Aging in America and Its Impact on the Home Care Industry (Bob Roth Pt. 1)

[ 00:00:19 ] Welcome everyone to Home Care U brought to you by Careswitch. I'm your host Miriam Allred. Thank you for joining us today it's great to be back with all of you. I'm really excited to be joined by the esteemed Bob Roth, Managing Partner of Cypress Home Care Solutions in Arizona. Bob; welcome to the show. Well thank you Miriam it's great to see you and be on your show. I did a podcast with you uh a while back but uh it's nice to be back with you full circle. We're back again and it's my privilege to have you on the show. I want to start off—you're a familiar name and

[ 00:00:54 ] face in the industry I think a lot of people know you have uh you know rubbed shoulders with you but I always like to start with kind of some accolades a little bit about your background and then I’ll give you a chance to fill it in with some color and talk a little bit more about cypress but uh sometimes guests hesitate to share you know kind of all the gems of their background so I’ll get started and then let you fill in so uh like I mentioned you co-founded cypress home care solutions in 1994 then took over as managing partner in 2003 so you've been at the helm for over 20 years at this point um you all are such a great team and I’m really excited to be here with you today

[ 00:01:25 ] celebrating I believe 30 years this year so a massive milestone congratulations on that um you've served as the board of director of the HCAOA and also with NAHC the National Association of Home Care and Hospice um you're no stranger to the microphone you also host a radio show their locally Health Futures: Taking Stock in You. So, I think you're going to keep me on my toes today as much as I’m going to keep you on your toe’s um and yeah more Importantly, also, you won the award for the best home care solution in the history of home care. You won the Home Health Care News Future Leader Award just back in 2019, so another really large accomplishment that speaks to your character and your leadership in the industry. Maybe we'll you'll talk about this today before home care.

[ 00:02:08 ] You were working in consumer products and worked for companies focused on sales and marketing and building brands with some really major companies: Quaker Oats, Gatorade, Dole. So, you've uh you've accomplished a lot in your career, but if I'm not mistaken, I think you're really passionate about aging. About home care, and that's what's led you to where you are today. So why don't you start by telling us a little bit more about uh Cyprus and some of your work there in Arizona? Well thank you uh you know I and I know you wanted me to reflect a little bit about my history um 1985 January 2nd, my mother had a massive heart attack and never was quite the same.

[ 00:02:46 ] She spent nearly two months in the hospital, 18 days in a drug-induced coma, and came out a very different heart stopped working one-third was working. And 1985 was a very different time; there were no in-home care providers, and just so you know, you know we are stuck with this moniker. Called non-medical, and I've been at its public speaking, talking about it on the radio and from the lectern; um, I really would like to change that name and I really am all in favor of in-home supportive care services. I think it really describes what we do because home health and home care get mixed up all the time a lot of people think we're home health but no, we're home care. We provide in-home supportive care services.

[ 00:03:38 ] So, in-home supportive care services weren't around back in 1985. Guess what? Assisted living wasn't around back then either, and so much of what has been created since that time and it really started in the 90s was as a result of the baby boomers. The baby boomers were getting thrown around, I mean when we think about baby boomers from 1946 to 1964 and we think about how boomers reshaped our society, I mean houses were being built, schools were being built, universities, churches, synagogues, the suburbs became to be so. Now you know people are aging, and now we need to find ways to help care for them, so in-home support of Care agencies has come about, and certainly assisted living, independent living, skilled nursing, and memory care. I mean, none of those things were ever thought of.

[ 00:04:32 ] It was institutional care back in the day. It was nursing homes. And that was really it. So, you know, we've seen a lot. We've seen a lot happen. And, you know, I appreciate the description of our previous or at least my previous experiences in the consumer product goods world. And the consumer product goods world is really where I cut my teeth. I learned how to really do just about everything business related. But I think the most important thing is I really realized how important relationships are and how important messaging is. And I think I really garnered those skill sets in my time with the Quaker Oats Company. And I ran the Gatorade business in the Northeast back for about five years at the end of the pandemic. And I think I really garnered those skill sets in my time with the end of the 80s and early 90s.

[ 00:05:22 ] And working with them and working on messaging is something that I've been very intentional on and really working on. So, you know, for me, it all really began that January 2nd, 1985. Miriam, just wanted to know, do you hear that noise out there? Is that disruptive? No, I don't. I think I do hear maybe your email or something going off there on your computer if you want to pause notifications. Yeah. So, how do I do that? I think it's maybe Outlook that's going off. Yeah. So, let me, sorry about that. No, that's okay. The guy's right outside my window. So, I'm like. Oh, no, I don't hear what's outside your window, actually. Okay. Nope. And I'm going to pause my, I think it was my Teams. Sorry about that. No, that's okay. I hear that. I don't hear anything outside the window. I don't know if you want headphones or something that would help. Well, no, you know what, this guy.

[ 00:06:26 ] Give it just about two more minutes and he'll be done. You want to queue up where we left off? Yeah. Yep. Yeah. No problem. We'll give it just a second here. You tell me when you're ready and we'll keep going. I think like shutting the blinds is going to make it quieter. It's not. Okay. That's okay. Yeah. Let me know what he's through. We'll keep going. Give it just a minute or two. So, where would you like me to pick up? There he is. Go ahead. That's okay. You were just talking about Gatorade. You were with Gatorade in for five years. Why don't you just keep going, run after that, and then I'll pick in. All right. He's right outside my window. Okay. Yeah. What we have a problem with here is mosquitoes.

[ 00:07:15 ] So, I get a guy that fogs. So, he's there with the fogger. I mean, it is literally right here. That's okay. When I was recording yesterday, it started hailing right on my window right here. And I was like, oh my goodness, I need the headphones. And then it turned into snow. We got snow yesterday. So, it was hailing for about 10 minutes, and it was really distracting. Well, I'm not surprised you get snow up there in Rexburg. Just yesterday. All right. I think we're done. Okay. Great. Yep. So, you just pick back up with Gatorade and then we'll keep going. So, the experience with Gatorade is really great. I think we're done. I think we're done. Gatorade really opened up a lot of doors for me and really key learnings and messaging was a really big part of that.

