Season 1, Episode 1: Independent Home Care Alliance Industry Insights With Kunu Kaushal

The purpose of IHCA Industry Insights is to connect you with resources and strengthen the entire home care industry by specifically focusing on empowering independent non-franchise home care companies. 

In this episode, Kunu, shares about what's been recently happening in the industry and what is on the horizon. He'll touch on latest tech trends, resources, legal, human capital management.

Transcript

Sarah Barker  0:01  
Good afternoon, everyone. Thank you for being with us. My name is Sarah Barker and I'm the director of alliances for the independent Home Care Alliance. Today we have Kunu Kaushal, the founder of Ica with us and the purpose of today's AI HCA industry insights with canoe is to connect you to resources with the intent to strengthen the entire homecare industry, by our specific focus on empowering independent home care agencies across the United States. I've asked canoe to take some time today to share about what's been going on in the industry recently, and what he sees on the horizon. Thank you so much for taking time today. Canoe.

Kunu Kaushal  0:44  
Thanks, Sarah. I'm glad to be here with everybody. So I will tell you one thing that I've noticed right now, there's a lot of content and people are zoomed out, and they just kind of want to get to the meat of conversation. So I will not beat around the bush too long. And just let's get into real information. And one of the hopes that I think I have for for bringing and digesting a lot of information around the industry together is this simply, although it's always been a pleasure to be engaged, it's a lot of information. And I think one of the things I'm noticing is a lot of agency owners operators, we're all right. Short on time, we're all certainly battling one issue to the other. I think everything from personnel issues, not just caregivers, but within the office changing requirements. As many of us know, the mini fire drills, I call it the federal fire drill between OSHA and an ETS and you know, life could be totally different this week, and not next week. So and how we manage our companies. But one thing that we want to do is just really be a source of being able to give you a condensed version of at least what we're hearing recently give you a pretty brief version of that in the sense of keep it under 30 minutes. 45 minutes. So

Sarah Barker  2:02  
we already have one question. So

Kunu Kaushal  2:05  
okay, all right, good. Well, let me get through a couple of top items. And then as people have questions, please do keep writing them in the chat box, I will leave plenty of time for for a question answer section, I hope to be able to get to some of the items that you're talking about. Alright, let's start really with COVID, we were very much in the thick of things. And everyone's excited about this being behind us. I'll give you on a broader scale, I'll try not to be too much of a commentator, but more of strategically, as we're looking forward some of the issues that maybe you're not hearing or reading in articles. One is one thing that's been true, I don't think of it's going away in the sense of like, it's going to be totally gone, where everyone hopes that becomes endemic, you know, much like the flu or something else where it can be manageable. So that would be a blessing. One of the other things that's become very relatable from a data science perspective is they're seeing kind of how the waves go. In the last few waves, it's been very obvious, you know, the large populated city centers, you kind of know, the the typical offenders on those, the wave starts there really starts to peak there. And then you've got kind of middle America, some of the second third rate cities from a size and population, it tends to lag a bit. Why is that important? Well, for organizations, I would say specifically, the independent home care lines, but health care, think you'll see CMS, you know, the hospital systems, large national players, I can tell you home health and hospice agencies right now are very focused on this type of thing, where they're able to then start making plans they want. Now the thing when you're a national provider, and you have for example, staffing contracts, you can do things right. So if you're a hospital system, and you know that your Northeast is being impacted pretty highly. You can do things like shift your staffing, contracts, traveling nurses, and so on. I realized that homecare isn't quite of that. We all wish we could ship in some home care workers at times, or clone them. i We won't have that kind of luxury. But I do think the level which your response as an agency is, is going to be something that becomes much more nimble. So thinking through protocols, you know, what happens is you start to see these inflection points coming up. So some examples of that is, you know how to deploy PPE when to get more PPE what what kind of supplies do we need in hand, I would tell you that one of the trends I'm seeing is to get communication plans together. As time goes forward. Let me give you an example. So those agencies that are more healthcare minded, you probably have an annual model in which you start to talk about the flu, right, usually in third, fourth quarter of the year, and you start to maybe recommend people get flu shots and so on. I think you're gonna start seeing this at very odd times. Like there's a wave coming. We know maybe for a certain area or region, your third He's 60 days out from it really hitting very hard. And so priming workforce priming your client base priming for short staffing, and all of that becomes a bit more likely. So certainly a trend on that side, I would tell you, that's a horizon piece. I'm not sure that you know, there's anything hard and set rules around this, but it's really as your business, what lessons are you learning throughout this, I would tell you, the worst thing that can happen right now is be like, Oh, we survived that last wave. But in the mix, you know, Where were your risk points, people calling out people not being able to do staffing, not being able to do you know, weekend on call, those all become real operational challenges.

