Conchy Bretos gives testimony to the Senate Committee on Aging and Entrepreneurship

14 Feb

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On February 12th I was invited to testify to the US Senate Aging and Entrepreneurship committees to provide information about the challenges that “late-in-life” entrepreneurs like myself face in starting their businesses. The purpose was for the Committees to gather recommendations on how to facilitate these initiatives. At the meeting were senior senators and chair of committees, Senators Bill Nelson, Susan Collins and Tim Scott. There was consensus among those providing testimony that older entrepreneurs constitute the largest group of small business owners today and is growing. Today over 9 million seniors are establishing businesses with 30 million more coming over the next decade. It is a matter of great interest to the Senate and a matter they want to prepare for and facilitate. These businesses are also the largest source of new jobs to young employees.

A main challenge that these older entrepreneurs encounter is access to capital to start and remain in business. Access to government, federal agencies and investors is also a barrier. Discrimination toward seniors is real and alive. Accessing capital from lenders always raises the question of how long the business will be operating given the age of the owner. Succession planning then becomes more necessary than ever. The myth that older individuals cannot learn new skills or new technology; that they take rather than give was shattered with the testimony and research presented at the hearing.

The Senators asked for ideas of what would make life easier including introducing legislation. Several workable ideas were submitted that include allowing the use of unemployment benefits for startups, new regulations to make it easier to obtain a Small Business loan, coordination at the federal level so entrepreneurs can communicate with federal agencies, and more.

The hearing was the first to address this issue We believe that it provided clear understanding of the role that older entrepreneurs are playing today and in the future and the obstacles that they face that could be facilitated by the Senators. More on this.

Conchy Bretos and Senator Bill Nelson after the hearing:
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Conchy Bretos’ testimony to the committee:

For the past seventeen years our firm has worked with public and private entities in 23 states. Later this spring we will be opening and managing an affordable assisted living facility for the District of Columbia Housing Authority. Our projects have proven to reduce Medicaid and Medicare spending by keeping our residents healthy, away from costly institutions, while generating thousands of new jobs and healthy operating margins. For the past two years we have partnered with low income housing tax credit developers, owners of affordable housing and private owners/investors to scale our model. This has required a major restructuring of our firm and our business model.
In 1995 I created Mia Senior Living Solutions as a for profit company understanding that if our firm was to grow rapidly it had to be fueled by profits. As Florida Secretary for Aging under the Lawton Chiles governorship, I got a good understanding of aging issues and developed a strong relationship with the aging network. I had lived long enough to learn from failures, how to deal with detours and the inevitable ups and downs. Changing the way we care for low income seniors and disabled adults was not a new idea but no one had created a successful model to do it. We created a model within an exponentially growing market with little competition.
Starting my own business was as much due to life circumstances as it was a career change. An empty nest, the end of a marriage, the loss of a job, I reached midlife with an urgency to leave a legacy, to contribute, to make money and live to the fullest those bonus years that longevity gives us. Wanting to leave an impact on the world grows stronger as we age. I asked myself if not now, when? If not me, who? For a long time I had dreamed of creating something lasting that would connect me with future generations. I did not want to defer this dream any longer. Not having health insurance kept me awake at night. I took some time to reflect and assess what I wanted to do, what skills I possessed and then tested the idea in the real world.
When my term ended as Florida Secretary for Aging, I came home to Miami with some savings from my job and an idea; to convert a public housing building into assisted living and allow for true aging in place. The Miami-Dade Housing Agency Director wanted to dispose of the highly deteriorated Helen Sawyer building in downtown Miami. I told him I had an idea I wanted to test in the building. He said yes but he had two requirements: One was that I had to prove my idea quickly and two, I had to find the funds to do it. That day I formed my company, invested some money in stationery and worked on a feasibility report with the help of some friends. At the same time I approached the State Legislature and was able to get a $1.2 million allocation of Medicaid waivers. I was awarded a five year contract by the Board of County Commissioners to start the conversion of Helen Sawyer Plaza with a promise that it would be self-sustainable by the end of the first year. We developed detailed budgets, worked on the policies and procedures needed, hired the staff needed, secured vendors. I worked very hard until what seemed like the impossible, happened. We opened the doors of Helen Sawyer and in six months the place was full with a good waiting list. I knew that this first project had to be successful if we were to move forward. This innovative project was featured several times in the media, won four national awards and became the model for the nation. It became a show place with constant visitors from the entire nation, senators, governors, secretaries and a multitude of housing directors who wanted to have one just like the one I had created. I was able to negotiate new contracts with housing authorities as far away as West Virginia. I was invited to speak at several industry conferences and build a community and a larger network. Although we did a lot of free work in the beginning, we moved away from the pro-bono and created a successful business. It was hard to keep up with demand with only myself so in 2001 I asked my daughter, a management consultant in New York, to join the firm. To my amazement she accepted. Mother/daughter teams weave together business and family life, school schedules, time with the grandchildren. All are important parts of the day-to-day routine. Succession planning is a prominent topic of discussion. Although letting go is not an easy process for me.
Receiving the first Purpose Prize award in 2006 and becoming an Ashoka Fellow in 2010 have certainly been turning points in our business life. These awards have provided validation for what we do and a network of professionals that are interested in our scaling our business. We have received expert and legal advice, mentoring and support. We have learned how to present ourselves, how to raise money, structure ventures, re-engineer our firm. I know now more about databases, LinkedIn, Facebook, electronic health records and blogging than I ever wanted. I do not have one boss anymore but many of them, our advisors, board members, funders, clients and investors.
However, most of my fellow entrepreneurs are not so lucky. Lack of capital, connections and mentoring remain major obstacles for us aging entrepreneurs. Relying on grants to sustain your work has become an impossible proposition. In order to survive, the initiative must generate its own source of revenues by selling products produced by the company and that can be replicated over and over again.
Most of our work involves partnering with government to change policies that represent obstacles. Today, more than ever, government needs individuals like us with the public interest in mind, talented and driven. Approaching government usually ends in rejection at least that was my case. Two years ago we made a major decision to team up with private entities to better grow our business. But this too has its own challenges like the distrust by investors of the reliability of government subsidies like the Medicaid waiver or the disconnection between the regulations of the Low Income Tax Credit program and assisted living. For these investors financial rewards come first and social impact is gravy. Maintaining that balance has been a major challenge for us. But we know consumers are demanding more socially responsible behavior from businesses. Businesses need to catch up with this trend. Profits are not everything.
America is a young country; our models do not include old people. The most common image of an innovator is that of a youth creating a great idea in a garage, a dormitory, or a makeshift office. In reality these are the exceptions. Research tells us that it usually takes 20 years for the birth of an idea to become fully implemented. It is around the age of 40 or 50 years that individuals are at the peak of their work. It has been proven that a 55 year old and even a 65 year old have significantly more innovation potential than a 25 year old. It is fair to say that less gray hair sharply reduces the innovation potential in an organization. Yet, stereotypes like old people cannot learn new skills, master new technology, that they take rather than give abound. Shattering these stereotypes must be a major priority for all. This hearing goes a long way to doing that.

