S2 E05: Where Expertise Meets Mission | with Cory Macdonald

Aging services is shaped by people serving in many different roles, including some the public may rarely see or associate with the field. Amanda sits down with healthcare attorney, Cory Macdonald, a member at Reed Claymon and longtime general counsel for LeadingAge Texas, who has spent two decades helping mission-driven aging services organizations navigate growth, change, governance, regulation, and public policy.

Cory reflects on the expertise, mentorship, and relationships with not-for-profit leaders that have shaped his career and deepened his commitment to the field. Together, Amanda and Cory explore what allows organizations to endure for generations, why regulation is both necessary and incredibly complex, how policy decisions affect residents and team members, and what serving as Board Chair of Family Eldercare has taught Cory about leadership from the other side of the boardroom.

Released during National Workforce Development Month, the conversation also highlights the breadth of people and professions that make up aging services and the many ways each of us can contribute to serving older adults and their families.

Highlights

• Cory offers a look at the legal, financial, regulatory, and governance considerations involved in operating and sustaining aging services organizations.
• Longstanding not-for-profit organizations have continually evolved in response to changes in leadership, funding, regulation, and the needs of the people they serve.
• Cory shares why protecting residents and supporting team members both need to be part of conversations about regulation and public policy.
• Cory also provides a helpful breakdown of Medicare and Medicaid and the differences among independent living, assisted living, and skilled nursing.

This episode is made possible by LeadingAge Texas' Partners: Communities of Faith, RRG, LeadingAge Texas Health Plan, Inc., Value First, and Ziegler.

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Transcript

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Amanda (00:03)
This is Uplift Aging, the podcast that's more than a podcast. This is a challenge to embrace growing older, confront negative stereotypes, and better understand what may come with aging. I'm your host, Amanda Wiedenfeld. Together, let's uplift aging.

Amanda (00:26)
Most of us only notice aging services when we suddenly need them or we know someone who suddenly needs them. But behind every thriving aging services or senior living community are people making decisions that most of us never see. And today's guest, Cory Macdonald with Reed Claymon spent nearly two decades helping organizations navigate growth, change, governance, and mission, and not from the resident side, but from behind the scenes. So we're gonna chat.

Amanda (00:51)
more deeply about that today. Cory welcome. Can you tell us a little bit about your story and how you ended up dedicating your career to aging services?

Cory Macdonald (01:01)
I went to law school and during law school in Austin, Texas, the summer after my first year, I was looking for places to work and ended up doing a summer clerkship at a firm in town that had a healthcare specialization.

Cory Macdonald (01:21)
they did a variety of things for health care providers, including representing hospitals and senior living providers and long-term care providers in regulatory and transactional matters. I enjoyed that summer. I learned a lot. I was asked to continue working there during the school year.

Cory Macdonald (01:42)
and I ended up doing a dual degree with the LBJ School of Public Affairs and the Law School. as I continued to pursue that while also working at this particular law firm, I started getting interested in specific legal issues related to senior living. there was an attorney at that firm

Cory Macdonald (02:02)
who specialized in long-term care and senior living, worked with a lot of the nonprofit providers in Texas. And she ended up becoming a reader for they called it a professional report, but it's a academic paper you write to get your master's degree from the LBJ school. And so I ended up

Cory Macdonald (02:22)
writing mine about specific fair housing issues that are unique to senior living. so that was really a point where I kind of dove in and learned a lot about a particular set of issues in senior living, but about the whole area in general. So did that

Cory Macdonald (02:40)
and ended up working at that firm and eventually after a couple of years became the primary associate attorney to this woman who specialized in the area. and just really continued from there. I mean, right off the bat, she was kind of starting to wind down her career to some extent. And as a young attorney, that gives you an opportunity to really

Cory Macdonald (03:03)
Take on a lot and I was able to start meeting a lot of folks, in particular in the nonprofit sector of aging services. started to make relationships, got to know folks that I still know to this day, leaders, of nonprofit senior living organizations.

Amanda (03:19)
one of my takeaways from what you just shared was that

Amanda (03:22)
this was not something that you were set on doing when you first, started out in law school. this

Cory Macdonald (03:27)
Isn't

Amanda (03:28)
kind of organically happened and once that door was opened, then you discovered

Amanda (03:33)
that you had a passion for it. and I think that's so lovely to hear. we do hear so many stories in aging services of like, I had an experience of being a caregiver for my grandparent or something like that. but I love when we're able to highlight the stories that just sort of happened through life.

Amanda (03:50)
And especially I heard you say multiple times the not-for-profit sector and those not-for-profit leaders, which with us being LeadingAge Texas, that is who our members are. I love that for young Cory that he got to

Cory Macdonald (04:02)
Sure.

Amanda (04:03)
experience relationships and building relationships with those people.

Amanda (04:07)
early in his career.

