Adding Adult Day Services to Home Care brings Synergy and Margins (with Bill Zagorski - Board Chair NADSA and CEO - American Senior Care Centers)

When Bill Zagorski took over his family's elder care services agency, they were mostly doing non-medical home care. Now they're mostly providing Adult Day health Services and their revenue per caregiver has more than doubled.

As a research PHD,  the leader of 3 adult day health centers, chairman of the Tennessee state association and board chairman on the National Adult Day Services Association (NADSA), Bill is perhaps the most qualified person in the country to talk about this, and the episode is literally a master-class for anyone interested in adult day services.

This slightly extra long episode  covers the following:

• How Adult Day Services is growing and gaining prominence
• Overcoming Fears and Challenges to adding Adult Day Services (like real estate, meals and transportation)
• Great synergies between home care and ADS
• How to Learn More

One great way to learn more will be to attend the National Adult Day Services Association (NADSA) conference from September 18th - 20th in Atlanta. The conference will be at the Buckhead Marriott. learn more by visiting www.nadsa.org.

As Bill shares in the podcast, he has a hard time saying no when it comes to helping advance home and community based services. You can connect with Bill on LinkedIn here, or email him at william.zagorski@centennialadultcare.com.

Home Care Heroes and Day Service Stars is produced and sponsored by Ankota - If you provide services that enable older or disabled people to continue living at home , Ankota can provide you the software to successfully run your agency. Visit us at https://www.ankota.com. 

Transcript

00:00

When Bill Zygorski took over his family's eldercare business, they were mostly doing home care and getting around $200 per caregiver per day. Well, now they're mostly doing adult day health services and they're getting over $500 per caregiver per day. This episode is really a masterclass in how to move back and forth between home care and adult day services and how they go together so well. Enjoy. Welcome to the Home Care Heroes and Day Service Stars podcast. If you provide services to keep older or disabled people living at home,

00:29

then this podcast is for you. Now, here's your host, Ken Accardi.

00:36

Well, welcome to another episode of Home Care Heroes and Day Service Spars, the podcast. A lot of our episodes historically have been home care focused. We've been doing more day services content. And today is actually an episode about day services, but it's for home care folks. And as a matter of fact, myself and our guest today, who I'll introduce you to in a second, are going to be at an excellent national conference, which is the

01:03

National Adult Day Services Association, NADSA conference. That's going to be in September in Georgia, right? In Atlanta, Georgia. And so what we wanted to do today was we want to talk about the adult day services market a little bit. And since we have mostly a home care audience, we want to talk about a trend that we're seeing, which is more and more home care agencies are adding adult day services to their mix. So without further ado, I guess I've already blabbed a lot. I'd love to...

01:32

introduce our guest, Bill Zygorski, or let you introduce yourself and tell you tell everybody about what you do. Yeah, thanks. Thanks, Kenneth. So happy to be here today. Happy to talk a little bit more. So my name is Bill Zygorski. I own and operate a home and community based organization in Middle Tennessee. So American Senior Care Center incorporated is is my company. We are primarily adult day health care in Middle Tennessee, three brick and mortar adult day health care locations. We also are a very small home care provider, non medical home care.

02:01

transportation provider, and then DAPL also in case management, chronic care management, have started actually into the PTOT and therapeutic space a little bit more through partnerships. So truly an HCBS provider. So this, you know, right up my alley talking about the combination of service and revenue lines. I also have the joy of serving. I have a problem saying yes, so I serve on a lot of different boards, but I have been the president of the Tennessee Association for Adult Day Services for

02:28

The better part is seven years, I chair the Tennessee Federation for the Aging. So the joy of serving as both the research committee chair and the board chair of the National Adult Day Service Association. So I've been on the research committee for about seven years and the board chair now going on for four years. So like I said, I have a problem because the problem is saying no. So I guess I say yes. Yeah, because you don't seem to have a problem saying yes at all. It seems like you maybe have a problem saying no. But I mean, what a fantastic background I mean, between serving.