In relation to COVID, and other areas around the the testing the COVID, testing the access to it. So listen, this is something that you know, isn't really, I would say, a political or argumentative scientific issue. You can take whatever stance you want to vaccinations or, you know, having immunity because you've had COVID. But the fact going forward is, I think testing certainly is a bigger piece of it. One thing that I'm telling you from a resource side as a trend, right now, while we are under a public health emergency, so as long as that period of time is still there, like many of you know that you shouldn't have to pay for a COVID test. It should be something that is just completely provided to you now there are people buying COVID tests voluntarily, they're going out. So one thing that we're starting to see is some health institutions starting to really get under their belt, how to do mobile testing, how to do by mail testing, you know, I think you've seen that during travel, you've had to pay privately, but really, health organizations that understand how to bill it. So for example, if you were to go to your primary health provider, if they had COVID tests, you would should not be charged for those at all. So one of the things to really think through is what kind of relationships, maybe with vendors or providers out there are possible in which you can have your team, your caregivers, or others have rapid testing available to them and available other than the things that the state or city is putting together as large testing centers. I realize this kind of starts to tiptoe into what OSHA was wanting, you know, CMS is requiring from a testing side, just know, as long as we're in a public health emergency, if this is an area where COVID has really been a major issue, you've had caregiver sitting out, but you're trying to do your best with COVID protocols. Finding testing partners is going to be a big issue for you, I can tell you, I do know, the independent Home Care Alliance is actively negotiating and working with different COVID testing resources and also partners around the mix where we're trying to solidify some of those relationships where we can get access and things figured out for you. But the biggest thing is really protocols. I mean, things have been all over the place. I don't want this to turn into a COVID update call. But the protocols needing to be updated as quickly as there are so I won't go into what the protocols are or you know, suggested protocols. The point being or the bigger point is, how are you training on them. I mean, I will tell you, I think having a learning management system, or a strong HRIS system in which you can launch out policies or updates to your workforce, and then having it documented that someone received that training or checked off on they understand the new way that the company is going to operate, is going to be more and more necessary. So for those of you that are maybe texting or emailing out information and counting that done, that's fine, I think as an early step, but you may want to think through documentation. The biggest reason some protocols are there, you know, it's kind of a double edged sword. Protocols help protect you because you as a business have tried to do the right thing. When you violate your own protocol, it creates liability. So that's one of those things is if you're going to do it, and you are going to adopt that protocol, whether it's required by the state or not, or you're going to go a step above. I think accountability to yourself on that protocol is really important. So it you know, this, hopefully is not all new information. But now we're seeing trends, right. So from a future looking perspective, I think you're seeing software programs, scheduling programs, you know, HRIS, the payroll system stuff, learning management systems, they're really seeing where infection control, infection control tracking COVID Something is going to become more and more commonplace. Whether it's COVID or not. I was lucky enough to be part of a larger conversation with a public health official And one of the things that they brought up in that conversation was, you know, all the COVID may come or go. One thing that's been very much shed light is that what we think as an industry, as a healthcare industry that we understand about infection control? We we were just completely, you know, underprepared. And if even if it's not a large,

