Tag Archives: elders

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.

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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!

 

 

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.

Change is Underway

3 Aug

In the beginning we felt a moral obligation to change the way we care for those less fortunate in our society, the poor elderly and disabled. We soon realized that by changing living conditions, we were improving the health of those individuals, cutting healthcare costs, reducing Medicaid spending, creating new jobs and economic activity, revitalizing neighborhoods and increasing the affordable housing stock. This was the argument we used in convincing government to invest in our project.

Global aging is a historical phenomenon impacting all segments of our society, work, retirement, entitlement programs and healthcare among others. The demographic tsunami of the baby boomer generation will only compound this crisis. Tackling the challenges of global aging must be a priority of all countries. We need to keep seniors healthier, away from institutions, working and engaged because our society drives when everyone in it does. Yet we continue to segregate the elderly, not to be seen or heard. We know so little about them, no wonder our younger generation does not see them as role models.

However, it is going to be hard to continue to ignore seniors in this country. Those of us who belong to the “boomer generation” will be demanding changes. After all we are known for our activism, a trait that has not diminished as we age. We have not given up on changing the world, we are more adamant than ever that we can.

 

Elders Do Better at Home

19 Jun

 What accounts for reducing healthcare costs, faster recovery of seriously ill clients and improved physical and cognitive heatlh? You will never guess – bringing services to where these clients live.

The private assisted living industry is now fully engaged in servicing elderly clients in their homes. Most major assisted living chains are now caring for clients by dispatching caregivers to their homes at a cost of $240/day. Most have seen a growth of 20% in this line of service. The impetus to engage in this line of service may have come as a result of the stagnation that private facilities have been experiencing for the last five years; or, perhaps it may have been the result of several studies revealing that 89% of elders wish to remain at home as long as possible. Hospitals are finding out that seriously ill elders do better when medical services are provided in their homes.

John Hopkins University School of Medicine began the home-hospital movement back in 1996 as a pilot program. Research has proven that elders with potentially deadly diseases like congestive heart failure and cellulites can be safely treated at home with astonishing results. Not only was the care as safe and as satisfactory as hospital care, but recovery was faster and the cost much lower, 60% less.

There is no doubt that the trend in the future will be to provide as many services as possible to elders in their homes. A great idea!

Stop Forcing Low Income Seniors into Nursing Homes!

8 Jun

This has been our battle cry for over twenty years. The benefits of keeping seniors at home with needed services has proven to be cost-effective, beneficial to the health of these clients and responsive to seniors’ desires. And yet, change has come slowly particularly in southern states. Under the pressure of skyrocketing Medicaid budgets fueled by the increasing numbers of low-income seniors our policymakers have had to shift toward funding more community instead of institutional care (nursing homes), what is called in the industry: “rebalancing long-term care.”

One state that has been successful in doing so is Oregon that rebalanced their budget back in the early 1980’s. Many other states have followed, including Washington and Colorado. The number of people receiving Medicaid-funded nursing facility care in these states grew at a much slower rate than in the rest of the nation from the inception of Medicaid home and community-based waiver programs in the early 19080s to 1994. The number of people in nursing homes as a proportion of the population age 75 and above in these states decreased faster than the average for the rest of the nation. Total annual Medicaid spending on nursing facilities also increased at a slower rate in the study states than nationally after controlling for growth of the age 75-and-older population.

Today only a handful of states remain committed to forcing seniors into nursing homes when no longer able to live independently – Kentucky, Virginia, Alabama and West Virginia do not pay for assisted living services. Although an increasing number of states have created Medicaid waivers to pay for assisted living services, the funding always falls short of the need which creates long waiting lists. clients in need of assisted living services cannot wait the two or three years it takes to receive an allocation. So seniors and disabled adults are still forced into nursing homes and we continue to pay for poor quality and undesirable care.

In 2003 our firm started the conversation with the Department of Housing and Urban Development urging them to join forces with the Department of Health and Human Services (federal Medicaid program) to properly fund community care at least for those living in public/subsidized housing. Seven years later, it happened and both departments partnered to create the Community Living Initiative that funds housing and services for low-income disabled adults. Seniors, however, have to wait longer and as of today no initiatives have been taken to address the issues of the seniors.

Apparently financial crisis alone will not prompt the federal government to act. I firmly believe the issue of low-income seniors ending up in nursing homes prematurely must arouse public opinion. Those most affected, the seniors, the families, the advocates, need to demand this change. Rather than being remembered as the “silent minority” we must be remembered as the generation that changed the way we care for seniors in this country.

The Challenges of Global Aging

23 May

America is a relatively young country as far as the percentage of individuals 65 years and older in the U.S. today. About 12% of the population in the U.S. is 65 years and older. However, that percentage is projected to increase to 20% within the next decade. Compare those numbers with that of other countries like Japan with the highest percentage of seniors currently at 21.5% of the population. Global aging affects all aspects of our society: work, health care, retirement, services and housing, among others. One of the major challenges is what we call the dependency ratio which means that for every person age 65 years and older there will be fewer than two persons in the workforce and available to care for the older generation. Exceptions are those countries with high birth rates (Mexico, Iceland and Turkey) or in countries like Australia, Canada and New Zealand with high immigration. However, in most countries the dependency ratio will sharply increase from 2020 to 2050. It is becoming more important that we create new ways to care for this aging population that is cost effective and dignified. The U.S. has the highest per capita health care expenditure in the world with a per capita cost per individual of $6,714. Japan, on the other hand, has the lowest health expenditure with a per capita expenditure of $2,581, half of that of the U.S. Most of the expenditure in Japan is paid by the government.

During the Ashoka Summit held this month we were able to discuss with other Fellows challenges facing their countries. Masue Katayama, a Fellow from Japan, has worked for the past twenty years in providing services to the older population in Japan. She came to learn how our firm has been able to change how we care for this older population. We believe that the global financial crisis is pushing us to make due with less and to learn how to use government funding more efficiently. Our firm has a proven track record of being able to service three times as many seniors with the funding the government spends on one. Japan, along with many European countries, has older people and lower health care spending than the U.S. They do this by fixing prices and manipulating prices to keep costs down. Every two years the price of each treatment, test and medication is examined to see if excess profits are leading to overuse and if so the price is cut. This is not done in the U.S. because those who profit from high prices are so powerful. This rationing and price cutting impacts the ability to control chronic illnesses at an early stage. Instead of rationing, Japan should look at ways to improve people’s lives by systematically changing lifestyles through better diets, exercise, medication management and supervision. This is something that Japan and other European countries can learn from the U.S.

Masue and I sat down to establish a collaborative effort that will enable us to learn from each other. She visited one of our affordable assisted living facilities and was impressed with the home atmosphere and the improvement in the physical and cognitive health of our residents. We agreed to formalize this collaboration by her sending a group of her operators to the U.S. for a month to live and learn at one of our facilities. Mia will do the same as we know that there are lessons to be learned from Japan as they tackle the common challenges of global aging.