Opening Your Own ALF with Carline Cadet Francois

Welcome to the Living to 100 Club Podcast. Here's our host, Dr. Joseph Casciani. Well, hello to everyone joining us today on our podcast. You're listening to one of our Successful Aging episodes this month on the Living to 100 Club program, and I'm your host, Joe Casciani. Each week, our conversations educate and inspire, helping you get the best out of all the years we're given, regardless of what obstacles come our way. On today's podcast, our guest explains the process of starting a residential assisted living facility. Carleen Cadet-Francois explains the differences between small residential ALFs and large commercial ALFs. With the burgeoning older adult population and the growing need for congregate housing, our guest shares the licensing, regulations, and financing process to owning and operating your own facility. Be sure to tune in as we learn the advantages and the challenges of being your own boss as owner and operator of an ALF. First, a little background. Carleen Cadet-Francois is a first-generation real estate investor and ALF mentor who empowers individuals to open and operate successful assisted living facilities. Her experience ALF owner and operator expertise guides clients in creating profitable and desirable environments. Through education and hard work, Carleen helps others achieve generational wealth and make a positive impact. She's also the author of the book Money Saving: Step-by-Step Guide on How to Open an Assisted Living Facility from Start to Finish, offering comprehensive insights for aspiring ALF owners. Carleen, welcome to our program today.

Thank you so much for having me.

Well, you're very welcome. I'm looking forward to this conversation. I know it's going to be education for all of our listeners. I always like to open by asking our guests to tell us a little bit about the journey that brought you to where you are today.

Thank you, Joe— Joseph Casciani. So I got into assisted living because I worked at the sheriff's office and I was Sergeant Cadet Francois, but I didn't have time for my little ones at home. And because of that, I had an itch to change career paths or stay home with the kids altogether. And I got into assisted living because my mom was already in the field. And ever since I could remember growing up as I was, you know, a young child, my mom was working as a CNA at one of those assisted living places. And so, when I thought about finding another career path, I figured I would go the assisted living route because I have a passion for seniors and for the little children. And so, that's how I ended up picking assisted living, and since then I've loved it.

Hmm, sure. Now, what was your mother's work in ALS? You said she was already working. Was she an administration or more direct care?

She was working more direct care. She was a certified nursing assistant, and she was pretty much taking care of the seniors, providing whatever help that they need, whether it's for activities of daily living, eating, dressing up, and companionship. She was already doing that.

Sure. Essential roles. Those are very much needed. Yeah. Well, so you made a decision to move in this direction, give you some independence and allow you to exercise your interest and passion for seniors. What were some of the first steps that you took to making this move? How did you begin?

So I began with one of the income-producing properties that I have. I'm also a real estate investor. And so I had a single-family dwelling that is freestanding, and I ended up converting that single-family home into an assisted living conversion, meaning I requested approval from the zoning department whether or not I was allowed to have an assisted living at that particular location. And then I then follow the instructions of the Agency of Healthcare Administration for the state of Florida, but for anywhere else, it's pretty much the licensing authority that governs assisted living facilities. I followed the instructions. I did a whole bunch of repairs to the home and then installed generators. It was a pretty long process, but I ended up converting the home into assisted living, and now we've been providing care for almost 2 years now. Mm-hmm.

Yeah, so you did a lot of the research up front. You checked with zoning regulations and existing laws for your area. Now, for me, when I think of assisted living facility, I generally think of a larger setting with, you know, maybe 50+ or 100+ residents. Now, when you and I spoke, you, you educated me, helped me I understand that assisted living facilities also refer to smaller structures as you have for yourself. So what's the difference between this kind of residential ALF and a larger commercial ALF?

Right. So most people, and you're not alone in this, most people only know about the larger setting types of assisted living when in reality there are smaller residential homes, if you pass by, you would not know this is a licensed assisted living. And the same government authorities that governs the larger ALS, like people, most people know about, are the same people who give us the license, are the same people who comes in and do the inspections. And we're pretty much the same thing, but the difference is at a larger setting, if say, for example, your mom is more active and she's, focused on pretty much just activities and maybe someone to remind her of when it's time for her medication. She doesn't really need extensive help. She doesn't really need too many hands-on. She would fit more for a larger setting. Whereas if she needed more care, she needed more hands-on, she is not able to do most of her activities of daily living. She would fit more into a residential assisted living because we are smaller and we are able to provide the more one-on-one care that because of the size of the larger settings that she would not be able to get.