you know, pandemic style event, but there's a lot of now question about there are a lot of homecare agencies, personal care agencies in our category, that, you know, they maybe were maybe doing TB tracking, maybe they were doing some flu vaccination tracking if they needed to, but there wasn't a lot of focus of that. So translate that down, I think the pressure as the industry goes forward is going to be for a much more complex and sophisticated human resources department, personnel management type of thing. And that you're going to see that the much more mainstream have a requirement. And I would also say is you're thinking about contracts with, let's say, payers, managed care, you know, everybody's excited about managed care as the years go on. Medicaid department's Long Term Care, VA, all of these payers, it is not unlikely that they push down some infection control rules, not as a mandate, but as a condition of participation. So if they're going to pay you for these services, they want it done in a certain way. And my suspicion is that it'll be driven by the most strict model. So because they have some care in some part of the nation in which they have that standard, they're going to want that standard everywhere for their own sake. Private pay when it comes to this, I think many of you are already experiencing it. Right? One of the challenges, I can't tell you, I haven't the answer for by any means. But a trend is certainly going to be there is that your agency may be friendly to the worker around vaccination, which is good. You may be trying to work within the sandbox per se and say we're going to be testing or do you know all these things, we're going to consider infection control. But if the client is asking for a vaccinated worker, even though they've tested even though they've done all the thing, maybe they were, they've come out of COVID, they have antibodies, this is going to become a much more complex discussion. It already is now. So I understand I know that it is now this is not, you know, earth shattering breaking news. The real question is as a trend going forward, I think at least for the next year, you're going to see this be a hot topic of an operational challenge that companies are going to have to get around. You know, our recommendation, as usual, is work with an employment law attorney. You know, the independent homecare Alliance has got some great partnerships with the nation's probably best in class employment law attorney group, you know, have protocols, the independent Airlines has helped promote a lot of those and build them. And then also, you know, through technology and kind of your own internal beefing up your HR department. Those are all things to be looking at around this topic. I just want to be really clear, because it sounds like this is not a vendor pitch. I'm telling you that I think the needs of how homecare is run in the future. We all know we need recruiters because we're feeling that pain. We all know we need schedulers because you have to be able to put that together. I think we all kind of agree we need to have billers and maybe payroll manager. It's not been very common to have sophisticated and dynamic HR professionals within our businesses as a leading foot. So sometimes what I call it is like, well, we have somebody who kind of does some recruitment candidates and payroll and every now and again, they'll kind of do some HR. I think the kind of the need for human resources, human capital management is a growing and much more necessary area. And it's good to right, it's professionalizing our industry. So let's talk about recruitment, hiring a little bit and trends that are going there. I will tell you, I think although a lot of people have had many different experiences over the last two years, and within the last year, there is definitely been a push towards private pay as a service line that I'm going to stick with how it relates to hiring for a moment. The demand of the workforce as far as what they desire for pay is something that is easier met when your pay or is private pay in the sense that you can wake up tomorrow and decide, hey, my bill rate is going to be 50% more. And, you know, that's kind of what you need for your business to continue to go forward. The greater cause conversation around that is number one. One challenge which I often find it And I'm seeing this being talked about through economists. It's also being taught through from a Department of Labor kind of conversation. I think you'll be surprised we're all doing survival tactics, right things that wouldn't normally make sense. And when I say normal, you know, who knows what the new normal is, but things we wouldn't have done maybe over a period of 10 or 15 years, we would have gotten there. From a conversation point, I would ask you this, think about the future in about a year. So let's say magic lawn right, Labor's getting better. workforce challenges are not as bad, I think we'll still be pressed because we'll always be in a bit of a shortage, but it won't be a crisis. And if a competitive agency near you is able to hire someone new as a new employee, at a slightly lower rate of pay, and also adjust their bill rate, so they're a bit more dynamic, or let's say price competitive to you. And yet, you've got a work force, that is good, which is great. But you've now set a new normal for your business in which you're paying caregivers, you know, X amount of money, let's call it $17 an hour, and somebody else is willing to go work for agency B for $13 An hour and the price sensitivity there. Today, I think we would argue, well, let's talk about the business and what we're providing, what our value proposition is, maybe the benefits. So I'm not arguing that. I think one of the trends or caution areas to think about is, it is always easy to give a employee or a caregiver more money, it is nearly impossible to reduce their pay. And the only way you're gonna get to a point of reduction and pay for someone is typically through turnover. And so, you know, I think our industry overall has really, pre COVID used to use the turnover rate as a big.

Let's say that, you know, if you had a great turnover rate, you were you would tell everybody, if you had a bad one, you'd make a lot of excuses. So I think we're gonna see over the next year. And maybe sooner than that turnover in our industry gets much worse. It's not just people leaving the workforce, it's that the business is trying to adjust and trying to stay competitive. Listen, I'm with all of you in the sense of I hope we can continue to charge 3040, you know, whatever, $50 for home care services. But I think the reality is this is kind of making sense in the crisis time when you go from crisis to just challenge maybe downgrade that, you know, how quickly are we going to adjust? I don't know. And that's one of those situations where we have a lot of questions about it, around curiosity of how we're going to tackle those. So hopefully through the course of this year, we'll continue to gauge and hear from all of you through the independent Home Care Alliance, and really get a sense of how you're dealing with those challenges locally, and maybe what some national trends are. One thing is for sure, if right now you've got staff, which is great, a lot of conversation around utilization, making sure that they're not tempted to other organizations. So this kind of leads into this next area of conversation, which is about the value of employment. I think we do we talk a lot about caregivers and a lot about office staff. So let me just kind of break the two conversation points. Talk about caregivers for a minute. I think one of the things that we're hearing a lot about is, you know, there's rate of pay, I think that's more important than ever. Anybody who tells you that it's not is

