In the first segment of the show Victor provides an update on the status of the NJ fiduciary rule for financial advisors.The rule is currently being discussed in informal conferences. In these conferences some financial advisors are claiming, should the rule be imposed, it will negatively influence how they are able to do their job, rather than looking at the rule as what is in the clients’ best interest.
In the second half of the show Victor is joined by Hilary Murray of Brandywine Pennington. In a continuation of the holiday season series, Hilary shares what makes assisted living and Brandywine unique. She shares her thoughts on when families should start considering assisted living for loved ones and some important signs to look for when visiting with older family members during the holidays.
If you would like more information on Brandywine you can visit their website www.brandycare.com/our-communities/pennington/ or call directly to schedule a tour!
Make It Last with Victor Medina is hosted by Victor J. Medina, an estate planning and Certified Elder Law Attorney (CELA®) and Certified Financial Planner™ professional (CFP). Through his law firm and independent registered investment advisory company, Victor provides 360º Wealth Protection Strategies for individuals in or nearing retirement.
Click below to read the full transcript…
Announcer: Welcome to “Make it Last,” helping you keep your legal ducks in a row and your nest egg secure with your host, Victor Medina, an estate planning and elder law attorney, and certified financial planner.
Victor J. Medina: Hey everybody, welcome back to Make it Last. I’m your host, Victor Medina. I’m glad that you can join us this Saturday morning, I am excited for today’s show.
We have another guest that we’re welcoming on who’s going to continue our series of what happens when you notice older adults around you needing a little bit of help. We finished with Thanksgiving a few weeks ago. That’s typically the time where we notice what’s going wrong with family members.
Where there might be mom, or dad, or grandma, or grandpa, that might need a little bit more help. How are we going to provide that for them? How are we going to keep them safe?
In week one, we discussed a little bit with a doctor who specializes in Alzheimer’s, talked to us about some clinical trials. I urge you to go back to that show if you’re interested in listening to that and you missed it.
Then last week, we talked with representatives from a home healthcare agency, who provide care, both skilled and unskilled care, inside of the home. We discussed that. If you missed that show, you should go back to that one.
This week, we’re going to be joined by Hillary Murray, who is from Brandywine, who is going to discuss with us a little bit more about assisted living. What that definition is, what it means, and when it’s proper to consider that. I’m excited for that interview, and excited to bring that to you.
We’ll be with that segment in a little while. Before we get to that, there were a couple of topics that I wanted to cover, some things in the news. A few shows ago, I let you know that New Jersey was considering imposing a fiduciary standard on all financial advisors.
They were going to do that more as an administrative thing. Through the Bureau of Securities, they were going to, basically, put in a new set of rules. It wasn’t a law that needed to be passed. It just had to be written as a set of rules. This gets into a whole administrative procedures act to discuss.
The point of it, they don’t need votes in the Chamber, or in the Congress, or the State Legislature, the Assembly. They don’t need any votes for this. They can just do it, from an administrative standpoint. They’re in the process of doing that.
One of the steps that they need to do in order to impose this rule is they need to hold open hearings, so that the people who are making the rules can consider what the impact to the public is.
The fight has begun on this matter. You know ‑‑ as a big listener of this show ‑‑ how important I think that people have a fiduciary standard advisor in their life. They have one when they hire a lawyer. They should absolutely have one when they have a financial advisor.
Too often people are working with somebody that doesn’t need to have their best interest in mind. Often doesn’t have their best interest in mind.
New Jersey’s trying to address some of that by imposing a fiduciary standard on all of the financial advisors. It has drawn out from the woodwork, a number of people that have started to talk about the doom and gloom of imposing this rule.
There was testimony by a gentleman named Dennis Cuccinelli who was an advisor. Basically, he was speaking on behalf of the New Jersey Chapter of the National Association of Insurance and Financial Advisors. By the way, in the title alone, you should be able to guess where they’re going to come out on this rule.
