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The Reality of Long-Term Care Costs and Mental Health in Seniors · A Place for Seniors

• 0:00
  SPEAKER_01: Welcome to a place for seniors, where we share the real truth about what seniors need.
• 0:05
  SPEAKER_01: This podcast features honest, heartfelt conversations, the ones we don't always have, but matter the most.
• 0:12
  SPEAKER_01: Here we share real stories and simple insights about aging with dignity, choice, and autonomy.
• 0:18
  SPEAKER_01: Together, we bring what we've learned from over 20,000 conversations with seniors and their families, guiding you through some of life's hardest decisions.
• 0:27
  SPEAKER_01: We invite you to listen, learn, and prepare with us because these conversations matter and the choices we make today shape our tomorrow.
• 0:37
  SPEAKER_01: Hi, and welcome to a Place for Seniors Podcast.
• 0:40
  SPEAKER_01: I'm Alison Carmen, and today I have David Salgado with me with Emanual Campus of Care.
• 0:47
  SPEAKER_02: Hi.
• 0:48
  SPEAKER_01: Hi.
• 0:48
  SPEAKER_01: And David, I'm gonna just let you kind of give us some background about who you are and how you came into this, but kind of start with why you're in this.
• 1:11
  SPEAKER_00: So kind of ironically, I started in the insurance world doing utilization review and working on that part of part of it.
• 1:19
  SPEAKER_00: And I just began to know a lot of the right people.
• 1:23
  SPEAKER_00: And uh one insurance company turned into another, to another, that's evolved into MercyCare long-term care.
• 1:29
  SPEAKER_02: Oh.
• 1:30
  SPEAKER_00: And so I became the supervisor for the behavioral health team on MercyCare, Altex.
• 1:37
  SPEAKER_00: And then simultaneously, after I finished my master's in counseling, I was running an adolescent drug and alcohol rehab uh on the side twice a week.
• 1:46
  SPEAKER_00: So I was getting the insurance perspective and then the direct practice perspective.
• 1:51
  SPEAKER_00: Right.
• 1:52
  SPEAKER_00: And um I just happened to know a lot of the right people in the insurance world.
• 1:56
  SPEAKER_00: And one of my friends from one of the rehabs says, you know, he was in marketing and he resigned, went on somewhere else, and offered me the position.
• 2:05
  SPEAKER_00: So I just kind of married both worlds into behavioral health marketing.
• 2:08
  SPEAKER_01: And uh Was that with the manual?
• 2:11
  SPEAKER_00: No, this was back at it was called Park Place, which has evolved into Park Place.
• 2:16
  SPEAKER_00: Yeah, it's evolved into Oasis Behavioral Health.
• 2:18
  SPEAKER_01: Oasis Behavioral Health.
• 2:19
  SPEAKER_01: Yep.
• 2:20
  SPEAKER_00: So I became the director of marketing and business development at Oasis.
• 2:24
  SPEAKER_02: Okay.
• 2:24
  SPEAKER_00: And eventually turned a clinical director, stayed there for a few years, and then uh left that position to go back into the long-term care world at Bridgway back in the year or two, uh actually a year, and then uh Windsor, which had a lot of the behavior health sniffs like Ridgecrest, Palm Valley, Maryland Gardens.
• 2:47
  SPEAKER_00: They were advertised for Maryland Gardens.
• 2:49
  SPEAKER_02: Yeah, great place.
• 2:51
  SPEAKER_02: Yep.
• 2:52
  SPEAKER_02: Yeah.
• 2:52
  SPEAKER_00: We're advertising for a director of business development and marketing.
• 2:55
  SPEAKER_00: So again, I knew all the right people because I'd worked at Mercy Care Altex and Bridgeway Altex.
• 3:01
  SPEAKER_02: Yeah.
• 3:01
  SPEAKER_00: So I just knew a lot of the right people.
• 3:03
  SPEAKER_00: Went there, pretty successful with them.
• 3:06
  SPEAKER_02: Uh-huh.
• 3:07
  SPEAKER_00: And then that moved on to Allegiant, uh, helped them start up their behavioral units.
• 3:12
  SPEAKER_02: Okay.
• 3:13
  SPEAKER_00: And then left there because some friends from Park Place Days offered me a position to start an adolescent drug and alcohol rehab in Phoenix.
• 3:22
  SPEAKER_00: So I went and did that for three years, and that was the craziest job.
• 3:26
  SPEAKER_01: I bet that was hard.
• 3:28
  SPEAKER_01: I bet that was hard.
• 3:29
  SPEAKER_00: Well, the kids, the patients were the easy part.
• 3:32
  SPEAKER_00: It was always the staff.
• 3:33
  SPEAKER_01: Yes.
• 3:34
  SPEAKER_02: Yeah.
• 3:34
  SPEAKER_00: Staff was most challenging.
• 3:36
  SPEAKER_00: You start with 5 a.m.
• 3:37
  SPEAKER_00: phone calls with call-offs and oh, call-offs.
• 3:39
  SPEAKER_02: Yeah.
• 3:40
  SPEAKER_02: Yeah.
• 3:40
  SPEAKER_02: Yeah.
• 3:40
  SPEAKER_00: And then I did that for three years, and then Emmanuel came calling, and uh that's where I ended up been for the last year and a half.
• 3:47
  SPEAKER_01: A year and a half ago.
• 3:48
  SPEAKER_01: Yeah.
• 3:48
  SPEAKER_01: And I've seen a huge difference with your presence there.
• 3:52
  SPEAKER_01: And yeah, actually, yeah, a huge difference.
• 3:55
  SPEAKER_01: And it it's oh it's traditionally not one that we've ever been able to be very familiar with because they wouldn't work with referral agents.
• 4:03
  SPEAKER_01: And I always say when you don't work with a referral agent, you're kind of cutting yourself out of the uh out of the whole um out of the whole industry in some sense, because we're the ones in and out of those places and we can sell it or talk to talk to it before and know it's the right position, right place.
• 4:25
  SPEAKER_01: So if we find the right person for your community, then we're going to say, absolutely, this is who they are, this is who the salesperson is, this is who David is, this is why you want to be there.
