Season 1, Episode 4: Independent Home Care Alliance Industry Insights with Kunu Kaushal

www.indhca.org 

IHCA is on a mission to further professionalize the caregiving industry! 
There are many validators showcasing the ever increasing importance of non-medical care services. 
Who should own the relationship with the care recipient? 
Be the care navigator for families.
Home Care can "be the hub" for care resources in addition to their service offerings.

Transcript

Sarah Barker  0:00  
Oh. All right. Good afternoon, everyone. My name is Sarah Barker with the independent Home Care Alliance. And today is our session of ih ca industry insights with our founder canoe. Cushaw. Thank you so much for doing this again today. Canoe.

Kunu Kaushal  0:16  
Thanks, sir. Yeah, always exciting to kind of recap everything that's happening or what we're hearing in the industry, and then bring it to all of you. So, you know, I always say I don't have a whole lot to present, because it seems like along the way, it's all more of the same. And yet, every time I start looking at notes, and then also conferring with other people in the industry, there's a lot of moving pieces out there. So let's let's just kick off with maybe the most prominent thing right now, I think recruiting has been a huge topic for a very long time. And I have to tell you, it is probably not in the fashion or reason or how it came to be. But inflation is helping us. It's hurting all of us. This isn't a political area, but it's certainly helping us in the way of recruitment. Just life is expensive. Right now, gas is expensive. I'll bridge that over to operations as far as driving and that for caregivers, but people have a need for additional income, the amount of people applying for side jobs, second jobs is up heavily. Lots of folks are looking for those opportunities in which it's something they can do on a PRN basis, you know, nights, weekends, that kind of thing. So use that to your advantage, I would tell you, I think we all know, the best kind of caregiver right now is one that's working full time, one that's eligible for all your benefits, the one that is sticky and stays with your organization. But also keep in mind, I think there there are plenty of caregivers and potential caregivers out there looking for additional income. So if you're open to that part of as an opportunity, I think, you know, my recommendation is make sure job ads are being updated. Make sure you're very prominently saying you know, this is a temp work or something else as an option to your other positions that are out there. Some folks are just looking for the ideal fit with inflation and cost of gas and cost of a lot of other things. When money is the determining factor. Just remember that population is going to be a little less concerned with your benefit package. And they're going to be much more concerned with what's the quick money elements like what's your speed of pay? What kind of bonuses are you giving? You know, is there an incentive out there somewhere? Do you pay for a higher rate of pay for, you know, overnight shifts and weekend shifts? And whatever else? Are you going to offer mileage reimbursement really prominently, right? There's some organizations companies, where if if fuel and mileage is a restriction for them, go ahead and answer that question. So you know, when you think about your value proposition, as an organization, somebody wants to come get hired with you, I would certainly, you know, recommend put two different personas out there, you know, profiles, one is the full time caregiver looking for, you know, a career someplace, they're going to be for years and years. And you do need to be open to this other category, which is that part time PRN employee, one that might only be here for a couple of months. Now, from an industry perspective, I will tell you, there are a lot of folks out there that are very keen on this retention number, right and your number of caregivers as far as turnover. I agree, it certainly is a number you should be looking at. I do think with some of your caregivers, that you know, this is gonna be a part time position or a temporary position, you might want to start thinking from a data side, if you measure that way is look at that as maybe a separate category. Right? So that's as simple as hiring people under a temporary status or part time. Can they become full time employees? Absolutely. You know, maybe they discover, oh, my gosh, is a great place to work or I love this kind of work. So don't ever stop that kind of flexibility. The reverse is also true that full time employee which we really want him full time but life changing for them, give them the flexibility to possibly go part time and you know, wait for life conditions and things to change again, and that's entirely possible. So recruitment, lots of focus around that. We are industry wide seeing an uptick in applications, seeing feedback that job boards and things are much more active.

