Josh Fertel: 0:04
Welcome to the Angry Biller, a show where we explore the people and the businesses behind the scenes of healthcare, those men and women that are the catalysts that allow providers to concentrate on delivering exceptional patient care. Welcome to the Angry Biller. My name is Josh Fertel, I am the owner of J3 Medical Billing and I am your host. Today we're going to talk about the costs of getting old in America. I've been doing a lot of reading and a lot of the practices that we bill for you know, the older patients, the older patient rosters that are on Medicare and need help.
Josh Fertel: 0:41
It's just phenomenal as to the amount of expense that they have to go through, what they have to pay for their coverage and all the things that come into play as you're just trying to live out the best years of your life. Today, very excited, we have David Lieberman with Michael Brodie Senior Placement. With Michael Brodie Senior Placement, he's been in the business for over 20 years of helping seniors find places to live, and thanks for coming.
David Lieberman: 1:12
My pleasure. If I would have known the name of the show, I would have run away the angry biller. All right, I'm going to live up to the name you will.
Josh Fertel: 1:20
There's a lot of things that go on in the healthcare world that need to be addressed, this certainly being one of them. So let's start from the beginning where. How did you get into what you're doing now?
David Lieberman: 1:32
So I guess this summer I'll reach 22 years in what I would call the senior healthcare field. That's awesome. You know, the how was always the long story, so I'll just basically say what I did and that I just loved doing it. The first five years I worked for one company that had a group of senior living communities down here independent living, assisted living, memory care and then shifted from that kind of to the other side of the fence and helped to build up a home healthcare company for 14 years. But so we were working with people at home, we were working with people in communities, assisted living and a combination of the two.
David Lieberman: 2:10
Over those first 19 or so years and now for more than two years, after we sold that home health care company, I've been working with Michael and now own our little company, and the focus here is what's called senior placement. That's awesome. We help people to find independent living, assisted living, memory care when they're at the point that they can't or shouldn't be at home anymore. The neat thing about our service and then I'm glad to talk about anything else is that from our perspective, the one thing that doesn't cause seniors as they get older is our particular service. We help people to find things at no cost to them. When they move into a community we refer them to, the community pays us a fee. So that's the great thing about helping people nowadays it's just a focus on their need, not about any cost for them.
Josh Fertel: 2:57
So where did this passion come from?
David Lieberman: 3:00
You know, good question. It might be something that was a slow burn. You know, growing up I'm actually a native down here and, as I look back, I had three grandparents in senior living places in the 70s, right 90s in places, and then my parents were in senior living and assisted living for about three years, starting in 2018, 2019. And it kind of built up into saying, as I started to look at this world, it all kind of made sense.
Josh Fertel: 3:40
I absolutely understand what you're saying, so I know you just touched on it, but what are the different options, living options that seniors have?
David Lieberman: 3:45
Yeah, let's talk about it kind of at an easy level. I'll start with assisted living. That's probably the most common thing people hear out there, correct, and nationwide. There are about 1.3 million assisted living beds or apartments in the country. Wow, seems like all of them are down here in South Florida. Not quite, but many of them are Right and you know that's probably the most common thing, given those numbers.
David Lieberman: 4:14
When people are at home and they're not able to be at home anymore, sometimes they've gotten help at home from family, from friends, from professionals that come on in and they continue to age at home. That might be because of falls, it might be because of memory loss, it could be strokes. At whatever it happens to be, the need increases and assisted living helps with some basics, and there's so many levels to describe this. I'll keep it just straightforward for now. They help with medication management. They have nurses on site, they have doctors that come in to visit, they provide three meals a day. They provide typically there's physical therapy on the campus that you can access through your insurance. They provide activities, they provide transportation to doctors and shopping. So it's kind of like the world is there for you in these communities, as opposed to needing to go out to do those kinds of things in your life.
Josh Fertel: 5:10
Understood.
David Lieberman: 5:11
Yeah, and if you're not feeling well, they're there for you as well, and besides assisted living, what other?
