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Welcome to The Sandwich Generation Survival Guide, where we explore the challenges and strategies of navigating life caught between work demands and supporting our loved ones while maintaining our own well-being. Join us in this dynamic podcast series as we uncover the complexities individuals face balancing multiple roles in the modern world. Our host, Candace Dellacona, shares personal experiences and professional insights to guide listeners through this complex journey.
Candace Dellacona: Welcome to the
Sandwich Generation Survival Guide.
I am your host, Candice Dellacona,
and I am thrilled to have join us
this morning, Beth Weeks a nurse
and one of the co founders of Senior
Living Consultants of New York.
Welcome, Beth.
Beth Weeks: Thanks so much
for having me, Candace.
Candace Dellacona: I'm
so happy to have you.
I hear from so many clients and families
about the quagmire that senior housing
really is not understanding all of
the options and the opportunities
available to seniors as they age.
So I'm thrilled that you're here.
You are the expert.
You are my go to for senior housing
options and guiding families through
what is, to the rest of us lay people,
a really complicated landscape.
So we're thrilled to have you.
Beth Weeks: Thanks again.
I really appreciate being asked.
Candace Dellacona: Absolutely.
For our listeners and, Beth, I'm sure
you know a lot of these statistics,
but I read a really interesting
statistic that the number of people
over 65 years old will increase by 42%.
And the number of people
over 85 will increase by 111
percent in the next 20 years.
That is baffling when you
really think about it, right?
Beth Weeks: Absolutely.
It's a staggering statistic that not
only do we have this larger population
of seniors, but people are living longer
and longer and having to make plans for
a lifespan that their parents never had
to or their grandparents never had to.
So it's a whole new unknown
world for a lot of people.
Candace Dellacona: Absolutely.
So why don't you tell us a little bit
about who you are and what your background
is and really what prompted you and
your wonderful partner, Paul, to find
Senior Housing Consultants of New York.
What led you to that?
And then we'll get into the nuts and bolts
of the different senior housing options.
Beth Weeks: Sure.
My background is that my very first
real job was as a secretary in a
medical equipment company that owned
senior living communities as well.
I had a great mentor.
It was a really great small family
owned company and I really loved the
population that we were serving and
they liked me too, so they kept, moving
me to different divisions and I got
to try out all sorts of different jobs
within the senior living company and
eventually found my way to a community.
And was in the process of becoming
a licensed administrator when my
mentor had a rule that we had to
do every job in the building if we
were going to be effective leaders.
So I went to CNA school, which was
terrifying but it was an interesting
experience and one that I didn't know
that I would enjoy or be good at.
And the first time I did hands on care
with a senior, I fell in love and I
decided in that moment I wanted to be
a registered nurse and I wanted to be
a nurse administrator to be able to
better lead and instruct the staff in
communities and to have more empathy when
it came to working with this population.
So after almost 20 years of working
directly in communities or in offices
related to communities my business
partner, Paul and I met while working
at a senior living community and
decided that there's a lot of noise out
there when it comes to this process.
There's a lot of
misinformation on the internet.
There is a lot of confusion and I
don't want to be so dramatic to say
subterfuge, but it's not clear.
There's not a lot of transparency in the
process and as a result, people can waste
a lot of time and sometimes precious time
looking at places that aren't appropriate
for them or their loved one or their,
whoever they're taking care of or that
they can't afford, but they're not told
that up front before they go to visit.
So the impetus for this was Paul
and I were working together one day
and someone referred a client to the
community where he and I worked and it
was a totally inappropriate referral.
In that there was no way the type of
community we worked for could support
the care needs of this individual.
And it was so sad because that family
had been led to believe that we could.
And until I actually had that
conversation, they weren't aware of it.
So in that moment, Paul and I decided we
would create this company, Senior Living
Consultants of New York with the mission
to guide people through this process.
By advocacy, education and transparency
and make sure that we are advocating
directly for that person and not just
their physical needs, but their desires,
their wants, all the things that make
up a human and eliminate that noise.
Candace Dellacona: Right.
I think the way that you put it
is just perfect with the noise.
