Ep 31: From Firm to Farmhouse, Family and Senior Housing Functions with Jean Makesh Part 1
Lucas: So, welcome to Bridge the Gap on a really exciting episode today with Josh, Lucas and our esteemed guest Jean Makesh. Welcome, Jean.
Jean: Thank you Lucas. Thanks for having me.
Luacs: So, we have a lot to talk about today because we are at Jean’s brain child experiment that has turned reality, an amazing concept for senior living. We are in Ohio, Chagrin Falls today recording live from your building and this is a really, really exciting experience.
So, Josh, tell us are you excited? What’s going on?
Josh: Of course I’m excited! I’m with Jean, I’m with Lucas, so naturally I’m excited here at the Latern. I’ll tell you as an operator in the industry, as a student of the industry, I’ve been able to read about and hear about what Jean has been doing here for the last several years. So, pinching myself today, I got to spend the whole day with Jean, picking his brain, hearing his story, hearing his passion. You’re going to hear about it today. But, this is also, this is the flagship, this is the mothership of where it all began.
Lucas: So, just to let our listeners in, we’ve spent the past probably several hours with Jean and his staff. They have literally rolled out the red carpet for us and the hospitality has been really unmatched by any other experience that we’ve had. I mean, it’s just the truth.
And so, Jean, we’ve been following you awhile. You’ve been in major media outlets. You’ve done TEDx talks. You’ve been on CNN. You’ve traveled the globe, talking about your concept. But, you’re also a really down to earth guy and humble, but you’re leader in the space. So, I think help our listeners get to know Jean a little bit better as we walk through a couple of topics that are just going to pull back the curtain a little bit and talk about your vision of why your vision of design, your vision of how it impacts our seniors and our elders and dementia and I think it’s going to be a really exciting experience.
So, Jean, give us a little bit of introduction into yourself and tell us why.
Jean: Thank you so much Lucas. Josh, you guys are super gracious. Thank you again for having me. Why? Why not? I always ask this question to myself: If I don’t, who else will? Couple of years ago- I’m a runner, when I travel I run- when I was running the streets of Chicago, I love to run by the lake and I was exhausted, tired. I stopped running, just looked up and looked at those trees. Beautiful trees, beautiful trees. And took my breath away. And I said to myself, ‘who planted these trees? Who planted these trees? Did they even know that one day it would grow up this tall and offer shade to someone like me?’
That’s when I realized that it’s important for us to start planting trees that we never get to see.
I asked the question over and over to myself- why? Why and why? And at this time, my mission is just very simple- it’s to offer hope. Hope to my elderly clients, hope to people who work with elderly, hope to my peers, hope to the industry.
So, as I was thinking, you all know that ideas come to you, one of the things I realized early on in my life is that anything that I do has to be relevant. What I mean by relevance is not relevant to me, relevant to the people that I create space or a design a space. You and I, when we build a home or we design a space, we make it relevant to our needs.
And, I just felt very compelled that it’s important for me to create a space that I thought would be extremely relevant to my clients. And the best way for me to go about doing it is to depend on my clients. I’m living my life with people that are a lot more mature, a lot more smarter, with a lot more years of experience, a lot of wisdom, and they are my best resource. And I started listening to them and really trying to understand what made them happy, what brought joy to them.
There’s a difference between happiness and joy. When you have joy, you’re at peace, you feel fulfilled. And that was a trigger in my life that pretty much propelled my thought process and started laying the footwork that I needed to pursue the things that I believed in.
Josh: So, I love it Jean. We want to let the audience a little bit on what we got to talk to you about today when we first met in this beautiful farmhouse which has we don’t even have time to tell our audience the great story behind the farmhouse and this land that this sits on, but tell us a little bit. You weren’t always in senior living, you know what point of your life and career did you kind of make that transition and kind of tie that in to your why?
Jean: Well, I was in my previous work life, I was employed with a very large firm, a very successful firm and at one point I was managing the compliance part of the rehab side of the business for this particular firm. I had about 120 nursing homes over 12 states.
It truly was an opportunity for me to get to know my clients not just from Ohio alone but from Oklahoma, from Texas, from New Jersey, from Wisconsin- people from different walks of life. I just realized that as we get older, all we are seeking is for someone to listen to us. All we are seeking is we have some form of companionship or friendship. I felt at the time that it was missing in our industry. Maybe missing is not the right word. I think as a caregiver, as a provider, we could offer more for our clients.
So, with that mindset, I was a lot younger. When you’re young people say you’re foolish too; maybe I was. And I said I’m going to change the world, I am going to change the industry like ant 20 year old does. I set on the mission, on the path and so I felt that I need to create a space that would be very relevant for my clients.
