An independently owned nursing home can make decisions around a named resident instead of a category. Maplewood of Sauk Prairie, in rural Wisconsin, has been owned since 1971 by the same seven local families: the founding couple, the brothers whose construction company funded it, and the town’s doctor, accountant, attorney and HVAC contractor. Administrator Carol Wilkes says that structure lets her decide locally, without corporate red tape.

For families on a tour, her advice is to look past the aesthetics. Chains often sell to the adult child, not the resident, and a bedbound person will never use the cafe or the bookstore. Ask instead how the facility connects with the town, whether volunteers and local clergy come in, and whether families can decorate the room.

Aparna Pujar: Hi everyone, welcome to AI-Powered Caregiving, the senior caregiving podcast. My name is Aparna Pujar, and I’m stepping in for our previous host, Ishanya Anthapur, who is off to school at the end of the summer. I’m really excited to be here today, and I wanted to introduce you all to a fascinating person that I met. I think you’ll like her story too.

When you’re considering care for a loved one, there’s one thing families don’t think about enough: who actually owns the facility their loved one lives in, and why that matters. Private equity and investment firms have been steadily buying up nursing homes over the past decade, and it’s raised real concerns about staffing and quality of care.

My guest today took the opposite path. Carol Wilkes is the administrator at Maplewood of Sauk Prairie, a skilled nursing and memory care facility that has been locally owned since 1971 — over 50 years — while most of its peers were absorbed into chains. We’re going to dig into what independence actually means for residents and families, whether it’s a sustainable model going forward, and what families should look for when comparing their options. Carol, really excited to have you here today, and thanks for joining me.

Carol Wilkes: Thank you for having me. I’m excited to talk about this topic. I’m very proud of Maplewood of Sauk Prairie and excited to share with you what’s been working for us.

Aparna Pujar: Great, excellent. So I wanted to start off with really understanding who you are. Tell us who Carol Wilkes is, and what a day in the life of Carol looks like.

Carol Wilkes: Well, Carol Wilkes is a mother of five children and a wife of thirty-four years. But I am proudly a daughter. I’ve had the opportunity to be the caregiver for both my mother, who passed in 2018 from Alzheimer’s, and now my father, who is currently 88 years old.

Having the opportunity to care for them helped me choose this career path. I wanted to be able to provide the resources, the culture and the care that our seniors deserve and have worked hard to receive. That is why I chose working at Maplewood and becoming an administrator here.

Aparna Pujar: Well, that is a fascinating story, and I can personally relate to it. I started Zemplee because I became a caregiver for my aging parents. So I completely understand your experience, working not only as a professional in this industry, but also on the personal side, where you have gone through the lived experience of being a caregiver.

This industry is generally known to attract people who have gone through a personal experience. And it’s nice to know that we’re transitioning that personal experience into a professional world, where we’re identifying the gaps and needs in the market and really trying to come at it from a holistic standpoint: what should be the standard for caregiving, and what should be the standard of care delivery.

So back to Maplewood. Maplewood has been locally owned since 1971, which is commendable in this day and age. What keeps you independent? What are some of the driving factors that make you determined to stay independent?

Carol Wilkes: Absolutely. Maplewood is a very special place. We had a gentleman and his wife, who was an RN, who were on this journey to open up a nursing home. They went to a community and met with some brothers who owned a construction development company, and they helped fund him. In this small community in rural Wisconsin, they were also able to find their local doctor to become their medical director, their local accountant, their local attorney, and an HVAC contractor who did the air conditioning, heating and plumbing.

These seven families came together to create Maplewood, and they’re the same seven families that still own us today. As a private, independently owned facility, we’ve been able to continue to offer that community service, that community care. We have a lot more autonomy in our decision making. We don’t have a bunch of bureaucratic red tape.

I am honored to have the ability to make a lot of decisions for Maplewood, and the board entrusts me with doing that. We can base all of our decisions around the personal care needs of our residents, as well as their families. That’s the difference between being independently owned and having that personal touch, versus being a big corporate-owned entity, where you have people sitting up in tall buildings who don’t really get to know the people that live in their community. That’s what Maplewood has going for it.

Aparna Pujar: That is super fascinating. They say it takes a village, and it looks like you’re a living example of that village. Given that this is rural, you were able to marshal resources from the community to help drive the vision for what that delivery model should be. And more importantly, all seven of these members of your community are continuing to support it over a fifty-year period. That is a fascinating story.

Carol Wilkes: They do. And it’s interesting, too: many of our board members actually have family members who live here and use our services. That speaks volumes for the type of care they’re receiving — that they entrust us with their loved ones as well. You don’t see that very often in corporations. They’re not really sending their families to the buildings they own; they’re sending them somewhere else. So we’re very fortunate to care for those loved ones and family members.

