Home care is amazing! Older folks overwhelmingly fear loss of independence and institutionalization more than death.  Home Care can save the day for folks when they lose their ability to perform Activities of Daily Living (ADLs) independently.  Caregivers help with hygiene, nutrition, safety, cleanliness and so much more, all while allowing a person to stay in their home and the surroundings that they cherish.

Adult Day Care is also Amazing: Another fear that outweighs death is the loss of family or friends. Day programs combat social isolation, provide nutrition, activity, movement, friends and a reason to get out of bed in the morning. When my mom started with adult day services, she told me "...and now I'm even going to camp."

The first proposed titles of this podcast were "We are not enemies!" and "We are not competition."

Powerhouse guest Liz Barnes, Vice President of Risk Management and Adult Day Services for Easterseals in the national capital area (Washington DC, Virginia, and Maryland) is a great proponent and advocate for all home and community based services. She has a wealth of knowledge and also a great energy and passion, and I especially loved two things about my interview with her:

1. She answers everything from the perspective of the participant
2. For Liz, "taking care of people" isn't enough, she wants them to live their best lives.

Coincidentally Liz is the Chair of the upcoming NADSA conference and comes bearing a Discount Code (Ankota20)

It's not a coincidence that the timing of Liz's episode is just about one month before the National Adult Day Services Association (NADSA) conference. It will be held from September 18th - 20th in the supercool Buckhead neighborhood of Atlanta (Buckhead Marriott). When we recorded the episode, she mentioned that it was one day before the "early bird discount" was coming to an end. I had to share that sadly the episode wouldn't be reaching you until today, but Liz took care of you and arranged for the discount code Ankota20 that will get you 20% off conference admission.  You can register for the conference here.

Please enjoy what Liz has to share.

Liz also graciously shared that she loves helping Home and Community Based Service (HCBS) entrepreneurs and that you can reach her via email at ebarnes@eseal.org.

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. 

Here's a Transcript:

00:00

Liz Barnes is a vice president at Easterseals. Today on the podcast, she talks about the combination of adult day services and home care to be a great benefit for both clients and the agencies that deliver the service. 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, then this podcast is for you. Now, here's your host, Ken Accardi.

00:29

Well, hi, and welcome to the next episode of Home Care Heroes and Day Service Stars, the podcast that really focuses on anybody who's helping older or disabled folks stay in their own homes. And today we have an outstanding guest. Her name is Elizabeth Barnes, but she goes by Liz, and she's with Easterseals in basically the Washington capital region. So she is in charge of enterprise risk management, as well as adult day services for Easterseals in

00:59

Washington, D.C., Virginia, and Maryland. And she's also in charge of adult day services, which in their cases in Maryland. And so first of all, welcome, Liz. 

Thank you so much. And I'm really excited to be here and to talk about a really important topic. 

It's great to have you and thank you for that. So you also just happened to be the chairman.

01:23

of the upcoming conference for the National Adult Day Services Association, also known as NADSA. And that there's an upcoming conference in September. It's going to be September 18th through 20th in Atlanta at the Buckhead Marriott, which I think Buckhead's like a cool neighborhood in Atlanta. I'm not that familiar, but I think I've heard of that before and I think it should be a great conference and I'll be there myself.  I know that

01:53

part of the reason you're here is you'd love for some folks to hear a little bit more about NADSA. What can you tell us about the conference before we even jump into our topic for today? 

Absolutely. Well, I'm really excited. Lambda is a really fun space. And I know that how hard our industries work with taking care of people. And this is really our time to get together and to bring great ideas, you know, to innovate, to kind of work on best practices to develop that network.

02:19

And it's also a time to kind of rejuvenate ourselves and being around other folks that are as passionate as what we are throughout the nation. I think it's incredible with our adult day services network. And I think that being able to learn from some subject matter experts, though, I think that sometimes we have so many people that have been in the field for so long and our field's still evolving. And I think there's some amazing things around that's happening in our healthcare space, in our social space that we need to continue to develop. And

02:48

This is a wonderful opportunity for that to happen. So look forward to seeing you guys in September. Yeah, that sounds good. So let's say, I mean, just thinking on this for a minute, if I am, let's say, a home care owner and I'm thinking about, hey, wouldn't it be great to have a day program because of all the synergies? And that's what we're going to talk about shortly. I've been to the conference now twice, and it's been great. But I've been there as a vendor because we make software for adult day services and for home care.

