Listen to Episode 04
Jennifer Cook-Buman, Owner, Portland Senior Housing
Jennifer Cook-Buman founded Portland Senior Housing in 2007. As a consultant, the objective of Portland Senior Housing is to find the most appropriate new home for seniors when living at ‘home’ is no longer an option. Selecting the right environment is vital to optimum health and wellness. Every community is unique in its amenities.
Matching the needs and interests of the senior with the appropriate services and atmosphere in a new residence is critical to a successful transition. Jenn’s effective communication skills have allowed her to build strong relationships with customers, internal and external. Experience as a CNA during her college years created compassion and perspective into the needs of both the residents and employees of the facilities.
Transcript of Episode 04 with Guest Jennifer Cook-Buman
Heather: Welcome to Your Best Years Begin Here podcast, brought to you by theseniorlist.com. Your Best Years focuses on bringing you interviews with experts and educators, to live a fun, free and fulfilled life as a mature adult. I'm your host, Heather Havenwood, so let's have some fun and get started. Hi, everyone. My name is Heather Havenwood, and welcome to theseniorlist.com. I'm so excited today because we are interviewing Jennifer. How are you? How are you, Jennifer? Are you there?
Jennifer: I'm here. I'm great.
Heather: Thank you, thanks for being here. I want to tell you who Jennifer Cook-Buman is. Did I say that right?
Jennifer: Buman, yeah.
Heather: Buman. I'm giggling over here because I'm like, I know I'm going to say it wrong, so I'm just going to put it out there and then pull it back. I apologize.
Jennifer: It's alright.
Heather: Let's talk about who you are. More importantly, you founded Portland Senior Housing in 2007 as a consultant. The object of Portland Senior Housing is to find the most appropriate new home for seniors when living at home is no longer an option. Selecting a right environment is vital to optimum health and wellness. Every community is unique in its amenities.
Matching the needs and interests of the senior with the appropriate services is truly important. Jennifer's effective communication skills have allowed her to build very strong relationships with customers, internal and external. Experience as a CNA herself during her college years really created compassion and perspective into the needs of both the residents and employees of the facilities.
Heather: Jennifer, I am super excited that you're here today because at The Senior List our job is to really help the caregivers as well as the adults that are looking at these kinds of options. I just want to have a conversation with you today about exploring what are the different options, the payment, who are you and how you can help people.
What does a referral specialist do for people if they're not in the Portland area, and they're listening and they're all over the country? Let's just start at the beginning. You founded in 2007 as a consultant. Why did you start the business?
Jennifer: I had gone through the placement process with a couple of family members. I learned that by the time you know what you're doing, you're out of parents. Now that I had all this knowledge and I was looking for a career change, I decided that this would be a good mechanism for me to apply to the growing aging population.
Heather: Absolutely, and so you are technically a referring specialist. Can you explain exactly what that is for listeners?
Jennifer: Sure. The easiest way to explain it is it's much like being a real estate agent, but instead of looking for a home you're looking at all the senior housing options. Everything from independent retirement communities, assisted living, memory care, adult foster care homes, the whole spectrum of care.
Heather: The whole spectrum. Just like a real estate agent, you're matching the needs of the client to the right particular kind of home?
Heather: Perfect. Okay, so let's look at the different kind of homes because you said the four there, there might be more. Can you just help us understand what are all the different options out there?
Jennifer: Absolutely. On one end of the spectrum, you have independent living. It's also called retirement community or retirement living. Picture a cruise ship. It's very free flowing, come and go as you please. A lot of people that live in independent living are still working part-time, or maybe it's a couple and one of the spouses is still working, often still driving, very engaged in their community still. They just don't want the upkeep of a home anymore. That's at the low end.
Then moving next along that continuum would be assisted living, so then you have an apartment. It looks a lot like independent living in many situations, with the exception that there are caregivers available 24/7. You have a care plan assigned to you, which is a living document that will change as you change. They can help with all the activities of daily living: bathing, dressing, medication management, meals are included, three meals a day are included in Oregon by law, I'm not sure if that's the same in all states, toileting. All of the good things: ambulation, transferring in and out of bed, in and out of a wheelchair, or getting them to and from locations.