Cory Macdonald (04:08)
that's well said. it wasn't something I went into law school thinking I would do. I think most folks have interactions with long term care at some point. And I certainly had them, roughly the time I was in law school, actually both my grandpar parents on my mom's side were at a a VA nursing home.

Cory Macdonald (04:28)
outside of San Antonio. So I was certainly, interacting with the settings and drawing connections to things I was working on at work. But but yeah, there wasn't a specific aging service related experience that triggered it. It was sort of happenstance, but like you said, happenstance turned into a passion and I was fortunate

Cory Macdonald (04:50)
that it sort of happened early for me in terms of being able to develop expertise, from an early stage in my career. And and I had you know good mentorship from a particular attorney. Like I said, sort of my mentor served as a reader of a paper on on senior living for me while she was a practicing attorney, which is a big chunk of time to commit to a young

Cory Macdonald (05:14)
you know, future attorney that may or may not end up working in your law firm.

Cory Macdonald (05:17)
I was fortunate to have that kind of a person involved in my career from an early stage.

Cory Macdonald (05:23)
and yeah, it really rolled into meeting a lot of leaders that I respected in that space and then

Cory Macdonald (05:29)
understanding that they had really committed their lives to these missions, that their nonprofit organizations serve and really I've always taken a lot of pride in providing legal services to nonprofit organizations.

Amanda (05:46)
It seems like that mentor that you had, was really someone who played a huge part in the trajectory of your career. I've known you for several years now and I know you as someone whose heart is very much within mission driven work. I see that

Amanda (06:00)
going beyond, aging services, ways that you've served the community in Austin on boards and things like that. it really seems like she played a huge role in that and seeing how as an attorney you can have a successful career and dedicate so much of your time and energy to helping those who are providing services to others.

Cory Macdonald (06:20)
Yeah.

Cory Macdonald (06:21)
She was great. Yeah. that's a

Cory Macdonald (06:22)
good way to put it. And she was definitely a positive influence. And not just her. I mean other folks at at that firm, my first firm and and other firms I've been with. you know, there are a lot of attorneys who do put a lot of emphasis on pro bono work

Cory Macdonald (06:36)
and I've been fortunate to be around a lot of those attorneys.

Amanda (06:45)
So I want to pull back the curtain a little bit. as our listeners, now know, you're an attorney and you work with a lot of not-for-profit aging services providers, aging services communities. I think maybe most people assume that senior living organizations and communities simply exist. and especially, I'm thinking of a lot of our members who

Amanda (07:05)
Truly have existed for a hundred plus years. especially in that not-for-profit space, so much community history with some of these organizations. people maybe don't often think or maybe need to think about everything that has to happen behind the scenes for those organizations So within your experience

Amanda (07:22)
what could surprise people about what it actually takes to build and sustain great aging services organization?

Cory Macdonald (07:29)
Hmm, good question.

Cory Macdonald (07:31)
if you don't mind, maybe we can sort of come back to that specific point

Amanda (07:35)
Mm-hmm.

Cory Macdonald (07:35)
of your question, but just sort of thinking about the history is very interesting to me. and like you mentioned, a lot of these organizations are, some of them are over a hundred years old. a lot of the ones in Texas are at least

Cory Macdonald (07:48)
fifty or sixty years old, seventy years. and it's interesting to kind of think through the history and the processes that got them where they are today. the processes that lead to initial formation have typically been at least in Texas, maybe a church or a denomination that decides

Cory Macdonald (08:06)
We need a nursing home in our town. they sort of get together a group of leaders in said church or said denomination and form a nonprofit. you know, usually there's some initial connection with the church, or maybe an original donor and

Cory Macdonald (08:22)
start a new board, they file their first articles of incorporation with the with the state of Texas. That's how you create you know a new nonprofit. It's always been interesting to look back at the original ones of some of these, you know, hundred-plus years old organizations, see that when they first formed it, they maybe said, This'll last for 50 years. then they have to come back 50 years later and say, never mind, it's it's perpetual.

Cory Macdonald (08:46)
then there's also some some interesting history in terms of, the changing missions. for example, a handful of Texas older organizations started started as homes for widows and orphans, which is

Amanda (08:57)
Mm-hmm.

Cory Macdonald (08:58)
kind of an antiquated concept now, but that was sort of the original basis. and over time evolved to retirees of

Cory Macdonald (09:06)
of both genders and maybe not orphans anymore,

Amanda (09:08)
Yeah.

Cory Macdonald (09:09)
or sometimes still providing services to to children.

Cory Macdonald (09:12)
So I like the history. why have some survived and some flourished and some

Cory Macdonald (09:18)
maybe not, you know, hasn't worked out. you know, good governance is key. a nonprofit board is a very, unique animal. You have

Cory Macdonald (09:26)
folks serving on a volunteer basis typically.

Cory Macdonald (09:30)
you have varying levels of expertise. You have what has become an increasingly regulated, area business. you need good governance to kind of evolve from eighteen ninety to two thousand and twenty-six and

Amanda (09:46)
Exactly.

