 to Inside Hawaii Real Estate, a community real estate show dedicated to providing up-to-date information news to Hawaii home buyers, sellers, and investors. I'm Wil Tanaka with my co-host, business partner, and wife, Leonie Lama, realtor with over 20 years of experience and various leadership roles in the Hawaii real estate industry. Thanks, Wil. Wil is a full-time realtor, a lawyer, a law school professor, and the former head of a Hawaii title and escrow company. Together as full-time realtors, we work as a team to bring you the latest in Hawaii real estate. And today, we're going inside Kupuna, our senior care services, with always best care. Right, Wil? That's right. And especially in Hawaii, everyone talks about multi-generational living. My in-laws, Leonie's parents live downstairs from us, and it's very common. It's part of our culture. And the purpose of today's discussion is to share valuable information about what support is available to our Kupuna, our senior, and for those who are impacted by these responsibilities. And this is something that often comes up in our real estate practice, so we want to address it. Yeah, that's right. And on a personal note, my parents, like Wil said, they live together with us in the same home, multi-generational living. And last year, they needed care far and above what Wil and I would be able to provide for them. And during that time, I felt really alone and incredibly overwhelmed. And luckily, a trusted friend of mine recommended that I contact Always Best Care. And our special guest today is Tyler Kimura. He's the owner of Always Best Care. And Tyler is a local boy that went to Kaimuki High School. And he owns many businesses, including Always Best Care. And he actually began in his industry because of his own personal experiences with his own parents. So let's just jump into the discussion about in-home caregiving options available, what they do to help the costs, how families pay for them, and senior assisted living facilities. There's several different options. So let's just jump right into the discussion and welcome Tyler. Well, Noah, thanks for having me, guys. Thanks for being with us today. So please tell us about Always Best Care. How do you help families or kupuna seniors? Tell us about Always Best Care. Well, Always Best Care in Hawaii, we're an in-home care agency. We provide caregivers to seniors who need a little help at home. Always Best Care, we're actually part of a national franchise. We have 100 locations nationwide, I'm the owner for Hawaii. We've only been licensed for a couple of years, but in just a short amount of time, we've grown to be one of the largest home care agencies throughout the entire country and here in the state of Hawaii. So we provide non-medical support. We have caregivers at our nurse's and CNAs. They can help our kupuna with the activities that they be living, like bathing, feeding, dressing, grooming, walking, standing up, continence care. We also provide homemaker-type services like meal prep, cleaning, laundry, household chores. Yeah, so we provide the caregivers to help our kupuna at home. Home could be where they've always lived or it could actually be in a facility. Some facilities, almost facilities, can't provide one-on-one care. So in order for them to stay where they want to be, a lot of times they call us up for a little bit of extra help. So yeah, we provide the caregivers a little different than home health, which you have nurses and occupational and physical therapists. We provide more daily care. That's a lot of services that you guys provide. Yeah, a lot of times we get calls from adult children who are, they have to work. They can't just stay home all day to take care of the cars so we can help there. Sometimes they need help at night because they need their rest too. Sometimes they go on vacation. There's a lot of different reasons why we get the phone call to provider services. And from a big picture standpoint, always best care. You call it the continuum of care for all. And besides the in-home care services, can you kind of describe generally what other, all the types of services that always best care provides? Sure. So in addition to the in-home care, we can also help you find a facility or a care home to move into if home is no longer an option. Most people want to stay at home, but if that's not an option anymore, then we can help them find a home. There are hundreds and probably even thousands of care homes and foster homes out there to choose from. And we can help facilitate that process at no extra charge. Yeah, so those are the two main things that we offer our component here in Hawaii. But we also help facilities staff their shortages. So there's a caregiver shortage throughout the country and we help about a dozen facilities around Island when they can get enough caregivers. So a lot of our caregivers are experienced in facilities, not just in home care. So those are some of the things that makes us different from other home care agencies is the fact that we have a lot of experienced caregivers that work in facilities as well. I just have a question. How serious would you say that the shortage of caregivers is here in Hawaii? Because I know you mentioned it's a nationwide issue. Is it pretty severe here in Hawaii or what does that look like? Oh, it's definitely severe. We're not immune to caregiver shortages throughout the country. But we seem to do a really good job in recruiting and hiring and training our caregivers. My philosophy is pay them well, treat them well. And coming into this here and my goal was just to create as many high-quality, high-paying jobs in such a very short amount of time. And one of the things that separates us and allows for our growth is our ability to attract new caregivers and to keep the