• 4:37
  SPEAKER_01: This is right for your family.
• 4:39
  SPEAKER_01: And then you have probably a 50 to 75% chance of actually having them in your community because we've sold it already.
• 4:47
  SPEAKER_02: Yes.
• 4:48
  SPEAKER_01: And that's what a lot of people are a little short-sighted.
• 4:51
  SPEAKER_01: They look at those big referral fees that they have to pay and they don't realize that, hey, we're out there.
• 4:56
  SPEAKER_01: If we're not talking about you, then we're talking about somebody else.
• 4:59
  SPEAKER_02: Right?
• 4:59
  SPEAKER_02: Agreed.
• 5:00
  SPEAKER_01: Right.
• 5:00
  SPEAKER_02: Yeah.
• 5:01
  SPEAKER_01: So, and I think it never ever, I don't care if you're 100% full, it's never stays that way.
• 5:07
  unknown: Yes.
• 5:07
  SPEAKER_02: Agreed.
• 5:08
  SPEAKER_02: I know.
• 5:09
  SPEAKER_01: It never ever stays that way.
• 5:10
  SPEAKER_01: And so you always want that pipeline, right?
• 5:13
  SPEAKER_01: Those people that are really good and really understand your company and everything.
• 5:16
  SPEAKER_01: So I I really, really love that they opened that up to referral agents.
• 5:20
  SPEAKER_00: Yeah, it's been a big difference in our senses.
• 5:22
  SPEAKER_00: Yeah.
• 5:22
  SPEAKER_01: Yeah.
• 5:23
  SPEAKER_01: Yeah.
• 5:23
  SPEAKER_01: So it was, it was really good for us because we have a lot of folks that can't afford other places.
• 5:30
  SPEAKER_01: You've got a great community.
• 5:31
  SPEAKER_01: I mean, literally, I will share with you.
• 5:33
  SPEAKER_01: I went over there for the first time to get my contract because they said they'd do it, you know.
• 5:38
  SPEAKER_01: And so I sat in the lobby there of, I don't know which building it was.
• 5:41
  SPEAKER_01: I I'm so sorry, but it was probably the assisted living or the independent living.
• 5:46
  SPEAKER_00: Okay, the gardens or the manor.
• 5:47
  SPEAKER_01: It was it was probably the very front there.
• 5:49
  SPEAKER_01: And I was sitting in there and I could hear this laughter going on in the activity room.
• 5:54
  SPEAKER_02: I love it.
• 5:54
  SPEAKER_01: And they were having so much fun.
• 5:56
  SPEAKER_01: And it, you know, it's it's low income.
• 5:59
  SPEAKER_01: So there's it's not fancy bells and whistles or anything like that.
• 6:03
  SPEAKER_01: But they were so much fun.
• 6:05
  SPEAKER_01: They were, it was residents.
• 6:06
  SPEAKER_01: They were in the activity room having just a blast.
• 6:09
  SPEAKER_01: And I thought, okay, I can refer here.
• 6:11
  SPEAKER_02: Oh, yeah.
• 6:12
  SPEAKER_01: I can refer here.
• 6:13
  SPEAKER_01: Yeah.
• 6:13
  SPEAKER_01: It's they're happy, they're in a place where they can thrive.
• 6:18
  SPEAKER_01: Then yeah, I can refer here.
• 6:20
  SPEAKER_00: Absolutely.
• 6:20
  SPEAKER_00: No, you're right.
• 6:22
  SPEAKER_00: You know, I mean, we don't have a big fancy gym.
• 6:25
  SPEAKER_00: Right.
• 6:25
  SPEAKER_00: We don't have an Olympic-sized pool.
• 6:27
  SPEAKER_00: We have a smaller pool.
• 6:28
  SPEAKER_00: Right.
• 6:28
  SPEAKER_00: Garden apartments, though.
• 6:29
  SPEAKER_00: Yeah.
• 6:29
  SPEAKER_00: We don't have a gym.
• 6:31
  SPEAKER_00: Yeah.
• 6:31
  SPEAKER_00: But a lot of the people when I get referrals from other facilities, they're like, you know, I'm paying for all of these amenities and they don't use it.
• 6:39
  SPEAKER_00: You know, they like to just stay to themselves in their apartment and enjoying, you know, a nice quiet life.
• 6:44
  SPEAKER_00: And that's really where we thrive.
• 6:46
  SPEAKER_01: Trevor Burrus, Jr.: Yeah.
• 6:47
  SPEAKER_01: Yeah.
• 6:47
  SPEAKER_01: Or you know, or they're they're socializing, but they're socializing with their peeps.
• 6:51
  SPEAKER_01: Yeah.
• 6:52
  SPEAKER_01: Right?
• 6:52
  SPEAKER_01: Their peeps.
• 6:53
  SPEAKER_01: Right.
• 6:53
  SPEAKER_01: And and they know I am such a huge proponent of people getting into a community.
• 7:00
  SPEAKER_01: You know, I think there's studies where they in Japan where or China somewhere, uh, I shouldn't say that as some Asian country.
• 7:09
  SPEAKER_01: But basically, they were basically committing laws, committing crimes, so that they could go to prison.
• 7:15
  SPEAKER_01: And they could get meals and they could socialize.
• 7:18
  SPEAKER_00: Oh my word.
• 7:18
  SPEAKER_01: And it was a long time ago that I saw this.
• 7:20
  SPEAKER_01: But that is, you know, the human, human people, humans need to socialize.
• 7:27
  SPEAKER_01: We need to be with each other.
• 7:28
  SPEAKER_01: We have to have connection.
• 7:29
  SPEAKER_01: We have to have meaning in our lives.
• 7:30
  SPEAKER_01: And I think when I saw you speak, I get completely that you this is meaningful for you.
• 7:37
  SPEAKER_01: This is what you like.
• 7:38
  SPEAKER_01: This is not insurance.
• 7:39
  SPEAKER_00: Right.
• 7:40
  SPEAKER_01: Right.