After I created the space, after I designed, after I constructed, I’ve been in the industry for awhile, I want to say at least for six or seven years, and I really thought that I knew a lot. I mean, I engaged with the vice president, senior VP’s, elderly clients from different walks of life, but when I started getting down on the floor and when I started engaging with my clients, I didn’t know anything about the business. I didn’t know anything about the elderly, I didn’t know what the needs are, what their preferences, what they desired. Essentially, I became a student.
They started teaching me. Everything that you see today that I have designed and I have built, is purely based on their feedback, what they told me, what they expressed to me. It was everything, every design that we currently have around- it was their desire.
Lucas: Interesting, interesting. So, take us back to that moment where Jean said ‘you know what, I really think that I want to build out my own platform and I want launch the Lantern Group so to speak. Kind of walk us through that thought process. What was that moment where you really envisioned it and saw it, even though you may have been a little unclear.
Jean: Well, like any youngster, why I wanted to be the most powerful CEO, a very successful CEO, well respected in Wall Street, but I do want to share an experience that I had.
I love techno and it was my kind of music when I was growing up. And techno was not, people were not very fond of techno. Techno had its own associated lifestyle but I love techno. And one day in my office, I still remember this day, I was in my office listening to techno and usually I listen to techno when I’m really stressed out and I’m stressed out when I’m looking at numbers. And I had the door closed and I was listening to techno music and I heard a very gentle knock on my door and I right away turned the music down; I didn’t want anyone to know that I listen to techno because techno is associated with drugs and partying and doing crazy stuff, which I never did any of that, I just loved the music.
And there was Eunice. Absolutely beautiful woman- every single day she just looked prim and proper- she just looked perfect. She looked at me and she said ‘Jean, what is you are listening to?’
I’m like, I’m being very apologetic and she says, ‘wait a second, no I love that music. Why don’t you play it on the PA system.’
I said, ‘Eunice, I can’t do that. No.’
And she said, ‘you’ve gotta play it!’ And she made me play the following day and I was really surprised- many of my elderly clients, especially my women, they just loved it. So, I started thinking about, okay, there’s a disconnect here and the more I started thinking about it, I felt it was all about me reminding them of being young, feeling young, being vibrant, full of energy. And I think that really changed everything for me.
Lucas: That was a moment, a transition point. And so, one of the things that we’ve enjoyed today are the brilliant stories that you have based on your experience of you really like to get your hands dirty, so to speak. You don’t just have an idea and then pass that off to someone else to execute. You seem, based on our conversations, that you really dive in and you want to learn it. The failures and successes. And I think that that’s one of the things that’s apparent as a leader, any strong leader, is they’re very open about the things they failed on because it wasn’t really a failure, it was an opportunity to learn something new.
And, so, I think one of the things that you’re best known for is the brilliance in your design aspects of how you lay out your communities. Talk to us about some of the stories and things that you learned along the way that got you to the point of thinking like this main street that we’re sitting on right now and encourage our listeners to go on to YouTube to watch this later if you’re listening on your podcast player.
What are some of the stories that led you into coming up with these concepts and ideas?
Jean: I had a client called Norma. Norma was in her early 90s, absolutely a vibrant, vibrant lady and a very successful entrepreneur. And she told me at one point she owned like three or four jets. And she was into fast cars. And she’s been a client of mine for almost two years then and I didn’t know anything about Alzheimer’s or the dementia at the time and every single evening around 5 o’clock she would stand by the front door, wanting to go home.
And the first few, this was again in 2005; the first few evenings, I would try to reason out with her. I would ask her why she wants to go home and she would tell me she wants to go home because it’s time for her kids to get off the bus and she needs to be there to prepare food. And I would try to reason out with her in a very nice, kind, polite way and it didn’t work at all. At that time, I said, I need to do something for Norma because she wanted to go home and if she’s not able to go home, that leads to, that becomes a trigger for other dysfunctions we call behaviors.
I just felt if there’s a way I can help Norma understand and that’s when I realized that it’s so important for us as providers, we need to dive in to their world (and) really find out where they are. Back then, I didn’t know much about Alzheimer’s and Norma kind of motivated me to look into Alzheimer’s and other forms of dementia.
What I realized after extensive research is, as the client as they go through different stages of Alzheimer’s disease, they revert to their early childhood days. There are about seven stages that we know of and each stage is tied to a cognitive age. And essentially, you know, at that given time, Norma was at stage four and she was very similar to a 10 year old in thinking and process, the way you engaged.
