Season 1, Episode 2: 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  0:02  
Good afternoon everyone. Sarah Barker with the independent homecare Alliance and today is the IH ca Industry Insights update with canoe the founder of HCA and the founder of Senior Solutions home care. Canoe. Thank you for being with us again today.

Kunu Kaushal  0:17  
Yeah, thanks for having me.

Sarah Barker  0:19  
So before we move into hearing the updates from canoe we would like to share so I HCA is a membership based organization solely for independent, non franchised home care companies across the United States. We are building a collaborative community between the independent owners and their operators, administrative staff, and even providing the support for not just the owner, but the entire organization. So that way we can empower and elevate them in their growth. We want to make sure that we're always sharing best practices and providing guidance on how to increase efficiencies in the agency. So that way, they can scale to the point that they want to be. And part of doing that is to look to our founder canoe for the insights that he's seeing the trends that he's seeing in our industry to sort of guide our direction, a couple of updates. Administratively, we have our upcoming ice executive workshop in Nashville, Tennessee, on March 4, beginning with a dinner on March 3, we are excited to announce that we have reached capacity. This is an exclusive, intimate setting where we have educators coming in to speak on various topics. It's not your typical conference, it is a workshop, just like the word implies where owners will be learning from industry leaders, and taking action on their agencies in the moment, and then going back to where of their operating territory is. And we'll be partnering with them to help them implement those aha moments that they have during the workshop. Can you let's go ahead and move forward with hearing about the trends that you're currently seeing in the home care industry.

Kunu Kaushal  2:02  
Thank you appreciate it. You know, just as a promise to all of you the thought processes, there's a lot of webinars that happen. There's a lot of content that's delivered, which we're so thankful for in the industry. One of my purposes is really to digest a lot of that information and give you a little bit of kind of a bit beyond that right and actionable of what can you do? And what are some trends that we're seeing, very thankful for our involvement and partners with so many people around the country, everything from scheduling software's to state associations, national associations, other groups just in general, and the many vendor relationships that we've got with HCA, it's been very impressive with how much I feel like the industry is trying to support itself, which is I think, a Trend number one would be there's a lot of interest right now, making sure that those of us that are continue to be in the industry are doing that from a position of strength. You know, let's be honest, there's a lot that's working against us right now. I mean, we're still dealing in many areas with confusion, just around everything from COVID protocols to kind of standards of practice for agencies. I know there's people that are kind of dealing with this idea of do I have to go in person to add met a client? Can I do it fully, virtually, is there an opportunity for, you know, partnerships with home health, still, considering that they've been so locked down? You know, hospitals and nursing homes seem to be still under quite a bit of lockdown. And so marketing in the community has been tough. So just generally, I mean, as a trend, I can tell you, you're not alone. If you're seeing hardships, you're certainly not doing anything wrong. You're not the only agency that's, you know, struggling through a lot of the challenges today. So there's a bit of solace. The other trend that we're noticing is, you know, with every one of the challenges, I get a little more gray in my beard, apparently, and there's plenty of gray still coming in. So we're not totally out of it. Let's jump into a couple of topics or categories. And then we can talk about some elements with that. Number one, I'd say recruiting i, we would be remiss if we didn't talk about the biggest elephant in the room, which is the the need for recruiting the caregivers are the lifeblood of this industry. That's kind of a no surprise. I think one of the things that we're seeing is trends is that, you know, a digital only approach certainly is not the answer. So for anybody who thinks like, oh, I posted the job, what regardless of platform that you're using, and I've kind of done it right, and then people aren't showing up, you're just barely scratching the surface. I would use that as like a foundational thing. You should definitely do that. There's a sense of passive recruitment that needs to also be talked about and passive recruitment feels like I mean, how many of you are still pushing your caregiver for Oprah? Graeme? You know, how's that going for you? Do you? Are caregivers still energized by your current employees? How's retention going with that? So if you have a current caregiver who's on staff with you? Are they feeling comfortable at their job? What is the reputation of the business? Currently? Are there some things we need to work on? Before we bring caregivers in? And maybe they there's a reputation that your organization has is like, Oh, they never get payroll, right? They never, you know, communicate, they don't answer their phones, so on so on. So just think about the total presence and brand value of an organization good and bad, right? It's great, you have a wonderful looking brochure, what is the actual experience of a caregiver within your organization. And also think about the caregivers that have been here for a very long time, it is worthwhile hearing from them and just asking them, right, it's like, Why do you say so long, those are the kinds of elements of just engaging people you already have within your group that it's, it's very meaningful when when you take the time to do that, but then to, you understand what to lean into. So it's possible your dental and vision benefit that you spend a lot of money on every year, nobody cares about it. But that money possibly could have been used towards better programs or bonuses or something else to that extent. So another element is, you know, it kind of, I don't know if this is going to be an aha moment for anyone. But something to consider. There is also a general aversion right now to take a job in which there's a lot of driving, I'm not talking about work from home, I'm talking about, you know, on the international stage, this is not a politics conversation, this is about the realities of the world is go to the fuel pump. Fuel is more expensive, not here to talk about why. But definitely here to talk about the realities of saying a caregiver is likely not as willing to say, Yeah, I'd love to drive my car around all over town, and go from this place to that place, or that place, and so on, and then wait for payroll to get paid. I can't really go into a lot of depth from a time perspective today on you know, how to solve some of those issues. But I can tell you, you need to be thinking about that whether, you know, if you're in the private pay business, do you want to add some kind of a fuel consideration to as a pass along to clients, not advocating for nickel and diming your clients but I am saying you need to think about how are you going to adjust for these kinds of needs right now. A caregiver getting mileage reimbursement for some reason, you know, the amount that you're reimbursing may not be enough. And that's something to think through, you'd be surprised what some gas cards can do for morale for somebody who's, you know, spending a lot of gas. With that in mind, I mean, once again, not your attorney don't want to give you any false information. fuel cards can be a business expense, they can also be a form of compensation. So you need to just consult, you know, Wage and Hour, DOL rules. Look at some of that, you know, as a part of HCA for our individuals that work in our power partner type model, and then also our kind of our performance groups, right, we share some of that information and some playbooks of how to make some of those things work. But for the general industry, I would say be focused on the impact of fuel to a business in which we drive to people.

