Please note: The transcript below is automated by speech recognition software and may contain minor inaccuracies.

Jeff Howell (00:07): 

Hi folks. And welcome to the first episode of home health, 360, where we speak with leaders in home health from across the globe today, I'm joined with two dynamic speakers and leaders in home health in north America. Zayna Khayat is a future strategist at St. Elizabeth healthcare in Toronto, a leading national home health agency in Canada, where she's, co-creating the future of health and aging in the home and guiding clients, families, the staff and partners towards it. I have seen Ana speak in person at the better outcomes conference in Niagara falls a few years ago, and I was furious writing down her wisdom. Welcome to the show, Anna, thanks 

Zayna Khayat (00:44): 

For having me. 

Jeff Howell (00:46): 

And we also have Matt Kroll who spent 11 years at a national home health agency as the national director of companion services. And he has spent the past decade at Bayada home health, which I believe has over 20,000 caregivers and nurses, and is a top 10 home health agency in the United States. Currently, Matt is the president of the assistive care division. Matt, did I get those numbers right? And thanks for joining us today. It's great to be here. Thanks for having me, Jeff. I think that the numbers are close enough. That's that's a good intro. Thanks. Yeah, well, I, and I certainly did you both a disservice based on the length of tenure in home health based on what I can see from your LinkedIn profiles, ZZA why don't we start with you? Why don't you give us a bit more color on your career path and what what's led you to the position that you're in today?  

Zayna Khayat (01:37): 

If I look back I'm a scientist by training. I have a PhD in biochemistry and diabetes research. And then I ended up in, in the business world with Boston consulting group. And really at the end of the day, if I look, if add it all together, all the different career pivots, it's been, you know, solving really intractable challenges in issues that are important to society with the team I love. And that's pretty much what I do every day at se health. So we work in creating the future of aging seniors health. And of course we believe that will occur in the home setting. And as a future strategist, I'm not a futurist, I don't pontificate about the future. I don't predict, you know you know, we just wake up every day as a dedicated little cell of this organization, scanning and sensing and mining the signals of massive change on all spheres of, of what we do in home health and translating those signals into the next product services, policies and practices that will allow us to keep at this for, you know, we're 112 years young. We wanna keep going for another a hundred years 

Jeff Howell (02:38): 

And give us a little bit more background on St. Elizabeth for the folks that haven't come across you 

Zayna Khayat (02:42): 

Folks. Yeah. So, so Elizabeth healthcare, we now go by se health, just like I always tell my students, IBM is no longer international business machines. They didn't know that you know, 112 years started with four midwives in some small area, north of Toronto, and now where some 10,000 people delivering about 20,000 exchanges a day across Canada and now globally and you know, mostly government funded home care, but a lot of adjacent business areas we've gotten into lately and senior living private pay and then you know, education. So we run career colleges to train workers. And then I lead one of the new business lines, which is E Liz, which is a caregiver platform. So for family caregivers, not care providers which is really a, a DTC type of a platform. So I think we're recognized as a pioneer in Canada and a leader, always pushing the boundaries. We were the first to do home chemo. We were the first to treat people with HIV in the home. And so just kind of continuing that legacy, but in a lot more of a structured way with our futures team. 

Matt Kroll (03:49): 

That's great over to you, Matt. Great. Tha thanks for having me, Jeff. So yeah, I've spent my entire career in home healthcare August I think August 5th, somewhere around there 21 years. So my, my background is business. I graduated with a marketing degree and found my way to home healthcare somewhat randomly to, to be perfectly honest. But I fell in love with it. You know what, my first week I visited one of our clients who was a veteran at the time, and my dad was in world wars too. And the, the, the prospect of having the opportunity to care for, for that generation was really attractive to me. And so I got to apply my, my business skills and you know, my dad owned a small business growing up a small appliance store and we did a lot of handshake, you know deals in the community with folks paying us week cetera. 

