Home Care U - All The Scheduling Optimization Strategies No One Ever Told You (Brett Ringold Pt. 1)

Episode Date: June 19, 2023

If scheduling is like a Rubik's Cube, Brett Ringold is like that guy you knew in college who could solve it behind his back. Learn his secrets to optimize this very key part of your operations.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 CareSwitch. Enjoy the session. Welcome everyone to Home Care U. I'm Miriam Allred, Head of Partnerships at CareSwitch.

Great to see you all. I hope everyone's having an awesome week and an awesome summer. I don't know about you, but I'm really stoked about this warmer weather and then spending as much time as I can outside. So I hope everyone here is also thriving in these warmer days. A couple things. This is Home Care U, U for University. This is, the concept is nobody went to school to learn how to run a home care agency. So we're here to demystify. We're here to go deep. We're here to talk about things that no one else wants to talk about. So you're in the right place if you've got questions and questions specifically about scheduling, which is today's topic. So without further ado, today we've got Brett Ringel, Vice President of a Long-Term Companion joining us. Brett, you're like my best friend of the industry. I'm stoked to have you on the

podcast. This is like my dream when it's people that I know personally and professionally and love to have here. So thanks for joining us today. That's my pleasure. I've been looking forward to this. I am so excited to be here, not just because you are my best friend in the industry too, but because we always have a lot of fun whenever we get together. And there's always a lot of very important insights that we share. So I'm hoping not only are we going to have a good time and everyone here will have a good time, but we're going to have a lot of takeaways. So thanks, Miriam. Agreed. And everyone here is probably going to feel like your best friend after this, because you're so easy to get along with and you know home care so well, and it's personal to you.

And every time I talk with you or I see you on stage, you know, you're just so personable and everyone can feel that. So I hope everyone joining is also excited to get to know you a little bit today and to learn about all your experience, learn from all your experience in home care. Thank you. So let's start there. Before we jump into the meat and potatoes of the conversation, I want you to talk a little bit about your agency and about your background coming to home care, you know, your personal journey and, you know, your mom starting the agency, just kind of like give us the story behind a long-term companion. Of course. So our agency, a long-term companion, we are located right outside of Philadelphia

in a town called Jenkins town in Montgomery County. We serve clients throughout Pennsylvania and New Jersey, and we were founded back in 2010. It's funny because I still consider myself pretty young in the grand scheme of things. I'm 35 years old, but I've been a home care agency owner and operator for over a third of my life. So I definitely have learned a lot over the years, made plenty of mistakes, but also have learned some really good nuggets and processes along the way that I'm excited to share with everyone. And, you know, as long as I've been an agency operator for, that actually wasn't my first experience. I first learned about home care

from being a patient as a young adult. I was diagnosed with Crohn's disease when I was 12 years old. And, you know, touch wood, I have been in complete full remission for the last 15 plus years. But from age 12 to 19, definitely had some pretty challenging years for my family and I. And, you know, everybody on today's call knows that home care doesn't just touch the care recipient. It's not just the client that receives care and that it impacts. It really touches everyone around them. So as a teenager and then young adult struggling with Crohn's disease and having flare-ups being in and out of the hospital and having home care in my life, that really made an impact on my brother,

my sister, my parents, my extended family. And, you know, Miriam, you said my mom founded a long-term companion. She didn't set out with an idea to start a home care agency back in 2010. She just realized that there was a need for better care for families like us who experienced it firsthand. So my mom, by background, was a preschool teacher for 18 years. She taught twos and fours and her job as a preschool teacher really afforded her the luxury to take time off, take extended leaves whenever I needed her as my caregiver. And in that one experience with a home care agency, we hired a home care agency that was a division of a local hospital. It was a relatively short episode, just a few weeks, but we had very professional caregivers. They were very competent, very trained, very skilled. They just weren't super friendly. And this is a family and a young adult

going through a lot of different challenging times and a smile would have made a difference or, hey, how's your day going? How are you doing today or talking about anything other than clinical clinically, this is what we're doing today. And we had somebody in and out of our house basically every day from the time that I was a patient. So my mom realized, you know, this is not how things should be. She asked me a couple years later, if I wanted to be her partner and start a home care agency. And candidly, I said, Mom, I love you, but I don't know if I could work with you. But I'll support you. I'll be your cheerleader from the sidelines. And very early on, I watched her, non-business background,

not a nurse or professional caregiver by trade. But my mom was going and visiting doctor's offices and hospitals and meeting with potential referral sources and meeting with families who possibly would become clients who needed care, interviewing and hiring the few caregivers that we had when I joined in week three. And when I joined in week three, it was very part-time. I said, I'll start taking the back-end operations off your plate. I'll do billing and payroll. I'll build out some processes and I build a website.

And, you know, long story short, very part time in 2010 turned into full time in a very short period of time. And what I love most about being a home care agency operator is are the caregivers. You know, I love meeting and getting to know the amazing professional caregivers that work on our family. We call them the long-term companion family. I love meeting new families and clients that we serve and we make an impact in their lives. And I also found out that I really enjoyed scheduling.