If feels like and I've used that word very loosely. It feels like we've got some tailwinds around hiring which is welcome news. We've gone through a bit of a dry spell. Now, I would tell you this as a shameless plug, I know that you've also gotten conditioned to running your business at the speed of hiring, right? And so if that is the case, you may also want to consider and think about, how do you take in volume of business, for example? Okay, now all of a sudden, you have 3050 100 applicants, one of the things and that is going to be how do you process them? Well, I mean, you know, remember, when you had scarcity, right supply and demand stuff, when the supply was down, demand was high, you maybe took on or hired some folks you wouldn't normally have done right? If your application pool starts to increase, and I would love to say we were drowning in applicants, we're not quite there, okay. But as your applicant pool starts to grow, and you've got more options, you've got to learn before you were choosing between none or one, what do you do between 10 and you only need three, okay? If you can get a little bit more oriented, in that, I would tell you hire 10. And see who sticks, right? We're a volume hiring type of mentality. But you certainly know that you haven't given up the importance of being a gatekeeper. So we'll go back to just typical standards, like background checks, drug screens, be thinking about policies, look at, you know, a great area is learning management, give them some online courses to take, see who is willing to, you know, level up to a certain position, I think you and I would both agree that if we were out in at a restaurant, you don't want somebody maybe, you know, doing food handling, right, making your meal in the in the kitchen, that hasn't even taken the basic food handling course. So depending on your state, and where you are, this is a bit of a parallel somewhere else. You know, there's no such thing as a licensed cook, or, you know, something to that effect, there's experienced cooks, with the baseline becomes when everybody comes in, they have to typically have some kind of training or certification or check off on safe food handling. So think about that in home care. Today. There's, you know, depending on the state, you don't always have those standards around. I think, thanks to our friends and leaders over at the homecare Association of America, also with the National Association of homecare, different, you know, associations and groups that are much more focused on policy and advocacy. I'm really thankful for the work that they do to try to standardize that in at different states, and certainly at different levels within organization, they're also trying to right size, right? We have plenty of states in which the regulations are too high or too burdensome in your organization, assuming your state doesn't have these very high bars, I would tell you, you know, quality drives, right? So quality should drive your organization. And how do you meet that. And that's just by having standards. Don't give that up. Because you went through a season of scarcity in which you had no options. So you took an option, and you tried to make the best of it. So as you start to see some of this build back, I'm a big proponent of go ahead and plan for as things are getting better. And they may get worse too. Okay. But as they get better or worse, and you ride that roller coaster, you need to have a plan. And along the way, you need to know where are the levels of, you know, bars that you're going to set for yourself. Okay, so recruiting, I think, you know, this is a vein we could go on and on about want to make sure that we also cover some other topics. Recruiting really leads now into we already talked about inflation, the positives. I hate to say that, but positives for some of us around hiring, the negatives around inflation, I would say the biggest issue at this point is, you know, we were already getting to a point of wage sensitivity. You know, we've gone through that say over the last two years, I hate to always do like a COVID thing, but you know, looking back, you went through a lot of pressure for wage increase. You're kind of getting that now to I do want to speak on one topic, which is be really careful some of the things that people are doing operationally around bonuses, fuel cards, you know, doing some kind of incentive plans and all of that. There are two things that I would want and really recommend as an industry number one, most important, make sure you don't do anything with money and a worker that you are not getting a second opinion or third opinion on somebody with,