Cory Macdonald (09:47)
continue, meeting those missions. And if I could

Cory Macdonald (09:51)
sort of tell you precisely what good governance is in three minutes I'd be, you know, a a millionaire

Amanda (09:57)
Ha ha ha

Cory Macdonald (09:58)
or billionaire, but 'cause it's it's very hard to it's sort of a secret sauce of figuring out the right amount of involvement and the right amount of letting good management do their job. good management is obviously key.

Cory Macdonald (10:14)
I've seen organizations sort of fluctuate in effectiveness and success based on, you know, changes

Amanda (10:21)
Mm-hmm.

Cory Macdonald (10:22)
in leadership at the, management level. good advisors are important, the right advisors.

Cory Macdonald (10:29)
I think the primary thing I would say it comes back to is is governance and effective leadership. you know, good CEO or an executive director. but there's also just sort of luck. There's regulatory changes, there's reimbursement changes. You know,

Cory Macdonald (10:44)
Medicaid was the sixties, adding that to sort of a benefit where folks that, were lower income, which a lot of older folks were, could have access to reimbursed nursing home care. that was a big shift. we talked about how the original organizations were

Cory Macdonald (11:02)
Widows and orphans, a lot of organizations kind of shifted, I I think in the sixties in reaction to there being a source of reimbursement for nursing home care. the charities were no longer really could be considered almshouses. That's another term you see in kind of the old literature,

Cory Macdonald (11:19)
that

Cory Macdonald (11:19)
shifted as there was a source of reimbursement to the providers to provide nursing home care.

Amanda (11:25)
Yeah, and it

Amanda (11:26)
was sort of like a boom at that time, wasn't it? Of these new organizations coming about

Cory Macdonald (11:30)
yeah.

Cory Macdonald (11:31)
I think you're absolutely right. I mean, when you find out there's a a way aside from just donations to provide a service that is needed, you know, folks are gonna jump in. I do think a lot of the LeadingAge Texas members were probably formed in and

Amanda (11:47)
Mm-hmm.

Cory Macdonald (11:47)
around that time as a response to the opportunity to like I said, have a source of payment for a a needed service.

Amanda (11:55)
Yeah. That's interesting, Cory, as you were talking, I was looking at my notes my potential

Cory Macdonald (11:59)
Mm-hmm.

Amanda (12:00)
follow-up questions, why governance matters, why nonprofits matter, why regulations are not just bureaucracy. And then my final one was why financing actually impacts resident experience. So without me even like prompting you to do any of those, like you

Cory Macdonald (12:12)
Yeah.

Amanda (12:13)
covered all of that. And I think what might surprise people, you know, going back to that original question,

Amanda (12:18)
about what it actually takes to build and sustain that great aging services organization is the fact that it is so multifaceted. there is so much that goes into that you are able with what you do to see a piece of all of those things that we just talked about.

Amanda (12:35)
if you were in an elevator and someone asked what do you do,

Amanda (12:39)
how would you explain what a healthcare attorney does?

Cory Macdonald (12:42)
I would probably say I'm at a healthcare firm but I specialize in senior living and long-term care and I do some healthcare work but I also do other other areas as well and it's all tied to that specific industry

Cory Macdonald (12:59)
they might say, well, what does that mean? You know, better call Saul. A lot of times people reference that show because the protagonist was a he was actually suing retirement communities. So that's a lot of folks' point

Amanda (13:09)
Mm-hmm.

Cory Macdonald (13:10)
of reference. I say, well, no, but like Saul in that show, I have, you know, been in a lot of retirement communities and I'm just not I'm not suing them.

Cory Macdonald (13:19)
I help them in the you know general business of being a retirement community. I don't I don't do litigation, but I serve as outside general counsel to a lot of organizations that are of a size that they don't typically have in-house attorneys.

Cory Macdonald (13:35)
if they have legal issues that arise, I'll be the first one that they contact and help them find out whether that's something we can resolve or whether they need, specialized counsel in a particular area, whether that's responding to a a subpoena for medical records, or whether that's a employment issue. the organizations

Cory Macdonald (13:56)
typically have some licensed component in their retirement community. So whether that's a license assisted living facility or a licensed nursing facility, a component of their community is license and I assist people with understanding what that means for them and helping them comply, you know, with those licensure requirements. That's sort of the healthcare portion of my practice.

Cory Macdonald (14:21)
I also say it's it's real estate too, because these organizations

Amanda (14:25)
Yeah.

Cory Macdonald (14:26)
enter into leases with their residents. that's sort of real property law. I help them with their, you know, financing and expansion, which often includes sort of an overlap between the regulatory processes. So if you're expanding, you're gonna have to go to the state and

Cory Macdonald (14:43)
you know, get permission to either build a new assisted living facility or increase the size of your current one. and that will kind of go hand in hand with, getting a bank to l loan you money to do that. that's a long elevator pitch. Yeah, thanks. But

Amanda (14:58)
Like you you do a lot, Cory.