Scheduling is not easy. It's a challenge. But I looked at it almost as a puzzle where there's a right way to do it. And yeah, it can be tough. But if you if you go through with a plan, and you are sticking with the strategy, you can kind of break through and solve that puzzle. So I know we're friends, and we love getting together. But that's not why I'm here. I'm here to really share those scheduling insights, and you know, hopefully help out the operators that have joined us today. I love that you're teasing the concepts. This is perfect because we're about to get into the

nitty gritty, but thanks for sharing your story. It's like a beautiful story. And I love when people have firsthand home care experience and then they start agencies based off that, like who better to do what you're doing than you who's lived it, breathed it on the recipient side. And now you're on the provider side. So, you know, you know, you, you know, the landscape and you know, you know, the warm and fuzzy, but you also know, you know, the nitty gritty and the details like scheduling, which we're going to get into. And also just say shout out to Michelle, your mom, she is amazing and she's not here, but she's here in spirit. So thanks for sharing a little bit about that. Before we jump

into scheduling, you know, we're going to like dissect scheduling. Brett has got this down to a science and he is here to give us all of his secrets, all of his secret sauce. You know, there's no boundaries here. So he's going to give us all that information. But before we do, you reference, you know, the agency started in 2010. Here we are in 2023. Talk to me a little bit about the demographic of your agency, you know, the payer diversification, locations, roster size, revenue, just kind of give us like a lay of the land so we know where you are at today. Sure. So we are licensed in New Jersey and Pennsylvania, but our main footprint is in the Pennsylvania side, on the Pennsylvania side

of the bridge. Philadelphia and the surrounding four counties, family owned and operated, but we have an amazing professional administration team of schedulers, registered nurses on our wellness team, client coordinators, recruiters and human resources managers. So we've definitely grown professionally and matured as an organization. We're also accredited by the Joint Commission, which is something that we're very excited about. We earned accreditation back in 2019, and that has really helped us tremendously as far as a quality management perspective. But as far as our roster size and client size, we still have about 100 clients, give or take, but we have a very specific niche in that our average client receives over 90 hours of care a week. We know over the years, you know, back in the early days, we would accept

clients who needed care three hours a day or two hours in the morning, two hours in the evening, two days a week, four days a week. We know that a good client for us needs 12, 14, or 24 hours a day. Our referral partners know who is a good client for us and who we're a good agency for. Our current caregiver roster size is about 175. And we're going to talk about that relationship between how many caregivers are on your roster and how many clients you're serving. You really want to pay attention to that at all times. As far as payers, we are a Medicaid waiver provider. The Medicaid waiver program in Pennsylvania is very robust. And we're very fortunate that our leadership in the state at Harrisburg recognizes the

importance of caring for individuals at home rather than in a facility. But with that being said, that only represents about 7% of our payer source. We're a primarily private pay agency. Awesome. You checked all my boxes, but one, and I just want to ask, because I always think it's interesting, what does that translate to in revenue? 100 clients, 175 caregivers, just roughly, what does that look like in annual revenue? Yeah. So we're doing about 85 to 100 to 9,000 billable hours in a given week. Revenue, we're under 10 million, but not by a whole lot. So we're that $5 to $10 million agency. Awesome. And the reason I ask is because,

yeah, like you're sharing, every agency looks a little bit different. So to some 100 clients, that doesn't equal $10 million in revenue. But if you craft your hours right, and you have that right fit client, you know, there's just like a lot of configurations of what agency demographics look like. And so I'm always curious to ask, and I appreciate you being willing to share because I think it's just interesting for people to know, like, what, what will I look like at five or at 10 million or beyond, like, it doesn't look the same for any two agencies. So that's why I ask. Oh, no, there are definitely agencies that have three X the client census, but not as many hours of care per week, or some agencies that just do, you know, 24 hour care. So there is no

right way to be an agency, you just have to know what's right for you, you know, what is right for you and your team and your client base and your referral partner. So exactly. Okay, let's get into scheduling. That's why we've got everyone here today. Thanks, everyone. You know, we've got people joining. So hopefully you kind of caught some of Brett's story. But now we're going to get into today's discussion, which is all things scheduling. So scheduling, be it whatever it is for your agency, a Rubik's Cube, a chessboard, etc. It's complex and you're dealing with a lot of people and a lot of preferences and a lot of schedules and it's just complicated. And so you and your team have built your own process, which is a three-parter, pre-scheduling, scheduling, and post-scheduling, which a lot of agencies probably just focus on that middle bucket of scheduling. but there's a lot that feeds into it and then there's a lot

that takes place after it. So just before we get into the specifics of pre-scheduling, which we're going to start with, talk to me about how this approach was born and what it's helping solve inside of your agency. Sure. No, and that's a great question. It's not something from day one or year one or year two that we established or even really recognize. Usually when you're a newer operator, you're putting out the fire du jour, you're triaging whatever the priority is at that time. So if you have a new client who needs care from Monday to Friday, nine to five, you're trying to stay off that schedule for that new client, but you might not be doing so optimally, or you might not really recognize

what are you doing beforehand, what goes into the changes. And it's not until you have the benefit of, I guess, experience, having a strong team around you, and just being able to step back and really establish processes and standards that you get to really realize, you know, scheduling is the overarching core component that we're talking about today. But it's not just scheduling. There is a pre-scheduling phase, there is a scheduling phase, and then there's a post or rescheduling phase. We really didn't start using that nomenclature until probably about 2015, 2016. We were definitely utilizing some of the strategies that we're going to talk about today before then, but we didn't, I guess, have the mature age to step back and recognize this at the time. But by being able to recognize it, what you're able to do is to break things down to the smallest component and then optimize for each. So I am,

you know, I'm a big analogy guy. I, you know, I've talked about the checkers or chess analogy, but I also more than analogies, I love professional football. I love the Philadelphia Eagles. And if we use the Eagles as an analogy for scheduling, you know, the Eagles are a football team. Yes. But there are parts of the football team. You have the offensive group, you know the eagles are a football team yes but there are parts of the the football team you have the offensive group you have the defensive group you have the special teams the coaching and then so those are the four components of the football team but if you actually dive you could drill deep on each of those so for the offense you have offensive linemen you have running backs quarterbacks wide receivers tight ends and if your offense is struggling you can't just say i want to fix the

offense or i want to be better you say, I want to fix the offense, or I want to be better. You have to find out, is it the offensive line? Is it the scheme? Is it talent? What do we have to do to improve this core component so that we could improve as a team? So by breaking it down into groups and then really double-clicking into the core component, you're able to tweak and optimize. So for us, for scheduling, we have specific facets that are part of the pre-scheduling phase, the scheduling, the rescheduling. On a regular basis, we assess how we're doing in each of these measurables, each of these metrics. And we want to make sure that what we have in place, it's consistent, regardless of the, if we

