Host Ankur Patel, MD, MBA, FAAFP, Chief Medical Officer, Tabula Rasa HealthCare, interviews Alan Sadowsky, PhD, MSW, Senior Vice President of MorseLife Health System. Dr. Sadowsky has administrative responsibility for the MorseLife Home Care division which includes Palm Beach PACE, Palm Beach Hospice and Palliative Care, Home Care services, Adult Day Care, Meals on Wheels, and Geriatric Care Management. Dr. Sadowsky serves as a board member for the National PACE Association (NPA) and the Florida PACE Providers Association. He previously served as president of the Area Agency on Aging of Palm Beach and Treasure Coast.
Host Ankur Patel, MD, MBA, FAAFP, Chief Medical Officer, Tabula Rasa HealthCare, interviews Alan Sadowsky, PhD, MSW, Senior Vice President of MorseLife Health System. Dr. Sadowsky has administrative responsibility for the MorseLife Home Care division which includes Palm Beach PACE, Palm Beach Hospice and Palliative Care, Home Care services, Adult Day Care, Meals on Wheels, and Geriatric Care Management. Dr. Sadowsky serves as a board member for the National PACE Association (NPA) and the Florida PACE Providers Association. He previously served as president of the Area Agency on Aging of Palm Beach and Treasure Coast.
Hello and Namaste everyone. I am Dr. Ankur Patel, Chief Medical Officer, Tabula Rasa Healthcare and the author of the book Age is Just a Number. Welcome to this episode of Keep Up With PACE. I'm pleased to announce today's guest, Dr. Alan Sadowsky. Dr. Sadowsky is the Senior Vice President at MorseLife Health System, a comprehensive senior care campus located in West Palm Beach, Florida. MorseLife Health System has more than 2,000 employees providing daily care for 900 residents and 2,500 people in the community. Dr. Sadowsky has administrative responsibility for the MorseLife Home Care Division which includes Palm Beach, PACE (three sites and fourth site and final planning stages) Palm Beach Hospice and Palliative Care, Home Care Service, Adult Day Care, Meals on Wheels, and Geriatric Care Management. The Home Care division is now the largest single entity in the MorseLife Health System, having experienced more than 50-fold growth since Dr. Sadowsky began his tenure in October of 2000 with the most recent budget exceeding 97 million. Dr. Sadowsky is the past president of the Area Agency in Aging of Palm Beach and Treasure Coast, serving a total of eight years on the board and currently serves as a board member of National PACE Association and Florida PACE Providers Association. He has lectured at local, state and national symposia on issues related to technology and aging and policy issues related to helping frail seniors remain at home to avoid institutional care. Dr. Sadowsky received his Bachelor of Arts at the University of Pennsylvania and his Master's and Doctorate degrees in Social Welfare at the University of California, Los Angeles. Namaste Alan and welcome to the episode of Keep Up With PACE. Thank you very much. I love the mantra of MorseLife - MorseLife is more life. Tell us more about your PACE organization. Well, I've been at MorseLife for almost 22 years and we're not an organization that sits still. And we have a very robust strategic planning process that we do very routinely. And we're seeking for new ways to reach the community. And the concept of exploring the feasibility of PACE was part of our strategic plan in 2009. And like any good organization, once it reached the planning process, we hired a national consultant to do that to explore whether or not it would be feasible given the current configuration of our services and staff. So we hired a company and PACE can actually provide up to 32 different types of services. It turns out that we were already providing 31 of them. Everything but acute care hospitals. Wow! That's amazing. The consultant said, if you can't do PACE, we don't know who can do it. We set about putting the wheels in motion to look at the financial aspects of how much money it would take to restructure and what kind of staffing we would need and all the things that go with the comprehensive strategic planning effort. And that was 2010-2011. And then we went about the process and we actually saw our first patient in November of 2013. That is a cool story that your organization was f orward looking organization. So you started in the first PACE center in 2013. How many PACE centers do you have now and what's your total census look like? We have three sites. The fourth site is in the final stages of construction. A lot of things have to happen to the city and the county and the fire department do all that, but the walls are up, the rooms are, the furniture is ready to be installed. So, we're very close. Our most recent census is 690, and that includes almost two years of being flat because of COVID. We're one of those sites. We never closed our doors during the pandemic. We had very limited clinic access, and we continue to enroll. The reason that we were flat is because we had high rate of death, which is the most common reason for people to disenroll. So we were enrolling and disenrolling 15-16 people every month. I do believe we're turning the corner now and we should be back on that pretty meteoric rise that we've experienced in the last decade. Yeah, that is unfortunate, what we are seeing on a disenrollment site from that. So even during