Making the Right Decision

30 Dec

When the time comes to move to an assisted living facility there are some questions you must ask. It is a difficult, traumatic and long term decision. You have to make sure that the move is pleasant and right. Below are a set of guidelines/questions that can help in making your decision.

  1. Is the residence licensed? Is it a good location to family/doctors? Is the entire facility wheel chair accessible? Is the décor attractive and home-like? Is there good natural and artificial lighting?
  2. do the residents socialize with each other? Do they appear happy and comfortable? Is the facility clean and odor-free?
  3. does the facility assist with self-administration of medications? What is their policy on medication storage? Do physicians visit patients on the premises?
  4. Is there 24-hour help available? Is the staff friendly & properly dressed? Does the staff know the residents by name?
  5. Are units private or shared? What safety features do they have in each apartment? Can residents bring their own furnishings? Is there a kitchen area in the unit?
  6. Is there an activities program? Is there a wheelchair-accessible van for transportation? Do residents have access to computers and the internet?
  7. Do they provide three meals daily? Do they provide snacks too? Are there set meal times? Are there special diets available?
  8. Are the rates all-inclusive or do you have to pay more for higher levels of care? Do they accept the Medicaid Waiver/Diversion programs? If so, is the family/resident expected to contribute financially to help cover the cost of care?

Asking the right questions will help ensure that the decision made is the right one.

The Final Installment

19 Nov

Today I am going to wrap up our discussion by speaking about two additional programs that are available to help low-income seniors: Assistive Care Services and VA Aid and Attendance.

