Innovations in Senior Living with Katie Smith Sloan

What if aging services led the way in redesigning care—combining smart technology with deeper human connection?  That’s the challenge Katie Smith Sloan, President and CEO of LeadingAge, brings to the table as we unpack the data, the headwinds, and the promise across nonprofit senior living, home-based care, and hospice.

Katie, also brings a powerful blend of policy insight, sector leadership, and human-centered vision to a wide-ranging conversation about the future of aging, workforce challenges, technology, dementia care, and the urgent need to break down silos across the continuum of care.

Together, Chris and Katie explore how collaboration, innovation, and values-driven leadership can reshape aging services to better serve older adults—and those who care for them.  Join us, it is a great listen. 

Guest:
Katie Smith Sloan, President and CEO of LeadingAge 

Host:
Chris Comeaux, President/CEO of Teleios

Teleios Collaborative Network   /   https://www.teleioscn.org/tcntalkspodcast

Transcript

Meet Katie Smith Sloan

Katie Sloan 0:00

I think I have the best job in the world, leading leading age and our incredible uh over 5,000 members around the country. Uh a lot of VR that we use and particularly for training, um, virtual reality, where you put on the glasses and you can uh imagine what it is like to live with dementia, for example, and creating that kind of understanding and empathy for staff who are then going to be supporting people living with dementia. That's just it's it's a much more effective way of training staff because it becomes so real so quickly.

Chris Comeaux 0:33

We had a, we call them future counsel within our TCN network, and we had a group specifically focused on technology, and very similar to you, hospice and powder cure people, right? The the care, the compassion part. You cannot simulate that in some type of robots or or AI. And so they kind of created a guiding principle that adoption of technology not to replace care but to enhance care.

Katie Sloan 0:56

Yeah, because if we don't have a workforce, we have no care. If you pay people a living wage, they go off public benefits, they contribute more to the economy and their community. When we're saying that, well, the Haitians have to go home or the Venezuelans have to go home. Suddenly 14 people are ripped out of an aging services organization.

Chris Comeaux 1:14

I use this story in my leadership training I do. Over a thousand people showed up for his funeral. This man used his platform of maintenance as a way to be the sunshine of those people's day. And they would make up maintenance requests just to get them to come to their apartment.

Katie Sloan 1:30

We just all assumed that safety means lock them up, put them behind a locked door, and then we reduce our risk. But maybe not. You know, um, as one of my colleagues reminded us, years ago we used to tie people down in nursing homes because we assumed that that was the only way to keep them safe. And we said, we need to think about safety differently. And we no longer tie people down. We haven't for years, for decades. And the tailwinds come from people with passion and innovative spirit and you know, a can-do attitude, and uh, those are the people that are gonna change the world.

Jeff Haffner 2:04

And now our host, Chris Comeaux. Hello and welcome. I'm excited today. Our guest is Katie Smith Sloan, who's the president and CEO of Leading Age. Welcome, Katie.

Katie Sloan 2:15

Thank you. Great to be here.

Chris Comeaux 2:16

It's great to have you. So Leading Age is the association of nonprofit, mission-driven providers of aging services to fulfill the organization's mission of being the trusted voice for aging. Katie's advances strategic priorities that increase impact through advocacy, enhance member value, and foster innovative solutions to improve services and support for older adults. Katie also serves as the executive director of the Global Aging Network, an organization with a presence in more than 50 countries whose mission is to learn from and with others to ensure that older persons can live their best lives no matter where they call home. Her sector leadership extends to serving on the boards of several organizations, including the Center for Aging and Brain Health, Innovation in Toronto, the Research Institute for Home Care Value First, which is a group purchasing company, serving aging services. Additionally, she co-chairs Dementia Friendly America, a multi-sector collaborative with a mission to foster dementia-friendly communities. Katie holds a master's degree from GW at George Washington University and a bachelor's degree from Middlebury College. Katie, did I leave out anything that'd just be good for our audience to know about you?

Katie Sloan 3:25

I think you covered the facts, but I would just add that I think I have the best job in the world, leading leading age, and are incredible over 5,000 members around the country.

Chris Comeaux 3:36

Yeah, and I'm I I can't wait for us to talk a little bit more about that. But I'm curious because usually people have a story. Like there's with some someone as talented as you and your background like you, there's a ton of things you could have done with your life. Why the sector of aging and senior services?

Katie Sloan 3:52

That's a great question. Um, so I was a poli sci and history major in college, and I was gonna cut you know determined to come to Washington to work in the Senate or the House, change the world. And I did get a job in the Senate, and the senator that I worked for was uh on the aging committee. So I was a lowly, you know, legislative correspondent answering constituent mail, but I also got involved in helping to put on hearings on then it was the Older Americans Act. And um, you know, just hearing these heart-wrenching stories of older adults trying having to choose between food and medicine and heat and made me realize that as a country, we did not do well by our older population. And there was so much that needed to be done. And that just sparked my interest and commitment to working uh in aging services and aging. Um, I worked at AERP for a long time before I came to leading age on a range of issues related to older adults. Um and uh, you know, still very much focused on both policy and practice, what happens in communities and what happens in the halls of Congress and in state legislatures. We've got a lot of work, we still have a lot of work to do.

What LeadingAge Does And Why It Matters

Chris Comeaux 5:16

Very much so, which maybe we're gonna hit on some of that as we go forward. But, you know, a lot of our listeners are hospice empowered care, so they may not be familiar with leading age. Can you just share a little bit more about what is leading age? What do you advocate for?

