we're a high touch people business. There's only so much you can do with some of that technology, but what we can adopt that frees our employees up, our associates up, to be able to actually spend time with the residents and the staff and the family members is huge and that's we're already seeing a lot of opportunity in freeing time up. Welcome to season seven of Bridge the Gap, a podcast dedicated to informing educating and influencing the future of housing and services for seniors. Powered by sponsors AccuShild, Align, Nickmap Vision, ProCare HR, Sage, Hamilton CapTel, ServiceMaster, the bridge group construction and salinity and produced by salinity marketing. Welcome to Bridge the Gap podcast, the senior living podcast with Josh and Lucas. We're here in beautiful Dana Point at the ASHA summer meeting and we have some amazing guests today. We really want to welcome Jennifer Prado, you're the executive director at Senior Housing Relief for Elders, also known as Shor. And of course, we have Sue Ferro, founder of Integral Senior Living. Welcome to the program, ladies. Thank you. Thank you for having us. Well, the listeners are really in for a treat today because we had a great pre-podcast conversation. We're going to be talking about a couple of different things and who knows, Josh may chase some rabbits, as you say. We may go down to a different trail, but we're going to talk to Sue about some history of the industry and get your background and your thoughts on kind of where we've come. Also, if we have time, I want to talk about where we're going, love your perspective there. And then we're also going to talk about you're not-for-profit sure. So, Sue, starting with you, how did you start? Where was the first start for you? I wonder if I should tell the whole story. Yes, you should. Okay. It was 1975. I had just moved to San Diego. I was an accountant and I was looking for a job. And I had a couple offers come in. One was from a young attorney who had a small office. I was single. I was pretty good looking at the tab. And I had this sense that that there might have been more expected from that position. So, luckily, or divinely, I should say, the other offer was from Danny Campbell with Camley Retirement. And he had opened up an office in San Diego. There were originally out of Wenatchee, Washington. And so, I took the job. It was less money than the attorney. But I took the job. And Danny is amazing. Danny still lives here in San Diego with his wife. Danny loved the art of the deal. And his dad Carl is the one really that had the passion for seniors. And I'll tell a little story about kind of how the industry got started back in Carl's day. But Danny loved the art of the deal. He didn't so much love operations. And so, in the middle of my doing financial statements and all the rest of it, he's like, "Would you call those administrators over there in Phoenix and talk to them about this or that?" And I was like, "Sure." I'm 25 at the time. That was in the days when we hired him. There's been a wife who were middle-aged. So, I'm a little start-up pup going, "You need to do this. You need to do that." But I fell in love with operations immediately. Immediately. And I've never looked back. For me, the beauty though is having that accounting and that number's background. Because for me, the numbers tell a story. And so, it's a nice mix certainly. But that was kind of the start of it. And I worked for Danny and Carl for 16 years. They were going to close up their San Diego office and move everybody to Wenatchee and said, "Please come soon." I said, "San Diego Wenatchee." I just didn't seem like the right thing to do. So, yeah. So, I've been in the industry ever since. Not for that many players, actually. After Camille, I worked for Transamerica. Actually, their real estate division had a large senior housing portfolio, which I operated for them. And they were going to stay small. And I think my intention was to be with something monitor. And that's when I went to work for Sunrise. And was the senior VP of Operations for Everything West to the Mississippi, which sounds so impressive. That was when they had two. But we quickly built. I mean, now they're pretty much on every corner, aren't they? What was that ride like? That ride was fast and furious and exciting. And we had done a lot of development at Camille. But what I hadn't done was site selection work. And, of course, Sunrise had a huge development arm. So, it was a lot of time spent looking at sites all over the West, which was just a kick. And actually, Rocky Goins, who was with Sunrise development at the time, is one of my partners in my development company, which is a whole different story, but won't get into that one. But basically, the Western Division of Sunrise kind of started ages. So, I was the founding COO for ages living. And then by that time, I think probably, for me, all the pieces were together now, being in a company starting it up from the beginning. And so, 22 years ago, I started my own with one little management company. And last year, I think we were ninth largest in the industry. So, it's been quite a ride. You've done a thing or two. A thing or two. And, you know, I mean, we probably don't have enough time today to ask you all the questions that immediately are coming into mind in Lucas's heads about, you know, even through all that infancy of an industry and the growth of the industry and how much it's evolved and changed through all the different economic cycles and presidencies and all the things that directly or indirectly kind of force us to change and adapt and how relevant that is to a younger generation of leaders that are coming in and thinking, how do we make this work? How do we weather these storms? And so, I would imagine that's equipped you to be able to really breathe some life and to young leaders that I'm sure you're nurturing and cultivating. So, you know, one of the questions that comes to me with everything that you've accomplished and what's one of the