45 Forward #246 - Aging in Place

Aging at home is what most people want — but few families understand what it really takes.
In this powerful episode of 45 Forward, Ron talks with Zubin Kapadia, CEO of Right at Home North Shore on Long Island, about the realities of home care—from preparing the house and the family to choosing the right agency, understanding costs, caregiver expectations, and the critical role of dignity, safety, and long-term planning. Zubin also reveals his Caregivers’ Advancement Fund, a unique nonprofit initiative that supports and uplifts professional caregivers through education and emergency assistance — a model that could change the future of elder care. Whether you’re caring for a parent, planning for your own future, or navigating the healthcare maze after a crisis, this episode delivers real clarity, compassion, and direction.

Topics include:
• Types of home care & what Medicare really covers
• When families should start planning (hint: before crisis)
• Signs a loved one needs more support
• Key questions to ask before hiring an agency
• Family roles, dignity, and boundaries
• Training, culture, and shortages in caregiving
• How tech like telehealth & fall detection fits in
• The coming caregiving crisis — and solutions

Guest Info:
Right at Home North Shore, Long Island
📞 516-513-1070
🌐 RAHLongIsland.com

Watch all episodes and subscribe at 45Forward.org

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Episode Transcript

Speaker 1 (00:00):
So let's dive right into just some some specifics about homecare,
because again I don't think people again really when they
as you know, often what happens is they don't think
about home care until they're in the middle of like
it's here, I need to think about it, even for oneself.
So let's talk about the different kinds of home care

(00:22):
that people can get, and you know, some of the
different kinds of care they need in terms of custodial care, healthcare,
aids versus you know, custodial you know, and the sorts
of things that they need and don't think about figuring
that out. Hell, everyone, this is Ron Roell. I'm the

(00:46):
host of forty five Forward, where my mission is to
help you make the second half of life even better
than the first. Now, if you ask anyone they approach fifty,
where would they like to live as they get older?
Eighty percent of the people will usually say they want age.
But the truth is many families don't only understand what
it makes takes to do this, what it's possible to do,

(01:07):
and they often don't even know where to start. So
what do they need to know before they hire home
carriage or aid? What questions do they need to ask?
How can we be sure that they'll get the right
kind of care for their loved ones. Today you'll learn
the answers to these questions and much more when we
talk with Zubin Kapatia, the CEO right at Home north

(01:27):
Shore on Long Island. Zubin not only runs a leading
home care agency, but he offers a unique perspective from
as many experiences in the healthcare industry, and today he's
going to bring his experiences into your home. So now
let's meet our guests. Zubin Capatia, Zubin, Welcome to the show.

Speaker 2 (01:46):
Thank you, Ron, it's a pleasure to be here. Thank
you for having me.

Speaker 1 (01:48):
It's a pleasure to have you. So I wanted to
start off by just mentioning people that we're going to say,
I'm asking you about your background because you bring it.
You know, lots of brands from healthcare industry, from lots
of different ventures over the years, and before we sort
of dive into a lot of the nuts and bolts
of home care, which I think many people might think

(02:09):
they know about but really don't. There's a lot they
don't know, and unfortunately there's a lot that they don't
know what they don't know.

Speaker 3 (02:16):
That's what often happens. But just talk a.

Speaker 1 (02:19):
Little bit about you know what your passion is, what
brought your homecare, you know from your whole variety of experiences,
what compels you about being in the business and running
a business.

Speaker 2 (02:30):
Sure? Sure, So I about thirty one years ago I
graduated as a lawyer, and the first fifteen years of
my career I spent doing legal work and financial work,
and the last fifteen sixteen I've been in healthcare. I
first got involved with in healthcare with Johns Hopkins Medicine International,
where I was the managing director for their international portfolio

(02:55):
in the Middle East, and from there I went to
several other academic medical in similar roles, and that was
a very macro view of healthcare, almost sort of the
cross section between public health and healthcare implementation. So we
did large management contracts, we did licensing agreements, We built

(03:17):
centers of excellence in countries like the Middle East. I
also worked extensively in China and Southeast Asia. But then
in twenty twenty I decided to acquire this company right
at Home, in large part because in the work that
I did previous to Home care. I was really looking

(03:37):
at healthcare from a macro perspective, comparing US systems to
international systems, and I was able to see some of
the gaps that we have in our country, and one
of the big gaps is taking care of our seniors.
It's a real issue because one, we have a growing
number of seniors. Right we have probably about ten or

(04:00):
eleven percent of our population today is above the age
of sixty five, and a growing number of older seniors,
so above seventy five, above eighty five, more one hundred
year olds than we've ever had. Secondly, there's a disproportionate
amount of spending that seniors account for in healthcare, and
most people know the statistics or roughly so, for example,

(04:23):
seventy five seventy five years in older account or about
about seven percent of the population, but they account for
roughly twenty to twenty five percent of healthcare spend, and
most of that is curative. So we don't do a
great job in this country of preventative medicine or wellness

(04:43):
and so home care. I was passionate about that because
I felt like that is an opportunity to fill a
significant gap in our healthcare system. And also to provide
support for seniors as they age and help them age. Well, all.