Katie Sloan 5:30

So leading age is a, and it's an association. We're a nonprofit, and we represent the continuum of aging services. Um, every providers of nursing homes, assisted living, hospice, home health, pace, adult day, retirement communities, a lot of affordable housing, and pretty much everything in between. Um, and we've been around for about 65 years. And the reason that we represent the continuum is because that's what our members do in communities around the country. They're not for profit. Many of them have faith, are faith-based or have a faith tradition. And they may have started a hundred years ago as a nursing home. Um, and now they also have an adult day program, and maybe they have a PACE program. Maybe they've built a few affordable housing communities. And so they really see their missions as serving people wherever they call home in whatever way they can, they can. Um, so our policy agenda, as you can imagine, is really, really broad because we're advocating for the needs of home health agencies and hospice agencies and nursing homes and assisted living and retirement communities and affordable housing, you name it. There's a lot of things that that are in common, but there's a lot of differences just because um our whole system is built in, frankly, in silos. So um we do a lot of education, a lot of training. We have a lot of online education and then several big conferences a year. We have a research institute that does applied research. And our purpose is really to do research that uh provides evidence to influence policy and practice. Uh so we're not doing research for research sake. We're really doing research that's gonna help improve quality, quality of lives, uh, make the case for policy changes. Um, and then we have a Center for Aging Services Technologies. It's been around for about 25 years before technology was really even a thing uh in aging services. And our and our purpose really is to take some of the mystery out of technologies that can support our members in their workplaces, create efficiency, support their residents, their clients. Um, and that obviously is just burgeoning right now.

Chris Comeaux 7:44

So um Yeah, I was gonna say, I bet you that's um it's kind of gaining a momentum now, I would imagine. But the fact that you said 25 years, did I hear that right?

Katie Sloan 7:52

Yeah, and you know, it's so interesting when you look back because the first years of CAST, Center for Aging Services Technologies, um, we were sort of jumping up and down, telling the tech world, hey, we're a big sector. We'd love to, we need some technology, and everybody was ignoring us because all the technology was going to acute care. Fast forward, you know, to now and in the last four or five years, and that you there's technology popping out of every, you know, pore and crevice that there is. Um, so now it's really what is actually technology that's providing that's providing value that can actually make a difference. Um, so anyway, there's a lot of uh lot to learn there, and it's we're learning every day.

CAST And 25 Years Of Aging Tech

Chris Comeaux 8:38

Wow. I think we're gonna come back to that in a little bit. So um, first off, thank you again for agreeing to do this. I had reached out to my good friend Jeannie Parker Martin and said, I want to meet Katie. Um, because one of the interesting things, I've grown up hospice palicare 30 years now, and I see that more and more opportunities to collaborate with senior living. When I was a hospice CEO, that was always high on my priority list. But I feel like our worlds are getting closer and closer as we go forward. You know, the aging of the baby boomers. But when I when I first met your team, prepping to meet you, they brought up this incredible report, the 2025 Leading Aid Ziggler 200 report, which maybe I'll refer to it first, uh brevity going forward, LZ200. And so it was just chalk full of data. At first, like the first time I've actually prepped for a podcast with someone, and the team goes, You got to read this report first. And so I thought that was great because it really was getting to the light of the gist of the things I wanted to talk to you about. So here are some things. So the report shows steady but moderate growth, about 2.3% over 10 years in the senior living space. Expansion is happening more often through unit additions and affiliation rather than new campuses. So here's my question: How do you see senior living organizations evolving structurally maybe over the next decade? Will it be affiliations? Will it be strategic partnerships, or will that continue to dominate the growth? Or do you maybe see a whole lot more of the original kind of new campus development?

Katie Sloan 10:06

Um, it's a great question. And the Leading Age Ziegler 200 is a report that we've been doing for probably 15 years now. And it was really to try to get a snapshot on the sector, what's going on out there. Clearly, in the last several years, we've seen there's a trend towards consolidation, absolutely. Affiliations, mergers, um, organizations getting bigger, not by building, but by affiliating uh and expanding their presence in communities across the country. Um, and so, and I think uh I think we're gonna continue to see that. And I think it in part because um you need these those economies of scale in many ways to stay um successful. Um, but also because it's just so darn expensive to build and to find the land, the construction costs, the financing, all of those things are just big hurdles for um our not-for-profit providers to overcome. Um so right now, in this environment, in this economy, I think we're gonna see much more um of the affiliations and mergers and consolidation in that way. I think the other thing that we're seeing certainly is just particularly with life plan communities or what used to be called continuing care retirement communities, um you know, they're just it's there's a response to the marketplace. They there's no no longer a one size fits all um kind of community. There's lots of different versions of of contracts and relationships with residents and rentals and entrance fees and refunds. And and I think what that is is just a response to consumer interest and demand um that uh older adults want to have some influence over shaping their um retirement experience when they move into a community like this.

Chris Comeaux 12:02

The McDonald's have it your way, impact and senior living.

Katie Sloan 12:05

Right. Yeah. So the bottom line is we are evolving.

Chris Comeaux 12:08

Yeah. One thing that jumped out at me in the report is, and I think it was one of my team members, went to your conference last year, which was incredible, by the way. She came back just raving. And one of the things that just caught my attention, she was talking about one of your breakout sessions was standing room only. But in the report, uh, it's continual decline of nursing home care beds. And so with a rising emphasis on independent living, assisted living, memory care. And I think that breakout session was talking about that. So, what does the decline of traditional skilled nursing beds and the rise maybe of memory care, assisted living? What does that tell us about maybe where the model is shifting and heading?