Jennifer: Then the next step beyond that would be possibly if needed, if there was Alzheimer's or dementia in the mix, then at some point if they're wandering or not able to find their way back to their apartments then memory care is another. That's the next stage. That's a secure unit where the residents are confined to a defined area. They still have activities, and they have their own bedroom or space. Sometimes it's a shared bedroom, but they have their bathroom. All of it is somewhat similar, but the care and the activities are all tapered to meet the needs of those suffering from the disease of dementia. Another option is an adult foster care home.
Jennifer: In Oregon, it's a home that's designed and licensed by the state to provide care for people who need it. In Oregon, they can have a maximum of five residents-
Heather: Oh, wow.
Jennifer: -in each home. It's very intimate care. It's very one on one. You get to know the caregiver. They live there on site too, so there is 24 hour monitoring.
Heather: Oh, wow. Okay. What is that best for? What kind of best clientele would that be for?
Jennifer: It's great for people who need a low stimulation environment. There are not a lot of activities. My grandmother was a perfect example. She loved nothing more than to do her crossword puzzles and watch the golf channel. She enjoyed eating, sharing meals with a couple of people and having a little bit of chit chat, but beyond that she was really not interested in playing Bingo or going on outings. She played a lot of bridge in her life and she was at a point where she really just couldn't anymore because of her eyesight.
She was just happy to be well cared for, very well cared for. They notice very slight changes because you have the same caregiver day in and day out. There's not three shifts of caregivers. They have relief caregivers a couple days a week, so they do have breaks but it's a very closely monitored environment. It's not a good environment if people are wandering, but it's often a great environment for people with dementia if they've gotten to a point where they cannot wander because they do have such close supervision.
Heather: Right, right. Okay, wow, thank you for explaining all that because I think there's a lot of different options out there. I love the analogy that you're a real estate agent, you're looking for what is the best fit for the client. Do you find experience that you're working with the senior or are you working with the caregiver, or both?
Jennifer: Both. I love having the senior, I love having that input. In 95% plus of the situation I at least meet them and ask them what's important to them. Oftentimes, they have relented to their family members to make the decision on their behalf because the whole process of looking at options and making that emotional change of giving up their home or doing yet another move is just an overwhelming concept to them. Typically, I meet the senior but I'm working with the family or the caregivers.
Heather: The caregivers.
Heather: Okay, so let's talk about … You talked about matching the needs, talked about the different options out there, but let's more importantly talk about where they're being proactive. Do you find that it's the best to be proactive before you actually need the helm or is it one of those things where in the crisis now's the time? What's going on out there currently in the marketplace? This is like houses. Sometimes there's a shortage of houses, sometimes there's a high inventory of houses. What's going on in the landscape? How can best people prepare?
Jennifer: In a perfect world, I would have every senior at least go scout out the landscape of what's available so they could share with their family member when the time comes, “This is where I would like to be.” Now, a lot of those are variable. Is it going to be available? Is it still going to be the right fit when the time actually comes for you to move out of your home? If you've taken a fall and broken a hip and are now relegated to a wheelchair and need assistance getting in and out of that wheelchair, independent living is not going to be a good option for you.
It really depends on when they're willing to make the move and what their current health situation is but it is helpful for the family and for myself if they have gone out and educated themselves on what the options look like and say, “When I need it, this is the type of place I want to go.” A lot of places are full. Most places stay 95-98% full, so getting on a waiting list is always encouraged. When their name comes up and the facility calls and says, “Hey, we've got an opening for you right up your alley,” you're not obligated to take it and you do not go to the bottom of the list. You stay on the list and you just say, “Call me next time. I'm not quite ready yet.”
Heather: Oh, that's good to know. It's not like a one time chance and they just go to the bottom of the list.
