When it comes to aging in America, there are many issues that seniors face. These include brain health/ dementia, to a broad spectrum of issues to affordable housing with services. You should also know what type of retirement community best suits your needs based on location and budget, from aging at home or Independent Living to Memory Care.
Seniors face numerous obstacles as they age, including the possibility of becoming disabled or losing a spouse. They must also consider how society will care for them in the future.
Seniors and their families will need to consider the following at some point: How are assisted living and long-term care different? What does long-term care entail? What services are provided by long-term care? How do you plan for the possibility of long-term care? What characteristics define a quality long-term care community?
Join me in conversation is Lou Woolf, President, and Chief Executive Officer, Hebrew SeniorLife.
Louis J. Woolf is the president and CEO of Hebrew SeniorLife, one of the nation's leading not-for-profit providers of senior services and is affiliated with Harvard University.
He has more than 30 years of experience in health care administration, including positions as executive vice president and chief operating officer at Partners Healthcare System's North Shore Medical Center and leading the Care Group Healthcare System.
Find Louis J. Woolf on LinkedIn: https://www.linkedin.com/in/lou-woolf-2808a828/
Hanh Brown: Hi there. Okay, so thank you so much for being here. We're glad that you're here. I'm Han Brown, the host of the Boomer Living Broadcast, and on this show, the industry leaders share information, inspiration, and advice for those who care for seniors. Our expert panellists discuss senior healthcare, dementia caregiving technology for seniors, and affordable senior living options.
Hanh Brown: All of which address the social determinants of health. So thank you so much for participating in today's conversation. Now check out Carestream, our recently launched platform where we match seniors with carers and guide businesses and their employees through the caregiving journey for their loved ones.
Hanh Brown: So please check out Carestream, and for those of you that tuned in on time, we apologise. We had a little bit of delayed technical difficulties, but we love that you're here, and we would love to hear from you. So please comment and ask any questions. We're all learning together as we move into the later years.
Hanh Brown: So we want to learn from your personal ageing journey, and thanks again for tuning in. So today's topic is: do you have an ageing relative that needs help and are unsure of what to do? When it comes to ageing in America, there are many issues that seniors face. These include brain health, dementia, a broad spectrum of issues, and affordable housing with services.
Hanh Brown: You should also know what type of retirement community best suits your needs based on location and budget, from ageing at home or in independent living to memory care. Seniors face numerous obstacles as H, including the possibility of becoming disabled or losing a spouse. They should also consider how society will care for them in the future.
Hanh Brown: Seniors and their families will need to consider Some of the following topics that we'll go through are: how is assisted living in long-term care different? What does long-term care entail? What services are provided by long-term care, and how do you plan for the possibility of long-term care?
Hanh Brown: What characteristics define a quality long-term care community? These are just a few of the topics that you should attempt to discuss during your Thanksgiving gathering. Today's guest is Lou Wolfe. Lou is the president and CEO of Hebrew Senior Life, one of the nation's leading non-profit providers of senior services, and is affiliated with Harvard University.
Hanh Brown: He has more than 30 years of experience in healthcare administration, including as a physician, vice president, and Chief Operating Officer at Partners Healthcare Systems, North Shore Medical Centre, and leading the Care Group Healthcare System. Slu, welcome to the show. It's a pleasure to be here, Han.
Hanh Brown: Thank you. Thank you so much for being here. So could you tell us a little bit about yourself, both professionally and personally?
Loius J.: Sure. So thanks. I've been the president and CEO of Hebrew Senior Life for coming up on 13 years. Previous to that, as you noted, I spent 15 years in the acute care hospital world, which has been a big help.
Loius J.: The continuum of care is so critically important these days. Over the last two years, that's been particularly accentuated because of the challenge of moving people through the hospital. So having that perspective is very valuable. I actually started out going to Columbia Business School with a degree in marketing and evolved into healthcare after 10 or so years.
Loius J.: So it's been a fascinating journey. I'm married. I have had two kids and five grandchildren over the course of the last three years.
Hanh Brown: Wow. Congratulations professionally and personally, and thank you so much for being here. So let's first talk about dementia and brain health. As we age, our brains change, but Alzheimer's disease and related dementias are not an inevitable part of ageing.
Hanh Brown: So according to the National Institute on Ageing, up to 40% of dementia cases can be avoided or delayed. Now it helps to know what's normal and abnormal in terms of brain health. So, I guess, why do you think brain health is important, and what kinds of brain exercises should we do? Right.
Loius J.: So there's no question in the world that brain health is critically important.
Loius J.: As we all get older It is extremely important to have a purpose in life. It's one of the things that I've learned from all the folks who I've spoken to over the last 13 years on this end of the business. As people get older, it's so important to have a purpose and to be in a position where you can fulfil that purpose.
Loius J.: That is such an important part of ageing and feeling like you're still part of society. You're still useful, and in order to be in a position to carry out that purpose, you need Physical health, cognitive health, emotional health, mental health, and spiritual health And the thing that is really foundational to all of those things is brain fitness.
Loius J.: Um, if you are not in a position where you are as cognitively intact as you can be, it is just much more challenging to go about life and to achieve all those things emotionally. You know, depression sets in physically. When you have some, uh, brain health issues, you become much less active.
