Navigating Retirement Communities Featuring Care Patrol

SPEAKER_02 0:00

Welcome to Ask Dr. Mia Answers on Dementia Caregiving. I am your pocket geriatrician and memory specialist. When I was helping my mom with her cancer journey, I knew I wanted to be her advocate and her care partner. But I didn't expect to have to rehash old patterns of communication like a teenager. Combining my knowledge as a specialist for older adults and my own experience as a sandwich generation care partner, I am here to empower you to take practical steps to not only care for the older adult in your life, but also take good care of yourself. Welcome. Welcome back to Ask Dr. Mia. And today I have both Gina and Allie from Care Patrol joining us to talk really about the transition to a retirement community. They are part of a company called Care Patrol. Care Patrol is a it's started by Gina Gordon. She is a nurse who has over 30 years of experience in healthcare, and she opened Care Patrol of Winston-Salem, North Carolina, to better support families navigating senior care decisions. She is part of my ideal listener as the sandwich generation caregiver, daughter of her aging parents. So she understands the client's experience on a personal level as well. And Allie Spangler, she's an occupational therapist. Prior to joining Care Patrol, she's worked in a number of different healthcare settings, primarily serving geriatric patients in acute care, long-term care, and inpatient rehab. So she really has had a lot of experience in guiding individuals and families through very complicated care transitions. And at Care Patrol, Alley helps each of the families that come through with understanding and empathy to really guide them through what can be a really challenging time. So the two perfect people to talk about care transitions with me and welcome to the podcast.

SPEAKER_01 2:21

Thank you. Yeah, we're happy to be here. Thank you for the opportunity.

SPEAKER_02 2:25

Absolutely. So let's let's jump in because I know that nobody really wants to move to a retirement community, but oftentimes that is the reality. What have you seen in terms of helping families consider a move? What what what are might be some common mistakes that you wish more families would know?

SPEAKER_01 2:47

Um yeah, I mean, it's it's it's interesting that we have several different types of opportunities of where we start with families. And so we always like to start as early as possible, right? So that we can have those conversations and have a plan. So it's a more planful conversation versus a reactive uh time in someone's life. I will tell you that probably, you know, Allie probably has a number in her head and I do, but probably percentage-wise, the majority of families that we work with, it's reactionary. So it's because of something. And so our approach is more of at what point, where are they in that trajectory and in that progress toward making a decision? And the more thoughtful and planful decisions we can help with working through some of the mistakes that often are made in terms of selecting an appropriate care community. But when it's reactionary, sometimes we just have to get to work faster and narrowing down those options and making sure that we we target the right care level. So, where where are we and what is the starting point? And then at that looking at a couple of key factors and making sure that care level matches or the care community matches the care need. Because unfortunately, a lot a lot of families think about location. They think about how does the community look? You know, how new is the community? Is it, you know, what are the paint colors? How pretty is it? How do you feel when you walk through the door? And it's important that you're thinking about that, of course. You know, you want to be comfortable in your environment, but how does that match with the true care need that that person has? And so we like, you know, making sure that we can clearly explain the different communities and how that relates to that person as an individual and what they actually need from a care level. The worst thing that can happen is as you find yourself in a care community that can't progress and can't meet the need, uh, and only to find out that it's just not from the very beginning, it was just not the right match and the right selection.

SPEAKER_00 4:55

Yeah, we say a lot of time for that. Oh, I'm sorry. Yeah. We say a lot, you know, the chandeliers are not the ones that are providing the care. You know, of course, you know, it's nice when both of those things go hand in hand, but they don't always. And so we we have to talk people out of that sometimes, depending on what the needs are.

SPEAKER_02 5:15

Yeah, there might be some very pretty places that don't offer a whole lot of medical assistance and and families are wondering, where does that money go? This you know, huge amount of money every month. So obviously being uh being proactive in terms of planning is always more helpful than reactive. If there is a say a crisis that happens, I know, and you guys know that oftentimes the the options may not be necessarily all that plentiful when we just need to get a place that is safe for the older adult. How do we how do we figure out like if someone is in, say, for example, a community that they don't necessarily like or uh but but moving the person with dementia into another community may also be disruptive and challenging. And it's it's kind of like I think about it with my kids' schools, like I don't actually know what happens if I send them to a different school or a different community until I actually get there. So how do you guys think think through that?