David Lieberman: 5:17
options are there. Even though it's under the assisted living umbrella, memory care usually comes with a separate wing or a separate building. Sometimes they're standalone, sometimes they're just part of the same campus. Indicates is for people who have got enough cognitive decline, where even in assisted living, where they're required to do a number of things on their own, has gotten too difficult. So there's an extra level of support and focus on you know and expertise with people that understand what cognitive decline is all about. The activities are different, even the food could be different and the way it's served can be different. Correct, so that's number two. Okay, in the assisted living world there's kind of a third thing. Again, it's the same umbrella, but the first two things I talked about are usually larger places. Right, they can be. I think the average size of assisted living throughout the country is about 40 apartments.
David Lieberman: 6:16
Okay, but there are plenty. I mean down here, hundreds and hundreds of assisted livings in homes, homes, you know, six-bed assisted livings they call them Right, Commuter assisted livings, right, and it's a bit of a different animal. It's for people who are less active. They can have cognitive decline and the upside of that is, during the day the rules are if you have six people in that home, there are two professional caregivers for six people, almost as intimate as help at home, like one-to-one. Yes, yes, yes. So that's really.
David Lieberman: 6:49
You know there's a certain niche of people that kind of gravitate to that kind of help. Last one is independent living. Okay, kind of gravitate to that kind of help. Last one is independent living. It sounds a bit different in terms of the marketing of it, but usually independent living down here in South Florida is kind of a step before assisted living. You have some needs, but it's good that there are two meals a day and sometimes three. You may be able to drive, but there's transportation for you and there are activities for you and there are activities for you. It's just that anything else you need is a la carte. If you want someone to help you bathe or get dressed, then that's its own separate fee. If you want some medication management, then that's its own separate fee. It's not built into the model. You would pay separately for it.
Josh Fertel: 7:35
Okay, so when you are engaging with a family or with a prospective patient, how do you assess what you think the best place for them is to be?
David Lieberman: 7:47
That's a good question and when I talk to the families I kind of say there are essentially four ways that we get to the best answer. The first one is, let's say, it's almost always family that we're working with. The first one is them. They give us their perspective. The next one is our visit to we call them clients our visit to the client and you know, just did one today and it helps to get another rounded impression of someone. If you kind of think of, you know that 360 kind of look someone you talk about. One side is the family One, you know, one perspective is ours. The next perspective is the community perspective. So if they were interested in a place, a nurse would assess them and the final assessment as part of this process comes from their primary doctor who provides information that talks about their status and medication. So between the four you're going to get a really good idea of where someone is.
Josh Fertel: 8:48
No, that's great, You're doing your due diligence as they get it. Yeah, you're right. That's the only way to do it, but you're right. And so let's talk about the whole reason that I asked you to come is the cost. Is there? What are the differences? What kind of ranges are there? I don't know.
David Lieberman: 9:04
You know what's that? What do they say? That the last six months of someone's life might be, you know the more expensive than you know. The five years prior to that there are different ways of looking at that kind of thing. Right prior to that there are different ways of looking at that kind of thing. But, yes, you could be living at home and have Medicare or maybe Medicaid and kind of living the simple kind of life, and you're not going out. Let's say you're 80 at this point.
David Lieberman: 9:27
And for five years you might be at home, you're not partying that much, spending a ton of money. Insurance covers a lot of your needs for healthcare. You're not going on big trips, et cetera, et cetera, and so people tend to live conservatively. And then it's time for these other things. So, yes, assisted living down here. You know they talk about nationwide numbers. It's maybe $4,000 or or five thousand dollars a month, but in reality, you know, to you want to refer to the right place and so you're. You know you're talking numbers that can I'm not saying these are, you know they can go up to. There's a big range a month.
David Lieberman: 10:07
Fifteen thousand is a big range but, um, you know it's very difficult to find something if you're paying for it on your own or your family is, et cetera. The rock bottom pretty much is $3,000 a month but realistically $5,000 is a good number to talk to people about a month. And what does the average person have in savings at this point in their life?
Josh Fertel: 10:29
My next question is how are these being funded? How are people paying for this?