• 7:40
  SPEAKER_01: This is real people and helping people.
• 7:43
  SPEAKER_00: And I've really developed my empathy for people while working on the insurance.
• 7:47
  SPEAKER_00: Believe it or not.
• 7:48
  SPEAKER_00: I mean, healthcare and all that, you know, and healthcare insurance gets a bad rap, but there's a lot of good people on the other side of that that really pulling for the patient and are held back by a lot of the policies.
• 8:00
  SPEAKER_01: Yeah.
• 8:01
  SPEAKER_01: But you're finding ways around those policies and you're finding ways to help them get the what you're doing.
• 8:09
  SPEAKER_00: And so that's really uh what motivates me.
• 8:12
  SPEAKER_01: Yeah.
• 8:12
  SPEAKER_00: Uh working with adolescents and the geropsyc and geriatric, the older population is just people.
• 8:19
  SPEAKER_01: Now, do you mostly work with you don't do the adolescence anymore?
• 8:22
  SPEAKER_00: No, I'm solely with Emmanuel now.
• 8:24
  SPEAKER_00: Okay.
• 8:24
  SPEAKER_01: So and that's um 65 plus, right?
• 8:27
  SPEAKER_01: 55 or 55 or older.
• 8:29
  SPEAKER_00: Yeah.
• 8:29
  SPEAKER_01: Okay.
• 8:30
  SPEAKER_01: And um so I know you're on the behavioral health end of it, which is and if we explain that to folks what that is, and a lot of times with dementia or with other things, you can have behaviors.
• 8:42
  SPEAKER_01: And so when we talk about behaviors, we m I always ask, you know, does that come out, say at three or four in the afternoon?
• 8:50
  SPEAKER_01: You know, are you having sundowners?
• 8:52
  SPEAKER_01: Are you having some, are you, are you um, you know, uh uh it's also environment, but are you, you know, are they hitting?
• 9:01
  SPEAKER_01: Are they spitting?
• 9:02
  SPEAKER_01: Are they yelling profanities?
• 9:04
  SPEAKER_01: Are, you know, are they out of the con out of control anger?
• 9:07
  SPEAKER_01: And there's a lot of medicines that can help them control that.
• 9:11
  SPEAKER_01: And we can take their foot off the gas and not have them revving all the time.
• 9:17
  SPEAKER_00: I like how you put that, yeah.
• 9:18
  SPEAKER_00: Right?
• 9:18
  SPEAKER_00: Because a lot of the medications, you know, people say, oh, they don't need drugs.
• 9:21
  SPEAKER_00: It's not drugs, it's medications.
• 9:23
  SPEAKER_00: There's a difference between drugs and medications.
• 9:26
  SPEAKER_00: And you're right.
• 9:26
  SPEAKER_01: I had a lot of families that are I don't want my parent on drugs.
• 9:29
  SPEAKER_01: Well, you don't understand.
• 9:30
  SPEAKER_01: Your parents are suffering.
• 9:31
  SPEAKER_00: You know, and it just takes the edge off.
• 9:33
  SPEAKER_00: It takes the edge of the Trevor Burrus.
• 9:33
  SPEAKER_00: For a lot of people, it takes the edge off.
• 9:36
  SPEAKER_00: And uh, you know, a lot of it's an art form, so you know if you get too much medication, it might sedate them, but then you know, all right, let's taper it back.
• 9:43
  SPEAKER_00: To find that right balance.
• 9:44
  SPEAKER_00: Right.
• 9:45
  SPEAKER_00: And you're right, as far as behaviors go, you know, there's the dementia with behaviors that you mentioned, the sundown and whatnot.
• 9:51
  SPEAKER_00: And then there's also the seriously mentally ill, which I hate that word, but you know, bipolar, schizophrenia, schizoathic, I have people call me all the time.
• 9:59
  SPEAKER_00: Delusions, hallucinations.
• 10:01
  SPEAKER_00: And those folks need a place to live as well.
• 10:03
  SPEAKER_01: They do.
• 10:04
  SPEAKER_00: Yeah.
• 10:04
  SPEAKER_01: And to be safe.
• 10:06
  SPEAKER_01: And that there and I I I was at a a I was telling somebody that um she's having a I had to move her to a uh assisted living residential home, a residential assisted living.
• 10:18
  SPEAKER_01: And I said, Well, she's doing this.
• 10:21
  SPEAKER_01: And and the owner, and this was long ago, he said to me, he goes, It's usually the environment.
• 10:26
  SPEAKER_01: Let's see what we can do with the environment, and and then we'll bring in some, you know, we'll get her on medications, we'll do all of it.
• 10:34
  SPEAKER_01: But it's usually the approach and the environment.
• 10:37
  SPEAKER_01: Not with seriously mentally ill, but I have people call me.
• 10:40
  SPEAKER_01: My sister's schizophrenic, she's been schizophrenic all her life.
• 10:45
  SPEAKER_01: We don't know what to do.
• 10:46
  SPEAKER_01: She's now 65, we don't know how to take care of her.
• 10:49
  SPEAKER_01: She's, you know, spiraling again.
• 10:52
  SPEAKER_01: And um, I can't place her in an assisted living.
• 10:56
  SPEAKER_00: Aaron Powell There's a lot of behavioral health assisted living, so different levels of care.
• 11:00
  SPEAKER_00: Um but you're right.
• 11:01
  SPEAKER_00: And then a lot of it is the environment.
• 11:03
  SPEAKER_00: We'll take residents from one of our competitors and they do great with us.
• 11:07
  SPEAKER_02: Yeah.
• 11:07
  SPEAKER_00: And we've also had residents that don't do so well with us, but they do great somewhere else.
• 11:11
  SPEAKER_00: And I'll put my clinical team up against anybody in Arizona.
• 11:14
  SPEAKER_02: Yeah.
• 11:15
  SPEAKER_00: Um, because we are the experts when it comes to behavioral health long-term care.
• 11:18
  SPEAKER_00: Yeah.
• 11:19
  SPEAKER_00: We've been doing it for over 25, 30 years.
• 11:21
  SPEAKER_01: It's pretty much it's a it's a very unique population.