Aparna Pujar: Yeah, and that raises the bar for you as the administrator, right? Are there any decisions you make at Maplewood every day — about staffing, programming or a resident’s care — where you feel being locally owned has given you a significant advantage over another facility, where it may not have been as easy? What are some examples, if you don’t mind sharing them with our audience?

Carol Wilkes: The decisions that we get to make here at Maplewood get to be personalized for our community. Being in Wisconsin, outside of Madison, we’re in a more rural community, so finding staff isn’t as easy as it is in big cities. So we work with the local high schools. We do a lot of scholarship programs for our certified nursing assistants, and scholarships for our nurses, RNs and LPNs. We work with a lot of different community-based organizations to help employ individuals who are trying to get back into the workforce.

We help take care of our staff by helping them with childcare needs and using different transportation services, so employees can work together to ensure people are getting to work on time and safely. We also understand that the balance between family and work is so important, so we want to make sure we’re looking at the whole staff — not just that they’re a worker, but that they’re a whole person, and they come with a lot of other parts.

We also get to support our local organizations. We currently have a nurse who works for us who sadly lost her son a few years ago, and every year we do a toy drive for the organization that she represents. It’s something close to home, where we get to give back to one of our own. We also work with a lot of other volunteer organizations and hospice organizations, so we bring a lot of people into Maplewood in a community sense.

We do a lot of community support groups. We have grief, dementia and caregiver support groups. We currently have a bereavement group that the community can come out and share with us, and we have an advance directive support group that we’re providing as a community resource.

So we’re really fortunate that we can do so many things for our community, and that we get to make those decisions as a team here, versus going to the people up in tall buildings who really aren’t part of the community. That’s one of the things about independent ownership versus a chain: our owners, our board of directors and our staff are more involved with what the community is doing, and we’re more focused on that.

Aparna Pujar: Thank you for sharing that. That is an excellent example of interdependent organizations supporting each other. It’s not just a matter of community — you’re building an ecosystem of partners. They say it takes a village, but this supersedes that example of a village. No pun intended, even though you’re rural, but I feel like this model can be adopted anywhere. As I say, it takes a person and a half to care for someone, and having all kinds of support systems in place is what makes the ultimate care delivery possible.

At the end of the day, you can’t keep paying for services. So partnering with organizations, using volunteers — and especially using students — is amazing, because at some point we have to get the younger generation involved in this ecosystem, so they become familiar with what the requirement is. And especially as American families are getting more and more nuclear, this sense of belonging has to evolve, and there’s no better way to do that.

Carol Wilkes: And because we’re in a community, we get to pull community members in. Residents here might have family members who work here. People who work here might have been their friends, or people they attend church with. We have local pastors and priests who come out and hold their church services here, so residents feel like they still get to go to church. They get to see familiar faces. A lot of times when you move into a nursing home or assisted living, you lose that community engagement.

That’s one of the things Maplewood tries to do: just because you moved where you live doesn’t mean you have to lose the people you grew up with and have been a part of. So we try to bring as much of that community as we can back into our building, so those residents feel they’re still vital and still an important part of the community.

Aparna Pujar: That’s amazing. So for a family that’s comparing options for a loved one, what actually differs day to day between a locally owned facility like Maplewood and one that is owned by a large chain? What should they be asking for or looking for when they’re making decisions about their loved ones?

Carol Wilkes: Well, as a daughter who’s had to make those decisions at times: when you walk into some of these chain facilities, it’s kind of like chain restaurants. When you walk into a restaurant that has a hundred locations around the country, you know what it’s going to look like. And a lot of times, that’s what you’re going to get in these chain nursing homes.

I would look for how they’ve integrated into the community. What community involvement do they have? Do they have volunteer programs? Do they have local families coming in and integrating with the residents? But also, what kind of services are they able to provide for the resident? Are they personalized services?

Something about Maplewood is that we get to make decisions based on the person and their family’s needs. Whereas sometimes in a corporation, it’s “you’re a resident, this is what a resident gets,” instead of “Aparna needs this, and Carol needs this.” We get to personalize because we’re so close with them as community members.

When you’re independently owned, you have a lot more opportunity to look at the resident as an individual instead of just as a patient — or, as the saying goes, as a head in a bed. They’re not just a head in a bed. They’re actually a person, a human who deserves dignity and respect in our facility. I think a lot of times that gets lost in the corporate jungle along the way. So we get to do that, and it’s actually exciting to see when you get to personalize the care.