Katie Sloan 12:46

Um, I think it tells us a few things. I think it tells us that the the financial, the business model for nursing homes is broken. Um, Medicaid is does not cover the full cost of care. There was just a study that was released um in the last month or so, which basically said on average across all states, it covers 80, 82% of the cost of care, which means that there is 18% there that has to be made up some other way. Um, and so that that in and of itself is a problem. And I think workforce challenges are s are a serious, uh, a serious challenge as well. So um, you know, what we've seen is, and then then, and I mean, then there was COVID, right? So um we've seen a lot of closures of nursing homes. Many of those have been freestanding nursing homes, not necessarily nursing homes within a life plan community, for example. Although we are seeing life plan communities cut back on the number of beds that they have, sometimes leaving out a nursing home altogether. Um, and as you suggest, we're seeing an increase in affordable, I mean assisted living and memory care. Some of that is in response to consumer demand and interest. Um, but if somebody needs 24-7 nursing home care by a nurse, there is no other place to get that but a nursing home. So we will never not need nursing homes. Um, there's a lot that can be done with home health. There's, you know, there's some things that can be done by assisted living, but state regulations only allow you to do so much, and they're only staffed. They're staffed very, very differently than a nursing home. Um so um, so I think we're gonna see we will have to see a resurgence of nursing homes, but um, and we'll have to see a continuation of those, but we'll also have to see investment in that business model in order to sustain them. And that is a lot of Medicaid.

Chris Comeaux 14:43

Yeah, wow. And that statistics staggering, just basically take an 18% loss. That's why the typical model is, right? You get the private pay to try to make up some of that loss. So what sounds like you're describing is a consolidation of those skill beds, but if a if a senior living community is eliminating those skill beds in total, are they just then depending upon Katie for that skilled care to be somewhere else and then they get them back into the community? Is that basically how it's working?

Katie Sloan 15:09

Yeah. Yeah. They'll have a partnership with another nursing home in the in the community where their member their residents will have preferred access or certain access to that community if they need uh to move into a nursing home. Um, but people are, you know, there's no question that the level of acuity in assisted living has gone way up. So people are living longer and longer with more and more um health conditions, chronic conditions in assisted living. Um, and that's something I think we uh really need to take a hard look at because we need to be sure that assisted living communities are staffed in such a way to be able to support those residents safely. Um and so that, and again, assisted living is regulated state to state, and every state is a little bit different. Um, so but I think that's that is definitely a trend, and um and we need to pay attention to that.

Chris Comeaux 16:06

Yeah, that's a great call out. The the other thing that jumped out at me, which this is where our worlds start to collide, um 46% in the report, so 46% of the organizations, I guess that were part of the report, now offer uh home and community-based services. So things like home care, adult day, pace models. So going forward, how central do you believe that home and community-based services are gonna be to the business model of senior living communities? And eventually, do you think that those ecosystems are gonna be totally blended, mixed bag, maybe, you know, some in some places yes, and other places just really collaborative partners?

LZ200: Growth, Mergers, And Models

Katie Sloan 16:45

I I mean it's already happening, right? I I think, you know, as 46% is a lot. Um, half those, half of those large communities are already offering home and community-based services and more are bringing them on every day, either directly or in partnership with others. I think I think it's essential. Um, because I think you know, aging is not linear and people's needs as they age are different one from another and different one week to another week. So what's important is that we have a full ecosystem of services and supports that can meet people's needs when they have needs. Um, and so if you've got an organization that's been in the business of providing services to older adults for sometimes decades, sometimes a century, um, they know what they're doing. And their ability to provide other kinds of services to serve more people in different ways is exactly what we're seeing happening. And I think I I see these, I I I don't I we have silos for sure, but I see there's an of an awful lot of convergence around um bringing home and community-based services into a broader senior living organization. Um, seeing some wonderful partnerships between PACE, for example, and assisted living. We've seen wonderful partnerships between life plan communities and then providing home care services out into the community or home health services. Many, many organizations are providing hospice services themselves or in partnership with another organization. Um, so I think, I think, as I said, it's we're evolving and we're evolving quickly, and we're evolving in a way that we can serve more people every day.

Chris Comeaux 18:29

Considering your history, this is my sense of it. And I've got about 30 years now in hospice and powdered care. It feels like it's gaining momentum quickly. Does that feel right to you as you look through the rearview mirror? Or has there always been those collaborative partnerships and maybe it's just a little bit more art, or do you see an acceleration of more of those, like to get to 46%? Did it go from five to 46 all of a sudden, or has it just been that steady incline in that direction?

Katie Sloan 18:55

Yeah, I mean, from this, from these reports, it's been a steady incline in the in this direction. Um and um, and it's a great thing, it's a great thing to see. Um, and something we didn't, when we first started doing these reports, we didn't even capture that and then started recognizing that's an important thing to capture because it's a huge part of uh the operations of these communities and ways that they're serving their mission.

Chris Comeaux 19:18

Do you know how long ago it was when you added it to the report out of curiosity curiosity?