Speaker 1 (05:02):
Right, it's absolutely essential. I think that your point that
a lot of it's curative, you know, as opposed to preventative.
I think in some cases, well like people think the
preventative doesn't make enough money, but in fact it saves
a lot of money and it saves a lot emotionally
for people who want to do that.

Speaker 3 (05:22):
So let's dive right into just.

Speaker 1 (05:24):
Some some specifics about homecare, because again I don't think
people again really when they as you know, often what
happens is they don't think about home care until they're
in the middle of like, it's here, I need to
think about it, even for oneself.

Speaker 3 (05:42):
So let's talk about the different kinds.

Speaker 1 (05:43):
Of home care that that people can get, and you know,
some of the different kinds of care they need in
terms of custodial care, healthcare, AIDS versus you know, c
stodial you know, and the sorts of things that they
need and don't think about figuring that out.

Speaker 2 (06:00):
Out, sure, sure, So home care usually becomes part of
the conversation around eighty to eighty five years of old
of age. Now it differs, right everybody's different. Some people
may have a disease that impacts them or an injury
that impacts them earlier, and some people will not need
assistance till slightly later. But on average, in that time

(06:20):
range eighty five, most people encounter home care after a
hospital visit because their loved one goes into the hospital
and they're about to come home, and the discharge nurse says, well,
you know, you're going to need some additional support before
you go home. So either they go to a rehab
center and then go home, or they go home from

(06:43):
the hospital but with some care in place, and that
first level of care is usually skilled nursing, and that
is the Medicare covered portion of home care. So Medicare
will pay for up to one hundred days of skilled
nursing care post acute. So typically that's a nurse, ot PT,

(07:06):
or any combination of the above that comes into the
home for potentially a day a week, two days a week,
three days a week, and it's very episodic, so they're
coming in for half an hour forty five minutes. They're
doing something like a nurse might be changing a bandage
or doing some infusion at home or administering medication. An

(07:27):
OT or PT would be helping the elder, the senior person,
you know, gets strength, regain some strength, and learn how
to function in the home again. But again that's limited
and Medicare will pay for up to one hundred but
most commonly it's about a month episodic visits. So that's
the first encounter with home care that most people have.

(07:49):
Now the second encounter, or the subsequent encounter is the
question that is raised when you know, family gets together
and says, well, mom and dad need more care. You know,
this sort of short period of post acute care that
they got is not enough. They need day to day

(08:09):
non clinical support and that is, in the truest sense,
long term home care, and that's what we do at
right at Home. We have a skilled license, so we
can send nurses into the home, but today we're only
focusing on the non custodial care. So that is the
non skilled custodial care that you would get in the

(08:32):
home for anywhere from let's say five or six hours
a day to twenty four to seven, and that covers
things like getting up in the morning, getting dressed, brushing
your teeth, toileting, bathing, you know, assistance with meals. It
can be companionship, spending time with your loved one, It

(08:56):
can be taking them to the doctor's office, taking them
for walks, and so most families don't plan for this
because the hope is that the loved one will be
able to function in the home as long as they
as long as they possibly get independently. And often the

(09:18):
decision is made in the hospital or right after they
are out of the hospital, when they start to learn
about the skilled nursing care that Medicare covers, and then
the sort of traditional home care that is not covered
by Medicare. So, yeah, it is. It's unfortunately not something
that we talk a lot about in our society. There

(09:41):
are very few guide books on it. You know, you
can read up on it, you can go to the
internet and find out a lot of information, but people
don't really get that information until they need it, and
so it often creates a moment of panic. So we
get a lot of calls like that, like okay, mom, dad,
you know, coming out of the hospital. Dad's coming out

(10:01):
of the hospital. I don't know what to do. Is
this covered by medicare? How much does it cost? What
type of care? Do you provide versus what the nurses
provide and so on and so forth. So is a
conversation that we have almost every day with our clients.

Speaker 1 (10:16):
Yeah, and usually it's sort of like, well, it's a
conversation you have had before you came to us, in
terms of looking at what you need. And I think
that the part of it, as you well know, is
the way our society is set up and the expectations.
And often the expectation is, well, my daughter will take
care of us, she'll come in and help, you know,

(10:36):
and or my son or my you know, my spouse
will take care of the other spouse. And I think
many cases start that way until they realize this is
not going to work, it's not enough. Well, you know,
there are too many demands or are there are things
that I'm not really equipped to do. So I think
that's part of the issue, is that people feel guilt

(10:58):
that they can't handle it themselves. Number One, I don't
think it's always it's sometimes it's the cost, but I
think it's from the family's perspective, the expectation of the
adult children. And also I think that there's sometimes they're
concerned over privacy around like I don't want someone coming
into my house. You know, that's my house. Who is

(11:21):
this person?

Speaker 2 (11:21):
You know?

