00;00;01;12 – 00;00;31;07

Jeff Howell

Welcome to Home Health 360, a podcast presented by AlayaCare. I’m your host, Jeff Howell, and this is the show about learning from the best in home health care from around the globe. Hey, folks, and welcome to another edition of Home Health 360. In 1985, the very first Sarah Care Center opened its doors in Canton, Ohio, originally called Sarah SRH, which stands for senior Adult Recreation and Health.

00;00;31;12 – 00;01;01;02

Jeff Howell

That’s like the best dad joke ever. The facility was one of the first intergenerational sites in the U.S. The senior adult day care center was located next to a child daycare center and served as a training and research site for the development of other unique intergenerational programs across the country. Dr. Meryl Griff combined her skills as a health care professional for senior patients and a caregiver for her own mother to develop the SarahCare way.

00;01;01;19 – 00;01;24;24

Jeff Howell

She brought to life the importance of a social atmosphere to enable seniors to retain their independence and interact with others so that they may share interests with. And while being cared for and receiving the assistance they need to get through their activities. The concept really caught on. Caregivers and seniors responded with enthusiasm to the new approach to care.

00;01;25;04 – 00;01;37;25

Jeff Howell

Currently, Sarah Care is located in. If I have this right, about 13 states and 24 locations with one even in Saudi Arabia. Dr. Merle Griff, welcome to the show.

00;01;39;06 – 00;01;42;18

Merle Griff

Oh, thank you, Jeff. It’s great to be here. Thank you for having me.

00;01;43;23 – 00;02;09;29

Jeff Howell

I also have a like here on Kelly Bishop, our director of strategic accounts, who also spent seven years as a director at Lincoln Health Care Events, the organization that puts on Homecare 100. And it was at a Lincoln health care event that the two of you originally met at. Kelly is also the world’s most niche and electrifying vlogger who only vlogs about twice a year for behind behind the scenes footage at Homecare 100.

00;02;09;29 – 00;02;11;22

Jeff Howell

So, Kelly, thank you for being here today.

00;02;11;22 – 00;02;15;24

Kelly Bishop

Thank you. I’m thrilled to be here, and I appreciate the lovely intro, Jeff.

00;02;16;21 – 00;02;20;01

Jeff Howell

So, Maria, tell us a little bit about your personal and industry background.

00;02;20;29 – 00;03;06;11

Merle Griff

Well, actually, unlike most of my colleagues, I actually started out working with children. I was a play therapist and started working with children from ages 3 to 12. I started to develop some therapeutic techniques that included parents and then developed a technique called intergenerational play therapy, which included grandparents. And so when an opportunity came up to do what we call and you spoke about this very well, just a shared site, child daycare center and an adult daycare center together in the same building, I just jumped at it and moved myself into working with seniors as well as working with children.

00;03;07;18 – 00;03;27;19

Merle Griff

When I opened up the adult daycare center, I just fell in love with Adult Day. I had managed nursing homes and assisted and independent living. I had done home Care. I did a lot in long term care, but just absolutely fell in love with adult day care. People come to us during the day. They have great fun, great food.

00;03;27;29 – 00;03;49;22

Merle Griff

They have friends. It’s a great experience for them. And then they go home at night, back to their families and they can continue to live in their communities. And so we just began to expand from that one center now into we now have new centers that are opening up this year. So we’ll be close to 30 centers in those 13 states.

00;03;50;26 – 00;04;03;13

Kelly Bishop

Wow. That’s great. Talked a little bit about the adult day. Can you walk us through what an adult day experience is, maybe just so our audience understands fully what adult day is?

00;04;03;21 – 00;04;43;26

Merle Griff

Sure. So we always say 101 activities and home by dinner, because that’s really the most important point, that people go home at the end of the day. We’re staff with Ahrens and Alpine’s. We can do health care for our participants during the day, and we’re taking care of a wide range of people. We do take care of people all the way from someone who’s very frail, and perhaps the family feels as though they don’t want to leave their home during the day because they may fall or they’re not taking their medication or they’re not eating, or they may be getting depressed and feeling lonely all the way to seniors who have had a stroke or

00;04;43;26 – 00;05;14;00

Merle Griff

Parkinson’s disease. They may be a brittle diabetic all the way to those with mid-stage or Alzheimer’s disease or other forms of dementia. So we’re able to do light skilled nursing in our centers. We have role in showers. We have many day spa in all of our centers. We’re really trying to take care of as many services as possible while people are with us during the day so they can come and get a shower, which is a big deal for many families.

