With 50 years industry experience, Sue Farrow, Founder  of Integral Senior Living shares how senior living has shaped her life, leadership and goals. Plus topics on active adult, affordability and relief efforts for seniors. Plus, Jennifer Prado, Executive Director of Senior Housing Relief for Elders (SHORE) discusses the bridge for subsidizing finances for seniors seeking senior living. 

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This episode was recorded at the ASHA Mid-Year Meeting. 

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Produced by Solinity Marketing.

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Become a sponsor of Bridge the Gap.

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Listen to more episodes here.

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Sue Farrow

We're a high touch people business, there's only so much you can do with some of that technology. But what we can adopt that frees our employees up, our associates up, to be able to actually spend time with the residents and the staff and the family members is huge. And that's- we're already seeing a lot of opportunity in freeing time up.

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00:25

Welcome to season seven of Bridge The Gap, a podcast dedicated to informing, educating, and influencing the future of housing and services for seniors. Powered by sponsors Accushield, Aline, NIC MAP Vision, Procare HR, Sage, Hamilton CapTel, Service Master, The Bridge Group Construction and Solinity, and produced by Solinity Marketing.

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00:50

Lucas McCurdy

Welcome to Bridge the Gap podcast, the senior living podcast with Josh and Lucas. We’re here in beautiful Dana Point at the ASHA summer meeting. And we have some amazing guests today. We really want to welcome Jennifer Prado. You're the executive director at Senior Housing Relief for Elders, also known as SHORE. And of course, we have Sue Ferro, founder of Integral Senior Living. Welcome to the program, ladies.

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1:14

Sue Farrow

Thank you. 

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1:15

Jennifer Prado

Thank you for having us.

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01:16

Lucas McCurdy

Well, the listeners are really in for a treat today because we had a great pre-podcast conversation. We're going to be talking about a couple of different things, and who knows, Josh may chase some rabbits as you say. We may go down a different trail. But we're going to talk to Sue about some history of the industry and get your background and your thoughts on kind of where we've come. Also, if we have time, I want to talk about where we're going. I love your perspective there. And then we're also going to talk about your not-for-profit, SHORE. So Sue, starting with you, How did you start? Where was the first start for you?

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01:47

Sue Farrow

I wonder if I should tell the whole story.

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01:49

Lucas McCurdy

Yes. You should.

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01:49

Sue Farrow

Okay. It was 1975. I had just moved to San Diego. I was an accountant, and I was looking for a job, and I had a couple offers come in. One was from a young attorney who had a small office. I was single. I was pretty good looking at the time. And I had this sense that there might have been more expected from that position. So, luckily or divinely, I should say, the other offer was from Danny Campbell, with Danny Campbell retirement. And he had opened up an office in San Diego. They're originally out of Wenatchee, Washington. And so I took the job. It was less money than the attorney, but I took the job and Danny is amazing. Danny still lives here in San Diego with his wife. Danny loved the art of the deal. And his dad, Carl, is the one, really, that had the passion for seniors. And I'll tell a little story about kind of how the industry got started, back in Carl's day. 

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But Danny loved the art of the deal. He didn't so much love operations. And so, in the middle of my doing financial statements and all the rest of it, he's like, would you call those administrators over there in Phoenix and talk to them about this or that? And I was like, sure. I'm 25 at the time. That was in the days when we hired live-in husbands and wives who were middle aged. So I'm a little startup going, you need to do this, you need to do that. But I fell in love with operations immediately. Immediately. And I've never looked back. For me, the beauty though was having, that accounting and that numbers background. Because for me, the numbers tell the story and so it's a nice mix certainly. 

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But that was kind of the start of it and I worked for Danny and Carl for 16 years. They were going to close up their San Diego office and move everybody to Wenatchee and said, please come soon. I said, San Diego, Wenatchee. Oh no, that just didn't seem like the right thing to do. So, yeah. So I've been in the industry ever since. Not for that many players, actually. After Campbell I worked for Transamerica. Actually, their real estate division had a large senior housing portfolio, which I operated for them. And they were going to stay small. And I think my intention was to be something larger. And that's when I went to work for sunrise and was the senior VP of operations for everything west of the Mississippi, which sounds so impressive. That was when they had two, but we quickly built I mean, now they're out there pretty much on every corner, aren't they?