the covid, you were still able to continue with your enrollment process. It's more because of the disenrollment y our net growth was not high. Correct. And we did some really interesting things during the pandemic. I mean, we're a comprehensive senior campus, so we have a large nursing home as part of our campus as well. And we were very concerned about bringing covid into the nursing home. So we restricted visitation, which was very traumatic for families. I know we didn't allow volunteers. We ultimately issued a mandate that required all of our staff to be vaccinated. And we lost close to 100 staff members, for whatever reason, decided not to take the vaccine. Now probably 25 to 30 have come back, but we took a very hard line about requiring the vaccine. And we segmented the campuses on 52 acres. So we segmented the campus to prevent cross contamination. So, for example, with a large home care division, and we didn't want people to, for example, be staffing in the skilled nursing facility, then work in, PACE outpatient, and potentially bring covid from one venue to another. So we segmented the campus, which resulted in a huge increase in overtime. But we felt that we had to err on the side of caution. So how did you handle the staffing management when 100 staff members resigned? We did a lot of things. That's a great question. First of all, we re- examined our pay structure and we wanted to make sure that we were considered one of the best places to work in South Florida. So we increased the wages of the direct care staff. Okay. Many staff were very intrigued by the opportunities for increased overtime. So we did that. We have also engaged in some, I think, truly creative approaches. For example, the western part of this county is an area marked by high crime, high unemployment, very high incidents of AIDS and cardiac issues. We are in the middle now of an initiative where since we know we're going to continue to grow and we're going to continue to have a demand for jobs we launched an initiative in that part of the community where we have engaged in a partnership with a local nurse training program. And we're training people. We're paying for them to be trained to be home health aides or CNAs or work in hospitality. Nice. And then we're paying mentors on this side to help them to make it through that first six months. We have found through our own analysis that if they're able to survive through the first six months, they're much more likely to become long-term employees. We've gotten a lot of receptivity from the political community, the educational community. We have some start-up grants. We have some philanthropists who are interested in helping with seed money. So, ultimately what we want to establish is like a farm system. So we have a ready pool of people from the local community who see this as a viable way out to a lifestyle that is economically depressed and entering the working world where there are opportunities for advancement and new career. Wow, I'm really amazed. What a creative way to handle the situation that can possibly help the community, create jobs in the community, serve the participants. And we know that. And you are absolutely right that in PACE and normally in senior care the first six months is very important because I can totally see that the first six months they are questioning that did I sign up for the right job? But once you are in PACE for six months I bet the satisfaction rate is higher. Yeah, it's PACE. It's all the different, we have 40 different portals that you could enter our campus for work. What happens is after six months, for example, we've learned one of the reasons people for whatever reason don't make it through their early months is they feel lost in the system. Sure. They don't know if their supervisor understands them. If they're contributing the way they're supposed to. So we're working on a mentor system and we've also added an incentive for the mentors so it becomes in their interest for a new worker to succeed. And when you're in a fairly large facility we have 2,500 employees it's easy to get lost. That's part A. Part B - there are practical things. They may not have a reliable car or they may have a childcare issue - a kid who's got chronic issues with health or something. So after a period of a few months they develop networks - I can care for your kids a couple of days, you care for mine, or we could carpool. They become part of the family here and they come up with their own creative ways so that they can be a successful employee and not be terrified that the kid comes home and there's no one to watch them. Maybe they have a shared relationship with someone who's working a swing shift or something like that. And it really helps to have work buddies. That is amazing. So who are the mentors? Like will it be one of the examples like a nurse manager or who are the mentors like? Probably someone not quite as high up on the totem pole. Maybe a floor person, could be an activity assistant, could be a CNA or a home care worker. But someone who by reputation, by experience, is someone that is a logical leader. We actually have within our system, we have a program called Morse Life Leadership Academy. In the not for profit world, there's often not great succession planning. You're right. Our leadership is constantly looking for people who you see something