02:55

not only the adult day services in your three centers, but also having at least a little foot in the door and doing some of the services in the other areas and being in the national, connected to the NADSA committees and those board roles and that type of thing, as well as in your state, but much broader. I think you're the perfect person to talk about this. So the first thing we'd love to just get a little bit more of your background is how did you get into adult day services? I mean, that's your main business. What got you there?

03:23

Sure, totally. Well, by accident and by provenance, I guess. So my parents started our company in 1991. So my father had been with HCA for a number of years, had a business fund for HCA to have hundreds of adult day locations in the 80s. They were busy buying hospitals and making a ton of money. So that didn't work out then. My grandmother had been in an assisted living in Chicago. And we moved her here with us about the same time that my father had exited HCA and they had decided to start that business plan.

03:52

to have hundreds of adult day locations, which again, that didn't work out either. But when we opened, it was about the same time my grandmother had attended a social model program. She became incontinent, wanted her dementia progressed, so there's nowhere for her to go. So we started as the first medical model adult day program in Tennessee in 1991. I was young at the time, not today myself, but I was not even in high school yet. I had no desire to stay home or anything, so my career actually took me to Ohio. I was...

04:20

Um, and, and pre-med med school, um, got bored. So I went back into research. Uh, so my tenure was actually as a non-tenure drag research assistant to research associate at the university since college of medicine, mostly in, um, cancer cell biology, and then pivoting over to neuro neurobiology, virology, immunology, and still love the research field.

04:41

hate writing grants. So left research in 2010, 2011, decided to come back home. And at that point we had had, you know, we'd been open for 20 years. We had one center running, you know, 20 members a day, but the majority of our footprint was in the home care space. At that point, Tennessee had gone, the man was one of the first to go through the managed care conversion, the Medicaid waivers. So we were a large home care provider.

05:07

Since then, we've retracted the home care space slightly, but we've really grown in the adult day space. So we do have the Ohio Open Health Second Center in 15 and a third in 18. The home care space in middle Tennessee was incredibly saturated back in 2015. So we just kind of declined that a little bit. We don't do a lot in the Medicaid waiver space in Tennessee, mostly in the state options program space, which is a little bit more challenging for smaller providers just because a lower amount of hours. But...

05:36

So yeah, I mean, it was kind of by accident, but totally fell in love with it. You know, it's to me, the entire home and community-based space is the answer to the OEGEL question of how do you age gracefully without being in a nursing home? Don't get me wrong, there's good nursing homes, but there's awful lot of bad ones and who could afford all the good ones anyway. So we try to make it a little bit more affordable for everybody who lives, let the rest of their lives. Yeah, perfect. Well, it's kind of interesting because you did start, or I guess you said that when you really stepped in and stepped out of research, that it was primarily

06:06

home care and now then you really grew up the adult day services side. So I guess what was attractive to you about that model? I guess you told me that the home care was a little bit more saturated in Tennessee at the time, but on the adult day services side, you know, like kind of what said to you, hey, this is something that we could grow and that maybe the world needs more of. Yeah. So, you know, at that point in time, the home care side was saturated in Davidson County, but the pay rates in the Medicaid waiver space were not very high. They're having free service time.

06:35

especially over the past few years. But since it was so saturated, it was highly competitive for members. And to be perfectly honest, I was a little bit more mission driven than profit driven. There was a lot of for-profit entities that were really pushing in the home care space. And there is still plenty of profit to be made. We operate a for-profit company too. But the adult day side,

06:57

Being able to serve individuals longitudinally with chronic diseases and chronic care management was actually really appealing to me. And it's still to this day hard to quantify and hard to show the value proposition, but being able to serve individuals with a much higher acuity in a group-based setting does kind of alleviate some of those challenges that you have in the home care space where one level of care can be a barrier. So

07:24

being able to have individuals with advanced dementia, advanced physical disease, but being able to interact with them and keep them engaged while still maintaining their health. And since we're a medical model, we have the nursing services and some connection to therapeutic services too. So we're able to serve a more highly acute population in a longitudinal capacity to really allow them to live at home longer and longer, and still allow the caregivers to afford that same lifestyle for a lot longer too. So...