Despite the number of low-income seniors needing long term care subsidies to remain at home, except for Mississippi, Florida has one of the lowest reimbursement rates for services. In order to entice private providers to accept clients into their assisted living facilities, the state decided to create the Assistive Care Service (ACS) funding program. This program is a matching fund. By taking some state funds and requesting the federal government to match it, the state was able to provide $9.28 per resident per day to help pay for services. Separate from the Medicaid program, Veterans are eligible to have services paid through the Aid and Attendance program. Unlike the Medicaid waiver program, this is an entitlement program, meaning if you are eligible, you receive it, no waiting lists. However, the time it takes for the VA to approve applications can be long, on average 6 months. Following are the requirements to apply for both the ACS and the VA Aid and Attendance programs.

ACS-Assistive Care Services (State Program)

Call DCF (Department of Children and Families)

1-866-762-2237

  • Must be 65 years or older, or 18 years of age and blind or disabled.
  • Must be a U.S. Citizen or qualified non-citizen.
  • Must be a resident of Florida.
  • Must have a social security number or have filed for one.
  • Physician must complete the 1823 for the client to be admitted to the ALF.
  • Client must be in an ALF.
  • Total asset limit is $2,000 for an individual or $3,000 for a couple.
  • The client will receive $9.28 per day to help offset the cost of living in an ALF. The program will not pay for any day the client is not at the ALF, i.e. days in the hospital or on vacation.
  • If applying for ACS, the client can NOT be on the Medicaid Diversion program.

VA Benefits – Veterans Aid and Attendance

Call the Department of Elderly and Veterans Services

Broward County: 954-357-6622

  • Must be eligible (served over a 90 day period, some of that time must be during wartime).
  • Any age may apply. The program takes 3 – 6 months to process; residents are responsible for the full rent until approved.
  • Program will pay retro-active from the date the application was submitted.
  • Must meet the medical criteria. Must meet the financial requirements.
  • Needs to be in an Assisted Living Facility to apply:
    • Veterans are eligible for up to, approximately, $1,703/month (2013 rate)
    • Widows are eligible for up to, approximately, $1,095/month (2013 rate)
    • Married couples are eligible for up to, approximately, $2,020/month (2013 rate)
  • Cannot exceed $80,000 in assets, not including a home.
  • Residents can apply for Medicaid Diversion and VA benefits. If qualifications for both programs are met, may receive both benefits.

I hope that I have helped to inform you of some of the programs and options that exist to help you care for your aging, low-income parents.

 

Another program to help you in helping your Mother

12 Nov

As promised, today I will discuss another program that is available to very low income individuals. The Medicaid Diversion program is available to very low income individuals who are eligible for supplementation to their social security check and to those with a small pension. This is a match funding program, meaning the federal government contributes some funds as well as the state. You have to be eligible financially as well as physically. Here are some of the requirements that must be met in order to be eligible.

Diversion – Long Term Care

(State and Federal Program)

Department of Elder Affairs 1-800-963-5337

Florida: www.elderaffairs.state.fl.us 1-850-414-2000

  • Must be 65 years old.
  • Must have a diagnosis of dementia plus need at least 3 out of 5 ADL’s (activities of daily living);
  • or require assistance with 4 ADL’s plus medication management;
  • or require assistance with 5 or more ADL’s.
  • Activities of daily living include: bathing, dressing grooming, ambulation and toileting.
  • State CARES unit will come to assess the client to see if they meet the program’s criteria.
  • Can also need IADL’s (Instrumental ADL’s which are: housekeeping, shopping, cooking, transportation.
  • A physician must complete a 3008 form for the State.
  • A physician must complete an 1823 form for admission to an ALF.
  • Must have income less than $2,130 for an individual, $4,260 for a couple. (These are 2013 limits)
  • Total asset limit is $2,000 for an individual or $3,000 for a couple.
  • Facilities are paid per contract; families are responsible for monthly room and board rate to the facility. Facilities may charge COLA increase annually according to a lease agreement.
  • Incontinency is a covered benefit.
  • medications are covered through Medicare Part D or the individual’s personal insurance.
  • PT (Physical Therapy), OT (Occupational Therapy), ST (Speech Therapy), Labs, Physician Visits, Hospital Coverage, Dental, Hearing and Vision will be covered if not otherwise covered by Medicare or personal HMO Insurance. Diversion will also cover any and all non-covered services, co-pays and deductibles.
  • The contracted Diversion company becomes the secondary insurance to Medicare.
  • Transportation is not a covered benefit. Medicaid should cover under Logistic Care.
  • There is a hospital bed hold up to 21 days. if the client is out more than 21 days the facility will not be paid and the family will be responsible for the difference.
  • Clients do not have to be on SSI or OSS to qualify for this program.
  • Client may NOT receive HOSPICE benefits while on a Medicaid Diversion program.

Next time I will speak about ACS – Assistive Care Services and VA (Veteran’s Affairs) Benefits.