special and the way anyone on the staff is approaching their work. That's the person who isn't going to leave at the end of the day until the work is done, or who the others look up to. Someone who is a real person of high moral character. So in our Leadership Academy, they get recommended through someone in management, middle management, or executive management. They go through a twelve month program. They have assignments every month. They are assigned to mentors within the organization. And it all culminates in a capstone presentation. At the end of the year they actually get a couple of days off. They're given a real life assignment. They form teams. They are graded in terms of how much teamwork they exhibited, the quality of their presentation, how quickly they understood the facts and how well they presented it to the executive team. We actually have cash awards for the winning team. And I can tell you in our own PACE organization we probably have five managers who are graduates of the MorseLife Leadership Academy. Great example. That is a very great example. So with the mentorship program, even like a floor staff has an opportunity to mentor the new employees and also they have a chance to make some extra money on top of their salary. Well, not just that. I think the culture is now that they want to get ahead. And by the way, I've learned sometimes the hard way, not everybody wants to progress in their career and take on more responsibility. But for those who do, they've kind of come to understand that one way to really move up in this particular organization is impress some manager and see if you can get into the MorseLife Leadership Academy because you will get recognized and if you shine, you will get promoted. So have you noticed that the staff members or employees graduating from that academy have a better retention rate with MorseLife afterwards? At least in home care, I can't think of anyone who has graduated through that program who's still not with us. Wow. That is amazing. I think for the listener, Alan, you already in the first half of the session, you gave very good information. So this is something to think about - what Alan just mentioned was one, is they lost 100 employees and how they recovered from that using the community networks, the local nursing schools, training them, the Leadership Academy, and the mentorship program. I think this mentorship program is something that even I will carry forward in my organization. So thank you for that information. I appreciate that. In our culture, one of the dirty words that we hate is staffing agencies. We abhor them, and for lots of reasons. Number one, they are prohibitively expensive, especially now because of this demand market. That's number one. But number two, which is probably even more important, is clinically, you lose continuity of care. To the degree that we can avoid staffing agencies, why not invest what we might have had to expend in staffing agencies, in our own staff. We believe in them. It's really important to keep challenging people. I share with the people who report directly to me that one of the most important jobs that you have is to, you're surrounding yourself with people who report to you. Absolutely. And your job is to keep them interested and motivated so they don't think about leaving. And money is important. You want to make sure that you pay them more than a fair wage, but you also want to challenge them. And you want to make sure that they're not bored and that you explore new things and you introduce new concepts. And just because you did it this way for five years doesn't mean that you have to do it for another five years. Absolutely. If you keep the ideas fresh, people will work hard. I don't think at least my experience is nobody here seems to want to avoid hard work. They get paid well, and they tend to, to me the biggest compliment is when they refer friends and family to the program. We actually have several instances of friends and family are either employees because someone referred them, or they're actually PACE participants because they believe so much in the program. I agree. We've been open for 40 years. In that 40 year period, we've had two CEOs. They are examples in the highest level of the organization where people drove through the night to get a loved one from another facility, sometimes out of state, to bring them here for care. And so the thought is, if you don't feel comfortable with your own mother being in the program or being in the facility, then we have work to do. Caring. Absolutely. That's the mantra where I walk in every day caring to take care of your patients as you'll take care of your loved ones. Yes. And even the most difficult or challenging situation you will come out of it. And what you mentioned about the word of mouth referral is the best referral. Whatever the surveys we do and what response we get from the surveys, but when you are getting those word of mouth referrals, your employees and other participants actually referring their loved one, that's the ultimate price. Yep. And then all those things you mentioned, and I'm just like curiosity wise, either with all these things with higher pay, all these things you are doing with the employee and everything but how, you were able to balance the budget? It's sort of an interesting phenomenon. We are a not for profit but we