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Glen Roebuck – Providing High-Quality Health Care Services to Older Adults | Assisted Living for the Elderly

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Glen Roebuck
Glen Roebuck

Glen Roebuck has served as a leader in senior health care and post-acute care for over 32 years. His career has spanned a wide range of positions with growing responsibility. He holds an MBA and Certificate in Leadership from the University of Iowa, and undergraduate degree from The College of Wooster. Mr. Roebuck has been a licensed Nursing Home Administrator in three states, and served as a regional director of senior care operations in numerous states throughout the Midwest and Mountain West. He has also served in strategic leadership roles, including operational guidance, business development and consultation, in environments ranging from single ownership models to large, statewide and national health care systems.

In his current role, Mr. Roebuck serves as Executive Director Home, Outpatient and Senior Services for Genesis Health System, based in the Quad Cities region of Iowa and Illinois. He has operational responsibility for community and inpatient hospice services, a large home health care agency, palliative care services, 18 physical therapy clinics, specialty clinics, occupational health, home medical equipment and retail pharmacy. In addition, Mr. Roebuck has implemented an outreach program placing Genesis Nurse Practitioners within high volume post-acute care sites, dramatically affecting quality metrics and readmissions. He also maintains regular communication with senior health care facilities throughout the Genesis service area, addressing health system throughput, interoperability of EMR systems, and opportunities for improved collaboration to achieve Triple Aim performance within the community. In addition, he is actively engaged in the oversight and post-acute engagement of the Genesis ACO.

Through community partnerships and collaborations, Mr. Roebuck has developed the Genesis Senior Services partnership, a collaborative between Genesis and community service partners,  providing access to trusted, proven providers committed to excellence and a shared vision to serve the Quad Cities older adult community.

Mr. Roebuck has published numerous professional articles on topics such as the successful leadership of skilled centers during challenging economic conditions, as well as preparation for health care reform and participation in Accountable Care Organizations. Mr. Roebuck speaks locally and nationally on a variety of topics on post-acute care and health system integration. Glen resides in Davenport, IA with his wife Diane. They have two adult children.

Topics Discussed:

  • Can you provide us an update on the state of the virus in your area and its impact on the senior living industry over the past months?
  • What makes the current state of long-term care so tenuous?
  • What are some things owners and operators need to do to keep the lights on and survive in the future, in a post-COVID world?
  • What changes need to be made to make long-term care services viable in the future?
  • For older adults in general, how has the pandemic changed what they need and want out of the various care models?
  • Can you share about what this is and how it’s making an impact on our seniors?
  • What is the importance of strong leadership in the senior living industry?
  • Do you think there’s anything different about the importance of leadership in senior living vs. leadership in other sectors?

Hanh Brown: [00:00:00] Today’s guest has worked in the senior healthcare and post acute care for over 32 years from nursing home administration to strategic leadership roles. Glen Roebuck has a varied experience. So I’m really excited to dive into those experiences on today’s show. Glenn, thank you so much for being with me today and boomer living, and I’m eager to dive into some of the hot topics and senior living industry with you today.

Glen Roebuck: [00:01:38] It’s great to be here. Thank you.

Hanh Brown: [00:01:39] Yeah. So can we start to have you share with us a little bit about yourself, where you’re from your work experience, what have you been doing and how

Glen Roebuck: [00:01:48] you bet? So I have been working in healthcare ever since I got out of my undergrad and a long time ago in 1986, and originally did work in community mental health for about 18 months and was looking for a change from that environment.
[00:02:03] And opted into an opportunity at a skilled nursing facility in Boulder, Colorado little did I know that would turn into 32 years of working within that health care sector. Over that time I served as a consultant. Four 36 facilities in Colorado, Wyoming, and Nebraska early in my career. I then became a nursing home administrator and was licensed in Colorado and Arizona.

[00:02:25] And then in Iowa, I did a brief stint. If you will, as a divisional human resources director for a large organization and delved into the deep human resources issues within the long-term care settings, and then served as a regional director of operations for a large organization. From there. I went and worked with a organization that did management services for long-term care facilities, predominantly nonprofit.

[00:02:50] So I’ve had a unique opportunity to work with both the for-profit and the nonprofit sector, which is a little unique. Usually people land in one spot or the other, and about eight years ago, While serving in a consultative role with an organization I was with the opportunity, came to engage in a consultant relationship with, in my hometown of Davenport, Iowa, with Genesis health system.

[00:03:12] And interestingly enough, we were helping them craft a senior services strategy and to make a long story a little bit less long. At the end of the day, they made me, they gave me the opportunity to come on board with Genesis stopped traveling. I traveled for about 20 years of my career, come home and serve in my community.

[00:03:29] It’s been the best decision I ever made and it’s been wonderful. It’s also been a great chance to really help. In a smaller microcosm attempt to reshape how we provide not only healthcare, but services for older adults, our community, and congratulations on your journey.

Hanh Brown: [00:03:42] Why don’t we ground ourselves with a little update to get started?

[00:03:47] So we both live in the Midwest where there has been significant surge in the COVID-19 virus. Can you provide us an update on the state of the virus in your area and its impact on the senior living industry over the past month?

Glen Roebuck: [00:04:01] this began for us the second week of March. Obviously the surges in March, April and early may were our biggest surges we’d experienced at that time.

