While serving as a caregiver to my mother-in-law during March through June, I worked with SCORE and the Chamber of Commerce and the Small Business Administration to learn all I could. I also worked to write policies and design programs for Grace Place.

We had submitted our application for a certificate of need March 3, which required full time effort to put together from January 1 to March 3. The Certificate of Need (hereafter referred to as the CON) process works in cycles. One must only submit an application before the deadline at the beginning of each cycle. One cycle goes from the March 3^rd to June 20^th, and that was the cycle we were in. We had to wait until June 20 to learn whether or not our CON application would be approved.

The certificate of need application requires documentation of funding, plus connections to other providers of services for seniors in the area, including hospitals, private practice physicians, transportation, staffing agencies, etc.

It also requires financial documents and spreadsheets showing that the business will be sustainable. It requires proof that the demographics of the area warrant the health care business that is applying for the certificate of need.

The CON also wants to know where the business will be opening and proof that the building is suitable (inspection documents). It requires a lease or a purchase document for a space that may or may not be needed. In other words, if the CON is denied, the building or building lot will be for nothing.

It wants proof that the regulations pertaining to the business will be fulfilled, such as a contract with a catering company, and documentation from the health department that the building fulfills their regulations for food services.

The CON also wanted documentation that the business has qualified staff, which was difficult because qualified people that I knew were working at jobs and did not want to jeopardize their jobs by signing documents saying they would work at Grace Place once it opened, because if the CON was denied it could not open and they could not work there.

The CON also requires a listing of the supplies and equipment needed at the business. The CON also wanted letters from people saying they would like to attend Grace Place.

Open records laws made it possible for me to visit the CON office on more than one occasion to review past CON applications as I was putting our application together. I saw those that were accepted and those that were denied. I copied those that were accepted and vowed to avoid the mistakes of those that were denied.

Soon after submitting our application for a certificate of need I learned that one of the adult day centers in town was closing. The article in the paper said they were funded by the County health department, and because of financial difficulties, they were closing the program, which was housed in the Lexington Senior Citizens Center. It was called the Center for Creative Living and was my favorite medical model adult day center. I had worked at one other medical model adult day center and had visited others to learn how they operated. My husband and I thought they might be good for Marjorie. We decided otherwise after visiting. Even the Center for Creative Living was not good enough because everyone was cramped into a small, bleak and unattractive room furnished only with hard chairs and tables. We loved the staff, but hated the accommodations. The programming was lacking too. How much can one do in a small room day after day?

I called the CON office to ask if we might transfer their CON to Grace Place, but they said it would cost the same and take as long. I wanted to be able to offer the attendees of the Center for Creative Living the opportunity to sign up at Grace Place when it opened. I visited the Center for Creative Living on several occasions to volunteer to work with the attendees. On one of those visits I ran into the woman in charge of making adult day centers profitable for the company I worked for in a fellowship position. After that I was told by the Center for Creative Living staff that I was no longer welcome there. The staff at the Center for Creative Living was supportive of my efforts to open another adult day center in town, and even expressed interest in working there, and apologized for having to ban me from coming there to volunteer.

The Center for Creative Living was closing in July. I so hoped we would be granted the CON in time to offer the attendees the choice of coming to Grace Place as well as the choice to attend the other adult day centers in the area.

June 20 came and went, and there was no word from the CON office. I called and they said something about the way the days fell that particular month and it would be a few more days. And don’t call them, they would send me a letter. It was June 28 before we had the news. We were denied.

I was heartsick. Why, oh why, were we denied? Had we not done everything that was required? The letter said our application was denied in all five criteria required. I was dumbfounded.

My husband and I have been faithful, God fearing people since before we were married. We believe that everything that happens to us, happens because God allows it. Testing is part of the Christian walk of faith. We also believe that everything works for good for those who are called according to God’s purpose. Those beliefs kept us sane during the period that followed. God is in control, and He loves us.

I called the CON office to ask what we should do next. They told me that we could file a request for reconsideration, and then the person on the other end of the phone said in a very low voice, “DG, nobody gets a certificate of need without a lawyer”.

