Home Care U - Operational Strategies to Beat Growth Plateaus (Jesse Walters)

Episode Date: August 27, 2023

Jesse Walters sees scaling home care agencies as a repeatable, predictable process if you understand the science behind it. Join us as we mine his knowledge from his time in executive leadership at TheKey and now as CEO of Hillendale Home Care.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 to Home Care U. Great to have you with us.

For those of you that are in back-to-school mode, I hope everything's going well. I hope you've had a great summer and you're excited and ready to get kids back in school. I think it's always a bittersweet time for people, but hopefully everything's going well. So quick introduction, and then I'll go over a couple of housekeeping items, and then we'll get right to it. So I'm Miriam Allred, head of partnerships at CareSwitch, one of the co-hosts of Home Care U. I'm excited to be with you all again. I've got Jesse Walters, the CEO of Hill and Dale Home Care with me. He's probably a new face to most of you. Jesse and I have been acquainted for a little over a year now, and I've been amazed and fascinated

by his experience and his expertise in home care. And so naturally, I wanted to bring him on to home care use. So at the start here, I'm going to let Jesse kind of run on his background. He's got a vast, pretty interesting background. And so I want him to kind of debrief where he's been, what he's seen, what he's done, so that you all can understand where he's coming from. And then we're going to talk today about operational strategies to beat growth plateaus. So it's very common in this industry and in business in general to, you know, hit some plateaus and to stall out for periods of time. And so Jesse has witnessed that firsthand and is actively, you know, building a team and building a company. And so he's going

to speak to how to address those plateaus, how to, you know, address them head on and how to work through them and how to get, you know, back on track to continue growing and progressing. So that's kind of a quick preview of what today's episode is going to entail. So without further ado, Jesse, why don't you jump in and introduce yourself and talk about your background and what's led you to where you are today? Awesome. Thank you, Miriam. And thanks for inviting me on today. And excited to hopefully help some of the folks who are on this call. I think I have a somewhat unique skill set in this business and experience. And I certainly hope to add value, not to spend too much time on it,

but a little bit of my background is I started as a caregiver in college. One of my mentors, my high school wrestling coach, decided to leave coaching and start looking and exploring the home care industry and invited me in to work as a caregiver for a number of his clients in Boise, Idaho. So I was a caregiver. I think I remember making $7.25 an hour with really no clue what I was doing. And that's a whole nother topic. But within a couple of years, my mentor opened up a number of companies in Las Vegas. He had left with his wife to Las Vegas. And so kind of on a whim, I packed my bags one weekend, threw them in the trunk of the car and drove down and actually lived in his garage for about six months while we worked on scaling

Medicaid-focused home care businesses. And I think when I started there, this is about 20 years ago, they had maybe four locations at that point. And over the next three or four years, we grew to probably 12 locations in Las Vegas and then a number of locations throughout. And it was all focused on the Medicaid market. And my role in there was a staffing manager. I would also start new clients and I was responsible for sales as well. So really deep experience in all of those buckets. And I've often said ever since that four years there that with staffing 24-7, if anybody's been in staffing, they know how around the clock it is. If anybody's been in staffing, they really know how around the clock it is. If anybody's been in staffing, they really know how around the clock it is. So ever since then, the hardest day at any other company I've

been with has been easier than or been harder than the easiest day at that company. But anyway, so we grew significantly and I had the opportunity to move to Walnut Creek, California to expand the company's brand. That's kind of a funny story. I was meeting with California to expand the company's brand. That's kind of a funny story. I was meeting with the CEO of the company and he said, hey, if you work and get the XYZ results, you'll become a partner. And he's like, we're going to Walnut Creek. And I think I had my car packed and everything ready to go before I asked, well, where's Walnut Creek?

Where am I going? Eventually found Walnut Creek and had a phenomenal experience, but I had to relearn sales and home care. There's not really a Medicaid market in this area. And I was this 24-year-old overconfident kid coming into this market. It's an extremely competitive market and really had to learn how to sell a higher value service and really expand a private business. So I did that for about a year and a half. And then we had a parting of ways where I then opened up a care management business. I had developed a number of really solid relationships, opening up that branch that I was able to parlay into care management, which I wanted to run a care management business so that I could play semi-professional volleyball the rest of the time.

So I built up a little boutique care management business for about three years and played semi-professional volleyball, semi meaning I paid, i wasn't paid um and then came across a company uh here in the bay area that you know i ended up meeting with the the chairman and the uh ceo where i thought they had amazing branding like it was the best branding i'd ever seen in the home care industry that you know home care industry circa 2007 2008 is is the old lady with the Coke bottle glasses with the cat on her lap and a bunch of really dark colors and just putting as many words into the page as possible. And this was all white background. I thought it was just beautiful. And I could tell that they didn't really understand the home care business, but they had this amazing vision on what it could be. So I ended up closing down my care management business and joined this company in 2011, where we were able to scale.