• 11:24
  SPEAKER_01: But I had just had a nightmare of a situation with a client of mine who um, you know, out of a crisis, um, his wife decided to put to place him in a home, but she was in crisis.
• 11:37
  SPEAKER_01: She was in absolute crisis.
• 11:39
  SPEAKER_01: And it was a terrible situation.
• 11:40
  SPEAKER_01: And it was not a very good assessment.
• 11:44
  SPEAKER_01: That assessment hadn't been done right.
• 11:46
  SPEAKER_01: And um and there's different kinds of dementia that will have different behaviors, right?
• 11:51
  SPEAKER_01: So um so this was not a good situation.
• 11:55
  SPEAKER_01: So he got sent out of that home to a hospital, refused to take him back, which is what usually happens, right?
• 12:01
  SPEAKER_01: And then to a behavioral health.
• 12:03
  SPEAKER_01: Got to the baby behavioral health 10 days, got him calmed down, got the all the different medications, kind of used a couple that they were, you know, I think the two famous ones, Haldal and uh Serquil, and they started using, you know, different methods until they got them calmed down, smooth transition into a home that knows how to deal with that type of dementia, which is you know, really makes all the difference.
• 12:30
  SPEAKER_00: Makes all the difference.
• 12:32
  SPEAKER_01: Makes a huge difference.
• 12:32
  SPEAKER_00: Yeah.
• 12:33
  SPEAKER_01: So um, and you can do that in communities too.
• 12:36
  SPEAKER_01: You know, you can do that depending on what, you know, would they thrive in a big community or would they thrive better in a smaller home?
• 12:42
  SPEAKER_01: You know, and then you have to know that.
• 12:44
  SPEAKER_01: You have to kind of understand that.
• 12:46
  SPEAKER_00: Yeah, definitely.
• 12:46
  SPEAKER_00: Yeah.
• 12:47
  SPEAKER_00: Agreed.
• 12:47
  SPEAKER_01: Yeah.
• 12:48
  SPEAKER_01: So by any chance, when you were working in AllTechs and MercyCare, what years were that?
• 12:53
  SPEAKER_01: What when was that?
• 12:54
  SPEAKER_01: When it came to Arizona?
• 12:56
  SPEAKER_00: A little bit after that.
• 12:57
  SPEAKER_00: That's funny, because I was actually with Maricopa Long-Term Care Plan.
• 13:00
  SPEAKER_00: And when I hired on my manager at the time, hired me in the interview, she says, you know, there's a new plan coming to town, Mercy Care, and we'll have to wait and see.
• 13:08
  SPEAKER_00: Yeah.
• 13:08
  SPEAKER_00: But don't worry about it.
• 13:09
  SPEAKER_02: Yeah.
• 13:10
  SPEAKER_00: And then six months later, I got laid off because our our enrollment dropped and Mercy Care spiked.
• 13:14
  SPEAKER_02: So okay.
• 13:16
  SPEAKER_00: But that's all right.
• 13:16
  SPEAKER_00: But um so I think I was there 2007 to 2014.
• 13:20
  SPEAKER_01: Okay.
• 13:21
  SPEAKER_00: Yeah.
• 13:21
  SPEAKER_00: Okay.
• 13:22
  SPEAKER_00: Long run there.
• 13:23
  SPEAKER_01: Yeah, that was a long run.
• 13:24
  SPEAKER_01: That's seven years.
• 13:25
  SPEAKER_01: That's a long time to do that.
• 13:26
  SPEAKER_00: It is.
• 13:27
  SPEAKER_00: A lot of good people there.
• 13:28
  SPEAKER_00: It's good.
• 13:28
  SPEAKER_00: I really enjoyed it.
• 13:29
  SPEAKER_01: Yeah.
• 13:29
  SPEAKER_01: Yeah.
• 13:30
  SPEAKER_01: That that's an interesting.
• 13:32
  SPEAKER_01: Um, we're constantly working with people that say, you know, we're too afraid they're going to run out of money.
• 13:37
  SPEAKER_01: Can we go into an all text community?
• 13:39
  SPEAKER_01: I'm like, let's look at the whole picture before we do that because there's qualifying, right?
• 13:45
  SPEAKER_01: So we have to make sure that you can't just be out of money to get all techs.
• 13:50
  SPEAKER_01: It's medical.
• 13:51
  SPEAKER_01: And it's medical that's gonna probably deny you because you're not at a level where you need that, right?
• 13:57
  SPEAKER_01: Yes.
• 13:58
  SPEAKER_00: Yeah.
• 13:58
  SPEAKER_00: I don't know how accurate it was, but uh about six months or seven months ago, I was in uh another networking thing and uh one of the doctors was presenting, and he said he heard from another doctor.
• 14:08
  SPEAKER_00: So he says, she said that they have an 80% denial rate.
• 14:12
  SPEAKER_01: Yeah, I think it's a lower.
• 14:14
  SPEAKER_00: Do you think it was higher?
• 14:15
  SPEAKER_01: I think it's a little higher.
• 14:16
  SPEAKER_01: I was actually with uh in another networking group where I was uh the um oh gosh.
• 14:24
  SPEAKER_01: Big legal firm that does a lot of Medicaid.
• 14:27
  SPEAKER_00: Linlaw.
• 14:28
  SPEAKER_01: The other one.
• 14:28
  SPEAKER_01: Uh Jackson White.
• 14:30
  SPEAKER_01: Jackson White.
• 14:30
  SPEAKER_01: Yeah.
• 14:31
  SPEAKER_01: Uh and they were taught the gal there who was she's all about alts, right?
• 14:36
  SPEAKER_01: And she's like 85%.
• 14:38
  SPEAKER_01: 85, wow.
• 14:39
  SPEAKER_01: Yeah.
• 14:40
  SPEAKER_01: 85%.
• 14:41
  SPEAKER_01: Well, you can understand it.
• 14:43
  SPEAKER_01: Yeah.
• 14:43
  SPEAKER_01: So my ex-husband, or my former husband, he's deceased now.