03:15

And but you're there with the cool kids in the general population. So if I came as a home care owner and I really wanted to explore, what kind of folks am I going to meet? Oh, yeah. I think it's what's really amazing is that you have folks that are interested in potentially enhancing and considering from a platform like a home care or an assisted living, venturing into the adult day space, whether a social or medical model.

03:43

And I think that there's definitely a group of folks on how do you even open up an adult daycare? I think that's a really big, important topic. And learning from some industry experts is pretty phenomenal for who we have as speakers and help us navigate through that. I think that the other piece of that, we have some fantastic exhibitors and sponsors throughout everything. It's a community that while we are, I feel like I say that adult day services is like the best kept secret.

04:08

is that we are a smaller industry and sometimes get outshined by like the assisted livings and like long-term cares and rehabs and whatnot. But I think that ultimately it's one of those, it's the opportunity for, you know, tenured adult day providers. We have folks that are.

04:25

from the technology world to help enhance and make our jobs easier within center. AI is a huge thing that's coming out. It's something that we'd like to learn more and more about. It's about, we talk about and have opportunities for compliance, person-centered care, being able to learn about what activities we could have as enhancing for our programs to really enhance that quality for our folks. Again, everybody loves bingo. Everybody loves those basic, I think, fundamental things, but there's some amazing activities that people are doing and being able

04:55

have it in a concrete setting, in a space that is very person centered and unique. And it doesn't have to be this cookie cutter because everybody is so unique and has amazing passes coming to us for services and support that I think is only right that we meet them kind of where they are and make sure that we're using correct language and we're making sure that we're being effective of all. And I think that that DEA lens is really a big part of us as well, is what we're seeing and evolving through our time.

05:24

us in particular in Maryland as an example is, you know, we're really, we serve 16 through the lifespan. So there's many adult days throughout the nation that are serving younger and younger participants. And I think that's one thing too, to just, you know, bring into our learning spaces and opportunity to also evolve into, you know, different populations as well. Yeah, fantastic. Yeah. And I mean, I would say that, you know, in the people I've interacted with at NADS, I mean, everybody really kind of has the heart.

05:52

for the same mission, you know, which is it's all about home and community based services. We keep somebody living in their home, they're happier, and you know, if we could help them and that kind of brings us to the topic for today's podcast. And you know, when you and I again, pre briefed and you said, you know, what you're really passionate about is that you you're like, well, it's not, you know, home care over here and day services over there. It's like, you know, some of these best programs are when you put that together and it's just like incredible.

06:20

you know, synergies between them and, you know, benefits to the organizations providing the services as well as to the participants in the services. And, uh, you know, so as I shared with you, I mean, if you look at the audience of home care heroes and day service stars, the podcast, it, it a little bit, you know, kind of mirrors, um, the folks that we service in and CODA. And so that is mostly home care providers who provide non-medical services, whether it be private pay or Medicaid.

06:48

as well as people who run adult day services. And then also folks, and you kind of mentioned 16 through 100 plus in terms of age groups. So we also have services for the disability community and it's mostly like intellectual and developmental disabilities where folks are receiving services in the home. We usually don't call it care in that space and they're also receiving day habilitation services.

07:18

So that's that. So I guess just knowing that that's the audience is kind of that sort of a mix of folks and that most of them don't really consider themselves all that medical. Let's start with the non-medical model of adult day services, let's say social kind of care, where somebody can come for the day and they're going to have activities, they're going to have meals, they're going to meet other people. Like what are?

07:43

You know, right there, like starting from that non-medical side, what are, what are some of the synergies that you see there, like having somebody who has that type of service during the day, and then also combination of that with home care? Absolutely. I think that what's pretty unique is I think adult day, well in regards of how your license, a medical model or a social model, adult day really encompasses the whole person. And I think that's what the amazing thing is, is around, you know, just as you had mentioned, activities, the engagement, the opportunity to be stimulated.