you know, an understanding of labor law, wage and hour type of implications? Yes, absolutely. Giving a caregiver one time a bonus to help them with fuel or something is, has implications on Wage and Hour and your policies and so on. If you want to think really big, and this is one of those, like, from a big compliance perspective, you want to be really good fine tooth comb. You should probably have a policy on how you award certain employees with gas card versus another and be really careful, because it's not just about wage and hour now you've also got like, unfair, you know, employment practices. You know, we love Suzie, Suzie. So good. And we're gonna give her bonuses and overtime and all the all the things we can, and then Jane's, okay, she's alright. But you know, you know, she just doesn't, she doesn't come by the office very often. So we don't focus on her as much. She's also an employee, right and should should have access and that to some of the benefits and things that your organization is doing. So there are some ripple effects. Okay. implications. Don't let that scare you. I'm not saying let it stop, you just do it. Right. It's certainly worth doing. But it's definitely worth doing. Right. So, you know, bonuses, gift cards, you know, inflation is kind of getting that carrot out there. So the first one I told you, right, look at a rubric of the first measure is make sure you're looking at it from a legal compliance policy. So here's the second one, you need to think about it from strategy. And what I mean by that is, if you do it once, right, it's the give the master cookie kind of a storyline. If you do something one time, the real question is, can you walk it back? Like, did you bring it out to your organization in a way that it was very understood, this is a one time special not gonna happen, you know, again, or don't expect it. And what I really mean by that is, and realize we're not doing like q&a type model today. But listen, if I would ask the proverbial audience here, how many of you have ever Uber's a caregiver to their shift? Why? Because well, the one shift was worth spending, whatever it took, in fact, if Uber didn't take them, you would take them or you go work the shift, right. So we've we've all walked that, that path. Some of you who have done that have also experienced now all of a sudden, that caregiver wants that Uber ride again. So what do you do? You've also got, I don't know how many of us have all done this. I know I have you paid a little more for this weekend. Oh, if you work this out of shift, I'll give you a little bit of bonus. Now, you're also conditioning certain people to hold out and go, you know, now shift offers with certain employees can go like, Hey, can you work this Saturday? No, I've got stuff going on. But, you know, maybe for a little bonus, I could work it out. That's not I'm not telling you good, bad, ugly, I don't know. But you can see, it's a slippery slope. One that if you do a good job of managing that managing expectations, setting guidelines, you know, dude, making it fair, whatever that looks like, great. Just be careful, I have seen entire organizations build a culture of Oh, you don't need to worry about transportation will Uber you. And they don't understand when they get a few $1,000 on their books with Uber expenses. You know, what happened, like, oh, my gosh, we woke up the next day, and all of a sudden, you know, we've got this fat Bill, you know, the bonuses on the weekend and so on.

You know, there's some strategies around there, I think our, you know, little plug for our performance groups that we have, we talk about a lot of these things. You know, there's policies and development that we talk about as well. So for those of you, you know, I realize there's going to be some questions and how do we format and make some of this stuff work. You know, Sarah, and the team can certainly get you more information about some of our performance groups. We also had a very successful run for the last few months here of our executive workshops. You know, just come on in come to headquarters for us to our institute of learning, and you're gonna spend a day and a half for however long you need and let's let's help you kind of get a jumpstart around some of these, these areas that can be real challenges. Getting back to other hot topics in the industry right now. I would say one of them that is meaningful is certainly I returned back to systems. And we've talked about efficiency we've talked about in the past, we've talked about, you know, remote work, and so on. And I'm not really speaking about that, I am more focused around the idea of think about your systems of what needs a revamp, I will tell you that you're in a season right now. So a little little secret that I don't share all the time, there is a season for you to look at technology stuff. I'm not saying I don't have any technology to sell to you, I'm saying it to you. And we have not been asked by vendor to say this, right. But what I'm telling you is this time of year, it is very typical that you've seen, you've got a pulse halfway through the year of like, we made goals for the year, we were thinking about the numbers we wanted to hit and some of the processes we wanted to deploy, and so on. This is about the time of year where you're halfway mark, you're closing in on the end of second quarter. And you need to do a little self reflection, and say, what did we accomplish, what they will accomplish? And then ask yourself, what systems didn't allow us to move forward. So you know, is your phone system a challenge is your EMR a problem is your and sometimes it's not the whole platform, it's, oh, man, we keep thinking we're going to revamp XYZ, we just haven't done that yet. But we keep talking about we will look at that feature in the system we've been paying for for a long time. But we need to make time to sit with our wrap and actually figure that out. The reason I tell you that this is the right time of year, you will start exploring now, you will evaluate it for the next 6090 days or something, you will then want to do it. And guess what, you're all of a sudden in October, November, right, you will start testing it, you will start tweaking it, whatever. So this is a very, you know, I would almost say methodical mentality on this. But if you want something to happen this year, with systems and operational stuff, I need you to hear from me, although there's some little tweaks, the fact is, if it was a little tweak, you would have already done it. There, the big changes, if you wanted to do it last year, this year, just go ahead and assume you're probably going to be at a full smooth run of implementation in January of 23. So don't let that be a rule. I'm just saying as guidance, you need time to adjust, train, a fix, and then tweak it again, train your team, train yourself work with the rep, you know, go into what I call, you know, support nonsense, which is just like, Okay, we did it, we were doing implementation now. It's three months later, and like, oh my god, I forgot what needs to happen. Now you gotta reach out to support and it's gonna take a while. So whatever those things look like, I would encourage you don't look at things as like a 30 day rollout plan. I'm telling you this as one of the things are so for those of you that I've known for few years, with my over a decade in the industry. But maybe for the last six or so years, I've been speaking a little bit and then meeting people at conferences. There, you will probably remember me telling you at one point or another that for us, we would revamp our business every 1000 hours of service. When I say revamp some things, you tweak some things you say, All right, what, what do we need to redo? Sometimes you got to find stuff, that's okay. And then either make it great or break it and then fix it again.

