Home Care U - How to Build An Agency That Can Grow Without You (Andrea Cohen)

Episode Date: October 2, 2023

Whether you plan to eventually sell, want to exit daily operations, or just want to get a good night's sleep now and then, you'll need to build up processes and leaders who can keep your agency going without you. Andrea Cohen, founder of Houseworks and HCAOA board member, is here to talk about how she successfully did it.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. All right, welcome everyone to Home Care U. I'm Miriam Allred, Head of Partnerships at CareSwitch. Excited to be back with everyone today. I know Connor Koons has taken the reins, my co-host,

the last couple of weeks, but I'm excited to be back in the saddle with all of you today, and we are in for a treat. I'm on the edge of my seat for this episode, literally just thinking about what we're about to share with you. So I'm excited and grateful to have all of you here with us. A couple really quick housekeeping items. We're here in a Zoom webinar. We can't see you or hear you, unfortunately, but please do engage with us in the chat or the Q&A box as we cover a lot of interesting information today. Feel free to add your own thoughts or comments or questions, and I'll be monitoring those. And I will facilitate them to our guests today throughout the conversation.

So, again, thanks for being here. I'm excited to have you all live with us here on Home Care U. All that being said, we're going to go ahead and get started. Today, my guest is Andrea Cohen, the founder and CEO of Houseworks in the greater Boston, Massachusetts market. We are going to start with Andrea's background. I'm going to let her tell her story. Today, I'm going to kind of let her paint paint a picture of her experience in home care and I'm going to just kind of guide this discussion and so

I won't introduce her you know too much up at the start because we're going to kind of get started with that and where I want to start today's conversation Andrea is actually retrospective you have had this long life and long career and a lot of success, and we're going to kind of debrief through that. But I want you to start with maybe your personal why and talking a little bit about your family and your parents and your kids and what influence they have had in your life and in your career. Thank you. And thank you for having me, by the way. This is, you know, I was saying to you earlier that it's just fun to have the opportunity and the space to be able to think through everything that, you know, like the why. So I appreciate being here. So anyway, I mean, and some people may have heard this, but I, my parents had me, you know,

when they were older, my mother was over 40 and that was pretty old for back then. And, you know, throughout my life, I always was worried about them. And I, I first, I, when I had got my first job out of graduate school and I was 33, they died within six months of each other. One followed the other. You always hear that story. They can't live without each other. It was probably them. And I was a social worker and I was actually sort of dibble-dabbling in home care and I couldn't do it. I mean, it was really hard. The care was fragmented. There were so many gaps in care. So when they both died, I just it was sort of, you know, looking back on it, it was just this

moment, you have moments in your life where you're like, whoa, and I just was really determined to sort of fix it and get it right. And, you know, any all of my work that I've done since then was sort of built on the premise of keeping that in mind. And then so I, you know, I started working when I graduated from graduate school. I decided to be a social worker. I went to graduate school. I did a little work in between that, became a home health aide, then went to graduate school and worked in a AAA for years in the not-for-profit world. And I really liked it. And then I got recruited by a for-profit mission-driven company that was sort of doing exactly what I was doing, but just doing it for sort of people who are low-income, sort of the mid-income people. And then in the middle of that,

I had got married. I had two kids. One of my kids had a disability and had to spend a lot of time navigating that healthcare system. So I really had my hands full with just trying to really make something out of this business that I was so focused on getting right and then raising a family at the same time. So that's what got me started. Yeah, that was a perfect place to start. Let's talk a little bit about kind of the early years when you were in college, you referenced being a home health aide. This was previous to your parents passing, you got kind of a look into home care and home health. How did you land there? And what were

those kind of early memories? Yeah, it was pretty incredible. I mean, I remember my first client, frankly, and I remember going to their house. It was in upstate New York, Ithaca. And I just I was just so taken. And I was watching her daughter and she was in her 90s, her daughter was in her 70s. And I was watching the two of them interact and it gave me, I was really fascinated by what could happen. But what it also did was I was sort of debating as to whether or not I should be a clinical social worker or sort of go more on the macro level in community organizations, social planning. And that's when I started thinking about impact. And impact is something that's really important to me. And I felt like as much as I love doing this one-on-one, I really wanted to make more of an impact. And I felt like doing something bigger and something systems-focused would help me do that. So that's when I got that macro degree in social work and then went to work for the not-for-profit and started out there in

the AAA. And it was a really good beginning for me because I learned so much there. And this was in the mid 80s. So things look very differently than they do now. So you reference, you know, starting kind of as a home health aide, kind of getting your toes wet, pursuing this degree in social work, you know, starting at the AAA, you know, was this a, you know, a common path? Did you feel like you were charting some new waters for, you know, yourself or females, you know, at this day and age? What was kind of the pulse? Yeah, it was, it was really different. You know, I just, I didn't think about it. I didn't think about that

most of the women in healthcare at the time were not at the top rung. They were sort of in the middle rung. All I wanted to do was make a difference. And I had such incredible opportunities to do innovation. When I was at that first job at the AAA, we started an intergenerational daycare center at Stride Rite, you know, in Cambridge. And that was just, you know, see, we started an intergenerational daycare center at Stride Right, you know, in Cambridge. And that was just, you know, see, I started thinking about all the different ways you could approach it and felt really lucky to be able to be involved in that at all. And so, yeah, it was very different for back then. And there really wasn't a private home care industry. I got hired by this company that was sort of in the late 80s, early 90s, what you would call a managed care company.

