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Moving to STX and want to expand our business.

marmalex
February 23, 2012 09:17PM

Registered: 2 years ago
Posts: 5

Hello,

My wife an I are seriously thinking of relocating and expanding our business to STX. We currently live and work in Las Vegas and operate a very small Elderly Home for Individual Residential Care out of our house. My wife is a Hospice RN, specializing in end of life care. We currently have a license in the State of Nevada to give such care. My question is has anyone heard of any laws pertaining to giving such care to persons in your home? Is a license required on STX. if so, who do i need to contact, and what are the number of beds allowed in such facilities? We are insured, bonded, and licensed to give such care here, however i know that license will not be recognized in the VI's. I can possibly travel to STX on Thursday of next week for a first PMV. I hate to sound like a mainlander, but i will have to cram as much into that initial visit possible. Hopefully to include:

Meeting a Realtor.
Shopping at a local grocery store.
Talking to as many locals as i can.
Finding any informational tools from the Health Department.
Finding a referral agency for Senior Placement.
Getting info for Broadband.
Potentially finding an agency to fill Nurse Aid openings.

We are very excited about this potential move. Any info would be greatly appreciated.

Thanks for your time,

Mike

Re: Moving to STX and want to expand our business.

Alexandra
February 24, 2012 11:55AM

Registered: 8 years ago
Posts: 1,432

Most of your medical and license related questions could likely best be answered by the hospital, health department and department of licensing. Nurses aides might be possible to locate through the nursing program at UVI, as they'd have a steady supply of new trainees who might want some work as they continue in the nursing program.

Your wife might also want to talk to one of the Travel Nurse companies to see if it makes sense for her to come initially as a travel nurse while the two of you pursue setting up your business licenses and get a property prepared to provide home health care services. That would assist your wife with getting plugged into the local heath care circle of influence so she could make the contacts necessary to work effectively in this facet of health care on the island. The travel nurse companies also assist with getting RN's their reciprocal license in the USVI so they can work here. Any help in such a process is invaluable!

Alexandra Bentley
Great House Real Estate
St. Croix, USVI



Edited 1 time(s). Last edit at 02/24/2012 11:57AM by Alexandra.

Re: Moving to STX and want to expand our business.

marmalex
February 24, 2012 01:28PM

Registered: 2 years ago
Posts: 5

Alexandra,

Thanks for the response. These are questions we need to find out. We are wrestling around with the idea of her being a travel nurse. Which companies are located on the island if you know? We do have our business here as well. We were hoping to bring someone with us. We do not want to do anything illegally so everything must be in order before that happens. I know for a fact it took just over 6 months for our complete license here. Does anyone know how fast or slow the License Bureau takes in St. Croix? My hope was to rent out a large house for at least the first 6-12 months to orient ourselves with the communities. After that we really want to purchase a large house, 7+bedrooms if everything goes as planned.

Is it just better to stop in and see licensing? I have called but i know how government agencies can be.

I see you are in real estate, have you heard of any of "Group Homes" or "Residential Care Facilities", for the elderly on STX? We are not trying to be competition but we are curious as if they exist? Like i said, we would be bringing our own residents with us. I would hate to rent/buy a house and a license does not exist and we end up leaving before even moving there. We are just a young family, without huge bank accounts, looking to give the best care possible, with an excellent view, for our residents.

This has been our dream and any help is greatly appreciated. I have flight benefits so i could travel to STX soon, for an initial visit.

Thanks,
Mike

Re: Moving to STX and want to expand our business.

OldTart
February 24, 2012 02:21PM

Registered: 2 years ago
Posts: 3,141

Quote
marmalex
Is it just better to stop in and see licensing? I have called but i know how government agencies can be.

