The defining challenge of home care, long term supports and services, and day services is recruiting and retaining caregivers.  One of the big recommendations that we hear regarding retention is to create career paths, but at the same time we struggle to make a reasonable margin at the rates that we're able to charge.  

Today's guest, in his 3rd appearance on the Home Care Heroes and Day Service Stars podcast, is Steve "the Hurricane" Weiss, the CEO of the consulting firm Home Care Evolution. Steve's organization is one of the preeminent home care coaching and consulting organizations in the US.  I had the privilege to attend one of Steve's Home Care boot camps and a specific session, on the topic of "Care Coordinators" resonated strongly with me.

Today's episode dives into the way that adding care coordinators to a home care agency does three key things: 1) It creates a career care, 2) It results in a differentiated level of care, and 3) It gives you an opportunity to charge more. 

The term "TRIFECTA" comes from betting on horse racing. To win this kind of bet you need to pick the first place, second place and 3rd place horses, in order.  So the connotation is that a Trifecta is a big three-part win.  Some of the key concepts addressed in the episode are as follows:

• Having Care Coordinators creates a career path within your agency for the right kinds of people
• These coordinators ensure that the client's needs are well understood and that the caregiver(s) are well-prepared to do an excellent job
• Since the best home care clients have complex needs, having a coordinator check in regularly makes sure that the care is evolving with those needs as they change.
• Another key benefit is that unlike your competitors who will start recruiting for a caregiver once they close the client, your coordinators have flexibility in their schedules to start care right away and meet families right away when opportunities present themselves
• Yet another benefit is that junior caregivers are supported and know that a senior team member will be visiting regularly to help them. This cuts down on cases where newly trained caregivers feel overwhelmed and quit
• Lastly, having coordinators results in a premium service that you can charge for.  Some agencies justifiably raise their rates when they have care coordinators and others charge separately for the coordinators, and families are willing to pay.

Despite this episode being a deep dive into care coordination, it really only scratches the surface. Home Care Evolution will provide a free consulting session to your agency on this topic or many others.  Plus, as I said, attending one of their boot camps opens your eyes to many ways the best agencies are thriving.

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:

Steve the Hurricane is one of the best home care experts that we know. Today's episode is gonna have Steve doing a deep dive into an awesome topic called care coordinators. This is a way that your agency can create career paths and provide better care and make more money in the process. I think you're gonna love it.

00:36

Hi everybody. Welcome to another episode of Home Care Heroes. We have a very special guest today. It's Steve the Hurricane. Steve was actually the very first guest on the very first episode of Home Care Heroes. And since then, a lot of things have happened with Steve's organization. I've actually had Melissa, who's one of Steve's great coaches at Home Care Evolution has also been on the podcast. And one of Steve's dear friends and a great associate, a guy named Nick Bonetotapis, put together an amazing episode on video marketing.

01:04

And so it's always great when we could talk to Steve. It's been a while. Another crazy thing that happened, which was great for me is I got to attend. One of Steve's boot camps, which was actually called a millionaires bootcamp. And, you know, and I would say that most of the room was people who are already making a million dollars in their home care agency, but also folks that are on that path and really wanted to accelerate that path. So that was very special for me. And actually this episode is going to be a follow up to something.

01:34

that really kind of resonated with me in that bootcamp was a topic that Steve talked about, which is introducing care coordinators into home care agencies. And with that, let me first of all, Steve, welcome. Thank you so much, Ken. It's a pleasure to be back here in 2024, man. I cannot believe that that is where we are right now today. It is, yeah. And

02:01

Crazy, it's great to see you. I mean, where last time I saw you face to face was pandemic, just coming out of pandemic. And I mean, we're in a better world. I think 2024 is gonna be a great year for home care and we're really, really happy to have you. But yeah, let me dive in. So this idea of care coordinators really struck me and because it was a way of creating career paths in your agency.

02:28

getting clients earlier, increasing revenue, getting clients kicked off on the right foot. It was really amazing. And a lot of times, you know, I think a sentiment that I have and folks have is, I can't afford to pay people more. I can't really afford, you know, how could I have a career path and that sort of thing. And there were just so many wins in this that I got really excited about it. And that's what we're gonna talk about today. So Steve, why don't you start telling us a little bit about this idea of having a care coordinator in your agency. You know, Ken, thank you so much. It's...

02:57

It's ironic. 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 Acardi. What happened for my agency is we went through this rapid expansion. And as we went through this rapid expansion, where we went from having, you know, a dozen, two dozen patients on our census to, you know,

03:24

50, 60 patients on our census. And the way that I was out marketing myself to generate these referrals, I was bringing on medically complicated, sick patients that needed a lot of hours. What we found was most caregivers needed additional support to manage these difficult patients. And so out of necessity, we created this position that I now call a care coordinator.