things you find the most joy in now after so much success and how do you spend your time today? How does that look different than maybe 10, 15 years ago? Oh, a lot different than 10 or 15 years ago. About the time you hire in a president's CEO to take over that role. I've always been a believer if you're going to put people in those roles, you let them do it. You don't hover over them. And so, collect great as our president's CEO and she's fabulous. She's probably been on your podcast before. If not, she hasn't, she's on our list. Okay, good, good. Maybe you can get us an intro. I probably can do that. So, a lot of my work now is what it was before and that's new business development. I gave myself my own new title. I'm the chief cheerleading officer, right? You know, you just got to keep the troops feeling good. And even in times that are tough, you just got to be back there cheerleading. So, that's a lot of my work now. We're still in a huge integration, of course, with discovery and trying to combine systems and people. And it's a lot of heavy lifting. So, now, you know, where I know here at ASHA, it's just getting started. We're getting to talk to you on day one. And it's always really interesting for me and Lucas to be able to participate, not only to podcast, but to be in the panels, the outbreak sessions and the keynotes and hear these amazing thought leaders, even like yourself, kind of help us understand where the challenges we're facing, how we go about navigating those. And I know you're going to be speaking into a lot of people's lives and their businesses and their thoughts while you're here. So, what are some of the themes that you think will be talked about here at ASHA? And where do you think we're kind of headed as an industry? What are some of those themes that come to mind for you? A number of areas. I mean, everybody talks about how we are not exactly early adopters of technology. I also believe at some point in time, we're a high touch people business. There's only so much you can do with some of that technology. But what we can adopt that frees our employees up, our associates up, to be able to actually spend time with the residents and the staff and the family members is huge. And that's, we're already seeing a lot of opportunity in freeing time up. It's hiccups. I don't like being a beta tester and I have been in the past and it's not usually very much fun. But I love seeing at these conferences more and more tech people come with more and more great ideas. So it's certainly a big, it'd be interesting if we're sitting here at 10 for years from now and seeing really how technology has changed us and I think the opportunity is certainly there. I think, I'm probably going to say something that people want like, that's okay. The whole push towards a more active lifestyle for seniors, which God bless, I can move into one of those today. I'm not fond of the term active aging. For me, it brings up versus inactive aging. I don't really get what that means. But I do see this whole opportunity and we've actually been working on some kind of structure around it, a huge opportunity to attract a younger population in. And by the way, when we were operating in the 70s, our average age was 75. So we have come along in this period of time, our average age pretty much even in our independent properties right now is 84. So to go back and try to recapture that age group again, developing communities that certainly have all the amenities that we're seeing. But also probably the rest of it is pretty much ancillary. So aligning with an uber-type system at some kind of discount that residents can purchase to create. I'm just going to go build this. I shouldn't say it all right. It creating a whole office executive suite kind of situation that's manned so that our folks that are still working have an office to go to. Even thinking through the whole dining piece of it, the amount of square footage we built into dining rooms in these communities that are used what a fraction of the time during the day, being able to even create a scenario like a, like a, I can't remember some of the services, the food delivery services, but that you actually deliver prepared meals up to the residents. Again, come back to living type situation, not a license building that's got a whole different set of requirements to it. I think that's a way in the future. I want choice. Guaranteed the baby boomers are going to want choice. So I don't want to come down to a dining room three times a day. Somebody in a kitchen produces some kind of go-to meals for me to take. I love it. I love it. So there's a lot of that kind of innovation I think is coming. We're having more and more fun with designing buildings and meeting current needs. I constantly, I start to say threaten, but that's not the word. I constantly encourage our folks to think about what somebody my age is going to want when they move into one of these communities. So that kind of guides as we're working on designing buildings. So yeah, there's a lot coming from a physical plant perspective, coming from technology, coming from the changing market and one our baby boomers going to want. There's a lot. I think one of the things that's been so exciting about this industry, unlike maybe other industries that are, I don't know if you're making widgets, maybe there's some innovation with widgets, right? But the way we're working today is so dramatically, thank God, different than the way we were working 49 years ago enough. If anything bothers me, it's that I'm not going to be around 40 years from now to see how much more it's changed. That's exciting, constant innovation. It's exciting. Well, and you touched on something just out of curiosity. I think I was hearing you say when you were talking about you didn't, you weren't really crazy about the term active aging and you're active adult is the right? So and you're crazy about active aging. Okay, active adult was the term then. So and you were talking about, you know, all