[00:04:09] What we’ve learned over time is those searches came back in earnest the end of October in ways we did not imagine. So in March and April. Our health system, which is composed of two major hospitals, as well as a critical access hospitals at any given time, we’re caring for 25 to 35. COVID positive patients, inpatient in the hospital back in March and April.

[00:04:31] That number surge to 130, just a few weeks ago. We are down to the mid eighties today. The senior living community has experienced the exact same level of search facilities in the spring. In general in our area had outbreaks of five, 10, 15 patients. Most of the outbreaks today are in the dozens. We are very pleased to see a downward trend that began about eight to 10 days ago.

[00:04:56] We however were also very concerned following the Thanksgiving holiday, when there was more travel Iowa uses, what’s called a test Iowa site. To provide testing in the community. I just exited an incident command call right before I jumped on this call, where we tested over 700 people. That just one of the test Iowa sites yesterday in Iowa, that does not count public testing that happened across the river in Illinois, in our Bi-State area.

[00:05:19] So. We remain very concerned. It has focused us to be creative in a variety of ways. Certainly while PPE was a challenge early on in this crisis, the biggest challenge we have now is that a human resources net of staff, it is very difficult to recruit for our longterm care senior healthcare partners in the community.

[00:05:37] In addition, they have staff that are out sick with COVID and that really is a profound impact on. Earn services for them, for our community.

Hanh Brown: [00:05:46] I love the article that you wrote, and that’s what got my attention to reach out to you. So you re you recently wrote an essay that’s published in the domain register that many nursing homes could face financial failure enclosure in the months to come.

[00:06:00] So what makes the current state of the long-term care? So tenuous, I think one

Glen Roebuck: [00:06:05] of the things to, to remember, and this really isn’t talked about outside of the long-term care world very frequently, is that for free standing. Skilled nursing facilities or nursing homes. That financial model is really based on an exceptionally thin margin.

[00:06:22] In fact, prior to COVID most facilities across the United States had a negative net income of about a half to 1% and they were cashflowing. Their operations now comes COVID. So in a long-term care facility, there’s a higher margin for patients that are short-term rehabilitation, patient patients, and most facilities lose money.

[00:06:43] Caring for Medicaid patients make up anywhere from 50 to 70% of the patients in a long-term care facility. So 50 to 70% of your population, you are losing money on. You have to make it up on that rehab patient volume that’s left. It’s an upside down reimbursement structure. That’s existed for years, and it really needs to change.

[00:07:03] However, what happens now is you have a tremendous increase in cost of care related to personal protective equipment testing, staff incentives to continue to work. Quite frankly. In addition, you have a decline of the rehabilitation patient, because there are not a lot. There is a decline in elective surgeries and electric procedures.

[00:07:24] And we also have customers who are avoiding, going to the nursing homes to avoid the isolation. And the terrible stories they hear, frankly, of what this virus does in the long-term care setting. And I need to make a point that what happens in the long-term care setting isn’t about the care provided in that setting.

[00:07:43] It’s about the fragility of those patients and that this virus targets. Patients in that scenario, I said early on that COVID-19 would walk into skilled nursing facilities on the feet of very caring, compassion, passionate, and on-time and asymptomatic staff members. And that’s precisely what happens and where we’re challenged as a society.

[00:08:02] As we seem to forget that I can feel fine and have no symptoms and carry this to someone and cause tremendous harm. So facilities are doing a lot of testing in this area. They’re required to test off staff and all patients twice a week. I just did a calculation for our 22 skilled nursing facilities in our immediate area that assuming they had 300 people between staff and patients to test to do that twice a week at a testing costs that comes with that they’re spending anywhere from 2.7 to $3.4 million just in our market in the month of November, just to test their staff.

[00:08:36] So it, it becomes a financial equation that three months, six months down the road, the cash reserves will run dry and it will become a problem for this or for this sector of healthcare. And while I propose change in the sector, we’re always going to need this level of care and we have to figure out how we’re going to be able to do that.

[00:08:56] In a cost-effective and efficient manner,

Hanh Brown: [00:08:58] everything that you outlined, all the moving components, they extra costs in the PPEs and the test equipment and the exorbitant prices that perhaps it’s marked up.

Glen Roebuck: [00:09:08] I haven’t really seen a lot of markup. And while the federal government’s testing and providing support for that testing.

[00:09:15] Did eventually arrive at four facilities. It did arrive late in the game. I think everybody would agree with that. And there is a cost with that. Even if the sum of the actual test is provided, you have the cost of labor to staff, the test, you have processing, you have laboratory costs. There are other pieces that go with that.

Hanh Brown: [00:09:33] Where is the turnover? So who is showing up for work? If they don’t feel confident, their safety they’re getting paid. $15, $12 an hour, that sets a longterm care, a workforce issue. So I think when you mentioned all of the moving components policy in social work type of issues need to change in order to handle the 10,000 folks turning 65 plus in several decades.

Glen Roebuck: [00:09:59] Yeah. I think one of the things to think about too is it’s we have this conversation about compensation for staff and, and how is the reimbursement directly follows? What. An organization can compensate their staff. Some States have passed through dollars that we’re giving you more money to take care of Medicaid patients, but every dime has to go to care for staff.

[00:10:17] So for example, the state of Minnesota, every staff member knows if the state doesn’t give you money, you’re not getting a raise that year. So it’s, it’s a challenging reimbursement and compensation system in which to survive. And I think the other piece to consider is our caregivers are growing older.

