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Agency Owner Adds High-Margin Revenue Stream from Facility Placements

Rob Christensen is a home care veteran who has runs 4 agencies and day services. 

Sadly, some clients get to a stage where they need to have 24-hour care and they can't afford to have that service in their home.  Rob learned that facilities are willing to pay a handsome finders fee (generally one-month of the facility fee)  for a new referral.   So Rob added a service for placing clients in facilities.  The results have been highly beneficial in a number of ways, as follows:

  • Finding the best facility is a beneficial service for the client and their family
  • By building relationships with local facilities, they'll turn to your agency when their residents (e.g., in independent living or assisted living) need services.
  • The payoff is both high dollar and high margin. Rob spoke of single placements that paid $8,000.

After making this process work in his first location, Rob went on to improve the process and automate a solution. This includes cataloging detailed facility information for making the best match, the ability to send HIPAA compliant referrals for evaluation, and a tool for tracking all the placements that are in progress.

Check out the full episode to learn more:

Home Care Heroes and Day Service Stars is produced and sponsored by Ankota - If you provide services that enable older or disabled people to continue living at home , Ankota can provide you the software to successfully run your agency. Visit us at https://www.ankota.com. 

Please read below for the transcript to this episode:


Rob Christensen runs four home care agencies and day services. He created a brand new high margin revenue stream for placement fees when the need arises for a client to go into a facility. Stay tuned to learn how it works. Welcome to the Home Care Heroes and Day Service Stars podcast. If you provide services to keep older or disabled people living at home, then this podcast is for you. Now, here's your host, Ken Accardi.


Well, hey everybody, welcome to another episode of Home Care Heroes and Day Service Stars. I have a great guest today. His name is Robert Christensen. I met Rob a few years ago out on the West Coast. And Rob actually, I think at the time, was running four different home care agencies. And he's actually sold off a couple of those and he's adding some in different geographies. So he's like a definite veteran of the industry. But something that is fascinating about Rob, and he's turned this into a side business as well, is that he


He kind of said, well, what's a bad day in your home care agency is that you lose a client because unfortunately, they're just not going to be okay with home care anymore. Maybe they need to be in some kind of facility. And what Rob kind of figured out is, well, if we have relationships with those facilities in our area and we help our client find the right place that we could actually...


We could actually get a commission for helping those people. And we're of course providing a service to our clients and has, you know, created just a new growth path for that. So first of all, I, I've been babbling on here, but let me introduce our Rob Christiansen, Rob, welcome. And thank you for being on the show today. Hey, well, thanks for having me, Ken. It's been fun just kind of ping ponging off things up with you over the last two years and so, uh, thanks for the introduction. Yeah, it's a pleasure. So kind of tell us more. I mean, I kind of introduced the idea, but how did you get this idea of making


making placements? Well, you know, I've been doing this now for 12 years in the home care space, right? And, um, one thing that you find is when you're a home care company, you know, we make our bread and butter off of servicing clients in our own home. And, um, two things happen. A lot of either the client's going to run out of money, um, and can no longer afford home care, you know, or the care levels that they need, um, you know, it's kind of beyond your scope as a home care company, right?


And so a lot of times we isn't just wanting to hold onto our clients too long. It's something, you know, because it's our bread and butter of how we make our living, right. Um, and, um, what I found was as I was, as my clients got sicker or as they ran out of money, we're running at a lower money, I'd get this call from them saying, Hey, we're going to discontinue home care because we need to make a change, right. And so, um, so I started thinking about that and, um, uh, that's when I, uh, came up with the concept of, you know, really focusing on.


full service senior care. And so when we bring on a client now, we educate them about home care and what home care does, and then the value also of assisted living, you know, and let them know, hey, there may come a time where they're either cashflow wise or care needs where you may need to transition. So we really take a full approach so they know that we're looking out for their overall well-being as we care for them, right? And yeah. And really.