08:12

You know, opportunity to also be able to be, you know, regulated, you know, in a safe space. And have that community and interaction as a support network and team for you and being able to feel as a sense of belonging. And again, in a supportive environment. And then I think the last portion that I can really think as a bucket is really that personal independence and autonomy to make decisions continued through, you know, whatever chapter the participant happens to be in and being able to have self-expression and be supported in that.

08:41

and kind of continue to evolve in their person and their development. I feel like one of the challenging things is that as people age in particular, if we're talking about the aging community, is that you're kind of like put in a bucket and it's kind of like, oh, well, cute grandma, cute grandpa, you're just gonna be able to be over here, pat, pat, pat, and really, they still have interest, they still have desire, they still may have goals that they wanna achieve. And I think that having being immersed with other peers.

09:08

that may be going through the same chapters and having similar hobbies and interests and likes and being able to develop that within their own community with an adult day is pretty incredible to see. And it kind of in a way marries to the opportunities with home care is being able to be continued to be supported and be able to have that independence and autonomy and be able to say, I may need a little bit of support here and there and you're helping me be able to continue on with my desire and my path that I would like to go on.

09:36

And it's going to be able to comprehensively support somebody from a psychological stance to be able to continue to on this path that they really would like of their choosing, whether that be aging in place for as long as possible, whether that be fully, you know, hope here at one point in time. Or even if this is just a stepping stone, and they want to go on to a CCRC or something else as they're continuing, whatever their desired path is, you know, the the the synergy between, you know,

10:03

home care and adult day services has this continuum and we're there even under a social model to be able to support somebody and to give them an opportunity to be able to do what they would like to do and be able to it's amazing to see like on site you'll have folks that may have been an engineer in the past and they're really interested in leading and facilitating a group.

10:24

that has to do with building and has to do with like, we had one in particular, like making birdhouses. I mean, how incredible is that to be able to utilize your skills and your space and still be able to give back to your peers that then, what are the peers that are interested in actually building a birdhouse too, and being able to really maximize on that. And I think that that's what the amazing passion is, is regardless of the industry of home care or adult day services, as you had mentioned, Ken, is that there is a true passion for serving people and being able to support them in the best manner as possible.

10:53

Fantastic. And I think one thing that I think you mentioned a little earlier was about managing the finances. So sometimes, especially if you're private pay, it might be that if you had a home care caregiver in the house for those eight hours in the day, it might be, let's say, 35 an hour or something. So that might be $280 for that day. So whereas if they could...

11:19

be in the day center, maybe it's not eight hours and six hours, but you kind of get the idea. I'd imagine that the tuition for your day in the day program is probably a little bit less than having a dedicated caregiver for the day. Plus you also, I love the fact that you gave a very person centered, customer focused answer on the benefits to that individual. But I think there could be also a kind of a cost benefit for

11:46

whether it's Medicaid paying the bills or whether it's the family paying the bills, that they can get more care and the socialization. And I love all those things you brought out about really being person-centered and whether... I know a lot of times when home care, as a home care professional, when we work for the first time with, let's say, developmentally disabled people, the first thing that we learn from the agencies is like...

12:15

I mean, yes, we're here to help them with their meals and their hygiene and activities of daily living, but we're really helping folks live their best lives and live them in their community. And I love the fact that you are bringing that to the discussion in the context of older folks, as well as people that are receiving disability services. So I think that that's really great and I appreciate that. So one little passion topic of mine though, is that,

12:43

You, like I said, you gave a very comprehensive answer on how it benefits the person who's receiving the services or the care, but I've also seen some incredible benefits for the agencies that do both. And part of it, one thing we've seen is, I mean, there's a battle for caregivers out there. And one thing we've seen more in the context of home care is that when somebody is coming in and they're getting some training on how to be a home care aide, they go from this,

13:12

you know, classroom environment and the cute little office of the home care agency into this, into the home of somebody who's like 78 years old. And, you know, maybe that home doesn't smell really great and maybe that person doesn't communicate really well and that kind of thing. So there is a lot of, you know, kind of failure to launch on the part of caregivers in home care. And obviously that's painful because you brought them on board, you trained them, you're ready for them, you paid them to train them and all that kind of thing. And then, and then there's attrition. So one thing I've seen is that