Mm-hmm. Mm-hmm. Okay. So there's more attention, more personal attention, TLC, with the residential centers. So how big can a residential ALF be? Let's say in your state, what's the maximum bed size?

So my state, you can get up to 15 residents into one, but the most common number is 6 to 8. And that's where most of those single-family converted into assisted living homes are able to provide more of that one-on-one setting because the number of residents are very small compared to the number of staff that there are. And pretty much that is the only big difference when it comes to a smaller setting versus a bigger setting, because we pretty much are governed under the same licensing statutes and we do the same thing. The only difference is we're able to provide the more one-on-one care. Let's say, for example, your mom is at a bigger setting, and when she when she got there, she didn't need so much help. But with age, and she declined a little bit, and now she needs more help, usually the bigger settings would require the family members to either hire the certified nursing assistant, CNA, and pay them separately from what they're already paying that assisted living to give the additional care. And then usually the family members would decide to go to a smaller setting because it's cheaper for them. They're able to get the level of care that, you know, their loved one needs without having to pay an additional charge or fee to someone else to come in and provide the additional care.

Mm-hmm, I see, I see. So when there is some decline, maybe on admission the person was doing okay, adjusting and managing, that level of residence, there's some decline and then the facility might say we need some additional help, maybe you need to hire some private duty CNA for that extra assistance or look at transition to a skilled nursing facility. I guess that would be another option before going to a smaller residential. But what you're proposing, it makes a lot of sense, is that if you can get into the smaller settings where there's more one-on-one, more attention, that person might be able to manage just as well rather than in the larger or ALF or shifting to a SNF. Makes a lot of sense. Yeah.

Right. And sometimes too, depending on how much help the person needs, let's say, for example, with a standard license assisted living, even at a smaller setting, certain decline we're not allowed to accept residents for, and they would be appropriate for nursing homes. And as you know, nursing home is more expensive because they provide the skilled nursing care and professional care that either larger assisted living or even the smaller assisted living cannot provide.

Mm-hmm. So you've, you've been through now 2 years at this and learning to comply with all the required legal regulations, zoning laws, and all of that. And I know when we spoke again, you did have some really strong recommendations for this model for someone who wants to have that kind of ownership operator role to play. And there are a lot of advantages, as you said. There's a lot of financial gain, revenue potential, but also there's some real, I guess, challenges or—— I won't say disadvantages, but well, maybe there are. What are some of the upsides to this kind of arrangement for the owner?

Yes, so for most owners who want to open the smaller setting, they usually have either a nursing background or they've been in the field of the ALS providing some level of care. And I would say if you have a passion for assisted living, and you probably never thought about you can own your own business, but you actually can. It's a bit expensive to start because consider that you have to have a home and make the necessary repairs and equipment that needs to be done to the home in order to get the license. And most people are frightened by that. What I would recommend is to joint venture with perhaps another, you know, CNA or person who actually wants to open an assisted living, and you can join together your money and come into a joint venture agreement. And instead of carrying all the costs by yourself, now you have someone to share the costs and the profits with and the responsibilities with. And of course, working for yourself, you get to have full control of the income. You get to, you know, pretty much make all the decisions that are necessary. Say, for example, you're not feeling well for the day and you don't feel like going to work. Perhaps you and your partner can determine who's working today, and perhaps you can decide to hire, you know, a couple of people to assist, and some days you can simply manage. But pretty much it's a win-win if you really look at it. The only thing I would say that is not So desirable is the fact that most people will not know that you're there in the neighborhood, and because you're not allowed to have signs, unlike the big assisted living, because we are residential. The whole point is so that, you know, our seniors feel like they are living at home. And so if someone is to pass by down the street, they would not know that you're there. So it would just That means that you would have to let people know what you do, let the people in the community network with the community, and let them know what you do. And if people gravitate towards you because they feel you're a good person, they're more likely to refer business to you.