The next major kind of update area, I would say, is around COVID. I don't want to get into kind of the past. And as far as like COVID regulations, it's we know it's very fluid. We've got the CDC feels like it's you know, they're changing rules, we've got state's changing rules and all of that, I want to talk more about the fact that everyone needs to realize, although today COVID has is transitioning into more of an endemic effect. I will tell you from some of the boards that I sit on, specifically also with with some state, from a health side COVID is something that no one is riding off today. Right? So this is a very in the moment, currently today, you might be able to say we don't have to wear masks or something, you might feel like well, we don't really need to go track vaccinations as much depending on your state and the rules. I would say, don't put some of that work totally behind you because it's very likely that this fall as we get into, I think what we're gonna get to is like there was always flu season, I think we're gonna go into like infectious disease season, which COVID can certainly play into that. But be thinking about some of the rules that you've already been thinking about, right? So if somebody today has a fever, do you want them coming to work? Do you want them going to a club Ain't tell, do you want them coming into the office? Preparing for let's just say it's not just COVID, you really ought to think about this communicable disease, this infectious disease type model of, you know, what, what could be some challenges? And what are some protective steps that you can take to make that happen? I will say just in general, if you're not doing it now, right, like, while there's a lull in time, if I was a betting person, I would say as you see rates of PPE going down, because availability is up, I would go ahead and start buying up your little stockpile, right? Get some, you should already be using latex gloves or, or gloves in general for protection from just general but you know, these disposable face masks or n95s, or whatever. Be just thinking about that and what you need to do. In preparation for when that time comes again, you're not left wondering, where am I going to get PPE supplies? I know that everyone else is taking a sigh of relief, okay. And so that is just from a trend in the industry, right now is the time where if you look at healthcare institutions, which Welcome to if you want to be a professional healthcare player, you need to really be thinking about challenges before they're happening and having an infection control program. Now is the time, definitely bright. Now while everyone else is taking a sigh of relief, you need to be thinking about PPE in general, think about your HR systems, think about updating records. You know, if it's not for COVID, what about flu? You know, where are you putting that information? How fluid is that? What are the expectations of your staff? I think we all know that if you're in an area that might because you saw some activity around it that might have some proclivity, you know, some kind of predisposition, you know, at the state level, but maybe from a licensure department, maybe from local rags, whatever, that vaccinations will, whether it's flu and COVID, and something else is going to continue to be a trend for you, you might want to start making sure that long education cycle with staff, it's starting to happen now. Right? It's that thinking through if you're going to create a policy or a standard, that do it during the time where it's not absolutely critical, and you can control what that looks like. Alright, enough of COVID I know we're all ready to more or less put that behind us for now as much as possible. Another major trend we're seeing still with around Labor and Workforce is this concept of full time and part time staff and being able to really compartmentalize those, depending on the size of your agency, you're probably already doing it with some ACA tracking that you're required to do the Affordable Care Act. It's possible you're building in some, some models around, you know, benefits, if you're adding any benefits and you're thinking about part time full time benefit people.

