HEALS had the pleasure of interviewing Julie Liebo, a skilled nursing administrator, who shared her experiences and insights on inclusivity in healthcare. Julie discussed the historical challenges faced by the LGBTQ+ community in healthcare settings, highlighting the lack of acceptance and discrimination in the past. She emphasized the importance of creating a welcoming and inclusive environment for all patients and staff members, sharing examples of how she has implemented changes in her facility to support diversity and equality.

Julie’s personal experiences, such as supporting a same-sex couple in her facility and advocating for their rights, showcased the progress that has been made in healthcare towards inclusivity. She also addressed the need for ongoing education and awareness among healthcare professionals to ensure that all individuals are treated with respect and dignity.

-> Listen on Spotify

-> Listen on Apple Podcasts

Listen Now.

Full Transcript

And welcome back to another episode of the HEALS Pod, where we unpack the different services, the different service lines, facilities, and the people that make up our community here in Las Vegas to be able to tell a story of the thriving healthcare community we have here. I’m very excited to have a special guest I’ve known for many years in the community of her. And this is the first time we’re going to get to know each other and kind of unpack what skilled nursing is, what it looks like, and how to build a culture that’s successful and really impact people’s lives. So without further ado, my guest today is Julie Liebo. How are you doing today, Julie? I’m fine, thank you. It’s a pleasure to be able to have you on. Thank you for having me. I remember your name came up when I was back. I was just becoming a chaplain since you were at Lakeview Terrace. So this was back before you moved into skilled nursing. Yeah, this is a while back. I know it feels like I’ve been in health care for like a year or three. Sometimes I’ll tell that story. I’ll tell people, oh yeah, we’ve known each other for three years. She’s like, yeah, I have a friend. She goes, you were at my daughter’s eighth birthday and she’s 18 now. I was like, oh. So yeah, time flies when you’re having fun. So how long have you been in health care?

JULIE LIEBO: I’ve actually was in healthcare prior to Lakewood Terrace. I was in skilled care as well and worked for the same company. Just took a little bit of a breather. I thought I was ready to go away. But once you’ve been in skilled care, you just you just can’t leave it. Yeah, you have a passion for skilled care. I had to go back and it’s a you know, it’s very different than it’s ever been and it changes every day.

DIEGO TRUJILLO: What would you say, because, so again, when I met you, you were in assisted living. Right. It would seem that it would be much more difficult, cumbersome, and I’m just shooting from the hip here, right? When it comes to skilled care, you’re dealing with a lot more regulations, patients that, you know, are a lot sicker, going through a lot harder of times. It would seem that some people would want to move easier in their career, but you have this passion for skilled care. What is the main difference? What do you think drives you to that?

JULIE LIEBO: You know, there’s so many different things. When I was in assisted living, but prior to that I had been in skilled care my entire career, whether I was a CNA, got my license, grew up in skilled care. And what I get out of skilled care every day I go in there is the dignity and the understanding that, you know, we’re there for more than just caring for the patients. For example, in my building, we have a vent unit. These people have gone through so much tragedy prior to even getting to College Park Rehab.

DIEGO TRUJILLO: That’s a really good point. I’d never even considered that.

JULIE LIEBO: Yeah, and so, you know, normally what happens is families are in that acute phase when they go to the hospital, and what we forget so much is that, you know, they have doctors, everybody around the clock, and when you get that day, kind of that one-on-one care and an acute care for a week or whatever, maybe with a vent a couple weeks, And then all of a sudden that family’s thrust upon the skilled world. And, you know, where they’re sharing a room now with somebody potentially. There’s lots of very, very sick people nowadays in a skilled care. Doctors aren’t there every day, the nurses, the eyes and ears. And so we have to be that person and those eyes and that person who understands that family and that family member.

DIEGO TRUJILLO: That’s a really interesting perspective when you mention that. And I’ll say this because, you know, people used to ask me, so I fell in love with hospice. I had never been exposed to healthcare. That’s how I kind of, my foray into healthcare was through hospice. And it wasn’t until like my second visit, I walked out of a patient’s home and I was just, you know, the sister was there and she was like, thank you so much. And I’m watching her tear up and just, That feeling of gratefulness, for me, it melted me. I was like, man, I could do this forever. And I realized, you know, when people would ask me later on, I was, you know, I eventually moved into marketing. And what I would tell them is, you know, for me, it’s not the marketing piece, because that could be a grind and you could sell anything. But the idea that someone’s just been given the worst news of their life, right? Your mother, you, you know, this is a disease process and there’s nothing else we can do. Typically, human beings, and I would explain this to people, tend to shy away from that. And for me, it was a privilege to be able to step in, to kind of help the family get control, ground themselves, and figure out what is our goals, what are our priorities, what are we here to do? And for me, there’s no words to describe that. It feels like every other problem you solve, I don’t know if you… I always do this every time I get very stressed out, is I’ll watch a Zoom out on YouTube of the universe. And it really puts in perspective how small you are, right? And you’re like, yeah, and you’re only here for 70, 80 years, right? It’s very humbling. But when you can impact people’s lives like that, it feels eternal. I’m very grateful for the opportunity and having the personality that was able to endure that. And it sounds like you’re very much the same way with skill. I’ve never heard anyone describe skill nursing like that.

JULIE LIEBO: Yeah, I feel like, you know, like even before COVID, we realized during COVID, well, I believe I realized a lot before COVID, but like, for example, during COVID, families couldn’t get in for the longest time. And I would read and read and read things on the news or read things in the paper, read things in the news, whatever. that families were not sure what was going on with their loved one, because they weren’t allowed to go into the front door of a skilled setting for the longest time. And then, this is so ironic, but I also heard many facilities decided at that point, well, now’s a good time. We’re going to become a non-smoking facility, and we’re going to do this, and we’re going to do that. Now, I’m not a smoker, and I don’t advocate it, but when you just entered a nursing home, and your life is going to be there, really, the smoking is the least of our concerns. So I thought, even something as simple as that, no, we’re not taking that away and we’re gonna find the time to help them and assist them out the door. This is where we’re at right now. But during COVID, we took it a step further and I said, they have to see it’s our loved ones. So we set up around the facility, luckily I’m a one story, and we set up around the facility, FaceTime TVs and chairs and coffee and everything around the whole building so they could sit outside the window and look at their loved one. And if they were not in town, then we would set up FaceTime or Zooms and different things to be able for them to look at. So that’s how I utilized my activities and my social service department during the COVID four years that we were not able to have families in.

