Business plan for a nursing home.

Many people are faced with the issue of caring for elderly relatives. Not everyone has the opportunity to devote enough time to the elderly. Constant work and household chores take up all my free time.

Elderly relatives require attention, care, and, most often, constant medical supervision. Therefore, modern nursing homes are an excellent option for permanent, comfortable living for elderly people.

In this article we will talk about how to open a private nursing home.

This business is quite attractive in terms of profitability and low competition. Therefore, it is profitable even in a crisis.

Business plan for a nursing home

Before starting a business, it is worth determining the level of competition. If, say, you live in a small town and there is already a nursing home in it, then most likely your business will not be profitable. After all, a relatively small part of the population uses the services of shelters for elderly relatives.

If you live in a big city, then opening a private home for the elderly makes sense. And this business idea can become profitable if you approach its organization correctly.

How to open a home for the elderly and disabled? What is needed for this?

Elderly people require proper care and attention. It is private nursing homes that can provide elderly people with care, interesting pastime and excellent comfortable living conditions.

Unfortunately, in our country the attitude towards shelters for the elderly is negative; many believe that sending relatives to such institutions is inhumane. But this is a misconception; in fact, everything is not so. Modern nursing homes are well-equipped premises for living, staffed by excellent qualified staff who will provide care and special treatment to each resident.

Business registration

Before starting this activity, you need to formalize all the nuances in accordance with the law. First, you should register with the tax service as a legal entity.

To run this business you need a medical license. To do this, you must have employees with appropriate education. Or the owners themselves must have a medical education confirmed by a diploma.

Premises for opening a private nursing home

Choosing a room is a responsible task. For a shelter, a room, for example, a former recreation center or sanatorium, is suitable. The area should be large; it is also desirable that the boarding house be located in a quiet, environmentally friendly place, because old people love peace and a beautiful view from the window.

One or two people can be accommodated in one room, no more. Old people should be comfortable so that they feel at home.

There must be a large dining room. It is best to have 3-4 meals a day.

Bathrooms. You can equip separate bathrooms in each room or make a shared toilet and shower on the floor. I recommend the first option, it will be more comfortable for older people.

Mandatory presence of a medical office. Elderly people get sick often, so your shelter should have solid medical care and care.

It is also desirable to diversify the gray everyday life of old people. Organize a dance studio, it has a beneficial effect on your general condition. You can also equip a living room for spending time together.

Staff for a private nursing home

Elderly people require attention and constant care, so it is worth choosing staff very responsibly.

If you are planning to open a private nursing home, then it must be modernly equipped for the comfort and convenience of its guests.

Particular attention should be paid to personnel selection. It is important that the people who will care for the elderly are patient, honest, friendly, friendly, sensitive and attentive. Under no circumstances should you be rude or upset older people, always fulfill their requests, and do everything to make the residents comfortable.

Also pay attention to the education of your employees. It is advisable to select people with medical education and psychologists.

Equipment for nursing home

It is very important to provide elderly people with comfortable living conditions, as close as possible to their home environment.

• Beds. Buy special beds with a position changing function, this will provide the vacationer with a comfortable sleep;
• Mattresses. They must have the function of protecting against bedsores. This is important, because people with disabilities often live in boarding houses;
• Bathrooms. Equip bathrooms and toilets according to all rules. The floor must be anti-slip and insulated. Also, bathrooms should be equipped with everything necessary for comfortable carrying out all procedures, because many old people cannot move independently;
• Handrails. Be sure to install special handrails around the entire perimeter of the premises for safe movement around the boarding house;
• Elevators. Mandatory presence of an elevator. It is difficult for elderly people to move up stairs, especially since disabled people can live in the boarding house;
• Emergency personnel call system. Be sure to equip special alarm buttons in guest rooms, as well as in bathrooms. Old people may often need help, so they can always get it on time.

In addition to all this, it is necessary that there is a 24-hour pharmacy on the territory of the nursing home, because old people often get sick. Read more about this on our portal.

Entertainment for the elderly

Organizing leisure time for residents of a nursing home is a responsible matter that cannot be neglected. Despite their advanced age, old people, like children, want to have fun. Therefore, organize a variety of entertaining courses for them. For example, checkers and chess tournaments, watching entertaining TV shows. Abroad, frequent dance schools located on the premises of nursing homes are very popular. You can adopt this interesting idea. Here, you will find detailed.

Advertising

It is very important to correctly build an advertising concept. This is necessary in order to attract customers. You can place advertisements in the media or on the Internet. It is also advisable to create your own website, which will indicate the address of the nursing home, prices and living conditions. You can additionally provide a photo.

How to register parents or relatives into a nursing home?

In order for people to be able to live in your boarding house, you will need to provide a package of necessary documents:

• Application from close relatives;
• Copy of passport, SNILS, INN;
• For disabled people - a certificate of assigned disability group;
• A certified copy of the medical record and insurance policy;
• Additionally, you need to sign a material and household inspection report and internal regulations.