I think one of the things that surprised
many families that I deal with when
they're looking for the next place to
go is the fact that they're being sold.
And that's really what I understand
you and Paul are trying to avoid to
ensure that the person is looked at
as a whole person and to make sure
that the place that they endeavor
to live, maybe for the rest of their
lives is the right place to live.
So let's talk about the
different housing options.
I know that you and Paul are specifically
keyed into assisted living and
independent living facilities, but
just for our listeners in general,
there are options that don't involve
assisted living facilities, but I want
to go over them for people who are
thinking about what the options are.
So obviously the first one
is aging in place, right?
And staying in one's home.
And, I have many clients who say that they
want to stay at home, that that is where
they are most comfortable, they feel safe.
It's been a place that perhaps they've
called home for, a good number of decades.
So it's no wonder why it makes sense.
I think many of the clients that
I see and that you see, Beth,
are the people that can no longer
stay at home for various reasons.
I think one of the major issues is safety.
And I'm sure you as a nurse when
you are, helping your clients and
the families, safety is a big issue.
Do you want to talk about the safety
issues that arise that people
should be on the lookout for when
a loved one is staying home and
maybe shouldn't be staying home?
Beth Weeks: Absolutely.
And you're exactly right.
It always comes down to safety.
And Paul and I, even though we do
this for a living, we believe that
home is the best place for someone
because that's where people want to be.
That's where I want to be when I'm older.
But it's only the best place until it's
not and what makes it not the right place.
And the first thing is safety.
So certain barriers that are obvious and
here in New York City, does the person
live in a walk up apartment and they're
no longer able to safely navigate stairs?
Are they reliant on medical
equipment that makes it not
possible for them to use stairs?
Do they require 24 hour home
care or live in home care, but
they live in a studio apartment.
So there's not space for a caregiver
to live and have quality of life while
they're caring for this individual.
Is there a hoarding issue?
Is there a clutter issue?
Is there a navigation issue?
Do they need specialized equipment that
can't physically fit in this apartment?
And then the biggest fear for us with
our clients, the bathroom situation.
Is there a bathtub in this, and it's
not safe for this person to step
over the bathtub to get into the
shower, so they're not, maybe they're
not taking care of their personal
hygiene, which can lead to infections.
There are a lot of different factors.
And it's very, very individualized
and it's very personal.
And some people don't have the resources
to either have home care at home or to
modify their home to make it safe to live.
Candace Dellacona: I think that
those are all really good points and
points that families should take in
and think about when these things are
happening to their loved ones, these
should be triggers to you that maybe
you should endeavor to start having a
conversation about this particular home
not being the right home at this point.
I was just, walking here in the city
to work and I'll tell you, people
walk really quickly on the sidewalks.
There's not an awareness
of personal space.
And there was an elderly gentleman
walking in front of me who clearly
was just out for his morning walk.
And I was sort of bracing for him.
So you add all of those factors
together, even leaving one's apartment
to run out to the store and grab a cup
of coffee, you might be taking your
life into your own hands as a senior.
So safety, I think, is something
that's always top of mind.
When the families get to the point where
home maybe isn't the right place, can
you get into sort of the facts about
Independent living and assisted living
and what those two settings are and the
type of care that one would receive so
that we can maybe educate our listeners
on the difference between the two.
Beth Weeks: Absolutely.
And just to back up a tiny bit people
aren't always sure what they need.
And most people don't know they
need me until they need me.
When somebody like you
refers me to come in.
What Paul or I will do is we'll go to
someone's home if they allow us to, and we
can help them identify if they have all of
the resources or the possibility to make
their home safe for them to stay there.
And then we connect them with
the appropriate resources
to make that possible.
But if even after that, it's
not possible or after a couple
of years, they call me again.
So independent living.
It used to be a misnomer, but these days
it truly does mean independent living.
Basically what that is, is an
unlicensed senior living residence.
So it's an apartment building kind of
on steroids geared towards seniors.
So you have a private apartment, whether
it's studio, one bedroom, two bedroom.