SPEAKER_00 6:24

Yeah, and I would say, you know, a huge part of our role is um setting expectations with people, letting them know what's normal, what may not be normal, and also emphasizing, you know, there's nothing is going to be perfect anywhere you go. But what really matters is how the staff and how the leadership respond to something when something doesn't go right. That's a huge part in all of this and how they respond and how they make you feel as you may be navigating some challenges with working through uh care changes and whatnot. So I think that's a huge piece, really, is the leadership that is within the building.

SPEAKER_01 7:06

Well, and great point because there's I'll call it sort of that honeymoon period where, you know, the the community needs to get to know the resident. The resident needs to get, you know, have time to acclimate to this new, this new home that they find themselves in. So to Allie's point, it's really setting those clear expectations of what's normal, what's not, what are you going to experience potentially, and how do you stay close and develop that relationship with the caregivers and with the community so that you can work together as a team to meet, you know, to make sure that that transition ultimately gets to a point where maybe they don't feel like they have to move. Now, let's just say you're three, four, five months down the road, and then there is a real reason that that person might have to consider another community. And this is this kind of goes back to making sure we get it right from the very beginning. But sometimes care levels can exceed a limit that a community might be comfortable with. And so if there is a point where there's some safety concerns on either side from the community, we don't feel like that we can provide your care anymore, or from the family, we're concerned you're not providing the care anymore that we expect, then that might be at a point where that that's a real conversation that needs to happen and consider that move.

SPEAKER_02 8:30

What might be an example of like common things that families may not know about as like this is what is typical or normally expected in a retirement community?

SPEAKER_01 8:41

You know, it's amazing to me. I'll answer real quick, and then I know Allie's got some input too. It's amazing to me how confusing, of course, it can be for families, but the understanding of what assisted living and memory care can provide in comparison to skilled nursing care and how many families incorrectly assume that just because my loved one needs a lot of help with their mobility and with transfers, we'll use it as an example. They might be a two-person assist with their transfers. They automatically think that they have to go to skilled care. And so I think making sure that people understand not all care communities are created equal in the sense in respect to care levels. Now, yes, assisted living and memory care communities are created equal and how they're they're rated by the state and their standards that they have to follow. And there's a lot of similarities, but it's that care level that is the defining factor for many of them and budget. And so understanding what are your care needs and how that matches up to what your budget is is probably where I would say that when we're putting this puzzle together for families, that is those two pieces that just have to match. You can't do it without with those two being correct for that family.

SPEAKER_00 10:06

Yeah. And I would say, you know, we always expect some sort of transition for people. You know, making a move is difficult for anybody at any phase of life, you know, going to college or moving to a new city is hard. And meeting people, finding the places you like to eat, all of those things that go into our day-to-day life, they are now having to navigate in a place that they may have not necessarily wanted to be initially. So I think, you know, allowing time for that emotional response. Um, I feel like, you know, a lot of folks have a natural wanting-to-go home response towards the staff or towards their families. And I think, you know, a lot of the staff is trained to be there and kind of redirect and be there with them emotionally through that. But I think for families to know and recognize that that's normal. And I think too, they may not jump directly into all of the things that you may want them to do in terms of the meals or the activities and whatnot, that may be a little slower, just depending on the person. But I think just giving folks time to really warm up to their new place, um, where where you might see things that are not normal, if you really feel like the staff is not being attentive to your loved one, if you're seeing a lot of hospitalizations, which is something that we are, you know, working with our partners to really understand where is this happening, extra hospitalizations, lots of urinary tract infections, if you're seeing, smelling things that would not be ideal, you know, those are all things to pay attention to if you feel like you're seeing any red flags in that regard.