have double the number of clients that we have today, next year, we still want to be following the same metrics because we've learned that it doesn't matter if you have 50 clients, 70, 95 clients, this is a proven system that works as long as you're able to really focus on each specific part. And you're a testament to, this is essential to scale. There are so many agencies that plateau at that 1 million mark, at that 2 million mark, and at that 3 million mark because they don't dissect their processes and refine them and optimize them to this level of detail that you have. And so you've been able to scale because, yeah, look at like year six, you were like, OK, our scheduling is good. We've got a lot of components, but we need to like systematize and optimize and assign ownership to make sure that this is a repeatable, sustainable process. And then that equates to growth and success because it's systematized and optimize to the maximum. So I just want to reiterate, you know, you have to

dissect your processes to this level if you want to scale, which you so eloquently did and now are seeing the success from that. And I'll just say, not a football fan, but I love the analogy. Forget the room is cute, forget the checkerboard, football, Great analogy. So before we dissect pre-scheduling, the other thing that you have spent a lot of time thinking about as a part of scheduling in the process is the role of the scheduler. And inside of every agency, that person looks a little bit different. Usually, they're good at solving problems and puzzles and think of scheduling like a puzzle. But I'd imagine you've had a lot of schedulers maybe come and go and you've identified who's a good fit for that seat. So who in your mind is a good scheduler and how do you identify

that person or what are some of the traits that you can identify to put someone in that seat? No, and that's an important question. There's no perfect, like you said, there's no perfect kind of agency. There is no unicorn perfect example of a scheduler. Everybody can improve as a scheduler. Some people have innate traits that make them better suited to be a scheduler than others. But there are some core traits that we see as pretty common in all successful schedulers. One is you have to have thick skin, first and foremost. Scheduling, it's not easy. Even if you love the challenge and you love puzzles and looking at it systematically and methodically, you're going to have days where it's not easy. You could be a

scheduler for your agency. If you have 10 or 20 clients, Monday morning, nine o'clock, you're having a cup of coffee. You're looking at your schedule for your agency, and everything's green. It's all scheduled, everything's in place, this is nine o'clock. And by 1030, everything, all bets are off, you know, you've had three call outs, you have new prospective clients calling, and things can change in a drop of a hat. And being able to be thick skinned and composed, realize that, yes, this is happening, but it's probably not the first time something like this has happened. And I'm not going to take it personally. I'm not going to be upset with the client who calls me at 445 on Friday to add overnights or to add weekend shifts,

because that means I'm going to have to work into Friday evening. I'm not going to be upset on Monday morning if my wonderful caregiver I love calls out an hour before the shift, these are things that you have to really expect it. You know, at a certain point, if I have X number of shifts scheduled, there are going to be Y number of schedule changes that are going to occur. So don't take it personally, just be prepared. So thick skin is a very important quality, I'd say. On the other end, kind of complimentary, you have to be empathetic and you have to be empathetic, and you have to be a good communicator. You know, we're not dealing with objects. We as home care agency operators, we're not engineers, we're working with people, we're working with clients,

we're working with their families, with our amazing caregivers. And you have to be able to communicate and relate with everybody who's a stakeholder in your agency. So you could, again, get that call from a client right before you're ready to sign off as a scheduler on a Friday and get frustrated because they're adding shifts on the weekend. But you might not realize that their loved one just fell or just is being discharged from the hospital. Or maybe their daughter who usually comes in is having childcare issues. And it could be seen as a stressor externally, but you have to really empathize with people and realize this could be a really challenging day for them. And my job is to try to make their day as easy and as wonderful as it can be. So empathy, being able to communicate really well and have patience is important because sometimes you're triaging two, three, four different situations at once and you can't get flustered. You have to be able to slow it down a little bit.

You slow down to speed up. So the empathy, the communication, the thick skin, and then the vision. You know, being that we're working usually not with just one caregiver and one client as an agency owner or scheduler, you're working with a number of clients, a number of caregivers. You have to be able to see all of the pieces, recognize that yes, everything looks good now, but there's a chance that I'm going to have a new client tomorrow or the next day, or get a call out tomorrow or the next day. And you have to be able to plan proactively and kind of see five or six steps ahead of time. And that all takes experience. You're not born with those

traits. You might be born to be a good communicator or listener, but you're not really a good visionary all the time. So some are learned, some are innate, but everything could really be improved upon with practice and with processes. You broke that down really well. I like, I can honestly just like imagine this persona that you've just described. And part of why I wanted to touch on this is because a lot of agencies want to promote from within or want to promote a caregiver to an administrative staff role, etc. But I've heard in a lot of cases where, you know, it was this prompt, amazing, great caregiver that wanted to come into the office. Okay, let's test them at scheduling. But they didn't have those attributes and they were trying to fit the person to the seat, not the seat to the person.

And it was just, you know, friction that was created there. And so I think it's important to identify a persona like you've just mentioned and then communicate that up front and find the person that has, you know, maybe 75% of those attributes, but then can learn the rest. But too often, you know, people are trying to put someone in that seat that doesn't really belong. And so on, you know, the owner's side or the administrative staff, you need to define what that persona looks like and then find people that fit that or can grow into that naturally and not force people into it. 100%. I couldn't agree more. And that's something that you see at times, usually a high performer when they're promoted to a new management position, they might not have all the experiences

and what got them there to be a high performer as a high performing caregiver, that might not translate. But with proper coaching, or patience, and knowing that innately, they do have the aptitude to be there with some training with some experience. That's that's really important. So I love your pointing that out. I also want to throw this out to the audience. Are there any other attributes that you have found that your best schedulers have? I'm just curious if there's specific traits or attributes or things that you have identified inside your schedulers that maybe Brett hasn't mentioned or that you want to throw out. So if anyone's willing and not shy, drop some of that in the chat. It would be interesting for us to see and for us to share with one another. While people are doing that,