Payback periods and costs

• Rental of premises and repairs;
• Purchase of necessary equipment;
• Costs for registration and obtaining licenses;
• Staff salaries;

Approximately opening a private nursing home will cost you from 100 thousand dollars.

But after a few years, you will recoup all costs and receive your profit from the business.

I wish you success!

The demand for boarding house services for the elderly is growing steadily, but the state cannot provide for everyone. But it’s not easy to make money in this market - seasonality and prejudices get in the way

The idea of ​​creating a private home for the elderly came to entrepreneur Natalya Peryazeva after one of her conversations with her grandfather, who once fought on the Japanese front. “I would like old age to be as fulfilling as life is today,” a 95-year-old grandfather once said, apparently believing that being 100 years old is not yet old. Natalya herself is only 38, but she “always dreamed of doing something for people over 80, so that they would not depend on their children.”

Before realizing her dream, she tried herself in different fields - she worked at Logovaz-Belyaevo, the first Mercedes-Benz dealer in Russia, and the gas production company Itera. She earned initial capital and created the IT company LogicStars, a software developer for car services. Clients include about a hundred car service centers, distributors and dealers, including official Nissan, Renault, Kia. A successful IT business allows her to now launch projects “for the soul.”

From childhood to old age

When Natalya’s daughter was born in 2008, she decided to open a developmental children’s center not far from her home in the capital’s Marfino district: “Back then the area was just being built up, there were no competitors.” Peryazeva rented 230 sq. m, made repairs, developed lesson programs. “But over time, competitors began to open up, profitability fell, and the poorly forecasted profitability for the season became an unpleasant discovery - we earned money for six months, while others spent our earnings for six months. In general, it became boring,” recalls Natalya.

After the birth of their second child, the family moved to the Moscow region, and in August 2015 they sold the development center. With the funds received, Peryazeva decided to open a kindergarten - her children had just grown up, and the business model of a kindergarten seemed to her more stable than a development center. She was invited to see the operating “Seven Dwarfs” garden in the village of Larino in the Lianozovo region in the north of Moscow - the village is located in a forested area, wealthy people live there. “When I saw this village, I realized that this was the ideal place to realize another dream of mine - to open a nursing home,” says Peryazeva. As a result, everything went at the same time: Natalya was negotiating the purchase of “Seven Dwarfs” and was looking for suitable premises for a nursing home.

We managed to find it on the street next to the kindergarten. In July 2015, Peryazeva rented a three-story stone cottage with an area of ​​500 square meters. m. A couple of months later, the nursing home has already opened. "Fast? Opening a boarding house for the elderly - what’s so difficult about that?” - Natalya laughs. The first guest at the House by the Park, 80-year-old Valentina Ivanovna, moved in in September 2015.

Photo: Vladislav Shatilo / RBC

“Opening a boarding house is really not as difficult as many people think,” confirms the owner of the boarding house for the elderly “Close People” Tatyana Ilyina. “The state does not regulate this area of ​​activity, and there are no legislative requirements.” You just need to register a legal entity (“House by the Park” is an individual entrepreneur in simplified form), indicate in the documents the appropriate type of activity, for example, “care with accommodation,” and prepare a standard contract for the provision of services.

Such an institution does not require a special license to open. “Due to the lack of general rules and requirements, everyone does what they are capable of,” says Ilyina. — The boarding house may have medical beds, a special diet or doctor’s services, or it may not have all this, the institution will still be opened. Therefore, when choosing a place for your family, it is very important to look at what kind of people are doing it. Only entrepreneurs who care about the elderly work successfully in such a business.”

Private nursing homes are controlled by Rospotrebnadzor and the fire service. According to Natalya, representatives of these services came several times at the start of the business, but after making sure that everything was fine, they no longer bothered me.

Seniors Market

The population of Russia, like the entire world, is aging. According to the UN, the proportion of people over 60 years of age in Russia in 2000 was 18.5%, and in 2050 it will be 37.2%. Today in Russia there are just over 1.5 thousand boarding houses for the elderly. For comparison: in France there are more than 7 thousand, in the USA there are more than 20 thousand. About 90% of all Russian boarding houses are state-owned. Most private homes for the elderly are located in Moscow and the Moscow region (over 90 boarding houses), St. Petersburg and the Leningrad region; in the regions the market is not at all developed - in cities with a population of over a million there are two or three private institutions. According to the calculations of the NP “World of the Older Generation”, 630 thousand elderly people in Russia need places in specialized institutions, but only 270 thousand are provided for. At the same time, not everyone is satisfied with the quality of public services, and many are willing to pay.

The cost of monthly accommodation in a private nursing home ranges from 24 thousand to 100 thousand rubles, on average - about 50 thousand rubles. The price primarily depends on the availability of medical services, quality of food and location. The main players are the UKSS network (700 places), Senior Group (230 places), “Close People” (120 places), etc. Natalya Peryazeva’s project “House by the Park” is very small - there are only 22 places, a month’s accommodation in a double room will cost at 60 thousand rubles.