If they’re working on behalf of insurance‑only advisors, these people hate that rule. They have lived under the more generous rule of suitability that allowed them really never to be working for their clients’ best interest. Generally, insurance‑only advisors are not subject to fiduciary, and they hate the idea of a fiduciary standard.
His testimony was essentially this. By moving forward with regulations and I’m quoting, “The Bureau of Securities will be creating a crisis, a crisis.” They’re essentially saying that if you put this rule in, there’s going to be catastrophe and a perilous state of affairs.
His continued testimony said that a state fiduciary standard would put brokers in the difficult, if not impossible, position of deciding how to comply with differing state and federal rules.
Well, you know what, that’s bunk, right? Because if you voluntarily hold yourself to a higher standard, which is what New Jersey State standard would be, you don’t have to worry about the lower standard at the federal level. You will have met the lower standard by doing the higher standard. This is an exercise in logic that takes about 15 seconds to get done with it.
What I think bothers me is that they expect everyone to take these words at face value instead of seeing through them for the transparent lies that they really are. What drives me nuts, of course, is that no one is really looking at this as what’s going to be working in the client’s best interest. They’re looking at about what’s in their best interest.
The people who are in the world of fiduciary standard advisors love the fact that they can rake their clients over the coals by offering products and solutions that are not in their best interest, but pad their wallet. That’s essentially what this is. In any threat to that is a threat to their livelihood. They’re going to fight and combat this at every level as hard as they can.
What is going to be interesting to watch is what will be happening as a result of this because the SEC is actually proposing its own rule. There’s discussions about having a rule at the federal level. We don’t know where this is all going to shake out. The comment period on the pre‑proposal for New Jersey is, essentially, December 14th, about a week from now, next Friday.
If you’re listening to this live or within the week after it’s being published, that’s basically all of the pre‑proposal public commentary. Then after that, they have the opportunity to formulate a rule. Then there’ll be public comments on the actual rule, on the proposal. Then they can adopt it.
These were informal conferences. Then they will get to the more formal public hearings on it and then they can impose the rule. What I found interesting, by the way, is a second comment that was in here and back to Mr. Cuccinelli’s statement.
He said, “The New Jersey Bureau of Securities would be unwise to do anything ahead of the SEC, since state rules are almost certain to clash with the SEC’s rules.”
Somebody else was arguing against that and said, “Now look, that’s misplaced, that argument because lawyers have lived with state regulations for decades and have been able to survive.” Hello, welcome to my world. I’m licensed in three different jurisdictions. I have to adhere to the rules of three different jurisdictions.
Let me tell you, it’s pretty easy to do, as long as I keep my client’s best interest ahead of my own and I do things for their benefit. I never put them in jeopardy, and I do all of the work that’s necessary to advance their causes over my own. I never have to worry about what those rules are, because I know that I stay on the right side of them.
It’s exactly the same in the financial world because I voluntarily live in the world where I’m judged by a fiduciary standard because I’ve created an organization that’s done that. RIA is Registered Investment Advisors, have been under that rule, under state regulations, under a fiduciary standard forever and ever.
It’s the bulk of everyone else who is in the financial advisement world that has lived under this lesser role and been able to prosper at their client’s expense. It’s going to be interesting to see where this goes. We’re going to keep you up‑to‑date in future shows. I hope you don’t mind me a little ranting and raving on this because you know it’s a big thing for me.
Victor: Everybody should be working with a fiduciary advisor. Not enough people are given the opportunity to do that or know about it so I’m sharing that information with you here. When we come back, we’re going to be joined by Hillary Murray from Brandywine, who’s going to talk to us about assisted living, so don’t miss that segment. We’ll be right back after this quick word.
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Victor: Welcome back to Make It Last. My guest today is Hillary Murray. Hillary works for Brandywine in Pennington. Hillary has been a good friend of mine in the elder law community for a number of years. Thank you so much for joining us today.
Hillary Murray: Thank you, Victor.
