Home Care U - The Story from Caregiver to Leading 7 Offices Across 3 States (Emily Isbell Pt. 1)

Episode Date: May 27, 2024

She started as a caregiver in college. Then quickly realized you could make a living in home care. So, she changed her degree and asked the owner how she could get to his position someday. 14 years later, she’s got one of the most impressive success stories in home care. Emily Isbell, former VP of Operations at Home Instead and current CEO of EI & Company, is here to share her journey and how she did it.Enjoying the show? Send me a text and let me know!Learn more about Careswitch at: careswitch.comConnect with the host on LinkedIn: Miriam Allred This episode was produced by parkerkane.co

Welcome everyone to Home Care U. I'm your host, Mary Mallred. It's great to be back with you on this Wednesday. I hope everyone's having a great week and things are going well for you in your business and in your personal life. Just a couple of quick housekeeping items as we get started to hear. For those of you who are joining us live, know that this is a live event. Emily and I are here in the session. And so if you've got questions or comments as we go along, don't hesitate to jump inside that chat box or Q&A box and let us know what you're thinking or if you've got questions tailored to the session today. Just an exciting announcement. I think everyone knows this podcast, Home Care U, is put on and sponsored by CareSwitch. We have got some really exciting updates and announcements

coming out the next few weeks. We've actually got a new website, a lot of new information coming out. So keep an eye on our site over the next few weeks as we announce some new exciting changes here at CareSwitch. So without further ado, we're going to jump into today's session. I've got the really wonderful Emily Isbell. Some of you may or may not know her. She's been in the industry for a lot of years, but has really been in her market, working hard, delivering results to kind of her market. But she recently has become a consultant in this space and she's popping up on more podcasts and shows and events. So it was natural for me to want to get her on the show to highlight really maybe one of the more incredible stories, success stories in home care.

So, Emily, thank you so much for being here. And I'm really excited for today's conversation and our session again next week as well. Absolutely. Thank you so much for having me. So let's let people get to know you out of the gate. You have a really interesting story starting even from your college years to where you are today. So I've asked you to kind of do an extended introduction of yourself to set the stage of all of this experience that you have. And then we're going to really dig in and I'm going to ask you some pointed questions about how you, you know, really got all of the success, gain all the success and what you're up to now and the book that you've written.

So we're going to just kind of divulge a lot, but I want to let people get to know you through your introduction. So why don't you start there? Sounds good. So if I get long winded, just interrupt. It's totally fine. It's a long story and I have to make sure to give you the close notes where I can. So you mentioned college. I was a junior in college. I was planning to be a clinical therapist and needed a part-time job to pay my rent. I was trying to take care of myself and stop using my parents for rent and utilities. So I began as a caregiver at Home Instead. And within the first week, technically first shift, I was amazed that there was a job that paid you to do the type of work that caregiving is. And at the same

time, I realized quickly, there's a business that provides this. And so I went and spoke with the owner of the home instead that I started at. And in short, he mentored me right away and told me, recommended I change my degree, and I did. And a year and a half later, I actually started in the office working underneath him. Backing up though, I'd asked him during that meeting, like, how could I be an owner? And it's actually kind of funny. Before I met with him, I sent an inquiry on the Home Instead franchise website asking, wanting to be a franchise owner. And I mean, I'm 19. I have student loan debt. I'm working a part-time job and just started it. There was no reason they

would want to call me and say, yes, you make a great franchise owner with Home Instead. Let's talk more. So I never heard anything from them, of course. And anyway, fast forward to a year and a half later, I work in the office with him as a coordinator. I served as a caregiver. I served over 2,500 hours. To shorten that story, I became the human resource manager shortly after and led a team of three other individuals. And then we grew that caregiver pool. We doubled it during the time that I was there. And it was always the plan once I graduated that the owner would purchase a location and that I would run that location for him. And so I would be the face.

I would be the head of it. We did that. We purchased a location in Franklin. And I'm kind of skipping some of the nuances to that for the sake of time. But we purchased that location in Franklin. And at the time that we took over, it was around $39,000 in monthly revenue. And we were able to build it in four years to around $39,000 in monthly revenue. And we were able to build it in four years to over $200,000 in monthly revenue. And then in 2016, we took over another location

in Nashville, Tennessee. So Franklin is just 30 minutes south of Nashville, then there's Nashville, Tennessee, and grew that business from $100,000 to $300,000 in a short period of time and then continued to grow into to the point where in 2020 we had seven locations across Alabama, Kentucky and Tennessee. Oh, my gosh. I really like get the chills of you saying that. I don't know why I've heard this story. I've listened to all these shows that you've been on. I just like get the chills of just what an incredible story. Like at 19, you saw firsthand, like the impact of home care and were so motivated. Like, I want to do this. I want to be an owner. I want to like achieve, you know, these goals at such an

early age. Like, I just think it's phenomenal. I know that was kind of like the short and condensed version, but just want to highlight how incredible that is. One of the things that you called out to me that I want to call out to those listening is the difficulty in scaling existing locations rather than just like building from the ground up. You articulated that to me. And I think that's really interesting and really does show how you went about, you know, this process. So just maybe speak about that, like the challenge of acquiring, like jumping into location and growing it versus like starting it from the ground up. Yeah. And, and I can only speak from my experience, right? So I have to understand there's a bias there. But for me, you're walking into a team that already has a lot of habits in

place and a lot of confidence in what they're doing. And for example, in the Franklin office, when I started taking over that business, the person in human resources was twice my age. And of course, I mean, I'm 24 years old and saying I know what to do better than you. And of course, I'd never said it that way, nor did I even have that level of arrogance at all, because I wanted to learn from her too. But I did know the framework that was working in the office that I came from. And I knew that if we trusted that and built it there, then we would grow the business. And so it is a challenge. You're working with people that have... It's like the saying, you can't say my baby's ugly. That's how they feel. There's an attachment to what they've done. And we had to go in and kind of reset the stage. But one thing I'm most proud of is we never cleaned house. So I never walked in and said, we don't need you. We're bringing our own team in. That wasn't the plan ever.

