Ep 16 - Navigating Elder Care Costs: Michael Chau's Journey from IT to Compassionate Care

Unlock the secrets to navigating the often overlooked costs of aging in America with our special guest, Michael Chau from Assisting Hands. Join us as Michael shares his inspiring journey from IT to healthcare, driven by his son's special needs. You'll hear firsthand about the core values of compassion, kindness, and reliability that underpin his company, and how they provide essential services like assistance with daily living activities and companionship. Discover the meticulous process of matching caregivers to clients' personalities and the in-home assessment techniques used to encourage even the most reluctant seniors to accept help.
 
Delve into the intricate details of elder care payment methods and services with our in-depth discussion on home health care versus facility-based care. Learn about the various payment options available, from insurance to Medicaid, Medicare Advantage plans, VA benefits, and long-term care insurance, and why planning ahead is crucial. We also highlight the pivotal role caregivers play in both home and community settings, offering daily assistance and much-needed companionship. Gain insights into the financial aspects of elder care and explore strategies for integrating socially awkward patients into their communities, as well as the benefits of using technology to maintain family connections.
 
Prepare to be moved by a heartwarming success story of a bed-bound woman who regained her quality of life through dedicated caregiving. We'll guide you through handling transitions when clients' conditions decline, from increasing care hours to considering facility options and hospice care. Michael sheds light on effective recruitment and retention strategies for caregivers, emphasizing respect, fair wages, and continuous hiring to combat industry turnover. Discover tools like AccessCare that streamline day-to-day management and communication. We wrap up with a forward-looking discussion on the growing need for caregiving services, particularly in regions with aging populations, and the importance of educating people about long-term care planning from an early age. Follow us on Facebook and LinkedIn, and visit us at theangrybiller.com for more.

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Transcript

Josh Fertel

00:04

Welcome to the Angry Biller, a show where we explore the people in the businesses behind the scenes of healthcare, those men and women that are the catalysts that allow providers to concentrate on delivering exceptional patient care. Welcome to the Angry Biller. My name is Josh Fertel. I am CEO of J3 Medical Billing. We are here at the Visuals by Momo studio. One thing I always like to talk about is what it's like getting old in America the costs, the health care, all the things that go into aging that we really don't think about, until it becomes a time where it's too late to think about it and because of that I'm very excited I have Michael Chau from Assisting Hands.  He does home health care. 

Michael Chau

00:51

And thank you, Michael, for coming. Well, thank you for having me here. It's great to be here, thank you. 

Josh Fertel

00:56

For sure, for sure. 

Michael Chau

00:58

You know it costs a lot right, it's expensive to grow old in this country. 

Josh Fertel

01:03

I want to hear about how you do things, but let's start from the beginning. How did you get into what you're doing? 

Michael Chau

01:09

Well, I started my career in IT, so it was totally different. But my son has special needs, okay, and I've known for a while. He's going to be needing care for his life. He's not going to be independent, and so I've got to figure out this whole process of how do you get caregivers, how do you vet them, what is that like? And so I figured, let me start something and create a company that's based off of core values that I hold important, and our core values are compassion, kindness and reliability, right, and so the way I explain that is like. Compassion is kind of the heart, where you're seeing someone in pain, someone suffering, and you're moved to want to help them. Whether you do or not, it doesn't matter, you just feel the need to do something. Then the kindness is the actual, the actions, the acts that you do to help ease their suffering. 

Josh Fertel

02:09

Okay. 

Michael Chau

02:10

Because compassion without kindness is just more buzzy feelings. And then reliability is really kind of the feat of showing up to work on time, being there every day, calling in with backups if you need to send someone else out. It's just the operations of the business. 

02:30

How long have you been? We've been active for four years. We started in 2020 in the middle of the pandemic. It's probably a really excellent time to get started. Yeah, there's a lot of people that were scared. They didn't want to go into living homes, they just wanted to figure out something, but they needed care Right, and I want to get into really the math of it and really what the costs are as far as insurance and long-term care and all the things that go into it. 

Josh Fertel

03:05

But your company. How do you assist? 

Michael Chau

03:14

Tell us what it is that you do. What do you do so? We help with what they call the activities of daily living. So these are like bathing, grooming, dressing, meal preparation, transportation to doctors and errands, and you can think of it like in a day, someone needs to help get out of bed, go to the toilet, get in the shower, maybe make some breakfast, maybe they need assistance with feeding, maybe they have some mobility issues. You can help transfer them out of bed into a wheelchair, those kinds of things. And then a lot of it is companionship and kind of being with them. A lot of seniors are alone. They don't have a lot of family around and they're just lonely. They need someone to talk to. Right and chronic loneliness here is equivalent to smoking 15 cigarettes a day. Chronic loneliness it's a crazy thing for your health and so just helping with that helps. 