And they had every part of the sort of post-acute system except for home care. Can you imagine? No home care. So they hired me to do the home care. And that's where I except for home care. Can you imagine? No home care. So they hired me to do the home care and that's where I started learning home care. And that's how I learned home care and how home care fit into all of the transitions and into all of the different parts of the post acute system, because that's what the company did. And I think, frankly, when I think back on that, that was a real big advantage and a learning curve because, you know, home care isn't especially now.

It's obvious it's not just about providing care in the home. It's about helping you through the transitions. And in order to provide good home care, you have to understand how it affects the family when you're going through these transitions. And, you know, assisted living, when I I started was just getting off the ground. So it was just a whole different ecosystem of services in the post-acute world. But people were really focused on trying to make it work. And that was fun. I would go as far to say as you were a pioneer in these days, you know, at the time, home care was an afterthought. Like you said, you know, they covered all facets of, you know, acute, post-acute, but home care, you know, this pivotal piece was missing. And, you know, we've still got a ways to go, you know, here we are, you know, years and years later, but, you know, we've come a long way, you know, and you were there kind of on the, on the leading edge of, you know, what is home care and what does it do? You referenced, you know, impact was your primary driver, you know, early on, you felt this, like this duty or this sense of fulfillment by serving

others and taking care of people. You know, that's kind of one, one drive being an entrepreneur, you know, probably wasn't even, you know, in your mind early on. And the thought of starting a business and, you know, taking on this massive weight was no small feat. So how did you wrap your brain around becoming an entrepreneur? And how did you essentially get started with Houseworks? Yeah, I mean, I think it was it was interesting, because I can't remember what it was. But I truly think that I looked up the word entrepreneur. Because I'm just like, entrepreneur, like everybody's talking about entrepreneur. And

you know, what does that really mean? And, and then, you know, you then you hook on to that social entrepreneur, because then you're, you know, you're doing good. Yeah, it was just it was funny. So I it's interesting because people would ask me that a lot when I was the CEO of the company and starting it up. And, you know, how did you start? And, you know, I think a lot of it when I think about it was just really hard work and really wanting to, you know, watching every part of the business. You have to watch every single part of that business to the direct care workers and, you know, to the referral sources, to the clients who are most of the adult children. And so you're watching the business, but you're also thinking sort of what it's,

you're not really thinking except for, you know, you have to remember there, there were no companies like houseworks. When, when I first started out, I remember I was on the board of the home care association of America, which is then called NPDA, which I forget actually what it meant, but it was the initial board with Alan Hager and Paul Hogan, who are the CEOs of Right at Home and Home Instead. And we were all young and we were just like, whoa, what's going on here? We can do this. But I was literally, there's a few of us who were the independents and not the franchises in this particular board.

And we were just we had no idea. We did not think of ourselves as entrepreneurs at the time. We thought of ourselves as people who want to have a really good business and we want to grow it. And we want to start making some money and we want to be able to scale it. But it was on such a different level than what it is now because there wasn't a private home care industry. We named it. It's really funny. How many people do you talk to? Is it private home care? Is it private duty home care? How do you talk about Medicaid? Is it out-of-pocket Medicaid and family funded? There's still 10 different ways to talk about the industry that we as the, you would say, pioneers started. Yeah. So let's, I do want to spend a couple minutes, we're going to kind of jump into like

your later years, you know, and when you started thinking about exit planning and the actual exit. And I, before we jump to that, I want to kind of debrief some of like the history of houseworks and just kind of talk through the history briefly. Cause I think it's interesting. So you founded the business in, in 1999 and you were, you know, active acting CEO, correct? Yes. And let, let's just talk briefly about, you know, kind of the, maybe the first 10 to 15 years, you know, just what, what was going on in your head, you know, kind of the maybe the first 10 to 15 years, you know, just what was going on in your head, you know, what your growth looked like, and what, you know, kind of your objectives were in those first, you know, 10 to 15 years. And, and that's kind of a long timeframe, but just kind of milestones and highlights. Yeah, I'm not going to tell you every single second of what I

did. But, but it was fun. I mean, it was really cool to be in home care at that time because we were just all trying to figure it out. And so, you know, in the first 15 years or so, we grew to be one of the largest single site home care companies in the country. So that means in Boston, we were one of the largest and people just couldn't understand how we did that. Like people, people always said to me, how are you doing it? And, you know, and it was really about, I feel like one of the things that was key was that we paid attention to direct care workforce

before there was a shortage. I mean, that was, you know, that, and, and we just did that because that's just where we naturally went to. But it was interesting because when it was launched, my desire to give back was almost as strong as my desire to have a profitable business. So I had to learn on the job. I mean, and I really did learn and I did learn that there's ways to do it. And I feel like I was a pretty hands-on CEO. I see myself now as a visionary leader, which sort of means you could see things that were happening, but no one else really saw them, which led to a lot of innovation. We did some really interesting models back then. I helped start Beacon Hill Village. We did some other rounds for associates.