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04:53

Lucas McCurdy

What was that ride like?

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04:54

Sue Farrow

That ride was fast and furious and exciting. And we had done a lot of development at Kamlu, but what I hadn't done was site selection work. And of course sunrise had a huge development arm. So it was a lot of time spent looking at sites all over, all over the West, which was just a kick. And actually Rocky Goins, who was with Sunrise Development at the time, is one of my one of my partners in my development company, which is a whole different story, we won't get into that one. But basically the western division of Sunrise, kind of started Aegis. So I was the founding CEO for Aegis Living, and then by that time, I think probably for me, all the pieces were together now, being in a company, starting it up from the beginning. And so 22 years ago, I started my own, with one little management company. And last year, I think we were ninth largest in the industry. So, it's been quite a ride.

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05:56

Lucas McCurdy

You've done a thing or two.

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05:58

Josh Crisp

A thing or two. And, you know, I mean, we probably don't have enough time today to ask you all the questions that immediately are coming into mine and Lucas's head's about, you know, even through all that infancy of an industry and the growth of the industry and how much it's evolved and changed, through all the different economic cycles and presidencies and all the things that directly or indirectly kind of force us to change and adapt, and how relevant that is to a younger generation of leaders that are coming in and thinking, how do we make this work? How do we weather these storms? And so I would imagine that's equipped you to be able to really breathe some life into young leaders that I'm sure you're nurturing and cultivating. So, you know, one of the questions that comes to me with everything that you've accomplished, what's one of the things you find the most joy in now after so much success? And how do you spend your time today? How does that look different than maybe ten, 15 years ago?

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07:00

Sue Farrow

Oh, a lot different than 10 or 15 years ago. about the time you hire in a president CEO to take over that role. I've always been a believer that if you're going to put people in those roles, you let them do it. You don't hover over them. And so Collette Gray is our president CEO, and she's fabulous. She's probably been on your podcast before. If not, she should be.

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07:19

Lucas McCurdy

She hasn't. She’s on our list though.

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07:22

Sue Farrow

Okay, good.

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07:23

Lucas McCurdy

Maybe you can get us an intro.

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07:23

Sue Farrow

I probably can do that. So, a lot of my work now is what it was before and that, new business development, I gave myself my own new title. I'm the chief cheerleading officer. Right, you know, you just kind of keep the troops feeling good. And even in times that are tough, you just got to be back there, Cheerleading. So, that's a lot of my work now. We're still in, huge integration, of course, with discovery and trying to combine systems and people. And it's a lot of heavy lifting.

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08:02

Josh Crisp

So now you know where, I know here at ASHA, it's just getting started. We're getting to talk to you on day one, and it's always really interesting for me and Lucas to be able to participate not only to podcast, but to be in the panels, the outbreak sessions, in the keynotes and hear these amazing thought leaders, even like yourself, kind of help us understand where the challenges we're facing, how we go about navigating those. And, I know you're going to be speaking in to a lot of people's lives and their businesses and their thoughts while you're here. So what are some of the themes that you think will be talked about here at ASHA, and where do you think we're kind of headed as an industry, what are some of those themes that come to mind for you?