I think when I joined, it was 10, 15, 20, somewhere in there. And then I think just recently, it was right around 700, 800 million, somewhere in there. And personally, the effort, the work that I put into building the locations within the Bay Area, Washington, Arizona, really taught me how to think analytically about the business. It was also hiring a number of people. So I was always terrible at hiring at the beginning and then trying to figure out how can I be better at this and how can we get better results with less effort and attract top talent. So about a year ago, a little over a year ago, maybe 18 months ago, we had another change come up where I had the opportunity to be a semi-retired stay-at-home dad, which I was looking forward to. And I had somebody call me and say,

hey, if you can find something, I'm in, let's do it. And this person happens to be an incredibly talented salesperson within our industry. And I think across the country, I've had the opportunity to see a number of salespeople and she just blows things out of the water. So I ended up reaching out to an owner who was looking to exit the business. And she wasn't looking to exit, but through conversation, she'd been burnt out for a little while and was really looking for someone to carry on her mission and what she was doing. So November 29th of last year, we completed the transition of her leadership to my leadership. And I acquired the company called Hillandale Home Care. We can get into some of the details on that. But the particular part that I'm really proud of is with Hillandale, it took them about

20 years to hit about $4 million in revenue. I think last year was their best year, $4,097,000. And the team I've put in place, we were able to hit $4 million by June. So in about six months, we've hit that $4 million mark and we're still growing like gangbusters. So it's been great. And maybe to touch on the broader goal that I have with Hill & Dale is how do we create a significant, I think, region within the Bay Area where we can work with some of the best teams to provide a really high level quality, high level of care, not only to our clients, but also to our caregivers and really find ways to make impact in people's lives. And so our financial targets are probably right around $100 million in the next five years, as far as under managed services. Awesome. Thank you for that extended background. I think it's so fascinating. You know, I've met a lot of people in this business and you, you know, starting as a caregiver, the volleyball story, building these very successful, growing, scalable home care organizations. you know, starting as a caregiver, the volleyball story, building these very successful,

growing, scalable home care organizations. You know, I think no one has seen it all in this industry truly, but I think you, you know, come pretty darn close to having, you know, worked your way all the way through the career ladder, seeing and doing it all, but also getting to that like top tier where we're going to talk about these growth plateaus. You know, you have gone to the very top where you're scaling you know multi-million very large you know home care businesses and so you know i wanted to bring you on to kind of talk about what you do early on and how you structure monthly and quarterly and annual goals to then achieve you know these very

lofty revenue targets and business targets, because I think, you know, that's less common in this industry, but it is possible. And so that that's kind of what we're going to get at. So thanks for just also like checking the boxes. I wanted to allow you to like kind of build your street cred here because a lot of people probably don't know you. And I think you've done a really great job at that. So I want to spend the next few minutes kind of looking back at when you joined Hill and Dale, like you mentioned, you know, about a $4 million agency, which is a little bit larger than the average home care business. But I'm fascinated to know, you know, you came in with a fresh set of eyes, very robust experience. What did you do early on to already achieve in

six months, you know, massive like goals and gains? I just, I think to hear you vocalize some of this will be a good exercise for everyone on this call of, you know, how do you consistently analyze where you're at, where you're going, how do you get there? So let's just kind of look back to your first week, your first month. What did you do when you first got into the CEO seat? That's a great question. There was a number of things that I did. And I think first off is I had a pretty keen understanding of who the top players were in the market. And a number of people had reached out to me, which probably doesn't help a number of people on this call.

But I also spent the last number of years identifying who the top people are in the market. So it's not something that happened to me. It's something that I've spent a lot of time. I think Jim Rohn says, dig your well before you need it um i'm always analyzing who the top players are in the market and can i create um an exciting enough opportunity that that they will want to join uh what what i'm doing and eventually what we are doing right a lot of times i've had the opportunity to be a part of of a of acquisitions, both past and present. And I see what I try to bring into the teams I work with is a growth mindset, is what is the

potential opportunity that exists within our industry and within this particular site. And then I think about how it is that the employees of the team, how can I get them to believe it? Because if they can believe it, then we can achieve it together. And how do I develop incentives to create that level of activity? Right. So I remember walking in and it was a team of five or six people were sitting around the table when I first met them. And everybody's first fear is, well, if we grow too

much, we're going to offer bad service, right? Our service standards will go down. We won't serve our clients, won't serve our caregivers, et cetera, et cetera. There's a whole bunch of fear associated with scale and growth. And I've seen enough just in this experience here. As we've scaled, the quality of our service hasn't declined, right? Matter of fact, one member of the team, one existing member of Hill & Dale's team who's doing amazing, She commented the other day, I'm amazed we're four times the size that we've been before you came here. And I get fewer calls from caregivers, from clients on like how, you know, with like service failures or whatnot. So part of it is giving permission to people to be aggressive and want to grow. There's so much to it. Looking at the structure of the office, the structure of the team, is this a team that

is built to scale? Do we have the right positions in place where we can start 10 clients a week? Or will that break the team? So I look at client starts, I look at what's the current recruiting engine. Actually, that was one of the first changes I made on the team was we had terrible caregiver recruiting results. I think there's this challenge that we have in this industry that there's not enough caregivers to take care of the seniors that exist. I treat caregiver recruiting the same way I treat client sales. If you're unable to get results and we make a bunch of changes, you're just not the right fit. Let me find somebody else who can be aggressive and get out and sell and capture caregivers. So we're regularly hiring 30, 25, 30 caregivers a month and starting 35, 40 clients.