And it was really an amazing journey. And every year we grew at a steady pace. When I first started the business, because we were literally the only game in town, we grew 20, 30, 50. We doubled and tripled in size some years. We just kept growing fast. And then there started to be some of the plateaus. But our growth was good, our innovation. And, you know, it was like I,

like I said to you many times, it was just this amazing time in my life. It was hard because I was also raising kids and every, every dynamic that goes along with that. But from a business perspective, I felt fortunate to be able to combine my social work background and my knowledge of the aging market to run a mission-driven home care company. And the one thing that I have to tell you that was very funny was, you know, it's very different now in social work school. People go into social work school to become entrepreneurs. But when I sort of left the not-for-profit and sort of went over to the deep end of the for-profit, I had to really prove the fact that I could run a credible business that actually provided great

service, even if it wasn't a not-for-profit. And that was a lot of the 15 years. But we won all sorts of rewards. It was just a really good time. And we provide a great service. One thing you referenced at this time, there were no standards, there were no benchmarks. What was your guiding light? Was it growth? You know, year over year growth? Was it the mission? What was your, you know, North Star in these early years? Yeah, that's a great question. So I was a sort of analytics freak. So we didn't have, and there was no backend systems, there was no clear care, there was no home care pulse, there was none of that. So we built our own system to be able to measure

sort of the business and make decisions based on some of the analytics that we found. But it was totally homegrown. I mean, I didn't switch over to a standard backend system until at least 15 years out because a lot of these systems that were coming out were for companies that were 2 million and we were already 12, 15 million. And so it just, they didn't work for us because I wanted too much information. So I measured it based on, you know, I would look at like the number of new referral sources that came in, not just the number of referral sources, like how much is the business growing? And, you know, how, and, you know, of course, looking at the margins and all of that, but we, you know, and then we looked at, and some

of it was, I started looking for high volume referral sources. We have a really good relationship to this day with Hebrew Senior Life where we do home care for them. And that's a very big contract, something I started and, you know, it took many years to develop that kind of a relationship. So it was really measured on, and, you know, of course, the number of customers. And we also had a home repair business at that time. And a lot about customer satisfaction. We had to do our own satisfaction. We had to figure out our home.

And then we looked at retention rates of caregivers. But our retention rates were really high back then because we really tried hard to make sure that they stayed. And we had long hours. So we came out of the gate being able to provide services to complex clients. And that was an advantage. A lot of the newer entrants didn't know how to do that. So we became that company and that really helped us. So I think it was probably what everybody looks at now, but we just had to do it ourselves. That's exactly what I was going to say. It sounds to me like you discovered the benchmarks, you know, naturally. You were, you know, figuring things out, learning on the fly,

you know, dealing with obstacles just ongoing. And so naturally you just found the benchmarks, found the standards, you know, gravitated towards those benchmarks that we still use today, you know, out of necessity, which I think is, which is great. So I want to, you know, we could spend a lot of time debriefing those first 15 years and I'm sure people would love to hear that, but I want to fast forward, you know, we're now looking around 2014. So this is about 15 years in and you come up on this crossroads, you know, you've seen a lot of success, you've served a lot of clients, you know, you've built a really strong business. And you, you know, start asking yourselves questions, you know, what, what's best for houseworks? What's best for me? What do I want? You know, where do I go from here? And so tell me tell me a little bit about that, like moment in time for you when you did some self-reflection and asked yourself kind of the, you know, the's really a great question too, because I sort of feel

like, I think that everybody does that. Every CEO must do that at some point, at some points in the life of their business, where you get to a point where you just start making decisions and which way you want to go. And I really saw, like, if you Googled the image for Crossroads, you know, you'd see the streets going both ways. And that's what I felt like it was, like these two, like, streets, one way or the other. And, you know, so the first street was keep it the same, you know, just keep it and just keep doing better at what we're doing. Cause I, I feel when you run a service industry, you can always do better. If you ever say that you're done getting better and you're

the best you can be, then, you know, it usually you're not. So I always, I, so I felt like I could do that. You know, I, I'd earned a reputation in the Boston area that was, you know, it was, and, you know, I worked really hard to get there so I could stay there. We had, you know, it was, and, you know, I worked really hard to get there so I could stay there. We had, you know, we were cash positive for a long time and it would have been easier, frankly, and it wouldn't have been bad because at that point we were already up to close to 20 million. I mean, we were, it was a good, it was a good company. And, you know, but for everybody, when you, when you know, sort of home care, private home care, when you're dealing with out of pocket, it just goes up and down a lot. And so there's definitely times when it's a little scary, but we always manage to keep moving the needle up. So that was one crossroad

was to keep it as is, find some more relationships, grow it even more. I also, you know, sort of had visions of maybe consortiums of private home care companies. We get together, we figure out like buying and purchasing power and to be together even without any formal relationship. Because at that point, I'm starting to, you know, there's starting to be more than just me, there's, you know, five to 10 to 20 other companies that are getting to be over $10 million in the market at that point. So it was kind of fun, we started hanging out all together. And maybe there's something we can do there. But on the other side of that, it's just like, wow, you know, we have this model, we're doing something right. And do I just try, you know, I just went back to that impact thought and said to myself, we had this little hidden jewel in houseworks. Why can't we make