13:41

when you have adult day services and you're doing some training for your folks, and then you could actually have them participate in the day services, they get a little bit more accustomed to communicating with older folks and being part of that and part of the community. And they kind of learn some skills there as well. And then interestingly, I mean, you did, one of the things we'll talk about this a little later is there's

14:06

different models, social models of day services, and then there's medical models, and different states have different rules about the ratio of how many people you need. So I think on a national average, I'd say generally it's like one person providing care services to six to eight participants in the center. So one way, since our...

14:30

Our agencies of all kinds are interested in recruiting caregivers and growth. So I kind of talked about a great way that that helps with caregiver recruiting. But when we get into the context of. Rhoads, um, you know, when somebody calls and that call that comes in all the time to the home care agency, which is, you know, Hey, my mom fell, she went to the hospital, they patched up her hip. I'm in Boston. Mom's in Florida. You know, like, um, I'm going to fly down there, but I need to get home care. Cause I could only come for a couple of days. Cause I have my young kids in school, you know, like that kind of a call.

15:00

You know, like three out of four agencies, maybe even nine out of 10 agencies are going to say, okay, I can start looking for a home care, you know, caregiver for you. We could maybe start providing services to your mom in two weeks or whatever. Whereas if you're, let's say you have those people in training and they're in the day center and then it's like, I could send somebody right over right now. I could pick you up at the airport. I can meet your mom. You know, we could get there. We could welcome her in the home. We can, you know, make sure that there's no spoiled milk in the refrigerator and make sure the plants are watered.

15:30

and all that sort of thing. And so right there, I mean, that's something that if you just have your three folks on the phone who are scheduling in the home care agency, and you don't have the day services where you could kind of bring those people in training in and cover your ratios and things like that, you're in less of a position to be able to meet somebody and meet their needs right away. So.

15:55

I feel really badly because you're the guest on the podcast that I've been blabbering for the last five minutes, so it's bad on me. Well, let's kind of go back to where we were. So you talked about, and I kind of coached you to talk about non-medical first because a lot of our folks who are listening are going to be providing non-medical care. But in the context of what you do specifically, which is more of a medical model of adult day services, how does that differ? And what are you able to provide in that context?

16:24

Absolutely. So the medical model, like I said, I feel like, you know, no matter what, even though it's, again, air quote medical model is we obviously have encapsulated all the social model as well, but we have taken up a couple of notches in the sense that we are able to provide the same level of nursing care that a nursing home is able to. So, you know, to give an example, we are under a medical director's license. We have an RN on staff. We have health techs, our CNEs and CMTs.

16:52

that are able to provide supports on the floor. We're able to triage a lot of things in the community and collaborate directly with the private care physicians or whoever is on their coordinated care team, which is really helpful to be able to just share observations, share in their goals, what they're achieving, what were, you know, there's some opportunities to help them with in different facets, whether it's around, you know, therapy services and rehab services, many medical models have.

17:22

OTPT and speech on site as well. So that not only supports the participant who is in services, but it also supports the caregiver. It has it a potential opportunity for a one less stop and coordination of trying to leave work or come in early to work if they're a professional caregiver and clock in and go take that person away from that setting. A more organic fit is to actually be able to have those therapy services on site organically to see if there's

17:52

an opportunity to help out to work on a sit to stand or for feeding or transitioning to the toilet and whatnot. And I think that that's really nice to see versus in a sterile office setting that you don't get to see functionally, you know, potential opportunities to work that participant on. So that's something that's really

18:11

Wonderful. I know that a lot of other adult day services that are under the medical model will provide, you know, a lot of those medication management. They'll also bring in podiatry. They'll bring in some of them will actually do behavioral health and bring psychiatry or psychology services in. Some will actually bring in primary care services as well, even being able to support on taking folks to their medical appointments as well. And I think that being able to have the true wraparound services and again, that coordinated care, again, both models can do that.