Katie Sloan 19:22

I don't, I don't, but I can tell you that leading age used to be the American Association of Homes for the Aging. And then we became the American Association of Homes and Services for the Aging. And then we had the wisdom to change our name to Leading Age. But so just like we started out as a as housing primarily, residential care, and then recognized, and this was probably now uh thirty years ago that we added services, um, maybe even forty, and uh and now we're leading age. But um so I think that's just the way the nature of the not for profit community is. That we constantly innovate and we're constantly looking for new ways to serve people better or in different ways. And so the evolution of services into an aging service organization to me feels so natural. Um, so it's feels so obvious.

Chris Comeaux 20:19

I think we're gonna replay that what you just said, because I feel like that's the Venn diagram of the passion of the nonprofit hospice and powder care side. Similar to what you that's both our ethos. Again, that's kind of one reason why I've been wanting to connect with you for so long. Well, another thing that jumped out 73%, so that's a big percentage, of the communities have adopted um electronic health record or some type of point of uh service type technology. Um, there's also, I think for the report, growing adoption of robotics, telehealth, infection control, even engagement platforms. So, what emerging technologies do you think are gonna transform that experience with the residents? And then also maybe the operational sustainability side. I don't know if it's right to kind of stratify them two different ways. There might be some bleed over between those two.

Nursing Home Decline And Memory Care Rise

Katie Sloan 21:06

Oh, well, I think there definitely is. I mean, I think the social engagement tools and and technologies that have come on the market have been transformational. Um, a lot of uh and technologies that help people who are living with dementia sort of retain memory and and which are just magical when you see them in action. There's a lot of there's uh a lot of VR if that we use and particularly for training, um, virtual reality, where you put on the glasses and you can uh imagine what it is like to live with dementia, for example, and creating that kind of understanding and empathy for staff who are then going to be supporting people living with dementia. That's just it's it's a much more effective way of training staff because it becomes so real so quickly. Um and I think there's a lot of technologies that just are able to make this experience for individuals more personal. And I think that's also a good thing, and I think consumers love that. Um, AI will create some operational efficiencies for sure, um, and already has. And I think we've only just scratched the surface on uh how AI is gonna impact um our sector and basically every other sector. Um, but you know, at the end of the day, we're in the people business. So AI, you know, there's all this talk about AI's gonna, you know, eliminate jobs. Our jobs can't be eliminated. We are in the people business. Um, so AI can help uh allow free up time so that the the people doing the caring has can spend more time doing the caring. And I think that's a huge opportunity for us and a huge benefit, particularly with our workforce challenges. Um, I think one of the things that we've certainly seen is that there's a lot of technology out there, and one of the biggest challenges is actually adoption. So if you you bring it into a community, you can't just like, here's the tool, here's the new software. It's the training and the retraining and the br and if it's a technology that residents are going to use, it's making sure you have those support systems in place so people can actually take advantage of the technology. Um, you know, there's a lot of talk about robotics. Um and where I see robotics used mostly now is in in dining rooms and in um in like landscaping, like cutting grass, you know, like these little robots that go, you know, like a robot that'll clean your full, you know, like a vacuum cleaner. You can do that inside. Um, so obviously that's helpful, right? Um, but I don't think we've seen the promise of robots yet, although the technology is evolving very, very, very quickly. Um so I think um I think there is an awful lot uh of promise with technology, but I also believe that we need to be um we need to just be circumspect about privacy issues, other issues related to technology um that may sort of get in the way of its effectiveness.

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Chris Comeaux 24:53

That's so well said. We had a um we had a we call them future counsel uh at within our test TCN network, and we had a group specifically focused on technology and very similar to you, hospice and palliative care people, right? The the care, the compassion part. You cannot simulate that in some type of robots or or AI. And so they kind of created a guiding principle that adoption of technology not to replace care, but to enhance care. Yeah. It was kind of the gist of it. I thought that was a beautiful way to phrase it. The other thing I love when you were poking on, um, I have a friend who went to a conference in Japan, and I think I heard this right, because Japan's baby boomers are about 10 years ahead of ours. Yeah, they are deploying the robotics from a care standpoint. Have you heard something similar?

Katie Sloan 25:38

Yes, I have. Absolutely, I have. Yeah. Yeah. And so, you know, we'll see. Let them test it out. Yeah. And then we'll we'll see see what works well and bring it to this country. But I'll have to say, at our con we just had our big conference in Boston a couple of weeks ago. And um, in our exhibit hall, which is quite expansive, there were quite a few robots, you know. Really? People, yep, companies, vendors who had robots for a companionship. There was one for, you know, that's provides companionship to to an individual. Then we've got their robots that bring, will bring a tray to your bedside or tray to your table, um, which frees up the caregiver to help with the feeding process or to sit down and just have a conversation with somebody while they're having a meal. Um, so just creating, to your point, the the kind of efficiency, a little bit of efficiency and freeing up precious staff time to actually provide more hands-on care and support. Wow.

Chris Comeaux 26:35

Whitney, I think the acronym was CAST, right, for your technology center. Yeah. Do you use it, do you use it as kind of like your experimentation station? Is it that like, can you just talk about it just a little bit more?

