Jeff Howell (00:01):

Welcome to home health, 360 a podcast presented by AlayaCare. I'm your host, Jeff Howell. And this is the show about learning from the best in home healthcare from around the globe.

Erin Vallier (00:18):

Hi folks, and welcome to another episode of the home health 360 podcast, where we speak to home health professionals from around the globe. I'm your guest host Erin Vallier regional director of sales for AlayaCare software. And today I am joined by two special guests, Bob Roth of Cypress home care and Neal Kursban of family nursing care to talk about out the changing face of home care. Bob is the managing partner of Cypress home care solutions. He opened the business with his family in 1994. He's got nearly 36 years of consumer product healthcare and technology experience, and he is successfully brought depth and breadth of his experience to the home care trade. He hosts a radio show called health futures taking stock in you. And in addition to that, he writes a monthly column called aging today for the Jewish news of greater Phoenix and 11 life. After 50 newspapers, Bob serves on the board of directors for the home care association of America in Arizona. And in 2019, he was selected the winner for the home healthcare news, future leader award. Welcome to the show, Bob.

Erin Vallier (01:33):

Thank you, Erin. Thank you for having me. I'm so excited for you to be here and we have Neal. Neal joined the family business in 1995. He has worked every single job in the company. I think receptionist care coordinator, caregiver services, recruiter, intake specialist, you name it, it manager VP of sales and on and on, but all of those roles enabled him to understand all the important details of running the company. And it gave him the background and knowledge he needed to lead the into the future. Neal became president in 2008 and CEO in 2018, and he currently has plans to expand family and nursing care services to other markets. In addition to running his agency, Neal speaks at conferences around the country and he writes articles that have been featured in a variety of national publications. Welcome to the show, Neal,

Neal Kursban (02:28):

Thank you. Looking forward to it

Erin Vallier (02:30):

It. All right guys. Well, this is, this is fun. I'm super excited to have you and have a question. So both of you, both of your companies have been around for many, many years, Neal family and nursing care for 53 years and Bob Cypress home care for or 27 years between the both of you, your families have over 80 years of experience in the home care space. So what do you see the biggest change that's occurred since the early beginnings and what has been the biggest change in the last decade and this layer, some pandemic stuff on top of that, how has the pandemic changed the home care trade, Take it away.

Bob Roth (03:13):

You

Bob Roth (03:17):

Of is you great admiration for Neal and his family. 53 years. That's, that's quite a Testament to the work that they do in their community and, and in home care in general, you know, when I entered into this space they were less than 10 home care companies here in the Phoenix metropolitan area. And they're probably close to six to 700. Now. It wasn't really one franchise that was around. So I can't imagine what it was like back in the 1960s, when Neil's family specifically, his mother started the company and, and how things were different. Then I can speak to the fact that what we have seen in this time is really the, the, the evolution. The respect home care was more of an afterthought. And a lot of times it still is, but, you know, we have, I like to say, I use the word respect, but we have been the Rodney Dangerfield of the healthcare continuum for a long time and time have certainly changed.

Bob Roth (04:24):

There's so many descriptors that have been given to our trade, right? Non-Medical nonclinical, private duty. What do all of these mean? I mean, especially when you start a trade out with a negative, like non, it tells the world, which you're not, it doesn't tell the world what you are. And, you know, I, I love Neil's company's name because it describes who they are and the services that they do. But, you know, we've, we've evolved over time. And when you really take a look at where we've come since the, for us, the 1990s and for meals since the 1960s and the whole talk about that to where we are today it's very, very different people understand in-home care services in-home personal care services. You know, it's a continuously it's, it's a, it it's, it's, it's something that we have to really do a better job of, not that we don't do a good job, but we continuously have to educate people about these types of services, because it's still to this day, it bewilders me that people don't know that home care agencies exist to help people age in place to help them with activities of daily living.