Speaker 1 (11:21):
And there are isolated cases of abuse that we're aware of,
But that's where your training comes in and you're vetting
of your care. So what questions do you want the
family and the care recipient to ask you?

Speaker 2 (11:38):
Yes, So there's a really good points you made. Wrong?
Is that? Let me just start with sort of segueing
from what you just said. I think it's critical what
you just said that it is really important to understand
that while you may be able to provide some support
as a family member, the stress that builds both on

(12:00):
the individual as well as the family unit is tremendous
over time. Now, you know, as I said earlier, if
they're relatively young in their seventies and they just need
to be driven around somewhere once in a while or
taken out on the weekends, that's not what I'm talking about.
But when the care needs get more extensive, either your
loved one is bed bound or they can't walk anymore,

(12:21):
or they can't use the toilet, it starts to become
an enormous strain. And yes, it is expensive to hire someone,
but what we always talk about is the opportunity costs.
So individual who's taking care of their loved one often
has to leave their job. Sometimes it's in the middle
of the afternoon to attend to an emergency. Sometimes it's

(12:43):
causing strain on their career. And so what we find
that it's not really the cost, because families will figure
out sometimes they pull their money together and it becomes affordable.
It's really what you said, Ron, it's the burden on
the individual family members, and particularly if it's one of
the spouses. If a spouse, an eighty year old spouse

(13:07):
is taking care of an eighty three year old spouse,
you know, partner or spouse, that strain becomes tremendous and
it often leads to the healthy spouse becoming sick faster.
So yeah, so very good points, Ron. So to get
to your last question, there so a few things that

(13:27):
we look at and we talked to families about. One
is you always want to ask, are is the agency
license bonded and ensured? Again, very few incidents out there,
but you know, even aside from any sort of criminal incidence,
someone can get hurt, right, someone can slip and fall.

(13:50):
The aide could get hurt or your or your loved
one could get hurt, and so those are critical questions
to find out from the beginning. Licensure in New York
is very strict. It's very difficult for an agency to
get licensed. It takes years, very rigorous examination of your operations.
The State Department of Health comes in in audits as

(14:12):
on a regular basis, so the licensed agencies are really
measured at a different level. The second question I would
really ask is how do you recruit, screen, and train
your caregivers. It's really important because caregivers, like in any profession,

(14:32):
can be good, they can be averaged, they can be excellent,
they can be you know, or not right, so any
of the above. So I think you really need to
understand what that agency's policies are, what their procedures are.
Are they vetting the aids in the beginning, are they
providing the continuing education? Are they supervising them that they

(14:53):
have a director of nursing who's overseeing them. Are they
making regular spot visits without without calls, you know, like
calling in advance. All of these things help. In addition
to feedback from the family, the agency, you know, ensure
that they have a high quality of service. I would

(15:14):
also ask about the agency's availability and emergency procedures. So
a lot of times things can happen, especially if you're
getting care in the middle of the night, something can
happen in the middle of the night. Does the agency
have an on call representative who can pick up the
phone and address the issue right away. Does the agency

(15:35):
have a nurse that can come out if there's an emergency.
Does the agency have every point of contact with the
family so that if one family member is not available,
they can contact another one. Do they have connections with
urgent care that can come to the home. So these
are really important things for seniors to know. And then finally,

(15:56):
how do you how does the agency handle a change
in condition? So one of the most you know, so
most frequent things to happen with our clients is that
they come in with one condition and over time you
see signs of deterioration. It could be something very simple

(16:17):
like they no longer remember where the front door is.
Our aids are the front line and so they see
that oftentimes even more than the family, especially if the
family members don't live with their loved ones, so the
aids can spot that they can identify those issues. It

(16:37):
could be again, it could be a cognitive issue, it
could be a physical issue. They can no longer bend over,
they can no longer open the open a closed door.
So what's going on there?

Speaker 3 (16:48):
Is it?

Speaker 2 (16:49):
Is it some acute medical condition like potentially a stroke
or or something that just happened, or is it sort
of a slow deterioration of a physical or cognitive function
over time. So those are some of the things you
want to that in the beginning.

Speaker 1 (17:05):
Yeah, just switching over a little bit to the family
itself in terms of what you need to know from
them and what they need to prepare for, because I
think sometimes they're not prepared and I think that certainly,
you know, you need to know as you mentioned before,
some of the needs are our physical needs. I guess
they're called activities of daily living ADLs, you know, So

(17:26):
it's you know, the toileting, the mobility issues, getting dressed, eating,
and so forth. So what do you need to know
from the family, What do they need to think about
before they even come to you and say, well and
figure out what do they need? You know, in terms
of the level of care, and as you said that
they often don't think about the progression that they may

(17:47):
need more.

Speaker 3 (17:49):
And let's start with that.

Speaker 1 (17:51):
And then I also want to talk about the relationship
of the family caregiving to the you know, the direct
caregiver professional, because sometimes I think families have difficulty you know,
letting go and you know, understanding that the boundaries of
what they're supposed to do and not do. So talk about,
you know, is what do you need from in terms
of feedback from the family when they've come to hire you.

