Charbel Daniel | Adding Life to Years: Rethinking How We Care for Our Seniors

[Intro] [instrumental music] Welcome to Design Makes Everything Better, a podcast about design as a process for making decisions and succeeding. Now, here's your host, Vince. [Vince ] Charbal Daniel, thank you, and welcome to Design Makes Everything Better. [claps] [Charbel] Thank you. Thanks for having me on your show. [Vince ] It's the first time we're meeting in person. We had a little bit of a chat over the phone before this, but, um, what I know of you and Northwood, your organization, is that, uh, you are CEO. Northwood is Atlantic Canada's largest not-for-profit in continuing care. Northwood provides long-term care, home care, affordable housing for seniors. Founded in 1962, your term as CEO is relatively new. Is that right? Like a year and a bit or something? [Charbel] Just, just over a year. Yeah. [Vince ] Yeah, yeah. Drinking out of a fire hose, I'm assuming. [Charbel] 100%, yeah. New industry. Yeah. [Vince ] Yeah. Yeah. Right. Well, we'll talk all about that. You currently are running as... Three campuses in the province, and you've got two new sites currently under construction. Is that right? [Charbel] Correct. There's a fourth campus that we also operate. It's through a management contract- [Vince ] Okay. [Charbel] And that's Shoreham Village out in Chester. [Vince ] Oh, in Chester, Nova Scotia. [Charbel] Yeah. [Vince ] Beautiful. So as I said, you're new to me, um, which, you know, we've had a few guests on our podcast that, uh, have been completely new to our office. And so it's not unfamiliar. Our listeners come from a wide variety of backgrounds and industries, design and business. It's helpful to have a little bit of a background in terms of your experience and what led you to becoming CEO of Northwood. So if you don't mind just taking the mic and the lead for a minute or two and just telling us where you came from and what led you to being the CEO of Northwood. [Charbel] Absolutely. So again, thanks. Thanks for having me. Uh, my journey is an odd one. I'll start with that. I had no childhood ambitions of being in healthcare. [Vince ] Hmm. [Charbel] Um, my ambitions, though they sound a little childish when I say them now, uh, were to be an astronaut and wanting to work for NASA. And so that's where I focused and, uh, and where I took my education. When I finished high school, I went to university. I did my physics degree and as I was accomplishing that, I was in a relationship that was starting to get serious, and the decision was travel to space maybe or have this serious relationship and make a career adjustment early on while you can. Uh, so I, I chose to, to stay grounded, and I'm glad I did. Married for 17 years. Three beautiful kids. Couldn't be happier. [Vince ] Right. [Charbel] COVID did give us the feeling like we were off planet, so I think I got the best of both worlds throughout my experience. Um, so I, I pivoted. I really liked the idea of medicine, but I have no family members that are physicians or nurses or anything related to healthcare. And so I decided that before I take it on and, and spend a lot of years in school becoming a physician, I should get some exposure, and I took the paramedic program at a school called Maritime School of Paramedicine at the time. It's now called Medavi Health Ed. And graduated from that. Started working in the field as a paramedic here in Halifax in the city, and I count my blessings every day for doing that first because I quickly realized I do not have the stomach for what people see in this field. [Vince ] Yeah. I've actually heard that. I, I know of somebody who became a paramedic, and they didn't last that long because the mental fatigue and just the, the PTSD that you end up developing seeing so many tragic stories. [Charbel] Yeah. And, and mine's even ... I didn't even get to take it that far of, of... I, I had a lot of exposure. I did it still for 10 years, but it's the sight of blood that makes me weak, and I didn't realize. And so it didn't matter whether it was a paper cut or [laughs] a gunshot wound. It made me feel the same way. [Vince ] I'm sure. [Charbel] Um, so after getting that exposure, uh, my family's always been entrepreneurial and business oriented. My, my parents, um, came here when they were in their late teens from Lebanon, and they started working their jobs and moved into, uh, property development and buildings. And so business talk was always around the table. 
And so then I became really interested on the business side of EMS, and I moved into the business development role at the college and helped expand that college into multiple areas across Atlantic Canada. We were successful in winning a military RFP for the Canadian Armed Forces. Uh, we'd taken it away from JIBC at the time, who had had it for over a decade. So that was a big success. We'd really focused and grown that well. And then I had the opportunity to lead an operation in the US, still part of the organization I'm working for in the New England area. I took that on and really liked it. I, I enjoyed it. It was that... again, drinking from the fire hose and ... understanding the, the different nuances. What I th- what I suspect helped make me maybe navigate difficult situations better, I take it right back to that... to my physics education. Because for four years, you get this idea beat into you of, you need to reason through analogy. Uh, you need to reason through... not through analogies, but through first-principle thinking. [Vince ] Yeah. [Charbel] Ask five whys, get to the core reasons of it. And so when you're getting into these leadership roles and you have that mindset and you ask those questions, you tend to get to the root problem much quicker than understanding or saying, "Well, it's been like that forever, it's always gonna be that way." 
Uh, so got that exposure, led the operation there, came back to Nova Scotia. This is home. Born and raised here. And, uh, an opportunity came to lead the operation here with EMS. Took that on pretty much when healthcare hit rock bottom, right? When COVID was, uh, going through, workforces were getting, uh, decimated. There was nobody that was really sustaining a strong workforce to deliver on anything. And healthcare was no exception. EMS was no exception. So we had a lot of challenges ahead of us. [Vince ] Yeah. [Charbel] We developed a saying, "Never let a good crisis pass you by." [Vince ] Oh, yeah. [Charbel] So we, uh, focused on trying things that otherwise we wouldn't have been able to try. Uh, deploying a single response unit to respond to calls, putting a, a clinical team in the com center, not sending ambulances to everything, designing a transfer system that doesn't include paramedics, and we really revolutionized the system that was here, and it was really exciting. A great time. A real highlight of my career, for sure. And it was during that time that, uh, Northwood's previous CEO was retiring and the opportunity came up and, uh, uh, the recruitment agency actually reached out to me and said, "Hey, we have this opportunity. Are you interested?" And I said, "Yeah, I'd love to learn more," and here we are. [Vince ] No, that's great. That's great. There... I find it really interesting, actually, the idea that you were studying physics, and the mental model that you would end up developing from that lens where you are always trying to bring yourself to first principles, and how that can layer into the other disciplines. Uh, there's, uh... I'm sure you've heard of Charles Munger? [Charbel] Mm-hmm. [Vince ] So he always talks about mental models that people have, sort of like if you're designers or architects, interior designers, they have their own mental model. They prioritize their thinking around what they believe is more important, and that doesn't necessarily fall in line with, say, a business owner. They are looking for different points of view- [Charbel] Mm-hmm [Vince ] ... and they have slightly different priorities, right? So having this sort of, um, experience in a variety of disciplines builds up a variety of different mental models where... And Charles Munger actually talks about it more like a, a latticework where the interconnected thoughts that you can layer over problems, so you can see it from these multiple different views because you've experienced a lot. You've studied a lot. You've... You know, going from an astronaut to, uh, getting into the, the space of paramedics and then, uh, on and on, just as a story that you've told, creates a breadth of thinking which I can imagine has worked really well for you in, in thinking and, and problem-solving and decision-making as a, as a CEO. So what, what would you say people would not understand about someone who would be in your position as CEO? What's maybe the most common misunderstanding of someone in your role? [Charbel] I'd say the responsibilities. 