[00:10:33] There’s going to be more older adults and fewer people to care for them. And we have to create an environment where providing care for older adults in a variety of settings can be not only effective for the older adult, but rewarding for those, providing the care and rewarding to the point that you have financial security, you should not have to have a poverty level.

[00:10:55] Of compensation to work on the front lines of healthcare.

Hanh Brown: [00:11:00] Absolutely. So COVID has obviously had a major impact in the senior living industry. So I’m sure there’s a lot for us to learn moving forward. What are some of the things that owners and operators need to do to keep the lights on, to survive in the future in a post COVID?

Glen Roebuck: [00:11:14] It’s always difficult now because you’re caught a little flat-footed because of the COVID-19. So if you haven’t thought of some of these things ahead of the pandemic, it’s hard to. Pivot very quickly for, from a strategic business perspective. One of the pieces I always recommend is the biggest risk is that freestanding skilled nursing facility that only provides a nursing home level of the organization that has that.

[00:11:38] And assisted living and independent living and maybe home health care services that they can provide it in people’s homes builds a bench. If you will, of other revenue streams, that’s not solely reliance on the upside down reimbursement structure for a long-term care facility. So I think that diversification to serve older adults in a broader spectrum in multiple settings.

[00:12:00] Is one option. I think another very important piece and something that we’ve strived to do here within the quad cities is really reinforced the need for strong partnership. I think the days of someone being in a skilled nursing facility, and then somebody over here running assisted living, or even another nursing home and people not communicating and talking about one another and how they can support each other moving forward.

[00:12:25] It is problematic. I reminded of a story I had years ago in visiting a local nursing home. And I was asking about how they provided hospice services for their residents and family members when that opportunity arose. And they probably brought out a binder of all the brochures of all nine hospices in our market.

[00:12:42] And so we give this to the family and my comment to them was you’re not helping. You’re the healthcare expert. When people come to you. Who are the providers that do the best job in this health hospices scenario? And be able to tell people we work with these three hospices very consistently, and here’s why we work with them.

[00:13:02] We will work with whoever you choose, but here’s why we select these three. Your staff have partners that they can regularly work with that the customer, the patient and their family have a comfort level because most people haven’t picked their hospice before. So we don’t do a good job of partnership.

[00:13:19] We have established the quad city senior care coalition, which is a group of skilled nursing facilities in our market. It is disappointing to me that we still have some people who just choose not to take part in that. And they miss out on a great deal of collaboration and options.

Hanh Brown: [00:13:32] I agree with you, instead of giving them a list, you should already have established relationship with a few.
[00:13:38] And when. You’re referring. It comes with a reputation in the credibility that you’ve established with that group. And that speaks more than just providing the family members a list. And I think everybody wins that way, right? The family yourself and that particular business that you already established a relationship.

[00:13:59] And, and I think the common denominator is always the relationship and the heart to serve older adults and their family members. Okay. It comes into all encompassing.
[00:14:10] Glen Roebuck: [00:14:10] One of the things we’ve been successful over the years in stressing, and I come at this from a different perspective because I’m part of a not-for-profit community-based health system.

[00:14:19] That’s small for arc smaller than national scale, but large for our community. And our focus is caring for the community. So when I’m interacting with people in, in other healthcare silos, if you will, whether it’s assisted living or Cedar or nursing homes, I always try to focus on how are we serving our community.

[00:14:37] What decisions are we making that don’t just serve your census or don’t just serve your bottom line, but also serve the community because when we do that, everybody wins. But if we only worry about our little slice of the pie, at some point, we’ll just be left with an empty pie plate and everybody else is off the feast.

[00:14:55] And that poses a real challenge.

Hanh Brown: [00:14:57] So it takes a mindset, doesn’t it for people to execute and live that way. And not only to in business, it’s almost like ministry work, because if it doesn’t work for you within your scope, you should consider extending your scope and extending your help to ensure that the family member and the loved one, get the help that they need.

Glen Roebuck: [00:15:16] I think you raised a very good point and analogy to a ministry is a very good one. It’s really about serving your community. And I think how a lot of senior healthcare providers can survive in the future is to look at this from a broader perspective. If your relationship starts, when, when Glenn’s grandmother falls and breaks her hip, and then you get called to the bedside in the hospital because she needs rehab.

[00:15:37] You’re too late, but it’s opportunity for the relationship was 10, 20, 30 years ago, regardless of who was leading a facility at that time to embed themselves in the community. And you can do both, you can be part of a brand. You can be part of a national brand, but have a community connection. So that everyone knows I’m going there when I need help, because those people are part of our community.

Hanh Brown: [00:16:00] Absolutely. It will show once you communicate with the family members, we’re all in a caring business. I believe because I’ve gone through this years ago with my mom, the, the heart to serve the passion in stepping out of your scope. And extending yourself. I think relationship and a heart to serve is huge in this business.

Glen Roebuck: [00:16:21] I think it’s key too, is it’s important for businesses to look at how they need to change with what’s happening in their environment. We still work with some providers from time to time who are, are almost offended. If we refer to patients versus residents. When in fact the people that are coming to stay with them are incredibly sick.

[00:16:37] Now. When I started this 32 years ago, you were at home or in your, or you were at a skilled nursing facility or a nursing home today. There’s a huge continuum in between. And I think it’s important for operators to recognize that as they plan their strategy and their diversification.

Hanh Brown: [00:16:51] makes sense, diversify, independent assisted living, dementia care, skilled nursing.

