Home Care U - What Is Care Management And How Does It Affect Home Care Services? (Catherine Vergara Pt. 1)

Episode Date: January 14, 2024

More and more agencies are focusing on care management as a referral source or adding care management as one of their service lines. How does it work, how does it fit into your overall strategy, and how can you decide whether or not to pursue it? Catherine Vergara, president of Texas-based CareFor, is here to tell all. Enjoying the show? Send me a text and let me know!Learn more about Careswitch at: careswitch.comConnect with the host on LinkedIn: Miriam Allred This episode was produced by parkerkane.co

Hey, welcome to Home Care U, a podcast made by the team at Care Switch. Nobody went to school to learn how to run a home care agency, so we're bringing the education to you. Join our live audience by going to careswitch.com slash homecareu or listen on your own time wherever you get your podcasts. Home Care U is hosted by myself, Miriam Allred, and Connor Koons of CareSwitch. Enjoy the session. Welcome everyone to Home Care U. I'm Miriam Allred, one of your hosts.

I want to start off and say Happy New Year to everyone. This is our first episode or session or class. We call them all of the above of the new year. So thanks for joining us. I hope everyone's having a great start to their year, whether you believe in resolutions or goals or, you know, themes for the year. I hope everyone's starting off strong. 2023 was awesome. Also bumpy for many of us, you know, still coming out of the pandemic. But let's all just, you know, put our minds to it and take it one step at a time and have a great 2024. Thank you to all of you,

our guests, our listeners, our subscribers, everyone for the support of Home Care U over this past year. Many of you have probably seen the announcement we became the number one rated podcast in home care in 2023. I am hopeful and anxious and excited that we can outdo ourselves in 2024. But I really, this wouldn't be possible without all of you, without our guests and without all of our listeners. So we hope to start the new year off with a bang. And I think we're going to do just that today. But I hope you all will stick with us and continue to give us feedback and insights

and attend these classes in the new year. And I really think we're going to have another stellar year full of great insights and information and guests. I want to just call out for any of you that aren't getting the sessions or these classes directly to your inbox, you can go to careswitch.com slash subscribe and join our email list to get the weekly podcast recording straight to your inbox. When you register, I know that's a little bit different. And so if you want to get these

directly to your inbox, just go to thatcareswitch.com slash subscribe, and you'll get them every week straight to your inbox. Without further ado, I have interviewed most of the top executives in the industry over the last couple of years. And just when I think I can't outdo myself or outdo this show, and I'll admit my bar is really high, I meet someone like Catherine. I've been anxious to get her on the show since I met her back in October. I think you all are going to love her as much as I do. She is, you know, maybe under the radar in home care, but I knew I had to bring her to light here. Out of the gate, connect with her on LinkedIn. She is someone that you want to get to know, be aware of, be following. So I am like over the moon to introduce you to Catherine

Vergara, who is the CEO of Care4 in Austin, Texas. CareFor is a care management company that provides home care services. So a slightly different model than what you all are used to or some of maybe the models that you all provide that are listening to this. But I felt strongly about bringing her on to bring some really unique perspectives and insights to the show. So Catherine, thank you so much for being here. Thanks for having me. Certainly an honor. I too was just thrilled to meet you in October. Andrea Cohen had just said so much about you and she's an amazing connector and I'm glad we were able to meet up. Yes. I also wanted to shout out Andrea Cohen. She was on the show this past fall. She is really a pioneer in home care in the Boston area, but also has served on national and state boards. So

she introduced Catherine and I, and I'm grateful to her. Andrea is Catherine's mentor, and Andrea has been an inspiration to me and many for years. So she connected us back at HCAOA in October, and the rest is history, and I think we've got a lot ahead of us. So with all that being said, let's jump in. I want you to start telling your story a little bit. Your journey to home care and landing at Care4 is pretty interesting and different than most. Everyone's story is special and interesting to me and to others. So I love to start here. So tell us a little bit about what you were doing before and then how you really landed at Care4. Sure. So I went to school to study to be a pre-med major. I was biomedical science at Texas

A&M. And my junior year, sort of like the MCAT season, I had gotten ill and needed to pivot and choose something different. And so I went ahead and graduated from A&M and then went back to St. Louis where I grew up and got a bachelor's of science in nursing from St. Louis University. So I graduated as a young nurse ready to sort of take over the pediatric world and landed a job in Austin at the Children's Hospital in pediatric oncology and just fell in love with the space, the physicians, the pathology, the families, the children, and spent the first seven years of my nursing career building the outpatient program there. I became a manager as the hospital acquired the program and then started operating and helping that program integrate into the hospital system. And I was kind of trying to decide what was next.