We didn't have a structure about how we went about doing an acquisition. And so it wasn't a given that they had a job. They would have to interview you. And we would also interview other caregivers and see if there was somebody that would make a better match for the position that we wanted the business to have, whether they were sitting in it exactly as we wanted it or whether it was tweaked slightly. And so they had a feeling that they had to perform and step up for the job, but they also weren't completely given the boot at all. That wouldn't have served anyone. And I think it built loyalty once they were chosen for the position. And so the Nashville location in particular, what was most exciting about that one is that we had the exact same team a year later and grew incredibly in one year with the exact same team.

And so it's not necessarily the team that's the problem. And it's not even necessarily that the leader is a bad leader in the sense of a bad person. Let me put it that way. Leadership, you can be a good or bad leader in terms of how you show up every day. So again, you're not a bad person. You just have to show up maybe a little So again, you're not a bad person, you just have to show up maybe a little bit differently as a leader. And so we were able to use the same exact team and build structure and accountability that made them want to show up for work and or just know, like, what is the goal of today? What am I supposed to be doing when I show up today versus the feeling that happens a lot in a 24-7 home care business, which is just, oh, there's a fire there or there's a fire there.

Let me put that one out. Let me put this one out. Can you help me put this one out? And everybody's just running around. And we kind of would come in and redevelop a structure where people knew what their job was, whether they were to turn on the hose or whether they were to aim the hose for, to keep that analogy going. Does that speak to what you? Yeah. Yeah, absolutely. A couple of times you're referencing like this framework. And so I want to pick your brain on like what that means and what that looks like. And just to recap, it's like you started as a caregiver, then you get into the office, you're a coordinator, work your way up through like HR.

So when did you start like formulating a framework? Was it when you got into a position where you had like some authority and power, or maybe even early days as like a coordinator, you were thinking like, there's a lot more efficiencies that I can see and I can create. So like kind of first question is like, when did this framework that you've built take shape? And then let's talk about like, what are the core pillars? Sorry, and I'm doing a double question here. So start with one, then we can keep going. Yeah. So one thing I have to say is you use the word efficiency. And I joke that efficiency is my love language, even though that's not a love language, it's mine. And so

that is definitely how I looked at everything. Are we being efficient with how we structure our team, with how we're asking people to manage the tasks of the operation? When did the framework get established? I have to give a lot of credit to the owner that mentored me. He had a good framework in place when I came on board. And it really, I didn't do very much to tweak it. And we can, we can dive deeper into that, the specifics of that framework. But what we did do the whole time though, is honor it and just made the use of the time better. So the framework, let me just go ahead and dive in if that's okay to the framework. So for example, when I look at,

when I work with clients today and something I talk about in my book is setting up this framework, there is such a thing called death by meeting. I can't remember who that quote belongs to, but it's true. And a lot of my clients that I work with, I see they are doing that to their team. But the problem is they don't know it. Their team doesn't know it. They're just way too meeting heavy. And a lot of times, it's a daily stand-up. In a 24-7 home care world, you don't need a daily stand-up. You need to know what's going on. And there should be communication channels to make sure the right people know what they

need to know. But that daily stand-up is, to me me a little bit of a, to use a sports analogy, it's like, and maybe this won't land. So ask questions to help make sure it does. But it's like, if you're, if you're the coach and you have a daily standup, it's like calling a timeout when your player has just stolen the ball and is about to make an easy layup. So you got four other players just down here, like, oh, what's going on? So it seems like it's a good time for a timeout to bring them together.

But you've got someone who's about to slam dunk. And so a daily standup is like, you bring everybody together and you've got your quality assurance person who is on her way to problem solve an issue in the home right away because it's so urgent. And then you're trying to get them to come back to the office to get together or be on the phone while they should be mentally focusing

on the problem they're trying to solve, not being on the phone, distantly partaking in this meeting just to hear that Mr. Jones needs more gloves in his house. It's just not putting the right priorities for that team member. And the reason why that owners don't realize that is because it feels good. It feels good to get everybody together. And man, when you're in home care, it can feel lonely. And so the stress of home care, you want to get together and just make sure, are we good? Are we happy? Do we love each other? Do we love our clients? Do we love our caregivers? And so it feels good, but really it's getting in the way of them actually getting that problem solved for that one client or getting that shift staff.

You're sending somebody to a voicemail or you're not answering. Maybe you are answering a call. I don't know how everybody structures their daily, but there is still no matter what a distraction from actually making progress. So I think a big part of the framework is just having the right amount of meetings. And so in my book, I speak to this. I recommend a weekly meeting with your leadership team, depending on the size of your organization. So the people who directly report to you as the owner, or if you're an operational manager and the owner is absent, then the people who directly report to that person.