03:54

And once I started my company, then my new company, Hurricane Home Care Evolution, I started to realize that as I was growing my patients, my clients' patient census, they started to need help supporting their caregivers. And that's when I put together the training on how to create these care coordinators who are essentially field service managers. They're managing the care that's given to the patient. They're supporting the caregivers.

04:24

They're helping to make the relationship between patient and caregiver a strong one. They are the main point of contact to the patient's families and they're the liaison between the office and the caregiver so that everything, they're kind of like the glue that holds everything together, patient, caregiver, agency. I love it. Well, that's a great, great start. So first of all, the first thing that that gives you is a career path.

04:54

And so who do you pick for this job? I mean, who's the right person to choose the care coordinator in your agency? So something that I always gotta give credit where credit is due. There's a fantastic book I read last year called Radical Candor and the author is Kim Scott. Now, Kim Scott is a former CEO for Google and she worked with Amazon and all these other high level, huge, huge, massive business entities.

05:21

In that book, she defines there's two different type of workers. You have your rock stars and your superstars. Your rock stars are people who are excellent at what they do. And the idea of advancing and promotion does not attract that type of a person. Let them be good at what they do. Then you have your superstars.

05:45

who are like a rock star, excellent what they do, but they want the ability to advance, they wanna be able to move up, they wanna challenge, et cetera. In the caregiving world, we being home care agencies and hospice agency owners, we have caregivers that are rock stars and caregivers that are superstars. Your rock star caregiver, let them be a caregiver, the thought of advancing and moving up, they wanna be a caregiver, they're excellent at being a caregiver, that's for that person.

06:13

Your superstar caregivers though, are ones that are excellent at being caregivers and they want an opportunity to advance. They wanna try management. They probably would be good at management. They'd like to get beyond the caregiver point, but they've mastered it first. That's the person that I recommend agencies promote to becoming the care coordinator because there's somebody who's mastered the caregiving position. They've taken care of a numerous amount of patients.

06:43

And when you think about a care coordinator being someone who is bridging the relationship between patient and caregiver, being a caregiver themselves will help them relate to caregivers. Having worked with multiple patients themselves will help them to bridge those gaps. So I recommend a superstar caregiver be someone that gets promoted or hired to become a care coordinator.

07:11

I love that. Yeah, that makes a lot of sense. I've never, I hadn't read that book. So I'll put that on my list and I'll mention it in the podcast notes for radical candor from Kim Scott, uh, rock stars versus superstars. That sounds great. Yeah. There's a, I can't think of the name of it, but there's a, the something principle is, is something that's applied to people who you take them out of their good job and make them a manager and they don't like it. And, uh, yeah, so I can't, you know, but this sounds like it hits it from a very positive perspective and makes a lot of sense.

07:40

So here's the thing. So a lot of the agencies are, you know, they're maybe like, especially these Medicaid agencies, they get, okay, this is the task for Mrs. Johnson, you know, she needs a bath or a shower, she needs some dressing and grooming, she needs some, you know, breakfast and lunch, and that kind of thing. And other folks, you know, maybe they just kind of get that list, they brainstorm with the daughter, you know, what do you think your mom needs and all that sort of thing. So what does a care coordinator do?

08:09

that raises the bar on that. So the biggest thing about a care coordinator and when you need to have a care coordinator, it's when you're dealing with medically complicated patients. Now granted, I know a lot of agencies out there, you know, non medical, right? custodial care. That doesn't mean that they're not taking care of somebody who's very needy. And I'm not saying needy like they need. But you know what I mean? They have low acuity.

08:39

So they're not able to walk, they're bed bound, they are incontinent, they're wearing a diaper, they need help with physical therapy, assistance to do it, assistance to transfer, assistance to walk. That's a lot of needs for a custodial worker. And a custodial worker, a caregiver, when you think about the training that most caregivers get from a professional schooling standpoint, and yes, there's plenty of online digital trainings, and there's plenty of

09:09

continuing education, but that's all digital. It's not reality until you physically have to do it, right? So when you're dealing with a medically complex patient in their home, unsupervised, you're not in a nursing home, you're not in a hospital, often the caregiver feels she or he is not trained adequately to manage this patient. This causes caregivers to walk off cases or turn down work.