I really loved what I did, but it was a little felt a little like tied in by the bulkiness of the healthcare system. And transparently, I thought I always would be in PEDS, but I was approached by an individual that I knew socially, who was an operating partner at this small new PE firm. And they were doing due diligence on this founder led care management business that had a direct-to-consumer, well, it was direct-to-consumer caregiving, PAS side of the business. And they were looking to grow and scale that. I grew up in an entrepreneurial home. And so that was interesting to me, but it was very

different than what I was doing. But I agreed to the meeting, mainly out of just common courtesy, was introduced to the founder. And while I was fascinated with the business, we were, like, frankly, both kind of mutually disinterested in each other at the beginning. She was like, you're too young. You work with children with cancer. I was like, I've never really worked with the aging population. And that's not really my deal. And so the operating partner kind of saw this all falling apart and he like repositioned the offer and said, what do you think about instead of just living elbow deep in it as a care manager, what do you think about like operating and helping and growing and scaling the business? And that was super interesting to me. I love the operations and how things work and run. And I

was young. I would just turn 30. I had no children. I wasn't married. And I felt like I was leaving good highs where I was coming from. And it was worth a shot to take a go and get to understand what this world was. I knew nothing about home care. I knew nothing about care management. And I said, yes. So, and that was 10 years ago this summer. This is so interesting. Okay. So, but quick, so, so people understand we're going to focus on care management today. We're going to talk about like what it is, what it isn't like kind of demystify care management. Then we're going to talk about like care management strategy and how it plays into home care. Next week, we're going to talk about your journey with private equity, like what you've learned, how it's gone. You, like you just

mentioned, came in with private equity already involved. So just so everyone's aware, like that piece is super interesting and Catherine's journey is like kind of unlike many. And so we're going to talk in depth about that. But I want to clarify like today's care management, next week's PE. So come back next week if you're really interested in like in the PE component. Before we jump in, though, I do want to like you to highlight the org chart just so that people understand when you came in, you mentioned the founder, you mentioned the firm, you mentioned you doing operations, just like super quickly highlight like what the org chart looked like

then and now, just so people understand like the hierarchy. So I had not, I mean, I had been a floor nurse turned clinic manager and operator. I had never been in the private sector and I had never operated a business. And so while I had what they felt like was the DNA to learn it and go do it, I had never done that before and also had never been in the industry that I was stepping into. So for the first three years, the operating partner from that firm acted as the COO. I was director of ops and title and our founder who had been a solo practice just took the title of founder. She was and still is transparently very involved in the organization, but from an org chart, like no one has ever reported into her. I reported up into the COO,

who was an operating partner with the firm. And then all of the hires that we brought on within the organization reported into me. Founder has a board seat, certainly an integral part and a strategic partner and thinker and someone who I have learned a ton from. And she's been a mentor to me. And I certainly value her opinion about the direction of the business, the way we provide services, but no one operationally has reported to her. And I have never reported to her from an org chart standpoint. Okay, perfect. Yeah, I just wanted to set kind of that foundation of like who's where so people understand. Let's get into it. And the way I want to start is talking about your service line. So you are a care management company, but you also do home care

services. You also do guardianship and planning. Tell us just briefly about like that structure. And if you can also like kind of ballpark numbers, like 80% is X, 20%, like kind of a breakdown of like numbers so people understand those service lines. And then we'll get into and talk about like how they feed into each other. So the home care side of the business is really 80% of our revenue, which is interesting because what we really market is the 20% in the care management that drives the home care. So within the care management, we don't historically break it down on a number standpoint, but within our care management, we serve about 180 clients and about three dozen of those are guardianship clients. So those guardianship clients receive care management services as well. A lot of

them receive home care services, but about 36 of that 180 we serve as legal guardian for. That's through the state of Texas. We're management through our guardianship services really grew a service line where we serve as medical power of attorney for individuals who either, who don't have someone to serve or need someone to serve secondarily. And out of that medical power of attorney program, because people have capacity when they're naming you, there's a huge need to plan and for people to understand what their options are and to express their wishes while they can so that when they can no longer speak for themselves, whether care for serving in that role or they've named an agent, that agent has a guide for what they want that

they've already expressed. And so the guardianship work has been an interesting part of our business. It's time consuming, but it's certainly not the bulk of our business as far as the types of clients we serve. But that has fed into the planning component of our services, as well as the medical power of attorney and just the general helping people understand. It's a lot harder for people to honor your wishes if they don't know what they are. So while we can, let's have those conversations and begin to map out knowing that things change and you pull different levers at different times. But that's been a really unique service, I think, that we've offered that has provided a lot of peace of mind for people when they think about aging and planning

and talking about, frankly, taboo topics around a lot of family members. As an industry, for many years, I would say maybe more so over the last decade, we've talked a lot about like, whole person care or patient centered care. Home care is an important component to that philosophy. Care for has a much broader stroke here of really owning like most of the pie per se with these different service lines. Just explain, you know, the founder's vision, your vision of this like whole person philosophy and why it's attributed to your success. Yeah. So when I came on, you know, I took a deep dive in care management. I took a caseload for two years and during those first two years were very formative of the, you know, the vision and the culture and the mission of who we care for was created to be and who we were