If a private boarding house for the elderly can prove the high quality of services (for example, in Moscow one of the requirements is five years of experience in the organization), it can be included in the register of social service providers. Then the guests will come at the direction of local social protection authorities, which will compensate up to 80% of maintenance costs. For example, Alexey Sidnev’s Senior Group is included in the register, with a subsidy providing one hundred places in his network of boarding houses. But, according to him, working with the state is not very profitable - social security authorities set the maximum cost of a place, for example, in the Senior Group - it is 66 thousand rubles, of which the guest himself pays only 11 thousand rubles, and the average bill in the network — 90 thousand rubles.

Where dreams lead

The investor of “Houses by the Park” is Peryazeva’s IT company “LogicStars”. According to SPARK, in 2015 the company’s turnover amounted to 16.5 million rubles, profit - 2.2 million. Both of Natalia’s projects are located in the same building: the last floor of a three-story cottage is occupied by an IT company, the first two are a home for the elderly.

The launch of “House by the Park” cost 2.3 million rubles, the rental price was 250 thousand rubles. per month (167 thousand rubles, if you subtract a third of the space occupied by programmers). Tatyana Ilyina says that the start-up investment figure looks underestimated: “It’s hardly possible to meet this amount.” To open her first boarding house with 50 beds, she needed almost three times the amount of investment. Peryazeva says that she saved money on renovations: “We took into account the previous experience of the “children’s” business, when we made expensive renovations “for centuries”, and after two years we sold the project. Therefore, this time we rented the building already renovated, and most importantly, there was no need to remodel it to suit the needs of elderly guests.”

We had to spend money on purchasing upholstered and cabinet furniture for the living room, kitchen area and living rooms (including several special medical beds) - in total it took about 500 thousand rubles. It was not easy for some clients to climb to the second floor, so they bought a step walker - a chair-shaped mechanism that allows you to climb stairs (another 300 thousand rubles).

A separate cost item is bathroom equipment. Most elderly people need help, so they need special equipment: a lifting mechanism for immersing a person in the bath (costs 25 thousand rubles), a special chair for the shower stall (about 10 thousand rubles), metal handrails on each side and anti-slip mats. In total, the purchase of special equipment and furniture cost 1 million rubles.

Natalya decided to save on medical care - in the “House by the Park” there is no permanent doctor, like in most private nursing homes. “For emergency collection of tests, procedures or doctor’s examinations, we have agreements with Invitro, Gemotest and commercial ambulance,” says Peryazeva. The house has a standard first aid kit and a nurse on staff, and residents bring their own prescription medications.

“The lack of medical services is not a barrier to entry into the market, but it narrows the circle of potential clients,” warns Ilyina. “After all, many older people do need regular medical care.” According to her calculations, the presence of a doctor increases the cost of services by about 3-5%.

Natalya Peryazeva also found a way to save money on catering. The food is prepared in the kindergarten on the next street, brought to the “House by the Park”, heated and served in the equipped dining room. “We don’t have the opportunity to organize special meals,” admits Peryazeva. In general, the cost of purchasing, delivering groceries, and preparing food takes up 20% of the total monthly cost structure.

According to Ilyina, as a rule, “a boarding house for the elderly is a social facility with meals for guests, so it is subject to generally accepted standards for organizing this process.” In particular, a separate room must be equipped for the kitchen, and various requirements of Rospotrebnadzor and fire departments must be observed. Cooking in another room reduces the likelihood of inspections and saves space.

Founder of the nursing home "House by the Park" Natalya Peryazeva (Photo: Vladislav Shatilo / RBC)

Business about people

To attract future guests, they decided to use advertising on transport - they entered into an agreement with a local fleet of minibus taxis and placed advertising layouts on the doors and bodies of the cars. The move worked. “The first clients came precisely because of this advertisement,” Peryazeva remembers.

Now, to promote her institution, she uses contextual advertising, shoots videos and posts them on social networks, and spends money on search engine optimization. Choosing a nursing home is not a spontaneous decision; as a rule, relatives carefully study websites and reviews on the Internet. In the first four months of 2015, spending on marketing and promotion amounted to 500 thousand rubles. and exactly the same amount for the entire 2016.

Today, in the “mini-hotel for the elderly,” as Peryazeva prefers to call her institution, 15 out of 22 beds are occupied (70% occupancy). That's not a lot. The fact is that nursing homes are a seasonal business; increased demand begins in mid-May, reaches its peak in the summer and decreases by the end of October.

“The planned occupancy rate, which allows us to earn a profit, is 85%. Typically, it takes a year or two for a new facility to reach such numbers,” says Alexey Sidnev from Senior Group (the occupancy rate of his network is about 90%). “So everything is fine; for Natalya’s institution, occupancy is a matter of time.” “There is still no full load, and ours is no higher than 85%,” says Tatyana Ilyina. “A more important criterion is the number of residents per nurse, optimally one for three people.” At the Park House there is one caregiver for every five people. A total of ten people work there, including a nurse, a social worker, carers, a manager and an administrator.

