a16z Podcast - The Hustler's Guide to Elder Care

Episode Date: April 1, 2020

This is the next cycle (Q1 2020) of Hustlin' Tech, a podcast series (from the a16z Podcast) about technology platforms that create opportunities for people. Recorded right before the coronavirus pandemic, these next 3 episodes touch on many things that are top of mind right now: from the profession of nursing; to taking care of the elderly; to fighting bureaucracy to get money and time back (and to get help delaying utility bills and rent payments that are eligible for an extension or waiver of late fees due to the coronavirus crisis).Episode #5, “The Hustler’s Guide to Taking Care of Old Folks” features:Seth Sternberg, CEO and co-founder of Honor, a home care company and national network of local home care agencies that brings high-touch, personalized care to elders while also scaling workforce management; matching special needs, skills, and unique demands; and offering tools that help caregivers with jobs and more.Samantha Ludwig, a care professional who has always had a job thanks to Honor (and who journeyed from abroad as a foreign nurse);...both interviewed by Ben Horowitz and Shaka Senghor.You can find the first cycle of this series (Q4 2019) -- including more about the what and the why -- here.

Welcome to this episode of hustling tech. Today we're going to talk about how to take way better care of the elderly and make a living and doing so. With me, I have Seth Sternberg, co-founder and CEO of honor. I've got our hustler, Samantha, who's going to tell us how she makes use of honor. And then I have with me, as always, my co-host, who hustled out of the joint to become a leader, advocate, management consultant, Shaka Sengor. I'm really excited to talk to you. What was the inspiration behind, honor? Yeah, so the inspiration was my mother.

When she picked me up at the airport and was driving me home, she was just driving slowly. And I was like, what does this mean for five years from now or 10 years from now? because, you know, she lives in Connecticut. And, you know, I don't want to be the son, whoever has to say to his mother, hey, I'm sorry, mom, you have to leave your home. And so myself and my co-founders looked for any solution around helping the elderly remain in their homes as they age,

and we found home care. It's really hard to figure out who to trust, who to turn to, where to go. And it's not just hard for you, someone who needs to figure out care for your grandmother or your parents. It's hard for the folks who work in home care. Really early on, we identified that we're not a normal tech company, no customer cares about a technology. They only care about the person who's going to go into the home and serve their mom or their dad. And so, first of all, we call those folks care pros, care professionals, and that's a unique name to honor.

And we did that because when we talk to care pros, they told us that they generally feel disrespected. And so starting honor is really about helping the elderly, but then also doing what we call care for the care pros. You know, trust is an interesting word because it's kind of beyond, okay, are they competent? It's who do I trust to be in my home with me who I can get along with and all that kind of thing. And elderly people are not very flexible generally and who they can get along with. So it's not just your classic super hands-off, everybody's a contractor thing, because training is critical. all of our care pros are actually W2 employees of honor in this space where someone literally will walk into the home of your mom

and potentially give her a bath to your point then on trust knowing that that person's like really good and vetted is a super big deal one of the issues about taking care of the elderly is that their needs are very specific one specific kind of need is who they like another specific kind of need might be the care pro who is dementia trained, who is not allergic to cats, who she gets along with, who lives near where she lives, who is available on her schedule. And so to be able to get the right matches is a really big deal. Also for the care pros, because one of the things that we found is one of the dominant things that makes a care pro happy and helps a care pro perform

better is if you put them in situations that are more appropriate to their skills and their personalities. And then the technology that we build is really just about how do we do that at scale so that you can choose from thousands of care pros against thousands of customers and kind of know how to make those matches appropriately. So Samantha, tell us a little bit more about your journey. So I was working as a nurse in London before I moved here around four and a half years ago. I studied my nursing in the Philippines and then in London it's different from the United States. when I became a nurse, when I applied from the Philippines, it was easier because they hired you because you've already just given you a six months probation, so they see how you work,