I went through all the DIY hoops when I opened a business on St Thomas. Even though I'd already lived here for 11 years and knew many "in the know" people, it was a real chore, to put it mildly. In my first two years in business, I finally found a professional who, upon retiring from the Department of Licensing and Consumer Affairs, had thrown his expert hat into the family's long established business consultancy operation. When the annual business license renewal came around he would, for a very reasonable fee, get the required tax clearance letter from the IRB (Internal Revenue Bureau), complete the necessary paperwork, pick up my cheques to DLCA and the Department of Health and then promptly come and deliver my new license in due course.

I'd guess there are equally reputable business consultants on St Croix who perform the same services and their knowledge and expertise is well worth their fee. I would absolutely suggest that you go to the DLCA office on STX to see what you would need and then go from there.

Good luck and all the best!

Re: Moving to STX and want to expand our business.

Native Son
February 24, 2012 02:44PM

Registered: 9 years ago
Posts: 297

Contact Tracy Sanders, RN, at Continuum Care (340) 772-2273.

Nurse Sanders moved here to STX from LA some years ago with her husband (who is a doctor). She started a hospice called Continuum Care, and she will have answers for your questions.

Continuum Care took care of my mother and my wife's mother in our home until they passed away. The care was excellent.

Re: Moving to STX and want to expand our business.

Alexandra
February 24, 2012 03:54PM

Registered: 8 years ago
Posts: 1,432

in that kind of health care, it isn't a matter of competing. There is never enough space in such facilities to go around. I have heard of very little of that type of service on STX and it would likely be well received by life long islanders and transplanted elderly alike.

For most business licenses, the applicant has to live on the island for a period of time and provide local references from people who have lived here at least 5 years. It can be tough for new arrivals to arrange that.

One of the travel nurse companies that places people on STX is "Worldwide". The number I have for them is 866-633-3700

Re: Moving to STX and want to expand our business.

marmalex
February 24, 2012 04:45PM

Registered: 2 years ago
Posts: 5

"For most business licenses, the applicant has to live on the island for a period of time and provide local references from people who have lived here at least 5 years. It can be tough for new arrivals to arrange that."

Do you know what the typical time period for business licenses are? References as well? And this is why i wanted to start now. Well it is great to meet all of you. It sounds like i need to start meeting you all, in person, very soon! It is good really. This way we can build all that trust over the next year. It is sounding like a travel position a temporary employment maybe the way to go. My wife is currently pregnant, so an immediate move is probably out of the question, as far as our health insurance is concerned.

Thank you all so very much. You have been a wealth of information already. If only the people here were so nice. That is one of the main reasons why we have decided to try and relocate to STX.

Re: Moving to STX and want to expand our business.

East Ender
February 24, 2012 06:16PM

Registered: 9 years ago
Posts: 4,099

I second contacting Tracy at Continuum. I have heard of a few group homes on St Thomas, but the problem is the pay source. Hospice and palliative care are very new concepts here.

Re: Moving to STX and want to expand our business.

Alexandra
February 24, 2012 09:07PM

Registered: 8 years ago
Posts: 1,432

When I applied for my real estate license, I had to have been on the island for at least 3 months. I had to provide 3 references from people who had lived on the island for 5 or more years each. I had it a bit easier than many new arrivals as my fiance had lived here for about 4 years at that time and we had a network of friends who had been here long enough that coming up with references didn't take too long.

You might be wise to make a PMV soon and make some contacts with long-time residents while you are here on your trip... then stay in touch with them when you go back to Vegas to plan your eventual move. By the time you head this way to live and apply for a biz license, you may have the contacts you need for the references necessary to apply for your licenses.

Networking is important in most businesses and it's especially helpful in the relocation process. Very few people move here with an extended family along for the new life. Transplants tend to adopt each other as extended family and to support each other in times of need and hang out on holidays together if they aren't able to spend them with family back home, etc.

Re: Moving to STX and want to expand our business.

roadrunner
February 25, 2012 01:23PM

Registered: 6 years ago
Posts: 585

A business like yours is BADLY needed on STX. There is no inpatient hospice, and there is only one "home for the aged" (as the sign says).