Cory Macdonald (15:01)
but yeah, I mean like I'd say at its core it's sort of outside general counsel to

Cory Macdonald (15:06)
more moderate size organizations where it's a little bit of everything and helping them find the right folks for more specialized work. And then with sort of regional and national companies, they will often need someone in Texas that knows specifically, the regulations for long-term care. And they they will need some assistance and I'll maybe be more

Cory Macdonald (15:29)
pinpointed there because those larger organizations will typically have in house attorneys that, handle work but need someone they're national, they don't know Texas. So they they come to me and say, Tell us, what we need to do to comply in Texas.

Amanda (15:45)
So I think that kind of leads me to one of the other pieces I want to talk about. So you serve as the general counsel for Leading Age Texas. I want you to talk a little bit about that. And also what your role is on our public policy team as well, because I know that you're a huge piece of that team.

Amanda (16:02)
and how did you get involved in that?

Cory Macdonald (16:03)
Well, we already talked about my mentor fair amount. I became her primary associate, I believe about two or three years into practicing, and she was the general counsel to Leading Age Texas, what was then Texas Association of Homes and Services for the Aging. so

Amanda (16:21)
Good old TAHSA

Cory Macdonald (16:21)
TAHSA so

Cory Macdonald (16:23)
she retired in approximately 2014. And so for about five or six years, I was her primary associate and she was general counsel. during that time, I started attending the Leading Age Texas annual meetings.

Cory Macdonald (16:39)
I started doing presentations at those meetings. I think in 2008 I did my first joint presentation with Fran on residency agreements. I I think by the end of of her career, I was doing most of the

Cory Macdonald (16:54)
work with LeadingAge Texas. I was serving on the public policy committee from whenever I became her associate until until now. so that goes back to there. but yeah, at some point, you know, LeadingAge texas kind of recognized me as the the general counsel. one part of that has been attending

Cory Macdonald (17:13)
Leading age the National Association has an annual meeting of all the attorneys that serve as as counsel to the state associations. And I started going to that in roughly two thousand eight, two thousand nine and and have gone almost every year since. So that's been part of that process.

Amanda (17:33)
We're only like a few months away at this point from the next legislative session.

Amanda (17:37)
what are some of the key things that you're like super interested in or kind of gearing up for for this upcoming session? and maybe if there's any sort of success story in

Amanda (17:48)
other legislative sessions maybe you can highlight some those.

Cory Macdonald (17:50)
I'd say one thing I continue to keep my eye on is assisted living regulations and statutes. You know, one shift we've seen among nonprofits in Texas and I assume and think this is probably happening nationally is

Cory Macdonald (18:10)
the nonprofits are pulling away from the from nursing homes and focusing their energy on assisted living. there's different reasons for that. One of them is it it can just be really hard to make it work financially in a nursing home when

Cory Macdonald (18:27)
you're, you know, a single location or one or two locations. I mean, these are kind of known trends. consolidation allows for economies of scale. And a lot of the nonprofits, they don't have that kind of economies of scale. So we're seeing that shift to assisted living. and we're just generally seeing more people people wanting to stay in assisted living longer.

Cory Macdonald (18:50)
what can happen with that is you can see a reasonable interest in in governing entities, you know, like the state wanting to have stricter oversight of assisted living. As more people are residing in there for longer, you have more vulnerable folks in that setting. The the reason the state

Cory Macdonald (19:10)
you know, regulates, one of the primary reasons is to make sure sort of vulnerable folks are getting what they need. So bottom line, as we shift to more assisted living, understandably there's gonna be more scrutiny, probably more regulation. as someone who represent providers, I want that regulation, if it increases to be reasonable and, something that

Cory Macdonald (19:33)
The organizations can comply with. So that's something I'll be thinking about in this session. And it has been for the last few sessions a success story. last session we updated our CCRC statute. this was something we kind of talked about doing.

Cory Macdonald (19:49)
for a long time and it was it was very satisfying to get that done. our C CRC statute is is very old in Texas. It was created in the eighties and it really hadn't had any sort of substantive revisions since.

Cory Macdonald (20:07)
continuing care retirement communities, there's about thirty-five or forty in Texas that are licensed. and most of them are nonprofits. So, you know, this statute sort of I interact with it a lot in my day-to-day practice. and just from common sense, you know, one can understand that a really old statute that hasn't been updated,

Cory Macdonald (20:29)
doesn't keep up with the way various, industries evolve. And that was true with CCRCs. there was also some confusion in the state over what was subject to licensure and regulation and what was not. So a goal was to get clarity on that. And and we were able to do that. So yeah, that was a big success. Worked very closely

Cory Macdonald (20:50)
LeadingAge Texas and the members. we also last session we were able to pass a change to the property tax code that made it not in any way automatic for nonprofit organizations to be property tax exempt, but it it clarified the statute and how nonprofit senior living organization can meet the requirements to be property tax exempt.