The main difference between private nursing homes and public ones is that people rarely live there permanently. Usually, as Peryazeva says, grandparents spend from ten days to several months in the “House by the Park”. Owners of private nursing homes say that, as a rule, relatives decide to send elderly people to boarding houses after complex operations when they need a nurse; Another reason is that children go on vacation on their own and cannot look after their parents; Sometimes boarding houses are seen as holiday homes where older people can socialize with each other. The Western model, when people live in boarding houses all year round, is difficult to take root in Russia - older people do not want to be separated from their families, and it is expensive for children to pay for their accommodation for a long time.

Only a few people choose to live in the “House by the Park” permanently. “The main problem is the rather high cost of our services; we can provide decent conditions for less than 50 thousand rubles. per month is practically impossible,” complains Tatyana Ilyina. “If the boarding house is really good, some clients return to it from time to time.” The conversion is at least 30%, confirms Peryazeva.

"Grandfather's Garden"

In 2016, the revenue of “House by the Park” exceeded 6 million rubles. In the fall, the project reached payback, but there is no profit yet; winter is the low season. By the summer, Peryazeva expects to increase occupancy to 85%, and by the end of 2017 to receive the first profit. According to Alexey Sidnev’s calculations, the average profitability of this business is 19-22%. In 2015, boarding houses brought the Senior Group about 250 million rubles. revenue, but the company is actively building new facilities, so it is still unprofitable. But Tatyana Ilyina’s network of three boarding houses near Moscow “Close People” earned 5 million rubles in 2015. net profit with a turnover of about 20 million rubles.

An unexpected synergy was discovered between Natalia Peryazeva’s kindergarten and nursing home. Children and grandparents regularly visit each other. Children attend a concert or performance, adults participate in master classes or read fairy tales to children by the fireplace in the living area of ​​the kindergarten. “We are the only ones in Russia who figured out how to combine children and old people,” says Natalya. “Children should see that old age can be different, and in an educational sense, combining a garden and a home is good, but from a business point of view, these are absolutely two different segments,” Ilyina marvels. “If the owner of House by the Park manages to turn such a model into a competitive advantage, great.”

Moreover, Natalya decided that the kindergarten business model could also be used in the market for services for the elderly. In the near future, she plans to open a “grandfather’s garden” in the boarding house - an opportunity for an elderly person to stay during the day without spending the night. “In Germany and the USA, this model works successfully - relatives bring their loved ones in the morning and pick them up in the evening. They don’t sit within four walls, they communicate with each other and have fun,” says Natalya. The fact is that many elderly people are afraid of nursing homes and do not want to live there permanently, and the temporary stay model allows us to solve this problem and attract new clients.

Tatyana Ilyina says that in six years of work there have been no requests to “leave grandma for a couple of hours.” Staying on weekends is also not popular - no more than ten requests. Alexey Sidnev is more optimistic: “This is a great idea for a boarding house located in Moscow; it works in densely built areas, less often outside the city.”

It's always painful to see older people alone. And I really want to give my closest people a decent old age. But in the everyday hustle and bustle of work and affairs, sometimes you forget about meeting your needs, not to mention others. Therefore, relatives of elderly people often have thoughts of going to a private nursing home. They are popular both in big cities and in the provinces. How to make money in this area will help you figure out a business plan for a boarding house for the elderly with calculations.

Input data

According to statistics, 4% of all pensioners are in state nursing homes. And only 0.5% of pensioners live in commercial geriatric centers. Unfortunately, the quality of service, repairs and personnel qualifications in government agencies leave much to be desired. However, here the issue of financing arises very acutely: not everyone can afford to stay in an elite boarding house, because the cost of monthly services can reach 3-5 times the size of monthly pension transfers. Therefore, this area can lure only 25% of all patients of state geriatric centers, but this is also a lot, more than one and a half million people. There is still a free niche that you can manage to occupy.

Before moving on to the description of a business plan for a boarding house for the elderly, we will determine the necessary information for its preparation. It is assumed that the boarding house will combine the functions of the geriatric department of the hospital and a classic boarding house. The following services will be provided here:

• Permanent residence.
• Nutrition.
• Laundry.
• Cleaning rooms.
• Organization of leisure time.
• Basic medical support - day hospital and physiotherapy.

The boarding house will have the following characteristics:

• Form of ownership – LLC.
• Type of taxation – simplified tax system (income minus expenses 6%).
• Room – 450 sq. meters.
• The yard area is 1 hectare.
• The type of ownership of real estate is rental.
• Number of rooms – 20 (10 rooms for two residents and 10 rooms for 1 guest).
• Number of guests – 30.
• OKVED-2 code 86.21 “General medical practice”.

The building must have an elevator, ramps and handrails for comfortable movement of people with disabilities. In addition, all rooms must be equipped with a special button for quickly calling staff.