DIEGO TRUJILLO: That was a very difficult time, and I couldn’t even imagine what that process would have entailed. I mean, you tell it really briefly in 45 seconds, but implementing a plan like that cannot be easy. But I think you draw on a point, and it’s very easy for us to become… I had a boss one time, someone that mentored me. And I remember the company we worked at, she came in and she was very firm. And, you know, everyone started like throwing a fit and like having a problem. And I was like, well, I don’t know enough to know whether I like her or not. You know what I mean? She seems very strict. She seems very stern. And I’ll never forget one time she walked into the office. She called a meeting because she heard all the people had been, all the chatter. And, uh, and we all sit at this table. She pulls out a whiteboard and she, uh, this was back in hospice. And she starts saying, hey, you know, do you guys know the difference between patient-centered care is? And everyone just kind of sat quiet for a second. She goes, listen, at 7 p.m. on a Friday, nobody wants to run a referral. I know you guys are just like me, none of us want to go and be there. We try to push it off for Monday, we try to push it off for Saturday, on to the weekend nurse, you know, we’ll do whatever we can.” She goes, but because you don’t want to get up and take an hour or two of your day to go help these patients, she goes, you have to stop to consider that these people are now sitting there for 24 hours, if they’re lucky, if you’re going to come the next day, they’re now sitting there for 16, 20 hours wondering what is going to happen. They’re going to be in anguish. They’re going to be in agony. And then she finished it up. So just to be clear, we are not a family here. We are a group of professionals that are here to serve these people that are going through this moment. And it was really funny because afterwards people are still angry. And I was like, I’m fully on board with this, guys. I don’t know what you’re talking about. So maybe I lucked out and my very first administrator was kind of like that. But again, it’s what are you going to prioritize? Sometimes we don’t want to take the extra step. I mean, we’re human beings and we tend to go the path of least resistance. That’s just human nature, right? So no one says, hey, do you want to set up a bunch of chairs outside in the heat? No. But if you taking that extra step means so much for people, why not do it?

JULIE LIEBO: They need to see them. They needed to, you know, all of a sudden the door was slammed. So we had an obligation to come back. And we have very, nowadays in skilled care, they are very sick. Like I said, they would be in the hospital and then all of a sudden, wham, bam, they’re in another facility where they don’t know anybody or whatever. And some of these people are transferred late at night, different things, you know, unfortunately for the healthcare system that we’re in, those things happen. So we do have to jump to the music. And I know I’ve spent the last number of years at College Park making sure that that occurred, that people were on board and trained at every level. And, you know, when I think about this, Diego, I think the biggest issue that I see out there right now is, you know, whenever we advertise skilled care, it doesn’t matter who’s advertising it. It doesn’t matter if it’s CMS. It doesn’t matter if it’s an oxygen company, whoever. Whoever advertises skilled care, if you look at all of the advertisements, it shows people in a way that are probably photoshopped some ways and some places not, but it shows the people playing jumbo board, playing cards.

DIEGO TRUJILLO: It’s like a resort.

JULIE LIEBO: Yeah. And the real issue in skilled care is just so far from that. And, you know, I think when families see that and then they get into a nursing home or skilled post acute setting and they see people, I mean, we have people in our facility that, literally were homeless prior to entering a hospital and come in to us, and we still find ways to discharge them appropriately for the first time ever into an apartment if they’re ready to go out of the skilled setting. We just had a thing that showed that our facility and most facilities around town right now, average age is more in the 50s and 60s, so we see a drastic change as well. They’re not all elderly anymore that are in the facilities. When you’re talking about the high-level care that the CNAs and the families give, my heart always goes out to that pulmonary care, that ventilator care, especially in a state like Nevada where there’s 120-degree weather. But we have, unfortunately, people do go through tragedies, from gunshot to botched surgeries to whatever. Those units are, we are it for those families. We’re the eyes, we’re the ears. They hug them, and you know what? We see no lack of care. We don’t see people being worse off. In fact, we actually win people to go home. The staff, what I tell them is we don’t even use the word can’t, because there just isn’t anymore. I don’t know what that referral is going to bring the next day, because everything is so different. But we have begun to educate ourselves to whatever we can expect. And it’s getting quicker and quicker from the hospital to a skilled setting. And what we need to do, not to mention all the different regulations and things today that we’re encountering with change. But I’ve been doing this, so my first lie My first license was back in 1991, so God knows I’ve seen everything over the years and the changes, but there’s still a surprise every day. What I tell my staff, and it never fails, after all of these years, when I walk in that door, I smile. I am happy to be there, and if my staff’s not happy to be there to support the families and the community, then we’re in the wrong place.