Speaker 2 (18:14):
Sure, So the first thing is we want to make
sure that the family has spoken to the client, the
end user, their loved one. It is critical because you
have to realize that that individual has lived eighty or
eighty five years and they have opinions, very strong ones,
often hard to change opinions. Many are resistant at the outset.

(18:38):
Many are very independent or have been very independent their
whole lives and are reluctant to accept help. And so
that conversation needs to start early. You know, plan on
having that conversation maybe a year or if you can,
if you can, you know, or at least six months
in advance of trying to hire someone, because then it'll

(19:00):
are to percolate in in that individual's mind like, Okay,
maybe I do need a little bit of help, and
they're very proud, right, so they might say, well, I
can get dressed, or I can take a shower on
my own, But you, as the child, know that yeah,
probably can. But you can also slip and fall in
the shower, hit your head and all sorts of things

(19:23):
can happen. So that's when the worries start creeping in.
So have that conversation really prepare get the house ready.
Some very simple things that you can do as as
your loved one is aging, removing sort of carpets and
mats that slide of course, you know, lowering lips so

(19:43):
that if there is a step up into a tub
maybe or a shower flatten that you know, making sure
there are rails in the bathroom for both the shower
as well as toilet lighting in the house and so
on and so for there are companies that actually specialize
in this, but getting the house ready is critical and

(20:07):
then talking to us as far as understanding what it
is that you want for your loved one. So you
gave some good examples, Ron, and it's a nice segue
to the next question that you had, just is how
does the family caregiving interact with the agency caregiving? So
think about that. So let's say you have two or
three family members, siblings who come over once in a while.

(20:30):
They might come over at night during dinner time, or
they may come over on the weekend. So how do
you build the caregiving around that, because you still want
to maintain some role and so you might say, yeah,
I will come over at night, make sure mom is fed,
and then make sure that she gets to bed. Okay,
But then I want the aid in the morning hours

(20:51):
or the afternoon hours to do some activities or go
out to doctor's office visits, or go to the park
or whatever. So I think it's having that conversation with
the family members and then letting us know because at
the end of the day, we create customized care plans.
As you said, you know, this is really about the

(21:13):
activities of daily living. It's not about clinical care. This
is about staying healthy and well in the home as
well as enjoying each day as much as their physical
and cognitive abilities allow them to. So that care plan
that we develop will include okay, medication reminders, you know, toileting, bathing,

(21:36):
and all of those things. But then what is it
that you think your mom would love to do on Monday,
on Tuesday and Wednesday with the aid, And let's design
a plan around that, because this is what long term
home care is. And so I think as long as
we have those conversations in advance, we're setting ourselves up

(21:58):
for successful experience together.

Speaker 3 (22:03):
So I'm just gonna so to review.

Speaker 1 (22:05):
So first, have a conversation with your level and make
sure that they're aware of what you're trying to do
and you know, get out the emotions of the opinions
about and the anxieties about it that this is going
to happen. Second, preparing the house, that's a great point.
And then third, you know, having the conversation with the

(22:25):
agency about what is the plan of care you know,
and what's and you know it. So there are family
dynamics to begin with, and then there are the interdynamics
between the professional care and the family care. And that's
so they're juggling a lot of things and mixing a
lot of things, and I think and families, you know,

(22:48):
Then there's the what I call and I have a
caregiving navigator guide that I know you're aware of, where
I try to map out some of these checklists.

Speaker 3 (22:57):
But then there's the what I call the.

Speaker 1 (22:59):
Siblings syndrome where you have you know, several family caregivers
involve us here started negotiating with them and making sure
that now does Usually you usually say like listen, okay,
there are several of you.

Speaker 3 (23:13):
Who's the spokesperson for your bob or.

Speaker 1 (23:16):
And and also making sure that that person again recognizing
the client still is your ear loved one, it's not you.
And I think this is another thing that you know,
family caregivers, you know, sometimes you know, try to take
charge and you know, like I know better now I'm
the parent, and it's just like, yeah, but this is

(23:36):
an adult, it's not a child. So you know, maintaining
that dignity for the care one is something I think
that you probably come in contact with, you know, implicitly,
But how do you work with your your caregivers to
basically be aware of these dynamics and navigate them.

Speaker 2 (23:56):
It's it's sometimes tricky and sometimes the family has figured
it out in the so as far as understanding who's
playing one role, we leave that to the family and
often they'll tell us, they'll say, Okay, you know, Joe
is going to handle the finances for dad, so you
send the bills to Joe, and Susan is going to
do the healthcare, manage the healthcare issues and the home

(24:19):
care issues, so you can talk to her about schedules
and doctor's appointments and so forth. So we definitely rely
heavily on the family. We work very very closely, and
sometimes they all want to be in the loops, so
we'll send emails to everybody, We'll send the care plan
to everybody. But often, yes, we do want one point

(24:40):
of contact for emergencies, for understanding, you know, the shifts,
and making sure the schedule is what they want it
to be. But I think again that dignity point can't
be underestimated because oftentimes what we do as children is
that we will dictate to our parents. When they reach

(25:03):
a certain age, almost the role reversal right as they
were dictating to us. We start to say, no, mom,
you have to eat this, No Mom, you have to
go here, you have to do that. And you know,
most seniors will comply, and that's just the circle of life.
But it's important to step back once in a while
and say, I know that I am now the parent

(25:25):
of my parent. In some ways. However, they are still
very proud of who they are. They're still they still
want dignity, they still want agency. So the it's sort
of a balance and being able to say, Okay, Mom,
what would you like this care plan to look like?