Unknown Speaker  12:59  
One thing that we would recommend is think about full time and part time, also being a priority as far as staffing is concerned. So what that means is if you have certain people within your business that are our, you know, full time staff, my recommendation or something that you may want to think about is having those individuals actually show up with a tag or designation somewhere in your system is full time and ensuring that your team internally is offering open shifts to them first. And why is that important? Well, if you do choose to build a benefit program, you do choose to maybe give higher pay to full time staff. I mean, we're seeing this as a typical trend. Most employers if people are doing, you know, higher rates of pay or something to that extent, they're assigning it to a workforce is willing to work more hours, because let's be honest, you having a caregiver on your roster who's only going to work Wednesday afternoons for four hours, is likely not your best employee. Your best employee, if you had a magic wand would be someone who's very flexible, willing to work seven days a week, you know, wants full time work and is willing to do whatever continuing education and stuff that you might have. So think about your ideal person, then think about what are you doing to incentivize to get that kind of behavior? And I would say it's recognizing them for sure. It is protecting them from an hour side making sure that they you know, have that income. And then the last is that, you know, if they're willing to be full time, make sure you're giving them full time work. So there's a little bit of strategic planning within your own company of is your staffing function is your staffing ability, that dynamic, where you can say oh, yeah, we know how to parse out our full time staff and we know how to prioritize them to open shifts, and make sure they have all the hours that they could want that kind of deal.

