Listen as Scott discusses how to choose the right home for your loved one

Transcript below:

JOHN: I'm Phoenix senior real estate specialist John Cunningham with eXp Realty and he's Scott Fischer; president/founder of options for senior living and co-founder of PASRS - an organization linked to raising the bar for the residential senior living. Good morning Scotty thanks for joining me today!

SCOTT: Hi John! Good morning, it’s good to be with you today!

JOHN: Yeah, I'm glad we can do this. And before I get started, I just wanted to let everyone know that our main topic today is going to be how to select the right home or placement for your loved one. And here's a quick overview of what I'll be talking with Scott about; there are over 2000 choices for the right home or placement and we're going to want to know how does someone make the best choice and we're going to talk about what assisted-living is and is the name the same as a nursing home or independent living. We're going to find out what a referral agent is or what a placement agent is and what these guys do and how they get paid. And then we're going to ask him who regulates assisted-living places and agents and what are the trap doors for problem areas when someone is looking for assisted-living or senior care. So Scott, going back to our original topic of how to select the right home or a place for a loved one, how does somebody begin to navigate this?

SCOTT: It can be overwhelming prospect John, you mentioned that just here in Maricopa County, there are over 2000 licensed facilities that doesn’t account for what we call ''independent living facilities'' or retirement communities, those kinds of things and I'll talk a little bit more about what distinguishes one from the other later. But when you have that many options and you have a health concern or a changing health care picture for a loved one, where do you go, how do you figure this out? Honestly, in today’s, people go to the Internet for a lot of information, there are some trap doors in that, let me get back to that, please. But of course there are great tools, the Arizona department of health services has a wonderful tool on its website that gives people kind of A-Z checklist on things to look for when they begin looking for assisted-living. It’s this overwhelming prospect that really created the niche that my business emerge out of 15 years ago, so even back a little longer than that as the first round of baby boomers were hitting retirement and their parents were aging and those kinds of things.

This referral specialist or placement agent kind of profession began just to appear, and so we became like the middle people like you're trying realtor between the consumers and the inventory. We've word there in-between the consumers and the inventory, so we become very acquainted with the different levels of care that are available, the different styles of assisted-living, the senior living, the capacity and perhaps the limitations of what these different facilities have to offer and we offer that inside an expertise to the consumer who's trying to do their best to research through this really modeled area. Even assisted-living itself has a licensed entity by the department of health, that’s really just happened over the last couple of decades, so it's a relatively new environment.

JOHN: Okay so just going down to the basics because I think that what happens is; with people they've never ever had to deal with this and then someone in their family gets to the point where they need something more than just a wrong house to live in and they really don't know where to go. So, what is assisted-living and is it the same as a nursing home or independent living, tell us about that?

SCOTT: Great! So you've heard of I think the three major areas to consider. So assisted-living was identified and designed and developed to initially be kind of a stopgap for seniors who are in some period of decline. It incorporated a lot of social activities, support with things like activities of daily living assistance, so people can get help with their bathing, their dressing, their showering, their medication management, meal preparation and those kinds of things. Assisted-living was not initially designed for people who needed very high levels of care, what we would call these kinds of nursing home people; we're wheelchair bound, having to be spoon-fed, maybe become incontinent of their bowels and bladder, we would consider those more historically the skilled nursing or the nursing home people right. So assisted-living was the middle gaps, so you hear initially these people who lived in these independent living, retirement communities here in Phoenix back in the 70s, they started seeing these campuses of care emerge when they had large independent living communities on them, small assisted and maybe even the skilled nursing unit where long-term care people could live at the end of their live.

An independent living, therefore, is people who are largely social, largely independent, don’t need any help or care need yet, but they were giving up their homes and the management of their homes for this great resort lifestyle, which was kind of how we saw it. So assisted-living then became a licensed entity by the department of health services to fill that second gap. And then, of course, we still had skilled nursing on the end which the nursing homes are licensed skilled nursing facilities who have nursing staff present 24/7, not just caregivers or CNAs, but registered and licensed practical nurses that are in 24/7.

JOHN: Okay, you guys who work in the placement industry are well acquainted with what’s out there and when you speak with somebody about their family member you probably have all sorts of ideas about what might be a good option for them.

SCOTT: And this goes right back, so we'll kind of circle back to the very first part of your question; how you start. Then I said, well you go to the Internet and people start gathering information. When I get contacted John, the first thing to do is to know how to navigate this; is I want to eyeball or see that person face-to-face. As long as it doesn’t cause them panic, paranoia, and disruption in their world which is potentially an issue if you’re starting to meet with or talk to someone who has some forms of dementia right.

