Your Next Move - Going in the opposite direction of everyone else

Episode Date: November 18, 2025

In this episode, Inc. staff reporter Ben Sherry sits down with Ayeshia Quainoo-Tefera, the  founder and CEO of the Springfield, Virginia-based Ultimate Care, a home health agency. Ultimate Care is ranked No. 2,345 on the 2025 Inc. 5000 list. Ayeshia discusses how she navigated Covid, trying to minimize risk while maximizing impact for her clients, and how systemizing everything she does is critical. She also emphasizes developing an inclusive culture by showing employees that you care.

With the VentureX business card from Capital One, you earn unlimited double miles on every purchase. Plus, the VentureX business card has no preset spending limit, so your purchasing power can adapt to meet your business needs. Capital One, what's in your wallet? I'm Sarah Lynch, and you are listening to Your Next Move, audio edition, produced by Inc and Capital One Business. For this season, we gathered a bevy of conversations with entrepreneurs who made last year's Inc.5,000 list. They joined us in our Your Next Move booth at the Inc. 5,000 to share lessons learned and anecdotes from building their businesses. In this episode, Inc. Staff

reporter Ben Sherry spoke to Aisha Cue to Farah. She is the CEO and founder of the Virginia-based Ultimate Care, a home health agency. The company is ranked 207 on the 24 Inc.5 thousand list. Ben started the conversation by asking Ayesha about the company's clientele. So who are the main clients that are getting these services? Seniors, people disabilities. So we have a wide range. We start from pediatrics all the way to seniors, all the way to disabled clients. Yeah. And where do you operate? Is it national or in a specific location? Yes. We operate in the DMV area, which is Virginia, D.C. area. Yes. And when did you found the company. I founded a company March of 2017. And what were you doing before that? What was sort of your

career trajectory to starting your own business? I am a registered nurse. So I was working in the hospital. As my last, I was in the infusion center, the director of the infusion center. And so what was it that got you to start thinking about starting your own business and how did you get the original idea to go off and do this thing. I initially had no intention of starting a business. I was comfortable where I was. Being the youngest patient care director, I knew there was a lot more opportunity for me in the hospital field.

So I was comfortable, but I was noticing gaps in care where home health agencies when we try to reach them for clients, you can get hold of them. There is no very clear, concise way of communication. or providing the care that I expected from other home health agencies. So at a point on time, I'm a first learner. And like every five years I have to do something new in the healthcare industry. And I'm like, oh, how about home care community? Like bring my expertise from the hospital and the leadership expertise I've learned.

And my skill set as a nurse, I wanted to bring into the classroom. community. Yeah. And so what was that process like of getting started? Have you raised any funds? No. I pretty much did everything by myself. Oh, wow. And where are you at now? How many employees do you have? I have currently 103 employees. 103? Yes. Oh, wow. Congratulations. Thank you. And so what was the most surprising thing that you've learned about yourself and the business as you scaled over the last seven years, I guess? Yeah. It's been seven years. What I learned about myself is the deep, unlimited potential I had within me. Because as a nurse, you never get asked for it to a business, how to, you know, manage or run the business.

Even when you're in leadership, you know, it's limited. But when I started this, and pretty much from registration and everything, I started everything by myself. And learning through the process and to be resilient and persevere, no matter what challenges come, I learned through that. So I realized that I have a deep unlimited potential that I can always pull out. You have that drive. The tenacious drive to make sure that what I'm doing is successful. And so what have been some of those challenges that you faced along the way?

I imagine that the pandemic was probably really tough, right? You know, although the pandemic was tough, it was actually our time of scaling up. I can see that. While everybody was backing out, we were backing in, you know, stepping into the gaps, taking the clients that people were willing to take due to COVID. We went forth and we just tried forward and that actually exploded us. Yeah. Can you talk about having like the bravery to go in and go in the opposite direction of where

everybody else is going and what that took? So one of the principles in my life helped me a lot. Okay. Which is if I don't know. do it, who will do it. So as people were struggling, everybody was running away because of fear, which I understand, I sat back and said, okay, what can I do to minimize my risk, but at the same time impacts the life of those who need us now.

And that's what we did. I sat down, strategize, put all the resources that is in place education-wise to make sure that we minimize our risk. but then maximize helping the clients. What's your key for staying productive and keeping yourself at the level of productivity that you want to be at without burning yourself out or needing to, like, take breaks?

What's your way of, like, prioritizing yourself? Systemizing everything that I do. Systemizing. And structuring. Putting down the processes. I'm a very deep process, detourented person. I write everything down. and when I write it down, I teach, you know, and I guide.