run very much like a business. I get a 30 page financial report every month on all the different areas that I have responsibility for. If there is a variance, I'm going to know about it. And I mean if the variance is positive or negative, it's my responsibility to understand that. Sure. We have an enormous advantage in that w e have very involved board members. We have probably 160 people on the various boards. We're really like nine entities and they demonstrate their support in many ways. We have a number of extremely successful fundraisers. I'm blessed to live in a part of the world where there's a fairly large and successful donor base and they are very grateful to the services that we provide. Great. But if you invest in the human capital portion of the operation, invariably it comes back to help you. I agree. I think one thing that I already learned in our conversation is what always Richard Branson says "you take care of the employees, they'll take care of your patients or they will take care of your customers." In our case, you take care of your employees, they'll take care of our participants. It's very gratifying to me. They don't know I'm like listening in the hallway and I'll hear some employees say to another employee we just don't do that here. That's not the way we do things here. We have higher standards. Yeah, I think that is amazing. That how you have put in this whole concept about culture. And that is something that I really appreciate you sharing because it always reminds me of when any employee is planning to leave their job and they think the grass is greener on the other side and I tell them that a lot of time grass is not greener on the other side. Grass is green where you water. That's a great quote. I'll use that. Yeah. And you are doing that. We've had people, especially in the nursing areas, the hospitals, some of the competing staffing organizations, they're offering huge sign on bonuses and different work hours, all that kind of good stuff. So we have lost some people because of that. But we've also had people, quite a few who've left and they now come back and they say it's just not the same or it was good for a while, but all they're interested is in the bottom line. One of the things that I have to my advantage is as a long term employee and someone high up in the organization, I don't worry about I had a bad week or a bad month or a bad quarter. We're a known quantity and we are like, for example, when we opened PACE you mentioned earlier in the introduction that I was the chairman of the board of the Area Agency on Aging. Well, for about a year before we opened PACE, myself and the program director were going to meetings at the various Area Agency offices, getting them ready, telling them about it. When we were going through site readiness and the state was coming to survey us and all that kind of good stuff, they were as excited as we were when we eventually got the okay to open. A proactive approach. Yeah. And then when we did open, they sent us some cases that were really complicated cases. I mean, they were really essentially testing us. And our doctor and our staff took the stance that we are not going to say no. We may have some difficult cases that actually may, it's marginal in terms of could they really live in the community, but we are going to prove to them that we are everything we say and more. And that turned out to be really helpful. I know I travel around the country, I see some of the other PACE programs and some of them have contentious relationships with the local Area on Agency. Our Area on Agency has been nothing but supportive since day one. And we use that approach even throughout the enrollment process with the Agency for Healthcare when it was, when appropriate, the Department of Elder Affairs, we make it so that whenever we submit a piece of paper, it's in perfect condition. There's no boxes that are unchecked. If there's ever an issue, it's a high priority. We want to make it so that their job, which is to review all these different pieces of paper and endorse the enrollment, is made easy for them. And again, we've adopted this culture that we will do everything we can on the front end to help the organizations that we so desperately partner with as we go through the enrollment phase to make their jobs easy. So they don't have to worry about if they get something from us that something's missing because we've taken the anxiety away from them about that. That's a good point you made. That not like talking to our other colleagues all over the country, they actually do not have that good of relationship with the local Aging Agency. So from your experience, what are the one or two tips you want to give to our listeners that they can build a relationship with the local agencies? How you did with yours. It's part of my academic training. Which is, you wouldn't tell because I'm talking so much today, but you really have to listen. And so when you go into these agencies, you really need to understand what drives them, what motivates them, what are their obstacles, and then you work to overcome them. So for some of these, it's really just they're inundated with paperwork and PACE is a lot of work for not that many people. They don't get a phone call from someone from PACE and they say, oh, great, this is the greatest thing in the world. But we set out to