how you interact with the clients, what you know, the knowledge you know, how you do your work. So that's how they basically hire you. And like here, it's different because there's another exam that you need to pass. The NCLEX, which is the licensure examination that you have to take here. And that's everything. And in the nursing field here in America, it's pretty challenging. challenging because if you're a foreign nurse, they basically tell you you're not qualified to be a nurse in the United States. You have to take some courses to enhance your studies. Sometimes they

tell you to do the whole thing. Sometimes it depends on who assesses your grades and your transcript of records. So it can be locked sometimes. And that's amazing that, you know, we have care pro shortages, nursing shortages here, and then we have a bureaucracy that makes only some sense. I mean, it's such an important thing, just societally. It says a lot about a society of how it cares for its elderly, and we just don't do a very good job of it yet, I think. So did you grow up in the Philippines? I did grow up in the Philippines, and I finished my college there. Amazing.

Home of Mani Pachia. Yes. Home of the champions. And, yeah, so that's how it started. And then I moved to Spain because I was half Spanish. I was able to move there, live there, and start my career there. and I started working as a caregiver because in Spain you have to convalidate your studies and it was not as easy when you're a foreign nurse, which is the same thing happening in the United

States nowadays. And so caregiving was always the first thing you do when you start in the medical field. And so that's like the startup thing to do. So your training starts from there, obviously, from what you've learned in college as well, and then you put your practice altogether. And so it started there. And so when I moved here a couple of years back, I worked with different agencies. And how is that?

It can be a challenge because the thing is with caregivers, you have to be a match with your clients, and your clients have to like you for them to have you keep coming back. So once you go to their homes and you're given a shift, you have to make sure that you're confident. You have to show them that you know what you're doing, especially with dementia patients, that sometimes they will not know exactly what they're doing at certain times.

And they might forget exactly what they did an hour or 30 minutes ago. So you have to be that guide to them and you have to be that strong backbone that they can trust and also, you know, just feel safe. I think that's the most important thing. Obviously, there's a personality match because in this job it's very interpersonal. So you really have to be a match. Not only with a client, sometimes with a whole family, because you're not just dealing with a client. You deal with a whole family.

And some families have different stories and different things that they go through and issues that they go through that, you know, you need to be part of. And one thing that with families that always knows, communication is a big deal? Yes, the app helps a lot, not only just to find work, because the app also, you write your shift notes. So basically, it's very beneficial for family members that don't live close to their families or to the clients or to their parents that we take care of because there they can see what we did throughout our shift. So basically, if they ate, what they ate, the amount of food, if they were able to go to the bathroom, all of these things. And so that way they're able to check on

their parents and communication is open based on the shift notes that we do. So what is that experience like from the family's perspective? For customers, we look like a normal home care agency. So we will go into your mom's home. It cannot be done over the phone with you. And then we figure out what the care plan is. And then once we know what the care plan for your mom is, then we can figure out which care pros are the best care pros. So it doesn't matter who you are. You want the phone.

Because this is who might like give your mom, you know, a bath in your mom's home when you're not there. That's scary. And so people do not trust not hearing a human voice yet. What we find is as people start to use honor, then they switch over to the tech. So then they change the schedule on the app. Then they request more help on the app.

Then they change the care plan on the app. But it's after they've been using it for a period of time because trust has been built up. So stuff like the notes, Samantha talked about that the care pros leave is literally the customer's number one favorite feature because it brings them into the home and they can see what mom and dad did

with the care pro from honor or what we call the wellness check. The wellness check is basically how their mood was on that day, how they slept. So there's different tabs that you need to click. How happy were they for that day from zero to ten? Their pain level while you were on the shift. So they are aware of basically what's really happening. Transparency, right?

So for the kids, right, which is usually the family. And when I say kid, I usually mean a 40 to 60 year old. Right, you mean me. Yeah, exactly. So the design point for the app for our care pros, is to empower them. It's professionalization. So know what's expected of you, give you the training, give you the tools, put you into the right environment where you can use that training and tools and be successful and then tell you how you're doing, rewards consequences. So that's professionalizing

care pros. And that's what our app is basically designed to do for them. So like client profiles, because that's a tool. So for the customers, what we think about is basically transparency. So it's scary because someone's going to your home. They're, you know, very intimate with your mom or dad. They're going to be intimate with you as well at some level. And so how can we show you and demystify what's actually happening? So with that established that trust and going into it from the wellness checkpoint, is it like, it's an easy way to just notify them via the app? Yeah. So one thing that happens is they literally just get after every visit, the note, is they could see, like, you know, mom's pain threshold is usually four.