[ 00:07:56 ] And I think that's a lot of what I've brought to Cypress and in the in-home supportive care service world as well, is really to help message the work that we do, right? And that is you really need to know who the recipient of that message is. Is it the adult child? Is it the professional who is a wealth manager or a social worker? Or is it the person who is the recipient of that message? The ultimate consumer of your services. So, messaging is really, really important. So, all of those were really key learnings for me. But at the end of the day, my brothers and I; we stood up Cypress in 1994 to really be able to help care for other people's moms and dads in the way we cared for our own mom.

[ 00:08:38 ] So, the idea was to really be respite for them. And you know what? We didn't realize in Arizona that most of the adult children were, not here. And we were doing not just respite. We were doing more or less total care. So, you know, we really became a full-service, full-line home-care agency. So, that was in 1994. I joined, as you said, in 2003. And I brought a lot of those skill sets that I learned from the consumer product goods world into what we did. And in 2005, we stood up what I believe is the very first in-home caregiver training lab. So, we had it inside of our offices. So, one-third of our office, you know, we had about 5,000 square feet. So, one-third of our office was dedicated to training.

[ 00:09:29 ] And we had an in-home training lab with life-size mannequins, life-weighted mannequins. So, we could teach people how to provide care. Not only did we do it for our professional caregivers, but we also did it for the community. And at one point in time, we trained over 1,500 families on how to deliver care. Because we knew that so many families just didn't have those skill sets. So, that was one of the things that we did right off the bat in terms of being innovative and being, you know, differentiating ourselves from the masses that were out there. And in 2013, we stood up a dementia program that, you know, we ended up getting a lot of accolades back in 2017 and 2018. We would make a difference in a lot of families' lives.

[ 00:10:17 ] We had data that showed that we could keep families together for seven to eight months longer than they utilized our services versus not utilizing our services. And seven to eight months doesn't sound like a long time. But in the world of dementia and Alzheimer's, it can be like an eternity to be able to keep your family members there. And we would ultimately have that visit with them and say, look, we've gone as far as we can. And now we need to talk about placement. Now, I just want you to know that there were some families that we were providing dementia care for over two years. It wasn't just everybody within seven to eight months, but seven to eight months was about the average.

[ 00:10:54 ] And then in 2019, you know, to talk about the evolution of CHIPS, we joined the Honor Care Network. And we were looking to innovate and looking to be different. You know, I shared with you prior to the show that, you know, we were sitting really pretty as it related to caregivers. We had over 200 caregivers working for us. What we did was, more than anything, we were helping staff about four other home care providers that were affected by this. And so, you know, one of the things that we were agencies. But I knew at the time that workforce was going to be an issue and I wanted to be prepared for that. And I was really, how should I put it? I was really enamored, and I was buying into the Honor Care platform. And, you know, it was an interesting experience.

[ 00:11:38 ] I wouldn't say it was a great experience or a bad experience. It was an interesting experience. I learned a lot and I was on that platform for about four and a half years. And February 1st, I came off of it. You know, I would equate it to like buying a boat, right? The best day of someone's life is when they buy the boat. The better day is when they sell it. You know what I'm saying? So, it was a good day going onto the Honor Care platform and I'm feeling really good about coming off the platform. So, I mean, really the evolution of where we have gone and come is, you know, we're looking to innovate and differentiate. And certainly, the experiences that we've had over 30 years have been nothing short of just tremendous.

[ 00:12:23 ] I mean, we've seen so much change. I think that's a perfect segue into the conversation that we want to have today, which is you sharing some of the broad strokes that you've seen over the years, the changes, because often we look back and reflect and it helps us, you know, kind of crystallize what we want and where we want to go. We should be going for the future. So that's really kind of the root of this conversation. The one thing I want to say before we get into it is I appreciate you sharing about your pre-home care background. I think maybe that's why you and I, you know, get along so well as we come from this kind of sales and marketing and this very like relationship-heavy territory.

[ 00:13:03 ] And like you've seen, I think that's part of why you've been so successful and thrived in this industry is you foster those deep connections, you treasure those relationships. And, and there's a lot of that in home care with the families, with the clients, with the caregivers, with the vendors, it's just this ecosystem of people coming together to support one another. And I think your background has teed you up so nicely to really embody that in home care. So, thank you for sharing that, that rich background and the history of Cypress. That's really useful for people to kind of understand where you're coming from. So, I want to talk about kind of broadly aging. You have been an advocate, a spokesman, you know, kind of a thought leader in your local market and also nationally about just aging holistically.

[ 00:13:48 ] And like you've just downloaded; you've been doing this for a lot of years. You've seen it firsthand in your own family. You've helped thousands of people in your own market. And so, I want to talk and kind of start with a broad stroke about just, you know, what you've seen over the last 30 years, how have home health and home care changed and why does that matter? Why do we need to kind of look back and reflect to understand kind of the broader picture here? So, kind of open it up that generally, you know, what, what's changed and why does it matter? Well, I, I think first of all, we're aging very differently. I mean, I am now in my early sixties and, you know, I can remember my grandfather being in his early sixties and he was old.

[ 00:14:30 ] I'm, I'm doing yoga almost every day. I'm playing golf and hiking and walking my dog. You know, these are things that, you know, Americans and most people are doing today is they're much more active. They're more active. They're more active. They're more active. They're more active. They're more active than they were before. So, you know, I, I, I think aging is very different in that regard. And also, you know, modern medicine, I mean, we're able to live longer and that has its pluses or benefits, and it also has its minuses and negatives. I mean, and I think we're seeing a lot of that too. I mean, because we have modern medicine and innovation and technology in the healthcare field, you know, people are, you know, they're, they're, they're, they're, they're, they're living their lives a lot longer.

