Home Care U - The Art and Science of Scheduling (Brett Ringold Pt. 2)

Episode Date: June 26, 2023

Part two of our deepest of deep dives into scheduling with the scheduling master himself, Brett Ringold of A Long Term Companion.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, U for University.

Great to have you with us. Hope everyone's having a great week and enjoying summer. I know I can't get enough of this warm weather. I just feel like I've got a pep in my step because of this warm weather. So hope everyone's enjoying it. I'm Miriam Allred, head of partnerships at CareSwitch. This is Home Care U, which is this weekly live event series. Like you all here are joining us today. We produce it after as a podcast. So for any of you asking out of the gate, will this be recorded? Absolutely. We'll send it out via email after this session.

So without further ado, we are back for session two with Brett Ringold, vice president of A Long-Term Companion. I hope most of you here have listened to the episode from last week. Some of you have said it was the best you've seen in years. It was the most detailed overview of pre-scheduling you've ever seen. So I'm really excited. We're back with Brett again today to go into scheduling and post-scheduling. So if you want the deep dive on pre-scheduling, which in my limited opinion is probably the most important component of this three-part process, go back and listen to that first episode, share it with your scheduler, share it with your team. There's a lot of detailed information about everything that feeds into the actual scheduling. And today, that's what we're going to go into. So before we jump in, Brett, I know we did a long intro on last week's episode. And so

I highly recommend everyone go and listen to that. Let's just do kind of a condensed version today. A little bit about your role, a little bit about a long-term companion, and a little bit about your background and your agency. Just share as much or as little as you want today. bit about your role, a little bit about a long-term companion, and a little bit about your background and your agency. Just share as much or as little as you want today. Well, first, thank you so much for having me back, Miriam. I am so excited. It was a lot of fun we had last week. And based on the feedback from agency operators, I'm hoping that we have another great episode today, which I think we will. My goal is to share how we break down scheduling and post-scheduling or rescheduling. And I really want everyone to leave with some actionable

insights that you can apply today to your agency to help with scheduling, which is a really important part of our operations. A little bit about me. I am an owner-operator since 2010. So I have been in the home care operation side of the industry since 2010, although my first experience with home care was as a patient. I have Crohn's disease. I was diagnosed with Crohn's when I was 12. I've been in remission for over 15 years, but from age 12 to 19, I did have some pretty challenging times. And we actually, my family and I, hired a local home care agency during a particularly bad Crohn's disease flare-up. That episode led to my changing trajectory of my life and my family's life. My mom was a preschool teacher. She taught twos and fours. Her life's mission and why she was put

on this earth was to teach two-year-old and four-year-olds for almost 20 years up until that point. She was my caregiver. Whenever I was not feeling well, she'd take off and care for me. And that experience we had just really left such an imprint. She knew that we had to do things better to serve the communities and the people who are in need of care and the amazing caregivers who work and provide the care for our clients each and every day. So she resigned as a preschool teacher, started a long-term companion in 2010. I've been partners with her since month one, and we're really passionate about what we do. I hope it shows we're family-owned and operated. We're accredited by the Joint Commission. We provide care in Pennsylvania, New Jersey. Everything that we've been through, all of the ways that we've developed and matured, we really have some things that we do exceptionally well.

One is caregiver satisfaction, which is what we're most proud of. And the other is scheduling. I was our agency's de facto scheduler for the first six years before we hired our first scheduler. So I made all of the mistakes that everybody on today's webinar has made and then some. But I learned throughout the years, I really found out what was working really well and decided that we have to find a way to duplicate and systematize this. And then what wasn't working, how could we tweak it to make a process that works and supports us as we grow?

So I am so excited to go over the scheduling and post or rescheduling phase of scheduling today. Miriam, I couldn't agree more. Pre-scheduling, we break it down to pre-scheduling, scheduling, and post-scheduling. Pre-scheduling is the most important, so please listen if you haven't yet. But what we're talking about today is really going to help. So I'm excited. Awesome introduction. Thank you for sharing that. I love your story and love hearing about you and your mom and starting the agency. It's just such a heartfelt and impactful story. So thank you for sharing that. And two accolades that I failed to mention last week that I need to mention today is your representation on the Pennsylvania Home Care Association Board

and the Home Care Association of America Board. You have worked so hard over the last 10 years and have developed this reputation in the industry as a thought leader who's built this incredible successful agency. And so I want to put in there that you sit on both of those boards and congratulations and success to you for your seats on those boards. Two other things that I want to throw in here before we jump in. We squoze this in at the very end last time, but I want to start with it today, which are your caregiver retention numbers. Part of why this scheduling process that you have dissected and built is reflected in your retention numbers. So can you tout yourself and speak to your retention numbers in general? Sure. It is. It's certainly what we're most proud of, our retention of our amazing

professional caregivers who are part of our family. We are not immune to turnover. Every agency experiences turnover, as do we. But half of all, almost half of every single one of our amazing caregivers at A Long-Term Companion, 47% have been working with us for at least three years. 29% of our caregiving team has been employed by A Long-Term Companion for five or more years, and close to 20%, 18% for seven years or more. We started back in 2010, so we're in our 13th year. We have a 10-year anniversary this year. We had one last month. We started back in 2010. So we're in our 13th year. We have a 10 year anniversary this year. We had one last month. We have some upcoming. So what we're going to talk about today, it's really helped our agency to make sure that we are having satisfied caregivers who want to find a home at a

long-term companion and that you're going to be able to apply this to your agency as well. Thank you for sharing. I have yet to meet an agency whose numbers are better than those, honestly. And I want who, if anyone's listening to this that can do better than that, honestly, I want to hear. I just, those numbers are an outlier in the industry. Those retention numbers are phenomenal. And so as we talk about the scheduling process, I want people to understand what it has led to inside of your agency. So last quick question before we jump into scheduling, just for context of like the demographic of your agency, just throw out kind of like roster sizes roughly or weekly billable hours, just so people understand kind of the size that we're talking about today.