Bob Roth (05:44):

They still consider the work that we do, nursing care. And quite frankly, one of the biggest challenges we run into is that many people think that Medicare pays for our services or their Medicare advantage plan does, or their supplement or the managed care company that they have. Well, you know, we disappoint, we disappoint almost 50% of our callers when we tell them that I'm sorry, but your insurance company does not pay for these types of services. And it makes it really hard. So we come a long way in the sense that our population's aging, the need continues to grow. I mean, we knew that baby boomers started turning 65 back in 2011. No one really started talking about the fact that they started, started turning 75 this year. I think we had a lot on our plate with the pandemic, but at the same time, you know, they started turning 75 and we're almost at 2022.

Bob Roth (06:44):

So in nine years, they're gonna start turning 85. So to answer your question, what has been the biggest challenge? I think it was a very different world. Back in the 1990s, it was much easier to find caregivers. The price of our services were much more reasonable than they are today. Minimum wage for me, when I first started was less than $7 an hour. And you know, now we're at over $13 an hour in the state of Arizona, you know, the services that we provide to our consumers that use our services were paying 15 to $16 an hour when I first started. And now they're paying somewhere from 31 to $39 an hour. So, you know, the price of our services have gone up. The caregivers wages have increased. The supply of caregivers has gone down and the need continues to outstrip the supply. There's

Erin Vallier (07:45):

Something wrong

Bob Roth (07:45):

With that. I don't wanna take

Erin Vallier (07:46):

Up.

Bob Roth (07:48):

I know there, there is. And, and quite frankly, that is the biggest challenge or conundrum that we are all faced with. And the only way we're gonna solve this is working together. And I think if anything that I can talk to and attribute to is the fact that I think, and Neil can chime in on this. I think home care agencies have never worked closer than they have today. You know, we have a number of home care agencies that we work really closely with and when we're having supply, meaning caregiver challenges we're able to lean on them and vice versa. So, I mean, I think that if anything has been something good, that's come out of it is that we're working together. But in the 27 years that I've been in the business my family's been in the business. The, the demand is I'll stripping the supply. It costs to serve, continues to go up and the caregiver wages have increased exponentially.

Erin Vallier (08:49):

Neal you're smiling. How do I follow

Neal Kursban (08:55):

That now? There was a lot there. So I mean, a couple things I'll double down on is yes, there are way more companies. I mean, the stories I've heard from is there was no, there wasn't even, there wasn't a competitor cause there was else doing it so clearly. And then when I joined the company 26 years ago, similar to Bob's experience, there was, you know, dozen or so in our, our market. And then now there's hundreds. So it's a very similar experience and I'm on the I'm on the east, on the west coast. And, and I think you could pretty much, you go to any city in the country, hear something very similar. I mean, one of the things that maybe I, I remember the first time that there was a TV advertisement for it company, like the industry is arriving like it's, it's already made its way onto the television set.

Neal Kursban (09:59):

And that was like a big deal. And now you, you see a lot of ads about care and caregiving at home from, from various companies. And I think that's great. The exposure alone to Bob's point where they just didn't, people didn't know that the industry existed. They didn't know they could call a company, they get someone to help their 87 year old parent or grandparent or loved one to get the care. So that's, that's it's nice that more people are aware of, despite the Rodney Dangerfield, there is an element of that still, but there is much greater awareness of the country. And the other thing touching on the, I recall also in the mid to late nineties, when the first, when we were telling the caller, say, look, I need, I have care. And I have insurance that covers it. And I'm like, I Don cause insurance doesn't cover this.

Neal Kursban (10:50):

And Medicare doesn't cover this and Medicaid. Doesn't like, it's a outta pocket out your own checkbook for say rainy day. And they said, well, you're mistaken you, what are you talking about? And anyway, so it turns out that at the time, I didn't know what long term care insurance was. Fortunately people, I mean now obviously well aware third of our clients, those have actually have care. I but that's something that they've independently to pay for the possibility of one day needing this kinda care. And so that is definitely different than just there was no such thing as long term care insurance covering home care in the growing part of the nineties to that.

Bob Roth (11:37):

Well, I'm impressed Neal and I have to learn from you how I get my mix up to 50% of my client base paying for services through long-term care insurance that, that in and of itself is quite an accomplishment. And I know just knowing you, Neil, you have an entire department that is dedicated to that and dedicated to doing the claims processing and all that stuff on behalf of the clients. So kudos to

Neal Kursban (12:01):

You guys. That is a true, yes, we do make the experience simpler for the clients

Erin Vallier (12:07):

Long term.