But you know, the last two years or three has been a different trajectory for different companies so that every 1000 hours isn't quite the thing. I would now tell you, you know, from a company organization, the tools and systems that you're using, now's a really good time. We have some great, you know, partnerships, resources within the independent Home Care Alliance. If you are a member, most of them are giving us some incredible discounts as part of our group purchasing agreements. You know, we really my point for that is start reaching out to some of them. Once again, you don't have to change your providers of anything. Go put in a support ticket, right go solve that thing. That was a real problem. The reason this is an industry type movement is you will be surprised how many of the vendors and suppliers and people out there How many of them have also changed? There are features out there that people are not always aware of, there's a better mousetrap essentially, for the moment. And for some of us with turnover, which this has been a big piece in our office and administrative team, with turnovers, one of the things you'll find is, well, we, you know, we haven't looked at XYZ area of our business because Becky used to do that. And Becky hates change. And Becky has been doing that for three years. But now Becky's not here. And now we're all of a sudden rediscovering parts of our business that certainly have some room for improvement. So I would just say, you know, don't be afraid to work on your business. You hear this all the time working in your business versus on your business. I love the working in your business, been there done that still do it. You know, some days who answer the phone calls, you know, do the admin or intake, go out and do the sales function, whatever that looks like. But you have got to start carving out time to work on your business and really getting a bit more strategic around it.

Sarah Barker  21:08  
Can you could you address and it's an analogy that you've said many times before, and I always get a kick out of it. We don't have to use a specific vendors name, but the whole concept of having the Ferrari of a, you know, a platform, but you're not using it at all, because through one to one meetings that I've been having with owners, it's some have signed up for platforms and not been using them at all. And it's oftentimes a lack of understanding how to use it or how to people.