And it takes time to take three months to get people into the growth mode and to understand the vision of the future. The vision of the future is how many clients are we supporting? How many caregivers are thrilled to be a part of our company? And this team of five people, I promised all of them when we were sitting around the table, I said, listen, by next year, there's going to be twice as many people sitting around this table. Your team will get bigger. So we have a responsibility to build a really clean process right now. And that happened twice as fast as I expected, but it's been amazing. Yeah. So it sounds like there was a variety of things, but I like how you're painting this picture

of like it started with a conversation. You know, you're a new face and a new name and you've got this team and there's trepidation and there's all sorts of emotions, but you sat down and had kind of a real conversation. And what stood out to me too, was that like, believe it to achieve it. You know, I'm very much of that mindset too, of you can accomplish

anything you set your mind to. But in your case, as the leader, you know, you had to set that precedent and then, you know, everyone has to come around to that mindset, but you have to like lead out on that. So I want to like drill down a little bit there of how, how do you get people to believe your vision? You know, how do you get people to believe your vision? How do you convince people? How do you sell people? What's your approach to getting people to buy into the vision? That's a great question.

My personal goal with leadership is it generally starts with my vision, and I might have that to myself. And then when I'm starting to nurture, develop, or sell people, my eventual goal is, can this become our vision? If it's our, people will work much harder for their own vision and their mission and their goals than they will for my personal goals. Robert Leonardus I see a lot of companies or a lot of leaders who think that the company is built to serve them, where I kind of have the approach that, well, I don't want to enable people to not perform well. So I want to support them when they need specific help. I do view my job as to work for them.

They only want to, people only want to work with me if they're feeling like they're contributing to something, if they feel significant, if they feel like they're making progress, both personally and professionally, and if they feel like we're together, right? We have psychological safety and love within our group. So part of selling the vision is first, I have to understand where people are and what they believe is possible before I can start chipping away at those deeply held beliefs for them to understand. And fortunately, I have some pretty good credibility within the market. And I've had an incredible number of teams who have grown from, let's just say, starting the year at $35,000 a week in revenue and ending the year at $105,000 a week. So I've seen people

grow two, three, four, 500% per year a lot, right? Not like a one-off, but very consistently. And so if I have done what I've said I've done, and I have enough people that say that, then the team will believe a little bit quicker. So present the vision, start to create the we vision. And then also, then it's my actions are what matters. Am I really thinking we're, are they seeing new faces come onto the team because we're expecting growth? Or am I just saying it and not putting money behind it, not putting action behind it? So I think there's a lot of, what do these people need to hear? And what's the bigger vision? And where do they fit into that bigger vision? And then what action am I

taking on a daily, weekly, or monthly basis to help ensure that they can see it, right? That they can see what I'm doing. There's many cultures where the team doesn't talk about revenue numbers so much. I mean, I've talked to enough people where where the team doesn't talk about revenue numbers so much. I mean, I've talked to enough people where the staffing manager doesn't know what the revenue is, the client care manager, salesperson, et cetera, everybody. And we, on a weekly basis, report our progress, report our results, new client starts, caregiver starts, what were revenue for the week, what's the caregiver margin. And it's something that we all celebrate. That's a direct reflection of the effort they're putting in. And that creates an opportunity for me to congratulate them and also ask critical questions. And we'll probably get into that in

a little bit on the plateaus. But I think a lot of I just try to be an open book to people and make sure they have the information that they need in order to execute on what they're doing. Training is also super important, right? What's our process for, what is this person following and how do they report out on their KPIs so that we can adjust their results by adjusting some of the actions that happened beforehand? Does that help? Yeah, yeah, absolutely. You touched on a lot of things. And it's like, we could kind of go down these paths to hit on each of these. But I want to keep moving and reference what you just talked about, which was like financial transparency.