[ 00:15:14 ] And I think that is part and parcel of why we're seeing such a high tick, if you would, or a tick up on dementia and Alzheimer's because people are living a lot longer than they ever have in the past. So, I mean, I think aging has really transformed itself. And, you know, as I talked about the boomers, you know, they really helped shape our society. And I think boomers today are reshaping and shaping the way we age, you know, the whole concept of 55 plus communities. You know, I, I talked about assisted living, not being around in the eighties, you know, really it wasn't until the early two thousand where these 55 plus communities came into be. And assisted living did not want to be skilled.

[ 00:15:56 ] You know, they made it really clear that they wanted to be a social setting, not a medical setting. And that's very, very different. And, and I think that's being driven by this sector that is aging between the years. They were born in 1946 and 1964. So, you know, we're aging at a very different rate, if you would, a different, you know, in, in, in, in terms of what we are wanting from aging. The other thing we know is that nine out of 10 people who are aging want to stay at home. They, they want to be where home is. And that is something that is really advantageous for us. That's in the un-home supportive care business. So, we can provide that care in the home.

[ 00:16:47 ] You know, the data shows us that 40% of the people that are turning 65 are going to need care on a regular basis. And 70%, 65 and older are going to need care at some point in time in their, their journey. I mean, it's, it's crazy. And then the data is even more compelling when you really look at it. You know, we've got, what's the number? 70% of people turning 65 will develop a severe long-term care need in their lifetime. So, 70% of people 65 and older, 48% of people turning 65 will need some type of paid long-term care services. And 24% of those people turning 65 will require paid long-term care services for more than two years. That is crazy. And then 15% are going to need to be in a, in a skilled nursing facility.

[ 00:17:44 ] So, you know, the aging population is growing so, so fast. I mean, when we look at 65-year old’s between now and 2050, that number is going to go from 56 million to almost 85 million. And I think the number on 85-year old’s is going to go from 7 million to almost 20 million by 2050. So, it's going to more than triple. So why am I doing this? I'm doing this because it's a, it's a huge problem solve. I mean, look, I, I think about Stephen Covey's, you know, seven habits of effective people. You know, he always, he talks about the first, right. Being, you know, what, what's it going to say in the end, right. What's your epitaph going to read.

[ 00:18:29 ] And, you know, I want mine to read that I was a loving husband, you know, a good son, a, a great father, a great brother, all of those things. Hopefully a grandfather, you know, all, all the things in life that we all want to be. But I also want to be a catalyst for this change. I don't want to be just that person who, you know, helps build a home care company for his family and serves just the Phoenix market. I want to transform the way we age. I want to be that person whom my grandchildren can say, you know what, my grandfather, he had a say in this. He had an input in the way we're aging. And we're doing this because some of the work that he did back in the 2020 era if you would.

[ 00:19:18 ] So, you know, I, I love this problem solve. I think it's a big, it's a big one out there. You know, it's a, it's a big, big meatball that we need to try to solve for. But, you know, one of the things I've learned, and we'll talk about it throughout this podcast is I can't do it alone. You know, we, we got to collaborate and, you know, collaborating with you, Miriam, and, you know, companies like Care Switch and others that are out there is going to enable us to do it. So, it is really a, a village effort. We need our village to be able to do it. But, you know, this is one of the big problem solvers that I'd like to be a part of.

[ 00:19:52 ] And, and I think I am a part of, and I hope that we can do this in my lifetime. I hope everyone feels something when you talk. I think that's why you're, you know, a spokesman and on stages is I feel something when I hear you say these words. And I think that's where this all starts are taking it to heart, you know, I love that kind of Stephen Covey example of we want to help other people write their own story. You know, you don't want to be defined by your last years. And we want people to age at home. We want them to have and finish their life in the way that they want. And that I think is what you know fuels you are taking that kind of personal approach to what do you want?

[ 00:20:33 ] And then ultimately helping other people have that same kind of rich end-of-life experience that, that doesn't define them, but really embodies what their life was and how they wanted to end. And I, you know, you share all those really staggering statistics. I think the one that you shared with me that just really is mind-boggling in just 10 years from now, in 2034, there will be more people over the age of 65 than under the age of 18. I know that just hits differently. 10 years from now, 2034, you know, that seems, you know, like, you know, kind of an impossible number, but just 10 years from now, the statistics are really about to turn. And so, like you say, we're all in it together, we have to solve these problems together.

[ 00:21:20 ] No one person can solve these. And that's why we're here, you know, just bringing to light this conversation. You talked earlier about baby boomers. I think they're, you know, kind of an important piece of the puzzle here. What impact do you think boomers are having on home care today? And what impact will they have over the next, kind of 10, 15 years? Well, let's talk about a; I won't use the word negative, but we'll use it in the context here, a negative impact of that. You know, baby boomers are not giving birth at the rate that we need to keep our population going. So, our declining fertility rates are really down. I mean, in order for our population in the United States to maintain its existence, we're all bearing females in our country to have 2.1 children, 2.1, to keep our population intact.

[ 00:22:20 ] And we are presently at 1.7 and going down from there. And why do I bring up this fact? Because boomers were more focused in on careers. You know, look what happened during our era. I mean, we not only, you know, had, you know, women, women's rights movements; we weren't only had, you know, the, the, the civil rights movement. We were driving women are more in the professional sector than they ever have. I mean, when you look at women, or you look at females and males that are graduating medical schools, I mean, you go back 50 years ago, and you wouldn't find females. Now more females are graduating medical school than there are males. So, women are working in the workplace, like, they never worked before.