Kunu Kaushal  21:41  
I mean, listen, we've all been guilty of it right? There a couple of things. One is the shiny object, in the moment sounds great, you can go get the shiny object. The second is forget the object, it really becomes out of like, Oh, I really want this thing. And you know, it's like, Oh, I know I need a car. There are some of us, not me, by the way, this is not a thing that I would ever do, which is go out and go buy the best version of it, regardless of price. And that's what Sarah's talking about. The analogy is like, you go out and buy a Ferrari, and you don't know how to drive a stick, you don't know how to turn it off, right? You don't even know where to put the fuel. And so there are elements of I'm not I'm not necessarily I do think there's a value in enterprise grade software. But I also think there are things that will get you by, but none of it works. If you don't learn it, implement it, you know, actually execute with it, you can always upgrade. Okay, so you can always say with good negotiating with with service agreements, just remember, you're in a tug of war, a lot of times with your vendor relationships, vendors want you to sign a three to five year agreement. Why because they don't have to worry about selling you again. I wouldn't necessarily say that that's a bad thing. Like some of them, you want to lock in your price, because their value is on a hockey stick. You know, in some ways, it's also beneficial because you don't want to you don't want to just be flip flop from one platform to another constantly. I mean, some of this stuff is pretty, pretty critical. Your interest really should be like get down your contract agreement as much as you can or know that there's going to be some clear outs if possible, it's a lot easier by the way to eat some of the loss, let's say of investment, if you know the thing you're doing is working so good. And now you really do need that upgrade and it's kind of what's called a sunk cost. And you say well, it's okay, you know, we're gonna go from there to there. I guarantee you if you're in a position to buy Ferrari, you'll be okay giving up the used you know, Honda Accord or something. Which by the way, we've had a Honda Accord for a very long time. We love Honda Accord. So I would just tell you like there's always a room to upgrade it'll be foolish though. Just go out and buy the Ferrari and then you don't know what to do with it. You've never driven one and so on. So you know, probably poor analogy. To be clear all of you deserve a Ferrari. You know, if I was Oprah you know, you get a car you get a car, you get a car. So yeah, overall, I would just say is this is the season Welcome to ending out about the halfway mark of the year. And you know, there's a good time to start evaluating some areas, you know, I will without mentioning any vendors or anything, we have some great partnerships once again, Sara and the team can really help you for members. You got some great discounts and programs in the mix. I will also tell you, for true platforms or systems or tools, just know almost anything that you're looking for Um, the big chunky things, there is a homecare specific version of it. Okay. And so unfortunately, there are a lot of platforms that are not. And I think we have spent a considerable amount of time, you know, testing through and just having to make some of them into homecare specific things. But I have to tell you, I mean, you, I'll give you a prime example marketing agency, so we don't do marketing stuff. But, you know, we support some of our members, we have some graphic design and marketing type services light for our performance group members, our business practice outsourcing partners, they've got a whole suite of people and a team that are assisting. But just in that one category, there are marketing agencies that specialize in home care, right? There's website development companies that specialize in home care. So you may want to just get with people who speak your language. Also, I am a huge proponent of you know, really, it's all about relationships, but I gotta tell you, sometimes it's detrimental. We were at Sarah, you might remember this, we were at an executive workshop, we had a room full of people here. And one of our partners or kind of

vendor partners was here. And they were presenting, and it's about something like insurance, right? There was a person in the room, a homecare owner in the room who basically is like, oh, yeah, I've got insurance through my childhood best friend. It's like in their local town, all the things. And, you know, and I think the guidance wasn't, if you're happy with your person, great, no big deal. But, you know, are you going to run your business as a hobby or as a real business, if you run as a real business, you shot in in that they just did kind of an evaluation, we heard about this, probably two months later. And in their evaluation, they ended up with a pretty significant dollar savings

Sarah Barker  27:04  
in just under $20,000.