Mm-hmm, mm-hmm. Yeah, so you have to monitor the impact on the community, of course, but there are these upsides to having your own business. With that dedication, maybe shared financial risk, it can be a very positive position for someone. I'm wondering what types of patients, what types of residents are referred and what kind of medical problems, cognitive issues, or is there dementia in the picture, family problems, what kind of population do you typically have in your facility?

Most of our seniors have issues with dementia and Alzheimer's, and of course, other age-related issues. Sometimes they may have fall risks and they need a smaller setting. And other times, their family members simply need help because, you know, life happens. And it's very difficult to care for, you know, an aging parent. Things get really difficult because life happens. We still have to work. We still have to take care of our own families. And, you know, when mom and dad need care, sometimes it gets overwhelming for family members to care for them around the clock. And so, most of our seniors that come into assisted living, they need help with eating. They need help with bathing. One of the things that they need a lot of help with is with their medication. Making sure that they take their medication as prescribed plays a major role. But pretty much anyone that doesn't need any expensive skilled nursing would fit into an assisted living. Skilled nursing, let's say, for example, if someone needs to be fed by tubes, they would not— we would not be able to admit them into an assisted living regardless of the size. They would be a fit for a nursing home, for example. So, if they're able to sustain themselves with help, we're able to admit them into an assisted living.

Mm-hmm. Mm-hmm. Oh, great. That's a very good answer. Thanks very much. So, what type of staff— what types of staff do you have? I assume if you're dispensing medication, you need some licensed personnel, maybe a CNA. But tell us about the staff that you employ. Right.

So licensing requirements are every single person that is at the facility, whether they are working or they're just supervising, everyone has to have a certain level of education, and that is the requirement even for being able to assist in helping our seniors get their medication. There is an extra core class that needs to be taken in order for them to assist our seniors. So everyone that is helping our seniors must go through a Level 2 background check. This may be different from state to state, but anyone who comes in contact with our seniors must have certain education requirements, and it has to be on their file, including myself. Mm-hmm. Mm-hmm. Sure.

Do you know what that level of education is? Is it high school or GED or—

Aside from typical high school and GED, they have to take either a certified nursing course or for me that I'm the manager, I had to take an administrator exam and state exam also, and it pretty much covers a certain sets of rules and statutes, and it goes over all of those educational requirements. And it— those courses have to be taken from someone who is also licensed and approved by the licensing authority. For Florida, it is AHCA, Agency for Health Care Administration, and they have to certify that we took those tests and those educational courses from them, and they have to issue a certificate for the files of each employee that is within the facility.

Sure, sure. Yeah, continuing education is really essential and it needs to be recorded and monitored. So what about payment? Is this something that Medicaid picks up or is this private pay? Who covers the cost? So it's both.

Medicaid pays for some parts of the monthly requirements, and then the rest of it could be family members pay directly to, you know, the owner, for example, myself, and that would fall into private pay. So it's both.

I see, sure. And then how do you get your referrals? Who, who refers residents to you? Is it mostly word of mouth, or do you get admissions from community organizations? How do you get your admissions typically?

Yeah, so pretty much from the community. I also work with placement agents. They're pretty much professionals who may know of a family member that are struggling to find a place for their loved ones, and they will reach out to someone like me, and they would bring the family member to tour the facility and if the family member feels that we are a right fit and they are a right fit for us. And then that's one way we get residents. Other ways is through social media and having a website and internet presence, and people look the facility up, and if they like what they see, the reviews that they read, and what the inside look like, they would proceed to calling me and making an appointment. But pretty much I tell everyone what I do, and those word of mouth goes a long way when it comes to being able to find seniors for your facility. Because unfortunately, seniors do pass away. Most, depending on their needs and their age, most pretty much could be out in a facility for sometimes less than 6 months, usually much longer than that. But I say this to say that, keep in mind, you want to build those relationships because you never know when you're going to have a vacant bed.

Sure, sure. Yeah, so have you ever had any high-risk patients or anyone that you've had to, you know, in SNFs we call it administrative discharge, but have you ever had any occasions when the person has to be transferred out, you couldn't manage their care?