07:53

Again, it's not that I think one is better than the other. I think adult day was just a little bit easier and we had the capacity in my Nashville location at that point in time to grow it. And then the opportunity to add on second and third locations was, you know, I've never backed down from a challenge. And so it's very challenging, don't get me wrong, but very rewarding as well too. So the reward aspect of it.

08:18

is significant. You do get to be very, very close with a lot of families and a lot of members over time. So we do go to more funerals, but the reward aspect of it is very fulfilling. Right. Okay. Well, I guess since we are speaking broadly about adult day services, how do you see that business in that market? And I mean, we all have seen the same statistics that the number of

08:43

people in their eighties in this country is still gonna more than double in the next 20 years and things like that. So how do you see the state of the market today, demand for adult day services and where do you think it's gonna go? Yeah, for sure. And so adult day continues to grow. And again, it was growing significantly prior to the pandemic. Pandemic happens, there was a significant attrition most of those adult day services, much like home care.

09:08

did not get federal support during the pandemic and of course being regulated at the state level way of even more difficult. But since then we've seen a return actually to pre-pandemic levels from brick and mortar locations if not higher. So the industry continues to grow and evolve over time too. The most significant areas of growth over let's say the past 10 years both pre and post pandemic

09:35

We've seen a real shift in the pay source. We've seen a shift in the size of programs. We've seen a shift in the clients that are served. And we've seen a shift in the operational capacity. So previous, you know, 15 years ago, the adult data industry was really dominated in the not-for-profit space, but the for-profit space has really increased over the past 10 years. And it's not because the margins are significantly higher, but it's because it is.

10:01

It's almost an easy add on services for some programs. It's also the for-profit industry is a little bit more nimble than the not-for-profit industry too. So being able to be very specific to a certain demographic is easier. Also, we've really seen a growth in age and diagnosis agnostic services. So individuals with intellectual and developmental disabilities made up a significant portion of the population of

10:26

of day have services prior to the pandemic, but individuals with ID are aging and experience the same issues as other aging individuals. Also, if you're running an adult day program, whether it be social or medical, it's not necessarily just for an individual with dementia. It's for an individual that needs assistance and individuals with intellectual developmental disability can be served either in the same exact same location or in a very similar manner, co-located, slightly separated either way.

10:54

The programs that are age and diagnosis agnostic, being able to serve individuals from 18 to 118 of every physical, cognitive, intellectual, and developmental difficulty have really grown much more significantly, much faster than dementia specific programs or 65 and older specific programs. And those programs are still growing. It's just a different demographic that being able to serve. The other aspect that is very,

11:23

poignants in the growth is that there's the class services of culturally and linguistic appropriate services. So you see a lot of programs that serve a very specific ethnic or cultural minority. Um, you know, there's, there's dozens of hundreds of Spanish speaking programs, uh, Chinese American programs, Korean American programs, um, Haitian CREGAL programs, Kurdish programs, Somali programs. So programs that are able to serve a niche community and a niche market

11:52

generally served by one of their own members. So it's kind of easy to start a program and then being able to serve that population. And kind of the other main reason for growth too is Adult Day was by and large a Medicaid-based service for years. And where it had been 80 plus percent in the Medicaid area, it's now down to about 40, 50% in the Medicaid space. And it's not that Medicaid is paying less, it's that other providers and other payers are paying more.

12:19

The VA is the second largest provider of adult or payer for adult day services. There's Medicare Advantage that pays some, Older Americans Act, there's lots of small grants too. So you see more payers, the private market continues to expand and it's still the lowest cost long-term care option. So there's a lot of tailwinds behind it. So the market as a whole is actually larger than it was pre-pandemic and I think it continued to grow significantly.