All of the amenities that one would
enjoy in a traditional assisted living
setting like meals in a common dining
room restaurant setting programs,
activities, engagement from a variety
of sources, whether it's lecturers
or entertainers coming in, outings to
different cultural events in the city
and communal living socialization,
which is really key, and another
safety factor for considering being
at home as one might become isolated.
What's not offered in independent
living sometimes meals are not included.
Sometimes just like a meal
plan that you pay for, personal
laundry is typically not included.
You might have to pay someone to
do your laundry or do it yourself.
There are laundry machines either in
the apartment or in a common space.
But the biggest factor for someone
would be to consider their care needs.
If someone needs a lot of supervision or
hands on care assistance or medication
management, the independent living
community typically has relationships with
home care providers who might be on site
or that you can bring in to provide that
type of care on an hourly basis, but it's
not the staff of the actual community.
Candace Dellacona: Got it.
Beth Weeks: In assisted living, it is
licensed by, let's just speak about
New York, it's licensed by the state
of New York, Department of Health.
And so it's overseen, there are
regulations in place for the types of
people that the community can employ,
the types of people that they can
care for depending on their license.
And assisted living in New
York is a varied model.
There are lots of different options.
It's not as black and white as,
oh, you have to be able to walk 150
feet to live in assisted living.
That's just patently not true.
There are a lot of different layers to
different types of licenses and some
communities can offer care almost up to,
I'm not going to say skilled nursing, but
they can come pretty darn close to really
high levels of care where one can truly
age in place in that setting, barring
some unprecedented medical event that's
not a normal part of aging like a stroke.
Candace Dellacona: Right.
Beth Weeks: And so the biggest
difference is, The care is delivered
by the community, it's overseen by
the community, they're held to a
standard by the state of New York.
And there's emergency
response systems in place.
So if someone does need something
in the middle of the night, a nurse
or a care staff will come in and
assist them and then all the other
things, the meals, housekeeping,
laundry, amenities, activities,
all the fun stuff too is included.
Candace Dellacona: So it's much more
structured than an independent living
facility, and I guess families probably
have a bit more faith in the fact that
that structure which is licensed by the
state of New York or whatever state I'm
sure you happen to reside in, and those
employees adhere to certain levels of
care and provide a certain level of care
pursuant to the license that they have.
That's really interesting in terms of,
an independent or an assisted living
facility, are there telltale, well, if
you are at this point, you really can
not consider an independent living, you
talk about being able to employ people.
Maybe not employed by the independent
living facility or sending people
in to do the medication management.
What's the sort of breaking point
where you say, well, this person really
should not continue in an independent
living that really an assisted living
is more the appropriate choice?
Beth Weeks: That's a great question.
And I'm going to answer
it with an anecdote.
So I have a lovely client.
His name is Jay.
And he has enjoyed tremendously
living in an independent living
community for many years.
He moved there before I met him.
But it was the perfect choice for him.
He's a social guy.
He was pretty independent, but he
was having some mobility issues.
He lived in a walk up apartment
with his partner and wasn't
able to navigate the stairs.
So he was really the poster child for
independent living because he could handle
all of his activities of daily living.
He just can't handle stairs and meal
prep and housekeeping and laundry.
And he was lonely.
He was isolated in his apartment.
But he had a medical event that
changed his life and his care needs
to the point where he required
nurse assistance with an ostomy.
He now has a colostomy and he's
not able to manage that on his own.
And due to the nature of colostomy bags,
especially new ones, as you're getting
used to caring for one, there can be some
accidents or unexpected events with that.
And he felt more comfortable being in a
setting with a nurse on staff 24/7 who
could respond in the moment to provide
care for his ostomy and he wouldn't have
to wait for a home care person to come in
or worse, have to go out to a hospital.
Candace Dellacona: Yeah,
that makes actual sense.
It's a great anecdote to
illustrate for our listeners
the difference between the two.
So I appreciate that.
Obviously, and we'll circle back, but
the next level of care is a skilled
nursing facility, which is quite different
than an assisted living facility.
Skilled nursing facilities are
facilities that despite the fact that
we call them skilled nursing facilities
really provide a lot of custodial care
which is different than needing
assistance with you refer to the ADLs.
