Home Care U - A Deep-Dive Into Territory Analysis & Optimization (Julio Briones Pt. 2)

Episode Date: February 27, 2024

You're almost certainly not taking full advantage of the local opportunities for referral marketing and recruitment within a few miles of your office. Julio Briones, CEO of Briones Home Care Consulting, is here to talk about why—and how to fix that.Enjoying the show? Send me a text and let me know!Learn more about Careswitch at: careswitch.comConnect with the host on LinkedIn: Miriam Allred This episode was produced by parkerkane.co

Hey, welcome to Home Care U, a podcast made by the team at Care Switch. Nobody went to school to learn how to run a home care agency, so we're bringing the education to you. Join our live audience by going to careswitch.com slash homecareu or listen on your own time wherever you get your podcasts. Home Care U is hosted by myself, Miriam Allred, and Connor Koons of Care Switch. Enjoy the session. Welcome to Home Care U is hosted by myself, Miriam Allred, and Connor Koons of CareSwitch. Enjoy the session. Welcome to Home Care U.

I'm excited for this week's episode with returning guest, Julio Briones. Welcome back to the show, Julio. Thanks for having me on. Always a pleasure to be here. This will be a really good one for those who listened to last week's. We talked about how to make a 12-month strategic plan for your agency. And what we found is that a bunch of the most interesting points of that discussion kept kind of bumping up against stuff we wanted to talk about this week. So this

week we'll be discussing market research, analyzing and optimizing your territory from the perspective of if you are a franchisee and you're looking to purchase adjacent territory, if you maybe are hoping to get into home care through means of an acquisition, or if you're hoping to expand into an area that you don't have any footprint in yet. What we're going to be talking about today is all the research and things that you can do to identify the growth potential in that area, see the strengths and weaknesses that you might have as you enter it, and then make a plan that is specifically built around those strengths and weaknesses.

You identify the advantages and disadvantages in the area, And Julio is the guy to talk about that. So before we dive into that, if you just want to give maybe a brief recap of your background, your journey in home care, how you got to be here today. Yeah, well, my name is Julio Bronis. I'm the senior strategist with Briones Consulting Group. I've been doing home care since I was about 15. So for the last 30 years off and on for almost 20 years consecutively. If you name it in home care, I've done it. Everything except change adult diapers. I've pretty much been there throughout the process.

And my career has led me through a number of interesting paths from being a care coordinator, scheduler, recruiter, into the world of business development, and ultimately into the world of franchising as being the architect behind the support system for a larger franchise that ultimately got sold to VC. Since 2015, I've been an independent consultant and trying to figure out ways to make home care agency owners as much money as they can make while maintaining a proper balance in their life. Awesome. Well, thanks for sharing your expertise and experience with us. Let's dive in. So my first question, before we get into the really nitty gritty stuff, maybe at like a high level, if you can explain what steps you would take to do this research and what your objectives would be in doing it. So this is a multi-prong

question. Okay. So it's really going to depend on what the situation is and where you're looking at to actually find yourself in a position to analyze your territory. Are you trying to buy an agency? Are you looking into the viability of that purchase? Are you a franchisee trying to expand, or are you just curious to see where you kind of want to fit in because you want to open the territory, right? So, these are the different reasons and what you're going to look at when all of this comes about. So, like, for example, in all instances, you're going to take a look at some really basic information. You need to know what is the breakdown of the population by age groups. Why is that important? Well, there's three elements that are needed to find a client. And we're going to get into a little bit as to what makes an ideal client down the road in this

conversation. But there's three basic elements. You have to have people that are the right age, that have the right amount of resources to make sure that your services, they can take on your services, and they have to have the right amount of either illness or injury in order to justify doing this. When we're looking at the demographics, we want to make sure let's start with age. 65 is the number everybody throws around. And just insider secret here, most people that throw around 65 and older as an age, 10,000 people every day turn 65 in North America. Fantastic stat. The reality is, unless you're selling Medicare supplemental plans, that number is pretty useless to home care. Because let's think about this.

I'm 47. My parents are in their 70s. When they were 65, they did not need home care. If I would have suggested to my parents at 65 that they needed home care, I would have had a shoe thrown at me. I mean, it's just one of those things. So we need to know what the reality is. And just in my years of doing this, I have found that the magic number is 75. It's actually 72, but 75 is what works for most demographic software. Okay. That being said, your average footprint in any given territory should have about 13 to 20% of people over the age of 75.

That's one of the stats that we need to look for. If we find a place and we do the numbers, we look at the overall population and we see that it's under 13%, not saying it's a dud, just understand this may not be the ideal location. The next thing we're going to look at is very dependent on what type of business you're running and what it is that we're looking for. That's household income. So if you take the median household income, just do a quick Google search. Google is our friend. And type in median household income, X county. Whatever that county number is, we're looking for private pay above 40% above the median household income.

Remember, median is not average. It's the number smack in the middle. So we want to know what is 40% above the median household income. That will give us a number, generally speaking, where people have enough resources to afford a certain amount of hours through your business with your agency, but not so much money that they can say, I'm going to stop working and I'm just going to take care of mom myself. Right. It's that sweet spot. You know, the ideal range is 40 to 60%. Okay. Now, if we're doing Medicaid, we want to go in the opposite direction. We want to look for somewhere roughly 40% under the median household income. Now, keep in mind when we're looking at this number that there's a few outlying factors.