00;05;14;00 – 00;05;33;09

Merle Griff

That’s really an issue for them. They can get a manicure, they can get their hair done, they can get a chair massage, they can have great food. It’s just a great place for them to be during the day, under the supervision of our nurses. Podiatrists come to us, audiologists come to us once again when that person goes home.

00;05;33;09 – 00;05;54;11

Merle Griff

At the end of the day, we want the family to just be with them and hear about their experiences during the day and not have to say, Oh, I got to take Dad for a haircut. Which sounds like a simple thing. Unless you’ve been a family caregiver, then it’s not such a simple thing all the time. So we’re really trying to take care of all of that during the day while they’re with us.

00;05;55;19 – 00;05;58;09

Merle Griff

It’s a snapshot of what adult day is.

00;05;59;02 – 00;06;06;27

Kelly Bishop

Yeah, it sounds incredible. It really is an incredible service that you’re providing to so many seniors out there and their families.

00;06;07;15 – 00;06;52;00

Merle Griff

So I will say this. I’m using the word seniors, and that usually meant 65 and above. All right. But I will tell you that we’re seeing two trends in our centers. One is people in their fifties. We’re seeing people younger and younger. Unfortunately, we are. And the other trend we’re seeing is we’re seeing more and more men than ever before where before the older generation of women felt even if they were getting ill and they couldn’t do it anymore and they were exhausted, they were never giving up the care of a spouse or father or a mother to someone else or this cohort, this generation of women especially understand that in order to keep caring

00;06;52;00 – 00;07;19;26

Merle Griff

for someone in their home, they have to have respite or they have to be able to go to work, or they need to be able to go to the doctor themselves. But they need some support and respite in order to continue going forward and caring for that person. Let me talk, if I could for a minute, Kelly, on a little bit about the relationship between adult day care and home care, because I know you are absolutely a leader in the health care industry.

00;07;20;03 – 00;07;39;22

Merle Griff

And so people out there may be seeking, what the heck does she have moral. GROSS But this is what they’re doing here. The relationship between health care and adult day is very can be very strong. And we work very well together. It’s a says we’re working with a home care company to provide what we call a puck services.

00;07;40;00 – 00;08;02;29

Merle Griff

So a home care worker goes in, gets that person up, gets them ready, they come into adult day or a Sarah care center during the day, and then they go home at night. And that home care worker comes back in at night and gives them dinner and helps them get ready for bed and gets them settled. They’re available for the weekends, They’re available on the evenings.

00;08;03;08 – 00;08;27;16

Merle Griff

This allows families finances to go a little farther. It’s a little bit of a less expensive option for them, plus the fact it allows our nurses to monitor their health during the day. So we work very closely with home care and we don’t really see ourselves as a competition to home care. We see ourselves as being able to partner with them and work together for really good care.

00;08;27;29 – 00;08;37;10

Jeff Howell

What’s your sense of standalone adult day services? I feel like I’m starting to see more homecare agencies that are offering adult day. Give me a sense of what the breakdown might be in the marketplace.

00;08;37;13 – 00;09;01;04

Merle Griff

Yeah, I think that there’s one particular home care franchise operation that has entered into the market of Adult Day. And so I think that’s happening. There are also adult day centers like Sarah Care Centers that have now entered into health care. It’s going both ways in terms of how the industry is moving forward from our perspective. And we’re just looking at standards of care.

00;09;01;16 – 00;09;17;08

Merle Griff

And as long as the standards of care are there and the standards are good, it doesn’t matter really, whether it’s home care that’s also providing adults or the opposite way or it’s a partnership. The focus really needs to be on the senior and the standards of care.

00;09;17;18 – 00;09;30;10

Jeff Howell

We’re going to have to ask the big question. So anything that’s facility based during COVID bring us through what life was like pre-COVID. And then I’m assuming the industry took a huge hit and I’m assuming it’s starting to bounce back now.

