With 33,000 followers, Karl Pierre is arguably the top home care influencer on Youtube. He started in home care at age 14 when he was "the computer guy" for his mother's home care agency.
In this episode of Home Care Heroes, Karl shares advice and perspective on questions from home care agency owners. Topics covered include the following:
- Engaging caregivers for a higher purpose
- Home Care Websites - what's important and what's not?
- Social Media and Search Tips
- Great Books for Home Care owners
Welcome to the home care heroes podcast, featuring trending topics and practical wisdom for success in home care. Here's your host Ken Accardi,
Ken Accardi (00:30):
Just to get us started I want to get to know you a little bit better, a real lot about home care. Can you give us a little bit of your history with the home care industry.
Karl Pierre (00:39):
Sure. Thank you very much for having me first and foremost to give you a little background about myself, I think it would be best to start with the story of my parents who immigrated from Haiti, both are healthcare professionals, Between 2010 and the present, we have been a home health healthcare provider in New York, focusing entirely on a managed long-term care patient census so these are all Medicaid patients who have a chronic long-term need. As of 2019 provided a little over 500,000 hours of services totaling about $12 million of revenue.
Ken Accardi (01:17):
It's interesting when, when we speak to agencies, I'd say our bigger agencies that we work with, their biggest issue is, attracting and retaining the best caregivers. And interestingly, for our smaller agencies, the biggest issue that they run into is, getting that, that first base of clientele. And there's actually a couple of questions around those, but, tis first question I wanted to pass to you is it says, what, what are some ideas or hacks or, tings that you've done to make the caregivers feel like they're part of a bigger team, in in home care, because some of the feedback from caregivers is that, they don't really feel connected to the bigger agency and sometimes they feel like they're in a, a communication void. So is that anything you have some ideas on?
Karl Pierre (02:02):
Plenty because that's something that's really important to us. One of, one of our core values is teamwork and making sure that people feel inclusive. So from the very first interaction, we try to treat every person that's going to be employed by our company as a member of our team. When it comes time to onboarding during our, our in-services, it's something that we repeat again, we ensure that everybody understands teamwork is part of our core values. And we have an open door policy regardless of level within the company. Any employee in our company has the potential to shift the company's direction. So we want our employees to be empowered and to function as entrepreneurs within the company, identifying problems with services, identifying problems in a patient's home and bringing that back to us so that we can find either a technology or fine tune, how we're delivering services and by involving them in that way and saying, Hey, even as a caregiver, as a personal caregiver, home health aide, CNA, whatever the classified are, as a lot of people tend to look at the education level and minimize that, that, that employee group, but they have the most value to offer the agency because they're there with the patients, the longest they get to see exactly how patients become non-compliant, what issues are they facing with the family members, neighborhood, et cetera.
Karl Pierre (03:29):
So we have them come back to the company during in-service during any opportunity that we have during our, our [inaudible] meetings to voice what their experience is like. And to even provide us with some solutions that they think can improve how we work as a company. So by, by having this open dialogue and having them be able to shape how we function as a company, ultimately lets them know that they are part of our team and that they have a voice. And they're just not a number on a list.
Ken Accardi (04:03):
Yeah. I mean, that's really, really fantastic. I actually, you might've seen me scribbling. I think that's really, really powerful that any caregiver in the company can change the direction of the company with a great idea. So I think that is very empowering and I loved everything you talked about with the in-services and, and how you do that. It's funny. I teach a,a, a couple of university classes, mostly in information technology, I'm a geek. And,one of the quotes that I share is that, Jeff Bezos from amazon.com is that, anybody in the company could win an argument against a more senior person if they bring the data and,that thing. So, I mean, it's a little bit of a silly analogy, but I think that it's a really empowering message to your, your, aregivers and your team.
Ken Accardi (04:47):
And that's fantastic. Another one that came in here is that, and, and we've seen this, I'm putting some context around it, but,sometimes we see an agency and they're getting off the ground and they get up to a certain size and they're like, Hey, we've hit our 25 clients, we've hit,a million in revenue we've had 30 and then they, they stagnate. And then every once in a while, or lack of a better term, I'm going to call it a bad Monday. Right. So, o what'll happen is, like just from some seasonality, some people have moved back to a different location, so you've lost two clients that day. And, sadly, I mean, the people we care for don't stay with us forever.