[ 00:23:13 ] And they're choosing to either not have children and be married to their careers or choosing to have children late. I know this firsthand, because I have a daughter who is a labor and delivery nurse in L.A. at Cedars-Sinai Hospital, she told me last month, they had a mother who was 59 that gave birth. I mean, how crazy is that? And but she sees women in their late 30s and 40s having children, and that's part of our problem. Our progressive problem is, is that we don't have enough people behind us. And from a workforce standpoint, that's where we're challenged most with. But on the other hand, I mean, boomers have reshaped everything. I mean, you know, active adults, I mean, that comes with boomers, you know, the creation of this new fancy sport called pickleball, which I debate whether it's a sport or not, but it's the boomers that are playing it, you know, but why are they playing it?

[ 00:24:09 ] Because it's a social engagement piece. You know, so boomers are really changing the way we work, we think, we live, you know, the whole concept of the fast foods and now delivered foods, prepared foods. I mean, that wasn't created by the GI generation or the silent generation. That was all created by boomers and boomers see the need and they try to fill the need. So, you know, they've really reshaped our society in a lot of really good ways. And I started off with just the, you know, in the sense that therefore lies the reason why we have a workforce issue. It is we did not have enough children. And because we don't have enough children, we don't have enough workers. And how's that transformed home care in a big way, a really big way.

[ 00:24:56 ] First of all, across the board, every single home care agency that is listening to your podcast right now, they know this because they're experiencing this between 2019 and now. The rate of our children, their kids, their children, their kids, their kids, their kids, our services have gone up over 40%. 40%! I can tell you at Cypress, we were at $27 and now we're approaching $40. And many of you that are listening are experiencing the same thing. What's driving that is labor costs. I mean, if I'm a worker bee, I could work for Chick-fil-A for $19 an hour, or I could try to get a job with a home care agency for 15, 16, or $17 an hour. Which one am I going to choose? I'm going to choose the $19 an hour. I get a free uniform; I get free food.

[ 00:25:45 ] So I mean, we're competing with that. So as a result of our wages going up, our costs of our services are going up. And that is really having an impact on the way we deliver care. So, one of the things that's really happened and it's happening at such a rapid rate is the adoption of innovation. And how are we doing that? We're doing it in many different ways. And we're doing it through technology. We're doing it through remote monitoring. We're doing it through artificial intelligence. We're doing a lot of really cool things at Cypress to really embrace that. Because consumers, even though our prices have gone up 40%, they're living on fixed incomes. So, they're figuring out how do I do more with less? That becomes a real challenge.

[ 00:26:36 ] I mean, you know what? We have consumers right now that are literally on the threshold of maybe poverty, middle class, and they're making decisions on whether or not to get their pharmacy filled or go get groceries or go and get care. We should never have that. One of my wishes and one of the things I would like to be known for is to be one of those people that impacted that care should be available to everybody. It should be a right. It should be a right. It should be a right. It should be a right. It should be a right. It should be a right. And Valhalla Madera’s from NAC used to say that is the last civil rights battle is the fact that care should be available to the infirm, elderly and disabled so that they can get it at home.

[ 00:27:23 ] We should do that. And how do we do that? That is one of the biggest problem solvers. But one of the ways we can do it now is being able to embrace tech and provide a wraparound service for these people that are needing care. And when I think about that, I think of a number of clients of mine that the family's really worried about them 24-7, but they've opted to only receive care during the awake hours. So direct care is being provided during the awake hours, but they're utilizing tech and innovation. And we're doing that right now, utilizing acoustic AI devices as well as radar devices in the home and trying to monitor and see. If there are changes that are happening so we can intervene before a medical event happens.

[ 00:28:16 ] And ultimately, that is not the goal. The goal is to provide in-home care, supportive services so that we can keep people at home as long as possible and prevent an admission to an ED or urgent care or, you know, right to, you know, a skilled nursing facility or wherever they need to go. So, you know, or leaving their home to go into an assisted living so that we can keep them at home. So, the goal is to do that. We can do that. I know we can do that with direct care. And we can do that with wraparound services utilizing innovation and technology. Yeah. So, let's go down this technology path. I think you've done a really good job of kind of painting this picture of the challenges, you know, the staggering statistics.

[ 00:29:01 ] We know where we are and, you know, let's talk solutions. I want to kind of go down this technology path. You are, you know, very vocal. About technology. I think the phrase that I've heard you say often is technology make things, makes things possible. Humans make things happen. So, you, while an advocate and, you know, kind of a spokesperson on technology are also very cognizant of what technology does well and what humans do well and striking that balance. So, I want to hear you kind of talk through technological solutions. You know, how do we strike that balance? You were mentioning, you know, kind of night hours versus awake hours. What are some kinds of breakthroughs in technology that you're seeing and that you maybe hope to see in the near future?

[ 00:29:47 ] Well, first of all, I mean, babies that are being born today are going to live to 110 or higher. I mean, it's crazy. We will be among the first generations to become superhuman by escaping mind and body limitations. You know, we'll be able to live, you know, longer and better than anyone has ever lived before. And that's really cool. I mean, it really is. When you sit down and you think about where we are, and we're at this inflection point right now, where technology and innovation is enabling us to really be able to do a lot of things. I think of Elon Musk and what is the name of his company? Neuralink or something like that, which is fascinating. And supposedly he's had a very successful run recently.

[ 00:30:32 ] And I remember reading something about it, but I need to read up more about it. But, you know, when we really think about it, too, you know, you know, we are really entering or have entered what I'd like to refer to as the fourth industrial revolution. I didn't come up with that name; the World Economic Forum has. And the reason being is that changes are being brought on by this revolution at such a rapid rate right now. They're faster, more volatile, and further reaching than they have ever been. They will affect every person on Earth. And we will be required to make decisions that we never thought we would ever be faced with. And then on top of which, I'd like to refer to the democratization of the world because everything's going to be available to us at any given time.

[ 00:31:18 ] I mean, I'd like to think, and I heard this futurist talk about it. Ben Lytle, he talks about having this. We'll all have this AI pal, right? We've all been playing around with ChatGPT and OpenAI, and other forms that are out there. But, you know, to think about it, when I was growing up, you know, my friends and I, we used to do sports trivia. We didn't have a smartphone. We didn't have any devices to use. You know, we all relied on our noggins, and we would be able to spit out sports trivia. But now all of us have all that information. Right. So, it's not about having, you know, being the person that just has that information. Everybody's going to have the same information. It's what you do with it.