We've transferred, we've also went to our referral sources and said the same thing, you know, whether you're discharging somebody that needs home care or senior placement, you know, we're your full service home care senior care agency. And so that's kind of how the concept evolved. And now it's really easy when we're working with our families and clients, you know, we do our 90 day service, you know, visits and see where they're at.


and check in if they're looking in for placements or, and so we probably transition about 10% of our clients a month, you know, from home care to, to senior placements. Wow. Okay. Yeah. So it's, it's really about, you know, what the needs of that person is at that time. And that's actually a much higher percentage than I thought it would be. But yeah, I guess if you think of the longevity and folks in home care, it makes a lot of sense. Okay. So here, I mean, you know, this is.


very altruistic to begin with and things like that. We wanna help them get into a better place and all that sort of thing. But you actually have found that you, there's a little bit of a financial benefit there. So how does that aspect work? Oh, sure. So depending on what size of the community is, but if you've got these smaller board and care homes that are in communities that are six to eight beds, and so if a facility goes without


you know, two vacancies in a month, you know, it can really be the difference of them being, you know, operational or not. Right. And so, um, and there's no different that, you know, when it comes to adding costs to a facility, um, whether you're going from seven to eight clients or you're really roughly the same cost, right. And so a lot of these facilities and it's pretty standard in the industry where if you are an agency that services that provides this service, these facilities will pay you depending on what state you're in, um, you know, a hundred percent of board and care.


know, if they come in and sign with you. So it's, we have contracts, you know, in the Northwest, we have 1500 contracts and, you know, throughout the United States, we have others as well. And if they start care, if they start one of our clients, then they pay us the first month's board and care. And if they don't take our clients, they don't owe us anything, you know. So sometimes they don't need our services and sometimes, you know, they do need our services. So.


It's a good working relationship with our communities they work with. And then a lot of times those facilities that we're working with, when they need a sitter or they need somebody so they don't lose them, they'll call us and we can provide care by providing a sitter at a facility, or maybe they just need somebody overnight because they're low on their staffing and in the evenings. So it's a good partnership with facilities. Yeah, perfect.


So yeah, I was going to say that. So the other thing is if you have relationships with these facilities, like a lot of our home care agencies end up getting referrals, you know, so somebody who's in assisted living, but, or maybe even let's say if it's a continuing care, retirement community, maybe they're in more of an independent living, but they're kind of not quite to the level where they needed to be assisted living or nursing care, that kind of thing, but they might need some home care help. So you have now a relationship with them as your home care agency.


and you're probably the first person on their mind when they're referring. Has that turned out to be the case as well that you're getting referrals from those facilities that you place people in? Yeah, absolutely. Not only are we getting referrals, because it's kind of a two-way. We're getting paid by them for bringing them people and then they don't want to lose people because they need to go to a higher level or like if they're in the independent level. So yeah, they


really see us as a marketing side on their side as well, that they can provide as needed home care services. So yeah, it's a great two-way relationship. Yeah, perfect. So it's symbiotic, you're making kind of money and there's now like kind of two revenue streams from that. Okay, so I guess, you know, now you kind of, we've talked about how you figured out how to do it on your own and for your agencies and your geographies, but then you actually went further and you said, okay, well, this is a service that we've learned a lot about.


and we could actually create some software online that would help other people do this. And the software is called Placed, P-L-A-C-E-D, and the website is elde and that sort of thing. So if I were to sign up for Placed, then what am I getting in Placed? And how is that helping me as an agency trying to make these placements?


Well, what happened was as this side of my business, this revenue line started to grow, it became difficult to manage. I mean, for those of us managing a home care company, imagine having 30, 40 caregivers and not having the encoder platform or a platform to communicate with your caregivers and assigning shifts, right? You'd be constantly picking up the phone, answering text messages, looking at emails. There was no way to really scale. And so, you know, having...


the background and using multiple home care platforms like Encoda, we kind of took some of those similar functionalities, you know, and so we started working with facilities and about seven years ago started this platform called Place you mentioned that is very similar in functionality that you're, we've got right now we have 70,000 facilities in our database. Also about 50,000 referring facilities, the hospitals, skilled nursing facilities.


And so all of these assisted living facilities or memory care units, they have their own secure portal, just like the caregivers have their own apps. And we now, when we get a client or working with a client that is looking at a memory care unit in a certain zip code, we can, but through a text message or through an email, send them a HIPAA secure communication where they can look at the plan of care and decide if this is an appropriate patient or resident for them.


and then communicate back. So it's a really a quick way for us to communicate with facilities, then to communicate back with us, share information, and then share that with families. And allows us to really scale the business appropriately. And also all of our referral sources, hospital case managers, nursing home case managers, they have a secure landing page where they can, when they're working with family members.