I've observed this a lot, you know, in just my few years in home care and in that smaller midsize agencies. I think there's this fear, you know, to share so transparently with your staff where you're at and what you're working towards and where you're headed. But like you mentioned, you know, there's this level of trust with your team, knowing your revenue, knowing your growth targets, knowing when you're failing as a business, like that needs to be at the forefront of everyone's minds, you know, to unify you, but also to make sure everyone's aligned on this vision and you're all working towards the same end goals. And so I think this is kind of a natural next place for us to go in that you mentioned at the start your goals with

Hill and Dale and your organization, which is, I'm going to repeat it, you know, a hundred million dollar business in five years. To many of you listening to this, that's probably a shocking number in a very short period of time. But in Jesse's mind, you know, it's realistic and it's what he's going to set out to accomplish. So I want to understand, you know, how you're breaking down that very lofty five-year goal into monthly, quarterly, annual goals and how you're articulating that to your team. Let's start there. First off, that number will happen. Not it will happen, but if that number happens, let's say that if that number happens, it happens with a combination of acquisitions and

organic growth, standing up new sites. So today I'm having conversations with a number of folks who have great reputations in the market and might be looking to exit in the next 12, 18, 24 months. And so some of that is through acquisition. And I also look at the Bay Area where I want to have sites and what gets us sites there quicker. I think the majority of the growth toward that 100 million is largely organic growth. I think we can skip ahead a few steps as we acquire or have the opportunity to acquire new sites with owners who are looking

to exit, but also don't want to sell their company to a private equity firm that's going to kind of chop it up and sell it for parts. So today, being so completely far away from that goal, what I'm talking with the team is really focusing on Walnut Creek, California, what are the impacts that we can make in people's lives? What's a great revenue target if we can get to $250,000 a week by the end of the year? We're in a really good place. And try to be clear with them on what our goal is with profitability so that we can be banking some investment to make that happen. And I really try to focus on what we can control. They can't control a lot within Walnut Creek. They can control their results and their efforts. So that's what I talk to them about. I have a very fractional executive team at this point that kind of CFO, CHRO, and this CAO administrative officer kind of helping build playbooks. And they're fractional. So we're,

you know, we connect 20 hours a month, 15 to 20 hours a month. And that's where we're kind of building out the playbook. I was just telling you before we jumped on that every Wednesday, we have a meeting and it's very detailed and kind of exhausting at times, but it's all really important to what needs to be true for us to stand up a couple of new sites next year or acquire a business next year. So with the executive team, I'm really working on the plans to build that. And with our Walnut Creek location, kind of single site right now, I'm working with that team on how to achieve the results that they want.

It should also be noted, one of the ways that I drive, I try to drive the behaviors I want at single sites is, you know, I kind of asked myself a question as a staffing manager, what would a staffing manager look like if I paid them? Or what would they do? What results would they get if they were worth $100,000 a year? And if I'm paying them $65,000 a year, California, that's kind of what we need to do for many reasons. But what would it look like if they were a top performing staffing manager? And I do this with client care. I do this with sales. And the 30% of it is what's our revenue, right? Just purely what's our revenue and profit? Can we afford it? The other 30% of it is what's our revenue, right? Just purely what's our revenue and profit?

Can we afford it? The other 30% is what is their contribution to that revenue that we've captured? How many clients are they servicing or how many hours are they servicing? What's our maybe conversion rate or retention rate? You kind of pick and choose your numbers. But then I'll design incentives and salary increases based on results, based on the effort and the results. And so I have staff managers who are being paid really, really well right now. I actually put together what I thought was like 18 months worth

of salary increases for people. And I think all of those will be met within the first like 10 months so i'm like okay i need to need to think about the next uh kind of tranche of increases and what revenue limits but i want everybody to to share in i have team incentives team revenue incentives individual uh performance incentives I want everybody to share in the success of the branch. I want them to feel like they own their job, they own part of this role and or part of the company through some of these incentives. Yeah, the two ways that I would just kind of recap what you've said is like hyper specificity on goals and incentives. You know, I started by asking like this very lofty five-year goal, you know, how do you think about and break

that down? And, you know, what you covered is like you have the five-year goal. So if you don't have a five-year goal, you know, put one in place. You're, you know, that's a great place to start if that's not in existence. But then getting really specific on the goals that are going to get you there and including your team. And then incentives. I think something that we have a lot of room for improvement on incentives. And I don't know if you've listened to previous episodes, Connor, myself, which we talk a lot about performance-based compensation. I think that is an underutilized lever in home care in that if you want to grow and your team is in the growth mindset, you need to compensate and incentivize based off that growth. And it sounds like that to you is essential in, you know, putting in place these incentives to motivate and

incentivize your team quite literally to achieve their goals and look and look at the results. You know, you just said you put together 18 month long incentive plans, your team's achieving them in eight to 10 months, which, you know, for you as the owner is probably like unnerving and you have to like reconsider things, but it's working. It's motivating your people to work harder, to work smarter, to work faster. And that could accelerate your business, could accelerate your goals. And so I think it's something in home care that we need to talk more about. And don't be afraid to put these incentives and these plans in place. Anything you want to say to that?