SPEAKER_02 11:50

Gotcha. Let's just go back and make sure that the listeners are understanding what are the state requirements. And I know we're talking about North Carolina specifically, so because every state has slightly different requirements, can you just um kind of briefly let us know what are the state requirements for assisted living versus memory care?

SPEAKER_01 12:11

So if you're thinking about assisted living and memory care, those are one and the same, so to speak, when it comes to how they are surveyed and rated for what they can accept, right? So how they're rated. What a memory care unit has on top of assisted living is extra requirements around education for the staff, a difference in their staffing ratios because of the increased need uh care level. Their staffing ratios are going to be different. But memory care in and of itself is an assisted living level of care with that extra layer of requirements in education for the community and the staff. I think what's important for folks to understand too is what is the threshold potentially is that cutoff point of where someone is no longer going to be qualified for assisted living or memory care. And as the state defines it. If you have a greater stage three or greater wound on your body anywhere, so skin breakdown that progresses to a stage three or greater, if you require tube feeding, if you require IV infusion, if you have a trach, if you need a fluid restriction, those are some absolute black and white rules that have to be met. And that is a threshold that an assisted living community just has to say no. Now, within that mobility range of what level of mobility an assisted living community is comfortable taking, they can define that themselves. So an assisted living community can say, or memory care community can say, we will not accept a resident if they're more than a one-person assist. So it takes more than one caregiver to assist them with a transfer from the bed to a chair. But then other, you know, the state doesn't say that. That's the assisted living community making that decision. Whereas you can have another assisted living community that's perfectly comfortable with a two-person assist, or even can choose to train their staff with a hoyer lift for someone who might be non-ambulatory as well. Do I miss anything?

SPEAKER_02 14:16

Yeah. So how would that I mean I and I think memory care also has a locked door. So if there's a wandering risk. Yes. Yeah. If there's a wandering risk, they cannot leave versus many assisted livings don't have a locked door, though some of them surprisingly do, where you have to push a number to leave, um, that that can be a wandering risk as well.

SPEAKER_01 14:37

That's a great point. And just one other quick clarifier, thank you for bringing that up. Our assisted living communities do a really good job of managing dementia as long as they can, right? And to your point, when those safety concerns of being a wandering risk or not or just not being able to socially function in a way that's appropriate for assisted living, then yes, those are definite thresholds of at what point would you need to advance from an assisted living, perhaps unsecure assisted living setting to a secure memory care setting?

SPEAKER_00 15:12

Yeah, and I will add to that as well, depending on the community, they all kind of have their own rules and thresholds. But, you know, if folks start requiring a lot more prompting and cueing where they would just benefit from that higher staff ratio, sometimes that can be a discussion as well about potentially transitioning from assisted living to memory care.

SPEAKER_02 15:33

Gotcha. And what is the minimum staffing ratio? I know we're just talking about the state regulations here for assisted living versus memory care.

SPEAKER_00 15:42

Yeah. Here in North Carolina, it's a one to 16 requirement. So one caregiver to 16 residents in assisted living, and then it's one to eight in memory care. So not every place staffs just at that. You know, they may do better than that, but that is what the requirement is. Gotcha.

SPEAKER_02 16:03

I would think that one of the questions to ask for families who might be touring or talking to multiple different facilities is to ask about their staffing ratio. Would you say that's correct?

SPEAKER_00 16:14

Absolutely. Yeah, that's something that we're always asking. And also if they have their own staff in the building versus an agency staff.

SPEAKER_02 16:23

Is that because the agency staff are less likely to do something than their own staff? Can you just further elaborate on why that is different?

SPEAKER_00 16:33

Yeah, absolutely. Um, I think it really comes down to the training and the buy-in of the culture within the community. You know, naturally, if you have longevity of your staff within the building, they're gonna take, you know, their job very seriously. So I think that's just important for the overall culture and longevity in the building, knowing the residents, knowing their preferences and care, care capabilities, even food preferences, what activities they want to go to.