Ken Accardi (05:29):
So, like maybe two clients passed and, and, and, and to move to another geography and all of a sudden, so you just went from 30 clients, like 26 and, you were just like there, and you're over that hump. And, nd I guess, like, first of all, it sounds like you really have a strong, growth focus. And do you have any ideas that you can share with, how do you avoid those, those bad Mondays when, when that happens now and again, and, and just some thoughts on always, having the growth engine going and not just plateauing or, any thoughts there.
Karl Pierre (06:05):
Yeah. That that's, wow. That's a pretty wide question. So what I've noticed is that a lot of smaller operators, they think small, and because you're thinking small, they're looking at their profit margin, being their profit, being the spread or the margin between their costs and their earnings, right. Which is, and by definition, it is. So they look at expenses in a very different way. And they're always trying to cut back on expenses rather than spend their way towards success. And because of that, they get, when they get to that 30 patient Mark or 25 patients who, like you said, that's about a million dollar rev pizza averaging around 40, 40 hours, or so they think that they've made it and they start looking at how to spend their profits. They get a bigger house, nicer car, they need to show to the public that they are successful in their business.
Karl Pierre (07:12):
Rather than re-investing in more marketing, right. And people who that can actually grow their business further using from zero to 25, your own marketer. And you're going out there, you're talking to people in your community, social workers, case managers, whoever it is that you're sourcing your clients from. And you never had someone who's in that role. And now you're busy enough that you're functioning as part-time marketer. Part-Time you're the administrator. Most likely you're handling HR responsibilities to handling all these responsibilities. And then you're keep raising your pay because you finally want to feel like you've, you've made it. And I think that's the mistake that they fall into. And then they lose those four patients or three patients on a bad Monday, and now they've even less likely to spend. So my, my recommendation for people who are just getting started, don't think of any of the early money as your money.
Karl Pierre (08:10):
All of the early money is the business's money. And every, every penny should be spent on growing your business. And that's through attracting the best talent you could get and the best marketing spend and the best advertising spend that you can do. A lot of just like you said, data is what drives everything that we do in our company. We look at, we look at the lifetime value of an aide. How much is a whole health? They didn't bring in revenue on average. How much time did he stay with the company? How much did we earn on that, on that home health aid, when they are working in the average capacity, we look at the lifetime value of a patient. How long does the patient stay with us? If they have a certain payer type, if that's managed long-term care, it's usually for live as long as we provide a good service.
Karl Pierre (08:53):
So how much are we willing to pay to either attract the home health aid or attract a new client? And we look at everything from that perspective, and we consistently adjust our spend, according to what the outcome is. So my overall advice to avoiding that, that initial downturn is use all the data that you've collected, what works for you to get clients and, and really think about how you can multiply yourself by hiring a marketing representative that will do exactly what you do or better, because they should only have the time to do that and quantify how much is that worth to you? Right? So if, if 10 patients a month is a target that you think that they could hit and you're paying them $8,000 a month, well, I know that in the New York market, a patient is worth about 10 to $15,000 lifetime value.
Karl Pierre (09:49):
So if that person's creating a hundred thousand dollars of value and you're paying them close to $10,000 a month, that should be a no brainer. Spend. A lot of people will look at that spend and say, well, I'd rather have that eight to $10,000 in income so that I can improve my lifestyle. This is why I started this business. So that's a long-winded answer. But that's truly what I've seen to be the pattern of what separates the companies at scale. And that don't, especially a lot of operators are usually nurses. They may not have really strong backgrounds in, in business. Probably never took a business class in their life. Don't really, they're, they're always been focused on sciences and, and the actual care administration. So they never built the mechanics of building a company. And because of that, they tend to have that small business mindset. And I think that's, that's what really, that's what really limits the growth there.
Ken Accardi (10:49):
Right? This next question. I'm just chuckling as I read it. So this one says like many home care agencies, we have a website that has stock photos and basically says that we provide the standard home care services. But, we're not really finding that our website is doing a lot for us. And we see that you have, tens of thousands of followers on your social media. So like, what would you recommend for us to take our, our website and our online presence to the next level?