Loius J.: You don't want to socialise as much. You're embarrassed because you don't remember things. So not having the kind of maximum brain capability that you're, that you could possibly have, gets at all of those different levels of health and dramatically gets in the way of having a fulfilling life and having purpose.
Loius J.: Mm-hmm.
Hanh Brown: Brain health starts sooner, the better. Right. There's no question. Not when you're in the later departure there question.
Loius J.: There's no, you know, Han. I said there was no question about that. And your comment about the fact that it is avoidable We have several researchers who have demonstrated that and feel very strongly about it.
Loius J.: When you are a young person, you start going to the doctor, you start getting EKGs, you start taking your blood pressure, and you start developing a history of understanding what your vital signs are and what's normal for you. And people don't start checking their brain health, doing things like mini-mental exams, until they're concerned they have a problem, at whatever age.
Loius J.: And we need to, as a society, we need to start assessing brain health much earlier. Get that foundational information and then start doing, you know, everything you can to maintain that brain health based on your situation. And it's absolutely true. So much of it is avoidable.
Hanh Brown: Mm-hmm. So now, how do you take care of someone with dementia?
Hanh Brown: And I guess what are some of the things that can be done for you to be more
Loius J.: patient? You know, treating patients is absolutely a critical aspect, and it's challenging. Most of the carers for people who have dementia tend to be spouses, and they are also ageing. They are not as physically capable of caring for people as much as, you know, you would ideally hope.
Loius J.: Uh, they're also in a challenging state of mind because, um, it's not the retirement they expected. They worked hard and had a vision of what life would be like, and it's different. So it is very challenging. To me, the key to being patient is, first of all, understanding the disease.
Loius J.: One of the big challenges that we have in our society is that many, many carers are not as Familiar with how to diagnose dementia, how to support families, how to educate them on what is coming and what to expect, or proactively understand what they should be doing when certain stages fall into place to make life as manageable for them and the patient.
Loius J.: So the first step to being patient is being prepared, and most people are not prepared, and the support systems aren't necessarily in place as well as they are for, you know, if you get diagnosed with cancer, you can get a tremendous amount of information and prepare, but not so much with dementia. The other thing I would say, once you're as prepared and knowledgeable as possible, is to develop the empathy that you need to truly look at the world through the eyes of the patient.
Loius J.: There are a lot of, uh, methods of simulation for dementia. Uh, if you, just this morning in pre-preparation, I googled, um, dementia simulation, and there's a tremendous number of virtual reality things people can do. But I believe that by doing that type of thing, even every morning for 15 minutes to, uh, go into a virtual reality and, and, and, and remind yourself what it's like,
Loius J.: I think that's really key to being patient: to be as empathetic as possible towards the patient, to really understand what they're going through, and to, uh, help you be more patient.
Hanh Brown: Absolutely. And you know, I hope that conversations like this that we put out in the media and on social media can be great.
Hanh Brown: This is one way to educate and inspire folks. You know, this is something that, if you get it, if you have it, there's nothing to be ashamed about. There's still life, Absolutely. In the dementia journey, and it's as difficult as it might be because your loved one is declining. But in that decline, there's a lot of life, and we meet them where they are.
Hanh Brown: Right? That's what we had to learn with my in-laws and my mom. Just meet them where they are and just embrace that moment and appreciate that because they're still physically there and
Loius J.: Yeah, it is, and they are there cognitively more than you think as well. Mm-hmm. Um, one of the things that I've heard is that, a little while back, I met a person who really embraced the situation and really took the time to fully understand what their spouse was going through and different strategies that they could take on.
Loius J.: And they actually became very proud of themselves, and it helped them to be more patient by actually challenging themselves to find new and different ways to meet the person where they are, as an example. Pulling up in front of the house with their husband saying, What are we doing here? This is not our house.
Loius J.: And instead of saying, Yes, it is, and, uh, pointing out to the person that they're mistaken, which is agitating and upsetting, to say, Oh my gosh, what was I thinking? Um, you're right. Backing out, driving around the block, coming back, and saying, Thanks so much. I don't know what I was thinking. Or coming into the room and saying, Where's my wife?
Loius J.: You're not my wife. And going back and saying, I'll go get her. And she would go change her dress, comb her hair differently, and come back and say, You know, Lucille said you were looking for me. Just do it. Go with it. And think about creative ways to move on without telling the person that they're wrong and reminding them that they have an issue.
Hanh Brown: Mm-hmm. I love what you said. Go with it, be creative, and be a part of that journey. As drifting away as it may appear, just be respectful, go along with it, be a part of it, because the worst thing you can do is correct them. That is, you're just magnifying the problem by doing
Loius J.: that. Totally.
Loius J.: And it's a form of denial. It's a form of denial that you're saying that you know the person's wrong. If you correct them, you can get them back on the path, but they're not going to get back on the path that you want them to be on. You have to join them on their path, and you do have to go with
Hanh Brown: That's true. So what would you say is the toughest thing about caregiving from your personal experience?
Loius J.: Well, the toughest thing I do believe is that so many of the carers are in a position where they are oftentimes the older spouse, uh, also older, and they're the spouse and, um, the mental mindset.
Loius J.: Of, uh, this not being the life they were expecting at this point and overcoming for them the depression that really comes along with oftentimes being the carer of someone with dementia. And, again, it's wanting to get back on that path, wanting to get back where they thought life was going, and the struggle of accepting the situation and optimising it.