(25:47):
And to the extent she has the ability, you know, obviously,
if she has dementia and can't really formulate those thoughts,
that's okay. But to the extent she has the ability,
let her play. And I think the more that that
that that that the children of their of the clients
do that the smoother it is long term.

Speaker 3 (26:12):
Yeah, I agree.

Speaker 1 (26:13):
I think that that providing that sense of dignity and
a sense of agency whenever possible, I think is you know,
involving them the decision making about what they want to
do and how to go forward, I think is critical.
Now one of the issues is that it's continued social
engagement when they're home. So that's one thing that I

(26:34):
don't think people think about too. So is that something
that you talk to the families about. I mean, see,
and I think certainly the the the direct caregiver, the
aide can provide some of that social engagement. And I
think that especially under long term circumstances. I think that
the family, I think they appreciate it, but don't realize

(26:55):
you know that the caregiver, the professional caregiver and the
care recipient often have very strong relationships in addition to
the family, and so they really they really care about them.

Speaker 3 (27:06):
You know. And so do they get involved in social activities?

Speaker 1 (27:12):
Is where that the discussion of the family that decide,
like they look, I want you to come with us
on this, you know activity, How does that work out
with the agency in terms of what they're allowed to do.

Speaker 2 (27:21):
So we're we're very flexible when it comes to what
the caregiver is involved in. Naturally, if the caregivers asked
to go to a family function, we'd want to know
in advance where is the function, what time and and
most times, for instance, if it's a wedding and they
want the caregiver to go to the wedding to assist

(27:42):
with mom and dad, that's that's completely you know, within
the bounds of what we do. If they want to
travel overseas or out of state, of course that requires
special approval. We want to make sure that our insurance
covers it and so forth. But on the day to
day you know, so you've got day centers. There are

(28:03):
a lot of senior day centers where seniors can go
and do activities for several hours, have some food, come
back home. You have specialty centers like Alzheimer's and dementia
care centers, which are wonderful for those with the disease
because they have specific activities that engage the senior. Those

(28:24):
are highly encouraged. In fact, we work very closely with
the family to help identify those activities or those centers.
Another one you know y mcas of course, and then
there's a Jewish Community Center, and there's several in our
area in the New York City metro area. So a
lot of our clients will go to those centers and

(28:46):
we encourage them to because again it's about there's the mental,
the sort of cognitive mental side, and then there's the
physical side. And to the extent as I said earlier,
that you're a to do certain things. So if the
seniors able to ride a stationary bike or potentially you know,

(29:06):
swim or do those things, great, If they can't, maybe
they sit and watch certain activities, maybe they're focusing on
their cognitive abilities. So it is very important both in
terms of maintaining function as well as, as you pointed out, Ron,
you know, the social aspect of it, because that is

(29:26):
something that keeps us alive right at the end of
the day. Having community, having socialization, having people that love
us and people that we can love, is a big
part of who we are and that doesn't stop at
any age, quite frankly. So again, it's customized. Some people
want some people are introverts and they want quiet time.

(29:48):
They'd rather spend maybe you know, a few hours socializing,
but they most of the time they want to be quiet.
So again it's it's definitely customized, and we work with
the families to identify those opportunities. Very very important.

Speaker 3 (30:03):
I wanted to shift a little bit too.

Speaker 1 (30:07):
The agency side, you know, the so interestingly, you know,
there's been a lot of talk and I've noticed in
my field of priding information about caregiving to caring for
the caregiver. Most of the time we talked about the
family caregiver and the concern over taking care of yourself.
As you pointed out, I think there, you know, there's

(30:28):
a lot of stress and the emotional strain and the
family member and the caregiver, they often have health issues themselves.
So there's a lot of focus on the carrier for
the caregiver in that sense. But what I found interesting
about your work is as you look at that part
of it, but also caring for the professional caregiver and
how you support them. Because one of the things that

(30:49):
has come up is, you know, I've done in a
lot of work for ARP in New York State and
you know, there's a lot of there is a lot
of uh, but it's to shift care to home care,
provide more funding for home care on a statewide basis.
But there's not really one of the issues as well,

(31:11):
the shortage of professional care career is like, well, because
the pay is low. You know, there's a lot of stress.
It's not a high level job. But you've done quite
a bit to really address these issues. So talk about that.