They can sign on and send us referrals. And so those referrals dump immediately into our platform. And then we have a CRM that we can do marketing to both family members and clients and to our referral sources as well and keeping them posted on how things are going and stuff that we're doing. So yeah, so Place Evolved, kind of the same way you need a platform to manage the home care business, as this begins to grow and you start working with,


four to plus clients a week in placements, you really need something to grow and manage that business. So that's what Placed has become. Yeah, that's fantastic. So yeah, if I kind of try to bubble it down. So first of all, I have a directory of the facilities around me with your 70,000 that you've captured, it's probably likely chance that most of the facilities around me are right there. Second thing is I have the ability to


do like a CRM. So I basically say, okay, these are the prospects that I have. These are the people that I'm trying to place. So you have a way of tracking those placements and that sort of thing. You have a secure and HIPAA compliant way of communicating with the facilities. And yeah, and I think that one thing when you showed me a demo, it was, it's been a while back, but you also, you know, have some matching criteria, right? So, you know, so if you're really trying to find the


you can kind of send it out to them as you said and say, well, here is the information, is this a good match for you? But then you also, I think have in some cases gained information about what might be the more appropriate facilities to check in for this person. Yeah, go ahead, talk more about that. All the facilities have their own secure where they can put in all the features about their facilities, that it's, they've got private rooms, they shared rooms, it's just, you know,


a secure memory care unit, two floors, all the features that these facilities offer and amenities. And then also all the services that they assist with, medication administration, bathing, dressing, transferring, toileting, all the things that the features, I mean, the services that they provide, well, our software that builds a plan of care and uses those same features or services in creating care plans. So we're gonna look at


What are the services needed? Yeah, and what are the services provided? And so it looks and says, okay, what's the best match both for services, for amenities and features on a facility and also reimbursements. And then, you know, we show that to our clients that we're working with. And then of course we tour all these facilities before we go in, right? And so we've got boots on the ground. We know the marketers, we know every relationship with them and we do an assessment. And so the platform has an assessment.


thing on there, much similar to like a five star rating scale that Medicare does for nursing homes. And so you're able to do an internal assessment. And then 90 days or 60 days, 30 to 90 days after they've been placed, a patient satisfaction survey goes out to either a family member or if there's no cognitive impairment and the client you placed wants to do those surveys, we collect patient satisfaction surveys, you know, by


uh, about the facilities, uh, from those that we were working with. So let me share it. And you can share that information, you know, with other clients, you know, not that person's, but as overall, we've placed 10 people in this facility and our rating was a 4.5 and the satisfaction rating is a, it matches that with a 4.8, you know, and so, so it's not just us, but it's what our clients have said. But in addition to that, you know, we also contract readmissions into hospitals. So if you've.


got somebody who's coming out that has heart failure, let's say, you know, and now the hospital's being held accountable to readmissions within, you know, 60 days or 90 days, right? Then we have a platform where you can do these readmission services and it will then trigger warnings of, hey, this could be a possible readmission to help prevent that. And then when you've finished the 90 days, if they haven't been readmitted, then there's case managers that refer the business to you, you can.


send them a report on how well their clients are doing and how much you as an agency are helping them achieve their goal of reducing hospital readmissions. Okay, so it was great. We were talking a little bit more about how we have the matching, we have the criteria. I thought it's great that you sign up or you probably use certain sources to find the facilities, but then you give the facility the ability to tell you more about what they provide and how they provide and what


that kind of thing. So I was with you there and then I was actually going to ask specifically about kind of the readmissions thing. So I know like taking a step back that hospitals for the last seven or eight years has been some legislation that said, hey, if you discharge somebody and they have a readmission, then that's something that kind of affects your reimbursement and that kind of thing. So I guess I'm a little lost though. Like how does the either the home care agency or


deal with the readmissions thing and how it is placed to help with that aspect. That kind of just didn't, it didn't quite crystallize for me. So, you know, for, you know, hospitals, left now hospitals that they'll identify according to Medicare standards, you know, 10 to 12 different disease states, right, where, you know, they're at higher risk for readmissions, right? And so Medicare actually pays clinics and they're become transitional care management clinics, right? Um, there's I think two or three different ICD nine codes where physicians are actually getting.