Loius J.: So, you know, I really do, and then that mindset is definitely one of the biggest challenges. But the other big challenge, which we started about four years ago, is a memory centre of excellence. So we're in Boston, and we have some amazing institutions. Dana-Farber for cancer care, Joslyn for Diabetes, Boston Children's Hospital for Children, and the New England Baptist Hospital for orthopaedics
Loius J.: We have the centre of excellence, which is a cocoon where when people have a concern or a problem, they can enter and get everything. They can get prevention. They can get a diagnosis, they can get treatment, and they can get family support. You really are in a wonderful position, and I'll talk to hundreds of people in the Boston community who will tell you about a challenging situation they were in but how the Boston Healthcare community was there for them.
Loius J.: You will never, and I've challenged many audiences for anybody to raise their hand, anybody that ever had a dementia or Alzheimer's type challenge in their family, and they said the medical system was there for them. It does not happen. It's an incredibly fragmented system. And many, many providers, whether they're physicians, nurses, or emergency departments, do not have adequate training on how to optimally care for people with dementia.
Loius J.: So to me, the biggest challenges are the whole mindset issue of accepting, uh, you know, the situation you're in and staying on that path and being optimistic about it and all, but also that the system is really dysfunctional as far as support and, um, and we are looking in the Boston area to really improve that.
Hanh Brown: Yeah. I concur with you about the system being very dysfunctional. You know, personally, when I went through it with my mom and in-laws, it's not something that people talk about in a positive light and offer services to support. I know it's growing, so that's great. Yeah. But eight or 10 years ago, at least, I didn't find it.
Hanh Brown: And there's nothing to be ashamed of. Period. Right. Okay. It's something that is very difficult, and you've got to somehow learn to embrace it. That's really hard. And it's a whole relationship with family dynamics and, you know, your doctor, your neurologist, your family, and the social worker. I mean, there are so many key members that are part of this team, and I, uh, I painfully feel for the people going through it.
Hanh Brown: Right. But I guess you've got to know there are resources out there now. Okay. One of which is this conversation, and there's a lot more out there, so tap into it. You do have a support system, and don't be ashamed of it. Absolutely. Absolutely. So now, I guess, back to the brain house. So what would you say is the most important thing to remember in order to keep your brain healthy?
Hanh Brown: Just some other tips, if you have any.
Loius J.: Well, one thing, like I mentioned, is to start early. And to not, and so many people are in denial and don't want to know. Uh, I talk to people, you know, my age, people in their sixties, people in their fifties, um, about taking, starting to test that vital sign, and starting to do baseline and understanding.
Loius J.: And, um, it's just that they don't want to know. They don't wanna, they don't want to be involved in it. They would never, in a million years, not take their blood pressure or not have somebody listen to their heart. But, um, so one of the most important things is to start paying attention to it early, understand what your baseline is, and then, you know, all the things that people say are really true.
Loius J.: There's no question that there is a connection between diet and brain health—high-fat foods, things like that. So, eating properly, exercising properly, and, uh, challenging your brain as much as you can You know, one of the big questions People ask, Is it really true That exercise really helps?
Loius J.: Do brain exercises really make a difference? And, uh, there's no question that that does make a difference. But you want to do things that are different. You want to do things that really challenge your brain and, um, are things that you've never done before. going out and, you know, learning a new language, things like that.
Loius J.: Things that are really, really hard for you, like don't keep doing It's just like when you exercise, spinning is great, but if that's all you do, that's not good because you're just exercising a few muscles and ignoring the rest. So you really want to do new things. You know, you're not good at crossword puzzles.
Loius J.: Do crossword puzzles. That's all the more reason, because that's the key: to use your brain and really challenge it.
Hanh Brown: Mm-hmm. Absolutely. You know, The old saying, What's good for the heart is good for the brain, couldn't be any more true. So it's absolutely
Loius J.: true. Absolutely true.
Hanh Brown: Mm-hmm. So, as we move into our later years, we're all learning this together, and I know ageing is a personal journey, so we want to hear about yours.
Hanh Brown: And for those in the audience, we welcome feedback on how people are doing or questions about what was said, which may help others, you know, going through similar situations. So right now, I just want to acknowledge a few folks who chimed in here.kay. I'm not going to attempt to pronounce your name, but thank you so much for doing this.
Hanh Brown: I have a question. Are there any activities that would reduce the chance of getting dementia or Alzheimer's significantly? I think Lou mentioned several, right? You want to just reply to Bakir,
Loius J.: Please." Sure. I mean, we have a very active Institute for Ageing Research, the DeMarcus Institute for Ageing Research, and we have three different researchers who spend a significant amount of their time on this.
Loius J.: And, uh, they all actually look at different aspects, but there's no question that diet makes a huge difference. Um, and so to the extent that you can look at, for instance, a Middle Eastern diet, but low-fat diets, um, there's no question in the minds of our researchers. The diet makes a huge difference.
Loius J.: Exercise makes a huge difference in the ex. The blood flow you get from exercise makes a big difference in your brain's health. Um, and doing those, as we said, cognitive exercises Um, I knew a woman, uh, seven or eight years ago, who learned a foreign language when she was 96 years old. Um, we are a Jewish faith-based organisation.