Yeah. The incentive piece, I read this book years ago called The Great Game of Business. I think it's actually like a coaching company as well. But they are an employee-owned business, but their comp structure is like 60% base and 40% incentives, right? Which allowed them to go through the 2008 recession and all people lost for their bonuses, but everybody kept their role. So I think the more, we're probably 80-20 right now as far as 20% incentives, but I think it's crucial.

What do you want me to do? What type of results do you want me to get? And what's the carrot? Because we don't need to talk about the sticks. We already know what the stick is, but what's the carrot? What do I get? And I think that builds momentum. What I want is people to want something bad enough to then start to ask, how can they be better at what they're doing to get the results that we both want them to get? I think it's a really, really, to me, an authentic way of like, hey, I want you to go out and get 50 clients. If you can do this, here's what you get. And then them say, how can I do that? What parts, what can I be better at? What feedback do you have

for me? What can you teach me in order to get these results? And it's just, it's a perfect, I think it's a perfect relationship that way. And those are really good indicators, you know, that your staff is in the right mindset. If they're not asking those questions, wouldn't go as far to say it's a red flag, but you know that there might be some complacency or some, you know, comfortableness. But if they're asking those questions, clearly, you know, they've caught wind of the growth mindset and they're asking the right questions, meaning that they are, you know, motivated to push and to grow and to grow inside their role. So I'm glad you articulated that. Let's talk, shift gears a little bit and talk about the plateaus that

you've seen or anticipate seeing. There's this really interesting concept, you know, you and I have talked about in that there are these kind of common plateaus that we see in the industry, you know, that 1 million mark, that 2 million mark, that 5 million mark, that 10 million mark. There's a variety of elements at play here. And I know we're going to have to speak a little bit generic because every business, every operation is different and the people and the processes. But I want to talk about these plateaus. And so in your mind, you know, what is a plateau and why are businesses, agencies specifically hitting these plateaus often?

First off, if somebody's hitting or if we're hitting a plateau, I immediately start with what are the right questions to ask, right? What am I not saying? What don't I understand? What would this look like if we were growing and how do I start to match that vision? I've seen teams plateau when you go from the number of people on the team, we may not have the right systems to support four or more people. For instance, if we don't have the right communication systems, or I use a lot of whiteboards in the office because I want information in front of people all the time, and they update the whiteboards. So do we have information flowing in a way? To me, that's a big system. Are we communicating well?

What does it look like if you start a new client, what's your process for introducing a caregiver or sending a caregiver out? And how do you get feedback? And who's the feedback shared with? And so today, do we have the right processes in order to scale? Can we take care of 100 clients with the processes we have the right processes in order to scale? Can we take care of a hundred clients with the processes we have in place and the people we have in place? So part of it is functionally the challenge between going from three people to five people, from five people to eight people. What's our onboarding and training plan? I've seen that a lot, but I'll share recently., we were probably averaging $190,000

a week in revenue, which is really great. But we'd pop up to 200, pop down to 185. It was really average, but we weren't growing as significantly. I'll share the first quarter, we grew 6,500 a week on average in revenue. And the second quarter, we grew 2,700 per week on average in revenue. So as I'm kind of seeing these indicators, I'm like, oh my gosh, I started having questions. And if I value my team, I think that they can contribute to the questions or to what we're looking at. So my first instinct was, do we have enough caregivers coming in the door? And how are we looking there? And so I'd investigate and ask the staffing team, do you feel like there's enough caregivers? I'd ask the recruiters, how's our pipeline looking?

I'd talk to our salesperson, How are we looking? What are you hearing in the hospitals? What are you hearing from your referral sources? Do we have enough client starts? I would ask the client care team, do we have, what's our client retention right now? Do we have a really, we probably need to develop a better or stronger retention plan. And so through all of those questions, we start thinking about maybe better processes in a couple different areas. Or actually what I did in this situation was we hired an additional staffing manager and client care manager to really aid with retention. Because I have two, we'll say two and a half client care managers right now. My general manager will put on a client care hat if need be.

But I have essentially two and a half people starting eight to 10 clients per week on average, which is the art is in the start, right? It takes 80% of your effort to start and maintain a client and about 20% of your effort to maintain that client long-term. And so I felt through my conversations that there was a bottleneck in our client care department. So we added an additional client care manager on. We also looked at a lot of the feedback from the salesperson. The census was low in the hospital, which tends to happen during the summer. So part of it is we need to be patient.

Let's get ready for the next wave of clients coming on board. We also, I looked at the incentives. Do we have the right incentives in place? Does our team understand what the goals are and what they can do to impact the goals? I mean, it makes me, plateaus always make me go back to square one. Okay, does everybody understand what our mission is? Can anybody share any challenges that you're having that might help us or support us if we fixed it to get to our moving on our mission, right? And today or last week, I think we build 212,000, 215,000, somewhere in there. So it's, I think we billed $212,000, $215,000, somewhere in there.