caregivers that we already have. So facilities, they do reach out to us. We actively brought in the first few facilities and the rest were a lot. One facility would talk to the next and next thing you know we're up to a dozen facilities. We have even other home care agencies like ourselves calling us up for help, believe it or not. I just got a call this morning inquiring about partnering up. So we help take care of other home care agencies that are considered competitors. But for us, we like to work with everyone. We don't have any enemies out there. And we have great relationships with even our competitors. And I remember you mentioning that for always best care, they're actually employees, the caregivers. Is that right? Can you talk a little bit about that? Because I hear different types of, some companies might have just independent contractors. In your case, they're actually employees. So you really take care of them and in turn they take care of your clients. Yeah, that's definitely a part of my, definitely just the liability reasons alone. I come from an insurance background. I was an insurance agent. So I know a lot of my business is awesome. If you, for example, a lot of people just hired private caregivers, they find them on Craigslist and Facebook and they just pay them on the table. That's kind of like driving around without car insurance or having a home without homeowners or hurricane insurance. Everything is finding that until something goes wrong. If you hire a private caregiver, for example, you really should be paying TDI, workers' comp, they have all those types of insurance. And if you get caught by the state, Department of Labor, they're gonna come on holiday. Where's your protection if the caregiver gets injured? If they come after you or your homeowner's insurance they're not covered up because it's like you're running a business now. So you definitely wanna come with an agency that will protect you. And yeah, that's that we're like an insurance, we're like your insurance policy when it comes to the caregiver, not worth the risk. Earlier we were talking about the different types of services that you actually provide. You kind of mentioned about non-medical caregiving. And can we kind of dig into that a little bit? And Leone, if you wanna kind of, you know, talk about some of the items. I mean, so you kind of, Tyler, you kind of mentioned a little bit about what the caregiver's services are that when they come into the home and so like they could do things like personal care, assist patients with that. What else can they do? So they're, we're regulated by the Department of Health and they're very strict about exactly what we can and cannot do. It definitely has to be within their guidelines. So you wanna go with a company that's not gonna bend the rules just so they can, you know, generate more sales. So for us, we always follow the rules of some things that we can and cannot do or as follows. So we can help our clients bathe. We can help them get dressed, toileting. We can help them walk. We can help them with range of motion exercises not to be confused with physical therapy, but we can help them walk. We can also do transportation to and from appointments or just go hola hola. You know, go shopping at the mall, you know, just fun activities. We also do a homemaker services like laundry and nobody likes to clean floors or wash dishes. We can help with that, meal prep. Yeah, we can help with a lot of different things but we cannot change bandages. We cannot do G tube feedings, colostomy care. We can't do tracheotomy care. So those are all medical and that's provided. Those are skilled services that maybe nurses will provide. We are in the process of applying for our home health license. And, you know, hopefully that's around the corner to where we are gonna be providing nursing, physical therapy and occupational therapy. But that's later on down the line. That's good to hear. So you're kind of in the future, you might evolve into being able to provide the medical assistance, but at this time it's not part of it. So anything medical is not gonna be something that you folks would provide, but for everything else you can, including the transportation that you mentioned, right? So for the transportation, how does that work? Like the caregiver drives them around in their car or how does that work? Like it could depend. It depends on the caregivers. You know, half the caregivers probably just catch the bus. But if you did need transportation then we would retail to our caregivers to do drive. So our caregivers could either use their car or the caregivers could drive the client's car. So it all depends on what the client wishes and whatever the caregiver agrees to. So it could be done either way with the caregiver's car or the client's car. And then for the in-home services that you provide, how does somebody pay for those services, whether it's the patient or the family's? Like what are the costs like and is that something that maybe health insurance covers? That's a good question. Health insurance is primarily for skilled care medical. So it does not cover in-home care. Medicare advantage might be coming soon but as of right now it's not quite available here in Hawaii. Medicaid does cover it but there aren't many home care ADCs that participate in the Medicaid. So primarily it's gonna be private pays on a pocket or if you're lucky enough for a mom and dad or you have long-term care insurance. So we do accept that. And we also work with a lot of our veterans. So if you qualify for veterans benefits, we can definitely help you there as well. So one of the things that separates us, there's a lot of things that make us different from other companies, but there are a few companies that actually do not have a minimum limit, a lot