Legal Rights and Responsibilities in CCRCs | Panel 1 (Part 1/6)

it is such a pleasure to be here and thank you very much Jay for making this possible just as a repeat for those of you who are watching us via live streaming you will be able to send in your email question the instructions for that or on the live streaming website and that way we should be able now and then to respond to questions that are sent in in the modern technology format in addition to that of this today’s program is going to be captured on video and offered by mcgeorge on their website and it will be done in a little bit of editing to make it work in pieces so that you can watch individual portions of this we know that this is the start of a conversation not the end one addition to thanking Dean moves and the number of people say right up front that there are we are appreciative of first of all the staff here at mcgeorge is and fabulous Mary Swanson sky foster who many of you have interacted with as we have done our registrations Amy pre wig who helped us all day yesterday as we were doing details lashandra griffin three who is our videographer here today for calling or sandy but I’ll shaundra is appearance fair named Jackie how joy Redmond Rosa Dennis all of them have somehow been involved my suspect they probably a few people whose names I don’t even know but he’s been involved in this melissa brown is the clinician here at mcgeorge school blog kathleen ever and originally we were going to be able to do this and realist timing-wise wrong way but I know the kinds of issues that we’re talking about here today she was already aware of because of the elder law and health law clinic that’s wrong here in mcgeorge in fact that’s how I first became aware of issues and continuing care retirement communities I began ran running and elder law and consumer protection clinic in Pennsylvania at Pennsylvania State University a number of years ago and a residence group came to our clinic to inquire about legal issues associated with continuing care and in Pennsylvania the regulation office is the department of insurance and the reticent group at the facility was concerned about a financial issue and they felt like the facility was not listening to them the Department of Insurance said they had no jurisdiction over the issue and so the question was what was there a way to facilitate a conversation that might result in that he should be addressed in part there was a way but it was not easy the residents had to give organized and stay organized and they were able to present their financial concerns in an articulate way to their community and they did so it exactly the right moment because if they had not done that sation their particular facility was embarked on plan to double in size and they would come online in 2008 for those of us who know about the CCRC industry 2008 was not the best you and and has a result of their articulate you know concerns about finances phase scaled back the project and came online a couple of years later and that facility has continued to be successful the facility that was just down the road that came online in 2008 was not successful and went into bankruptcy and so sometimes I learned residents have a very strong and articulate voice about things that somebody should pay be paying attention to well that brings us to California how did we get to California how to law professor from Pennsylvania end up in California well part of the reason is for a number of years now I have been approached by residents and lawyers and academics to as asking me questions about regulation or laws pertaining to continuing care retirement communities and so I’ve always been aware of the California market it’s one of the most vibrant CCRC markets in the country with many strong and very interesting models very diverse models in California by last count there are more than 100 CCRCs in California and and also California is interesting most of the market nationwide usually we say in the neighbor eighty-five percent of the market is not for profit tax exempt in the nation in

California it’s about 75% twenty-five percent by the last calculation 75% not for profit tax exempt and twenty-five percent of being for profit and the issues you know it’s definitely overlap between the two but there were slightly different issues and so you also have to take that into account when you’re doing regulation the commonality is the thing that I find most appealing to see CFCs and as I voice candid in admitting it’s the reason why office industry to survive I want it to be here we’re not ready for it and I’m hoping and I’m hoping that will be next year I’m hoping it will be a few years down the road so I want to make sure this industry is still going to be here it promotes healthy active living in fact one of the early concepts that emerged from CCRCs was that traditional actuarial tables did not work very well when they first begin using actuarial tables because they haven’t taken into back into a Fed that people would live longer as a result of the health remote and so they had to revise their actuarial assumptions fairly on the commonality is also the contractual promise to provide some form of combination of services for more than one year and in many cases for the rest of the individuals live there was an advocate conference that was somewhat similar to this that was promoted by that little rival academic institution in Pennsylvania the University of Pennsylvania I mean you know I think they’re still around and the Wharton School of Business there they combine on the conference back in the early 80s that was about CCRCs and they brought together people who were actuaries accountants providers lawyers all into the same room to talk about you know what were the different ways in which this model could try could improve and they capture that in a small book and eventually several the people involved in that conference wrote another book in early age so that was kind of the first of the the evaluations early aids we’re now 2013 and as far as i can tell vision ever been another vaca germany conference so this is that next wave i think academic evaluation of this model in nagrand for our first um helm who’s sitting right here ready to go i want to invoke the words of somebody who could not be here today was very wise mary ann a nicole will is a PhD in sociology and she says ecrc resident she is in washington DC today doing work and one of the things i quickly learned about CCRC residents is they’re always busy doing something it’s a very engaged community but i was tributed in in 70 her regrets she commented that her particular interest in CCRCs as a sociologist and as a resident but as a sociologist was in relationships and community aspects of CCRCs and she commented that wall that was her interested interest other people were more interested in the legal and financial side of renee CCRCs but here was the important she said fundamentally both concerns demand openness and now these days we call transparency above all we’re talking about honest communications and so invoking the spirit of Marietta whole wealth we will begin with honest communications our first panel today is residents and we’re going to go as you as you all can tell from the agenda for today we have four panels plus a feature to speak speaker plus a lunch speaker we’re going to keep you working right till the end that I’m today and all the moments in between and so our first panel is a panel of residence and and each of them are going to be speaking about the getting a better 10-minute presentation of issues they feel are most important then we’ll open it up for comment in questions both from our live streaming audience and members of the room and Pamela’s talking among themselves so we’re going to begin the buzz gilson yes well Marvin Griffin and they have a barber cream speaking today and I’ll let them decide how much they want to say about their backgrounds but all of them are accomplished in their own rights that’s pretty start us off morning everybody remarks here are my hat on as a CCRC