There's always variables that we're looking at here. If you are, for example, in an area that is just generally poor, like you know the entire county is well below the poverty level of the United States, that number is meaningless to you. There's going to be pockets of places, but if you're doing private pay, you're not going to hit the targets. So those are things to consider. The other thing that we're going to take a look at is where our caregivers live when it comes to the area. And again, let's take a look at the age distribution. If we're looking for caregivers that work the Medicaid service, we want to look for a different demographic set

than if we're looking for caregivers in the private pay space. And this is something that trips people up all the time. Most agency owners, this is what they think. I need caregivers. Hard stop. I need caregivers. They don't sit there and they don't think about the caregivers that are going to work the clients, how many of these caregivers are actually going to show up. They don't understand the dependability of these caregivers. Now, this is where demographics becomes your friend. And we're going to get into it a little bit more in detail down in the conversation, but just because when we start building the profile, but just a couple of things to keep in mind here. Generally speaking, and

before everybody starts leaving comments or anything and starts killing the messenger here, generally speaking, there's always exceptions to every rule. The majority of your caregivers are female. The majority of your caregivers tend to be single mothers. So taking into account age is very important, whether you're providing private pay service or Medicaid service. And it has nothing to do with discrimination or bias or anything like that. What it has to do with is the dependability and availability of the individual you're expecting to work. Younger women with younger children tend to be less dependable when they're single mothers because they don't have a lot of a support group that can pick up the child if the child were to get sick or if you need to cover

last minute cases. So when the children are a little bit on the older side, 10, 9, 10, 11, 12 years old, they are in school more stable. They have a less likelihood of getting sick. They have a less likelihood of a lot of other stuff going on in the household. And that's the real big difference with dependability. So if you have a bunch of caregivers that are 18, 19, 20, 21 years old, you have, again, statistically a higher likelihood that if they have children, they're going to have children that are newborn to three years old. Okay. And so if you're looking for caregivers that are going to be a little bit more dependable,

reliable and everything else, you definitely want to start looking for caregivers in the upper age groups, 35, 40, you know. I have found that there's other things to keep in mind, but I have found that the ideal target age group is 45 to 54 years old. They tend to have higher rates of reliability, less call-outs, less no-shows. They tend to be looking at even work as a caregiver as a way towards upward mobility. There's a lot more stability in the finances of the home. And that means you're not necessarily going to find them in the same neighborhoods as you're going to find the caregivers that are on the younger end of the spectrum. The next big thing that we're going to look for in all of this is homes that have at least one resident who is 65 years or older. This is more for caregivers than it is for clients because a lot of times family caregivers are overlooked.

If I'm already taking care of mom, I'm experienced. I may not have the licensing and everything else. So as an agency owner, if I was really in a situation where I felt that I'm falling for the myth of a caregiver shortage, when that comes into play, understanding that there are communities of caregivers, it's going to expand our potential employee pool. And it's just going to be a matter of reaching the community and targeting the community in a particular way to be able to convert these at-home caregivers into possible employees. And another part of when I do a demographic analysis is I like to look for homes with retirement income or with social security income. On the higher end, when we're looking for private pay and homes that have people in it who are on some sort of public assistance, if I was doing Medicaid. It's also a metric that I will use

for private pay if I'm looking for caregivers, communities that have a lot of these factors in play. Just understanding both of them, both ends of the spectrum there. Awesome. Let me kind of stop really quick here and address a couple things and recap a few things. So we'll get into this, but I can already hear the questions people have of like how exactly you're doing this and like what software you're using and everything um so to address that uh we had already talked before the beginning of this episode so there's a list of sites that you can kind of do a lot of this uh without having to pay a lot or like without having someone who's an expert in this we will post the list of those sites that Julio suggests in the show notes for this episode.

Now, that being said, my understanding is that you have software that you purchased that like will let you do this really, really in depth, right? Yeah, you can do this all yourself. There's a couple of websites you can go to. You can get census data and comb through hundreds of Excel files. It's a lot of fun, believe me, about as much fun as having a tooth pulled with no cane. But to save yourself some headache, you can actually use Google Maps as a great tool in order to look at this. Now, there are ways, if you can do a quick YouTube search on how

to use Google Maps for route planning. Okay, because you can actually make custom Google Maps by, if you're on a desktop, if you're familiar with how to do it, it's not terribly difficult to find, but it is a great tool to use. There's this website that will really early on in my career that I used to use. It's called maps, zip code.com. You can go on there and it'll allow you to compare three zip codes or four zip codes at a time. And you can actually see some of the data points that I'm talking about. Not all of them. Look,

the fact is you're not going to find a whole lot of stuff for free out there. You know, because some of this data, just as a company that purchases this data regularly, it can get very, very costly, okay, to maintain, you know, the quarterly data sets. Another set of tools that I look for, which actually brings me to something we'll talk about later on, that's the Genworth cost of care website. You can go in there and find out kind of what the average cost of care is. Let me give a bit of a disclaimer with them that they don't provide on their website. They're taking an aggregate. So they are combining the Medicaid rates with average private pay rates. So if you see in your area that they're trying to say that it's $28 an hour and you know very well that you're charging $45, don't panic.