Victor: Give us a little bit of background. I know a little bit about how you showed up to where you are, but just give us the briefest outline about who you are and how you got into working for Brandywine.
Hillary: I have been in this field, as you mentioned, for about 20 years or plus. I’ve always been interested in elder care. I remember when I was in commercial real estate way, way back, I was asked by a real estate company. They were doing some speculation on building a Hyatt, a Classic Residence by Hyatt in Teaneck. I said, “What is that? What is a Classic Residence by Hyatt?”
He explained that it was a senior living community in Teaneck, New Jersey.
Victor: I’ve never heard of that.
Hillary: I said, “I’m interested to learn more.” One thing led to another. They built it and they asked me if I would interview some of the residents, just as a volunteer. I actually asked them. I interviewed a couple of the residents on the side to see if I liked the field and I did.
Victor: Nice. You continue on and then how long have you been with Brandywine?
Hillary: For about three years.
Victor: Tell us about what your specific role with them is. What are you responsible for?
Hillary: I’m responsible for maintaining census. I’m in admissions, marketing, and community relations. My job is to explain what assisted living is to the community and families.
Victor: Then you’re properly positioned to start there in our conversation. What is assisted living?
Hillary: Assisted living is a concept that grew about maybe 20 years ago out of a need for people who were aging in place at home, who needed more care, but certainly did not need nursing home care.
Victor: Back in the day, all it was was the old folks home if you weren’t at home. That was what we called nursing homes.
Hillary: That’s right, and then people decided that, “Well, I’d like to stay home as long as I can,” which is great. After a while people said, “Well, it’s lonely at home. I would like to maybe be social and move out of my house. So where can I go?”
Assisted living communities are, by‑and‑large, hybrids of independent living and assisted living. What I mean is many people who live in assisted living are independent with their activities of daily living…
Victor: Fully independent. They’re living there, but it’s not that they’re making use of the medical component or the care component of what assisted living could give them. They just happen to be in an assisted living facility.
Hillary: Because they perhaps don’t like to cook, or clean, or have to worry about the taxes, or maintaining a mortgage. Assisted living communities were built about 20 years ago, to fill a need that was certainly there for people who wanted to be independent but might need help with the independent activities, such as meal preparation, having all the bills paid.
It’s a very simple concept where it’s a rental. It includes the utilities, the meals. There’s a package of services that the residents pay, one monthly fee which covers pretty much everything.
Victor: They boiled everything down to one check that they’ve got it write, their food prep, their cleaning fees, the property maintenance, their actual living facilities, and things like that.
They’re their quarters and what not. That give rise to this interim stage that people could go through before leaving their home in which they weren’t cared for there or being able to be cared for there.
Then moving into skilled nursing. We call it skilled nursing but really a nursing home. Are there certain qualifications for when people…beyond just not wanting to worry about what’s going on at home any later? What ends up being a part of a need to go into assisted living? What qualifies them for that?
Hillary: Well, that’s a good question. The other component are people who have aged some place at home. They might have maybe a home health aide helping them at home with maybe dressing, or bathing, or those things that we call activities of daily living because they’re becoming frail.
Maybe, somebody has diabetes. They need someone to help them with their insulin. That’s something that we do at assisted living. That’s a very common reason why people move from home, because it’s difficult to get a home health aide to administer insulin to a diabetic at home.
It’s very expensive to hire a nurse. We do that in the assisted living setting because we have nurses on‑site, 24 hours a day. That’s one thing, diabetes. People who maybe had a stroke, or heart disease. They’re finding it very difficult to maintain the home, and they stop driving.
That is one of the major reasons why people move to assisted living is that they’ve stop driving for a variety of reasons, whether they feel uncomfortable driving because they’ve maybe had a few fender benders. Or their kids have had to take the keys away from mom and dad because of memory issues.
When people stop driving, the world becomes a lot smaller. They’re isolating in the home, and we know that that’s contributes to depression.