Katie Sloan 26:45

Sure. Well, one of the things that CAS does and has for years is identifies areas of technology that are of interest to members and really looks at the marketplace and looks at some of the characteristics of those technologies. So medication management technologies. What are some of the features that might be important to an organization? And then what are the certes, what are the vendors, what are the products that are in the marketplace and just matching them up? So, you know, it may be a medication management tool that's used on an iPad, or it may be a medication management tool that an individual uses in their own home. So sort of just matching those up, it's not a consumer reports. We're not saying better, worse, or rating. What we're simply saying is as an organization, figure out what's important to you as you're thinking about employing medication management or social engagement or even an EHR, and then the and then match it up against the the products that are available in the marketplace. And we update update that every single year. We've got about 12 different um technologies that we keep track of. The marketplace is changing, you know, products come on the market and then they go off the market. A lot of that in technology. Um, but our point was, and and it continues to be, is we want to take some of the mystery out of decision making related to technologies. If we can help members sort of get over that hurdle of figuring out how to select a technology, then we want to do that because it's usually a pretty expensive investment. And we all know the technology changes a lot. And so we want to help them make the right decision for their organization, their operations. And because everybody is a little different, we're not going to tell them what to do. So those are all uh available on our website. And, you know, again, we update them every year. So that's a part of what we do. And then the other part of what CAST does is really brings, we're doing a lot of conversations and webinars and workshops on AI right now. How do you use AI in a senior living environment? Um, what are some of the ethical issues around AI? Uh, how to think about it? So just trying to bring almost a case study approach as well as a uh to thinking about new technologies and drawing on experts from around the world on technology. We the, you know, as part of the global aging network, there's a huge international conversation in social care right now about ethical issues with AI, um, really spearheaded at Oxford University, where they've really taken created almost an institute looking at what are the ethical, how should we be thinking about privacy and empowerment and um all of those issues related to AI. So we're all we're part of that conversation as well. It's a lot going on. Wow.

Home And Community-Based Services Converge

Chris Comeaux 29:42

Do you um so I imagine you have to have a pretty kick butt process to vet these technologies? Do you also teach your members the process? Because that in itself feels like a help to them. Um, and then my second question to that is I bet you're seeing a volume increase, right? Because it feels like every day I'm I'm bumping into, I've got a folder now in my um my Google folders. I just call it substitution competitions because I feel like I'm bumping into new innovations, some of which are complementary, some of which could even be substitution competition to the work that we do. And it's just like every day is growing exponentially. So two questions. Do you pay the process for? Because I imagine it's a great process. And are you seeing the volume of things that you could be looking at increasing?

Katie Sloan 30:25

So uh yes and yes, um, for sure. I mean, we've we've sort of I don't, I guess uh having done this now, these tools for 12 years maybe, um, we've sort of got we've kind of got our process down. So um it's pretty efficient. Um, but also um there is, there's, you know, it's sort of the sky's the limit. And the so the question for us is really how what are the most, what's the highest and best use of our time in supporting members around technology? And we and a lot of it is driven by what we're what members are asking. Um, we have lots of channels of two-way communication with our members where we're really asking them all the time and hearing from them all the time. And, you know, as an association, our job is to provide value to our members. So we're we're responding to what they're asking for. And right now, a lot of it is around AI.

Chris Comeaux 31:16

Yeah, I would imagine so.

Katie Sloan 31:18

Curiosity. Yeah.

Chris Comeaux 31:20

Oh, when I was referring to our future councils within TCN, of course, technology was one focus group. But as you can imagine, workforce was another because it's one of our top challenges, is one of yours. And we kind of touched on this a little bit, but that workforce challenge is only going to get more acute as we go forward. So you've alluded to some innovations, but are you also seeing maybe, maybe I'll call them system-level redesigns that are helping address this workforce issue? Um, it's almost like we've got to even think about our work in different ways. I know, like in the hospice side, you know, we've brainstormed are there new disciplines we could weave in, like the idea of community health workers is one, paramedicines another. Um, but then also thinking about the work differently. So I'd imagine you're doing similar things. Can you talk about that?