Bob Roth (12:08):

And, and I do wanna echo on your comment about the commercials. I thank home instead and bright star and visiting angels and all the franchisors that are out there running those spots on television, because what that does is it just draws awareness to the work that we do. And, you know, people understand this work because they're seeing these spots running on television. So they really help not only their own own entities, but they help our trade as well.

Erin Vallier (12:36):

Yeah, for sure. And I,

Bob Roth (12:38):

And there are other franchisors out there that I probably did not name. So there, it's not just isolated to those well,

Erin Vallier (12:46):

They are raising awareness and I think that's probably helping everyone just to bring more awareness to the industry in general, which leads me to another question that you guys have been around for decades and decades. And there's not a lot of businesses that can survive that length of time in any market. So beyond raising awareness beyond, you know, navigating this really interesting math problem, you presented to us, Bob how have you been able to stay in business so long? What's your secret sauce? And, and is that even gonna take you into, no,

Bob Roth (13:22):

You want me start Neal?

Neal Kursban (13:24):

I like you Bob story. And I follow it. That's so,

Bob Roth (13:28):

So, so for me, you know, first of all, you have to evolve you know, the old adage, if it ain't broke, don't fix it. That that doesn't work. And the definition of insanity from Einstein is you know, doing the same thing, expecting the same results. I mean, the landscape continues to change, you know, Cypress nearly three years ago, we made a conscious decision to change our model. And a lot of people looked at us really funny and said, you know, why would you do what we did? And what we did was we took a entity that was 25 years in existence. And we partnered with a group out of the San Francisco area called honor. And Neil will tell you as well, I, and many others, you know, they were looked at as the evil twin sister out there, whatever you want to call them because they were known as a disruptor and, and somebody that was really trying to come into this market and use tech to really differentiate themselves and Neil and I, and Aaron, you know, this too, I mean, this is a high touch business.

Bob Roth (14:38):

This business is personal. You know, when a consumer opens up the door to their home, they open their life to a caregiver. So how in the world, could you take a, a, a agency that has established himself for 25 years and just turn it over to a tech company? Well, you know what, I have been involved around this one group called aging 2.0, which is a curator or platform for tech and innovation for the senior world. And I had followed on from its very inception from 2014 to at the time it was 2018 and they certainly evolved. They understood, they op stood up and opened up their own home care agency in San Francisco. So yeah, they were somewhat a disruptor at first. And I think everybody was, you know, really leery and concerned as to what they were going to do. They've learned and they've changed.

Bob Roth (15:32):

And I was not having an issue personally with recruiting caregivers, but the data that we were getting from resources like the paraprofessional healthcare Institute outta New York was not really looking good. We were gonna have a shortfall between 20, 20 and 2026 of roughly about 1.8 million caregivers. They call 'em direct care workers. And in the state of Arizona, it was over a hundred thousand. So I knew that honor had a secret sauce, so to speak, to recruit caregivers and utilize their tech on the back end, but allow us to still be able to be relevant on the front end, to do the care managing and the relationships and all the stuff that established trust in your community. So to answer your question, I mean, you know, we have to evolve, whether you take a leap like we did at honor, or you change internally, you've got to really be able to overcome the obstacles that we are definitely faced with.

Bob Roth (16:34):

And we've talked about it when you're first questioning about, you know, the affordability challenge as well as the workforce challenge. So each one of us has, and, and the ones that have been around as long as Neil and I, we don't stay static, you've gotta be dynamic and you've gotta be able to change. And, you know, we certainly have embraced honor. It's been a bumpy road for sure, but you know, we've smoothed out the kinks. We, we learn from each other. We just are in the process of re-upping our contract with them, cuz it really is a contract. I can walk away if I wanted to, but I'm choosing this day. But, and answer your question. I mean, we have to look at all our options, how do we exist as entities? How can we be able to survive? And for me it was how do I survive for the next 25 years? Cause we existed for 25 and today we're one of the hun care agencies in the entire state of Arizona. And I thought honor gave a, the best chance to that.