When this happens, families usually identify that mom and dad are not doing well. They’re getting depressed. This is usually when the phone rings and we hear from families and caregivers. They say, “My mom, she doesn’t drive any longer. She really needs some socialization.”
That is probably the major reason why people move to assisted leaving.
Victor: One of the things that we have been following since Thanksgiving has been when families come together around an event, like Thanksgiving. People start to discover that their older adult, the person that they care in their life is just not thriving in some fashion that they have to do something around that.
I’d imagine that you probably see those time periods very similar. It’s like when people finally get their eyes open then they start exploring what are other alternatives there are? Is that fair to say that that’s what you see at assisted living as well as where I see it over in elder law?
Hillary: Yes, we do. Usually, that’s exactly right, Victor. Usually, family gatherings, holidays, is when people realized that they have been calling mom and dad. They sound great from a distance. Long distance caregivers who have been calling mom in Chicago or California, they put up a good front.
Then when you see them in person, you realize that there are telltale signs that’s something’s just not right at home. That can be looking in the refrigerator and seeing mold on food. That could be watching bills pile up, things that are not maintained that they used to be able to handle on their own.
These are classic signs that something’s not right at home and we need to take action. Yes, we get the call.
Victor: What do you find is the largest obstacle for people to overcome to accept that assisted living might be the right choice for them? What are you battling on those types of discussions?
Hillary: That’s a great question, because we see this all the time. Usually, the caregivers, the adult children, identify the need before their mom or dad have accepted the concept.
It’s very difficult to accept the fact that they need to move from a very comfortable setting which is a home, and fear. It’s fear of the unknown, fear that they won’t fit in. It’s also the understanding that they view it as more institutional. They feel like they’re going to lose their freedom.
Victor: I think it’s only conceptual academically because I’ve been over to Brandywine‑Pennington, and I’ve been to other facilities. It doesn’t feel institutional, whatsoever. They’ve got the plushest carpets I’ve ever stepped on. I feel like I want to take off my shoes and wrinkle my toes every time I’m there giving a presentation.
You go through great lengths to make this a very comfortable environment to be in. I know that something that’s done deliberately. Do you find that it’s effective that people once they’re actually there get some of that fear allayed and it’s not as fearful as they thought it was going to be?
Hillary: Exactly. One of the challenges that we have is getting mom or dad to actually come to the building. I say, “As long as you can get your mom over here for lunch and see it. I think all of their fears quickly subside.”
Because they see other residents who are like them and they say, “Oh, I see this woman. She’s walking around. She’s enjoying herself. She’s having fun, and I look like her.”
They need to make a connection with somebody when they visit. That’s our job, to make them feel comfortable. They see the apartments are very large. Some are two bedrooms. Some are one bedroom, but as long as they can see that it’s more of an apartment rather than institution. They feel much, much better about making the move.
Victor: If they’ve been home‑bound, or they’ve had taken their car taken away, or something like that, the world just gets a lot larger for them. Even if they had a larger home and they are moving to a smaller apartment, the fact that the rest of the life outside of that that where they eat, where they socialize, and where activities are. That world just opened back up to them, no?
Hillary: Yes, yes, the best thing is when we see people making friends, and we introduce residents so that they feel comfortable. Initially before they move in, they’ve already visited two or three times.
We’re making sure that each visit they’re meeting new people, having lunch so that they know that they’re going to see their new friend, Betty, or Marge, or whoever when they move in.
Our job is to make it as similar as possible to where they’ve moved from. Decorating the apartments so that it looks pretty much like her bedroom or his bedroom at home so they feel like, “OK, at least I have all my own things, my own furniture.
“I can still make coffee or tea in my kitchenette.” In assisted living, you do have a kitchenette, and you do have a refrigerator. You can make breakfast.
Victor: Let’d important for me. I really like my own coffee. I don’t know if I have to be stuck with somebody else’s coffee. The beginning component on the less intrusive side, it’s trying to mimic what home life was about. There is an element of safety and security as you progress and needing more and more.