David Lieberman: 10:35
So they're funded privately up from themselves Right Lots of times working with families that have to sell a home to help. Lots of times family is supporting.
Josh Fertel: 10:47
Yeah.
David Lieberman: 10:48
There is a neat thing out there that we've all heard of, and when they have it, it's a big help. Long-term care insurance.
Josh Fertel: 10:55
Okay.
David Lieberman: 10:57
Most people don't have it, some do, some seniors do. Okay that long-term care insurance if it applies for assisted living, let's pretend you know a number is $100 a day.
David Lieberman: 11:10
Right $100 a day is $3,000 a month. If you have that policy, it's much better to have $3,000 a month available for a $5,000 a month cost. It makes a big difference? Sure, absolutely. You don't get it at age 80. You get it in your 50s and maybe early 60s and possibly 40s. But for those that did get it 15, 20 years ago, it makes a huge difference.
Josh Fertel: 11:31
But you're finding most people do not have it, most don't yeah.
David Lieberman: 11:35
That's a shame. I'm going to guesstimate that maybe down here, 15% of the people we work with have it Because nobody thinks they need it, and it's an expense that tends to go up too. Right For sure, every five to 10 years the insurance companies increase the cost.
David Lieberman: 12:04
For sure, like other types of insurance that are out there, homeowner's insurance things go up, yeah. So, yes, it's considered. A little bit of a can happen through the world of Medicaid For assisted living. If you qualify and I'm going to give you roundish numbers, not exact If you have less than $2,500 of income a month, let's say from Social Security, et cetera, and you really have essentially nothing else in assets in your bank maybe $2,500, essentially nothing else in assets in your bank maybe $2,500. Right, and you have the physical needs and the cognitive needs, and or you can qualify for a Medicaid. It's called long-term diversion and that could be $1,600, $1,700, $1,800 a month, which helps. So it means you don't have much, but this will help you, right. So for someone that might have $2,300 and they get another $17,000, that's $4,000 a month.
Josh Fertel: 13:04
It's very much needed and people are applying for it all the time.
David Lieberman: 13:10
This whole process, let's say with Medicaid and finding the right institution for them, if that's the right word do you take care of a lot of those steps On those we're always advising Okay, some people will go to a professional of some kind and they will get to help and they'll pay for it, and other people will go to nonprofit organizations. So, for example, in Broward there's the Area-Wide Agency on Aging and they'll do Medicaid applications for free. Oh, that's great. So they're doing hundreds of months, say the name of the agency, the Area-Wide Agency on Aging. That's great yeah.
Josh Fertel: 13:47
Oh, very good, the facilities that you recommend. How do you pick those? How do you choose which facilities in particular? Good question.
David Lieberman: 13:57
And I'll change how do you pick those? How do you choose which facilities in particular? Good question, and I'll change how do you vet them? And I'll give you a different name, because they used to all be called facilities, right. And then at some point people said, well, facilities sounds sterile, right? Right, we call them communities, communities, just so you know I will change my verbiage.
David Lieberman: 14:14
Easy one to change, so you know. Easy one to change, so you know it's time. So you go capacity and my partner and the founder of our company, Michael, has been doing this forever also, so there's experience. The second thing you look for is kind of the results of what you've done. So if you've referred someone there and they have moved in and it's successful there, then you kind of have that extra phase Right. Number three you kind of look at the company that owns it or manage it. You look for telltale signs which maybe are not so telltale, like has there been a lot of changes in ownership management? Has the executive director been there a long time or is there kind of a wheel of change in some of these places? So it's a combination of all those things where you say you know, here's my comfort zone with X amount of places Right.
Josh Fertel: 15:26
I had the experience with my father-in-law where he was you know, at the end of life I suppose. And you know we looked and we visited a bunch of places and we actually ended up opting for him to stay in his apartment and bring somebody in. Certainly was a cost, but he was very peaceful at the end. I think we were able to find the right people. So I mean, the work you're doing is just so important.
David Lieberman: 15:57
And it's new for everybody. Virtually, it's not like people are old hands at this point in their loved ones or their parents' lives.