• 14:46
  SPEAKER_01: Um, he uh was a social worker in the 70s in Arizona.
• 14:51
  SPEAKER_01: And in the 70s, he was the person they gave him$400.
• 14:55
  SPEAKER_01: And he had$400 with a line of homeless people outside.
• 14:59
  SPEAKER_01: And yeah, no kidding.
• 15:01
  SPEAKER_01: And it they had to be there at six o'clock in the morning.
• 15:04
  SPEAKER_01: So he had to meet them at six and they had to be off the streets at eight for all the business people to come in to work.
• 15:10
  SPEAKER_01: Because no, everybody left Phoenix at five and came back in at eight.
• 15:14
  SPEAKER_01: That's how it was in the 70s.
• 15:16
  SPEAKER_01: And so he had$400 that he could divvy out to those people.
• 15:22
  SPEAKER_01: And he it it sometimes it came down to the best story or the most you know, the hardest case.
• 15:28
  SPEAKER_02: Yeah.
• 15:28
  SPEAKER_01: But if you think about it, there's only so many Medicaid dollars.
• 15:31
  SPEAKER_01: Agreed.
• 15:32
  SPEAKER_01: Right.
• 15:32
  SPEAKER_01: So how are we going to decide who to give Medicaid to and who not to?
• 15:37
  SPEAKER_01: And if you have a big turnover in all text, then how do you have, you know, in the people doing this job, how do you have enough people deciding the right thing?
• 15:47
  SPEAKER_01: You know, because it and you can always reapply.
• 15:50
  SPEAKER_01: You can always do that.
• 15:51
  SPEAKER_01: But now you're still suffering.
• 15:52
  SPEAKER_01: You may be homeless soon.
• 15:54
  SPEAKER_01: You may be, you know, you know, uh a parent dies or a or the caregiver dies.
• 16:00
  SPEAKER_01: And now what are we doing with this person?
• 16:02
  SPEAKER_01: You know, I don't know that it's gonna get simpler.
• 16:05
  SPEAKER_01: It's only gonna get harder.
• 16:06
  SPEAKER_00: Yeah.
• 16:07
  SPEAKER_00: I don't see how it could be made more simple.
• 16:10
  SPEAKER_00: Yeah.
• 16:10
  SPEAKER_01: No, it's gonna get harder, right?
• 16:12
  SPEAKER_01: Because there's only finite dollars and the population is growing.
• 16:15
  SPEAKER_01: So yeah.
• 16:16
  SPEAKER_01: Yeah.
• 16:17
  SPEAKER_01: It's I I would love, I I always say I want to go talk to Congress, but I can only do so much in my lifetime.
• 16:23
  SPEAKER_00: Yeah.
• 16:23
  SPEAKER_00: You know, I'm conflicted at times.
• 16:24
  SPEAKER_00: I had this conversation with a friend the other day because, you know, being on the front lines, I'm like, I want everybody to have alt text because, you know, if they need the help, let's give them the help.
• 16:34
  SPEAKER_00: You know, we have openings, a lot of competitors have openings.
• 16:36
  SPEAKER_00: There's enough for everybody.
• 16:39
  SPEAKER_01: Yeah, we love alt text.
• 16:40
  SPEAKER_01: Yeah.
• 16:40
  SPEAKER_00: But then as a taxpayer, I'm like, you know, I mean, if these people are giving their$100,000 to their kids trying to hide money, I'm like, that's not fair.
• 16:48
  SPEAKER_00: They do try to do that.
• 16:49
  SPEAKER_00: I don't want to pay for that guy.
• 16:50
  SPEAKER_01: Yeah, yeah.
• 16:51
  SPEAKER_00: I'll pay for her.
• 16:52
  SPEAKER_00: You know, please let my tax money have.
• 16:55
  SPEAKER_01: Medicaid planning.
• 16:56
  SPEAKER_01: And I'm like, you know, no.
• 16:58
  SPEAKER_01: I agree.
• 16:59
  SPEAKER_01: It's very hard.
• 17:00
  SPEAKER_01: Yeah.
• 17:01
  SPEAKER_01: It's very hard.
• 17:02
  SPEAKER_01: And and I will have people call me many, many times and they'll say, um, so we're just gonna turn my mom over to be a ward of the state.
• 17:11
  SPEAKER_01: Or uh, she has no money.
• 17:13
  SPEAKER_01: We okay, we're ready.
• 17:14
  SPEAKER_01: We're ready to put her in a home because she has no money and we can't take care of her.
• 17:18
  SPEAKER_01: I said, It's not the money.
• 17:19
  SPEAKER_01: You can be destitute and not get alt tics.
• 17:22
  SPEAKER_00: Yeah.
• 17:22
  SPEAKER_01: Right?
• 17:23
  SPEAKER_01: Unfortunately.
• 17:24
  SPEAKER_00: I get those phone calls every day.
• 17:26
  SPEAKER_00: Every day about people that are just shy of, you know, what like$2.
• 17:31
  SPEAKER_01: Yeah.
• 17:32
  SPEAKER_01: Yeah.
• 17:32
  SPEAKER_01: But it's$2,800, isn't it?
• 17:33
  SPEAKER_01: $2,800 now?
• 17:34
  SPEAKER_01: $2901.
• 17:35
  SPEAKER_01: $2901.
• 17:37
  SPEAKER_01: Okay.
• 17:37
  SPEAKER_01: So 29, it was when I first started in the industry, it was 2120 or something like that.
• 17:44
  SPEAKER_01: And now it's 29, you know, so you can make up to 2,900, but you can't have any other assets, right?
• 17:50
  SPEAKER_01: So that's where the hiding of the assets and the all of that.
• 17:53
  SPEAKER_01: And there's a five-year look back.
• 17:55
  SPEAKER_02: Yeah.
• 17:55
  SPEAKER_02: So that's fair.
• 17:56
  SPEAKER_01: You can't do it in five years.
• 17:58
  SPEAKER_01: And um, yeah, so all of that.
• 18:00
  SPEAKER_01: But no, you I I would not encourage somebody to plan for Medicaid.