Sure. So our average client census is right around 100, generally a little less. But we schedule almost 9,000 hours a week, about 8,600 hours on a weekly basis. Our clients tend to have greater needs and need more care than most of our agencies in our community. And of the 100 clients that we serve, we have a caregiver team of about 175 professional caregivers. And that's a ratio that we monitor. We make sure that it's never askew, either too many caregivers, the clients, or not enough caregivers, the clients. We talked about that last week.

And that's very important to always be mindful of your caregiver-to-client ratio because it's going to prevent unnecessary turnover. And it's also going to prevent unnecessary strain on your schedulers. There's always that happy medium that you can find. Perfect. Thanks for sharing that. I wanted to just, I like to set that baseline understanding so people know where you're coming from. So, and I also want to reference that in the previous episode, we talked about what makes a good scheduler, what his client to caregiver ratio is, you know, and then we jumped into pre-scheduling. So those are some things to look for in the previous episode. So let's jump into scheduling. I think I've held us in suspense long enough. I'm looking at my list here and there are like 10 to 12 elements of your scheduling process. So we're going to kind of work through them one at a time. But I want to preface to everyone, there are about

10 or 12 components here. So we're going to cover a lot of ground, but know that this is all living inside of Brett's scheduling process. And then we'll work to the rescheduling or the post scheduling. So let's start with the first element, which is knowing your clients and caregivers. And I think every agency owner operator would say, you know, we know our team, etc. But what does knowing them, truly knowing them look like inside of your agency and the impact of truly knowing them? No, and that's a great question. And that's a great place for us to start in scheduling. I have no doubt that every agency operator on today's webinar and listening to the podcast,

you do know your clients and your caregivers to a certain extent. But the real tricky thing is what do we do with that knowledge, right? We look at it as having a thorough intake process for both our clients and our caregivers because scheduling, it's really a two-part equation. It's not just finding a great caregiver or caregiving team for your client. It's making sure that your client is also a great match for your caregiver. So when we are starting care for a new client, we have an intake process where a member of our wellness team, a registered nurse performs an assessment. You know, we do the standard assessment that most agencies do, a fall risk assessment, a home safety evaluation, a needs-based assessment, and we construct a care

plan based upon that individual's assessment. But all the while, our client relations team and our nursing team is also finding out what makes that person, our new client, unique above and beyond what their needs are, right? What are they like? What are their hobbies, interests? What's their profession or their past profession? And these are questions that we ask and we take into account and put into the client's profile in our scheduling software. But we're also getting a sense for what kind of personality is that person? Are they very bubbly, extroverted, engaging, and they want to show you pictures of their family and tell you stories about their grandchildren. Or are they more of a wallflower and they want to have the assessment finished and then just have a caregiver who's going to perform excellent care for them, but not have that companionship element. So we want to know our clients on a personal basis, which I would venture to say most agency does.

Our caregivers, same thing. You know, we want to obviously know what are your skills, what are your experiences, what are your backgrounds, make sure that we're going to have the right match from a skills standpoint, but also through orientation, through that first call and on an ongoing basis, know your caregiver personally. The same questions we ask our clients, what do you like? What do you dislike? What are your hobbies? What are your interests? These are, we're also capturing for our caregivers and we're finding out about our caregivers. In orientation, do other caregivers gravitate to them? Are they a natural leader? Are they more so introverted? And when we're doing our matching, our scheduling for a client and a caregiver, we're really paying attention to both sides of that equation. And that's something that,

you know, it sounds well and good, and it's not always easy to do. But that is really one of the reasons why we have the retention rate that we have, because we go the extra mile for our caregivers. Our caregivers know that we're working for them. We're going to work for them. And our job as schedulers, as agency operators, is to find a client for them with a schedule that works for their schedule. They're going to be working the number of hours that they would like to work and with a client that they enjoy going to work with. And that's something that's really important is just knowing your clients, knowing your

caregivers, and truly matching for both sides of the equation. Absolutely. Lots of good information here. Part of what I'm thinking too is at scale, this comes down to training your team in conducting those assessments. And then also which we all have room to, you know, room for improvement on the, on the documentation side. But when you're dealing with so many elements, like you were saying, you know, it's not just their schedules and the ADLs and the IADLs. It's not the basics, but there's all this additional more qualitative assessment that's

going on. How have you trained your team and how do you ensure enriched documentation? If you have a caregiver roster of two, three, four, 10 caregivers and a client census of two or three, it's a lot easier and a client census of two or three, it's a lot easier to know your caregivers on a personal basis and your clients on a personal basis. As your agency grows and as you scale, you have to have systems in place. So part of it is asking direct questions and fine tuning your intake documents. For your client, we do ask point blank and we capture that. We also have conversations and we have certain things that we train our wellness team, our nurses on, our client relationship coordinators on, our schedulers on. They're all looking for different aspects of these soft qualities, so to speak.

But you want to have as much as part of your intake doc, and that is part of a living, breathing document. Same with our caregiver's document. We're going to ask for the caregiver application, for the onboarding documents, certain questions that are maybe going to seem a little bit unique when you're looking at other agencies. We want to know about your skills, your experiences, but we also want to know about you. So you want to try to have as much information input by your clients and caregivers as possible, but it's also just having those good listening skills and being able to sometimes, you know, a good example is we'll have caregivers who are new to us at sitting at orientation and they're really, really quiet, or they're sitting at an interview and they're not, you know, sharing a lot and opening a lot about themselves.