I was stunned. We did not have money to pay a lawyer. In my mind, this meant that the CON process prohibited anyone who was not wealthy from obtaining a CON, and it angered me. I sought counsel from people at my church. Some said go for it if you feel led by God and others said forget it. No one offered to loan me money. We had already spent around $2,500 on the CON application fee, plus gas money and printing ink, etc. My husband’s salary and part time job left us $1,000 short for our necessary expenses every month. If we paid myself for my time as a caregiver for Marjorie at $10.00 an hour and for expenses we incurred as a result of her residence with us, we had barely enough. We had to pay a caregiver when Larry and I were not at home.

We prayed and read scripture and then determined to proceed with the request for reconsideration. Shopping for legal services was unfamiliar to me. I researched online, I called lawyers that I knew from other connections, and I prayed some more. We hired the husband of a woman I worked with when I taught at Sayre, even though he had no experience with the CON process. A week later he committed suicide. I have no idea why.

To say this was a stressful and very sad time in my life is an understatement. My father had a heart attack at the same time our lawyer killed himself. We had Marjorie living with us, and her negative attitude and ongoing illness was stressful. Our three sons were aged 27, 25, and 21 and brought their problems to us regularly. I had to give up my stress reliever, a big dog named Chestnut, because he was not a good match for Marjorie.

But I forged ahead and eventually decided on a legal team that had experience with obtaining CONs. In fact, it was their specialty. There were many legal firms that specialized in obtaining CONs, I discovered. Their quotes varied widely.

The legal team we hired had a lawyer that was the mother of some of my past Sayre students. She and her two assistants interviewed me. They decided to take our case. Then they put me to work. Literally. Without pay. Go here, go there. Get this, get that. I did all they asked and more. In essence, we duplicated everything I had done before, but with more documentation. More of everything.

Then, at the end of October, we had a big day of meeting with a judge for a hearing to be interviewed. The judge did not seem familiar with the world of healthcare or elder care, yet the judge’s  decision would determine the health care options for many people. It seemed to be our job to educate the judge on elders, elder care and the current state of affairs, which seemed an insurmountable feat to accomplish in one day. But she took our material to study before reaching a decision.

Then we waited. On November 18, the lawyers called to say our CON had been granted. I was at work enrolling people in insurance plans (I had taken a course and passed tests to be licensed to sell life and health insurance earlier in the year). Thanksgiving was in a few days, then people would be busy getting ready for the holidays. Not a great time to open a business. So we did nothing to get the business open but I continued to work in insurance.

January came and we were busy working to get Medicaid eligibility for Marjorie and hiring caregivers through the Consumer Driven Option program so I could be away to sell insurance. I could not fathom opening a business without having a solid plan for caring for Marjorie while I worked to get it open. Lawrence was busy teaching school and could not help me till summer. We never did get a solid plan in place because as I shared in a previous blog entry, Lawrence’s brother swooped in and took Marjorie back to Indianapolis to live with them. He kept us thinking he was bringing her back for a month, though. So during April, we were making plans for Marjorie to live in a personal care home or a nursing home just until we could get the business open, because after setting up the Consumer Driven Option program according to Medicaid requirements, I realized it was much too labor intensive and stressful for opening a business at the same time.

But then reality set in. We owed the lawyers money. We owed money for my school loan. We had bills. The economy was bad. The man who originally said he would loan us the money for the business was uncommunicative. He was having problems of his own. A market analysis that the small business administration promised me fell through due to lack of funding. I became terrified that if we opened we would go bankrupt due to a lack of customers. The CON process had not reassured me that there truly was a need.

So I continued to work in the world of financial services, still keeping my finger on the pulse of what was happening in the world of elder services by attending networking meetings, health fairs and conferences and researching. I also worked part time in an assisted living facility. I even did a couple of focus groups to see what people would like. In essence I learned that people wanted an adult day center like the health club for seniors that we were trying to open, but they did not want to pay for it.

I prayed for a sign that God wanted us to open the health club for seniors.

Next week: A Sign