this bigger and help more people and do that? And, you know, and I really went back and forth. And then at some point point I, you know, I talked to my family, I talked to my friends, I talked to my mentors. I talked to you, you talk to everybody, you have your little care team in a sense of business advisors at that point. And and I decided to, to make a decision to scale. And, you know, I knew that in order to scale, we needed to make an investment in the business because and you know I knew that in order to scale we needed to to make an investment

in the business because you know you've got to invest in people you got to invest in talent you got to invest in technology you got we could run as we were but we weren't able to make to put more money necessarily into it unless I did something big um and and when I look back on it, it took about four years because, you know, we looked at so many different ways of doing it, different, you know, whether they be private equity firms, VC firms, just institutional money, you know, however we looked at it and there were lots of deals on the table. And, you know, some of it in the process of trying to see if it's the right deal. And you meet with these people that either, you know, we were going back and forth. Should we be acquired or should we acquire?

We were there was also that we were thinking about. And, you know, sometimes I would start meeting with people who either indicated interest one way or the other. And, you know, the minute you sit down with them, it's like, this isn't going to work. So yeah, it did take a lot of time to be able to do that. And, you know, and there was a lot of work that went in with all of those decision points of those four years before we actually found the right investor. So for anybody who's thinking about exiting, I mean, some people exit and it's fast, you know, and some people exit and they don't necessarily have a choice. But there, you know, if you are thinking about it and you do have a choice,

you got to know it could take, you know, a year, it could take three years, it could take four years. It also really depends on, you know, how long your runway is, how fast you have to do it. And, you know, this was all new to me, this was not an area that I knew a lot about. So I'm really cautious. Yeah, a couple things I want to call out, you know, like you've mentioned, this is a four year process. And you were coming at it from this lens that you knew, you know, you knew your lane, you knew what you had done well, and you come up on this crossroads and you have to kind of shift your thinking, shift that lens a little bit and start thinking differently.

And so, you know, a four-year process, four years is a long time, you know, four years is a long time to be thinking about these decisions. But the other thing I want to call out is a long time, you know, four years is a long time to be thinking about these decisions. But the other thing I want to call out is you've built, you know, a $20 million business. That is incredible. You know, we talked before this, you're very humble in nature and you don't want to, you know, stroke your ego, but I just want to bring light to that. You built a $20 million business in 15 years, which is remarkable. And so you come up on this crossroads and it's uncomfortable you're asking all the hard questions you you know are asking like the dumb questions out of you know curiosity and learning because you don't know you know where what to do in this very

kind of you know important milestone in in your business and so um I want to continue the story. You decided to scale. You made the intentional choice to go the scale route, which is I need to bring in some more money so that we can really accelerate our growth. And so that was 2014 was the crossroads. This is fast forward to 2018, where you find your first investor, you, you know, have gone through all of that legwork to decide the right fit, decide the path, you know, decide the plan. And then you find this investor. Tell me about, you know, what, what that looked like.

You finally find him and this brings on a whole new wave of change, emotion, unknown, you know, what goes through your mind at that point? Yeah, that was, you know, and just if you take back, if we go back a little bit before we actually get to that first investor, I was advised, but I also sort of figured it out, you got to get your house in order. You know what I mean? You can't just go out looking for investment or partners if you have the opportunity and choice to be able to do it and not prepare. And so we, you know, you always, you know, that your senior management team has to be strong. So, you know, you've got to really look at your people and you've got to say, if you do have a weak link in there somewhere, maybe it's this is the time now to do that.

So you're already starting. It's already becoming uncomfortable when you're like being that honest with yourself that you have to do things. And, you know, and I was lucky I had the data to support the business. I had a strong book of referral sources, you know, and I was starting to have open conversations, really very minimally, you know, it started more in 2018, when we actually took the investor on, you know, what do I want as a leader? And, you know, I got to tell anybody listening to this podcast, wherever you're doing it, that's one of the most important things that you have to do is what do you want? And what's best for the business, you know, you want and what's best for the business? You start with

what's best for the business and you go to what you, I mean, everybody approaches it a little bit differently, but there was a lot of that going on. And the other thing that I just want to say is that it's really distracting. I mean, once I got the investor in there and even when I was preparing for the investor, the distraction factor can't be underwhelmed. I talk to people now. I see them at conferences now, and I understand where they are at in this process. I'm just like, oh, I know exactly what they're going through, where you're going to all these meetings. You're making all these decisions. You're always on, and everything has these huge implications. And so every day, in addition to solving all the business problems, because, oh, by the way, you have to keep the

numbers up and the employees happy, you've got all of these other things going on. So you actually, it's like a third job. You've got your business and then you've got your preparing. And then once you have your investor, you want to make sure you're doing it right. You don't quite know what they want because they're new to you. So there's all of these different dynamics going on. And, but this is really where strong leadership comes into play. Like you've got to, you've got to be there. You got to be there for your people. You've got to be there for your investor. And I knew that bringing in an investor, I would learn a lot because I wanted to bring in an investor that didn't have the a way that I have never done that. Yes, thank you that 20 million is a lot, but I also knew that 20 million can be a lot bigger, but that wasn't my strong suit. It was like getting from 20 million to 50 million. That's not what I do as well, or I'd never done it before,