Some people are just uncomfortable at interviews. Some people really, you know, just with test takers, you could be a brilliant 4.0 student, but then you could fail every exam. You could be an amazing, empathetic, warm, caring person, but you may not be the first person to open up about yourself. You might need somebody to ask you. And if you're not comfortable opening and accepting, that's fine. That's where the conversation stops. But sometimes just a little cueing goes a long way. So it's something that we discuss with our team, but it really is important to just surround yourself to hire really caring, empathetic people with these soft skills because traits, certain know, certain things as far as processes,

those are the things that can be learned, but something innate as to how to be a good listener, how to be a good communicator, those most people are really born with. So you just have to make sure when you're building out a team that these individuals on your team have these skills. Yeah, absolutely. One more thought to kind of close out this section is you need to share all the information about the client with the caregiver. You don't want to blindside the employee before they go visit, especially in the first visit, but you want to share all this information. So how do you, what does that process look like? And how do you ensure that the most up-to-date, accurate information about the client is being relayed on to the caregiver. Sure. And that's something that I kind of wish we didn't have to talk about. I would hope that everybody, every agency was doing this. Unfortunately, we hear time and time again from new caregivers that that's not always the case with other agencies. So it starts with a thorough intake process. Make sure that you are doing a comprehensive assessment and can create a plan of care. But that's not where the client's needs end. You know, clients change. A client today, their baseline could change

drastically tomorrow. So you want to make sure that as agency operators, you have elevated touch points for new clients and new caregivers, but you also have ongoing communications. You know, every agency operator, whether you're part of the scheduling team or the recruiting team or the operations team, you're dealing with so many different things on a given day. And if you don't have a process in place, things are really easy to fall through the cracks. So you should really try to have a standardized process that we're going to talk with every single caregiver and client after the first shift and and after the third shift, and after the fifth, the seventh, the tenth, and then maybe once a week thereafter, just to get feedback. Because a member of your wellness team, your registered

nurse could go out, do an assessment, your client seems like we know exactly everything about them. But after the first shift, you get feedback from your caregiver that the client is different. They have different needs when it comes to transferring or toileting or bathing. So things aren't static. They change all the time. So by having regular communication with your caregivers and clients, that's one way that you as an agency scheduler administrator can update your client profile, make sure that you're always sharing the most up to date with your caregivers. And, you know, I'm sure that you're always sharing the most up-to-date with your caregivers. And, you know, I'm sure that there are times where you just overlook something, but you should never neglect, you know, on purpose to share something about your client with their caregiver.

If you're in a bind to fill a shift and you know that if your caregiver knows that your client is bed bound or has a Hoyer lift or has dogs or cats, and you tell that with them, they're going to say no. But if your client shows up without having the full picture, you're putting your client at risk, you're putting your caregiver at risk, and then you're going to have very dissatisfied clients and caregivers. So it really affects your operations across the board. Yeah, really good insights. That seems straightforward, but it's good to just reiterate some of these elements. So let's talk next about consistent permanent schedules. Talk to me about how you build and structure schedules. A lot of people say at the final interview, they're not leaving here without a schedule. Just talk through some of those

elements of giving their know, giving their caregivers and creating their actual schedules. Yeah, it's, it's more important now than ever before. You know, I've been in scheduling and operations as an agency owner since 2010. And it's, since the start of 2020, things have really changed, not just for our agency, but for every agency. Your caregivers are interviewing and with you are attending your orientation, but they may have already attended an orientation last week, the week before they may be rostered with five different agencies. You have to realize that your new caregivers are not necessarily coming and going to wait for a day, a week, or a month for you to have a schedule for them.

So the sooner you're able to schedule them with a schedule that, you know, isn't a cursory schedule. If your caregiver is looking for overnights, Monday to Friday, and you're offering them weekend shifts during the day, you're offering them a schedule, but it's not what they're looking for. So make sure that you're finding out your caregiver's availability, their optimal schedule, and the number of hours that they'd like to work for a week. And your job as a scheduler is to offer them that schedule as soon as possible with a client that they're going to like working with. Miriam, you said a great thing as far as try to leave the orientation with a scheduled shift, whether it's a shadow shift with a client and an amazing caregiver that you know is going to do a good job of training them to how you do things specifically at your agency. That is always one of our favorite strategies because you might not always have that new caregiver's perfect

schedule, but you're always going to be able to have shadow shift opportunities, training opportunities, different ways to make sure that your caregivers are leaving your office with some sort of guaranteed paycheck. And sometimes you do take a little bit of time before you have that perfect schedule, communicate it. It's really important to be very clear that our job is to work for you, to find you that schedule that you're looking for with a client you like. It might not be tomorrow. It might not be next week. but in the meanwhile, this is what I'm going to do. I'm going to schedule you with this client so you can train. I'm going to schedule you with this client. It might not be the hours that you're looking for, but I am working for you. And inevitably, if you have that proper ratio where you're not way over staff and you're just having a lot of caregivers on your roster for the sake

of having caregivers on your roster, you're going to be able to be very knowledgeable knowing I'm hiring this person. I'm going to have a case for them within the next few days. One thing that I want to ask, I hear a lot of owners and operators say, you know, my caregivers want full-time work and they're kind of like stumped. Like how do I offer 40 hour weeks to my caregivers? There's, that's like a multifaceted problem here. And it's how you structure your schedule. You know, it's difficult to get to 40 hours when you're offering a bunch of two to four hour shifts, et cetera. So talk to me about, are most of your caregivers working full time at your agency? Yes or no? Or what that breakdown looks like?

And then how you've structured your shift lengths, and if you have minimums, to then make some of that easier? No, that makes perfect sense. And this question, had you asked me back in 2010 or 15 or today, it's changed. We do most of our caregivers for the first part of your question, Miriam. Most of our caregivers are full-time and only work with our agency. We are some of our caregivers' secondary employers and tertiary employers that pick up shifts PRM. But most of our caregivers are full-time.