I think they're slick, but they're using old information. It is absolutely that rate of pay if you have to do what you have to for your family. And I think today right now, especially if you think about your workforce and the challenges that they have, in general, they are going to go to the highest bidder, if they can get that job and they feel like they can go there. That doesn't mean they don't care about you. That doesn't mean they don't care about their client, it doesn't mean that they're not passionate about the industry. But like many of us, I'm sure we've had many different walks in our careers. And one of the things that maybe made a shift one way or the other was pay, I mean, you know, it's enticing to say okay, I can earn some more. Now, there's the other side, though of there are caregivers, we're also trying to entice right to come into home care. So we can't forget there's other people who were maybe doing housekeeping for Hilton, and they don't like that job, but they want to do something more with people and more with engagement for folks. And maybe homecare is the right thing for them just as an example. So they're making a change to this industry. One of the kind of trends that we're finding is if you're trying to attract caregivers, and you can't you can do something about pay but not always a whole lot. One point to take Keep in mind is what is the total benefit package of employment with your organization? And this is a dicey area, I will save you a whole lot of conversation and tell you the answer is see all of the above, right? Because if you think it's 401k packages, and that'll be the silver bullet, you're wrong, if you think it's PTO policies, and that'll fix it all that's wrong. The reality though is it's about the individual, the individual, it has to fit into what they desire, what they're looking for. Having flexible benefit type of pools in which you can offer as many things as possible, and let people select the thing that they want, that is helpful. Once again, we're going back to human capital management, HR type of approach, what kinds of things could we have? One of the very simple things is an area like the employee assistance programs, right EAP s, as many of you have heard them. So one of the things that we recognize is really from our base, our membership base, a lot of them were saying, I can't always do something in pay, but let's talk about benefits for our caregivers. And I'll go on the softer end of things. One side is we're in a business and when we're asking someone to deal with individuals, you know, the PC way of saying it is like end of life, in the golden years, and so on. But the reality is, is a really tough time in their lives, there's depression, there's watching someone decline, there's, you know, seeing the family turmoil for them, many times they become the son or daughter that they never had, and helping them in a way that they can't. There's complex dynamics in the home. And then on top of that, our caregivers have their own lives that they're combating with. So one of the things that we did as the independent Home Care Alliance is really recognizing that need and I think Sarah, and her team have done a great job of vetting out organizations that can really answer that needs. So it will tell you, we been very proud to hear about the announcement of the independent homecare Alliance having the industry's first purpose built EAP in which we as a Alliance are really perceived as a 10 or 20,000, employee group. And we're getting pricing like that. So when I don't know the details, I'm sure Sarah and her team would be happy to kind of get into that stuff. But the point is, when you think about invest, if you're going to give a caregiver $1 More an hour, the real question is, what would you do for a guy shirt? Let me do the math, less than five cents an hour, right? Of like, what benefit? Could you provide them that they really need? And you can go Google EAP programs is like what are they but the short and tall of it is let me give you a real situation caregiver has been with Mrs. Smith for the last nine months, and has seen this person decline be very challenged. And Mrs. Smith, you know, goes to the hospital never comes home. And we as a business, you know, call Julie, the caregiver and are like, Hey, can you take the next shift? Because we have an open shift, the the processing of grief, the processing of a relationship, the processing of did I do enough for this person, there's a lot happening there. And a good EAP program is going to provide things like counseling and ours, you know, the one that we have been able to promote does do that. And not all EAP programs are equal. And I will tell you for what we've done, we've given a really strong, let's say, a Cadillac style program at the cost of, you know, a bicycle. And I think our number one goal was make it accessible. There's really no reason as an industry, if we're not taking care of our caregivers. That's a problem. But here's the number one issue. Most of us don't go the extra mile. Because you yourself need an EAP right. I mean, like we're all also dealing with our own challenges. So sometimes the best thing to do is make care and programs accessible to them for the same reason. That right like you don't want me doing your dental work, you would create a benefit program, get them with a dental program in which that would happen and then all of a sudden you're providing vision, dental, health and so on for people. So I will say I think a trend will be the value of employment how a company views its workforce in general. Most of us I think are tired