frankly. And it wasn't something that I really wanted to do. I felt like I had learned a lot and I loved what I was doing. So I felt like that was a good bring in people and the people, the investor that I brought in, you know, it was the first institutional money that we got. And he had a lot of experience with the payers, you know, with the other side, you know, a different, he had a different view on things. And it was really helpful to bring someone in like that, who was able to do that. But it was uncomfortable. I mean, because you just feel like, you know, like, for someone like me, who can easily default into I'm not good enough, right? Like, there were plenty of times when I'm

like, whoa, you know, this is like, this is like a lot, but like, you just sort of have to take a deep breath and, and, and just, you know, really understand that you got to this point because you got to this point. And now you've got people in here who might not see the, see things, everything the way that you do, but they're there to support you because the goal at the end of the day is to grow the business. And that's what we all wanted. So it was just, it was just complicated and it sort of depends on the day, if it was a good day or it was a difficult day. And all you could do is take it one day at a time, literally, you know, like you mentioned juggling, you know, what, what are like three, you know, C-suite level roles, you know, all these executive like

decisions that you had to make. I want to kind of finish out kind of the timeline here. And then we'll jump back to the exit planning, because I know you were kind of scratching the surface there. I want to really deep dive on, you know, what you did and why and how you did it and like the takeaways and lessons learned. But I just want to kind of finish through the timeline so people can understand, you know, you brought in this investor in 2018, you stayed on as active CEO for multiple years after that. You know, that was kind of another, I imagine crossroads in and of itself.

And you referenced this deciding what you wanted at that juncture. You know, some people back away right then and there and bring in new management. You decided to stay on for a number of years from 2018 all the way up until 2022. You know, talk me through kind of those years, just high level, you know, 2018, what took you to 2022? So yeah, in those, you know, we were just moving forward. We acquired two companies during that time, one in New Hampshire that covered southern Maine and one in Pennsylvania. So, you know, and that was great because we really learned how to integrate the acquisitions.

We bought companies that had been around for a while and had really good reputations. So we thought that, you know that our 20 years of operating experience would be really of value to these companies. So we did a lot of that and expanded our footprint. One of the companies in Pennsylvania also had a small GCM company attached to it, and we learned from them and that and some of those relationships. We learned how to really cultivate relationships. Yeah, it was a really interesting time from that perspective because we had every relationship.

We had a lot of relationships in Boston. So how do you take that credibility from the Boston relationships you have and move that into new markets? And that was an interesting challenge. And, you know, we did a lot of speaking, we found the right face person, we did all of that and we grew the company. And, you know, I ran the company through the pandemic. And so that was in, you know, really in January, you know, what was it? You know, everybody loses track.

Yeah, the 2019, 2020, 2021. So there was two and a half, you know, that was almost two years of running the company through the pandemic where frankly, all you're doing is changing your operating model. I had felt really strongly that it's important for us to take COVID positive patients because we've been doing it for so long. We're leaders. And I spent a lot of time in the industry talking nationally and in Massachusetts about how to do it. How do you take your workforce and how do you get them to work? So that was almost a two-year period. And, you know, and we were, we had some really strong relationships in senior housing. So we were actually still able to go into senior housing. So our revenue, we actually did pretty well during the pandemic. And then, you know, so, but it was exhausting. I mean,

it was scary. You know, I remember the first call that I had when I had to tell a family, you know, talk about, you know, someone dying of COVID, you know, and it was, so we did all that. And once that happened, then it's, I started thinking maybe it's time. And that's when the investor and I were, again, having these open conversations saying, you know, that was sort of my personal thing that was going on. Everybody else during the pandemic was like, you know, hanging out and I'm sitting there working 24 seven, right? It's like, okay. So, you know, and I know, I knew that houseworks had done well under my leadership, but I also knew that it could get bigger and stronger and that, that, that that's when it would be great

to bring in someone who actually knew how to go from 20 to 50 and what that looked like and what the service mix is and how to do that. And so we both agreed on that. And we both agreed that the skills that I do have would be of value to the company, even while this new CEO came in in 2022, and we came to an agreement, and I spent a lot of time still advising on these largest strategic relationships that we had and that I had built. I spent a lot of time on the Home Care Association board and on the Caregiver Action Network board, both supporting professional caregivers, the industry, and family caregivers. So, you know, I was still doing a lot of work in the industry. And I, you know, then I become that person who's, you know, the one who has

the historical knowledge. And then you're like the old person, and then it's like, whoa. And we get to learn, we get to learn all of your trade secrets, you know, this timeline, I wanted to go through it, because it is so interesting to hear, you know, the 15 mark, you know, when you bring in your first investor, when you have the conversation with the investor to step back as CEO, you know, these are really large milestones. And so just hearing you kind of divulge your experience is really interesting for providers of all sizes, you know, startups to really seasoned veterans in the space. This is really insightful for them to hear. So just to kind of close out the timeline, you know, to get back into like the meat of the exit planning. This new CEO comes in in 2022. Like you said, you know, you knew your strengths, you knew your lane, you knew how to, you know, get from zero to 20 million. And you knew that there was, you know, kind of this turning point for someone else to come in, you know, that new Medicaid that do all of these payer sources that knew how to enter new markets. And you, you know, intentionally decided to, you know, kind of turn the business over in a sense for all the right reasons, you know, it was the, an intentional choice to, you know, let someone take the reins from here that knew how to scale. And, you know,