We have never been averse to scheduling overtime, which I'm sure we're going to dive into later. We gladly offer health insurance to our full-time caregivers, supplemental benefits to all of our part-time and full-time caregivers. We like having a comprehensive benefit and compensation package to our caregivers. We know that it might be more than the agency down the street, but we also want to make sure that our caregivers are very happy and want to stay with us at a long-term companion. So yes, most of our caregivers are full-time. We initially had a number of clients. They would schedule us for four hours a day, two hours in the morning, two hours in the evening, Monday, Wednesday, Friday, or just on weekends. And we would always

say yes because we didn't want to let anybody down. My mom wanted to start an agency to help the community. We would say yes to everybody. But we've found over time, we know who's a good client for us. And our referral partners know that too. So nowadays, our client census, a client on average receives over 90 hours of care a week. Most are 12 hours a day, seven days a week, 14 hours a day, 24 hours a day and two 12 hour shifts. So we're able to offer longer shifts that our caregivers really want to work. There are calls that we get on a normal basis every day, basically from clients who are looking for lesser hours. And we refer them to agencies that we know that is their core competency and competency. That is their niche. Their rosters have caregivers that most of their

caregivers are part-time. It's a secondary employer. They're able to schedule shifts like we, pay them straight through or pay them for travel time, depending upon, you know, how much time they have for breaks. But you have to be very creative. I mean, we are, I heard Jeff Weiberg say this at a Home Care Association of America conference last year. He was giving a presentation. He said, you know, we're in the care industry. We provide care to individuals who need our help. We are amazing employers to the caregivers who work for our clients. But if you really think about it, we're in the logistics industry. We are logistics providers. And it's something I laughed when he said that because I've been saying that with my team for a while. We are in the care industry,

but we are in the logistics business too. And you have to make sure that you're able to schedule in such a way that you're able to maximize for your strengths. So it's not easy to schedule everybody full time if you're working with clients that need lesser care. Sometimes those clients do end up hiring you for more hours, and sometimes they refer clients who need more hours. So if you're a newer provider, you may have to accept more shorter shifts than you'd like. Just make sure to try to

have your caregivers working as much as possible. And I know that's kind of general. You could double click and we could dive in more specifically. But today, that's not as much as a challenge for us because our clients are receiving long-term care. No, thanks for sharing that. And I think it's just good perspective. There's no one right way here. And there are successful large agencies that are scheduling shorter shifts. There's no one right way. But I've thought a lot about offering full-time work. And to me, the easiest course of action is longer shift durations and less clients per caregiver. So it's just, it's the configuration that makes sense in my mind. And that's kind of the approach that you've taken. But I also want to reiterate, like, it's not the only way.

But something that you mentioned here is one of these other scheduling points, which is identifying your right fit client and being okay, turning away clients, you know, for new owners, it's like, you know, absolutely not. I can't do that. And I can't afford to do that. But when you get to this level of sophistication into this size, you have to prioritize right fit clients because you know what you're capable of. And you also know your care team and you need to be willing to make those judgment calls. So speak to, you know, developing your right foot client and how did that look over the last, you know, 12 years? And then how do you tell people, no, how do you turn people away or what does that look like in

your relationships with other agencies that you referenced? So we do turn people away more than we say yes most days. And I will happily speak to that in a moment. I want to circle back, I guess, on that full-time question that you asked me, because that's an important one, especially for newer agencies who have more inbound calls for shorter care. Part of what we always did successfully,

my mother especially, and then our client relationship team who gets most of the referrals from prospective clients, we educate our clients before they're a client. So if we get a call for a client who says, I need two hours a day or I need two hours in the morning or two hours in the evening, our job as a client relationships coordinator is to help that person, whether or not we're going to help them individually or refer them to another agency. Sometimes as a newer provider, you don't have that confidence telling them why what they're asking for might not be the best fit for them. Yes, we don't want to schedule you longer care than you're asking for just to have higher revenue, just a billion more. I might tell you, look, if you need two hours in the morning and two hours

in the evening, I can get you a warm body. I can find a caregiver who will show up for that shift, but you're also going to have more churn. You're going to have different people in and out of your home every day. You're not going to have the consistency that we want to hold ourselves to that standard of. So if you're comfortable with instead of doing two hours in the morning and two hours in the evening, scheduling for eight hours straight through. A lot of times the pushback that you're going to get from that prospective client is, well, I don't know what they're going to do for eight hours. We will offer a free day or schedule, we'll schedule for, charge you for four hours and have eight hours of care. So you can see what that caregiver is going to do in that day. They could go grocery shopping, they could run errands, they could take you to the pharmacy,

they could take you to the park. There's that, for somebody who's new to home care, they don't always really recognize how much care somebody needs. So a lot of time it's communicating with them and educating them to maybe what they think they need isn't truly what's appropriate. And if they're willing to try you for more than they think initially and they see that you're a good fit for them, they know that they're going to have a caregiver who is consistent and you're able to have a full time position for a caregiver who can now work 40 hours a week rather than work two hours a day for a few days a week. So I guess that's one strategy you could do circling back, focusing on knowing who's the right client for you and saying, oh, it's not easy. You know, I shared that we did not say no really at all for the first few years. And that was a good thing for us initially because we developed some really strong ties with referral sources who knew that they could rely on

us and knew that we would go to work for their clients and come through when they needed care. As we started to become more mature and grew and knew, you know, we could staff this client who needs split shifts, but it's going to be more burden for our scheduling team. Our caregivers aren't going to be particularly happy. And it's going to be a guaranteed revenue stream knowing that we're going to have eight hours a week for this client. But it's going to create a lot of different headaches. We had to have that very frank conversation amongst our operations team and say, we're going to start being more picky. We're going to start being more selective. There will be a downswing. We're going to see our census from a billable hours and from a number of clients served perspective, it might dip,

but in the long run, we're going to stick with this because we know what we are good at. We know that our caregivers want to work eight hours or more. We know that we are excellent providing live-in care. And we're going to really identify those caregivers, those clients that are right for us so that we can be where we want to be tomorrow and stick with that goal. So we will say no to clients who are not a right fit. But it's not like they call and we say, nope, good luck finding somebody. We might spend an hour or two with that individual. It could be a client.