Neal Kursban (17:38):

So the secret sauce, oh, should I

Erin Vallier (17:41):

Turn

Neal Kursban (17:43):

Be around piggy the need to constantly evolve and innovate and tweak. And I mean, that's, that's has to happen otherwise, you know, be around and similar. We also, you know, in our particular market we're and actually I think in, I think we're the largest company that serves at one market. We do over 40,000 hours a week of care in, in a pretty tight geographic area. And so there for me there, hasn't been like a playbook on other companies conferences about how you get from, you know, the 20 to 25,000 to 30. So I, I just, you constantly trying and tweak. And I remember internally changing our own business model, not through, not through an outsource, not different company, but having to take what was working and realize, you know, I don't think this us from 25 to 40,000 hours. And so we had to sort of reinvent ourselves and it took a lot of big leap of faith from not just for me thinking it's gonna work, but also the trust of my staff and to say guys, despite how things have is we gotta continue to.

Neal Kursban (19:12):

So that certainly is the case. And yet the same token, I would say there's certain things, the secret sauce hasn't changed. So on one hand you have to do all that. And then the other hand, I'd say there's very, very little change to when I started my started the company in, in its simplest form is finding amazing, wonderful, caring, compassionate caregivers to go to the homes of people typically in their eighties and nineties. So the essence of what we do is very consistent. It's find the best, treat them well. They're gonna treat the families and clients well. So that formula hasn't changed despite the, I mean involves right, all these statistics about the para you know, the shortage and how to overcome it. I mean, all those challenges don't change to the end. They don't care that there's a, that whatever's going on. They just wanna know that this caregiver else he's gonna care great wonderfully for my 87 year old. And there's gonna that I can leave the house and not worry cause I have a that's coming in. That's gonna build trust and really be there and be, and just so again, yes, there's a lot of tweaking the business model from the internally, but to the end user, it's not that different.

Bob Roth (20:42):

You, you know, I wanna, if I can chime in Erin, Erin, you know, family and nursing care, you know, to Neil's point, you know, they've evolved. And I learned so much from other home care operators and, and I've learned a great deal from Neil and, you know, Neil is, he tends to be a little modest and he, he's not as outspoken as I would like him to be because he's, he's done some really remarkable things. And Neil, if you wouldn't mind share with us, you know, your secret sauce to retaining caregivers because you are an anomaly, you do it differently than anyone else. We know what home care pulse tells us in their benchmarking studies. But the first time I, you, that question you were in a single digit number in terms of turnover, not retention, but turnover. I know you creeped up into the double digit number around the pandemic. I don't know if you're still there or if you went back to single digit, but to me that is an incredible accomplishment and that's something that you are doing. And I think it speaks volumes to the fact that the business hasn't changed and you're recruiting, caring, compassionate caregivers to go into people's homes that are in the seventies, eighties, nineties, or hundreds. But there's something that you're doing that connects family and nursing care with their caregivers to keep that retention with.

Erin Vallier (22:07):

And just for the record where you at, I didn't have to ask you for your secret sauce. Bob did that.

Neal Kursban (22:14):

No, I'm happy to share. I think it's a great, I mean, is that where you wanna go with this hearing? Is that, oh

Erin Vallier (22:18):

Yeah, it was, it was in my mind to ask you, so let's just go there.

Neal Kursban (22:23):

The caregiver phenomenon, that's the case. And then my, you know, my view just from a high level business perspective is, you know, you're any area of the company that's, you know, you're only as strong as your weakest, right? That's an expression that is, is very true in business. And so me the idea of someone calling or for any of us or anyone listening, it goes into a Starbucks. Bob holds star drinking anyway it's a tea,

Bob Roth (22:59):

It's

Neal Kursban (22:59):

A tea from anyway. So Starbucks and so notion that someone call a home care company and say, yeah, I'm I'm outta caregivers. Well, isn't that what you do? So this whole premise of like, I don't, so what can we then do to make sure that we have, we have caregivers, not just caregivers, but wonderful, great are gonna make a difference in the lot. So it's not just do I have a caregiver it's like having the right kinda caregiver. So to Bob's point, yes, we have very low retention. It's 12% at the moment. So 12% turnover of caregivers.