Families end up taking care of their elderly relatives, and while that's an honorable thing to do, it often simply becomes too much for the family, who also need to keep their jobs, raise children, have a social life, accomplish things off-island, etc. (Even if they have nothing else going on in life, sometimes caring for an older adult is just simply not physically possible for the family, as I'm sure you know!) It is not uncommon for an elderly relative to be taken to the hospital by the family and for the family to not return to pick them up when the hospital deems them ready to go home. It's a horrible thing to do, yes, but I can also see how the demands on the family become too much and they don't know what else to do because the resources available on island are so minimal.

I hear that many families who are able to do so send their relatives to a stateside nursing home when the time comes. The one that exists on STX is perpetually full. It would be wonderful for people who were born and raised on island to know that they don't have to spend their last years in a strange place and for families to know their loved ones are well cared for and within easy visiting range.

Re: Moving to STX and want to expand our business.

ian112
February 25, 2012 02:22PM

Registered: 2 years ago
Posts: 3

Hi Mike,

I don't know anything about opening a business here on STX, but I am a nurse and would like to pass on a little advice for your wife. The RN licensing process took about 3-4 months for me to hear back once I submitted it. They do make you jump through some hoops, such as having two letters of recommendation from your employer, pictures, etc. It would definitely be much easer to submit the paperwork from the States. Also, the Nurse Licenser Board is located on St. Thomas, so it is not a place you can just drop in and see how your paperwork is coming along, but I do recommend calling often to check on the status to ensure it gets looked it. It can be a very frustrating process if you are in a hurry to get it, so it is best to start early.

As far as travel nursing goes, the companies I spoke with didn't help to get your license down here, but would reimburse the $75 licensing fee once you secured a job with them. "RN Network" was a travel company recommended to me by a retired island nurse.

My husband and I only moved to St. Croix last August, so I can vividly remember having so many questions and uncertainties about Island life as a "mainlander." Our realtor, Sharon Early ( 340.719.2002) was a great help to us in finding the perfect house when we moved here. She is from the States, but has lived here for years and knows the island very well!

You mentioned you want to go to a local grocery store. I highly recommend Plaza Xtra. They have two locations, and usually have the best selection and prices. It takes a while, but once you get used to the stores you will realize that although they may not have the brands you are used to, they do have pretty much everything you need.

Feel free to personal message us with any other questions. Hope this helped & Congratulations on your pregnancy!

Amy

Re: Moving to STX and want to expand our business.

Iris Tramm
February 25, 2012 02:32PM

Registered: 4 years ago
Posts: 693

Quote
roadrunner
A business like yours is BADLY needed on STX. There is no inpatient hospice, and there is only one "home for the aged" (as the sign says).

Families end up taking care of their elderly relatives, and while that's an honorable thing to do, it often simply becomes too much for the family, who also need to keep their jobs, raise children, have a social life, accomplish things off-island, etc. (Even if they have nothing else going on in life, sometimes caring for an older adult is just simply not physically possible for the family, as I'm sure you know!) It is not uncommon for an elderly relative to be taken to the hospital by the family and for the family to not return to pick them up when the hospital deems them ready to go home. It's a horrible thing to do, yes, but I can also see how the demands on the family become too much and they don't know what else to do because the resources available on island are so minimal.

I hear that many families who are able to do so send their relatives to a stateside nursing home when the time comes. The one that exists on STX is perpetually full. It would be wonderful for people who were born and raised on island to know that they don't have to spend their last years in a strange place and for families to know their loved ones are well cared for and within easy visiting range.

Seconded. I can only imagine what is available here, and how inadequate -- if not outright awful -- it is.

In addition to just having options for us regular folk, high-end end-of-life care is going to be big business as the population ages and the Caribbean is the perfect place for it. STX has the space, the serenity, and a population that could be trained as hospice workers. It's really a shame we lost that regatta. I dunno what the story was there.