Unknown Speaker  14:59  
I think You know, it's kind of an ongoing to that is if you have part time staff in the mix. Okay, so this part time staff that's there, it's okay for them to be part time, maybe you're their second job, maybe you are, you know, fitting into their their schedule right now the way it works, the big question you ought to ask yourself routinely, is that as a group of people that maybe the biggest care for them is that if they would just pick up one more shift a week, they would just work, you know, one or two more cases for you that they would be kind of a full time staff member. And if they were full time, they could get paid more, they could get access to benefits, they could do some of these things. So you know, look at that, as an internal pool of people, you maybe don't need 10 More caregivers, you need five more caregivers within your organization now, to go from part time to full time, okay. And that could be for them as easy as just picking up on one shift. I do want to say one thing, which which I love hearing this feedback, whenever I get it, oh, can you they don't want to work, they don't want to work that shift, they you know, blah, blah, blah, I can't tell you right now everything is so fluid, people situations are totally different. So there were folks that were, you know, making their availability a certain way, a few months ago. And now it's different. Now, once again, I don't want to get into all the scenarios, but you can imagine, maybe somebody has childcare figured out now maybe some of these, you know, school is back going, maybe their COVID Fear has been reduced, maybe their transportation is fixed, right? Who knows what the situation is. But this, managing the relationship with your current staff, having a routine touch base with them, your caregivers, is almost more important, I would say then what emphasis you're putting into recruiting. So make retention, your higher priority, and then make recruitment that second priority in order. And, you know, we're gonna have some debate around that, right. Some people are gonna say, Oh, I do a great job engaging with my employees or my caregivers, I'm not worried about them. You know, our problem still is we don't have enough caregivers coming in. I think that assumption is probably dangerous. If that's the result, great, but you want to, you know, trust but verify. Right? So that's a that's a saying that never gets old? If I could put it on a, you know, a tattoo on my face? I would is this kind of thing of what you think you know, what you think is happening, what you what should be going on? isn't necessarily what's actually happening. So part of I think leadership and homecare right now is don't do any assumptions at all. Go back in some ways, even foundational, right? Basics. I promise you, regardless of the size of your organization, anytime you start to focus on an area of your business, you're going to uncover a rock that you just didn't know was quite that way. The other element to that too, is be willing to change. Now, this seems like a little bit philosophical the way I'm talking to. But let me just give you a scenario that might make sense. Your assumption is that your revenue cycle management cash flow, right, so more simple terms getting paid? Is you think it's locked down, you think it's good. You have to go look at when's the last time you looked at your AR report, which is your accounts receivables. What is the average days outstanding for your accounts? What's going on with Mrs. Smith and the fact that she hasn't paid her last two invoices? You know, all of that. What is the process that's been built to catch that stuff so that you're not sure for payroll? I think you'd be surprised that the average days outstanding inside of home care as a goal should be less than seven days. So here's what I mean by that. A very highly operating right performance kind of expected model in this industry is you should bill every Monday for the previous seven days, it should be ACH or credit card, you should have money in the bank, three to four days later. I'm not talking about payroll, I'm talking about billing. And if that's not the case for you, I would assume one of two things is happening one you're in some kind of governmental pay system right so it's Medicaid VA long term care insurance as a structured payer something that's a different scenario. Those are parent payers, right they operate slightly differently but individual from for companies, an individual buyer of your services should be less than seven days. You should be in an as automated fashion as possible, and your cash flow in that way should be pretty well set. I will tell you, if you have 30 clients and your accounts receivables, billing, some of that function is not 100% clean.

Unknown Speaker  20:16  
That is an area like just one of the examples of, you might just spend time looking at it. And it's totally fixable. It's stuff you're in control of right? Account. Accounts. Receivables Management has nothing to do with a potential war overseas that jacks up fuel prices, okay? Your AR management has nothing to do with the federal government competing with you for wages and hours for caregivers. Your AR cycle has nothing to do with, you know, having a big enough office space that has pretty furniture or not. Right. So this is a very fundamental quarter your business doesn't matter about a lot of the outside impact. You're choosing to run your business that way. And that's one item. So just imagine if we had a list of things, which, you know, shameless plug, these are the kinds of things we do. When you know, Sarah, and all of us get it together for our performance groups. We do this kind of work definitely with our our business practices, outsourcing power partner groups, these are the kinds of things that we're really working in. Right, and we're very engaged around is that we want to dive into that kind of stuff with with with within organizations. When we talk about what are we seeing in transit and in the industry in general, to kind of bring it full circle to you? Yes, we're talking about recruiting? Yes, we're thinking about impacts of COVID and ongoing impacts of COVID. And yes, we're talking about full time, part time management of caregivers. Those are really things that you want to work on assuming the very core of your business, and we just named one, which is just revenue cycle management, you feel really good about take what could be perceived as crisis, right? And oh, my god, we're way off of our revenue goals. We're way off of our recruitment goals, all this stuff. Don't spend all of your time worrying. Okay. And so if I could give you any other trend is this is the season right now, what I dare to say offseason, this is the time where companies that I'm fairly certain are going to continue to survive, are spending a lot of time working on themselves working on their business inside of it. They're working on really making those changes to be a little bit cleaner. Also, remember that operations today are getting that much more possible. For scalability. I, personally, if I can speculate a lot as we go forward. I think we're going to see over time with partners like homecare Paul's Right? They'll tell us with the data in the years to come, they'll say, you know, the shift post COVID was the the amount of revenue per agency compared to the amount of administrative staff they had. reduced a lot, right. So define that a little bit more. You today, the average company or kind of the median company's doing, I don't know, latest number, maybe 1.41 point 5 million in revenue a year. And they may have let's call it six individuals that are running the office in some capacity, scheduling, sales, something something whatever, right? Billing Office Manager, payroll owner, something, there's six people, I think in the years to come, we'll find that that six people came down to four people. Now that doesn't like seem like earth shattering is like, Oh, can we would all try to run our companies a bit more efficiently. It's not what's happening. When I mean, what are most of us saying is the answer the most of us are saying hire more people in the office even right? Oh, my problem is talent. My problem is I don't have enough people putting in hours in the office. When my argument to you is yes, you need talented people. Yes. You need, you know, people for being very focused and productive. Absolutely true lifeblood of an organization is its leadership team. So zero questions about that. But I do think

