Ep 63: Matt Shadle, MHSA, Senior Placement and Referral Specialist with Gentle Hearts Living Solutions, Caring in America

Richard Wexler
Good morning. My name is Richard Wexler and we have a great episode this morning with Matt Shadle. After completing his undergraduate studies in psychology, Matt went to work serving vulnerable populations, working as an advocate for at-risk youth and adults with developmental disabilities. In the course of working with administrators and beneficiaries of Medicaid Services, he developed an interest in health and public policy and went to work for the State of Colorado in the field of Health Care Regulatory Compliance. After eight years in the public sector, he earned his Masters degree in Health Services Administration and moved into the private sector as the Director of Health Services for a senior living community. As a Retirement Counselor, he guided perspective residents and their families through the important decision of transitioning into a retirement community. Matt finds true fulfillment in applying his background, education, and experience to assist seniors and their loved ones in his role as a Senior Placement Specialist with gentle Hearts Living Solutions. Matt, are you there, Sir?

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Matt Shadle
I am here. Thank you, Richard. 
Thanks so much for having me. Been looking forward to it.
 
Richard Wexler
Sounds good, I want to talk about this placement industry, which I know fairly well, but want to start by asking you some questions that will hopefully really educate our audience. You know what I'm seeing is more and more senior placement agencies are opening and why do you think that's happening? And then how do you and your agency set yourself apart?
 
Matt Shadle
Sure. Thank you. So yes, there's been, you know, relative explosion in the presence of senior placement agencies and specialists like me in this field. We're obviously here because there's a demand for us. We we feel there's increasing demand because there are more and more seniors moving into the senior living space. We all know that baby boomers are aging to the point where they're starting to consider their retirement living options, and with that growth comes more availability. There's more communities springing up that promote different levels of care and services and amenities. And man, it can really be a maze to navigate all of that and find a good fit for you or for a loved one that is going to meet their needs, fulfill their life, and be a good next step for them. So I feel there's so many folks like me out there now just because our services are needed.
 
Richard Wexler
This is interesting, and I totally understand it. And folks, we've talked about this a lot the numbers, the numbers I used- there's about 110 million people in this country over 50, and as Matt knows well, we have almost almost 80 million baby boomers moving north, so I can see why the need is there. I mean I'm still 71 years old and I'm smack in the middle of the baby boom generation. We played with Yo-yos and hula hoops, and now all of a sudden we're the ones potentially moving to senior living communities.

So what should a family expect from a placement agency? I know that some have more of a hands on approach, some have more of a hands off approach. I mean, what should they expect and what's your philosophy?
 
Matt Shadle
Sure, the the Gentle Hearts philosophy is really to join families and seniors on this journey of making a decision like this. And that's the case no matter where the senior is transitioning from. We work with a lot of folks who are in the hospital, they're in rehab setting and the advice they're getting from the clinical professionals is that discharging back home, or to your previous home, is not the same safe option for you and you should consider senior living options. The other most common one is folks still living at home who are in a lot of ways doing just fine at home, but they and their family are planning for that transition regardless of where the resident is coming from. They should expect a really personalized journey with their Placement Specialist. So some things we do is when we first meet a client, we develop a really detailed profile of them through an assessment of not just their need, but also understanding what their preferences are, their priorities, what they value most, what their goals are for this phase of their life. And we achieve that by really spending a lot of time meeting with the seniors and their families. As soon as we learn of a new potential client, we are meeting them in person. We are going where they are and making sure we really start to understand what it is they're looking for. We along the way educate them on the levels of care available to them in the community. We start sharing what we feel might be a good fit in terms of the community, but really we leave that first meeting with a lot more work to do.