DIEGO TRUJILLO: I think that attitude, your point there, it’s very interesting you mention that. I moved over from my position right in marketing, and I took on the role of CEO. And it was very funny. It was very interesting to me the way that people would approach me. And even old friends would all make a joke and be like, oh, Mr. CEO. And they would crack jokes. And it really took me to reflect on why. Why is that joke so pervasive? And I really think that, fundamentally, it goes on the reason that you’re there. And I would tell them, I was like, look, I know you think that CEOs in modern culture are very much seen as people of privilege, people that get all of these benefits. And, that’s not been my experience. And even if it was, I very much feel that this role that I ended up here, and I find myself in a place where I can impact healthcare statewide and really make changes and really drive something in the community. And I feel like I have a duty, right? If I’ve been given this opportunity, that I have a responsibility to live up to that opportunity, not just name drop and, you know, and all of these things, I very much don’t view it as a position of privilege. It’s very much to me as a position of responsibility. What do I owe my community? And I know, I mean, you’re going back, right, you went to 1991. When I was back in the 2000, 1999-2000, I actually, my sister at that time was about 18, 19, and we were playing tackle football at the park. And I was playing with her. She had a three-month-old baby. She was newlywed. She had a three-month-old baby. And sure enough, her husband got tackled. Well, he rolled to the ground, kind of banged his head really quick, got up. We played a couple more. We did a couple more plays. And then he said, hey, my head feels really funny. And then he kind of rubbed it, went off to the side, and then dropped to the ground, started convulsing. Ambulance came. He died on the way to the hospital. I think I sat outside at UMC. It felt like four to six months. We were there for a while. And then back then, because they were young, it was Medicaid. And so it was just denial after denial. And we ended up at Horizon, right by Valley Hospital. And I remember going in there and the treatment. My sister still stays in contact. He was there for about two years and a half before he finally succumbed to pneumonia. But the entire time, I, the way the staff would bond, right? And you would, people are sometimes very quick. I would say this with Desert Springs Hospital back in the day when we’d take my father and be like, Desert Springs, you know, why not Summerlin and why not? I was like, you know, it’s an older building, but everyone’s been there a long time. Like their, their teams are teams. They understand because they’ve all worked alongside each other. And it always brings me back, like I mentioned, back to 1999, when we would walk in, there was nicknames, because she would always bring my niece in. She basically grew up in that rehab, just going on a daily basis. And you think back at those times, the people that took the time to smile, right? It’s misery in there. Nobody wants to go, because it, right, unlike the advertisements, it’s not a resort. If you’re there, it’s because something bad happened. It’s not anything you desire, right? It’s not like they installed a new limb or a robotic leg and you’re going to be faster. I mean, you’re there because something negative happened. And so I very much agree with you. It’s the attitude. And I believe it starts with the administration, right? One of the things I worked with looking at workforce development and workforce pipeline, right, is the difference of what a culture can mean. And the amount of administrators and HR directors that will be, well, people just jump for 50 cents an hour. While sometimes true, that’s not what the data reflects. And, you know, I will bring up studies and say, well, you know, well, no, but that’s what they’re telling me. No, I understand that’s what they’re telling you, that they’re paying them 50 cents, you know. And for me, I stuck with my company. Back then, I was at the same hospice for like six or seven years because of the leader that I had. It really is what kept me there. I got offered more money, but I just really appreciated that. I always felt like my leadership looked after me, not the company’s agenda only.

JULIE LIEBO: Right. And like at my last all-staff meeting, I do a monthly all-staff meeting to make sure that we’re up on all the different regulations and things. That’s the other point is, whether they’re doing the dishes or whether they’re the RN charge nurse, this is their career. They all need to understand what’s going on. So I do a lot of education that way while we do some quick stand-ups on a regular basis every day. I feel there’s a need to bring them real quick and do a 10-minute stand-up. or we do an all-staff, but you know… Like a restaurant, right?

DIEGO TRUJILLO: Yeah, exactly. We do a wine tasting. Not quite that way, but actually… Right, but it bonds the team. It brings people together. It makes us feel like we’re a team. Exactly. Not random individuals running around the hallway.

JULIE LIEBO: Exactly. And the last all-staff meeting, not this last one, but the one before, I gave away, talk about people having a culture I believe we have a wonderful culture. I gave over 15 certificates and boss certificates to my CNAs, my housekeepers, my nurses, everybody who had been there more than 15 years. And then there were an additional five or six that were there over 25 years and the longest serving was our charge has been 31 years. I’ve been at it about 20 years. So there’s a lot of longevity in my building and I do believe it’s because they have a tough job and because of my caring for them as well, and I will do anything to care for that staff, because that staff is the one who’s accepting that 8 p.m. Venn patient needs us at the last minute, like you were talking about earlier, and not saying, no, we can’t do it or wait till Monday. We don’t. We’re constantly moving people that we have to accommodate people and to work with the community, with the hospitals. But what works for me is, We do this a lot, like all of our meetings will be with managers, or all of our QAPIs, or quality improvement projects, all that. It’s like, for whatever reason, we seem to have managers. I absolutely make sure the line staff’s involved in every meeting so they can be consciously involved in what, why I’m making this decision, or why all of a sudden are we having to take these heavy care patients, and things like that.

DIEGO TRUJILLO: It drops that us versus them mentality. Oh, totally, totally. And it helps them to understand. I mean, even for some that, you know, there may be people whose roles require them to look forward to earning calls and, you know, those kinds of things, that’s the job. But when everyone’s kind of involved in what that, of what that looks like, I think there seems to be a buy-in from people a lot more. And I mean, I don’t even have to say it seems, right? You just mentioned all the certificates you gave out for people that have been there a long time. It makes them feel valued, important, and you never know. It gives people an opportunity to give an idea that you may never have had.

JULIE LIEBO: Absolutely, and they do matter. They’re the ones doing the hands-on care. The other thing I did to make sure, speaking of hands-on and being out there, is about seven years ago or so, I walked out and I realized, wait a minute, my key managers, though, that can help communicate appropriately to the families and to the residents, you know, are scattered throughout the building. So I moved everybody. So when you walk in my building, I’m first, and the door’s open, and they see the administrator. Like, our eyes meet the minute they walk in the door. The next door is the director of nursing, who’s right there in the front. The next door is the social service director, who’s right there in the front. And so we, all of us are, and I tell them, absolutely without exception, our doors remain open. So many times you go into facilities and you know, you have to walk through a hallway to get to the administrator or, you know, another hallway to find the director of nursing. I think that’s exactly why it’s incredible where I work because people can, and they feel freedom enough because when we tour them or we say here’s where we are, this is where you find everybody. And then when you want to speak to the direct care nurse, here’s what the wings look like. Everybody is there for a reason. You know, we can get so caught up in paper pushing, and there are a lot of regulations, and certainly we have to do it.

DIEGO TRUJILLO: Yeah, I mean, that’s the nature of it. That’s our punishment.

JULIE LIEBO: Right, but we’re really there to listen to them, and honestly, I believe it cuts down on so many concerns that if they know, you know, I put my email specifically and phone number, and it’s never been that abused over the years to families because, you know, we are in a different situation. They’re more long-term. They have, you know, they don’t, you just don’t have the closest and it’s understandable in an acute setting until they get to us where, you know, like what’s going on. I mean, I had a family conference last week with 14 people came, which is really unusual.

