Aging with Dignity: Isabelle Guarino Redefines Senior Care
33 min
•Jan 26, 20264 months agoSummary
Isabelle Guarino discusses the residential assisted living (RAL) industry as an alternative to traditional institutional senior care facilities. The episode explores how entrepreneurs can build profitable RAL businesses by operating smaller homes (6-16 residents) in residential neighborhoods rather than large commercial facilities, while providing better quality care and dignity to seniors.
Insights
- RAL model offers superior care ratios (4-5 seniors per caregiver vs 30-1 in large facilities) resulting in faster emergency response times and better outcomes, creating a competitive advantage for operators
- Regulatory framework allows RAL in all 50 states but remains underutilized due to lack of awareness; positioning as alternative to institutional care is a significant market opportunity
- Multi-property clustering strategy (3+ homes within 20-40 minutes) enables resource sharing and cost efficiency while maintaining the home-like environment that differentiates RAL from big-box facilities
- Demographic tailwind of 'Silver Tsunami' combined with post-COVID consumer preference shift away from institutional facilities creates favorable market conditions for RAL entrepreneurs
- Action-taking and coachability are stronger predictors of RAL business success than knowledge or capital; fear of execution rather than concept understanding is the primary barrier to entry
Trends
Shift from institutional senior care to smaller, home-based residential models driven by COVID-19 exposure of large facility failuresRising demand for 'aging with dignity' solutions as adult children seek alternatives to traditional assisted living facilities for aging parentsEmerging Silver Tsunami demographic wave creating urgent need for 3.5 years of daily care for 70% of population, driving entrepreneurial interest in senior careReal estate investment approach to senior care gaining traction as alternative to healthcare operator model, attracting real estate investors to RAL spaceMulti-property portfolio strategy becoming standard practice for RAL operators seeking economies of scale while maintaining quality care differentiationMemory care licensing expansion within RAL model reducing transition friction and allowing operators to serve broader senior population segmentsCaregiver retention and satisfaction improving in RAL settings due to manageable ratios, creating competitive advantage in tight labor marketBook-based education and storytelling emerging as marketing tool for RAL industry to reach families unfamiliar with residential alternatives
Topics
Residential Assisted Living (RAL) Business ModelSenior Care Facility AlternativesAging with Dignity and Quality of LifeReal Estate Investment in Senior CareStaffing and Caregiver Management in RALState Licensing and Regulatory Compliance for RALMemory Care Services in Residential SettingsMulti-Property Portfolio StrategyCost Comparison: RAL vs Traditional Assisted LivingEntrepreneurship in Senior Care IndustryPost-COVID Consumer Preferences in Senior LivingFinancial Freedom Through RAL InvestmentCaregiver Training and Professional DevelopmentFamily Decision-Making in Senior Care SelectionSilver Tsunami Demographic Trends
People
Isabelle Guarino
Guest discussing residential assisted living business model, entrepreneurship coaching, and senior care industry tran...
Mick Hunt
Podcast host conducting interview and asking questions about RAL business model and entrepreneurship
Rudy Rush
Co-host introducing the show and providing context about the episode
Quotes
"We all deserve to age with dignity."
Isabelle Guarino•Early in episode
"If you fall and break your hip and press your call button you're getting a response in 90 seconds right when you go to a large facility the typical response time is over 90 minutes that is a huge difference right that could be if you fell and got a brain bleed that could be the difference between life and death"
Isabelle Guarino•Mid-episode
"No one cares about you as much as you care about you."
Isabelle Guarino•Quick Five section
"Action breeds actions and most of the time as simple as the sounds you just have to do it."