Speaker 2 (31:27):
Sure, sure, So I mean at a higher level, you're
absolutely right. It's not a glamorous job, right, It's it's
a hard job. You're taking care of someone at the
end stage. You're doing the things that are difficult, you know,
helping them toilet and bathe, and and it's stressful. You

(31:47):
watch many of your clients pass away. So this can
this can eat at people, and so I find that
the people who come to our profession and stay in
the profession are those who are most passionate about it.
They almost see it as a calling. In fact, many
aids have said to me, I don't do this for

(32:07):
the money. It's a calling, and so I really that's
a big part of why I do what I do
and why I love it so much. So one of
the things that I did when I bought the agency
is about six months after I acquired the agency is
I set up a support structure for them called the

(32:28):
Caregivers Advancement Fund. So it's a nonprofit fund that has
two components. One is it has an allocation for educational
advancement and the other is an allocation for emergencies. So
we provide grants, small grants somewhere typically between five hundred

(32:50):
to one thousand dollars in both categories. And so for education,
we've done things like helped caregivers get certificates h Home
Health Aid certificates or Personal care Aid certificates. We've helped
them take additional college courses. I had an aide who
wanted to become a teacher, so we funded part of

(33:12):
her semester to do that, and so we don't discriminate
on the topic or the specific curriculum. The focus is
really how can we help you advance your career, whether
that's in caregiving or outside of caregiving. And on the
emergency side, it's things that for us might be relatively

(33:34):
easy to manage, but for a caregiver, a five hundred
dollars car bill or a flood in the basement that
cost them one thousand dollars to repair might set them
back for weeks or months and often impacts their career.
So they may have, you know, a husband and wife working,
maybe they have a father mother in the home, and

(33:55):
they have kids, and all of a sudden, this one
small emergency is causing them to really spiral backwards. And
so the idea is that and where I got the
idea is that in a lot of the hospitals and
large companies that I worked for, there were these types
of benefits or funds for the larger population, and large

(34:20):
companies are able to do that. Small companies, small businesses,
it's very difficult, you know, because you have to set
up a five oh one C three. And so what
I did was I created I work with a community
foundation that is a five oh one C three and
I'm able to park under their five oh one C
three designation, and so all the administration aspects of it

(34:41):
are a lot easier. The irs rules around what you
can distribute are a lot easier when you're a sub fund,
and so on and so forth. But the true inspiration
for this is kind of a is my own story.
So I am a first generation immigrant, and my parents
came here in the early seventies and they worked multiple jobs.

(35:02):
My father was a medical technician, worked in a hospital,
often working two or three jobs, night shifts, day shifts.
My mom was an unskilled labor She worked as a seamstress.
At times she worked in retail. And you know, for us,
you know, in the seventies and eighties, I saw the

(35:22):
struggle firsthand, myself and my two siblings. So when I
got to where I did, and I saw the pool
the workforce that I had, So I acquired this company
and today we have about one hundred and sixty one
hundred and seventy staff. And I looked at the workforce,
I saw my own parents in them, and they are

(35:47):
many of them our first generation or second generation immigrants.
And you know, I said, well, heck, I came full
circle after you know, fifty some years of life. And
so it was a real eye opener for me and
an opportunity for me to give back and say, Okay,
I know the pain, I know how hard it is

(36:07):
for these people, and their salaries are not great. The
good thing is that New York State has been regularly
increasing them and now there's a separate category for home
care workers. Their minimum wage is actually higher than the
state minimum. So right now it's nineteen dollars and ten
cents an hour and it continues to go up, whereas

(36:29):
I think the regular minimum wage is around sixteen dollars
or sixteen fifty And so they've created this two tier structure.
And what that's done, and it's happened over the last
few years. It's brought in more caregivers, higher qualified caregivers,
and I think we have to continuously look at that.
I am also, in my very many hats that I wear,

(36:52):
I'm also the co chair of the Home Care Association
of America's New York chapter, and that's one of the
issues that we continue to look at, is how do
we support the caregiving workforce because as you said, Ron,
what's really critical as we look at the next ten
twenty thirty years is we have this baby boomer population

(37:13):
that is now coming of age. So the first baby
Boomer turns seventy five a few years ago, and so,
as I mentioned at the outset, you have care needs
typically after eighty. So now we're entering that phase where
many of the baby boomers when they hit eighty or
eighty five are going to need a lot of care.

(37:35):
And this is the largest segment of our population in
the history of America. So there's going to be significant
strains on this industry over the next ten twenty thirty
years unless we do more to incentivize caregivers to come
to the profession and then we support them while they're

(37:56):
in the profession by giving them educational opportunities and you know,
emergency supports. So I'm doing my little part, but I
think the real thing is advocating for it and trying
to do it at a state level in Albany as
well as a federal level, because it's a bigger problem.

Speaker 1 (38:14):
Yeah, I think that certainly the demand is going to increase.
I'm in this baby boomer generation, so I see that
in the immediate cards, but I think that just to
increase that, you know, it's it's going to just get
larger and larger. So they're with gen xis in back
of us. And then you know, the millennials after that

(38:36):
are even larger population than baby boomers. So it's just
going to be inclementally growing because we're getting be getting
older and older. But then, as you point out, that
would increase longevity, there'll be more people in their nineties
and hundreds getting care while the others that the lesser olders,
you know, in their eighties are still going to be

(38:58):
coming up and eating care.