12:49

Yeah, well, that's I mean, so that's so many sources of growth that you shared. So thank you for that. And a lot of different payers and models. And it sounds like, you know, like you said, the Medicare advantages coming up, you know, most of our audience here is what I would classify as non medical home care, as opposed to, you know, kind of your home health that do the Oasis and the 30 day post acute, that's not so much the audience of home care heroes were more of the folks that are taken care of, both older and

13:18

IDD folks so they could stay in their homes for a long time. So I think that there's more synergies there. I guess let's talk a little bit about, obviously your expertise with the medical background and everything and being able to create a medical model and the impetus with it being your mom and all, you've kind of grown on the medical side, but I would say for our typical listener, if they're running a non-medical home care agency, maybe they have their one or two nurses on staff that are doing,

13:47

evaluations and those kinds of things. And then they wanted to go into, into adult day. For me, that would seem like a little bit lighter lift than, you know, to kind of go to a bigger medical model. So I guess I see you nodding in agreement for those who are listening to the podcast as they're driving somewhere. I guess having said that, you know, let's kind of look at it and say, you know, in, you know, and obviously it's a big country and the rates are very different in Boston than they are in

14:15

the Buick or whatever, that kind of thing. But let's say that our average home care agencies are getting like maybe 35 an hour or something for private pay services and the Medicaid programs are paying, hopefully most of them are paying an worth of 20, but 24, 25 an hour for that. And that's like a one-to-one, one caregiver working with one client in their home and that sort of thing. So talk to me a little bit about the rates and the ratios.

14:44

in an adult day center. Yeah, absolutely. And just real quick, touching on kind of that social medical division, it's really not a huge division. There are a number of states that have differential licensure for social model of care and medical. But the majority of states really have either a single level of licensure or if you're licensed as a medical model, you also have a social model as well too. And the NPL survey, the National Post-Acute Long-Term Care Survey from the CDC.

15:12

does analyze where this industry is. As of the last report in 2020, 80% of the market was a combination of primarily social with some medical or primarily medical with some social. So there isn't this huge siloing on the edges anymore. It's really this huge bell-shaped curve where most providers are somewhere in the middle. Talk about average rates and average ratios.

15:38

You know, this general earth of course runs the cost of care survey where it shows that the average cost of care and Medicaid rates are fluctuating. By and large, the staffing ratios are between one to six and one to eight across the United States. Some states are a little bit more stringent where it might be one to five, especially in the medical models. And I've seen it, I think it's as little as one to nine or one to 10 strictly in some

16:07

more social model states. Really the industry standard is kind of a one to six, one to seven ratio, and that really serves both the social and the medical aspect of it. So financially it's not really a significant difference. The pay rates too, there are some states that have a differential pay rate for social model and medical models, but again, they're not significantly different. When you're talking about going from $12 an hour to 14 an hour, those pay rates are not really different. When you have

16:36

a high enough volume of services. And even the states that have medical model licensure, whether you call it adult day healthcare, medical adult daycare, medical model services, most of those medical model services, it doesn't include MD support. It does not include the requirement to provide PT, OT and speech. So you're really not providing that skilled level of care. There are a few states where you do have to provide that, I mean, mostly on that.

17:04

left and the right coasts or even in Mass or California. And the rates of course are higher in that medical space. But you know, at an average staffing ratio of one to six and your pay rates are $13 an hour, sometimes as a per diem, sometimes as a per unit, you know, you're looking at, at, you know, 80 to $120 a day for services. So

17:25

for five participants at $700 in reimbursement per individual staff at an average pay rate of say $17 an hour, it's already profitable and it covers those services. It's not a high margin industry, by and large, kind of operates in that 10 to 20% margins, it's on that app. But again,

17:48

As an add-on service is really where, you know, I've been preaching for years and a lot of times just preaching to the adult day environment saying, you know, add on home care services, add on transportation, add on other HCBS services. And I've worked with a lot of home care providers too, that are talking about, hey, we have, you know, we have a brick and mortar office and we have this building near the suite next door at that 2,800 square feet. Do you think that would be a good addition for a smaller day to day program?