Mick Hunt•Mid-episode
"You can't push a rope you can't force someone to do it as much as I meet someone I'm like they're going to be so successful. And then they don't reach out they don't even try"
Isabelle Guarino•Coaching discussion section
Full Transcript
So amazing episode with Isabel Garino. If you are someone who has family members that are in assisted living facilities close to age to being in them, or if you're an entrepreneur looking for a business to get into, like this episode, we go deep into assisted living, residential assisted living. We're going to break some myths on how you could and should get into that business. But this episode, we go deep on entrepreneurship. We go deep on senior living, and it's just a pleasure to talk to my good friend, Isabel Garino. So ladies and gentlemen, here we go. You're listening to Mick Unplugged, hosted by the one and only Mick Hunt. This is where purpose meets power and stories spark transformation. Mick takes you beyond the motivation and into meaning, helping you discover your because and becoming unstoppable. I'm Rudy Rush, and trust me, you're in the right place. Let's get unplugged. Isabel, how you doing today, dear? I'm doing great. Thanks for having me on the show. Thank you for being here. You know, I was telling you offline, I'm so honored and excited about the work that you're doing in the assisted living space. Having a mom and my mom isn't assisted living ready or anything like that, but seeing what my grandparents went through and how my mom aunts and uncles cared for them. It now has put me in a place where these are things I need to care about, whether my mom is ever going to need assisted living or not, whether my relatives, wherever needed or not. I need to look around. And Isabel, what I've seen is that these assisted living facilities, and this is not a knock on anyone, I think it's just day and age and time. They seem like institutions. You walk in and it's like, I don't want to put a relative here. I don't want to come visit here for longer than an hour if I need to. And again, it's not a knock. I just think these institutions, as I'm calling them, were built at a time when that was okay and today it's not. So I applaud you for taking this step into one, changing the viewpoint, but honestly, making sure that people, when they need them, it feels like home. And that's what I've really been so proud of you following you as much as I have, that the work you're doing is letting people live with dignity. So thank you for that. I think you're right on the money. What has been in the past is not what we want for the future, and it's not acceptable. And I think things like COVID shined a nice bright flashlight on what's happening in what I call the big box communities, right? The big commercial facilities with long hallways and impersonal staff. COVID let people understand and know what's actually going on there, you know? And all of a sudden, adult children started ripping their loved ones out of those care homes, looking for alternatives. And we've kind of always been over here saying, hey, smaller is better. And there are other options, but we just don't have the big billboard and the big sign, but that started to kind of rise and come into more public, you know, knowledge that there are options. Staying at home one-on-one, being isolated isn't always the best fit, and a facility isn't always the best fit. There's something in the middle called residential assisted living, and it's just a much better option for everyone involved. So I'm grateful for COVID, and I am grateful to be in this space with the coming Silver Tsunami of seniors, because people are looking for something different and better, and they should. We all deserve to age with dignity. Absolutely. And, you know, again, following you and having this groundbreaking aha moment for me, and I was telling you, you know, I've got a friend. I'm helping on the board with starting an assisted living facility. And again, touring all these is like institution, institution, institution. Talk to us about your breakthrough with the residential side, because I don't think a lot of people understand that that is a thing that could happen. You know, following your research, I realized, oh, all 50 states allow zone residential to also be assisted living, and I don't think a lot of people understood that. So talk to us about, one, the research that you and your companies have done, and then two, how you're bringing this insight forward. Yeah. So 15 years ago, when my own grandmother needed care, we were looking for options for her and found nothing suitable. Nowhere I'd want to leave my goldfish, let alone my grandma. So my dad had been a real estate investor, and he was looking for a place for her and did quick math and was like, wait, wait, wait, wait, wait. If we just owned this home, we could cash flow really well. She could live for free. She's going to get that quality care. And it just made a whole lot of sense to kind of go that direction. So what we found was single family homes that were zoned residential in regular neighborhoods that house anywhere from six to 16 seniors living in the home, getting that 24 seven care, medication management activities, everything that you get in a facility, but in a home, not something home like, you know, it's an actual home, right? Yeah. So he purchased an existing RAL to get started for my grandmother to move in. She passed before we could move her, but it really sparked something in my family to kind of dive all into this industry because we realized we're not the only ones going through this. Everyone is. And if they're not, they're going to one day, right? 