Matt Kroll (04:41): 

And, you know, there's so many parallels to, to how home healthcare manifests itself in each individual community. Even though we provide services nationally, it's really about getting deep into each community, which, you know, for me, it was much like, you know, the small business that, that my dad dad ran. So fell in, in love here I am 21 years later. I started really in the front lines, recruiting and scheduling caregivers and have enjoyed the opportunity to slowly and slowly take on more responsibility to, to where I am today, where I lead our private pay, personal care services across 14 states. Almost 50 location, you know, beta as a whole, you mentioned 20,000 field clinicians. You know, we are a multi-service home healthcare company. What I mean by that is we provide acute, you know visit nursing visit therapy, visit services into the home post, you know, hospitalization or skilled nursing facilities stay. 

Matt Kroll (05:40): 

We provide personal care services and we also provide private duty nursing services to children and adults who are, you know, for the most part technology dependent on ventilators, et cetera at home. And we also do some behavioral health and physician services as well. So multi-service provider trying to I guess Zana match St. Elizabeth, you know, our, our vision is to be here in a hundred years. We were founded 1975 by mark beta. And he's slowly grown and diversified the organization. And about three years ago, gifted the company to a, a profit with the, the, the sole desire to be here in a hundred years and to have the opportunity to care for millions of people worldwide. So great story a great man and has left a really solid foundation for us to, to work into the future and help continue to, to innovate and solve challenges know. 

Matt Kroll (06:37): 

And, and ZZA, you mentioned being on the forefront with chemo at home and, and the like, and we were really one of the first home care companies to even dream it possible to take children home who were, you know, special needs and vent dependent and take some of the more complex cases into the home where we're managing, you know, do EME and helping to teach family members and, you know, really critical life or death situations with some of the clients we manage at home. So we're excited to continue to support more folks, being able to have more services in the home as we look towards the 

Zayna Khayat (07:11): 

Future. Yeah. And Jeff, just to put a finer point on our introductions, you know, at se health, we really see Beata at, as a sister organization in the us, usually when I'm trying to explain who I work for and what I do, I just anchor to bio and everyone's like, oh, okay. I get it. <Laugh> and then I think, yeah, you know, when beta went nonprofit a few years ago, I think that really got the two organizations a lot more similar. I think the platform of a nonprofit really allows you to experiment in the long run, very different ways than the pressures of the capital markets. And of course, our CEO, my CEO, Shirley Sharkey, is, is on the board of bio, you know, since at least a year or so now. Yeah. 

Jeff Howell (07:49): 

Well, it's it's a small industry, well, Jayna, not every company has someone in house that has the word futurist in their title. I, I ha I'm, I'm trying to see if I can get that title for myself, but I, I think I'm vastly underqualified <laugh>, but can you bring us through what does a day in the life look like in your role? 

Zayna Khayat (08:11): 

Yeah. So again, not a futurist, I'm a future strategist. I think, I think I'm the only one in all of home care, and there's probably five of us in he in the whole world who are an in-house specialist just to keep our eye on the future. Right. I always say we, we, we, we protect the future instead of protecting the past in healthcare and wow, does healthcare love to protect the past? And so so basically every day is a bit of scanning all the time. I've got a system of reading and sensing and mining signals, patterns, trends moves that are being made. Like, for example, in home healthcare, there were two major moves last week, two big acquisitions. Like those are signals of something, they were a big tech integration place for traditional, you know, labor-based delivery services. So a lot of that, and then, you know, my team is like an innovation team. 

Zayna Khayat (09:01): 

I, I just don't like the word innovation. I think we're beyond innovation now in healthcare. And so, you know, we design incubate tests and then scale next practices. Mostly we feel focus on new to the world offerings, new to the world business models definitely new to se health. And so we're focused more on new business models, new practices, and getting them, you know, worked out so they can be introduced at scale. So we have a portfolio, we've got focus areas. We have about an 80% failure rate which is exactly what we be because we're, we're like a lab experimenting and every now and then some of what we work starts to get selected and work. And then that becomes either a spinoff, a separate venture separate company, or it gets integrated into the core business. And that we're just at that stage of, of those things happening now, four years since I started. And do you have 

Jeff Howell (09:55): 

An example of, of something that's been implemented? 