going to continue to be going forward. And what has always been, you know, number one North Star was patient first. And, you know, the uniqueness of a care management model where you're working directly for the patient is, it stands out in the healthcare space because that isn't always, well, it should be center. It doesn't always stay that way. And the way that care management allows us to put the patient at the center of the conversation, you know, home care for us is a solution in a lot of ways, which is why we provide that service. It's an amazing solution to stabilize cases, to allow people to age in place or to extend their time living in whatever level of care that they're in. But for us, home

care is not the center of the wheel. It's potentially a spoke that comes out of that center and having a care manager in the middle of that with the patient to make sure that you are directing care and making choices and navigating the road in a way that honors their dignity, their preferences, their wishes, and provide some clarity, understanding, and knowledge behind whatever complexity they're facing, I think has been really important for us and has been helpful as we think about who is care for, what kind of services do we offer, who do we want to be. Keeping the patient first has allowed us to say, you know, does this add value to the continuum of care for them? How do we either A, provide it ourselves or build strategic

relationships to make sure that we can make that a seamless addition to their care plan or a seamless transition into what's next for them. Great. So let's dive into care management. I want people to understand it to the level that it warrants. I want you to speak from the lens of some home care providers today are offering a degree of care management, whether they call it that or not, or offer it as like its own service line. That's a really like mixed bag across the industry. But I think it's really important that people understand like what care management is, what it isn't, and, you know, like demystify some of the common misunderstandings. So let's start here of you explaining what it is, what it isn't, and helping home care owners understand what it is and isn't.

Sure. So home care management either means 10 different things to 10 different people or nothing, because you have no idea what that means. So there's a blessing and a curse to it being unregulated. And if there's no, you know, federal standard to say like, this is what this is. We do have a wonderful resource in the Aging Life Care Association. And I'll just put a little plug in there. If you want to learn more about the national organization that care managers belong to, aginglifecare.org is a great place to go to just read more about ethics, standards, resources, and who our national organization is. That is where care managers go to be a part of a national organization. But care management as a whole

is generally an organization that's sometimes an individual or a collective group of people that have some connection to the clinical or aging space. And that's so broad because there are so many different types of care management firms or solo practices providing care management. There's usually a clinical component at Care4. We are largely clinical and nurse-driven. We have one social worker, social workers, gerontologists, PT, OT, ST, people that are in the mental health space. So there's lots of different types of providers in the human health services that are providing

care management. But what I think is important to know is that, or sort of like what care management is not, it's not so much that like, what is it not, but it can be so much more. It can be so much more than what people think they're offering. And it can provide such an amazing solution for families. If you will connect with a care manager or build a care management line that has the capacity to go deep. And to go deep, you have to have the time and space and energy to deal with the clinical and social complexities that come with folks in the aging, mental health, disability, illness, change space. So I think, you know space. So I think care management means a lot

of different things to different people. For me, it's complex problem solving for the socially and medically complex. But I think a lot of agencies say they offer care management, and while they are offering a piece of it, if they structured it as its own service line, I think they could offer it in a much more effective way. It's not that what they're doing isn't care management. It's just that they could be doing a whole lot more to add value and to really be critical in the problem solving that's going to stabilize the case. Because home care as a service line isn't structured to have the bandwidth to truly deal with the 90,000 other things that are going on, not only in the home, but within the social structure of this family situation

outside of providing the care for that individual. And there's just so much more complexity around medication management, appointments, compliance, discharge planning, DME, equipment, home modification. Do we need to move? When do we move? Why do we move? Who goes? Who goes with them? The disease progression, education, and then you've got the family dynamics of not everyone's on the same page. And that's usually like to say it lightly, if it's just generally mildly not getting along versus having, you know, very strong different opinions about what to do with their loved one. And at the end of the day, you hope everyone's wanting the best thing for that person. But in crisis, everyone kind of has a different way of dealing with it. And to have someone that has the time and energy and space to enter into that scenario that has experience, that's not emotionally connected to the situation, that is a professional that has

seen this space and has the time and bandwidth beyond just figuring out how many hours of care do we need for this individual this week, and here's the two-week schedule or whatever maybe. But to really start to dig into those other problems and solving it, I think it requires more bandwidth than the structure of a home care company can provide. I want to insert a disclaimer here. The primary audience of this podcast are home care owners, operators, leaders. This is by no means an endorsement or a call to action of every home care owner needs to provide care management services. You're not coming across that way,

but I just want to vocalize that's not our objective here. It's more to educate on what care management is. Later on in the episode, we'll talk about working with care managers as a referral source. So I just want to like throw that disclaimer out here so people understand like the objective here and what we're trying to accomplish and know that this isn't like a, you know, every home care provider should be doing care management. Like Catherine is saying, it is extremely complex and most, you know, small to midsize home care providers aren't equipped to provide this level of care or this service offering. And so there's a lot at play here and we just want you to understand like what it is and what it isn't so that you can potentially

incorporate it down the line or partner with other care management providers in your area. I want to dive a little bit deeper here. You just did like a really good kind of overview of what it is, how complex it is, who it's for, etc. I want to talk about who the care managers are. Like, you know, talk about, you know, you have, I think, like 10 or 12. Who are they and what qualifications do they have to be care managers? Just because I'm curious, like who they are and how they're qualified. And just so you're prepared, then I want to talk about like who the clients are. I know you just mentioned some kind of criteria of who would need care management. If you can get a little bit more specific of, you know, who are the clients that need care management services and why? So start with care managers that will work to clients. Yeah. So the care managers that care for are largely nurses, bachelors prepared, registered nurses. I have one social worker that's on our team that has been a tremendous asset, but our business was nurse founded, nurse led through myself.