paid or clinics are getting paid to provide transitional care management. So, and it's basic stuff that we, as a home care agency, most of us, we're doing these services anyways, right? So when we sign, when you sign somebody up for services and you place them in somebody in an organization, whether it's the person that's placing, that's helping them with the placement or, or maybe you've got a nurse on staff, you know, cause remember a placement, a lot of times in Washington, a placement is $8,000 in revenues, you know.


know, build 30 days from now. So the margins are really, are, are, are, are, there's a lot of margin and room to have somebody help manage this process. So when we play somebody in, you know, within 48 hours, we try to give a phone call, you know, to the family member and just ask some basic questions like, Hey, how was your discharge? Do you know your plan? Did you, you know, did you, somebody review your discharge orders with you? Do you have your medications? Do you have your, uh, durable medical equipment? Right. Do you have a doctor's appointment set up? You know,


some basic questions there, if they don't have their durable medical equipment, right? If they don't have their medications, there's a higher chance for a readmission, right? And so you can flag that in the software as you're collecting that information, and then it'll send an email directly to the onboarding person at that facility that, hey, we just completed some of our readmission prevention services. And it looks like they're not aware of their medications they need to be taking, and they don't have their durable medical equipment. You may wanna follow up with them, right?


And so those are things to help that. And then a week later, you're going to follow up again and find out, Hey, did you make it to your doctor's appointment? How are things going? Do you have those things? Um, have you gained any weight? Some additional questions. There's about 10. Um, and then, so that's a good checking point at about the 10 days to 14 days. And then at the end, the 30 days, we just follow up with a final call, you know, asking pretty much the same questions. Um,


And if they're not readmitted and they don't have any problems, you know, you complete the survey and it immediately sends a, an email to the referral source, the, saying congratulations to referral sources. Yeah. I mean, you, your, your referral you sent us has completed our readmission prevention services and they were readmitted and thanks for your trust in us. And, um, and we'd love to service more of your, your, your clients. And then it does the same thing to those hospitals. I mean, those, those, um, assisted living facilities.


letting them know, hey, great job in providing care for our client, you know, and, and, and, and helping keep them safe at, you know, in your facility. So, and then you can generate all types of data and rep, you know, give that to your referral sources. And so you're really bringing good value to your referral sources, good value to your clients, because you're providing that service to keep them home, keep them in that facility safe and then to your agency. Yeah. So.


Yeah, so as we talked in the beginning, I mean, you're getting that placement fee and wow, I mean, $8,000, that would be like, you know, that I had no idea those fees could be that high. So that's really impressive. And then we talked earlier about now you would have the relationship with the facility. So they're probably referring to you for home care. And then they could also, you know, as part of your service, you could make sure that those transitional care activities and like some of those, you know, tenants of, you know, high quality transitional care, making sure that we have


the right meds, we have the right care plan, we have our DME, we have a follow-up doctor's appointment, all those kinds of things. You can assure those as well. I totally get it. Okay, so before we started recording, I asked you, because I had seen on the website that you kind of referred to an agency that I think in their first 60 days working with you, they did a large number of referrals and I think it was 100,000 in placements in


60 days. So like, you know, I mean, you know, without giving details, like, I mean, that's somebody who also does home care, right? And like, you know, so, yeah, I think that this agency that we were working with was doing, you know, they've been doing home care, they were in business for about eight to nine years, they've been in business for quite a while doing home care. And, you know, I know the owner and good friends, and he was asking me what I was doing, and he was interested. And so he just went to those same referral sources.


You know, and said, Hey, we're expanding and, and now we're, we're, we are providing full con senior consultive, you know, services, senior care services, whether they need placements or home care. And within the first 30 days, he had received, I think it was about 44 referrals, um, uh, that month for placement. And he got a handful for home care as well. Cause he continued to always get home care, but specific placement referrals, about 44, uh, uh, referrals.