Talk a little bit about how assisted living can graduate their care up to…How they can travel with them, because I think some people’s fear is that this isn’t the last stop. How far can that go in terms of other things that they might need?
Hillary: Has residents’ healthcare needs change or evolve over the years or months? They’re assessed by our nurse before they come into the community. We know what their baseline is. In other words, if somebody takes a certain amount of medications, we know that. If someone had a heart disease, we know that already.
In anticipation of what may come in the future, we have nurses on‑site 24/7 as well as home health aides. Their job is to help residents who need help with bathing, dressing, grooming as their healthcare needs change or evolve.
We can maintain residents for as long as we can safely provide the services that they need in their apartment, whether that be through an outside agency, home health agency, or our staff or combination thereof.
We even have hospice which is care for people who have a terminal illness. If they elect to use hospice, they are situations where they certainly may stay for the duration of their life.
Victor: As long as it’s being able to be met in the facility, it doesn’t dictate…If you need hospice care, it’s not like you’ve got to move to a hospital to go and get it or a hospice center to do that. You can do that inside of assisted living?
Hillary: Yes, you can. We also have a memory care residence called Reflections. That’s a place where it’s more secure and safe for somebody who has symptoms of Alzheimer’s or other types of dementia. That’s, again, staffed 24/7 with a nurse and home health aides.
There, we find people who have hospice. Probably a greater number of residents have hospice services so that they can just stay in their own home, in their own apartment, in their own bed for the duration of their life.
Victor: I would imagine that the need for that is growing. When we’ve had on Dr. Apter who talked about just Alzheimer’s being the plague of the 21st century, the thing that we haven’t cured yet. Is that been your experience as well is that the need for progressive cognitive related care is growing in that field?
Hillary: Yes, definitely, Victor. You said it. The longer people live, the greater their chances are of developing some form of dementia. We’re seeing residents who are well into their 90s. Centenarians are not as uncommon as they once were.
It doesn’t mean that you’re necessarily going to get dementia when you’re 100 or 90, but the prevalence is increased. All Brandywines do, and all assisted living communities for that matter, do have Alzheimer’s or memory care residences, which we, in Brandywine, call Reflections.
That’s great because you can start out in assisted living and be perfectly fine or maybe have a little bit of cognitive impairment. Mild cognitive impairment is something that a lot of people have, but do very well for several years in the assisted living setting before they have to make that transition to the memory care residence.
Victor: What do you think that is? Things normalize because they know that they’re being fed regularly. They’re being engaged a little bit more than they might be if they were at home. If you had to peg it to why that is possible?
Hillary: Well, I do think that people are on a regular schedule. I’m not saying that it delays the onset of Alzheimer’s, but they don’t have to go to the Alzheimer’s residence as early as they may if they were living at home. Yes, having proper nutrition is really healthy.
Socialization can keep and maintain someone’s cognition. That’s been proven. Just having your regular socialization, meals, and oversight by the nurses and doctors at visit.
Victor: Let’s hit something straight on which is finances. This is a rental situation. It differs from situations where you might have to have a buy‑in. What are we looking at when somebody is investigating assisted living? Just in the form of a more financial qualifications standard.
Hillary: Thanks for bringing that up because a misconception is that’s very expensive. However, in New Jersey, we have this wonderful program that started about 20 years ago where we are mandated to accept a number of residents who transition to Medicaid. meaning they exhaust their resources.
When a resident transitions to Medicaid, they may stay at Brandywine and in most assisted living communities. To answer your question about how much money someone would need, we have a requirement of two years of private pay.
What that means is we need to know that somebody can pay the monthly fee for, at least, 24 months before they apply for Medicaid so that we can operate the business. People usually say, “Well, How much money do I need to have?” Now if you own a house, chances are it’s affordable.
Victor: It’s the value of the home you’re exchanging, because you’re going to be getting rid of that anyway. If you put that bucket of dollars, you’ve bought your lifetime into that new living situation at assisted living.