if you are willing to share, you know, kind of what's, what's come to fruition just the last year or two with Houseworks. Yeah. I mean, Houseworks is, is on a roll now. I mean, and I have to tell you, and I think I mentioned to you this in another discussion that, you know, the person, Mike Togilio is his name, when he came on, we were both in Massachusetts. We just didn't know each other that well, because he was focusing on the Medicaid home care population, and I was focusing on the out-of-pocket home care population. So when he came in, you know, I was like, Medicaid? You know, it wasn't that I didn't want to do Medicaid. I just felt like it was a different business. And I felt like, you know, how are we ever going to do both? And I got to tell you, like, it's been an incredible, it's working. You know, he came in and made two immediate acquisitions in the first couple of years he was there, which doubled the size of the company that I had started because it was fast growth with Medicaid. And then it got to a point where we knew that even over and above that

we needed a new capital partner because we just wanted to grow even more. And at that point, we brought in Intandum Partners. And Intandum Partners, that was a couple of years ago. And with them, we really become the best of class regionally, both in the private community, as well as expanding the vision to Medicaid. And that's really cool. I mean, and I feel like I just watch it with awe in the sense that it's happening. And this little company that I started, like is now this large company. And now we're looking to actively expand into New York. And that's a big deal because New York

has a lot of money to spend on home and community-based services. And, you know, we're close to, it's close to 200 million annualized now, housework. So we took this little company, we grew it really big. We got a really good capital partner who wants to see us succeed. And it's, you know, I really couldn't be prouder. And so it feels it's, that's a feel good thing. Good, good. And I love just hearing the self reflection, you know, in your voice and in your words, just, you know, letting it sink in, you know, even in a moment like this, where we're just talking, letting that sink in, you know, this, this business that you built, you know, at a young age, and where, where it is today. And, you know, it's not all about the money. It's about the impact, the amount of people that you

have served and allowed service to be provided to, you know, we're talking probably hundreds of thousands of people at this point, you know, so many lives impacted because of what you did and what you had the courage to do. And I think it's amazing. So thank you. Thank you for sharing that. I mentioned to you before, it feels kind of intimate to like get to witness your journey and I just appreciate you sharing it. The next 20 minutes, I want to talk about, you know, kind of the nitty gritty of the exit planning. You know, you mentioned, you know, getting your house in order. We can kind of spend some more time there. You mentioned distractions. I think that's a topic in and of itself that we could dissect. So let's kind of go back to just before the crossroads and you are making all of these

decisions thinking about how do I structure this business to sell and to bring in an investor. Let's talk more about the team. I think this is kind of a shockwave for you as an owner, but also for all of the people in place. How do you approach and make decisions for your people with something so large as this? Yeah. I mean, I think the first thing that I did sort of in preparation with the team was to make sure everybody understood what their job was. You know what I mean? Clear job descriptions. I mean, all of us in fast growth companies, we all say, oh, that job description is two years out of date or whatever. Oh, they have a new title or, you know, so you, you know, in order, in order, cause, cause you want your team to feel confident. You want your team to feel

they add value. You want them to understand how they add value. So when a new investor comes in, they can represent themselves well. And so, so a lot of it was, you know, a lot of it with the team was that, and a lot of just talking to them and helping them understand, you know, a lot of it with the team was that and a lot of just talking to them and helping them understand, you know, what it could be like, what it would be like, you know, that we're all in this together, that we're here to support each other, and that the people that we're bringing in are here to support the company. But you know how it is with change. I mean, everybody sort of jumps to their own story. Everybody's got a narrative in their own head of what it's going to look like. So, yeah, we did a lot of people probably don't have chief financial officers. They might have a finance person. Is that going to be good enough? Is that person not going to be needed? Who's going to be

needed? Who's not going to be needed? So you have to start that process. I used to make, you know, as you would imagine, just knowing me a little bit, a chart, you know, well, we have this person, you know, so, so I think, but a lot of that team, what you have to do in a team is, you know, well, we have this person, you know, so I think, but a lot of that team, what you have to do in a team is, you know, you also, you're talking to the investor about that before you sign the deal. You know, like, who are you bringing in? And what are you thinking about? And then you're thinking about your own people. And then you're thinking about who fits. But, you know, I had one company who wanted to buy us come in a long time ago and basically said, OK, well, if you want us to buy you, then, you know, 50 percent of your folks have

to go like just right off the top. And, you know, that, you know, that clearly wasn't a deal that we were looking for at that point. But, you know, I mean, but to really understand the expectations of what the investor might do or really what people they have with them, because a lot of investors bring a team with them. If you're looking for expertise,

they're going to have a team. So you want to understand how that's going to affect your people and keep talking to them. So I think that's just really important. And depending on who your investor is, depends on what they need in a team. I think that was great. You know, the transparent conversations are probably

obvious, but less so the role definition define what they do, you know, on paper, it's probably out of date, you know, from two or three years ago. So, so having those conversations, but then surfacing in getting, getting specific on their description and what they do and, and, you know, kind of putting, you know, pen to paper in that regard of, you know, what, what are they doing today and how does that play into this next wave of change? I think that was great. The other thing I want to call out is defining your value and your differentiators. You know, you have been in it for 15 years and you know what you've done and you know what you do well, but you probably had to take a step back and