Getting together once a week with a structured template and knowing what they need to focus on, what together once a week to really with a structured template and knowing what they need to focus on, what success looks like for that week. And then only doing that once and then having one-on-one meetings with each person where they get undivided attention on a monthly basis. And so that framework in terms of meet, there's a lot of frameworks that we can dive deeper into, but I think that's one of the foundational pieces is having that structure. So people together hold each other accountable, know what they're supposed to do that week and what success looks like. And then monthly, they're continuing having they continue to have an opportunity to recalibrate their goals with what they're doing in the business and whether or not they're showing up for their teammates like they need to be. But they have that one-on-one so that

other teammates don't have to be there to witness some of that possibly vulnerable space that they need to have with their supervisor. Makes a lot of sense when you talk about a lot of businesses are meeting heavy. I think it's just this kind of natural tendency to check in, to over-communicate, make sure everyone's on the same page and that can get just taken too far too quickly. The area that I'm curious about is actually these one-on-one meetings. A lot of the businesses that you work with, are they already doing one-on-ones? Are they doing them, but they're sporadic? I think that's an area where there's probably room for improvement for a lot of businesses and A, having them and having them consistently, and then B, how they approach those meetings. Because I think there's a lot of value in obviously the team setting, but I think

that's pretty natural and obvious to people. But I think the one-on-one is an area probably for improvement for a lot of businesses. So I'm curious, a lot of the businesses that you work with, are they doing them and are they going well? Or is that a big area of improvement? So I looked up and really thought about that question. I can't think of an owner that I've worked with that does them the way that I just described. What I see the most is what you just said, either sporadic or not at all for one-on-ones. And the sporadic, actually, I would say I doubt that not at all is actually happening. So let me backtrack because I think every owner is having a pop-in meeting with someone to problem solve a situation.

And that's one-on-one. And it's definitely a one-on-one meeting. That is very problem specific. It's not proactive. It's not looking at the goals. It's not looking at their performance and how they're measuring up to what their expectations are in their role. And I would even argue that owners have an open door policy. It's not that there's this shying away from the willingness to do one-on-ones. To go back to what do the one-on-one meetings look

like in terms of structure, for us, it starts with having an expectation of what your role or your department, if you are the leader of that department, is expected to deliver. Yeah, to deliver. So the reason I just paused there is because I speak about the concept of this home care hunter-gatherer mindset in my book. And it's this mindset that we need to know what we're supposed to, if we go back to our primitive way of being, and we think about the fact that we were either going to go hunt for the day and bring food back to cook that night, or we were going to gather for the day and bring vegetables to cook for that night. So I think about the mindset of those monthly meetings are them telling you what they brought to the dinner table every day. And did they do their part?

Are other people having to pick up their slack? Or is it making other people's jobs harder? For example, to relate it back to home care departments, if your HR team, your recruitment retention team aren't bringing in the number of qualified caregivers, then your scheduler is struggling. They're not meeting the needs that marketing might be bringing in from a client side of things. So the structure of it for us is we would do an annual planning meeting and establish what KPIs we wanted for each department. And then we would get on a more macro level and say, who owns that within that department for our larger offices? For our smaller offices, that was the one person. And then on the monthly meetings, we would be looking at how did

they measure up for the month. But I'll even go back to even more micro, and that's the weekly. So we were also looking at that in a peer perspective on the weekly meeting with each other. The difference is you have some time to recalibrate during those weeks before the month's end. And then when you have your one-on-one meeting for the month to review, it's kind of like that day, it's your report card, so to speak. And you're kind of looking at how did you measure up compared to where your results were the whole week. We talked and we recalibrated and we said, hey, this isn't working. Let's try this differently. And do you remember your teammate John suggested X, Y, and Z? How did that go? That happens on the weekly basis. On the monthly,

you get to set eye to eye with your supervisor and brag on yourself, hopefully, but also maybe here's some tough accountability to say, John gave those wonderful suggestions, but you're telling me you chose, you said you would do them, but you didn't? Tell me more. And so you have that one-on-one space and it doesn't have to be ugly because you've created this framework that says, these were your results. What did you do to accomplish them? What do you plan to do differently next time to make sure you do accomplish them? I could keep going, but I'm going to pass the ball back to you for... Yeah. I think this is great. And I think you're sharing a lot of good nuggets here. And I think it's actually interesting that you started with this. I'm guessing that's somewhat intentional, but just how important this is and how important this was for your success is

meeting cadence, one-on-ones, accountability, communication. Like those are just like some pretty fundamental things, but to hear you kind of like lead with this and talk about this, it goes a really long way. You know, when you let these things slip is where you can see decline, where you can see larger challenges arise. So, you know, just want to call that out. I think it's interesting that you're starting with this. I do want to kind of transition a little bit to other areas of the framework. You mentioned there's like kind of this overarching framework, but there's a lot of like pieces to it. So I want to let you talk about some of the other pillars of this framework that you think are very important and attributed to the success that you had.

Absolutely. So I referenced this as well in my book, and I see it as four pillars. There's caregiver acquisition, caregiver retention, client acquisition, and client retention. And then kind of what holds interwoven between it all is finances. You have to pay attention. Are you paying your caregivers the right amount compared to the market clients? Are you charging the right amount? And are you managing your expenses? So that's interwoven throughout all the departments. And then what holds it all together is just that strong leadership where you lean on your policies and procedures that you have in place, or you start putting them in, or you're constantly tweaking them. And I even want to stop myself and

be careful about the word constantly, because your team needs to know where the goalpost is. You don't need to keep moving it, but you have to be willing to be flexible if you recognize this policy was pre-COVID, for example, and it just doesn't make sense anymore. Can we do virtual interviews versus they always have to come in person, for example. So policies and procedures that are flexible, but that you are consistent with and that you keep your team consistent with. And so if you're thinking about those four pillars and you're paying attention to all four equally, not just client acquisition and doing a great job of marketing and not just caregiver acquisition

