Aging in Place: Assisted Living Communities

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Steve Lorberbaum:

All right. So I want to welcome everybody to this edition of What’s Your Plan. We, monthly, at Assisting Hands, try to talk to an industry expert about a different area of elder law, and elder issues, and aging in place, so we can all benefit from their expertise, and this week we’re really excited to have Jonathan Edenbaum. He’s the owner of Eden Homes and he’ll give you a little bit more rundown on that. But basically, Jonathan has years of experience in helping people find the right place to live, and we thought he would be a great person to have to help explain housing choices and to talk about group homes, give us a little bit of information about Eden Homes as well, and then kind of compare and contrast sort of large communities to the smaller group homes. So Jonathan, welcome. Why don’t you introduce yourself?

Jonathan Edenbaum:

Thank you, Steve. A lot of you know me, Jonathan Edenbaum, owner of Eden Homes of Potomac, and I’ve been in the industry, well, in long-term care, we opened our first home 20 years ago. I have an undergrad in psychology and a master’s in healthcare administration. Worked for large companies for many, many years, and then decided to open up my own. I just felt that a lot of things fell through the cracks and I really enjoyed the smaller model, and I felt people got a lot of good attention. So we have two homes in Potomac. We’re building a third. I know a lot of the models worked for a lot of the companies but staying quiet for the next 20 years.

Steve Lorberbaum:

To explain a little bit about, because I think Maryland is sort of unique in its style where you can have a smaller home, and so what’s the typical home size for these smaller group homes?

Jonathan Edenbaum:

Well, it depends on how you want to be licensed. The typical model is eight or less, and people wonder why that magic number eight comes up a lot. With eight or less, you’re still considered residential. So when you go up to nine, you have to get a special permit. So you can also go down to five where you don’t even need a licensed Level 3 license.

Steve Lorberbaum:

Gotcha. So you mentioned Level 3. So what are the levels of care that a person can have? Can I, at the age of 62, move into one of your homes? Would I want to or what’s the ideal reason someone moves into one of your communities?

Jonathan Edenbaum:

If somebody needs, obviously they can’t live at home because they can’t live on their own… It’s similar to a lot of the facilities, help with all your ADLs, your meal prep, want activities but want more individualized care, and a licensed Level 3, which is the highest acuity of assisted living, pretty much you can stay until the end of life. The only reason that you couldn’t is if somebody needed IVs, obviously a ventilator, or were significant three to plus transfer.

Steve Lorberbaum:

Okay. So when I think about the spectrum of care, I think about sort of what Assisting Hands Home Care Potomac does where we provide assistance for people that want to remain at home, and then there are these smaller group homes, and then there are these larger communities that have assisted living and memory care and things like that. So why would someone choose to be in a smaller group home over one of the larger communities that everyone’s heard, Sunrise or Brightview, and one of those places?

Jonathan Edenbaum:

Well, first of all, the staffing ratio. In our facilities and in a lot of them around, my facilities have a one to two and a half ratio, three caregivers for eight people. A lot of them have two, one to four. Whereas in the larger facilities, you have a much higher staffing ratio. So sometimes you have to hire private help. In our places, very rarely do you have to hire private help, also a lot more individualized care, so it’s not as overwhelming to have seven other people as opposed to 60 other people.

Steve Lorberbaum:

Gotcha. So what’s a typical house look like? Do people get their own bedroom? Do they have to share? Are there living rooms, dining rooms? Kind of how is the typical eight-bed home configured?

Jonathan Edenbaum:

It’s a residential home in a community that you or I would live in. You really can’t tell from the outside. So in our homes, everybody has their own private rooms, their own private bedrooms. Some have private baths, some have shared baths. We can do couples. That’s not an issue. And it’s like a regular house with a living room, dining room, family room, kitchen. You have the run of the house.

Steve Lorberbaum:

So I assume that meals are made for people. Are you taking into account people’s individualized food choices or is it just you make a meal for eight people and how does that work?

Jonathan Edenbaum:

Well, first of all, we always post the meals so everybody knows what’s on the menu. If somebody wants something else, because we’re only eight people, it’s easy to make something else that they would like. But before someone moves in, we also have a food Like and Dislike Form for the family to fill out. So we know if somebody hates beets, don’t give them beats. So we’re pretty familiar and because it’s only eight residents, we know who likes what and they’ll tell us, too.