And for our listeners, those are
activities of daily living and
there are seven or eight of them.
But the activities of daily living
generally are eating, bathing, cooking,
cleaning, transporting, using the
bathroom and those sorts of things.
And once they reach to the level of
a skilled nursing facility, what is
the difference between the assisted
living facility and one entering
into a skilled nursing facility?
And is it always necessary, Beth, to
go into a nursing home when residing
in an assisted living facility?
Is that where everyone's
going to end up anyway?
Beth Weeks: I am so glad you asked
that because I get asked this question
a lot with people having, they assume
what I'm going to say, which is
yes, everyone needs a nursing home
and the answer is absolutely not.
Candace Dellacona: I love
that answer by the way.
Beth Weeks: I'm a little
bit passionate about this.
We're very fortunate that we're in
this sort of Renaissance period of
assisted living where communities
are offering higher and higher
and higher levels of care safely.
By their own staff.
Where people are able to live in an
assisted living community who might
need a catheter, who might need an
ostomy, who need a mechanical lift to
be able to get in and out of bed, who
are chronically in need of the use of a
wheelchair and they can't self propel it.
These are people that 20 years ago,
they would be in a nursing home where
they'd be home with 24 hour care.
Candace Dellacona: Absolutely.
Beth Weeks: So now we've got these great
options out there that are really getting
hip to the fact that because people are
living longer and longer and other disease
processes are now being diagnosed earlier
and earlier people live with these chronic
illnesses like Parkinson's disease for
much longer than they have in the past.
And they need a lot more care as
they progress through their illness.
I wish I had a specific statistic, but
I can say in my over 20 years of working
in this field, the people that usually
quote need a nursing home was because they
exceeded the guidelines of the current
assisted living where they live, which
nowadays is not really an issue anymore.
Candace Dellacona: Sure.
Yeah.
Beth Weeks: Or going back to that phrase
I used earlier, an unprecedented medical
event, that's not a normal part of aging.
There are certain things we
plan for as we get older, but
nobody plans to have a stroke.
And the outcomes of a stroke are
unpredictable and sometimes can
lead to things like needing a
tracheostomy or needing a feeding tube.
Those are examples of things that
cannot be safely cared for in an
assisted living community and would
necessitate a skilled nursing facility.
The other not so great reason for someone
to move to a skilled nursing facility in
New York is because we don't have a great
Medicaid assisted living model here, and
as people outlive their money or they
worked in a field where they didn't have
a retirement fund and they don't have,
or they had some emergency where they
had to use their money for something
else, there's not a great plan for those
folks not in the metro area anyway for
them to be able to go to an affordable
assisted living facility under Medicaid.
So we do see some folks end up in skilled
nursing facilities because Medicaid
is a payer for that type of care.
Candace Dellacona: That's the perfect
segue into, the cost and I think
that, A, people are living longer.
And B, I think because of that, there are
people in generations older than ours that
didn't expect to live as long as they did.
Or they have, or they are.
And, while it's amazing that they are
living past what they anticipated would
be their lifespan from a financial
perspective, it can wreak havoc in a
family's sort of existence to figure
out how to pay for these things.
So I think first and foremost, our
listeners should know Medicare does
not cover any sort of long term care.
Medicare is not something that
anyone can turn to for long term
home care for any sort of assisted
living facility or for a nursing home.
Medicare does not cover any
long term housing options.
That's number one.
Number two, I think it's really
important that, especially people in
our generation, Beth, where we're maybe
one generation removed, hopefully two,
from thinking about our long term care
options, but, long term care insurance
does help pay for the cost of assisted
living facilities, independent living
facilities in some circumstances.
So it's really important to think
about how to cover the costs
so that one has more options.
What would you say, Beth, the average
cost of an assisted living facility
is here in the New York City area?
Beth Weeks: That's a really tough average
because yeah, in this renaissance that I
alluded to we've seen these ultra, ultra
luxury communities pop up, that come with
price tags, starting just for an apartment
at, 13, 14,000 dollars per month.