these emerging models and things like that. Would you think that, you know, it seems like the regulatory environment for those licensed healthcare communities, they're obviously state regulated and that's a little bit different in every state. Some's more favorable than others, but it seems like the traditional senior housing, as we know it, continues to get more and more regulated, which even on the life safety code, which is kind of putting traditional senior living as we know it into this acuity box, which is kind of forcing a one group of owner operators developers into one category. And it seems like a lot of those traditional senior living providers are seeking to go lower down the acuity spectrum and going into the unlicensed building types and getting creative. Do you see that our industry senior living as we know it is starting to move towards a more unlicensed model? Or do you still think that the majority of senior housing as an industry will continue to be majority licensed type communities or something in the middle? There's always going to be a place for licensed communities. You know, if you're if you're in unlicensed independent community, you really can only go so far with home health or allowing in private duty aides and not really having control over those various folks. So there's always going to be that need and and yes regulation changes and yes, every time a horrible story comes up, we all probably get visited by our regulators more often, but there's always going to be a need for that, especially as our acuity rises in assisted living in memory care settings. What what has changed and I think a lot of people maybe maybe don't know these times, but even here in the state of California, if you were an independent unlicensed community, you could not have a a home health care agency come in and occupy space in your in your community and offer services to residents. You were considered then an unlicensed assisted living community, basically. So that is all changed. Now I'm not saying it's all changed in 50 states. We're in 24 states right now, but we're seeing that more and more. We operate 32 communities under our solstice banner that are all old holiday. I shouldn't say old like they're falling down, but older legacy buildings legacy. Oh, that's wonderful. That's what they are. They're 32 legacy buildings and we have a home health care agency based in each one and their arm's length. We don't we don't own them, but we're able to provide the services that you can find quite frankly at a lower price point, then a traditional assisted living memory care community. Okay, so that brings up affordability. This is a rabbit I want to chase now, just talked about, you know, a more affordable, more attainable. So we have, and I'm sure you've been hearing this, you know, the the older adults they're coming this this demographic is coming. I've been I've been at this for 15 years and for 15 years, I've heard they're coming get ready. They're coming. It seems like now they really are. Am I right? Over the next five, 10 years, they're probably dribbling. Yeah. Sage is ushering in a new era for senior living with its unified care platform. Use the app to coordinate care and shorten response times improve team performance with real time data and provide families with the transparency. They need to know that their loved ones are safe. Communities using Sage see a 53% reduction in response time, a 40% reduction in caregiver churn, and an additional $250 of net operating income per resident per month. Embrace the future of senior living with Sage. Learn more at hellosage.com. I thought of my friends and I suddenly moving into which, sorry guys, if you're counting on all of us, I'm not gonna happen anytime soon. But again, probably the need for that new design of community, like what would drive someone like me or my friends into a community. And it would be changing the amenity packages and it would be a change in choice and services and it would it would just have to reflect how active our lives really are. And I'm sure the active adult. Okay. So there's that piece, right? So what about a whole group of population and demographic that look, they just don't have the savings. But they still want, you know, a great place to live out there years is there. And I've heard many people on all of these panels that we go to. It just doesn't seem like anybody's really cracked that egg on affordability. And maybe technology is the thing to come in and change that or streamline that or there's an arbitrage there somewhere. I'm not sure. But I'd love to get your thoughts on next five, 10 years, what, who can build an affordable place for people to live and win at that? Yeah. Well, I think some of the older communities actually play a part in that as well. And again, these 32 solstice communities are a really good model for future baby boomers, right? Those older communities were built with a lot more square footage than current, of course, land prices were a lot different, right? I mean, there was a whole lot of reasons for that. But the space is more generous with certain amount of capital put into them. You've got the requirement, at least, for the larger size apartments and those amenities. Again, it's kind of bringing in the services as well. So that's certainly an option. And you're hearing that a lot, right? You're reading the literature. So there's a lot of that already. People approaching that. I think there's got to be more of that kind of building. It's a conundrum. And you hear a lot of people talking about it. I'm not sure I'm hearing that many solutions to it. But hence, sure, which I know we're going to talk about, and that's the whole point of the nonprofit, is that whole group of people that's not going to be able to afford what we know is an amazing lifestyle and quality and prolonged life. And so I think there's going to be other ways around that. And that's, I think we've got to convince, push, embarrass, whatever you need to do with