let's get into pre-scheduling. We've kept everyone in suspense long enough, but we've covered kind of the foundation to tee us up for this. But let's talk through pre-scheduling. You have sent me kind of like the list here, but why don't you like overview the concept of pre-scheduling and then we can kind of dissect each and every point there. But why don't you just speak to like the bigger purpose of the pre-scheduling portion first? I guess it's just preparation. We could go back to the Eagles. You know, you can't show up for Sunday and expect to win without all of the meetings, all of the practices, all of the before the big game day work that goes into it. You know, whether you're talking about somebody playing football as a grade schooler and going through college and maturing as an individual, you still need

coaching. You still need a plan. You still need strategy. I don't really, I'm not concerned. You could be the most talented person in scheduling or whatever it is that you're doing, but without putting in the work beforehand, you're not going to ever reach your highest level of success. So scheduling in order to do it properly, there are some behind the scenes things that you have to do. So pre-scheduling is essentially getting ready for whatever the scheduling puzzle throws at you. Whatever changes are going to happen, you've done the work beforehand. You can anticipate exactly what change is going to happen, but because you know the process that you have to do leading up to it, you're prepared for regardless of whatever's going on. And it's the age old saying of like,

what you put into it, you get out of it. You know, like you said, you can't just expect the schedule to execute as planned. There's all of these initial precursor steps that if you put the legwork in, most likely you're going to have less call outs. So you're going to achieve those outcomes that you desire if you put the work in upfront. And I think that's part of what you're saying here is like you've identified that that extra legwork upfront is worth it in the end. Let's start by talking about like client to caregiver ratio. I think this is an important piece of identifying, you know, you said you have like 175 caregivers to about 100 clients. That ratio looks different inside of every organization. And this is part of like the

scheduling puzzle is how many clients or how many caregivers do I need per client? So speak to this concept. And then if you also don't mind sharing like what your ratio is and how you came up on that ratio for your agency. Absolutely. And like you said, Miriam, it's going to be different, probably not drastically different, but slightly different based upon what your average hours per client is, how many hours per day per week. There are different variables, but what we found for our agency, the proper ratio is just under two professional caregivers for every one client that we're serving. If that ratio, and the reason we didn't, you know, once upon a time, just determine two to one's the right ratio,

we looked back, we, I'm going to share some strategies for what you could be doing today, if you're not really measuring your ratio, and you don't have a complete grasp of what the right ratio for your agency is. But what we started doing is just tracking week to week, and we really found our sweet spot. So just under two to one is right for us because we found that when a ratio is too high, you know, if your ratio is 2.2, 2.3, 2.4 caregivers for every one client, you're going to be able to staff your schedule pretty easily, but you're also going to have higher turnover than necessary. We all know attrition in home care, the caregiver turnover rate is going up. It went up again this year for most agencies industry-wide, and we don't want to add any unnecessary turnover.

So if you're going to have two and a half caregivers on your roster for every one client, you're going to have too many underscheduled caregivers, and thus, you're going to have a lot of extra turnover that could be avoided. On the flip side, if it's too low, we found that if it's 1.6, 1.7, even 1.8 or so, we're able to staff most of our shifts or all of our shifts. It just puts a lot of extra strain on our scheduling team. So for us, we're able to maintain less extra turnover and still have a comfortable balance for our scheduling team by maintaining that just under two to one. And again, if you're not tracking it right now, I'd say this is an easy thing that you could start doing today as an agency owner or scheduler. Just measure every single week, measure the number of clients that you're serving each week, how many caregivers you have on your roster, how many caregivers are actively working, and how many caregivers have left your agency that week. And start talking with your team every single day.

Have a conversation every Monday or every Wednesday. Choose a day, stick to it, and say this week was a very challenging week for scheduling or this week was really easy. We had call outs. We had schedule changes. We had new clients. But we also had four caregivers leave our agency. And I don't know if that had to be so. So you're going to have to keep measuring and you'll land on that number that's right for your agency. And from agency operators that I've talked about with very different type of agencies and different sizes of census and revenue, that 1.8 to 2.2 seems to be the

sweet spot for many. Awesome. A lot of really good information in that response. That's going to be one that people need to go like re-listen to because you pointed out, you know, what people can be tracking today if they're not to identify this ratio. And you mentioned earlier on, you know, you optimize for longer shift durations. So naturally your ratio is, you know, comparable to the shift duration. And if people have a lot shorter shifts, that ratio will look differently, but every single agency has the capability to identify that right fit ratio based off how things are going in their current operation. One thing on that I wanted to ask, do you have minimum minimums, like a shift duration minimum or a weekly minimum of hours?

Yes and no. And that's not a good answer, but I'll explain. Our client service agreement, we do have different, we have a fee structure that says different fees for different types of services. And also part of that is the length of the shift. So if we provide care from zero to five hours, that's one rate. Five to eight is another rate. Eight or higher. And then live-in is a separate rate. So technically, we could provide care for two, three, four hours. And early on, we had some clients that we were serving for six hours a week, for 12

hours a week, two split shifts, two hours a day, five days a week. We really were saying yes to every client and referral source that came to us. Now in practice, we're much more picky because we know who's a good client for us. Our minimum, I actually look back leading up to our call, our minimum in the last couple of months has been eight hours a day, five days a week. And that's actually very high for many agencies. For us, it's actually really low. Like our ideal client that we're a good fit for, they need 12, 14, or 24 hours a day, seven days a week. And our referral partners know that.