[00:16:57] I think that breeds the continuum. For the older adults in general, how has the pandemic change you believe like what they need and want out of the various care models?

Glen Roebuck: [00:17:09] No, I think one of the pieces that I hear about is this fear of isolation and the ability to stay engaged and we’re human beings and we’re wired.

[00:17:20] For sleep and food and water and human contact. And when that’s restricted to just my caregivers, that becomes a real challenge. And when we started this journey in March, I don’t think any of us ever grieved on that, we would be doing this for Christmas and probably for Valentine’s day and St. Patrick’s day and Easter, or if we’re lucky or halfway over a little more than halfway over the home.

[00:17:45] At first, I think people just retreated. We’re holding back on where if they want it to go to a more supportive living environment. And I think what people are beginning to see now, is there some great value in being part of an independent living community that’s bigger than your home, particularly if you’re currently at a point in your life where you’re living by yourself, because that can be very isolating.

[00:18:04] I know there’s some people in our neighborhood that I keep an eye out on and a couple of them have said when they finish that new retirement community, I’m not doing this, but in my house by myself again. And I think it’s important to recognize that there is a significant need for that social interaction to not be isolated.

[00:18:20] And we have the opportunity to provide that in the seed world.

Hanh Brown: [00:18:23] Uh, folks who move into the independent living, they’re still very active, engaged, vibrant, and they’re seeking for that wellness. That’s typically provided by the activities coordinator. I think that’s wonderful, but in the midst of all this.

[00:18:40] That is at an, either at a very low level or non-existence because of the safety guidelines. Um, the socialization is so important before COVID and after COVID, and it’s so unfortunate that we are in this lockdown or easing back into socialization now, even up to next year. So in the midst of all this.

[00:19:03] It’s a fine balance to keep the residents safe and also engage. How do you think that can be done? What’s your thought on that?

Glen Roebuck: [00:19:13] We have our relationship with a group here in our community that is predominantly people over the age of 65, who are still actively independent living in the community. And for the past several years, I’ve hosted educational forums for them.

[00:19:24] And it’s been something that they have grown to enjoy. We start with 20 or 30 people, and now we see 200 people. Our recorder we’re run out of big rooms to post it’s a wonderful event. We have relationship because we have these half had these interactions. We can’t meet now. So we’ve gone to doing video.

[00:19:38] And one of the things that I spoke with them about just last week in a video is okay, Christmas is going to be different. Okay. This isn’t forever. Whatever your years of Christmases, this one’s going to be different. So. Here’s some things you can proactively do and not everybody’s proactive. Some people have to be pulled out of their shell a little bit, but some people just need those ideas.

[00:19:57] So, first of all, for those who have older adults in their lives, you need to be reaching out. You need to be calling. If you need to create those small pods of people that you can go and see folks and do it safely by all means help them do the things that can eliminate risk, do the shopping for them. And then when you bring the shopping back, then visit with them.

[00:20:16] That’s better than mom go to the grocery store right now. I’ve really encouraged people to embrace the technology that we’re used today. And what can you do on zoom? How can you show someone how to Skype or FaceTime? I think the, a lost art that I’ve recently discovered in the past years is the art and the impact of the handwritten note or the handwritten letter.

[00:20:35] So how can, if I can’t get out frequently, can I write three notes a day? Can I make two phone calls to friends at church every day being I’m at work today, I’m out and about. Uh, my wife is teaching her college classes from our living room. And she’s been out once in about 10 days. It’s, I’m the lucky one by far.

[00:20:53] So I get a little bit of picture of what that isolation starts to look like for folks and. It’s important that people look at those look at not only themselves, but the people around them and how they can keep people engaged. I think for older adults, they need us during this time. Even if they say, Oh, no, I’m fine.

[00:21:10] This is a time to be really be reaching out and helping people stay connected.

Hanh Brown: [00:21:14] They don’t want to be a burden. So they’ll say to their kids that I’m fine. I’m fine. But I would say, keep calling, keep safely visiting. I think that’s really important, especially during this time, if you can’t physically be there, there’s so many ways to engage through technology.

[00:21:30] And one of which, like what we’re doing right now, technology has been great. But depending on where your loved one is, let’s say middle later, stage of dementia, nothing will ever come near to be present with them. Because they may not speak as much, but it’s the presence. It’s a disposition is the walk.

[00:21:48] And it’s just watching them eat for instance, that there’s no technology can never replace it.

Glen Roebuck: [00:21:56] As caregivers and family members are working with people in the last stages of life or involved in advanced dementia. This is probably the most difficult to experience because while you’ve had this disconnection happened over time, You still have that opportunity to just sit and watch your favorite TV show and Saturday night together, or just sit or go for a walk and just be together.

[00:22:19] And that’s not there right now. And that takes its toll. That takes its toll.

Hanh Brown: [00:22:24] Yeah. So I know you’ve developed something called Genesis senior service partnership. Can you share about, I guess in depth, how it’s making an impact then on the seniors?

Glen Roebuck: [00:22:34] You bet. So what we wanted to do, and this goes back to our concept of partnership is we wanted to create an easy menu for people because oftentimes we found people having to engage in caregiving, not knowing where to start.

[00:22:47] So we created a menu, if you will. And it’s on our Genesis website@genesishealth.com backslash senior services, where you can go and see a variety of services that we have available for older adults in the community and the people who care for them. So it doesn’t start with a nursing home. It starts with a housekeeper.