00;09;30;17 – 00;09;55;20

Merle Griff

Right. The adult day industry took a terrible hit because of most states. The governors closed all the adult day centers, which was a disaster for many adult days. Interestingly enough, in many of those states, legislation has now been passed that will never allow them to do that again. They just won’t be able to do that because the impact was not only on the adult day providers.

00;09;55;26 – 00;10;19;11

Merle Griff

The impact was on the families and on the seniors that we care for. Health care just could not handle everyone that needed care at that time. Plus the fact the advantage of people coming into indoors in addition to the home care is that socialization and that lack of isolation, because they’re with friends, they make friends and that went away.

00;10;19;18 – 00;10;46;18

Merle Griff

They became very isolated people. We saw people really regress. They became very depressed. It was really difficult for everyone during that time. Now, at Sarah Care, we did the best we could do. We did virtual calls. We stayed in touch with all our families. We delivered activity baskets to people. For those who were living alone, we often delivered fruit baskets to them.

00;10;46;18 – 00;11;07;00

Merle Griff

So we stayed in touch on a regular basis. But it was still very hard. It was very hard for everyone. And I don’t think the governors realized how hard it was going to be on the families and how hard it was going to be on the seniors and the type of regression that was going to happen and that people got worse.

00;11;07;00 – 00;11;11;21

Merle Griff

And suddenly we saw nursing home admissions increasing when they really didn’t have to.

00;11;12;21 – 00;11;22;09

Jeff Howell

And what’s your sense of the impact on number of adult day providers? And I would imagine some of the smaller organizations just got wiped out and are not coming back.

00;11;22;15 – 00;11;43;02

Merle Griff

Yeah, I mean, you’re absolutely right. Some of the smaller organizations did get wiped out and they’re not going to reopen. And that’s a real concern for us as an industry, because many of those centers that are not going to reopen are in smaller rural areas already, a lack of services. And now there’s even going to be less services.

00;11;43;13 – 00;12;07;14

Merle Griff

So we’re very worried about what’s going to happen with all of those families and all of those caregivers. We are responding. Things are getting better. And what’s interesting to us is through COVID, people became more aware of adult day health care as an option, or they really weren’t aware of it as an option. And no one really even thought about it a lot.

00;12;07;14 – 00;12;14;18

Merle Griff

Many times now suddenly it’s on their radar and now suddenly they begin to see it as an option for care.

00;12;15;00 – 00;12;21;15

Kelly Bishop

Meryl, I have a question for you. So you have two centers. Is that correct, in Saudi Arabia?

00;12;22;07 – 00;12;26;09

Merle Griff

We have two centers that are under construction, Under construction.

00;12;26;09 – 00;12;31;28

Kelly Bishop

Okay. And is the model similar over there for adult day as it is in the States?

00;12;32;15 – 00;12;54;29

Merle Griff

It’s interesting. There are obviously not a lot of adult days in the Middle East. There’s more in Israel, actually than there are in Saudi Arabia and the UAE. The model is basically the same. The difference is it faces each other. We have a men’s section and we have a women’s section. We had to divide them. But other than that, it’s basically the same.

00;12;55;15 – 00;13;20;21

Merle Griff

It’s interesting to me the activities are as we planned them now planned to be very much the same. The big difference is those centers are going into buildings that have multiple geriatric services in them. They have outpatient rehab, they have a geriatric assessment center, they have a pharmacy, they have physician offices. So people will be able to come and get a lot of services all in one place.

00;13;20;21 – 00;13;24;29

Merle Griff

And they won’t be moving from place to place in order to get their services.

00;13;26;06 – 00;13;47;14

Jeff Howell

That’s fantastic. You expanding into so many different states, I’m curious about challenges that you encountered state to state and second to that in every state, really the dominant funder is Medicaid. And I’m just curious how the payer mix. Is there a big market for private pay, adult daycare? Can you bring me through how you went through so many different states, some of the lessons that you learned?