Re: Moving to STX and want to expand our business.

dougtamjj
February 25, 2012 08:29PM

Registered: 8 years ago
Posts: 2,139

The problem is that you won't get paid. I had my elderly mother here and had to keep her residency in the states to continue her medicare, medicaid. In our home state she qualified for home health care for eight hours a day in our home. Here nothing. She had COPD and in our home state her oxygen was covered as well as an oxygen consentrator. Here we had to pay for everything and provide all care including nursing ourselves. I did not leave my house here on St. Croix for two years because I could not leave her alone. Even in the states, all states are different. In South Carolina where my sister lives our mother could not get any home health care. She would have to go into a state run nursing home which is horrible. We had to take my mother back to our home state because her quality of life was horrible here and I was providing 24/7 on my own.

I don't mean to squash your dream but I cannot imagine you moving your clients here, finding doctors for them, being able to afford air conditioning, (which they would have to have), affording a huge house, being a young family, dealing with a new baby while trying to transistion your clients. It just doesn't sound fair to your clients to me. Not to mention if they have relatives that may want to visit them. Plane fare is crazy exspensive to St. Croix.

Just my opinion.

Re: Moving to STX and want to expand our business.

Native Son
February 26, 2012 05:17AM

Registered: 9 years ago
Posts: 297

Quote
dougtamjj
The problem is that you won't get paid. I had my elderly mother here and had to keep her residency in the states to continue her medicare, medicaid. In our home state she qualified for home health care for eight hours a day in our home. Here nothing. She had COPD and in our home state her oxygen was covered as well as an oxygen consentrator. Here we had to pay for everything and provide all care including nursing ourselves. I did not leave my house here on St. Croix for two years because I could not leave her alone. Even in the states, all states are different. In South Carolina where my sister lives our mother could not get any home health care. She would have to go into a state run nursing home which is horrible. We had to take my mother back to our home state because her quality of life was horrible here and I was providing 24/7 on my own.

I don't mean to squash your dream but I cannot imagine you moving your clients here, finding doctors for them, being able to afford air conditioning, (which they would have to have), affording a huge house, being a young family, dealing with a new baby while trying to transistion your clients. It just doesn't sound fair to your clients to me. Not to mention if they have relatives that may want to visit them. Plane fare is crazy exspensive to St. Croix.

Just my opinion.

Like I said, please call Tracy.

My mother AND my mother-in-law were both taken care of by Continuum Care. My mother-in-law had long-term health insurance, and my mother did not. Both were on Medicare/Medicaid.

At no time did Continuum have trouble getting paid. The nurses who came to my house, and the aides, were extremely professional...they became like part of the family, and even attended the funerals.

Continuum procured hospital beds, oxygen, medications...the full gamut of services. WE had absolutely NO issues.

If people want to haggle about the price of air fare when a family member is dying, they should NOT visit. When our moms passed away we had family come from as far away as Israel. If people care, they will come. If they care more about their wallet they should stay away.

WE NEVER paid a penny out-of-pocket for caring for our moms, who both passed away within a year of each other...my mom was 91 and died of congestive heart failure, and my mother-in-law had Alzheimers.

Do not let anyone scare you away. Talk to Tracy, she's in the business.

It was a very difficult time for both me and my wife, and without people like yourself we would have been even worse off. Thank God for hospice workers.

Re: Moving to STX and want to expand our business.