JOHN: You're intense guys Scott; sometimes you make me feel paranoia.

SCOTT: Well you're not the only one, but my clients I have been really careful with because I don’t want to create any anxiety or disruption for them particularly if there is some dementia in the picture. But it’s important for me as a former nurse and the clinician and really everybody on my staff, we want to start with that face-to-face assessment because we need to gather as much information as we can and you can’t just do that filling out an online form in my estimation. I have to see this person to know how they're going to best fit into the right senior living environment later and that’s a big discerning, dividing factor between myself and local agents that does what I do and some of these online service providers, lead generating companies, you just can’t get all that filling out a form. So, by doing that face-to-face assessment John, you quickly give us some direction on whether or not independent living is going to be enough support for that person right now or whether we need to be in assisted-living or inside assisted-living, there are multiple choices and options to go down, but that face-to-face assessment and meeting with the family meeting and meeting with the potential resident, that’s where it all starts.

JOHN: You know there are all sorts of different sizes of facilities and houses that people can live in. I've met a lot of people who are in group homes where there may be 4-6 or 8 people in those and I've met people who run really large facilities where there are maybe 400-500 people live in. And, is it the same exigent that oversees these facilities or are they different to people who regulate those?

SCOTT: The Arizona Department of Health has an assisted-living license that they issue to these large facilities and to the small residential facilities. And so they're all part of the Bureau of licensed residential facilities under the umbrella of the department of health, so that’s where they all house or reside there. The state divides the facilities by the numbers of beds that they host. The definition for a group home or an assisted-living home like you refer is to is a facility that licenses 10 or fewer beds. And then what they call an assisted-living center licenses facilities 11 beds or more. So there are some really large group homes that are 20 and 30 beds that are licensed to a center. So there are small centers or big centers like you said that have hundreds of people in them and then there are these small private residences that assisted-living is the licensing entity on.

JOHN: Just listening to all the options makes me feel a little bit overwhelmed and I’m sure that when somebody has been looking on their own for a little while and might begin to feel a little overwhelmed, maybe they feel some sense of relief when they run into a guy like you. Hopefully, that's the case and maybe that eliminates some of those trap doors, but let’s says if someone doesn't have a professional helping them and they begin to navigate these by themselves, what are some of the big obstacles or trap-doors as you referred to that they could run into?

SCOTT: let me touch on the Internet thing for a minute and I don’t want to take a shot and this isn't my 11:40 so to speak about Internet companies, that's not it at all, but here's the situation. So families are searching online, they're just gathering information John and often, let me equate it like this; sometimes if I'm looking for a hotel and I'm looking for a specific hotel, how often do you Google that particular hotel and end up finding yourself on a website that's not that hotel, but one of these in-between broker companies like Expedia or Kayak, do you hear what I'm saying?

JOHN: Oh yeah!

SCOTT: So similar thing happens with assisted-living, I’m looking for a particular facility or I'm looking for a particular ZIP Code as a family member who is concerned about a loved one. And now I find myself not on that website or I'm not getting the information, what I'm getting is an invitation to be on a website that brokers these situations. And then what they don’t know often is that the online entity that you're now engaging with has a binding contract with the facilities that they all represent. And so they will at times even without your permission or that you didn't know that you authorized it, you’ve now authorized your personal information or your family member's personal information to these third parties and I have story of families not knowing what they’ve done now getting 10, 20, 30 emails from the facility. And so people are just unaware fully of what's going on and there’s all kinds of disclaimers and disclosures in those websites so I have to say be very careful about when you navigate online or what you’re looking and where you share your personal information, that’s a big deal.

Here's another one - you're just a concerned loved one and you see these new places being built and they have them been built all over town right now, we're in a boom for builds. Even when it says senior living or we have assisted-living or this and that, whatever. Assisted-living inside the license of assisted-living, each one of these facilities has to apply for different levels of care within that license. So, there are a lot of facilities out there that don’t take care of people to the highest level of license. So we have a great license with a breadth of services that can be provided at assisted-living so that we don’t have to always put people end up in these nursing homes so they can still live in the assisted-living, but not every facility license itself at that level. So what they don’t tell you; the sales directors is not going tell you when you move in is that - hey, there could be a time when mom's going to have to leave because her care has exceeded their license. So they don't tell you that a lot of times, so what I find is I get called, it works fine for me because this happens two years ago and I get a call that mom's, they didn't tell them that mom won't be able to stay the rest of her life and now I get a call from the family saying we got a referral or someone gave me your name that you could help us find a new place that mom needs more care than the place she's currently in.