Registration

To open a nursing home, you need to obtain a special license for medical care. For these purposes, it is necessary to carefully study the relevant SanPiN, purchase special equipment and hire medical personnel. Otherwise, the procedure for registering a business does not differ from other types of activities:

Organizational stage	Amount, rubles
LLC registration (state fee)	4 000
Authorized capital	10 000
Seal	1 000
Registration of a current account	2 000
Purchasing a cash register	32 000
Registration with the tax office	–
Conclusion of a lease agreement for a year*	675 000
Conclusion of engineers on internal infrastructure	20 000
Ventilation maintenance contract for one year	50 000
Security contract for a year	120 000
Contract for disinfection and deratization	30 000
Agreement for solid waste disposal	30 000
Obtaining medical licenses	–
Obtaining permission from Rospotrebnadzor	–
Obtaining permission from the SES	–
Obtaining a fire inspection permit	–
Notification from Rospotrebnadzor about the launch of the project	–
Total	929 000

In addition to all organizational expenses, the entrepreneur needs to make repairs to the premises. It is worth allocating about 700 thousand rubles for these purposes. In total, at the preparatory stage you will need 1,619,000 rubles.

Technical equipment

For a geriatric center for 30 people, you will need specialized equipment and a lot of furniture:

State

A large number of guests require constant attention. This requires a large staff of employees.

Employee	Number of individuals	Number of bets	Salary	Total for all employees	Payroll with deductions
Nurses	3	3	23 000	69 000	89 838
Nurses	4	4	23 000	92 000	119 784
Cleaning woman	6	6	18 000	108 000	140 616
Cook	2	2	20 000	40 000	52 080
Gerontologist	1	1	35 000	35 000	45 570
Psychotherapist	1	0,5	35 000	17 500	22 785
Accountant	1	1	25 000	25 000	32 550
Total	18	17,5		386 500	503 223

Also, from time to time you will have to seek help from loaders and drivers using your own vehicles, which can lead to an increase in the monthly wage fund by 10 thousand rubles. In total, 566,605 rubles will be required to pay employees and contribute to state and non-state funds.

Marketing

To successfully and quickly fill a boarding house, it is enough to advertise in:

• Newspapers.
• Clinics and hospitals.
• Internet.
• Banks.
• Large corporations (to attract relatives of potential guests).

All these needs will require about 60 thousand rubles. Events are held once and are not repeated.

Volume of capital expenditures

Name of expense item	price, rub.
Organizational expenses	919 000
Room renovation	700 000
Technical equipment and purchase of furniture	3 710 000
Marketing	60 000
Other unforeseen expenses	30 000
Financing activities until self-sufficiency	2 000 000
TOTAL	7 419 000

Work schedule

This area of ​​business is not seasonal. However, it is better to open in summer or spring. This is due to the fact that in the warm season it will be easier for old people to get comfortable and get used to the new environment. And opening, for example, on holidays will make it easier for elderly family members to move for their relatives. Therefore, it is better to begin work on preparing the premises and opening a business in July of the previous year.

Financial indicators

The expenses for maintaining a boarding house for the elderly include the following items:

• Rent – ​​225,000 rubles.
• Utility bills – 50,000 rubles.
• Meals – 160,000 rubles.
• Payroll – 503,223 rubles.
• Cleaning products – 10,000 rubles.
• Expenses for organizing entertainment events – 15,000 rubles.
• Unforeseen expenses - 5,000 rubles.
• Taxes – 10,000 rubles.

In total, monthly costs will be 978,233 rubles.

The profitability of the shelter will consist of the following parts:

• Stay of 1 person in a double ward for a month – 35,000 rubles.
• Stay of 1 person in a luxury room for a month – 45,000 rubles.

According to calculations, the house in question can accommodate 20 people in double rooms (35,000 x 20 = 700,000) and 10 people in single rooms (45,000 x 10 = 450,000). The total monthly profit will be 1,150,000. Net profit will be 171,767 rubles, profitability - 15%. If the boarding house is fully occupied, the initial investment will pay for itself in 3.5 years.

Benchmarks:

• Project start: July 2017.
• Opening of a shelter for the elderly: May 2018.
• Full occupancy of the nursing home: August 2018.
• Reaching projected income: August 2018.
• Payback period: January 2022.

Eventually

Today's realities ruthlessly dictate their own rules. The age of the average Russian is growing, and already more than 60% of all citizens of the country are pensioners. More and more elderly people are ending up in nursing homes. A young entrepreneur can turn statistics to his advantage and build an entire business on it. In addition, a permanent residential geriatric center may qualify for subsidies from the federal or regional budget, since it is a socially oriented project.

hospice Vladimir

In the Welcome section to the question of how hospice stands for, asked by the author Vladimir Teplov, the best answer is I don’t know how it stands for, but it is:

Hospice (from English.

hospice) is a medical institution in which patients with a predicted unfavorable outcome of the disease receive decent care and service. Hospice patients are surrounded by ordinary “home” things, with free access to them for relatives and friends. Medical staff provides palliative medical care: patients can receive oxygen, painkillers, tube feeding, etc.