It's an aggregate. They're not. They're adding it all together and taking one big average. And the Medicaid rates in some areas are so abysmal that they drop the overall. And this is what they're looking at. If someone did want to use the same software as you are using or the databases, what is it called?

Well, okay. I personally use Maptiva. It's one of the more affordable ones out there. And they do offer a lot of data bundles. For most home care agencies, it's really an expense that's not worthwhile. But especially if you're a multi-unit owner, it's definitely worth the investment because you should be doing a data analysis at a minimum every other year, if not annually. Populations shift all the time. And you got to see, especially over the last three years,

COVID did a number on a lot of areas. A lot of the politics caused a lot of people to move from one place to another. And older people may stay in your area and their kids may move to another state that's more tax friendly. There's a lot of implications there. So understanding the shifts over the last two, three, four years in any given area is going to help you tremendously understand what's going on in your business. You may have noticed that pre-COVID, this is a question I get a lot, pre-COVID, you might be doing $6, $7 million a year. All of a sudden, revenue has been dropping and dropping and dropping no matter what you're doing to try to keep it up. A lot of times, the answer is simply people moved away. People may not live in the same areas you thought, or the overall

income levels may not be what they were in 2018, 2019. So being able to understand all of this may help you better strategize. And this last one, it's BatchGeo. This is the last website I'm going to talk about here for now. I have a couple others that we'll talk about as we go along on the explanation. But it's going to give you commute times in major cities. So if you understand what the average commute is in an area, and it'll help you better understand why your caregivers aren't showing up to work. If average commute time is 20 minutes and you're asking your caregiver to go 35 minutes, that might be why they're not showing up.

You know, so those are some of the, some of the links, but, um, MAPTIVA for my purposes, I like it because they, they allow you to create multi-layer analysis of any data so you can look have you know based on population based on income based on age and you can really do serious in-depth analysis on any area okay cool and like i mentioned we'll put those in the show notes too so that you can just like find them there more easily let's there kind of are three sections to this that you touched on so there's like the demographic analysis then there is like the client profile specifically of like finding what is the ideal client in your area to be marketing to um and then there's the caregiver side of all this so let's go back to the demographic stuff first.

So you had mentioned, generally speaking, the percentage of the population that is 75 or over is generally going to land between 13 and 20%. You said? Yeah, generally. I like having that range. Let's say that I'm looking it up and it looks to be no higher than 10%. How concerned should I be? And would that necessitate thinking about this differently or adopting a different strategy? How would you go about thinking about that? If the population was, let's say, 8% to 10%, because there are some pockets in the country that are much younger generally. And now we're going to have to, we can't look at it as an isolated thing. All right. Is that 10% in an area that is ideal for the payer source? So if our focus is on the Medicaid market, does that 10% live in areas that are generally 20 to 40% below median household income? And the same thing, the opposite.

Are we looking at places that are 40% above the median household income? The other thing that we got to look at, and this is something I mentioned briefly in the beginning, remember, they got to be old enough. They have to be able to pay for services on one way or the other, whether it's Medicaid or private pay, and they have to have the right combination of illness or injury. Okay, that's the third element here. And at this point, what we're going to do is take a look at where the hospitals are, because everything begins with a hospital. Even if you're not actively marketing to a hospital, you have to understand where hospitals fall in the big picture of a territory. So in

most urban areas, a person, you drop a map, a pin on a map in any urban area, and you will find that it is within four miles of your average hospital. On average, it's within four miles of a hospital. In the suburbs, that number is about 6.2 miles. And in rural areas, it's roughly 10.5 miles, give or take, give or take a few feet here and there. This is kind of where the analysis gets much more in-depth. So if we are looking at an area that has a low percentage of people that are in the ideal age group, but they do have the majority of that percentage is in the right zone for payer source. The next thing we're going to take a look at is where is it that they are going?

Okay. So if you go to the American Hospital Directory, ahd.com, and the link will be in the show notes. All right. You can actually look up the hospital profiles for most people for most areas. Okay. Now, not every single hospital is listed for a number of reasons because sometimes they have licensing and, you know, the name may not match up because of the way corporate structures work. But I have found over the years, the majority of the hospitals are there. And if not, you can always go straight to the source, which is cms.gov.

And you can dig through all of their information there. But the easy way is American Hospital Directory. And what we're going to look at is a couple of things. Number one, we're going to take a look at what are the specializations that, so what are people coming to that hospital for? Now, all hospitals will have a high percentage of admissions or people visiting that deal with general medicine. We don't care too much about that. We want to take a look at what is their utilization for cardiac issues? What's their utilization for neurological issues? What's their utilization for orthopedics? Things like that, the common things, broken leg, broken hip, broken femur, heart attack, all the stuff that we wish never happens to our own loved ones.

But as a business, we rely on other people experiencing in order for us to have clients that we can service. Okay, now that's the one thing. The next thing we're going to take a look at is if you use American Hospital Directory, it will give you the three primary discharge zip codes. So now you're armed with demographic data and you're armed with the three zip codes that are most likely to have people discharging to. Now, that doesn't mean that the skilled nursing facility, if they're going to one, that it doesn't fall in the right zip code or no, that's not it. This is where the people live. Okay. So now you can have a good idea that we have the right age.