Cory Macdonald (21:14)
just like an old CCRC statute, the property tax law was really old, hadn't had enough updates since the time that nursing homes were alms houses. We talked earlier about, you know, the history of of

Amanda (21:29)
Mm-hmm.

Cory Macdonald (21:29)
nursing homes and back when that statute language was originally written, it's probably predates

Cory Macdonald (21:35)
that infusion of Medicaid funding into nursing homes. so the statute really is written for a time when nonprofit nursing homes and nonprofit retirement communities really were just fully funded by donations. And that's long not been the case. so we updated the statute to make it a little more clear

Cory Macdonald (21:55)
now the statute has sort of a separate test for qualifying if you've been around or affiliated with an organization has been around for 20 plus years.

Amanda (22:07)
I think it's important to talk about too that aging services long term care is one of the most regulated fields or industries in the United States. when someone really thinks about it it makes sense. but

Amanda (22:20)
when you look at other fields, like I know we talk within the space a lot like the operational manuals for a long-term care organization are more intense and longer than than a nuclear power plant's guideline. it's so interesting when you

Amanda (22:33)
sort of spend a little bit more time thinking about aging services or if you have know a loved one who lives in in a community you start really thinking about all of the ways that a resident is impacted by lawmakers' decisions thank you for doing the work that you do

Amanda (22:48)
on both sides of that, on helping, create policy or as you were saying earlier, clarify statute and also, being there in ways for the actual members or the actual organizations to then understand how to move and and implement said policy when they do become law.

Amanda (23:06)
I think it's so important to raise I'm glad that, we're able to to sit here and have this discussion for our members to listen to. Because I mean, truly, Cory, before getting into this field, like I had no idea that this is one of the most regulated industries in our country. and so much of the time and energy and emotional capacity of our members, especially at that executive level.

Amanda (23:26)
like I'm thinking of a lot of our board members, like so much of that goes into this, and goes into understanding and sort of distilling for their staff like how how all of this, matters within the organization itself. So it's just really nice to kind of have like an overview of that. thank you for sharing that.

Cory Macdonald (23:43)
fortunately I've never had to dive into those nuclear power plant regulations, but I can

Amanda (23:47)
Yeah.

Cory Macdonald (23:48)
attest to, you know, in particular the nursing facility regulations being extremely detailed, multiple layers.

Cory Macdonald (23:55)
it's extremely extensive. And, you know, the reasons we we just talked about or I mentioned, you know, there these are vulnerable folks and they need to be

Amanda (24:04)
Yeah.

Cory Macdonald (24:05)
protected. There, there's a reason why it's highly regulated. and I think another sort of explanation for it is that you know there's funding. So whenever another whenever the government controls

Cory Macdonald (24:18)
the purse or or is a source

Amanda (24:19)
Mm-hmm.

Cory Macdonald (24:20)
of reimbursement, you know, they are going to, you know, give themselves the right to have a say in it. So we have that unique combination of of kind of a vulnerable population with with government funding. On the other hand, you know, we want these organizations to continue and to exist and it can be overwhelming. It can make it very

Amanda (24:42)
Yeah.

Cory Macdonald (24:43)
hard for

Cory Macdonald (24:44)
smaller organizations to keep up with all the changes, to implement all the changes. it ends up being very personal to the organizations

Cory Macdonald (24:55)
it is tricky. I see other healthcare sectors that are not nearly regulated as tightly. It doesn't doesn't feel fair sometimes.

Amanda (25:03)
two things can be true at the same time,

Cory Macdonald (25:04)
Okay.

Amanda (25:05)
right? especially being in and among our members for fifteen years, like there is no doubt in my mind that they are here and doing the work that they do for the residents. they are so driven by

Amanda (25:16)
supporting residents, right? I think as a field we can hold space for that and also recognize that there is so much regulation

Amanda (25:25)
on how to then do that. it's so important to to be able to spend time and have a moment to really reflect on that and

Amanda (25:31)
just how intense it is in in this field. and again, not because it's a bad thing and not because it shouldn't be regulated. Just acknowledging that and being aware, for the public to kind of have that understanding is so important when honestly when thinking about

Amanda (25:45)
where you want to potentially live if you want to live in a C C R C in a life plan community one day. thinking about all of the things that are a part of that, that it's not, just that that community alone, that there's so much more going on in the whole space. So yeah.

Cory Macdonald (25:58)
Yeah. I would add

Cory Macdonald (26:01)
you you asked earlier about sort of policy priorities and

Cory Macdonald (26:06)
something I I continue to think about and would like LeadingAge Texas to continue to figure out how to prioritize and support is is the well being of the folks that work in these highly regulated settings and

Cory Macdonald (26:23)
You know, that's assisted I'm I'm thinking in particular of assisted living and nursing facilities. And

Amanda (26:29)
Mm-hmm.