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08:43

Sue Farrow

Yeah, a number of areas. I mean, everybody talks about how we are not exactly early adopters of technology. And I also believe at some point in time we're a high touch people business, there's only so much you can do with some of that technology. But what we can adopt that frees our employees up, our associates up, to be able to actually spend time with the residents and the staff and have family members is huge. And that's- we're already seeing a lot of opportunity in freeing time up. There's hiccups. I don't like being a beta tester, and I have been in the past. It's not usually very much fun, but I love seeing at these conferences, more and more people come with more and more great ideas. So it's certainly a big- it would be interesting if we’re sitting here ten years from now and seeing really how technology has changed us. And I think the opportunity is certainly there. I think, and I'm probably going to say something that people won’t like, but that's okay, the whole push towards a more active lifestyle for seniors, which God bless, you know, I could move into one of those today. I'm not fond of the term active aging. For me, it brings it up- versus inactive aging. I don't really get what that means, but I do see this whole opportunity, and we've actually been working on some kind of structure around it, a huge opportunity to attract a younger population in. And by the way, when we were operating in the 70s, our average age was 75. So we have come a long in this period of time. Our average age, pretty much even in our independent properties right now, is 84. So, to go back and to try to recapture that age group again, developing communities that certainly have all the amenities that we're, that we're seeing, but also probably the rest of it is pretty much ancillary. So aligning with the Uber type system at some kind of discount that residents can purchase to create…somebody is going to go build this. I shouldn't say it all, right? If creating a whole office executive suite kind of situation that's manned so that our folks that are still working have an office to go to. Even thinking through the whole dining piece of it, the amount of square footage we built into dining rooms in these communities that are used, what, a fraction of the time during the day, being able to even create a scenario like a- I can't remember some of the services, the food delivery services, but that you actually deliver prepared meals up to the residents. Again, convective living type-situation, not a licensed building that's got a whole different set of requirements to it. I think that's a wave in the future. I want choice, guaranteed the baby boomers are going to want choice. So I don't want to come down to a dining room three times a day. If somebody in a kitchen produces some kind of go-to meals for me to take, I love it, I love it. So there's a lot of that kind of innovation I think coming. We're having more and more fun with designing buildings and meeting current needs. I constantly, I start to say threaten, but that's not the word, I constantly encourage our folks to think about what somebody my age is going to want when they, when they move into one of these communities. And so that kind of guides us as we're working on designing new buildings. So, yeah, I know there's a lot coming from that physical plant perspective, coming from technology, coming from the changing market. And what our baby boomers are going to want, there's a lot. I think one of the things that's been so exciting about this industry, unlike maybe other industries that are I don't know if you're making widgets, maybe there's some innovation with widget, right? But the way we're working today is so dramatically, thank God, different than the way we were working, you know, 49 years ago. And if anything bothers me, it's that I'm not going to be around 40 years from now to see how much more it's changed. That's exciting, constant innovation, It's exciting.

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13:33

Josh Crisp

Well, and you touched on something I, just out of curiosity, I think I was hearing you say when you were talking about, you didn't you weren't really crazy about the term active aging.

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13:44

Sue Farrow

Active adult is… yeah.

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13:46

Josh Crisp

Active adult.

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13:48

Sue Farrow

I’m crazy about active aging. 

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13:51

Josh Crisp

Okay, okay. Active adult was the term then. So, and you were talking about, you know, all these emerging models and things like that. Would you think that, you know, it seems like the regulatory environment for those licensed health care communities, they're obviously state regulated in that it's a little bit different in every state. Some is more favorable than others, but it seems like the traditional senior housing, as we know it, continues to get more and more regulated, which even on the life safety code, which is kind of putting traditional senior living as we know it into this acuity box, which is kind of forcing, one group of owner operators, developers into one category. And it seems like a lot of those traditional senior living providers are seeking to go lower down the acuity spectrum and going into the unlicensed building types and getting creative. Do you see that our industry, senior living as we know it, is starting to move towards a more unlicensed model? Or do you still think that the majority of senior housing as an industry will continue to be majority license type communities or something in the middle?

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15:01

Sue Farrow

There's always going to be a place for licensed communities. You know, if you're in an unlicensed, independent community, you really can only go so far with home health or allowing in private duty aids and not really having control over those various folks. So there's always going to be that need and yes, regulation changes and yes, every time a horrible story comes up, we all probably get visited by our regulators more often, but, there's always going to be a need for that. Especially as our acuity rises in assisted living and memory care settings. What has changed? And I think a lot of people maybe, maybe don't know these times. But even here in the state of California, if you were an independent, unlicensed community, you could not have a home health care agency come in and occupy space in your community and offer services to residents. You were considered then an unlicensed assisted living community, basically. So that is all changed. Now I'm not saying it's all changed in 50 states. we're in 24 states right now. But we're seeing that more and more. We operate 32 communities under our solstice banner that are all old holiday, I shouldn't say old like they're falling down, but older.

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16:29

Lucas McCurdy

Legacy buildings.

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16:31

Sue Farrow

Legacy, oh that's wonderful. That's what they are. They’re 32 legacy buildings. and we have a home health care agency based in each one. And their arm's length, we don't own them, but we're able to provide those services that you can find, quite frankly, at a lower price point, than a traditional assisted living memory care community.