It could be their daughter. It could be a geriatric care manager who's calling this for their client. We know within a minute we're not a good fit for them. We're going to be very honest. Hey, I don't think that we're going to be able to provide the care because you live outside of our service area or because we really specialize in providing 12 hours of care or more and our caregivers don't want to just work three hours a day. But let me tell you the questions you should ask when you call other agencies. Let me tell you other things you should be looking for. Let me tell you a few providers that we know have done amazing jobs with clients similar schedule to yours in your service area. You want to do everything you can to help that

client because although you might not be helping them personally with your agency, you want to do everything you can to help that client. Because although you might not be helping them personally with your agency, you're helping them find the care that they need. And the person that you're spending two hours on the phone with, it's not a wasted two hours, they're going to be appreciative of that. And whenever their friend, family member, colleague needs care, they're going to remember that conversation, they're going to think of you, and they're going to recommend your agency to that person who needs care. So no conversation should ever be thought of as a waste of time or effort. I know we're all so busy, but you want to make sure, you know, we are in the care business and whether it's care directly through us or pointing them in the right

direction, that's what we have to do. The words that come to mind are above and beyond. That is what a long-term companion is doing. You're not settling for the bare minimum. You're not doing what some other agencies are doing. Your reputation is at play here. And every interaction that your business has with someone externally is part of your reputation. And you all are going above and beyond with every single interaction, which speaks volumes. And like you said, you know, it may not be the right time for this specific client, but they've got dozens of family members and friends that could be right fits, you know, at any point in time. And so you're going to remain top of mind. So kudos, honestly, to you all for prioritizing this because it is

extremely important. So a lot of really good information in that whole segment. I'm glad you backtracked and jumped forward because there were some things there that I, yeah, we didn't cover that you hit on, which was awesome. We are moving really quickly here, and I want to get into maybe some of the juicier topics of scheduling like overtime. That's something that is a little bit controversial and you may have, you know, hot takes about overtime into maybe some of the juicier topics of scheduling like overtime. That's something that is a little bit controversial and you may have hot takes about overtime. So let's talk about the cost of recruiting and then let's transition into overtime pay. Let's first talk about cost of recruiting caregivers. That's something that agencies are grappling with all of the time. So

what would you like to share around, you know, the cost? Absolutely. No, it's important. And I hope that you don't leave the webinar, you don't turn off the podcast when you hear overtime and additional expenditure. It is costly when you're factoring in providing overtime care, but we're going to talk about how to make it worthwhile. So the cost of recruiting a new caregiver, when you're talking about a financial, as far as hosting an add-on indeed, or having a referral bonus, or hiring a recruiter or recruiting team and a human resources manager, the time, energy, and effort that goes into training, orientation, everything that is associated with hiring a new caregiver is expensive in terms of time, energy, and effort.

So agencies that are doing it really well, they might have a cost of hiring a new caregiver at about $200 to $250 per caregiver. Some it costs way over $1,000 per caregiver when you tie in all those factors. So recruiting is really expensive. And as we know, turnover is very, very high across the industry. We have wonderful retention rates. We still have turnover, especially with those newer caregivers. So when you're looking at, I think it was 77% turnover rate last year across the industry, an agency who is between two and a half and five million dollars in revenue, it's almost 100 percent. It's 96 percent turnover rate. Think

about that thousand dollars per caregiver times 100 percent of whatever your agency size is. That's really expensive. You know, that is a known entity that is very, very costly and time consuming. So we look at overtime as a strategic way to combat that. Our caregivers as a whole, we do have some part-timers. There definitely are some caregivers who work part-time. It's less than 20% of our roster at any time. Most of our caregivers work full-time and more than the part-time, more than 20% work more than 10 hours of overtime a week. We use overtime strategically. Our caregivers love it. It leads to satisfaction for your caregivers because chances are if they're scheduled 20 hours with your agency, they're going to work with another agency or another two agencies to make the income that they rely on, that they need to support their family.

But also it's going to lead to happier clients by just math. If you have more hours scheduled per caregiver with a client, you're going to have less caregivers per client scheduled. So if you're an agency that you're working with a client 12 hours a day, five days a week, many agencies would have two caregivers with that client. One scheduled two days and one scheduled three days. We many times will schedule the same caregiver for five 12 hour shifts if they are reliable and we know that that's what they want to do. We'll gladly do that and have 20 hours of overtime for that client, knowing that there are going to be less schedule changes, knowing that there are going to be less dissatisfied clients and caregivers.

And that's something that it took us a long time to recognize, especially considering we do many two 12-hour shifts, seven day a week for clients. Many other operators, they might do seven or eight caregivers to make sure there's no overtime, that there's no full time. Again, we welcome the extra benefit costs and overtime costs to try to maintain that level of satisfaction. And you could look at it as a short term or a long term factor, right? You could say in the short term for new clients, I know that the first one happy and they're not going to be here for week four, five, six, and beyond. So even if you don't have the perfect care team for that client who needs 60 hours a week, you might consider just having one caregiver who you know is exceptional working with that client for those first three weeks until you're able to find that perfect complimentary caregiver that you're going to staff for that new client. It can be very specific for short term.