And just the acuity and the types of cases that we have built our business around are very medically complex and have a strong need for a strong clinical medical background. Care management as a whole, I think lots of organizations have usually a clinical nurse on staff. Some are largely clinical like ours. There's usually a lot of social workers that are involved in care management, but physical therapists, occupational therapists, folks that have been in the senior space for a long time, folks that have backgrounds in gerontology, masters in psychology, folks that provide the care management service, because the reality is the types of needs that patients have are very vast. I mean, there's three or four firms in our area that do similar work, and the makeup of the care managers within each organization is very different.

And everybody kind of has like their own little niche on the types of services they provide. And those firms are largely primarily care management firms that have partnered with various home care groups. And they have a couple of strategic partners that they usually work with very closely. And so to your point from your previous comment, you know, at the end of the day, I think it's just really important that home care sees the value of care management, whether you choose to infuse it into your organization or to partner with a solo care management firm. Ultimately, you're getting better outcomes for your patients. And that's why we're all here in the first place. We're here to provide excellent care that provides peace of mind to the aging, injured, and mentally ill. I mean, that's what we do at CareForward. I think in the home

care space, everyone's essentially trying to do something similar. So that's who care managers are. And as much as it sounds like a really sort of vague, what could be a lot of people, the reality is, it is, it can be lots of different types of people providing, like serving as a care manager. I think that was perfect, though. Like, like you said, diverse backgrounds make for really good care managers. And then you as a company of 10 with divert, like, you can bring on clients with a variety of a good fit from personality and skill set. So even though my care managers are largely nurses, they all have a different clinical background where they served. I mean, I'm the only one that comes from pediatric oncology, but we have folks that have come from other chronic illness. We have folks that have come from hospice, folks that come from home health, chronic illness, cardiology, rheumatology, things like that. Our social worker has an extensive

background in hospice as well. And then just temperament. You can sort of tell by the background of the individual or the way they're talking or what they say they want and don't want. You want that to be a good fit because you're really hoping to not have additional barriers in that relationship because what you're dealing with is usually pretty sticky and challenging and stressful and you want to make that as smooth as possible so that you can actually be effective. Well, it makes your business like deep and wide, like deep expertise, but then also wide and that you can service a lot of different client needs. So again, like I said, I think that was great. Before I have you jump into kind of the client side, earlier you mentioned, if I understood

right, when you're marketing care for, you lead with care management. So you're quite literally like leading with care management to go out and find clients. Like caveat here, you have such a strong reputation in your market that to my understanding, most of your business are referrals at this point in time. And that's like a luxury that you've built. But I want to talk about who these clients are. And just, I add in that, like you're marketing and leading with care management. So you're looking for these very specific clients. Who, who are they? And I know that's kind of a broad stroke question, but, and I know they probably need home care, but who is like the ICP ideal customer profile

for a care management case and why? Sure. I don't want to understate what's potentially assumed, but our business is exclusively private pay. So that is the market of the clientele that we serve. And the ideal client for us is someone that, and we had talked about this earlier, that has some level of medical and social complexity and the ability to privately pay for a complex solution. And that looks so different for so many people. It can be

consultative where they just need someone to come in with a professional expertise and provide an assessment and provide a plan of care and give everyone the roadmap or to make a professional opinion on what this individual needs. And then they're capable of executing it going forward. And it's really a one-time consultative service that we provide. The bulk of what we do does allow us to be involved with people ongoing because we will start with that same assessment and we will provide a plan of care, but the implementation of it needs someone to quarterback and own the systems and what we're going to put in place to make this successful. So that might be medication management that we're providing. That might be in-home care that we're providing. That might be a decision on we need to relocate this individual and this is

how we're going to go about doing that. And it could just be ongoing managing of medications and doctor's appointments and dealing with family members and making sure that it all goes smoothly. The levers that we pull are the types of things that we provide for clients because it is patient first and patient centered and based on their needs, ebbs and flows as the relationship changes and the individual ages or improves or declines based on the need. So it can be a one-time consultation that then they circle back around when they've had a medical event or an ongoing need. And as much as the home care may continue, the care management may come in and out. They need care management to come in and get things