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16:54

Lucas McCurdy

Okay, so that brings up affordability. This is a rabbit I want to chase now because you just talked about, you know, a more affordable, more attainable. So, you know, we have, and I'm sure you've been hearing this, you know, the older adults, they're coming. This demographic is coming. I've been at this for 15 years. And for 15 years I've heard that they're coming. Get ready. They're coming. It seems like now they really are, am I right? Over the next 5, 10 years.

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17:21

Sue Farrow

They’re probably dribbling in.

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17:24

Josh Crisp

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18:00

Sue Farrow

I’ve thought of my friends and I suddenly moving into a community, which sorry, guys, if you're counting on all of us, That's not going to happen anytime soon. But again, probably the need for that new design of the community. Like what, what would drive someone like me or my friends into a community. And it would be a change in the amenity packages and it would be a change in choice in services. And it would, it would just have to reflect how active our lives really are. 

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18:32

Sue Farrow

Since I’m sure, the active adult.

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18:33

Lucas McCurdy

Sure. Okay, so there's that piece, right. So what about a whole, a group population and demographic that, look, they just don't have the savings, but they still want, you know, a great place to live out their years. Is there, and I've heard many people on all of these panels that we go to, it just doesn't seem like anybody's really cracked that egg on affordability. And maybe technology's the thing to come in and change that or streamline that. Or there's an arbitrage there somewhere. I'm not sure, but I'd love to get your thoughts on the next 5 to 10 years. Who can build an affordable place for people to live and win at that?

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19:09

Sue Farrow

Yeah, well, I think some of the older communities actually play a part in that as well. And again, these 32 solstice communities are a really good model for future baby boomers, right? Those older communities were built with a lot more square footage than current, of course land prices were a lot different, right? I mean, there was a whole lot of reasons for that, but their space is more generous with a certain amount of capital put into them. You've got the requirement at least for the larger size apartments, and those amenities, again, is kind of bringing in the services as well. So that's certainly an option. And you're hearing that a lot, right? You're reading, you're reading the literature. So there's a lot of that already. People are approaching that. I think there's got to be more of that kind of building. It's a conundrum. And you hear a lot of people talking about it, I'm not sure I'm hearing that many solutions to it. But hence sure, which I know we're going to talk about. And that's the whole point of the nonprofit, is that whole group of people that's not going to be able to afford what we know is an amazing lifestyle and quality and prolongs life. And so, I think there's going to be other ways around that, and that's, I think we've got to convince, push, embarrass , whatever we need to do with various agencies to start to subsidize. We're seeing it with the VA a little bit right now, the willingness to look at subsidizing veterans in assisted living communities outside of the veterans communities, more needs to be done. We see the Medicaid waiver program in many, many states we operate in, but the reimbursement rate is not enough to cover the cost of doing business. And that's a misnomer I think, for the public, I think people people think there's a lot of people out there making a lot of money off of these communities, and it's a very expensive business to run and it certainly gets more and more expensive as minimum wage rises and food costs and all the rest of it. So, there's got to be the opportunity to influence states' Medicare waiver rates. but I also think Medicare needs to step up and step in.

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21:53

Josh Crisp

Well, you know, and that's a great segway to a couple conversations that I want to continue here. You know, and obviously we're at ASHA. What a great organization to help rally us together, to bring one voice to these agencies and to Washington, to legislators to improve our industry. So we're so thankful, for our long term media partnership with Dave Schless and his organization here in ASHA, they do just a phenomenal job. But you give us a great segway to SHORE. You know, give us a little bit of the why behind that, which I think you alluded to there. And then what's going on there? What are you guys doing?