We have the right payer source are now by looking at the hospital data. We can understand if the right amount of injuries or illnesses exist. And then if we're going to really, really hone in and take a look at where, you know, where our potential clients are going, now we're going to take it a step further and we're going to look for skilled nursing facilities using Google Maps to take a look at where in relation to the hospital are the post-acute and sub-acute facilities. You know, your skilled nursing and rehabs that people go and stay there for a few days instead of the ones that they come in and they go there because they sprained a wrist. All right, so these inpatient short-term rehabs, typically speaking,

hospitals feed skilled nursing. So the acute facility, which is your hospital, will feed your subacute and your post-acute facility, which are typically your skilled nursing and rehabs, the places that are short-term inpatient. And more often than not, it goes by distance. The hospital will generally have their own facility, someplace that they own or manage or have a direct relationship with, within a couple hundred feet to up to two miles from the actual hospital. All right. And the further out, the further away from

the hospital, you know, the less a feeder source that hospital is. That's just generally how the process works. So, if I understand, if I'm looking at the map, and I know that this hospital specializes in or has a high percentage of utilization for orthopedic surgery, then I see that within a quarter mile, there is XYZ skilled nursing. Now I'm going to go visit another website. This website is snfdata.com. And again, if the information that you are looking for, the specific facility is not listed on that website, please don't shoot me.

I didn't make the website. Go to cms.gov and you can do your research. Okay. Now, what you're looking for there is a couple of things. Number of beds and the amount of days that those beds are occupied. So that's going to tell you a couple of things. One, we have the right zip code. The people are there.

Even the 10%. it's much lower than what we would like to see. But that 10%, let's say 8% are in that zip code. They're visiting a particular hospital that's within the zone of where they live, and that hospital is discharging a lot to those areas. So we know that's where our clients are. We're taking a look at the utilization. So we understand that XYZ skilled nursing is the facility that has the highest likelihood of being fed by that hospital. And we happen to see that they have 80 beds

and out of those 80 beds, they have an average utilization rate of 20 days. So that tells me that every 20 days, we can expect all 80 beds to have flipped out, depending on the date that the bed was occupied. So roughly speaking, we can now say, this is how we're going to build our marketing campaign. And this is how we're going to build our messaging. We know the conditions in the area. We know where the clients are.

We know the facilities they're visiting. Surrounding these facilities are all the support facilities, the home health, the hospice, the attorneys, the doctor's offices. And this is how this data analysis can help your business grow from a client perspective. And the same thing works with Medicaid. It's just a matter of changing where you're starting your process. Your income levels go one way or the other. I hope everyone's paying attention because there will be a test on all this at the end.

Yes. The test will be on December 31st when you're closing out your books for the year. Exactly. Do you mind sharing some examples of how your decision-making might look different depending on what you find as you're doing that research? Okay. So if I was a brand new agency, okay, and I was just starting out exploring the whole process. And this is something that I'm going to say probably about 15-20% of the calls that I get are

people in this phase. And what we're going to do is I'm going to have an idea as to where I want to open. I'll use where I'm at. I want to open here in Indiana. I know I need that the money is in, let's just say Carmel, because that's a pretty wealthy area near here.

All right. So I know I want to get clients from there. So the first thing we're going to do is we're going to take a look at where the people are, where the caregivers are in relation. And let's just say I am dead set on opening my office on the far east side of Indianapolis for whatever god awful reason. I'm going to take a look at that and I'm going to say, okay, is this really the ideal place? So a couple of things that I'm going to take into consideration or when, you know, or if I'm going to advise somebody on, you know, what's going on here is take a look at where everything is in relation before you make a decision as to the actual pinpoint of the, of where the office is. You know, understand what type of a business you want to have. Understand that what type of service you want to offer. Meaning, are you trying to implement just hourly standard, you know, personal care? Are you trying to implement concierge service? Are you trying to be a Medicaid agency? You know, what? I'll take a look. Let's take a look at some of the verticals. Are we trying to put in live-in care? What is it that we're trying to do to, one, generate revenue, and two, to distinguish ourselves

from other agencies? Now, the other thing that we're really going to want to take into account is where do the caregivers live? Because in most instances, a client is not going to walk in off the street. They're not wheeling themselves into your office and saying, oh, look, I just had a hip replacement. Can you please come and take care of me? They're calling you on the phone or the family is. They're not really actively walking into your office. So you're going to have to look at what's going to be easiest for the caregivers to get to your office should there be an issue. Caregivers may not always walk into the office, especially since COVID and everything else. A lot of people have moved to a primarily virtual situation.

But if you want to have good retention, then that means you're going to have to, at some point or another, interact with your caregiver as a human being. So it makes it much easier for your caregivers to show up to the office. And that's really where your focus is going to be. A couple of other considerations I'm going to have is the big three issues. Like I said, and I'll say this probably a number of times more before we're finished. They have to be old enough. they have to be sick enough, and they have to be able to pay. So if I'm finding that there are not a huge amount of that combination in my area, that's something that's going to throw up a big red flag for me. If I do have the right population base in the general 20 mile radius from where my office is going to be located, then great. But if all the people in the right age group are in the wrong income areas, then that may not be the best place for me. You know, that area may not be viable for me.