[00:23:06] It starts with a service that can come to your home or that you can download an app to your phone and do us a safety check in mom and dad’s home. Mom and dad might want to stay in their home and not want to leave until an objective person comes over and says, it’s going to cost you $45,000 to safely stay here.

[00:23:24] And all of a sudden the condo starts to look pretty good. Our partner who’s done that has had some great successes that were family members may have. Craftsman too close to the scenario we work with non-medical home care providers. We also have our own Genesis home health, hospice, outpatient palliative care services.

[00:23:42] So we’ve really tried to put together a menu of opportunities for folks to see what can be available. Everyone’s vetted, everyone’s bonded, licensed insured. Meets directly with me and my staff to ensure that they can meet the needs. We live in a Bi-State area. So when we do things like setting up a home care options that are, uh, non-skilled home care options, but reimbursed by Medicaid, that’s not a service that we do within Genesis, but I have to have providers that can do that in two States.

[00:24:10] So we’ve tried to, again, whittle down the list for folks so that they still have choice. But make those selections easier and also help plant the seed that this could be something you might want to consider.

Hanh Brown: [00:24:23] So this allows them to live in their home as long as possible.

Glen Roebuck: [00:24:27] Okay. Our motto is we want people to live long and love life because one, without the other, isn’t going to work.

[00:24:32] I’ve been very blessed. My mom just passed away this past may at 98. She was pretty doggone healthy until her just her last couple of weeks. I am the unexpected bundle of joy. I’m by far the youngest, she never thought I, she would see me get out of high school, let alone hit my mid fifties. So I’ve been able to take what I’ve learned over the years and help her stay independent.

[00:24:53] And that has worked for us very well. And then it also meant leaving the house. At some point, I share these stories when I’m working with seniors in our community, because. Leaving your home. Doesn’t have to be the end of anything. It can be a new beginning and it can free you up from some of the things that are now the stressor, like a Lauder is the basement or kind of more the grass.

[00:25:13] I don’t want to another the grass. I certainly don’t want to shovel the snow. So what are some opportunities that we could present to help people be active, be independent, and frankly, avoid the need for more intrusive, more restrictive, more expensive levels of care.

Hanh Brown: [00:25:29] That’s so important because.

[00:25:31] Regardless of the acuity level of what age they’re in. People want options. They still want a sense of independence to make choices. And most importantly is that they want to continue to live, contribute and have a purpose. It. And I keep saying, when I use the word, they, I have to remind myself that’s you and I as well.

[00:25:50] Right. Okay. So it’s not just because they somehow there’s a, this misbelief that they’ve somewhat are less valuable because they’re contributing less the society very wrong. So I have to remind myself that. What the older adults want is the same thing that you and I want is a sense of contribution, purpose in continue to thrive and live vibrant.

Glen Roebuck: [00:26:14] Yeah, absolutely. We w everyone wants to continue to be engaged in life. And I think it’s our roles as leaders in Cedar healthcare. And. I don’t even like to receive her that much anymore, as much as it is older adults. And how do we help people across the continuum? I think one of the pieces that has to change moving forward is we have, from a policy perspective, we have to stop thinking about how do we save the nursing home, or how do we make this better and start thinking about what’s best for the older adult?

[00:26:40] How do we best serve an older adult and newsflash? It’s not starting when they’re an older adult, we have to help people live healthier early on. And make healthy choices. Not everybody does that. Case in point I’m fairly new to taking care of myself from a fitness perspective. It’s only been the last three or four years, but that makes a difference 20, 30, 40 years from now.

Hanh Brown: [00:27:04] But I still want to be active in here instead of encouraged them to live vibrantly in an independent housing at let’s say 85. We all to start the sooner, the better, and it’s never too late to start living in a brain healthy lifestyle.

Glen Roebuck: [00:27:16] I think you’re right. I think anything we can do to promote concepts like the blue zones is a huge opportunity for us.

[00:27:23] I think when we think about we’ve talked and it’s been a lot of coverage over how people don’t save financially for their retirement saving financially for retirement, although very healthy to do. It’s not something a lot of people have either done or felt that they could do. We also need to have those same conversations about how we address our health so that we can have a healthy lifestyle in the future.

[00:27:45] And that’s a piece we haven’t addressed as much people are, tend to be more athletic when they’re in high school and college. And I’ve met some of my friends from who were athletes in college, who perhaps don’t look so athletic today and maybe didn’t make that adjustment as well as they could. And I think there’s opportunities for us to help people.

[00:28:03] Live that lifestyle differently. Without that we don’t change the dynamic when it comes to caring for older adults. I really think from a policy perspective, we need to take a step back and not look at how we just. Sustained, uh, freestanding nursing homes. But how are we going to, we have to look at this in a much broader perspective, this to talking about reimbursement and regulatory reform, which are the two pieces that have come up for my 32 years in this is not going to get us there and waiting for CMS to impose an idea on us is not the way to go either.

[00:28:34] Uh, we’ve had some good pockets in the country. I think we’re off to a, uh, a small start of that here in the quad cities, where we bring people together to make healthier decisions and keep people healthy. You just need to push that farther up the age train. We need to be talking to people in their thirties and forties in their fifties and sixties.