Zayna Khayat (09:58): 

Yeah. So a great example is you know, we've been inspired by new org models. I think a big unfinished business of all of healthcare and definitely home care is to challenge industrial era norms of org models, org theory, how we pay people. So getting rid of management layer and stopping paying people on the visit basis. So a salary based kind of outcomes based payment. So we designed and tested a model for that. We call the hope model for about two years in our lab in a defined geography worked out the bugs took a lot of inspiration from models around the world, like Brizo and our colleagues at Kaiser per mane, and a little bit of biota as well. They were going through a similar journey, I think with nurses and and got the data, got the facts, figured out the tech figured out this change management, the policy change, this is like a seven layer innovation. And then now we are implementing it across our entire workforce. So it's a great example of bringing it inside instead of spinning it out. Mm-Hmm <affirmative> 

Jeff Howell (11:00): 

Matt, are you guys doing any, any sort of programs like that? 

Matt Kroll (11:04): 

You know, we've, we've taken a long look, you know, as we as za mentioned, you know, as we converted from, you know, for profit to, to non, for profit, you know, as it relates to compensation, we we've really been trying to figure out how do we have a balance compensation model, right? Your, your typical, you know, capitalist, you know you know, revenue or operating income, you know, based compensation models really don't fit for us in, in home healthcare because we wanna be focused like Zana said on outcomes. And we call them clients, but patient satisfaction and employee satisfaction, and what we really believe are some of the drivers of outcomes and all, you know, financial as well as care driven outcomes. Right. So, yeah, we we've been on that journey and I'll say it's a journey, you know, we're, we're constantly trying to evolve and improve and make sure we have the right, you know incentives as well as hooks built in there. 

Matt Kroll (12:00): 

If we're not, you know, working down the path that we wanna be working down, you know, how do we make sure the operators know that and have an eye towards improving certain things you know, that the, that we measure, but you know exactly what to measure exactly what the, the carrots and, and sticks are as something that, you know, has been a, a, a long journey for us. Jeff, I will say what, what we're committed to is making sure that we're looking at P performance from a balance standpoint. Yes, we're nonprofit, but as our CFO always says no money, no mission. You know, we do have to make sure that we are managing our margins and managing the, the, the dollars and cents so that we can reinvest to help the next generation of, of clients and patients that we're taking care of. 

Matt Kroll (12:46): 

But make sure we're doing it in a way that's aligned to our mission and that's helping the broader healthcare system. Mm-Hmm, <affirmative>, you know improve the care that we're delivering to to patients. And so it's really been a, a, an interesting journey and, you know, for us, you know, being a multi, what we call a multi-specialty provider, but providing, you know, multiple different levels or types of care with different funding sources, we're now trying to figure out how do we incentivize weaving those together so that, you know, even inside Beata, we're working better together when we're providing multiple services into the home. And then how can we extend those learnings outside of Beata to some of our partners in the hospital systems and, and elsewhere, so that we can have a more coordinated care experience for, for the consumers. 

Jeff Howell (13:41): 

So I'm gonna ask the big question you know, about almost two years ago now, things were we had a more predictable world and so Soze, you talk about signals that you see, and I presume most of your research is actually done outside of Canada to try to accumulate some, some best practices moving forward for se health. I'm curious on your thoughts when COVID hit, what, what changed and what new things did you see develop as a result? 

Zayna Khayat (14:11): 

I mean, I generally say that what COVID did was for sure, in so cases accelerate the existing trends and signals that in some cases it reversed some and then some were neutral. And I actually wrote a six blog series about this. We could put it in the, in the chat after and, you know, in general, although everybody wants to talk about how much change happened, cuz of COVID, if you actually unpack it against all the shifts that we're underway, it's actually not that much, right? Some absolutely obviously the constraints of time and place and distance, which were designed around how care is delivered were lifted because all of a sudden there was this thing called the risk of physical contact and it changed behavior overnight of both clients, as well as care delivery colleagues. So of course, other channels to access care opened up. 