Unknown Speaker  24:25  
one of the things that happens there is it's about the the as much as what are we doing? It's also like, how are we doing it? Okay, it is very possible. And I've used this quote before, it was very possible for two people to take a trip down a river in a kayak and one person travel 14 miles and another person travels seven and the difference is the one doing it. Seven miles is working hard. They're in a direct almost as much of a direct path as another, the one doing 14 mile Miles's like left, right, left, right, left, right, and they're twice as tired, because they are doing it the most inefficient way, they haven't figured out the right tools to use right or whatever. So I do think just a general trend is when we say as an industry, we are trying to be efficient, we're working on our companies, I would tell you a trend is definitely not going to be just we're waiting for new hires to come in. So as a general point of contact or point of topic, I would say is, be be ready for change in the right places. And for the right reasons. If you're going or contemplating talent management change in your company, you're thinking about roles, right and responsibilities in your organization, you're thinking about any of those things, I hope very much so that you'll continue to engage with the independent Home Care Alliance with whether it's through membership, whether it's through programming that we're providing, or even the power partner levels, some of the work that we do, there's a place for you here, and if you're an independent agency, and you know that you want to work on your organization, we want to help wherever we can, whether it's connecting you with resources connecting you with other owners that want the same stuff, right? We're kind of here for that. What we are definitely not here for is to get into a mode where, you know, we just want to have a big membership base, and some, you know, something like that we would much rather have a very tighter knit group of individuals that want to be at the top of their game. And so being a high performance group for us looks like there. Yes, we are a bit exclusive. Yes, we have a vetting process. Yes, we, you know, don't take everybody that wants to be part of it. No, we don't sell a bunch of consulting. That's not what we're here for. There's a bunch of people that do that stuff. We are really here for collaboration, and then jointly want to make sure that independence are not only perceived as the best model of home care, but they actually are right. And that's what we're here for. So with that, Sarah, I'll get off my soapbox. Sorry for that and turn it back over to you.

Unknown Speaker  27:11  
Nothing to apologize for canoe. Those were some amazing insights that I'm certain everybody that's listening or will watch the rerun of this episode will find valuable. And I do want to just go ahead and double down on what you were saying about I HCA and reiterating sort of what our philosophy is for independent non franchised homecare companies. So, we do not want to be an organization that is simply going to get you motivated, and then you don't see any growth in your agency. That is not what we're about. We are about group purchasing power, right, making sure that you're getting the services to run your business at the same rate that your fellow franchise homecare companies are in your markets, but also education and step by step guidance on actions that you can take actively in your agencies that will get results. So if you are interested in learning more about membership, you can check us out@www.indhca.org forward slash join. I hope everybody enjoyed the updates from canoe today. Make it a productive day. Bye, everybody.