Aparna Pujar: There’s true meaning in “small is beautiful.” And when I say small, I don’t mean small — you’re larger than life, the way your community has been set up. But quality comes out of smaller, dedicated, well-designed communities, where you’re individualizing everyone’s experience and curating it for the maximum benefit.

Carol Wilkes: I think sometimes the aesthetics draw people in, right? The big, bold and beautiful. They walk in and think, wow, look at this and look at that. But the reality is, how often is your loved one going to use those things? A lot of times nursing homes, especially corporate nursing homes, sell to the family. They don’t sell to the resident.

So look at the resident’s needs. The family sees a little cafe over here, or a little bookstore over there. Is a bedbound resident really going to the cafe? Is a bedbound resident really going to the bookstore? What are they bringing to them, so they feel they’re still getting the services that make them feel at home, versus just a patient at a hospital?

Our residents have moved from their home. They’re grieving the loss of their independence, of being taken from their home, maybe even away from their spouse or their loved one. Now they’re living in a smaller room, and it feels like a hospital. So we allow the families to go in and decorate their rooms, put up the pictures, hang up the favorite clock or put their own television in there, and make it personalized. They feel more comfortable with familiar things around them, and it makes them feel like this is my home now.

A lot of those places don’t allow that. They have everything stocked and in place where it goes, and that’s just what it is. You have a small corner where you can put something up as your own personal decoration.

Aparna Pujar: That’s amazing, and thank you for sharing that. I can relate to the number of families who are really looking to create that sense of comfort, the cherished memories you want to surround your loved one with, because that is what makes it a home, not a room, as we call it.

So going back to your comment about chain organizations: there is a lot of private equity and REIT-based activity and transactions going on in the market today. What is your take on that trend, as someone who’s been running an independent facility? How viable is it to stay independent? I’m sure the large PE organizations have a goal and a vision for what they want to do, but how does that impact you as a facility? Does it impact you at all? Is there a trend where you’re seeing things change more in your favor, or less in their favor?

Carol Wilkes: I think there’s a place for everybody. I do think that financially, creating an independent facility is a little bit more difficult. There are a lot of hoops and bureaucratic red tape you have to jump through, and for an individual it’s going to be a lot more difficult than having a big team of corporate lawyers and corporate people helping you do this. Again, we had seven families from the community who said, sure, I can be the medical director. It was a different time back in the ’60s and ’70s.

So today, I do believe you can still have these independent facilities. I do think, because of the red tape, it’s a little bit more difficult. I appreciate the regulations that are in place, and the guidelines and the enforcement, but not having the deep pockets a corporation has, it is going to be a little bit more difficult. And it’s unfortunate, because you’re not going to get that one-on-one, personalized private care you would normally get in an independent setting.

The bigger corporations can build bigger facilities — three- and four-story facilities that can house a lot more people. Independent owners aren’t going to have as big a facility; they’re going to have smaller ones. So the ability to take in as many residents and patients is going to be harder, too.

It’s unfortunate, because like you said, it takes a village. It’d be nice to keep our villagers in the village, close to home, instead of moving them twenty or thirty hours away just to get to the next facility. So it would be nice to have more hometown places, but financially it’s going to be hard. Legally it’s hard. Opening any business nowadays is difficult. Financial sustainability is one of those things someone has to really think about, and that’s where the seven families we had could get together and sustain us. But can you do that today? I think some people can. And I would hope they do. I hope they try.

Aparna Pujar: Like you said, there’s a place for everyone, but grassroots, community-supported models are the ones that can provide sustainable care over a longer period of time. I did want to congratulate you: I know Maplewood earned a CMS five-star rating last year. That’s a true testimony to how your community has come together to maintain that level of care. I don’t think it’s a small feat, and doing it as an independent organization is very, very hard. I can see where your efforts have gone.

If you could change one thing about policy, Medicaid or Medicare, what would that be? And what would you want to tell policymakers about being an independently owned facility, and how you’re creating a difference in the community for everyone? It’s not just the elders — you’re creating a difference for the businesses around you as well.

Carol Wilkes: Absolutely. I think what’s difficult are the insurance companies, and Medicare and Medicaid. They make it a lot more difficult to get residents into the facility. The hospitals play a part in that, because they too have to follow those guidelines. So when a resident doesn’t get their three-night qualifying stay at a hospital, then as a facility, do we take them in? Are we taking them in on private pay? Are we taking them in on a 30-day mandate, where we work directly with the insurance companies? Because Medicare won’t cover it at that point.

So again, we have to look at the patient as an individual. We can’t just standardize and say every single person gets the exact same thing. That’s not what America was based on, right? We were based on the fact that everybody needs to be looked at as an individual, and that we all deserve an individual look. That would definitely be one thing I would change if I had that magic wand to wave.