70% of us will need daily care for an average of three and a half years. So we wanted to be a part of that change and kind of bringing this forward. So yes, in all 50 states, residential assisted living exists. It's typically zoned residential six to 16 seniors, 24 seven care. And what we show people how to do is not be the caregiver and work in the home or live in the home. We show them how to own the real estate and kind of do it as an investment play. Right. But it's still really cool because then it's an option for your own family members if and when they need it. Yeah. And so I want to talk to you just for a moment on the entrepreneur side. So I know you're doing it from the investment side, but let's just say you are that person that's like, I have this vision of a 66 or 70 bed facility. You know, the traditional mindset. How do you switch that into. Okay. Let's do this through properties, whether you're leasing some of your properties or you're going through your program and you only you're going to operate. How could that? How does that work on the healthcare side? So again, you've got a home, six to 16 residents that are living there 24 seven provider. Is it just, Hey, you've got to staff each home as if you were going to do the big box facilities you're talking about. Talk to talk to me a little bit about that. Yeah. So staffing is very different in the smaller homes. You don't have a doctor or nurse on call or they're a part of the, you know, monthly salary. You have a licensed administrator who is licensed through the state and in the real estate world, we kind of call them the property manager, right? So they might do the hiring, firing, scheduling of the caregivers. They do the marketing and the tours of the new families coming in and they take care of all the day to day. You can be that person, right? Become a licensed administrator. It's just a quick license. You can't do the state, but that is one role that you'd be hiring if you're not going to do it yourself. Yeah. They're hiring those licensed caregivers who again are not nurses. They're actually typically LPNs or CNAs, but licensed caregivers again through the state and they're doing the 24 seven care of the seniors. They might be in charge of cooking and cleaning as well. If you don't have a private chef in the home, but that's really kind of how staff is structured versus in a large community. You've got the owner, the executive director, the activities director, the chef, the janitorial, the landscape. You've got all sorts of categories of people. So a lot higher bills really at the end of the day. Yeah, more cost, right? Yeah, but there's more seniors. So more income, more expenses. It kind of all evens out in the wash. No, I like that. And then I guess you're looking at true assisted living. Do you have any of your folks that are doing anything on the memory care side with that as well too? Yeah, you can get licensed for memory care in an RAL and it's actually a really great way to go because the reality is we're all dealing with the transition. Right. Yeah. So if you're not licensed for it, then legally when someone kind of goes beyond what you can handle in the home, you have to transition them. So I really recommend everybody get licensed for it regardless. So what I'm hearing, and this is more selfish for me, sorry for my viewers and listeners. I know you were out there too and you want to hear this too, but it sounds like a good alternative to at least consider a ponder is if you wanted, if your vision was 66, 70 bed facility, maybe look at a few residentials and almost package it together. You have better cost control, it sounds like. Things like the private chef so some of those expenses can be shared. So let's just I'm making this up. If you had four homes for residents, right? Some of those expenses can be shared amongst those four like a chef doesn't have to just be at one home, right? That chef could go to three or four homes. Yeah. And if I think what you're what you're kind of starting to think about is what if you bought a large plot of land and you built 10 of these that had 10 beds each instead of one commercial facility. Exactly. You had 10 10 beds. You can absolutely do that. You can share staff, you can share resources. Many people are kind of going that direction. That's one way to do it. I really recommend at least three homes within 20 to 40 minutes of each other because of the ability to share resources. That is the best way. You're right. And I can break this down for people that are listening that are like why are making is about having this type of conversation. Because again, the current and this is not a knock but the current look of assisted living feels institutional. I know they're a handful that don't but a lot of them do. It's just tough. And when you look at building an assisted living facility from the ground up in the zoning and all the things that you have to do in the land like you're looking at 1415 million. Easy. Easy. Easy. Just to do that versus building homes or buying homes that already exist and doing some things like is about talking. I mean that is a much more cost effective way to look at it and to the point that is about making. If you have a big plot of land and you've got enough that you can put homes on now your activity centers can all be centralized so your activities director doesn't have to travel 20 minutes per location per day like it could just be there so Isabel this is eye opening for me and this conversation is needed so I thank you for this part this the first 10 minutes was Mick personally asking questions now we'll get into the show ladies and gentlemen how about that. You know I think though it's it's great that you're talking about this because a lot of people do want to go bigger right and then I see well why why can't I why shouldn't I and they understand the institution they understand the expenses but there's really this whole other piece of it which I