Speaker 3 (38:59):
So I think that demand is there.

Speaker 1 (39:02):
But I really love your commitment to this and vision
in terms of supporting the professional caregiver because I think
that most people say, well, just pay more, you know,
but it's not just that. And so what I liked
about what you said is that I think you've created
a culture that's different and I think probably people sense
that when they come into your company.

Speaker 3 (39:24):
Is that not so?

Speaker 2 (39:26):
Indeed, I hope they do. And I talk about culture
all the time with my staff. My office staff, we
have about eight nine people in the office and then
you know, the largest part of my staff is in
the field. Culture is the most critical thing to run
any successful organization. But I think in this space, having

(39:47):
a culture of caring for your workforce, caring for the clients,
being responsive is critical and you can't really run a
successful agency without it. We are consistently looking for ways
to motivate and scent and you know, train and expand

(40:10):
our workforce. And it is it is a three hundred
and sixty degree approach. It is are you happy you
know what works for you in terms of your schedule,
in terms of what you want to you know, accomplish.
How can we support you in that? As I said,
it's a it's a tough, tough job. You're going day in,

(40:33):
day out. So typical caregivers existences. Wake up, you know,
get ready for the day. If they have a morning shift,
they're going from their home to the client's home and
then they're going back and then the next day. You know,
it could be the same client or a different client,
but it's it's rinse and repeat and and there's no
there's no building, there's no hospital or clinic that you're

(40:57):
going to, so there's no rah rah, you know, there's
no lunch party or motivational events that are happening as
typically you would have in a building. So we try hard,
and these are employees of mind, they're not contractors because
in New York State license Agency has to employ their aids.

(41:18):
So we try hard as an employer to build that
culture in sort of a virtual, remote sort of way
through a lot of communication, a lot of recognition events.
Last year, so Right at Home has an annual award
for Caregiver of the Year, and we were fortunate last
year that one of our caregivers was the winner of

(41:40):
the Northeast region and that was a tremendous moment for
her and her family. We had them in for photographs
and dinner and recognition ceremony. We shared that with the
other caregivers. This year, we've nominated another fantastic caregiver and
we're keeping our fingers crossed that he that he wins

(42:00):
the award. But you know, though, we are consistently looking
for ways to do that because again, as you said,
ron culture is critical.

Speaker 1 (42:11):
Absolutely, So you know, last chapter of our conversation is it.
But I just want to talk about some of your
broader thoughts about how home care fits into our larger
ecosystem of care for our elderly and for you know,
special needs populations.

Speaker 3 (42:26):
I mean, I think that.

Speaker 1 (42:30):
I don't think we think about enough in terms of
how how much caregiving broadly is part of our society. Certainly,
you know, you sort of mentioned you know, you're growing up,
so you recognize your parents raised you. They were caregivers,
although we call them parents and that as he said,
you've come full circle. And I think that you've you know,

(42:52):
come full circle too, from from the grassroots to the
higher you know, perspective of the mountain and now you're
back to the grassroots. So how do you think we're
doing you know, overall, and and you've looked at them.
I know you've looked at some well, I think one
of your previous your Global Solutions unit, and a few

(43:13):
years ago you developed partnerships with the providers and mostly
in China and Southeast Asia, developing new models of care.
They are culturally sensitive. So to some of your final
thoughts on you know, what you wanted to going forward
and what do you think the needs are in terms
of the industry.

Speaker 2 (43:29):
Sure, so I think the we're doing okay, I'd say
as a nation, we're doing Okay, we're not doing nearly enough.
It's a global problem, universal problem. I wouldn't I wouldn't
pin any blame on the US in particular because in
my travels, whether it was in China or the Middle East,

(43:51):
or South Asia, or Europe or South America, I saw
common issues. One is rising by population of seniors across
the globe. Too, is we're living longer. As you said,
run right. So if you retire at sixty five and
you live in the old days, you live to seventy five, Okay,

(44:14):
you didn't have a whole lot to think about. But
now if you live to eighty eighty five, ninety ninety five,
now you've got a good you know, twenty five thirty years.
Maybe more so financially obviously that's a big issue. How
do you support yourself. But from a care perspective, it's
really important to age well. That's really what we all want.

(44:36):
And aging is hard. Aging is really really hard for
many people, and sometimes it is tied to socioeconomics, and
sometimes it isn't even wealthy people sometimes they're not aging well.
And so I think there is a lot that we
can do to focus on wellness, prevention, caring, for our

(44:58):
seniors in the home anticipating, you know, because think about
just some very basic things. You want to be able
to go to the grocery store, lift a grocery bag.
You want to be able to lift maybe your grandchildren,
your great grandchildren. You want to be able to walk
the neighborhood in the park, just some very basic things.