resident over the years last 700 my life and I around him to different CCRCs one not-for-profit and one for profit Court has Justin catherine has suggested there are some similarities and so there are some differences but the issues that we’re talking about today and going pertaining to both now whatever I practice law for guess a good practicing law for 47 years and having burned out fairly early the last 15 years that benefits of you know that getting paid most of the time but necessarily it’s hard for me to get away from my lawyers skin what to say that I was in I am a finance and business lawyer securities lawyer I’m a litigator and I believe that the issues that we’re talking about the immolation if it’s happening change its change that ought to happen in discussions between residents and providers a rather than in court for a lot of different reasons but then again the notion of change is in the eye of the beholder and this idea of predicting making predictions is said directors an open future so I would be fluent know what you’re going to tell you that suggests to you that change is happening and perhaps even more foolish to suggest that I knew how that’s going to come out nevertheless rushing right Ian I’d like to identify at least three essential elements of what I believe are elements of change that are going on right now in this this CCRC industry the first dose of governance and management and the notion is when you expect change after all the CCRC industry is now existed unstable model that has existed for over a century which you expect it to change over that time in that respect it seems clear that the early model of CCRCs website even though I CCRC resident was coming into independent living that nevertheless the assumption was that the CCR isn’t would not want to or indeed perhaps have the capacity to actively exercise the authority to participate meaningfully in the governance of his or her community and one of the fundamental fact one of the implications of this conception they are that residents which is essentially passive and the providers would be in essence cassone now you’ll excuse me I’m going to be guilty of something I properly here because there are obviously there are these lands and shades and all this but for my purposes let me use them use change if you will I call this the go play and we’ll take care of your attitude CCRC legislation reflective these assumptions and CCRC law is often assumed that the residents were going to be essentially nested in need section 17 71.7 the California CCRC long cotton suggests that the provider is to encourage the residents to form an association to to provide a vehicle for them to indicate their concerns this is someone paternalistic attitude that implicitly cathay needed to be encouraged to do that in the provider on the help them to do that hand but any event this residents association is very inviting to be always advisory and no right to participate and management of governments however the possession of residents councils that were formed at least in my experience from that we looked at a couple and and observe some others is that the council’s themselves tend to be tend to want to keep the lid on if you go they tend to want to protect their fellow residents from the issues that are lost and the council decides our needs to discuss with the provider to protect the residents from them because ever after all that at my cost some people take it out of context and come unduly concerned and so there is some custodial attitude even among the residents themselves in the process and I keep calm and no don’t be troubled by these psychologists keep of it on attitude that’s the original conception the changes in resident profiles leading to changes in