DIEGO TRUJILLO: Wow, the whole family, yeah, right?

JULIE LIEBO: Yeah, well, they were Filipino. Okay. And they came in from the Philippines, they came in from Hawaii, whatever, and everybody’s like, I said, no, you know, first of all, that’s very cultural and it will be okay. And it was. But they were looking for so many answers, you know. And honestly, when they left, they left thank you notes for everybody and did fine. But just that few minutes of being able to sit down with everybody and let them know, you know, we can’t tell you yes or no, but what we can tell you is people in this condition have done this or, you know, whatever. So to give some hope as they leave long distance. I think the communication, and a lot of times, you know, I will always introduce the certified nursing assistant. I will introduce the nurse on the floor. This is the person you can go to. And the staff are not the same. The staff might be different on a weekend, but they’re not different. They’re our staff, but somebody works, because we have 12-hour shifts, they’ll work Monday, Tuesday, Wednesday, or Friday, Saturday, Sunday, or whatever. So they know that that’s staff that’s current and on board, and they will see all the time.

DIEGO TRUJILLO: Well, it helps. I think it helps a couple ways, right, from the patient side. And I can relate to this, again, being in hospice. You know, sometimes it feels like you’re being told what’s going to be done. That’s typically, through medicine, it’s like that. One of my favorite selling points on hospice was letting families know, we meet as a team. On these days, our doors are open and you are more than welcome. Or, you know, you talk to a family member and they’d say, I just don’t want them to take this medication and blah, blah, blah. Because they’ve always felt that someone walks in the room and says, OK, you’re not doing this, this, this. You’re now doing this, this, this. So they don’t feel like they know who to listen to. And more importantly, they feel disempowered. Right. Disempowered? Unempowered? Right. It was the lunch, is what we’re going to blame. But they don’t feel empowered, is the point. And giving them the ability to say, hey, when you talk to your RN case manager, bring up what meds are important. Before you ever sign paperwork, make sure that you’re good with these medications and with the changes they’re suggesting. We typically don’t bully, and you’re involved in the plan of care. And that goes a very long way. I know for me, every time I worked with a Hispanic population, because I’m Colombian, that was one of the first things that would that I would bring up because they just felt, again, like they were always being told. Not like they were being interacted and they were working alongside them. And at the end of the day, it’s their life that we’re working with, right? Their loved one, etc. And then the second thing that I was going to bring up that, you know, listening to you discuss that, right, is it’s kind of the idea that the general is always in the front. It’s a very different feeling when the general is leading the army versus when the general is sending a letter saying, yeah, tell them to throw their bodies at it. You know what I mean? It’s a different type of commitment and showing your face and being up front and being there, right? I know I would always pride myself as a marketer because whenever I had someone call to complain, I would say, hey, I’m right near your building. Can we hang up? And I want you to say this to my face. I’m not going to run. If we made a mistake, if there was an accident, please let me know what we did wrong so it never happens again. And it was just always showing up and showing face. And that goes a long way for people. We’d all make mistakes. We’re human beings, and I mean, this is the nature of the world that we live in. And so, for me, it was very important that people felt heard, that they felt understood, and that I wasn’t running. Right? And I think your team sees that. Circling around, and I know we wanted to touch on this because we’re coming up on Pride Month, right? And we’ve, a couple of the things that you mentioned as you were speaking really kind of push towards inclusivity, right? Not pushing to put people outside of populations where you feel like you’re another, but you’re a part of that community. I’ve observed you over the years, right, on social media, and it’s always been very interesting because of your push for inclusivity. And so I wanted to delve a little bit into those topics, right? I would like to look at historically, because people that are never a part of a population typically go, well, why are they complaining? What’s the problem? I don’t see what the problem is. And like, well, really? You don’t see the problem as a, you know, as a person not from that community. Whereas when we’re from communities, right, we tend to notice certain things. For me, it was always like, yeah, if you get pulled over, son, roll down all the windows. It just makes the police more comfortable. And it wasn’t until a friend of mine that was American, he was just like, huh, that’s really interesting. I never thought about it. I was like, yeah, I thought that’s, I always did that. And honestly, it’s a smarter thing to do. They’re very on edge. So just roll your windows down and keep them calm. But I never realized where that comment came from, right? And so, I want to ask you, uh, things historically of how they may have been different and what you have pushed to change. I was thinking on how to unpack this, right? And we could sit here and say, what do you do now that is amazing? But I’m sure that this is something that not only has unfolded, but is continuing to unfold, right, as our, as our culture progresses forward, as we look for better, um, just merely for the, for the point of better outcomes. So can you tell me a little bit in the 90s what that may have looked like when we looked at, right, the inclusivity? I wanted to show a little bit of progress, hopefully, right? Hopefully. And I’m sure the world was very different then. And so, yeah, I’d like to figure out what were things like key things that you would see or you might notice or observe that were kind of irritating that you thought, you know, when I grab the helm, I’d like to see things differently.

JULIE LIEBO: Right, well, obviously it was virtually unknown in the 90s.

DIEGO TRUJILLO: It wasn’t something you do. It was a don’t ask, don’t tell was the policy.

JULIE LIEBO: Yeah, you don’t come out and say whatever. But I’ve actually felt, even as an administrator, I felt that discrimination in a company early in the 90s where I have a wife of 30-some years, 35 years. You know, she ends up having a one-time bad illness and, you know, it comes into focus that, why are we paying for this woman? And, you know, it brings up this, oh, they’re gay. And all of a sudden, my numbers weren’t right. I’ve always been a very successful administrator and I lose my job. We all knew it because I’ve been there before and we all knew it was very subtle, but it was because, you know, something was influencing here and it wasn’t my performance. Whatever, you move on. But from the 90s, I would say it wasn’t in most of the handbooks even where we don’t discriminate on sexual preference or same gender, however you want to put it, wasn’t even there. And even in the company I work with, which is pretty progressive actually, and I’m very proud to say I work for Fundamental because they really did take a look at it early on with me. Like, what can we change? What can we do? And we did, we did some, you know, they added to the employee handbook, which was fantastic, you know, finally way back when. Now there’s a lot of programs and we see, you know, under CMS new rules that are acknowledging that there are same sex couples that are entering nursing homes, things like that. I did a subtle thing like just all of a sudden one day I took out the male and female bathrooms and made them gender free. And no one ever, ever said another word. They’re gender free. And also when you walk in the door, I put up a very unassuming equal rights sign on the door of the facility. And we have proudly given our brochures out with a pride flag on it at different things because the company has also supported that. But along with all of that comes, and so if I bring it internally into my building.