of hours that they can request. So some agencies because of the lack of caregivers, they say you can't do anything that's in eight hours or four hours. We'll do one hour, two hour, three hours just based on the availability of our caregivers. So we don't have a minimum. And that's one of the things that VA really loves about us. So that's why we fail, we can't say this on record, but we feel we're kind of at the top of their list in terms of go to agencies that makes their lives easier. Yeah, it sounds like it because you give a lot of flexibility, it sounds like. You know, in addition to the in-home care service, you also talked earlier about placement services where you help place the Kupuna into the senior living facilities. And can you talk a little bit about what's actually available for our seniors here and what are some of the best solutions? What's the process and how do you actually help them through the application process? Yeah, so the smaller type homes they're called adult residential care homes and they're also foster homes as well. Foster homes are typically up to three beds. It could be private pay or it could be Medicaid. So each foster home has up to three beds and two out of their beds, they must have Medicaid patients. So if you want to start from Medicaid, then foster homes is the way to go. Most care homes, some of them do, but most of them do not accept Medicaid payments. So if you're going to pay out of pocket, you could do foster home, but the most popular one would be the residential care homes. So we have contacts with probably around four or 500 different care homes around the island. So if you wanted to, if you could no longer stay at home, then we can help you find a care home in your area. We can work with your budget. You provide us with a level of care and we'll see who's available instead of you trying to reach out to a few hundred care homes before you actually find someone. And there's no charge for that service too. There's no charge to the police. But there are other options out there. There could be independent living facilities, facility facilities like Juan Calacaua, Cala Nui, if you got a million dollars to drop, free facility, Arcadia. Those are all other options that you can move into. So independent and assisted with facilities are another option. So you say for your in-home care services, are there any clients who's actually using your services almost like 24-7, or is that in-home care usually for a few days a week, a couple of hours a day? Or what type of situation are your clientele for the in-home care services? So most agencies, because of the caregiver shortage, they have, I think all the agencies have an easier time fitting the longer shifts, eight hours to 24-7. Those, I know for us, is much easier to fill. A lot of the agencies, probably 75, 80% of them don't even do the shorter ones. So for us, we can do one-hour shifts, one to 24-hour shifts. We don't turn anyone away. We try to help everyone, even if it's temporary, respite, meaning that I want to need care for a few days and we'll just call you if we ever need you again. We'll pretty much help everyone. So it doesn't matter. It could be ongoing. It could be just a week or two out and see how it goes. So there's no minimum contract, no obligations. For these residential care homes and then the foster home options, you mentioned there's hundreds of them available. But is it really difficult to get placement into one of those? Or is it pretty? I mean, is there always a spot available? Or how challenging is that? I would say it's pretty challenging. So if you were to call 10 of them, you're lucky if you have one that has a bed open of it. And yeah, I mean, it's not an easy process if you're going to do it on your own. So having someone on your side helping you to make the connection would probably reduce a lot of stress. Well, you have a lot of other things to worry about. And if we can take a few things off your plate, especially if there's no charge for that, why not give us a try? Yeah, I know up to this point, we've been talking about our carpuna, our senior. And at the same time, do you also service other types of groups beyond the seniors? Yeah, so even though we're senior care, anyone who needs assistance, as long as they're adults, we don't do pediatrics. But we have clients that are in their 20s that need our services in their 30s, 40s. So it's a wide range. It's just a way to then be majority of our clients are seniors. But as long as you're 18 or over, we can assist. Good to hear. So in terms of, I guess, thinking about someone who wanted to reach out to you, I mean, do you have any suggestions or tips based on your experiences working in this industry or with your company? Is there anything that you would kind of recommend in terms of tips? Well, if you wanted to start the process, just give us a call. Just tell us the situation we're here to listen and put you in the right direction. Even if we can't help you, we're very knowledgeable about a whole lot of other areas in our industry. And we can at least guide you along the way. If you're planning for the future, definitely if you're an adult child, have that talk with your parents. Final what their needs are, final what they want. Make sure you get their finances are in order. Make sure they have their will trust, health care directives all set up. If not, need to get on it right away. Find out how they're going to pay for it if they have insurances that can cover like long term care, if they have veterans benefits that they could inquire about. But yeah, definitely start that conversation as sooner rather than later. I think that's really good advice because I think having that conversation it was incredibly hard in our own situation. And I think like my dad didn't really