resident expectations we all recognize this phenomenon that people are not only living longer but but they’re living more inviting Stephanie suggested there more actively engaged with intellectually and miss and pointed a physical ability to be involved and engaged that vigor and decisional analytical skills I know that is particularly if you will by the it just as an exam by the rvm ers discussions it was clear if you are aware of those discussions and I’m sure that there will be some discussion that plated today blength that the residents they are needed certainly they they were appropriately assistant by council but in terms of the ability to analyze and to negotiate they didn’t need any help from outside the hip they had the power to do that so looking at what’s happening to to the aging process in general to seniors wouldn’t you expect change and this change would reflect the fact that moving from one’s home ones condominium into a CCRC independent living environment does not suggest that all of a sudden you can’t do when you once you were doing before you move participating many in board governance participating course taking care of your own home so one would expect that people coming from that environment attaining the intellectual vigor would be interested in taking part in the governance of their own Association now I don’t want you to take this wrong in the sense that the pareto principle which is also known as the law of the vital few will continue to apply a doesn’t mean and every resident of every CCRC is going to want to be involved in the management of the CCRC it means that probably a small percentage of twenty percent or less perhaps want to be involved their involvement their willingness to participate his instrument instruments of exchange that I’m assembly is what is helping for the changes to come down so what are some of the changes that one might expect if you expect change and one is the change we’re seeing an obesity reflected in the rvm PRS settlement agreement the movement for residents becoming fully voting members of their resident of the voice of their providers and also being qualified to be members of the executive committee second and probably of greater significance is a change in perception and that is the perception that residents are not supplements in their own view we’re not talking about from the provider standpoint from the resident standpoint the willingness to recognize the residents are contracting parties and the S contracting parties they have the right to interpret their contracts just as the provider was prepared the contracts introduced and given that the contract assist these contracts as we know or so-called contracts of adhesion that is there’s something wrong with the contractor teaches by the way people tend to take that as majority suspect if you’re the teacher parking ticket it’s a contract you don’t negotiate you just taken a real partner and that’s very much the way entrance bremen service and sealants are for CCRCs there’s nothing wrong with that except that if there is ambiguity if there is some destruction that’s capable more than one interpretation then the provider and draft of the contract bears the burden that and the resident has the right to expect it be interpreted in a way that a reasonable business which interpreted the summit’s that the notion of residence as contracting parties is the willingness that residents will start to have to challenge performance and numis consequences there has been the concern as you can imagine that well if we make waves that it simply say that there’s something that we don’t like or do some respect in which you believe the providers should act differently that there might be retaliation and rightly reasons and after all we’re essentially asking for favors and that attitude which I still continues to exist among i believe is gradually changing to a willingness not only to interpret a contract but to ask the provider when the resident personally will provide is performed in accordance with the contract and finally in this respect that the pot of gold that CCRCs provide that provides for on his tea so far

that’s basically what come here and estaphan said a shrimp and enjoy a vibrant intellectual an active community and if that’s the pot of gold then they are criminals should provide our me he’ll to the gold standard and the gold standard in contractors but in my lawyer seven is the notion of fiduciary obligations NASA that’s a notion that suggests that what is not just contracting arm’s length that one is the phoenician area always informative do your candor to the person who has the benefit of distribution area occupations of the provider and track in the very best interest of video of the residents in that case and perhaps although it is the shortest revision in the entire of settlement agreement ancient people has a binder has copied movement PRS and if you go to us to look at section 1 point 9 on page 5 it’s very short solo region it just says every RPL director must buy them to assuming office agree that as a director he or she has a fiduciary duty to rtm ARS agrees that it doesn’t you should those are very humorous with great need operations of our year especially i think i’m going to stop at that point and we will take up the rest of what i’m going to talk to make your any question and you find the way you have copies of my slides your german station very much our next speakers are Barbara and Margaret and he will come up here in one state for them okay good morning i am here under false pretenses i am no longer a resident of a CCRC i moved out three months ago after 18 years in the same community why did I move out I moved out for one reason and several others but I’m not going to talk about I’m just going to say that in 18 years my monthly care fee doubled for the same services everything is the same but my monthly care if you don’t I can no longer afford to live there so I moved out I now add am a proud owner of my own home and not having a lot of fun i missed the socialization that is very important thing being a resident for 18 years in a community gives you quite a perspective on what’s going on I became an advocate for resident interests on the pass a resident rights resident interests almost immediately upon moving into my community I was fortunate enough to come into contact with modern jimtran suit but were the founders of the resident association in California known as Cal Pro California continuing care residents association it’s a very strong life Jim mod gave me a perspective of providers that was pretty hospital and they were the true grassroots organizers but I they on their own travel from in from community to community throughout the state on their own talking to whoever they could to try to galvanize interest something as buzz was talking about to try to galvanize interest in something which was a common thing has to do again with money constantly rising monthly care fees was the problem and people were upset about this so that was the common theme that brought people