The word “hospice” came into English from Old French (“hospice”). There it, in turn, was formed from the Latin words hospes and hospitium (“hospitality”). This term has been used since the 6th century AD. e. designated resting places for pilgrims. The first hospices were usually

The word “hospice” came into English from Old French (“hospice”). There it, in turn, was formed from the Latin words hospes and hospitium (“hospitality”). This term has been used since the 6th century AD. e. designated resting places for pilgrims. The first hospices were usually located along roads along the main routes of Christian pilgrims. These were, in a certain sense, houses of charity for tired, exhausted or sick travelers. However, hospices also helped local residents. From English the word came to other European languages ​​in the 19th century.

How to open a hospice

Hospice (from the English hospice) is a medical institution in which patients with a predictable unfavorable outcome of the disease receive decent care and service. Hospice patients are surrounded by ordinary “home” things, with free access to them for relatives and friends. Medical personnel provide palliative medical care: patients can receive oxygen, painkillers, tube feeding, etc. A minimum of doctors and a maximum of paramedical and junior medical personnel. The main purpose of staying in a hospice is to brighten up the last days of life and alleviate suffering. This is humane and, moreover, more cost-effective than treating terminal patients in an intensive care unit. In the post-Soviet space, this problem has not been solved, since it still requires significant investments, obtaining a license to work with controlled drugs, etc.

Word " hospice" came into English from Old French ( "hospice") There it, in turn, was formed from the Latin words hospes and hospitium (“hospitality”). This term has been used since the 6th century AD. designated resting places for pilgrims. From English the word came to other European languages ​​in the 19th century.

Basic principles of the hospice concept

The hospice provides care to terminally ill patients in the final stages of the disease. In the CIS countries, hospice care is provided mainly to cancer patients with severe pain in the last stage of the disease, confirmed by medical documents.

The primary object of medical, social and psychological care in a hospice is the patient and his family. Patient care is provided by specially trained medical and service personnel, as well as relatives of patients and volunteer assistants who have undergone preliminary training in hospices.

Hospice provides outpatient and inpatient care to patients. Outpatient care is provided at home by teams from the hospice field service (“hospice at home”). Inpatient care, depending on the needs of the patient and his family, is provided in a 24-hour, day or night hospital stay.

The principle of “diagnosis openness” can be implemented in a hospice. The issue of informing patients of their diagnosis is decided individually and only in cases where the patient insists on it.

The entire range of medical, social and psychological assistance to the patient should be aimed at eliminating or reducing pain and fear of death while preserving his consciousness and intellectual abilities to the maximum possible extent.

Each patient in a hospice should be provided with physical and psychological comfort. Physical comfort is achieved by creating conditions in the hospital that are as close to home as possible. Providing psychological comfort is carried out on the basis of the principle of an individual approach to each patient, taking into account his condition, spiritual, religious and social needs.

The sources of funding for hospices are budget funds, funds from charitable societies and voluntary donations from citizens and organizations.

Basic principles of hospice activities

Hospice services are free. You can't pay for death, just like you can't pay for birth.

Hospice is a house of life, not death.

Controlling symptoms allows you to qualitatively improve the patient’s life.

Death, like birth, is a natural process. It cannot be rushed or slowed down. Hospice is an alternative to euthanasia.

Hospice is a system of comprehensive medical, psychological and social care for patients.

Hospice - schools and support for relatives and loved ones of the patient.

Hospice is a worldview of humanism.

Prospects for the development of palliative care for cancer patients in Russia

The future development of palliative care is associated with the need to solve a number of problems of an organizational, scientific, medical, social and economic nature.

At the first stage, it is advisable to use the existing finite fund of urban oncology hospitals, which will allow, in a short time and without large financial costs, to create a network of palliative care departments to improve the quality of life of patients in need. At the second stage, along with the existing palliative care departments, the construction of hospices will be carried out. On the third stage - (as hospices are put into operation) - expand the functions of palliative care departments to multidisciplinary units of the palliative medicine system, in which patients with various forms of chronic diseases (neurological, endocrinological, pulmonological, etc.) in the terminal stage of development will receive the necessary care , i.e. patients whose specialized treatment has already exhausted its capabilities and/or is impossible due to the severity of the patient’s general somatic condition. As a result, the system of palliative care for cancer patients created in Russia can be used as a model of palliative medicine service, the basis of which is territorial centers of palliative medicine.

2.1. Opening of a hospice. Hospice Regulations

The hospice provides assistance to patients in the Central District of the city.

The organization of the work of the PMH is carried out in accordance with the Regulations on this institution, approved by the Moscow Department of Health and which is the fundamental document for the organization of the work of hospices in Moscow, including the First Moscow Hospice. Below is the full text of this provision.