A lot of time you see or you hear about CEOs that are, are in over their head, busy, running around, and not to say that we're not busy and that I'm not, but my, my job isn't really to execute and/or to get in deep into operations unless something isn't going well. [Vince ] Mm-hmm. [Charbel] I define mine and any CEO role as, uh, three main prongs that need to be achieved. The first is designing and developing a strong strategy that has buy-in across the organization. The second is culture. As, as a leader of an organization, you own culture. Many leaders fail to see that or talk about it. In fact, I've been around the table in other organizations where they talk about how terrible the culture is and what do we need to do to turn the culture, and you can't help but look around the table and say, "We need to start here." It's a top-down effect. There's no doubt in my mind if I come in, I'm having a bad day, all those that I interact with at the leadership team are gonna have a bad day. They're gonna interact with other people and have a bad day.   [Vince ] Oh, yeah. [Charbel] And that domino effect goes all the way through. You can have a team of 10,000, they're all gonna feel it. [Vince ] Oh, yeah. I- I've, um... I've walked into businesses for the first time as potential clients and you can... It's almost like you can smell it. [Charbel] Mm-hmm. [Vince ] That there is a leadership direction that is off. Like, there, there's, uh, a point of view or it's just an attitude and an approach which creates this sort of contagious kind of anxiety or frustration that carries through the entire organization. [Charbel] Hundred percent. [Vince ] It, it... You can't, you can't hide that. [Charbel] No. [Vince ] Right? So it's- [Charbel] And people try and hide it, and then people think that it's not related to them. [Vince ] Yeah. [Charbel] That it's happening somewhere else and we need to get this mindset around it, but you really just need to step back and look in the mirror and say, "Well, what's, what's going on here?" So that's the second piece, and then the third piece is all around communication. You need to be able to communicate those first two very clearly and effectively across the entire organization. The strategy needs to be well-understood. It needs to be executed aligned with the values of the organization. People need to understand what you're trying to achieve as a culture. And if you can do those three things and you've got your leadership team, who is your operational team executing on everything else and following those principles, you've got a very well-oiled, strong organization. And it's... You know, no pun intended, it's not rocket science. Right? [Vince ] [laughs] [Charbel] It's [laughs], it's, it's a pretty- [Vince ] Well, that would be easy for you. [Charbel] Well, it would be. It might make more sense. Uh, but it's, it's, it's a very simple approach and sometimes people feel that it's too simple or, or others define their accomplishments by how busy they are, and it's, it's really gotta be results-based. Are you achieving your goals? Are things going well? And is the team aligned? How does the team around you feel? What does the culture look like? We've... One of the things we focused heavily on at our culture at Northwood, and we started this conversation... Two months in we started this conversation because I was at a Chamber of Commerce lunch and they had asked me about what are our recruitment strategies coming up. So I talked about what they were. "Well, we're gonna focus on this. We're doing some international." All these things. I went home that night and I ruminated on that for a bit. I was like, "Recruitment strategies. Recruitment." Like, words matter. People don't realize how much words matter. And we talk about recruiters and re- recruitment teams and, and new recruits.And I got hung up on that word. And the next day, I came into the office and I, I met with the team. I said, "We're gonna try something really radical here." And I said, "We're gonna stop recruiting. We're not gonna have any recruiters on the team. We're not gonna use the term recruitment." And so at first you get a bit of a shock. You're like, "Well, how do we... How are we going to build a team here? People don't always stay." And I said, "It doesn't mean we're not going to do the work, but the word recruitment, it's a military term." [Vince ] Mm-hmm. [Charbel] It's what you used to call new recruits. And the military recruits because if they're injured or dead, they, they can't work anymore and you have to get new recruits. The problem is the business world adapted that. And now these big organizations, they recruit people and instead of focusing on nurturing that team, they push them to the edge of breaking. If they don't break them, and this, that's okay, if they leave or it doesn't work out, we'll recruit some more people. And what really brought this to light was COVID. When you think about COVID, a lot of people have this peace of mind in thinking, "Ah, our workforce got decimated like everyone else. It's just what COVID did, it shed light on things." That's looking at the 99%. But why don't we look at the 1% who was unaffected? When you went to Costco, you didn't see any shortage of staff there. [Vince ] That's right. [Charbel] It was full. Everybody was there. You went to the Apple store, you still had people there standing around twiddling their thumbs, figuring out who to help, right? Because those organizations got it right. They attract, they retain, and they're a magnet organization. They don't focus on what they need to do to replace or have these funnels coming in. They focus on, how do we become a place where people want to be? And once they're here, they don't wanna leave. [Vince ] Right. [Charbel] And so that's where we've shifted our mindset, and we've driven that hard, so hard that earlier this year we've had the best staffing at our Halifax site that we've seen in 25 years. So the model works. [Vince ] Amazing. [Charbel] The process works. [Vince ] So what, what were some of the strategies that you implemented to, I guess, cast, uh, a message that was appealing for people to join your team? [Charbel] So the first part is communicating this across the organization and te- telling people that... Helping them understand that they matter. We're gonna do and, and implement things for you, just for you, nothing in return, and that's it. And so we started with that. We started with little things in adjusting certain roles, making sure we had the right structure. We rolled out a program called Dialogue for our entire team across the entire organization that they can use to interact and get, uh, virtual physician support and things of that nature. A lot of our team members are... Uh, there's a good majority of them that don't have family physicians. So being able to put something like that in place at no cost to the team, Northwood funded, and it's, it's a program that's for them and, and simply as an end. What I mean by an end is, we're not doing this as a means to say, "We're going to do this for you, now here's what I want in return." [Vince ] There's no exchange for it. [Charbel] Exactly. Exactly. Uh, we've got gym facilities that had, we had a very nominal fee for people to sign up. Uh, we've eliminated that, made it free for all of our staff. And we continue to focus our, our mindset right now is every three to six months, we need a new staff-led initiative that we're gonna roll out that's gonna be for the team. And what does it look like? It can be large, it can be small, but it's got to be something. [Vince ] Mm-hmm. [Charbel] And we would just want to change that idea to say, "We're gonna do things just for you." Because I can't think of a single organization where the- they've got a strong culture and a good workforce, and they have bad customer service or they make a bad product. [Vince ] Yeah. [Charbel] Those, those don't exist. [Vince ] Yeah.   [Charbel] And we focus too much on the end product. Thinking, "Okay, I want to make this great, but I'm going to step all over these people to get there." You don't need to. [Vince ] Yeah. It's a process. [Charbel] It is. [Vince ] It's, it's thinking about that, the relationships and the, the, um, the culture before you get to that end goal. [Charbel] Exactly. [Vince ] That end goal will continue to evolve and it will continue to change. If you just get to that end point, then- [Charbel] Right [Vince ] ... you have to re-evaluate and start over again. And then you... It, it, yeah, it's a, uh... I can see it being a recipe that doesn't lead to the ongoing future success. [Charbel] Exactly. [Vince ] I find it really interesting, and in the space of continuing care and seniors, there are so many different people with so many different backgrounds. You've got people that are working in the culinary side, you've got medical people, whether or not it's doctors and physiotherapists and nurses, but then you've got admin staff, you've got people who are focused on the build side, you know, property managers and maintenance people. And it's such a almost complex ecosystem. So to create a culture around so many different people, I imagine is really challenging. Just because, again, that sort of latticework, like people have a mental model of what their priority might be. So given even that there are all of these different people, that there is still a character or personality trait that is a common thread amongst all the different people? Or is that oversimplified to say that? [Charbel] It's not oversimplifying it. I look at it a different way, and I, I talk about value alignment. So there could be different characters, different means, uh, people want to contribute differently, but if the values are aligned, that's when you have true success. And our values are about respect and people first and accountability, and that we can always do better. Those are, they're not complex values. But if they're... somebody's in the culinary area or the property management or any part of however they want to contribute, and there's that alignment in values, then you're going to be successful together. And that's what we look for, and that's with our focus on attraction is highlighting these values so that we can attract people who really pay attention to those values. Um...... it's, it's not... W- we don't have this huge overhaul of people that w- that's changing to achieve that. They already exist, and it's just refinement of it. And now, as we attract others, we are continuing to focus on that. Uh, but the industry also brings people in that want to be there, and it's such a rewarding place to be because you can see the impact you're making in real time. [Vince ] Yeah. [Charbel] Um, when, when I started a year ago, October's Continuing Care Month, so we're just about approaching it here, the second time around for me, and we have our long service awards, and we give out certificates for years of service. And other places I've been, it's, it's typical. You've got a lot of people where you have five years of service, 10 years of service, 15 years, 20 years. What I was blown away was when we got to this event and I get this pile of certificates, and I get through the first third of it, and I'm past the 20 years. I'm thinking, "What is, what does the next two-thirds of this look like?" We're going through 25 years of service, 30 years of service, 35 years of service, 40 years of service, and I see a couple at the bottom with 45 years of service, and you just sit there and you go, "There's something special." Nobody stays anywhere for 45 years if there isn't something special or there's an alignment of values. And, and that's what we just... We're trying to build on that. How do we maintain that? It's... There's not a lot of long-term commitment these days anymore. Right? [Vince ] Yeah. [Charbel] You look at people's resumes, it's a newspaper.   [Vince ] Yeah. Yeah. [Charbel] There's all these people jumping around. Historically, people used to define what they did by the place they worked. [Vince ] Yeah, the company they were at. [Charbel] The company. [Vince ] Yeah, that's right. [Charbel] Exactly. [Vince ] Yeah. [Charbel] Today, they define the profession. It says a lot about what people think about the companies. And we wanna- [Vince ] That's really interesting- [Charbel] ... take it back to saying, "Well, we want you to... We want your definition of what you're doing to be where you're at." And there's a lot of pride with the, with the team that works at Northwood. I, I do personally note that when people are talking to them, they say, "What do you do?" They say, "I do this and this at Northwood." They always follow it up with Northwood. [Vince ] Interesting. [Charbel] And, and that's something to be proud of because they're proud of where they're at, and they should be. [Vince ] Well, yeah. Well, there- there must be a significant amount of meaning behind the work, because Northwood, as a not-for-profit, I'm just making an assumption here, that the social justice component of it is intending to change maybe a, a gap within culture, or- [Charbel] Mm-hmm [Vince ] ... something that isn't right in the way that our culture operates. And to be an organization that is leading that change, uh, is... It gives a lot of people that sense of purpose, especially if they feel like they're directly connected to it, right? Like you're saying, they- they see the results of their work every day. [Charbel] That's right. [Vince ] They can see somebody happy from just being there with them. And, you know, those things are really deeply meaningful. [Charbel] Mm-hmm. [Vince ] Um, and I think a lot of people struggle to find meaning in their work. Probably why their resumes look like they're just traveling from one place to another, looking for that meaning. [Charbel] That's right. [Vince ] So, so, uh, the social justice component of this is, is really interesting because when you ask anybody on the street and ask them, "What, what is, what is your point of view on seniors? Do you care for the seniors in your community?" I don't believe anybody... I've never done this, but I don't believe anybody's gonna say, "You know what? Really, uh, they're not my jam." [Charbel] Right. [laughs] [Vince ] Right? "I don't, I don't wanna see them." And, but at the same time, I've spent a lot of time in Europe, and you see a real mix of demographics. I remember going to Holland, and there was this giant outdoor music festival, like hardcore dance music, and there were grandparents with kids on their shoulders, dancing in the outdoor square. And every mix and... Just it's a cultural mix of people and demographics and race. It's just- it's amazing. Here, it just doesn't feel like it exists in that same way, which would make me think that we don't really care about our seniors the way that we do, to the point where w- you, [Vince ] uh, and everybody at Northwood has to be a part of a not-for-profit that is trying to create a better environment for seniors. I guess my question is, from your experience, w- where's, where's the gap? Like why... If that purpose is so, like, meaningful to people, why does that not show itself on the provincial government level? Like, why isn't there money there so that the support is more abundant, and housing is more abundant for them, and care is more abundant? Can you note why that exists? Is it, is it a cultural thing? Is it a political? W- is it a financial issue only? Wh- wh- how would you describe the care that we give to seniors and why Northwood has to exist, I guess? [Charbel] Hm. So th- that's a complex question with a bunch of layers. I'll do my best to peel back. [Vince ] Sure. Yeah. Well, we got all kinds of time here. [laughs] [Charbel] Okay. Excellent. Excellent. Uh, so first off, let me just touch on the provincial government investment side of things. [Vince ] Sure. [Charbel] Like anything within the province or anywhere, uh, that'll come and go in waves depending on the political mandate of, of the current government that's in place. Our current government is very focused on this topic, and there's substantial investments happening. They've committed to 5,700 new beds. About 1,000 of those are already open. There's 2,000 of them being built right now. It's, it's a substantial commitment. The commitment that's being done and, and, and the way that it's being done is, is, is to the best of the environment that exists right now. The challenge is cultural. I mean, you hit that on the head.There is... Well, when you think about the aging population here and the aging crisis that it's sometimes referred to, I don't like using that word because looking after our seniors is a privilege. [Vince ] Right. [Charbel] And, and it should only be seen as that. [Vince ] Yeah. Yeah. [Charbel] At some point throughout time, there's been a big focus on, "Well, we want to live longer, and this is the things to do." And now you've got seniors that take a handful of medications every day to live longer, but are they living better? [Vince ] Yeah. [Charbel] Are they truly living their best years? And, and that's not a question of saying, "Are those years worth living?" But what we focus on is, and we say this all the time, it's not about adding years to life, it's about adding life to those years, and what does that look like? [Vince ] Yeah. [Charbel] And so the, the cultural piece that has a lot of work to happen is, is North American. In that, the mindset a little bit seems to me that as our parents get older, we move... Or we have a tensity- tendency to move pretty quickly to institutionalizing our seniors.   [Vince ] Yeah. [Charbel] Versus understanding that it's our responsibility to look after our parents. And that means how do we build homes to ensure that they have a space to live in as they get older? How do we provide them care at home? The, the best place and the best solution for an aging population is aging in community. [Vince ] Yeah. [Charbel] And that's where the work eventually needs to get to, but we can't get there right now without that substantial investment in infrastructure so we can eliminate the backlog that exists and then go back into investing in community. [Vince ] Yeah. [Charbel] This is a multi-decade project that'll need to take place. [Vince ] Yeah. [Charbel] But it's not something that you see globally because... I mean, I'll speak to my own background in, uh, in Lebanon. There's a couple pieces there. First off, the average age there is not as high as the average age in Canada. Canada has one of the highest average ages globally. But also in Lebanon, it's very well understood by children that as their parents age, they're living with them. [Vince ] Yeah. Yeah. [Charbel] That's their responsibility. There's no discussion about... It's not even an idea. In fact, if you mention it to them, it's a, it's almost an insult. And I'll, I'll tell you a funny story. When I was going through this competition and I got awarded the role, uh, I hadn't... Uh, you know, my wife knew what was going on. I hadn't actually told my mother at the time. She lives across the street. So I got this great announcement, I'm excited to go share it with her, and I'm like, "Mom, I got some news to tell you. Here's what's happening. This is where... Uh, I'm moving out of EMS, moving into long-term care." And she's like, "Well, that's great." And she's like, "So what, what does that mean?" And I said, "Well, I'm moving to Northwood and this is what Northwood is and all this is..." And all of a sudden the smile and excitement on her face started to fade. I was like, "Mom, what's, what's the problem? I thought you'd be happy for me." And she goes, "Is this some idea to try and get me to move into a nursing home? I'm not going into a long-term care facility." [Vince ] [laughs] [Charbel] And it turned into this whole discussion and I was like- [Vince ] Yeah, [Vince] Imagine. [Charbel] ... "This has nothing to do with you. This is right now all about me and I'm just letting you know-" [Vince ] [laughs] [Charbel] "... I got a new role and you're staying right here and it's exciting and I want to celebrate." And so that... But that shows you a glimpse into what that looks like and, and what that thought process is. A lot of our, our workforce right now that we've been, uh, that we've got good integration within our team is, uh, people coming from India. And when, when I talk to those team members, they tell me, "We don't have a lot of long-term care facilities in India. This isn't really a major industry." [Vince ] They just don't either.   [Charbel] And when you think about it, 20% of the global population is in India and this is not a thing. Like, they live and age at home in community. I'm sure it exists to some extent, but not as much and, and at the forefront as it is here. [Vince ] Yeah. Yeah. [Charbel] So some of it's culture. It's just cultural, just sh- shifting that mindset. Um, the, our current government right now, I, I really... They are investing. They are doing the work that needs to be done and, and we're really glad to see that. [Vince ] Yeah. [Charbel] Actually, this morning, I just came from Fall River where we did a sod turning event to announce our new facility there, another 144-bed facility. [Vince ] Oh. Wow. [Charbel] Uh, we've broken ground on it. In a few years, it'll be open, but that's a, that's a provincial government investment- [Vince ] Yeah [Charbel] ... and we've got another one coming up in another month. So they're... It's trying to do some catch-up here. That's gonna take some time on a system that you really don't have a lot of time in. [Vince ] Right. Yeah. There's so much in that that I, I want to kind of pull apart a little bit here, but the, the idea of supporting your family... I wish I could pronounce it properly, but there's actually... Uh, my background's Dutch, and there's actually a word that doesn't have a direct translation, which is caring for your grandparents. You can tell that there's a different frame of mind and a deeper point of view in terms of how they believe seniors should be taken care of, and their contribution then to the larger community. Uh, you know, there's this belief system that when... You have these sort of three sections in life. You have education, work, and retirement, and that's kind of it. And retirement has this sort of end space, education has a beginning and end, and it, it, it doesn't have the sort of nuances that a lot of other countries that... You know, Holland, for example, would be supporting where when you retire, there's, there's a whole other social dynamic that happens with family and community, and you're engaging with your community in a different way. So retirement isn't just ending your career and then looking for meaning, it is growing into a support mechanism that is making life really, really rich. It's just, you know, there's so many other countries that do that. You know, Japan, for example, like if... You know the Blue Zone? Uh, are you familiar with Blue Zone, right? [Charbel] Yes. [Vince ] Centenarians have the highest concentration in a few countries, like Greece is one of them and Japan being another. But-Yeah, and I tried to do a fair bit of reading into it to try to understand how these two metrics exist, which is ... or statistics I should say. Where in Japan, it, it actually has one of the highest percentages of elderly living alone, but they also have the highest percentage of centenarians. And that's because they are so stitched into the community and they are supported by their family and their neighbors that allow them to live at home. So there's, there's a degree of independence, but it's not like seniors living alone here, which is a, it's an epidemic of loneliness that there isn't a social network that they can connect with because the cultural support system doesn't exist. So they're alone until they can't afford it. And when they can't afford it, then they move into the family. So that's, I, from my reading, that's one of the reasons why there's an actually increase in North America of seniors living in multi-generational homes. It's not a choice. It's a forced predicament, which is so problematic, right? Because they're not ... Anybody who is not a welcome guest in a home can feel it. So if you're a parent or, or a senior moving into your kid's house and you're like, "Oh my gosh. Like, nobody wants me here, but I don't have a choice." It just, it doesn't ... You're not gonna live to a centenarian if you, if that's the environment you're growing up in, right? [Charbel] No. [Vince ] So it's, it's really, really, really sad. So I just, just to, before we get onto some of the other things that you'd mentioned, like how do you culturally shift that to move into a space where it's more inclusive? What can we borrow from Lebanon or from Holland or from other countries that would make it more supportive for seniors just within our environments versus what seems to be like they're segregated, right? Go to a home and then that's, that's it. [Charbel] Right. Some of it, some of it came from good things. I mean, we wound up where we didn't want to wind up, but it didn't come all from bad things. When I, when I think about Lebanon as an example, some of them is probably a result of the economy. And it's the same here, but in the opposite direction. Economically, it's, it's been fantastic. Kids are growing up and, you know, prior to this COVID and post-COVID world, but people are getting jobs, being able to afford a home at a young age, moving out. So it creates that gap where you can't really look after your parents 'cause you're not there living with them. One of the circumstances in Lebanon is that it's economically not that stable and people aren't able to move out so quickly. So they're stuck at home with their parents and, and they look after them. So it's cultural, but also economically forced. [Vince ] Right. [Charbel] Um, for here, it's, it's gonna end up being a shift in mindset. And I'm not talking about this global shift. A lot of people that you talk to will tell you, "Well, yeah. We, we want to be able to do more." But everybody's also got families. You're working. And it's the prevalence of some of these underlying diseases too that are making it difficult. So... if we, you know, if we talk about dementia, dementia's a tough one because once you've got a parent or a loved one that starts to develop dementia, you, you can't leave them alone. And if you don't have access to home care to do that, there is good reason for institutionalizing. It just shouldn't be blanketed, and that part's getting better. Um, but dementia is on the rise, and our understanding of it is still evolving. And in fact, I think in the Netherlands is where they're leading all of the, the frontline things on, uh, dementia care. They've got a village there called, uh, Hoogevak. [Vince ] ... I've seen, seen ... It's really remarkable. [Charbel] Yeah. [Vince ] Right?   [Charbel] And we've, we work closely with them because we worked with their team, uh, Eloy and Janet, who helped build that village and design it, to design our, uh, first floor at the center there for the programming that we have called the Behavioral Support Unit. [Vince ] Amazing. [Charbel] Totally focused on dementia care and personalized dementia care and understanding dementia. Because I mentioned earlier, I got into education with paramedicine and did a little bit at the school for a little while. And I remember when, when we had that module on dementia, short and quick, but people always define dementia as when seniors start to revert back to childlike behavior. That is one of the worst statements, and I can't believe how often I said [laughs] it and I've been taught it, to make because the first thing that comes to mind when you think about children is no stairs, no sharp objects, can't go near water, all of these things. That's not what dementia is. That muscle memory is still there. If they knew how to cut a steak, then with dementia, you can still give them a steak knife and they'll know how to cut a steak. That muscle memory isn't gone. If Michael Phelps, for whatever reason, developed dementia, and you threw him into the deep end of a pool, he's gonna swim... just fine to the side, right? He didn't forget how to swim. Um, and that's the understanding that's starting to develop. But there's these underlying notions that, A, the growth of th- of these diseases are not helping and we need to understand that more and how do we control or, or, um, resolve that a little bit. Uh, but the other side is completely around just cultural mindshift on, on how do we create these? Is there, is there enough community programs around that can support seniors to live at home? Because when I think about Northwood, uh, our logo says Northwood, right under it says Live More. And the idea is to provide and create a community where all the amenities are there so that our seniors can live more. When they are at our Halifax site...... you walk into our main street, that's what we call the main area, and you've got a drug store to one side, you've got a private banking to the other side, you've got a, a cafeteria and a restaurant there, you've got a salon there. It's just about bringing all of that together, and a health center, and all of these things, so that they have all the amenities they need to thrive. [Vince ] Mm-hmm. [Charbel] So then the question becomes, how do you do that in community?   [Vince ] Yeah. [Charbel] How do you make it more accessible? Because the matter of the fact is right now, accessing healthcare is a challenge and it's getting a lot better- [Vince ] Yeah [Charbel] ... but it's still a challenge. And if you can't access that at home- [Vince ] Yeah [Charbel] ... then you may need to be somewhere to get access to that. So there's, there's no one simple solution to this, there's no silver bullet. [Vince ] Yeah. [Charbel] It's going to be a lot of these incremental changes that are working in tandem with each other, that we may not realize it as the work's happening, but we'll wake up one day and we'll say, "Wow, okay, hang on, we don't have to move this direction anymore. We have everything we need." [Vince ] Yeah. Yeah, yeah, interesting. There's two things I wanna talk about a bit more. The component of dementia and how that's influenced the, the building itself and what some of those lessons were that you've learned. The other is the, uh, uh, speaking of the location here in Halifax, that you've built, which I think is relatively common where you have a series of amenities within the building that provide additional services and kinda community-focused environments, whether it's social spaces, worship spaces, and- [Charbel] Exactly [Vince ] ... um, retail and all th- these things which are super important and critical. The other thing about that is tho- those services, outside of the dementia component, but like, those services do exist in downtown cores and in small communities and so on, like say Chester, where you're building. [Charbel] Yeah. [Vince ] Is part of the selection process of where to build evaluated by what is nearby for [Vince ] their own interaction with the community? Um, like, I can imagine in the north end, a- again, I don't know who would be the predominant demographic there- [Charbel] Mm-hmm [Vince ] ... whether or not they have dementia or other physical challenges and, and so on. Like, if you imagine in, um, a building for seniors, being in an area where it's right next to a public school, right next to a grocery store that they can walk to, that is walking distance to parks and, you know, other little retail shops so that they can actually walk and engage with a broader community, versus being self-sustaining, which is tying to that bridge to reengage seniors into a larger mixing of demographics versus being independent. Is the location specific to allowing that or is it just that the, the financial structure is such that we, it's so much more expensive to build right downtown than, say, in, in a smaller village? I- does that weigh into some of the decision-making that you have in terms of where a senior's development could be, so it's close to services or not? Or is it not really a factor in decision-making? [Charbel] It depends on the facility. So when we talk about long-term care, specific, that, that higher level of care for seniors, they're there because they can't access those amenities elsewhere- [Vince ] Mm-hmm   [Charbel] ... and th- so typically they wouldn't be in a long-term care facility and able to go to the grocery store next door, nor would they need to, 'cause in long-term care, they're, they're, they're served three meals a day- [Vince ] Yeah [Charbel] ... that, that are made in, uh, in house- [Vince ] On site, yeah, yeah, yeah [Charbel] ... and, and all those things. But when it gets into assisted and supportive living and affordable housing, absolutely... that is critical because there's a bit more independence there- [Vince ] Yeah [Charbel] ... and you want that community interaction and th- they don't have all of those amenities embedded in the facility. The Halifax location here with Northwood is a very, very unique facility, not just for Nova Scotia, not even just for Atlantic Canada, but even across Canada, because it has affordable housing, it has assisted and supportive living, and it has long-term care. And there's about somewhere in the vicinity of 800 to 1,000 residents that live within the combination of those buildings. Um, that's unique. That's not typical. Go, a lot of the buildings now are either affordable housing or assisted living or long-term care. They're separate, they're in all different locations. And, you know, going back to something you said earlier, I'm just l- looping back a little bit further, when you talked about the need for this and the, the social justice aspect of it. That, that's why it all started. Back in the '60s, it was Ed Roach that heard on the radio of this elderly couple that were having to vacate where they were living 'cause they couldn't afford it, but there was no affordable housing for couples. And so he took to the, to the community and went and started fundraising. So in a few years, they broke ground, and the first building that Northwood built was actually simply affordable housing for seniors. That's it. There was no care delivered there, there was nothing else aside from just saying, "Here's a home that you can afford and you can live together as a family." [Vince ] Is it still standing, that, that building? [Charbel] It is, yeah. [Vince ] Right. Oh, wow. [Charbel] And so that developed into another building next to it, which is the Manor Building, which is- [Vince ] Right [Charbel] ... uh, actually offers, uh, supportive and assisted living. And that has people still living somewhat independently, but has care workers coming in. And then that led to the Center Building, which is our main building with 385 rooms and residents living there, that receive full care. [Vince ] Right. [Charbel] And everything from food to helping them with their activities of daily living and so on. [Vince ] Right, right, right, right. [Charbel] Um, so th- that's why that arose. There, there's still a massive demand for social justice enterprises, especially around affordable housing. I believe w- our stockpile in this province is somewhere around 5% to 7%, and that's on the higher end. Uh-... it needs to be around 20%. [Vince ] Yeah. [Charbel] When you look at communities that have real sustainability, it needs to be there. Again, something the government's working and focusing on ... but we just can't build quick enough. And also right now there's, uh, kind of a pause on some of the immigration things, which is starting to slow down, um, on the rental property side of things- [Vince ] Yeah [Charbel] ... in general. [Vince ] Yeah, yeah. [Charbel] Um, so a, a lot of those pieces somewhat have to work in tandem together. But going back to the, to the main question here on, on those locations. It's really based on, especially when it's long-term care, that full care, on where are there gaps in the province based on the list of people that are waiting. Where do the... What communities do they live in? And those are the communities that then the de- the department is putting proposals or sending out an RFP, a request for proposals, for us to submit on. [Vince ] Mm-hmm. [Charbel] Their latest request that was sent out at the beginning of August is for Pictou County and Kings County. So again, as they go through their criteria, they're identifying these areas, they put them out, and then anyone that's interested will submit a proposal. [Vince ] Mm-hmm. Um, so to come back to the point that you made earlier about the, uh, the Dutch partners that you were working with, uh, through the community that was focused around dementia. [Charbel] Mm-hmm.   [Vince ] What was the name of that community again? [Charbel] Uh, it's called Hoogovek. [Vince ] Right. I, I should know how to say that really well- [Charbel] [laughs] [Vince ] ... but I'm not gonna bother. [laughs] What were some of the things that they learned that you were able to implement into your building? Like, what were the findings that were unique? [Charbel] Most of them were around just simplicity and familiarity, right? With, with, uh, dementia residents or anybody that's suffering from dementia, it's the frustration arises when you aren't aware of where you're at or you feel lost, and then you get angry and it just cascades from there. So on the last floor of our center building, we actually rebuilt an area called Kay's Place, and we do dementia programming up there. And the design of it is just very simple. It's open shelving. It's everything is easily accessible, bright colors. Dark colors tend to be areas that, uh, anybody with dementia will stay away from. So you design spaces that... Oop, actually even our gym facility in the center, it's the only dementia-friendly gym facility we know of in North America. And the design there was all around, first of all, a circular scheme so that people don't get lost or- [Vince ] Yeah [Charbel] ... or walk down a- any hallways. But also is the color coordination of saying, "If there's dumbbells there and that's dangerous and we wanna keep anybody away from there, you put these black tiling down." Because of the dark flooring, the residents with dementia won't go near it. [Vince ] Oh, shut up. I've never heard that. [Charbel] But the lighter flooring has, has a little bit more comfort and they're able to go to those areas more safely and move around. So these are the things that we're learning and designing spaces that are comfortable for our residents- [Vince ] Yeah [Charbel] ... that, uh, that have dementia. And, and again, it's, it's just growing. Unfortunately, it is growing and we have to make sure that we can accommodate the growth in, in the spaces. [Vince ] Yeah. Yeah. [Charbel] 'Cause if it's designed for anybody with dementia, it also works for everybody else. [Vince ] Yeah. Oh, for sure, for sure. [Charbel] Yeah. [Vince ] For sure. Um, what it... What I've noticed now in terms of, you know, what environments are working, what might not be working, there's, um, a different expectation from the maybe the demographic that's soon to enter into a facility that isn't like the generations before. They, they have a higher expectation or... And, and we see it. Like, we've designed so many spaces for when we started the office with this younger group that's, we've been kinda like following this age group. [Charbel] Yeah. [Vince ] And, like, now we're getting into the senior space and we're thinking about it in terms of, "Is that the kinda space that I wanna go to?" So, the social spaces are different. The bars are different. There's VR rooms in some places. It's just a completely different way of thinking, which is super exciting, and I think there's so much opportunity there. It, uh, outside of the dementia component, what is what got me thinking about it, in some of the newer facilities that you're doing, have you seen the discussion change from... I know that you're, you're new in the space, but I'm sure that you've heard the conversation that they need to do things differently. Have you heard them say, "This is the way that we used to do it and we need to do it like this now." Or, "This is the kind of room that we need to have and why it might be..." Like, what are some of the... How it's, how is Northwood's built environment changing to address the new needs of seniors? Not dementia specifically, but just generally speaking. From their own kind of... From your ability to make them happier. Like, is, is there, is there something that you're doing that's different? [Charbel] There's a couple. And, and then I'm gonna tack on