Nicole McBee has worked with over 300 home care agencies, many in her home state of Missouri but also many in Michigan, North Carolina, Florida and other locations. Her expertise and bubbly infectious personality are unmatched. In this episode of Home Care Heroes, I learned that Nicole likes to organize her advice into 3 part plans.
Since we share a lot of customers with Nicole in Missouri, we tended to talk about Missouri Medicaid home care a great deal, but as you'll see from the outlines below and listening to the episode, her advice applies nationwide.
Nicole's 3 Pillars of Home Care Consulting:
- The Business, and
- Recruiting and Retention
Nicole's 3 phase plan to rolling out systems:
- Electronic Visit Verification (EVV) first: Get your schedules clock-ins and clock-outs flowing smoothly
- Payroll: Next have your EVV system flow to your payroll
- Billing: Nicole said "If your butt cheeks are in the seat, your not out caring for your caregivers."
You can reach Nicole on 314-650-6712 or visit her website at www.newdayconsult.com.
Home Care Heroes is produced and sponsored by Ankota - the Software for the Heroes of Home Care. We truly embrace the notion that caregivers and home care companies are heroes. Our top priorities simplicity, caregiver retention and outstanding service. Visit us at https://www.ankota.com.
Ken Accardi (00:01):
This episode of home care heroes is mostly about startups and Medicaid agencies. We feature a consultant named Nicole McBee who has helped to launch over 300 home care agencies.
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 (00:27):
Today's episode of home care heroes. Today, we have a very special guest. Her name is Nicole McBee. Nicole is a home care consultant out of the state of Missouri. Her company is called new day consulting and the website is new day consult.com. Nicole has helped launch over 300 home care agencies. Many of those are in her home state of Missouri, and she works with a lot of agencies in Michigan. And I know that we talked to her about agencies in North Carolina, she is helping and Florida as well. We have a rock star on the show today, so welcome!
Nicole McBee (01:02):
Thank you so much. It's a pleasure and honor to be here with!
Ken Accardi (01:05):
And we're going to jump in. And before we started recording today, you were telling me that one thing that you start with when you talk to an agency is a concept of three pillars. So I won't even say any more, just tell us how that helps with Home Care Agencies.
Nicole McBee (01:19):
Sure, absolutely. So the very beginning with home care agencies, whether they're startup or they've hit that growth spot, or even if they're mature, we are always going to say, let's look at these three pillars and make sure that we're working well within our state and one being that we are compliant. It is what we're mandated to do , is actually knowing the business of the business. As I mentioned to you, Ken, I get a lot of clinicians. I get a lot of registered nurses, a lot of caregivers who start home care businesses because they want to do something. They want to offer something different to the marketplace and we love them. However, we must maintain the business, understand our financials, and understanding recruitment. That's actually the third pillar: maintaining staff with high turnover ratios with caregivers, especially with COVID. We have to figure out all three of those avenues and try to work within them.
Nicole McBee (02:15):
So I get business owners who say, well, I'm solid and we're not going to be strong in every area, every area of our business. However, we do need to say, okay, when we look at the business spectrum, the finances, our partners, our systems, where are we at? Are they working well? Or are we always in damage control or are we proactive versus being reactive? When we're looking at employees and staff, we want to know, if we are recruiting, retaining and onboarding individuals that are going to be quality individuals, quality caregivers. Even if we think about it, we have to look at ourselves and say: "hey, what's in it for me?" Many of these individuals are your minimum wage workers. So what are we doing to take the time to offer them more? Or we all three insurance, disability insurance, Aflac is available. It's payroll deducted. It's not that much work for business owner or their accounting team, but it also is a sign that you care. Are you offering paid days off or are you offering sick leave? And these, again, these are things that you can do of course, plan ahead that you can do to say, Hey, I can have a client. I can have a client and a caregiver, and it's a great team and we can move forward with so many things.