(45:19):
So how do we do that as we age? You know,
what muscles do we need to continue to grow and
keep strong? And how do we prevent to the extent
it's possible, cognitive issues? Right? I mean, certain cognitive issues
are unpreventable today because we just they're genetic and we
don't have cures. But to the extent we can keep
our brains sharp, how do we do that? So there's

(45:42):
a lot that we can do. We're not unique around
the world. I think the best systems are those that
have concern and knowledge of social determinants of health and
have funding for social care. So what I mean by
that is there's a whole science around social determinants of health,

(46:04):
Like what causes you to be healthy? You know, nurture nature,
So sometimes it's genetic and sometimes it's your environment. How
do we sort of analyze that and say, how do
we create environments for seniors that are healthy for them
walkable streets, you know, easily accessible public transportation, stores and

(46:27):
so forth. And I think creating models of aging in
place that are suitable for us as we expand it is.
These are big picture thoughts, and I know it's it's
a lot, but I do think that we need more
effort from a policy level as well as from a

(46:51):
business level in this area. And I am optimistic. I
do think that we have a lot of knowledge in
this kind entry. We always have. I think we've been
at the forefront of a lot of discovery and health
and medicine, and we will continue so long as we
can control the costs of it. And I think that's

(47:11):
really the biggest challenge, honestly, the rising costs.

Speaker 1 (47:17):
This last thought on Obviously, there's a lot to talk
these days about AI technology. Are there ways that we
can leverage technology to help us in home care? That
there are certain devices that are exploring in terms of
basically basically sort of a system technology as part of
the human component.

Speaker 2 (47:37):
Sure, I honestly believe there are. I don't think technology
will ever replace humans in this area. I think having
an aid a human being taking care of another human
being is a very unique thing. So that I'm not
I don't think is going to change rapidly and I'm

(47:57):
not concerned about it for my business. But there's a
lot of assistive technology. So there are you know, we've
always had fall detection devices. They're getting a lot better.
We now have very sophisticated lasers and cameras that can
detect falls. In addition to the wearables that do we have,
you know, clothes and bracelets and wear watches and things

(48:21):
devices like that that can measure blood pressure, heart rate,
that can predict a fall, or can predict or that
identify as a changing condition. There are robots in the
home now and some homes that can read the newspaper
to a senior, or can act as a medication reminder
or dispense medication. There's telehealth, of course, that's become huge

(48:44):
in the last you know, five ten years, particularly after COVID,
very very useful for seniors, particularly those who can't get
out of the house and they have some basic issues
that can be dealt with. There are now urging care
companies that come to the home and so instead of
you know, if you have heart palpitations or you have
something that is causing you pain. Instead of rushing to

(49:06):
the er or rushing meaning you go there and you
wait for five hours, you can actually have a doctor
come to the home within a couple of hours. Saves
a lot of money, and obviously if there's an emergency,
they will send you to the hospital. But those are
critical functions. And now some states in New York included,

(49:26):
have started to implement hospital at home programs, so even
for those that are very sick, they can replicate a
hospital environment in your home. So you know, putting the
monitors and the television cameras for the nurses to dial
in the hospital bed, the ivs and so forth. So
there's a lot of technology that's entered the home that
will facilitate home care and care of seniors in the home.

(49:52):
I think that's the frontier. I really think that. You know,
as I said at the outset, there's stages of aging.
You get from your seventies when you need a little
bit of support, to your late seventies or maybe your
early eighties when you need a little bit more, to
your late eighties and nineties when you need a lot
more and so depending on when you need it and

(50:14):
what you need, you can start with technology as a
as a greater proportion of your support in the beginning,
and then a human as a greater proportion of your
support down the road. So I think it's very I'm
very eager to see how this all plays out.

Speaker 3 (50:31):
Well.

Speaker 1 (50:32):
Thank you Zamin for a terrific conversation. I really appreciate
your time and your thoughts and your innovative approach. Now,
if people want to get in touch with you and
find out more about your work, especially they want to
know about this character's advancement fund, which I think is
really extraordinary. How did they get in touch you and
find out more about you and your company?

Speaker 2 (50:50):
Sure? So I can be reached by phone, email, or
you can just go to our website. Our phone is
five to one six five one three one zero seven zero.
Our website is our a H stands for right at
home our Ahlong Island dot com. And I'd love to
answer any questions that you have. And even if you're

(51:11):
not don't need care at this point, or just curious,
I love talking about the topic, So feel free to
reach out and thank you. Thank you Ron for your time.
I really appreciate it.

Speaker 3 (51:23):
It's been a pleasure.

Speaker 1 (51:24):
So again, folks, if you want to listen to Zoom
and you can hand you'll be able to find him
on my website forty five forward dot org and you
could go there and find out upcoming shows as well
as an archive of my previous shows. If you have
comments or questions, you can reach me at Ron at

(51:45):
forty five forward dot org and you can also sign
up for the podcast or for my newsletter by going
to forty five forward dot org. It comes out once
a month and I look forward to horn engagement with everyone.
So until the next episode, folks, keep moving forward forty

(52:06):
five Forward. Mm hmmmmm.