DIEGO TRUJILLO: If I may interrupt really quick, so what year, for example, the manual that you mentioned, at what year? Because I’m assuming in the 90s, coming out of the 80s, must have been a pretty difficult time. Yeah. Coming into the 90s, it was maybe a little easier, but it wasn’t that much easier, I’m assuming, right? Yeah, we’re talking 2000, probably, you know, 10 maybe. It took a while.

JULIE LIEBO: And then now we’re You can’t force that, and I think sometimes people, we look at our main tool, the MDS right now, now we have to all of a sudden say, what do they prefer to be called? Who are they? What are they doing? I remember years ago, this is a very interesting story. Years ago, I had a woman in my facility. This would have been a little bit later on. I had a woman in my facility that was very sick. And after going in, and it wasn’t, we didn’t even have to ask people that. We didn’t have to acknowledge it. Nobody cared whether somebody was gay or not. And in speaking with her, we found out she had a partner in a facility in town here in Nevada, one in Henderson, and she was in my building. Come to find out they had been together for 20 years and had not seen, they were in separate nursing homes. They’d never seen each other, and they were bedridden. So I worked with that administrator at that point. I mean, there’s a lot involved in it, but I worked with that administrator and brought that person to my facility. And I have to tell you, because back then, now they’ve both since passed away, but back then, even putting two women in the same room was… It was like a nightmare for everybody. I’m like, no, this is this is her because same-sex marriage was not legal either at the time Okay, this is their partnership of 20 years. And yeah, that’s very true.

DIEGO TRUJILLO: Everybody If you had a dog if you had a friend for 20 years, they’re gonna be a pretty big part of your life Let alone if now dad Romantic relate, you know what? I mean pretty significant significant individual.

JULIE LIEBO: Exactly. And when we moved the beds together, oh God, that was really pushing. And I said, why? What’s the problem? Again, before they entered nursing homes, they had all these years together. So we’re going to give them those years before they die. And we did. But that was probably the most tragic thing I had seen. But I know some of that still goes on because people haven’t taken the time to ask or to get to know. But moving fast forward to more recently in the last few years, I did work with, at the time, Comagine, and I worked with CMS, and we worked together to put a pilot program together, and I helped consult on that. Unfortunately, COVID hit right about that time as well. designed pins that if they went through this whole training and they understood what to look for with both gay, trans, lesbians, whoever, that they would look and know what to ask. Example being, you can get, and I have this in my building, you can get a trans individual in your facility that has not completely transferred, or has not completely finished that transition. So instead of, you know, we realized in that video that the first time, it happened to be a physical therapist, helped to assist with removing their pants to help them. get cleaned up, and of course, seeing the fact that there was maybe a male autonomy and a female on this person still, they went, you know, like, oh my God, what do I do? And not to laugh, not to do anything, but to understand was very critical. And so, and everybody’s thinking it won’t happen. I have two people in my facility right now that have not finished transition because of illness. So we deal with that every day. And I know that there are other places in our community that that’s happening. I remember recently when I had two guys, they were married, and I had two guys, and I happened to go into the room to introduce myself because I hadn’t met the husband yet. Now picture this, Stigl, this is even more current, so we still have a little ways to go. So here’s the husband sitting in a chair in the room, talking to the patient in the bed, right? And the nurse is facing the patient in the bed, and I’m watching this whole conversation, and never once kind of turned over to bring the husband into the conversation. So when she walked out the door, I just followed her out. Great nurse. And I just said, I just want to point out one thing to you. I said, do you know who that man was in the chair next to him? Yeah, that’s his partner. I said, it’s his husband. I said, you never acknowledge the husband during the conversation. So this is what we’re going to be training. But if that was, think about this, if that was a heterosexual couple and the husband was sitting in a chair and the wife was in the bed, you automatically would be turning and bringing that husband into that conversation. So we have to learn to observe and to look. So now we try to find a little bit more of that up front so that people know. You gotta remember, the majority of us, myself included, after 35 years, I had said earlier, when my partner got sick years ago, I couldn’t get past the door of the ER. I could not get past that door. Like, are you family? Yes. But we weren’t legally married yet. We had documentation, but we weren’t legally married. And it wasn’t until I was, because she was very ill, and it wasn’t until I practically screamed at the top of my lung that a pastor came out of God knows where and helped me to get through the door and to see her. But we’ve certainly come a little bit further, but I can’t tell you how many times people will walk into a place and they’ll go, who’s the real mom? Who’s the real dad? We have two children that we adopted years ago. Who’s the real mom? Well, we’re both real moms. But, you know, we see that when they walk in the door. We try to find out, well, currently I have three gay couples in my facility and two trans, and they need that care. And they remain in that facility because they’re acknowledged for their relationship. And we actually offered to have, because my wife happens to be a pastor, we had even said we could marry them to help them financially, because they didn’t know. But even bigger than that, that’s why my staff stay. This is the other thing. I have several staff that have come out in the facility, just have never worked anywhere where I’m accepted, and I’m not going anywhere. I can provide this care for you, because you acknowledge who I am.