Bob Roth (23:44):

Yeah. I, I just wanna correct you high retention, low turnover. Go ahead. Cause you said low retention. Oh, good

Neal Kursban (23:51):

Point.

Erin Vallier (23:52):

You're way humble.

Bob Roth (23:54):

So go ahead. And those numbers again, please.

Neal Kursban (23:57):

So, which is high retention and, and we're proud of that and it's not without, I mean, my whole view, this is kinda like a Phil philosophical view on, you know, I happen to be in the home care space, but this is my view of people that are making lower amounts of money. It's hard to on 13 and hour in your market, 15 an hour, like whatever, the, the going wages. And then, then companies that cap out. This is sauce that and say working than a hours a week, 84 hours, I mean some 12 hour shifts is a very common shift in our industry. And five days a week is 60 hours. And some, I also, it's not enough for me to only work 60 hours Monday through Friday. I, I need another. So I mean to those have to compete with another company to keep the caregivers. To me, doesn't seem like an approach. I, I don't like that approach. So I prefer they all stay with me and just work and they can even get more money and they work more 40 hours a week. So we we've kind out there. And the clients tend to like continuity people in thess have some of dementia and they prefer people outta their home. And so it's sort of, it's a win-win cause caregivers, don't a second job and clients wanna outta we've embraced just boatload of overtime and sort built.

Neal Kursban (25:49):

And so that's, that's a big chunk of the secret sauce. And does it mean that we have lower margins than other companies? Yes. So the amount of money that my caregivers make compared to the rate that the customer pays that's the caregivers make more. So therefore my business margins are smaller, but I also been able in the format been able to grow much larger is what you heard me share earlier. It's

Bob Roth (26:15):

40,000 hours a week's. Yeah,

Erin Vallier (26:19):

It's really simple. And it makes sense, like give your caregivers the hours that they need so that they can take care of their family. Pay them a little bit more. But I talk to agencies all the time and one of their main things is how can I manage overtime? How can I know when somebody's going into overtime? Cause I wanna avoid that. Like in both of you in your opinions, why is there so much Fear about paying overtime and what's it gonna take to change that paradigm shift? Well, it's time and a half, right? So you're, if you have to hire another caregiver to fill a shift, you're gonna have to pay them a whole time. Right? Like just, I don't know. Maybe I'm thinking about that wrong.

Neal Kursban (26:59):

Let me take this. So let's just say it's $13 an hour and then another character that goes is making 13 an hour. And so you don't have to pay it's 13 time and a half 1950 trying to do quick that. Right. Anyway. So instead of paying 1950,

Bob Roth (27:17):

You're

Neal Kursban (27:17):

There that's a lot more expensive to you as a business than its to and just have. But then my view is you're paying the home care pulses and the statistics come out and say, well, you're gonna have 70% turnover of caregivers. Well then you gotta have more people in your office and more salaries on more caregivers and having to beef up internally and having to pay those salaries and benefits and expenses. Why not just limit the amount of turnover. And then you don't have worry about losing seven outta 10 of your, I think just to, you know, know, and I've heard people say, well, Neil course, you can do it. You can afford it. You're bigger. And I say, well, I dunno how you can get bigger without doing it. So you have to almost take a leap of faith and say, in my view to say, look, I dunno how else I'm gonna, I dunno how I'm gonna get clients to stay with me longer because unfortunately there's more issues.

Neal Kursban (28:28):

I mean, just simple math of, if you have four caregivers in the course of a week or two caregivers in the course of a week, there's four caregivers have lives also and mine one may have to take off or go to the doctors or take their kid to an appointment. Then you have to it then elderly another person that they coming into home. So if you can just sort minimize it and just, I dunno, pay the overtime and you make up for it by having last your less longer and you don't have have much expense internally.