18:38

especially with home care. But I think that ultimately both models are something again that can work so synergistically with home care. And just as you had mentioned that financial aspect, regardless if it's a social model or a medical model, there's an immense cost savings for using this, whether you're Medicaid funded or even private pay, especially from the family and the caregiver lens if you're talking about private pay, because they're sharing costs of not a one-on-one,

19:07

just to your point, the ratio of a one to six, is much different and cost effective and usually could include an extended day. So for us as a nonprofit, we're able to go and fundraise and fill in our gaps and we actually offer our caregivers a potential 10 hour day. So they're able to participate in the workforce to be able to get some respite for themselves as well as also take care of themselves for their own needs.

19:32

you know, medically and go to the, you know, the grocery store without having to feel as though they have to rush home to something or take care of like kind of those mundane everyday things, go get themselves a haircut, you know, that they need to do in order to keep on, you know, being that unpaid caregiver. So that is something that is, you know, definitely also an opportunity if you're talking about those total coordinated services and wraparound services. In addition to I think that the flexibility and the customization.

19:59

for both models and being able to, we're able to kind of pivot and change along with home care support as being able to say, hey, we're able to communicate a change in that person's needs or care, even if it's temporary. Let's say it was after surgery, some additional levels of need that's needed from an ADL standpoint in home, but that at the center, we don't see as much. And I think that being able to have that communication across

20:22

You know, that channel is really a wonderful opportunity for being able to have that true holistic approach. While also you had mentioned it, the fantastic thing is that an organization is willing to do either is dabbling in adult day and interested in diversifying their service delivery as well and considering different programs is definitely by entertaining home care or vice versa, would be there is an incredible opportunity for resource sharing and training. And I think that

20:51

Ultimately, I think that that's kind of where I switch off to my like little enterprise risk management hat and share that I think it's one of the most important things to do things consistently and make sure that there is a lot of feedback. There is, you know, kind of establish those surveys in place to make sure that you really are.

21:08

providing a good quality of service and being able to have the capacity to actually take that constructive feedback and actually implement that. We do as an example, caregiver surveys and it touches all the major touch points around transportation, meals, activities, staff engagement and communication, all of those things in order to make sure that we're providing a quality service. And I think, and we give those to also the professional caregivers too. So if we're working with a group home or specifically home care, that's something that we also get feedback on.

21:36

which is really important for us because, you know, a caregiver is a caregiver. We understand that they may be unpaid or professional, but it's a lot to be able to provide, you know, true caregiving supports around the clock to somebody, you know, to make sure that they're able to have that meaningful, you know, life and day for themselves. So I think that that's really important. And again, I think comprehensively, both medical and social models, regardless of how they're really truly bucketed, can provide both of that in collaboration with the home care.

22:06

Perfect. One thing you touched on, I mean, you touched on so many things that I have a lot to come back to here, but one of them was about, you know, kind of the regular day, extended day kind of thing and how that provides respite to the family caregiver sometimes and things like that. But I guess, you know, when somebody is running an adult day program, are there, are you seeing kind of situations where they're

22:30

setting the model and saying, okay, you know, like we're, we're providing either a morning program, an afternoon program, an extended day program and things like that. Like what, you know, what, what does, what does a typical center do in terms of providing a day of services and like what are typical hours for that? Sure. So for us as Easterseals, we have that kind of extended day, just because we have that opportunity as a nonprofit to be able to

22:54

cover those gaps in that shortfall. We are fee for service in the state of Maryland. And so we only get one daily rate. And as long as you've hit that Medicaid minimum of four hours, that's all you get. So we have to cover the additional expense costs through our fundraising and grant opportunities. But we've seen kind of across the board, some folks do have an AM shift and a PM shift. Some of them do have.

23:17

you know, just that one time four hour shift per day. Other folks will have also the extended day as an opportunity as well for folks. So you pretty much can kind of configure it, regardless of if it is, you know, CCRC, regardless of whatever type of industry of serving people in general is a tough business. And, you know, Adult Day has, you know, there's so many opportunities to build your infrastructure and your business.