together and finally the emerging incorporated California continuing care residents association after Jim decided he was going to retire I was been elected president I served two terms and during that time I had the interest that I had was in getting a resident representative with the vote on the provider board of directors that was what we were trying to do and we at that time did not have a lobbyist and so it was direct negotiation between providers and residents there were three residents volunteers facing a table full of providers to negotiate the terms of this halfway through the negotiation which lasted over a year we finally found someone who would work for almost pro bono and become our lobbyists name was Mark Brown when he took over things changed tremendously because he had their resources that we lacked we passed the bill and it had a lot of wonderful things in it for the benefit of residents but we were not able to get the vote we did get a resident representative on the provider Board of Directors and because contracts vary so much throughout the state negotiating anything like this is very very difficult we didn’t do it now that that issue as important as it was now we have another you that i have taken on and that is as you know the governing body oversight that has oversight is C is the California sorry social service social service I’m having a senior moment sorry california department of social services but we have the no bets not the mainland well I’m sorry do you have to realize I’m going to be 90 years old Bob tells yes I know but the that body who is kinda mental and licensing oversight over the industry is almost non functioning at this point and it’s my thing to try to change that the legislation that put this body into place something has to be done about this because there is no effective financial oversight the licensing is still in place but the financial oversight over the industry is lacking totally lacking this must be changed now during the 18 years and I served on various things I was served on the advisory committee to the continuing care contracts fractions is the name of the skate continuing care contracts French and it was not effective then and it’s totally not effective now we need to do something about this all this these financial matters are the ones that are predominant which is unfortunate because month the time that I spent at my community I thoroughly enjoyed living there the services that I had were very very good I enjoyed every bit of it that was not the problem the contractual services are always met and sometimes even more so but now there were other issues with the community where I lived or I tried to galvanize interest and its failed totally I really had a bad experience in that respect

because the resident council what should have represented my issue which I’m not going to get into refuse to do anything about it so that is another why I left the community because I felt that there was an there was something going on here that needed to be changed but I was the only one that wanted to do anything about it so this is very much in keeping with my buzz was talking about it’s very much alive and an issue the the time that I spent in my community was rewarding and it’s this the civilization that I had there I missed that in living by myself now although I’m still very close to a lot of my friends but my whole experience as a resident was a mixed blessing I can’t exactly say that it was a bad experience or a it was just an experience was evolving and constantly evolving just one thing I would like to say in that business I this part what we’re doing here all of us here trying to do is a step and a half in the right direction this is so much needs to be discussed so many things need to be changed all those we have already had a lot of changes they haven’t touched what is the real problem here and that is the way that the residents are as those mentioned paternal eyes by the providers this is not a good thing there is the respect that they should be giving us because after all without us it wouldn’t be much of a CCRC industry thank you so much wearing my name is Margaret Griffin I’m an eight-year CCRC resident and I’m also the current president of Cal credit stable a resident Association only 38 states have specific CCRC regulations and in those 38 states CCRCs are overseen by a variety of bureaucratic entities could be the department’s of finally have some insurance most usually in this state at Barber said it’s the Department of Social Services so there’s really no consistency between states in terms of oversight type or effectiveness of regulation but in California we often hear that we’re the most regulated state when it comes to CCRCs which sounds pretty good but given the variety of approaches state line under nationwide merely having a lot of laws on the books really doesn’t say very much we’re really actually at the top of a pretty me turkey when it comes to regulation I think and the statutes that we do have largely reflect the interests of the providers at the expense of meaningful consumer protection provisions this morning I’d like to talk a little bit about it Cheryl de status if akisha Capra feels recording it will be supporting to try and change our current law to strengthen the resident rights and improve transparency and accountability in the operations of our communities first as Barbara and we’d like to see transfer of the financial and contractual oversight our communities from the Department of Social Services to the Department of Insurance we feel it’s necessary because the actuarial and financial expertise required to really oversee our communities resides within Department of Insurance not within social services second we’d like to require that force a requirement that all CCRCs conduct periodic actuarial studies to assess the financial condition and long-term viability of their organizations