Our professional caregivers love it. We tend to authorize more overtime than many other agencies, but that's actually a strategic thing that we do. And it does help with the turnover factor that every agency has to deal with. So yes, in theory, we don't really have a minimum, we can accept the client with two hours a week. But in practice, when we get a call for a client who lives outside of our main footprint, or maybe has shorter hours than we're comfortable with, we'll refer them to another agency that that is really more of their core competency. Awesome. That was a little bit

of a rabbit hole. But thanks for sharing. And thanks for sharing like the evolution and sophistication of your org. Early on, it's yes to everyone and anyone because it's, you know, referrals and you can't say no, but you've learned, you know, who your right fit is. And the result of having these longer shifts, it's beneficial for the client and for the caregiver and for the business. So it's like, you know, checks all the boxes. And I'm sure people listening, you know, that may not be this established or like envious. Of course, I wish I could have more 24-7 cases or more 12-hour cases. And that does exist, you know, but you have to get your agency and your business to that point to support that type of structure,

which you have done. And so I know this is slightly tangential to scheduling, but I think this is an important component to think about how you're structuring your schedules and your hours, because that plays into the client aspect, the caregiver aspect, the scheduling aspect. So kind of reeling us back in a little bit, let's talk about, you know, like the big board, you know, there's this component of pre-scheduling that is quite literally like looking at the schedule, seeing the greens, the reds, that whole element. What does that look like for you? Who owns that board? Who's interacting with that board? And what does the pre-scheduling piece of that board look like? I love sharing information about our big board. If there's one takeaway today from our pre-scheduling and scheduling facets that we're going to talk about, I would imagine it's the big board.

It's probably what has had the biggest impact on our agency from really taking that next step, being able to schedule optimally with less stress for our scheduling team and just more positive outcomes for our caregivers and clients. So like you said, Miriam, the big board is just, it's a visual representation. In the early days, I used to have, I did the scheduling for our agency up until we had almost 50 clients and for the first five plus years. And I used to do an Excel sheet in the early days, and I would have our roster of caregivers on the A column, and I would have their availability going across the columns. And that would change from week to week. We've matured since then in the sense that we have in our scheduling software three fake client profiles. We have an available for daytime, an available for nighttime, and an available for live-in.

Clients name that. And what we do no less than twice a week. It was once a week. But caregiver availability schedules, it's dynamic. You know, nothing static. We could hire an amazing professional caregiver today and her availability is X. And then in three days, that changes for one of 100 reasons. So it's definitely not

scheduling isn't a set it and forget it thing. It's a set it and continue to check in and continue to tweak so that you could be successful. So what we do is twice a week, we check in with our professional caregivers who are not scheduled to their max number of hours that they're able to work. Some of our caregivers cannot and do not want to be scheduled anymore. Many who are already scheduled, they're up for taking overtime. They're up for picking up shifts here and there. And some are not scheduled. They're definitely underscheduled and they're looking for a new client

or they're maybe waiting to work with a different client with different availability. So twice a week, we check in with our caregivers and we add their availability to the big board. So if we have a caregiver, Katie, who she's available Mondays, Tuesdays and Thursdays from 7 a.m. to 7 p.m. And then on the weekends from 7 a.m. to 3 p.m., that'll be on our available for daytime. You'll see Katie's. It's a shift. It's an actual shift as though she's working with a client, but it's a fake client. It just says available for daytime. And we'll put that in today. And then by the end of the week, we'll check again. We'll tweak it as needed.

And this big board, it helps us in a couple of different ways. We're able to see visually when we have to start hiring for certain types of caregivers with certain availabilities. So if we see that we have many caregivers listed on the available for living and available for overnight, but we're struggling with caregivers on the available for weekend daytime, we know that we have to start recruiting and making an appoint to hire professional caregivers with that weekend daytime availability. Or maybe we have to start incentivizing our caregivers currently on a roster that are available. They're not working, but they just would rather not work. Maybe there's a bonus system. Maybe there's overtime.

There are different ways that you could try to optimize because again, you don't want to just recruit new caregivers who are going to be on your agency's roster, but not really working. You want to try to maintain that balance of caregiver to client ratio. But that big board is really important. It took us years to kind of tweak it. It hasn't changed much over the last seven or eight years. And it's a really important tool. Our scheduler is really the owner of the big board. And then we have support staff that helps with capturing availability, updating availability. And then our scheduler works in tandem with our HR team, our recruiting team, and our client relation sales team to make sure that we're in a healthy position. Okay. A couple of follow-up questions.

First one being around that communication that takes place. You've got 175 caregivers. You're saying availability shifts literally overnight, you know, so that's a lot to keep track of and a lot of communication that takes place. Do you check in with every single one of your caregivers or how do you identify the people that you need to be checking in with on their availability? Is it based off like tenure or schedule or how, do you know what I'm saying? Like, how do you know who to reach out to, to check in with on their availability? No, that's a really great question. And it's, and as your agency grows, if you're, if you have a hundred caregivers or 200 or 500, it's a lot of people to, to check in with and maintain. The more that you could automate the better. So we do have a touch point with every single professional caregiver at

least once a week, just that's we feel is good minimum, even if it's quiet and things are well, you have to at least check in and have a conversation. But this scheduling process is somewhat automated in the sense that we have a digital availability sheet that we send twice a week. Sometimes we have to follow up with sending out an additional one or a phone call if somebody doesn't answer. But our caregivers at this point know that they're going to get their digital availability sheet twice a week. They answer the questions. We're able to, we have on-call admin team that work overnights and work weekends. And so we have part of that responsibility of our overnight on-call is they update the availability in our scheduling platform on the big board.

So our scheduler wakes up in the morning, sees the real-time availability. And if we are lean in any area, then she's going to start making phone calls and really proactively working because once you have a need, it's too late. You have to really start doing this process, anticipating the need, knowing that on average, you have this many new clients, this many of X new clients, Y are going to need overnights, live in all likelihood, this is how many call outs you're going to have. So you kind of get into a cadence and an understanding of your business by just measuring it every week. But it is a team effort. And just to out of like curiosity, you know, you're saying it's like an automated process.