Heather: That's a good opportunity. That's a perfect world, when we all prepare, but what's your current situation? What do you find currently, that people come to you in a crisis or they're about two months out? Usually a crisis? Okay.
Jennifer: Usually a crisis. Even if it was a temporary crisis it was something to make them decide okay, this is it. I healed from that fall, but I fell and I need to change. I'm not safe here anymore.
Heather: Yeah. Yeah, it's usually a crisis with the senior, that something happened. Then boom, they call you.
Heather: Okay. In a perfect world, we all prepare.
Jennifer: Yes, yeah.
Heather: Let's talk about payment options because it can seem very overwhelming to the caregiver and the adult, the senior. What are the options out there? Is it longterm care? If someone's listening right now … Myself, my mom passed away at age 64. She passed away quite young, so we didn't have to deal with it that much. At the same time, it can be potentially overwhelming and a burden for caregivers in their 30's and 40's that just don't know what to do.
Jennifer: Absolutely. Longterm care options, which is what we're discussing, are not covered by medicare. The only part that is covered by medicare is skilled nursing for the purpose of rehabilitation. Medicare is not an option to rely on. It is private pay dollars or longterm care insurance policies. Those are great. They cover most of the options. Sometimes there's a variable on what amount they'll pay for settings such as adult care homes. Sometimes those are considered an in-home care option by the language in the policy, but it's still better than nothing. Oftentimes, an adult care home is the right fit.
Jennifer: I'm happy to help review those policies with my clients to help them understand what the options look like and where the monies might be coming from, but overall it's going to be private pay dollars. This is what your 401k for the senior, from the seniors accounts, any equity in a house … Then worst case scenario, they run out of money. Then every state has medicaid. Every state has different options of what medicaid will cover, however. In Oregon, we're pretty generous with the seniors. Assisted living, and adult care homes, and memory care are all covered by medicaid.
Heather: Oh, wow.
Jennifer: The senior does have to qualify by need, and they do have to be down to their last $2,000 to qualify.
Heather: Oh, wow. Okay. They do it really down to the end.
Jennifer: Down to pennies. Also, the veterans. If they had served during an active time of war or are a surviving widow, they can't have divorced them but if they are a widow of a wartime veteran there is a veteran pension specifically for longterm care.
Heather: Okay. Okay, good. As a caregiver, when's the best time to start looking at longterm care or looking at these payment options? Is there a possibility that you can start looking at longterm care and going and starting payment arrangements now, or is it just in the moment when they move in?
Jennifer: It's not until they move in. You can get on a waiting list and there's typically a fee associated with that, anywhere from $500 to $2,000 dollars to get on a waiting list. The wait list deposits are refundable until they've offered you an apartment, and you've accepted it.
Jennifer: With very few exceptions. There are very few exceptions.
Heather: A deposit to get on a waiting list is between $500 to $2,000 in your experience?
Heather: Wow, okay. Are you allowed to get on more than one waiting list?
Heather: Wow. Let's talk about funds for a second on private pay. If you could give us a range, I know you're in Oregon, it probably varies from state to state, but giving us a range of understanding of each the four different ones, how much it could cost on a monthly basis or yearly basis.
Jennifer: They're monthly. The ones I work with are month to month. There are also continuing care retirement communities. It's a CCRC license. It's a federally acknowledged license. Those are buy-in communities where you have to go in independent. You lay out a large sum of money, generally starting at a couple hundred thousand dollars.
Jennifer: Then you still have a monthly fee.
Jennifer: It's an investment. Then you do get a percent back when you leave, or to your estate. A chunk of it will come back to your estate.
Heather: Is that the golf communities? Is this the high rent?
Jennifer: They are high rent.
Heather: That sounds like a high rent place.
Jennifer: I don't work with many of those. I generally work with the people who are in crisis, and needing to find a place in the next week or two or a month. It's month to month. It's a 30 day notice if it's not working out. It's less than that if the facility can no longer handle their care. For instance, if they're in assisted living and it's someone who has dementia and now they're wandering out of the building and it's an unsafe situation for them, they'll call me.