So, that’s when I realized that, okay, we need, anything we design has to remind them of their timeframe that they can relate to. If there’s a way to remove the as many conflicts from the environment as possible, maybe there’s a chance for me to engage with Norma meaningfully. And that was one of the factors that really pushed me into understanding and learning about what is relevant for Norma (and) what would be relevant for my other clients.
Josh: So, switch gears here just a little bit, because we were kind of talking about your background, your history and then we started about some of the design features. There was a couple of themes that seemed to guide that and I think I myself, I’ve just know Jean and Lantern as memory care here and you talked to us a little from programmatic standpoint about the assisted living and memory care and you talked about a couple programs that you do here…
I also want to hear you touch on something that I thought was really fascinating which was person-centered care and you’re kind of opinion on and what you guys focus on here instead of the term person-centered care.
Josh: Yeah, so go back and tell us a little bit about the programs, how you divide up the assisted living and memory care and then work us in to that not person-centered care model and explain that to our audience.
Jean: Absolutely. So, essentially, what the latest studies revealed so far is only nine percent of Americans don’t have the risk to develop Alzheimer’s. Only nine percent. If we have, if one has a single copy of APOE4, the risk of getting Alzheimer’s is anywhere between 30 and 50 percent. If one has two copies, the risk goes up to anywhere between 50 and 90 percent. Now, with that kind of statistics, we as a caregiver, a care provider, I just felt that we got to find a way to help the 91 percent.
What is it we as a provider can do? We know that at some point there’s going to be a tremendous amount of need to deliver good treatment, good care and treatment. I was listening to another speaker the other day and she was telling the audience that she asked a very open-ended question. She asked, ‘who wants to live up to 90?’ And pretty much everyone in the audience raised their hands. And she very politely said, ‘well, if you live up to 90, there’s a very good chance either you will have Alzheimer’s disease or you will be carried for one. So, that is the real truth that we have.
So, as a caregiver, as a provider, what is it we should do? What is our moral responsibility? So, I just felt that it’s important for us to have the assisted living component and also the memory care component. We are known for memory care but our memory care is only 30 percent of our business; 70 percent is AL (assisted living).
So, there is something called a cognitive reserve. There’s been a lot of studies, a lot of revelations that have been demonstrated the last couple of years or so. And essentially what it is is in a nutshell, you and I have complete control over our functional side of our brain. And it’s the way we live our life. It’s what we do with our brain. How we keep it healthy, how do we work it every single day, are we able to create new neuro-networks. So, I thought, maybe, what if we coming up with, designing a program potentially on the AL side that we could use to for the 91 percent or maybe the 50 percent or 80 percent, whatever the number is- Can we develop exercises, activities, cognitive activities to prevent the manifestation of the system.
So, we developed a program called JIVE. It’s called JIVE, it’s what we use on the AL side. So, essentially, every single day, pretty much every client is subjected or is taken through the program. So, essentially, the intent is to increase the blood supply to the human brain, to activate as many parts of the human brain and to keep the brain healthy.
On the memory care side, you know, by the time the clients come to us, some have an established diagnosis, some don’t. See a disease or a medical condition is a problem for you and I only when it prevents us from caring for ourselves or for caring for others. When you look at diabetes, high cholesterol- we pop a pill and we’re able to care for ourselves (and) we are able to care for others. It becomes a problem when we are not able to care for ourselves or for others.
So, the SWAYS program, again we developed an activity exercise, brain integration program and tapping into the cerebellum, called the mini-brain, to see if there’s some way we can keep our clients healthy and functional. In other words, can we enable them to care for themselves.
So, two different programs with two different missions and two different objectives.
Josh: So, fascinating. One of the things I love about you Jean is just how you think and how you process and how you see a problem and how you try to get to the route of the problem and I love that you’re not afraid to be unpopular when you really believe something and this community, your programming is evidence of that. And we’ve gone through and talked about several things that maybe you got a lot of pushback on when you first started on that mission.
One of the things that I could see as getting a lot of pushback and maybe you could share is how you interpret person-centered care. And maybe we’ve digressed a little bit when we’ve talked about person-centered care and what your approach is here at the Lantern to that.
Jean: Absolutely, I’m sorry, Josh, you did ask me that question.
Well, to me, a person-centric approach or person-centric care should be a given. It’s like this; when you check in to Ritz Carlton or a W Hotel, you expect a certain level of service, right, it’s a given. No one is saying that at the hotel that they don’t have a flyer at the hotel that says ‘we will treat you as a person when you walk in’ or ‘the bed sheets are clean, they’re fantastic.’ They don’t talk about that, it’s a given. When you check into a Ritz Carlton or W-Hotel or a fancy Mariott, it’s a given.