Bob Roth (29:01):

And, and to something you said earlier, Neil, you have less people coming into the home. And that's what our clients, especially during this pandemic, they were fear fearful of getting COVID. They didn't want as many caregivers coming into the home. So you, you have consistency there and there's nothing more frustrating than churning caregivers. And having the client have to take that caregiver, a new caregiver almost every week take 'em through the routine that they have to learn and go through. And then all of a sudden they go, not only is it frustrating for the client, but the industry experts say costs us roughly as home care agencies, about 4,000, 200 for every caregiver that we turn over. So my hat's off to you, Neil. I give you a lot of credit and I've learned a lot from you. The, the one thing that I would love to have you share and Erin, I hope you don't mind me

Erin Vallier (29:55):

Question,

Neal Kursban (29:56):

But,

Bob Roth (29:56):

But you know, I, the radio show and you, you mentioned, and inquiring minds want to know, you know, Neil, you took a leap of faith that you shared with me during this pandemic, and that is you cut back your minimums and you expanded those hours. Are you still at a higher minimum hours than you were before? And how's that working for you? Because as I said, you know, clients don't want all these caregivers coming into the home, but caregivers too, don't want to be stacking up shifts where they're going into two, three or four clients homes in the same day, they would prefer longer hours with fewer clients. So to speak,

Neal Kursban (30:40):

To go there, I I'm happy to.

Erin Vallier (30:43):

Oh, sure. Well, I was gonna ask how you guys are innovating, you know, to, you know, stay relevant in today's market. And I think Bob just asked that question of you in just a little bit different way, so you can go, but Bob, you have to also input too. We wanna know about you as well.

Neal Kursban (31:04):

So, you know, across the private pay home care space across the country, there's minimum caregiver. A that's just been the case that I do think with the shortage, the nationwide shortage of workers and specifically home care workers, home caregivers, it's, it's, you know, it's almost like what's a better service experience for family. And so by we at least for a period of time, I don't think itself, I think for a of time we're like, and despite the fact, wow. And so we turn, we had chosen to turn away clients at one across the nation. Most companies would turn away caregivers that want less than four hour shifts. So we bump that up to six hours and we bumped it up to eight hours and then we bumped it back down to like, it's all about like sort of that whole of client demand thing to make sure that and experience the family and the client is gonna be a great cause they don't care. They just don't care. Whatever issues are going on and wanna reasons you can't or you don't, they don't just great caregiver's and

Erin Vallier (33:01):

Bob, what do you have to, to add to that?

Bob Roth (33:04):

So, so I will say this, there are so many home care companies that are looking to bolt on new revenue sources and, you know, people are trying to get into the pers business. And for those that don't know what that is, that's the personal emergency response button that you push. And they, they, they customize that or white label it and sell it under their, their banner. And they have people managing those. You know, they also, you know, go into this side of you know, having home repair work worker, do workers come in and you know, they, they look at bolting on all the, as service lines. And you know, for me, I think you, you gotta stay with what brought you to the dance and that's caregiving and that's really what sets you apart. You know, one of the things that we built tiered, Cypress and Neils aware of it is that, you know, we, we had a training lab that we opened up in 2004 and we trained all of our caregivers in that.

Bob Roth (34:03):

And we also trained family members in that, cuz that's the space we're in, we're in caregiving back in 2014, we evolved into extending our care services to dementia care and Alzheimer's care. And we have a dementia program that specific to trying to keep people in their home. We have data that shows that we or were, and are able to keep clients in their home seven to eight months longer versus having them place seven to eight months longer. And to people that are dealing with family members have dementia or Alzheimer's, that's like an eternity. And what is involved in that? It's caregiving, it's caregiver training. It's teaching caregivers, especially on the dementia Alzheimer's side, how to make meaningful days, you know, anybody can stick a older adult in front of a television. So many parents do that with their children. But one of the things we know about dimension Alzheimer's is you keep them socially engaged. You make sure that they eat their meals at the right time. They take their medications in the right doses at the right time. You can keep people in their home longer than you would otherwise. So that's, you know, really the secret sauce is really sitting down and thinking about how you can make your company exceptional. I don't think you need to bolt on new lines of services and get outta your core. Your core business is caregiving and you should stay true to that core.