or not just care, any of them, I could pick all four. If you're making sure that you really give the equal amount of attention to all of those, your revenues will increase, your hours of service will increase because it's just going to happen. I can keep going, but it just does. I think one of the biggest problems we have is we focus on caregiver acquisition quite a bit and we focus on client acquisition quite a bit, but we don't focus on the middle there, which is the caregiver retention and then the client retention and making sure that people aren't coming in and then leaving as quickly as they come. And so that's what causes the, I guess, the two steps forward, one step back feeling sometimes is because you lose your 24-7 client to assisted living only because you didn't focus on that

client retention as much as you could have for that person. There's nothing wrong with assisted living, but maybe in this situation, they just didn't understand that you could be equal to what that assisted living could do. And you simply just weren't paying attention to them because you were marketing to the assisted living for a next client instead. So you got to do both. I don't mean don't do that. You just have to do all of it, all four equally. And really make sure that your KPIs show that, that there's an equal amount of attention to all four of those pillars. I really like how you have, like, you just call them out kind of the key pillars there. Every business structure is a little bit different. No two home care agencies are the same. Everyone comes with a different background, you know, but I actually really like how you like

slice this up, which is client acquisition, client retention, caregiver acquisition, caregiver retention, finance, and then like leadership is like kind of like the overarching principle. You know, some people get, I've seen really large agencies get in the weeds on like HR or, you know, specific like operations. And it almost like convolutes what we're setting out to accomplish, which is what you've said, which is client acquisition, client retention, caregiver acquisition, caregiver retention. Like that's the foundation of this business. And sometimes the operations like convolute that. And sometimes maybe we lose sight of like the core of what we're trying to do. So I personally just really like how simple and clean that is. I'm guessing that that you like have massaged that out and

that like evolved over time. Maybe it wasn't always that clear cut. I'm thinking back to your 19 or 24-year-old self. Maybe that wasn't so obvious. But over time, you realize that is the core of this business and we need to structure everything around that. I'm guessing that that's how the business is structured. You probably have different departments, had different departments, different people, but it was all coming back to that. Are we driving new acquisition? Are we driving retention?

And then how does that impact finances? I'm just kind of assuming here, but was that kind of an evolution to get to this structure? Or was that pretty natural, maybe from what you saw early on? Thinking back to when I joined as a caregiver, the caregiver retention piece was missing. But we actually, again, I credit the owner that mentored me, we had a client retention piece. But to show where it's evolved, my first position in the office after being a caregiver for a year and a half was titled retention coordinator. So I was brought in under a pilot where they recognized their caregiver retention was bad. And I meant to prepare the

exact statistics to share with you guys today, but I don't have it handy. But nonetheless, they knew it was a problem. And so I came in as a retention coordinator, I was part-time. And my job was to focus on making sure that we did things to make sure caregivers felt connected because it's hard because we all know this. We're in home care. We know that the caregivers, they just go to their clients and they go home. There's not this coming in to clock in with their office in person and have a chat in the break room.

And so it was the goal of trying to be connected and to create structure around retaining them, rewarding them, making them feel a part of the team. And what's fascinating is, so I did that for a year. I believe I did it for a year. And then in that year, I turned down an opportunity to be promoted actually to the HR manager because I was still in college and I wanted to finish my degree. And all that to say that the person who then took that role didn't work out. And so 90 days later, I finally said yes and became the HR manager. And we replaced that person, but we kind of realized that the results we had from the retention coordinator pilot

was simply just a shift of mindset that we had one person, which was me, teaching the rest of the team in the office how to have a retention mindset. It wasn't so much the fact that I mean, honestly, we did all these events. We would do bingo. We would do fishing. We would do bowling. Go see Greece. We had over 250 caregivers, and we'd have the best attendance, maybe 15, that would come to these events. The events didn't connect people. It was just that constant mindset of recognizing these are humans on the other side of the phone.

They're not seats or butts in seats. They are people who make a difference. And it was the effort of doing what we call touch points or what you hear a lot in the industry is touch points. We actually call them wellness calls where we would just check in and say, how are you doing? How was your son's graduation? Things of that nature. And so we ended up kind of absolving that position because it didn't matter as much as the mindset of having a retention mindset. Now, on top of that, though, we also had data that we started tracking. And so this circles back around to the two weaknesses of client retention and caregiver retention. What I saw

evolve is that when we first started, we had somebody doing client retention, but we didn't have good data to show that it was working or not working. And so over time, we got to the point, and that's kind of where I left off before you asked this question, was you want to make sure your KPIs are fairly equal between the four. So you have a similar number of KPIs you're tracking. Now I need to stop there and say, when I think of KPIs, I think of goals. I don't think of metrics. So a KPI is a metric. A metric is not necessarily a KPI. So you might have a bunch of metrics about client acquisition.