Loius J.: We care for a wide array of people, but she was a woman who was Jewish, and she learned Hebrew at the age of 96, which is an extraordinarily challenging language to learn. It's a whole different alphabet system. And she swore by the fact that when she went through that process, which she probably started when she was 91, and I met her when she was 96, there's no question she felt as though she was using parts of her brain that she had never used before.
Loius J.: And, uh, she felt so much more cognitive clarity as a result of that hard work. Just like you would, if you did six new exercises and really worked at them, you would feel better, lighter, and stronger. And she felt the same exact way. Yeah.
Hanh Brown: What a great exercise as far as
Hanh Brown: Keeping your mind stimulated by learning a new language My golly. You're in your nineties, so, wow. Yeah. Okay. So one other thing, I want to comment: Ramel Timbo loves your centres of excellence, Lou, so that's great.
Loius J.: Yeah, no, that's, uh, something we're very committed to. We don't feel as though we need to do everything ourselves, but we're really looking to create a front door for people to come in and be able to get that full health and stay healthy. diagnosis, treatment, rehab services, um, family support, um, I'm sure Han that you would agree that family support and family education are oftentimes, as you get into the mid- to late-stage stages, the more important services that you can offer to a family than actually services that you're offering directly to the patient.
Loius J.: And, uh, and, and the classic healthcare system is just not set up for that because physicians generally don't get reimbursed for family support. And, um, it's just, you know, we have a very strong team of geriatricians that work for us, geriatricians, psychiatrists, neurologists, and, um, they spend a significant amount of time with family members, probably more than half their time with the family members, helping them support their own mental health in a lot of ways and their own physical health to make sure that they're taking care of themselves and helping them to support the patient as best they can.
Loius J.: Mm-hmm.
Hanh Brown: Mm-hmm. And I want to add another: if you are going through this with your loved ones, your family dynamics will change. There'll be some turmoil, but you have to remember to stay cohesive because it's a journey. It's got many, many innings, and you'll need each other. And particularly when your loved one passes away, you're going to need each other as a family.
Hanh Brown: So
Loius J.: It's very true. One of the things that we see quite a bit is that, um, by the time somebody is with us and we're taking care of them, they oftentimes have children who are geographically dispersed. And oftentimes, for the children who are further away and maybe feel as though they haven't been as attentive over the last decades, this situation arises.
Loius J.: There are struggles, and there is this kind of hero mentality that the further away kids decide, this is how I can make up for lost time. I can come in and provide a great, you know, benefit now. And oftentimes, you know, they're not as informed, and there can be a lot of family struggles as a result of that.
Loius J.: So I do encourage families to really sit down together. Do that joint education together, and really, it's a time where you oftentimes have to address some kind of prior baggage and make sure people put that aside and focus on the task at hand and what's best for the patient and not get complicated with previous family dynamics that so often come into play.
Loius J.: Mm-hmm.
Hanh Brown: I love what you said; it's not about your baggage that you're bringing into the mix.t's about your loved one going through this difficult journey. So leave your baggage aside. I know it sounds really harsh to say that, but you know, if you are going through it and you realise how critical it is, you cannot add in the mix of all of this drama and baggage from before it.
Hanh Brown: something to take note of. Okay. So, all right, I'm going to acknowledge Claudia. Fine. I am happy to hear that you are focusing on family support. The problem. Is that the health system doesn't recognise the critical role families play in maintaining the health and wellness of dementia patients. They need much more than training on how to provide real care in a cost-effective, easy-access way.
Hanh Brown: Very true. Very true. Do you have any thoughts on that, Claudia Fines comment?
Loius J.: Um, well, I think I'm very hopeful. I'm not sure I heard the very end of it because I lost you for a moment. But, you know, we've historically lived in a healthcare system that paid people to provide medical care when people got sick.
Loius J.: And procedures are evolving to a system of population health where health systems are being paid more for. Prevention is really encouraged by prepaying people. So I'm very hopeful that things like family education, um, other preventive measures will become much more prevalent because people will learn that by providing family support, by providing more advice, by giving the time to the family, you're actually going to reduce hospitalisations, emergency department visits.
Loius J.: Uh, classic example: when somebody with dementia gets a urinary tract infection, they tend to get more confusion. An uninformed family will take mom or dad to the emergency department. Emergency departments are not equipped to Take care of people with dementia quickly. So they send them, and they admit them.
Loius J.: So you have an emergency department visit, you have an admission, you have money spent, and you have, uh, increased dementia because delirium often happens in a hospital, and that makes dementia worse. So I'm very hopeful that the system is realising that more investment in things like family support can avoid a significant amount of cost than it's worth the upfront investment.
Loius J.: So it is critical. We are focusing on it, and we're hoping the system—you know, we're kind of going where the puck is going on that. Mm-hmm.
Hanh Brown: Thank you. Thank you for your thoughts on that. And I think it's great what Hebrew Life is doing, and I hope more and more will follow suit. So let's talk about affordable housing with services.
Hanh Brown: Okay. So, How do you feel about living in an affordable home without services? And I guess, do you think that the people who live there need help with various things like transportation or getting groceries?
Loius J.: I do. So first of all, there's a huge shortage of affordable housing for seniors in this country. But to the extent that you have the ability to get into an affordable housing community without services, it certainly is a step in the right direction.
Loius J.: There's no question that there's a benefit there, but it is totally incomplete. People who live in affordable housing have the benefit of having a roof over their heads that's affordable, but to the extent that they're in a community that's not offering them help, they are quickly In our research, in our estimation, and in our experience, they are going to deteriorate more quickly than they would if they had services, and they will end up prematurely in a nursing home because there is not an excellent model in this commonwealth anyway.