Ken Accardi (03:42):
You really have to start with compliance. We have to get our back office, right? We have to have our policies and procedures to know what we are doing, know how we're going to pay our bills and have money come in and, and keep track of our finances, all those kinds of things. That's our compliance side that you work with a lot of private pay, as well as Medicaid agencies and the Medicaid agencies have to comply with electronic visit verification. And it's not very easy to go and bill. I think that that's a really great start. It's to say, a lot of our owners, start as a nurse or a caregiver themselves. And they say: hey, I could do this. I could run a business. I have the ambition. Maybe they have their focus. I really know how to care for people, or I really know how to sell, but , whatever your strength and your focus is, you've got to do the back office and the compliance, and you've got to get it right. So I think that's a great place to start.
Nicole McBee (04:32):
For compliance. This is what I always say. I tell every business owner, think of this as a franchise. We're going to repeat the same processes every single day. We're going to have checklists. We're going to run drills. We're going to do self audits. A lot of owners they're newly self-employed. It gives them a false sense of freedom. And I say that because I was in that, in that space at one time or another. And so we say, Oh, well, I can put that off tomorrow on what I can do today. No, let's go through the drill. So we're doing this and one o'clock every day. And if it's going to happen at one o'clock every day, Monday through Friday, it has to happen. It's a great way to say we can set aside the time to do it now so we don't falter later.
Ken Accardi (05:21):
That's so right on. And I really appreciate that. Yeah. And I do think that you get this, as you said, this false sense of freedom. We can do what we want, but really you have to have that discipline and having the checklist and the procedures and sticking to them and running through the drills every day is even though you're your own boss, pretend that you have a boss, who's making sure you do all those things. That's a great plan. Okay. So then pillar, number two, of course you said was the business, and you mentioned a few things in there. It's like, hey, we're in this for ourselves. And then we're starting a company because we want to, we're doing good in the community. We're helping people, but we want to do well by ourselves. And we want to make money in our business and succeed and thrive.
Ken Accardi (05:58):
Let's dig a little bit deeper into the business here.
Nicole McBee (06:01):
Yeah, absolutely. So what I'm finding is that business owners, they haven't attained a general counsel. And that's my first question. As a consultant, when I walk in, I want to know who's your attorney, who's your CPA? Do you have a personal relationship with a banker? And I'm a banker, I'm a former banker. All of my customers have strong relationships with me, they can call my cell phone and we can get things done. When that foundation is not properly laid, you're always working in damage control. So with that being said, those are the first things we want to know who are our partners, because now we're on an Island by ourselves and there is no pick up the phone and call the help desk. We are the help desk. We are HR. We are payroll.
Nicole McBee (06:49):
We are counseling where everything is all rolled up in one person, and that can be overwhelming for a business owner, especially solopreneurs when they're on their own. If they haven't yet built out a team. And that also leads me to building a team. You're only as good as your team. You're only as good as your team. And it's tough because you've invested this money into your business and you want it to do well. And now you're having to leave basically your baby in the hands of another person sometimes, but have that foundation understand what systems you're using. And I'm really big on systems because a lot of things can be automated and it'll save you some time. So when you have partners, and this is again, the business of the business, when you have strong, solid partners with good advice, when you have business consultants, such as myself, who's going to give you practical, real, straightforward advice, and also willing to get down and say : hey, tell me the document outside as well.
Nicole McBee (07:49):
I don't want to just be a mouthpiece. Let me also put my hands on it and let's tie it a bit. And let's also, seek advice when needed, but then also having systems in place. When you have systems in place, you're not fumbling. You're not fumbling to say, what am I doing for payroll? What am I doing? What am I doing for billing? Have the systems in place, utilize the systems early, especially for startups. I tell startups all the time. Don't wait to call Kim after you already got your first client, call before. And those are the drills that I talk about was even with systems. I was , Hey, put a dummy person in their practice. The demo is great, but practice. You should be punching in and out as if you are a caregiver yourself, even before you even would let the caregiver use the system, you should have used it.