I think the cost of medications and services would definitely be something to look at as well. Senior citizens have paid into our system. They have dedicated their lives to our system, served for us, raised children and families, and built up our communities. What are we doing to give back to them? In a long-term senior community, what are we doing to honor our seniors — be it insurance, government, facilities being available, or making it affordable?

I live in Wisconsin, so selling the farm to afford retirement is actually a real thing. People do have to sell their farms to go into a nursing home. And that’s a really sad state, when you have a generational family farm that you have to sell to put Mom and Dad into a home. I wish there was a way we could almost gift that to our seniors as they age, instead of making them give up so much on top of what they’re already giving up.

Aparna Pujar: That’s a very profound thought, and I completely appreciate you bringing it up, because a lot of families out there are struggling every day to figure out the right choice for Mom and Dad. I talk about this quite a lot in my other conversations and webinars. There has to be some sense of what I call “warm dues.” Someone took care of you when you needed a diaper changed. So what are you going to do to give that back?

Carol Wilkes: Yeah. And I think one of the injustices we do to families is that we don’t educate them about what the future looks like for their loved ones. We don’t educate them on how much it costs. Medicare doesn’t cover long-term stays. So when somebody brings their father in and says, “Well, he has Medicare,” it’s a really sad discussion when we have to say, “Well, Medicare doesn’t cover that,” and he says, “Well, where’s that money coming from?”

They have no idea that Medicare doesn’t cover that type of service or that type of stay. They don’t realize that staying in a long-term facility costs tens of thousands of dollars. It’s not a cheap fix. So not being able to provide that service for their loved one because they can’t afford it is heartbreaking. When they need the services, we should be able to supply them, and provide the level of care their loved one needs, just as much as for the person who has the financial means to do it.

Aparna Pujar: It’s interesting you bring that up, because we are all part of the system, and all of us should start thinking about how we want to be cared for when we’re at the point where we need care. Not just you and me, Carol — even the policymakers who are writing bills. How do they want to be cared for? This is a question that is very personal to all of us, and all of us have to own this as a problem and solve it collectively, not just as individuals, but as a community and as a society as a whole.

Carol Wilkes: Absolutely. And nobody goes into a nursing home wanting to. There’s nobody that sat across from their loved one and said, “Hey honey, one day during our golden years, I’m gonna have a stroke and move into a nursing home. That sounds fun.” Nobody does that. This is really their last resort. So providing them with a facility that is willing to give them dignity, independence and support is so important, because there’s nobody in any nursing home who says, “This is where I was hoping to be.” They all wanted to be at home with their families.

Aparna Pujar: And the converse is also true. No family member wants this for their loved one. That was the last thing I wanted for my dad when he needed care. His statement was, “I’m gonna live here, I’m gonna die here. You’re gonna figure out how to make that happen.”

Carol Wilkes: You want to make it available for them. You want to make it so they can. And when they can’t, you want to make sure they’re going to be cared for the same way you would hopefully be able to care for them if you could.

Aparna Pujar: Absolutely. What a great thought, and I’m hoping the policymakers listening to this are reflecting on it in a way that is directionally right for all of us. We’re almost coming to the end of the show. What are you watching or reading today that’s interesting or fascinating? What would you like to share with our audience?

Carol Wilkes: I always like self-help books. I’m much more of a factual reader than a fiction reader, so I like self-development books. Right now I am reading The 5 Levels of Leadership: Proven Steps to Maximize Your Potential, by John C. Maxwell. I just love all of the points. At each level, I’m able to look and grow and develop a little bit more as a better leader, and a better member of my staff community, but also my community with my family, outside, and my neighbors as well. I enjoy reading those types of books that help me grow as a person, so I can better serve.

Aparna Pujar: Great. Well, thank you so much. This has been an exciting conversation, and I’ve enjoyed learning more about you as a person. It’s always nice to know who you are and what is inspiring you to do what you’re doing.

And to all our audiences out there: meet fearless leader Carol Wilkes, who is standing on her own, sustaining an independent senior care facility and delivering care to her community. Whether it’s a small rural community or a larger urban setting, there’s a need for people like her. She’s a mother, she’s a daughter, she’s a wife, and she runs a nursing home. You can see how she’s combined her experiences from all her roles into a leadership role that she’s using to serve our communities.

Thank you, Carol, so much for joining us today. It was great having you. I wish you all the best, and we’ll keep in touch with you as you progress on this journey of yours.

Carol Wilkes: Thank you, Aparna. I appreciate you inviting me on here, and I look forward to talking with you further.

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