East Ender
February 26, 2012 06:43AM

Registered: 9 years ago
Posts: 4,099

Again, funding is a problem. Home health care and hospice benefits under Medicare, are for intermediate, not total, care. In the VI, this includes Seaview home care and Premier, if they are still around, Continuum and La Paz Hospices. But someone has to take responsibility for that person during the hours home care is not there. Inpatient rehabilitation and skilled nursing care are paid through Medicare (not
Medicaid, which is called medical assistance here) with a cap and a co-pay. Medicare does not pay for long term care. Medical assistance pays for long term care in a certified facility. The territorial facilities, Herman Grigg and Queen Louise, provide 24 hour nursing care care but are not CMS certified. They are funded through the territorial government. Seaview is the only facility that is certified by CMS for medical assistance patients, and the number is capped by them at around 20 residents, although the facility was initially built for 60. That means that in a territory of around 120,000 people, there are 20 beds for citizens who need 24 hour care.

Re: Moving to STX and want to expand our business.

dougtamjj
February 26, 2012 07:12AM

Registered: 8 years ago
Posts: 2,139

Native Son, I must have been given wrong information when I brought my mother here over six years ago. The only reason she went back to the states is that we couldn't get any help. I wish that we would have known it was available. I would never try and scare someone away that would provide a good needed service. The original poster said she would be bringing the people she cares for here with her. I questioned if that was fair to them as it would not be easy for relatives to visit, but it isn't really any of my business. I am sure that they know what they are doing.

In Virginia, my mother qualified for 8 hours a day of care. That was the max. At the time my mother was here we were told that home health care did not exist. I am glad to hear that was wrong information. Also in Virginia, the doctor will call in hospice when he feels that death is imminent within 6 months. When we had hospice in they did provide everything. When my mother was here, we were not ready for hospice.

I am sorry for the loss of your mother and mother in law. My mother passed November 19th and I miss her terribly.

Re: Moving to STX and want to expand our business.

East Ender
February 26, 2012 08:48AM

Registered: 9 years ago
Posts: 4,099

"Like i said, we would be bringing our own residents with us."

Okay, I totally missed this. Do I understand that you want to move elderly Nevadans to a totally different culture? Who pays for their care now?

Re: Moving to STX and want to expand our business.

OldTart
February 26, 2012 09:15AM

Registered: 2 years ago
Posts: 3,141

Quote
East Ender
"Like i said, we would be bringing our own residents with us."

Okay, I totally missed this. Do I understand that you want to move elderly Nevadans to a totally different culture? Who pays for their care now?

Apart from bringing them here being a logistical challenge of, I would think, rather immense proportions, I'm not even sure how such a venture would strike the licensing department and other departments involved overall. If our community is in need of such facilities for our own residents, what benefit is it to them to import people to fill this proposed facility?

Re: Moving to STX and want to expand our business.

marmalex
February 26, 2012 12:47PM

Registered: 2 years ago
Posts: 5

Wow, thanks for all the replies. This is Great! So much concern/questions, it is very constructive.

I think most of you have the concerns in which we did when we started our business. How do we get paid, who pays it, etc. My wife is an RN Case Manager currently working for a Hospice in Las Vegas. She works in Assisted Living facilities, group homes, residential homes, and so on. She visits with patients who are generally given less than 6 months to live or have some major health problems. Those people have their medications paid for, her RN costs are paid for, she can send you an Aid up to 7 days a week, like others have said oxygen, and hospital beds can be covered, as well as a few other things. I am not the in the business so i am sure i am leaving out a few things. However YOU as the patient must still find your own place to live. Generally people live in "long term care", Assisted living facilities", with your own family members, or in our case, in our own home. Now my wife use to work as the House Supervisor for a Long term care facility. She was the only RN for 190 patients. Each Nurse aide generally had a load of 10-12 patients to take care of on the shift, 8 hours. Some people rarely saw anyone. It is sad and the costs for such care are crazy high. I had to even put my own grandmother in such a facility when she broke her hip, Medicare does pay for 3 months rehab after hospitalization, but i had to bring her home after a week because she was not getting better. That was the day that we decided to make this our mission to give the care needed and demanded.