So I think a lot of that was probably the hospital beds filling up and a couple of good clients came on board. But I'm also really curious to see what happens the next six months as we've added on an additional client care manager to kind of open up that bottleneck up front. Can I regurgitate, you know, what you shared? Because I'm like mapping some of this in my brain and I want to like kind of spit it back to you and then ask a specific question. In an agency, there's three buckets here. You know, there's the client bucket, there's the caregiver bucket, and then there's the staff bucket. You're managing three buckets simultaneously.

And when you hit a plateau, one of those three buckets or multiple of those buckets are stagnating and there's an issue with either the people or the process. Is that kind of feel like a fair assessment of like, these are the buckets and something is plateauing or stagnating in one or multiple of those buckets. And then you need to identify what that is. And then, you know, laser in on, is it the people? Is it the process? Is it lack of vision? You know, what is behind it? That's a great regurgitation. I appreciate that. And I can, we can even simplify it further. If we're hitting a plateau, it's a caregiver and or a client problem, right?

So in the past, in some experiences I've had, we've been starting, let's say 20 clients a month, and we've kind of tapped out at some revenue number, 6 million, right? Because we're at replacement levels right now with these clients. So we'd look at, okay, what additional referral accounts do we need to bring on over the next six months in order to ratchet up our client volume? So maybe we can start 24 clients per month and capture that next revenue threshold that we're looking at. So I don't have those problems here yet, but I will in the future is we have maybe five great referral accounts. And we've done a lot of due diligence with these referral accounts to understand their

total potential referral pipeline. And we're at 80% max on these accounts. So that probably means we need to add three additional referral accounts or five additional referral accounts. So that's, to me, that's simpler math. And if we don't have enough caregivers, then I'm saying, okay, we need to increase our caregiver referral policy and understand what every single person on the team is doing to garner more caregiver referrals, right? So that's like the simple math. If both of those are working out, then I'm asking other questions like retention, retention activities.

What are we doing to retain clients? Are caregivers happy? You know, really looking at the team and are they blockers of our success because of structure or because we may not have the right person? I've unlocked significant growth in many locations by removing a really negative energy, i.e. person from a team. So that's always on the table as well. That's kind of asking questions in all those buckets. Yeah. So I think you kind of came around to what I wanted to highlight, which is I would challenge and say that the staff bucket is really essential. The clients and the caregivers are like primary buckets, but then the staff, I mean, I would say is a primary bucket, but you could maybe look at

it as a secondary bucket, but the staff piece is so important for that reason. You know, I've seen a lot of businesses stagnate at that three to 5 million mark for the issue that you mentioned, which is they have five people in the office and that's how it's been for a long time and they're they're afraid or you know don't can't find the resources to add seats to that office team and that is the hang-up you know it's them getting in their own way and not being willing to hire more office staff which then can grow the client and the caregiver rosters. So I think the office piece is one that these mid to larger agencies need to consider and break down those barriers of growing the office team

and back to what you've been hounding on, which is incentives and KPIs. You put the right people in the right places and give them the right incentives, they're gonna grow the business because of everything that you've put in place. And so I think I just wanted to reiterate, like the staff piece, your administrators are so essential, you know, an essential bucket in this, in this, you know, operation and identifying plateaus, you need to make sure you're allocating attention to all three.

Well, they are the core, right? They're the foundation. You can't build a house without a foundation. You can't build a home care agency without a foundation of the admin team and making sure that they all understand what their role is, what their responsibility is. Are they receiving coaching? And do we have the incentives aligned? And do they understand how people will get demotivated if you put a big fat incentive in front of them and no path to get there? So it's a combination of supporting them with that path, accountability, et cetera. So you're a hundred percent. I'm glad you highlighted that because the admin team, I don't have a, I mean, I have a really terrible job if I don't have an admin team, like I'm doing it, you know, I would be doing everything today. I get to spend a lot of time on

strategy and coaching and support and very little, if any time on, on client care or caregiver activities. I want our clients to have an incredible experience. And if, if we take care of our caregivers, they caregivers, they'll provide that nine times out of 10, which means I need to take care of my staff who take that I'm thinking about is, is what we've talked about very much like wash, rinse, and repeat in that this is applicable at 1, 2, 5, 10, 100 million? Or looking ahead and looking at some of the larger organizations you've been a part of, you know, that 10 to 20 beyond, is everything that you've covered today very much aligned with what needs to happen at that stage? Or are there other components

that we haven't talked about that come into play when you do hit, you know, those larger revenue milestones in your business? I mean, it's all, to me me none of it changes there's there's no change there's there's clients and caregivers and if you can support more clients this year than you did last year you're probably growing and you can start to map out what your average monthly uh client revenue is and then kind of map out where you need to be to hit your goals. Galing significantly to me is just having five sites who do that, right? And a number of different personalities in each site, but if the core and the structure