Cory Macdonald (26:30)
a lot of the mo most challenging situations I see operationally involve staff being treated badly by family members and residents,

Amanda (26:43)
You in hand.

Cory Macdonald (26:44)
and obviously there's

Cory Macdonald (26:46)
most family members are great, are they supporting

Amanda (26:49)
That's not air.

Cory Macdonald (26:50)
their loved one. They're in certainly in tough situations. You know, it's always hard to see a family member kind of health deteriorate and to need that kind of care for them. But our regulations and our statutes prov

Cory Macdonald (27:06)
Without getting too into the weeds, there's some some gaps in terms of the recourse that a facility can have when you have that occasional, but but it does happen situation where someone is being verbally abusive, you know, to a staff member or a staff member is just in a s a a a residence condition is such that providing care to them in a given setting

Cory Macdonald (27:31)
is leading to, you know, really hard situations for the staff member. that's something that I've had in my mind is just figuring out ways to make sure that facilities can respond effectively to, you know, situations where their their teammates are being mistreated. Again, it it's it's rare, but it happens enough

Amanda (27:52)
Yeah.

Cory Macdonald (27:53)
that

Cory Macdonald (27:54)
that sort of lack of a solution is glaring.

Amanda (27:57)
thank you for saying that and mentioning that, Cory. there's sort of a a through line in terms of our association of seeing that, with me and the leadership development and education space, we have, so much focus on burnout crucial conversations, how to how to respond to family members who are upset, like all of these things in terms of

Amanda (28:16)
you know, providing resources or education on something and then with leadership support of how to do that for direct care staff, so it it is just like helpful for me, you know, on that end to hear that that is something in, the regulatory and policy space that is being, considered and talked about thank you for elevating that. And so important, especially for the staff to even

Amanda (28:36)
hear that that is something that is being thought about and intentionally looked at at this point. So thank you. Thank you for that.

Amanda (28:46)
I want to shift now, to talk about another hat that you wear Tell us a little bit about Family Eldercare and how serving as board chair and being on their board previous to that has changed the way that you think about aging.

Cory Macdonald (28:58)
I can't say it's changed exactly how I've thought about aging. it has changed how I've thought about aging services. It's also changed how I've thought about board governance. And so to kind of take a step back, it you know, as I mentioned earlier, I've been working with nonprofit.

Cory Macdonald (29:18)
senior living providers for you know roughly 20 years, And for a large part of that time, I had I hadn't hadn't even served on a board, you know, at least at the beginning. I probably joined my first board, you know, roughly five to ten years into practicing law. I hadn't been a board chair until f three and a half years ago. So here I was and you know and I had spent

Cory Macdonald (29:41)
a lot of time around other attorneys that advise nonprofit boards. I certainly spent a lot of time reviewing articles and bylaws, but I hadn't had and being in board meetings, you know, as an advisor.

Amanda (29:49)
And being in board meetings, right? 'Cause I'm like, Yeah, yeah.

Cory Macdonald (29:53)
So so I'm not I I don't want to say 10 years ago I gave bad counsel. but ten years ago I didn't have the practical experience of serving as as a board chair. And so that has

Amanda (30:04)
Gotcha.

Cory Macdonald (30:04)
really helped me

Cory Macdonald (30:05)
I think it sort of enlightened me on practicalities of governance and, you know, time limitations and ways to make governance easier on your board members. You know, you really want them to have the time and ability to focus on the most important questions

Cory Macdonald (30:24)
It's made me, I think, a better advisor to other nonprofits to experience some of that firsthand. In terms of what I said about aging services, you know, one one thing that the LeadingAge Texas members have, there's variety among the members, but most are getting some amount of revenue from

Cory Macdonald (30:43)
People that are paying privately for services. You know, you

Amanda (30:47)
Mm-hmm.

Cory Macdonald (30:48)
have a range. You have some organizations that are more dependent on government reimbursement than others, you know, folks that have more of a nursing home presence or that participate in Medicaid or both, certainly Medicare. but most of the organizations in LeadingAge Texas have some, or a lot of them have some source of

Cory Macdonald (31:08)
private payment, you know, people that are receiving

Amanda (31:10)
Right.

Cory Macdonald (31:10)
services and have the resources to pay for them. And and so they balance that. You know, they're giving some charitable care, they're they're receiving some government reimbursement, they're getting some private pay. Organizations like family elder care that that I would say serve generally are serving mostly folks on, you know, the lower end of the financial or socioeconomic spectrum.

Amanda (31:35)
Mm-hmm.

Cory Macdonald (31:35)
And are

Cory Macdonald (31:36)
much more dependent on government grants and government contracts. And that is is very different and it has been is very different from what I had experienced, just the extent to which, you know, it's much it it's a a tighter financial proposition to rely

Amanda (31:54)
Yeah.