00;13;47;23 – 00;14;16;12

Merle Griff

Sure. So our target market really is the private pay market because we’re actually less cost than 4 hours of home care. I probably shouldn’t say that. Or a home care station. I’ll be Barnes and everyone to dispel that is turning me off. I thought you could stay with me if we get. We really can work together. So our target market really is private because we have a lot of people who need to go to work during the day and they need to work 8 hours dinner.

00;14;16;12 – 00;14;47;21

Merle Griff

Yeah. And so cost becomes a big factor for them. The Veterans Administration also pays for adult day health care, long term care insurance. Some of them also pay for adult day health care. But you’re right, Medicaid is a big funder for adult day health care, and that depends on what state we’re in. So there are states like Pennsylvania and Ohio and Michigan who pay a decent rate Medicaid rate for adult day.

00;14;48;01 – 00;15;17;06

Merle Griff

There are states like North Carolina and Texas, where we have centers, but we do not have Medicaid contracts. And the reason for that is Medicaid. And those states pay something like $38 a day for care. Well, it have origins in pounds or $38 a day. It just doesn’t work. And so, unfortunately, what happens in those states, the adult day, health centers, very often in those states, if they’re primarily Medicaid centers, are huge.

00;15;17;13 – 00;15;46;27

Merle Griff

They’re taking in 120 people a day. It’s not the kind of care we really like to see, but they have to have in order to exist for their care for us, for our quality assurance across all the states and all the centers we have is course, which is the national and international accreditation body for adult day health. And so we have achieved core of accreditation since 2003.

00;15;46;28 – 00;16;11;27

Merle Griff

We’re very proud of that. It’s a very high standard. I’m actually a certified calf surveyor and one of my staff is also a certified calf surveyor. We do surveys primarily in the United States and Canada, but that is our quality assurance. So all of our centers, everything that we do is run according to calf standards, which across the board is higher than any standard in any state.

00;16;13;14 – 00;16;14;15

Jeff Howell

How do you spell that acronym?

00;16;15;04 – 00;16;18;02

Merle Griff

C. A. R. S.

00;16;18;23 – 00;16;29;09

Jeff Howell

Okay. Got it. What’s the average location look like? How many employees would you have? How many clients would you take in per day? What’s the size of the facility?

00;16;29;24 – 00;17;00;07

Merle Griff

They run about 6000 square feet. Okay. 15 to 18 staff in each of those centers. The design is basically the same in each of our centers. And so there is an area for demetra only that has its own bathrooms and its own shower. Looks like a hall, but it’s larger living room, dining rooms, activity areas which are used according to the people we have and what they want to do.

00;17;00;18 – 00;17;22;13

Merle Griff

Rowland Showers between the bathrooms, nurses area so she can administer whatever she has to do privately. We try to make that as home like as possible so when people come in, they feel comfortable and they feel warm and the caregivers feel comfortable and warm and it’s a lovely place to be, but you don’t want to be too fancy.

00;17;22;17 – 00;17;44;13

Merle Griff

I’ve walked into adult day centers that they think they’re going to appeal to the private pay market by being very fancy. And there’s China and silver and oriental rugs. And my question to them is, people don’t live like this every day for the most part. I’m sure there’s a few percentage, small percentage of the population that’s eating in China and silver every day.

00;17;44;21 – 00;18;00;02

Merle Griff

And I’ve even walked as was just a living’s like that where they’re like, we don’t understand why the people don’t use the space. You made it too fancy. You made it too. There is a point where you’re too upscale, so our centers are really beautiful, I think. Anyway, they’re really. You want a.

00;18;00;03 – 00;18;03;24

Kelly Bishop

Warm and welcoming and cozy? Yes, absolutely.

00;18;04;06 – 00;18;16;08

Merle Griff

So that’s what they like. We all have vans, so we provide transportation and all our vans have wheelchair lifts. And that’s a really important issue for families.

00;18;17;14 – 00;18;24;02

Kelly Bishop

How many rides are you typically doing a day? Is that a standard for most of the clients that you serve?

00;18;25;03 – 00;18;44;14

Merle Griff

It’s standard for about 60% of the clients that we serve. Yeah, we have families who are going to work and they really want to bring their person into the center and then pick them up. At the end of the day, they don’t want them home by themselves. But about 60% of our clients get transported in by us.