The facilities will call me and say, “Hey, can you help with this family?” If we can get them moved in three or four days, then the most in Oregon that they can charge is 14 days of rent. That's enough time for them to turn the apartment and get it re-rented.
Heather: Oh, nice. Okay. Okay, so what does it cost on a low end to a high end? What's the low end to high end on monthly cost?
Jennifer: In independent living, a studio apartment … They have studios, one bedrooms, and two bedrooms. A studio is going to start at around $2,000 dollars a month and generally includes one meal a day, and all your water, sewer, garbage, activities, transportation to shopping and medical appointments, and activities. They usually have planned field trips to farmers markets, the flower gardens, theater, musicals, things like that. Then assisted living is going to be roughly $1,000 dollars a month more than independent because you've got caregivers. Then the add on layer is you've got three meals a day, plus all of those things that I just mentioned.
Jennifer: Water, sewer, garbage. Basic cable or expanded basic cable is typically included, also. The only outside utility is phone because a lot of people have cell phones now, so they don't have a landline. Phone is never included. Internet wifi is typically included. That's a newer add on. If you need hardwired internet access, that's going to be on you. That will be an additional. All of those are included in the independent living and assisted living options, just the add on is the caregivers.
Then just the base rate is going to be … For a studio … Really, the more average price in the Portland market is for, let's use a one bedroom because that's going to be the most common situation, so in independent living it's going to be on the low end $2,400. The average is closer to $3,000, in independent living, and up.
Heather: And up, okay. As you move up the different kinds of care, all the way down up to memory care and then to foster care, it's just going to go up in price per month?
Jennifer: Yeah, so foster care starts at around … They prefer adult care home.
Heather: Adult care home, okay.
Jennifer: The base rate is averaging around $3,200 a month as a base rate. That includes all your meals, and typically assistance with a couple showers a week, laundry. Things that are not included, those would be add ons in the assisted living environment.
Jennifer: You have a bedroom in a house and typically a private half bath. Then it's a common shower room. The room is typically like a giant tiled room with heat lamps in it to make it very easy, low barrier for showering in an adult care home. On the high end, a one bedroom in independent can be $5,000 dollars and a one bedroom in assisted living could be $6,500 dollars.
Heather: Okay, that gives you the range. It could be all over the place. This is also Oregon prices. It could range from state to state as well.
Heather: Okay, great. This has been good. It gives you an idea.
Jennifer: The shocker is memory care. It starts at around $5,200 a month, starts.
Heather: Okay, that's a lot.
Jennifer: It will cap out close to $9,500 a month.
Heather: Wow, okay. Wow, that's a lot. Yeah, because it is full-time care. It's full-time care and it's …
Jennifer: A lot more caregivers to resident ratio, also.
Heather: Right, wow. Okay, that's a big difference.
Jennifer: That it is.
Heather: It's a huge difference. I know that caregivers in their 30's, or 40's, or even 20's if their parents had them later in life, this could be overwhelming to even consider that you're now looking at adding that bill to themselves or dealing with. Right? This could be overwhelming. Just get an idea of how important it is. Let's talk about what's going on now in our environment now with different laws and regulations. There's a lot going on with seniors, of course, and lawmakers. There's now something that came out with as referred to a referral specialist. Can you talk about the law that's coming down?
Jennifer: Yes. July 1st of 2018 there's a new law in the state of Oregon. It's the first law of its kind on placement and referral people, that's what we call ourselves, either referral agencies, referral consultants, placement agencies, placement consultants. Oregon was the first one to pass it and it will require registration with DHS. Not certification or licensing per se, it's just a light touch of regulation. It's starting with registration so that they know who we are, who is out there. We have to have a $1 million dollar liability insurance policy.
Heather: Wow, yeah.