Is that like a text that comes in as a push notification? And is that part of your scheduling software as well? Or is that like live elsewhere? No, I'm happy to share. So it's an external. We try to use, you know, the fewer systems you're using, the better, just for sanity's sake. But one of the processes we use, it's called JotForm. It's a platform.

It's a HIPAA compliant form system. That's how we construct our availability timesheets. We're able to have a link for this timesheet that is sent out through our scheduling software. So it lives within our scheduling software. It still is an external site, the JotForm, but it's the cleanest way that we're able to do it with the least amount of components right now. Awesome. Yeah.

Thanks for sharing because I'm just thinking what that looks like in practice and it's useful for people to understand that may or may not live in the scheduling software, but there's like an easy way to build that then to automate it. So then it goes out through their app, etc. And my thinking is, correct me if I'm wrong or tell me what you think about this. At first, I was thinking, wow, twice a week, that seems like a lot. You might be bugging people. They may think like, okay, they're asking me this every single week but then my second thought was they appreciate the check-in and their availability is changing so often so it's probably not that redundant because life happens and things come up and their kids need a care you know like so many things

happen so it's okay to reach out that much do you ever get that people like complain about you checking in about their schedule so often or do they appreciate that someone's thinking about them and checking in about their schedule so often, or do they appreciate that someone's thinking about them and checking in with them? No. And that's a, that's a great question. Most people do appreciate it. They like the extra touch points, even if it's in, and we're not just sending the availability. There's always a message, you know, a check-in, a nice, it's, it's not impersonal. So people as a whole, our caregivers really like it. There have been a few over the years that really

don't love it and they ask to be taken off. And we don't want to bother anyone. That's the last thing we want to do. We know that if you're a professional, everybody has a career, but they also have a life. Everybody's really busy. And we try to communicate. That's why the communication aspect of the scheduler is really important. You want to try to communicate why it's important. We don't want to inundate you. We don't want to bother you. We just want to make sure that we are staffing the times that you're available. And if you want to pick up overtime, if you want to work a different schedule, a new schedule,

we're here working for you. And this is why we're doing it. It's not to annoy you. It's that we're going to work for you every day. And this helps us to get you the schedule that you want. Usually, if you phrase it that way, people are on board. You still have some professional caregivers that are like, that's fine. These are my hours. It's never going to change from here until the end of time. Stop bothering me. And you respect it. Generally, if that's the case, that could be a red flag of another issue. If your professional caregivers

are communicating with your admin team not very nicely, that's something that you really want to revisit because you want to make sure that your clients are receiving the best care possible. But as a whole, most people appreciate it rather than resent it. This is really good stuff. I know this seems like foundational, but this issue, updating availability, I've talked to hundreds of agencies, small to very large, updating availability is this constant headache. But look how you've broken this down. Check in twice a week with an automated text, updating their availability, that gets sent to the scheduler in a live big board format. Like that's how this gets solved, you know? And, and I'm just thinking out loud, like this is such a complex issue that everyone struggles with, but look how you can like

systematize and automate and check in with your employees, like all in one swoop, which is amazing. And you can, and this is repeatable with a hundred caregivers with a thousand caregivers, like this can be done in any format. So I'm just like sharing how insightful this is for me to hear, but I hope everyone listening to this and everyone that does listen to this is it can be simplified and it can be done. And this is a way to go about it. I appreciate your saying that we love it. The big board has helped us tremendously. And yeah, I hope it helps everyone who hasn't started using it yet. Please try it. Dip your toe in the water and see if it works.

It's a win-win scenario across the board. And this is why we share. Steal good ideas. There's no harm in taking what Brett's done and built and thought through for years and applying it inside of your business. That's why he's so open and willing to share, which is amazing. Okay, there's a couple more factors about pre-scheduling that I want to get into.

The next one is matching. And we could spend the rest of our time on this, but just in a couple of minutes, let's talk about the role that matching plays inside of the pre-scheduling. This is like the puzzle of scheduling. And I'm just curious how you all have approached matching. And then one of the things that I wanted to ask is like,

are there less common factors of matching that you've identified that play a bigger role that like maybe other agencies haven't thought about or identified? No, no. And matching is a very important piece of the scheduling puzzle. You know, the big board's great because you get to see where you stand as far as what your agency can support in the terms of new clients and schedule changes. But if you're not really diving in and know your clients and caregivers inside and out, you know, pretty much every agency is able to staff a client with a warm body. It's staffing them with the right caregiver. That's the right fit. So you have a happy caregiver and a happy client. So we use tags and we want to put as much information as we have possible about our caregivers and our clients into our scheduling system, into their profiles, and really utilize tags. Again, this is something that we did on a very rudimentary basis years ago, and it's evolved over the years.

So what we're talking about today, we might have a new way of looking at it and talking about it in three years. But there are definitely some lesser thought of strategies. And then there are some pretty basic table stakes, I'd say. So the basic table stakes for any successful scheduler, you want to know your caregiver's availability, which is through the big board, but also tagging. So for every caregiver that we have on our roster, on our team, they are tagged in certain ways, such as daytime, overnight, live-in, weekend availability, willing to pick up shifts. These are all things that we capture as part of the interview process, and we tweak it over the term of our employment with our professional caregiver. Skills are really

important. Does your professional caregiver have experience working with clients with dementia, with hospice, with ostomy bags, queer lift, gate belt, the list goes on and on and on and on. And it could be as exhaustive as you'd like, or at a very minimum, probably cognitive impairment, dementia, you know, that has to be a tag. But most agencies really want to get very granular with that, depending on what your client census looks like. So for every tag that we have for our caregivers, there's a corresponding tag for our clients. So if there's a call out, or if we have a prospect, and we are able to capture a lot of information, we could pull up a short list of the caregivers who might be a good fit based on scheduling and based on skill set. That's important. That's something I really believe

every agency should be doing. Where is a little less common are the soft skills, right? The personality and the preferences. So one thing that we've been doing from day one, when my mom would start meeting with clients, before we had registered nurses on our wellness team doing the assessment process, my mom would want to know about you as a person. You know, what do you like? What do you dislike? What are your hobbies? What's your profession or your past profession? And just through conversation, get to know that individual. And we do the same with our professional caregivers. On our application, we would have all the standard questions, but we would also want to know what makes you you. What makes you unique?