00;18;45;05 – 00;19;06;04

Kelly Bishop

So, Meryl, I’m going to switch gears a little bit. And you are such a dynamic woman and leader in this industry, but you also have just a bevy of other interests and activities going on. So I was hoping you could tell our listeners today a little bit about your own personal podcast.

00;19;06;09 – 00;19;36;15

Merle Griff

Sure. The podcast is called Caught Between Generations, and it really came out of my own experiences as a family caregiver, first for my mother after she suffered a very dense stroke. She lived in my home for three years, actually. She also attended one of my Sarah Care centers during the day. She was in my home until she passed away and also for caring for my husband, who had a chronic care condition for many years until he passed away.

00;19;37;00 – 00;20;01;28

Merle Griff

And I really felt very strongly that many of us are in this situation of caring for multiple generations ends, and we just sort of had the time to go to this podcast for this information and that podcast for additional information. And then we had to go over here. There’s just enough time in the day assuming I could stay awake doing all those podcasts anyway, which has nothing to do with or be boring.

00;20;01;28 – 00;20;33;15

Merle Griff

But with my being exhausted as a family caregiver. All right. So I decided we needed to take topics from multiple generational perspectives. And that’s what caught between generations is. So if we’re talking about family estrangement, which was our highest rated show, we’re talking about it from the perspective of adult children, parents and grandparents. If we’re talking about caregiver stress once again, we’re talking about it from the perspective of multiple generations.

00;20;33;26 – 00;20;50;21

Merle Griff

We’re talking about diseases like diabetes. We’re doing diabetic type one and type two diabetes because you may have well, generations with different types of disease states. So that really is the premise between caught between generations.

00;20;52;03 – 00;20;56;24

Kelly Bishop

And where can our listeners find caught between generations.

00;20;57;06 – 00;21;00;29

Merle Griff

It’s on all the major podcasts, channels, including.

00;21;00;29 – 00;21;02;04

Kelly Bishop

Spotify.

00;21;02;10 – 00;21;19;12

Merle Griff

Amazon. Actually, I didn’t even realize that Amazon had picked up the podcast. I’ll just tell you a quick funny story. I was talking to my granddaughter one day and I was giving her a little lecture about once something is on the internet, you can never erase it. All right. It’s there forever. All right. So you have to be very careful.

00;21;19;18 – 00;21;34;08

Merle Griff

So she kind of smiled and looked at me and said, Grandma, if I Google you, what the Internet? What would I find? I was like, Oh, my gosh. So she grabs me, and what pops up is all the podcasts on Amazon.

00;21;34;08 – 00;21;35;19

Kelly Bishop

Oh my God, I.

00;21;35;19 – 00;21;36;16

Merle Griff

Made it through that.

00;21;36;28 – 00;21;53;12

Jeff Howell

I can’t help but think that the caught Between generations. There’s so many parallels with how Sarah Care started with I can just the one thing that just really struck me was the number of people that would be dropping off a parent and a child to the same building at the same time.

00;21;53;24 – 00;22;10;19

Merle Griff

Absolutely. I had someone who used to joke about that. Someone would say what really is adult day? And he would say, Think of it this way. You load everybody up in the car right? You take your mother in law to Sarah carriage all day, and then you drop your child off at the child daycare and you still have your dog in the car.

00;22;10;19 – 00;22;17;22

Merle Griff

So you take them to doggie daycare. That. All right. You finally get to go to work summarily.

00;22;17;22 – 00;22;20;00

Jeff Howell

You have a book coming out in September. Tell us more about that.

00;22;20;01 – 00;22;47;12

Merle Griff

Wow. Yeah, That’s called Solace in the Storm. Solace? I would spell it because of my accent. It’s social AC and it’s being coming out September 12th. It’s being published by Forbes, which we’re very proud about and very happy about. They’ve been great to work with. So what happened was, at the end of each of my podcasts, I do what’s called a take away not a really good name, but that’s what I called it.

00;22;47;22 – 00;23;14;07

Merle Griff

So it was just a little blurb, a little something you could do to integrate into your life, to either relieve your stress or to help you be a better caregiver or whatever it is. Forbes picked that up, and because caregivers impact on the workforce is such a significant issue at this point, they asked me if I could put all those takeaways into a book, and that’s how it’s designed.