is the same, they can all support each other in how they grow and you can bring together a really great network of people. I think the complex part of multi-site support is how to build that corporate support team to make sure they're fueling growth and fueling energy into those local sites so that they can achieve their results. But I really genuinely don't believe it shouldn't be different. If it's different for me, then I may not have a process that I can replicate. And I'm going to have a ceiling on how far we can grow. I think you'll find at a single site that's at $15 to $20 million a year, you do start

to look at, am I fully saturated in this market? And what type of annual growth can I expect at $20 million a year, you do start to look at, am I fully saturated in this market? And what type of annual growth can I expect at 20 million? It might be 10% to 15% annual growth where to get there, I mean, this year we'll have 150% annual growth, right? So it's like your growth percent goes down, you're still growing really well. And that's where I'll need to capture additional growth in additional locations. Well, hopefully, this response is a little bit like a sigh of relief to people. You know, I came into this thinking, you know, there's really nuanced differences at each phase. But I think the way that you're explaining it is that, you know, it is unchanging. If you build a really strong foundation and you build these repeatable processes and you

get the right people in place and the right incentives in place, you can do that in kind of like a micro organism. You know, if you can do that on such a small scale, you just repeat that, you know, you just continue to scale that exact process and just replicate it on a much larger scale. And I think that, you know, like I said, is hopefully like refreshing to hear from people and that, you know, if you've done it well at a $2 million business, and if you want to get to five or 10 or 20, you just have to keep adding layers, but keeping that foundation really strong and consistent. Yeah. I mean, if you look at a lot of the processes that are important to me are

processes around communication, team communication, communicating with clients, caregivers, introducing caregivers to clients before the start of any shift, et cetera. And what you'll see with, I think, a lot of a number of organizations is when you're at three people on the team, communication is pretty flawless. There's very few, you know, it's so simple. It's the structure is a triangle. It's like so sound and so solid.

And then you start adding a fourth and a fifth person. You say, okay, we need to now standardize how we communicate because it's going to get much more complex with potential lines of communication between so many people. And now my team, my ops team in Walnut Creek, I think has 17 people in there. And so it's making sure, again, that this process that we built at five or six people does scale. And if it doesn't, what would it look like if it could scale and start building that process to make sure that communication is smooth. People understand what's

happening before it happened. You know, it's communication to me is 100% of our business. Someone has just asked, you know, are you heavily private pay? Is Hill and Dale exclusively private pay or heavily private pay today? Yeah, we're 90% private pay and 10% long-term care. Awesome. Well, people are maybe chatting in. Oh yeah, here we go. Same thing. Yeah. What type of referral sources are referring most of your business? The ones that I have the best relationship with. That's a great question. I was actually, I'm glad that question was asked because that's another process I think that is really important to scale is if I look at some great

referral accounts, geriatric care managers, in your living communities, hospitals, if your team doesn't have a process to service those, the referral stores and the people. And I usually with my teams, any team that I work with, it's not just my salesperson. My salesperson's job is to get me a client referral from this account. And then once that account is unlocked, then we start to send in my staffing managers, an assigned staff manager, an assigned client care manager to make sure we can actually take that relationship from superficial to a really deep and trusting relationship where the salesperson has a great relationship staffing and client care,

where then that referral source feels they know the team. It's a great team and there's clear accountability. She knows exactly who she can call if she has an issue with one of her referrals. So there's great processes for senior living communities, care managers, hospitals, some of the other smaller accounts. And I think you're in a unique position in that your team has been established in that area for a little while or for a long while. And so there was existing relationships there. A lot of these new businesses that are just getting started out, you know, they're coming in to, you know, very established organizations with existing relationships. And so it's tough to break in. Someone asked, do you pay for referrals? And how do you develop these

relationships? I know that's a loaded question, but what's maybe like a 30 or 60 second response there? That's totally no. So we do not pay for referrals unless you count dinners and supporting the hospital through their fundraising arm, but nothing is tied to a direct payment for a client. And for many reasons, one is just, I'm pretty sure everywhere, but at least in California, it's certainly frowned upon. And a secret between two people is not a secret, right? So I would not pay somebody for a referral because that will get out. And you'll find as large companies, as you become top players in the market, people will actually say that you are receiving or that you are paying for clients. You can't find any other way that you're winning. So it's unfortunate. Before I try to develop a relationship, I really, really encourage everyone to validate the potential opportunity. When I was