you know, I'll be the first honest one to say that it feels like a boxing match most days. I'll say this is just kind of tongue in cheek but slightly seriously. You know, I spent half the day getting punched in the face and the other half anticipating getting punched in the face. So I think just generally these are these are tough times times but these are also the times in which people can step up. And I think this is a survivors you know, industry right now, if you can be dynamic, if you can stay in the fight, you will be here and you will continue to thrive. The only you know more to caution is if you go way overboard, if you become the most expensive homecare agency in the market, just know that your client, although could love you could become an affordability issue, right? You could be the highest paying employer in the in the market to a caregiver. And at some point you forget to wrap your arms around the employer or make I'm sorry, the employee, make them feel loved and a part of the work family. And then they may also feel that level of detachment. And then at that point, you know, you're no better than maybe Amazon that puts you on a workshop floor and doesn't really care about you. So we hear about those stories as well. So in very much in your mind, thinking about the kind of company you want to be. And that applies to caregivers, and office staff. I think right now with your non caregiver payroll type folks, your office people, schedulers, and so on. The number one trend we're seeing is one between I think we know the old story, right, you got schedulers that are bouncing a kid that's got virtual school or somebody in their family right now probably has COVID. And so now they're quarantined at home, the need to balance all of that. I think the hidden risk, which isn't so hidden, but as soon as you started, go looking for it, you'll find it has been the kind of the three o'clock slide, which is it's three o'clock I'm spent, I'm not doing any more for today. And it's like we had a call out just considered a miss visit. And, and I'm not saying that's a fireable offense. So don't hear me say that my point is, those are signs of you know, burn out micro burn out a little bit of needing support. Certainly the trend right now is energizing teams, finding ways to bring the why and the purpose back into the mix. You know, thinking about things like having them appreciate clients, I think operating in a form of gratitude, you could be having the worst day possible, I will tell you, you tell a scheduler instead of fussing at caregivers to take a shift and put them in a mode in which they call clients. And just thank them for continuing to be a client and for hanging in there. What typically happens if you tell a client thank you so much, Mr. Smith, for sticking with us. I know staffing has been a bit rocky, but it really appreciate your patience with us. Not only is that just good customer service, I think Mrs. Smith is going to say back to the scheduler. Julie, I'm so glad you you know like I know you're watching out for my best interest. Listen, I know staffing is crazy, I can't even imagine what you guys are doing. I mean, you have to open that line of communication, otherwise, we're going to be living in kind of a bit of a vacuum. Although I I think the third party satisfaction, services are really good, which they are. I think they're good benchmarks don't abdicate that responsibility of communication, in relationship and that type of deal. So make sure that you're in there for that. We're getting close to my just couple more points. I'm trying to be brief and kind of into the topics as much as I can remember, if you've got questions or thoughts, keep putting them in the chat. And we'll get to those in just a moment. So the last two big points are one is around in a specifically revenue and growth. And one of the

it's not about growing your company. I think it's more about what business do you want to be in? And what I specifically mean by that is you're in a situation right now, where not all business is good business. I think we've discovered that through COVID, right, like short shifts are not ideal. And maybe they are depends on your business, facility staffing, maybe it's not the most exciting. Or maybe it is you've got to really define a bit more in an analogy that's probably overused or example and expression that sometimes that is, you know, to a hammer, everything looks like a nail. And I think we've all been guilty of that at some point where you want to say yes to every opportunity possible. I think when you've got a workforce shortage, you know this right, and you're living it so I'm not telling you anything new. When you gotta work for shortage, you have to prioritize and also learn how to decide which business are you going to go after because it's more meaningful to your ultimate mission right or your ultimate needs as a business. My point to you right now is little I think the companies that are doing it well and doing it in strength are taking their minimums weekly and per shift minimums very seriously. They're looking at the business in which they are just not successful. It's not about low hanging fruit. So please don't hear that. I think what I'm talking about are the clients that are, for example, never going to be happy. So you're doing facility staffing at a assisted living, or, you know, whatever. And they call you last minute on a Friday to do an overnight shift, and you're not staffing it and they're just blessing at your team and causing a budget stress. I think these are times where you really have to think like, Should we be in the staffing business? Is it the best like for effort ROI? I use that as a just a one example. Because I'm also hearing of businesses, they have a hard time just pulling out of certain, you know, contracts or agreements. And I think this is the time more than any other where you have to think about