win them over and we wanted to understand what their biggest concerns were, what their biggest obstacles were, what some of the stresses are. And we did that with all the agencies. We did that with some of the assisted living facilities, the HUD housing facilities that are great referral sources. So now they love the idea that they have a place to send some of their people during the day and they love the idea that they're helping. We made the place visit friendly. You don't have to, and we invite people all the time, but we really, truly want people to come and see what we do because when you come to the facility, it's just a wonderful experience. You come here in the morning, all morning long. I'm really in the van business now. We have a fleet of vans. Vans arrive all day long. People get off the bus, there's a chairlift. They walk in and they get a hug. They come in and they're already feeling welcome. And we do that sort of metaphorically with the potential partners that we have, whether they be assisted living facilities or even representatives from the state or the federal government. We just had a monitoring call today and we look at these as it's like a midterm exam or a final exam. They're trying to monitor what it is that's happening within the organization operationally. We make sure that if they ask a question about a client, they're going to get our undivided attention, our statistics are checked and rechecked so that everything that we send them is corroborated. And as a result of that, they look forward to, it's not like, oh, you have to call Palm Beach PACE and God knows what they're going to tell us about this data or that data. We're ready and it shows. And they have told us that they really enjoy coming here. They enjoy when they have phone calls and conference calls with us. And maybe it's just common courtesy, but it's also smart business. No, I agree. And I hope the listener can take this point away that how you can build a relationship with your local agency because that is one of the keys to success in PACE and other senior care as well. So most of the people, our colleagues, always talk about, like, one of the challenges is even the agency, local agency approves that okay, this participant can join in PACE on June the 13th, but now they have to wait till July 1. Is that the same case in Florida? It is. There's some legislation so that you can actually enroll, not just at the beginning of the month. My approach to this, there's things I can do something about and there's things that I can't. So right now, that's the law. We don't do retroactive enrollment. There are people and places that do that and essentially they are taking on the responsibility without getting the reimbursement. And from a gap principles of accounting and our CFO's influence, that's not something that he feels we can expose the organization to. Sure. What we can do is, if someone, all the approvals are in for the 13th, but they're not going to start until the 1st, we can do a lot to make that person feel welcome. Visit them, call them, make sure that the day that they actually are enrolled, all their medicines, all the issues that they have about seeing this specialist or that specialists are taking care of. So they're essentially part of the family before the day of their official enrollment. That is a very good idea that even if you have to wait, just make them feel welcome. It's kind of like a pre-orientation. Yeah. And there's a social aspect of PACE which is not to be discounted. And I point that out. Like during the pandemic, we had to restrict numbers because of the risk of infection. And so there was a period of two to three weeks, we really closed for short periods of time relative to other providers across the country. But if I could have captured on video some of our members when they came to the center for the first time, they haven't been out for three weeks or so. Oh yeah! They walk in, they get their hug, and they just start to cry. I mean, these are their friends. This is their family. And then another example is, for example, when we did our second site, we took all the names of the people in PACE. We put them on a map of the service area. So everyone was on the service area with a little flag. We drew a line in the map. We said, okay, all these people north of this line will be in this site. All these people will be south of the line, will be in the second site. Well, that was pretty naïve thinking on our part because we didn't realize that Mrs. Jones and Mr. Pepper were not going to be apart. No matter where they live, they look forward to being with each other in that day room and come hell or high water they weren't moving. So we quickly learned that the geographic demarcation was essentially a suggestion, and we had to be very flexible about it because we've had people meet in PACE. We've had staff members meet family members and get married. We've had clients become couples. It becomes a very social existence as well. Which is a very important part of aging socialization. Absolutely. And I think that's the beauty that PACE brings on the table. So how many weeks? So just for two to three weeks now, is your PACE organization at full capacity when it comes to the day center? We're at full capacity. We just now had an outbreak in the last couple of weeks. We have done remarkably well, I think, in