23 years old, opening up a startup in a very, very competitive market. I can remember really calling on the clients, sorry, the referral sources that liked me. I only found out later that they would just never refer to me. So I think kind of find it and then maybe because they don't have referrals or they have a closer relationship with somebody else. And so I think validating, if I'm walking into a senior living community, I'm asking them, you know, I'm touring it and throughout the conversation, how many clients are you, how many clients are working with a home care company today? How do you work with them? What are your frustrating points, et cetera. But I'm also evaluating, okay, if there's 20 clients in this, in this building,

and my average client is 6,000, then I know that this is a $1.5 million opportunity if I can maximize it over the next 12 to 18 months. So then I'm looking at within this community, what value can I bring to them that they're not receiving today? And it's not home care. Nobody needs more home care, but somebody needs someone to lead activities. Somebody needs somebody to sponsor an ice cream social or to do little things to help them do their job. And so that's probably my salesperson, Francesca Vogel, has too many horses that she brings out to communities and to the hospital. And referral sources and clients absolutely love meeting the horses and they're the hill and dale horses. So there's always finding creative ways to find out what needs are not being met by this potential referral source after you validated that they are a potential referral source

and then find a way to meet those needs. That was perfect. And that was a good condensed version. Two more questions in our last two minutes here. Let's see if you can get both of these. One is which hour, I think of like hour formats are giving you the most revenue. You haven't talked about like, are you servicing live-ins or, you know, longer hour cases or short cases? Like what, what's kind of like your

blueprint at Hill and Dale? And what do you, what do you recommend? Even though, again, this is like very situational. What, what's, what have you found to be successful from an hour format perspective? I think our average client is about 34 hours a week right now. Just looking at about that $6,000 a month mark. A number of 12-hour shifts. You'll see that with hospitals. We receive a lot from hospitals. And those are great because we have a number of client starts.

Those are not great because we have a number of client starts. Those are not great because we have a number line every day. So we've got to be dialed in on that. I think senior living can be great. I don't offer staffing to senior living communities unless they're in dire straits and they are an established referral account, meaning they refer one-to-one clients. So I'll only provide staffing at that point. What else? I think that was good. You referenced the 20-hour week minimum, which I was curious to hear. If you have a minimum, some agencies do, some don't, some's high, 30, 40-hour minimums, et cetera. So I want you to interpret this last question. I would maybe take it a different one direction. I don't know which way you'll take it, but this person's asking, is there another way you can generate business growth other than scaling your workforce? If you're in home care, then I've seen different AI technologies.

You can try to sell ball detection. You can make an extra 25 bucks a month per client on that. I have not seen, and I've seen a number of technologies. I have not seen anything that's going to scale to the degree that serving one client really, really well will scale. Yeah. I was thinking, I'm guessing they're referring to just like different service lines. Some people want to branch out and offer different lines of service. Oh, that's a... Yeah, I've seen that. I had yet to see... I had a large senior living community, group of communities reach out to me years ago,

and they tried to bring me onto their leadership team to develop a home care division. My response was, you're running a $200 million senior living community, and the most I'll be able to scale your business is to like 10, 20 million, somewhere in there. We're never going to be a priority. Why would you even consider it? So I see a number of companies that are trying to add additional services on. I'm of the mindset to go deep in what I'm an expert in and try to maximize wallet share within the market versus trying to have 20 home health clients and 10 hospice clients and kind of being the jack of all

trades. I haven't seen it scale significantly, even on the public markets. There's some really big companies, but they usually, I mean, there's the health insurance. Who was it? Humana shut down their home care division. You can, and certainly good luck. I think anybody who's dialed in on their particular expertise will eat your lunch. I like the raw response because I see a lot of this chatter and banter in the Facebook

groups of like, when do I diversify? When do I add new service lines? I think everyone's asking themselves that question, but I appreciate, you know, what you've said in that, like master your craft. And until you've mastered your craft, don't even, you know, get distracted with new service lines, you know, because it will become just that a distraction. And then your time is divided and your staff is divided. And that's just ripe for errors. The beauty of our business is there is no competition in the market because there's so many clients that need service, right?

There's just more than we can imagine. And we get to practice every day. We get to make mistakes. We get to... Our team members get to practice every day. We get to make mistakes. We get to, our team members get to screw up. And so to me, it's similar to sports or something that anybody's ever wanted to be the best. You have unlimited potential to make mistakes, make improvements and get better. And I can't imagine being a billion dollar company and then deciding to diversify.

Like if you're a billion, then great, go five, go 10. You know, there's, there's just unlimited potential to work toward mastery in our business. Yeah, 100%. Well, let's end on that. Awesome job in the hot seat there at the end. I was just like rapid fire, throwing things your way after kind of a loaded session.

So thanks, Jesse, for being here. Really good insights. You know, we've talked about a variety of things, but I know, you know, there were nuggets in here. I know I wrote down've talked about a variety of things, but I know there were nuggets in here. I know I wrote down a few like aha moments that I had. And so I hope this has been fun for you, but also really useful to everyone that's listening and everyone that does listen in. So thanks for joining and thanks for being willing to go over time a couple minutes. Yeah, of course. And anybody can reach me on LinkedIn. I'm sure you'll share my other or

share this on LinkedIn. So happy to answer questions, connect with folks and super passionate about this business and love to work with leaders who want to be great or are great. And I can learn from as well, but thank you. Absolutely. Well, we'll end here. Thanks everyone again for joining us and we'll be back same day, same time next week if you want to kind of continue the conversation. So thanks, everyone. Have a great day and we'll see you again soon. 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.