DIEGO TRUJILLO: Yeah. I mean, from the get-go. It’s unbelievable. Yeah. It’s unbelievable. We live in a world, and I’ll say this, because I am, and I tend to be a little bit more man’s man, and when I, I say that in a traditional sense, right? But at the same time, I was very close with my sister growing up. So people are like, well, how do you understand? I just know my sister, and I understood her and saw the struggles she would go through, and I tried to put myself in her shoes. And then, right, when I was a little bit, I want to say middle school homophobia was a little more popular. It started kind of phasing out. One time I was in high school, I was like, yeah, this is kind of terrible, right? to go to that extent. And it feels like we’re very much in a reactionary world. And it always reminds me, there’s an expression, right? Talking is the cost of being heard. And unfortunately, everyone’s been giving a microphone. So now nobody’s listening to each other whatsoever. And we’re all just trying to tell everyone, you know, they’re going on recently about this, this football player that made this speech, and I don’t want to get too political on this podcast, but But one thing that is blowing my mind is how it’s just, I’m watching these two sides form. And I was like, guys, first of all, right, because then you have the women that are like, oh, women shouldn’t just be. And I was like, if that’s what she wants to do, like, why are we telling other people what to be and what to do? If you want to be a stay-at-home mom, great. The football player’s mom’s a physicist. Great. I mean, everyone should be able to reach for whatever potential they want to aim for. And I would feel in a health care setting, and this came in mind, one of my, I want to say my fourth patient, was fascinating to me. This is back when I was a chaplain. He had no family. When his spouse died, he walked out of the front door and left everything there and went to Brazil. So he lost everything. Now, as I started unpacking, now he was living in a studio apartment by himself. He had been with his partner for about 60 years. And so I remember talking to him and being like, what is Like, I can’t imagine what being gay is in 1950 in Brazil, right? And for him, it was kind of funny because he was like, actually, it was a very pleasant experience. I did a really good job in the military. And I was like, wait, you were in the military too? So he had a good, uh, a good, uh, he had a, he would share a lot of insight on what his experience was. And he had a lot of video. They, they, they did very well. And he came from a very, very well-to-do family, which was the tragedy. When he walked out, there was paintings from the 1700s. from the 1800s. I mean, he really had, he was like, yeah, I left all of this. And so it was very interesting how it really hit me hard how badly hospice had let him down. Because his husband had died and he was in a different, anyone that would have spoken to this man could have seen, hey, he’s a very high risk, bereavement risk. Like we really need to stick with him. And they just kind of let him go. And I think this crosses over all bounds, right? Because we have this on the one push, the push for equality for women for all four. And then there’s now this push for like, yeah, men don’t have friends. And as I’ve grown older, I see this, that the loneliness that exists in men and I start Sometimes we try to outdo each other with what we’re going through. And I’m just sitting here thinking like, hey, do you guys not realize we’re all going through something? Like, this is precisely the point. And for me, what must have been really hard looking at the examples that you’re giving, I put myself in the world that I grew up in, which wasn’t as hostile. I couldn’t imagine growing up in the 50s and 60s where we had to lie about our relationship our entire lives, and now I’m bedridden. How much more vulnerable can you be as an individual? I’m dependent on these people. What a great opportunity to be able to give them a chance to be seen. probably for the first time in their life, at least very much in healthcare, if someone would have just asked, for 20 years they live separated, right? And I think it speaks more to the issue of not just how we’re treating a specific population, but really how we’re treating all patients from a point of understanding and comprehension, right? And just learning to listen. Which is a little hard, you know, again, we’re very busy. Like I always joke, right? I don’t see healthcare workers like bored sitting around. It’s like a social worker. They’re all very busy and they’re all going through things, etc. All these things are happening. And so to be able to take that time and to be able to guide your staff, do you ever have staff that are resentful when you say things like that? Is there a pushback?

JULIE LIEBO: I have not had any pushback to be quite honest, but I do go to orientation right away and I let them know what our goals are and what we do. I do place, there’s some signs throughout my building and the break room and other areas too that say we accept all. I have everything I can up there that says we celebrate our diversity. I make sure we do all kinds of parties for every potential person that comes into the door that’s an employee so that we recognize who they are. And so I think as we continue to do that kind of thing, they do stay because they do feel like people know who I am. And so I haven’t really felt resentment, but I do let them know in orientation. I said, I’m really sorry if this is a problem. We could talk about this, but this is who we accept, and these are the kinds of patients, and these are the staff that we accept when they come out. We have a staff person that transitioned completely in our facility, and she’s very, very happy. I believe in my heart and heart she couldn’t have done that anywhere else with the dignity that happened there. So I think we’ve still come a long way, or we’ve made a lot of good strides. We really have. The problem’s going to be, and like you say, it’s people in general, and the problem’s still going to be that health care, it’s about getting better, and it’s about accepting the family. So we have to, whether we want to hear the answer or not, we have to hear about it. We have to ask. We have to say what about them. And in a lot of cases, families are a little bit still embarrassed by what, you know, who this person is or how they live their lifestyle.

DIEGO TRUJILLO: Well, because they still have that mindset. Again, just because we’re here now today doesn’t mean I was raised like that for 40, 50 years. I had the one, actually, this patient that I was telling you about, I remember one time I brought up and I was like, hey, look, they legalized gay marriage. And he goes, Oh, no, no, no, no, no, no, no. That is unacceptable, unacceptable. I was like, you were with your partner for 60 years, right? And unfortunately, I mean, progress is slow, but we sometimes have this attitude that recognizing someone else means ignoring somebody. And I just, that’s where I get frustrated in today’s culture. I get very frustrated because it’s always a, well, you know, um, an either or. Right? It’s never the and. And like, oh, also there’s these people that need to be seen as well. And I don’t know if it’s just my life trajectory because I, again, going through the, on the issue with trans people, uh, as I was speaking with, I had a friend and, uh, and one time they sprung the news on me and I was like, huh. And so, and it really just led to me asking a tremendous amount of questions. And as I was learning, it would really help me, oh, okay, I see where you’re coming from. Do we agree on everything a hundred percent? No, not necessarily. And she would get sensitive. She’d be like, well, I just think, and I’d joke and pry and be like, oh, they’re definitely giving you too much estrogen, right? And we’d have fun with it. But it was always, again, going and circling back, hey, you know that I love you as a friend, that I care about you, and I want what’s best for you. And if you think this was what’s best, and sure enough, I mean, what she’s blossomed into versus who she was back before she transitioned, it was a night and day difference. And so I’m just like, yeah, if this is what has given you fulfillment, as opposed to being suicidal and wondering why you’re here all the time, I mean, what is the alternative, being forced into this mold. And so again, going back to that, just that approach of understanding and also the inclusivity, which for many people, again, if you grew up in San Francisco, you’re going to think, well, I don’t know, why is everyone complaining about discrimination? It may be a little different if you’re from Dayton, Ohio, right? It’s very different lives. And I would hear people sometimes I had a friend one time that said that, well, I just don’t understand what all the protests and the problems with race that’s going on. And I was like, really, as a blonde-haired white girl, you wouldn’t see what the problem with race is, even for me growing up in Las Vegas. It’s a lot more diversified. I went to seminary in Dallas, and it really put it into perspective. I was working alongside a food runner who was much older than I. And he told me I mean he made a comment I was like, huh and he goes yeah I remember when you know They would put the white people in the front and then us Mexicans would ride in the middle and the black people would go in the back and it was always history to me it always happened like so far back and I was like Wait, you saw that? I mean I which I should have known because I know the dates and I enjoy history But it really just brought that to like to life it added color to a painting and I realized wow This wasn’t that long ago Right? We might think that because we’re learning about it in a book, but this man is telling me, no, that’s how it was and this is how we treated each other. It’s just very interesting. Again, circling back to that, to the comprehension and understanding and listening and again, acknowledging populations. What areas do you think we could work on as a community in general? You’ve implemented some pretty great things. I know there’s people that may be listening. There may be even people rolling their eyes and being like, oh, here we go again. And I want to leave, Right? That’s why I wanted to focus on the history first to understand, you know, we’re coming from somewhere. It’s not like we just decided to complain all of a sudden. Right. What do you think we can, what small steps do you think that other administrators, buildings, health care workers, staff members, you know, offices, what small steps could we take to help to further that?