Kunu Kaushal  27:08  
I mean, you know, those are the kinds of and I, I would assume ended up with a better coverage plan, too. So like I said, there are opportunities where it's not just about money, but there are seasons in which you should be shopping, looking at opportunities, you know, so on. I think with the independent Home Care Alliance, the good news is we've done a heck of a job of shortening that list down to some that we have certainly trusted over time. And so we certainly appreciate all our partnerships with that group there. Gonna move on to just one other area. And we're trying to keep these updates a bit more brief. One other area that I will say it's a hot topic for organizations right now is performance management of your, your non caregiver team. Okay, lots of focus, I think going on with the caregiver recruiting, hiring, retention, and so on. All right, then you got this other area, which is office staff turnover, you know, some challenges there. The one thing I would just recommend you think about, in fact, our performance groups are now working on this a lot tighter. It's okay to dine at, you're gonna have some turnover, that's, that's fine. But your office staff, you also need to think like, what are what are we doing as a team to be in a growth mentality? Like, are we evolving at all? Do we train on certain elements of the business? If you're using, you know, some of the things like, you know, give you a great example, we really like our relationship with homecare, Paul's, and you know, their satisfaction surveys they do. I see a lot of you do those. Okay, we see that in the industry. What is underwhelming is people who are using that data, and actually making changes on a consistent level in their organization. So an ongoing issue, let's say is communication. If communicating with your office is kind of tough, like it's not just about technology, it's maybe about the people within the organization, like do they want to answer the phone? Do they want to be helpful? Do they understand how important it is to call that person back and not say I'll call them back on Monday? You know, I'm ready to shut it down for the weekend. That seems like very, very basic. I gotta tell you, all, all of the magic I have noticed, is in these details that we think are foundational, and we're a long time ago. Like, you know, we dealt with that four years ago when we, you know, did some kumbaya moment in our business. These are on doing things right? So I would say leadership development, performance management, goal setting, it's time to reengage. Once again, you're coming up to a midpoint in the year. I can already tell you the sentiment right now is kids are out of school. Summertime is here. We're ready for warm weather. We're looking forward to our next vacation. You know, all the things. Welcome to home care. 24/7, right? Business Ownership 24/7. So it is okay, take time to relax, certainly take time to like, you know, make the the vacation and the family time and all that. What I'm telling you is you need to just like you would make time for the vacation, you would make time for the you know, that family trip, you need to make time for your work family,

you need to make time for the education that's not day in day out. Okay, it can't be the how many hours? Should we staff? What's the revenue? Do we do the billing is the payroll process. Okay, great repeat. So on, I think you're gonna have to try to elevate a little bit. And think about your team. And shameless plug here, guys come to one of our future executive workshops, and, you know, get kick started again, since some of your teams I loved our last one at the end of it. I think, you know, Sarah, you were asking, like, what did you What are you going to do when you get back to your agents, we had two or three people were like, I'm going to send so and so from my office, huge compliment in that way. So very much appreciate, Sarah, what you're doing with the organization, you know, engaging with our members, you know, also our performance groups. All of that it's we have a lot of work to do. So going back, I would just tell you take hold of some of these tailwinds of applicants and hiring inflation as a drag on gas inflation is very much fuel on the fire no pun intended for hiring. Right. So like where you can't afford the gas to put it in your car, put it into your hiring stuff, because it's, it's certainly cranking up and you're missing out. If you're not doing some of that stuff. Be careful as always do it right? Do it ethically. And then last is take time to think about systems. So inside think about systems, think about your people inside. But Sarah, thanks again for inviting me as usual to this and always enjoy it.

Sarah Barker  32:32  
Absolutely. Thank you so much, can you we always get super positive feedback from when you do these sessions. People love to hear from you. As canoe shared, we do have our next IHC executive workshop in Nashville, July 28 and 29th. It's a day and a half of networking with other independent non franchised homecare owners. And the feedback from the attendees just continues to grow and grow. I'm not sure why I get stressed every time thing. But so it's very reinforcing the feedback that we get at the end of just how much they learn and the excitement that they leave with to go home and implement it. And as a reminder with our workshops, it's not just that day and a half, we bolt on sessions for sessions after included, to make sure we're providing our availability to help them take any aha moments they had and communicate the changes they want to make with their staff and help them move forward with actually executing on that. So again, if you've not registered July 28 and 29th in Nashville, I'll be sure to relieve the registration link in the comments. Last thing our performance groups continue to grow. It is all independent non franchise homecare company owners and operators that are coming together to share best practices help work through issues share what's working for them with an actual deliverable. So it's not just a conversation, there's an actual deliverable where the other owners can take as sort of a guide to execute on what's working for the owner that shared the best practice. So if you have interest, please go to our website www.in DH ca.org/join. Thank you so much for tuning in today and we look forward to seeing you again