Zayna Khayat (15:02): 

And that's been talked about in home healthcare forever, and it wasn't really possible before. So I think that's great that we opened up alternative channels, but that's not that much change in the big scheme of things relative to the shifts that were underway. So the shifts underway was, you know, all things moving to the home and, and Matt talked about, you know, much, much higher acuity than ever before. You know, I, I saw a graph once of the acuity level of care in the home setting that's possible now is higher than when hospitals were first opened, right? So the curves crossed and I think that has happened a bit, but not as accelerated, you know, as we would think from COVID. I think some of the business drivers hasn't been, you know, physical contact it's been, hospitals are full, or their ICUs are full. 

Zayna Khayat (15:48): 

And so they need to have these alternative settings, you know, versus an outcomes based thing. But the other shifts I asked you to think have been lessened. So, you know, a couple around agency and power. So that's been a huge current of the shift to the future of all healthcare, but for sure, home health is choice and power and decision making of our clients and their families, but all aspects of their care, the plan how they get it, where they get it, when they get it, who they get it from <laugh> choice was stripped away during COVID right. You know, I think we really went backwards on you know, giving power to people in the say of what they want because, you know, there were so many other priorities in the health system. And then, you know, the last one I'll say that really was a negative and it turned backwards is just social isolation connection. Wow. Did we strip that away from our most vulnerable people? And I think it's gonna take years to get back to the pre COVID COVID level where I thought we were starting to make a dent in social isolation in many ways. I think we got a lot to catch up on there. 

Jeff Howell (16:55): 

Yeah, I was just saying that loneliness is such a powerful social determinant of health and you know, obviously it's been a real, real challenge for everyone during these times. So Matt bring us through COVID hits how did life at Bayata change? 

Matt Kroll (17:10): 

Yeah, I, I, I remember we we, we mean every quarter for, for all of the, the verticals or we, what we call specialties, where we come together and, you know, focus on each of our business lines, but then also on, you know, how do we collaborate together? And I remember, you know, the second half of our meeting, we said, well, we should really address, you know, COVID. And that was the early March of, of 2020 me. You know, listen, the COVID experience has been there. There's been some similarities across all the services that we provide. It certainly hit us hardest and fastest in the beginning, you know, in our Medicare, what we call home health as opposed to private duty services, you know, hospitals were shutting down you know, new patients were not coming through at the same rate that they, they used to our census really plummeted super fast. 

Matt Kroll (18:00): 

We have a big concentration here in the Northeast of the United States, and that's where, you know, COVID was, was making an impact first. And so, you know, hit us really hard there. And we had to make some, you know, really tough decisions around our staffing patterns and, you know, what do we do and how do we respond, you know, on our personal care and, and skilled nursing and behavioral health services, you know, slowly but shortly, we saw lots of clients, especially clients who weren't getting, you know as za mentioned, you know, talking about of isolation, you know, if our clients didn't absolutely need us, they cut us off. And they said, we don't want anyone coming into the home. And maybe we were there a few hours a day helping with meal preparation, those sorts of things. You know, some of those clients decided to take that on themselves, but in the process, you know, Zane, as you mentioned, you know, isolated and created other sets of, of challenges you know, some of our caregivers as their clients who were their regular clients decided not to have services, they didn't want to go see new clients. 

Matt Kroll (19:00): 

They were comfortable going to see their existing clients. But they didn't want to go see new clients because that relationship wasn't there. So it was this, you know, really fat and, and a really fast moving process of, you know, new clients going away, existing clients, going away, our workforce going away, and all of us trying to, to get our arms around it. And, you know, looking back, it was probably about an eight week period where we didn't really know what was gonna happen. And then things started to slow down a bit. You know, some of our clients began to come back. Some of our caregivers began to come back and, you know, since then, I think the, the biggest challenge we've had is predicting what the next, you know turn will be and trying to get out of this reactive posture to the various different waves or, you know, we're dealing right now with vaccine mandates in many of the states and to many of the entities where we provide services and you know, we have to operationalize, how are we gonna test the folks that aren't vaccinated? 