18:12

Well, absolutely. Yes. It's, you know, you're a nominal increase in, in operation costs and you hire three additional staff to add in another $15,000 a month of revenue. Absolutely. So, yeah, yeah, for sure. Yeah. And I guess, you know, just kind of going down the crux of the math, I think in, in home care, people mostly think in hours and a lot of times in day services, folks think in days, right? You know, because a lot of times the program is, you know, the folks are coming in for like a six hour day or something like that, but.

18:42

I'd love you to recap, like you mentioned in there that sometimes the social model is $12 where the medical model is $14. I think those were hourly rates. Is that correct? Right. But you did kind of throw out that, for example, given that you have, let's take the worst case scenario, that one to six ratio, and let's say that that's where you're required to be. So you have one staff dealing with six clients. Let's say that they're getting...

19:11

six hours a day times $12 an hour. So that would be like 72 times six. So seven sixes are about $450 a day. And if that caregiver is, they're probably not for six hours, but more like eight hours, because they're there to greet people and see people go, then that is gonna be more like, you're paying your caregiver 145 for the day and you're collecting based on that, like the 450 per day was the math that I did.

19:41

And maybe in the medical model, it's more like 500 to 700 per day. So I guess in a sense, it sounds pretty attractive. But then the other kind of question that sometimes when home care folks are looking at this is they're afraid of the unknown. I mean, just like the day services, people would say, oh my gosh, I'd have to do EVV. All these kinds of things. They don't know that home care people are like, oh, that's so easy. But then when we look at it from the opposite direction,

20:11

home care person saying, well, you know, I need real estate and I need, you know, food and things like that. So, you know, so what's your, I mean, what would you tell somebody who was like running a home care agency and considering this about, you know, those aspects and, you know, that the unknown that's unknown for them, probably like, you know, you could do it with your hands tied behind your back on your side. Yeah, yeah. I mean, the fear of the unknown is definitely, you know, a challenge. And of course, you know, the hardest

20:40

hurdle is usually the real estate aspect of it. Lease rates are not inexpensive, but if you have, someone that has a brick and mortar home care location that has a larger capacity or a suite next door that you're able to work out a lease agreement for a three-year lease for a social model program, build out costs for social model programs, depending on how it's already built out are pretty low. You really don't need.

21:04

a significant kitchen, a lot of programs have their meals catered. So you might just need a microwave and a kitchenette. Bathroom requirements are usually in that one to six, or you need two bathrooms. So you have two ADA compliant bathrooms and two kind of large rooms for activities. You might need an extra office or if it's next to your home care operation, then you already have an office involved. So the lease rates are the single largest

21:34

Meals, yes, you can have them catered in. We actually create all our own meals. We cook all our own food. We do that as a single location and then cater basically to our other locations, either frozen or fresh. There's reimbursement in adult day space for meals. So the Child Adult Care Food Program does allow each individual state to administer it to adult day programs. So that offsets the overwhelming majority of your food costs. So.

22:01

You know, even as a for-profit institution, you're allowed to enter the CACFP. So, you know, some of those questions are easily answered. But yeah, you get to the simple economics of it. You know, you have a manager that has a little bit of capacity to be able to kind of be a program director, a co-manager, so you're not really experiencing any additional costs from a management perspective. And if you hire two staff for an eight-hour day, where participants are really only coming six and a half hours,

22:31

you have your first two staff and yes, you do have to get to that, you know, seven member a day average capacity, but anything above that until you hit 12 members is, is all profit. And then if you're at the 12 members a day, you hire a third staff members and you get to 15. So, you know, it is kind of this incremental step-wise increase. Yeah, that's a good point. Yeah. That's something that you don't deal with in home care is, I mean, when you, when you're paying that caregiver, you know, 17 an hour and you're getting paid, you know, 30 an hour, that's kind of one to one. And if you lose that client, you know, that's,

23:00

or you gain that client, that's what your margin is. But here, yeah, I guess when you get to that point where you go from, let's say 12 clients to 13 clients, 14 clients, now you're paying three caregivers. So there is that step-wise function and there is that benefit. Yeah, very, very good. Yeah, so I was thinking real estate, and like you said, they have their offices and they're expanding. As a matter of fact, we got into adult day services because...