Jennifer: We become mandatory reporters, which much like doctors, social workers, school teachers, police, emergency responders. I believe even banking professionals are now mandatory reporters. If we see any sign of abuse, we are required by law to report it to the proper authorities. We are required to have a disclosure statement that discusses the options that we present. Are they only facilities that we're contracted with? Do we work with medicaid options? Who pays us?
Which, in most instances, it is the facility that you move into, that the senior moves into, pays us a fee. It's essentially a finders fee to bring them a resident that's going to be a good fit in their community. Then there's another little clause that's very confusing regarding subsequent placements. That means people that have gone into one, like the assisted living now needing memory care situation, that it's very specific to inter-agency … It doesn't really affect the consumer that much.
Heather: This is passed in Oregon. What's happening in the other states currently?
Jennifer: Washington has had a law on the books since 2012 but it's a retroactive, very punitive … It's not a proactive law that is designed to protect the consumer. They're actually looking at rewriting their own. California has one in session, I'm not sure where it's at. Arizona just passed a law also, I believe it will go into effect in January. It's very different from ours, but it's a start for them as well.
Heather: Nice, so that's good. We have Oregon, California, and the other? Washington?
Jennifer: Washington and Arizona.
Heather: Arizona, okay. That's something to really consider when you're looking at different facilities, maybe potentially moving the senior there because there are obvious options. Let's talk about what you do as a referral specialist. The big question I would have is, well, who pays for you? Do I have to pay for you on top of the fee? How does that work? Who pays for your awesomeness?
Jennifer: My services to the consumer are completely free. I get paid, like I said, a fee from the facility that they move into. At my company, Portland Senior Housing, it's a flat fee. I don't care if you go to the Motel 6 style place down the street or the Taj Mahal in the penthouse, I'm going to get the same fee. I personally have no vested interest in trying to sway you to one or the other.
Heather: That's really nice because we all know that realtors obviously get a percent of the commission of the home. The bigger the home you buy, the more commission. I think that's really interesting that you've created such a flat rate. That really helps the consumer to know that you're on their side, that you really just want to make sure it's the right fit because either way you're going to get paid the same price. I think that's really smart. Is that normal? Is that normal behavior commission structure cross the country or is that just something that your company's doing?
Jennifer: I can't speak to the rest of the nation. There are a small percentage of the companies here that do a flat fee, but very few.
Heather: Okay. Well, that's a great question. What are some questions that if they were looking for a referral specialist like you in their area and they're not in Portland, what are some … One, where can they go to find someone like you? What do they search or where can they go? Number one. Number two, what are some questions they can ask to make sure that they're a right fit and can they ask that question flat out, what's your commission? I don't know if you're allowed to ask that, like a real estate agent.
Jennifer: They can find a placement agency through their doctors offices. The doctors, the hospitals, the rehab facilities all know who we are. You can google placement agents or referral specialists Portland, Portland Senior Housing, senior housing in your area. It should pop up with someone.
I would caution people though when they're looking on the internet, only because there's a different model of referral specialists that work strictly on the internet. They work strictly on email and telephone. They never meet the client face to face. In most instances, the person that is working with the consumer has not been through any of the facilities that they're referring to.
Heather: They've only seen the pictures, the pretty pictures they put online.
Heather: Which you and I both know isn't always the case. Pretty pictures of, look at this beautiful dining hall. You know what I mean?
Heather: It's like oh, nice dining hall. What happens in the dining hall?
Jennifer: They had a rave.
Heather: Right. There are so many pieces when you walk in, and the smell, and the feeling, and the experience, and the cleanliness when you walk in versus the picture that was obviously staged.
Heather: It's a big difference, right?
Heather: Your company, Portland Senior Housing, do you only work with clients in Portland?
Jennifer: I do.
Heather: Okay, okay, okay.