But if you really were to break down
when I give somebody in Manhattan
a good starting point for assisted
living, not including care services.
So not including if you need
help with bathing or dressing
or toileting or feeding you're
starting in a studio apartment
around like 70 to 7, 300 per month.
And that's not going to be
in a setting that offers a
very, very high level of care.
If you do need a lot of care services,
your starting rates are more in the 8,
500 to 8, 900 dollar per month for just
the apartment, the studio apartment.
Candace Dellacona: So when a family thinks
about an assisted living facility, they
have to think about sort of two things.
The actual cost of the residence.
And the level of care that your
loved one needs, which could really
be all over the board and can really
significantly add to the expense, right?
Beth Weeks: Yes.
So when we are helping people evaluate
that go through that problem we're
looking at the types of communities
and how they bill their care.
So some communities bill their
care sort of an a la carte tiered
system where they have levels.
And each person's level can
be very, very different.
I often get that.
Well, what's included in level one care?
Well, it depends on, what Mr.
Smith needs to be ready
to answer that question.
So level one care for Mr.
Smith could be, he just needs somebody
to come in in the morning to help him
get out of bed and then somebody else
to give him his medications and that
might cover his services under level one.
But Mrs.
Smith, his wife, might need someone just
to take her to the bathroom in the middle
of the night, and that's all she needs.
And that could be her level one.
So some communities now are offering all
inclusive models where all of their care
and medication management services are
bundled into that base rate, which is a
really great deal for somebody who either
needs a lot of hands on care help now,
or we project that they're going to need
it in the near future and make sure your
costs a lot more predictable as you age.
Candace Dellacona: Predictability of cost
is a big deal because when you're talking
about a senior or a family that's trying
to financially help support that senior
or at least, perhaps enhance their options
by contributing to the cost of the care.
I think you're right that at least being
able to navigate what's in store so that
a person doesn't run out of money that
you can budget and you're not forced
into, a long term nursing home situation
and leaving a community that you now find
is your home, which is what one hopes an
assisted living will become for a senior.
Isn't that right?
Beth Weeks: Absolutely.
And it's not to be crass, but
Paul and I call it one and done.
That's our goal is we want
people to move one time.
Moving is traumatic at any age.
I just moved.
And I think I'm still going to need
some therapy to get over it, so
complicate that by this decision being
motivated by probably some event.
Or some trauma.
It's emotional.
People are vulnerable.
Sometimes they're making this decision
while wearing a hospital gown, lying
in a bed, and they're making this
decision that way, which is a terrible
way to make a major life decision.
Candace Dellacona: Or having lost a
spouse of 50 plus years and thinking
about their own mortality and their own
fragility, and it's so important that when
family members start these conversations
with their loved ones, they think about
it, all that it symbolizes, right?
It's the loss of independence.
Beth Weeks: A perceived loss of
independence, sometimes it's not
actually, but it's that perceived,
and they're losing, losing your home.
That's a loss, losing the ability
to make decisions on your own.
That's a loss.
So when we help people through this
process, we're really looking at as
much as we can trying to predict that
this can be the place where they spend
the rest of their life if they choose.
Candace Dellacona: Absolutely.
One of the things that you mentioned is
that New York, unfortunately, doesn't
have a great model for Medicaid to
pay for assisted living facilities.
I did some reading in anticipation
of our conversation today, and what I
actually found out is that nationwide
there really are only 18 percent of the
people that are in assisted living look
to Medicaid at all to help cover the cost.
And I think that figure is going
to continue to be reduced as our
Medicaid programs from state to
state are slowly chipped away.
So it really is important that people
of our generation that are watching
our parents go through decisions like
that, that we also prepare ourselves for
the cost, which could be significant.
I think that, one of the things that
I really appreciate about what you and
Paul do, Beth, is when you meet with
a family, you talk about what they can
actually afford so that they're not going
to the creme de la creme and thinking,
Oh, this is, I could live with this.
And then realizing there is no way
that they could possibly afford that
level of maybe concierge assistance.
For our listeners out there, one of
the greatest things about Beth and
Paul and what their organization does
with Senior Living Consultants of
New York is they don't charge you.