23:26

in Kentucky are home care providers that are providing for the state. They have to have adult day services. And I've been in a number of those centers and some of them are even like they use space in a church, you know, it's a lovely space. Right. And, you know, that kind of thing as well. So, you know, and I guess, you know, the pandemic kind of left a lot of commercial real estate, you know, a little bit emptier than it used to be. So there might be some, some bargains there as well. So yeah, and that's kind of interesting to see a CFP.

23:54

is, you know, so even if you're a for-profit day center, you could apply for meal reimbursement. Yeah, and is that like, I guess is it like, you know, you're billing your whatever the program is, or the, you know, the payer is for the adult day services straight up, but then like is the CACFP, you know, you're kind of

24:14

it's the same kind of thing you're doing a separate bill to this separate entity or they... It is a separate entity so it's actually administered by the USDA or the USDA and then each individual state administers it a little bit differently. You know you can kind of do it in two different ways. Yes it is a separate service and an individual center can apply and they do have to meet certain criteria. I think it's at least 50% and have to the participants have to be below the poverty line. There is a graded reimbursement for breakfast, for lunch, for afternoon snacks.

24:44

Um, you know, it can be a little bit complex and cumbersome from an administrative side when you're first enrolling in the program. Um, but there's another way, um, through sponsor programs. There's a lot of, you know, it's a child adult care food programs. So there's not as many adult programs, but I sponsoring organizations. So if I was a new adult day program, I can contact sponsoring organization X in Tennessee. And I say, I want to roll in.

25:06

CFP and they'll actually do all the administrative work, tell you what you need to do. And of course they take a percentage of the reimbursement, but they'll go through all that, that all the hoops for you. And so instead of receiving, you know, $3,000 a month in reimbursement, you're going to receive 2000 where the sponsoring organization keeps the other thousand. And you know, it's a great entry. And when you reach the capacity to be able to operate independently, you no longer use the sponsor and you just apply directly.

25:31

Um, but yeah, it's administered differently in every States. It's kind of like adult day where it's, you know, federal dentists, state money. Um, but the, the overall regulations are the same. And anyhow, you do have some, um, you know, industry standards that you have to have certain amount of whole grain food, a certain amount of protein, a certain low amount of sugar. There's, there's challenges with it. But again, if you're looking for, you know, cost assistance, then it helps. Yeah, for sure. I totally get it.

25:58

Okay, and then I guess the last aspect of the fear of the unknown, like I was thinking of was transportation. So to a lot of the programs, you know, kind of hire, you can get your own van and you're pulling people in or do you, you know, like I've heard of some agencies that, or some centers who, you know, have like a third party transportation or, yeah, give us a little way to land on that.

26:21

Yeah, yes to all. So a lot of it depends on what the state requires or what the state Medicaid agency requires. So some Medicaid agency reimbursement for adult services is inclusive of transportation. So the provider is responsible for getting the member there. And whether that be they have their own vans and go pick them up or they contract with a third party administrator or the local paratransit organization.

26:45

they'd be responsible for arranging transportation. And then instead of being a per hour reimbursement, usually that's where the states are the per, you know, per diem reimbursement. And it's a six hour per diem where, you know, at $125 a day, but it's inclusive of transportation. And that can be in the facility at minimum three hours, but up to seven hours. So that's definitely one model. There are other states that the Medicaid model of reimbursement is.

27:12

just for the hours in the center or the day in the center, and the programs can decide how they wanna handle transportation. Some of them states, like Tennessee, for example, Medicaid reimbursement is for the hours in the center. There is additional reimbursement for transportation. And so then that can be handled in the same way. You can contract directly with another agency to provide that transportation. They get paid for it. You can be a transportation agency and transport the members that attend your facility and we get reimbursement for it.