settled and make a decision on care, get everyone in place. But the nature of the stickiness of the dynamics, it requires a third party professional to help manage and get it all settled. But then once it's settled, until there's an event, it's pretty sad. And so care management kind of takes a back window. We check in periodically, but we're not having an active presence with that family or that individual until then there is a particular event or a change in status or something needs to happen and care management re-engages. So at Care4, once you're in, you're in regardless of what service that's being provided, but it's not the same every week. It's not the same every month. Some clients we see annually

and some clients we see three or four times a week on the care management side. Okay, great. So yeah, just to recap, like, and it's okay that it's general and broad because that's like the nature of it, which I think is important for us to highlight. Before we kind of shift gears a little bit and talk about like care management and like the strategy and how it feeds home care and fuels like your home care service. Like I want to ask or talk about like the billing side of things you bill per minute or per like 15 minutes. I want to talk about like how you bill care management. Cause that's pretty interesting. And then if you can share, you're in Texas kind of like a ballpark range for how much you bill care management. I think that's just interesting for people to understand like how much more or less than it is for hourly care. So talk about

like the billing element just because that's interesting. So we bill in 15 minute increments, teaching clinical nurses that have worked in insurance funded spaces how to bill privately for their time is its own episode. But we bill for our time in 15 minute increments. Our current rate is 175 an hour. But we bill for everything we do. So we bill for face-to-face time, drive time, documentation time, time on the phone, time on text, talking to family members, talking to medical professionals, sitting on the phone with social security, filling out a Medicaid application. All of the administrative stuff that is required for us to serve that patient well is billed at the same rate and in the same way as if we are filling

medication boxes, attending a doctor's appointment, accompanying a client, sitting with them in urgent care or being a part of a discharge plan, coordinating all of that. Being able to participate in their entire world allows you to be more effective in the small tasks that you need to complete. But faxing records and communicating, sending referrals, getting appointments, those types of things, everything we do for the client, we're billing in a 15- minute increment for us at 175. Okay, great. I wanted to add that because people may or may not know that and not to like scare people out of this, but that is the level of complexity you're dealing with with care management, you know, tracking 15 minute increments and tracking and billing for

every single thing that gets done. And so I think that's just, that's a nuance, an important nuance. It's pretty differently than. But I think it's why you can go deep because you can have the personnel to spend the time to do it. So our caseloads that our care managers have are based on billable hours. People always say, how many patients do your care managers take care of? And it vastly varies between care manager because it depends on the acuity of the clients they're taking care of. So they're all billing around 35-ish hours a week, but that looks different for, you know, we have one nurse that carries a deep mental health caseload. Those are much fewer clients because their needs are just really great and become very acute very quickly. We have a nurse that's really

good with the planning and the medical power attorney type clients. That's a higher caseload because they're largely pretty stable. But billing in that way, and I think that's the part sometimes when we say home care could, if you take a nugget, it's that like from the jump, value the service that you're offering in this way and bill for it in a way that you can actually get in there and solve the problems. And it's going to make, it benefits everyone. It certainly benefits the patient. It also benefits your organization because problems are being solved. The schedulers are happier. The caregivers are happier. The patient has better outcomes because you have someone that's dedicated to help solving

these problems and you can dedicate them in that way because they're being compensated, like the business is being compensated for what they're doing. Mm-hmm. I think this is kind of that first distinction of a lot of home care businesses are doing some variant of care management. But I think that that you just called out, imagine if your caregivers had, you know, these care managers that were really experts in the cases and the needs and all of like the complexity and the caregivers could focus on just the care, like the difference that would make in your organization. So we're going to kind of keep going down this vein of how the services support and like balance each other out in different ways in kind of the same vein of what we were just talking about around like the billing components. We talk so much about margins and home care and how like razor thin the margins

are. Can you speak to the margins of care management and how that influences like the cash flow of your business? So I just pulled 2023, our care management margin in 23 was 47%. I mean, I'm pausing because that's high. Sure. And so yeah, what does that mean for like your business as a whole, like your financials holistically? Because I don't know if you know, like your home care margin off the top of your head or if you pulled that, but just what that, how that cashflow influences the business. Yeah. So, you know, 20% of our total revenue is care management. So 20, we market for, you know, 20% of the business that also feeds this 80% of the home care. Our home care margin for 23% was 40%, I think.

Our length of shift is very high. When you market care management and you're serving these, I listened to Becky's episode in December. I don't know her. I really enjoyed listening to her, but the way she described her agency was, had a lot of similarities as far as like very boutique, very high touch. We know who we are. Culture's huge. The way we take care of our employees is a reflection of the way we care for our patients. But the length of shift for us is 10 hours. And so we carry these, we have smaller volume of cases that have a lot

more hours because you are going after these patients that have very complex problems and their need is great. And so they need more than a caregiver. They need a comprehensive solution. And while home care is a piece of that solution, they need a broader plan and where home care is a piece of it. And care management for us can be a big piece of that broader plan and not so much the answer to the plan, but the one that's going to facilitate the effectiveness and seeing that plan through. Okay. You mentioned about 180 clients that you have, correct? And you're saying 20% of your revenue is funded by care management. 80% is home care. CareFor wasn't always providing home care services, if I'm not mistaken. So let's talk about that evolution and how you convert care management cases into home care and then what that home care evolution looks like for your business? How does that all coexist, I guess? Sure. So when I joined in 2013,