Loius J.: And in many states, there isn't really an excellent model of affordable assisted living. So if you have money, you can go into independent living, then assisted living, and then long-term care when the right time comes. If you don't have money and can get into affordable housing, the road to a nursing home is much quicker.
Loius J.: So there are a significant number of services that we find really bring the equivalent of the triple aim of healthcare, which is better health, a better life, and more cost effectiveness. And it supports the activities of daily life. But it's also encouraging people to be active if food services, uh, good nutrition, exercise with somebody who can actually help you and motivate you
Loius J.: One of the things that we have in our housing is a programme getting back to purpose and the extraordinary importance of purpose. We have a programme where we sit down with residents and talk to them about their lives and what their goals are going forward. Oftentimes, people who are over 90 say, No one's asked me about my goals for 20 years.
Loius J.: But you talk about goals, and a classic one is, You know, I'd love to go to my granddaughter's wedding in Denver in nine months, but there's no way I could imagine having the physical ability to do that. So we say, Well, how would you like to dance at your granddaughter's wedding? And you know, the answer's like, Well, that would be crazy.
Loius J.: So you established that as a goal. And then it leads to a focus on nutrition, exercise, and socialisation that the person didn't have the motivation to do before because they didn't really see the purpose. So the services that can be available in affordable housing that we very much promote and have done a lot of research around include all those things: activities, but also health, wellness, and, uh, navigation of the healthcare system.
Loius J.: We talked about the importance of navigation when somebody has dementia, any older adult, particularly in affordable housing where they oftentimes don't have the same robustness of family support. They need that navigation. Uh, we've had our Vitalized 360 coach, which was what I described before, sit down with people and ask them about a health situation.
Loius J.: And they would say, Well, my, you know, elbow is really bothering me a lot, but don't worry about it. My daughter's taking me to the emergency department next Tuesday. Mm. I mean, right. So just that kind of navigation and re-steering people to going to a doctor or having the physical therapist come and look at them, but going to the emergency department next Tuesday, that just says it all.
Hanh Brown: Yeah. I love what you said about finding the seniors and why, like you said, she wanted to go to her daughter's or granddaughter's wedding. Right. And now that you know why, how are you going to get there? How are you going to help them move or get ready for that reason or that purpose? So I think that's wonderful, and you know, it takes a serving heart to care and to want to do that because I'm sure you have hundreds to look after.
Hanh Brown: Right
Loius J.: Now that we do, we have about 2,500 people who we care for in a variety of different settings. And our staff is extraordinary in that they really do look at every resident as an individual and, um, look to Really coach them up to be the best person they can be, physically and cognitively. One of my early experiences, you know, I won't tell you the long version of this, but one of my early experiences, uh, coming out of business school, was that I worked for Parker Brothers and, uh, in the game business, and we did a lot of work with the Children's Television Workshop, and they talked a lot about Sesame Street and Muppets and how the focus of the Muppets is that many people go to Muppet movies and they think how smart these people are because they put all this adult humour in so that parents won't mind bringing their kids to a Muppets movie.
Loius J.: So we complimented them on that, and they said, That is so wrong. Um, everything in a Muppets movie, including the two men in the balcony who have a little bit of an off-colour sense of humour, is for the kids. And the point is that parents and teachers, From their perspective, underestimate the ability of children to really understand situations and things like subtleties and sarcasm, and everything in those shows is for the child's development.
Loius J.: And Hebrew Senior Life has the same view of older adults: that they have much, much higher capabilities than most people give them credit for. And that is key to the health and wellbeing of all of the people we care for in their families, to help everybody be the best that they can be. If you don't mind me borrowing a term from the Army, that's, uh, and people appreciate that.
Loius J.: People want to be, whatever their situation is, at the top of their abilities, and we really encourage them to do so and help them do so.
Hanh Brown: Absolutely. It's the same thing that you and I would want. You know, we're all going in the same direction. We're all going to be declining at some point, wherever the decline is.
Hanh Brown: We still want to perform to our fullest. So I think it's great what you're doing for the seniors, and yeah. So I know you mentioned some of the roadblocks, but I guess what has been the biggest roadblock in affordable senior housing? Services and things like that? What? What's been the roadblock?
Hanh Brown: Other than that, it's not enough.
Loius J.: So the biggest roadblock is a very simple one. Actually. The federal government wants to be as effective and cost-effective as possible. I believe that the challenge in this topic is that we have HUD, which funds housing; We have Medicaid, which funds services for people who can't afford them at that age; and y wehave Medicare, w whichpays for hospitals,emergency department visits, and other healthcare.
Loius J.: So if there were one payer that was responsible for all of that, the wisdom of investing in prevention to save money on the back end would be obvious. The problem is that we need HUD to spend more money on services so that Medicare can save money on hospitalisations and Medicaid can save money on nursing home costs, and it's disconnected.
Loius J.: So we have been working very hard for the last five years. We were funded. Research project by the Massachusetts Health Policy Commission and demonstrated the savings that can be generated. And we are working hard with the state government, which is very progressive and helpful in Massachusetts, on ways that we can try to get this financial challenge fixed.