23:44

plans just around what would be the best and most suitable based upon your state and where you are. I think that that's the one thing that is great because some states may be through an MCO. When MCO, you don't have to do any of your marketing. Unfortunately, we're a waiver state, so we have to go and do all of our marketing. So it's always this kind of give and take and kind of where you put your buckets for capacity to then also help dictate how are you going to be able to best support the caregiver and their participant in your model and where you are. Got it.

24:13

Yeah, love it. Okay, so the next thing that I picked up on was, that kind of occurred to me or life well went off about kind of the synergies is that a lot of times, I mean, of course we do have high attrition in caregivers and part of that is your rates, which hopefully are getting better and things like that. But usually a lot of times when folks leave it's because they need to get a certain number of hours. And in the case of the Medicaid side, you're authorized for a certain number of hours

24:43

home care and in the family side, you know, like it's, it kind of comes down to the care mom needs and the, and what the family can afford. So they might get, okay, you know, like I, I have, um, you know, this person for 20 hours and then the caregiver comes on board to provide that home care, but they're really looking for a 40 hour job. And when they get that offer from the Amazon warehouse for the 40 hour job or something like that, they, you know, even though they have a heart for caring, they'd rather be in the home. They, you know, they need the 40 hour job over the 20 hour job. So it sounds like there's

25:12

maybe an opportunity if you are running both that you can, you know, kind of balance people out and get them to the number of hours and maybe, you know, even take advantage of that little bit of over staffing in the center for some concierge services. But yeah, go ahead. Yeah, I was gonna say, absolutely. And I think the, we have even worked with our community partners, whoever those providers are, and said that, you know, we're happy to collaborate, even if we don't work. So Easter Shield doesn't do home care as an example.

25:41

But we absolutely, if a participant has a caregiver in a home that gets off at 7 AM or 9 AM, shall I say, 9 AM, and they're coming to the center and want going to come to us, there's no problem for us going through that same hiring process to have some consistency for our participants as well if we have a vacancy and a need. So it's a nice way to develop a PRN pool. It's a nice way to develop, as you had mentioned before, you're going to have some more consistent training and opportunity in a more supported structured environment.

26:10

to be able to have the best interactions with the participants and have the best customer service, again, in more of a controlled environment to have, again, constructive feedback to be then given and translated over to then working potentially one-on-one with somebody in their home.

26:25

And I think that that's one thing that we've explored for sure is, are there group homes and providers working that overnight shift that would really enjoy continuing to work on? And yes, they're only at that 20 hours or they're only peer on their float in their provider, but we're able to offer them as day shift and true day program Monday through Friday or Monday through Saturday or Sunday, full time hours. That's going to be very attractive for both entities to keep our workforce in place.

26:54

Perfect, I love it. All right, so I guess just going in one last area, I mean, time flies when you're having fun, so we're kinda coming close to our time window here. But when I talk to some home care folks about day services, they do these impossible things. I mean, they get caregivers, they get them to homes, they find their way there, they do this electronic visit verification stuff that's really, really hard. But then when they talk about day services, they're like, oh my God, I need real estate, I need a place, I need...

27:23

meals, you know, and these seem to be like daunting things. So, I mean, as somebody who has really a broad experience in home and community based services, I mean, do you think that's fear of the unknown? You think they could get help? You think they could come to the NASA conference and learn more about that? But I mean, what's, what's your thought on, you know, somebody who has run a home care agency, maybe they just have a small tiny office, and now they're thinking of, you know, needing to have a place where folks could come during the day and

27:50

and they're going to need to provide some nutrition to them, not just with one caregiver on one basis, but you know, like feeding a number of people, they're like, I can't run a restaurant. What would you say to that? And what are some experiences that might be able to help folks out? Absolutely. So I would say that, yes, I think that exploring any new thing is definitely daunting. I would actually...

28:12

highly encourage you guys make the investment. I really say that the NADSA conference is wonderful beyond just like a state association conference and whatnot to really be able to come in here across the board throughout the nation or a presentation again of your true subject matter experts that have been doing this that have found out what works, how to collaborate on different things, how to do kind of like special waste.

28:37

scenarios on trying to reduce all those kinds of things. I think this is a really creative group that's been able to, again, the business model for adult day is rough. And I think that being able to get everybody in the same space and being able to really bat ideas off is a true, it's a worthwhile investment.