Josh Fertel

04:13

And how do you assess what? 

Michael Chau

04:15

is going to happen in the course of a day with a patient. So what we do is a free in-home assessment where we go out, meet with the client, meet with the family members and come up with a plan of care together. So we look at their current routine, what it is that they're looking to get out of it, and then we come up with that and then we'll figure out a schedule. We'll figure out what's the best personality type that's going to match with the client Makes sense. Maybe they want someone outgoing and chatty and energetic, right, sometimes they want someone reserved and gives them space and that kind of thing. So it just, it depends. So that's a big part of it. Sure, that matchmaking, and I know that the families really are the ones that are making a lot of the decisions Oftentimes. 

05:00

Yeah, yeah, and so tell me what kind of questions will they usually have, or how do you engage with the family more? 

05:07

Again, a lot of you know putting the bill for the service. I know it comes from the family, right? So the family often asks things like well, first of all, there's a stranger now coming into their loved one's house. They don't know where these people come from. They don't know you know a lot of these kind of things. So they're worried about safety first. How do you vet your employees? How do you do background checks? How do you do all these kind of things? 

05:31

Once they feel comfortable with that, they ask more about how do we pay for this? Right, and there's a lot of different options that we could talk about. But that's the next kind of thing that they think. Now, if they can find the funds and they can do it, then they say well, how do we, you know, engage now, like what? Maybe there's difficulties with the um, their mom or dad not wanting someone to come in, maybe they're like figuring like, oh, I'm losing my independence, I don't need help, you know. Then they say, hey, you do need help. We're doing this kind of you have to convince them, convince them, and there's techniques we do to work through that. 

Josh Fertel

06:07

And you talked about vetting your employees. What's the process for that? 

Michael Chau

06:10

Well, the good thing in the state of Florida is that all the background checks are mandatory from ACA, which is the agency for home care, I don't even remember, anyway so they need to have a level two background check. 

Josh Fertel

06:33

Okay. 

Michael Chau

06:33

So they take their fingerprints, they check, see if they have any criminal history and they go on to a roster so that if they were to be arrested tomorrow, we get alerted right away so that we can take them off, so that it's not just a one-time check, it's an ongoing, continuous check. Yes, agency of Healthcare Administration, and so we also check. You know their previous jobs references. These kind of things we do a lot because they're employees of ours, and that allows us to train them better, it allows us to supervise them, and what we're looking for are people that are basically two things Are they giving us great attitude and great effort? Those are the two things that they can control. Now, maybe they don't know how to use a Hoyer lift, maybe they don't know we can teach all these other things, but the attitude and effort are the important things and that's what we look for. 

Josh Fertel

07:29

No no. 

Michael Chau

07:30

Absolutely for sure. You want somebody that's caring, right? Right, you have to have somebody that's caring. What are some of the things that you do not do and, for example, an emergency situation? Tell us how you handle those Things that we don't do are kind of the skilled nursing type of things. 

07:49

Okay, and those would encompass physical therapy, occupational therapy, speech therapy, wound care and medicine management. Right, so we can do the just everyday activities of daily living. But if there was something were to happen a fall or something we'd obviously call 911 immediately. Okay, the aide will also call the office so that we can get in touch with the family, let them know what's going on. Mom or dad has been transported to the hospital. We've got their medications on file. We have some of their history on file so we can talk with the paramedics about what's going on, and so we interface with that. 

08:31

Have you had a? Has there been a specific instance where everything worked out the way it was supposed to? Well, yeah, I mean, things happen, and generally a lot of times it will be. Sometimes it will be like a fall, but sometimes it's not. When our aide is there Right, our aide is there generally whenever we're watching. Sometimes the aide will show up the next morning and mom's on the ground, okay, then they try to help if they can, but they first have to assess the situation Right, and if they say, okay, yeah, we need to call someone, then they call and it's taken from there. 

09:11

So we've had people where we walk in and just go immediately to the hospital. Um, I'm assuming in that situation, 24-hour care is probably the next step in such as um, it can be, it can be, and so we have a couple of ways to do 24-hour care. Um, we would typically either do two 12-hour shifts so that the person's awake and watching all the time. We also have what we call live-in care, where the aid is there but they get eight hours of sleep at night, and so that's good for people that are generally able to sleep at night, not get up to go to the bathroom, not do any of those kind of things. But you just want someone there just in case, and so that's why it's a little bit cheaper. 