various agencies to start to subsidize. We're seeing it with the VA a little bit right now. The willingness to look at subsidizing veterans in system living communities outside of the veterans communities. More needs to be done. We see the Medicaid waiver program in many, many states we operate. But the reimbursement rate is not enough to cover the cost of doing business. And that's a misnomer, I think, for the public. I think people think there's a lot of people out there making a lot of money off of these communities. And it's a very expensive business to run. And certainly gets more and more expensive as, you know, my wage rises and food costs and all the rest of it. So there's got to be the opportunity to influence states, the Medicaid waiver rates. But I also think Medicare needs to step up and step in. Well, you know, and that's a great segue to a couple of conversations that I want to continue here. You know, and obviously we're at ASHA. What a great organization to help rally us together to bring one voice to these agencies and to Washington, to legislators to improve our industry. So we're so thankful for our long term media partnership with Dave Schles and his organization here at ASHA. They do just a phenomenal job. But you give us a great segue to shore. You know, give us a little bit of the why behind that, which I think you alluded to there. And then what's going on there? What are you guys doing? Yeah, I'll let Jen talk about the what we're doing, because I'm cheerleading still, right? Jen's in the grassroots and nitty-gritty of it all. So you can't spend that many years in this business and not be affected by people that come to your communities that just can't afford what you're doing. You can't, of course, I want to fix it for everybody. I want everybody to find their spot. And we do the best we can with referring folks to other communities that might be more affordable to them. That's just one element of it. The folks that have lived in our communities that spend down their assets as an operator, what's your choice? You know, I'm one of seven kids. Everything has to be fair. So you can't just subsidize those people in your communities and not give a break to every other resident in the communities. So, you know, how do we keep them in their homes that really was the basis for sure. It's giving back, first of all, because this industry has just been so amazing to me. So we started tackling it a little at a time. I had a wonderful advisory board when I first kind of floated this idea, and they were amazing, and then formed the board. And with Vicki Clark, an industry icon, and some other just great folks. And these, you know, I think I'm going to go big, like, right, right away, go big, right? And they were like, okay, let's start small. Let's do something that we can, that we can wrap our hands, arms around easily, and then we can think about conquering the United States. But right now, let's just kind of stay small. And so initially, we took on the Veterans Aid and Attendance Benefit program, because it's something it's established. It's something we could get our arms around. It's something certainly that a lot of residents in my communities have access to that benefit. And so, kind of started there, started in San Diego County, again, just so we could get our arms wrapped around it a bit. And, but it also didn't want people, and this is the thing that Jen and I talk about a lot. I don't, I don't want people to think this is just a Veterans non-profit, there's a non-profit just servicing Veterans. It hopefully, ultimately, is a non-profit that helps folks all over the US, be it veterans or non-veterans or any background, quite frankly. It just was, that was an easiest, an easy place to start. I'm all at Jen, give the kind of ass. Jen, a bit over here eating popcorn, just listen, thinking it all in. I'm really loving this, loving this. Really, our vision is just to ensure that, you know, everybody has access to senior housing. That's really what Shore's vision is. And we really target this private pay family that didn't, you know, anticipate senior housing, doesn't have, you know, funds to enter in. Maybe somebody who is in a community has spent down, and needs to stay, we're trying to solve that problem and fill that gap. And so we do that in a variety of different ways. Like Sue mentioned, the Veterans Fund is one that we target. We actually subsidized two months of the pension benefit for a veteran so that they can enter a community. And that's where we found the gap, right? It's like you want to go into a senior living community, but you can't afford it. You can't afford the first month rent. You don't know when that money's going to come in, so we help subsidize that. It's kind of our focus. It's a great bridge. Yeah. Huge bridge, because that benefit takes a little while to get as well, even if you kind of almost, for lack of a better term, kind of pre-qualify them with understanding if they're even going to be able to be eligible for that, right? Yeah, and here's my next one. A great segue for that part is we, it's like, you know, you need to file for bankruptcy, but you can't, you know, for the bankruptcy attorney, right? And so, you know, I think like 13 or 16 percent of people are even taking advantage of this benefit across the nation. And so we thought, okay, well, we got to solve even that problem. How could they get the benefit so they can get into a community? And so we partnered, I think you've had Suzette with Patriot Angels. Absolutely. So we have launched a very new partnership right out, hot off the press, where we're actually going to be helping support folks who need to take advantage of her services, but can afford it. And so we will cover those services for them. We've done that through another organization through aidandattendents.com. And so we're really just trying to find where's the gap, and we're trying to fill it so that you can get into a senior living community. Wow. That's great. It's such a great