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22:29

Sue Farrow

Yeah, I'll let Jen talk about the what we're doing because I'm cheerleading still. Jen’s in the grassroots and nitty gritty of it all. So, you can't spend that many years in this business and not be affected by people that come to your communities that just can't afford what you're doing. You can't. And of course, I want to fix it for everybody, I want everybody to find their spot. And we do the best we can with referring folks to other communities that might be more affordable to them. But that's just one element of it, the folks that have lived in our communities that spend down their assets as an operator, what's your choice? You know, I'm one of seven kids, everything has to be fair. So you can't just subsidize those people in your communities and not give a break to every other resident in the community. So, you know, how do we keep them in their homes? That really was the basis for sure. It's giving back, first of all, because this industry has just been so amazing to me. So we started tackling it a little at a time. I had a wonderful advisory board when I first kind of floated this idea and they were amazing, and then formed the board and, with Vicky Clark, an industry icon and some other just great folks and these and, you know, I think I'm going to go big like Ray, right away. Go big, right? And they were like, okay, let's start small. Let's do something that we can't, that we can wrap our hands, arms around easily, and then we can think about conquering the United States. But right now let's just kind of stay small. And so initially we took on the Veterans Aid and Attendance benefit program because it's something, it's established, it's something we can get our arms around. It's something certainly that a lot of residents in my communities have access to that benefit. And, so kind of started there, started in San Diego County again just so we could get our arms wrapped around it. And, but also didn't want people, and this is the thing that Jen and I talk about a lot, I don't want people to think this is just a veterans nonprofit. They're, it's a nonprofit, just servicing veterans. It hopefully ultimately is a nonprofit that helps folks all over the US be veterans or non veterans or any, any background, quite frankly. It was just, that was the easiest,  that was an easy place to start. I'll let Jen give the kind of fast.

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25:38

Speaker 3

Me and Jen have been over here eating popcorn, just listening, taking it all in and really loving this. I’m loving this.

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25:46

Jennifer Prado

Really our vision is just to ensure that, you know, everybody has access to senior housing. And that's really what SHORE’s vision is. And we really target this private pay family that didn't, you know, anticipate senior housing, doesn't have, you know, funds to enter in. Maybe somebody who is in a community and spent down and needs to stay. We're trying to solve that problem, and fill that gap. And so we've done that in a variety of different ways. Like Sue mentioned, the Veterans Fund is one that we target. We actually subsidize two months of the pension benefit for a veteran, so that they can enter a community. And that's where we found the gap, right? It's like you want to go into a senior living community, but you can't afford it. You can't afford the first month's rent. You don't know when that money's going to come in. So we help subsidize that. It's kind of our focus.

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26:31

Lucas McCurdy

It's a great bridge.

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26:32

Jennifer Prado

Yeah.

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26:33

Josh Crisp

Huge bridge, because that benefit takes a little while to get, as well. Even if you kind of almost, for lack of a better term, kind of pre-qualify them with understanding if they're even going to be able to be eligible for that, right?

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26:46

Jennifer Prado

Yeah. And here's my next one, a great segway for that part is we, it's like, you know, you need to file for bankruptcy, but you can't afford the bankruptcy attorney, right? And so, you know, I think like 13 or 16% of people are even taking advantage of this benefit across the nation. And so we thought, okay, well, we got to solve that problem, how could they get the benefit so they can get into a community. And so we've partnered I think you've had, Suzette with Patriot Angels on here recently.

27:12

Lucas McCurdy

Absolutely.

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27:13

Jennifer Prado

So we have launched a very new partnership, right? Hot off the press, where we're actually going to be helping support folks who need to take advantage of her services but can't afford it. And so we will cover those services for them. We've done that through another organization to aidinattendance.com. And so we're really just trying to find where is the gap. And we're trying to fill it so that you can get into a senior living community.

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27:30

Josh Crisp

Wow. That was cool. It's such a great service and great benefit. And, you know, I think that's why, and we so appreciate you all getting on the show and sharing this because this is not a problem I don't think any one provider or one organization necessarily, or one person, one great leader is going to fix. It's a catalyst, right, to rally everyone together. And great meetings like this and a podcast is a great way to talk about that because people need to come alongside what you're doing.

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28:05

Jennifer Prado

100%.

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28:05

Josh Crisp

And join that because, it's always better together, and we can accomplish so much more than what we could just kind off, trying to do our own little things, right?

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28:09

Jennifer Prado

Yeah, and I've had so many conversations with operators like, you're doing what? You're giving money? Yes, we're trying to help these private seniors who didn't, you know, anticipate this, get into your communities because they can't without our help right now. And so having to really educate and do the outreach, and they really do think it's a good cause, but I agree with you. I think it's an industry kind of thing where everyone has to understand the importance of it. And I think that's what SHORE is trying to do is trying to educate the importance of that gap.

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28:35

Sue Farrow 

I think I think a couple things have, well, there's a number of things that happened initially. I think initially people thought I started this just kind of as an arm of my company to get more seniors to move into our communities,  and that's far from, Jen can tell, I mean, we've moved people into Brookdale communities, she can give us a bunch of the folks that we’re there were moving in. But we also found it was hard to give away money. 