Karl Pierre (11:25):
Perfect question. I actually liked that one. It doesn't matter if you have stock, first of all, it doesn't matter how your website really looks because people only know of your website if they know of it, right? That's, that's like the back in 1996, having a website was a big deal. Now it's a standard thing. The difficulty is driving people to that website and making them aware of the service that you provide. So you could do that at one of two ways, either by organic discovery, which is going to be SEO, content creation, that sort of thing, or by paying for ads, ads are expensive, especially now they get more and more expensive. So let's not photo doesn't really matter. The design makes a difference somewhat, but a lot of sites are crappy anyway, in my opinion. So what really matters that you get people's eyes, right?
Karl Pierre (12:21):
You need people to be aware of who you are and then that's your opportunity to, to upsell them. So or to sell them in general. So one of the ways that we get traffic to our site is through social media, social media to create content is free. Okay. You can, you could create blogs on information that, on your experience as a company and the, when you're creating a blog or you creating any content, you want to make sure that the content that you're creating is addressing either a coordinate that people have, or a critical question that people have. One of my most viewed videos on my channel NTP life is how to start a home care agency. I created that series because I was in the process of starting my home care agency here, Fort Lauderdale. And I was like, you know what, people, I'm sure people are curious as like, I'll just start documenting it, right.
Karl Pierre (13:17):
Just documenting my life. And I phrase it how to start a home care agency, because that's what people would typically search. If they're going into Google, how can I start a home care agency? And that's how most people find me. So you want to make sure that you're creating content around the house, only searched ideas or concepts, how to feel a visiting nurse, how to find a home care nurse, how to find a home care agency paid for home care agency, what payers exist, free home care, how to get it now, whatever, whatever would come to your mind as like commonly seen, I searched phrases and terms that the general public may use too, around that help the whole healthcare industry. You should be creating content around that so that when people are searching and using Google using YouTube, or even if they're discovering you through Facebook, Facebook, yeah.
Karl Pierre (14:14):
It's also going to track your search behavior and it's going to offer you up what you've already been there looking into, right? So you want to make sure that you're, you're, you're presenting or creating content that addresses people's questions and that are, that's drafted in a way that answers what they're looking for. Right? And when you do that, you start to get that organic natural information. And then you start to position yourself as an expert in that area. So you could do that with blog. You could do that with YouTube, another company that does this really well. And I highly recommend that you check them out as a company called slide by slide bean creates like a pitch decks for startups. And they it's pretty much like PowerPoint, but cooler in a way, slide bean has a YouTube channel and on their YouTube channel, they talk about all things, startup related growth cycles.
Karl Pierre (15:18):
So I have that failed, like why the Nokia fail? Why did research and motion or, or ramp or Blackberry, why did they fail? What did these giants do that either propelled them like Airbnb or killed them like Nokia and everything's around like tech ideas, but in every single video that they put out, they talk about slightly and why it's great now. And they've been able to grow their subscriber base based on providing good content. That's interesting and engaging for people that may have the same interest in starting a company or maybe a startup founder. So you want to create content around that. Like one video that I'm thinking about doing is how to care for someone who's recently had a stroke, right? In that article or in that video, there's so much to cover, right? Because the person who's re who's actually searching that, that topic, most likely scaring for a spouse or a family member who's recently had a stroke and they, they don't know what to do.
Karl Pierre (16:23):
They're in a jam. This, this is somebody who may need home care. So as you're talking to them about, this is how you care for someone who has partial paralysis due to a stroke. You're sitting there saying, I am also the founder of eight book, a home health care agency in Florida. This is what we do. We help out sometimes provide caregivers, physical therapy, speech therapy, whatever may be needed for someone like this. The more you put in those threads, out into the internet universe, the more roads you have leading back to you. So I hope that that gives you some insight as to how I think and how I approach driving traffic from the internet. It's not about your website. It's about what sort of information you're putting out there that will pull people to attract people to you, or you pay for traffic.
Ken Accardi (17:14):
Yeah. And this is just my color commentary here, but a few things I've seen people do is like, let's say that I named my agency like angels of love, home care. I'm really focusing on my brand name, angels of love, and that's not what people are going to be searching for. And then another thing that I've seen people do is that, like there's like it, I know in New York you have like the,the certified agencies and the licensed agencies and the TODs and Alexis and all that thing. And people get very hung up on, well, I am providing nonmedical home care. So I, I'm not going to say, like, I'm not going to put on my site about finding a nurse. Right. Because I don't provide nurses, I provide caregivers. But, eah, if you think of some of the examples that Carl provided at first, I mean, the, the person who's mom, fell and broke her hip and she's coming out of the hospital in two days, she doesn't know the difference between a nurse and a caregiver.