And like I said, for long term, it leads to increased satisfaction and decreased turnover. You want to obviously not just do it, you know, willy nilly, shoot by the hip and say, I'm going to authorize overtime for everyone. That's not smart. You will not be able to sustain as a business for that long. So you want to make sure that you're budgeting for overtime. You can budget for overtime two different ways. And we actually use, we monitor both different factors. One is a percentage of all of your gross, of your salaries, of your caregiver payroll. A percentage of that payroll cost is going to be allocated to overtime. And you also want to monitor X percent of all of your billable hours are going to be overtime. Whatever you're comfortable with as an operator, you should

have a budget and you should try to stick to that budget. I'm not saying make it 100. If you're scheduling 1,000 hours a week, don't schedule 1,000 hours, including overtime for everyone. Maybe you'll be comfortable having 50 or 100 or 200 hours of overtime. Set a budget, stick with it, and it's going to lead to increased satisfaction across the board. And one thing that I would suggest, if you're working with a client who has a third-party payer, such as the Medicaid waiver program, Medicare Advantage, the VA, you're not able to bill for overtime, but we're a primarily private pay agency. We're able to pass along a lot of our overtime costs to clients. It's in our client service agreement. It says, if you request to

have a certain caregiver and that caregiver is going to be put into overtime, you're going to agree to pay X rate. It doesn't have to be 2X your normal rate. It doesn't have to be time and a half. You could just make sure that you're covering your additional payroll plus a little bit of additional margin. But you want to pass along the cost to the client if that's what they request. And we do have many clients that will gladly not want to have different people in and out of their home, and they'll pay extra to have some overtime. The only caveat there is if they don't want overtime and you're scheduling and there happens to be overtime because of a one-off pullout or just because it's easier for you and

your scheduling team, you can't pass along that overtime. It has to be very specific in your agreement. The client has to agree to it, but that will cover a lot of the extra overtime costs for private pay agencies. I don't have any follow-up questions. You just checked all the boxes on that topic. I wanted to get to budgeting for overtime. Do you pass that on to the client? Is that a new service agreement? That's going to be a seven- minute section that everyone needs to re-listen to because there was a lot just in that section. So that, that was perfect. Honestly, I feel like you hit that and you hit everything that I wanted to cover. So let's just move on if that's okay. That was a lot,

but let's keep going. There's, let me look at my notes here. There's kind of two more things that I want to hit on in scheduling for probably the next three minutes. And then I want to spend the last 15 on rescheduling. So the last two elements here is, you know, scheduling is a team sport. Last week we talked about, you know, what your scheduling team breakdown looks like, which is pretty different than other agencies. So we'll talk about that for a minute. And then as far as like scheduling as a team sport, then there's also like caregiver teams and like A teams, maybe B teams. So talk to me about some of like these elements of like your scheduling team and then like your caregiver teams.

Sure. So we are definitely unique in the sense that we have one full-time scheduler. She happens to be wonderful. She's an excellent, you know, a great compassionate person, a people person, but very excellent as far as, you know, solving that logistics problem. So it's having that right person or persons, but it doesn't just fall on her. You know, scheduling is a team sport that you want to make sure that your team is cross trained. Our client relations team, our recruiting team, they are all involved in the scheduling part of our operations. You know, often if our client relations manager has three or four clients in the pipeline, she's already looking at our

scheduling software, identifying who is a good candidate as a caregiver or caregiving team for that client. So the onus doesn't all fall on our scheduler, but by having a team approach and really by having systems in place, mostly those pre-scheduling systems, a lot of the scheduling work gets done before you have a new client. So having all those pre-scheduling facets checked, it allows you to really operate with a lean scheduling team, but still do it at such a high level because you do have that collaboration and you have those processes in place. As far as caregivers, you know, you might have a client that is posing a lot of challenges for you. They could be taking up a lot of your time because there's call outs, or it could be

a client that maybe isn't taking up a lot of your time. But let's say that they have very specialized needs that not many of your caregivers would be a good fit for. That client who has, let's say, their own hospice, or they have late stage Alzheimer's disease, or there could be many different factors why they are very high touch client for your agency. That client could have two caregivers. It's a perfect schedule. You don't have to worry about it. But if you have a call out, what are you going to do? You know, if it's a two team caregiver approach, that other secondary caregiver can always fill all those shifts. So what you're better doing is ahead of time, introducing that client with shadow shifts and

training shifts, some of your other most skilled caregivers, so that when there is a schedule change, whether it's a plan for vacation, or it's a last minute call out because that caregiver is not feeling well, or their child's not feeling well, you have somebody that's met that client that has trained with that client and is able to help and know and be set up for success from day one. As far as that A-team, we do. We recommend having an A-team of caregivers that their job is to open up cases with new clients. If you have a predictable number of clients that you're going to start care for in a given week, you're going to know that you might not always have that perfect caregiving team for that client. So as we talked about before, that first one to three

weeks are really important with a new client. If you know that you have some of your most skilled, trained, dependable, compassionate caregivers, that they are only opening up cases with new clients and working with them for the first one or two weeks, you know, you're not going to have turnover. You're not going to have call outs. And it all goes back to that communication. You want to tell that client, you know, look, we're going to have two caregivers who you're going to meet for the first two weeks. They're not going to be your long-term caregivers. A lot of clients at that point are not going to want that. They don't want to meet somebody only to meet somebody now. But when you explain the reason that we're going to have these two caregivers is they've been working with our agency for six years. These are their experiences. These are their trainings.

And we know that they're going to be able to provide feedback to our office to make sure that the perfect caregivers are going to work for you in the long term. So you're really setting the table stakes. You're having very clear expectations and very clear dialogue. There's no surprises. And if you do have that consistent number of new clients that you're starting each week, it is something I would recommend considering. Some of this is new to me. I didn't know about some of the inner workings of this A team. And I'm like, shoot, I wish we had another 30 minutes to like dive into this A-team because this is a pretty different concept. I've heard of like slight variations of this with other agencies. But I wish, you know, I want to like spend the last, you know, talking about this.

But maybe an encore session about this specific element because it's really interesting. But we need to get through the rescheduling and the post scheduling. So that was a lot of information on scheduling. That was like 10 parts, lots of like nuances and intricacies there. But that was amazing. Let's talk about what happens after, you know, shifts are worked, and then you're doing some analysis on like how your scheduling is going. So let's first talk about like data and tracking trends. What are your scheduling KPIs or your scheduling metrics that you are using to know if your scheduling is successful? Sure. Well, some of the KPIs are going to be very

similar for every agency, billable hours, number of new clients, client census. I would definitely recommend doing that caregiver to client ratio. That's something that helps us immeasurably. And then some others are things that many agencies are probably tracking. I'm sure you're scheduling software, you're able to run a report and see the number of lateness and call outs. But it's not just knowing how many call outs are going to have or how many times a caregiver is late. It's knowing this is what happens historically, and this is what I can predict with a fair degree of certainty is going to happen tomorrow. So we track call outs three different ways or actually four different ways. There's a same day call out. There's a call out one or two days notice. There's a call out three to six days notice and then a call out for a week or more.