even know like what he had if he had long term care or not. So, and it was just difficult at the time because we were in a situation where we needed to help right away. We didn't have that conversation in advance. So I think that's a really great tip. Yeah, and now is the best time because as time goes on, dementia can kick in and once that happens, it could be very, very much accelerated. You just never know. It could be Alzheimer's which takes time to develop but it could just be an episode like a show, a heart attack and instant on dementia. Now is a good time as any. And in terms of responsiveness, I mean, you guys were so professional responsive. Can you just walk us through the process for viewers? What would happen if a family member reaches out to always best care? They make a phone call or email inquiry and then what happens next? The most, I would say more than 50% of the cause of people are just standing. But again, the other 50% they're in reactionary mode. Whether there was an episode and mom had to go or grandma had to go to the hospital and the hospital is saying, all right, you need to leave on Friday, insurance is gonna end. If you don't have safe discharge set up, then you're gonna have to pay. So they call us up in a panic. Oftentimes the turnaround more likely than not, we can get an assessment of schedule is that day or the next day and we can already start working on fitting shifts immediately. We've had some times where a patient needs to get discharged from the hospital that night and they need a 24 seven care. Luckily we're able to find caregivers to jump in with just three, four hours notice. We can never guarantee results like that but we do work wrong the clock. My admin staff are schedulers. We work really hard and we're always waiting to step in any hour of the day, any day of the week, whether it's Christmas, New Year's, doesn't matter if something needs to get done, we're gonna be there for you. So we're 24 our business and all of my staff knows that. And then in terms of let's see that, after the interview process, the caregiver comes to the home and is there a process or a period where like, you know, okay, I kind of like this caregiver but can we try someone else? Or are you kind of stuck with the caregiver that's provided? And how does that work? So you can always request for a caregiver that's provided in the beginning. Usually, you know, you're not gonna have, everything is not gonna be perfect in the beginning because you don't have caregivers that are just sitting around waiting for the phone to ring, waiting for the perfect client, waiting for the perfect shifts Monday, Wednesday, Friday between 12 p.m. and 2 p.m. And yeah, you're gonna get the same caregiver promised guarantee all the time. It doesn't work that way. We do need time. So our main goal is to provide care with someone qualified and a good fit. But we're willing to work with you to give us your feedback and we'll do our best to meet all of your requests. But, you know, in this business you can never guarantee results. We do work hard and if you look at our reviews, you know, we get some really good reviews relative to what we have to do. So, yeah, I mean, it's not perfect. You know, there's no perfect plan and I like to just put things into perspective. There's only the best available. Sorry, that's the best answer I can give you, just the best available. I think that's great. Yeah, I mean, it's good to know that there's flexibility and that, you know, you just got to work through the process but that there are such supportive agencies like yours that can help people when they're in that situation and we would face it first hand. So we're pretty familiar with what you go through in a review, so. You know, communication is one of the most important things when it comes to families. You know, their understanding, they know that they're going to be call-offs. Caregivers are human beings. They get sick. The kids get sick. You know, they run late, stuck in traffic. But the main thing is that we constantly communicate with them and we do. So I think that's very important. We communicate seven days a week. It doesn't matter, 24-7. We also have an online portal where they can see the schedule. They can see the caregivers that are on the schedule to come in. They can even see their pictures. So people like that portal that they can view and that just provides a lot of transparency. Yeah, all of my admin staff, you know, when I interview them, I say, hey, you know, this is kind of like a tech company we just have to provide health care, home care. That's good to know. So as we wind down, do you have any final thought that you want to share with our viewers today? You know, just encourage your parents or just stay active, you know, eat healthy, stay hydrated, make sure your home is safe, well lit, no trip hazards, you know, no fall hazards. Falls are the number one cause of death among seniors over 65. And there are a lot of resources out there. You know, there are senior expos that you can attend and they're all free and just throughout the entire year. And it's all free resources. So yeah, definitely reach out to us and we can always give you advice and point you in the right direction. There's a lot of resources out there. So yeah. So good to know. And, you know, Will and I truly appreciate the support Tyler's team at Always Best Care provided to our own family. And we've been talking about in-home caregiving services and assisted living facilities with the owner, Tyler Kimura, of Always Best Care. So we'll be back in two weeks and we'll see you again soon. So thank you so much, Tyler. You are awesome. Thanks for having me, really appreciate it. Yeah. We are your hosts, Wotanaka and Leonila on Inside Hawaii Real Estate. Mahalo. Mahalo, thank you.