Today she said seven. So, like, they can see, oh, something changed. Like, I should figure out what's going on with mom. And that's a new level of kind of, you know, data information that people didn't have before. But now, you know, we get literally a Dickens novel worth of, like, notes from Care Pros every single day. Humans can't read that much information. So our computer can literally read all the notes. and determine when it believes a fall may have occurred,

even when honor wasn't at the home and even if the word fall was never used. Literally, the note might say, you know, it's fall outside and we went for a walk, the computer will ignore it. But the note might say, I arrived at the home, Mr. Smith was on the floor, I helped him get up, he was a little bit sore, and the computer will see it. And flag, there may have been a fall, and then our care managers can intervene and notify the family. So this is just like crazy stuff that you can start.

to do if you build it into your platform. And are the family members, is it sometimes that the family member had been the caregiver and then is transferring it to honor? So almost always the family members at some level are the caregivers. The question is, are they there or not? And even if they live far away, oftentimes they're helping with like paying bills and, you know, kind of lining up supports, lining up to doctors visit on the phone. Usually 24-7, then we're often like the dominant provider of care.

Another thing I was curious about was whether does this interact with insurance companies, like how do families pay for the services? So non-medical home care today, which is like helping with activities of daily living. So these things like getting out of bed, getting food, getting dressed, is usually not covered by insurance. So if you need something like IV changed or if you need a wound pack, like if you're breaching skin, that usually is. But in our world, it's either people are usually paying out of pocket or you need. they're using long-term care insurance. So if they did purchase long-term care insurance, and about 30% of our customers have long-term care insurance.

And how does that cost compare to putting them in a home or that kind of thing? So basically the kind of crossover point is about 50 hours a week. So if they're getting honor for less than 50 hours a week, it's probably cheaper to use honor. And if it's more than 50 hours a week, if it's literally just about money, you would choose a facility. the trick with facilities is most people don't want to be there. A lot of my clients actually do prefer to stay in their homes.

I believe that a lot of my clients that have worked hard, they believe that their money should be used towards them. So they always fight for the money to be spent on them. Because sometimes there's a connotation. Like family members think, oh, because my mom is old, oh, let's put her in a facility. And then let's have somebody else take care of them. but that's not what they want.

And it's a battle when it comes to that because they think, oh, but I have all this money to pay for my care, why can't I keep my caregivers in my house, where I feel comfortable, where this is my home, I've lived here all my life, then to go to a new home

and have to deal with other people that live there. So that's always a dilemma when it comes to the care industry. Do people want to put their parents in a facility because of calls, and so they can get the rest of the money or they don't know about in-home care, what drives that? I think it's all about the cost.

That's what I feel. Because some clients don't have dementia. I've had clients that I took care of and they reach 100, 1002 years old with no dementia. Just basically, you're just helping them on the day-to-day, like with their food, with their baths. You know, not everybody has dementia so they can still make decisions for themselves. And sometimes it's a battle with a family. because they feel like their decisions for their parents are better than their own. And so it becomes a battle.

But it's always about the money, unfortunately. A lot of, you know, videos come out of elders being abused in these places. And so with that in mind, it does honor, like, interact with, like, a nest or something like that where people can actually visibly see the care that's going on in a home. Yeah. So we've run the experiment. And oddly, when you ask our customers if they want cameras, it's very unpopular. So the home care agency kind of industry today, the way it does quality is either what it hears from customers or random home visits.

We do random home visits. We partner with their partners to do that. We've actually started our own program where we do it even outside of our partners. But we get a ton of data from the app that's kind of inferred data that can point you to where there might be problems. And so even though you're not seeing a signal that says of physical abuse, you're seeing signals that indicate lack of care pro quality and then you can take action before hopefully you end up in like a truly bad situation.