Here’s another one - you have a loved one who has a memory care or Alzheimer’s, dementia needs and there’s a dementia place right down the street from you so you go on and talk to them and you move mom in. Well, not all of them are equipped and this sounds crazy, but it's true. Not all of them are equipped to take care of people who have agitation, paranoia, and combativeness. When some people have dementia there are psychiatric symptoms that come along with it and not every facility wants to take care of those people who have that season or that expression in their disease process. So it takes a professional that knows where those facilities are that take those people or that have a higher tolerance of behavior disruption. So that's where we come into to kind of guide people through some of those, but those are just three that I thought I roughed up my head.

JOHN: That's well spoken, I really appreciate you for setting a little light on that topic and today we got some good insight into senior living placement and we definitely discussed the various options that are out there and kind of talked about what assisted-living is and we were able to show how there's a difference between a nursing home and an independent living, an assisted-living and memory care. We discussed what a referral or placement agent is and how they get paid.

SCOTT: Let me talk about that for a second. So, as I mentioned a few minutes ago; the referral agencies then you know began emerging to be that broker, that in-between person, similar to serving the community like a realtor does. Our fees are paid on a referral fee or contractual basis with the receiving facilities John, so I literally have hundreds and hundreds of contracts with these small residential homes all the way up to the big memory care and assisted-living communities. We typically do not refer to a deal with these skilled nursing facilities, it gets complicated because you're dealing with insurance money and Medicare dollars and all that. So there are some off-limits to that in terms of paying referral fees for those kinds of placement. So we stick to the assisted-living, the senior living, the group home and things like the independent living.

The industry itself though is a new entity, it's an unlicensed, unregulated business, so where you guys as realtors John have to go get your...You have to take a class, you have to get a license right to do what you do. There's a million guide, more than a million, there were a couple of dozen and that was 15 years ago, there are now several hundred people running around Phoenix now calling themselves referral or placement specialist. Some of those people have clinical backgrounds, most do not, it’s the beauty of the business, for a few enterprise there’s no barrier to entry, there’s low investment, all side are pretty good. The downside for the community is that there’s no license assured, no barrier to entry, nowhere to check these people out. So, as part of the group you mentioned ''PASERS (the professional Association of senior referral specialist)'', I was involved in some advocacy work several years ago at the area agency on aging here in Phoenix and there was a lot of questions, concerns and even complaints at their offices; the senior helpline, the ombudsman’s office about people that do what they do and there wasn't any process, there wasn't any disclosure on how people get paid. There were a lot of unethical practices that were being identified.

And so myself and a couple of colleagues that were concerned with the help of the folks at the agency, we formed this non-profit trade association that we call ''PASERS'' that is dedicated to establishing, educating, establishing best practices and educating the public and the community on these pitfalls, these trap doors, the behaviors, the professional behaviors that have been an issue and these best practices and code of conduct have established a guideline for agents like myself to operate our businesses within that framework. So, it’s been widely received by a lot of the assisted-living industries, that interest is growing, we have touched over just under 50 agencies now statewide that are voluntarily participating with us as industry members. And John like yourself and another couple of hundred of what we call affiliate members, other industry professionals that touch what we do have joined us as part of our membership, so we're really proud of that. And just in the last few weeks, myself and a couple of my buddies have launched the first national alliance of placement agencies, I'm on the founding board of directors for that, we're just getting off the ground, but that includes representation from Washington, Oregon, Florida, California, Arizona and other states to come. So, it’s pretty cool that there’s a movement to make sure that how we serve the communities locally is addressed via the highest level of professional standards that we can come up with for us.

JOHN: I love that, I think it’s awesome that you’re directly involved in helping to build an organization that is there to raise the bar and makes those involved in our seniors' lives more competent and professional. So after that little slobber, Scott went on to talk about who regulates assisted-living places and the regions and then finally he discussed what the trap-doors were involved in the industries. So, I just like to thank you, Scott, for joining us and I'd also like to invite you to maybe join us again for one of these conversations. Someone wants to speak with you today about housing needs for their loved ones, what's the best way to get in touch with you?

SCOTT: I'll give you our website John, and there’s a contact us button on our website, but if someone were to go to You can reach us via the website and you can email us at and our office number is 602-845-1320. My staff and I cover the valley from surprised San Tan Valley, we're all over the city and there are 7-8 of us now; four nurses in the staff, so we're busy and we're here to serve families if you need our help.

JOHN: Thanks everyone for listening. I'm Phoenix real estate agent and senior real estate specialist John Cunningham with my special guest Scott Fischer signing off. Until next time, thank you for joining us.