call the heart part of it right in in a traditional big box facility you'll have 30 seniors to one caregiver in an RAL you might have four to one or five to one. So if you fall and break your hip and press your call button you're getting a response in 90 seconds right when you go to a large facility the typical response time is over 90 minutes that is a huge difference right that could be if you fell and got a brain bleed that could be the difference between life and death and it's not that those caregivers don't care and don't want to be there and don't want to help of course they do they're doing this because they love seniors and they want to do that but if you're paying the same as a senior living in those homes you want to get the care so an RAL becomes a much better option for the senior and the family members and the care caregivers because they can actually do the job that they're getting paid to do versus a big community so yes the money the staffing of this that but also the senior and the care which is what it should be about at the end of the day. Absolutely absolutely so thank you for that insight so so now we get to ask Isabel questions about is it about RAL and RAL and all that so Isabel I love asking my guest about what I call your because that thing that's deeper than your why right like to me your why is a little superficial I could probably guess it but why something is your why again I call it your because is always unique so I'm going to ask you Isabel like all the amazing things that you do right the mentorship that you provide the strategy that you give the heart that you have what is your because why do you do the things that you do. Hmm. I love that I love the perspective of it's deeper than your why right you know when when I got started in this space it was really just to help my dad I saw what he was doing and I saw that it was exciting and and cool and I think that's kind of where it started but to see other families become fully financially free. Quit their jobs go travel and hang out with their kids and do all this fun stuff because of a choice to invest in this space. It absolutely changed my perspective of why I'm here on earth and I think that I am here to help people create businesses whether it's RAL or any other type of business to become financially free and get time freedom so that they can go do whatever God put them on earth here to do you know what we're breaking free of those chains and we're going to do that. We can live in abundance. The whole world opens up to us so I feel like my because is because I want to make as many people financially free as I can. That's why I love you. That right there. That's the that's the ticket right the impact to change lives and impact lives like that's you know my because is a promise that I make to people to do those same things to impact and change lives and if I give you a promise I'm always going to deliver like that's always been my mission. Let's talk about RAL a little bit so you know you're helping people become entrepreneurs you're helping people understand this game and we have a lot of viewers and listeners that are just that they're like how do I take something that I'm passionate about turn it into an actual career into a business for me and you've done that really well and I think that RAL like what you're doing is something that everybody that's watching or listening should consider. Because you are actually making impact and that's what I love about businesses that are designed to make impact to me it's fulfilling right it's not about joy it's not about happiness it's fulfilling so talk to us a little bit about RAL the Academy that you have and just feel free to go wherever you want with that. Yeah I love that because our motto is to do good and do well because in the reality like you can make money so many different ways that's what's so cool about our world nowadays it's not cookie cutter there are people making you know millions of dollars on YouTube that didn't even exist 50 years ago you know so it's beautiful there's so much opportunity so finding what suits you is the best thing and if you do love seniors and you do understand you know this coming silver. tsunami and you're like oh my gosh timing's never been better than it's a great way to have impact investing because not only are you providing a better community for that senior you are allowing the daughter or son to be a daughter or son once again. Many times people try to do in home care where they care for their own loved one for a while and I talk to people who do that every single day it is tough man it is so tough and it strips away your ability to be that daughter or son. You are now a caregiver you grow a lot of resentment a lot of anger there's a lot of guilt that even got you started doing that there's so many emotions bottled into these moments of life. And to be able to kind of burst that bubble pop that bubble and say we've got mom we're gonna love her the same way you do if not even better because we're trained professionals. You get to be the son like you just come and love on her and hang out with her and that's all you need to do from here forward. That is so beautiful to give back to families in this way to provide jobs to caregivers who are being used abused neglected in these larger facilities. It's just all the way around it's one of those things where you're cash flowing but you feel good at night you feel proud of the work that you're doing. That's hard to do in a lot of industries and yet in ours it's like you you're just proud of yourself proud of what you're bringing to the market and that's a beautiful thing. Amen. Amen. And so talk to us about the program a little bit like how how do people get selected to be in it or what's the process like talk to us about that journey a little