09:49

Yeah, I would think because I've had this in my family where a dementia patient would need supervision around the clock just to protect themselves. Yeah, it can be, especially if they're wonder risks and it depends on the kind of the cognitive impairment that they have. 

Josh Fertel

10:06

That, uh, that we would see and so, just on the on the flip side of that, how do you protect? 

Michael Chau

10:13

the, your caregivers, you know, for you started in covid. How did they? So? We provide all kinds of um ppe for, so we'll give them masks and gloves and those kind of things. We've also, you know, teaching them, which they know from school. But we also emphasize okay, wash your hands, you get in, you do these other types of things, but we also just protect them by first going in to do. 

10:41

When I do that assessment I talked to you about, we're also doing a home safety evaluation to make sure that they have, uh, a working smoke detectors, we have a fire extinguisher on hand. These kind of things make sure that I wouldn't think of that. Yeah, like their medicines are not, you know, uh, scattered all around, or this fall trip hazards with throw rugs everywhere. So it's these kind of things we we have to work with and make sure that the environment is safe too. Absolutely, it makes a lot of sense. I want to take a break, uh, when we come back, I really want to talk about the math, and you know, really, what it costs to get to get old in this country, okay, great childhood sexual trauma should not hinder your quality of life. 

Josh Fertel

11:21

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We're back with Michael Chau of Assisting Hands Home Health Care. 

Michael Chau

11:49

So, Michael, let's talk about the services that you provide. I know that in your industry you're either paid by insurance or you're paid by cash. How does your company work? So we do take all forms of insurance. We take things like Medicaid. Some forms of Medicare are providing some hours, so, for example, Medicare Advantage plan from Humana. They are providing a number of hours per year for their clients year for their clients. 

12:28

Besides that, there's VA. So if you're a veteran and you have some needs, those will be covered. And then long-term care insurance. So if you bought a policy previously and I would encourage everyone to buy a policy because it's not cheap we're absolutely for to get care Insurance. Ahead of time is generally a lot better. If I've learned anything from doing this, it's that how important long-term care is Right right. 

Josh Fertel

12:56

So you have an instance where you're interviewing a potential patient. What makes the decision whether to have home health care or to go to a facility. 

Michael Chau

13:09

Um, so it's, it depends on on their own wants, kind of, and so, okay, both of them are are good. They're not, you know, bad options, especially when someone just needs they can't be alone. Whether you have some place to go to in a facility or a community, they will have your dining set up, you have a place to live, you have social interaction and those kind of things. So you don't have the one-to-one. That's the biggest thing. So you can still go to a community and have a home care aid with you, and oftentimes people do, right, it's just it costs more, right, of course, it's always an option. Now, some people they really want to stay at home. They've been living in that house for 40 years. They've raised all their kids, they know exactly where everything is. 

14:07

There's a lot of people like that, right, and there's nothing wrong with that if they just need a little bit of help. And sometimes you'll see it's a gradual decline where you start off with a few hours of home care Right, you get more hours Eventually. If you're up to 24 hours you may decide yeah, maybe we need to go to a long-term care or, um, a memory care, depending on if they have, uh, outside births or things like that. So there's no right or wrong, it's preference, really understood. 

14:38

Yeah, and um, when a one of your uh your caregivers goes to a facility, what kind of things are they doing so they will help them? Um get a bath, for example? They can, because sometimes um at assisted living, they have people that can come in and give a bath, right, those kind of things, um, it'll rotate they'll. So maybe you just want the same person all the time, right, you want your personal yeah attendant person so they can take you to go to your dining hall. 

15:10

Sometimes they can help you go to activities. So just do your wheelchair go with you on a walker. If you're a fall risk those kind of things, just an extra hand right and um, and, to be honest, some people just like it because their friend has one too. They're like, oh, you got one, I want one, I want my person, and it's just that extra level of care. 

Josh Fertel

15:33

That's basically what it is. 

Michael Chau

15:36

And so, from a cost perspective, how does something like that get paid? Right, because they're not there for four or eight hours at one time, I assume. If they're just doing some tasks, no, generally they'll be there. It could be two to four hours Oftentimes. It is sometimes just companionship and helping play games or do other things. 

15:59

Some people just aren't that social right and it's hard for them to integrate into a community. Yes, and some people need someone to hold their hand and kind of go with them and they do that and they feel more comfortable. It just depends on the personality. But they pay for it generally through long-term care or through private pay, and when they're at assisted living they can use it however they want. 