So my SOPs are always written now, even up to where they go to the client's home. One of the benefit for us is our advantage is that I am a nurse. So mostly when we start, I'll go start the case. And then as an RN, outline how to really care for this client to maximize their recovery or sustain them. And so when I send nurses in, they have a very common. clear guidance how to provide the care. So you're really developing a care plan personally for a lot of your clients? In the VIEWR care plan, which is detailed.

So, yes. And that really helps a lot because everything that goes on, even when they don't know the client, they have a clear guidance, how to provide a consistent care to the clients. And how has it been finding people who are prepared to be doing this caregiving? I've talked to a lot of people, especially here at the conference, who've said that in the caregiving space, it's difficult to find people who are ready to put up with all of the challenges that come with, helping somebody that it needs care. So how have you found identifying talent and bringing them into your organization? I'm very good in retaining talents. And how I do that is that

first I put myself in their shoes and I try to anticipate what their needs will be and developing a culture that is inclusive and very respectful and they know that I am there for them as well as I'm there for the client so it's not a client or like clients first how do you like customize or is right

that's not the principle we run by we will hear both sides and then address it as needed and to be honest we don't do a lot of recruitment is our staff that actually refer their friends police to us so we don't put heavily in like doing maybe zip recorder or indeed or stuff like that

it is the word of mouth of our staff and mostly it's all it's not mostly it is because of the way we treat them and how they like to be treated and you know in the company so out of all the 103 staff that we have I can solely one person that I got through zip recorder wow and and And how's your turnover then? I imagine it's pretty low. It's very low. Our turnover is very low. In home health space, what happens is sometimes we lose a client

and then you have stuff that doesn't have work. But with us, it's very minimized. So our turnout rate is higher than the national level. When we come back, Ben asked Aisha about the biggest lesson from her career jump. But first, a quick break. Here's a tip for growing up. your business. Get the Venture X business card from Capital One and start earning unlimited double miles on every purchase. That's right, with unlimited double miles, the more your

business spends, the more miles you earn. Plus, the Venture X business card has no preset spending limit, so your purchasing power can adapt to meet your business needs. The VentureX business card also includes access to over a thousand airport lounges. Just imagine where the Venture X business card from Capital One can take your business. Capital One. What's in your wallet? Terms Conditions Apply. Find out more at Capital One.com slash VentureX business. What was the biggest lesson that you had to learn when you went from being a nurse and running this section of the hospital to running a business and putting all of that together? Or is there anything that you thought that you wouldn't need to know that you ended up having to do deep dives on? What were sort of the big blind spots that you had when you started that you kind of had to fill in over time?

Financials. financials. Knowing the numbers. Because in the hospital, what you do is you just provide care, they go home. You don't deal with no billing issues. You just do your part, provide a care document, and go home. And then there is a department that handles that. So I was very unfamiliar with that part. So I really had to dive deep to learn how to bill, how to manage the financials of the company, you know. So how did you do that? Learning.

I'm a self-learning. So I dive a lot into learning, reading books, webinars, listening to anybody that will talk about finances, how to know your statements, how to read them, what to do, you know, how to minimize your expenses. So I did learn a lot. I love attending conferences so I can learn from that, from experts. So that's what I did. and it really has brought me to this level. That's great, and I'm hoping that the Inc. 5,000 is a good example of that. Oh, yes. Oh, yes.

That's why I keep coming. The Inc. 5,000 is I love the way it's structured, right? You do have the learning part and you have the fun part, which every conference should be like that. What has sort of your approach been to getting the word out about your services? When you're thinking about marketing, do you use social media, do you use newsletters, TV? What's sort of the best way to reach, the demographics you're looking to reach? So starting this last quarter is when I've been trying to start being innovative in marketing. Previously, my strategy has always been the stakeholders.

So I recently noticed that I have a huge concentration risk because all my referrals are from stakeholders, right? Because I do establish that credible, repeatable service. So always, this person will tell this person about me, they will call me, I'll start it, you know. But I want to use more marketing strategies like TV, social media. So we started. We already started posting a lot on social media, telling about who we are. And we do have data to back our credibility. How did you go about developing a marketing plan as a business that had been mostly relying on more of

mouth and referrals up to that point. So recently is when I've been thinking about marketing outside the comfort zone that I know. But when I was in the hospital, I knew that it's always the stakeholders, the case managers. They are the ones, the referrals, they know. So I always want to partner with the hospital, partner with the doctor's office, partner with county. That has been my to go. But that has limitation, right?