Steve Lorberbaum:

Oh, I’m sure of that. Would you say that that’s fairly typical of the other group homes throughout Montgomery County in terms of the way they set up and look?

Jonathan Edenbaum:

Yes, I would say so. For the most part, yes, I would say so. There are some that are a little lower scale, some that are middle, and some that are upper scale just like neighborhoods.

Steve Lorberbaum:

Gotcha. So if I’m a son or daughter of someone who’s older and maybe needs to move out of their home and I’m helping mom or dad, what are the things I should think about when I’m trying to pick? There are lots of small group homes. There are hundreds of communities now. They seem to be sprouting up everywhere. What are the kind of things I should think about when I’m making the decision?

Jonathan Edenbaum:

Certainly, you should look at the staffing ratios. You should make sure the physical plant looks good. Now with COVID, it’s a little hard right now, but make sure everything looks how you would like it to look. Make sure there were no smells. Make sure people look happy. And what I often tell families is they should make an unannounced visit, not just their regularly scheduled tour to make sure they’re seeing what they want to be seeing. You want to see people engaged. You want to see people smiling. It’s always nice to have home-cooked meals in the house, I mean, which we have, but the smells are very important besides the food cooking. So everything’s made on the premises. So you really also want to, when you’re looking at a house, you should also get references from families, not just talk to the staff.

Steve Lorberbaum:

I know some of the draws of the larger communities, they talk about all of the activities that they have. Do you have activities well in your homes?

Jonathan Edenbaum:

Yes, we do. We have activities as well. We have activities all day long and we really try to make them mentally stimulating, and we have an art therapist, music therapist, and we do current events, and music seems to be the key for everybody because it touches them no matter what level they’re at. During non-COVID times, we have lots of performers come in, so now we’re performing, so. Little things change. It’s going well. Actually, we found a lot of hidden talents in a lot of our staff, myself included.

Steve Lorberbaum:

Excellent. All right. So let’s talk COVID a little bit because that’s not going away anytime soon. So now I assume people aren’t coming to your home necessarily, they’re doing virtual visits, or can they come and see the house?

Jonathan Edenbaum:

They are doing virtual visits and we will meet outside with them. We’ll meet on the deck, on the porch. We have a front porch and a back deck on most of our homes, and then we do a virtual tour just because we can’t take any chances, and that’s how we’re visiting with families as well. Families are visiting with their residents, I mean. We have haters out there, too.

Steve Lorberbaum:

Well, that was my next question. So I know, at least I’ve read in the paper especially in the larger communities, they’re locked down, so loved ones didn’t get to see their loved ones for Thanksgiving or Christmas coming up. They’re not getting to visit. Are you different in that regard or you have the same rules? Is it easier because it’s a smaller home? Kind of explain to me how do people get the state connected with their loved ones while they’re living in one of your homes?

Jonathan Edenbaum:

Well, what we do in our homes is we have outside visits. Like the larger facilities, we can’t let people in from the outside. So we have decks and porches, and what we do is they make an appointment to visit their family because we can only have a certain amount of people at one time, and then they visit with their families outside. Even though it’s cold, we have outdoor heaters, we bundle them up and try and get them where the sun is, so. It was a lot easier in the summertime, so. So people have managed to visit. We’re also doing Skype and we’re doing Zoom visits as well.

Steve Lorberbaum:

So your staff can help if I had a loved one living in one of your homes and we wanted to do a FaceTime thing and they’re not capable of using a computer, you all could help arrange that.

Jonathan Edenbaum:

Oh yes. We set it right up and one of our staff usually stays with them just in case there are any technical difficulties.

Steve Lorberbaum:

Gotcha. So now I know obviously it’s a little bit of a biased question because you own and run smaller group homes, but kind of tell me what are the reasons people would consider moving to one of the larger communities over a smaller group home.

Jonathan Edenbaum:

Sure, and not every model is for everyone so I should emphasize that. They might move to a larger place if they want to have much more socialization. Let’s say they’re much higher functioning and they want a strew of friends and they want a large dining room where people they can socialize with as opposed to just seven people. So that’s usually a good reason why people could, but I think it’s all in the staffing ratio, I think, and the ability of socialization and the level of where the resident or potential resident is at.

Steve Lorberbaum:

Gotcha. So do you have, or maybe in group homes generally, are there some that are targeted towards maybe people that need more physical help versus having more cognitive issues, or are people just kind of mixed together? What’s the general way it works?