the business was originally founded in 2000. So it had been a solo practice for 13 years, primarily care management with a direct-to-consumer home care solution. So there were private caregivers that work directly for the patients and our business process the payroll. Well, labor laws, joint employment, all the things as we thought about really looked at growing and scaling the business to do what we wanted to do and to be able to control the quality of care we were providing the caregivers needed to work for Care4. So in 2017, the caregivers became Care4 employees, but it's a, like, we already had this private network of folks that were, we were providing care management for, and all of those employees basically became ours kind of overnight. I mean,

we planned for it, but on October 31st, they didn't work for us. And on November 1st, they did. So we inherited about 150 caregivers very quickly. So that is when we became a home care company and started living in the home care world per se. But it's also why we culturally have always been a care management firm, because that's the origin of the company. And home care was always a solution for our clients. What the business beats for is the care management work as far as being able to get in there and deeply be effective in solving complex problems for these

patients. Andrea Cohen's the one that's drugged me into the home care space. And I was like, this is a wonderful world and you need to know these people. Andrea Cohen's the one that's drug me into the home care space. And it's like, this is a wonderful world and you need to know these people. And it's been a wonderful introduction and I've thoroughly enjoyed getting to know other operators. And when I come, all I know in this space is what we've built at Care4, which is not culturally

how a lot of home care companies operate. Yeah, it's a less traditional model. But I think that's why we're here is there are a lot of diverse models in this industry. And it's people like yourself that aren't typically up on stage or just kind of nestled in your market, just absolutely rocking it. And we want to like surface these really unique models because there's something for everyone to learn here. And like the disclaimer, it's not that home care needs to do care management, care management needs to do home care. It's how do

they coexist? How do they benefit one another? How do they fuel one another? Which may be a good segue into using care managers as referral sources. I know this is like kind of one step to maybe remove from what you're used to, but if you were, say, a home care provider today, what would your approach be to go and warm up to a care manager and become, you know, a really strong referral partner to them? What would you do and how would you do it? You know, the website I referenced, aginglifecare.org, that's where I would go to find who are the care managers in my area and who are the folks that are doing this work. And I would get to know them and understand the types of clients that they're caring for. And I would build that relationship any way I would build any other referral relationship and say, you know, I would love to, you know, be a solution for your clients. At the same time, even though we provide home care, there are home care companies in Austin

that call us and say, we need help. This is like, what's going on in the home is beyond the capabilities of our home care company. And our caregivers aren't wanting to go to the home for X, Y, Z reasons. And can y'all come in and provide some care management to help stabilize this case? We've talked to the family. They would like y'all to come out and meet with them. So I think there is an amazing relationship that can happen between care managers and home care providers. Care managers need home care. They're largely not providing it within their organization. And it is a phenomenal solution for so many patients that want to age in place or, you know, stay where they are just a little

bit longer or to have some companionship within the community that they live in. And so, you know, care managers need home care partners too. And with any relationship, when you're making that referral, you're, you are leveraging, you know, the reputation that you've built. And so you want to trust that the person you're handing them off to is going to care for that individual the way that you would. I think what's really important between the relationships between that you're building between like home care owner operator in that care manager is the level of trust and respect and communication that when it doesn't go right, you can have a clear and honest conversation because the reality is it won't at some point. I mean, we're dealing with people, we're dealing with, you know, complex

situations. And so having the rapport where you can, you know, talk through the situation and, you know, have the opportunity to correct whatever wasn't great, you know, whatever the caregiver, you know, say you had a caregiver that didn't live up to expectation or the patient is saying a particular thing. I think there's sometimes this unspoken competition or like, who's really in charge and are they going to take my business? Are they going to take it somewhere else? Or, you know, it's more of like a liability, but I think if you can build these relationships where you trust and collaborate and respect each other and really understand the value that these services bring to the patient,

I think it's ultimately the best outcome for the patient. But they can, not only will it provide the best thing for the patient, I think it will make the service that your company is providing smoother. And you can also be really solid referral sources to each other, I think. Yeah, the way I'm thinking about it, and this is like cliche, but it's like providing the full package to the client. You know, like you said, care management goes hand in hand with home care and vice versa. And like you're saying, a care management firm without home care, like their, their care and their capabilities only go so far. And so it's really like you need, you know, care for has the full package, but if you are a home care provider and want to work with a care

manager, you have to like build that package together. And like you're saying, just establish really clear expectations and services and solutions, like just map all that out. And then, you know, I see it as a way to just like insert your agency, your business into a care management firm and that you're working so closely together because it's part of the full package that the client receives. So, you know, you're in this position where you're doing the whole bit, but go in, you know, basically like insert yourself as a solution that the care management provides. Like we offer home care, it's through X company, but it's like part of the full package. So I guess like my question to that to you is how do you bundle it? Like when you're doing an assessment with a client, like you probably bring up home care in that initial conversation, but how do you like package all of that?