You know, so these are all little things when it comes specifically to territory analysis that I'm going to take a look at. Now, if I was opening a franchise, that's much easier, but the concept works the same. You have to know what your intent is. So I'll give an example of a client that I had not so long ago, maybe early last year. They're franchisee of one of the bigger franchise systems out there. I didn't get permission to talk about them ahead of time, so I'm not going to go into details of which franchise it was, but they were in an office that was primarily focused on the Medicaid space. They're very successful, doing a few million dollars in the Medicaid space.

They wanted to explore and move into the private pay space, and there were a couple of territories available around them. Now, the territory they were in was ideally suited for Medicaid. Very little possibility for anything beyond that. It's just where they're situated. It was not great for private pay. So we had to sit and take a look based on the data that was given by the franchisor and start analyzing and taking a look at other stuff to see which of the available territories were better suited for private pay so they can establish a second office there. And these are the things that you're going to take a look at. So if you

have a lot more flexibility when you're doing it on your own versus a franchise, because, you know, the franchise, they pick, they tell you what's available as opposed to you picking, but the same things have to be considered overall. What's your, what's your vertical, what services are you specifically trying to offer and where do your caregivers live in relation? How easy is it going to be for you to operate? Something that you've referenced here and there is like the role of looking at your competition in the area. What should that look like in this process? And how much weight should that have on your decision making? Contrary to popular belief, okay? This is one of the few industries where you want to see a lot of competitors. Okay. And I know there's people listening right now screaming at their radio or if they're watching this live, they're going, this guy's crazy.

Something's wrong with him. No, the fact is this. Business is service businesses are going to go to areas and they're going to flourish in areas where there's a lot of need. Okay. Now, there are other considerations. Now, that doesn't mean, like, for example, if I were to look in Maricopa County in Arizona, there's like 200 agencies listed there because there's no licensing requirement, which means absolutely anybody that feels like it is going to open up an agency. I could open up Julio's agency today and John's agency tomorrow just because I screwed up with Julio's agency.

It's not going to make a difference. All right. So, and take that into account and take into account at that point, what you're going to do is take a look at how much serious competition there is. Or if you're in a state that's more regulated, then then the level of competition, you actually want to see a lot of it. OK, depending on the size of the population percentages and things of that nature. So roughly, you want to take a look at, in a given area, if you're hitting that number between 13% and 20%, let's just take a national average of 18%, all right, so of people over 75, and you see it should be roughly one agency per thousand people in the ideal age group for private pay. For Medicaid, that number is actually a little bit bigger.

It's like per 1,500. So the reason for it is the way that businesses are structured. Look, you could be the absolute best agency in the world. You're not, in private pay especially, you're not taking care of 2,000 clients. Like, it's just not going to happen. So, that's kind of where your judgment is going to come in from. You know, it used to be about 80% of all the population in a given area would go for agency care. Now, because of the rising costs of labor, agencies have gotten a lot more competitive because a smaller pool.

I believe, if I'm not mistaken, Home Care Pulse last year said to roughly 20% are using agency now because of all the shifts in the in the economy so this is this is something that you want to take a look at should it scare you away i i i've never let it scare me away um i've worked with a lot of agencies over the years i've seen i've successfully opened in agencies with clients and worked with agencies that have been able to flourish where there's one area in New Jersey where you have very literally on the same block, 40 agencies. They're just lined up one next to the other and you could still flourish. I had a client there that by the time we were all said and done, the agency was doing almost nine mil a year. So, I mean, it doesn't make a difference.

What really makes the difference is how capable are you of providing the service that's needed in that. Now, what would be a huge red flag is if I'm trying to open a private pay agency and I look in a particular area, 20 miles roughly from where we're trying to open, and I see that there's three agencies, I'm going to wonder why. So at that point, I'm going to put my thinking hat on and I'm going to wonder why. Okay. So at that point, I'm going to put my thinking hat on, I'm going to start calling these agencies. Do you provide private pay? What are your rates? Great. You know, I'm going to mystery shop them. Now, if I see that they just all three agencies in that area are telling me that there's that they don't provide private pay, but everything is, you know, aligns the other way. I'm going to wonder what's going on.

There must be a very high population of people in that area that have hired privately, or they've reached that tipping point where they are too wealthy, and they don't want to bother with an agency. Because when people reach a certain wealth amount, they like to travel, and agencies are very limited geographically. You can only take a caregiver out of state usually three to five days before you lose insurance coverage for them. So that's something that they don't want to deal with. Or then, you know, and if that's the case, you know, that might not be the best idea.