define your differentiators and your value. You've got to really understand what your competitors do. If you've got someone coming in who's looking to maybe buy you or you're looking for an investor, how are you different than your competition and how do you do something? How can you define what you do that might be better than your competitors? So I think that's really important. And we would sit around as a management team and talk a lot about that. We would also look at our analytics, you know, so that's why analytics are so important because you can actually say to an investor or to anyone, you know, we've got six new referral sources this year that we didn't have last year. This is working,

that's working. We looked a lot at our, you know, our digital marketing at that point, you know, so I think that having really good analytics that you could show to an investor is really important. I did these decks where some people, again, would think it's overthinking it. But for me, it was just a really easy way for me to, when I was talking to people, present information to them that told a story of how this works. You have to get your story down the same way that, like, you have to get your own personal story down when you and I were talking about that, because I did some reflection about what it felt like, you know, why I did what I did.

Well, it's the same thing. You have to self-reflect on your business, and you have to be able to prevent presented in such a way that makes it feel like you're um you know things happen for a reason you have to understand you know even if you're not trending up the whole time you know at this point when things weren't as good this is what happened and here's how we got back to where we were really important to understand your business because there's no place to hide. When you bring in an investor, nothing is off the table. So you have to A, have your story straight, and then B, your numbers.

Your numbers don't lie. And so I think that's a good practice for any business of any size, is just making sure you are keeping track of your numbers. Because at some point, they'll come to fruition and they'll be out in the open on a table and you'll have to be able to defend them. And I like what you're saying too about, you know, the low points, you know, naturally, you know, in a conversation you could speak to your year over year growth, but you know, it's, it's also addressing those low points and being able to speak to them and the why behind them and own up to those,

but then explain here's how we, you know, surcame that issue. Yeah. And that's really important. And then, you know, if you go out there and talk to business advisors, they'll always say to you, you need, you know, at least three months of trending in a certain direction. And, you know, so there's certain things that you learned. And I actually hired a business advisor to help me, which for those of you who might not be strong in the deal-making area, which is many of us who are CEOs, many of us are strong in that area, it really helped to have someone sort of by my side to answer any question that wasn't too small.

And I just felt a lot more confident making decisions doing that. Yeah, I think that's great advice. And I just felt a lot more confident making decisions doing that. Yeah, I think that's great advice. And one thing that I want to talk about is preparing yourself. You could have, back to the crossroads, you could have stayed in your lane. You could have kept doing what you knew well and growing the business like you had been. But making this choice opens up this door to being really uncomfortable. And, you know, going back to maybe like the 101 of, you know, what questions do I ask? What are they going to ask me? How do I prepare? How did you prepare yourself for this

really uncomfortable, difficult circumstance? You know, what helped you throughout? I was thinking about that today when I was exercising because in the pandemic, of course, like most people figured out a way to exercise at home. Exercising and music did it for me. And I had a friend that worked across the hall for me before the pandemic, and he was in the process of selling, selling his company or stepping down as CEO, I don't remember. But he used to tell me he was basically went on his bike every morning and did that. You just for me, it's just you need space to be able to take it in, you're making these big decisions. You don't, there's not one right answer. There's never a right or wrong

answer. And then you have to be comfortable that the decision that you made is the right decision because you made it. But like in order to do that, you really have to build your strength and resilience and all that self-doubt that comes into all of our minds just because it does. That's the way we're wired. Some people might not say that out loud, but I imagine that everybody has those feelings in some way or another. So for me, I was able to, I actively worked on ways to get that voice out of my head and say, you know, you know what you're doing. You've got good advisors. I learned early on, I was coached for a while when I first became CEO. I learned early on to surround myself with people that I really trust and people who might know more than I do in certain things and not feel uncomfortable because

somebody knows more than me. I'm trying to teach that to my daughter right now, who's starting her own business. And I, you know, she's one of those, she's 31 and she's a female who feels like she has to know everything. And I'm like, no, not coming from your mother. It doesn't work that well. But I must say that I see that same trait in her that I had in me, which is really, you don't have to know everything. You don't have to control everything. You just have to be able to kind of go with it a little bit.

And for someone like me, who's pretty control oriented, it's not easy. It's really not easy to do. I think that's great advice. Surrounding yourself with mentors that can support you in your journey. And then you mentioned at the start, giving yourself time and space. These are massive decisions and you don't have to make them overnight. So just allowing your mind, your body, you know, your life to just, you know, kind of breathe and giving yourself space in these moments of high stress and, and important decision-making. I just want to say one quick thing about that. The only thing I wanted to say to people was that deal fatigue is real. You know, everybody talks about that. That's like a lingo thing. Everybody said deal fatigue, you know, we have to keep doing it fast because there's deal fatigue.

What deal fatigue can do, because it is real, is it takes you off your game because you're so tired and you just start making decisions based on, I'm just so tired. I want to get this done. Don't. That's my only advice. But I didn't mean to interrupt your question. Good plug. Good plug for that.