this is a very graphic way of looking at it. But like in healthcare, you know, you have to learn cutting off the toe in order to save the body is maybe the right move. Now, that's not exciting. It's not fun, it's hard, it's painful. But you also have to think about the greater good for your organization. So when you're thinking about revenue and growth, don't just think more, I think, think about more of what specifically. And I have to tell you, if you're not doing a good job, staffing nights and weekends, you just need to tell clients, you know, we can't do nights and weekends, or I'm going to have to charge you so much more, in order to make up for the enticement or the incentive to get a caregiver to comment nights and weekends. That, you know, like are going rates $30 An hour and nights and weekends. It's 45. Now is that, do you feel good about it? No. But the reality is, you're going to take that entire differential. And that's the kind of effort and time and incentive and bonus you're going to try to give in order to try to get staffed. So I'll give you kind of a parallel, kind of like the interest of the restaurant industry. You've got with a shortage. And with all the challenges that are in the mix, right? There are some restaurants that for example, we're not opening for dinner, and they're like, Hey, we do enough lunchtime business and like the people who are going to come out they that's what we can do but to staff dinner and not know if we're going to have enough work or whatever. So it's trust me, they're not excited about it when things come back to normal that we certainly would. So revenue and growth think a little more strategically. And And also be careful what you're setting yourself up for, of just taking every opportunity that comes in. And I promise you there's a facility out there right now, I know at least a few of you have experienced this because I've heard from you. There's a few of you or facility has called in and said you can be our exclusive stamp contract, right? And you get excited you're like yes, and you're not realizing the real burden that it brings. And then the last point, which is always brought up in some format, one way or the other is around consolidation, valuation of companies and so on. I will tell you, we are big promoters. From a kind of the independent homecare Alliance perspective, we want companies to be strong and successful, regardless of what your goal is with it. So I don't think it makes sense to run your business as if though you are trying to run it into the ground. I don't think anybody would advocate for that. But consolidations and valuations, I think right now we are seeing lots of activity, which is good. I think there's opportunity out there for most of it. Most of the exits are definitely just burnout. I mean, it's just people that are like they're done with what's happening. One of the things that I'm very proud of is with the independent homecare Alliance, we're finding ways to essentially support agencies to avoid some of that burnout at different levels, right, like if you want some energy around marketing and growth, or you want some energy around best practices, and really just working on your business and more of a kind of roundtable type model, or even at a at a higher level of finding a partner who can really, you know, take off a lot of burdens for the back office operations for you. We were I think as the Alliance we want to be resources to help you find that. What does no one any good is agencies just shutting down because we people need your care. There are certainly communities that that really depend on the senior care providers in the marketplace. I think there are caregivers, although many of them, not all of them are appreciating our opportunities today, but they will need our form of health care to be employed by so I would tell you stay in there stay in the fight. But consolidations and valuations are certainly out there. I would only caution one thing, I think there are a lot of opportunist type of investments money out there, and I'm not going to call it Smart Money or dumb money, if you're going to make any move, if you're going to evaluate your company or anything else, I would tell you that you're probably better off making sure that you have worked on your business very intentionally for a period of time. And I'm not saying wait for things to get better, right? I mean, I'm not saying like until you're five times of size, don't hear that, what I am saying is, you need to find this push of making sure like, if someone else came in, and I was trying to sell it kind of like selling your house, right, you're not going to sell your house without staging it, without making sure minor repairs were done without making sure it was in the best shape possible. That work in itself is something that is going to take, in my opinion, not a consultant, you really need. A consultant can tell you kind of what to do. But most of us need help actually getting it done. And I know for a fact the independent Home Care Alliance in some way, fashion or form, can support you and assist you, whether it is ultimately just growing valuation of your business getting stronger, getting better, and what you choose to do with that, after the fact is totally up to you. That's the beauty of being an independent, you can do whatever you want, grow it, sell it, consolidate it, you know, pass it on to someone in the company, seller, finance, SBA, finance, I mean, the world is your oyster in that way. And but you can only, you know, make that decision one time. So up to that point, make sure that you're running your business with with kind of an end in in mind that you want, that's going to be the best for you.

That's that's the end of the rundown. I hope I you know, actually didn't feel like a southerner. For one that talks pretty fast.