Nicole McBee (08:40):
You should know that all the nooks and crannies and the quirks, and don't press this too soon press that later etc... You should know that you should be able to inform your caregivers on how to utilize it. And also you don't want to be taken by surprise. My biggest thing is that you can only be surprised once anything else you're just unprepared and you don't want one surprise, that's it working at the business of the business, because again, and I say this over and over again. Yes. Our mission is to care for individuals for vulnerable populations. Yes. We're taking care of seniors, developmentally disabled. We're taking care of children. We are there. Our heart is already there, but let's also make sure that our business is fundamentally sound so we can do our job.
Ken Accardi (09:28):
This is great. I mean, we have three pillars. I'm going to save the last pillar of recruitment and retention for last, because home care heroes is all about this big battle for recruiting and retaining caregivers. We'll come back to that. We're going to end with that one. But I love the fact that you brought up systems and with Ankota on home care heroes, we are a software company, but we try really never to talk about us. But the way that I got to meet Nicole is that we started getting these customers. And I said, well, how did you hear about us? And they said, Oh, well, we heard about you from Ms. Nicole McBee. They say, I mean, you're one systems. You really know how to do everything we need in our state. We do have a lot of common clients, that kind of thing in Missouri. But I'm going to put myself on the spot here. When we spoke the first time we actually spoke live, you said, you know what? All the customers I've referred to you are really doing well. But one called me and said, Oh my gosh, they're trying to do a little too much with me here. You gave me a little counseling. One thing I picked up about Ms. Nicole, she's about the power of three, right? So we have three pillars. You basically have a three-point framework for implementing a system. So let's talk about that.
Nicole McBee (10:32):
As a consultant, I'm there to treat the business owner in the business in a holistic fashion. So I have to eliminate some of that anxiety and build confidence at the same time. So there's this emotional and mental phase that I'm working through with each individual owner, as well, even before we can talk about a system. So often what happens is there's a sales rep and we love our sales rep. The sales rep is saying, Hey, you know what? I want to get everything. And I want to get everything in one time because you need these things. And a great sales rep is going to do a needs analysis. And based upon the questions that are asked, they're going to determine, okay, yeah, you need not only EVV, but you need also some assistance with billing and also payroll.
Nicole McBee (11:18):
And we can package this and give it to you and we roll it out. And we punch you with all of it at one time, and we want to train you, boom, boom, boom, boom, boom. And that is completely and utterly overwhelming. So when I say implementation, I always say again, we want you to have all three. However, when you're looking at systems and a person is presenting packages, and they're saying, these are all of the lines of services that we can offer you, is that we become proficient at let's address. Our occurred in immediate need. And if the current and immediate need in the state of Missouri with a new mandate is that you must have an EVV system in all caregivers, not some. And I'm going to say it again. All with with a big A must be utilizing either clocking in on the caregiver's phone, a landline phone, not their cell phone, a land line, phone, an app, or some device, a FOB or some device that can be left in the home.
Nicole McBee (12:24):
So we need to address those things first, make sure that you understand the mandate, the law, that's the complaint. There's no getting around that we can song and dance all day and all night. So we want to, implement that first let's implement EVV. The next thing is going to be payroll. The payroll should roll next because there, the question is I have the time and I've collected the time. How do I process the time that should be rolled out two to six weeks later after we've gotten all of the knowledge we can give from the EVV system. Now I'm going to definitely say, make a commitment. You want to make sure that you are getting a rep. That's going to train you in that there's time allotted for each business owner. Then the next thing is going to be the billing, because again, we need to free you from the desk. We love cheeks in the seat. However, we're going to talk about retention and recruiting. You can't be in the seat billing all day and all night on a Friday, purchasing more of the software is a benefit to you and to every business owner, because it gets you out of the seat and into the community.
Ken Accardi (13:30):
Let's just make sure we're hitting our whole audience. A lot of our audience is private duty. They're like, what is this EVV thing? So electronic visit verification. If we're billing any government payer, I mean our biggest one being Medicaid, but also veterans administration, County programs. Any of those types of programs, we have to comply with this. What's called the electronic visit verification mandate. And that came out of the 21st century cures act. So that was actually the bipartisan legislation toward the end of the Obama campaign. And what it basically says in a nutshell is that when you do your home care visits, we need to know that you're not committing fraud, right? So that's kind of what it says in a nutshell, but what it comes down to is we need to know what was the date of service, the type of service, the person receiving the service, the caregiver at the exact time in and time out.