terms of the number of covid cases. But we also get a fair amount of referral from assisted living facilities in this community. We have contracts with 46 different facilities. They don't all have the same standards that we have. And our nursing home, for example, is five star. There's something in Florida called the Gold Seal, which is less than 2% of the nursing homes. We have that. We're the only teaching nursing home in the state, so we have very high standards. We're five star and all that. So we have very high standards, but we can't demand that all these assisted living facilities have the same standards that we have. So there have been periods of time where we had to quarantine facilities. There were times when we couldn't accept people coming into the daycare part of the program from certain areas because of the quarantine. But what we've learned over the last couple of years is that it works best for our clients when we can interrupt the daily operations as minimally as possible. I mean, obviously we want to protect people. When you close a clinic or close a daycare program, there's lots of consequences that are usually negative. I mean, we see these people, we get to see for ourselves if there's any decline in function, our drivers pick them up. Their drivers are trained to look for certain things as well. And that's the point I'd like to try to tell our listeners too. An example that you mentioned, our drivers are trained to look for certain abnormalities. And for listeners who are not in PACE yet or planning to get into PACE, this is something the heart of PACE is our interdisciplinary team that every member matters. Doctor is just one of the members on the team. And our drivers, our aides, they all are trained to look for signs and symptoms that can give us a pre-sign that patient is not looking good for some reason and needs to be seen by the provider. And that is one of the ways that how we prevent unnecessary ER and hospital admissions. Dr. Patel, I couldn't have said it more eloquently, and I've been around long enough that before PACE I've been in interdisciplinary teams and everybody speaks and then the doctor says, that's all very interesting, t his is what we're doing. Yeah, I agree. At least our doctors are extremely respectful. They want to hear that, for example, a frail senior goes to a physician for chronic pain - this is not in the PACE program. That doctor may have no clue that there's an adult child in the home that's abusing medicine. Yes, you're right. We're going to know because we're in that home. We see who's in that home and we know if they're taking the medicine or if someone's taking the medicine. And so the driver who says, I saw some person on the front stoop when I went to pick up the client and he was nodding because he was high on medicine. That's something that we're going to know. And the other thing about PACE, which is so wonderful, is we have the ability to be creative. I use this as an example. Early on, we had a client who kept getting infected in her own home. She had a problem, I hope nobody's eating lunch, but she had a problem with vermin and lice and all that. The way the current structure is with Medicare and Medicaid, there was nothing you could do about that. With PACE, we could make the decision. We tended that home. We invested in that client's well being. And that person hasn't been in the hospital in like three years. And before that, they were just routinely going, cycling in and out of the hospital to these events. Their quality of life is better. The government and the taxpayers save money and everybody wins. Yeah. And it's the right thing to do. Absolutely. And that's weird. Like, a lot of times I'm talking to somebody who are not in PACE. And when I say that about how strong our teams are and they'll be like, oh, we also have a multidisciplinary. I'm like we call it interdisciplinary team, not multi because we all interact and talk and listen, get feedback from each other, and that's how we make decisions. And believe it or not, I always tell my other friends that taking care medically of the sickest patient is the most easiest job. Actually, what factors that comes, and especially the social factors, that's where the team brings the most value that helps me as a doctor to care for our patients. Right. And a good PACE doctor, like you have had the experience, is a good listener and they piece together all these different pieces. What I have found is PACE becomes almost like a mission for people. We've had a number of people join our staff because they were relocating from one part of the country to another and they knew about PACE or they worked in a PACE program. And what they wanted to do most was hook up with another PACE program because of what you just said. It's truly interactive. You see the results of your work. I mean, the clients become like family. I could tell you some stories that are so heartwarming. Sure, please. We love stories. Well, we've had people during hurricanes. Here we have an issue with hurricanes and some of our clients have nowhere to go. And staff just took them in because they were concerned about that. I was at a conference several years ago and the governor of Virginia was the keynote speaker and he started off his speech, he said, I have seen the future of healthcare and I spell it P-A-C-E. Wow! I am