another piece to this. Might sound a little tangential, but it's, it's all relevant. The, the biggest piece right now that's being seen across the entire sector is about shared spaces and moving to independent rooms. [Vince ] Mm-hmm. [Charbel] So there is a, a lot of shared spaces pre-COVID. COVID taught us that doesn't work, especially when a pandemic is on the rise ... that the independent space allows you the safety to, to protect everybody and not cause widespread. So all new facilities have independent space, and that, that's key because the, the idea of a long-term care facility used to be that it's kind of like a hospital. We're need to rethink that and move towards reminding ourselves that it's their home. [Vince ] Mm-hmm. [Charbel] That may be the very last place that they go. And they're not guests there, we are guests there. We're there to serve them and to support them in their home, and we have to remind ourselves of that. And it needs ... to be embedded in our minds as we work around that. The other pieces are, are probably more so around physiotherapy and occupational therapy with, uh, with our teams. And w- not with our teams, but our teams delivering it to residents. So, there was an idea of do you make the rooms a little bit bigger and have portable equipment that you can take to the rooms?But really where we're at, at Northwood is no, that's... We want people to come out of their rooms, so we design a friendly space, a large enough space. We book people through and we get them out there. They're getting out ... they're getting to the   [Vince] That's right [Charbel] ... space, walking through them and going ... through all that. Uh, so those are the ideas, is how do you... You want the independent space, but you still want the general spaces for where a, a lot of the other things that might take place have to be done. So that it's not spending an entire day in one room for X amount of years until the end of that individual's time. [Vince ] Yeah, yeah. [Charbel] 'Cause that's not living better. That might be living more, but it's not living better. [Vince ] Yeah. Exactly. [Charbel] And we, and we want people to live better. But going back to your comment on how things are changing and, and the expectations. So this is a concept I've been trying to wrap my head around, and what better place than for us to discuss it here ... and you can tell me what you think. [Vince] Sure, yeah. [Charbel] So, uh, um, have you heard of the blue dot experiment? [Vince ] Uh, I've heard of it. I, I don't know if I'm confusing it with blue zones. [Charbel] Okay. Uh, I'll walk you through it really quickly. [Vince ] Okay, okay.   [Charbel] So researchers had set up a very simple test. They had brought in people, put them in front of a computer, and literally flashed up a blue dot, and gave them two buttons. A blue button and a purple button. And they said, "Every time you see a blue dot, you hit the blue button. And every time you see a purple dot, you hit the purple button." And as the different colors flashed up and they had a good mix of 50/50, it was almost 100% accurate with everybody. What was interesting was when the purple dots started to diminish and almost disappear. People started looking at blue dots saying, "Hmm, I haven't seen a purple one in a while. That one might be purple," and hit the purple button, and so they started creating these purple dots that didn't exist there. [Vince ] Interesting. [Charbel] So they took this a step further and they said, "Okay, let's do this with facial expressions. We're going to show you happy people and angry people, and same idea." Exact same results. When it was a mix of both, they were pretty accurate. When it was just happy people, some of those expressions were misinterpreted as angry. And then they took it a step further, and they said, "Okay, let's, let's go a little bit further with this. We're gonna show you ethical situations and unethical situations, and again, select which one works." So they run them through this experiment, same results. When they were split, it was perfect, but when it was all ethical situations, they started looking at them and saying, "That one's probably unethical," and selecting it as unethical. And the idea behind it or what, what it led to as a result was that we live in the best time ever right now. I mean, it's hard to debate or argue otherwise. [Vince ] Yeah. [Charbel] But we sometimes make problems out of things that don't exist, and expectations change. And there are certain industries that I, I'm coining this term of I'm calling them blue dot industries, where it doesn't matter how great things get, there's always gonna be purple dots. And if you think about it, healthcare is a perfect example of a blue dot industry. Where we've been when you talk about medicine and care and where we are today, are light years away. But people still die-   [Vince ] Yeah [Charbel] ... and so there's, no matter how great it is, there's these purple dots popping up even though a lot of it is blue. And there's other industries that don't w- that don't see that, right? When you think about maybe the, the car industry. When a new feature comes out, it is actually great. There's nothing great until something better than it comes out. But in healthcare, it doesn't matter how great the newest advancement is, they'll, somebody will find a problem with it fairly quickly because ultimately we don't live forever. [Vince ] Mm-hmm. [Charbel] And when you're talking about expectations and seniors in long-term care, th- the industry is a blue dot industry. That's, that's what I'm calling it, and I don't know maybe it'll become a saying one day. But it's an industry where it, no matter how much you enhance it and, and do great things, A, you can always do better, but B, expectations are always changing. And because those expectations are changing, there's going to be perceived or seen problems that may not be as big or as serious as they have been historically, but it's still something and it's still a focus and it's, and it's something to work through. So that's one of the challenges that healthcare will probably face until the end of time. [Vince ] Yeah. Yeah, yeah, that's... I had... So I, I haven't heard of that before. That's totally different than [laughs] than, uh, the blue zone. Yeah, it's... You can see it and hear about it so often where people talk about the situation in the world today being so terrible, and it's, it have to be, it has to be understood relative to what it used to be like. Like, we all live better than the Queen of England in the 1800s. [Charbel] Yeah. [Vince ] Right? Like, we just... I have no idea what her life was like. I'm just making an assumption. [Charbel] You're probably 100% accurate. Yeah. [laughs]   [Vince ] We live a pretty... Even like the worst case scenarios that I can ima- and I'm speaking from a place of, you know, privilege. Like, I, I'm healthy, I'm strong- [Charbel] Of course [Vince ] ... and all that kind of stuff so, I, I, it's not to di- diminish others that are really having a hard time and suffering. But, um, you can see that, um, as a result of this kind of comfort that we're all so familiar with, and that expectation that our healthcare system is gonna make us healthy versus your, in your own control, it's up to you to be healthy and to maintain the longevity that you want. It's not your doctor that's gonna make you healthy, it's, it's up to you. So there is that expectation. That blue dot is, "My situation must remain comfortable," and the expectation is there. So when something doesn't seem quite as good, there's that purple one. If, if that's the analogy that we're- [Charbel] Yeah [Vince ] ... carrying through. And moving forward...Um, and I would say that it's not may- maybe necessarily a, a Northwood challenge to the same degree as it would be for private ownership in the space that you're in, where if they're gonna be paying out of pocket more significantly, they're looking for a big, beautiful blue dot when they are retiring in a home, right? [Charbel] Yeah. [Vince ] Or, in an environment where there is a great deal of services and, and care that is, is comfortable. So what it's like in Northwood where people would be in a space that they need to be taken care of, 'cause they can no longer afford to be at home by themselves, and they make an application and Northwood said, "Yes, you, you met the cr- You, you meet the criteria here for the support that we can provide." They will still come with expectations, like you're saying, right? And I don't, from my point of view, not as a healthcare provider, I, I have, I don't, I don't know how all of the medical equipment works and what their expectations would be of an access to an MRI machine. Like, I can't solve those things [laughs]. But from a design point of view, I think there are ways to create environments that make people feel, um, welcome when they're not at home. So I, I think that, you know, this kinda touches back on the other point that you were saying, uh, uh, um, commenting on is like this is their home. But there's this really weird tension where they don't want to necessarily be there when they get there. "I wanna be at home," possibly. Maybe like they could be very excited because they have the support system that can allow them to be there. Like, that's, that's different. But I mean that there would probably be a percentage of people that would be forced, like say your mother when she was upset about, you know, thinking that she would have to be pulled from the family to go here. [Charbel] Right. [Vince ] What happens when there's a scenario where that is the case? There are people that will love and take care of her that are not her family, but provide the support that's necessary to be a human being. But it's th- it's still a purple dot. [Charbel] Yeah. [Vince ] So the blue dot in that scenario, I think from a design point of view, is about creating that comfortable