How important is it for the caregivers to be taken in consideration in regards to their needs as a caregiver as well? So what you find broadly in the industry is people usually will work for like two or three agencies at a time because each agency is too small to have enough customers that fit the very specific skills of that caregiver. I used to work with three agencies because the thing is you always have to have plan A, plan B, and plan C.

Because the thing is, anything can happen with the elderly. They can pass away. They might have to budget, so they cut down hours, so you lose some of your hours. And you don't have that consistency. Sometimes you lose a job, and what if you're not a fit for the next client, then almost a week or two you have no income. because you get paid as you work. So now all of a sudden you've got like a 25 or 30% pay cut

because that agency doesn't have new work for you next week. So what do you do? And so you have to kind of find another agency that has work which might conflict with like one of those other agencies you're already working for. And so thinking about how you can take care of someone and even just like making sure that you can get them very consistent hours to support their needs in life

is a really big deal and it's part of the reason why having a full network was very important so we'd have so much demand that Samantha and everybody like Samantha could keep consistent work.

What does that look like when you log in and like, you know, are you like a basketball player like, yo, let me see what kind of numbers I put up tonight. Like, what do you... Yes, well, it actually is a motivation

I think. It helps a lot so you know you keep yourself in check because sometimes you could get very comfortable as well when clients like you and you're doing good and you're getting jobs and everything. But, you know, there are also times that it's not the case. So the app just doesn't help you with how you're doing.

Some clients will make you a favorite. Some clients will give feedback to the agency and then the care managers will let you know, here are the things you can improve, here are the things you're doing really well. So I think that helps a lot. And then in the app also you can see different clients. And I think if you really know which scope of practice you're good at,

then by reading the care plans of different clients that have available shifts, you will know if you're a fit. And when you apply for it, it doesn't really, like, approve you right away for that job. The care managers normally check first, and then they allow you to work on that shift based on your experiences and if you're a fit, if they feel that you're a fit for that work. And Seth, with that, like, what would you say that the average difference is between somebody who's on honor versus a caregiver who's not in terms of salary?

You know, the average difference is, you know, maybe 10%. It's not that much. The difference is, do you get surprised because all of a sudden next week, the difference is 50%. So what will happen is like you've got two clients, two different agencies, half your times with one client, half times with another client, one of those clients passes away. 50% pay cut next week. So it's like those moments of panic.

Because that literally can impact food. That can impact transportation to school for your kids. I mean, that's a big deal. And so it's more about not having those, like, momentary, extremely painful experiences. I've never had no job. Like, I've always consistently have a job. Because not only is their network big, they work with different small agencies as well. And they're the ones that provide them with caregivers.

And especially me, I like to work during the nights. always a challenge to have 24 hours because of the expense as well. Tell us a little bit about your life and like at home and like who are you taking care of. Yeah. So I'm also a full-time mom. So that's why I always prefer to work during the night so I can be with my son. So yeah, I'm a full-time mom and I'm also currently studying for my nursing so that I can get back to my BSN. So I'm doing that. I'm working on that. And as at the same time, I work at least four to five night shifts with honor. So obviously the distance where you're working as well, helps a lot because if you find clients that are closer to where you live or in the area where

you live, then that is also a bonus. So those are one of the things that care professionals look for. And of course, a start time as well, because like for me, I have to drop my son to school and pick him up. So almost I have to do a seven to seven to seven 30 to seven shifts because if I do an eight to eight, then I'm not going to be home enough to drop off my son. And then like Seth was saying, also what you're trained to do, what your capacity is as a caregiver, because sometimes some clients are harder for you and it's just not going to work out. You know, when you look for a client as well, it has to be a fit, not only personality-wise, but also the job. Am I going to be able to lift this person or am I going to be able to help this person with his transfers, to help him go to the