Sarah Barker  36:49  
So you were you were perfect canoe. super valuable information. I especially enjoyed that last part. And I'm not sure if this is an accurate analogy. But as I've been talking to owners across the United States, people are fatigued, and they're burnt out. And you know, what I'm hearing is there's just this overwhelming desire for for relief. And so some of them are feeling like selling is the only option. And so, you know, I'm happy that us here at the independent homecare alliance can say wait, there are, there is another option, you don't need to essentially like short, sell your home care agency and get you know, get pennies on the dollar of what you actually want to get like, let's understand your goals. And let's figure out where you fit in the Alliance. So that way we can empower you to reach those goals. So you can either start to enjoy your business again, or let's help you work towards you know, increasing your your multiple to sell for what you want to so I like that part. So we do have some questions. We have an lease gear or gear. So I'm, I apologize. And Lisa, if I pronounced your wrong incorrectly. So her question is, what's the impact of the great resignation on home health staff?

Kunu Kaushal  38:01  
Now, great question. And it's always good to hear from you and see you. She is a professional, for sure in the industry. You know, I would tell you, the greatest impact of the resignation is we're got people that are turning over. I mean, you've got office staff that are moving on, they're looking at options. I'll take zoom out for just a little bit of not just home health staff. I mean, you know, you've seen the nurses, the therapists in the skilled side, I would say in the personal care divisions, we have less of these certified type folks, and you have more individuals that are your schedulers, your, you know, office managers, your salesperson, something to that extent. So these these titles are maybe roles in which experience is the greatest value. It's not necessarily the skilled certification, like a nurse LPN, RN, so on. So one of the I think challenges of having experienced people evaluate other opportunities is that number one, their greatest strength is going to be the impact that they can provide a home care organization, because that's where their experiences I mean, it's where their greatest ROI is. I think the second part to that is to say, there are a lot of folks, I'm gonna say this as a homecare owner and operator of saying, I think there's a lot of folks getting jobs that they're not probably the best fit for, right like somebody else's scarcity right now is an artificial level of getting into a position. Let me tell you what I mean by that. So you have an organization, I'm going to take stuff that's completely out of our industry, so nobody's feelings get hurt. So you have an organization in which they're looking for a very high level architect or engineer, and you've got someone who's kind of early, they don't have a ton of experience. They've done a little bit of it or they're interested in the thing, and an organization out of desperation. hires a lower qualified or generally someone they would not have felt was qualified enough into the position. The number one challenge most organizations have is they're not good teachers, you know, companies that have big checks, let's just say big wallets, they tend to not have the time to spend individual because their organizations are so large. So that engineer, architect type person who's fairly much a novice right now is going to get put through their paces. The dangerous part is in about two to three months, or when you know, the shift, and the churn goes the other way. That company is likely not blind. And so they're going to continue trying to hire. And at that point, I think for some organizations, you know, loyalty is as good as their options. And just generally, I think we're seeing churn in our companies in home care in general, I think the office staff has seen some churn. However, here is the silver lining in some of that stuff. And I'm going to put on my operations hat for a minute. I think things are getting more efficient, too. I think we're also starting to see, it's been a while since we looked at a different way of doing this, you know, I'll be, I'll do a shameless plug of saying, you know, business practice outsourcing, like, do we really need a payroll manager in just our company, and yet, with some of the outsourcing work that we do under our management, solutions, weighing, you know, we can help support that and much, much more. So all of a sudden, now you've got a business that used to think they needed six FTEs, maybe really only needs four. And those four people are excellent, and maybe they can do better with pay and benefits and things for their for FTEs. I mean, there are different different ways to attack this. I think you're seeing the same thing. I wouldn't go as far as saying automation. But I would just say efficiency is certainly been a better, better focus around this. So I think there's good impacts and negative impacts of the great resignations, we're seeing

Sarah Barker  42:11  
great answer canoes. So let's move on to the next question. Thank you Annalise. Okay.

Is paying more than other options, the best way to attract caregivers, what works? So I take that is paying more than the other agencies in your market the best way?

