Welcome to the Healthcare CEO podcast. Join us as Daniel Fernandez, healthcare leader and patient experience advocate, leads dynamic one-on-one discussions with healthcare executives, consultants, and other industry experts. Listen in as they share actionable insights and unique perspectives in the day in the life of a healthcare CEO.
*The following has been adapted from our full-length interview, which can be found here.
Meet Francis LeGasse
Francis LeGasse is the president and COO of Assured Assisted Living in Denver, CO. He’s also an innovator, entrepreneur, and podcaster. In addition, he has experience as a managing partner within the senior living industry — dedicating his life to changing the way we provide care to the aging population.
Getting Into the Senior Care Industry
Daniel Fernandez (DF): One of the things I love the most about you, Francis, is that you challenge the status quo. One of the ways you’re doing that is challenging the way we view aging in this country.
Francis LeGasse (FL): Yes. It’s definitely a pleasure to be here. This will be a great conversation. We’ll talk about issues people often want to avoid. So I’m really excited to share how I look at it, and start talking about it now, so that we have a voice in how we age.
DF: Let’s start with your why. What got you into this field?
FL: Personal experience with my grandfathers. My paternal grandfather had dementia, tied to his years with military service — a couple of tours in Vietnam. Strong guy, seeing the sacrifices in his career and the impact on his brain and family. And my maternal grandfather had Parkinson’s. And just seeing the stress of my grandmother and the stress on my mom — they took the primary caregiving roles. And just watching the change in the family dynamics and wondering how we could do it better. How can we make it more personalized so that aging doesn’t seem so negative, but as a blessing and an honor, and an opportunity to share legacies with younger generations.
DF: What are your thoughts and views on the current care model that’s in place for the majority of America?
FL: I think we settled when the first models of nursing homes first came out in the ‘40s and 50s. I think we’ve just made them look a little prettier. But we’ve lost focus of the care model and placed more emphasis on the real estate or the grounds. You hear the phrase resort-style living a lot, which is an amazing idea, but the execution is not where it should be. We lose track of the care model — the belief that we have to be providing high-level care for residents and family members. It can’t just be how the building looks. We need to take a time-out and say, hold on. Is our current building design the best way to encourage a positive aging experience?
DF: You’re thinking about things from a fundamental aspect. Way beyond the structure and the typical processes that are in play today.
FL: I have a physics degree from the University of Michigan. Go Blue, by the way! We learned a lot about tech and a lot of cool up-and-coming industries. I started when I was about 27 in senior/aging services. And people asked why? And I would say because I think we need the best and brightest and most creative to look at this industry just like we look at technology. When you look at technology — smartphones and how they’ve evolved, for example — things have changed a lot. Having the best and brightest will have a fundamental impact, and that’s what I think we need to do for aging.
Rethinking How To Do Business in the Wake of COVID-19
DF: In that vein, sometimes things are done because it’s the way they’ve always been done. And sometimes you need to rethink things.
FL: And COVID’s done that. We are at this disruption point. The point where we are taking pauses and asking, does this make sense? Or are we doing it because it’s the way things have always been done?
DF: And speaking of COVID, what did it look like earlier this year? What sort of impacts has your business seen?
FL: Trusting our systems. We had some pretty rigorous systems. We locked down our buildings to almost all visitors. March 6 is when our team decided to be proactive. Since we had one case in Douglas County — which is just outside of Denver. We locked them all down. I don’t think we were the most popular at that time. Some people thought we were over-reacting. But what happened in Washington state made us think really hard about this. And then it was really trying to adjust and adapt — fast and quickly — to stay ahead as much as we could. Whether that’s how we handled our staff, or presumptives, or all these things. We began to build policies on the fly and implement them.
Once we got that settled, we had the stress of acquiring PPE. And that was a real challenge. There were some price gouging and surprise shortages. And we needed the stuff, and we needed it now. And we had to figure out what that would look like financially. So there were a lot of unknowns we began to work through. But we have an amazing team. I’m so proud of them. Everybody responded and adapted quickly and efficiently. We did a pretty solid job communicating with families. That’s one of our main focuses — improving communications among family members. It’s pushed us to just do better. To be better. To think outside the box. And to challenge these unknown problems as dynamically as possible.
DF: In talking with other CEOs, everyone agrees that the world will look differently once we come out of this. What does the future of senior care in this country look like?