Ken Accardi (18:07):
So like, so make sure that you're using like, those, those search terms, that like, I mean, cause people might be looking for a visiting nurse, even though they want a non-medical home care giver. And, and another important thing is Carl, I mean, has this business in New York and part of that, he talked about and also, his, his brand and a lot of things he does are nationwide. And that's how he gets, followers. But a lot of you are very local, right? So you're going to want to make sure that you have content that covers the names of the specific towns that you are providing services in. And it makes sure that you're not just like saying, well, come on, I built my page around the keyword, angels of love, home care, and nobody's finding it. And that's because, people aren't specifically searching for angels of love. They're, they're searching for, help for my mom after she heard her hip, or is there, or, I need I need home nursing in, in Dubuque, Iowa or whatever the case may be. So that's
Karl Pierre (19:02):
Nobody, nobody cares about your brand, your logo or any of that until your brand and logo means something, right. You can have the prettiest logo and the best name, but nobody cares about it unless they've, unless you have mass effect of people interacting with that. So I, I agree with you. A lot of people get caught up in that, and that's not what makes the difference. And you did touch on a really good point since you are dealing in a, in a local environment, it might go, it might be good to create content like how to pick a visiting nurse in whatever your city is. Right? Because even if you segment down to a certain city or a certain neighborhood, the search engines know what neighborhood you're in, and they're going to serve you information that resonates with you in some, in some way, right?
Karl Pierre (20:00):
That even if you're, if you're local to caramel in New York and somebody has an article about home care and Carmel, New York, what do you think is going to happen? The Google machine is going to match you up with that article or that blog, because they know that you live in Carmel, New York, and they know that you've been Googling or searching visiting nurses or home care, or you've been in the hospital for a certain amount of hours every day for the past week. So obviously somebody has been hospitalized cause that's, that's not your job. So you have to start thinking like the machines thing and start trying to position yourself between how the machines are thinking and consolidating information and making sure that you're showing up in front of them. Perfect.
Ken Accardi (20:46):
All right, I'm going to go onto the next one here. I'm reading it off the screen. Okay. It says that
Ken Accardi (20:53):
Hold on, I'm just gonna try to paraphrase this a little bit. All right. So it basically says that people might be searching for, like special things to differentiate their agency from anybody else's agency. And and I, again, I'm trying to paraphrase, but, could you think of certain, special types of skills other than regular home care and maybe memory care that people might be searching for that might be unique and help an agency to differentiate themselves in some way
Karl Pierre (21:27):
Searches from the public perspective?
Ken Accardi (21:31):
Yeah, I think so. I think that they're, they're just trying to say, like, what, what, unique,instead of being just a vanilla agency, like what, what are some, maybe unique things that if they specialized in a certain type of, of scale, I guess you gave an example earlier with,like,like, after a stroke. So that might be something that would, would search for, but do you have any other ideas of, of something special other than, standard home care that people might be?
Karl Pierre (22:03):
I would target ethnic groups and subcultures within the U S because there's often times, for instance, one, one group that I'm looking to target in New York is the Nepalese community. There's enough people from Nepal in New York city to, to have a community, but there's no one really speaking to them. So if, if all the advertisements are in English or Spanish or whatever, those are the two most popular languages in the U S why not look at how to niche down to certain ethnic groups, especially if you're in an ethnically diverse city, big cities tend to be ethically, ethnically diverse. So you can concentrate on a certain language, because especially when you're doing personal care things like customs, religion,food choice, et cetera. If you have an aide who doesn't understand their food culture, or doesn't understand your household culture, it's, it's that relationship is not going to work out. So matching your agency to satisfy a subset of, ike society or minority group within the, within the United States. I think that's one way you can differentiate yourself and it's, it's relatively common and easy to do that. No one is speaking to those, those smaller communities. So you can start speaking to those smaller communities and build around that, and you become the expert in home health care for that particular community.