Jennifer: I stay just in Portland. I have. Yeah, I specifically do but I network with a lot of fantastic, trusted professionals that work in the same manner that I do across the state of Oregon. We have an association, it's the Oregon Senior Referral Agency Association. It's a lot to say. We also, as an association, reach out to our neighboring states and try to find trusted professionals. We keep a database of people so we can help. We can often help find people in other locations, if they're looking.
Heather: It's a starting point. They could reach out to you and the association and say, “Hey, we're in Florida. Do you have someone?”
Heather: Just a starting point, and then go from there. Do you find that most of the agents like you, referral specialist agents, they stick in one central area inside of a state or are they just more state broad? I guess it would depend on the state, how big it is.
Jennifer: Most stay in a defined geographic area. Again, think about a real estate agent trying to stay on top of what's available, but it's even more important to know what's going on in all of the communities, the turnover, how they did at their last licensing survey. Have they had any complaints? How are they handling the complaints? Is their workforce stable? Are they having a lot of turnover in their management? Are they cutting corners on their food, things like that? Are they handling the upkeep of the building? Is the Taj Mahal crumbling?
Heather: Yeah, is the Taj Mahal crumbling. Right. You don't always know that from the reviews online. There are other types of reviews and complaint areas and agencies that you as a referral specialist can help them find, right?
Jennifer: Absolutely. We stay on top of that. Part of our new disclosure statements in Oregon is also the state has a website for complaints, the substantiated complaints. We are obligated to provide that to the family's as well, that website.
Heather: Oh, wow. That's actually really helpful.
Heather: Okay, great. Well, you've covered a lot here. You've covered about selecting the right environment, the different kinds of environment. We've gone over the different options out there. We've gone over being proactive, the different costs that are associated to understand the different costs, payment options. We've gone over who you are, and what kind of referral specialist does across the country, the new laws that are coming down federally.
It sounds like state, by state, by state, by state is going to have to go but right now we have California, Oregon, and Washington. You guys just passed one in July 2018, and Arizona as well. What else can you share with our audience that can really help them through that process of just finding the right environment and finding the right match for their loved one?
Jennifer: I would say try to find a consultant to work with. Don't be afraid to interview a couple of them, just like you would a realtor. Ask how long have they been in the area, how long have they been in the business, how do they go about learning about the communities that they're recommending?
Jennifer: Those are just really important things. They don't necessarily need to have been in the industry a long time. They could have lived in the area for a long time. If it's a smaller community, they're going to know. Small towns talk.
Heather: Yeah, small towns do talk. That is very, very true.
Jennifer: You need to feel very comfortable with the person that you're working with because they're going to be picking your next home for you essentially, or picking out the options. Then also they have access to your health information, your financial information to some degree. You really need to have a level of trust with that person off the bat.
Heather: That's a good point. That's actually a really good point because they're going to have access to a lot of information, probably social security numbers and birthdays.
Jennifer: No. Birthday, age, but we don't collect social security numbers.
Heather: Oh, okay.
Jennifer: There's no need for that.
Heather: Okay, so address, and birthdays, and potential health information. Okay, that's really important to know when you're going through that. You do like to trust them because you never know. Well, this is good. Is there any last words that you want to say before we wrap it up, Jennifer?
Jennifer: No, just that thank you for this opportunity. I really hope that people find us valuable, and that if they have any questions they're more than welcome to reach out to myself or to the Oregon Senior Referral Agency Association.
Heather: Absolutely. You can find out more about this interview at theseniorlist.com/livingright. You can also find Jennifer at Portlandseniorhousing.com. Alright, everyone. This is Heather Havenwood with The Senior List, and we want to make sure that you have the best years of your life. Thank you for listening to Your Best Years Begin Here podcast, brought to you by the seniorlist.com. I'm your host, Heather Havenwood.
Please visit our website at theseniorlist.com, and join many of our community groups on Facebook. Here at The Senior List we want to hear from you. Do you have a recommendation, or a person, or a company you want us to interview? Tell us. Email us at firstname.lastname@example.org. Again, that's email@example.com. Until next time, one goal, one passion, helping you live your best life.