That's like we did. We had like 20 where we would know where dollar amounts that came from referral providers and how many hours they were worth and how many did we get? There was a lot of metrics. But then our KPIs that we actually focused in on, on the weekly meetings, the monthly meetings, and what their meal that they were, what they were bringing to the meal at night, those were like anywhere between four to six for each pillar. And so we got really, we got much better at having KPIs that were results-based

and actually move the needle in terms of caregiver retention and client retention versus just having someone who's kind of there and having a role, which is what we had when I first started back when I was like 19 as a caregiver. That person just made sure, honestly, back then, they were a good person. They were good service. But we were just making sure, really, long-term care was taken care of. And back then, we were a good person. They were good service, but we were just making sure really long-term care was taken care of. And they had back then we were using paper journals. So making

sure there was paper there and that gloves were in the home. And if there was a complaint, somebody could answer it. And that was wonderful, but that's not where it should stop. There should be so much more beyond that. Yeah. I want to zoom out on retention and then ask a more specific question. Zooming out a little bit. Why are more businesses focused on retention? Like what's the hang up there or what's the rub? Why isn't it obvious that retention is as important as acquisition? Like what did you see and why is there kind of like a misunderstanding there almost? This is just a bias of where I'm at today. So in a year, you might ask me that and my clientele base may lead me to give you a different answer. But as of

today, my clients are just too nice. They're just too nice. And that's such a weird thing to say for that question. So maybe people are now on the edge of their seat. But what I mean by that is they're nice and they're insecure about the product they have. They don't recognize how all the benefits home care has. And when a client daughter says, Hey, we're going to move mom in with me. They don't know naturally the research that shows how bad that is for them. It's not the daughter's fault, but it's just the move. It's one of the top five stressors in your life is a move. And add to that that they have dementia, Parkinson's, whatever. I mean, that's only going to be that much more, I'm going to say it, traumatizing.

And so owners are nice to that daughter versus being an advocate for that mom. And then they're insecure about believing that their home care product is better than that solution. And so in this example, I'm saying that we're going to assume that that daughter is moving mom into another to moving mom into their home a couple states away or moving mom into the home and saying we don't need home care anymore. There's always different situations. And maybe there maybe that is the right situation for a mom. I'm not trying to that fully. But the problem I see with owners is that they don't, they're conflict avoidant. They don't want to ask those questions or feel like they're stepping on toes. When in reality, that is their role as a home care expert. And they are the expert that daughter

knows. They don't know. They might, but they probably don't know anybody else with more expertise in the home care industry than that owner or the person that's the role at that location that's job is to retain them. And so, yeah, I think the biggest thing I see is there's just this shyness about stepping on toes, being nice. And I like to say, don't be nice, be kind. And being kind is actually having that tougher conversation and at least asking questions, not telling this daughter she's wrong, but just asking questions of, have you thought about this? We could also change our schedule up a bit. We could do X, Y, and Z. All of that is solution-minded and helpful.

It's not confrontational, but there's this barrier of insecurity. I think I see in owners a lot that stops them from doing that. I want to ask about your time as this retention coordinator. I think that's A, really interesting and people should consider what that looks like, especially if the mindset is missing or lacking or waning in your business. But I want to ask, you talked about initiatives. It's easy to assume that events will bring people together. Everyone will just show up and have a great time and get to know each other. But maybe not.

I'm curious what other maybe specific initiatives you could throw out that were successful. You mentioned the calls. How do you do that, especially at scale? Or were there other ways that you really felt like move the needle on retention that were working well? Yeah, sure. So events were not. It's fascinating, because you survey your caregivers, and they want those things. They can't wait to have them. But then when it comes to you're paying for their ticket to do it, they suddenly have friends in town or whatever it might be. And that's how we all are. It's not just caregivers. It's how we all are. It sounds so good. But in reality, it's like, ah, I've got, I'd just rather stay in my pajamas tonight. So events are not the greatest. What I'll say that we learned with events is that

we had two to three a year. We considered the walk to end Alzheimer's an event. And we had, so we would raise money with the caregivers and bring people together to be there to walk. And then we had a summertime cookout and a Christmas party. And that's it. That's what we ended up doing after learning for probably two years is how long we overall tried doing monthly events to really encourage engagement. We also

had quarterly caregiver meetings. So I'm not thinking about that when I was thinking about events, but that's a professional gathering where you're training your staff together, and you're also hopefully celebrating them, potentially treating them to milestones. Like, I know that I served over 2,500 hours as a caregiver because I got a little lapel pin that showed that. And so things like that that you can do to celebrate at a professional caregiver meeting on a quarterly basis, I think is a really healthy frequency. During COVID, that kind of messed things up with a lot of people. But I think it's now time to kind of to start that back if you haven't. So the touch points or wellness calls, in terms of scaling that, what we ended up doing once we stopped having that position

is we created a KPI for departments to have a certain number that they did. And it's a bit of an honor system, but you would hope that you have people that are honorable working with you. And so you would set up a goal of X amount per month or per week and make sure you track that. And you would define it carefully, or we defined it carefully as you're not calling them for anything at all. You're just calling to check in on them. And so your voicemail, if you have to leave a voicemail, if you follow up with a text needs to make that very clear. And you cannot sneak in a question about their clients or long term care logging or a shift to be staffed. None of that. It has to be very, very much just a check-in on

them as a human being like you would if you bumped into them in the hallway. So we did that. Then we would also do a KPI for cards to be sent out, handwritten cards being sent in the mail. But you're not wrong about the scaling. That can be a challenge. If you just do a little bit, though, you're eventually going to get to all your caregivers. So if you have, let's say, 120 caregivers, you just did 10 a month, scatter between your whole office, right? So if you have 120 caregivers, you probably have five to seven staff at least. And so divide that out. That's not very many people having to stop what they're doing in a month's time to make a call or to send a car. So figuring out a way to scale in that way. Yeah, I really like the idea of breaking it down and letting everyone in the office talk to them. Because it can be, especially as you scale, easy for someone in finance or a specific

role to get slightly more removed. But it's healthy for everyone to be having proactive conversations with these caregivers. And I love what you say about making it really intentional that this is, you know, just, just a wellness call. It's not asking about their schedule, asking them to pick up a shift, asking about a client and not to, not to criticize people that are doing that, because I do hear a lot of businesses that kind of tack on some wellness questions to the end of a call where it's like, I need to talk to them about something, but then I'm just going to ask them like how they're doing at the

end. You know, that's okay. But I think the better way is be really intentional about a call that's all about them, all about their wellbeing. And you're not, you know, sneaking in those other questions. I think being really intentional is great. I think with what you just said, that should just be a part of doing business, right? Like it's not sneaking in. It's just you're talking to them as a human. And so then how you do the wellness call is you've done that part well. And you know that their son's supposed to graduate, right? To use that example from before.