service and great benefit. And, you know, I think that's why, and we so appreciate you all getting on the show and sharing this. This is because this is not a problem. I don't think that any one provider or one organization necessarily or one person, one great leader is going to fix. It's a catalyst to rally everyone together. And great meetings like this and a podcast is a great way to talk about that because people need to come alongside what you're doing and join that because it's always better together. And we can accomplish so much more than what we could just kind of off trying to do our own little things, right? Yeah. And I've had so many conversations with operators like you're doing what? You're giving money. Yes, we're trying to help these private-based seniors who didn't, you know, anticipate this, get into your communities because they can't without our help right now. And so having to really educate and do the outreach, and they really do think it's a good cause. But I agree with you. I think it's an industry kind of thing where everyone has to understand the importance of it. And I think that's what you're trying to do is trying to educate the importance of that gap. I think a couple of things have... Well, there's a number of things that have initially... I think initially people thought I started this just kind of as an arm of my company to get more seniors to move into our communities. And that's far from... Jen can tell us, I mean, we've moved people into Brookdale communities. Maybe she can give us a bunch of the folks that we're moving in. But we also found it was hard to give away money. The hardest... People didn't believe us, I think, or thought there had to be some kind of catch to it or... Yeah. And don't get me wrong. We're helping operators, you know, our biggest grantee right now is Brookdale, and we're having these conversations. We're just kind of creating awareness of we're here, and this is what we're doing. But there are operators who are doing philanthropic work. And so, you know, let us be a partner with you and let us help your future residents, but also help us work through this work for years to come. Yeah, well, and I've heard of operators out there that see the same problem, right? I think none of us are ignorant to many of those challenges and problems, but it's like, how do you tackle it? And I've seen operators doing creative things of trying to even they expose themselves to some of the risk and say, "Okay, well, we think you're eligible. Maybe we'll write a promissory note or something to try to bridge the gap to allow you the runway," but then sometimes that maybe comes back on them or their ownership structures won't allow them to do that. So there's it's challenging, even if you want to. It is. It's a risk. And so that this is also trying to help mitigate the risk for those communities, because I mean, even in communities in my company, if somebody moves in and looks like the veterans going to get those benefits could be 60 to 90 days for those to kick in, you really are anticipating that that retroactive check is going to come if that veteran has to go into a higher level of care and and leaves prior to that 90 days or them forbid passes away or just moves out by their own desire. That community is out that amount of money that they basically subsidize that about veteran. So it's it helps mitigate the risk for those communities. Yeah, and if they have the problem, you know, they have somebody that's never spent down. We want to be the call they make to allow somebody to stay for extended amount of months. You know, if that's we can't solve big problems, but we're trying to solve the little ones little by little. So that's meaningful. So so what does Shore need today? Like where what what's the goal over the next, you know, year two years, five years, what what does Shore need? I need podcast opportunities like this. No, no, yeah, no, definitely. It's just creating awareness that we're we're there. We are your partners to do the work that you're trying to do, get residents in, keep residents in. I definitely just think it's understanding that you're going to work shoulder to shoulder with us to do this work for years to come with that whatever that may look like opportunities to speak to this, you know, opportunities to advocate for policy change at some point. We would love to do that. And then in the in the future. So that means medicaid waiver problems can help, you know, more. We have a lot of dreams, hosu, big ones, big ones. But we are we're small fish still and trying to get our name out and do the and talk about the good work we're doing. So this allows me to do that. Well, Lucas, what an awesome podcast and story. We've just scratched at the surface, but a pioneer in the industry continues to pioneer in the industry. And it's so cool to see this being formed. And, you know, bridge the app is lucky to be able to share stories like this. And we hope our audience will connect. I mean, it's such a great resource. It is. It is. So for our listeners out there, if you enjoyed this conversation, we would invite you to be a part of it. You can scroll down into your podcast notes right there. We're going to have connections to shore and to Jennifer and Sue and all of her companies. And you can connect with them there. Go to btg voice.com connect on this content and so much more. Catch us on LinkedIn. Be a part of the conversation. Sue Jennifer, thank you so much for your time today. Because this is great. Yeah, it is. I do kind of feel like I'm in your living room. There we go. Yes. Yes. It was a great conversation. I learned a lot. Enjoyed it. All right, Josh. This is our sign off here at Asha podcast down and so many more to go. Thanks to all of our listeners for listening to another great episode of bridge the gap. Thanks for listening to bridge the gap podcast with Josh and Lucas connect with the btg network team and use your voice to influence the industry by connecting with us at btg voice.com.