Because I think this might help home care owners as they approach care management companies, like insert themselves into that package that everyone can provide. So just very practically, whether they engage in the care management services from the jump, it's on the customer service agreement that they already, that they signed. So they see it on the customer service agreement. So whether or not they take advantage of it, day one or not, they've signed off on it. So if, and when they do utilize it, it's just a matter of starting. But in that initial call, we're all listening for the perceived need because you want to meet the perceived need and then also help them also understand the other services that we can offer. There are people that call us that need a home care solution. see the value of care management they don't at the time or they truly just don't have a

care management need at the time and we need to just provide the home care. And so we will get that started. But the integrated model at Care4, the schedulers are deeply entrenched in the work that the care managers do through our weekly meetings and then just culturally the way everyone collaborates, they're also listening to the needs of the client and the types of calls that they're receiving from family members to kind of know like, gosh, they could really benefit from a care manager. I will also say our caregivers are very used to having care managers on their cases. So if they're on a case without a care manager and they feel as though one is needed for various reasons, they will often call and say, I really think Mrs. Jones would benefit from a care manager. Can someone come out and talk to her about that? And that is sometimes,

if it's been a home care client only, our individual that does relationship management and business development will go out and circle back and have that conversation. But if they've developed a really strong rapport with their scheduler, they'll have a conversation with them and they'll introduce the service. And can I have a nurse come out and talk with you and get that going? So from like very practically, everyone like signs off on the rates for care management and caregiving with the agreement up front. But we talk about our business and solutions. We will certainly identify the two service lines, but we talk about our business and solutions. We will certainly identify the two service lines, but we certainly talk about it as an integrated solution to their

problem and whether they need home care or care management right now, both together, one or the other. They also, we present it in a way that they know that that's fluid. And just because they're using both right now, it doesn't mean they have to use both forever or one or the other. It can ebb and flow as their relationship goes on. I think that was really important for people to hear. And like, just like what's ringing in my head is this is why it's so important for home care to understand care management, because even if you don't take it on yourself and kind of create this integrated model, like you're speaking to, if you partner with the right care management firm, if you can build that trust and that credibility and provide the value that they're looking for, imagine the business that can come

from this. You've shared your ratio. That could quite literally equate to a ratio even through a referral source. If you create that level of depth in a relationship and you are the go-to and you like integrate into their package, this could become like a massive source of business for a home care agency. When people call me and say, you know, I'll have a friend call and say, my parents are up in Dallas. Okay. Well, we don't serve the Dallas market. I don't know. I'm not connected to the services there. They say, who are the good caregiver? Like who's the best care home care agency to call? I reach out to the care managers I know in the area and they're saying, oh, such and such company or service. Cause they're, you know, they're the ones that I use and that I know and trust. So people are

at times looking to care managers for who's the best in town for these various services. And so to build a relationship with the premier care managers in town are going to elevate your service and put you among the folks that are going to be the first ones to be referred. Which means it's going to be competitive. And most likely they already have those relationships established, which is inevitable. But like you just said, elevate yourself and your business and, you know, seek that out as an opportunity if you're in that position. I mean, the industry is growing too. And like, you know, partner with someone that's starting out that's, you know, trustworthy and that you've built a relationship and,

you know, they're doing the kind of, you know, they're caring for the kind of patients that you think fit well with your agency. And, you know, there are folks that certainly already have those established relationships, but I would say, like, we always say, we just need them to give us one chance. Well, you mentioned even your founder was kind of a sole businesswoman. Is that, you've referenced that a few times, is that pretty common for an individual to have their own caseload that they manage? So even seeking out those people may be hard to find, but they themselves have like a personal caseload. And a lot of those folks are members of the association, but the solo, there's basically two camps. There's a lot of these solo practices. And then I would say more common the last 10

years are firms and groups that have teams of care managers. In my market, there's certainly both. There's solo practices and then there's a couple groups. That's a good reminder. I think where I want to end this, and this is putting you on the spot, we didn't talk about this, is talking about maybe telling a story or two of clients that you've had that have benefited from this integrated care model and just the result or the outcome for this, this individual or this family. I think this model is unique, but it, it really is the essence of whole person care, which is ultimately what we're all striving for. even if we can't provide every service or solution for individuals. Home care and this industry, the post-acute space, is striving for that goal.

And I think your integrated care model is really doing a great job of that. And so I want to just maybe put you on the spot, a story or two that has resonated with you of an individual or family that has benefited from this model? Yeah. So I think two kind of come to mind. They're sort of a little bit different. One, we got connected to, this was at the beginning of my time at Care4, we got called about a woman living alone by her neighbor. And she was concerned because she felt like she was declining and she was living independently. And she was, you know, seemingly confused, looking like her hygiene was declining. But all she knew about was a son that lived overseas. And because her husband had previously passed away.