So now you have to post out there in the social media. So one of the things is using AI in this field, yes. How are you using AI? Oh, I love AI. Really? Yes. Okay, okay. Tell me about it.

So using AI to do market analysis, right? I'll come to tell me the market analysis or competitive analysis within this region or where we serve. What AI are you using? I've used chat GPT and I've also used meta AI. Okay. Yeah. And we also use Gemini by Google. Okay.

And right now we are building, I think, synestia, we are using it to build into our processes to streamline and automate a lot of reminders for the staff. You know, so it's helping, like, questioning. So we build a button to our website where if you have questions, questions, you ask the board, and the boards will provide the answers. Has that been a popular feature, as you've seen it on your end with the website? Have people been responding to the chatbot? People are very slow in the space when it comes to use of such technology.

So the key is continuous education and helping them see how smoother it makes communication. So that's what we've been doing. So continuous education, because we just started. like last summer is when we started incorporating AI into our systems. Right, before you were just using it sort of for your own sort of research and information. My own research and information, and I realized that, oh, how can we implement this into our system to make it smarter? Mm-hmm, yeah.

And have you had to, like, bring in anybody, or has it just been, like, you experimenting around with your own AI and figuring out use cases? So I done some training on AI. Okay. And so I have a CTO currently. So I brought one of my staff had finished cybersecurity and stuff. I said, okay, well, so you are in that space of IT, can we give you another title and train you more to do this stuff? And so he's been the one helping.

So with the training, I've realized all the A.I's forms of AIs out there that we can use. And so we are individually testing them out. but we haven't brought an aspect. We have learned from ESPIC how to use it. So when you look to the future, what are you sort of hoping to accomplish with your company? Are you looking to continue growing? Are you looking to eventually sell?

Yeah. So my, I know, it's kind of like an exit strategy at the same time was, you know, currently. So in the phase that we are in, I say we are in the like young adult phase of our company. And my strategy about that is to scale up and make it become a home health system, which means have more services and have, like, all-inclusive service, whatever you need, we are providing that, right? Because home health is really range. You have home infusion.

You have just the personal care. You have the private duty nursing. You have the skilled nursing. Currently, we're doing almost all of it. So our focus is, okay, we're going to develop them separate. but under one umbrella. Our exit strategy is that I'm not willing to sell it, okay? And the reason why is that it's very dear to me

and at the same time, my employees are very important to me, right? So I want an exit strategy where I get the employees to go public with it and get the employees to become part-owners of it. I mean, I love SPACs. So, yeah. Or not, not, not, yeah. Not SPACs, exactly. SOPs, yeah, exactly.

Spacks are a totally different thing. Acronoms. But, you know, I love that, though. Have your employees expressed interest in potentially doing that someday? Only one person really expressed that interest a long time ago, but that person was a higher person. He's my CEO. But that time I wasn't ready.

And as I learned more, I said, okay, let me start thinking about my ESS strategy. And I want that to be an ESS strategy whereby, as we get to the prime, Right? You know, the 12 stages of, oh, I don't want to get to the prime and don't know what to do. So now I know that's my as a strategy. Maintain a percentage of ownership and have percentage goes towards the employees. That too will be invested. How do you create a such a great environment for your employees? Why do they love working for the company so much? Because I love people and I show them that I care.

And how do you do that? How do I do that? What's your love language? So I always tell people, I'm a very honest and straightforward person. My three afts of leadership is unfair, I'm flexible, and I'm firm, okay? So accountability, I'll hold you accountable. By the same time, I will show the care. I'm the type I'll reach out to you quick.

I connect with them. As a CEO and a founder, I have an open-door policy. I know almost everybody in the company and have a relationship with each and one of them. them. So that makes them feel valued. And that's the most important thing to me. I always talk about the money. It's about the people. I love that. And you're helping people every day, both in the company and your clients. So you must feel very satisfied and fulfilled. I am. I am fulfilled just to see the ability to be able to help clients, help and staff. I provide my staff with any resource to help them. be so sexful. All right. Well, I think that's about all the time we have. So Aisha, thank you

so much. I really appreciate you taking the time and chatting with me. Thank you very much for having me. That's all for this episode of Your Next Move. Our producers are Blake Odom and Avery Miles. Editing and Sound Design by Nick Torres. Executive producer is Josh Christensen. If you haven't already, subscribe to Your Next Move on Apple Podcasts, Spotify, or wherever you listen. Your Next Move is a production of of Inc and Capital One Business.