currently this is required only for facilities offering plus eight or life care type contracts but we feel that it should be applied to all CCRCs we would like to see that financial information that’s currently required to be provided to rest Selene every six months instead be provided quarterly and include a written explanation of any significant budget variations this may sound like a big deal that we don’t think it is we believe that providers distribute this kind of information to their boards right now and we just think that it should also be extended to include residents so that residents are fully informed we would like to see the establishment of a firewall between the CCRC and its parent or management company specifically to protect the assets of the CCRC so that they cannot be pledged on behalf of other activities of the parent company and as the Desmond said several times this morning we would like to see an acknowledgement of the providers fiduciary responsibility to residents providers particularly the nonprofit’s like to say that they are mission-driven that they’re in this business really to do good and provide services to seniors which sounds very heartwarming but I gotta tell you depending on who says it context I tend to find that either insulting or irritation I prefer to see the phytic fiduciary approach that acknowledges the imbalance of power in the provided resident relationship and makes it clear that the provider has an obligation not to screw over me I think that’s an acceptable legal concept but it basically means that they are to act to protect my poverty they have an obligation to my benefit which is different from the condescending pat on the head or the referred to we would like to see that all nonprofits ECR see board meetings except for executive sessions are open to residents and we would like to see that all boards have an audit committee and nominating committee consisting of independent directors or trustees some of these elements you’ll recognize from sarbanes-oxley legislation came about as a result of the end debacle in terms of how private industry operates and we think a lot of those concepts have resonance for our our industry as the next to provide or require a self-evaluation while nonprofit boards be conducted and that the evaluation be made available to residents we would like to see provider investment policies clearly articulated in writing and made available to residents and as you heard several times this morning we would like to see a minimum of one resident is a full voting member on CCRC boards I think it’s important to recognize that this is already gone in Washington DC Maryland and New Jersey it’s established practice with the Kendall Corporation which operates probably a dozen CCRCs on the east and in the West and interestingly enough there are at least five California communities that had voluntarily adopted this practice so that certainly IRS ruling 70 to 120 for which establishes a tax-free status requires that CCRCs be operated at the lowest feasible cost so we would like to require that our boards annually determined that this requirement has been met and then share the basis for that determination with residents we would like to see posting on the CCRCs

website of all the information reports that they are required to file with department of social services including their IRS Form 990 we would also like to have our providers porch residents quarterly on any complaints or concerns that have been filed with them with their management board or Department of Social Services we’d like to know how those complaints were resolved and when any unresolved issues will be resolved those are the issues that we have before us and I’d like to hear what you think or if there are other concerns or issues that members of the audience I thought they might the fireworks started before too long and I think we’ve begun we’re on the portion al we have about a half an hour when we can entertain questions from the audience discussion among the panel and anybody who is watching us feel the live streaming they certainly send in two questions by email I would start with the audience is there anybody in both in the audience would like to see it unfortunately what we’re going to have to do if you say the question I’ll repeat it so that we have a captured for the real recording and appending the audience like to start us off yes requirements of applicants residents and perhaps alright the question for the camera is could there could the commentaries from analysts talk a little bit more about their interest in disclosure periodic disclosures what might be included in those disclosures and whether you could also include not only current residents but prospective residents people outside the community might be considered neck yeah it didn’t seem right for you sis what’s on it’s very on just again using a securities lawyer background perspective the SEC has evolved a notion of management’s comments and discussion the angel condition and results of operations called heaven DNA and so when one buys austerity from an issuer in the public markets and as well if one is a security older seems important from the issue an annual report filed with the sec it contains this so-called young DNA section which is a little bit more than the boys self-evaluation that Martin was referring to let me just give you a quick statement of what the ways described in the SEC is released the first proposed is in the you a disclosure active 2002 it says and I’m going to just change the language a little bit to refer to regulators as distinguished from issuers and it says management’s discussion and analysis of financial condition results of operations when I’m not adopting the thrust this this kind of disclosure in quotes information that the provider believes to be necessary to an understanding of its financial condition changes in financial condition and results of operations with particular emphasis on the providers prospects for the future that would be provided to every prospective residents as well as to every existing resident annually it’s the it’s the providers own analysis of the recent results of its operations and what it sees as the challenges financial resources going forward and just along the lines of disclosure for the disclosure to existing residents the so called key indicators report is a portion of the annual filing the providers they tell in California and it’s a fascinating document with a lot of information in it it’s not easily accessible aveda what’s a public document in today’s mail hold on the branch if the ranch were able to automate it and to supplement it for example with a with the branches on analysis of what general trends over a long rosette who’s here with this day and was formerly president of the Calgary as observed that the key indicators report would be much more meaningful if they included with