[ 00:32:01 ] Right. And that's what really sets us apart. So, really talking about innovation, some of the things that I've seen that are looking really, really cool. And you know, we have a partnership right now with Sensei AI, and this isn't intended to be a shameless plug for them, but I think that they have got something that's very, very clever and they're utilizing acoustic devices. And I was talking about it earlier, where you can have them in a setting where they are absolutely getting all kinds of information; anyone understands artificial intelligence, it's really understanding the changes in those patterns, and we see those changes in those patterns. That's when the alerts go up and being able to have all that stuff in the background, but it's working. It's your eyes and ears.

[ 00:32:52 ] But the alerts are the only thing that you see. It gives you an opportunity to act on them. We're also utilizing testing out radar company called Help Any or Swiss, Switzerland-based company. And they're using radar to really kind of do the same stuff. So, you know, we're utilizing those types of things. And I think that's really important. And then we're also using a lot of these other types of tools. And when you sit down, you think about the cost of our services. You know, if you can wrap around services and include those which we are doing now for clients is that we're not charging a la carte. You're not saying, oh, it's $5 an hour for this, $2 an hour for that. You know, we're packaging it all together and we're promoting it as a really a new model of care.

[ 00:33:33 ] And for me, it goes back to, you know, a lot of people use this, and we've been utilizing internally at Cypress is really reimagining home care. Because you asked me this question before. I mean, how much has changed in 30 years? I can tell you 20 at the helm. When I first started, our services were $14 an hour back in 2003. In 2013, we were $17 an hour. In 2019, we were $27 an hour. And now we're close to $40 an hour. So, we've got to be able to figure out how to provide services, be able to, you know, have a meaningful impact into people's lives. I mean, you talked about, you know, being involved in these people's lives. I mean, for us, I mean, we get to be in their final chapter.

[ 00:34:25 ] And, you know, some call it discharging to heaven, but, you know, sometimes we're not always there till the end, discharging to heaven, but we get to be part of their lives. And when they do indeed discharge to heaven, I oftentimes attend funerals, and I get to learn about these incredible people that we get to care for. And yes, you know, they may not have been that person that that person at the lectern that is talking about them. We get to hear that and just it makes me smile, makes me, you know, feel really good that I get to be a part of someone's life. And I think everyone that is listening to this today or watching this has had that experience. And let me tell you some of the things that I've learned from this experience; all is when they call you out.

[ 00:35:10 ] And I got to tell you, I mean, I've been called out so many times, I do get a little embarrassed because everyone looks at me. But at the same time, I mean, it just feels really good that whether they're calling me out, and in a lot of cases, they're calling out the names of the caregivers, because the caregivers have actually impacted their loved ones' lives. And I had a rabbi once say, not only did they give my dad years in his life, but they also gave him life in his years. And I mean, that just hit me so in the heart, I was just like, wow, we cared for this rabbi's father for seven and a half years. And there were 11 caregivers that he named out during that experience.

[ 00:35:50 ] So I want to go back to you know, technology. So, you know, we're in exciting time right now. And things are happening so rapidly. And I only named a couple of companies, and they're the ones we're working with. But there's so many others are out there. But I do want to give you a plug. I'm going to give you a plug. I'm going to give you a plug. So, I'm going to give you a plug with Careswitch. And I know you guys are new to the table. And, you know, for us, you know, coming off the Honor Care platform, we were looking at a lot of enterprise software solutions. And with the help of my nephew, we went through seven different ones. And we really liked what you had. And while we didn't choose you, because we were doing Medicaid, and Medicaid seemed to be the stumbling block for us, because we do Medicaid, and we need to do Medicaid billing.

[ 00:36:32 ] And, and I imagine you and I haven't had this discussion. But I imagine Careswitch will get there. You guys just weren't there just yet for us. But I, you know, I will tell you that every one of these companies, from the days that I was before honor to now, it's like, I stepped into a time warp. I mean, unbelievable what these companies are doing, and how they're embracing automation. I mean, let's face it. I mean, for us as operators, we need to use automation to do a better job of running our business. You use techs to run your business. And that's a quote that I like to use. And that is, technology makes things possible. Humans make things happen. My team will tell you that I want more human experiences with our caregivers and our clients and their families.

[ 00:37:18 ] And how do we do that? We do that by utilizing the tools that we have available. So, like for onboarding caregivers, I mean, the friction that I've removed, the process is so smooth. I mean, I engaged an engineer who is outside of any of the enterprise software solutions that really helped me bring caregivers aboard and the enterprise software solution that we chose; he was able, he didn't even have to talk to somebody. The API was on their website. He read the API. Now, all of a sudden, all that information gets connected into the software and it populates my caregivers. I mean, I don't, there's no keying in. And if my caregiver is complaining they didn't get their W-9 or, I'm sorry, W-2, or if they didn't get a paycheck stub, it's on them.

[ 00:38:08 ] They're the ones that filled out the application because that's how it populated. So, you know, for me, it's embracing a lot of the automation and stuff. It really eliminates the repetitive tasks, eliminate redundancy, and eliminate workarounds. So, the goal is to try to operationally be so finesse, so, so fit finesse. I'm stumbling on words, but so, so fit that you, you know, are really taking a lot of the work that you used to do out of it. So, you can have more human time because the human time is what really counts, right? More human experience. I mean, caregivers don't want to receive text messages. They want to talk to humans. And I, and I used to always say that when we have a call-off, the best solution for that call-off is that person who's calling off.