Cory Macdonald (31:56)
on.

Cory Macdonald (31:56)
on government contracts to that that extent.

Cory Macdonald (32:00)
it does offer some perspective for me to to kind of experience leadership in an organization that is

Cory Macdonald (32:08)
sort of only not only because they do have a few private pay programs, very small ones, but basically, primarily s serving those who you know, who can't afford anything other than, you know, something that's reimbursed through a government program.

Amanda (32:26)
tell us a little bit about what they do. I remember first learning about Family Eldercare when I moved to Austin for college. and

Cory Macdonald (32:33)
Mm-hmm.

Amanda (32:33)
I learned about because of the summer fan drive that's been in existence for I don't know how long. but that was like my first kind of introduction into the organization. But for maybe those of us who aren't Austin locals, I would love for you to share

Amanda (32:45)
who Family Eldercare is and what they do and how they serve

Amanda (32:49)
and I will say maybe I'll let you springboard off of this, my favorite fun fact about Family Eldercare care is that it was founded by two women in like the eighties, right?

Cory Macdonald (32:56)
Mm-hmm. Right?

Amanda (32:58)
I love especially leadership stories that involve women having just a fabulous idea and making it happen. So yeah, tell us a little bit about it.

Cory Macdonald (33:05)
Absolutely. Yeah.

Cory Macdonald (33:07)
Well, it's got multiple programs. there is a sort of housing component. So a lot of other LeadingAge Texas members created low income senior housing projects via a program called the HUD 202 program. that

Cory Macdonald (33:22)
provides a grant to build low income senior housing project Basically everyone in that lives there is receiving assistance for rent from the government, all the seniors that live there. So like other members of Leading Age Texas, they have one of those. It's called Lions Gardens in Austin. been around for about 20 years and it's a it's a great, a great

Cory Macdonald (33:45)
Complex. they are also sort of partnering in the development of the first senior housing community in Austin that will be sort of LBGTQ plus affirming. So it's

Amanda (33:59)
Mm-hmm.

Cory Macdonald (33:59)
not exclusive to that population, but it's kind of gonna be designed to

Cory Macdonald (34:05)
you know, sort of serve specific needs in that area, seniors in that area. so that is in progress. It's gonna be called Iris Gardens when it's completed.

Cory Macdonald (34:15)
we will provide services there in addition to you know being part of the group that that you know has an ownership share in it. they also operate

Cory Macdonald (34:27)
a a community in North Austin called Pecan Gardens that is housing and services for formerly homeless seniors. So that has been going for about a year and a half or two. it's an old it's a former hotel that was converted to housing. So

Amanda (34:45)
Mm-hmm.

Cory Macdonald (34:46)
so we you know oversee that and off provide services there.

Cory Macdonald (34:51)
a big part of the mission has always has been for a long time guardianship services. So we have agreements with Travis County, and I think at least one other jurisdiction to basically serve as as a guardian for folks that are in a position where, you know, these are typically seniors, though not always, but that, you know.

Cory Macdonald (35:13)
are at a point where they are not able to make decisions for themselves and need a trusted, you know, guardian to manage their affairs, both financial and you know, personal. So we we have that guardianship division. We do some other related services where we're not at the level of guardian, where we're not sort of in charge of everything, but we help seniors with, you know, paying bills

Cory Macdonald (35:39)
and managing of financial affairs. And then we offer various other support services to formerly homeless seniors and others with disabilities. that's to name a handful. You know, we're a very yeah it's

Amanda (35:53)
I know, I'm like that's just a small portion of what you guys do for sure.

Cory Macdonald (35:57)
a it's a very wide you know wide ranging set

Cory Macdonald (36:00)
but those are some of the the core ones.

Amanda (36:02)
Yeah, thank you for sharing that. And we'll definitely

Cory Macdonald (36:04)
Mm.

Amanda (36:04)
put a link to Family Elder Care in the show notes. thank you to all of the people involved and and to you for your leadership in that organization. And thank you for sharing that. You've had you know, within your role as board chair that you've learned learned so much through that. and I know

Amanda (36:19)
that through your experience in sitting in boardrooms and helping boards, for so many years that that has made you such a great leader in that role. so they're so lucky, to have you.

Cory Macdonald (36:30)
Thanks.

Amanda (36:31)
but I love that you're still taking leadership lessons away from from that as well. okay

Cory Macdonald (36:35)
Trying to

Amanda (36:35)
as

Amanda (36:37)
as we sort of wrap up

Amanda (36:39)
is there anything that we haven't covered today in your space of

Amanda (36:43)
legal or regulatory or board governance that we haven't talked about that you think our listeners should know.