After our discovery is done, we tap our resources of the communities in the area and we start developing a short list of communities that check a lot of the boxes for them. We're not just flooding the zone with referrals, we're not just emailing referrals to communities that might be in their geographic area- We are planning tours at communities that we feel like will be a good fit for the senior, but also for the community. We insist on accompanying our clients on these tours as we want to be there to make sure good questions are asked. We want to be there to advocate for the senior's needs. We want to be there to lift up the community and help their team highlight what it is they do best. Then following these tours, we are sitting down with clients and we're doing follow up visits with them. We want to see what they learned during those visits, what lingering questions they may have and take their feedback, and perhaps it's consider more options, or maybe it's whittled down the options we've already established and focus in on a few. Then, when they have chosen a community, at an agency like Gentle Hearts, we are happy to accompany them on contract signing day, we are happy to meet with them ahead of time and review these complicated contracts to make sure they're comfortable with the contents and then we will facilitate any negotiations or questions they might have. And then when it's time to move, we are right there with them providing moving assistance- either personally or connecting them with our Senior Relocation Specialists here in the area we work with. And then, once somebody's settled in their new home, we know that the work's often not done for them, for their planning. So we want to make sure that we're available to them to them, after the fact to refer to realtors, elder law attorneys, Medicaid application specialists, whomever it is in our in our network of professionals that might continue to assist them on this journey. The last thing we do is we follow up periodically after the move with both the client and the community to make sure both parties involved are satisfied with the process and happy with the outcome.
 
Richard Wexler
Now, that's excellent information and that's a lot of information and a lot of- talk about hands on, hands off, that's a lot of hands on services. You may know, I talked about this a lot on my episodes, this dirty 4 letter word called "P-L-A-N" that people hate, because I'm wondering about some of the key factors families and that seniors should be thinking about. Let's make up a scenario. Let's call this individual "Mary". She's in her mid 70s, she fell and she broke her hip. She got through surgery and she's now at skilled nursing home. I know that's a place, as you said, you may meet people and this whole idea of of the key factor she and her family should be thinking about, can she really go back home? Can she bring a professional in the home? How much is that gonna cost? Should she go back home by herself? Or when she gets discharged from skilled, should she go off to a community? What are some of those factors they should be thinking about?
 
Matt Shadle
Well, boy, the list is long and that is, you know, that is why we do it. We do this because trying to understand these factors on your own with a loved one. or you yourself as a senior, it's not something you think about every day and it's not something you plan for in most cases. So that is when we come in to help them with the factors. What some of those are is understanding the level of care that your loved one, or the senior, requires. It can be independent living with maybe home care, it can be assisted living, memory care, skilled nursing, etc. There are many different levels across the continuum and really before we embark on touring communities or honing in on a decision, we really need to understand what this senior's level of care will be. 

Factors we look at: 
Gentle Hearts is owned by a husband and wife and they are both registered nurses, Nick and Michelle Sayles. I'm happy to be part of this team because it's small enough where they can assist me. I'm not a a nurse, so with interpreting seniors histories and physicals, understanding they're complicated and in some cases multiple medical needs, and give me guidance on what level of care they feel this person may need today and down the road. That's one factor level of care. The other is of course the cost of these services and budgeting concerns that people need to consider. We help folks with guidance on what to expect from different levels of care in terms of the the monthly service fees and cost of care. And then if budget is a concern, we start to explore options through their insurance through Medicaid, through VET vet benefits and so forth. So that's the early conversation and one factor to consider. The next is an obvious one: location. You know, families and friends, local hospitals, and other amenities- It's important that those things are convenient for the senior and for their family. We want to understand where in the community they hope to live and we use that as one of many factors. Another is the the quality of care being provided out in the community. We'll talk in a minute about the services and amenities that senior living communities are integrating into their offerings. A very important factor to consider is the quality of care being delivered in those beautiful places. So that's something we help folks understand. The safety and security they should expect in these communities, the lifestyle, and social activities they should expect, what just the the look and feel of the environment is a factor to to start talking about. The list goes on and on and as you can see, it's a long list and it can be a confusing one. We just help folks understand these factors start to prioritize and justice begin to educate them.
 
Richard Wexler
You know, that's amazing. I'm sitting here thinking about my example with Mary in her mid 70s, who's now in skills. She's probably gonna be there for three or four weeks as she moves from a wheelchair to her a walker and so on. Everything you just said is fantastic. And I'm sitting there thinking, if I'm her son, if I'm her husband, whoever I am in the family, it doesn't seem that complex, but everything you just talked about, there's so much thought. That's why I talk about this dirty 4 letter word called PLAN, that needs to go into this. So you as that senior or you as that family really understand what is the best move for the Mary's of the world. You kind of read my mind talking about the latest trends in senior living communities, you know, I'm talking about the different care models and amenities- This isn't 1980 anymore, there's a lot of technology out there. What are you seeing?
 