Tech That Enhances, Not Replaces, Care

Katie Sloan 32:06

Yeah. I mean, I think there's there is definitely a lot of sort of workforce redesign in terms of what just happens in a workplace, like different ways of thinking about jobs. In in the nursing home world, it's it's so heavily regulated. There's not as much room for experimentation. Um, but what we're seeing across the board is heavy, heavy investments in building strong workplace cultures. Really, it, you know, and instead of saying that, you know, the resident is the main thing, it's the worker that's the main thing. It's our workforce is the main thing. Because if we don't have a workforce, we have no care. And um so member our members are just in vet really thinking about thinking hard about how do we help our staff as human beings with real with lives, um, in addition to helping them do their jobs well. And so I think, and that's it's all about quality of care and it's also about retention. Um, it's and it's also about just respect and dignity and treating people well. Um so I we're seeing a lot of that. I think there's also a lot of uh one of our big issues for the year, for the years has been um professionalizing the direct care workforce. This is not, we call them low-wage workers, and therefore that is there's a stigma attached to that. They not may not be paid a lot, but they're highly skilled. They're highly skilled. You can't do direct care without being skilled and trained to do it. You also can't do direct care without the heart to do it. And so we have, we several years ago worked with a labor economist and published a report called Making Direct Care Work Pay, and um focused really on what it would, what would the world look like if we paid these folks a living wage? Which we don't right now, using the MIT Living Wage Index. And, you know, what the labor economists in running all of their reports and tables discovered, it well, not maybe not surprisingly, is it sort of pays for itself over time. Like if you pay people a living wage, they go off public benefits, they contribute more to the economy and their community. Um, you know, there are all these the benefits to them as people and as um contributing members of society, uh, and worse to the community at large. So um, so that's been just part of our agenda for a long time is that we've really got to reframe how we think about and how we appreciate and support our direct care workforce. Um and we will continue to do that. We're in a, we have a project right now, grant-funded project, really looking at what's the possibility, what are the possibilities around creating apprenticeship programs for direct care workers where there's actually a career path. So, you know, you may be a direct care worker, and then maybe you want to become a wound care specialist, or maybe you want to become a specialist in dementia care, or maybe you want to be an RN or an LPN. So that it's not a dead end job, that it's a some people may that's all they want to do, and God bless them. But um, they're but really creating opportunities that hasn't traditionally existed. Um, another big part of our workforce agenda is around immigration reform. You know, 28% overall of the direct care workforce is foreign born right now. And in home care is it twenty twenty-eight? Twenty percent, twenty-eight percent. But in home care, it's thirty-two. Um, in residential care, it's twenty-four. Nursing homes, it's a little less twenty-one, but still. So if you think about 80%, 80 to percent of your workforce, I mean 20% of your workforce being from other countries, and suddenly we're not bringing people in from other countries, it's creating huge problems already. Um, but it's also we've lost our pipeline um for for workers because it takes a long time to get somebody into this country uh into a direct care or a nursing job, for example, or a therapist um who are coming in from other countries. So we have been advocating and you know, yelling about um in the need for immigration policies, legal immigration policies that uh support aging services, uh, so that we continue to have a pipeline. And these folks are coming from countries where they revere their elders. And the idea of having and the opportunity to work with older adults in the United States is like it's it's a privilege. It's a privilege. And yet um we were cutting off our supply. And now, even with some of the changes to TPS, I won't get political here, but the changes to pull TPS when when we're saying that, well, the Haitians have to go home or the Venezuelans have to go home, suddenly 14 people are ripped out of an aging services organization. And it's not just that the workers aren't there, it's the relationships are broken. The work we do is teamwork, right? It's a team between a resident or a client, particularly like in hospice, a resident client and a and a worker. And it's the team of workers that work together to support people. Um, so this is a big part of our policy agenda. Um, we think there are some uh creative solutions uh to legal paths for immigration built on existing programs that work well. Um, but uh we we need a different environment to do that.

Chris Comeaux 37:32

Kudos to you guys on that. I've been poking the associations we're part of saying we should play offense. Thank you. You're the first one I bumped in and said that you're out playing offense. Um anything we could do along those lines, please let me know to help you.

Katie Sloan 37:44

Thank you. I will.

Chris Comeaux 37:46

I'll take you up on that. Um, whenever you were talking earlier about just the stories, Katie, one story that's automatically came to mind, the this hospice where I was the longtime CEO, the lady who was our matriarch, she founded that hospice in her living room. She became a resident in this beautiful senior living community here. And um, so she she came, became my adopted grandmother, spent a lot of time in that community with her, and their maintenance guy died. And I use this story in my leadership training I do because over a thousand people showed up for his funeral. This man used his platform of maintenance as a way to be the sunshine of those people's day, and they would make up maintenance requests just to get them to come to their apartment. He was just that the stories were just, and I use that story because it just shows it doesn't matter what your platform is. But I wanted to pay that forward to you because um it just totally reminded me of that. And there were probably so many people like that throughout the country that you know are kind of under your influence of what your members are have many people like that within their facility.

Katie Sloan 38:48

So we're not in the people business, we're in the relationship business.

Chris Comeaux 38:52

Absolutely. And I I saw that, and that was her community. And it was so neat when she, because I kind of became like her adopted uh grandson. And just to get to our table in the dining room took at least 15 to 20 minutes because she had to introduce me to it, was her community. And it just touched my heart because hospice is so much about community. It's just so great because it was kind of in one location, whereas you know, maybe in the old days we walked down the street and people were on their porches. Now it's kind of within these communities. It just really hit me.

Katie Sloan 39:20

Yeah, that's wonderful. Thanks for sharing that.

Chris Comeaux 39:22

Uh you bet. Well, and which maybe leads us to another good question. Uh and maybe your answer is going to be, well, the way it's always been, or is there deeper ways? So here's my question. How do you envision hospice and powder care maybe integrating more deeply into these senior living settings? Um, and especially as you know, you know, the baby boomers are getting older because people are living with multiple chronic diseases. We're probably seeing maybe more acute situations. Um and so as we get more into that, does is it just we need to keep doing what we've been doing, or are there ways that we can integrate better together?

Katie Sloan 39:54

So when I look across our membership, we have many members partner closely with hospice organizations. Others Offer it themselves. And it really depends, the decision which way to go really depends on the availability of partners in the community or close by and also just the mission of the organization. But when there's clear alignment and the and clear, you know, mutual goals, partnership is is really an effective way to go. I was talking to one of our members who I asked her if she partners with a local part hospice that I was aware of. And she said, no, I do it myself. I've been taking care of these people for years. Why would I let them go at the end of their lives? Which was a really interesting, you know, like she felt like these were her, this was her responsibility. Now, not everybody feels that way or has the capacity to take that on. So I think what we're seeing is lots of different versions of how do we provide the end of life care that people um that people need in a way that makes sense to an organization. But um I think, you know, we'll see more and more of that. I think you're right. Um, and I think the key is if you're partnering, find the right partner. Find the partner whose mission aligns with you and that you can feel totally confident that the care, the quality of care that they're providing is equal to or better than the care that you provide.