Loius J.: You also have people in the buildings who have a variety of health insurance, and more and more people are on managed Medicare, or in PACE programmes, or in senior care option programmes, which are in Massachusetts. So there are health insurance companies that are very focused on caring for people globally.
Loius J.: And we have, we have demonstrated to them this value and we are getting payments from insurance companies like a per resident, per month fee in order to provide these services cuz they know it'll keep people out of the hospital. So that has been effective. Uh, the problem there is that we have in a building with one of our building communities has 500 residents and there's, you know, a hundred different flavours of insurance coverage that they different that they have.
Loius J.: So you don't have a critical mass where one insurance company has a significant number of people and you can actually have a good funded programme. So it's, it's, um, it's very haphazard negotiating with a variety of insurance companies on the 20 people or the 15 people that they might have in the building.
Loius J.: So, really, the flow of funds is the biggest barrier, and we're figuring that out.
Hanh Brown: Yeah, very true. I mean, we can't continue to work in a silo, right? It's all intertwined, and everybody's got a role, but they're not separate from each other. Right. It's a village. It's a whole nation that has to come together. I guess making it more cohesive for the seniors, and that's you and I and everybody else that's breathing and it's on their way,
Hanh Brown: So let's go into the specifics of continuing care retirement communities. Okay? Yep. So first of all, you know, what is it? What services do the CRCs provide? And what do you think we should look for in a life plan community? Right,
Loius J.: So, continuing care retirement communities tend to be very different from affordable housing.
Loius J.: Continuing care Retirement communities are communities that typically have a full continuum, where you have people moving in who move in to independent living, which is very independent. People could live in independent living and take advantage of, you know, eating in the dining room, going to movies, and other things that you might think of as almost like a resort.
Loius J.: Um, and not really take advantage of any of the healthcare services because they may be still working and functioning totally. Um, totally independently. Then you also have campus assisted living, where there is another level of care and a community of people who are similarly challenged, either physically or cognitively, and there is a higher level of staffing.
Loius J.: Uh, there is typically, um, an hour or an hour and a half of services that people would get. Uh, it's not as much assistance as oftentimes people think when they move into assisted living. And there's a lot of effort to try to educate people on what that is. And then there's also typically a long-term care facility on the campus where, when people get to the point where they really need a much higher level of care, they will then move into long-term care.
Loius J.: The community may or may not have memory care. In one of our communities, Newbridge on the Charles, we have a significant amount of independent living in different types of apartments. We then have assisted living, which is both traditional and memory-based. And then we have long-term care, which has neighbourhoods that have different levels of cognitive decline.
Loius J.: So there's totally, you know, no cognitive decline. There's moderate, and then there's also a locked unit where people really need to be protected much more. So. So all those levels exist, and typically there isn't, um, insurance support for independent living or assisted living, but once you get to long-term care, there is, you know, Medicaid support if you need that.
Loius J.: Mm-hmm.
Hanh Brown: Mm-hmm. So now let's say how much. Do continuing care communities incur costs through those, you know, varying levels of care? Right. And how does someone pay for this? How much and how do you pay for this?
Loius J.: Yeah, so it really varies dramatically in cost. Uh, in independent living, generally the model is that you move in and there is an entrance fee that you pay.
Loius J.: And typically, people are selling a home. So they have some funds. They then pay an entrance fee, which could range from a few hundred thousand dollars to, I've seen cases where it was 2 million. So it really depends on the community and what kind of apartment you're getting. So just like any other living environment, there's quite a range.
Loius J.: The philosophy behind the entrance fee Is that an opportunity both ways for the resident to put down a significant amount of money and have what is referred to as kinda wealth protection? Um, because typically the entrance fee is paid, and then a significant portion of that is refundable.
Loius J.: When the person leaves the campus, either they decide to move elsewhere or they pass away. So the family has the benefit of, you know, let's say it's $500,000, and they enter into a contract that's 90% refundable. The family knows they're going to get $450,000 back. It's not going to appreciate that necessarily, but it does protect that from the organisation's perspective.
Loius J.: They get that money, and they're able to invest it. Um, and the organisation is in a PO position where they can invest it more aggressively than a 90-year-old would probably invest it. So there's actually an arbitrage opportunity there where the organisation's getting more out of that money than the person would.
Loius J.: So it's, um, it's actually mutually beneficial. And then, by paying that and having the organisation have that ability to make money, it keeps the monthly fee lower. So if you didn't pay an entrance fee and the organisation didn't have that interest, then the monthly fee would be much higher. So if you look at a community that, let's say, is in that 500,000 to, um, you know, even a million and a half dollar range for entrance fee,
Loius J.: The monthly fee would then be, you know, three to $5,000 a month. Uh, and it covers everything. It covers food, it covers activities, and it covers You know, property taxes are in, so snow removal in this community So, you know, when you look side by side at that monthly fee and the cost of the person actually living in a home, it's actually not bad.
Loius J.: It really looks very good to people. So it's a nice model where you have this wealth retention plus a monthly fee, which is perhaps not dissimilar to what they would've spent otherwise or less than what they would've spent otherwise. Once you go to assisted living, the fee is much higher because there is a higher level of care.
Loius J.: So, you know, in this community, assisted living could cost between $8 and $11,000 a month. And if it were memory-assisted living, it could be even a little higher than that. Then once you get into long-term care, it's, you know, the daily fee can be, you know, $3 to $500 a day. So that gets incredibly expensive.