shower, the baths? What are their expectations for my cooking, for my meal preparation? You know, we don't do any medications because we're non-medical. that's on the side. The families do that. So these are things that you also look out, the environment, what type of home I'm going into. Obviously, there are really nice homes and there are homes that are different. So those are things that you look for. So the easy way to think about how hard is to kind of match what people need with what Care Pros can do is if you think about like getting a car, Uber or Lyft, a rider looks like a rider. So like all of us look the same to Uber basically. And all the drivers, you know, look the same to Uber. And so they just have to make

a simple match. We have to think about pretty complex stuff, not just a personality basis, but something like, okay, this person has diabetes or this person has dementia. This person has steps in their home and they need lifting and transferring support. So like, is this care pro a medium or a high on the skill of lifting and transferring because this customer needs support to get out of bed and get into a wheelchair and then get out of the wheelchair and get into a bath. And then this person has cats.

And so the care pro for that home has to be like a medium or a high on lifting and transferring and not allergic to cats. So now we've got like an innate skill, which is basically innately you are or are not allergic cats and then a learned skill lifting and transferring. And so matching is a very nuanced thing because we would say that it's a two-sided heterogeneous marketplace. Everybody's got different skills and different needs.

How do you find the caregivers to allow them to engage in this? So we basically start top of funnel. How do you find people in mass? And most of that happens online. So we tried stuff like going to nursing schools, going to vocational schools. We didn't get the amount of volume that we needed. So it turned out that online and using job networks produced a pretty good type of funnel. And then we have some automated systems that basically figure out are people qualified for kind of honor specific qualifications.

And then people go through a phone screen and then people go through an in-person assessment. And then ultimately they can be approved to be an honors platform. Right now it's pretty hard to make it through the funnel. Like the acceptance rate bounces between kind of five and ten percent. So we really are looking for like the best people. What are you looking for? So if I wanted to get in, what do I need to be? So it depends on the state a little bit.

So there are different requirements by state. But fundamentally, you need to have six months paid experience of being a caregiver. You will have to have a clean drug test. So we do drug test everybody. And then we assess skills. So like when people get to a point where they're coming in to honor, they'll literally do like a lifting and transferring exercise in the office. they'll be assessed for their familiarity with

and comfort with working with people with dementia that Samantha was referencing. So you're vetting for all these things. So what about the families? Like what happens when you run into that difficult family member that's just like all over the place and making it really difficult to get care for? Like what happens there?

You know, so it's really interesting. There are customers who are super easy to serve. There are customers that are super hard to serve kind of for two different reasons. Either they're need. needs, like their absolute needs are difficult. Let's say someone weighs 350 pounds and the need lifting and transferring support. That's difficult.

Or let's say someone's kind of late-stage dementia. That's difficult. And then there is this other kind of difficult, which you're referencing, I think, which is this personality difficult. And it can be either the person who needs care or it can be the family. And so what we try to do there really is matching. Again, it goes back to like this care pro with their personal. personality and their skill set is better for this particular kind of customer. There's also

price differentiation. So you might have a customer who is really difficult to serve, and it might be that care pros are paid more to serve that person because of the unique needs of that person, and so therefore it earns a higher wage. I agree with Seth that there can be very difficult clients and difficult families. And with my experience, it's pretty amazing because sometimes your client's really awesome, but the family's not. They're hard. We hear that a lot, actually. Yes. And I think that most of my clients, that's always been the problem, that, you know, they're pretty easy, you know, like they get along with the caregivers, but the family sometimes make it about it themselves, and they forget it's about the people that were taking care of. And that makes it a challenge.

So, for example, I had a client before, and then, well, he was living with a daughter because the situation changed. The mom couldn't take care because she was elderly. So he moved in, the client moved in with the daughter and she was all over you know we are trained we do our jobs and everything but she was always there you know so it was hard to do your job and it makes it a challenge and she just you know sometimes tells you oh you need to do this and then she gives you instructions and then changes it the next moment so that makes it challenging because you want to work in peace you want to go happy to your job you know especially if your experience you know what you're doing you want them to trust you but they don't really trust you literally looking over your shoulder