They do all the research and they are
paid by the assisted living facilities.
So, they are able to give you an
unbiased view of what your options
are in doing all that research,
which takes a lot of time, Beth.
How many assisted living facilities
would you say that you and Paul
have visited in New York since
you started your organization?
Beth Weeks: That's a great question.
We spent the first six months we were
in business just visiting communities.
So it's over a hundred that we visited
and we continue to visit . That's
something that's very important to us.
People often ask me, what's your
favorite assisted living community?
And I say, I don't have one.
And the reason I don't have one is
number one, it's specific to the person.
Cause what's best for me, isn't
best for somebody else necessarily.
But things change in these
communities, staffing turnover.
There can be negative feedback
related to care, related to meals,
related to the amenity services.
So we are in these communities
on a regular basis.
We have relationships with leadership,
with the nurses, sometimes with the
direct care staff, we stay in touch
with our clients sometimes long, long
after they move into communities because
it's not a straight line and nobody
should be making these recommendations
based on geography and budget only,
you have to know what's going on
in these communities and sometimes
communities come off of our list.
And we have those tough conversations
with leadership about why.
And until they meet our level of
satisfaction and safety we, don't
necessarily work with them or we tell our
clients why we're not recommending a place
if they ask about it so that they can
go in with their eyes wide open if they
choose to proceed with a community that
we may not be recommending at the time.
Candace Dellacona: Which is super helpful.
One of the things that, you point out is
how important it is to set your eyes on
a place and really go into the community
and not perhaps read, reviews online
that could be a year or two old and not
reflective of current staff changes.
So that's super important.
The last thing I want to talk about, Beth,
that I love about this industry and the
way that it's headed is that particularly
in New York, there are specialized
communities popping up all over the
place to really cater to different
communities and different ethnicities and
languages and all those sorts of things.
And in fact there is a community
that was started in Queens.
And I believe if I recall correctly,
it was started because a physician
couldn't find the right place for one
of his parents and they were Indian
speaking and I think they were calling
it the India house that was opened in
Queens to cater to certain communities,
the way that they cook and their
traditions and those sorts of things.
What do you see in terms of
the future of the industry
with these sort of subspecialty
facilities popping up all over?
Beth Weeks: Well it's a really
exciting time, that more seniors
are, people are living longer and
longer and the traditional models
in some cultures are falling away.
Historically Asian families live together.
I grew up in Asia.
I am not Asian, but all of my
friends grandmothers lived with them.
Their grandparents lived with them or
they lived with their grandparents.
But now we are seeing more
diversity in senior living.
And people of that generation are
more open to communal style living.
While we don't have as many that are
popping up that are specifically geared
the entire community geared towards
one culture or lifestyle we are seeing
communities get more hip to the fact that
they need to be catering to all sorts of
different people and training their staff,
not just on care delivery and safety
protocols and fire drills in the building,
but cultural awareness and sensitivities
and we're seeing communities that are
endorsed by SAGE or endorsed by LGBTQ
communities because they're training their
staff to work with the older out adult.
Or the older adult who may not be out, but
has shared with you that he or she is gay.
So it's really we have a new awareness.
But I think as we progress and
more communities open, because the
demand is there, as you said in the
statistics you were quoting early on,
I think we will see more smaller kind
of boutique communities opening up.
Candace Dellacona: I had some folks
from SAGE on last year, and I'm happy to
provide a link to our listeners if they
want to listen to that, but organizations
like SAGE are providing that training.
So many assisted living facilities
are bringing in these organizations
like SAGE or particular cultural
organizations to educate the staff
so that people are more comfortable.
Ending on that theme of not only
living longer, but really living
better and finding the right place.
I'm so happy, Beth, that you were
able to spend some time with me
today and impart some of your wisdom.
Really, this has just been so enlightening
for me, and I'm really thankful for
all of your guidance and expertise.
Thanks for being here.
Beth Weeks: Oh, thank you so
much for having me, Candace.
This is wonderful and happy to have
been asked and I really enjoyed it.
Thank you.