Matt Shadle
You're right. Well, technology I'll speak on in a minute, but really what we see and and what we share with our families, is that these communities are really offering customized care plans for their residents. You know, they want to tailor their services to the unique needs and preferences and goals of their residents. They're offering that because that's what's expected. That's what this next generation expects from their senior living communities. Communities are offering personalized activities that draw in the interests of their residents. They are offering really interesting, farm-to-table style dining options, and providing wellness programs that are developed by professionals and delivered to people at all levels of their physical health. In addition to that, communities, we're especially seeing a lot of them here in the Treasure Valley Idaho area, they are providing or offering, a continuum of care in their community.

Continuum of Care
So what we mean by that is they offer a range of services, usually independent to assisted living, to memory care, all under one roof, or on the same campus. What this allows people to do is age in place. Folks can receive just enough care or support to remain as independent, active and vibrant as possible- Knowing that someday if they need a little more care, it's right there for them. The transition is relatively seamless and they don't have to uproot their life again to get those needs met. To speak to your point on technology integration, that we're also seeing in the industry. Telemedicine has boomed, and of course through the COVID pandemic, it was leaned on big time to keep patients in touch with their healthcare providers. That only continues and our seniors are increasingly tech savvy and willing to utilize this technology. What's important to know when you're evaluating communities to move to is what their capacity is to assist the seniors with those services. Are they themselves knowledgeable about the telemedicine options? Do they have the availability and willingness to sit with a patient and make sure their visit gets started? Do they have the capacity to help with any follow up that's required after one of those visits? It's just an adjustment that residents and communities are going through right now to keep up with it. You know, seniors are also wearing wearable health devices more and more for their own tracking, but also, communities are adopting them themselves because, they find that if they can remotely monitor residents' vital signs and sleep patterns and things, they can effectively respond to changes in conditions and just generally, keep a closer eye on the health and wellness of their residents. Smart home features that we're all familiar with, like the Alexa's and smart lighting and things, that's being adopted widely too across communities. They see opportunities there to better respond to to resident concerns to just generally monitor their day-to-day a little more effectively and keep them safe. Safety monitoring systems are also advancing and being adopted across senior living communities- from fall detectors, GPS tracking for those who may leave a community without a particular plan on how to get back, etc. These are really addressing safety concerns and just making it easier for communities to monitor health and closely support their residents.
 
Richard Wexler
This is a lot of fantastic information, Matt. I mean folks out there, one thing I talk about a lot, Matt certainly understands this, so many people don't even realize all the services, and Matt's talked about a lot of things, that they're doing and offering for the seniors and their families that they work with- It's incredible. So I really want you tell your friends, tell your neighbors, when someone gets to this position in life (hopefully they have planned), but when it does make sense, instead of doing all this work yourself, or going on the internet and trying to find the right community, and I want to talk about that in a second- Finding the right community, it really makes sense to work with someone like Matt, who really is an expert in this field and can really guide the senior and guide their family. So talking about the right community, you know, everybody's different, so I'm sure some communities aren't right for one person where they'll be right for another. I mean, what are the potential consequences if someone is maybe moving into a community that's not right for them?
 
Matt Shadle
Potential consequences - There are many, and that's why we spend so much time getting to know our clients and understanding their needs, goals and preferences. That's why we do so much work on the front end. And I'll pause just to say that another thing I really enjoy about being at Gentle Hearts, is me and my colleagues doing this, we are afforded the time to do that important work.
How things are structured, we do not rely on commissions, or high fees from our partner communities to pay our bills. You know, we earn a generous salary and because of that we are empowered to really spend time getting to know our clients and helping them make a well informed decision and not just rushing to get someone moved. So what are some of those consequences we try to avoid? One is that we would hate for a senior to move into a community and experience a decline in their physical health. That can happen if the community is not equipped to meet their needs or that it's just a poor match in terms of their level of care and what can be offered. Another consequence to avoid is potential depression or anxiety over this move. We would hate for a resident to move into their new home and have it make them anxious, have it make them feel isolated or frustrated. That is why our seniors are central to the decision making process as much as is practical, and that they are as well informed as their loved ones on why we feel this sort of move needs to take place and we hope that they move into their new home, not anxious or depressed about the decision, but looking forward to the next chapter for them. You know, there can be increased behavioral concerns for folks with cognitive impairments if they move into an environment that maybe isn't the right structure for them, or doesn't have the right programming for them. Loneliness and isolation can occur if someone moves into a community that does not effectively welcome them and integrate them into the larger community of their senior living. If someone moves somewhere where their self worth and dignity is not promoted, they may lose a sense of identity and may withdraw into their home and not have a sense of purpose in their life. We would we would hate for something like that to happen if it was not a right move for them. And really what we hope to see with our clients, no matter where they move, is that there is a rebound, so to speak, in their quality of life and in their health. So often we encounter clients who are still living at home and are getting by day-to-day, but their family and, they themselves or their spouse, are concerned that they're seeing a slow deterioration in their health and in their well-being and their mental health, for example, and so often when we help make a good move to the right community for them, they get settled there and we see that their mood improves, their appetite improves, and their engagement with their neighbors is something that the family had not seen in years- That their overall outlook and well-being improved. Our goal is to not help someone move somewhere that just gets by for them or just keeps them safe, we want to help them make a decision and move to a community where they thrive.
 
