Old Money

By Hannah Wallace October 31, 2007

We all know the U.S. is getting older, but Manatee and Sarasota counties are getting much older than the rest of the country. According to the 2006 American Community Survey conducted by the U.S. Census Bureau, 30 percent of Sarasota County’s 369,535 residents are aged 65 or older, compared with 22 percent for Manatee County, 17 percent for Florida, and 12 percent for the United States.

And if those numbers sound staggering, just wait. The Bureau of Economic and Business Research predicts that the number of people 65 or older in Sarasota and Manatee will reach 203,360 by 2010 and 326,564 by 2025.

As our senior population skyrockets, so does the need to care for them. According to the economic development agencies in both Manatee and Sarasota, the healthcare and social services sector accounts for approximately 36,092 jobs here with total annual wages of almost $1.4 billion—and it’s growing fast.

Businesses can share in that growth if they come up with new ways to care for aging residents—and that’s just what three forward-looking local entrepreneurs did.

A boutique approach to home care.

Fifteen years ago, registered nurse Nicci Kobritz had a realization. “I saw people in nursing homes having a great deal of difficulty making it through each day,” she says. I thought, ‘This is going to be me someday. How can we improve this picture?’”

She started a home health agency, but soon realized her clients needed more personalized care than she had anticipated. So four years ago, Kobritz started researching how to convert her business from mainstream to boutique, eventually opening Youthful Aging Home Health a year ago. Licensed to operate in Sarasota and Manatee counties, Kobritz’s model is like concierge medicine or private banking, catering to clients’ every need. Unlike traditional home healthcare agencies whose profit margins come from volume, Kobritz charges 10 to 20 percent more (depending on services needed and requested) and is capping the number of clients at 75 while employing 100 caregivers.

“By reducing the number of clients we serve, we’re able to focus on the rehabilitation programs and personalize their total healthcare,” Kobritz says. “We provide certified nurses, assistants and therapists, and we get our clients to maximum physical capacity. We communicate on a regular basis with each client’s physician and family members. All clients have access to our cell phones and can call us anytime, and we have a conference call center so children from all over the world [can] talk about their parents.”

Clients see the same caregiver every day. Kobritz also uses a personal fitness trainer, a brain fitness trainer (for better memory and cognitive function), an art therapist and an activities coordinator, who makes sure clients get out into the community to the theater, museum, mall or just lunch. Her caregivers regularly update doctors on their clients’ conditions and medications.

Kobritz’s in-house instructor provides continuing education and support for caregivers and helps them set up individual care plans. The instructor also works on caregivers’ dress, grooming, language skills, self esteem and motivation, since caregiving is such a high-stress, low-prestige occupation.

Caregivers deserve a better image, says Kobritz, and as their services become more sought after, she predicts that will happen. According to the U.S. Congressional Research Service on Long-Term Care, $194.3 billion was spent on long-term care in 2004, comparable in size to spending on prescrip

Kobritz sees Youthful Aging as a national model and plans to grow her business to other regions slowly: “We have to be able to replicate and maintain the integrity of the product,” she says.

Matching overseas nurses with U.S. jobs.

All those aging Americans need nursing care, and that demand has helped to intensify the critical nationwide shortage of nurses. But Sarasota’s Bart Walker has a solution.

“We currently have a shortage of 400,000 nurses in this country,” Walker says. “Projections over the next few years are as high as a million nurses short.”

As president and CEO of CPI Temps/Crown Staffing, a domestic and international nurse recruitment firm, Walker recruits nurses from India, the Philippines and other markets overseas to work in the U.S.

According to Walker, only 30 to 40 other companies are doing this across the nation, including a handful in Florida, but many of them are just brokers, not recruiters. “There is competition, but there’s more demand than supply,” says Walker.

Two years before the nurses arrive, Crown Staffing arranges for them to take the U.S. nursing boards, obtains their work visas and places them in hospitals. They work for Crown for the first two years, earning the same wages as other nurses in the hospital.

Crown Staffing charges the hospitals 30 percent per year of each nurse’s salary. Crown’s nurses earn about $42 to $52 per hour, an all-inclusive rate that includes benefits.

“We’ve done all the upfront costs before they ever go the U.S.,” he says. “We’re the risk taker. We charge the hospital an all-inclusive rate, which is going to be slightly higher than what they’d usually pay for a nurse,” he says.

Walker believes foreign nurses will not only ease the current nursing shortage, it will also create more nursing educators.

“In the U.S., nursing educators are retiring faster or going into the private sector,” Walker says. “About 30,000 to 40,000 nursing school applicants are turned down each year. We simply don’t have the educators.”

Walker believes India’s emphasis on higher education and academic credentials will yield more nursing educators, even though nursing educators are usually paid less than practicing nurses.

“In India, most nurses have a bachelor’s degree, and many ask about continuing education,” he says. “We can benefit from this if some of them go into educating future students. You have to understand the culture. There’s a lot of pride. Grades and study are the most important things that families think about.”

After recruiting healthcare workers for 20 years, Walker became involved with his current enterprise four years ago. Since then, he’s grown the business to about 75 employees, including nurses and the people who staff the agency offices. Crown Staffing has placed nurses in Florida, South Carolina and California.

The company’s future rate of growth hinges on an element largely out of his control: how government decides to factor healthcare workers into its current immigration bill.

“By the end of this year, we should have 100 nurses working,” Walker says. “Next year, we could bring over another hundred. It’s not that we can’t get the nurses, it’s that we need the U.S. Citizenship and Immigration Services to allow us to do it properly.”

Assuming the USCIS sees the same light Walker has seen, he’s confident his business will continue to expand: “We have the capability in the next couple years of bringing in anywhere from 250 to 300 nurses a year,” he says.

Helping the elderly downsize.

The idea for Solutions for Carefree Moving came to Trudy Clark in 1997, when she was handling marketing for a senior community. “I saw that seniors needed more support with moving,” she says. “The process is overwhelming for all of us, but especially as we get older.”

So now Clark, who has a background in design and a penchant for organization, helps the elderly (and anyone else, for that matter) downsize their homes and possessions and prepare for the big move.

“My business is pretty nebulous,” says Clark, who is more concerned with filling a need than following a particular business model. “This was cutting edge 10 years ago; there was no way for me to look at another company and see what they did. Different people across the U.S. got this idea independently; we are finally getting together and supporting one another through the National Association of Senior Move Managers (NASMM).”

Clark charges her clients a base fee of $60 an hour, and the average total cost of her services for a move is $2,200-$3,000. Clark meets with the client, creates a plan of action, helps hire a mover, handles floor plans, and figures the disposition of items. “Everything is put away. The boxes are removed. We put the food in the fridge. We hang the pictures. We give emotional support. We hold hands. We have a level of intimacy with our clients,” she says.

Although she recommends movers, Clark says she’s “not beholden to any one mover because they’re only as good as their last move. I like to pick and choose. I match the mover with the client.”

Clark started out alone. Now she has an associate, Nancy Vogl, as well as six people on call. “For the average move, there are three of us during the unpacking and set-up; we can go up to five or six,” Clark explains. “It all depends on the amount of possessions.”

She says the business has grown by 90 percent in 10 years, and it’s still growing. “Even with the real estate market as bad as it is, we have remained busy,” she says. Her new business comes primarily from word-of-mouth, referrals and a good working relationship with retirement communities.

Clark says her biggest challenges are “getting her clients to give up control, allowing someone they just met to help them through this transition, and for them to trust everything’s going to be OK. That’s the most rewarding thing: We help people through a traumatic time.”

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