And so you knew that because you just said, how are things? Got anything exciting coming up? And you're like, well, my oldest is graduating. My mama heart is hurting. And they bring that up. And so you make it intentional as the scheduler. Let's say that's you. On the date after the Monday following graduation, that's when you schedule yourself to make that wellness call. And then you check that off. You did your KPI. You met your goal for the month. But it was very thoughtful and genuine. Even though it's a data that you're tracking, it's still very genuine.

I think it's something we didn't mention at the front of the call. I looked down at my notes. I think it's important that people know that the size of scale that I was leading. I don't think we said that, did we? No, you just kind of glazed over like how many locations. So you can go into that a little bit more. So out of those seven locations, we were serving over a million hours of care a year. And so I think that's important for people to hear. These weren't smaller locations. Each office had

multiple layers of departments. So we were able to do these things at larger size. So one of our more rural locations was one of our biggest ones actually at 23,000 hours a month. Did you break that down to caregivers, like ballpark caregiver client count? What would you say that equated to? A few hundred caregivers? Yeah, that particular office, 300 probably. And so that's the thing in home care, people say that number, but then they have like 100 they haven't talked to when they're at that size. So I would say 300 with about 50 that we were constantly having to figure out if they still worked with us. And so on that note, we weren't perfect. We had those vanishing caregivers that you wondered if they still worked with you. But overall, our turnover rate was much healthier once we

kind of made some of the tweaks we've been talking about. Yeah. And I kind of cut you off there, but you were saying that all of this can scale. And that's what you need to think about as an owner is, is it realistic to make X amount of phone calls every single week at, you know, scale? But I think you were saying that like, you can do everything that we've talked about so far at scale. And that's kind of the beauty of it is making sure you can do that. Yeah. I think I wrote down here something I say a lot, which is to make goals reachable and not laughable. And it's not so much you laughing, you might want it.

You may want that to happen because it just sounds glorious. But your team member after that meeting's over where you've announced they need to call, I don't know, a caregiver a day, they're going to walk away and laugh at that because they already think, how am I supposed to do that plus everything else I'm already doing? So you don't want them to be laughable, but you want them to be reachable. And so I recommend starting out small. Just like I said, if there's 120 caregivers, it's 10 calls or cards a month and dividing that out to the right people every month. It's very, very much reachable. I'm not the biggest fan.

This is kind of unrelated, but related in stretch goals. Like I hear that a lot. To me, that's the laughable goal. It's like, yeah, that would be amazing. And it might happen. But let's actually just make sure and to use a weight loss analogy, let's make sure we lose 10, two pounds this week. So we can lose our goal of 20 in six months. Like, we're not trying to lose 20 this week. So that's what I think about when it comes to setting goals that are reachable in your KPI. So I just want to mention that as something that we made sure of in every office as we did the

acquisition. We didn't come in there and say, you need to meet exactly what this 23,000 hours a month office is doing in terms of number of new caregivers or number of new clients. We would make it make sense for that market and where they were at the time, and then continuing to tweak that as we achieve them. And as we recognize that we could achieve more. So yeah, really, really good points that you just made there. I want to, if you're okay with it, talk a little bit more about retention on the client side. I know, I think your role was kind of maybe focused on the caregiver side. I think client retention is a little bit easier, more natural because, you know, for a lot of businesses, there's like supervisory visits or check-ins that are mandated by the state,

et cetera. So client retention looks a little bit different, but I wanted to give you an opportunity to speak about kind of client retention. Were there any initiatives or, you know, things that you all did that maybe were different or move the needle on client retention that you want to bring up? Yeah. So even though my, where I cut my teeth in home care was retention for caregivers, that was a year of my time. Outside of that, then I was overseeing all the different operations and all those pillars. And so one of my more proud shifts that I made was probably not until 2017. I can still remember kind of getting the client,

we called it client care. That's who focused on client retention and also who focused on the acquisition after marketing brought on new clients. And I can just remember getting them together and realizing like, this isn't working. We're not retaining clients like I know we can. They're not recognizing that we are able to do more than we're doing for them. And they want you, if your minimums are three or four hours a shift, and it's maybe three or four times a week, they put you in the bucket of that. So when it comes time for a knee replacement or some sort of bad fall happens, and they go to a facility, they're not thinking of you as the solution when they get home. They're thinking of home health or they're thinking of whatever those medical providers are still sort of old-fashioned thinking about, which is always tends to be more of a skilled facility rehab. We're not against that. There is a place for that. Just always hear that when you hear me talk. There's a place for that and there's nothing wrong with those things. However, we just really shifted our questioning of clients. And that sounds like I'm interrogating them, but we would do these

visits to check on services. And prior to 2017, I think my team constantly believed that they were customer service individuals. So are you happy with our care? And I think that's important. And it's definitely important, but that's not it. You need to have equal amounts of making sure that they see you as an expert in home care. So are you happy with our care, which includes like, is your caregiver taking good care of you? Happy with how the services are going? Do we return your calls timely? All of that.