Yeah. So that makes it challenging. And sometimes just family turmoils. The siblings don't get along. Some people want different things for their parents. The others want different things. And they don't get along so their parents go confused. They're like, so who am I going to follow here? And then as a caregiver, that makes it challenging. Because you go inside a job and then you're like, okay, so who are my bosses here? Who do I listen to here? Is it the client they take care of or the children that are two sides telling me what to do? Who do you listen to? to my client and to honor so if i almost call honor and my care managers if there's anything like that that happens and i feel uncomfortable i make them deal with the family members and they're the ones that call and you know say hey the caregiver saying that this and this and if they really like you they'll try to mend things a little bit because they don't want to lose you because they know that they can trust you to take care of their parents but you need to talk to them one thing that we find is, you know, honor's platform is great for noticing, like, look, this family member called

and said a care pro is late, but they weren't late because we're tracking the GPS chip. Yes, we have the app. So you cannot clock in or clock out unless you're in the premises of the client. And so why would the families say they're late if they're on time? Probably what happened is the mom or dad told their son or daughter that the care pro is late, and probably that person has dementia. Or actually, we've discovered that it's a good way to find out when people are slipping into dementia. So, like, no one knew. And then they kind of tell their kids, hey, you know, Samantha was late.

And it's like, well, she wasn't. And it happens too often. You know, my grandmother had dementia at the end. And I was living with her in New York as I was going to school there. And convincing my father that that was the case because she would answer the phone to talk to him. And she was, you know, like that was her. She would say, okay, I'm going to get my best five minutes in right now. and she would be sharp, witty, interesting, this and that and the other.

And then the next thing, you know, she would watch the same news program like six times in a row. And I'm like, no, grandma's slipping. Oh, no, no, grandma's fine. And so it is a confusing situation. I had a client that actually said I wasn't there. When her family called, she said, nobody's here. And I'm like, well, I'm right here. And so they hear me over the phone.

And then they say, oh, Samantha, we're glad. We know you're there. You know, because they know that they hire you and they know that you're supposed to be there. But when they talk sometimes, they're like as if nobody's there, like they're on their own. And that's their part of, you know, wanting to do things by themselves, you know, because, you know, they've lived all their life being independent. You live here in America. You have no help.

You do everything for yourself. And then now you start to accept help from other people. That's kind of like a challenge for them. How are families responded to that, though, when there's a recognition that their love when it's slipping into dementia and when they weren't even aware? So there's a saying the customer is always right. and so when you don't have the data you assume the customer is always right

and you say to the family I'm so so sorry we'll make sure that that care pro is not late again but when you have the data it's so powerful because it helps the family you're able to say you know what you're not right but that helps because now you recognize

that your mom has a new need and so we actually have a process around what we call re-evaluation where we have a customer we're serving them with a certain care plan. And then we learn some stuff. Either, you know, care pros report something that happens in the home or the family report something or our partner report something.

And so then we will reevaluate their customer because people actually do sometimes in honor really do not get better, right? Someone had a knee replaced, a hip replaced, they need this for a little while, and then they get better. But sometimes people, you know, progressively have more needs. And so if honor can use our data to both kind of protect care pros and treat them justly at the same time

that we help the family understand the real state of how mom is doing and then provide better care for mom as a result, everybody actually wins. It might be hard in the moment, but everybody wins. So Samantha, how did you feel like shifting from the old model to the new model? They make it very easy, you know, for everyone to use,

obviously. My prior agencies, they didn't have the app so you wouldn't know what jobs you have there. So basically you're at home waiting for a call to have a job with the prior agencies, they would call you like a million times. And sometimes you tell them, I'm not available, and then they still call you. And I'm like, I just told you guys, I'm not available today. Aside from the communication was always, you know, all over the place, there was no consistency of jobs.

Here it gives you like a sense like, oh, okay, I don't have a job today, but I'll check the app. And if they have other shifts, then you have to make a little bit of a sacrifice to take some shifts, but at least you know you're going to earn something while you're waiting for something that you're looking for. That's one thing that caregivers like to know. Am I going to have a job tomorrow? That's very important, especially in the field that you're dealing with life

because you never know. One of the design points when we were thinking about the app that CarePos use is we wanted to make sure it showed them that there was always more work. Because there's this underlying stress. It is. Like sometimes I have clients that you know are already on hospice. So basically you know what hospice.