Jonathan Edenbaum:

People are usually mixed together. Usually the cognitive and the physical sort of go hand in hand. But a lot of times it just depends on the individual. But certainly in the smaller homes, at least in my homes I would say, everybody has, and I shouldn’t generalize this, but we’ve noticed that some form of dementia where it’s very early stages and you can’t even tell versus people aging in place. So that’s the kind of folks that we see, so a mix. And sometimes the higher functioning bring up the lower functioning and the lower functioning really enjoy that and they rise to the occasion, and I have many examples of that. We have many wonderful situations where that’s happened.

Steve Lorberbaum:

Gotcha. So let’s say again, I’m a son. I’ve got an aging parent and I’ve got to figure out what to do. I try to make the choice. Do they stay at home? Do I help them make a decision to move somewhere? How do I get help? How do I find group homes? I mean, there’s got to be hundreds of them. How do I know? How do I pick the right one? What’s the best way to figure this all out?

Jonathan Edenbaum:

Well, one of which is you can always go to a life-care manager. They’re a good referral source, and they can sum up the situation and give you a few places to look at. That also helps. There’s a list in Montgomery County. You can always get that from the Department of Aging of licensed group homes. And also, there’s a wonderful thing called The Source Book which has a number of smaller assisted livings listed there. Oh yeah, and then you start visiting and inquiring.

Steve Lorberbaum:

So you mentioned care managers as people that can help out, so my understanding of care managers is they are paid by the family, but then I’ve also known that there are places like A Place for Mom, or I think it’s Care Patrol where those folks will help find a place, but they’re paid by the community. Do you participate with any of those people? Do group homes participate with them and sort of how does that work?

Jonathan Edenbaum:

Group homes do and yes, we do. So they’re sort of like care managers, but everybody’s different, so every company is a little different. Some people really are hands-on with the family and really know the needs. Some people just give them a list and tell them to go look at this place. So we participate in all of them and we do pay a commission, but it’s also a good screening tool, so the folks that know us to know what we can handle and know who would be a good fit, and for the other communities as well.

Steve Lorberbaum:

Gotcha. If you have really complex medical needs, are there group homes that specialize more in sort of super needy people versus the general population, or is it everybody who can handle everybody?

Jonathan Edenbaum:

You’ve got to pick your mix. You can’t have a whole house full of people that are with total care because your staff just wouldn’t be able to handle it. So I’d say, me personally, we will take a few people who are heavier care than people who are lighter care, just so we have the mix and everybody gets the attention they need. A lot of places might just take anybody whereas we’re pretty selective about who we’ll take because we want it to be successful all around.

Steve Lorberbaum:

Gotcha. So without putting you on the spot for pricing, what’s the range of pricing for sort of group homes versus, and if you know, the larger community? So I mean, what can people expect to spend per month at these various options?

Jonathan Edenbaum:

So the range, I mean, on the low end, around $4,000 a month in some facilities. On the higher end, it can be $15,000 a month. It all depends on what you’re looking for, the staffing, the glitz, whether you want a fancy place, you want a more middle of the road place, or you want just a bed and meals. So I think it all depends on that. The larger places range from sevens until about 15 to 17. So same thing, you got to figure out what you’re looking for, what they’re offering. So again, it all depends on if you want a large apartment, do you want all types of services, or care is more important than the physical environment.

Steve Lorberbaum:

Gotcha. So I was talking to a family the other day. They’re one of our clients, but they’re contemplating should they move their dad to a community, and the dad is capable of participating, and he’s engaged, but they were sort of bewildered because it seemed like some of the communities, you have to buy everything. So it’s not just a here’s what it is, it’s $4,000 a month or $5,000 a month. It’s, oh, you need medicine administration. Oh, that’s another. Oh, you want three meals a day. Oh, that’s another. Is there a rule of thumb? Should you stay away from places that kind of have a gazillion different fees or is it it’s just a different model?

Jonathan Edenbaum:

It’s a different model and it all depends on do you want to know what your bill is going to be at the end of the month? For our models, we do an all-inclusive price so it’s no matter how much care or how little care you need. There are a couple of little extras, but that’s right upfront. So a lot of places do that. It’s mostly the larger places that do that, but the smaller ones, the ones that I know and I know most of them, we’re all pretty much an all-inclusive price.