JULIE LIEBO: Yeah, I think, you know, it really helps probably to sit and talk with your staff first. I think you’ll find that a lot of staff in your building probably are gay or are, to be honest, are trans. We’re in every building. They’re in every building. And once they kind of understand what they go through, I think we can understand what the patient population will be going through. But it’s going to be very small steps. And this didn’t happen overnight. We’ve come a long way, like I say, from not acknowledging same-sex couples to today being open on a referral that says this person is trans or this person has a husband.

DIEGO TRUJILLO: You know that or a wife that yeah, you know is you brought up that acknowledgement piece I so honestly, I never even took that into account now that you bring that up I’m like combing through my history. This is my stories thinking, huh? Yeah, did I ever do that? Because it’s again we have this behavior that it’s just in us We’re not thinking about how we’re interacting with every person right each one of us is kind of the way we are Sometimes we have to take that step back and be a little more conscious about how we’re engaging, right? That was a very interesting poem, a very interesting story, because, yeah, I wonder if there were moments, right, where I just was going about the average? Because I know, for example, so my father died from kidney disease. He ended up having kidney failure. He had a rare disease that shut his kidney down. There came a point where we had to make a decision. Now, for a Hispanic to go on a hospice, you’re already fighting an uphill battle because they will tell you, I’m not giving up. I’m not giving up. That’s not what we do. And then number two is we’re not sending them to some place, right? And so I remember The first thing I’d always bring up, if I was dealing with a Hispanic family, I would say, okay, so hospice is not a place, it is a service where you are. It allows, you know, and then I would explain that to them. And if it ever turned into the, if I ever looked, right, and you looked at, it was kidney failure and they weren’t gonna do dialysis, I would walk in and say, hey guys, I can give you this big, long speech on what hospice is, and I feel like it’s very important. I’d like to give you literature, but just, you know, so we’re not here for one hour entertaining ideas. If you choose this service, he will have to stop dialysis.” And the family would be like, absolutely not. Okay, I wanted to save us. There will come a point where you have to make that decision. Let’s get that out of the way. I’m not here to sell you anymore because you already told me you will not, you’re not willing to discontinue dialysis. But here’s what the future may look like. There may come a point where he’s too tired, where it’s this, and I would kind of explain it. I would approach it completely different than I would, you know, people from other cultures because I had an understanding of what, right, I was raised Hispanic. So it’s very interesting, again, when we start thinking of different, of different people from different backgrounds and learning how to connect with them. which we see statistically the benefits, the outcomes that we have in patients’ lives when we do that. We just see better results in people. And at the very least, if you don’t care about any population and all you’re worried about is that, is those end of the quarter calls where you’re looking at your earnings, it very much will impact your bottom line. I mean, if you’re treating patients better, if they’re being seen, if they’re being heard, and again, this goes, I was sharing with you before we started the podcast, there was a new study that came out, that as a woman, if you have a female provider, you will have much better outcomes. So these things are not too distant. They’re not too far from home. We all have a sister, we all have a mom at the very least, right? So having an understanding, there is a lot of benefits to this. It’s not just simply a burden. It’s not simply that. But the outcome is a better world. And I don’t think a better world’s ever been forged easily, right? I don’t think the people that landed after crossing over the Atlantic was like, well, that was really simple. What if we just push west, right? It always required optimism that change could happen, that we could get somewhere better. And then it took a lot of blood, sweat, and tears to make that happen. And I feel like we’re still at the early ages. You know, it’s really funny you brought up gay marriage. Yeah, I saw that happen, and it still feels like it was a really long time ago, and it wasn’t even a problem. I always relate to a story. I remember a physician calling, and there was a couple inside of the ICU. He was yellow. He was jaundiced. She goes, he probably has a few days to live. I’ve called eight chaplains, and they all refuse to marry him. And I was like, but what do they need? Well, just someone to come fill out the paperwork and do the ceremony. I was like, wait, really? And everyone was worried about what their needs, wants, desires, everything. I was like, at the very least, just for the ease of the legal paperwork and everything that the partner is going to have to go through, I say partner because eventually they’re a spouse. So I went in there, and I got a little nothing but cake, because you couldn’t have a wedding without a cake, right? And I was just like, come on, man. It just seemed very heartless to me. Right? You’re already dying. And you really got to stick it to them one last time, huh? Just to prove your point. I mean, have some humanity. At the very least, it seems like, uh… When an eight-year-old is dying of leukemia, you’ve got to come and tell them, hey, Santa Claus is not real. You get what I’m saying? It just seems like cruelty to a certain point. You’ve got to set yourself aside and your own feelings aside to be able to serve. What else do you see towards the future? What are you excited about? What is your outlook? I mentioned that there’s one of my favorite expressions is, optimists build the future. So we have to remain optimistic. What are you optimistic about?