And inside of the first 90 days, he did $100,000 in placements. Uh, that was about a year and a half ago. And at this point now, that company just hired their second placement person on, uh, or senior advisor, you know, whatever you want to title them. Um, and they're doing well over a hundred thousand dollars a month in placements. Um, so they've really been, uh, become to this, the referral sources, that full service senior care company. Um,


where now they just go to, they kind of have one person they can go to. They don't need to think, okay, here's the person I send my first replacements and here's the idea of my home care. And then, then there's the existing home care business as well that you naturally would lose because they are, you know, moving out of home care to, to, to placement. So it's been a great addition. And since then, in the last year, we're, we're growing rapidly in, in agencies using our platform.


Yeah, fantastic. So let me, I mean, you know, a lot of times I think when we on the podcast here, we share a growth idea. Yeah, I think a lot of agencies are, you know, there's like an inertial thing there. It's like, you know, hey, we do home care, you know, I mean, this sounds different, you know, that kind of thing. I mean, we looked at the home care pulse report, and we know that, you know, depending on your geography and your size, that, you know, most home care agencies are making pretty low margins on home care.


But when you kind of gave that example earlier, it sounds like with the bringing on a second person, so it's really been kind of one main person doing this placement service and their revenue is about $100,000. I would imagine that this placement person is not making $100,000 a month, right? So as compared to the caregiver who probably is making two-thirds of the revenue, right?


of the hourly wage that you're collecting for the home care, you might be paying that out to the caregiver. So I guess for people who are saying, I'm not sure, I'm not sure, what are the margins like that you're seeing on the placement side? Well, it's interesting because what happens is usually when you start offering this service, a lot of times you'll set aside a percentage of, and it can be very lucrative for your placement specialist that's in there.


40%, you know, even up to 50%. You know, so if you've got somebody who has great relationships with referral sources and you're making, you know, some, you know, on the, on the average, I think the average is a national association that you can, the placement companies that work with, I think the average place is about four grand nationally. Right. You know, so, um, you know, we're talking $2,000 going to the placement rep and another 2000 going to, to your agency. Um,


But as you grow though, what happens is, and I've seen some other companies that we've brought on, you know, they then really, they bring on a nurse full-time or licensed clinical social worker, right? And they come on at their regular nursing wages and rates, you know, and so now you have a more of a flat fee service, you know, where the nurse or the social worker that's working with these, with the family to do the placement, you know, they're kind of flat feed, maybe with a


Um, but your marketer now is going out and marketing and getting, picking up home care, and they're also getting, picking up placements and now they're getting paid a smaller commission, like a 10% commission, you know? And so as the referral source comes in and, you know, you're able to scale and make those margins where there's 60, 70, 80% margin on top of, of it, when you're getting into the point where you're now billing in, some of these agencies are doing $2 million in placements a year.


Yeah, unbelievable. Yeah. And you know, and I use the term I think earlier, as we were talking here, you kind of called it full service in your care. So really, you know, you're kind of expanding, you know, not only do we do home care, or a lot of the audience now of this podcast is also people who run day centers, and things like that. But not only you're doing home care or daycare, but you're providing a more complete service, you know, and you might find somebody who say, Hey, you know, the right thing for you now is the day center, the right thing for you is


you know, for you and your family is to have somebody in a facility and you're providing more of a service, you're becoming more of a resource to your community and that kind of thing. So, I mean, this is, I think it's a home run. Rob, I'm really, really, really glad that you shared this with us today. So I think we'll bring it to a wrap up. I, you know, so let me just say again, one more time, thank you to Robert Christiansen, Rob, and also, you know, if you'd like to learn more about this software that can really help you jump start in this business.


Go to the website. It's ElderCarePlacementSoftware.com.  That'll take you right there. And you can get in touch with Rob and his team and get a demo of the system and, you know, take a take a serious look at adding placements and really adding to the capabilities of your agency. So with that, thank you so much, Rob Christensen. You bet. Thanks for having me, Ken. All right. Have a great day. You too.


Thanks for joining us today on the Home Care Heroes and Days Service Stars podcast, produced by Ankota. You can listen to back episodes by visiting 4HomeCareHeroes.com. That's the number 4, then the words HomeCareHeroes.com.


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