It's pilot of care. You already know that at some point they're going to go. But you don't look at it that way if you know that it's okay. I'm going to stay here until this happens because this is my job right now and my loyalties towards my clients and being there for them in the hardest times of their life and being a support to the family. And then after that, you know that honors got your back. They're going to give you another patient.

Even if you love taking care of people, like the job structure is so bad, Do you think that more people will want to go into and stay in the field? So I think there are two things that we measure that kind of show that. One is just how happy are care pros? And so the net promoter score, which is how likely are they to recommend something a good friend. So our net promoter score is about twice the net promoter score of Google employees. The second thing that we really focus on is what is the churn or what's the retention of cure pros? So this is crazy, but in home care today, on average, it's 82% churn a year.

So that means only 18% of care pros on average will stay for a year with an agency. And at honor, two-thirds of our care pros are what we call optimized. They're like in a market where we have enough work, we're dense enough, et cetera. And their churn is 32%. And what do you credit that difference to? Like, people will churn, so you can literally decipher mile by mile in a given city. Like, if Samantha lives in one place and a customer lives in another place, what is that person's likelihood of churning mile by mile in a 30-day period?

So the increasing satisfaction then literally becomes density of the network? One thing's density, but, like, another thing, people have shadow schedules. So if you schedule someone for kind of a long-term assignment in a, shadow schedule, which is when they don't actually really want to work, then they will not stick and they'll churn because it's not good for them. Another thing is, like, if someone is not, let's say, well dementia trained in a home with someone with dementia, other than a bad customer experience, like the care pro does not like that because they know they're not doing a great job. They don't feel good. They feel bad. And so they turn. So it's all of this

stuff kind of mixed together that then drives this really low turn rate that we have. And that, I think, is, like, super critical. And to that end, like, what do you do? How do you approach training for care pros? So there's training when people start. There's annual recurrent training. And then we've built training material into the app on a website and literally just even in the use of the app.

So it's even little stuff. Like, one thing we found early on is, oh, my God, so many people are, like, checking in when they're not at the homes. But you cannot say to everybody, hey, like, you're fired, right? It was clear the industry just structurally did this. So it became a cultural norm. We intentionally did this in a very specific way. If you try to check in when you're not yet at the home, we don't say you can't check in.

We say it looks like you're not at the home. Are you sure you want to check in? And that's training. Yeah, yeah. So you build it in. Yeah. Right? You build the culture.

You build the culture into the app. We work to treat the care pros as true professionals. And what true professionals get is, here's what's expected of you. Here are tools to help you do that. Here's training to help you do that. And we'll put you in the right environment where you are uniquely suited to succeed and then tell you how you're doing and then rewards or consequences. And Samantha, what kind of training do the other agencies provide?

So I actually used to train a lot of care professionals for an agency that I used to work. and basically they hire you but the first two years you need to have experience already like working in another agency but not taking care of a family member because sometimes they use that as experience like oh I took care of my grandmother I took care of my son I took care of anybody that's ill no and then we have a whole list of policies that you need to follow what are the things that you can't say and all that so we run down different trainings some agencies also provide different online trainings so like you watch a video and then at the end of the video they score you and then they give you

a certificate for that. So it's not always physical training, but you do every year. You have to do at least, I think there's 10 prerequisite trainings that you have to do every year to continue your caregiving. Just keep your license and all that, right? And then so we train them based on what they feel they're locking. Safety is very, very important when you're doing this type of job. So yeah, we train them from safety precautions and transferring and how to be polite to even just proper hand washing. Thank you so much for being here, Seth and Samantha. Thank you so much for sharing and for creating a platform to help health care providers get work, but also help families get the, you know, the type of quality care that they need. And thank you, Samantha, for doing the most noble work

that there is. You know, we're all owe a debt to you and your colleagues. Thank you very much. And thank you for having me. Thank you. Awesome. Thanks, Samantha. Thank you, y'all.