So we have opened our house to 2 residents. They pay according to their needs. We provide housing, meals, clothing, entertainment, a family atmosphere, constant monitoring, RN to patient 2:1, not 190:1. We do have an employee, she has 15 years experience. We are the best care in the Las Vegas area. We have been looking to buy another house her to open up a "Group Home" which will house 2 employees as well as 5 residents. We will not live there but will give supervision as needed. This house will be cheaper, for the residents, but will still have private rooms, private bathrooms, access to TPC Summerlin country club, home cooked meals from scratch, along with a 5:2 ratio of residents to employees. All of our facilities are constantly scrutinized by government agencies. We have been inspected 3 times in the last 2 months. We are licensed, insured, and bonded. That costs us over $500 a month.

I wish i could be in front of you all and tell this story instead of typing it but i too have questioned the relocating aspect. This is what has drawn me to this discussion board. We never thought that this we be an option for us this soon. We don't want to rush into it. Not every resident that we have, has a family. There are people living in colder climates looking to escape. Yes we may have enough interest from our current residents. We may not. I would definitely house residents from STX if there is a need and desire. We want to make STX our home and flagship for our company. We will still have locations on the mainland and they may have residents who would like to spend just a little bit of time in Paradise. Maybe they want to return in a few months. Maybe STX residents want to have a Las Vegas experience. We might be able to help make that a reality.

If we did open a house in STX we would only help the local community. By bringing in some residents, Nurse Aides, local hospital, doctors, HOSPICES, and pharmacies would gain our residents as customers. I am sure some would be Hospice appropriate and we would have to call in Continuum or someone like that. If there is such a demand and not a company that can provide that service, then we may look into that in the future, but that is not our true goal. Like i said, in my opinion, we are the best care available. Travel can be a nightmare. I travel for free and so does my family. Traveling for our resident's families may be pricey and hard at times, but hopefully we can offset that we free Casita rentals for them, on sight. I don't have every answer yet, but with your help I hope we can get there. You are all wonderful with giving your options/insight.

The Licensing department scares me as well. I think that they will be our biggest hang up. I am thinking of flying out on Saturday/Sunday this week. I will only be able to stay for a short time, but i would love to see how this might go. Any ideas how fast that ferry moves from STX to STT and what are the costs? I will be able to fly into STX but i will have to leave from STT.

Re: Moving to STX and want to expand our business.

OldTart
February 26, 2012 01:08PM

Registered: 2 years ago
Posts: 3,141

There is no ferry currently running between STT and STX so your only option is air. Seaborne Airlines (seaplane) and Cape Air run regular flights between the two islands.

Re: Moving to STX and want to expand our business.

marmalex
February 26, 2012 02:38PM

Registered: 2 years ago
Posts: 5

Do you know how much a typical fare would be from island to island? are they generally full?

How busy is the island during Spring Break? Are we in Spring Break right now? That may prevent me from being able to find a flight in.

Re: Moving to STX and want to expand our business.

OldTart
February 26, 2012 02:41PM

Registered: 2 years ago
Posts: 3,141

Quote
marmalex
Do you know how much a typical fare would be from island to island? are they generally full?

How busy is the island during Spring Break? Are we in Spring Break right now? That may prevent me from being able to find a flight in.

We're not a big "spring break location". Check online with Seaborne and Cape Air for fares. You should have no problem at all finding a seat as they run many flights a day.

Re: Moving to STX and want to expand our business.

blu4u
February 26, 2012 03:11PM

Registered: 3 years ago
Posts: 855

Quote
OldTart
Quote
marmalex
Do you know how much a typical fare would be from island to island? are they generally full?

How busy is the island during Spring Break? Are we in Spring Break right now? That may prevent me from being able to find a flight in.

We're not a big "spring break location". Check online with Seaborne and Cape Air for fares. You should have no problem at all finding a seat as they run many flights a day.

RE: spring break. VI is not typical hot spot "girls gone wild" spring break action. BUT most of schools take a vacation and mainland families visit during the school break. STT carnival is held in the spring. During school break and carnival flights are more full.

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