[ 00:39:01 ] If we can convince them to go back and not take a personal day or whatever they've got going on, or maybe work half a day, or maybe just get the shift started for the first two hours and give us some time to fill that shift. I mean, you can't do that utilizing technology. You can do that by picking up the phone and calling them and having that personal experience. I want to ask a kind of a follow-up question on the technology piece on the consumer side. Today, it feels, and I think what's possible is technology is playing a supportive role. You mentioned these devices in the home, you know, all of those capabilities. It's really a supportive role today. I'm curious what you think may come in the future.

[ 00:39:47 ] You know, we're seeing robots, we're seeing, you know, different, you know, interactive devices that are maybe more proactive than reactive. I'm just curious, kind of your take on the future of technology in the home. Do you see it at any point, maybe the tides turning it becoming more of a leading role, or do you feel strongly and believe that, you know, the human will always be first and technology second? I know maybe that's a controversial topic, but I know you feel and think deeply about technology. What do you see maybe in the future and how do you feel about it? Well, I mean, I think it's going to play a big role. You know, first of all, I had the chance to play with that, what's it called?

[ 00:40:28 ] Apple Vision Pro, I think it is. To your listeners, if you haven't had a chance to check it out, check it out. I'm not saying to buy it because it's really expensive, but I had a friend of mine have it. I was blown away, absolutely blown away by the tech and innovation. Oh my gosh, it is so fascinating what it does. So, you know, I think that stuff is here. You know, one of the companies I grew really close with before I joined the Honor Care Network, was Embody Labs. Are you familiar with them? So, Embody Labs uses virtual reality for caregiver training. And I found it fascinating what they did. I mean, especially for dementia training and end of life training, because at the end of the day, I mean, one of the things that we need to do is really provide adequate training for our care professionals that are out there.

[ 00:41:23 ] And, you know, the day of bringing them into your office to do a four-hour training, eight-hour training, those are gone. I mean, one of the biggest changes we've had, Miriam, is that, you know, we had the big office, 5,000 square feet. I told you one third of it was dedicated to training. We used to have training classes, you know, as many as 40 people, but typically I wanted, you know, training classes 10 to 12 people because I wanted them to be more intimate. You know, now caregivers don't come to us anymore. We have to go to them. I mean, we are so needing caregivers. We need to meet them where they are. And, you know, that has changed in the last five years, six years where we used to have them come to us.

[ 00:42:05 ] We go to them, we orient them where they're at, but we also need to be able to give them the tools and the training. And I think in body labs, and we also have a partnership with Navon, and I'm not here just promoting Navon. There are other caregiver training programs that are really fascinating out there and utilizing a lot of techs, but to be able to give caregivers the tools that do their job is going to be paramount to our success. So, when we talk about innovation, I know you're talking about robots, you know, more importantly, we need to make sure that the group that's coming up, even though it's 1.7 rather than 2.1, that group that is coming up, we need to give them the skillsets.

[ 00:42:44 ] We also need to make sure that immigration isn't a dirty word because we need to open up the doors to these caring nations, whether they be African nations or West Indian nations, you name it, there are so many caring nations out there that would love to come here to America to be able to care for our elderly. So, and we need to figure out how to be able to give them the skills. Now, when it comes to delivering care, you know, I think that there are ways that are going to happen. You know, certainly I think the village concept is something that we're going to have to embrace. You know, one of the things that we're doing as it relates to innovation is we're doing fractional care.

[ 00:43:25 ] We've been doing that, and I don't know if I shared that, or if I shared this with you, Miriam, before, but we've been doing that for about eight months now, and we're rolling out to multiple other communities to do this, and we're doing care by the minute. And, you know, while it sounds a little crazy, when people are living in these communities, how hard is it for you, the listener, to get a four-hour minimum in one of these communities when they just need someone to help them get down to the dining, or they just need someone to prepare a meal, or just to make sure that they're taking their medication, every one of these communities is having workforce issues. We're just having care issues.

[ 00:44:04 ] Just think about if you're an ED, executive director, one of these CCRCs, these Continuing Care Retirement Communities, you've got care, you've got food service, you've got housekeeping, you've got engineers. So, these guys have all been stuck in these positions where they've had food service doing care, they've had care doing food service, they've had engineers walking people down the street, walking people down the dining. I mean, they use the resources that they have. So, we're in a great position to be able to help a lot of these communities out. But, you know, the concept of putting four hours into a community with one designated client is something that is really, it's really taking a square peg and trying to push it into a round hole.

[ 00:44:49 ] So I know this is a long answer, but I really believe that clustering people together in communities, sharing resources, and a village concept like the Beacon Hill Village concept, there's 200 of them out there right now, and there's about 200 others that are being built. You know, we don't have PACE here, but there's talk about bringing PACE. So, I mean, it's bringing these types of services together, but also bringing the older adults together, I think is going to be the secret sauce to providing care. So, I know it's a long answer. It's not a direct answer. I really don't think we're going to see robots in at least my lifetime. You may. I think social robots are there, but I think the biggest obstacle is the affordability. Who can afford a robot?

[ 00:45:34 ] A robot that can lift somebody who's 200 pounds. That's going to be a hard problem to solve. Now, don't get me wrong. They're working on that. And there are companies in Japan and Korea and others that are doing stuff that is really fascinating. But at the same time, I mean, how much is that robot going to cost? And if anyone's never seen the movie Frank and the Robot, that's a really good movie to see. It's a fun movie. Good plug there. I like where you were taking this, though. When we think about innovation, I think technology is kind of the natural tendency, is how do we innovate through technology? But I like where you were taking this about innovative care models. We need to think differently about how we structure care, which in and of itself is innovating.

[ 00:46:18 ] How do we take kind of the traditional hourly model and adapt it, evolve it to the needs? And I love where you were going with this like village, village concept of how do we pull resources? How do we put people together? How do we provide minute by minute care? I think there's so much to unpack there of how do we innovate the care model? How do we adapt it? How do we think differently? And I think there's a lot of businesses that are going down this path of how do we create new structures, new models that appeal to our market and appeal to the needs? I know you've kind of highlighted a few, but are there any other innovative care models even that you've seen or hearing about industry-wide that you think may take off or that are proving successful so far?