That's important. But equal parts is, do they see you as the home care expert who they will call when there is a major concern coming up in their aging in place plan? Or if they're just curious about, they learn about something and they're just, oh, that's who I need to call. I need to call so-and-so at my home care provider because they know, they've always helped me. And we were here, we were in the customer service. We were not in the home care expert. And

so when I go back to go back to the questionnaire piece and questioning them to make that shift, we started with like, let's look at what we're asking when we go out and meet with these clients and check on how things are going. And that's the first step if you're not doing that, is making sure you have somebody who's focused on client retention in the way of making sure that they're being seen face-to-face in some capacity on a frequency. I don't want to go too much far down a rabbit hole, but I can hear people laughing like, yeah, we have time for that. So I understand that. And some clients, you may not need to see very frequently. And so what we did was we created a frequency for if you were a 24-hour client, you're going to see us more face-to-face because from a business

perspective, you're more at risk for us making a mistake. Bottom line, we have more faces in your home, more care being provided. We need to be ahead of those mistakes because of that possibility, higher probability. Whereas if we're three days a week, we might not see you as frequently as we would a 24 seven. So that's a sidebar. I'm going to come back to the questions. And so we, we looked at the questions we were asking them and just realized how much of it was just about customer satisfaction and said, let's, let's keep some, but let's make equal amounts about setting us up as home care experts. What do we need to say differently? What do we need to ask that leads us to know that? And some of it was training and

just teaching our team to really think of themselves differently. And I think it's important to note, not many of our staff that were doing that, they weren't social workers that used to work in a rehab facility. They weren't gerontologists. They were, honestly, for us, we promoted primarily from within, just like my story. So we had a lot of caregivers that were promoted and incredible professionals. Anyway, to finish this questionnaire piece, we just made the questions, just really set the stage for them to recognize that we were here to help them should this happen in their life. Should this next step happen? Tell me about your last doctor's appointment and how that went. Were there any concerns? And then the follow-up to

that question would be some sort of casting a vision of, should this happen? We would be here to provide that care for you. And not just with the client, but the decision maker. So our process was to have that conversation in the home, evaluate the client, then call the decision maker, whoever that might be, daughter, son, whoever, and say, we went to your mom's home today. We recognize X, Y, and Z. Based on what we learned, our professional recommendation is to keep the care as is, no changes needed. Or the next time might be professional recommendation would be to increase care to X, Y, or Z, or to, in some cases, when they're in a rehab situation, decrease.

And so you're setting yourself up as an expert who's going to provide a professional recommendation on the prescription of home care and help them understand just where you stand in their aging in place process. So you got me on a soapbox there. I'm going to shut up now. No, this is great. You and I hadn't really discussed like focusing in on retention,

but I'm glad we are because I think you and I both know a lot of new businesses, even mid-sized businesses in this industry, it's so easy to focus on sales and marketing and new client acquisition, new carrier acquisition. And that's, like you said,

that's half of the puzzle here. But the businesses that I see that thrive and scale and accomplish really great things are the ones that double down on retention and are so good at it. You know, they're retaining clients and caregivers for years and years, and it's because they're doing these things really well. And in my observation of what you shared today is it's a lot of just like tweaking. I'm thinking of like dials. It's a lot of like, you're doing good things. You're having the meetings, you're doing the communication, you're asking some questions, but it's like, how can you ask better questions? How can you rephrase things, communicate things a little bit differently and a little bit better. And so I hope,

I hope this is just like reassuring for people to hear most likely they're doing a version of what you've shared today, but it's just these really like fine tuning of processes of wording of messaging to really increase your retention of both clients and caregivers. And then naturally that can help you grow your organization because you're keeping people longer. So that's kind of my take on, on where this conversation has gone and what you're sharing today. Any kind of last thoughts as we kind of, I want to kind of close that retention, but any last thoughts that you want to share on client or caregiver retention, what we've covered? I think just going back to where I started with making sure the KPIs or the goals

have measurements. So, you know, like I did X amount of this. So I am on track with, with achieving this. And so as much as we might do a quality assurance check or, or whatever you want to call it, a supervisory, does it in the home? Did you track it? Is it in the system? Do you have a plan for next time? Did you make the phone call to the daughter? Like having KPIs, metrics and KPIs that, that track that is really key. And then to go back to what I said before and where I started, which is that meeting

structure where you're reporting out to your team, hey, I did this. This is what I owned this past week. This is what I learned in the process. There's pure accountability that gets to happen there that you as the owner don't have to fully drive. And you can kind of sit back and watch. Not fully. Not fully.