You know, someone wouldn't even know to ask that, that hasn't been there. So that was a great plug there. Kind of two, two more things that I want to cover and just talking about, these are both loaded, but the components of the deal, you know, deal structure and who to bring it. Like there's so many layers that we could unpack here, but just a couple of nuggets from you of what did you learn about like structuring a deal and how to think about a deal and the documents and the people, like what, what did you learn in that process that you would advise someone? Yeah, sure. In terms of deal structure and document, I mean, there's a ton of documents, like you've got to, you've got to be so top organized so there's documents and um you know you have to be thinking about and you probably want to get most everything in writing that you

can you know like what do you want for you what is your expected role what do you want for your staff you know again this level of detail might not be possible and the investor might not have any interest in doing it but if you can do it um it it, it's not a bad thing for you to be able to think about. We talked before about role clarity. Role clarity in deal structure is really important. Looking at all of that, looking at your agreements and all of that is rote. But even beyond that, it's just role clarity. And then I think that some people, you get so tired after the deal that you forget. Like I did talk a lot about communication throughout the process, but like how you communicate it to your referral sources and making sure that you stagger it in such a way that

the largest referral sources you have first and the largest customers, whoever it is, the way, what you say and how you say it and when you say it is really, really important. When you drop the press release, when you do, I mean, all of that, you've got to, that is not like, that can't just be an afterthought. Because integration of any acquisition or vice versa is sometimes harder than the deal itself. And it's your baby, you know, you, the investors come in with an agenda and, you know, they, they may push or prod or encourage you do things a certain way, but you know, you, you're passing off, you know, relationships that have taken years and years to build and you don't want to let those slip away. So that, that was kind of an aha moment for me.

If I think about how you communicate this to your employees and to your clients, but how you would communicate this to your referral sources and the community and the impact, you know, the greater people that you're impacting, how you communicate it to them and the order. And, you know, the timeline I think is really important.

So those are great call-outs as well to make sure that you're not rushed into any of those really big decisions and you do them on your own terms. Yeah. Yeah. And the only other I know we only have a couple of minutes, but I just wanted to say one other thing that I was nervous about that. When you take that transition out and you start moving away from something that you've been really identified with for your whole life. And I have a very strong network of colleagues across the country that I've spent a lot of time with over the last several decades. They don't go away just because you might step down as CEO. Your network is still with you and your network opens up differently. And it's really interesting that was a that was sort of an aha moment for me because I

was like nervous about that and and you know my network is as strong as ever and I feel very um really grateful to have the kind of professional colleagues that I have many who have turned into friends so it's a support system that will never leave you, you know, they're in it for the long haul, whether you want them there or not. Just in our last couple of minutes here, I know you and I have talked about your takeaways, you know, we've covered so much in this last 60 minutes and you have learned so much in this journey.

Do you want to just overview a couple of your personal takeaways? Sure. You know, first of all, and I think I mentioned this before, that the process takes over everything that you do. So you just have to know what's coming. So if you start doing this, just consider this another 33% of your time, and then it gets more as the deal gets real. But it really is, you have to be able to take it on, and you have to have the time to take it on, and you have to have staff that's going to pick up what you can't do anymore because you're in this process. So that was the first thing. We talked about communication. We talked about control. We talked about being open, again,

to things, you know, just because someone different might come in and do something differently than you doesn't mean that it's not right. And that's, you know, that's humbling, I got to tell you. But it's real, because we're just used to doing things a certain way. So, I learned that. That was a takeaway for me. And it also takes time to adjust. That two years that I had sort of working with the company, but not as CEO, really helped. I mean, it helped me have the time and the space to be able to, to be able to detach, you know, detach from, oh, I wish I were still there. Oh, I wish, you know, oh, I, you know, and why shouldn't I have done that? Or, you know, all of that, all of those things that can go through your head, it does take time to move through them. but I feel totally whole. I feel good and I feel like I'm ready to embark. I think I mentioned to you that my work is more centering around

organizing family caregivers in such a way to have a voice and to be able to... Family caregivers are really part of the healthcare system and they're finally being recognized so i'm doing some work with this organization it's a not-for-profit that we're standing up um to be its own 501c3 called daughterhood and you know so i i feel like and that was a natural transition for me and you know how i'll see what that where that takes me but it feels good to be able to get out of the operating role and kind of move into just sort of this fluid and choose what I think is important to me and what I think is important to the world. And, you know, so I think those are some of the biggest takeaway, which we sort of went

through them there. But like, I feel like I appreciate the opportunity to be able to just say them again. Absolutely. Many, many would think, you know, you're done after all of the success that you've had, but your, your passion is burning brighter than ever. You're still going, you know, you still have work to accomplish. And I, I just want to say it's been a delight talking to you. It's been a delight preparing and kind of reading your history ahead of this

episode. And I am inspired by you and your journey. And I think there's so much that people can learn from you. And thank you for sharing so openly your experience here in this moment and in this session, but on stages and conferences and webinars over the last couple of decades, you have so graciously shared your wisdom with so many, and I appreciate it and everyone appreciates it. So we'll, we'll wrap here, but Andrea, thank you so much for giving us your time and journey today. Okay. Thank you. All right, everyone. Thank you again for joining us. We will see you all back next week. We'll send out the recording to this episode and we'll, we'll share a link to Andrea's information as well. So you can connect with her on LinkedIn and connect with her afterwards. So have a great rest of your week. Thanks everyone.

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.