[ 00:47:03 ] Well, I think, and there's some that are doing this, and I need to do a little deeper dive into it, but I think intergenerational living is a big piece to this. Because we have, we talked about baby boomers. And one of the biggest challenges we have as a society, and it was happening long before COVID, is that one-third of our population, 65 and older, lives home alone. And social isolation is crushing our older adults. Then you put COVID into play, and now you're forcing people to stay in their place. They're dropping meals at their door, and they're visiting with family through glass doors. Social isolation: they've said it's as much as smoking 15 cigarettes a day. People are absolutely self-medicating, whether it be with drugs or alcohol. It's crushing us.

[ 00:47:55 ] So I really believe that the intergenerational model is a big one. And if we really think about it, well, first, on social isolation: one-third of our population, 65 and older, lives home alone. Dr. Joseph Coughlin from the MIT Age Lab says between 2040 and 2050, which isn't that far away. I mean, we're really talking in, like, the next 15 to 20, 25 years, that number's going to encroach on 50% of our population. I mean, that's a lot of people who are aging population living home alone. We talk about baby boomers. We have a lot of people that are married to their careers, both male and females. They never took a partner. We have a lot of divorces. I mean, our baby boomers got divorced at the highest rate of any generation and didn't remarry, and they're alone.

[ 00:48:42 ] Or they're widowed or widowers, and they're living home alone. So, the concept of intergenerational living, because we have many parents, and we have so many women, who I mentioned before, who's a labor and delivery nurse, will tell you there are a lot of single women that are having babies, that are single moms. They need some help in raising their children. And what better help to get than from an older adult that has more left in their cup to give? So, if you put an intergenerational group together, and you have young people and old people together, then you almost put together a buddy system, right? And you buddy them up with someone. So, when the kid comes home from school, they can go visit George, who's living in apartment 702, and just check in on him and see if he needs anything, run to the pharmacy for him.

[ 00:49:35 ] And by the way, George happened to be an old English professor. He might have been an accountant. So, the child needs some help with his homework. There's a perfect place to get help with the homework. I really believe that intergenerational living is going to be a real solid key for success. And I think we're going to revert back also to the nuclear families. I see that. I saw it personally. My wife and I, we like to go to Hawaii. And the bartenders at these resorts, they know everything. They really do. So, it's interesting. We went right after COVID. So, we went in 2001, I think it was, for the first time we went back. And in this property that we're at, there were seven restaurants, and only two of them were open.

[ 00:50:22 ] They were open up for a limited amount of time. And the bartender shared this with me, and I validated it with someone else. And that is the reason why they did not open all the restaurants is the people, when they shut it down on the island, people that were in Hawaii that were from the mainland went back home. And he told me that he had talked to many of the people that he worked with, and they weren't coming back because when they got home, they found that mom and dad needed them more. Mm-hmm. And I think that that's endemic in our society. I think that when children have to go home, like in this case, or do decide to go home and they see where mom and dad are at, I think that they realize they either need to go there or they need to move mom and dad to them.

[ 00:51:09 ] And I think that's a big deal. I mean, I really do. And I think we're going to see more of that nuclear family together. I think we're going to see grandparents living with children and grandchildren. I mean, let's face it. I mean, the houses, the affordability is just ridiculous. My daughter got married last year. She and her husband just bought a house in Rockville, Maryland, and I cannot believe what they paid for this house and what her mortgage looks like. I'm like, I didn't ever pay half of that. Yeah. So, I think that's where we're going. I honestly love this concept. I'm glad you kind of ran on this of intergenerational living. I have spoken briefly about this. I lived internationally in South America for 18 months.

[ 00:51:57 ] And I think we have a lot to learn from cultures outside of the United States. Aging looks very differently around the rest of the world. And it’s a lot of this intergenerational living. It’s not uncommon for kids to be growing up with their grandparents or even great-grandparents. And there’s a lot of value in that. There’s a lot of value in young children, young generations learning from and living alongside of elderly. And I think there’s just a lot to be learned from other countries and other cultures. Another one that I’ve seen, maybe you’ve seen this online, I believe it’s in Korea that they subsidize college education and trade that with hours serving for the senior population. So, you quite literally go and care for elderly in different settings, and then they subsidize your credits and your cost of education.

[ 00:52:51 ] I think that is, when I was reading about that, just so innovative. And just the value of those two generations coming together. How do we bring young people and old people together in this setting that is so rich and good for both of them? You think of the socialization, maybe for the elderly, and just the value and the learnings and the insights for these young populations. There's just a lot of innovation. And we're going to really have to dig deep to solve some of these really large challenges. As this aging population just continues to accelerate. But it's conversations like this. Its people like us. We've got to put our heads together, think deeply, and get creative. Because the future is now. And these numbers aren't going away.

[ 00:53:37 ] And we have to focus on what we can control. So, in just our last couple of minutes, I want to just give you a few minutes to talk about what should be top of mind for home care providers as we look to the future. You know, we've covered kind of this vast landscape in this conversation. But where should people's focus and headspace be at as we look to the future? Well, I think first and foremost, they should be optimistic. Because it's easy to get pessimistic about it. I mean, you know, if you've been at it a long time and you see the costs rising, and you feel the frustration of trying to bring on caregivers, I think you should remain optimistic. I really believe that our workforce of tomorrow, and I will share this with you.

[ 00:54:25 ] The book that I was referring to, and I know this gentleman, and this is a shameless plug to it, but it's called The Potentialist, Ben Lytle. He talks about the future and the new reality of the next 30 years. You know, one of the things he talked about, and I saw him speak, and his son and I are really good friends. And, you know, he actually was the one that created Anthem and Silver Sneakers and some other great companies that he's, let's put it this way, he has definitely earned his right to be a futurist. And, you know, one of the things he said is, you know, for agency owners out there right now, don't get disheartened by the workforce that we're employing right now.