1. General Provisions

1.2. The hospice is created in the manner prescribed by the regulatory legal acts of the city of Moscow.

1.3. Hospice officials and staff are guided in their activities by the legislation of the Russian Federation and these Regulations.

1.4. The hospice is a legal entity, has an independent balance sheet, current and other accounts in banks, a round seal with its name, a corner stamp with the name of the institution, and forms.

1.5. The hospice operates in accordance with the Charter and on the basis of a license obtained in the prescribed manner.

1.6. A hospice can be a clinical and educational base for medical educational institutions and research institutes.

1.7. The hospice acts as a plaintiff and defendant in court, arbitration, and arbitration courts in accordance with the legislation of the Russian Federation.

1.8. The hospice carries out state measures for mobilization preparation in accordance with current legislation and regulations of the Moscow Government.

1.9. In order to implement state, social, economic and tax policies, the hospice is responsible for the safety of documents (managerial, financial and economic, personnel, etc.); ensures the transfer of documents to state storage.

The hospice provides services to the population of the assigned area, numbering up to The capacity of the hospice is determined by the number of beds.

2.2. The selection of patients for hospice is carried out by hospice doctors based on:

– the presence of terminal cancer, confirmed by medical documents from the referring institution;

– the presence of pain syndrome that cannot be relieved at home;

– the presence of socio-psychological indications (depression, reactive states, conflict situations at home, inability to care for the patient).

2.3. Hospice provides outpatient and inpatient care to patients, which, depending on the needs of the patient and his family, can be provided in the form of intermediate forms - day hospital, mobile service.

2.4. Providing psychological comfort is carried out on the basis of the principle of an individual approach to each patient, taking into account his condition, spiritual, religious and social needs.

2.5. Medical care and qualified care for patients in a hospice are provided free of charge. Subsidies (payment) from relatives or patients are prohibited.

2.6. The hospice does not engage in commercial or other activities that contradict its charitable nature and violate the principle of equal access to the institution and equal opportunities for medical and social care for all incurable patients.

2.7. The hospice provides medical, social and legal protection for patients registered with the hospice.

2.8. Hospice provides social protection for hospice staff.

2.9. The hospice carries out organizational and methodological work on the primary training of personnel: doctors, paramedics, junior medical staff, volunteers and training relatives in patient care skills.

2.10. The structure and staffing of the hospice is approved by the chief physician of the hospice, based on the number of the assigned contingent and the volume of medical and social care provided (within the limits of the wage fund).

2.11. The hospice provides organizational, methodological and practical assistance to institutions and specialists on palliative treatment issues, takes part in meetings and conferences on current issues of palliative treatment.

2.12. Hospice provides:

– emergency medical care;

– specialized medical care;

– selection and implementation of the necessary analgesic and symptomatic therapy;

– qualified medical and social assistance to patients, provision of psychotherapeutic assistance to the patient and his relatives;

– nutrition, including dietary, in accordance with medical recommendations and the wishes of the patient;

– organizing and conducting supportive palliative treatment of incurable patients;

– organizing the necessary advisory assistance;

– carries out the development and implementation of new methods of palliative treatment and patient care into practice;

– analyzes the effectiveness of the medical and social activities of the hospice;

– carries out mobilization preparation and civil defense activities;

– carries out operation and repair of hospice property;

– maintains statistical and accounting records and provides reports on the activities of the hospice in the prescribed manner.

3. Hospice objectives

– the formation of a new form of medical and social care, based on a compassionate and humane attitude of the public and the state towards the problems of incurable cancer patients;

– increasing the availability of inpatient medical care for terminally ill patients and improving medical care at home;

– providing socio-psychological assistance to patients and their relatives, training relatives in the skills of caring for seriously ill patients;

– ensuring the selection and implementation of the necessary analgesic therapy;

– organizing the necessary advisory assistance.

3.2. In accordance with these tasks, the hospice is entrusted with:

– creation of a service of volunteer assistants providing free care for patients at home and in hospitals, training them;

– communication with religious organizations of all faiths for the performance, if necessary, of religious rites during the period of stay in the hospital and at home;

– communication and active work with charitable organizations, both domestic and foreign;

– communication with other hospices, both domestic and foreign;

– communication with social protection authorities;

– communication with the media.

4. Hospice structure

1. Reception department.

2. Hospital beds.

3. Day hospital.

4. Field service.

5. Administrative and economic service.

6. Support services (sterilization room, pharmacy, disinfection unit, laundry, catering department).

5. Hospice property and finances

5.2. The source of formation of property and financial resources of the hospice are:

– city health care budget;

– other sources, in accordance with the legislation of the Russian Federation.

5.4. When exercising the right of operational management of property, the hospice is obliged to:

– use property effectively;

– ensure the safety and use of property strictly for its intended purpose;

– prevent deterioration of the technical condition of the property. This requirement does not apply to deterioration associated with standard wear and tear of property during operation;

– carry out major and current repairs of property;

– charge depreciation charges on the worn-out part of the property.