Hanh Brown: [00:28:48] That’s exactly what I was thinking too. I think another component that we haven’t touched on, I want to add is the attitude towards aging, right? The age-ism and also looking at the older adults, less valuable because where did we’ve gone wrong in Alder? Countries, they value the older adults because of the wisdom and the.

[00:29:10] The stories and the experiences that they can pass on. But somewhere along the way, we’ve neglected them. We pushed them aside. So we have to change that paradigm shift. And I know people talk about it, but I wholeheartedly believe it starts with every individual. It starts with you. It starts with me and not just wait around for the policymakers to enforce that.

[00:29:33] I think it’s very important to be a part of that shift and not just talk about. We need a paradigm shift.

Glen Roebuck: [00:29:40] Yeah. Yeah. I think, I think you raise a good point when it comes to ages. It is alive and well, it’s unfortunate. We hear it. We’re so accustomed to it. I don’t even thought that we always hear it. And I will tell you that the response to the pandemic would be very different.

[00:29:57] If the target wasn’t frail elderly people. But it was children under the age of five, we would have a different response just would, and that’s unfortunate, but it doesn’t mean we can’t change that.

Hanh Brown: [00:30:09] I think you’re so right about that. It’s an unfortunate truth. And I believe that we all can be a part of this shift.

[00:30:15] And I keep emphasizing that because I think we often hear a lot of noise that people complain about it and regurgitating the problem and the complaint. We all know that. So I think by, I would say enough. I would just say, take ownership and be that shift. And I think it’s very unfortunate if the target demographic was the younger children, I think the response would be very different and that’s a sad.

Glen Roebuck: [00:30:41] it probably isn’t maybe we’ll get a couple of calls and comments that people don’t like that concept, but I think you only need to look when testing occurred and what support happened when from a policy perspective too.

[00:30:52] To play that out, but again, it doesn’t mean it can’t be changed. Sure. Sure.

Hanh Brown: [00:30:56] So now what is the importance of strong leadership in senior living industry? And do you think there’s anything different about the importance of leadership in senior living we’re versus leadership in other sector?

Glen Roebuck: [00:31:08] Well, that’s an interesting question.

[00:31:09] I am a strong proponent that the fish can rot from the head up, so to speak that leadership can make a world of difference. Early in my career, I saw some facilities and organizations just thrive. When the market wasn’t on their side, the physical plant wasn’t on their side, the community demographics and economics were on their side, but the buildings rocked it.

[00:31:32] They did great. The staff were engaged and it was all about leadership. It was all about leadership. So one of the challenges in senior living is ensuring that we have sustained leadership in places. And that’s not just at an administrative level, but at a clinical leadership perspective level as well.

[00:31:51] And too many times we see, uh, longevity being two or three years, not eight, 10, 12 years, 15 years on a campus. And I think we’ve got an opportunity there from a leadership perspective within senior living to make a more longer-term commitments. As well as have a longer vision, we need to think beyond the month and the quarter of the year, or where do we want to be in three years and five years from now.

[00:32:15] And because so much changes from a regulatory and reimbursement perspective in this sector, it makes it that much more challenging. And leaders to move in that direction. Well.

Hanh Brown: [00:32:26] there’s a lot of talk about occupancy and I get that. It’s very important, but I think there’s a bigger scope of so many moving components that you have to be very effective.

[00:32:35] One of which is leadership. The other one is team cultivation before you can get to your academic , but we knew here a lot more about occupancy and the issues with that. So I think a paradigm shift, I think it’s necessary to cultivate the staff culture and also provide some means of advancement for the caregivers when pay them better.

Glen Roebuck: [00:32:58] I don’t disagree. The challenge there is in an organization where you’re you already have a negative net income line and you’re cash flowing. You’ve got to be able to drive revenue, to pass it onto your staff. And if 70% of your patients are at a Medicaid level where you’re losing 40 to $50 or more a day based on Medicaid reimbursement, that becomes a challenge.

[00:33:18] One of the challenges in senior living is those consumers with resources have a lot more choices. Including before they ever have to get to a skilled nursing facility. So if in most States not all, but in most States assisted living isn’t even on the table for someone who’s, who doesn’t have the resources to pay for those level of services.

[00:33:40] So they automatically end up in a nursing home setting.

Hanh Brown: [00:33:43] Yeah, I on a personal level, what do you think is your biggest strength that enables you to have a unique, impactful effect on older adults? Maybe something that’s not well known about it

Glen Roebuck: [00:33:55] as I age you’re, as you grow older, your perspective on some of these things change.

[00:34:00] When I was six years old, mom dropped me off at the neighbors and she told me what to say. I ran up to the door and I said, hi, daddy had a heart attack. Can I stay here tonight? That was the beginning of my journey of being a caregiver in some capacity in my life. And whether it was me doing it, which I wasn’t as a young child, but watching my mom do it for 27 years and then doing that for her for the next 21 years, you become hardwired a bit to, this is the right thing to do.

[00:34:30] And over time to watch senior health care, continue to evolve. Candidly is very rewarding. I think the perspective that for whatever reason, like I can’t really explain that I see is that it’s bigger than one sector and it’s bigger than one building and one entity, if you will, but praying, but maybe it’s not national.

[00:34:54] Maybe it’s a community focus. Maybe it’s a small community of 20,000 people in South Dakota. Who says here’s our skilled facilities. Here’s some assisted living opportunities. Here’s our AR program from all inclusive care for the elderly that helps Medicaid. Patients stay independent and healthy in their homes that can make this work.