SPEAKER_01 17:01

You know, it is, and it's such a good point to talk about because some of them, the when we have families that are just scared to make the decision, you know, and it's it's huge. This is such a big decision. And some of those concerns are are the people in this community going to care for my mom or my dad, my spouse? You know, are they gonna are they gonna get to know them? Are they going to understand what's important to them, you know, what their morning routine is and what's their night routine? And I think just the stability of a community, we get asked often at how do we pick our favorite communities? And, you know, we don't, but we do have what's tried and true signs and indications that you've got a strong culture within a building and it's stability in your leadership structure structure, it's stability in your clinical leadership, and it's stability in your staff. And so that trickles down to that relationship that a consistent face and sort of the same people coming in and out of that community day and night does result in what feels like better relationships for the family and for that resident.

SPEAKER_02 18:09

And I know there's inevitably transitions, but what is considered stable? Like, and what what type of leadership are we talking about? Like nursing leadership, owner leadership. I mean, I feel like there's so many different roles within a retirement community.

SPEAKER_00 18:24

I'll say real quick and then get to your more specifically to your question. I do think that there is value, you know, it's not a necessity, but I do think there is value in kind of promoting within the facilities as well. Some of our best administrators have started as CNA staff, you know, and they worked into a med tech position, they worked into activities, maybe RCD resident care director, and then later into the administrative uh administrator position. And I think there's a lot of value in that of understanding all the players and all of the roles in that go into running a building. And so I think there's a lot of value in that if you're finding that as you're going on tours and speaking with the leadership staff.

SPEAKER_01 19:10

Yeah, it's a great point. And to your questions specifically, you've got within communities sort of a standardized leadership structure, right? You're gonna have within your assisted living and memory care communities an executive director, and then you're gonna have your clinical leadership, which is um gonna have that nurse oversight. So either an RN or an LPN that provides that nurse oversight of the actual care team delivering the day-to-day hands-on care, which could be CNAs or patient care assistance. You've got med techs who are also trained and who are administering medication. There's a lot of variation from community to community, how they sort of delineate those roles. So, for example, some communities will allow med techs to just be med techs. Their job is to man the med tech cart and make sure everybody's getting their medications as they're ordered. Sometimes you'll have communities, and there's not a right or wrong. I'm just sort of giving examples of how you might see some differences and how their roles are designed. Then you'll have some that are med techs, but they're dually trained also as CNAs. And so they might during a med pass time frame deliver the meds, but then they also might assist with showers or with just ADLs at other times. And so you'll see some variation in how that is coordinated for the staffing model for your buildings that will take on a higher acuity. So you might have four or five residents in your building that are a two-person assist. And so you have to then staff accordingly to where you've got two people for that many residents who need those two bodies every time an activity needs to be assisted, versus a community that does not take the higher acuity, then their staffing you'll see is going to be reflected a little more, you know, from not needing two bodies, you know, for those, for those care tasks. Yeah. So that that variation um could just be, you know, because of of how you your selection for residents, but the structure should be very similar from community to community.

SPEAKER_02 21:16

Right. And I think um also maybe helpful to point out to listeners that um the nursing presence in assisted living and memory care is oftentimes not like 24-7 weekend nights. It's like your bank, not bank hours, but your, you know, your usual business hours. Um, and that at night, oftentimes it's really just the CNAs or maybe the med techs that are in the building. And that is actually the norm, not a exception. I think that is something that a lot of families also don't necessarily understand before they get into, you know, looking into facilities. Thinking that they'll have like a nurse around all the time, which I have to say, well, a CNA is not going to necessarily be able to evaluate and triage a patient in the same way that an RN or even an LPN is going to be able to do. And that can be very different in terms of, you know, the clinical information that is being transmitted, as well as who is on call. I know a lot of these facilities have sort of their in-house provider groups. You know, our geriatric group was in some of the groups, and there's definitely differences in terms of just the amount of clinical information that could be accurately relayed, depending on the level of personnel that is in the building at the time, which is always seems to be nights and weekends when something happens.