• 18:06
  SPEAKER_01: I mean, you wanna I would encourage somebody to plan to take care of yourself, you know, first and foremost.
• 18:14
  SPEAKER_01: But sometimes you just can't, right?
• 18:16
  SPEAKER_01: I mean, you're in this industry more than I am.
• 18:18
  SPEAKER_00: The hardest phone calls I get are uh couples, you know, where the the wife or husband needs memory care, they have thirty five hundred dollars combined income.
• 18:27
  SPEAKER_00: Um It's really sad.
• 18:29
  SPEAKER_00: He needs assisted living, she needs memory care.
• 18:31
  SPEAKER_00: Yeah.
• 18:32
  SPEAKER_00: And just we're some of the least expensive out there.
• 18:35
  SPEAKER_01: And I look in that's you are you know but you can't do it for$3,500.
• 18:39
  SPEAKER_00: Yeah.
• 18:39
  SPEAKER_00: I mean for both of them, that's$8,500 a month.
• 18:42
  SPEAKER_00: No.
• 18:42
  SPEAKER_01: That's where I'm pulling at the family.
• 18:44
  SPEAKER_01: I'm pulling it, I'm I'm going to the family members and I'm going, come on, there's five kids.
• 18:49
  SPEAKER_00: Yeah, I mean, that's gonna be an amazing part of your job.
• 18:53
  SPEAKER_00: The hard part of your job is to really I'm going, you know, come on.
• 18:57
  SPEAKER_01: Every one of you could put$200 a month together, you know, or$400.
• 19:02
  SPEAKER_01: You know, it's not outrageously.
• 19:05
  SPEAKER_01: I'm not asking them to do five, six thousand dollars, you know.
• 19:08
  SPEAKER_01: I'm asking them to just pool their money.
• 19:10
  SPEAKER_02: Yeah.
• 19:11
  SPEAKER_01: And a lot of times they don't have it, you know, they don't and I don't know what to do for them, you know.
• 19:16
  SPEAKER_01: But that memory care and that that assisted living, or even just both of them.
• 19:21
  SPEAKER_01: I have a couple that came to me that were at uh another independent living in Glendale, and they had$2,300 between the two of them.
• 19:33
  SPEAKER_01: And he's she's got uh she can't walk.
• 19:37
  SPEAKER_01: She pretty much bed panels, she can barely move her legs in and out of the house.
• 19:40
  SPEAKER_01: And and he's got dementia.
• 19:42
  SPEAKER_01: And they're living in an independent living.
• 19:44
  SPEAKER_01: And the family, I'm like, well, um, I did find them somebody uh for who she will she'll do it.
• 19:52
  SPEAKER_01: She her base rate is 497, but she'll get them through the alt text process.
• 19:57
  SPEAKER_01: Um, and she's wonderful, by the way.
• 19:59
  SPEAKER_01: I'll give you her name.
• 20:00
  SPEAKER_01: I do want that.
• 20:01
  SPEAKER_01: I do want that.
• 20:02
  SPEAKER_01: And she'll get them through the alt text process, but she even said, if they don't have the money, I'll just take 50 bucks.
• 20:07
  SPEAKER_01: Just give me something so that I can keep going.
• 20:09
  SPEAKER_01: God bless you.
• 20:10
  SPEAKER_01: She's amazing.
• 20:10
  SPEAKER_01: Yeah.
• 20:11
  SPEAKER_01: Yeah.
• 20:11
  SPEAKER_01: And she goes, I can I and she works all across the United States.
• 20:15
  SPEAKER_01: I'm like, how do you do this?
• 20:16
  SPEAKER_01: You know, but she gets two or three people a week and she gets them through.
• 20:21
  SPEAKER_01: So yeah.
• 20:22
  SPEAKER_01: And I've done it for two people, and it's an arduous process.
• 20:26
  SPEAKER_01: I mean, to be the representative and be on those calls and go through all the finances and then get them through the medical.
• 20:32
  SPEAKER_01: I did get one lady all the way through, which was my claim to fame.
• 20:37
  SPEAKER_01: Right.
• 20:38
  SPEAKER_01: Yeah.
• 20:38
  SPEAKER_01: Well, she was 62 with degenerative dystisease.
• 20:41
  SPEAKER_01: She was literally bent over, literally like this.
• 20:44
  SPEAKER_01: And she couldn't um, you know, she she had to use a walker to walk.
• 20:49
  SPEAKER_01: So she couldn't carry anything.
• 20:50
  SPEAKER_01: She certainly couldn't cook, couldn't even wash her hair, you know.
• 20:54
  SPEAKER_01: So, yes, she qualifies for alt text, but she was under 65.
• 20:58
  SPEAKER_01: So it was really hard to get it when we got it for her.
• 21:02
  SPEAKER_01: Yeah.
• 21:02
  SPEAKER_01: She didn't she lasted, she passed away two years after, but yeah.
• 21:08
  SPEAKER_02: Good for you.
• 21:08
  SPEAKER_01: Yeah, we did it.
• 21:09
  SPEAKER_02: Yeah, you did it.
• 21:11
  SPEAKER_01: So um, but uh that's part of why I do it is because I really want to understand it from doing it.
• 21:18
  SPEAKER_01: I want to understand it from really, you know, so that when people are asking me about it, I can actually talk about it.
• 21:24
  SPEAKER_01: I talk about VA aid in attendance for the same reason.
• 21:27
  SPEAKER_01: I did that for people when I was in an independent living community.
• 21:31
  SPEAKER_01: I actually filled out their paperwork, stayed on hours of calls with VA to get them their VA aid in attendance.
• 21:38
  SPEAKER_01: And I did it.
• 21:40
  SPEAKER_01: So a lot of those things are that's how how I can intimately know a subject is by doing it.
• 21:48
  SPEAKER_00: Right.
• 21:49
  SPEAKER_01: But by helping all those people with the insurance claims, you actually did it as well.
• 21:53
  SPEAKER_00: Yes.
• 21:53
  SPEAKER_00: Yeah.
• 21:56
  SPEAKER_00: I'm pretty confident I know the alt text world pretty well.