standard set prepared by the branch against which the indicators then in an average of California’s CCRCs for each indicator comparing an average year after year would provide an indicator of where the industry’s head its examples of the kind of additional discipline Barbra Jean additional observations not not specifically I think what we’re really interested in is getting the information to residents timely and in a format that’s understandable it was Buzz indicated there are reports that have to be filed annually now from the providers with social services and even though that information is public it’s not readily accessible and therefore really not very usable either by current residents or prospective residents in terms of getting a look at the industry as a whole or getting a look at a particular facility just one more comment another’s in them and a parent subsidiary structure this is a particularly challenging difficult issue because to the extent that the financial disclosure exists it exists with respect to the subsidiary subsidiary being provider and not a prospective apparent and Lawson subsidiaries very much control by the parent in many respects and the financial relationship between the subsidiary parent sub-step without information about financial condition of the parent one is only getting a small party picture mail current so that’s one of the challenges I think because going forward parents and city instructions the risk to the resident is that the resume of perspective innocent doesn’t know anything about what’s going on up top it just so about the provider oh but you may have to do what would the presidency recent use of industry how would it change the residential experience so the question is how would it change the residents experience to know more about finances if they are in a single entrance fee model central Spain or any residents okay so once your page your entrance fee how would help residents to know the this additional information we’re going to give one posits that residents ought to have a more meaningful participation in their governance as marketers pointed out on financial environment without financial aspects of the operations to continue the ability to provide the province services going forward and trends in the financial condition of the provider if one is to be able to analyze that and there aren’t there are residents can do that there are residents of financial backgrounds business and financial that was many residents head and the interest of doing it in order to do it you need to have the financial information to work and so even though your engine see isn’t funded having that information allows you to participate more meaningfully with the provider in looking at what’s happening to the to the institution for example I think the example Catherine provided at the outset of the resident I was able to fight as a proposal to materially increase the size of the provider at a time when the residence in field was justified with that information any expertise to you so they were able to make a contribution which ultimately 2020 eyesight allow the operation the CCRC dignity well and I think a more recent example even is what happened in Rogue Valley manner where the residents were able to take the information about the operation of their particular CCRC and the parent corporation and file suit that was ultimately settled with some important benefits to residents I suppose it’s

possible that the providers right Arnie that’s exactly why you shouldn’t have the information i would like to think in the long run though that residents that are engaged and involved in their facilities make it better make it stronger you can tell when you walk on the campus what what the environment is and ultimately that’s what’s attractive to potential risk let me ask a question in my role as devil’s advocate in 2008 it clearly was economic recession that not only hit the global markets fell hard it’s easy errands industries particularly hard because of the importance of perspective residents being able to sell their homes at high dollars and when the housing market fell apart so did that Rennie available supply people who could sell their home to move into a CCRC and pay a high entrance fee are the concerns that are being raised by Khafre you know too focused on the impact of the 2008 recession or do they go beyond that particular financial event I think certainly that financial event is very important but I do think it goes beyond it as well because if we’re going to look at a long-term strong industry we have to look at how it’s going to operate and I think having the financials in place making that information widely available so that we can get the best possible approach and set up and is what we need one system to take the providers point of view I think is important for resident problems as reasons to recognize that providing information and taking on increased responsibilities if that has to happen all costs and costs of providing and therefore you know that would be cost the residents and you can’t have it both ways there will be additional costs and there also will be perhaps few or prospective providers we’re going to come into an industry that’s more heavily regulated it would be good if we could avoid materially great or healthy or regulation but the only way we’re going to do that is for the providers and the industry to recognize what’s happening and decide to get in front of it and do what will media ray some of these concerns that’s the negotiating process than surrender earlier and I think truly residents and providers at the end of the day want the same thing we all want our communities to be successful one of the questions one of the proposals that you’ve raised and has been raised another community there are other stands as well is this idea of residence serving as voting members of boards of governance of their providers what about the potential for a male content somebody who simply cannot find anything that they’re happy with being elected what must was the way in which that won’t be a problem for divorce well I would assume that would be handled the same way anymore now would handle either a mal content or someone who turns out to perhaps not have the strengths that the board initially anticipated that they would have I don’t think that it would be crippling necessarily in any way and the board would probably deal with that in terms of the person’s service on the board and if it’s not valued I think the residents would bring a different perspective yeah i think the perspective is important but the possibility of someone who is not constructed being pointed before always exists all the way the residents have been given this opportunity would exercise it with as good judgment as they can bring to elect a representative who will represent their views a disowned and constructive man it’s obviously the case that someone who is going to do so basically by ranting and raving about everything it’s not going to contribute to the problem effective functioning of before and now we’re talking about still for his residence representing a minority and for this market its attitude if you do have someone a little more juice minority am not constructive