16:26

The other part of assisted living is that they could be in an independent living and, okay, they don't have those services necessarily. They basically just have a place to live and some activities, yeah, and food, yes, um, and then an aid makes more sense, because now you get a little bit right and, um, the independent living communities, they, they like having their people with aids and caregivers, because they can stay in their unit longer, because they're able to do those kind of things without having to go to a more skilled person. So when you are looking for in a business, when you're looking for more patients, an assisted living facility would be a good referral source. It could be Absolutely yeah, because they have those patients that might need a little extra care that they don't provide Correct Right, and that's why we'll go sometimes out to different facilities and just show our we'll maybe sponsor some kind of event Right, like an ice cream social or some that's nice, you know someone playing music and doing those things, and then we ask are there any va? 

17:34

you know people were spouses of a va veteran, right? Uh, are there, um, people that need some extra help, that wants to just sign up for a few hours and and we can get people out that way. The, uh, the patients that are a little awkward socially, like you were talking about, do you? Do you find ways to? You know, and, you know, get them involved with the other patients that might be in a facility or or if they're home to see their friends, or does that happen? Yeah, yeah, we try and to do especially what the family thinks is best. Now, some people have been like this for their whole lives and you're not going to change anybody, right, but some people they just like talking with somebody. Yes, and it doesn't even matter who it is, and we will be able to come in and just talk to them. We can help them with technology and they can FaceTime their family. 

Josh Fertel

18:23

Oh, very good, these kinds of things. 

Michael Chau

18:24

Yes, so we do try to promote those social interactions. Oftentimes, though, if you're in, you know, at the CIS living, some people are very social and they just want to go to the next thing, the next thing, the next. You know, at our age we'll take them around. 

Josh Fertel

18:41

Oh, that's, and they're. 

Michael Chau

18:42

Chaperone. 

Josh Fertel

18:43

Yeah. 

Michael Chau

18:44

They just they're fine. It just depends on the personality, really. Do you have an example of a great success story? A great success story, A lot of success stories In general, one reason we have we had a woman. She was basically bed-bound, she was living with one of her sons and we just would come in, clean her up, feed her, let her just kind of just stay with her. But our caregiver was like so sweet with her she would like sing to her, as she was, you know, helping, you know wash her, and these are kind of this. Eventually she was nonverbal. When we got her she started talking again and then she started kind of perking up. She was able to sit up, we were able to transfer to the couch, watch TV, interact, and so it was a big transformation. Remember, before she was just lying there, really. 

Josh Fertel

19:39

Right. 

Michael Chau

19:39

And just a little bit of you. Know what was the time frame on? I mean, it wasn't quite a way. No, it was at least. I'm sure it was probably at least a year, Something that's agile. It was a long time, but helping get her quality of life changed Absolutely. She's doing so much better. Yeah, no, that's a good story. That's definitely a lead. How do you alert the families that say listen, we've done everything we can here and now. The next steps need to be taken, and I'm assuming that happens. Yeah, generally, the first conversation around that is that we may have to increase hours because we've been seeing that there's some decline going on. They need some supervision or other things like that. 

Josh Fertel

20:32

Right. 

Michael Chau

20:34

And we start that conversation, they ask, well, what's going on? And we do keep them apprised of everything, sure, so that there's no real surprise, surprise, right. But so they'll say, yeah, I understand, understand. And then they'll often say, well, what are the next steps, what can we do? And then we may say, okay, well, we can look at a facility if you'd like to do that. We can look to increase care to 12 or 24-hour care, these kinds of things. Some people decide to move their mom or dad to wherever they're living. 

21:10

Right, I see that Because it just depends on where it is. We'll also maybe ask them, okay, how the doctor's visit has been. Hospice care may, may be an option now, right, okay, hospice will. Um, when two doctors say that there's about six months of life remaining, they can then get hospice services as well through Medicare. There's a lot of those types of things and people just don't really know a lot and we just help guide them through that whole process Right. 

21:42

It's information, you're getting the information, you're passing it along and together everybody's trying to make the best decision possible for your patient. That's right. 

Josh Fertel

21:55

How are you finding? 

Michael Chau

21:57

your caregivers Many ways. So one is that the building where actually we are in is there's a school right there, so we get a steady stream of people coming in through there. We partner with other schools as well. We go visit them so that they know who we are. Word of mouth is a big one and we offer bonuses for people that refer their friends to come. That incentivizes them to bring, so good caregivers often will know other good caregivers. So we want to keep a high level of quality um and then just um online postings, indeed, or other job boards. You're constantly looking for more people who are always hiring. We're always hiring you. Just, you have that much work that needs to be done. Yeah, yeah, yeah. And it is a high turnover industry. Okay, we have pretty good retention in general because I think we uh treat them well with treatment, with respect, we pay a fair wage and those kind of know that. And their employees, they're not right in our contract. That's correct, and there's definitely a benefit to that. 