Then you may have to want to look into the regulation and see, is there a certificate of need problem? You know, like some states have that issue, like New York right now has pretty much locked down the new agencies from opening because it's prohibitive because of the certificate of need. You have states, I believe, if I'm not mistaken, Alabama is another state with a certificate of need or Louisiana, one of them. So these are all states that have these issues. So that's kind of where you want to take a look at it. Is it regulatory? Is it because the demographics aren't right? There's too much to look at. But for the most part, I'm more worried about a lack of home care than I am about an excess of home care. That's interesting. A couple questions about that. So you mentioned, if I have this right, that the kind of proper ratio that you should be looking for would be about a thousand people in like the private pay demographic

for each agency or about 1500 people in like the Medicaid demographic for each agency. How did you arrive at that number? Is that something that you learned somewhere or is that one that you have kind of found experience? Yeah, that's just, I mean, I've, I've not seen any studies on it. This is just something that my own research and my own experience because like one of the big things about my consulting practice is that we work with data, you know, but data that I work with is the data my clients provide me first and foremost. So understanding that is what's led me to those numbers. Your average home care agency has a finite capability. And if you're looking at roughly a thousand per, that will support an agency up to about $3 to $5 million very comfortably before expansion becomes a concern. Just because of the number of clients that you're going to need and based on averages

for the number of billable hours per client. And it also provides a demographic where you will have, typically, if you're looking at a thousand per, you should also not run into recruitment issues. We'll talk about recruitment here momentarily. I have very strong opinions on recruitment and retention. Is there anything else along the lines of client profile or demographic research that we should talk about before we shift to talking about the caregiver side of things in our last 20 minutes or so? No, no. For the most part, demand, you know, once you understand what your area looks like and,

you know, the big takeaway from this, if you take nothing more from all my ramblings for the last 40 minutes or so, understand that your population in the area you're choosing has to be old enough, sick enough, and able to pay. That's all. Any one of those elements are missing or underserved, you're going to struggle in your business from a client perspective. There's a lot of other factors that go involved in this. Technique has something to do with it, but just from a purely demographic point of view, as long as you are achieving these numbers, 13% to 18%, 75+, 40% above or below median household income, depending on your business model, and the proper amount of discharges based on hospital admission rates and hospital utilization, that should give you a really solid idea as to your likelihood of success, not your actual success.

There's a lot of factors. And please understand that there's a whole lot more that goes into this beyond understanding the data. Love it. Let's talk about caregivers. So before anything else, I'm just going to make half of the people listening to this very upset. There is no caregiver shortage, period. End of story. If you are struggling with caregivers, yes. Well, here's the thing. Let's take a look at this not from a fear-mongering perspective, because this is where, look, everyone has a business

and everybody's out there to make money. Let's just call it what it is. I'm in business to make money. As a home care agency owner, you're out there to make money. And that in turn means that one of the fastest ways to make money is fear mongering. Let's create scarcity. So this is what it is. The fact is this, before the existence of home care as a service, people took care of their loved ones.

There are caregivers everywhere. If you look at your own roster, here's a free tip. If you want to figure it out, believe it yourself, put out an ad on Indeed. How many applicants are you going to have? I'm not asking how many are going to show up, how many are going to actually apply for your job. How many are going to apply? If you're seeing large volumes of applicants that have not worked for you before, guess what? There's no shortage. What's the problem that you're actually having? That's where you have to understand the breakdown. You more than likely do not have a recruitment issue. You have a retention issue. And that's where it comes in. Are you looking for the right caregiver?

Once your right caregiver is in there, are you putting the protocols in place to create an environment that is going to retain your caregivers? From the moment that initial contact is made after the application is submitted, are you fostering a relationship with your caregiver? Fix that, you fixed your recruitment problem. Go through your database. If you've been in operations for a couple of years, take a look at every single caregiver who has been in your system inactive more than six months, less than 24 months, but was not terminated for cause. The ones that fall off, okay? We all know that they exist. Reach out to them. You'll fix your recruitment issue, okay? Not all of them will come back, but you will find that that is probably your richest source of caregivers

that you have available to you without spending a single dime on Indeed and all the money that they ask for the pay-per-click version. And that's all that it comes down to. It's a systems problem, not a lack of caregiver problem. Economy is getting worse. People are trying to go back to work. If you can't hold on to them, that's another problem. And I know everybody's sitting there going, oh, who does he think he is? I do a great job. I have a great relationship with my caregivers. You probably do, but there's something missing. The whole other conversation, and if anybody does reach out, I would love to have this debate with anybody, but the reality is, more often than not, the people who manage your caregivers, your care managers, your schedulers, they're doing something what's called in-group, out-group behavior or clicks.

They have their favorite. Oh, just call Maria. She's my favorite. And by doing that, she's ignoring the rest of your caregivers and they're not being put to work and they're moving on somewhere else. And that's why they ghost you. They're just not taking you seriously. Enough of my rant, though. I just watched two people leave the Zoom room.