Kunu Kaushal  42:34  
Yeah, that was a good question in the sense of it sounds simple. And yet, it's probably one of the things that keeps me up at night. You know, here's what people will say generally is like, people will come aboard to an organization for pay. And then they will leave based on their experience or, you know, their manager, or what the culture of the company and so on. I have a slightly different I think that's true. I think there's a deeper aspect to that, which is you kind of have to ebb and flow with the workforce, meaning you got to figure out what is it that they're trying to get and have a relationship with? This sounds terrible. I think your job ad, your job posting cannot be your interview. That's probably one of the biggest mistakes. I'm feeling right now in the industry, in general, people are putting up job ads, you might say what the pay is right? Put a range, it doesn't really matter. You're trying to say but right now, people are like through platforms, like indeed, they're just click 40 jobs apply to all rapid apply, or whatever indeed does to make sure that they you know, get the the best hit rate or whatever. So I think what's happening is people are applying to jobs, they're not even really reading some job ads. I don't think that's always the case. But that is a trend. So I would tell you, when you're engaging with an applicant, your question is what works, I would say ask the individual, what are you looking for? Why are you looking for a different job? What are you looking for in an employer? I mean, I think we got to stop telling people and maybe start asking some stuff. So if a caregiver or excuse me, an applicant says, I am looking for flexibility. And one of my greatest challenges is like I can't do an eight to five office job because you know, I have stuff in my life, whatever that is. I think you need to have somebody very cleanly. Be able to tell them how your company views flexibility, whatever that is, I mean, your companies, your company. I have thoughts, I think I know we have some best practices, but you have to decide on that. Give me another example. Some applicants sitting in front of you and says Pay is really important to me. I've been a caregiver for the last 20 years. And I've you know, done this and I've never made over blank You need to answer that. Because if they if that's a rate that you can meet or hit or do something good, do you have a career development thing? Could this person be a recruiter in your business with 20 years of experience? Could this person be a mentor in your organization? Could this person be, you know, like a five star, you know, whatever, some ranking in your organization where you go, I'm gonna put you with our top echelon clients, because they want people with real experience, and they're willing to pay a premium. I think those are the kinds of things where you've got to think a bit more dynamically. And when your question is what works, I would say, this is a jerk comment, but you'll understand what I mean by this, everything works, and nothing works. I mean, you know, like, it all depends on situation, I can tell you one is not going to apply to all. And the person you've got to figure out is on an individual basis. And let me tell you, that doesn't feel good to somebody who wants to apply a template to everything. That's going to be a you need to sit with this person and actually have that conversation with them and say, What are you looking for an employee, there's a reason they apply. Alright, they didn't do it for fun. And as much as we think that was to collect unemployment for the state, maybe it was but you know, get past that step. What about all the others that applied? And if you were doing your part, you need to ask them? What's it going to take to get you to work here? What do you look for to be stable? I'll tell you a powerful question asked people doesn't matter what role, caregiver office staff, whatever, what could we do as an employer that would turn you off and you'd want to quit? And then you got to be quiet and listen, they'll tell you, if they're, if they're honest and open enough, they're gonna tell you. If they're like, if you're unethical, I'm out. If you mess with my pay, I'm out. If you you know, don't trust me to do my job. I'm out. If you micromanage me, I'm out. If you expect me to do a bunch of like, apps and stuff to clock in and out, I'm out. Well, welcome to modern homecare, right? It's like, well, so you've got to figure out here, the red flags and I think have that communication and people will talk to you and tell you, it's what you put into it.

Sarah Barker  47:15  
Thank you. So we are getting close to the end canoe. So should we wrap it up? Sure. Yeah. Okay, well, thank you for providing the homecare industry updates on behalf of the independent Home Care Alliance and sharing everything that you have a pulse on as you go out to the industry conferences. And as you talk to other industry leaders, I'm certain that the independent home care community really appreciate your insights. So just a couple of updates. As far as the growth of iasca, we have launched our mastermind meetings for the performance level membership, and that mastermind meeting is on February 1. If you're interested in participating in that, feel free to go ahead and to our website, and you can sign up for that level of membership. We're also launching the power partner level mastermind groups. And these are 90 minute meetings once a month where we will bring in guest speakers but dive deep into education. So that way, we are essentially hand holding the agency owner, but not just the owner, the director level people in the agency, right so that way, we're empowering and elevating every person in the agency to drive towards that growth goal. We also we have done the HCA executive workshops which are weary and each time they were growing in numbers and the feedback that we've been receiving was very positive, the demand is increasing. So we are doing one on March fourth. So as a recap, the upcoming mastermind meetings for power partner, January 26, which is today and then for the performance level is February 1. And then our upcoming ICA executive workshop, we have a special promotion today. So anybody listening into this who is interested in participating in that guided audit process, if you are an independent non franchise Home Care Organization percent off today by using the coupon code Industry Insights canoe. If you have any questions about that, please feel free to reach out to me happy to answer the questions. And last but not least, if you are interested in learning more about membership with the independent Home Care Alliance, as you can see right there that is the link to our membership page. You can go ahead and view those options or at Barker at ING aca.org I'd love to schedule a meeting with you figure out what your goals are and discuss them How are we can work with you to help you? Thank you for tuning in today. We really appreciate you those of you that are already members and if you're not a member yet