Hillary: It’s a monthly rental. You know that. You just pay the monthly rental fee. There’s usually a small entrance fee. It’s usually equal to a month’s rent. no big entrance fee.
Victor: They’re not holding onto big dollars in the future. I spent some time in an earlier radio show a few months ago just tearing apart some of these continuing care retirement communities that require a large entrance fee, but whichever portion of it that they’re telling you is refundable. It’s only back to you after they’ve relet the place and only at certain rates.
There’s been legislation that’s been introduced to try to curb that. That’s not the case with assisted living. They’re not holding onto any dollars. There, it’s just a month‑to‑month arrangement for that.
Hillary: Yes, exactly.
Victor: Obviously, the monthly rental is going to be keyed to how much care you’re requiring. At a very base level that’s going to be on the lower end. As you progress up, that’s obviously going to be more services that are going to be needed for a period of time. They’ll just make an assessment about what that is.
Hillary: There, the nurse is constantly assessing. We do this each month to make sure that if things are changing, that we can address them upfront. Maybe, as more services, more home‑care hours to that person’s care plan. Everybody has a care plan.
If you were at home and you needed more care, you would have a home health aide coming into your home. Just as that would happen at home, it’s the same in assisted living. It’s a little more economical in that.
Think about it. We have about 100 residents. The caregiver doesn’t have to stay longer than is needed. In that respect, it’s more economical for the family.
Victor: Because by the time somebody’s talking about needing a caregiver on a 24‑hour basis, what they’re saying is at any moment of the day there might be an issue that needs attended to, not that for 24‑hours out of the day, there are issues that are being attended to. We can’t predict when something might rise to that level.
If you’re not getting services provided for all 24‑hours, you shouldn’t be paying for that level of service.
Hillary: Everybody does have an emergency call pendant. If they need help at any time during the day, they’re pressing their pendant button, the emergency button. Like you said, they’re on call, they’re there. They’re staffed 24/7. That’s important to know.
If something happens in the middle of the night, if somebody has a fall ‑‑ God forbid ‑‑ but it does happen. There’s a nurse that’s going to assess and call the ambulance rather than having that nurse off‑site which is the case in many places.
Victor: How long of a lead time does somebody need to start to investigate this? Are they 30 days out? Is it a matter of start three months out? How do people learn that information so they can start to get comfortable with making a decision around this?
Hillary: I’d say, the earlier the better. Only because it’s good to find and look for things and do your research before there’s an emergency, before your mom or dad are in rehab. We usually get the calls when, “Oh, my mother was admitted to the hospital of dehydration.” Or, “She fell and broke her hip.”
Now she’s in a rehabilitation center, and the discharge date is in four days. That is not the best circumstances. That does happen and we can certainly help families when that does happen.
However, just to lower the stress level, it’s better to look. When you think that things are changing, educate yourself and know what’s out there so that you can think about it and talk to friends and family over the course of a couple of months so that you say, “All right, I think we’re ready. We feel good about this place. We looked at it a couple of times under different circumstances. My mom likes it.”
I always recommend to families come first yourself. If you get a good feeling, then bring your parent back.
Victor: I’m famous for saying that the crisis period is the wrong period for education. It’s very difficult to be in that scenario and feel like you’ve got your hands around all of your options. You’re so overwhelmed with everything that’s going in there.
You fear missing something. You fear overlooking something. You fear your own judgment skills because you realize that you’re under pressure. If we can take it out of that realm, people are going to be better for that.
If people want to learn more about Brandywine and then Brandywine, specifically, in Pennington, how can they contact you, or how can they learn more about that?
Hillary: Obviously, our website, brandycare.com. Our phone number is 609‑730‑9922.
Victor: Brandycare is B‑R‑A‑N‑D‑Y‑C‑A‑R‑E dot com if they want to learn more?
Victor: Thank you so much for being our guest today, Hillary. I really appreciate your time and all the information you shared.
Hillary: Thank you, Victor. This has been really fast, and I enjoyed it very much.
Victor: No problem.