No, I haven't had that because when I go to do the assessment, whether or not someone is fit for my facility, I'm very careful about who I admit into the facility because I don't want to take someone and then less than, you know, a month later or 2 weeks later or, you know, very short down the road that this person needs a higher level of care that I'm not licensed to provide. And so, when— it's very important for the administrator of the assisted living to be able to assess the patients appropriately. And state license and statutes and trainings will help you to determine what to look for and how you should assess your patients. So, for me, I've had one that was a fall risk. And pretty much we pay attention to her and making her feel safe. And then with her loved one, we talked to the doctors and tweaked the medications a little bit. And now she's doing great. So sometimes all it takes is a little bit of more TLC, tender loving care, and then they feel safe. And then they feel like if they stumble, there's someone right around the corner to help them. And then it helps because the nerves calm down and a little bit of changing this medication. We work with doctors and other specialty people that comes in and provide licensing, you know, higher level of care that they need that I'm not trained to provide. So it's pretty much everyone comes in to give them the care that they need, and we all work as a team to make sure they get what they need.

Mm-hmm, yeah. So a good assessment will identify any potential risks, or you know, as you talk about the kind of risk management, you make sure if there is an admission, you really will look more closely at the individual, monitor more closely, and you do have these outside contractors, it sounds like, other professional specialties that contract to provide the more specialized care. So that includes primary care physicians, I guess maybe psychiatry, or what other specialties do you contract with?

Yes, for both. So it's also for, you know, the podiatrist, for example, that comes in to provide care for their toenails. You know, the eye doctor comes in if they need any X-rays or anything like that, and the doctor ordered these X-rays, they'll come in and provide those services at the facility. And I don't have to pay for any of that. The resident families and their insurance usually cover all of that pretty much The doctors that comes in, the nurses that comes in, we all work together as a partnership to make sure that our clients get the best care that, that they need. Of course, we work with the family members also. If, if there's any other specialty person that they feel needs to come in to assess and to provide a different level of help, we also work with them and they come in and they do that.

Yeah, it makes good sense because these are medical specialties and these are medically necessary services. So in many cases Medicare covers, and if not Medicare, then Medicaid would cover it. So you have a full complement of care. I can see that. And with this setting and whatever the patient's needs are, medical needs are, you can help address that need. That's great. Yeah, right.

Unless they need anything extensive, any open wound type of procedure, then their doctors would have them go to a hospital to do that. But if it's the basic level of skilled nursing type of care, then we're able to do that under our licensing requirements. Yeah.

So you're operating this facility, um, very competently and carefully, and you're providing care to your residents. So as an owner-operator, you're doing this good work. Now you also talk about kind of recommending this to others as a way to build some wealth, and you even refer to generational wealth. You can kind of recommend to others who want to go down the same road. Tell us about this. What's your thinking about this, building this generational wealth?

Yeah, so I am all in for building generational wealth and leaving the next generation better than how we found it and how you know, we've had. And being able to be your own self-employed person and being able to be in charge of the income that comes in, even giving yourself the freedom to say, "I am my own boss." You know, I've been treated a certain way working at X, Y, and Z, and now I have the ability to work for myself and, you know, make the rules and keep some of that income. And perhaps you can use it to invest into other things. My sweet spots are always real estate because I really do believe real estate helps people build generational wealth. Now, there's other things that you can do with the money, but for me, I always end up in real estate, and it has served me well. And I think sometimes people, people believe that there is no way when in fact there is some ways. And oftentimes all it takes is to listening to a podcast like this, and then you, you begin to have other ideas of things that you can do that will help you to not only live a better life, but also leave something for your generation, if that's something you're passionate about.

Sure, sure. And you've, you've written a book, I know, and it probably captures a lot of the same material, same kind of content. Tell us about your book and who's your, who's your typical reader? Who are you? Who have you written the book for? Yeah.

So when I wrote my book, when I started this assisted living journey, I looked around and I didn't see, you know, I'm an avid reader. I like to get educated and find out what I have to do. I love to read policies and procedures books. Those are my kind of thing. And when I was opening, I didn't find any such material that was so focused with the state of Florida. And it took me forever to open because I did so many mistakes, trial and error. And, but I documented my process. And so I knew once I was open and was successful at it, I was going to write a book to help other people and avoid some of the pitfalls that I went through. And so I opened this— I wrote this book for people who are trying to open an assisted living, or you may think that you can, but you want to read a little bit more about what's required, about, you know, what are the step-by-steps. Taking care of seniors is the same from state to state, but it's just the licensing requirements that are a little bit different from state the state. So my book is more focused for the state of Florida, but for someone who wants to know what this opening in assisted living is all about, the book is on Amazon. I recommend getting it. You're going to get value out of it, and it's going to help to open up your mind and help you to think of other ways that you can— perhaps if not an assisted living, maybe something else. To help you think of other ideas that you can do to help you make money. For me, it was, I had the property already and I converted it into an assisted living for highest and best use. Mm-hmm.