Ken Accardi (23:34):
Any other thoughts to close out today's Q and a with things you'd like to share with the folks online or things that they might be able to find more about you and that thing? Sure, sure. I got it.
Karl Pierre (23:46):
I got quite a few. So first more about me. I go November tango, Papa space life on YouTube. I'm also the, I'm all also under the same name on Instagram, but that's a smaller following and it's just pictures. So I not much to really capture there also I have a few technical solutions that I build out. I know that you're in the same space, but one of the things that, that we're working on, that's pretty cool is a referral management platform is entirely free. You can register for firstname.lastname@example.org. What I realized in New York, working in New York, it's pretty fragmented. The process of just getting somebody from being Medicaid eligible to enrolled into an MLTC plan, and they're all disconnected. It's, it's awful spreadsheet. You have tons of spreadsheets that you're managing and tons of communication, different players. So I brought that into one platform and what we're doing now, there is we're bringing providers onto the platform and trying to create a a two-sided marketplace so that the providers who are looking for a home care service agencies can make referrals on the system.
Karl Pierre (25:05):
And then the agency that had on the other side are able to benefit by getting those open referrals and potentially meeting that demand. So it's preliminarily free. You can use it, you use a demand for all the referrals, and then as we start to route referrals into different areas, especially for markets that we're not in, we it's important for us to have agencies that, that we can route that referral flow to so that they can benefit and grow while we either prepare to get into that market or, or just being able to, to make that process a little smoother. And last bit of advice that I would give, I think would be to read the book, the lean startup by Eric Reese. It is a book that truly teaches you how to think like an entrepreneur and teaches you how to make your decisions.
Karl Pierre (26:00):
And they use a method called validated learning. And it's really a play off of lean manufacturing, which is the, the model that, that Toyota used to penetrate the market the way that they have. And really what they're saying is that every decision that you make in your business, just like Jeff Bezos said should be driven by data. And if your company focused in this way, every employee can come to the table and say, Hey, I've made this observation that we're losing cases because of X reason I've been tracking it for three months. It's because our phone system is trash, right? We need, we need to upgrade our phone system. And this is the chief complaint that we're getting, et cetera. And it teaches you that you could make that argument how to, how to present the idea, how to capture the data and communicate the data.
Karl Pierre (26:57):
So that it's clear. And the thing that we do as entrepreneurs or people in business is sometimes we're tracking the wrong metrics. So it, it teaches you the difference between vanity metrics, right? With things that may not matter, like how many likes you have on your, on your Facebook page or something like that. It's like, it doesn't matter if people like you, how many of these likes are converting into clients? How many of these lights are converting into the end result that you really want for your company? So it teaches you the difference between those two. And so if you really want to grow your agency and you really want to compete with the bigger players in your space, you can need to think like the bigger players. And that's probably the best book to give you a step-by-step model for you to follow so that you're starting to think in a more business savvy way. So the lean startup totally recommended. Fantastic.
Karl Pierre (27:47):
Go ahead. I get, like, I give three books to all employees when they're onboarded, rich dad, poor dad, lean startup and crucial conversations, rich dad, poor dad, so that they, all my employees can understand how money works in this country in a very simple way. We were in it to make money completely a capitalist. And I want my employees to make as much money as possible as well, lean startup for the reasons I just told you and crucial conversations, because there's so much that gets lost, especially when you're having high conversations that shouldn't get lost. So it helps our employees manage how they interact with patients, how they interact with patients, families, and how they interact internally, especially when there's a lot of tension and in home health care is going to be, so those are the books that I recommend. And that's one of the things that I do to, to shape the mindset of all the employees within your organization.
Ken Accardi (28:44):
That's like, I think, I mean, it's funny. We book-ended today's conversation. I think the first question that came in was about retraining, retaining and communicating well with caregivers. And then the last,the last thing that you shared today was, I bet that,not that many home care agencies are starting their relationship with a caregiver by giving them three books that can make their life better. So I think that that really sends a great message and,really shows who you are and the character that you are. And that's why, prt of the reason why you've been so successful.
Thanks for joining us today on the home care heroes podcast, home care heroes is produced by Ankota the software for the heroes of home care. You can listen to back episodes by visiting for home care heroes.com. That's the number four. Then the words, home care heroes dot com.