL2010 2 ‐2 3 0 32011 2 ‐2 3 0 32012 2 ‐2 3 0 42013 2 ‐1 3 0 42014 2 ‐1 3 0 42015 2 ‐1 3 0 5


SeniorIndependentLivingHousingDemandAsdiscussedabove,long‐termcaremeansdifferentthingstodifferentpeople.Therealityisthat,withinthefullrangeofoptionsavailableintoday’smarketplace,elderlyconsumersareinapositiontochoosewhatisbestforthematanygivenmoment.Priortolong‐termresidentialfacilities(e.g.,nursinghomesandassistedlivingfacilities),manyseniorschoosetomovetoseniorindependentliving. Independentlivingcantakemanyforms,includingapartment complexes, duplexes, condominiums, and covenant‐protected neighborhoods.Many independent living options include special amenities that are attractive to seniors,such as commonmeals, transportation, or protective covenants (for example, restrictinghomeownerstopersonsaged60orabove).Theseoptionsallowseniorstocontinuelivingas independentlyastheywish,andoftenincludetheopportunityforthemtocontinuetoowntheirhome.TheU.S.CensusBureautracksthenumberofpeoplewhomoveannuallyandrecordssuchdataintheir“GeneralMobility”reports.Thesereportsexamineanumberofcharacteristicsofthosepeoplewhomove,includingtheageofthehouseholderandwhethertheystayinthe county of their residents when they do move. General Mobility reports are alsoprovidedonaregionalbasis.WyomingisincludedintheWestregion.AccordingtotheCensusBureau,3.23%ofallhouseholdersaged55andolderintheWestregionmadeanintra‐countymovein2008‐2009(themostrecentdataavailable).Thatis,526,000 peoplemoved to a newhome, but remained in the same county they had beenliving. A similar percentage of movers exist throughout the nation. However, thecomponentsoflocalpopulationsvariesfromtheregionalmix,andsothisstudywillapplytheWestregion’spercentageofmoversbyagegroup,tocalculateamoreprecisenumberofpeoplewhoare likely tomove in thePrimaryMarketarea. For this typeof long‐termcare(i.e.,independentliving),thisstudyexaminesonlythepopulationwithinthePrimaryMarket. WhiletheremaybeafewpeopleintheothermarketareasthatwillmovetothePrimaryMarket area for independent living, it is unlikely that the total number of suchpeoplewillbesignificant.Accordingly,marketsizeisdeterminedbymultiplyingthenumberofhouseholds(groupedbyage) inthePrimaryMarketbytheWestregion’spercentageofmoverswhoremainintheirhomecounty.Thus,Table16belowestablishesacurrentmarketof58personsaged55orolderwhoarelikelytomovetoanotherplaceinthecountyduring2010.

Table16:PrimaryMarketArea‐IndependentLivingMarketSizebyAgeGroups(2010)Demographic 55‐64 65‐74 75‐84 85+ TotalNumberofHouseholds 784 540 338 145 1,807US/West%whomovewithinthecountyannually 4.42% 2.80% 1.35% 2.76% 3.23%

MarketSize 35 15 5 4 58

ItisveryimportanttonotethattheMarketSizecalculatedaboveisthetotalmarketofallmovers.Amoredetailedanalysiswouldbenecessarytodeterminethehowmanyofthese


peoplewouldchosetomoveintoaparticularproject.Forexample,aprojectanalysismightscreentheabovemarketbymeasuringincomequalifications,orrestrictingtheprojecttosomesmallersegmentofagegroups,orperhapsevenbyconductingasurveyofpotentialconsumers todeterminewhat typesofamenities theymightwant inaparticularproject.Thosetypesofconsiderationsgobeyondthescopeofthisstudy.Populationprojections for2015 indicate that theMarketSize for independent livingwillgrow,asseeninTable17below.

Table17:PrimaryMarketArea‐IndependentLivingMarketSizebyAgeGroups(2015)Demographic 55‐64 65‐74 75‐84 85+ TotalNumberofHouseholds 774 635 335 133 1,877US/West%whomovewithinthecountyannually 4.42% 2.80% 1.35% 2.76% 3.20%

MarketSize 34 18 5 4 60

The number of households that are likely to be moving but remaining in the PrimaryMarket(PlatteCounty)in2015isestimatedat60.ThereareatleastthreeHUD‐financedindependentlivingfacilitiesinthePrimaryMarket.These facilities market to low‐income senior citizens (age 62+ or disabled). They aresummarizedinTable18below.

Table18:PrimaryMarketArea–HUD‐FinancedIndependentFacilitiesFacility #Units #Occupied WaitingList CityPlatteCountyHousingAuthority 28 28 10 WheatlandPlatteManorApartments 18 18 3 WheatlandSkyViewVilla TBD TBD TBD Guernsey

Total 46 46 13

Source: 11/3/10phonecallstoCarolatPlatteCountyHousingAuthority,DeAnnaBrantatPlatteManorApartmentsandDanielleFlaherty,SkyViewVilla,Guernsey.Basedonthesefindingsandthenumberofpersonsonwaitinglists,thereappearstobeasufficient number of households that could be targeted for a senior independent livinghousingproject. Aprojectdevelopershouldstudythismarketfurther,exploringwhetherthismarket’sdemographicsandpersonaltastes inhousingmatchwiththe intendedcost,style,andlocationofnewhousingunits.


ConclusionBasedonthesefindings, itappearsthatconstructionofadditionalnursingfacilityunitsisneededtomeetcurrentdemandinthePrimaryMarketarea(PlatteCounty).Additionally,constructionof anewassisted living facilitywill be required tomeet current and futuredemand.Considerationshouldbegiventooptionsforaccommodatingthismarketdemandwhen reviewing the costs and opportunities of remodeling the existing nursing home.However,givenconsumerpreferencesandconstructionefficiencies,thecommunityshouldalsoconsiderdevelopmentofanentirelynewlong‐termcare“campus,”buildbothtypesofresidential facilities there,andanticipate theneed forexpandingall services for thenext40‐50 years. Finally, there appears to be a sufficiently large population of elderlyhomeownerstoexploreaseniorindependentlivinghousingdevelopmentproject.


APPENDIX

AppendixA‐PlatteCountyPublicParticipationPlanAppendixB‐AdvisoryCommitteeandCommunitySurveyResults

LONG TERM CARE MARKET ANALYSIS · 2019-07-19 · Platte County Long‐Term Care Market Analysis...

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