27:42

or families can transport themselves. And so that's really kind of the whole lay of the land. In general, across the United States, about a third of providers, or a third of participants are transported by family members. About a third are transported directly by, you know, the adult day programs themselves, and a third are transported by outside entities or outside agencies some way, whether it be state or a third party administrator.

28:10

And again, it depends on the state, depends on the program. And some providers, like we only do ambulatory transportation. So if somebody needs wheelchair-based transportation, it can be provided by a paratransit agency. So there's kind of that fine-graded response. And it depends on the state, too, kind of what the van requirements are. There are some states that require full ADA-accessible van and transportation, where other states are saying,

28:36

If you guys are a adult day provider and you want to allow your employees to utilize personal vehicles as long as you have insurance, there are states that allow that as well too. So you have an employee that picks up three members on their way and they're covered by your transportation and your insurance. So you've already included that transportation in your staffing costs. So it's kind of another reason where the home care, adult day, really kind of mesh together. So if you have home care employees.

29:04

And again, there's reimbursement for it too, whether it be Medicare Advantage or outside plans. If they're paying for, you know, six dollars for transportation to an appointment, well, a dual day is that appointment. So there might be a Medicare reimbursement for the transportation service, bring them to the brick and mortar location. You have a home care employee that's getting paid for that, might work in the center as well, and then start work in the afternoon, either taking them back home or providing home care shifts in the afternoon and the evening.

29:31

Um, a lot of adult day providers that also have home care services, their staff will have either additional shifts or pick up additional shifts in home care. And vice versa. I've seen home care providers that start adult day agencies and they have home care staff where a client passes away, where they were working 35 hours a week. Now they only have 20 hours a week. Well, the two days a week, they're in the center as the employee, you know, in the center, so you have this cost allocation of FTEs, um, it can be split without any additional, you know, really.

30:01

you know, anything additional to the bottom line. Right, yeah. I mean, a few things like, you know, talking about those staffing ratios and things like that, that have always come to mind for me are that one thing that happens in home care, if you're just in home care, is you bring folks in for training, you're paying them for training. There's a lot of, they get in a home with a senior and the home doesn't smell like they're used to, and they have trouble communicating, and now you've trained them for two or three weeks and they quit in the first week, and...

30:29

I feel like one thing is if you have those folks coming in for training and they're in the center, they're getting hands-on experience and they're really getting more of a flavor for what they're used to, but they're also at the same time, they could be helping your ratios and that kind of thing. And then one thing again is that a lot of home care agencies, it's like, hey, my mom fell, she's coming out of the hospital tomorrow. A lot of these home care agencies are like, well, I think I could get a caregiver for you by the end of next week or something like that.

30:59

they're out of the running. And you know, and if you're in your adult day center, and you have like some of your supervisors in there, and you have the staffing ratios, especially if you have trainees in there, you're like, you know, hey, when are you coming? I can pick you up at the airport, I could take your mom home from the hospital, you know, we can get out there today. And I think that there's a lot of, you know, maybe maybe a little bit of those things that, you know, play to your favor and your advantage as well. Absolutely. So this has been a time flies when you're having fun kind of situation.

31:27

two of us here. We've covered a lot. And, you know, kind of, I was going to ask the leading question and say, you know, how could folks learn, you know, especially home care folks learn more about this industry. And I was hoping that you'd say the answer is they should come meet folks at, at the NADSA conference. So we'll kind of assume you're going to say that. But, you know, I've been to NADSA twice, but I'm like, I'm in the vendor area. So I haven't really been there in the main.

31:51

I guess my question is, who are they going to meet there? And do you think they can meet people who have been through that and people who are both like yourself have experience with both sides? Yeah, absolutely. And so the conference, it's electrifying experience for crazy people like me that love the industry already. It's like Christmas. But normally it's multiple 100 adult day providers at one location.