Erin Vallier (35:43):

I like the theme that, that you guys have set here. It sounds like there's a, a two pronged approach to being successful. You've gotta be agile on the business side of things and look at the market and leveraged to technology, leverage this whole gig economy that's coming about and expanding your pool of people that you can draw from. But really at the heart of your business is providing that good care and that what you do in the home, the quality of what you should be providing in the home really hasn't changed very much in many decades. And if you can just focus on being really good at that and being agile on the out, outside, and like be aware of how the market is shifting, then that's the recipe for long term success that I kind of summarize that from everything that we've been talking about.

Erin Vallier (36:35):

Okay, well, we've talked about a couple of challenges that, I mean, some really big challenges, like getting in the home because there's a caregiver shortage keeping our caregivers. But I think that there's, there's challenges outside of that, even though that's what everybody is talking about these days, in your opinion, what are maybe two or three additional challenges that are real salient and will be important to address in 2022. And can you also provide your perspective on how agencies can get ahead of these challenges as they're thinking about what are my goals for next year?

Bob Roth (37:22):

All right. Thank you, Neil. First of all, I think one of the biggest challenges we have is really earning our seat at the table and the healthcare you know,

Bob Roth (37:35):

Home healths physicians, hospice, they all share in same pool of dollars. They all share in Medicare dollars, managed care dollars. They all get data and data is the key to really substantiate their service to their communities, as well as the institutions, the acute and post-acute providers that they're providing two. So, you know, one of the biggest challenges I see for us is really earning our seat at that table and really being able to provide data. And that's where we need people like all Eli care and others be able to provide us data and collecting data that shows the work that we're doing. And, and what specifically in my talking about I'm on a committee with the home care association of America, I'm one of their board of directors and it's the data and research committee. And we are working with all Eli care and, and many of the other software providers to start to collect data on ER, visits, falls, UGI care visits customer satisfaction, because we don't have the data that CMS delivers to, to the world on how these providers are performing.

Bob Roth (38:52):

So I think, you know, one of the things is, is that we have to, to earn our seat at the table. That's why I said early on, we can't call ourselves non-medical or non-clinical, we are very medical. I mean, if we're not in that home, making sure the clients are being fed, they're safe, they're getting bathed, you know, they're clean, they're comfortable. If we don't do those things, they're gonna end up back in the hospital and they may end up, you know, not, it may end up passing on. So we are a very integral part of that. We're that tip of the sphere and our clients, or should I say our caregivers see the changing conditions before everyone else does because the home health person coming in for an episodic visit and a lot of cases, maybe more so in my market than Neils where, you know, this is more of a destination Arizona where the adult children live in other markets.

Bob Roth (39:47):

You know, we see those changes and we have to report those changes and we have to intercede. And hopefully we can do that in such a way that we can event an event, a medical event from happening. So I think the biggest thing that we need to do is really earn our seat at that table. I think if anything that happened with this pandemic, a spotlight was shown on communal living and it wasn't very favorable. And I for 1:00 AM a little bit older than the two of you, but, but if I had trouble staying at home, there is no way I am wanting to go into a senior living community, especially with Amron out there or whatever the next variant is out there. It's a scary place to be. If you can stay at home, we should be able to give every person that right. And ability to do do so. So I think the biggest challenge facing us right now is earning our seat at the table, collecting data, utilizing resources, like all care and other providers to help us collect that data, to support our, our, our place in the healthcare continuum.

Neal Kursban (40:55):

I, I echo Bob. I, it might make, make sense. And why wouldn't we have a seat at the table because Bob said, we're not getting reimbursed the government, if you private pay, or if you pay for long care insurance, then I mean, that's, it's paid for. And then so there's requirement for private that's however, these, you know, the discharge planners that rehabs and hospitals and the, the, there is like this taboo and there are some affluent or more affluent or on that side of the affluent scale of people that are in a hospital or rehab, and then they're gonna get discharged. And they would've been, they would've liked to have known, OK, it's outta my pocket, but at least I know it exists. Like it just, that's, that's part of the challenge around my view about why there's this taboo about talking to, I could go on and on about that.