28:53

We do travel all over the nation. So, you know, and if we're closer, you know, next year, we hope to see you then, but hope that you'll, you guys would make the investment this year because I think that we have a wonderful conference schedule. Take a look at the website for ANADSA and, you know, feel free to, you know, connect with the executive director who's wonderful and being able to answer any questions about possible learning opportunities. But I think ultimately the facility.

29:19

the transportation, the food, the actual nitty gritty of it's beyond just providing that human capital, right, and being able to go into somebody's home and provide ADL supports is, you know, there's lots of creativity. I've seen adult days in churches. I've seen adult days in different hours of, you know, local, you know, government.

29:39

buildings. Right now, post COVID, everybody who's in a hybrid work schedule, some are from still fully remote schedules, depending on where you are in the nation, I think it's really incredible to see the kind of opportunities that folks will have for very low rent. So if you happen to be a for-profit company thinking about, oh my gosh, I won't be able to afford anything, you know, think again, there's actually a lot of, you know, real estate out there and workings around to be able to support the community and community needs.

30:04

as well as also from the nonprofit lens, we've gotten a rent for a dollar before. So being able to really talk about that brick and mortar space, there are lots of opportunities. Transportation, I can't really sugar coat that one. Transportation is tough just because post COVID, all the supplies to make our buses are definitely expensive, but there are opportunities again to buy a used bus. There's lease to own options. I'm gonna name drop Enterprise as a great lease program.

30:32

as an example, especially even working with a lot of group homes for doing like minivans and wheelchair accessible vehicles. But I think ultimately it's there are solutions and there are cost effective solutions. Food, I will share that some programs are actually more ethnically and culturally geared and they're supporting a specific population and part of the community. And I think that it's amazing to see

30:59

the community efforts that will come together to provide a compliant child and adult food program authorized menu so that adult day providers can actually get reimbursed for those meals of a breakfast, lunch, and a snack. And isn't that incredible to have something that for your participants is that home good cooking that makes your belly feel good at the end of the day. And the other caters I'll share that for us in Western Maryland, we're one of two providers

31:27

And we actually had to provide the training to what a caterer, but the caterer was more than willing to comply and shared with, you know, we have the, you know, the, the kitchen, we have the staff, we can do this for you. We just need to be told what the parameters are. So sometimes it is the, the, um, the unfamiliarity about what the what is and the unknown. Um, and I think that that is willing to take a deeper dive and to really explore with people, um, you know, how they did it, you know, somebody else in your fellow state.

31:55

One of the things that I share that I use the word as co-op petition is really, you know, bringing adult day services, bringing other industries together is the only way that we're going to make a better service for, you know, our customer base. And being able to share all those resources is really important. And it's a once a year. So I think if you guys can get together once a year, you know, and maximize and use the best of the learning opportunity and be able to ask your questions in a safe space. I love it. Right.

32:22

up here. So first of all, thank you so much for being on the podcast. One thing you said is, you know, hey, this year we're in Atlanta and other years we're in different places. Last year was Chicago. I think the year before that was Pittsburgh. So different locations. But you know, I actually just booked my tickets from Boston to Atlanta. And I was astounded to see that like I could get, I think my round trip, like it was like less than $100. Then I actually said I wanted a carry on bag and it became a little over $100. But I think it was like,

32:51

It wasn't that much to get to Atlanta. So I guess, you know, being a hub city, that was kind of good. But yeah, if you could just remind us, you know, as the, putting on your hat as the chair of the, you know, of the this year's national conference for the National Adult Day Services Association. Yeah, give us the details one more time and you've got the last word. Absolutely. Well, looking forward again, seeing you at the annual national conference for adult day services. It's gonna be,

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in Atlanta at the Buckhead Marriott, September 18th to 20th, as Kenny shared. It is actually very cost effective to get down there. Our early bird rate actually ends tomorrow, July 31st. And we are really going to be excited to see you all there. All right. I love it. Thanks again, Liz Barnes. And thanks, everybody, for joining this episode of Home Care Heroes and Day Service Stars. Thanks for having me.

Thanks for joining us today on the Home Care Heroes and Day 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.