bit. Yeah so we have online courses and live trainings in Phoenix Arizona where we show people basically step by step how to start on and operate care homes, whether they want to be on the landlord side whether they want to be involved in the day to day, or owning and operating kind of passively we really go through all aspects of this industry and what it looks like. We've been teaching and training for gosh almost 11 plus years and so we've got thousands of students who own and operate these homes across the country now. And it's so much fun I love just being able to see the light bulb and having fun in that moment to really just impart knowledge on them and get them to say oh my gosh it goes from idea and exciting thought to I have the plan I know the steps I can do this exactly just follow the steps. Yeah. How do you take, because I do coaching and entrepreneurship as well too and I always have to go through everybody wants to do it and then when they really commit they have that fear and anxiety almost right it's like okay this is real. What I just do. Why am I doing this. I love to hear from you how do you get people past that initial stage right like it's like yeah they're going to do it. They're all in and then all of a sudden it's real and it's like wait wait wait a second. I know. I always like joke with people so I used to be a flight attendant and I had this guy I was sitting in first I was up in first class and he comes up to me and he goes are you afraid of heights. And I was like what a weird question like we're at 30,000 feet in the sky why are you asking me this you know and I'm like no not afraid of heights but if you push me out this plane I'd be terrified right so it's not necessarily the heights that scare us a lot of times it's the edge. It's what happens when I have to go take action when I have to go get a loan when I have to go talk to people and make this happen. That's what scares people is the action part of it. So we can talk theory and knowledge all day but action is really what scares a lot of people and that's what makes the difference between the 1% who actually goes and does stuff than the people who sit back and don't. So a big thing we talk about you know in our training but also just with clients who want to work with us is are you coachable and are you an action taker and I'll ask them about other experiences in their life and see if they've taken action or not because it tells me a whole lot if they're going to be successful in this space or any space. If there's someone who just talks talks theory thinks about things. You're probably not going to be successful. That's just the reality of it. Yeah, I am the same way all the time right like action breeds actions and most of the time as simple as the sounds you just have to do it. And there's I don't there's not a guru there's not a coach there's not a consultant that should tell you anything different. No, are there systems. Yeah, right. Are there processes. Yeah. But none of that matters. If you don't take, not even just the first up but it's usually like the third and fourth step after that because that second step there's usually like a challenge and obstacle that nobody could see for you. And you've got to be able to push through that and that's one of the things that I know that you also help people with is like how do you push through because scaling and when you talk about generational wealth like none of that's possible without those breakthroughs. Totally. We were just at our assisted living conference a couple weeks ago and some of the students, you know, haven't taken much action yet. Naturally, in a coaching program you're going to have those who are super successful and those who sit on the sidelines right. And there was a lot of students who in the room who were like we opened a home we closed on this we accepted residents you know sharing their wins and success. And every single one of them when we asked well what did you do how did you make it happen they're like I leaned into the coaches I did the calls. I went above and beyond they talked about all of this action that they talk. And the ones who were sitting there who hadn't done anything when they come up and say well I haven't made any progress and I'd say what did you hear that everyone else did. And they were like, Oh, well they've done a lot more support calls than me they've done a lot more, you know, meetings than me they've done more this more that and it's like action. So what are we going to do this week so that you can take action because we as a coach. It's so frustrating because you can't push a rope you can't force someone to do it as much as I meet someone I'm like they're going to be so successful. And then they don't reach out they don't even try they don't do this stuff it's so frustrating it's beyond because you want them to with and sometimes it feels like more than they want to with you know. So that is prerequisite for me to work with me. I've established a really good question slash interview process. That's deeper than just some basic info or some mid level info. If I sense that I want it more than you want it. We don't work well together because again everybody wants the end result. Right, we all want the end result. But there's a lot of crap that goes on in between there there's a lot of sacrifices there's a lot of mindset shifts that you have to make and there's a lot of obstacles. And I can tell really, really quickly, if you just want to win, or if you want the journey and if you're not ready for the journey. It usually doesn't work well because when you want the when what I typically hear is you want the quick tips you want the shortcuts you want the instant gratification and is about you know just like I do there's really no such thing in that journey so I care more about