Cory Macdonald (36:48)
I'll be a little I don't know the word for it. Maybe this is a little annoying, but if you know we kind of talked about my my history and how I got into the area. And I one thing I didn't say was that when I was doing the dual degree with the LBJ school, in addition to that academic paper on fair housing and senior living, I also started to focus my studies on

Cory Macdonald (37:12)
healthcare policy. So I had a couple really good teachers there. and we're essentially kind of examining Medicare, Medicaid, and and programs like that. and I learned during that process, the difference between Medicare and Medicaid. and so that that's something that I just I think is interesting. I don't know if we have any folks, you know, outside of the industry that listen.

Cory Macdonald (37:32)
Hopefully so to the podcast, but knowing the difference between Medicare and Medicaid is, you know, an important thing to understanding this area.

Cory Macdonald (37:41)
and something that not everyone knows understandably, with Medicare, for example, you you know typically covers up to a hundred days after a hospital discharge. You know, you're getting, you know, rehabilitation.

Cory Macdonald (37:54)
hopefully help you recover from a a surgery or or a fall. Medicaid and we're talking in the senior setting, you know, Medicaid is a longer term situation where it's covering your sort of daily room and board. but different program, you know, everyone is eligible for Medicare. You have to have certain income thresholds, you know, be below them to be eligible for Medicaid. Another

Amanda (38:17)
Uh-huh.

Cory Macdonald (38:18)
one

Cory Macdonald (38:18)
Just kind of a similar deal, you know, understanding the difference between assisted living and nursing and senior living. you know, people use a lot of different terms for senior living or independent living.

Amanda (38:29)
Yeah.

Cory Macdonald (38:30)
but a lot of folks don't realize that in Texas and in a lot of other states, independent living is not regulated. from the eyes of the law, it's really just an apartment complex. there's no state

Cory Macdonald (38:42)
requirements related to housing, seniors in apartments. you go into it what you know, what we'd call an independent living community, and and I think a lot of folks would think I'm in an assisted living facility because a lot of the folks there use walkers and things like that. But it really, from a legal standpoint, it's an apartment complex that offers some additional services.

Cory Macdonald (39:03)
assisted living is different from a nursing facility, they're all just kind of used interchangeably. assisted living is generally lower acuity. the folks there don't need as much assistance, don't need 24-hour care typically like you would need in a nursing facility. And in Texas and in and in most states, there's no government reimbursement for assisted living. It's it's really almost all.

Amanda (39:26)
my god.

Cory Macdonald (39:26)
private pay. There's a few programs here and there where there'll be a little bit of government funding for assisted living, but that's a big distinction between assisted living and nursing homes. So I know most of your regular listeners know all that, but but I do think they're kind of core concepts that that sometimes get lost when you're watching Better Call Saul and, you know, different shows

Amanda (39:48)
No, thank you for lifting that up. I think that's so important. we were first starting off on this episode, talking about there's so much within the field of aging services that so many people don't know that maybe they need to know until they're in a situation for either themselves or a loved one.

Amanda (40:03)
so I'll just plug our website, Upliftaging.org. There is an explore aging services tab, and then we have a guide to the field, and then types of aging services, and then we also have a little bit about that not-for-profit difference, or we say the not-for-profit advantage. so for anyone who, light bulb just went off when Cory was talking about those specifics, we do have those resources at UpliftAging.org and

Amanda (40:25)
I will say, it's not something you can learn within a day. and there are so many assumptions that are made by a lot of people going into this or, you know, they find themselves in the hospital and then needing to go to rehab and and are just kind of flooded with this information. So this is a great reminder, Cory, to any of our listeners to maybe just spend some time

Amanda (40:45)
educating yourself on these things while it affects when we are at the polls it also can affect all of us personally So thank you for saying that. I think that is is super important.

Amanda (40:59)
okay my last question

Cory Macdonald (40:59)
Mm-hmm.

Amanda (41:00)
how do you, Cory Macdonald,

Cory Macdonald (41:01)
Okay.

Amanda (41:02)
uplift aging?

Cory Macdonald (41:03)
I uplift aging by

Cory Macdonald (41:05)
Speaking positively of all the people that serve the aging and by reminding people that you can live a very full active life for your whole life, as you age.

Amanda (41:19)
Perfect.

Amanda (41:20)
And I would add that you also uplift aging by all of the things that the podcast covered, all the things that you do. you are

Cory Macdonald (41:26)
Thanks.

Amanda (41:27)
a true advocate for uplifting aging. So truly, Cory, this has been wonderful and thank you. I hope our listeners enjoyed us kind of getting into the nitty-gritty of some of the things that go behind the scenes in the field.

Amanda (41:39)
and thank you so much for your time and for all that you do for our members and for the field.

Cory Macdonald (41:43)
Thank you for having me.

Amanda (41:47)
Thanks for tuning in to Uplift Aging, a production of Leading Age Texas. Check out this episode's show notes for more about Leading Age Texas, today's guest, and the Uplift Aging movement. Until next time, join us on socials at Uplift Aging as we continue to elevate the conversation on aging.