09:39

because they don't know what to do for this sick patient. And they feel it. Like caregivers are good people for the most part, right? Enter your care coordinator. Your care coordinator has experience. Your care coordinator knows how to transfer somebody. They've done this because they've taken care of multiple patients themselves. They understand working with dementia. They understand working with somebody who's urinary and bowel incontinent. They understand doing physical therapy with the patient. Now they can come in

10:09

open up a case, set it up for long-term success, and then as problems arise, which when you're dealing with a medically complicated patient, problems will arise. Patients will have good days and bad days. They can then be the field supervisor to come in and support as things develop. This leads to a higher longevity of the client staying on services with you because at the end of the day, a patient only discontinues for several reasons.

10:39

Often they discontinue because they're not happy with services and they'll never tell us. They'll say, oh, everything's great. But then they discontinue. Then they move mom into an assisted living. Right. So it leads to increase longevity of patients. It also leads to superior outcomes because your patient is getting the assistance that they actually need because there's somebody managing and supporting the primary caregiver. And the more I would say is the best benefit to the agency.

11:09

increased retention of caregivers. Because when a caregiver gets the proper support that he or she needs for a patient, that builds trust, that builds loyalty, that builds a situation, which I remember I experienced myself with my own company, where caregivers would say things to me like, Steve, I will work for no other agency other than yours, because you provide training and support that I never get anywhere else. That's tremendous.

11:39

That's how you create more rock stars to be the amazing caregivers and develop future superstars to advance in your company. Fantastic. And yeah, I know that one of the things that you talk about is finding those people who are medically complex, but it's interesting that you talk about you know, these medically complex people and that shouldn't scare these agencies away because you know, the support, let's say,

12:08

the care that a medically complex person needs isn't a doctor or a nurse all day long. I mean, like you said, it's like they need to be clean, they need to have a good meal, they need to feel comfortable, they need to get off the couch and a lot of those things. So yeah, and there's actually been a movement kind of in healthcare in general in the past couple of years that they call the social determinants of health. And I think people more and more

12:35

are realizing they're looking and saying, well, you know, why is healthcare statistically better in Northern Europe and things like that than it is in the US? And it's because in those countries, healthcare includes making sure people have shelter and companionship and nutrition and these kinds of things covered. And that is exactly what our caregivers are providing. So that's really incredible. All right, so here's the hard thing, but this one, you blew me away, like, you know, Steve.

13:04

hurricane always blow away the competition. But one thing you blew me away with was this kind of concept that this isn't just like adding expense into your organization. And I guess kind of relaying back to what we talked about on our first podcast together, he talked about taking folks when they're really ready for home care. You know, if they, if they want somebody to come babysit for their mom, you know, while they go out on a date once every two weeks or something, that's not, that's not home care. That's more like, you know, babysitting and they could get that.

13:33

that care in a different way. But I guess two things that go together here, you talked about how having care coordinators on staff actually does create a business model where you could bring folks on a little bit earlier and support them with your care coordinators in a way that makes you a decent amount of money. So yeah, like tell us a little bit more about that idea. So I love it. You kind of opened up like three different things that comes together. And the first point is the target customer.

14:03

Right? Like you've heard me talk about this, where from an agency standpoint, we are better suited to take care of patients that need total care or care every day. Then we are to take care of a patient that, like you mentioned, a son or daughter is the primary caregiver and they want somebody to stay with mom during the weekend because they have a wedding to go to, or they want somebody to come in, you know, a couple of days a week just for spot.

14:33

visit just to make sure mom's okay and help out around the house. Those kind of services, those are very difficult for us to staff, very difficult for us to manage. They have high turnover because it's very difficult to build a work-life balance, 40 hour a week schedule for our caregiver, which leads to increased turnover and always other challenges. This is why I like to talk to a customer being somebody with great need, medically complex.

14:57

who needs help, not only do they need it every day, but they need a lot of hours every day, 40 hours a week, 56 hours a week, 84 hours a week. I always talk about the nerd, right? Great need, elderly, resources, disabled. With that being said, that transitions us to having a 20 hour minimum. When you have a 20 hour minimum, that nerd customer, they need more than 20 hours, right? But when you go below 20 hours, that's extremely difficult for us to staff.

15:26

and it's very difficult for us to manage, that's why I say for that patient, they're better off going to caring.com or hiring a caregiver directly because they're the employer, they can, it's usually on an as needed basis, not every time, but more often than not, this is why my clients are so successful. I help them build the higher need, medically complex patients. So they may have 20 patients on their census when they start with me, a year later, they still have 20 patients on their census.

15:56

but the hours per week per patient went from 15 to like 40, right, so their hours are almost, you know, two and a half times what they were doing when they started with us. Now that leads us to the last point, which is to everything you're saying here, the care coordinator. The care coordinator is a necessity to a medically complex patient. The families, they want that layer of supervision. They want...