You got to still be there and be present. But there is some beauty that comes with that where people come together and they're mission-minded to what you guys are doing, which is helping seniors stay home. What more beautiful of a mission can there be? And so having numbers and goals that reflect that and structure to be able to accomplish that is just a key part. So don't forget to track it. Don't just say you're going to do it because I think that's the problem we see a lot is with the tweaking. Yeah, it's small, but I think where they fail to tie it up is in the metrics that actually make sure that they do it and that they hold themselves accountable to what they said they would do. It's so easy to see how new client acquisition

equates to dollars in the bank. Retention is a little bit more challenging, but I like what you're saying of get really granular and track your retention efforts. And you will see the dollars in the bank. Once you have those metrics in place, I'm thinking of like specifically like lifetime value of a client, lifetime value of a caregiver. That's an easy way to see, okay, if we keep a caregiver for five years, look what that's doing for a business. If we keep a, I think I said a caregiver, you keep a client as well for three years. Like what, what does that equate to in a business and in a revenue sense? We're not talking a lot about finance, but what we're saying, you know, about retention, you can tie that back

directly to revenue and it can be as impactful as, you know, bringing in a new client or bringing in a new caregiver. So really great comments about retention. I want to, we've just got, you know, time has gone pretty fast here. I want to zoom out just for a couple of minutes and talk about some of the challenges that you overcame. You did this, I think for about 14 years, 15 years, it's a long time. And I'm sure we're talking about, you know, maybe all the great things and the successes that you've had. I'm sure there were some big lessons learned along the way. We don't have time for too many, but maybe one or two hard lessons learned that looking back, you maybe would have approached things differently. Yeah, sure. So in my story, my extended introduction, I did leave out this part. So this is a good time to go there. So in 2016, so after oversaw the first office for four years,

we've grown it. The revenue is wonderful. All things are pointing towards success. I am absolutely miserable. So I haven't gone to the dentist. I had moved locations. So I hadn't taken the time to figure out a dentist. I hadn't taken the time. I don't even know if I had the right state license yet for my driver's license. There was just so much. I was driven to build the business and kind of forgot about everything else for myself. And so in 2016, I actually went to call it quits. We didn't really go on the market, but we knew a buyer. And I showed them around the office.

I introduced them to the team. The team didn't know why. And as she's telling me about her small children and I'm thinking about the business I'm wanting to sell to her, and how excited she is. But she's telling me about her small children. I'm just like, oh my goodness, if she's going to succeed, I'm going to have to do, just to save time, X, Y, and Z. I mean, that list actually was much longer to make this business a success for her. Basically, I cared more about her for a moment than I did myself and her small children to make sure she could have a work-life balance that was healthy. Even though the revenue was great, she wasn't going to have a healthy work-life balance. And so in 2016, when that happened,

I had that thought in my head. I went home that night. And I also had another thought in my head from another owner in Florida who had said, there's no other business where you can make the kind of earnings you can make as an owner, or in my situation, sharing the profits that you could make and give back the way that you can with home care and seniors and caregiving. So I had that thought in my head. I had the thought of, well, man, I've got to change X, Y, and Z before she even is the owner to make sure this is a well-oiled beyond what it already is. And I woke up maybe in the middle of the night.

Every time I tell this story, I can't remember. So I change it every time. But essentially, by the next morning, I said, if I could do it for them, because it was a husband-wife couple and the wife was going morning, I said, if I could do it for them, because it's a husband, wife, couple, and the wife is going to operate the business, if I can do it for them, why not do it for me? And so I just kind of like, all right, let's get to it. And so actually, the next thing I did outside of telling the owner, let's tell them sorry, which was not fun. And I felt awful for that, their hopes and dreams of owning it. But outside of that,

the next thing I did was brought somebody in my office and said, you're not sitting in the right seat. We've got to move you. I am so grateful for you and you have so many gifts, but we have to move you. And I held back doing that for so long when in reality, that's all I needed to do. And she looked at me and said, I trust you completely. I mean, I had chills and I just wanted to cry because I built a relationship with her. She trusted me, but I was too scared to have that confrontational discussion to do what was right for the caregivers and clients all along. So that's one example of the many things I had to do. So yeah, there was rough moments of that. And so the frameworks we've talked about today was a key part of that. And I think it was, you can have those frameworks, but if you don't have the accountability structure,

like if you don't have the mindset of accountability and actually holding people to it, you can say meet your KPIs and you could have these one-on-one meetings like I did with her. But I just kept kind of saying, I believe you can do better. When I've realized, bottom line, she was just not in the right seat. She needed to be elsewhere. And so that's a whole another can of worms, possibly, where we could talk more. But in short, it wasn't always rainbows and unicorns by any means. But thanks for sharing that story. Honestly, pretty interesting. Like, A, you were ready to call it quits. But then B, you were about to like help someone else do something that you could have done for yourself, which is really interesting. And maybe that's what it takes.

You know, I think not everyone's story will look like that. You know, when you're ready to call it quits and sell, you know, you'll have this like aha moment. But I think that's really interesting that you did. And then you knew what you needed to change based off like those feelings you had at the thought of, you know, selling the business. I think that's really interesting. I'm sure we could talk a lot about more challenges and lessons learned and challenges that you overcame, but I want to maybe leave our audience wanting more next week. I want to deep dive on leadership today. We talked about retention, which were kind of two of the five pillars, something that you

feel really strongly about. And I think that's kind of a tone in today's conversation is just about being a leader yourself. And we'll talk more about maybe the challenges that you overcame, especially as you scaled as a leader and then how you empower and build other leaders. You know, we've talked about these one-on-one meetings and, you know, KPIs and accountability, but that's easier said than done. You know, how do you really build leaders that you can trust to operate or run the business

almost without you there? Like that's, I think what every owner wants, but how to actually do that is another story. So why don't we wrap up here and come back again next week, continue the conversation, talk about this framework. I want to say thank you for bearing with me. We've taken this in kind of a completely different direction, but you've shared a lot of really great insights as we've gone here. So thank you everyone for joining us live. I know that went really quick, but we covered a lot of ground and we'll look forward to seeing you back next week. Yes. Thank you so much for having me. Awesome. Well, thanks everyone

for being here. We'll look forward to seeing you back. We'll have Emily again, same day, same time next week. Thank you, Emily. 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.