frustrated because we have, I don't know, whatever the number is 60,000, whatever the number they tell you from National PACE, I think PACE should be available to half a million or a million people. I agree. It would save money. It is the least restrictive. Look, I'm involved with a very quality, high end nursing home. The grounds are immaculate. It's high end all the way through. Even so, people would prefer to stay at home, age in place, and PACE does that. And when you go to the hospital, PACE is geared to help people avoid going to the hospital or get them out once they go. We have people going to the hospital and they get there, and we get there at the same time. And we're talking about, you got to get them out, this is a bad place for them. Right now the way reimbursement is if someone is in a hospital, they're really sick. They go to the hospital, they come back, they now have pressure ulcers, they're malnourished. If someone gives them a tray of food, they place it down on the end of the bed. The person can't feed themselves or they're demented, they lose weight, they get psychotic. Obviously, there's lots of exceptions, but to the degree that we can avoid it, we want to get people out of the hospital or avoid the hospital entirely. And one of the great things about the structure that we have here at MorseLife is that we have a fairly large nursing facility with a sub acute step down unit a nd so we can frequently avoid hospitalization or get them out if they've had a surgery very quickly, so that they don't spend much time there. Yeah, and also that is a great example you are giving because a lot of time we can use those sub acute facilities, rather than hospitals, for those gray area admission. So do your doctors and other providers use a sub acute facility for possibly like, early state COPD or CHF exacerbation? Yeah, and not only that, it's very effective because it's right here. So our medical director can just walk 300 yards and he could see seven or eight people. He doesn't have to get in his car and drive all over town. No, that is the key. And it's good to hear that you mentioned that a keynote speaker, the governor of Virginia, mentioned PACE. And this is one of the reasons I started this podcast, is to increase PACE awareness. So to all the listeners, please share this podcast to your colleagues, friends, family, whoever knows, because our goal is to increase PACE awareness. So please do that. And to the story of one of the, on my PACE organization when I used to be the Medical Director, that the daughter was in a different state, did not want mother to move to that state because they didn't know if mother will get the same care. And guess what? We were in New Jersey. The daughter lived in Pennsylvania. My social worker looked it up and they had a PACE center, actually in Pennsylvania a nd the daughter's home fell under the zip code. And we actually transferred that patient to another PACE program with a very hot sign out with exactly what needs to be done with the patient, first of the month. Yeah. Pennsylvania is a great example. I think there's 19 programs in Pennsylvania. You could drive to any program within less than an hour. Yes. So in my fantasy world, that would happen where you'd be able to move people from one site to another. One of the issues that we deal with in South Florida is there are a lot of frail seniors. When I say frail, I mean older than 85, lots of comorbidities and they don't have any family here. They've outlived their friends, their family is in the Northeast, the public social service system, forgive me governors and elected officials, but it's not that sophisticated down here. And so we become their family. And the other thing is that there's an awful lot of gated communities. When you think of the term gated community, you think especially if I say Palm Beach, you think of mansions. But there are a lot of very extremely modest, even lower income communities that happen to have a gate at the front door. And once they lose the ability to drive, those gated communities become like prisons. They can't get out and people can't get in. So that's a particular issue that we have here in South Florida. That and the disconnectedness from their family members. It's not typical someone has issues with activities of daily living. They move in with their adult children. It happens. But it doesn't happen as frequently as it does in other parts of the country. Your organization is a very forward looking organization. Where do you see PACE in the next ten years? I think that PACE is going to gain more acceptability and with that, from a social policy point of view, unignorable. My training, my love, is really what I call macro issues, social policy issues. And when PACE is not even in every state and relatively small numbers, although 60,000 is nothing to sneeze at. Once you get to a few hundred thousand or a half million people, it becomes the sociologists talk about the tipping point. It will become part of the everyday vernacular. People will know what PACE is. They'll demand to have PACE programs in their communities. The legislators and decision makers and the purse strings will understand that it's a good investment of dollars. One of the things that has happened as a result of the pandemic is I think we'll look back on this as the golden age of PACE. And I'll tell you why