[ 00:55:06 ] You know, I know that we're all frustrated with the millennials and Gen Zs. But, you know, us, meaning baby boomers, I'm on the tail end of the baby boomers, we still have a lot left in our cup to give. And I really believe that in the future, I see a future, and Ben does too, and that is: I see a future of older adults, 65 and older, working two to three days a week. Not five-day weeks, not six-day weeks, not four-day weeks, but two to three days a week. And if you think about that with this demographic who are caring spirits that are reliable, they're dedicated, they still have a lot left in their cup to give, they want to work.

[ 00:55:50 ] And, you know, they want to be able to have some extra money to be able to maybe spend on their grandkids, or maybe they're in a pickle themselves and they need the income to help pay for their medications or healthcare supplements, whatever it is. I really think that that is part of our future, is relying more on our older adults to be caregivers. And, you know, obviously we can’t put them in situations where they’re doing high lifts and transfers, you know. We can’t put them in situations where they just can’t do it because age is to their detriment. But I’m a baby boomer, and guys, I know how to use technology, and most baby boomers do. So, for EVV, clocking in, clocking out, putting down the care plan, and then putting down notes, I think this generation can do it.

[ 00:56:38 ] So, you know, I want our listeners and the people that are being a part of what this podcast is trying to bring to them. Don’t get discouraged. Definitely, you know, know that there is help out there. It's just how do we reach them? I'll go full circle back to, you know, my learnings when I was with the consumer product goods companies like Quaker and Gatorade and Dole. It's all about messaging, right? And how do you get those people aboard? You know, there's a really progressive home care, not home care, but a healthcare institution here in Arizona. It's called Sun Health. Sun Health owns these, you know, these CCRCs, these continuing care retirement communities. There are three really big ones that they own. And, you know, the guy who's the President and CEO was telling me the challenges he was having with workers.

[ 00:57:24 ] And I just said to him, I said, exactly what you said, what was going on in Korea. I said to him, I said, your workers are right there. And he goes, what do you mean? I said, they're your residents. Older adults want to help others out. I mean, what if you had one of your residents’ cares for someone and they get credit for care when they need it? I mean, this is the exact conversation I had with Joe, who's the CEO. I just said, you know, Joe, you have self-contained inside of your community, your workforce. Now, don't get me wrong. The stuff that they really need may be more on the medical, clinical side or high lifts and transfer side. You may need to bring outside, but many of them just need companionship.

[ 00:58:06 ] Many of them just need reminders to take medications. Many of them need, you know, meals that, you know, help prepare. I mean, the biggest challenge we have with older adults, they skip meals. And we need to make sure they take their meals because if they don't eat, then they become fragile and then you're talking about a fall. So, you know, I really want our listeners and agency owners to not get discouraged with this workforce. Know that there is help with the older adults and don't give up on the younger generation either. But, you know, don't let that bring you down. And also, I'd like to think that we're going to probably solve the immigration issue. I mean, we've got to come up with new visas that we can bring workers in from other countries to really help us.

[ 00:58:51 ] But I also believe in the conversation that we had intergenerational living, families living together. I had an employee that worked for me for a long time. She was a single mom, and she sold her house. She moved in with her mom and dad. And her mom and dad were retired and helped raise her kids. I mean, she's got one in college, one in high school. And she works every day, and she couldn't do what she did without her parents helping. And that goes my case in point. And we have older adults that want to help. And they definitely want to help their own children or grandchildren, right? This was a perfect place to end. I love your optimism. And I love that you want to spread this optimism.

[ 00:59:32 ] This has been such a rich conversation, slightly different than kind of the norm where we deep dive on operations or on a specific topic. But I love this really just kind of broad stroke of the industry, of the landscape, of aging. I think you speak so eloquently to this topic, Bob. And I'm grateful you have been recognized and have had the platform to do so. But I hope everyone really just enjoys this conversation, and less of the nitty-gritty of maybe operations, but more of why we're here, and what we're doing, and how to think about the future, and the impact that we're having, and how to get creative and get innovative. And how we all can work together. Again, I think that's why I admire you so much as you are so positive, but also so collaborative.

[ 01:00:19 ] You really embody, you know, we're in this together. You work closely with the agencies right there in your local market. You're always quick to collaborate with others. And I think that too is just a huge part of the future of home care and of aging in America is all of us working together for this common goal. So, Bob, I just want to say. I do want to end with this if I can. And my wife would love that I'm using this. Everyone, if you've not seen the show Hamilton, you should. It's a great show and, you know, it had incredible meaning. But there was a lyric that was used in that show, and it was the Schuler sisters. They sang this one song and there's this one phrase that I think embodies where we're at.

[ 01:01:07 ] And that is, look around, look around, at how lucky we are to be alive right now. And I got to tell you how lucky we are to be alive right now, Miriam. It is awesome. I mean, we are in the inflection point of innovation and technology, and we've got this aging crisis, and we together can help problem-solve this. I mean, this is an exciting time. It really is. I'm so excited about the future for home care. And as I like to say, in-home supportive care services, not non-medical. So, thank you, Miriam, for the opportunity. Absolutely. I couldn't agree more. Perfect place to end. Bob, thank you so much for your time. I know you're a busy guy, so it means a lot to get an hour of your time.

[ 01:01:49 ] So thank you for everything that you shared, everything that you stand for, and just the leader that you are in this industry. It means the world to all of us. Everything that you're doing locally, nationally. Thank you for your efforts. I'm blushing. I don't know if you can tell, but I appreciate those accolades. Thank you. And thank you for being my friend. Absolutely. Well, we'll look forward to having you back again to talk about a grant. Talk about innovation. You all are doing some really exciting things in the state of Arizona with Medicaid, and you've pulled in some other technology partners. So, stay tuned as we bring Bob back to talk about this grant and what he's doing in Arizona to innovate on the Medicaid front. So, Bob, thank you. And we'll look forward to talking again soon. Thank you, Miriam. Make it a great day.