Chris Comeaux 41:24

Well, that's incredibly well said. And just to respond to your friend that said, I totally get the heart behind that comment. I spent a lot of my early days as a hospice CEO walking into those conversations. And I think that hospice, first off, is a beautiful model of care, just like your senior living communities, the team-based model, the focus on the care plan, the holistic care, all of those things make it so unique. And when it's done well, it looks almost easy. Like anybody could do it. But, you know, I think where we've maybe sold ourselves short is just like you want to go to world-class cardiologists if you have a heart problem. And so we have become sufferologists, and there is a core competency. And if you have a good partner, it's not that you're totally letting them go with someone else. You're bringing in a beautiful partner that you can collaborate on. Quite, you know, if we're gonna, if we're gonna delegate to a robot to bring the tray, surely you could partner with a, but I think the key is that I could kind of read behind some of your comments. Not all hospices are made alike anymore in the country. And that's certainly my p purpose and passion is to get as many of them as possible up to high quality standards. Therefore, then you have a lot, a lot better pickings of partners that you could bring into your facilities.

Katie Sloan 42:34

I think the partnership is also with the family. I mean, both of my parents died under hospice care. And I felt so supported by the hospital. I felt they were providing tremendous support to my mom and then my dad. But um, I also felt like they were supporting me even beyond the after my parents passed away. And so I think that is, I think that's in many ways the untold story of hospice care is that it it is that holistic care, but it's holistic in a much broader sense than we normally think about.

Chris Comeaux 43:08

That is so brilliantly sad because I then put myself in the shoes of your senior living partners, while they may have some of that, we do that at a totally different level. So that makes us better partners because we could partner on that side of the equation where maybe sometimes they don't have the tentacles and the impact that we do. I'm so glad you pointed that out. That's awesome. Is there anything on the public policy side that you think that we could do, should do that may enhance our ability to partner more, or are we kind of good there from your perspective?

Katie Sloan 43:36

Yeah, I know. Public policy is the hindrance there at all. I think it's really, I mean, I I think if if an organization really wants to partner, they'll and they can find the right partner. That could be a beautiful thing.

Chris Comeaux 43:48

Awesome. And then, you know, value-based care is all the mantra in healthcare. Um, I'm sure in your world it's being talked about quite a bit as well. How is that spilling into senior living? Is do you think that's gonna maybe force our hand in even more collaborative partnerships up and down the value chain of healthcare?

Robots, VR, And Real Adoption Barriers

Katie Sloan 44:07

I would say, in response to your question, how has it been integrated? Not well. Um, I mean, our entire continuum at leading age from senior living to home health to hospice and palliative care has really not been well integrated into value-based care on the post-acute care side. Um, you know, we are often viewed as a piggy bank rather than as a valued partner. And um, and we're we usually are not viewed as a source of care coordination, which I think we do incredibly well. Um, so whether it's in a senior living community or it's in a person's home, um, the opportunity to uh adopt a value-based value-based care with the right partners is is huge, but I think up to date, it's really been unrealized. So I opportunity ahead, um, but we have to have a system that actually respects and understands the value that we bring to the table.

Chris Comeaux 45:07

Can you unpack because it really feels profound? You're saying treat it like the pig, the piggy bank. What what does that mean?

Katie Sloan 45:14

That we can we can provide the savings, but we're not gonna realize any of the savings. We are gonna realize it's living, somebody else will realize it, even though it's because of our work that the savings are realized. Would that make sense? Gotcha.

Chris Comeaux 45:26

Yeah, and it makes a lot it feels like you're saying back to me what I said a couple moments to you about, you know, people go, well, anybody could do hospice. They don't you do so well what you do as senior living, they don't realize the ecosystem and the impacts that you've created and how probably keeps them out of the hospital, keeps them out of the ER, um, maybe even for helps them live better longer. I mean, all those things that are supposed to be the true goals of value-based care. I'm so glad I asked you that question.

Katie Sloan 45:53

You know, we've we have long um believed that our residential-based provider members can serve as an integration hub for older adults that they serve and connecting them with care services and supports when they need them. And but without true communication, without true coordination, collaboration, uh, we can't succeed at that. So, integration, you know, of aging services, whether it's in a value-based environment or anything else, it it what we do is a team sport. And so we also all need to do this together. We need the game plan and to do it together. So our hope is that we will continue to hammer away at that because clearly there's a lot of value in value-based care.

Chris Comeaux 46:38

One more question, Katie, and then we'll wrap up. So obviously, the predictions about dementia care, um, people suffering Alzheimer's, you know, staggering statistics going forward. So, how are senior living communities maybe innovating in that space in particular? And if there's any ways that you think maybe we could collaborate better as hospice folks along that. But really, the first part, you know, we just did a podcast released about a couple months ago um with a Glender model out of San Diego, a lot of really interesting adult daycare innovative model, and they're now franchising it nationwide. So that's really the gist. Like what type of innovation's in that space?