Oh, yeah. Again, I know it 10 steps up people when I say these things. But this is just again, look, I've I've worked with well over 100 agencies over the years. And a lot of my calls are, I can't recruit, I'm having a hard time staffing. And, you know, once we do some very simple things, we figure out very quickly, it's a retention problem, not a recruitment problem. Now, as far as demographics goes, okay, let's just bring us back on topic while we have only a few minutes left. So, what we're looking at is, like I mentioned before, you want to, if you're in the private pay space and you want to target, like let's say you want to do a postcard

campaign or something along those lines, okay, you want to target areas that you're going to find high populations or high percentages of females because it's not to be sexist, not that men don't want to do caregiver work, but generally speaking, this is a female-dominated industry. Over 80% of all caregivers tend to be female. So you also want to, if you want to have increased reliability, you want to find females that are under 54, under 55 really, but over 35. The ideal range being 44 to 55. Generally speaking, their kids are older. Many of them are either close to college age or at college age, and that means they have a higher likelihood of wanting to be

upwardly mobile. They don't typically live in that 40% under range. They typically live in 20% under the median household income. Why? Because it's household income. If you have older children that are of adult age, there's a higher likelihood that one or more of them are working, even a part-time job, which brings the household income up, which means that you have an ability to move out of the lower income neighborhoods into maybe lower middle class neighborhoods. And that's where a lot of the times the recruitment campaigns fail. They're looking for all the caregivers out of the same area instead of trying to focus in on where the highest likelihood there will be to find the

right caregiver. Also, when people get older in age, they become more mature. Maturity tends to bring an appreciation or a desire for financial stability and emotional stability, which again means there's a higher likelihood that there will be in some sort of a partnered relationship, meaning household income increases. So they also, most people, when they get to what's considered middle age, you know, 40s or so, late 30s to the 40s, they're looking to buy a home. They're also tend, they have a tendency that when they come into apply, because of, again, the maturity that comes with age, they will tend to be more proud of other achievements they've made. I'm CPR certified, I have BLS, I have phlebotomy, I have a CNA, all of these extra

things, they're not going to be quiet about it, but because they are upwardly mobile. Okay. So again, female, 35 to 54 years old, you want to look for higher median household incomes, not the 40% under, but the 20% range. And they will typically also have an ability to reach your clients more because they tend to live in the neighborhoods that are closer to where your clients will live as opposed to closer to where your Medicaid clients live. And that's, excuse me, and those are the benefits of targeting caregivers demographically. Also, keep in mind, the caregivers that are working in the facilities where you are trying to market to get clients out of, these people are coming from somewhere. And I hear this all the time.

Oh, they're fully staffed at such and such assisted living. Why can't I find? Well, why you can't find them is because you're not targeting them the right way. And a lot of these times, the people that run the recruitment practices for these facilities are targeting the neighborhoods that I just mentioned. All right. So the final website that I got to add it to that list is actually the USPS website, United States Postal Service. You can, yeah, it sounds crazy, but here's what it is. If you go on Canva, you can build your own postcard.

You can have the postcard printed a number of different places. It's giving you free resources to do all of this. Yeah, canva.com. Yeah, sorry. It's an easy graphic. Okay. So yeah. So you can design your own postcard there.

You can go a number of different places, find the best price for you, get these postcards to print it up. And then the post office, you can go on there and they have this program called EDDM, every door delivered mail. Okay. So you can use this demographics to actually send recruitment postcard campaigns to the very specific neighborhoods on specific routes and target people. All right. This way, there's not a lot of guesswork. There's not a lot of wondering, how do I reach out to these people? And the biggest thing you guys are going to thank me for is because I just saved you thousands

of dollars sending out BS campaigns to a bunch of people that are never going to apply. Postcard campaigns, you will spend on average $10,000 to $15,000 to run them multiple times to try to get some sort of a result. But if you do it targeted, you can cut that price of those campaigns by more than 50%. I actually helped a client design a campaign like this that the total cost for two rounds of it was $5,000 and the return on it was almost 40%. And that's phenomenal, phenomenal for any recruitment campaign. Not all results are the same. There is a lot of stuff. It really depends on specific needs. I've got one or two questions, and then we also have a couple from the people listening.

So you have talked in the past about your belief that in choosing the location for your office, the proximity to the caregiver demographic is more important than the client demographic. Talk about that a little bit. Here's the thing. I said, between my time in franchising, between all the clients that I've helped independently, I have seen this over and over again. And I have my own YouTube channel. And I even interviewed a guy that specializes in finding locations before. And it's just a general consensus. While having a pride of

ownership location, meaning that really fancy office or that fancy storefront that has a lot of high traffic visibility, it's great. It feels good. It's really nice. And you may get an occasional client walk in. The fact is, if I'm a caregiver and I need to get to the office and you make it so horribly inconvenient for me, I'm not going to go. And it's going to reduce the availability of caregivers for you. Okay. And again, it's like I mentioned a few minutes ago, it's not a recruitment problem. You'll get the applications. It's a retention issue. So how are you fostering the relationship?

And the office is a big part of it. You know, I'll use a very specific example of a program I put in place with a client a couple of months ago that tremendous result on this. They got into the habit of having the caregivers come in by giving them gloves and a little bag. So every shift that the caregiver works for the agency, once a week they come in and they get two pairs of gloves per shift. They don't have to worry about buying gloves. They don't have to worry about whether the client has gloves in the home. They have them. They also get a little bottle of hand sanitizer. Costs what? Maybe $1, $2 in total for the bag. You're giving them the PPE. Here's where the magic comes in with that

process. The caregiver is coming into the office to pick this up. Somebody is out front to give them that information. They are building a solid relationship with your office. It doesn't matter what happens down the road. You may not have a good volume of clients at the time, But whenever you call that caregiver to come back, they will have a higher likelihood of making themselves available because you've built a relationship with them. They will not feel ignored. If you set it as an overall policy,

this is what's going to happen. Now, as far as location goes, if I have to drive 45 minutes to get to your office, because I live in this neighborhood and you're, you know, in neighborhood A, let's say I'm put into relation. And let's say I live in Newark, New Jersey. And I have to drive 40 minutes through traffic and three buses later to get to, let's say, Teaneck, New Jersey. Right there, that's a significant amount of travel to come in and get a $2 bag just to talk to somebody.