32:15

And there are some educational sessions, obviously that's where the entire thing is, educational sessions, but networking opportunities. There's usually some pre-conference sessions. One of the most popular is always a three hour in depth of how to open a day center. We usually have a couple of webinars of those every year too. And then kind of an educational curriculum. I know this year we have one of, well, I opened a day center. What do I do now? And it's a three hour about marketing and payer assistance and things like that too.

32:41

But yeah, so it's not just adult day providers, primarily, well, primarily adult day providers and a lot of vendors in and around and adjacent kind of tangential to the adult day space. But many of those providers, they span the market, they span the states, they span the geography. So it's the not for profits and the for profits, it's the ID and the aging. It's pace providers and home care providers, it's providers that have provided.

33:07

you know, medical services, non medical services, home care and not. So you really do get spam spam the entire breadth of the industry. And there will I can guarantee there'll be something for everybody there. You know, it's a it's a great opportunity to network with other providers and find out what works and there's a lot of research sessions. Obviously, I'm a big data nerd. So there's a lot of information that kind of where the value based proposition is. And another thing that, you know,

33:36

where home care and adult day meets in the future is the value-based proposition, value-based care arrangements and things too. So, you know, we have the ability, especially together with home care, to really affect a change in those value-based arrangements with much less risk. So nobody likes that assumed risk for the total care. But, you know,

33:57

PACE programs are continuing to expand. A lot of MCOs or managed care organizations are kind of dipping their toes into value-based arrangements inclusive of adult day and home care, non-medical home care. ACOs are continuing to show interest in post-acute discharge to adult day with home care implications too. So really the possibilities are endless and it's a great handheld partnership. And I've been a fan for years, obviously, with my experience.

34:27

Adult day can add on home care, home care can add on adult day. There is no right or wrong. Um, but the fear of the unknown is, is the, is the challenging, but I can tell you how they're both, um, they're, they're both unique and they're both challenging, but they're both. I mean, easy to be successful. Um, I mean, I really think they're, they're both incredibly viable options that they're really good together, you know, hand in hand. Wonderful. All right. Well, let's wrap it up and let's kind of.

34:52

give just the details of NADSA. So it's going to be that conference will be September 18th through 20th. It actually starts with a there's a lot of these free conferences that happen on that Wednesday the 18th. Right. And there's like a reception the evening of Wednesday the 18th where a lot you know a lot of the folks as you know sometimes it takes a good part of your day to get into whatever wherever you're traveling to. So this is right in Atlanta downtown. It's the Buckhead Marriott. So I haven't been but I'm sure it sounds like a lovely hotel right now.

35:21

in the downtown area. And you would go to learn more about that at the National Adult Day Services Association website, which is nadza, N-A-D-S-A dot org. And yeah, anything else to add to that, Phil? Yeah, I said the one thing on that first day of September, there are those educational sessions. We also arrange for, I mean, I think about a half a dozen site visits. So if individuals are there in town and wanna do the site, we have supervised site visits. So we'll take them to

35:51

one of the adult day programs in the area. I think we have either three, four, five, six different programs that we're associating with. So we have those site visits available. The reception on Wednesday night and on Thursday nights, Thursday night there's a superhero theme. So you might see me dressed up as a couple of different superheroes. But those receptions really to me, that is probably one of the most valuable parts of the conference because of the networking opportunities with other providers.

36:18

Um, you know, not just some friends, but you know, well, not just colleagues, but true friends and friendships I've developed, um, through the NASA conferences has really been invaluable. Um, so. Perfect. Well, thank you so much to Bill Zygorski for spending your time today and sharing so much with us. And hopefully we'll see you and some of the listeners who learn more about adult day services through this podcast in Atlanta in September. Absolutely. Thanks for having me and, uh, happy to provide contact details for anyone's follow up.

36:47

Thanks for joining us today on the Home Care Heroes and Days Service Stars podcast, produced by Ankota. You can listen to back episodes by visiting 4HomeCareHeroes.com. That's the number 4, then the words HomeCareHeroes.com.