Josh Fertel: 16:05
Right.
David Lieberman: 16:05
There's so much to it they're not used to being. The child has to become the parent in that situation to be able to go from the person who listens to mom and or dad to being the one that you know is advising them. Changing dynamics, family dynamics, funding all those things there's a lot going on.
Josh Fertel: 16:23
And I know that when we visited these communities, he was not with us. What's the transition like for a person that's going to be entering this community? How do you handle that? How do you hold their hand?
David Lieberman: 16:41
There's a transition process in the communities. Communities, and some do it better than others, okay and there's a transition process with families, and then there's a basic transition process with us. So, um, the communities you know that are doing it right will do everything from have the professional team meet with the new resident and guide them through their first couple of days, right, kind of a gentle version of tell them, tell them, tell them, you'll have this, you know, here's where the dining room is, here are the activities, here's how you sign up for things, the kind of handhold. They'll also a number of communities will have what they call ambassadors, so residents that are there and that like to volunteer and that are, you know, good at welcoming people, that can be the same. They'll knock on the door and they'll meet someone, or they might sit with this ambassador for the first few days, you know, upon a move.
David Lieberman: 17:36
So those are some nice things that help them. Along with that, there's that family support too, depending on what the situation is, memory care can have special weekly or monthly meetings for loved ones to kind of cope with the changes, Right, right. So there's that, that's out there. As for us, one thing that we like to do I like to do? It's that final touch. Family can always call us, but I visit everyone who's moved into a place.
David Lieberman: 18:04
You stole my next question, um yeah so, um, I've got uh someone I'm gonna who moved into a community last week, right, and I'm gonna be visiting her, you know, this week, um, and it's it's a touch right. Um, sometimes it's, you know, really simple I bring some flowers, I bring some candy, we have a chat, uh, depending on their situation, sometimes it's into a stressful situation like a memory care where I've done for a nervous spouse or child, I've done almost an informal assessment, talk to the executive director, talk to the nursing director, and I really get into conversations with them to make the family member just feel comfortable that what is happening is really happening for them.
Josh Fertel: 18:47
And when you're making these follow-up visits generally, how does it look?
David Lieberman: 18:53
You know, the good news is that if you do all that due diligence up front, there usually aren't too many surprises. There can be Okay, but that's the exception. Well, that's good, that's the exception.
Josh Fertel: 19:03
Yeah's good. That's the exception. Yeah, give me a success story, give me one that you know. This is this.
David Lieberman: 19:11
This is the story that I love to tell about, about how you help somebody um, you know, probably the success story, for some reason that comes to mind is more the more difficult situation okay.
David Lieberman: 19:26
I could always follow up with you. But, success story, there are times when we're working with and it's not only men about, you know, I just feel I've run into this situation a few times men that were three or four years ago working right, and you know, whatever it happens to you, business owner, et cetera, and their dementia is pretty fast moving and that causes difficulty because their minds, to a certain degree, think they're large and in charge, but so much is changing on the fly. So I've had situations where I had gentlemen who have jumped out of cars because of their frustration. So I've had situations where I had gentlemen and I could just have jumped out of cars because of their frustration. So we get that call and there's that kind of flashing red light we need to help, we need your help and we're happy to help, and so, um, to that end it's where do you go for something like this, right?
David Lieberman: 20:20
And? And what do you do with someone who, in this case, when they're frustrated, likes to walk? So in this case you might look for a memory care and they're not too many of them with a large courtyard, because then they can go outside it is still all fenced in and they can walk around and someone will check on them. Excellent, so, to have solved the situation like that. This is not around the corner from you, but it's there for you and let's go tour it and let me show you how someone who's having these specific difficulties would better thrive in a certain situation. That's an example of what can be tough, because now it's almost life-threatening to taking someone with their changing habits but ongoing. I like to walk, I need to move, I need to walk away from something that's bothering me, and we had given them a location that can do that.
Josh Fertel: 21:12
So the life changes where somebody jumps out of a car. I actually had an uncle with dementia who just drove from Boca to Hialeah and nobody knew where he was. So you kind of have to fast-track what you do at that point, correct?