Ken Accardi (14:22):
You can't just tell us, Oh, we did a three hour shift and we also need to verify that the location. So basically we need to verify that the caregiver was at that location. And the way we do that, and the call went through, this is one is with a traditional thing in home care, the voice telephony, where we could call from the client's home phone or the other way to verify is with GPS. And so that would be that the caregivers clocking in and out on their cell phone and we're using the, the latitude and longitude where they it and out third way that it sometimes gets done is we do this token device called a fob. I really liked the way that Nicole has outlined this. She's , let's get everything under control. So we have our schedules are cocking in and our cotton out in place, and we have our records and everybody knows how to do it.
Ken Accardi (15:09):
And then we can move on in phases. We need to do billing acts or payroll next, but we have to do one, two, three, and knock them out. And interestingly, in every state, the Medicaid program is different. And in Missouri, I would say most of the startups that we deal with they're in a program that's called the consumer directed services program. And in the consumer directed services program, the person receiving the services is from a tax perspective. They're their own company. And it's like, they're the one who's paying the caregiver. So doing payroll and being able to do the payroll taxes is complicated. Then the third thing of course, is that the billing in Missouri, I mean, there's a lot of complication to it. And we have to know that our personal care and our nursing get billed to one cost center and our home making and respite go to another cost center.
Ken Accardi (15:59):
And that lesson learned, and here I am on the podcast for the world. We haven't been perfect with some of our customers is that we're so excited that we're handling these hundreds, thousands of clients, agencies in Missouri. And we're like, Oh, we figured out all these tricks to make sure you use all your units in the month. And we've made sure that it's really easy to clock in when the visits are back to back. And and Hey, if the, if the caregiver only works an hour and 58 minutes, there's you can't, you can only bill an hour and 45, but you can hold onto those extra 13 minutes and, and build it the next day. If you work. And the lesson learned from this whole thing with Nicole , is break it down into phases and get them up and running with their scheduling and their clock ins and outs, then move on to your payroll and get all that straight.
Ken Accardi (16:43):
Obviously, the most important thing we do is, Hey, ourselves, pay our caregivers. And then of course we can't pay anybody. If we're not billing, we'll stick with the Missouri example, we have to bill for five clients. There's this portal from emo med, the electronic, Missouri Medicaid system, where we can log in and we can bill for five clients. And it's not going to take us a whole bunch of time. Now, once we get to 15 clients, once we get to 30 clients, 50 clients, a hundred clients, and now we're running a two and a half million dollar business. Nobody's going to want to be punching any hours in the moment. But I really like the fact that Nicole took us through this and broke it down into the three days. And so I've been rambling for a while and I apologize for that, but yeah. Why, why don't you how can you help me with what I just said? That I, that I get most of it.
Nicole McBee (17:25):
Yeah, you got it. All right. You definitely got it. All right. And even for the private duty agencies, their family members want to know, Hey, give me verification that the caregiver was there. And that electronic visit verification system gives that reassurance. It gives that peace of mind. It gives them that money's not being wasted when they're paying from their insurance funds or from veterans or even out of pocket. Family members want to know that they're getting what they, what they're paying for. And so it becomes very important. And can you hit it out the park? Absolutely. It's actually just having that power of three and just taking baby steps. The best way to eat an elephant is one bite at a time.
Ken Accardi (18:07):
Perfect. All right. I think we're going to call this webinar episode. Something like the power of three with Nicole McBee and we'll get the rhyme and everything. So I did say that I wanted to swing back to the third, one of your pillars, which is recruitment and retention as a consultant, as strong as you are. And with as hard as it is to recruit and retain caregivers, what are one or two ideas or maybe it's Nicole. So there might be three ideas.