• 21:59
  SPEAKER_00: I know what I'm saying.
• 22:00
  SPEAKER_00: What's important to them, and how we can mold our business to satisfy what they need because they have deliverables to the state.
• 22:10
  SPEAKER_01: So Emanual Campus of Care has an independent living.
• 22:14
  SPEAKER_00: We have 140 independent living, 100 assisted living, 25-bed memory care, and a 210-bed skilled nursing facility with seven behavioral health units within that SNF.
• 22:25
  SPEAKER_01: Several behavioral health within the skilled nursing.
• 22:31
  SPEAKER_01: Now are you finding that people come and live in the skilled nursing or are they graduating out?
• 22:38
  SPEAKER_00: We have quite a few that step down to our assisted living.
• 22:41
  SPEAKER_00: So they'll come uh to the SNF, usually under long-term care under all techs.
• 22:47
  SPEAKER_00: They stay for a while, get healthier, and then they step down to our assisted living.
• 22:51
  SPEAKER_00: I think we have two transitioning this month.
• 22:54
  SPEAKER_01: Great.
• 22:54
  SPEAKER_00: Yeah.
• 22:54
  SPEAKER_00: It's really amazing.
• 22:56
  SPEAKER_01: Yeah, that is.
• 22:56
  SPEAKER_01: That is.
• 22:57
  SPEAKER_01: I have a lot of seeing I do a lot of education, so I do seminars and webinars.
• 23:01
  SPEAKER_01: And I asked a group of seniors that were with me, and I said, How many of you have been in a skilled nursing?
• 23:08
  SPEAKER_01: They're like this.
• 23:09
  SPEAKER_01: And then and one lady said, I had a wonderful experience, one out of 10, right?
• 23:12
  SPEAKER_01: And the others were, I'm never going back.
• 23:14
  SPEAKER_01: And I said, Well, let me ask you this.
• 23:16
  SPEAKER_01: How many of you think that's senior living?
• 23:19
  SPEAKER_01: And they all raised their hand.
• 23:20
  SPEAKER_01: Oh.
• 23:21
  SPEAKER_01: And I thought, oh, wow, that's not what senior living, that's not what assisted living is.
• 23:26
  SPEAKER_01: No.
• 23:26
  SPEAKER_01: And it's not what independent living is.
• 23:28
  SPEAKER_01: And it's not a residential care home, obviously.
• 23:32
  SPEAKER_01: But um the the fact that that is their perception.
• 23:36
  SPEAKER_01: And we always said everybody thinks it's a nursing home.
• 23:39
  SPEAKER_01: No, everybody thinks it's a skilled nursing that that's where you're asking them to go live the rest of their life out.
• 23:44
  SPEAKER_01: And most of them don't want to do that.
• 23:46
  SPEAKER_00: Yeah, of course not, right?
• 23:47
  SPEAKER_00: I mean, the old joke is Mom, I'm gonna put you in a nursing home.
• 23:50
  SPEAKER_01: Right, right, right.
• 23:50
  SPEAKER_01: Yeah.
• 23:50
  SPEAKER_01: Right.
• 23:51
  SPEAKER_01: No.
• 23:51
  SPEAKER_00: Yeah.
• 23:52
  SPEAKER_00: My mom says she she can't wait to go to an assisted living.
• 23:54
  SPEAKER_01: I I I agree.
• 23:56
  SPEAKER_01: There's no yard work.
• 23:57
  SPEAKER_00: No, she's in Tucson.
• 23:58
  SPEAKER_00: Oh, okay.
• 24:01
  SPEAKER_00: Okay.
• 24:01
  SPEAKER_00: Yeah.
• 24:01
  SPEAKER_00: Well, they're doing very well right now.
• 24:03
  SPEAKER_01: So yeah.
• 24:04
  SPEAKER_01: No, and and you know, there is that point, and it's usually 70, a little over 75, where you slow way down and you stop being engaged.
• 24:13
  SPEAKER_01: Now, I'm gonna say probably 80 to 83 is the sweet point, is for me to say you're declining at home at home because you're isolating.
• 24:23
  SPEAKER_01: So let's go take a look at what you can afford.
• 24:26
  SPEAKER_01: So we go by budget, location, and then we match them to the right community.
• 24:31
  SPEAKER_01: So I think we placed somebody with you that was like really young.
• 24:35
  SPEAKER_01: She was 56.
• 24:37
  SPEAKER_00: Yeah.
• 24:38
  SPEAKER_00: That's one thing that's really unique about Emmanuel on all of our communities is we have a traditionally a younger population.
• 24:46
  SPEAKER_00: Yeah, you do.
• 24:47
  SPEAKER_00: Our average age in our nursing facility is 54.
• 24:50
  SPEAKER_01: Amazing.
• 24:51
  SPEAKER_01: Right?
• 24:52
  SPEAKER_00: Because we have the behavioral health units, those folks tend to be a little bit younger.
• 24:55
  SPEAKER_01: Yeah.
• 24:55
  SPEAKER_00: And so we get a lot of request transfers from other SNFs for just a younger population.
• 25:01
  SPEAKER_00: Our assisted living.
• 25:02
  SPEAKER_00: Um we have a couple of 20-year-olds, 30-year-olds, 40-year-olds.
• 25:07
  SPEAKER_00: Wow.
• 25:07
  SPEAKER_00: So it's just a younger population.
• 25:09
  SPEAKER_00: So more vibrant in our activities departments off the charts.
• 25:12
  SPEAKER_00: Trevor Burrus, Jr.
• 25:12
  SPEAKER_01: I know.
• 25:13
  SPEAKER_01: It is.
• 25:14
  SPEAKER_00: Yeah.
• 25:15
  SPEAKER_01: I mean, very happy, both employees and residents.
• 25:19
  SPEAKER_01: I think everybody is super happy there.
• 25:21
  SPEAKER_01: Yeah.
• 25:21
  SPEAKER_01: Would you agree?
• 25:22
  SPEAKER_00: I I would.
• 25:22
  SPEAKER_00: 100%.