SPEAKER_00 22:52

Well, and that's a good point as well. You know, some buildings may have more than one nurse. And so that could be good to be asking as well, especially depending on the size of the community and what their expectation is of that nurse. Is she on call 24 hours a day? What is that expectation? What is your process? If someone does fall, do they call the nurse? Do they call the in-house provider? What is the process for that? And I think each place would answer that slightly differently. I think that that would be important for your listeners to ask whenever they are considering different communities.

SPEAKER_01 23:26

Yeah, we just, it's interesting. We would just had a meeting this week with one of the care communities in the area. And it was just a sort of an opportunity to do a review of residents and, you know, see how they're doing. And we are intentional about having some good data points around are we getting it right? You know, I mean, are residents moving into these communities and thriving? And is it the right choice and any rehospitalizations, et cetera? And the conversation came up about this, and I liked their approach that instead of relying on a CNA level or PCA level who might have been, who may have witnessed a fall or may have an event that's going on in the evening, you know, having to relay a lot of extra information or perhaps resulting in a hospitalization that may or you know actually not be needed, but using those in-house physician services to be more of a screening tool and pulling in those clinical resources pretty heavy, you know, in those moments where you want a good clear assessment so that we are getting that right in terms of not, and particularly with our dementia residents, you know, not putting them through that, you know, eight to twelve hour stay in an ED if it can be avoided at all cost.

SPEAKER_02 24:46

Yeah, absolutely. And and sometimes you know, people do need to go to the emergency room. So we also don't want people to um prevent people from going to the emergency room when they when it's needed, because um it's like Goldilocks, you know, you want to get it just right, not too little, not too much, just at the appropriate times. Um ladies work through lots of families. What kind of advice that you think will be most important for, you know, say sandwich generation caregivers who are looking at facilities for their aging parents to consider as they, you know, think about transitioning. Obviously, it's some it has to be a match between the financial, you know, calculus as well as what is the person's needs and what the facilities can provide. I'm just hoping to get your advice on what what kind of key points to keep in mind.

SPEAKER_00 25:43

Yeah, I think, you know, one thing in particular to think about is the fact that it's their parent that is going to be moving into the community. It's not you that is moving into the community. So trying not to let your own preferences drive that too much, you know, in terms of the space you may choose for them, kind of back to the whole chandelier thing a little bit, right? You know, we see the the razzle dazzles and the pretties, and that, you know, always isn't necessarily what your loved one may need. So I think just keeping a level head through all of that and just really getting to the core of what's important with their parents' care needs and really what is going to be the best fit for them from that regard. I didn't interrupt.

SPEAKER_01 26:29

No, go ahead. Uh that for sure, and location. You know, I think this idea of convenience, I want it, I want to be close so that I can go visit often. And we sort of describe it to families this way. You want it to be right, you want the care to be um uh the perfect match from that perspective, because a five-minute drive can seem like a really, really long ways when you're concerned when you leave and you're concerned about the care. And a 30-minute drive can be very, very short and very relaxing when you've walked away feeling good that care needs are being met. And I think it's important as listeners are hearing us, and and I think about this all the time when we have these conversations, is it sounds like there's sort of a good, bad, or you know, negative negative connotation when we're talking about what might not be a good fit. And it's not necessarily a reflection at all on the community. It's just that we're all individual humans, we have individual care needs, personalities, and you just want it to fit right. And, you know, we've had um really interesting story. It didn't happen to me, but I learned a lot by this story is uh a family member that moved into a community and she was just not happy. And the family could not figure out what's, you know, what's wrong and why is this not, you know, why are you not happy? And you know, the mom finally said, I just feel so uncomfortable here. It doesn't feel like home. She needed something that was more like her home and that just felt more comfortable to her. And so I think to Allie's point is that for kids to understand this is, you know, and it's very different situation when it's dementia versus an assisted living move. You know, you sometimes those factors sadly are not as important. But, you know, when they are and you can really just, you know, allow some of that to still be true and real for that person, you want to make sure that that those are that that lens is trying your best to look through their lens too, as well as, you know, what's best, you know, for them. Right. Absolutely.