Steve Lorberbaum:

Gotcha. So again, it’s pretty much buyer beware. Just figure out, ask questions, make sure you understand so that you understand if there are any fees.

Jonathan Edenbaum:

Right.

Steve Lorberbaum:

Okay. So a couple of questions from the chat. I think you mentioned it at the beginning, but how many homes does Eden Homes have?

Jonathan Edenbaum:

So Eden Homes has two and we’re building a third.

Steve Lorberbaum:

Okay, and when do you expect the third one? Do you have any idea? [crosstalk 00:20:29]

Jonathan Edenbaum:

We’re hoping for early spring.

Steve Lorberbaum:

Okay, and if I recall correctly, you have probably one of the few homes that is an old kosher home.

Jonathan Edenbaum:

We do. One of our homes, it’s a kosher home in Potomac on Gainsborough Road, and it’s in a nice community, a very welcoming community, but it’s also non-sectarian. People don’t have to be Jewish to be there. We have people who aren’t Jewish that just like the house. But the fact is that we have a chef there and it is a kosher kitchen and we follow the dietary laws.

Steve Lorberbaum:

Gotcha. So how are residents welcomed in? When they’re onboarded in now, it’s probably much harder to have a new resident come in, but how are they welcomed in, and the other question along with that is, is there sort of a theme to each home?

Jonathan Edenbaum:

I wouldn’t say there’s necessarily a theme. Our residents are very welcoming to each other. So we just had a resident move into one of our homes. Actually, it was the kosher home. The staff of course give them a lot of TLC, a lot of introduction, and she just felt at home right away. I mean, she’s already made friends. People are chatting with her. If she’s late for the table, they’re all looking for her. So we engage people in activities quickly, so you come right in and we start off into activities, so it really can break the ice and make people feel welcome. And again, it’s not a huge group, so you’re not overwhelmed.

Steve Lorberbaum:

Gotcha. So with COVID, I’ve heard it’s across the board. In some communities, you basically come in and you’re stuck quarantined in your room for two weeks, where they bring you your meals, you’re not allowed out. Others, you have to have a COVID test, but you’re quarantined for a couple of days. How does it work at Eden Homes?

Jonathan Edenbaum:

Well, that’s a good question. So what we do is on a new admission, we do a COVID test on assessment, and then we do another COVID test right before they move in, and they have to have a negative before they move in. We don’t isolate. We don’t quarantine because I think it’s just too hard on them, a new place, and then being sort of set in your room and not being able to come out. So our nurse observes them carefully, temperatures are checked several times a day and obviously sanitizing and face masks and all that.

Steve Lorberbaum:

Gotcha. All right. That’s great to know because I know at Assisting Hands we’ve actually been hired by families to be part of the transition team where someone’s moved into a larger community, but they are sort of segregated to their room for the first week and family can’t come in, so they need help unpacking, getting settled, getting organized, and then sort of being with them for a week. It’s sort of unusual for us to be doing that but we’ve been asked to do that. It’s great that you’ve figured out a way to onboard people quickly without having that hard part of isolation.

Jonathan Edenbaum:

Right. Right. Yeah, a new place, unfamiliar people, it’s tough.

Steve Lorberbaum:

You had mentioned a nurse, so you have a nurse on staff?

Jonathan Edenbaum:

Yes. We have a nurse on staff, an RN, and she’s on call 24/7. She’s my business partner, Terrie Ship, and she lives right in the neighborhood. When she’s off, we have a nurse that covers for her, and we also have doctors that come in as well.

Steve Lorberbaum:

All right. So those were the questions in chat. I don’t know if anyone has any questions. Certainly, feel free to open up your mic and ask Jonathan or me any questions you have. All right, well, hearing none. Jonathan, thank you for joining today. This was super helpful. It really gave me, in particular, a great understanding of group homes and the Eden Homes concept in particular. So I thank you for your time and I thank all of you that listened in today, and we look forward to you joining us for the next What’s Your Plan which will be in a month from now.

Jonathan Edenbaum:

Thank you, Steve.

Steve Lorberbaum:

All right. Bye-bye, all.

If you would like to schedule an appointment to discuss your Alzheimer’s and Dementia care needs or to set up a free in-home evaluation with one of our nurses, call us today in MD at (301) 363-2580, or in VA at (703) 556-8983. We are located in Bethesda, MD, (301) 363-2580, and Reston, VA, (703) 556-8983.