and making it difficult to operate or it’s managed to get the work they need to do done in spite of that in various ways the other interesting thing that I found in in researching this issue over the last year I talked to someone from Kendall corporation where they have done this as a matter of corporate practice for years and I’ve spoken to resident board members in Maryland and Washington DC as well as here in California at those communities where this is happening they’re all consistent about the value of the resident perspective and that it’s important that the resonant board member just like any other board members have the interest of the entity first you have to be able to set aside personal interests small interests to look at what’s best for the facility and the resident can do that as well as anybody else and that’s really the key to having an effective resident as a better board representative I let’s all this welcome to the audience and macaroni will come to the front row back row first in front are continually how oversight from okay so the question for the camera is what what fears of residents exists in addition to or besides the concern about rising monthly service fees and how specifically my movement of oversight from the Department of Social Services to a department of insurance type of arrangement change that dynamic from your perspective obviously as Barbara suggested and bathroom I’m sorry and Margaret has noted right now the continuing care contract range does not have tools to address the kind of financial regulation that is appropriate to protecting the interests of residents in these ECC our students it’s not that they don’t exercise against that the statute doesn’t provide it provides what is only a started thermonuclear war about when when the condition of a provider has deteriorated to such point it’s on the verge of being unable to fulfill its mission that any action can be taken by the breakage so when the legislation needs to be modified to permit that that’s a major concern for the intro oversight but it’s not financial oversight tend to be an immunity since its intended to be able to intervene and participate if it sees the provider moving in a direction or these transients finances and operations our worries the standpoint of its continued ability to provide services so that needs to be changed I differ a little bit with Martin sense that I don’t think that it’s necessarily a plane this is during transfer to the Department of Insurance that function yes in fact the legislation to think some help what the legislation has to be there to provide reasonable and effective financial participation over scientific wheel of the branch and two it needs to be given the personnel carry that out Bob Thompson has is a jd/mba and the 17 years of experience here and he could do that he can’t do it alone and he can do a graphic statutory authority to do strongly yes just this model of the parents of scenery the only model that exists in the industry is there no such failures are self-contained okay so the question is is the parent subsidiary model the only model that is practiced in this industry or are there also self-contained units that are entirely unitary in their operation i know from Pennsylvania’s perspective there are emotional Ottawa and nation why there’s just an extraordinary array of models but I’m sure California what about in California are you aware of any non parent-subsidiary organizations there are some not not that many but

there are some one of the impacts of that has happened in the industry certainly as a result of the 2008 financial crisis is there has been a recognition of strength in numbers and so there has been somewhat of a tendency of the industry to draw together and share finances and share and thereby lower on the cost for the individual units through that so that has been a tendency since 2008 someone I’m assuming that perhaps also happened in California other comments your questions do we have any I’m coming in from our streaming audience yep okay good how about how about how do people here are in are somehow associated with a continuing care community right now so many people how many people have never been to a CCRC that are interested in a novel it so that so really fun person is in the never been there yet but intra and pretty much much of the room has some connection to see Sarah sees how many are on the provider side of CCRCs okay so we have a small animal provider side but thank goodness we have you and most importantly we’re hoping that you will speak as well because part of this is we want this to be a conversation from all sides of the perspectives I mean one of the questions that often comes about we’re talking about this before the program starting today was the attorneys and you know there is a tendency in this world for the problems to dominate the good you know and so if there is one particular problem child in the industry everybody focuses on that problem child and we assume that everybody has the same problem to what extent is this a small percentage of the communities in California that raised concerns to what end to the ascendant you’re aware this to what extent do you think this is really that many of your concerns are widely shared on residents do you have a perception of that have you’ve done for example a resident serving in California we have not done resident survey I realize it’s harder to do in California in a small physical state but it sounds like that I feel useful so I need to be very useful when it is interesting that since we have part of an organization is going to CCRC operations and although the chairs of the resident councils of each these organizations has each other’s the chair hat each one has the telephone has a telephone this for all the others they talk to each other and marietta let me protect that rest very carefully and so it’s not easy it’s not it’s not really facilitated for the residents of various CCRCs to talk to each other about common problems so it’s hard to know I I suspect person without I know that there that there are other discussions with going on in the path on other negotiations if you will between residents and providers vogue in California and outside Calvin on occasion may grab to end up in litigation most of the time those that taking place happy and settled as they should have been settled in the negotiation mediation process but exchange of information other than organizations like calc rough but exchange of organisms of information on one resident councils i think is almost used to my knowledge all was not existed california yeah i think it’s generally not supported by providers they would really prefer keep things insular and to to keep control i had an interesting experience a few years ago when i first got on the cal per board and I side you know gee this is great we ought to be able to expand membership you know contact some of these other places where we don’t currently have members so I got the list of communities from social services and started calling around first you get the reception desk and I asked for the chair of the resident Association resident council and they wanted to know who I was they wanted to why I wanted that information and I invariably got shunted off to marketing or an executive who told me quite frankly that that information was kind of potential and they really didn’t want me around