the journey than I do. Yeah, it's it's so important and I think no coach if they're a good coach wants to take someone's money when they're not going to do anything. No, so it doesn't make anyone feel good it's like the client thinks oh you you just did this you just care about that no actually I don't like I'm mad that you do this. No one wants to work with someone who doesn't want to take action that's not why we become coaches and mentors you know. Yeah, no, absolutely, absolutely. Alright so I teased earlier that you know you've written some amazing books. What I didn't say in the opener is that you are a multiple time New York Times bestselling author. So let's talk about your latest book a little bit like like give the floor to talk about the purpose the strategy behind the book and who the ideal audience is. Yeah, most of my books have been business books but this latest one assisted living revolution is its fiction. It's actually more like chicken soup for the soul vibes and I really wanted to kind of take my my whack at that to see how that went and based on the stories I've heard over the years of families, not knowing about assisted living options not knowing where to go who to call who to talk to who to trust. I kind of put all of those thousands of stories I've heard together in three different stories of families who are going through that decision of how to choose assisted living for their loved ones and kind of breaking down the pros and cons of all the options and giving you know readers resources on what they should be asking where they should be looking and so I really enjoyed writing that book but I've been enjoying even more having people read it and be able to relate to it and say I wish I had this earlier and it's kind of a good book to read and then pass to a friend who you know is is going through that are going to be going through that. It's a very shareable resource and so I'm really proud of that one assisted living revolution. I love it. I love it and I usually do this is about is for books that I like and that I'm intrigued by. I usually purchase 20 copies one to support the author. So I'm going to do that. So I think the first 20 people that message me the letters are a L. Right and people get mad at me all the time because I say the first 20 these episodes release at 4am Eastern. So I always go through the first 20 and I don't care if that's Instagram LinkedIn if you have my email if you personally know me text me whatever it is RAL first 20. I'm going to make sure that I get you a copy of this book so is about thank you for that. Well, thank you for the support. I appreciate that. Absolutely. So speaking of RAL your books your sites where can people find and follow you personally. Yeah. Instagram the is about Guerrino and if you want to schedule a call with me or the team RAL 101.com is a great resource to kind of dig into there's boot camps and information on there and you can schedule a call so RAL 101.com. Love it. This has been so insightful like I think I need to have you back on just because I personally have some meetings are actually I'm going to book a consultation. Have questions. Let's do it. Let's chat. But I want to I want to end this with my quick five so rapid fire. Five questions. You got to answer honestly ready. Okay. All right. Question number one I know you're in Phoenix. Are the Suns ever going to win in basketball again. No. At least you're honest. I like it. I like it. Question two what the heck is wrong with the Cardinals. I was just at the game. It was terrible. I don't know what's going on. All right. I'll get serious now. Those were two questions I didn't want to ask you. So question three what's one lesson that you learn from your dad that you are always imparting to others. To my young entrepreneurs. No one cares about you as much as you care about you. Hmm. I felt that one. I felt that one. You also are a keynote speaker. So when you go on stage whether it's real or in your head what's your walk out music. Oh, Dang, I can't think of the name of it. I know I know the song. But I don't know the name of it but it's like it's like it's actually lame. It's a Katy Perry song but it's like it says I'm grateful and like all this stuff I'm grateful and thankful like it's just a really positive song. Good stuff. Good stuff. All right. Last question. If you were not doing this, if you're not doing what you do today, what would you be doing. I would probably be doing something with young kids. I love kids so much. Good stuff. Good stuff. Isabel, I'm so honored to have you on. This has been an amazing episode. Thank you for asking for answering my questions. Thank you for the insight that you gave to the guests. For everybody again remember message me RAL you're going to get this book and you know what is about like you do have some good business book what's what's your second favorite book what was the the latest the release before this one. The Living Legacy which is like about my story when my dad passed and these businesses being passed to me so it's sharing how you know you should create these businesses to pass a blessing to your kids instead of a burden so. All right. That's a good one too. So, so the 10 people that want that book message me legacy. So RAL for the latest book, Legacy for the Legacy book and I'll make sure I get those. Thanks for your generosity, Mick. I love it. You got it. And to all the viewers and listeners remember your because is your superpower. Go unleash it. That's another powerful conversation on Mick unplugged. If this episode moved you and I'm sure it did. Follow the show wherever you listen. Share it with someone who needs that spark and leave a review. So more people can find there because I'm Rudy Rush and until next time, stay driven, stay focused and stay unplugged. you