Stay Tuned!

 

 

What Can I Do for My Mother?

25 Oct

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Every day we get panic calls at our office. Most if not all of them deal with “What do I do with my mother? She cannot live alone anymore. She has so few resources.” The problem arises not only because seniors find it difficult to communicate with the outside but also the outside is a hard system to navigate. The case of my 92-year-old mother, who speaks very little English, is a good case. She dreads the thought of having to speak with a computerized phone system and follow the instructions. It becomes a labyrinth of sometimes insurmountable barriers.

One of the essential benefits we offer, at the facilities we manage, is to help these seniors navigate the system. If you are low-income there are multiple benefits that can help you get help at home, pay for services if you live in an assisted living facility, get transportation, and many others. The problem is that most of these services are offered by different agencies and these agencies do not talk to each other. So you find yourself calling several agencies, that is, if you know whom to call, and getting different answers.

So let’s take the example of my mother again. She is low-income, has a small pension and several mobility issues that make it impossible to perform easy daily activities. The first step is to decide what services she needs. At this stage of her life, and mainly because she is of sound mind, she needs someone to come to her home 3 or 4 times a week to clean, prepare food, help her with bathing. She lives in Florida and although Florida is one of those states that has yet to place all senior services under one agency, she will first call the Area Agency on Aging for her district. This will be done with the assistance of the helpline (1-800-955-8771) a 24-hour service that directs you to the right agency and/or individual.

There are several programs that seniors and disabled adults are eligible for depending on age, disability and income. These are: Social Security Income Supplementation (SSI), Assistive Care Services (ACS), Medicaid waivers, Diversion programs and Veterans Aid and Attendance. We will cover, in this blog, the first step: applying for Social Security Supplementation.

SSI – Supplemental Security Income

(Social Security Disability)

  • You may apply for this online at the Social Security website
  • The program is based on Financial qualifications ONLY
  • You must be a U.S. Citizen or an eligible non-citizen
  • You are eligible for SSI if you are over 18 years old and are deemed disabled by a physician, which means that you have a physical illness &/or mental problem expected to last more than one year or result in death or are considered blind.
  • You can get SSI up to age 65, after that your benefits automatically convert to retirement benefits (Monthly Social Security Check).
  • You must have worked long enough to have paid into the Social Security System.
  • The monthly income requirements, to qualify, are as follows: $00.00 to $710.00 for an individual and $1,066 for a couple.
  • Total assets must be less than $2,000 for an individual and $3,000 for a couple.
  • It takes 3-5 months to process claims.
  • SSI pays monthly checks to the elderly or disabled person to get their income up to $710.00 (i.e. your monthly income is $300, SSI will send you a check for $410.00, if your income is $600 your SSI check will be $110.00).
  • If you are in an Assisted Living Facility, the entire monthly income (less a personal needs allowance) will be submitted to the facility to pay for your care.
  • If you are on SSI you may be eligible for other State and County programs such as food stamps and Medicaid. (If the person is in a facility, food stamps will not apply).
  • Call the local offices for more information.

In subsequent blogs we will discuss and provide information on the other programs. Stay in tune!

 

 

Replication – An uphill battle?

27 Jun

Replication becomes a moral imperative for social entrepreneurs. Once we find out that we are making a difference in our communities we have this undying desire to replicate our idea. Most, if not all, social issues are global, and a good solution can travel anywhere, with some caveats. We know through experience that global aging is posing challenges to all developed countries. In places like Japan & Italy the growing senior population comprises over 30% of the population. This aging wave affects may aspects of society: work, retirement and healthcare among others. So why not introduce our idea to them? While it makes common sense, for an idea to travel many factors must be in place. Capital, connection, understanding of regulations, the culture and language are critical if we are going to be successful. These were the issues we confronted when we tried to bring our program to Japan last year. While both parties agreed that it could be transplanted and we were both eager to do it, several obstacles had to be overcome.

Last year, through the Ashoka network, we discussed introducing our model to a very prominent woman that started a large nursing home business in Japan. She was interested in bringing about a less institutional model like ours. There were few if any regulations in Japan that would prevent implementing such a program, no competition exists and the government could reimburse for services through their healthcare/pension plans. However, for our program to work, we needed to overcome some major barriers like language and raising the capital to establish relationships in such a close knit culture. Overcoming the language problem (only 3% of Japanese converse in English) required the hiring of a full-time interpreter. We also needed to employ an agent so we would have a direct presence there. Trying to raise capital in Japan became difficult as there are today very few foreign investors. The initial investment proved to be too onerous for us.