Matt Kroll (20:08): 

And so it's been lots of twists and turns Jeff, and you know it's been really challenging for our clients. You know, some of whom are still scared and, you know trying to explain to them, you know, how PPE in addition to vaccination protects them and you know help them along the way has, has been a challenge. You know, the, the good part has been the silent generation, which is the generation we're really taking care of right now, you know, folks over 75, they had been very slow to adopt technology. Yeah, they didn't wanna have, you know, FaceTime calls. They didn't wanna have video monitors in the home. You know, we have client portals available to them. I think the status less than 30% of clients actually ever even went into their client portal. So the, the good news from a technology front is I think the generation that we're caring for right now became much more open to, I turned my TV on and I could see my physician or, or I could see my, you know, home healthcare practitioner, et cetera where they were not open prior to, to COVID. 

Zayna Khayat (21:14): 

Yeah. I'll just, I'll just maybe add to that. I did a slide once of just, yeah, exactly. My, I think you summarized these waves of pivots. I think more pivots in a year than I think in decades. Or at least we had more time to brace, you know, the first was absolutely massive declines in volume, very instantly. I think everybody felt that for the same reason, both client behavior, but also staff behavior then just around the corner was PPE. I don't know, in the us, but for us, we have no power in the supply chain. Everybody wants the supply chain, hospitals sucked up all the oxygen. And so, you know, we couldn't even get safety equipped meant to our people. So we had to deal with that and clean up our supply chain in a way we never did. Then it was testing for us getting a test access to a test speed of results, taking time off work to get tested. 

Zayna Khayat (21:59): 

So we had to deal, you know, get that infrastructure. Then it was vaccination from a distribution of vaccines because people work all day they're in the field. They can't go to the place to get it. And you know, now it's vaccine hesitancy and the vaccination rates in the health workforce, Ontario just this week kind of mandated vaccination, not really, but it's, you know, gonna be a lot harder to work in healthcare if you're not vaccinated. The implications of that on our workforce is our next tsunami. We, we that's now <laugh> right. And then like Matt said, what's next? You know, and then behind that in, I think all of our sectors is a policy environment that was already on its own change curves of, you know, new mandates and new rules and what's in scope and hospital to home. And so it's like these several layers of change, you know, all at once. I think we've built resilience, but it is exhausting, you know, and sometimes I wonder, are we gonna have anything left in the tank for, you know, the, the year and the two years ahead? 

Matt Kroll (23:02): 

So it's a great point. You know, that that's the, that is the next pivot, you know, how, how do we keep all of the, the folks closer to the front line and engaged and energized enough? And, you know, ZZA, you mentioned earlier about, you know industrial staffing models and those sorts of things. I, I do think we're gonna have to be thoughtful about how do we have the right staffing models to handle all of these different pivots and meet our, you know, workforce where they are because they're the ones where the emotional strain is really the, the hardest and, you know, talking to, you know, the caregivers in the front lines who may have some vaccine hesitancy, you know, for, for one reason or another, and may now have to test once or twice a week. And you know, it in, in an already strained labor market this is gonna create more strain. And we're gonna have to figure out how do we problem solve through that to get to some of the innovation and, you know, technological or otherwise that we'd like to get to that I think all of us right now are thinking about, you know, how do we do that and still respond to the ever changing environment that we're facing right now in front of us. 

Jeff Howell (24:16): 

Yeah. And, and you know, we have a, when, when the COVID first hit I, I was of the opinion that this is gonna be an economy killer and you know, ironically most people's the value of their home skyrocketed the value of their portfolio skyrocketed. And, and now we're in this phase where if, if you're not aware in the home health agent business turnover is about 60 to 80% year over year. And now we're seeing in all across the board there are more jobs than there are workers. So it's a real challenge for other industries even to compete. Z what's one thing that you think is a false narrative out there today. 