well there is just a defensive active there is there is a real issue confidence young and from the provider standpoint the provider probably ought not to get involved in providing a lot of resident information but the residents ought to do that we went to the extent that we want to have that kind of interchange certainly got the foul additional restriction on it got the power to do what we just have hasn’t gotten back support now we’ve mentioned this organization how promote perhaps we should define it more clearly for people who might not be aware of it however what is the acronym akron stand for California continuing care residents association it’s strictly residents of CCRCs and we we live on on dues from residents we don’t have any other grants because we are see 501 c 4 organization we we don’t get any kind of help that other nonprofits typically get in terms of grant support or foundation support do you do a residents of a community belong through their community do they have it have any come involved in this state they’re all individual members in some states like I think New Jersey the community is the but here it’s all individual members we have about 20 100 members currently out of approximately 20,000 CCRC resins it’s been as a question I would have served providers perhaps the single most important factor residents receptor well let me just repeat the question for the camera so the question was about the importance of a constancy rates for the provider how the residents feel about that same occupancy rate residents are very interested in occupancy and in most communities of a give you mine for example there I residents who have volunteered who want to host prospective residents who make their apartments available to show prospective residents residents are very interested in occupancy and they realize that if we’re going to have viable community we need to keep it home I’m taking that to the building down where the muddy Mississippi there is nobody else who’s Katrina budgets of CCRCs are all funded by the residents that’s that’s where the money comes from consequently when she fall below certain levels of occupancy you start to have some serious financial problems because there’s nobody else here to pay the bills and consequently least concept if the occupancy level Falls to a sub to some levels lower levels than one would be decided and it’s not very long by the way we’re not talking about sixty percent or seventy percent were talking about falling into a lot of 90 persons you can see start to hear the kind of financial problems where got a new one of two things one we’ve gotta cut services or the quality of services or two gotta increase monthly fees neither of which is a happy thing that have happened in consequently residents have a real financial interest in the continued high occupancy of their 60s ensue if you can imagine that creates something of a conflict of increased since that if the resident sentient providers are sparring about something least publicly as far as something or if they’re some concerning amount there’s a lag they don’t get along it’s what I’m trying to say that certainly going to affect a decision of an intelligent perspective us and not and that’s one of the one of the issues that drives residents and should drive them in trying to reach agreements about things that they’re concerned about in a way that preserves our voice mutually assured destruction might hurt the provider but it will certainly here at the community as well we had a comment from the live streaming that pointed out to us that nobody had talked about the importance of a contract in the relationship between the residents and and the contract really in many respects is everything and both good and bad and I think we’ll have opportunities to talk about that role of that contract as we go forward in them in the sessions for children some of our afternoon sessions I certainly

like a goes up every year I also and more importantly don’t want equality housley maintenance grounds so I were concerned about that frankly I do people should probably read the contracts a little better before the excitement I because they they but they think that long-term care sure ok close to market and each nations in house you they were so it’s so bright a watch but it just can’t be okay for the camera important comments first of all L from a resident who’s been a resident CCRC six years she said she may have gone into her after the state with unrealistic expectations and others might as well that on one hand she liking but he does not want to see costs go up on a monthly basis but I’m more importantly she just want to see services go down and there’s that clear trade-off she also commented about the importance of tight see contracts which is sometimes that that acronym is used for fee for service contracts but we’ll talk a bit more about different ways in which these letters can be confusing and she was coming out of importance of really understanding the type C contract so that you don’t get into that format not not realizing how much you will have to fund out your own and may be unable to put on your own and then finally an important comment about Capra that meaning the perception was that it was a gripe session and that it was negative and that that was not useful response well I think that’s a really important consideration and a lot of times I think what happens at local facilities it’s really driven by local personalities and as I said earlier residents really have same basic interest that the providers do and that is that the facility being successful which means you need to find a way to work together now what our administrators may call successful might be no no staff problems no complaints residents residents call successful might be good food well cared for facility but doesn’t mean what is right ones wrong you know it’s all important and it has to come together to be an effective community and I just hope that perhaps that the personalities may change at your facility and that there’s opportunity for a different kind of dialogue well with that comment an important response let’s take our break let’s connect as close as possible to 1125 as we can and we’ll get started with our second panel and I know we’ll have important things to talk about that second channel there are restrooms on this white side