Josh Fertel

23:00

Um, as far as you're um keeping your keeping track how do you keep track on the day-to-day of your caregivers? 

Michael Chau

23:07

uh. So we talk with them quite a lot, okay, uh, we also talk with our clients to get feedback as well. We make sense. We just call them to say, hey, how's this doing, how's this going. So once we open those communication channels, we get just the feedback loop so that we can keep track of all those kind of things. And is there a checklist, a paper or digital, that a caregiver would have when they go to? 

Josh Fertel

23:33

visit a patient. 

Michael Chau

23:34

Sure, so on. There we use a software called AccessCare and so on. There that's what they use to clock in, clock out. It's a video fence so that they can only clock in when they're at the site of where the patient is Excellent. And then the hazard list of EDLs that they need to do, which are activities, daily living, right Activities, and we'll have notes and stuff and they could leave notes and they can update us as well. So there's that communication too. We pass those along to the families often and so everybody's communicating the way they're supposed to. 

24:09

How would somebody get in touch with you? They can visit us at assistinghandsfortlauderdale.com. Ford Lauderdale spelled out, fort Lauderdale spelled out F-O-R-T, and then also our phone number is 754-900-5102. 

Josh Fertel

24:28

Okay. 

Michael Chau

24:28

And then that's our office and we're manning that 24 hours. We're always on call, so everything that needs to be handled we can handle on nights, weekends, holidays, I'm sure. Where do you see your business, or caregiving in general, going in the future? Our business, we see it just growing because also caregiving in general is growing. We have an aging population, especially here in South Florida. It's an immense amount Just going to make sure that we have caregivers available to help with that In order to make that happen. I see those wages increasing because you're competing against lots of other industries as well. The good thing about this is it's fairly recession-proof and those countries in the economy can do whatever it needs, but people are going to need care. 

Josh Fertel

25:29

Always, and so that's the best of them. It's. 

Michael Chau

25:30

America is getting older and older, but people are going to need care, and so that's the best of it, and it's America is getting older and older, yep, and you know as well as I do probably better that nobody's prepared for it, or very little people are prepared for it. Right, and that's why you have the situations that we have. We've talked about people that have your service, and there's more, probably, that are struggling to find a way to get that service Right. Right, and that's unfortunate, right. 

Josh Fertel

26:01

So, with that, I'm going to ask you if I had a magic wand and I gave it to you to change one thing about your industry or fix one thing in your industry. 

Michael Chau

26:11

What would it be? I didn't know you had that power, josh, a magic wand, I mean really. It's just. It's just really the money to have basically universal care, you know for everyone. 

26:29

If that was an option, that everyone could have that and all the caregivers could be paid a fair wage, that would help quite a lot. Because what's the alternative? You have people just dying in their homes alone. That's not a great alternative. As a society, we kind of want to take care of our older generation. Now, some things can be helped with the family, but we should be paying our family members to take care of them too. Right, that would be, you know part of that if we had this universal option pay family to help with that, because they're not able to work and, you know, have job, oh that's. And so this way it still helps the economy because you have to spend money to right to, to direct all that work and everything. So it's, it's a. It's really a money problem. If we have, if we, if we really wanted it, right, no, it's a possible. It's a great answer. 

27:32

I really appreciate that you came in and shared your expertise with us. One of the main things I have is just really what it costs for healthcare in general and especially the aging population. So I want to continue to have this conversation with you. As things change, perhaps in your industry, you'll come back and we'll talk again and find the advancements and the things that you're talking about. Hopefully, we can get it put in place. However, it needs to be done, but in the meantime, thank you for coming. 

28:05

All right, Michael, thank you very much. I hope you had a good time. I had a great time. Thank you, you did wonderfully a good time. I had a great time. Thank you, you did, you did wonderfully. So, as I just said, and just to recap it, really the aging of America and the cost of getting old in this country is is out of control and it needs to be addressed. There has to really be, uh, education about long-term care, and it's not something that can come from insurance agents, it's something that's just got to be taught right from the beginning. As any business person. 

Josh Fertel

28:37

Here are the things that you need to do in your life whether you're putting money away for an IRA you've got to put money away for your health care when you get old, because if you're not going to be, able to enjoy your life when you get old, then what's the sense? 

Michael Chau

28:51

to enjoy your life when you get old, then what's the sense? So we have to keep drilling down that. We have to teach everybody about what it's going to cost them as they get old and as they age. 

Josh Fertel

29:01

Thank you for listening today. Please follow us on Facebook and LinkedIn, and you can check us out at theangrybiller.com.