Zayna Khayat (25:01): 

I mean, I don't know if it's a false narrative, but I think there's some really sacred cows that you know, need to be turned into hamburgers. And it's gonna take courage. And I think leaders like biota and se health have the platform to do that. And I think of three, I think, again, this transaction based paradigm, not just in home healthcare, in all of healthcare makes zero sense for complex con right? That clay Christensen wrote an entire book about this in 2004. So just emancipated from, by the visit models. And, you know, it could be some blended thing, but really paying for the health. You're creating, not for tasks is one. I think the second again is layers of management. I think that a command of control supervising and just telling people what to do, where all the creativity, the passion, the energy, the emotion, all the value of the work we do is created at that interface, you know, with at the point of care and just letting that be a little bit freer and letting people and teams problem solve their own problems and giving them some freedom and flexibility. 

Zayna Khayat (26:11): 

So just new org theory and models have to be challenged. And then finally, you know, I think we have to get out of the word of healthcare. It's, you know, in the, in the kind of people we see, we do life care, we don't do healthcare. You know, we might have to do some medical tasks, of course, but if you just do those at the, without looking at a lot of other things going on in people's lives, like Matt said, if they've been alone and not seen their family, can't pay their phone bill, you know, if all that matters to them is getting to church on Sunday, that's what our care plan should be about is those goals. And sure, medical things are the way. And I think that shift is happening across of all of healthcare. I think the rock face of it is in the kind of work we do with older adults in the home setting who have complex illness. 

Matt Kroll (26:59): 

I think that's such an important point. The, the life care, I, I, we see that every day, right. And in, in some ways, you know, some of the buzzwords that are out there right now around social determinants and some of the things that you hear all the time on podcasts like this one, or, or otherwise are really getting at that concept of how do we take care of the entire person with many different services, as opposed to transactional based services that, you know, go in, fix a problem and move on, you know, here in the United States, you know the, the way the, the system has been designed is really in an, an episodic way, right? We treat you, we get you to a certain point and then you move on. And so I think, you know, we, we really should be thinking about, you know, into the future, how do we care for the whole person and how can doing that really help save money in the long run and, and help that person, you know, li live their best life with all the services they need, not just the physical therapist that you know, was, was prescribed at a particular point in time. 

Matt Kroll (28:02): 

Yep. 

Jeff Howell (28:04): 

Yeah. I love that. And I I'll always remember the first time I, I ever heard that, you know, we don't have healthcare, we have sick care, you know, it's it's a reactive model of waiting until someone needs to go to the hospital and then get treated instead of keeping people vibrant and healthy throughout their whole life. So I love that concept of life care. Yeah. 

Zayna Khayat (28:23): 

A, another one I've heard a lot is, you know, we don't have evidence based care. We have reimbursement based care <laugh> right. So, you know, the only thing that matters is what's funded, but really what matters is often what's not yet funded because in needs policy change to get that. And, and I wanna get out of evidence based care, which, you know, is like academic studying data. That's two years old from like four years ago. And then making policy that might change in five years to intelligence based care, where you're literally learning at the point of care in real time and adjusting as you go. I mean, that's where we're gonna head to. 

Matt Kroll (28:56): 

Yeah. And I think we're at a really exciting place, a exciting point in time, you know, both in, you know, what the, some of the opportunities that that COVID has created because of, you know, the, I, I mentioned the silent generation adopting technology more, but I don't hear enough people talking about the consumer preference shift that's gonna happen in healthcare. Yeah. You know, as the baby boomers who the first one will turn 75 next year, and, you know, I, I consider the personal care services to really be a form of long term care. And for us on the personal care side, the baby boomers are just gonna be getting, you know, into quote unquote long term care next year. And their preferences are gonna be vastly different than the silent generation who, you know, didn't want technology saw some of the passive and active monitoring things they could do in the home. 

Matt Kroll (29:46): 

As intrusive where I think the baby boomer generation is going to expect if I can do it from the comfort of my own home, with my cell phone, you know, with my smartphone, they've been FaceTiming, their grandkids. They've been, you know, I, I watch my my own family, my mom, my aunts, you know, they're, they're playing, you know, all the games, candy crush, and everything else on their iPhone, and they're gonna be, you know, their preference is going to be much more technologically driven than this current generation. And I don't hear enough people talking about that because that's really where, you know, the opportunity to can, can really come and help accelerate, you know, some of the things that have been around, you know, passive and active monitoring in the home has been around for 10 plus years, but no one has wanted to, to implement it. I, I see that changing dramatically, you know, over the next five years or so with the, the as a baby Boomer's age. Yeah. 