social space. And I've always kinda thought of these places like hotels, uh, the really good hotels. [Charbel] Yeah. [Vince ] You know, environments where you walk in, and we've all felt it when we've gone into a restaurant, and you just feel deeply comfortable. Just people there that you know that you're, you're there for a financial exchange, but still, you would choose to be there over eating at home. Th- there, there is a way to build an environment that has built within its structure an optimism. I think you can actually build these things. Where that social space isn't your home, it is that, it is the city center, so you feel connected to it to a degree. But then your own, the environment that you move into, which is your own unit, your home, has an ability to personalize it, and that's, that's the kind of having an apartment in an apartment building kind of a, a thing. [Charbel] Right. [Vince ] Like it's not, it's not your own house, but it's still a home that you can personalize. So there's all kinds of little things that you can do- [Charbel] Mm-hmm [Vince ] ... that can make it personalizable for a period of time. So I think that's where the blue dot can still be hit. Uh, maybe it's not the same size. Maybe they don't have, they don't have the same neighbors. But that transition is gonna be... I think it's still possible to hit a blue dot and meet expectations, 'cause I do think that they're different now. I think that when people are walking into a seniors home, they want to have that higher end kind of experience, right? [Charbel] No question. [Vince ] Like, they, they wanna have that. And I think, I think there's, I don't think it's impossible. I really don't. I think it's, which I think is, is really exciting. So we can really change the landscape of what it looks like so we can all be excited about getting there versus being forced to be there and away from your family. I don't know. Like, does that kinda touch on some of the blue dot versus purple dot that you were talking about? [Charbel] Yeah. Yeah. I think ... like you mentioned, that there, the design space is winnable. There's no question about it. You'll have personal preferences from individuals. Some people like bigger spaces. Some people like smaller spaces, all of those things. That, that personal preference is, you can't ever get around. But it's about the standardization. What will it look like? What will the quality of, of the builds look like? And these buildings are not built for temporary periods of time. They're designed and built to last. [Vince ] Yeah. Yeah. [Charbel] Again, when we look at our center building, that's in the decades now. But if you walk through it, you wouldn't really know that because we've got maintenance people there that keep it up to date, the painters, electricians, plumbers always working through it. [Vince ] Yeah. [Charbel] Um, but yeah. As the, as the design changes and, and people's expectations change, that's, that's definitely a winnable space to ensure that it's more inclusive, better designed. [Vince ] Yeah. Yeah. [Charbel] Uh, even as we think about, um, [Charbel] well, well, the Fall River location, e- some of the things that we've done there differently is that it's one of the few that I know of in the province as a long-term care facility where we're trying to be as en- environmentally aware and conscious as we can. And so it's, uh, we're working on geothermal for heat ... in that building. Um, so that's, you know, the- these are things where we're trying to incorporate some forward thinking, but they come with substantial investments. [Vince ] Oh, yeah. [Charbel] They're just not cheap to do. [Vince ] Yeah. For sure. For sure. [Charbel] Yeah. [Vince ] Um, just kinda touching back to one of the other comments that I'd made that some of them might not want to be there. [Charbel] Mm-hmm. [Vince ] But at the same time you have this culture that you described earlier of people that have a lot of purpose being there, and that it's, I think that's the only way you can get them to be excited, people that are coming in, to, to be there. Could you describe maybe that a little bit, just...... from a, I don't know if it's an operational point of view or if it's a perspective. Like when somebody comes in and they, they literally are struggling with the idea of being away from their family or their previous home, how do you make them comfortable? What's that, what's that transition like? [Charbel] So I can offer you a couple interesting perspectives on this one, because if you recall earlier on in my career as a paramedic, I would have picked up some seniors from home that are going to a long-term care facility for the first time ever. And of all the difficult calls that there are to do, that, that's up there. I know people would think more along traumatic type of calls and cardiac arrest, things like that. But when, when you're with an individual who feels that, "Okay, I'm now agreeing or coming to terms with the fact that I've lost my independence, and I'm putting my trust into someone else. I'm moving out of my home and to another home," it's, it's hard. It's a very emotional call to do. The work that we do during that transition period is a lot of work with not just the resident that's going to live with us, but with the family. There's a lot of programs, materials to read, tours that we can provide, just to ease them into that environment and, and help them understand. Now, it depends on why they're coming there as well. If it is a resident that has dementia, that's a different situation altogether because of their level of awareness and understanding of their surrounding. For those that are completely aware, understanding, and coherent, but it might be a physical limitation why they need to be in a long-term care facility, i- it's a, it's a different type of journey. Because again, they're, they're leaving their home, they know that they're potentially never going back there. And so we, we do it as a collaborative approach. We work together with all of our teams. We make sure that the family is there to support and understand. The hardest part is actually not on us, it's on family. Because what we, what can happen is that once they're relocated, families may not visit as often, and that's really hard. And we hear that often. I, I try and get down to the facilities as often as I can when time permits, just to interact with the residents and talk to them and get to know them and build these relationships. And I remember last year, it was just around Easter, a conversation I had with one of the residents right after Easter weekend. Uh, we met, we were talking, having a coffee together, and he asked me how my Easter weekend was. And I said, "Oh, it was great. You know, we got together, kids, met at my mom's house, we did this and the other thing." I didn't know what I was saying was gonna have such an impact. And I said, "How was your Easter weekend?" And he goes, "It was the worst one I've had yet." Now, he's been with us for 25 years, so it's not, you know, it wasn't overnight. He's been there for a while. And he said, "It's the first Easter that I had, didn't have a single family member call or visit." He goes, "None of them. My kids didn't call, they didn't visit. No- I didn't hear from anybody." He said, "You know, the team here was great. Everybody was here, they were supportive, there was events going on, lots going on." He goes, "And, and I appreciate the fact that we're working as family." He goes, "But my actual family, I, I didn't see them." And that's the hard part. That's the part where families just have to realize that you still need to be there. Y- you have to show up. They're waiting on that, and they're, they're counting the moments between your visits so they can see you. They wait for that smile to come around the turn. And that's why it's so important with the care that we provide to ensure that we're not, we can't make that side any more difficult. We, we need to have a team that's passionate, caring, and showing up for the residents every day, because sometimes those families may not show up. It's not a very common occurrence, but it happens. [Vince ] Yeah. [Charbel] And that's, that's hard, because that's outside of our control. We can't really pick up the phone and call so-and-so's son or daughter and say, "Hey, why didn't you show up or call this person on this day?" [Vince ] Yeah. Yeah. [Charbel] That's way outside of our responsibility. [Vince ] [laughs] Yeah. [Charbel] And, um, but, you know, it's- [Vince ] That's heartbreaking. [Charbel] ... it's hard. Yeah. [Vince ] That's really, really sad. You know? And what an amazing perspective to have gone through it from the person as a paramedic that was bringing them to a facility, and to know what that's like from that side. That's, that's, that's again, that latticework and mental model to, do you understand something different that's ... I, I don't, I can't imagine a lot of people in your position would understand it to that, that depth, right? [Charbel] Right. [Vince ] That's, that's really [Vince ] ... Yeah, that's sad, and it's very moving. Um, okay. Just to wrap it up, I don't know how long we've been here. I, think I can ... To close, like what, what, what would you say, uh, in your maybe strategic plan, um, that it might be a part of this, where do you see Northwood in the next five years? Like what, with you in a role as CEO, what's the picture you have for Northwood and, and how would we recognize it in the future? [Charbel] Northwood's always had this history of being a place of firsts. It truly is a place where innovation has, has always lived. It's challenged the status quo, it's led significant change, and I see us doing more of that, especially as we get into this era of understa- standing how data is gonna work and, and how we interpret it, and especially where AI plays a role. That's not clearly defined in this industry yet- [Vince ] Mm-hmm [Charbel] ... where it'll play a role. And I, and I think about the conversation around data similar to a conversation that probably happened 30, 40 years ago around the internet. When that rolled out, people might have said, "Well, we don't need that. We're gonna focus on everything else." Nobody exists without some type of web page or some interaction through a network. [Vince ] Right. [Charbel] AI is 10 times that. And so we're, we're focusing really hard on what role will that play, not to provide automated care or anything of that nature. We want to continue to focus on humanized, personal, compassionate care. That's key. [Vince ] Mm-hmm. [Charbel] You can't remove the human piece from it. [Vince ] Mm-hmm. [Charbel] You shouldn't be trying to substitute that. [Vince ] Mm-hmm. [Charbel] Um, so i- it's going to be about developing how these work in tandem without eliminating some of the human touches. And I say that because-It's all about perspective and where you're sitting, right? If we're sitting at this end of the spectrum of the five years, looking at it from today, you think, "Okay. AI may go into some type of predictive things and it needs to do these things." But really, we gotta sit at the other end of the five years and look back and say, "We know where we wanna get to. It's continuing to humanize care. Where does AI integrate into that?" [Vince ] Right. [Charbel] And what does it look like? [Vince ] Yeah. [Charbel] So more of that. Um, of course, we'd like to be able to provide care for more seniors, which means growth and development. We have our career college that we launched last September, a year ago, and we ran our first, uh-   [Vince ] We didn't talk about that at all. Yeah. [Charbel] No. That was, that was new. [Vince ] You expand on that. Yeah, yeah. [Charbel] Yeah. [Vince ] Tell us more about it. [Charbel] So it's... We launched our first program last September, continuing care assistance, and we had a pilot program, a class of nine that graduated in May of this year. And we want to develop that more. We, it's n- none of the career college, um, ambitions are about competition. It's about capacity. There's a lot of demand. There's new facilities opening up. Those beds that we just talked about- [Vince ] Yeah [Charbel] ... are all gonna need continuing care assistance. And so it's about how do we add capacity and how do we leverage that and provide programming in the right communities. Uh- [Vince ] Is that, is that, uh... Is the school itself contained for Northwood, or would people that graduate from this possibly go to different organizations, or is it, is it intended to keep- [Charbel] They could go anywhere. [Vince ] They could do whatever they want?   [Charbel] Precisely. Yeah. [Vince ] Yeah. [Charbel] We would hope that they would stay with us- [Vince ] Sure [Charbel] ... but there's no mandate to do that. [Vince ] Okay. [Charbel] In fact, the current programming with all continuing care programs at the moment is that it's fully funded by government. So it's a subsidized program with a return to service agreement that they have to work in a long-term care facility- [Vince ] Sure [Charbel] ... for X amount of years. So there's no restrictions to say, "If you took a program with this college, you have to work at this facility." It's just, "You have to work at one of them." [Vince ] Right. [Charbel] And we're hoping through the quality programming that we're developing and delivering and the, the relationships we build with our students, that they'll want to stay. And that's been the case, I believe, in the last program. 90% of them stayed with us- [Vince ] That's great [Charbel] ... uh, which is fantastic. And now as we leverage that and grow it, so we'd like to see more development there. And just, uh- [Vince ] Well, you could also teach it too. You've got some, some teaching experience, right? [Charbel] Yeah. I'm not sure I'm allowed anymore. Yeah. Um, but that's... Yeah. Just more, more growth and development, more about the compassionate care. How do we continue to humanize care? How do we create more advancements in, in how to... The delivery of that care, challenging the status quo. Uh, going back to our very first conversation, going to first principles, not reasoning ... through analogy. It doesn't have to be this way because it's always been that way. [Vince ] Yeah. [Charbel] And, uh, changing those things. I mean, even the delivery right now of care in the last year has evolved so much. So now there's the rollout of the RNs, our, our nurses that can actually prescribe. [Vince ] Not sure. Yeah. [Charbel] Before they couldn't write prescriptions. And so that was a whole trip and, and venture through ... the healthcare system. Now we're running a pilot at one of our locations where the RNs can start IVs. And it's a skill that they were trained on. They're able to do it, but historically they weren't allowed in that environment. And so if you had a, a resident that's dehydrated, that's a, a trip to the hospital- ... and all of these other resources. [Vince ] Doesn't make any sense   [Charbel] Not at all. It's, it's a very straightforward skill. They can get rehydrated. We have physicians at the sites that can oversee it, and it's all good from there. So just driving, pushing that boundaries of care and how do we bring the care to them. Before this industry got so big, w- which is good 'cause, I mean, an aging problem is good. We're living longer. [Vince ] Yeah. Yeah. [Charbel] And again, it's about living better. Um, but it was a... The idea was that they integrate into the health system. But the sector's gotten so big that it doesn't make sense anymore. It's about how do you bring the amenities they need to them? [Vince ] To them. Yeah. Yeah. [Charbel] So an example of this, which I'd, I'd love to see, and, and maybe I'm, I'm kind of hanging this out there for, uh... We've, we've had some discussions on it. But when we talk about imaging, there's a, a lot of resources and, and logistics that go into X-rays, of transporting our seniors to hospitals to get an X-ray for whether it's a chest infection or if they've fallen. And that is something that can be done in a portable unit and brought to them. And now, again, we look at how big that industry's got. These are the things that we should be looking at. How do we pull them out of the system? It's a win-win. Take some pressure off the hospitals and- [Vince ] Of course [Charbel] ... our healthcare system and provide the services and the comfort of where the individuals are. [Vince ] Yeah. Makes perfect sense. [Charbel] So it's just paying attention to those things and seeing where we can find some efficiencies.   [Vince ] Right. Um, like, do you, do you generally find with some of the things that you just described in the sort of future vision for Northwood, do you feel like the provincial government, which is largely the regulatory board that is allocating funds to these programs, do you feel like there's alignment or do you feel that... You know, we see it a lot in the affordable housing, which you're a part of, and there is a misalignment between the variety of different regulatory boards that decide what building goes where and so on. Do you find in the seniors care space that there is a, a real alignment from the provincial body, uh, that is enabling you and your team and others to, to get what needs to happen done? [Charbel] For the most part. I, I don't believe they'll ever be 100% alignment. There's different things playing on either side, for sure. Uh, but I would say for the most part, on the majority, especially the important pieces, there's quite a bit of alignment. [Vince ] Yeah. [Charbel] And it's, and that's what, why we're seeing so much progress, is because we want to deliver the care. We know that there's more resources needed, more access needed, and this government is laser, and has been laser-focused on it. So it's, it's been very good. [Vince ] My last question. 
How might you define success for you in your role? [Charbel] I would say-I, uh, I think success for myself in this role would be knowing that the team is supported, that they're happy being where they are, that they feel that they're achieving their goals, and that our residents feel like they're at home. That's true success. [Vince ] That's great. I don't think I could imagine that it would m- would be better if it was anything else than that. [Charbel] Yeah. [Vince ] It's been a pleasure meeting you. [Charbel] Likewise [Vince ] ... I think the work that Northwood is doing is, is remarkable. And I imagine in the role of a CEO there's always this complexity in selecting a CEO, which the board would've been doing to, to, to get you. To have that balance, especially in this space, between like competence and warmth because you're working in a space which is not just grinding out a particular initiative of a board and just cut all costs and drive a financial agenda. In the not-for-profit space and especially in this space here that you're working in with seniors, which is just that an under-cared-for, culturally problematic, all the things that we've talked about, you need that warmth. The competence doesn't come without the warmth. So yeah, I can see you have that, which I can imagine- [Charbel] Thank you [Vince ] ... is one of the reasons why you were, were selected. And yeah, it's been a real pleasure meeting you and- [Charbel] Oh, likewise. It's, it's been a great conversation and really appreciate you having me on the show. I really enjoyed the conversation. [Vince ] Yeah, absolutely. And let's hopefully keep in touch. [Charbel] Love to. [Vince ] Okay. Thanks. [Charbel] Thanks.   [Speaker 5] Thanks for listening to the Design Makes Everything Better podcast by Breakhouse, a Canadian strategic design firm. A full transcript and show notes can be found at breakhouse.ca/podcast/1. Have feedback or ideas for the show? Drop us a line at [email protected]. [lo-fi music plays]