SPEAKER_02 28:41

Yeah, to go with what your parent would want, not necessarily what you yourself would want. Yeah. Yeah. Yeah.

SPEAKER_00 28:48

Um and then just a word of encouragement to the listeners as well is um, you know, a lot of people we talk to a lot of families that feel like they're just giving up or they're doing something wrong by choosing to kind of outsource help for their family, whether that be other friends or family or neighbors or more formalized through going into a community or having home care come in. And we try to coach people a lot on, you know, a caregiving role is not necessarily for everyone. They have a lot of different roles more than likely in their life, particularly for your group with the sandwich generation. And so we really try to um encourage, you know, you're you're adding on to your care team, you're not giving up this role. You know, we really want you to embody that relationship again of being a daughter, being a son, being a grandchild, and not necessarily feeling like you're just in the day-to-day of managing everything and all of their needs. So I just want to add that, you know, as a little bit of encouragement.

SPEAKER_02 29:57

Absolutely. And I I do the same in that sometimes people do better in the community than at home with their family's help, even though that's what everybody wants is to stay at home. But I've seen people really blossom when they have that social engagement, when they have more activities and stimulation, when they have more monitoring, um, you know, a team of staff rather than one person, oftentimes the primary caregiver at home. So it's definitely not a giving up when people do choose to move into a retirement community. Um, and I think that's not said often enough. And oftentimes there can be family sibling disagreements about what is the right thing to do. And usually it's the sibling that is not local that says, no, no, you don't, mom doesn't need to move to a retirement community. You got this. I'm like, well, yeah, yeah, you got this, sister. Yeah, just I'm like, tell your brother to come still spend two weeks with your mom and see and then see what he says. So yeah, you know, yeah, it's so true.

SPEAKER_01 31:00

It's so true.

SPEAKER_00 31:01

And I say the same thing to families, you know, respectfully, you know, you have to understand what the day-to-day looks like here. And that can be certainly difficult managing different relationships and dynamics.

SPEAKER_02 31:14

Yeah. And and last question uh before we go is can we talk about like how do people because uh there are a number of different agencies out there, you know, some are really big and national and some are local, like care patrol. Is it better to go with a company that is more say fee-based and that fee is paid for by the family versus an agency that's sort of paid by the facility? You know, what might be advantages or disadvantages of both ways? And if you can tell us a little bit about what's the model at Care Patrol as well.

SPEAKER_01 31:52

That's a great question. And there are certainly options, you know, for families. And I I think you want to find the right option that works best for you. And there's some fabulous geriatric care managers that work in this space, and they typically be work more on a fee schedule. And they also work more within the true care management role, right? So this is sometimes folks that will come into the home and provide assistance, you know, with managing medications for a while and with scheduling doctors' appointments and managing care, as the name implies, up until a time when perhaps a move to a community is needed. So there's a, you know, that's a that's a different model for us at Care Patrol of Winston-Salem, we specialize in the actual transition of care. So when it's time to implement care of some sort, be it in-home care, and then probably the bulk of our work being helping families to transition from home or the hospital or the rehab to a care community. And what a fee schedule that does not allow or does not require that the family pay us a fee and where we're then reimbursed through the care communities, it removes that barrier because cost is such a huge piece of this decision. And for many of our clients, we do not draw any barriers or any lines of who we will help. So we help people with the Medicaid route. We help people who are on very, very low budgets, and we will fight and fight and advocate and advocate for communities that would be willing to do a reduced rate for folks so that we can help people who make too much to qualify for Medicaid and not enough to pay for care. It's a really, really tough spot there. And then, of course, private pay, because at the end of the day, Medicare is not going to pay for this. Insurance companies are not gonna pay for this. This is a private pay space. And so we want to be that navigator and that advocate and that advisor, irregardless of the situation. And so for that reason, it removes that that barrier of the ability to pay us a fee. And yes, you know what? That results sometimes in, you know, at the end of the day, we may or may not get paid. And that's a business decision that that I've made from the very beginning, or that my husband and I have made, that that's, you know, we want to lie down at night and put our heads on our pillows and feel really good about how we're assisting our families. And so if I'm the consumer and if I'm listening to this podcast and some of your families that you work with, you know, I think you have to just understand what your situation is and what you need. And do you trust the person that you're talking about? Can you feel like that they're going to have your best interest at heart? I think some important questions to ask are if you're working with a family, they need to ask whoever their advisor is. Are you going to limit the places that we can see? Is there going to be a, you know, a cap just based off of your business model? And if the answer to that is yes, that there is going to be limitations based off of, you know, that particular business's contracts or whatever, then this is a Gina opinion, but that, you know, that would be a concern. You know, you don't want to be limited for that reason. So if that's concerning, you know, then, and you don't have any other option, you know, as far as doing it the way we do it, then maybe a fee, paying a fee to someone would help to relieve some of those concerns. So I think it really is just understanding the business a little bit can make you smarter as you're looking for and looking for that advisor.