Sounds like a book you wish you had before you started the journey, right? Right.

I definitely wish I had that book before I started my journey. And I've since, I have a course that literally went step by step for the people in Florida because that's where I opened. But pretty much, if anyone, anybody else want to know in general what to expect, you can still get these resources. And then follow up with your state licensing authority. And if you don't know who that is, pretty much Google an assisted living that you know of, whether big or small, and you'll find out who who is the licensing authority, give them a call and ask them for an application to open an assisted living. The application will have all of the requirements on there and you can go from there. Yeah, wow.

So the book is How to Open an Assisted Living Facility from Start to Finish. It's available on Amazon. And you also mentioned the course that you have that helps people walk through. Is this on your website?

Yes, all of that information is on my website. I also have a guide on my website. It's a free guide that have a sample zoning letter. It has some of the things that you will need. I can't cover too much in the guide, otherwise it'll be too big. Most people wouldn't want to get it, but it's free on my website, carlenekadetfrancois.com, and I share a lot of good tips on social media all across, Carleen Cadet Francois. And I have a Facebook group where people come in, they ask questions, and they have direct access to me. And it's Facebook, How to Open an Assisted Living from Start to Finish on Facebook. So, if anybody wants to come and ask questions, I'm readily available, and I'm not stingy about answering questions. If I can help anyone, I will.

Sure, great. So the website is carlene cadet francois— I'm going to spell that for our listeners— c-a-r-l-e-n-e c-a-d-e-t francois, f-r-a-n-c-o-i-s.com.

It's actually c-a-r-l-i-n-e Yes, L-I-N-E, and it's Carleen Cadet Francois, so it's C-A-R-L-I-N-E C-A-D-E-T F-R-A-N-C-O-I-S dot com. You can just Google my name too and you'll find it.

Sure, okay, I should have let you spell it for me.

Oh, you're fine, you did the best that you could. I have a long name.

Yeah, no, thank— and the Facebook group again is How to Open an Assisted Living Facility, so people can go there and really have some opportunity to interact with you. That's great. That's great. Yeah. Well, this has been a super conversation. As I envisioned, it was going to be very educational. You know, I just want to underscore the fact that, as you mentioned, the specifics to Florida also kind of transfer to most of the other states. They might have different names. For example, as I mentioned to you, in California we have board and care facilities, large and small. But all states have settings, this kind of residential setting, I'm sure. So that's an important point that you mentioned, that if you look for the licensing board, licensing entity, you'll get all the information you need about your specific state. So that's important, you know, because ALF, again, you know, we envision large commercial setting, but they're not. And some of them are very small like yours. And as you said, older adults need very similar types of care and support and enrichment. And no matter what size the setting is, we're not so different from one another. So that's so important. Yeah, I think you're doing a great job. I want to commend you on that, and thanks for being a guest on our, on our program today.

Thank you so much for having me. I really enjoy talking to you and your listeners. Great, great.

Yeah, so we are out of time. Uh, you know, you're very welcome. Yeah, Carleen, but I just want to remind our listeners to visit my website livingto100.club, sign up for my email list, and download a free copy of my 9 Tips to Make Living Longer Enjoyable. You'll also see an option to contact me with your questions and comments. I welcome your feedback. So, Carlene, thanks again for being a guest on our show today, and people can go to your website and learn more about your work, carlenecadetfrancois.com. My pleasure. Okay, and thanks to all of our listeners for tuning in. Hope to see you next time.

Hi everyone, this is Meredith from the Senior Fitness with Meredith podcast where I discuss all things for seniors, from fitness, your health and wellness journeys, how to be all over strong and beyond. I also have my mini podcast called Motivation with Meredith. It's a great, quick motivational pick-me-up for your days. Join me, listen now. Search for Senior Fitness with Meredith on your favorite podcast platform.