00;23;14;13 – 00;23;39;00

Merle Griff

It goes all the way from infancy caring for infants to caring for seniors. You can read chapter 159 if that’s what you need, or read chapter two and four, if that’s what you’re interested and that’s what you need. And in every single chapter throughout the chapter, there are quick tips, something you can do quickly, easily, because, you know, I’m really tired.

00;23;39;00 – 00;23;58;17

Merle Griff

I’m a psychologist by training. So I’m not coming down on therapists. I don’t want to hear about how I should own the problem. It’s fine. All right. Now I understand it’s okay for me to be angry, sad, or whatever it is I’m feeling as a family caregiver. But I need a solution and I need something I can do quickly.

00;23;58;23 – 00;24;17;24

Merle Griff

And I don’t have an hour to meditate and I don’t have $500 to join an upscale gym. All right. So I need something I can do quickly and inexpensively. And that’s the premise for Solace in the Storm. Quick, easy, good tips that you can easily integrate into your life on a daily basis.

00;24;18;05 – 00;24;20;20

Jeff Howell

September 12th. And where can people find it?

00;24;20;20 – 00;24;35;09

Merle Griff

It’ll be on, of course, on Amazon Kindle, Barnes Noble’s, we think in the every major bookstore. It’ll also have an audio version that’s being recorded now. So it’ll be all online.

00;24;36;01 – 00;24;46;02

Jeff Howell

We look forward to racking up a copy. We’re just about coming up against our time here, so I’ll get you out of here on this map. I’ll give us a reason to be optimistic about the future of care.

00;24;47;18 – 00;25;13;20

Merle Griff

I think that through cozadd people have become very aware of how important care is, how important it is to support families in their care, regardless of the age that they’re caring for. And I also think it’s made us think, as the old saying goes out of the box, because now we’ve had to be innovative and we had to think differently and we had to approach problems differently.

00;25;13;29 – 00;25;36;24

Merle Griff

And I think it’s opened the door for a lot of very unique, very different ways of caring. I see it going on even in states where they’re looking at different ways to spend their Medicaid dollars in ways that might be more creative and actually provide better care at a higher standard and be more attuned to how that care is being delivered.

00;25;37;02 – 00;25;59;23

Merle Griff

So I’m really very excited about it. I think were posed to do some really unique, really different types of programs and services that are really more customized to people, to those we serve and I think really may help them more than we’ve have in the past because we’re just more open to different ways of delivery of care.

00;26;00;16 – 00;26;15;27

Jeff Howell

I love the way your brain thinks. I took three pages of notes here. I was excited to do this episode and good on you for being someone who puts things out there and needs to do things like podcasts and write books. It’s such a noble work that you do.

00;26;15;28 – 00;26;16;10

Merle Griff

Thank you.

00;26;16;20 – 00;26;23;17

Jeff Howell

So Marilyn Kelley, this has been a great way to kick off a Friday here. And I want to thank you both for coming.

00;26;24;07 – 00;26;30;14

Merle Griff

Oh, thank you so much, Geoff. I really appreciate your kind words and I appreciate the work that you’re doing. Thank you so much.

00;26;30;25 – 00;26;38;19

Kelly Bishop

Yeah, thank you, Jeff and Meryl, you’re incredible. You’re an inspiration to the industry. So thanks so much for joining us today.

00;26;39;00 – 00;26;40;20

Merle Griff

Thank you. My pleasure.

00;26;42;08 – 00;27;11;15

Jeff Howell

Tom Hill, 360, is presented by AlayaCare. First off, we want to thank our amazing guests and listeners. To get more episodes, you can go to alayacare.com/homehealth360 spelled home health 360 or Search Home Health 360 on any of your favorite podcasting platforms. The easiest way to stay up to date on our new shows is to subscribe on Apple Podcasts, Spotify or wherever you get your podcasts.

00;27;12;03 – 00;27;35;07

Jeff Howell

We also have a newsletter you can sign up for on alayacare.com/homehealth360 to get alerts for new shows and more valuable content from like here right into your inbox. Thanks for listening and we’ll see you next time.