SPEAKER_02 35:47

Yeah, that's a great point. Because I've also heard of the opposite way where one of my patients, when I suggested, you know, someone to help her son uh look for a facility for her. And she's open to going. I said that, you know, they there's no fee for you to use this advisor. They're paid by the agency or the retirement community. She was like, oh, well, then they're they're gonna pass that cost down to me when I move there. And I was like, uh it's not a free service. It's not a free service, you know, somebody has to pay at some point.

SPEAKER_01 36:22

Well, it's a great point, you know, and I think those are good questions to ask, you know, if that's something that's weighing heavy on a consumer's heart, then, you know, we're very open to, and I know our communities would be very open, you know, the the same price sheet, you know, you're gonna get the same price sheet for your care cost, you know, whether you walk in the door yourself or whether you walk through the door with us. You know, they don't, there's not two separate sheets, you know, it's the same. Now, you know, there's marketing dollars being spent somewhere. And, you know, again, to your point, it's, you know, this is for the most part, it's, you know, it is a private pi pay service. And, you know, there is cost associated with. I wish it was different, you know. I really do. I wish it was a whole different conversation, but it is currently how how it's set up.

unknown 37:10

Yeah.

SPEAKER_02 37:10

Well, I mean, it's also a valuable service. It's like, you know, you don't go to the doctor and say, you know, just treat me for free. Right. Because some we do have to make a living somehow. And uh, I think a lot of families are helped by having professionals like you, you ladies who know the industry, who know the communities well, that can potentially bypass a lot of the self-research that people have to do. And some people love that kind of stuff and wouldn't trust anyone else to research it on their behalf. And there's gonna be people who really don't have the time, energy, nor desire to do that kind of research and really need some help. So, you know, there's both there's no right and wrong. Yeah. Yeah. But I think that relationship and how how comfortable one feels in terms of the communication and the honesty of like what the costs are and what the realities are is really what sets up that relationship well. Yeah, absolutely.

unknown 38:10

Okay.

SPEAKER_02 38:11

Well, thank you so much. Did you have more to add, Ali? No, no, no. Thank you though. Okay. Yeah, I was just gonna say I can talk to you ladies forever, but I really appreciate this conversation. I hope that those who are listening can take away lots of good tips in here. So chandeliers don't matter as much as staffing ratios, fee base versus you know, pay by the facility can have its own advantages or disadvantages, and that pick something based on what your parents want, not what you want, are some of my personal takeaways. If you've enjoyed this episode, please share it with someone who might enjoy it as well, or leave me a review on your podcast listening platform, and I'll talk to you next time. Thank you. Thank you. Thank you so much for listening to this episode. Please click the follow button on your favorite podcast platform. Please remember that this is educational content and that do talk to your own doctor if you have specific questions. Original music by Grant Willis. The podcast is edited by Builder Librarian. And finally, please repeat after me by taking care of myself, I can better care for the older adult in my life.