[00:35:13] And we’re going to fund this in our community. We’re going to figure out a way we’re gonna have to charge people for it. We’re going to have some level of government reimbursement or we’re going to have some level of foundation support or full philanthropic support. And we’re going to take care of our town.

[00:35:28] That’s I think we need to think more broadly in those terms. And I think when you get to rural communities, I often said this as I worked with rural communities, we have man, how come the care is just so fabulous when you go to rural, you just never have to worry about the care of a rural community. And the answer is simple.

[00:35:45] No one had to do the social intake form because everybody knew the person before they walked in the door and you’re not going to mess up taking care of your best friend’s grandmother. You’re just not so most rural facilities, it’s a different microcosm than say in a suburban or urban area. And how did, so how do we replicate that feel if you will, and create community we’re currently we may have fiefdoms or silence.

[00:36:08] I think that becomes the vision that we need to look at going forward.

Hanh Brown: [00:36:11] I agree wholeheartedly. So now another question on a personal level, what have you done to prepare yourself as you’re getting

Glen Roebuck: [00:36:18] older? Ah, great question. So one of the things that I did probably 20 years ago, and this was not hardwired in my family, it’s I got a personal primary care physician.

[00:36:30] I’ve had that same primary care physician for 20 years and I go see him religiously every year for physical. And all those things I’m supposed to do as a man who ages over time, they get done over the years. There’s been some tough conversations in there because I was heavier and I didn’t take care of myself as well.

[00:36:45] And when I was driving on the road, it was real easy as that passenger seat, as a buffet, to get me to the next 200 miles stop, about four years ago, I started to take better care of myself. I had some great advice from some colleagues. He said, why don’t you try this? And it worked for me. I have never been athletic, but a little bit of backsliding because of COVID.

[00:37:02] Cause I’m not going to a gym right now. But I’ve made an effort to try to take care of myself and be more physically active. And I monitor that on a regular basis. I eat differently than I used to. I don’t graze fast food more than maybe once a month. I don’t drink soda anymore. So I’ve tried to make some healthy living choices that hopefully will have some long-term benefit.

[00:37:22] I feel a lot better. I’ll tell, I’ll say that I don’t, I didn’t give up everything. I’m sure there’s people who will watch this and go, Hey, I know what you had for dinner last weekend, but I haven’t given up everything. I certainly haven’t given up living, but I’ve made a point of trying to be, to practice the preach, so to speak.

[00:37:39] Um, trying to live a more healthy lifestyle.

Hanh Brown: [00:37:41] Yeah. It’s so important. And I got to talk March, April and may. It was really hard to motivate myself to what I do. The activity level that I was accustomed to prior to March, because all the gyms were close and I had to learn to appreciate the walk around the neighborhood, around the park, the jogs and.

[00:38:02] Again, it’s a reset or reboot of your lifestyle, of what you accustomed to and now you make, do with what you have and still have a means to exercise. Not only physically, but mentally. And I get cranky around here too. And it shows that my kids would tell me, go work out, go do something. It’s all interrelated, which you’re saying.

[00:38:23] Your physical and your mental and your spiritual. It’s all one.

Glen Roebuck: [00:38:27] I will tell you that I that’s a very, I’m glad you put that up. My stress level goes down when I work out. So I can’t go to the gym right now. So I’m doing some different things at home and doing walks, but it’s real easy to sleep in and not get up at four 30 or five to do that.

[00:38:39] So it’s about setting the routine and setting the alarm and making sure you do it. And it has some reward for you at the end. It’s like the kid with the M and M or whatever works, but you made a comment there about the spiritual as well. And I think this is for anyone who has a spiritual connection with their life, making that connection now is harder.

[00:38:57] If your routine was Sunday morning, you’re going to worship with friends. And now that’s online. That’s very different and it doesn’t necessarily meet the need for everyone. And that’s another component that we’re experiencing this pandemic. And I think really impacts some of our older adults as well.

[00:39:13] When many of their friends were associated as part of their spiritual family.

Hanh Brown: [00:39:17] I, I agree with you. One of the things that I look forward to when my family come together because they’re college kids age and I have, I have a 2321 and an eight 18. But one thing that we do come together is getting ready to go to church sometime they come home for the weekend.

[00:39:34] Cause if not, we all divert in different directions as a family because we get busy, we have our own responsibilities, but I enjoy there’s one thing that we all come together as chaotic as it might be, but we’re still together. But now I feel like as a family, we’re pretty good the first month or two online, but it wasn’t the same.

[00:39:55] It’s w we need all that. One-on-one sitting next to someone and hearing the pastor, and it’s just not the same.

Glen Roebuck: [00:40:03] Yeah. You need that connection. Now, one of the things I’ve noticed as well as I have adult grown children, and one is very close and one lives in Washington, D C, which is a two day dry for us.

[00:40:12] And no one’s flying for it. We’re not flying right now for obvious reasons and staying in touch with them and monitoring how they’re doing through all. This makes a big difference as well. All of a sudden the weather’s turned, the pods have gotten smaller. There’s a spike in infection. So now we’re just staying in that house and we’re working all day and then we’re stayed in the house.

[00:40:31] The more we see ourselves doing more zoom and doing more things and trying to just keep people’s spirits up and. Yeah.

Hanh Brown: [00:40:39] I was worried about my mom who is in the latest stage of dementia, her mental health, and not able to see her kids and grandkids on a regular basis. And then as time progressed, I was now considerable, my kids’ mental health, the mental health and the wellbeing for all of us.