Zayna Khayat (30:41): 

And I would add, you know, when we met one of the stickers, not only will there be a poll for these types of new experiences, a massive poll, like reminder a boomer was born every 10 seconds in the United States. Like, we don't even know what to do with this population yet, but there's also a push away from the current alternatives. Right? So the data here in Canada, I think before, COVID maybe 90% of people, you know, preferred not to ever go to a multi residential facility like a nursing home or something like that. It's now at 97%, they do not wanna go to these places. Where do people prefer to die in their home? Right. 70% in Canada prefer to die in their home, 15% do that's a market right there waiting to be happening. So I think you're right. I think this will come from a pull from consumers, but be enabled by very visionary policy from Medicare in the us who I think actually, I dunno how much if you criticize them that, but I think they're the leader for the world, to be honest for the, the aging population and new policies those enable it. 

Zayna Khayat (31:43): 

And then, you know, organizations like us and biota will be there to deliver. 

Matt Kroll (31:48): 

Yeah, well, I, I think the good news is everyone's ready to listen, right? Because of the, the stats that you mentioned Z a around, you know, people's desires, but also I think, you know, trying to build more financially stable models of care, you know, the, the, the Medicares system or the reimbursement system and the acute care system, I think wanted to, to influence or dictate, you know, what would happen in the home. And that's shifting as well, where, you know what we call home care is now at the table, brainstorming and anding around, how do we leverage some of this technology that's available to us? How do we do more in the home? And how do we do it from a partnership perspective versus a, we need you to send a home health aid in, you know, two hours Monday through Friday for two weeks. You know, and, and again, be being more at the table. I think that's gonna be, be helpful as things, as things shift towards the future. 

Zayna Khayat (32:43): 

A and another signal on that of, you know, home is at the table, you know, in a way I've never seen. And Matt you've been in the industry longer than me. I think some coalition formed in the us during COVID the bring health home coalition, or I, I forget what it was called, but, you know, an Amazon is part of that. Like what, you know, if Amazon is getting into an area, you know, it's the next thing that is gonna get a lot of new capabilities and it's come to home healthcare. 

Jeff Howell (33:09): 

Yeah. Yeah. That's a good point. Well, we're almost up against our time here. It's been a real pleasure spending this time with you Zanya, how, if I'm looking for care for a loved one, how should I get in touch with St. Elizabeth and where can I, can I follow you if I want to connect with you professionally 

Zayna Khayat (33:26): 

A few ways? I mean, just similar to Bayada there's government funded services, which go through central agencies but, you know, just go to sehc.com and you can see the different pathways. Also our separate business for family caregivers, E Liz E I double z.com is we do caregiver coaching and a lot of in-home respite and other support through that. And we wrote a book, the future of aging. So it is about the five big shifts on all aspects of aging, not just care. So if you wanna check that out, it's available on Amazon. <Affirmative> 

Jeff Howell (34:01): 

Great. And same question for you, Matt. 

Matt Kroll (34:04): 

Great. Yeah, you can find you can find Bayada at Bayada, BAY ada.com. You can access all of our, our different services through there, through our, find a, a location page and saying, I think you missed too how to connect with you. You follow, I know you had mentioned some blogs and things like that, that you've done, so I'll kick it back to you, but you can find me on LinkedIn, macro on LinkedIn. And thanks a lot for having me today. Jeff, this was great. 

Jeff Howell (34:31): 

Yeah, my pleasure. 

Zayna Khayat (34:33): 

Yeah. And I'm mostly on Twitter at Zana Khayat and I think you can find my spelling cuz it's a long one to spell <laugh> 

Jeff Howell (34:39): 

Yeah. Yeah. We can include that in the show notes. Well, thank you again to both of you for taking the time today and to the listeners out there. If you're interested in listening to some engaging fireside chats with home health leaders from across the globe we're using this two guest format, so it's more banter and less interview. So go ahead and click this subscribe button and we'll see you in the next episode.