What do you like? Yes, caregiving is a career, and you're a professional, and you're going to be working with a client, but we want to make sure that you enjoy working with that client. And we're going to do everything we can to make sure that you're a good fit for the client and vice versa. So for the soft skill tags, you know, some of them are more basic as far as okay with dogs, okay with cats, comfortable, likes sports, loves engaging in conversation. Because if you want to not only schedule with a client, but you want to schedule optimally and not have too many schedule changes than necessary, you want to make sure that that client and caregiver are a good fit for each other. So just try to really get to know your caregivers and clients. Make sure that information is translated into your scheduling software. And again, just like schedules aren't static, things change for people, their availability. Sometimes somebody does have experience working with hospice later on in their tenure. So you have to keep tweaking these tags. Again, it's pre-work, it's work that doesn't

necessarily have to do with the active scheduling, but it makes the active scheduling a lot easier and more successful. The word that's coming to mind is enrich. Enrich those profiles as much as almost humanly possible. Create those tags, put in those notes, add as much enriched information as you can so that the scheduling can be done optimally. And I'm just thinking, you know, the options are limitless with how you create those tags and what you identify as important versus not, but just like enrich those profiles so that like you're saying, the scheduling can be done optimally based off of all of that information. And it's, and it takes work, you know, it's this pre-work that we're talking about. That's, you know, do you text or

call those caregivers to fill in and enrich that profile? Or do you, you know, talk to those clients again to enrich that profile? It takes work, but it's worth it in the end to optimize those schedules, which then results in retention. If you've got the happy clients and you've got happy caregivers, they're going to stay with you. And it's a win-win all around. So really, really good information there. And a lot of different applications here. This could be interpreted in a lot of different ways, but the components that you're mentioning are universal, which is great. There are three more components of pre-scheduling that I want to get through in the next 10 minutes. We're going to have to be quick here, but I want to make sure we can get through all of this.

And just for anyone, you know, that may have to jump at the top of the hour, we have Brett back again next week, same day, same time, to talk about his scheduling and his post-scheduling. So today we're just starting with pre-scheduling, but we're going to have him back for another hour next week to talk about scheduling and post-scheduling. So join us again next week. So yeah, a couple more things here.

One of them are like standup meetings. You involve multiple team members in this pre-scheduling element. Who's involved and what are those meetings look like and what's discussed? Sure. No, that's important. You're as a scheduler, you're essentially in a lot of ways, you're the linchpin of your agency. You're working with your clients, you're working with your caregivers. You have a very good understanding of your agency's operations at any given time. Your scheduler should be communicating regularly with your sales or client relations team, and also with your human relations and recruiting team. So whomever at your agency is doing sales, whether you're an agency owner that is meeting with prospective clients and meeting with families, or you have people on your sales team build out and client

relations team, those individuals have to be communicating with your schedulers regularly to know what does our pipeline look like? Who are the prospects that we've been talking to? Do we have one client that might be starting today? Or do we have four clients that might be starting next week? What are the hours needed for these four clients? Are they all live-ins? Are they two overnights and daytime around the clock, just daytime? You really have to have your finger on the pulse of what's coming in the pipeline, because you don't want to wait to get a call from somebody at your agency to say, hey, we're starting tomorrow for this case. Please start scheduling.

You can do it, but you're not going to be able to do it optimally. So you always want to have an idea of what prospects you have in the pipeline. And then on the other side, you have to client ratio, but we know that we're starting with three clients next week or in the next four days who need two 12-hour shifts, our ratio is going to be a little bit out of whack. So we're going to have to start recruiting for caregivers. Maybe it's a certain availability. Maybe they live in a certain service area, but your recruiter and human relations team and your sales client relations team, all what we do is we have them have regular meetings with our scheduler. And that can be done daily. I would do it no less than twice a week, just so there's communication and their shared knowledge.

And just keep that communication flowing because the changes are ever changing. And so, yeah, so that's what I was curious. You said, yeah, maybe daily if need be, but at least twice a week. And just to be clear, you know, it's a scheduler in that meeting, HR, a recruiter, and like a salesperson. Is that kind of typical? Maybe like those four boxes?

Okay, awesome. Yeah, I just wanted to be clear on who was that. One tangential question before we hit the last two. What is your scheduler ratio? Sometimes like it's one scheduler to a thousand hours or one scheduler to 35 clients. Do you have a specific ratio of like what one scheduler owns? Or it sounds like you may just have one scheduler that owns different pieces or what does that look like? Yeah, I get people pretty surprised when I talk to other agency owners and operators all the time. We have one amazing scheduler. We have support staff. So as I said, we have on call for weekends and nights who do help with schedule changes, who help capture our caregivers availability. But truly by using these systems, we're able to staff for close to 100 clients with one scheduler. The onus doesn't fall 100% on the scheduler.