David Lieberman: 21:25
Sometimes it's fast tracking, okay. So we've had clients that could be two years from making the decision because it's not urgent. Right, they're just starting to look, um, maybe more than two, but you know, certainly two uh to a, you know.
Josh Fertel: 21:42
Yeah, so I I'm really concentrating on the things that can be fixed in healthcare and in your situation. You know, it's the dollars that are amounted and $4,000 is a lot of money and that's just somebody and that's, and that's a baseline, as as you're saying.
David Lieberman: 22:03
It's been going up pretty drastically since about the second year of COVID down here. Yeah, that makes sense, yeah, that makes sense For all the reasons, whether it's the fact that the line staff has just gotten more expensive, Right, you know, not just in healthcare, but certainly in healthcare, yeah, staffing To everything else that's going on. So you know it's going up. And to your point, I mean, you know, for you who are probably dealing with younger people, not people who are about to move in, right, and if you're thinking about a mission and it's easier said than done.
David Lieberman: 22:57
And if you're thinking about a mission and it's easier said than done, but I would talk about, there's 1.3 million assisted livings and another whatever 1.5 million with independent living, and then there's maybe 3 million people getting help at home as we speak now that if you think of that number, it's the preparation that might help. I don't know if you have to plan ahead for this Right Now. There are bigger picture things than that. You can say, well, what can the government do to help? Right, you know Medicaid is that one example? But you can't count on that and we don't know 20 years if you can count on it, if you'll be able to, yeah.
David Lieberman: 23:34
So people have to plan ahead. So it's the planning ahead, putting a bit away, and I really do recommend taking a look at the long-term care insurance, if it's doable, because in my example still $3,000 a month today is much better than not having it and I have it myself. Yes, I have long-term care insurance myself.
Josh Fertel: 23:52
No, if $3,000 today is a difference of $10,000, hopefully you'll never use it, but it'll be there. And to fix this problem, if I had a magic wand, how would you use it?
David Lieberman: 24:11
You know I'm not telling you this is well thought out, because it's a great question. Yeah, but there was someone out there recently I forget who it was some congressman or a senator said you know what, put everybody who's born, give them $7,000 and, you know, put it in a certain kind of investment. So by the time there's 65, it's going to be worth a million dollars. There you go. So if you think of something like that and you extrapolate and say, well, if everyone's born, I'm just going to say double that, you know, and put it aside and keep it in something safe. And by the time they're 85, that might be 1.5 million and even in future dollars which should do the trick.
David Lieberman: 24:52
And if you think of what's happening at the end and how much they're spending at the end, that $15,000 that you might put aside now would be nothing compared to what the government's paying out later, because Medicaid is what they're paying out now by the billions one way or the other, and I haven't even gotten into nursing homes that if you're paying privately, or $15,000 a month and up, or the government's footing the entire bill. So I don't know, If you give me a magic wand, that might be it. That's a great answer.
Josh Fertel: 25:23
That's a great answer. What a genius. Thanks to you. How would somebody contact you?
David Lieberman: 25:30
I'll give you my telephone number and I always recommend that I could always share a website, but the first thing that I do often enough are phone calls, initial phone calls, or just an hour or more, and I'm happy to have that conversation. So the number for Michael Brodie, senior placement for me in particular, is 954-732-9657. And I'll say it again Go ahead 954-732-9657.
David Lieberman: 25:59
And I think you kind of get this. This is a true passion for me. It's it does it comes out, you know. You know it's a great way for me just to help people who really need it, and I get it professionally and I understand it deeply personally. Yes, well.
Josh Fertel: 26:14
I want to thank you for coming, thank you for having me. Really appreciate your input and we're hoping that you'll come back and visit us again.
David Lieberman: 26:20
My pleasure.
Josh Fertel: 26:22
Thank you for listening today. Back and visit us again. My pleasure. Thank you for listening today. Please follow us on Facebook and LinkedIn, and you can check us out at theangrybuilder.com.