• 25:23
  SPEAKER_00: Manual's been the most uh gracious, gratuitous, generous company I've ever worked for.
• 25:30
  SPEAKER_01: Trevor Burrus, Jr.
• 25:30
  SPEAKER_01: Are you nonprofit?
• 25:31
  SPEAKER_00: We are.
• 25:32
  SPEAKER_01: Okay.
• 25:32
  SPEAKER_01: Yeah.
• 25:33
  SPEAKER_01: Great.
• 25:33
  SPEAKER_00: And it's really amazing to watch those dollars come back into the community because we're remodeling the SNF.
• 25:39
  SPEAKER_00: We've done huge projects throughout the campus.
• 25:42
  SPEAKER_00: Um and we're just about to embark on our remodel of the assisted living.
• 25:46
  SPEAKER_01: Oh, wow.
• 25:47
  SPEAKER_01: Very cool.
• 25:48
  SPEAKER_01: I need to come over for that.
• 25:49
  SPEAKER_00: Well, we haven't started yet, but uh afterwards.
• 25:52
  SPEAKER_00: Yeah.
• 25:52
  SPEAKER_01: No, I will say, I mean, it's a really, really well-run uh place.
• 25:57
  SPEAKER_01: And um I think it's getting better and better and better.
• 26:01
  SPEAKER_01: You know, I think it's like, oh, okay, you know, and then you have people that are just living on social security, you know.
• 26:07
  SPEAKER_01: So it's very hard.
• 26:09
  SPEAKER_01: What are your price points for the uh independent living?
• 26:12
  SPEAKER_00: Independent living for one bedroom, it's$1,180.
• 26:16
  SPEAKER_01: Oh my gosh, eleven hundred dollars.
• 26:18
  SPEAKER_00: And that includes utilities, cable, Wi-Fi, housekeeping once a month, 12 trip round trip transportation, and safety phone calls in the morning.
• 26:26
  SPEAKER_00: How about meals?
• 26:27
  SPEAKER_00: No meals, but we have two restaurants on site that serve meals for$5 each.
• 26:31
  SPEAKER_01: Yeah, perfect.
• 26:32
  SPEAKER_00: Yeah.
• 26:32
  SPEAKER_00: And those they're good meals.
• 26:34
  SPEAKER_00: Their salads fill me up.
• 26:35
  SPEAKER_01: Wow.
• 26:36
  SPEAKER_00: Perfect.
• 26:36
  SPEAKER_00: I eat there every day on my campus.
• 26:38
  SPEAKER_01: Perfect.
• 26:38
  SPEAKER_01: Perfect.
• 26:39
  SPEAKER_00: And what is your assisted living for assisted living for a studio apartment all to yourself?
• 26:43
  SPEAKER_00: It's$3,000.
• 26:44
  SPEAKER_00: And that includes all the care you need, whether it's just medication.
• 26:47
  SPEAKER_00: Yeah.
• 26:48
  SPEAKER_00: Whether it's just medication management or full hands-on care.
• 26:50
  SPEAKER_01: Oh my gosh.
• 26:51
  SPEAKER_00: Same price every month.
• 26:52
  SPEAKER_01: That's amazing.
• 26:53
  SPEAKER_00: A one bedroom's$3,400 all in, all inclusive.
• 26:57
  SPEAKER_00: Our memory care is$53,75.
• 27:01
  SPEAKER_01: That's all inclusive.
• 27:02
  SPEAKER_00: All inclusive.
• 27:03
  SPEAKER_00: That's your own apartment.
• 27:04
  SPEAKER_00: Our own one bedroom apartments.
• 27:06
  SPEAKER_00: Yeah.
• 27:06
  SPEAKER_00: I've been told that our are actually our memory care apartments are a little bit too big.
• 27:11
  SPEAKER_01: Probably.
• 27:12
  SPEAKER_01: Yeah.
• 27:12
  SPEAKER_01: Yeah.
• 27:13
  SPEAKER_01: Probably.
• 27:14
  SPEAKER_01: A little too much space for you want them out in the community more, right?
• 27:19
  SPEAKER_00: Which your activities team does do.
• 27:20
  SPEAKER_01: Yeah, which they bring them out.
• 27:21
  SPEAKER_01: But then yeah, you've got all that space.
• 27:25
  SPEAKER_01: Right.
• 27:25
  SPEAKER_01: Right.
• 27:25
  SPEAKER_01: Right.
• 27:26
  SPEAKER_01: Wow.
• 27:26
  SPEAKER_01: 3,000 all-inclusive studio apartment for uh that is amazing.
• 27:32
  SPEAKER_00: Yeah.
• 27:33
  SPEAKER_01: Are you full all the time?
• 27:34
  SPEAKER_00: No.
• 27:34
  SPEAKER_00: We still have uh we have quite a few studios open.
• 27:37
  SPEAKER_01: Good.
• 27:37
  SPEAKER_00: Yeah.
• 27:38
  SPEAKER_01: Good, good, good.
• 27:38
  SPEAKER_01: Well, my team's gonna know what about it.
• 27:40
  SPEAKER_00: Good for the community, not for me.
• 27:42
  SPEAKER_00: I need uh Oh no, that's fantastic.
• 27:44
  SPEAKER_00: That's fantastic.
• 27:45
  SPEAKER_01: Well, David, I really want to thank you for coming.
• 27:47
  SPEAKER_01: This has been great, and I can't wait to have you go ahead and put this on your website and join us as well as our podcast at be podcast partners as well as uh referral partners.
• 27:59
  SPEAKER_00: Well, thank you very much for having me.
• 28:01
  SPEAKER_01: You're welcome.
• 28:02
  SPEAKER_01: Thank you so much for joining us today.
• 28:04
  SPEAKER_01: I want to invite you to go to my website at aplaceforseniors.org.org and sign up for one of our webinars or our seminars.
• 28:14
  SPEAKER_01: I talk all extensively about the risks of staying at home alone and uh being able to thrive in a community and what the difference is.
• 28:23
  SPEAKER_01: So I hope to see you there.
• 28:25
  SPEAKER_01: Have a great day.