FL: One: The welcoming of new technology. We’re using some new technology to improve our communications — to make it more efficient, to make it easier. I think we’re going to take a pause as to telehealth. How does telehealth improve the lives of our older adults living in aging environments? I think we’re going to take a pause about designs. We’re at a great point to finally say stop. The way we’re taking care of adults — collectively — is below par. There are some great organizations doing great things, but collectively, it’s time to stop settling on ideas from the 40s and 50s. It’s time to really give a voice to everyone on how they want to age, so that when they get to that point, they’re aging almost mindfully; not because this is the default.
A Misguided Way of Looking at Senior Citizens
DF: Historically speaking, when they get to that point, we typically look to isolate them. They’re being isolated. What are your thoughts on that?
FL: I think it has unintended consequences. When the majority of the states went into this really rigid lockdown for their long-term care environments, I think it was a necessary evil for a short period of time. Right now, a lot of them have gone to outside visits, which I think it’s great. The more we isolate any group of people, they experience cognitive decline, they’re having withdrawal symptoms, isolation, depression. All the things we know happen to everybody. Add to that aging, a pandemic, not being able to see their families, and you’re just snowballing things.
We live in communities where there are young and old, and everything in between. Why do we think at this point that because we’re older or need a little more help, we have to go live only with that group? When did it become good to segregate based on age? And I don’t have an answer. I don’t think there’s ever a good reason to.
Taking Care of Your Team In Ways that Matter
DF: I couldn’t agree more. This has been a major stressor on everyone around the world — especially for some of the people you’re caring for. But what about the caregivers? How are we taking care of them? And how can employers take care of employees as well?
FL: We need to give recognition — a tremendous amount of recognition — to direct caregivers. Direct teams. Administrators, executive directors, CNAs, home health aides. Those amazing, compassionate, driven individuals. Yes, leadership matters to an extent. But if you don’t trust your boots on the ground, you don’t trust your frontline staff, you don’t give them every tool possible to be successful, I don’t care what you do as a company, you’re missing out. Because your direct line people, whether they’re licensed or unlicensed — from the janitorial staff to housekeeping — they are what matters. And I think we need to recognize that and do a better job collectively to improve the opportunities we provide for them, as well as the benefits we provide outside of pay. Whether that be housing, transportation, whatever it is. Because I believe that to solve some of the housing issues that we have, employers need to take a pause and say, what can I do to benefit my employees? We do offer some housing for a lot of our direct care staff as part of their employment. And that has been a huge help for us. We bring in some food and groceries as well, too, for the team, so that they don’t have to go out as much — even prior to COVID. But I think we have affordable housing issues in many states and employers could have a positive role in that. I don’t always think the government will always be able to solve that. But we can begin to offer benefits besides just a pay.
DF: Essentially, employers taking a more active role in the well-being of their team.
FL: If you do that, your turnover is reduced. We’ve created this culture of a top-down philosophy in many of our organizations. I don’t know why, but I feel like we used to have a different philosophy of what a staff member or employee was. It would be an individual we’d cultivate and want to grow with, and it was this idea that we worked together. It’s not always this hierarchy of the top-down telling us what’s going on. We have to listen more and implement the suggestions of the team that works directly with the residents. So that’s what we have to cultivate together. When we do that, you’re going to see better retention, care outcomes, and happier people across the board.
My dad taught me from a young age that we treat everybody with the same level of respect. No matter if they’re an entry-level employee to the executive level. And I think our ideas of what corporations are are constantly shifting. But when we look at the core of what we need to do when taking care of people, you need that touch, that compassion, that emotional connection. And if you’re stressed about other things at home, you’re not gonna be able to do that. So we as employers can take some of that off their plate. Reducing food insecurity or housing insecurity, we might have just freed their mind of a stress that they don’t have to worry about anymore.
DF: That’s beautiful. That’s a lesson that can be learned and used in every industry.
FL: It’s not always easy, but we can do it. It’s one of the reasons why I wanted to talk to you. I love what you guys are doing, and I know that we can have an impact through discussion and through action.
DF: Right. And part of it is having open and honest conversations.
The New Normal in a Post-COVID World
DF: There’s so much uncertainty as we look ahead. Are there any policies or procedural changes you see coming that people should be aware of?
FL: The big one is health screenings in any long-term care environment. Which I like. I think it’s a good idea – especially during cold and flu season. So a lot of the things we’ve done for COVID, we’ve had in place for cold and flu season — not to the same extent. But we’ve done a really good job with symptom checking, tracking of residents and staff. I think we’re going to keep seeing consistent mask use for long-term environments for a long time. Much longer than the general public; which, if you look at it, is a positive. I do want to find a way, though, for residents to see expressions; especially if they have hearing issues. A lot of them read lips. So if I have a covered face, you can’t really tell what’s going on.