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29:04

Jennifer Prado

The hardest.

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29:05

Sue Farrow

People didn't believe us, I think, or thought there had to be some kind of catch to it or…

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29:06

Jennifer Prado

Yeah, and don't get me wrong, we're helping operators like, you know, our biggest grantee right now is Brookdale, and we're having these conversations. We're just kind of creating awareness of, we're here and this is what we're doing. But there are operators who are doing philanthropic work. And so, you know, let us be a partner with you and let us help your future residents, but also help us work, do this work for years to come.

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29:25

Josh Crisp

Yeah, well, I've heard of operators out there that see the same problem, right? I think none of us are ignorant to many of those challenges and problems, but it's like, how do you tackle it? And I've seen operators doing creative things of trying to even, they expose themselves to some of the risk and say, okay, well, we think you're eligible, maybe we'll write a promissory note or something to try to bridge the gap to allow you the runway, but then sometimes that maybe comes back on them, or their ownership structures won't allow them to do that. So there's, it's challenging even if you want to.

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29:57

Sue Farrow

It's a risk. And so that, this is also trying to help mitigate the risk for those communities because, I mean, even in, communities in my company, if somebody moves in and looks like the veterans is going to get those benefits could be 60 to 90 days for those to kick in, you really are anticipating that that retroactive check is going to come. If that veteran has to go on to a higher level of care and leaves prior to that 90 days or, heaven forbid, passes away or just moves out by their own desire, that community is out that amount of money that they basically subsidize that veteran. So it  helps mitigate the risk for those communities.

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30:47

Jennifer Prado

Yeah, if they have the problem, or they have somebody that's never spent down, we want to be the call they make to allow somebody to stay for an extended amount of months. You know, we can't solve big problems, but we're trying to solve the little ones little by little.

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30:58

Lucas McCurdy

Well that's meaningful. So, what does SHORE need today? Like where, what's the goal over the next, you know, year or two years? Five years? What does SHORE need?

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31:09

Jennifer Prado

I need podcast opportunities like.

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31:11

Lucas McCurdy

Great, good, check.

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31:12

Jennifer Prado

No, no, yeah. No it definitely, it's just creating awareness that we're there. We are your partners to do the work that you're trying to do. Get residents in, keep residents in. I definitely just think it's understanding that you're going to work shoulder to shoulder with us to do this work for years to come. With that, whatever that may look like, opportunities to speak to this, you know, opportunities to advocate for policy change at some point. We would love to do that in the future, so that these Medicare waiver problems can help, you know, more. But we have a lot of dreams don’t we Sue?

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31:43

Sue Farrow

Yes, the big ones.

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31:45

Jennifer Prado

Big ones, but we are small fish still and trying to get our name out and do the and talk about the good work we're doing. So, this allows me to do that.

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31:52

Josh Crisp

Well, Lucas, what an awesome podcast and story we've just scratched at the surface, but a pioneer in the industry continues to pioneer in the industry, and it's so cool to see this  being formed and, you know, Bridge the Gap is lucky to be able to share stories like this. And we hope our audience will connect. I mean, it's such a great resource.

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32:14

Lucas McCurdy

It is, it is. So for our listeners out there, if you enjoyed this conversation, we would invite you to be a part of it. You can scroll down into your podcast notes right there. We're gonna have connections to SHORE and to Jennifer and Sue and all of her companies, and you can connect with them there. Go to BTGvoice.com, connect on this content and so much more. Catch us on LinkedIn. Be a part of the conversation. Sue, Jennifer, thank you so much for your time today.

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32:39

Sue Farrow

You guys, this is great.

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32:40

Jennifer Prado

Yeah it is, thank you.

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32:41

Sue Farrow

I do kind of feel like I’m in your living room a little bit

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32:49

Lucas McCurdy

There we go. Yes, yes. It was a great conversation, I learned a lot, I enjoyed it. Alright Josh, this is our sign-off here at ASHA. A podcast down, and so many more to go. Thanks to all of our listeners for listening to another great episode of Bridge the Gap.

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33:01

Sara Mitchell

Thanks for listening to Bridge the Gap podcast with Josh and Lucas. Connect with the BTG network team and use your voice to influence the industry by connecting with us at BTG voice.com.

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