Loius J.: Uh, but mass health in this market—the Massachusetts Medicaid, you know—does pay for that. And also, long-term care insurance, uh, typically, depending on the policy and all, will pay for assisted living and long-term care. Mm-hmm.
Hanh Brown: So basically, what you said is that with regard to independent living, there's an entrance fee, a large one, and there's no assistance.
Hanh Brown: But when you move into memory care assisted or long-term, there's assistance; whatever that percentage is, it's dependent on how much you pay for your long-term care insurance.
Loius J.: Exactly how much would that payment be? And, you know, on the independent living side, there are supports that are not dissimilar from what we described in affordable housing.
Loius J.: There is, you know, medical practise on site; we have physical therapy on site. Uh, we have. We have a lot of services available to people, but they're not obligated to take advantage of them. They don't generally need it in a big way, but it is available to them, so they know it's there.
Loius J.: Mm-hmm. Mm-hmm.
Hanh Brown: So now how do families know? What are some key signs that it may be time for CCR or Continuum Care?
Loius J.: So, that is a great question, and I spent seven years working in an orthopaedic hospital, New England Baptist Hospital in Boston. And 99% of the people I talked to had a hip replacement, not to compare senior living to a hip replacement right away.
Loius J.: But 99% of the people who get a hip replacement say the same exact thing. They wish they had done it sooner. And I find the same exact thing true for people who move into A C C R C at the independent living level. Most people look for It being a need, Mom or dad need this because they're physically, you know, declining; they're cognitively declining; there's a need that's developed.
Loius J.: And the first answer to your question is that people should be thinking about this kind of community before they need it. Because people that come into these communities when they are, let's say, in their late seventies or early eighties and totally healthy, like, have no needs, They come in, they meet people, they socialise, and they develop a new community, which they never imagined they were going to have at this stage of life.
Loius J.: And because they're healthy and well, They are optimising their ability to make those connections. And as time goes on, as things do start becoming more of a challenge, they have developed this new support system of friends and activities that is amazingly helpful to the person who's declining and the spouse who's not as far away as a support system.
Loius J.: So, my first answer is to think about it before you need it. Think about it before you start seeing signs. Certainly, once you start seeing signs of, uh, a physical or cognitive challenge and you can see that there are going to be more supports necessary, there is a significant reaction oftentimes, particularly by adult children.
Loius J.: So let's say the The patient, or, uh, the resident we're talking about, does not have a spouse anymore. It's so common that children say, You know, I told mom I'd never put her in a home. I told her I would never, because, you know, she wants to live at home. She wants to, you know, stay home. This is her environment and everything.
Loius J.: For many people, that is fine, but keep in mind that staying home when adult children are, let's say, having mom or dad move in with us, you're going to work. And mom or dad is alone all day, and loneliness is the new smoking. I come across so many people who stay at home as long as they can because they think it is the right thing.
Loius J.: They do. They, they, that's what they always promised mom they would do. And when they finally move into a congregate setting and see the benefits of socialisation and support, They so wish they had done it sooner. And oftentimes people have said to me, Mom, you know, three months later, it's like, mom went back 10 years.
Loius J.: You know, she's moving again. She's talking again. She's smiling again. We've had people move into our communities. We had a person who moved into one of our communities about seven years ago, and she went to the dental clinic and asked if she could get her teeth straightened. She was 88 years old, and she wanted to know what we could do to straighten her teeth.
Loius J.: And we gave her some advice and talked about it. And the technician actually said to her, So I'm just curious, why? How long have your teeth been this way? And she said, Oh, for decades. And she said, Why are you wanting to do this now? And she said, It's the first time in 15 years that I've been around people.
Loius J.: I want to socialise, I want to talk, and I want to smile. And I care about how my teeth look, and I haven't been in situations where I have cared for the last 15 years. And that was great. I mean, that just said it all about the benefit of being in a more communal setting. So
Hanh Brown: Yes, they have a purpose.
Hanh Brown: They have pride in how they look, communicate, and engage with others, just like you and I. You know, there's this notion that as you age, in the later years of, let's say, your health, somehow your goals in life are different. No, they're the same as you and I, and again, every time that I say the word they, I have to correct myself.
Hanh Brown: It's we. Right. Right. We, there's, I just don't believe there's, they, so everything that my parents or grandparents pass away, my mom has the later part of dementia right now. Their hopes, aspirations, goals, and quality of life are the same. It's true.
Loius J.: Yeah, it's very true. And I, and I think this analogy that I'm creating, I, I want people to take this very seriously, to think about older adults not dissimilar to the way you think about young children, both in terms of their capabilities and all.
Loius J.: One of the things that I talk to people a lot about is that people will never use the term good enough for their children. Never. It's like my kids in school, but they have more capabilities. So I think they should be at this school. I think they should be elevated. I think they should be at a higher level.
Loius J.: We should send 'em to private school. We should. You want the best for your kids. You never say it's good enough. People say that about older adults all the time. Exactly. Mom's safe. It's fine. It's fine.
Hanh Brown: It's good enough. So it's
Loius J.: It's not good enough, and it's never good enough. And you should have that same mentality for older adults as well.
Loius J.: They do have that vitality; they do have that awareness. They have goals and lives. Treat them like you would want to be treated yourself.