I think we’re going to continue to monitor health better in these environments. Really track symptoms and be more responsive to symptoms as a way to be proactive in care. Policies — I’ll be really curious to see what federal, state, and local governments do. Because I think you’re seeing a strain on a lot of the Medicaid and low-income providers because their costs are rising faster than they’re being reimbursed. What are we gonna do for that?
This gives us that pause of where does long-term care housing (not just medical care covered by Medicare) fall under the financial model over here? It’s often overlooked that we think medical care is the only thing that matters with age. But there’s a housing component that a lot of time gets slipped through the cracks.
DF: In terms of lessons you’ve learned over the past six months or so, what would you share with CEOs, physicians, or COOs listening to this podcast?
FL: I would want them to know that you have to be willing to adapt. If you think that your current philosophy or ideas today are the only way to move forward, you have to be prepared to pivot and be adaptable to overcome the challenges that we face. I believe that we are [sometimes] too rigid and not keeping a sense of paranoia. We have to be ready and dynamic in what we’re doing. If we’re complacent, we’re already possibly out of business and don’t even know it. Maybe not tomorrow, but are we gonna be relevant in five years? Are we gonna be relevant in ten years? If we’re so fixed in the ways that we do things today. Adaptability is one thing we’ve learned in the last six/seven months. Because every day it seems like we’re getting updates from the CDC or the Health Department, and I’m like Ok! I guess we’re doing that now! So we’re just adapting, overcoming, and being proactive in what we’re doing.
DF: Do you find that is probably one of the greatest challenges today? There was a time when you could plan the next five years. But now, it’s like, what will the next 45 days look like?
FL: Daniel, yes. That is correct. Good companies are going to forecast creatively. We’re going to push the envelope. Look beyond the challenges, look at solutions and work the way back. That’s what I think really matters. We know we need to have these creations in place and deal with the curveballs. But if we set our standards above the minimum, we can be proactive in what we’re doing.
Redefining Senior Living
DF: In closing, is there anything you would like people to know about senior living?
FL: Senior living has a lot of opportunity for us to have an impact today. It’s not stuck. It’s not rigid. We have an amazing opportunity to give our older adults the aging experience that they want. But we have to start by looking at what we can do and how we can change. We have to get away from the mindset that what we currently have available is the only way to age. We need to look at other cultures, other nations, even other nationalities and how they’re aging and see how we can create best practices across the globe — or even across the state — to share these ideas of how we can do it differently or better. I don’t want anybody to feel scared or worried or concerned about aging. Because I truly believe it’s an honor and a privilege to get older. A lot of people don’t have that privilege and we have to stop looking at aging as a burden, but as an amazing opportunity to share history, to share love, to share stories, so that we can grow together as a community.
DF: I love that. Thank you.
FL: That’s just how I feel. It’s been a wild ride for almost 11 years now. My why goes back to my family, but the more I meet people and the more families I work with, I see this trepidation of I’m scared. When did it change from we’re gonna help each other to we’re gonna do the bare minimum. Are we only gonna live well for 40, 50 years, and after that, it’s ah, you’re aging! That doesn’t make sense, and we have to get back into that mentality of being in it together. This is cool. There are so many cool things we can do and we can learn from each other. We can learn from 90-year-olds and 100-year-olds, and we can learn from our two-year-olds as well, too. So it’s that whole idea that we just have to have a lot of fun with it, too. It doesn’t always have to be serious. People are like, you have to be serious about aging. No. Life is fun. If we’re not having fun, what are we doing?
DF: I agree. There’s a lot that we can learn. They have seen all of the things that have happened.
FL: Think about the toughness of those growing up in the great depression. Is this pandemic anything really to them? Maybe not. I’m not trying to downplay it, but that’s tough cookies. Growing up in the Great Depression era is a different level than any of us will ever comprehend. So let’s lean on those older adults and their toughness.
DF: There’s a Truman quote, “The only thing new in history is the history that you don’t know.”
FL: Oh. I like that! That’s a really good quote. I think it’s very important to acknowledge that we don’t always pay attention to history.
DF: I agree. And I want to thank you for being a guest on our show. I want to thank you from the bottom of my heart. Thank you for sharing. I can tell you’re very passionate about this and it comes through.
FL: And I really appreciate what you guys are doing and encouraging people to learn more and listen. So I thank you for the opportunity. A true honor, and it’s been fantastic. I’ve really enjoyed our discussion.
Learn More about How Francis and Other Healthcare Leaders Are Shaping the Future of Healthcare
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