We track these call outs. So whenever there's a call out, it's tagged one of these four different kind of callouts. And we're, to a very high degree of certainty, able to know any given week, we're probably going to have this many callouts track each and every day. It's something you should actually reflect and dive into at least once a week. If you only have time to do it every two weeks, that might be okay. But at the end of every week, go down and really dig into your numbers. And after a couple months, you'll probably be able to say, okay, I'm probably going to have this many call outs in the morning, this many in the afternoon, this many in the evening. And on a macro level, being able to expect call-outs. You know, call-outs are an inevitable part of every home care agency's operations. We shouldn't be floored as schedulers and operators when there's a call-out. We shouldn't be surprised. We should know that it's coming. And if we plan for it and it doesn't come, kudos. You know,

that just makes for an easier day. But chances are the past trends are going to predict what's going to happen in the future. So know that from like a macro level. On a micro level, look at what your caregivers are doing. You know, if you have a new caregiver who is calling out for their first shift or one of their first few shifts, that's generally a predictor that we've seen means that that caregiver is not going to be very reliable in the long term. We do have outliers that, you know, we've had caregivers who have called out for a few of the first shifts. Long story short, they've been with us for seven, eight, nine years, and they are amazing. So it's not always the case. But just

know that there are certain red flags that you're going to be able to identify. And even if it's not a new caregiver, let's say there's a caregiver who's been working with a client for two years, and they're generally very, very consistent. But last month, they called out two Fridays. This month, they called out three. Something's going on. We have to have a conversation before it gets to three this month. It should be sometime last month. Have a conversation with a caregiver. Maybe it's a temporary issue. Maybe we have to do a schedule change that'll work out for your client and caregiver. But you don't want to wait until there's a big issue. Maybe we have to do a schedule change that'll work out for your client and caregiver. But you don't want to wait until there's a big issue to deal with.

Many of these problems can be identified when they're still kind of just bubbling and you're able to prevent any kind of dissatisfaction. I'm glad you're hounding on this call-out issue because I've heard it described as like the nuclear event in home care. And it's something that every agency is dealing with, but the way in which agencies are solving for it looks very different. I see in the Facebook groups all the time, people are complaining about this issue, but look at what you've put in place to identify and track and monitor call-outs. And you know how often it's going to happen and can predict,

you know, the cost and the amount of times that it's going to happen. It's just, it's how you deal with problems like this that will define your agency success. And I want to share a couple of statistics that we have at CareSwitch. We have been thinking about this issue for months and we couldn't find any like quantitative data on call-outs. And so we've done our own surveying and testing and tried to extrapolate some numbers. So let me share some of this, which is kind of mind-blowing. 1% of scheduled shifts will result in a no-call, no-show. Doesn't sound like a lot, but when you're dealing with a lot of shifts, 1% adds up. There's an 18% chance that a no-, no show will result in a client cancellation.

So think of like the lifetime value of a client. If 18% of those call outs result in a client cancellation, what that impact is. So statistically, every individual no call, no show will cost approximately $1,600, which is, you know, like you just said, you know, you know, there's call outs coming every single week. So 1,600 per-out. And then we took that one step further and thought, you know, what does this do to your bottom line? Like, what does this translate to in revenue? The average agency is losing an amount equal to 7% of their annual revenue due to the direct costs of no call, no shows. So 7% is also, you know also under 10. So it's not huge, but you think of the scheme of things and you think of a business the size of yours, what 7% translates to on an annual basis.

The no call, no show issue is massive and it's tough to crack. But like you're saying, there are processes and checks and balances you can put in place to identify, predict and solve for this very specific issue. So any reactions? I don't know if you've seen that data. Let me drop in the chat the link to this article where we show how we got, you know, this data and these conclusions. But yeah, while I'm doing that, any thoughts, Brett? It's mind blowing, Miriam. I love what you and your team at CareSwitch are doing to really find the data. You know, a lot of operators, you operate on feel, right? You know that something's going on, but you can't really always quantify it.

The fact that you were able to dig in and identify 1% of all shifts are call-outs, 7% dip in revenue. It's costing you $1,600 per no call, no show. That should cause everybody to just wake up and want to do something about it. And that's why these systems are so important. You can't predict necessarily which shift there's going to be a call out from day one, but over time by measuring data, by putting in systems with a pretty high degree of accuracy, we talked about paid on call before, we talked about overtime. There are things that you can do to definitely mitigate it. Some involve extra expenses, but it's a lot cheaper than what you just said, Miriam. So it should be a wake-up call for everyone. And there are

definitely systems that counteract hopefully some of what we talked about, but be prepared for the no-call, no-shows, and just have a system to how to respond and soften the blow. And you can have a no-call, no-show that you could still staff within 30 minutes or 60 minutes or two hours and salvage that client that would otherwise leave your agency. So by doing all the legwork leading up to that no call, no show, you could hopefully have a satisfied client in the end. Totally. And I'm glad you hit on that because those are the two things that I wanted you to reiterate, which is have a process to respond to every call out the same way. Because it's so frequent, you need to make sure you're not responding in this angry, frustrated tone and you're scrambling every time it happens.