Richard Wexler
Again, that's fantastic information folks. As we get ready to wrap up, I do want to ask you, and I know this is kind of a broad subject, but in a couple of minutes we have left, can you really help people understand the difference between independent living, assisted living, memory care, and residential care homes?
 
Matt Shadle
Sure. Well, you know, folks living in an independent living/senior living community, they are generally safe behind the closed doors of their home. Of course there are degrees to this, but they move through their day with very little assistance and they choose to engage in activities and events around their community as they please. In many cases they still drive, volunteer in the community, etcetera, and they choose to access services and amenities when they like. They're there to enjoy those things.

Moving into an assisted living community, folks are beginning to need help with one or more activities of daily living, whether that be reminded to take the right medications at the right time at the right dose, or maybe they need hands on assistance safely moving in and out of the shower. Then at the other end of the spectrum of assisted living, it's folks that maybe need extensive support with their activities of daily living- One and two person assistance with getting dressed or bathed, or ambulating for example. So what's beautiful about the assisted living setting, is folks can really age in place there along a wide continuum.

Moving into memory care they offer specialized programming to serve folks with Alzheimer's, dementia and other cognitive impairments. The spaces are secure, meaning that folks can't access the greater community without being accompanied by family or team member and team members are alerted if they do choose to open a door and move out. But more so, just as important as the secure nature of memory care communities, they also provide specialized programming for residents with dementia. Their teams are specially trained in that in that service.

And then you mentioned residential assisted living and and board and care homes, and that's such an interesting concept and one I think that needs to be utilized more in the Treasure Valley. Certified care homes are four or fewer beds certified by the state to provide care to really a wide range of recipients. In many cases, in this area anyhow, it's family members caring for their loved ones in their own home. Their loved ones could have a range of health concerns that they're addressing from assisted living type services, but also folks may be living with a traumatic brain injury, mental illness or folks that have developmental disabilities. These are small residential settings and it's the home of the provider. So they are right there with their loved one or their client and it offers a great alternative to the bustling nature of some larger assisted living and memory care communities. They're also small assisted living communities that are usually bigger than four beds, but not more than about 12. That's also residential in nature, but provides the same level of care as an assisted living and is subject to the same rules as a more conventional assisted living community. Now that I think right there is where we have the opportunity in Idaho to grow- is to provide that quiet, home like, intimate setting for assisted living residents who may not feel like a large community is right for them. The homes are there, but it's just operators choosing to serve that population of seniors who want that environment, it is an opportunity we have and I wonder if that's the case around the country as well.
 
Richard Wexler
Matt, again, this is fantastic information, folks. I really encourage you listen to this, pass it on family, friends, a lot of information in the last 30 minutes or so. I mean, this is golden for a lot of people to really understand. There's someone like Matt out there to help. There's guys like Matt and ladies like Matt around the country. It is a fantastic service. As we do get ready to wrap up, Matt, if people want to reach out to you, what's the best contact is phone number or e-mail website. What do you want to give out?
 
Matt Shadle
Sure, a quick Google search of Gentle Hearts Living Solutions will take you straight to our page. You can learn about our team and all of our personal contacts are right there on the site. So you can learn a little bit about the small but mighty team. We have our backgrounds, our history on there. And feel free to reach out that way. We would look look forward to hearing from your listeners and helping where we can.
 
Richard Wexler
That's excellent. I want to thank Matt again.
And and folks, as I say on every episode, if you want to get in touch with me, you have a question. You have a comment you'd like to be a guest on the show, best e-mail [email protected]. 

And until we talk again, have yourself an awesome day.