And so she was living alone in this home and she had a son over in Italy. And so we, you know, the neighbor's just saying like, I've heard great things about y'all and I think you can help. And so we reach out to the son and he says, oh, I talk to my mom every day. She goes to the grocery store. She goes and plays cards. She's out and about, but she calls me every day and it sounds like she's doing really well. I don't think she has any needs. So we have that conversation with him and go out to the home and sort of have a different scenario that we see. And the neighbor continues to sort of see the issues. But he's just convinced, well, she calls me and tells me all these

things that she does every day. And, you know, I have no reason not to believe her. Well, the son's, uh, spouse ended up coming back to the States and staying for a week and seeing very clearly that she was not doing any of the things that she said she was going to do. Those were things she did, you know, a decade ago. Um, and it was not safe for her to be in her home anymore, but the spouse was basically that she said she was going to do. Those were things she did, you know, a decade ago. And it was not safe for her to be in her home anymore. But the spouse was basically there to lay eyes

on it and was about to go back to Italy and had, you know, no plans to stay or to help facilitate what actually needed to be, what actually needed to happen. And there was a big concern about, you know, where do we move or what do we do? Where do we go? How do we help her? And so the first thing we did once the family saw sort of the need is we immediately put 24-hour care in place to keep her safe. And we were able to provide the care she needed while we continued to get to know her and her son to understand, you know, what is the appropriate plan for her? Is 24-hour care sustainable? And is it the right thing? Is 24-hour care sustainable? And is it the right thing? And that amount of care in the home was not financially sustainable for the family, and she did need to make a move. But again, families over in Italy

were here. She needs care, but also needs to make a transition. And so we were able to help transition her into a wonderful memory care. And we were able to keep the caregivers that she had developed relationships with over sort of that six to eight week period in the transition. And she was a very social woman. She was far more demented than her son had really understood. And she never really fully understood that she had even moved from her home. We were able to move all of her things and create her bedroom to look similar to her room from her home. And she basically became the hostess of her new community. And she had a job there and loved greeting people and meeting people. And she kept care. Care was financially sustainable for

her for four to six hours a day, a few days a week. And that allowed her son to have the life he wanted for her to be safe and to live the rest of her years with dignity. But the care management coupled with the home care in that situation gave her immediate safety and then also gave us the time to build the plan to, you know, provide for her in ways. And, you know, we developed a great relationship with the son and he, you know, continued to stay in Italy and was able to sort of stay up to speed as far as what was going on with his mom. So that's one. And then I think kind of what we do a lot of is differing opinions about what the right thing is for loved ones. And so coming in and making that third party assessment,

we work with a woman, she just turned 99 yesterday, and she did have the means and the ability to age in place. But sandwich generation child is raising kids as well and doesn't really have the time, energy, and bandwidth to attend all the doctor's doesn't really have the time, energy and bandwidth to attend all the doctor's appointments, manage all the medications, manage the household. And so that's a situation where while she's needed a significant amount of care, she's also needed someone to manage the care because there hasn't been anyone in the family to do that. And so we've

cared for this woman. You know, she was part of my original caseload almost 10 years ago, and she's has a very stable, lovely life in her home with her caregivers that have been with her the whole time. And then care management provides med management and various things for her. And, you know, that whole is sort of a more traditional case, but it's a way where we can provide a solution and then ongoing support for individuals that are certainly, you know, families well-intended. It's just a bandwidth and time situation and they need, they want the home care solution, but they don't have the bandwidth to manage it themselves. And they needed us to come in and help with that. Thank you for sharing. I love to just bring it all to life. You know, a lot of times in these episodes, we're in the weeds on like the business side of things and the financial and operations, but sometimes just like paint the

picture of what it all means by sharing those stories is really impactful. So thank you for sharing that. I'm sure we could sit here for another 60 minutes and you could share dozens or hundreds of stories of lives that you've quite literally impacted, changed, saved. And I think, you know, this model is so fascinating and I'm glad that we've given you impacted, changed, saved. And I think this model is so fascinating and I'm glad that we've given you kind of a platform to share this with others. I'm sure people are going to connect with you. I know we had someone here in the chat,

like I wanna talk to her after this episode. Hopefully I'm not signing you up for like a consultative role here, but thank you for sharing so openly and so willingly. Yeah, thanks for having me. I hope people see it as an approachable way to serve clients. And even if it's not something they build, just to know that it's a resource to meet the needs of so many people.

Absolutely. Well, thank you for giving us an hour this week. We are really excited to have you back next week. Like I mentioned at the start, and for those of you still with us, we are going to talk about private equity and care for being backed by a PE firm, Catherine, working directly with those partners. So it's going to be another really interesting, pretty heavy hitting episode. So we hope everyone will join us again next week. Catherine, thank you so much for your time. And we'll look forward to having you back next week. Same. Take care, everyone. We'll see you

next week. 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.