Nicole McBee (18:34):
There was definitely three for RNR, for recruitment and retention. There's RNR with perfect because there's three reassurance. So whatever caregivers you have right now today, you reinsure them. That they're the most important individuals. That's a text message to say, we're proud to have you on your team. Thank you for taking care of Ms. X. Reassurance. And it's the most human thing to do. And we often forget it because we say, Oh, well, we reassured you with a paycheck. No, they did their job. You gave them a paycheck, but to just acknowledge them, people forget what you say, but they definitely won't ever forget how you made them feel. So if you made me feel good about me doing a good job, and I may have been sucking that day and in this balances out, I could have been using that text message. I probably was late.
Nicole McBee (19:24):
The tire was flat. I kicked the dog, a thousand things going on. And that text message comes, changes. The dynamics of the day is what I've heard from caregivers. And then I've had caregivers that are, near perfect. We love them. But the text message comes and she went above and beyond even more that day. So just to acknowledge a person and reassure them that they're doing a great job. The next thing is, let them know that you care monetarily. You don't have to pull out these whole thing for bonuses, but $10 for lunch goes a long way. If it's just a random, Oh, well, we're going to pick one person per week and we're going to buy lunch, or we're going to give them a gas card, but money talks. And I'm going to just say it. And it doesn't have to be a huge amount.
Nicole McBee (20:12):
And then also acknowledgement programs. So acknowledgement programs lead to performance based duties. So if you know that you have a person that's struggling, what you do is you do, if you were in competition of who's clocking in the best, you can put your name in the bag for raffle for it. For a $50 microwave. It doesn't have to be again. We are all being mindful of budget, but these small things that we think sometimes are not much are huge for a person to be at their local store saying, Oh, my job gave me a microwave. Ironically, mine just busted. That's where I got it from. I was literally standing in target and the young lady was holding the gift card in her hand saying her job. And I noticed she was wearing scrubs. And I asked a question, I'm like, where do you work? She told me she worked at a facility, but she was like, it was so crazy that I won. And she said, my microwave had just busted. And I was like, well you been doing something great gir! And so those three things are huge. Acknowledge, reassure do programs. When you can add benefits add have benefits. Benefits sell. They offer a day off, just get a replacement worker and say, Hey, you know what? Next Friday, last Friday of the month, it's a pay day off enjoy.
Ken Accardi (21:31):
I love it. Interestingly, on the private duty side, there's this resource. And actually a lot of Medicaid agencies don't know about it. It's called home care, pulse and home care pulse. One of the things they do, they put out this survey every year that helps companies benchmark themselves against others. And interestingly, there's a big section on caregivers. And if you look at the area, that is why do caregivers leave and and caregiver satisfaction, the power three. I wrote them down a little bit differently. I wrote reassurance for the first one. I put recognition for the second one. I put rewards for the third ones. I won't the three RS. If you look at that home care pulse survey, they have a page of the top 10 things about six of them have to do with communication. And even that really reassurance is just as simple as, Hey, thank you for being a caregiver with our agency.
Ken Accardi (22:18):
It lets that person who, by the way, never sees you. And especially in COVID, they never see you. All they see is their, their client and their caregiver and hopefully their paycheck and that kind of thing. But I mean, it just lets them know that they're delivering for your agency and that you've got their back. And I think that's a great place to wrap up our podcast for today. So with that, I've enjoyed our time together and I've enjoyed everything I've learned from you. People want to get in touch with you. How can they go about doing that?
Nicole McBee (22:47):
Sure. So I can be reached by phone (314) 650-6712. You can also check my website. It is www.newdayconsult.com. You can sign up. You can also get me on Instagram and Facebook under Nicole McBee. There's only one Nicole McBee in the state of Missouri. So you can definitely get me through those channels.
Ken Accardi (23:15):
Listen, Nicole, thank you so much for being here today on a home care hero. This has been really, really enlightening. I think you're really going to help our listeners a lot. Have a great day. You too. Thank you.
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.com.