Katie Sloan 47:16

Well, I would say there's a lot of innovation. There's also a lot of um just an uptick in interest in brain health and a recognition that we, you know, we've talked about heart health for years, and now we're talking about brain health. And I think that's a really good thing. Um, so one of the conversations that we have been having at leading age with our members for the last probably two years is around inconclusive dementia. And the idea behind that is really to think about why we have created environments where we put people behind locked doors and we don't uh we inhibit the ability of people who are living with dementia to live sort of free, freely and fully integrated into the community that they live in. And so we decided we're not necessarily taking a position, but what we're saying is we should have a conversation about this because we've just all assumed that safety means lock them up, put them behind a locked door, and then we reduce our risk, but maybe not. You know, um, as one of my colleagues reminded us years ago, we used to tie people down in nursing homes because we assumed that that was the only way to keep them safe. And we said, we need to think about safety differently. And we no longer tie people down. We have them for years, for decades. So I think that's the same kind of thinking that we need to bring to how do we support people, the millions of people who are living with dementia in a much more um dignified, perhaps, way. Um, so again, we've just we said what what we do often at leading age is we set the table and see who comes and then have a conversation. So we set the table and we had tremendous interest, and then we set another table and had some, you know, so it's it's a it's a continuing conversation. Who knows where it will lead, but it's at least getting us all to think about to challenge the assumptions that we have been living and acting and operating on for a number of years, which I think is incredibly important now, given the numbers you described of people who are living with dementia and how that is gonna grow.

Chris Comeaux 49:29

Um Man, I can't wait to hear more about that. I love that that you guys are doing that and us sitting here processing. That's such a brilliant question to ask. And because the numbers are gonna be staggering. And I'm just thinking, you're making me reflect on even some family experiences on both sides of the equation. And I never reflected back about the ones that were more integrated. It actually felt better. I mean, just I'm quickly processing and I'm kind of an end of one, but I think you're on to something with that.

Katie Sloan 49:58

I think, you know, I I think fair, I think we are too. I just don't know where it ends up.

Chris Comeaux 50:03

But that's what that's gonna be cool. It's okay. Future future podcasts together. I love definitely interested. Well, here's here's always a fun question, especially someone with your background. If you could redesign the entire continuum from independent living, assistant living, if you throw hospice in that to be a truly person-centered, integrated model in the US, and Katie was queen or president, madam president for the day, what would she do?

Katie Sloan 50:26

Well, I would start with valuing older adults and ask them what they want. Um, and I would break down the silos. We have we're a system, we're a system built on silos. And we have silos because that's the way we regulate, that's the way we work, we we uh employ people, uh, that's the way we pay people. And what it does is create divisions. We need to break those silos down and create a fully integrated system because as I mentioned earlier, people don't they don't age in silos. They age as they age, and everybody ages differently. And so we need to create a seamless, integrated system of long-term care that doesn't impoverish older people and their families.

Chris Comeaux 51:11

That's so well said. Um, we had a podcast earlier this year. I don't know if you know Peter Benjamin, he does consulting in the hospital space. And Peter, we titled the podcast A Conspiracy of Verticals. I never heard someone frame healthcare that way, and I love that framing. And then, you know, the conspiracy part, I love it. It's a really good kind of poke on man, we should fix this. It's really screwed up. That is so well said. I would I didn't think about asking you till this till now. We have fallen in love with the four M's. We've had a couple of podcasts this year. We brought Dr. Wynne, um, Kai Wynn on our podcast, um, the uh Johnny Harfer Foundation, Marcus Escobito. So we have, and we're all in. We're bringing it to our network. And I see you shaking your head. So the four M's feels important to what you're described if you were Queen for the Day.

Workforce Culture, Wages, And Immigration

Katie Sloan 51:58

Exactly. Because the 4M starts with people.

Chris Comeaux 52:02

Absolutely, and what matters most to them.

Katie Sloan 52:04

Right, exactly. Exactly.

Chris Comeaux 52:06

Wow. Final thoughts, Katie.

Katie Sloan 52:08

Um, well, this has been a great conversation, and um, you know, we have a lot of work to do to uh to make this place, make this world a better place for people to grow old. Um, I feel like there's a lot of people who are putting their hearts and soul into making that happen. Um, I see that globally. I see it here. Uh we got some big, big hills to climb. A lot of a lot of headwinds, but I think there are a lot of tailwinds as well. And the tailwinds come from people with passion and innovative spirit and a you know, a can-do attitude, and and uh those are the people that are gonna change the world.

Chris Comeaux 52:44

Hmm. Wow. This is exactly probably why I had the sense I need to reach out to you because um we're, I mean, our purpose and passion is exactly what you just said. We're just focused a little bit more on that kind of serious illness space. And we do feel like we're we're we're doing some amazing work. Yes, they're headwinds, but in the long run, it's gonna be so well worth it, especially now. You know, the baby boomers are presenting a very unique challenge and opportunity at the same time. They've never gone quietly in any part of our society as they've, you know, we have suburbia, we have um suburbans, we have, you know, SUVs, all the things that we kind of take for granted that are a part of our society is because baby boomers asked for, they wanted it different, and I think they provide a unique challenge and opportunity all at the same time. And this is our time to rise to the occasion. However, we can collaborate together, Katie. I can I feel like we're similar folks and teams working on the same thing. So just want to offer that. And thank you to you and your team. I've always heard great things about leading age. I'm even more impressed now. I know our listeners will be as well.

Katie Sloan 53:45

Well, thank you. Thanks for having me on, and thanks for the conversation. It was great.

Chris Comeaux 53:49

You bet. And to our listeners, we just want to thank you. Hit the subscribe button. This is also a show I want you to pay forward to your um co-workers, your leaders within your organization. Um, thank you for listening, and as we always do, we want to leave you with a brain bookmark to close today's show. Thank you for listening to TCN Talks.

Jeff Haffner 54:07

The future of aging will not be defined by the buildings we build, but by the communities we create and the compassion we commit to. The measure of a society is how it cares for its elders. Our responsibility is not just to extend life but to enrich it.