[00:40:56] It’s, it’s pretty shaky.

Glen Roebuck: [00:40:58] One of my roles at Genesis is working with our employee assistance program. And we anticipated a very big search in April and may, and it didn’t happen, but we’ve seen a little bit of a blip as recently, but not a huge one. And my worry is that people are so focused on the intensity of the moments right now, particularly healthcare workers that when all this is over, it’s going to be like a post-traumatic stress.

[00:41:26] Experienced folks. I’m very concerned about that. I’m very concerned about people waiting to reach out until they no longer want to work in healthcare anymore. And that’s not the solution for our communities. We’ve reached out on numerous occasions to encourage people. To, to reach out. So I’m hopeful that as the holidays proceed, we’ll continue to see some more people get engaged with

Hanh Brown: [00:41:49] me too.

[00:41:50] Is there anything else that you would like to add?

Glen Roebuck: [00:41:53] I would just say, I think, see, I’ve been in senior health care for 32 years, hon, and I’ve seen some great progression. I think we’ve reached a point. I think the pandemic kind of accelerates that point. Or we just need to, we just need to stop for a moment and not keep adding regulation and adding ideas to the existing pot, but we need to go buy a new pie.

[00:42:13] And my wife had just remodeled our kitchen a little bit ago and she went and bought new pots and pans. I’m like, well, why don’t you go out and buy new hotspots? We got a new kitchen, canis, pots, and pans. We need a new kitchen and we need the right tools to make that kitchen. Huh? And the same is true in senior living.

[00:42:27] We can no longer just be focused on, increase my reimbursement and give me regulatory relief and to think and make change. And we have different sectors and lobbying groups within assisted living nursing homes, home health hospice. We where’s the lobbying group for the older adult without RP would say they are it, but their scope is so broad.

[00:42:52] We need that health care older adult. Focus that can really look at how we move the needle forward and get some novelists of experts around the table, but some fresh eyes as well until we do that until we get serious about that and get that longterm vision laid out that can sustain any administration changes.

[00:43:11] We’re going to continue to struggle a bit.

Hanh Brown: [00:43:13] Yeah. Amen. You mentioned that there’s so many component that is not sexy to talk about. Let’s talk about that. No, let’s not only talk about that. Let’s come up with some actionable plans to provide solutions.

Glen Roebuck: [00:43:27] Absolutely. So one of the, one of my comments in my head as I was preparing for this today was are those with resources will always have more choices.

[00:43:34] However, because I have fewer resources should not relegate me to only bad.

Hanh Brown: [00:43:39] Exactly.

Glen Roebuck: [00:43:40] That’s what we want to do is give people an option that maybe it’s not glitzy. Maybe it’s not glamorous. Maybe it’s not fancy, but it meets your needs, keeps you safe and keeps you engaged in an active lifestyle. There’s nothing wrong with that.

Hanh Brown: [00:43:53] There’s nothing wrong with it. One more important thing is that keep you near your children and keep you where your children can continue to have that strong relationship with your loved one. Once you move into a community, the caregiver is the one it’s like an extended family. We also want to make sure that the, we provided an environment where the children and the grandchildren can continue to.

[00:44:15] Visit and thrive and engage. It concerns me that you mentioned that we’re going to be going into this until March and spring. You might be true.

Glen Roebuck: [00:44:25] Like one of my fallacies and my friends will be done with this by me. April’s boys April’s really stinks, but by will be by may. It’ll be getting better. That was seven months ago.

[00:44:34] As I jokingly told someone of our board members a couple months ago, I said for my next pandemic, I’ll be more prepared because we. This is all new to us. You can understand that we won’t have a vaccine for months, but what does that really mean? You can hear that what’s going to come back in the fall.

[00:44:48] What does that really feel like? What does it look like? So now we’re there

Hanh Brown: [00:44:51] and here’s the thing though. The vaccine is not necessarily a silver bullet solution either. It’s the execution of the vaccine. Who’s to get it. When do they get it? How do you roll this out? How much is it who’s paying for it?

Glen Roebuck: [00:45:05] So the CDC today is supposed to be laying out those guidelines.

[00:45:08] So any moment now, actually, so we’ll have to see how that works. The other thing we have to think about is do you do this again? Next fall? Is this a recur? Is this a vaccine we’re going to do every year? Is this the new flu? Is this the new measles, mumps and rubella that we have to create a treatment plan for as long-term.

Hanh Brown: [00:45:24] And are you going to be the first one to take it ?

Glen Roebuck: [00:45:26] Yeah, so I’ve given that a lot of thought and I’m fortunate to work with some great epidemiologists and some great physicians. And when my physician say I’m in, I’ll be the first one in line and early results are looking really good. So. I feel less uncomfortable about that than I did say maybe a couple months.

Hanh Brown: [00:45:47] good. Good. I thank you so much for this opportunity to talk to learn more about you and your work. And I just appreciate this opportunity to connect with you in social media.
[00:45:56] Glen Roebuck: [00:45:56] Dresses would wonderful. We’ll have a great holiday season.

Hanh Brown: [00:45:59] You too. Take care.

Glen’s Links:

LinkedIn: https://www.linkedin.com/in/glenroebuck/
Genesis Health System: https://www.genesishealth.com/
Twitter: https://twitter.com/GlenatHDG

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