Raising capital for our social ventures is an arduous job, absorbing a big chunk of our time. We knew that when we started and that was the main reason we decided to create a for profit company. We were also in a hurry and could not wait the time it takes to create a non-profit entity. Our first contract was the most difficult. Once you have created a successful and replicable model, it becomes easier to sell to others. There are no blueprints and no road maps with a new idea and a lot of non-believers. We took three steps, first: change individual behavior, second: create a successful program and third: change national policy so we can replicate with ease. We never wasted the opportunities that this global crisis offered us. From the onset we knew what we wanted to achieve and what outputs we needed to derive (number of people served, cost efficiencies, operating margins) and the impact we wanted to effect (change the way we care for low income seniors). From day one we established clear outcomes and collected data to measure progress. Performance management became our principle. When you provide data to mission driven people, the results are profound and these measurable results are essential if we are going to obtain capital needed to scale.

Connections and collaborations were a turning point to our small firm. We have never acted alone, but we realized that we needed to be connected to a larger network if we were going to make a difference. These connections are not easily made; it takes a lot of time and effort to achieve. Becoming an Ashoka Fellow in 2010 opened a multitude of doors and connections that have propelled our mission inside and outside the U.S. We formed a Board comprised of private investors and successful business owners that have guided our steps, re-engineered our firm and paved our way to the corporate world.

My years of working in government made it possible for our firm to change national policy. I understood how it works as well as their reluctance to deal with social issues. My approach in understanding regulations, culture and language has always been to understand before asking to be understood, respect and a sensible approach has served us well so far. We would have thrown out many babies with the bathwater if we were not able to work with the government as an ally.

Every single day for the past sixteen years I wake up in the morning and ask myself a simple question, if not now, when? 

The Journey Begins

25 Jun

On November 12, 1995, an event occurred that completely changed the course of my life. While serving as Florida Secretary for Aging Services I was summoned to a public housing building in Fort Lauderdale, Florida where a fire had killed 12 of the residents. For the first time I came face to face with the squalid and precarious conditions in which low-income seniors in this country subsist. The image of that day never left me and I made a promise to myself that I was going to make it better. Charged with this moral obligation and strength I was able to secure a deteriorating public housing building in downtown Miami with the promise of turning it around and creating something new. With my political ties in Tallahassee still fresh I secured $1.2 million to retrofit and license that building. In six months it was full with a long waiting list, had become the model for the nation and had won four national awards. Some may say it was luck, I believe it was stubbornness and commitment that made it happen. I had fulfilled my promise. To the 104 seniors living at Helen Sawyer this was the beginning of the best time of their lives. End of story. I never had the intention of doing this over and over in twenty-three states. But it was no longer up to me; the notoriety that this little program gained made it impossible for me to turn the page. And so it began, my journey in replicating this common sense approach to providing 24 hour services to low-income seniors where they live so they will never be forced into a nursing home.

There is no doubt that good publicity helps in creating an innovation, but that alone is not enough. I knew that innovation is almost always built on rejection. There were so many obstacles that had to be overcome. The worst was the mind set of policymakers and public officials reluctant to change the way we care for the poor elderly. They seem to have a spiritual blindside that prevents them from seeing the human side of the dilemma. If I was going to replicate this program in other counties and states, government funding was critical. My experience in government was important in understanding government, what moves them; how to obtain their collaboration. We needed to gather some ammunition to win them over. How about doing more with less? With the funds they spent for each individual forced into a nursing home, I was going to care for four. How about if we could prove to them that our care involved changing lifestyles and improving health? We started gathering data that proved that we were avoiding hospitalizations, emergency admissions, reducing the number of prescription drugs and 911 calls. That certainly caught their attention and in 2010 our little company was able to change national policy. Funding this type of program instead of nursing home care became a priority. The Community First Option program was started in collaboration with two large federal agencies: Health and Human Services and the U.S. Department of Housing. The program was initially funded with $46 million. Until now, they did not talk with each other, and now they were cooperating in making it possible for low-income seniors to live with dignity in the comfort of their homes. What a novel idea!

Now, I said, we can concentrate in avoiding other obstacles in scaling our program. What would it take to convince private investors to provide the capital to purchase distressed properties and hire us to provide the services to this exponentially growing and long neglected population? A good return on their investment perhaps? Although corporate America needs to be seen as having a social impact, what they are truly interested in is good returns. Conquering corporate America became a major goal for us. We never forgot, however, that our social mission had to be safeguarded.

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