You know, that's just not sustainable. So have this repetitive process of how to respond and then communicate with your client. You know, you can salvage clients after call outs, but you have to be very transparent, very quick to respond and very thorough in how you approach that communication because, you know, it can be saved and this is going to happen. And so you just need to refine this process so that you're prepared when it does keep happening. Definitely. And don't look at, you know, you talked about the lifetime value of a client, Miriam. I think that's so important to always recognize, you know, you may lose money, have a negative, negatively profitable shift. You may lose money, have a negatively profitable shift. You're going to lose money on

this shift because you have to pay your caregiver extra or you have to schedule paid on call. But guess what? In the long term, these investments are worth it. So have the process and communicate. Let your clients know that we're going to work for them. If there's a call out, let them know immediately. If we have a call out for a 7 p.m. shift at 9 in the morning, we're going to call our caregiver. We're going to call our client and let them know. It could be a brand new caregiver that they've never met, but they've been told that they're going to meet or their favorite caregiver who comes every Wednesday at 7 p.m. Let them know immediately. Update them about what you're doing as the day goes along and call them and tell them why your substitute caregiver is a great fit

for them. It's going to make the client less dissatisfied and less likely to leave your agency. And it's going to make that caregiver have a more positive first shift because if your clients mad at your scheduler, mad at you, mad at your client relations, just imagine that poor caregiver that's walking in that day. First shifts are not easy for the most part as a baseline. When you have that extra element, it's not very good picture. So when you're able to communicate and really soften the blow for your caregiver, it's going to go a long way. Absolutely. Robin in the chat said, can you repeat the scheduling KPIs? She says she couldn't write that fast. I know you kind of like blazed through a few. Are there like three to five that are like your must track KPIs? Yeah. So as far as our scheduling KPIs that we track are always scheduled hours or billable

hours, client census, number of new clients and clients who end services, that caregiver to client ratio, which is super important. And then as far as like the nuts and bolts that we talked about to predict trends, it's lateness, and it's call outs. So for call outs, it's the same day, it's one to two days before the shift, three, four, five, or six days before the shift, or a week or more before the shift. Awesome. That was perfect. And I am like throwing so much your way and it's amazing. You can remember all this stuff. Hopefully that was helpful, Robin. That was yeah. Perfect. That was perfect. In our last two minutes here, two things, which is don't be afraid to adjust scheduled shifts. You know, sometimes it's like

it's on the board. Don't touch it. What's your philosophy there? And then the last thing is availability, being available to your caregivers. This is a 24-7 gig and you need to be available to them. And so just briefly talk about both of those things, not being afraid to adjust the shifts and being available 24-7. Sure. So not being afraid to adjust the shifts is something that I had to learn. I was our agency scheduler for six years. I would never think about doing that for the first few years. But we found that sometimes the best option is the not traditional one. So if you have a client, you have a call out or a scheduling gap for that client. And like we talked about before, they live in a service area that's hard to staff,

or maybe they have needs that require a very highly skilled and trained caregiver that you don't have many on your roster to care for that client properly. If you have a call out for that client that is very challenging, and you have a caregiver who could be a potentially great match for that client, but they're already scheduled, you really should consider moving that caregiver who's already scheduled to that more difficult, challenging client, as long as that client that you're moving your caregiver off of is still going to receive the same level of services. You know, if this client that's already scheduled maybe needs less elements of personal care, more so companionship, or maybe they have other caregivers who work with them, and you're able to ask one of their other caregivers to fill in a shift that day, so you could free up this caregiver who is more trained and skilled and is a good fit for your

call-out client, something you should absolutely consider. As long as you're making sure that your one client isn't left in a lurch and they're still going to be satisfied. It is a win-win generally. And as far as 24-7, it's something that we implemented back in 2012 or 13. It's a 24-7 employee hotline. Our caregivers have one number they dial. It could be three in the morning on a Wednesday or three in the afternoon on a Saturday. They dial one number. They're able to reach a member of our admin team 24 seven,

not an answering service, not a third party. And we're able to help them. Somebody that's trained in our office can help them. We've been told time and time again by caregivers new to our agency, they've gotten reprimanded from their other agencies because they call or they text their scheduler on a Saturday, they're supposed to be there

on Monday for a shift and the scheduler signs on at nine o'clock, they see the text and they flip out. Long story short, they had already tried to alert your agency that they couldn't be there in two days. They were doing everything they can to try to let you know that you needed a substitute caregiver. If you have a one dial 24 seven hotline or a way that your caregivers could reach you 24-7, that is going to alleviate a lot of headaches in the long run. Wow. I've had you in the hot seat for 60 minutes straight here, and you have delivered every single minute here, Brett. Thank you so much, honestly, for sharing this level of detail this transparently. Some of what you've shared last week and this week

is your secret sauce, but you've been so willing to share everything that you've tried and tested over the last few years and i hope everyone that's listening to this is just grateful that you're so willing to share because that's not always the case so thank you so much for sharing all of this so openly and thank you for your service in the industry. You know, I mentioned your seats on the board. You do so much at your agency, yet you're so involved at the industry level and in the advocacy that's taking place. And so I can't thank you enough for everything that you're doing. And thank you for sharing so much these last two weeks. It's my pleasure, Miriam. I just hope it's helpful and I'm happy to follow up with any questions or to dive deeper. Anyone could reach me on my email, brettatalongtermcompanion.com. And it's my pleasure.

Our agency can't help every client out there. There are so many clients that need great care. So if we could help other agencies deliver that care, that's why I'm here. Amazing. Well, thank you again. And this won't be the last time that you all see Brett. He's going to be back. You know, we just all want more of his time and attention. So thanks for everyone that's joined us live today. Like I mentioned at the beginning, this is being recorded. We'll send it out via email in a podcast format.

We'll give you Brett's email address. Stay tuned for some of our upcoming episodes. Next week, we're going to talk about AI with Sensi. It's going to be pretty interesting. So thanks for joining us. Hit careswitch.com if you have more questions about us or want to register for more of these episodes and have a great week. Thanks for being here, everyone. That's a wrap. This episode was made by the team at CareSwitch, the first free home care agency management software. If you're tired of running your agency on an outdated software that looks

and works like Windows 98, and you want to save a little money for your bottom line, check us out at careswitch.com. Thanks for listening. See you next time.