So, in our organization, we just felt that the person, every single client, has to be treated as a person, no matter what. Now, what I also realized is that, you know, Dr. Barry Rice Burke’s Theory of Retrogenesis clearly describes how an individual as they come down with the disease, they regress back to the childhood days.
When they’re reverted back to their childhood days, what we have seen personally with our clients is their personalities come out. And it is important for us as caregivers to know our client’s personality and many times, you know, you and I, who we are, what we are, our personalities are formed based on experiences that we had between the ages of three and ten. Some say between the ages of three and five, some say between the ages of three and seven, but that pretty much defines and really shapes who we are.
Now, we know that our clients are regressed back to their early childhood days, they’re reverting back, so it’s so important for us as caregivers, as care providers to know what the life was like, what did they do, what excited them, what they didn’t find exciting or joyful, it’s really important to understand that and I always use this example- when I go home, you know, I see my wife in the kitchen doing her stuff and she looks at me and she doesn’t acknowledge me, she just looks, and I know that something is not right.
Lucas: We’ve all had that look.
Josh: Yes, often.
Jean: And I go like okay, well it’s not the best time to ask for a cup of coffee. And the reason is because I know her very well. She knows me very well. My staff that are very close to me, they know exactly when to ask what.
Now, that is knowing someone’s personality. You know that by being close to one another, by living with one another. Now, when the client regresses, reverts back to early childhood days, you know, what we have often seen is their personality. And I know when we go in to care for them, how do we know that they want to brush their teeth, they want to do a certain thing. Are we compelling or pushing our views that we think is good for them?
I’ll give another example. We all have rituals and I talk about this in my book. Rituals, you and I every single day, we go through this every single day. I’ll take you through my own personal ritual.
So, I get up in the morning and I usually pray then right after that I go to my den and I start working. When it’s time to get ready, I go up to the bathroom. The first thing I do is brush my teeth. And as I’m brushing my teeth, I’ve soaked my cheeks with shaving cream lather because I want my cheeks to marinate, as you say, right, so that I can have a good shave. Now, so I brush my teeth, I shave then I take a shower and what I do, I’m kind of giving out a lot of personal details..
Josh: No, we want all the details.
Lucas: We’re diving deep.
Jean: It’s important for everyone to understand. We all have our rituals. Then I walk into my walk-in closet and I pick up my pants, shirts, my belt and I get dressed. I do not button my shirt. I walk back into my bathroom. I blow dry my hair and then I will button my shirt, tuck it in and then put my belt (on). Go down, grab a cup of coffee and look for my keys and get out.
That is something that I do every single day. Every one of us, we do that every single day. Okay, now, if I’m a patient and someone is caring for me and they come up to me, you know what Mr. Makesh, it’s time to get ready. Let’s brush your teeth. And if they give me a brush on bedside or try to get me dressed on bedside. What am I going to do?
Josh: There’s going to be some pushback.
Jean: I’m not going to cooperate. When I don’t cooperate, you know, well Jean is not cooperative, he’s a very difficult client and we as care groups are going to keep pushing and pushing and pushing and I’m going to push back, push back and push back. Ultimately, they end up giving me a psychotropic drug to calm me down.
So, how much do we know about our clients? We all have rituals. I have a friend who told me the other day as I was talking to her about the rituals, she said every single night before she went to bed she had to lotion up and one night she was so exhausted, she didn’t want to do it. She tried sleeping, she couldn’t sleep. She had to get up, do her ritual and then she was able to go to bed.
Every one of us has a ritual. Do we know our clients rituals? And I think it’s important for us to understand the personalities, the rituals in order for us to provide care that our client desires and prefers.
Josh: I love that. So, one of the things that is fascinating to me as we spent time with you today, walking through the community, being fed a wonderful meal by your staff, is how intentional every aspect of it was. I think as senior living operators, as developers, we all want some in our day and time, a silver bullet that’s like oh, this is the magic pill, or this is the secret- it’s all in the design. But, it’s a lot of things and the things you are touching on, you know, you wouldn’t be able to do a lot of the things if you weren’t very intentional.
For example, in recruiting and retaining and educating your staff as we’ll talk a little bit, you know here in maybe the next episode about design and things like that. I love that you are even intentional with your staff areas and making wonderful lounges and things like that.
We’re going to hear hopefully some of the stories of, you touched on psychotropic drugs, that’s a big topic and we all want to know how we can reduce those but where’s the gap, how are we filling that gap when we remove those psychotropic drugs? What are the interventions and things like that?