Hanh Brown: Absolutely. Absolutely. Wow. Thank you so much. I just want to acknowledge a few folks here. Hey, Michael Mann. Thank you. Thank you for joining in and appreciating that this is a great conversation.
Hanh Brown: So we're going to go to geriatric teaching and research. So what are some common, I guess, misconceptions? And I know we talked about misconceptions about seniors, and I guess what do you think will be the biggest challenges facing geriatrics in the future?
Loius J.: Yeah. Well, the, uh, that is, uh, that is really a scary answer to me.
Loius J.: You know, um, clearly, there are more people who are living longer. There is a higher incidence of dementia among people who live longer. Um, most of the hypotheses I've seen have been Regarding things like high-fat diets, the same reason why there's more diabetes and things So more people have dementia, and more people can't afford it because of the challenges in our society with so many more people who don't have resources and don't have savings.
Loius J.: So people can't afford the services they need as well as they used to as they get older. And the population of geriatric carers is diminishing because it's such an incredibly undervalued and low-paying profession. So you have more people, more problems, less funds, and fewer providers. So unfortunately, that's a bleak picture.
Loius J.: Um, so what we're trying very hard to do to address that, uh, first of all, as far as geriatric education, There will never be an extent to which we continue to have geriatricians being the people who care for people as they get older. Um, there aren't going to ever be enough geriatricians to care for the ageing population.
Loius J.: So one of the big things that we feel strongly about is that more clinicians of all types need to better understand the nuances of older adults and caring for them. If you look at a bottle of aspirin or any other medication, it will give you a different dosage for children under six and children six to 12.
Loius J.: And then it says adults, so it doesn't say
Hanh Brown: 55, 60 plus.
Loius J.: And when people get older, their dosage should change, and it should go back. And so there should be, and that's just one example of how the healthcare system generally treats older adults as one homogeneous group. So one of our big efforts is to try to get the curriculum of all healthcare providers to be more understanding of geriatrics and dementia.
Loius J.: Uh, and geriatricians need to be specialists who are called in, just like cardiologists. Primary care physicians do a lot of work around heart health, but you call in a cardiologist when you need to, and that's with geriatricians. So we're trying to restructure the system that way at Harvard Medical School, and we're very involved with teaching medical school students and, you know, physicians of all types about the nuances and differences in geriatrics.
Loius J.: So, On the education front That's a, that's a big step forward We think it is very
Hanh Brown: important. Absolutely. And, you know, you're talking about seniors that cannot be grouped together, right? There are so many cohorts within Right. seniors, and so forth. I'm 55. My health needs, expectations, and so forth, are right.
Hanh Brown: Are things going to be different when I am between 60 and 65? 70 and 75. So we have to be very mindful when we talk about seniors, and there are many, many cohorts, and we have to kind of hone in on each of the cohorts.
Loius J.: Absolutely. And, and so much also, I would say so much of what we talk about these days regarding diversity and understanding different cultures plays more into the care of seniors as they get older than it does to the care of the generic adult, if you will, the 40 to 50 year old as people get older and as their cognitive ability narrows.
Loius J.: Somewhat, and we think it only has to be somewhat; it doesn't have to be as dramatic, but, you know, there is a natural ageing process. So cognitive ability does diminish to a certain degree. Naturally. People do gravitate back to their roots. What makes them very comfortable People oftentimes want to be surrounded by things that are more consistent with their culture, how they grew up, and things that they really treasure.
Loius J.: So recognising cultural differences in the care of seniors is more important than it is for your, you know, 35-year-old.
Hanh Brown: Absolutely. Wow. Thank you so much. Thank you so much for being a part of this and for just sharing your wisdom and your professional and personal stories. I truly appreciate it. Of course.
Hanh Brown: Do you have any other thoughts that you would like to share?
Loius J.: Well, I think, um, kind of wrapping up, I think the two most important things to remember, honestly, are the idea of older adults and having purpose. No matter if people are living at home, in independent living, long-term care, or whatever, recognising the value of everybody having a purpose is so core.
Loius J.: And then the second thing is then putting people in a position with the proper supports around them to not only establish that purpose and raise that bar as high as possible, but to then achieve that purpose through helping them and coaching them through their cognitive and physical, um, challenges. And having a coach that really talks to them about how they can best achieve that purpose
Loius J.: So having a purpose and then being in the best environment to actually achieve that purpose To me, pretty much everything falls into those two buckets. Mm-hmm.
Hanh Brown: Very true. Very true. Well, if you are a senior or know someone who is, I hope that this conversation was useful to you. We discussed many challenges that seniors face and what they can do about them, and we've discussed several critical topics, including dementia, brain health, affordable housing or services, CRCS, continuing care, retirement communities, and being a supportive family member.
Hanh Brown: So whether you're personally experiencing these challenges or simply want to gain a better understanding of them, we hope that this conversation sheds some light on navigating the later part of life. So the issues that seniors face are many and vary, but one thing is clear: the senior population needs a lot of support.
Hanh Brown: So it's conversations like this that bring awareness, educate, inform, and hopefully inspire you to better support your family members, your parents, or your grandparents. Remember to subscribe to our YouTube channel, Ageing Media Show, where we offer tips to help families navigate the later part of life.
Hanh Brown: And tune in next week and the upcoming weeks, when we will have conversations about healthy ageing, baby boomer retirement, and also building wealth through real estate investing. So thank you so much for joining, and have a great week.
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