I think that. Nursing homes is where a lot of people died. More than ever, people are trying to avoid long term care facilities. There's always going to be a role for nursing homes, but I don't see a lot of people building nursing homes. It just doesn't make sense. But I do think that there has been a sea change in terms of home and community based services. So more and more people are choosing to stay at home. For example, I mentioned earlier, we're very involved now with getting our hospice program certified in a different way than it is now, which would give us total access to the community. But hospice care is 95% at home. Correct. So much of what we can do, you and I have had separate discussions about remote wireless technology and all the things that we can do to monitor people at home. So I do think, in answer to your question about the crystal ball, I think there's going to be continued more movement away from institutional care into community based care, and it's going to get better and better and people are going to demand more and more standards. But I think that is where there is going to be significant growth. To that point, how can external vendors like CareVention HealthCare, remote patient monitoring companies, can help your PACE organization growth? I think too often the people who are selling products are in the business of selling. They are not in the business of listening. They are typically telling you what it is that you need to do to manage the people that you serve. If they could put as much time and effort into hearing what it is that are your needs, they would be well served and they would be much more successful. Because I think the people who have direct experience in providing for this population, if you step back and you think about it, the business of PACE is risk management. We are managing risk. We are insurance providers. We know every day what goes into our costs. We know where we are most vulnerable. We know how to invest. I'll give you a perfect example. First full year of operation comes around Thanksgiving. And I got a lot of requests for increased home care. So I kept asking the question, has anything changed in the home? Has the clients needs changed? Do they need more hours? No, nothing's changed medically. So I was like, well, it doesn't make sense. There's no rationale. So we denied the request for additional home care. So what happened during Thanksgiving week? The family members dropped their loved ones off in the emergency room and they had their Thanksgiving meals or they went out of town and did what they wanted. The next year when they asked for additional home care for that two or three day period during Thanksgiving, we were a lot more sophisticated. We typically honored and said, you know what, we're investing in that family. They need a break. We'll give them some respite, we'll provide some more hours. So those people who've been around in the PACE community for a while, they know what they need. Yeah. And the vendors can tune into these folks and listen, and I think they would come up with better solutions. I agree. So, to all the PACE vendors out there, I think one of the good lesson learned - be a good listener. So before Alan, we go to the very part of my show, which is the Rapid Five Round. How can listeners connect to you? We're not hard to find. Our website is MorseLife. M-O-R-S-E Life. One word, L-I-F-E .org or Palm Beach PACE. And we have a pretty significant presence on the internet. Okay, thank you. Now, we are going into the Rapid Five Round, where I will ask you five questions, and you can answer in one to two sentences. No car for good answers, huh? No cars! No cars. But we will wish you a higher enrollment in PACE so you can grow. There you go. Okay. Question one what does failing mean to you? One of the people who had the most influence on me was the chair of my doctoral committee. And she said to me once, if you're not failing at least three or four times a day, you're not trying hard enough. Good answer. I think one of the lessons I've learned is don't be afraid to fail, it's okay. Great. Describe PACE in one sentence. Comprehensive. Great. If you had a magic wand, what is the one thing you would change about PACE? I would change enrollment process to make it more accessible. Okay. Tell us one thing about Alan Sadowsky that your PACE colleagues might not know. I was a competitive fencer in college. Really? After this, we'll talk more about that! One positive message for our listeners? I think that it's very helpful to try and understand why things are the way they are, because that will lead you into a strategy to help things get where you want them to be. Great. Well, on that note, we are at time. Thank you, Alan, for being our guest, and it was a pleasure speaking with you. Always a pleasure to talk to you. Thank you for joining us for this episode of Keep Up With PACE. We hope that you found the information shared valuable, and I invite you to join us for the next episode. Keep up with PACE is sponsored by CareVention HealthCare, a division of Tabula Rasa HealthCare. CareVention HealthCare provides comprehensive services and solutions for PACE organization at every stage. For information about CareVention HealthCare, visit our website at careventionhc.com. See you in the next episode with a new guest. Until then, namaste and goodbye.