It is a team effort. There are other people supporting. But we have one full-time scheduler who's wonderful. And there's definitely a lot of processes that lead into that success. But I talk to agencies that have much smaller client sizes than us that have two, three, four schedulers. That might be wonderful for your agency. If that works for you, I wouldn't suggest you have to change it. I would just say, make sure that you have the systems in place to be able to grow efficiently. Yeah. Thanks for giving us that unique perspective because that's,

I would say you're more of an outlier in this department, but it's back to the systems and processes and building out, you know, the optimization. So two, two more things in five minutes here. Dry runs is one, you know, like the training shifts and then also paid on call. You decide how long to allocate to both of those, but let's just hit on those last two pieces of this. Sure. And these are probably, I hope these aren't the parts that everyone's going to turn off because they hear a paid on call and training runs and more expenses with higher wages and operational expenses. I promise you there's a reason there will be ROI from these extra expenditures. Training shifts, what we've been doing for a long time is whenever possible,

if we have a caregiver who's going to be working with the client for the first time, a client that we've been serving, let's say we have a caregiver who's going on vacation next week. We're going to try to have the professional caregiver that's substituting for them go in this week to have a training shift with that client and caregiver. Our process is when we get a call for a schedule change, when we know that we have a caregiver going on vacation, our scheduler is going to reach out to whome schedule change, when we know that we have a caregiver going on vacation, our scheduler is going to reach out to whomever is the best fit for that client, going to give them broad view. These are the hours. This is the general location where they live, general needs.

Is it something you want to learn more about? If that client seems like a right fit, then somebody from a registered nursing or wellness team is going to call and go over the care plan. That's super helpful to have a registered nurse who's done the assessment, who knows the care plan, review this with our caregiver. But much better than that is having that caregiver work and do a shadow shift with the caregiver that knows that client inside and out. It's beneficial for two reasons. One is that I'm sure everyone's had the call, I can't find the client's house. How do I get into their apartment? Where do they live? It's dark out. This eliminates that. But also, it just sets them up for success so that your client and your caregiver are happy. They both know that you're vested very robust big board, you might not need to do the paid-on-call, and you might not have to do it. You certainly don't have to do it blanket.

So you don't want to say, I want to have caregivers paid-on-call for every single shift. That's not feasible. That's not sustainable. But you want to look at your agency, see where do you get the most call-outs, where are you having trouble staffing. For us, overnights are not really a problem. We could have a number of call outs for an overnight in any given night. Thankfully, it doesn't happen. But if it does, our big board would be able to support that very, very easily. As far as weekends, daytime, there are some weekend daytimes that our big

board just is not where we want it to be. And so what we'll do is we will have a number of caregivers who are paid to be on call. They don't have to be paid to be on call for 12 hours. You know, if somebody's paid on call for the week, weekdays, we'll generally have them paid to be on call from let's say seven to 12. Because most of those call outs are going to happen between seven and noon, they're going to be paid regardless whether they work or not. If they pick up the shift, they're going to be paid for those hours that they work. And a lot of times it's overtime, but yes, it's an extra expense. But what you find is that if you have call outs that are happening and you're not able to staff those call outs, that's an immediately decrease in billable hours. It's an immediate loss of revenue.

So the paid on call you're paying for, but you could be saving some of that decreased revenue in billable hours lost. But also, if you have a call-out for a client, let's say over the course of two months, one of their caregivers calls out three weekends out of two months, that client's going to be upset if they're going to have different people in and out of their home, or maybe they have nobody, they could love your agency, they could love their primary caregiver. But if they're not having the consistent care that you're promising them, they might call the agency down the road. So we'll have a highly skilled professional caregiver that has either already trained with a client who could be a pain point down the road for call outs, or just somebody that we know has the skill set and availability to work with most of our client census. Those are the type of caregivers that will generally have paid on call, or it could be a caregiver who has recently, their client may have passed away or moved out

of our service area. We'll pay them to be on call so that they still have that income coming in until we have a new client for them in a few days. So don't look at it as a added expense. Try to look at it as a savings for an increase in satisfaction. That was amazing. Take a breath. Oh my goodness. That was a lot of good information.

The last thing that I want to end on, and I don't have the numbers in front of me, your retention rates. You have some of the best caregiver retention rates that I have seen at any agency in this country. Tell us what those are to close this out because everything that we talked about today leads to caregiver retention. And that is what you have seen.

Yeah, no, and thank you. And that's, you know, everything we've done, we're certainly most proud of our caregiver retention. There's a direct correlation to caregiver satisfaction. We just celebrated a 10-year anniversary last month. We have another one coming up in a month, in two months, and we've been around for just over 12 years. Of our professional caregiving team, we have a 47% retention for three years or more, 29% retention for five years or more, and almost 20% of our team, 18% of our professional caregivers have worked with us for at least seven years. That being said, we definitely go through turnover.

It's generally our newer caregivers. If a caregiver stays with us, part of our family for 72 days, there's a high likelihood they're going to stay with us for seven years. So we have that attrition early on, but these strategies are not theoretical So we have that attrition early on. But these strategies are not theoretical. They have really helped our agency immensely. And that's why I'm happy to share them. This is me nerding out. I got the chills when you said those retention numbers.

That's how much we care about this type of stuff. It's amazing what you have done. It is absolutely like nothing short of amazing what you've accomplished at your agency. I hope this conversation, nobody has dropped off i hope this conversation has been useful to the people listening to this today brett is not on social media which i love and hate but give him some love here in the chat if this has been useful to you or i don't know if we can throw out your email just so that people can connect with you and ask you further questions or pick your brain or say thank you people want to surround themselves with you like you just know this business through and through and thank you for sharing so much so openly today this is really useful to so many people so let's cap here thank

you thank you thank you and we'll be back next week to talk about scheduling and post scheduling my pleasure beer thank you so much it been wonderful. You can reach me at brett, with two T's, B-R-E-T-T, at alongtermcompanion.com. Everybody asked me to be on LinkedIn. So I will be joining very soon. I promise you can connect with me there soon because I get requests all the time. But email is great. And I'm happy to have conversations and follow up with everyone. So I hope it was helpful. Awesome. You're the best, Brett. Thanks, everyone. We'll see you all again next week. That's a wrap. This episode was made by the team at CareSwitch, the first free home care agency

management software. If you're tired of running your agency on an outdated software that looks and works like Windows 98, and you want to save a little money for your bottom line, check us out at Carewitch.com. Thanks for listening. See you next time.