5.5. The property of the hospice, assigned to it under the right of operational management, may be seized either in whole or in part exclusively in the following cases:

– during liquidation or reorganization of a hospice;

Study the demand for the services you are going to provide. The requirements of various authorities for the activities of private homes for the elderly and disabled are very high, and the legislative framework is still being created. Study all legal and organizational issues.

Main risks

Despite insufficient funding and terrible conditions in public institutions, regulatory authorities pay close attention to private ones. The risk of “drowning” in litigation due to identified violations of sanitary standards, insufficient qualifications of personnel and other inconsistencies is extremely high. Strict adherence to regulations, exemplary service and a contract with a good law firm will help minimize these risks.

Private homes for the elderly and disabled are still a rarity for the CIS countries. The wary attitude of the population is reinforced by numerous cases of fraud against the elderly and disabled. There is only one way to change the opinion of society - to provide exemplary services, provide clients with maximum comfort and the opportunity to feel their social significance.

Location

The ideal premises for organizing a home for the elderly and disabled is the building of a health resort, recreation center, or private boarding house. The layout and communications of such institutions are already adapted for the stay of people in need of medical care.

The area of ​​the premises depends on the number of residents of the boarding house. No more than two people should live in a room. Also, examine the building for compliance with sanitary standards and the list of services you plan:

Sewerage.
- Fire safety.
- Air conditioning.
- Dining room.
- Possibility to organize bathrooms.
- Possibility to organize medical offices.

During the repair process, the most important point is the heating system.

Equipment

For organizing a private home for the elderly and disabled, the same rules apply as for state institutions.

It is necessary to purchase special beds and mattresses to prevent bedsores.

Bathrooms must be equipped in such a way that people with limited mobility have the opportunity to perform hygiene procedures. The floor is covered with anti-slip tiles.

An important point is handrails that ensure safe movement for people with disabilities, wheelchairs, walkers, and canes.

If a building has several floors, it must have an elevator. All rooms must be equipped with emergency staff call systems.

A prerequisite is the presence of medical rooms equipped with everything necessary to provide medical care and carry out restorative procedures.

Organizing adequate nutrition is also an extremely important point, requiring significant investment and compliance with sanitary standards. The building must have a full-fledged dining room, providing 4 meals a day to the residents of the boarding house.

If your budget allows, you can place a TV in each room. As a last resort, it is necessary to create rest rooms on each floor and install televisions there. The boarding house should create a library and provide residents with the opportunity to engage in handicrafts and other forms of creative expression. Refrigerators should be installed in every room. Modern nursing homes provide the opportunity for residents' family and friends to be welcomed into their rooms.

To transport food and other things necessary for the full functioning of the boarding house, you should purchase a cargo bus.

Personnel

Personnel should be selected with particular care. The success of your nursing home depends on the professionalism of these people and their attitude towards the older generation. To work in such an institution you need a medical education. It is no secret that working with this category of patients is extremely difficult. Patience and respect for residents are mandatory criteria for hiring.

The owner or administrator of the boarding house must personally conduct interviews and carefully check the candidate's personal file.

In addition to medical workers, cooks are needed. Your clients will suffer from many diseases, the work of the canteen is designed to prepare special dishes. This means that a nutritionist is needed on staff who can formulate a nutritious diet depending on the diagnosis of each nursing home resident.

You will have to work constantly and hard to comply with sanitary standards. The number of support staff depends on the area of ​​the premises and other features of your establishment.

To handle financial affairs, you need to hire a full-time accountant.

Documents and licenses

The process of registering a home for the elderly and disabled is very troublesome and lengthy. To comply with all regulations and speed up registration, it is better to hire a law firm that specializes in this area.

The organizers or managers of the boarding house must have appropriate medical education and a license to provide a wide range of medical services.

Registration with the tax office is only part of the process. Each region requires additional registration and a number of permits. Fire and sanitary services, and the local health department will grant permission to operate only after the boarding house building has been brought into compliance with the standards of each of these authorities.

To organize and obtain permits, it is necessary to provide contracts and certificates of conformity from all suppliers.

A separate issue is the settlement of many legal and financial issues with the Pension Fund and the Department of Social Protection. Issues of transferring pensions of residents of nursing homes and disabled people to the institution’s account are resolved by local authorities.

Marketing

Advertisements for finding a caregiver for the elderly and disabled can be seen literally at every turn. Advertising in local media will definitely bring results. Then everything depends on the quality of service in your establishment. This niche in our country is still absolutely free. A high level of service will provide you with a constant flow of clients.

Collaborate with medical institutions. If in hospitals relatives of disabled and elderly people are offered your booklets and recommend your establishment, the problem of finding clients will disappear instantly.

Summary

The minimum amount of start-up capital for organizing a private home for the elderly and disabled is about 40 million rubles. If events develop successfully, you should expect payback in 5-6 years. The main thing to achieve success in this direction is strict adherence to standards, qualified personnel and a high level of service.