JULIE LIEBO: You know, I’m optimistic that, always optimistic and believe that we will be a world of peace. I really believe at some point we’re going to learn to respect each other, every culture, everything. I really do in my heart of hearts believe that. And as I see, like even something as simple as when we changed our mission packet to read you know, person one or person two, not husband and wife or child or whatever, you know what I mean? Son, daughter, whatever. I mean, little things like that matter 100% when you’re looking at, you know, paperwork and you’re looking, it gets people thinking a little bit of, you know, what are we doing? Who’s out there and who are we representing? So I’m very optimistic and at some point, we’ll have enough education behind us that people will understand the types of patients that they are taking. and who they’re bringing in and not do any laughter. I mean, I had a, this was a really interesting one, story. I had a trans individual who got shot here in Vegas in a bar, and she had, she was a dancer. In training the staff, which we do all the time about diversity and whatever, she and she gussied up every day. I mean, she and her friends would come in and it really, the facility was a blast. The therapy department was so great after education that they actually taught her to dance in heels. You know when she was getting her they were doing all the gait exercises and everything not just to you know be able to stand up and walk 10 feet down the hallway but no this person’s going to do some high kicks again or go into the bar and whatever and it was a it was so fun to this day she’s actually moved now to the Midwest but I I still stay in touch with her on Facebook all the time, you know, how she’s doing and whatever. But I think if we can get to that point where people have that kind of fun and acceptance of people’s lives and want an interest in learning who they are, obviously somebody saw that, like you said, women being cared by women might change the outcome. Well, the more staff that can relate to patients, too.

DIEGO TRUJILLO: Yeah, I think in general, I mean, that study happened to study women, but it just feels, again, you’re being seen and heard.

JULIE LIEBO: Exactly. And so if they can walk in and even me, I mean, there’s been several times where, you know, we’ve been chosen as a facility because of who I am. It’s like, well, I’ll feel comfortable going into that facility because there’s going to be an understanding of who we are.

DIEGO TRUJILLO: I won’t be another one of those, right?

JULIE LIEBO: But it’s the same thing. You know, we take people of major size. And so I, when I started that years ago too, I said, look, We want to continue to take these people, and we can’t take one. I want to take, you know, three or four at any given time, because nobody wants to deal with people that kind of size. And we have now built that program within the facility as well. And so there’s a dignity behind that. There’s a dignity behind being trans and being in that facility, or gay in that facility. Very important. You know, that’s, in most cases, that becomes their home. We’ve got to understand who we’re caring for inside and out. Otherwise, they’re just laying away the way that they were before. If they’ve got nothing left but living in that type of facility, why should they go on more years to come without being able to come out and say who they are? I don’t know how to explain that, but it’s the saddest thing in the world when you’re closeted. Your life just goes by, and you want to share who you’re in love with, or you want to share who shares every moment with you like any other partnership, and you can’t. So we have to look. I tell all administrators, you have to look. You have to want to teach.

DIEGO TRUJILLO: I agree. I agree with you 100%. And I think that one of the major things, which it’s really funny now, I always show it to people when people are kind of When I see them as stubborn or where I see them as like really firm on their positions I’m like, hey, let me I don’t know if you’ve ever seen this video There’s a video from the 70s where they made it illegal to drink and drive And I and I always tell people I’m like if you don’t know right I saw this with like the mask Oh, you’re not gonna tell me and there is a video of a news station interviewing people And there is literally a woman with a beer in her hand and a baby in the front seat right in the in the strap And she’s saying well, you know now they want to come and tell us that we can’t drink and drive and but you know if a man is right somebody else like well You know if a man wants to put in a hard day’s work and have a beer on the way home What’s wrong with that? I’m like Yeah, that’s how people used to be. You’d sound pretty dumb if you said something like that, right? And so we have to hope that some of this will stick and slowly things will progress and things will change. So I very much admire your optimism in what you just said. It does sound I find it frustrating that it has to be a naive statement or come off that way, because I don’t think it is. We have to hope for something. But if not, what are we doing? Right? There has to be a better future. We need to pay for ourselves. And unfortunately, the tribalism that kind of comes in us, maybe it can go towards other things, like, you know, people on other planets. No, I’m kidding. We can get it against them. They’re, they’re, no. But that we can learn to kind of unite and bring those things together. For me, I always drive home the point to be just, just listen. Just listen to where they’re coming from. And if you ask the right questions, you know, typically you don’t have, now there are some people that are just, you know, they’re just trying to outrage and bait for those things. But if you really listen to where people are coming from, it seems to make sense. We’re all shaped differently. And so our experience are different and you’re always going to be better off. You’re never going to be worse off for having more knowledge on how people or how the world is. So at the very least, even if you disagree at the end of that, at least you can kind of come together on the fact that you have learned a little bit more and you know a little bit more, and you’re more educated on your position if you choose to, you know, continue to hold that. Maybe you’re going to tolerate now and accept later. Who knows? But just remember the 80-year, right, the 1980s alcohol video. You can YouTube it too. God, it’s so funny to go back. I still continue to go back and watch it. I’d be like, wow, people really used to argue that. They got upset about big government telling them that they couldn’t drink and drive. Yeah, exactly. We have come a long way. Well, thank you very much for coming on. I told you it would only be about 45 minutes and we went well well over that but this is a very interesting conversation and more importantly I think it’s a conversation that needs to be had on a more frequent basis. I really appreciate it. I always tell my guests it’s very interesting the way you kind of connect over a podcast with people. You wouldn’t think it because you’re like, well, what is he gonna ask, right? And I’m thinking what am I gonna ask? Yeah, exactly. But I like when the conversations come out natural like this and we just kind of find out a little bit. I didn’t dig into your past, but you mentioned something right as a CNA and working in skilled nursing. So I appreciate you being able to share a little bit about your experiences and what you’re doing to pave a better way in our community to be able to serve the people in our community. Thank you. Thank you for having me. Thank you very much for coming in, ladies and gentlemen. Thank you very much for tuning in for another episode of The Peels Pod. Have a wonderful day.