16:21

that layer of communication. They want this person coming out and managing the caregiver on a weekly basis and giving them updates as to what's going on. This is above and beyond the standard home care. So as a result, you don't have to eat this cost. You can do one of two things. You can either bill directly for it as a complimentary service, but it all goes together. So it's here's the caregiver piece, here's the care coordination piece. And this is why it's necessary.

16:51

for this difficult situation, which again, when you're sitting down with the patient, you're not sitting down with the patient and their family saying, this is something you don't need. You're sitting down with the patient and the family saying that we recognize that your mother is very medically complicated. In order to keep her safe and out of the hospital, this is what's necessary. Very different than saying this is what we're gonna do. This is what's necessary to keep mom out of the house. And the families understand that, so then you bill accordingly.

17:20

The other alternative to having it built separately would be to just factor it into your price. So you go over, we do this, this, this, and this. Now someone may say to you, well, Ken, $4 an hour, just hypothetically speaking, for your agency more over this other company down the street, that's significant. Why should I go with you? And then the answer is real simple. It's not apples to apples, it's apples to oranges.

17:49

They don't have the care coordination piece where we're sending someone out who's managing the case, who's doing this, who's doing that. That is the value add in this situation. Again, the key is the nerd patient, right? The medically complex patient. That person, they need this. For that person, if you don't take care of this correctly, their only alternative usually is the highest level of care in an assisted living or...

18:16

They're gonna pay out of pocket and move mom into a nursing home where there's nurses and staff there 24 seven. So it's not so much, are they going to spend the money? It's where are they going to spend it? Most people want to try home care first. You factor this into your price or you bill it separately. Either way, it covers the cost of having this, I say, position of need. And we used to do this all the time with my patients and all of my clients, when they add the care coordination.

18:45

component to their agencies, they don't have an issue with it at all. All right, well that's great stuff. And I think you've hit on all the topics, but I'm sure anybody who listens to this has said, wow, that sounds really, really good, but I don't really know how to kind of put it in place from here. So I guess this could be a good segue and believe it or not, we're already like 20 minutes in. So we should bring it on the home stretch here, but.

19:12

you know, like let's say that somebody wanted to understand with some help from Home Care Evolution and the Hurricane Organization, how could I bring care coordinators into my organization? Or, you know, and please feel free to open the door for like, you know, for folks who aren't familiar with you yet, like what kinds of other things that you're helping agencies with. Yeah, thank you so much for that, Ken. I appreciate it. I'll actually see here. One thing I will...

19:42

definitely talk to every single person and tell them to do is check out our website, home Because the on our website, you'll be able to find, I was looking for a magazine. I thought I had one here, but apparently I don't have one here that I can share. I think this is one right here maybe. Um, but the homecare evolution quarterly magazine, these magazines you can access for free on our website, home

20:09

The first year I did this, we've now completed eight of these every quarter the magazine comes out. The first year I did this, I did a four part series called The Road to $10 million, where I walked through sales and marketing, staffing, recruiting, the office staff team, and then finances, time law on how to be able to grow your business to over $10 million in revenue. In one of those issues, I actually talk a lot about the care coordinator position. So this is where you can get some free resources

20:38

on what is the care coordinator position, accountability measures, et cetera. Now, if someone wants to invest, I would recommend when you're on my website, sit down, ask for a strategy session for free. We give those away for free. You can speak to my director of business development and he can go over some of our programs, specifically the Hurricane University, where one of the programs in the university is called Home Care Special Ops. And in the Home Care Special Ops course,

21:07

There's four lessons on how to create the position, the responsibilities of the position, how to do all of the responsibilities of the position, accountability measures, who to promote, how to pay, everything. It's everything you need to be able to create this vital position in the organization. It will be a game changer, I kid you not. When I look at the most successful clients that I have, the members of my Home Care Elite Academy.

21:36

Every single one of them, they all point back to you bringing in nerds helping us do that. But the care coordinator position and managing the caregivers is such a position of need. It allows agencies to scale a million to three, three to five, five to eight and beyond. It's wild to see what happens when people add that. So home for everything. And you know, let's help you blow away the competition. I love it.

22:05

All right, everybody, Steve, the hurricane, the inimitable. So it's been great having you. I hope that we could do other things throughout the year. And especially if some of your other coaches would wanna get on the pod and they have something they're passionate about, we'll talk about that as well. But hey, for everybody, we'll wrap it up for today. Thanks again for participating and listening in on this episode of Home Care Heroes. And thanks again to Steve, the hurricane. Thank you for having me, Ken. I appreciate it.

22:33

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