This is where the problem comes in. If I was smart, I would open the office closer to where the character, not in the rough neighborhoods or anything like that, but closer to. So I would pick, in that particular example, let's say Hackensack. Why? Because there's a bus depot there. It's easy access. It's close to highways if somebody is going to drive.

And when the caregiver comes in, I'm going to have like a Keurig machine, maybe some wrapped cakes or something to make them feel homey, to make them feel comfortable sticketing around for an extra 10, 15 minutes so I can converse with them. And that challenging the thoughts on recruitment a little bit and says, I have a caregiver recruitment problem. I have posted with care.com, not happy with them. The local community, college, letters to churches,

all amounted to nothing. Suggestions for what rocks to look under. I know that this is a big question and we can do episodes, you know, on this today's, but in like three minutes, what's your response? Okay. It's a really hard question to answer specifically for you because I don't know where you are. Okay. So that's the one issue. But typical suggestions, underutilized resource is

the unemployment office. That is a resource that's very highly underutilized because most people don't know how to use it. All right. Every unemployment or any unemployment office that's properly run will have a community business liaison. Okay. It's not the person at the front desk that tells you register on the website and fill out the form and then go with it. No, this is somebody in the office whose sole purpose in life is to build relationships with community employers to help them with something called positive recruitment, which is like a sole purpose job fair. They host job fairs. They work with the community colleges, things like that. That's one. Another thing is the traditional schools. And now here's, again, we're going to put this in relation specifically to the demographic analysis. Let's take a look and

let's understand where the target caregivers live and let's look at where our target clients live and let's go grassroots 100 grassroots design a flyer with the little pull tab with your office phone number hiring caregivers you know make it nice make it look good and go into these neighborhoods nail salons hair salons laundromats, supermarkets, coffee shops, anywhere there that they will let you post up this flyer with the pull tab and start actively looking for caregivers on a grassroots basis. Internet, technology, COVID forced us all back into the office and we forgot that we are human beings that crave human contact. Let's get out there and let's remember grassroots is always the best.

Just like the fastest way to grow your business is not buying leads off of a place for mom, fastest way to grow your business is to go out there and build human-to-human relationships. The same thing is going to happen internally with your caregivers. Get out there. Get into the community. Host job fairs. Host open houses. Post these flyers up in any business that would be commonly visited by the target demographic.

This even goes to where your clients live. Your clients like to get their hair done. Your clients like to get their nails done. Your clients go to barbershops. Your clients go to supermarkets. Your clients need laundry done and they don't always have a washing machine or a washing machine will break. So you find these resources in those communities and guess what? Your competitors are taking care of clients in those areas. That means they have caregivers that are actively visiting these areas and a grassroots campaign should fix a big chunk of your problems. Solid response. Thanks. Go ahead and wrap things up. If someone wants to get in touch with you, how can they contact you? Easiest way is you go right onto my website,

www.thebrionesgroup.com. Second easiest way is just type in my name on Facebook or LinkedIn. I'm all over the place on there and just connect with me, send me a chat. I don't have some weird VA on the Philippines answering my direct messages. I actually do answer them myself. And I'm always open to answer a quick question or have a conversation with someone. Awesome. Well, thanks again for joining us and

sharing all the things that you've learned. I'm going to take just a second here before we close out. You know, this is, we are at about 14 months into Home Care U. You know, we've already hit over 20,000 downloads and a lot of fun milestones like that. This was my last episode of Home Care U. I am going to be leaving Care Switch actually probably by the time that this episode airs and taking some personal time before going back to work. I'll probably be staying in the home care space though. I'd really like to. First off, if you're listening to this, just, you know, thank you for supporting Home Care U

and Care Switch. This has been one of the more rewarding things I've done in my career. Seeing how it's helped people constantly hearing from people who love the podcast and are using the things that they learned from it in their businesses. I've met lots of awesome people through it, got into lots of great conversations, learned a ton. And it's just been a really rewarding thing. So I want to thank everyone. As I mentioned, I am hoping to stay in home care. I really love the home care industry. So please reach out to me on LinkedIn. Let's connect. Let's stay in touch. My LinkedIn is in the show notes for the podcast. I would love to meet and talk to more of you. So all that being said, thanks again, Julio,

for joining us today. Thanks everyone for listening and supporting the podcast and have a great rest of your day. Thanks. Thanks for having me on and you'll truly be missed. Reach out to me when you have a chance. I will for sure. Thank you. That's a wrap. This podcast was made by the team at CareSwitch, the first AI powered management software for home care agencies. If you want to automate away the menial of your day to day with AI so that you and your team can focus on giving great care, check us out at careswitch.com.