Neal Kursban (41:58):

Let's my two, I think the two other challenges I would say are, and I know we're talking to and is great, but of the, of sophistication of the, you know, honor and lie care, I think are three, four ahead of the curve. But I still believe that there's, it's just not, you got 87 year old spouses and often immigrant workers that are lower wage incomes that have to understand this software. They have to get on the, your smartphone and figure out how to properly clock in and out. And you a, you dress, you the, did you feed, like I tell this story and he was navigating around it. I'm like how the three yearold, they can't read knowing where to go. I was fascinated. And the, the genius of the simplicity isn't hasn't yet arrived in my view for the home care workers and the 87 year old spouse.

Neal Kursban (43:15):

And quite frankly, even the office workers that are trying to navigate the software. So that is one area of, I think, is a challenge. The other one in my view is a lot of the, the regulations to do home care are outdated. And what was done 15 years ago to create a home care license. We talked about how we have had to evolve as an industry and as businesses. Unfortunately, I think in a lot of states, the regulations are archaic and they're not even applicable to what we're doing. And so you either have, let's say, outdated or regulations at this that don't, that are literally hindering the experience of a like, or force the customer or client to pay more money cause of the amount of regulations that aren't even relevant today. And so businesses gotta do a bunch of other extra stuff so they can check the go I surveyed. But in reality, it has no real material impact on the actual caregiving screens. And that I find,

Erin Vallier (44:25):

How do you think we change that?

Bob Roth (44:30):

Well, I, I can, I can say this, you know, one of the biggest challenges that Neil mentioned is so true even with honor, is that, you know, they rely so much on tech and, you know, I, I think it's gonna be hard, but I think it's gonna change itself. And I, and I hate to, you know, just bring up this fact is that we're going through this gen interracial shift. I mean, I talked about the baby boomers already and you know, the baby boomers are a lot different than this last generation. I mean, 87 year olds, aren't really good at navigating on their devices, but I will tell you I'm a boomer and most boomers I know are really good at that. And, and I think that shift is happening right now before all of us. And we're not really realizing that's happening. I mean, I am seeing more and more clients come on service that are boomers more so than ever before.

Bob Roth (45:22):

And, you know, they have some serious health challenges, but they are more akin to adopting tech. But other than that, you know, I know that a I care and honor, and others try to make it as easy as possible. You know, we do a little bit of Medicaid here. And the biggest challenge we have with is with this EVV electronic visit verification. And I will tell you, oftentimes we find ourselves with caregivers that just can't remember their passwords and, and we're resetting their passwords time and timing, and we know who those culprits are. And I guarantee you, there's not one of 'em that's 50 years or younger. It's the ones that are 50 years and older. So I, I don't have that solution, but I think it's, it's gonna take care of itself in, within the next 10 years, if not shorter. I mean, we are going through this shift right now and it's happening right before

Erin Vallier (46:19):

Us. Yeah. I think it coming from a technology company, we absolutely have a responsibility to listen to you guys and listen to the people who, who use the technology and, you know, do things like facial recognition and fingerprints. You there's no sense passwords. I think we just need to work together. I'm I'm I, you know, if you guys need the data to produce, to, to prove that you guys to pay your sources, that you're worth what you say you are, and that you can keep people out of the hospital, then your technology partners are, have to be able to serve that up to you. And I'm just wondering if there's something that we can't help you with on the, the regulation front. I mean, dealing with that, those government entities, that's a really slow and very frustrating process. I have I have some experience in trying to change things in tax to like, make it more provider friendly, but it's just a slow and tedious process. Neil, do you like, what are you, I mean, that was your thing. Like you think the regulations are off, like why, like what, what pieces of those, and, and what's your, what's your idea for agencies listening to this to, to make a difference to move this in the right direction. That's a

Neal Kursban (47:38):

Great question. So I think, I mean, it's twofold and you know, around 53 years, we've done a lot of this to help frame and shape regulations in my market, but it's, it's a combination of the civics list, the legislator brand, like going to the local state senators and delegates and getting them to put pressure on the, the healthcare department, spective state, and preferably, and ideally just talking directly to the people in the health department and trying to, to help them realize, like, I don't think they're ill intended. I just don't. I think it's a lack of awareness about how things have changed as much as they have in this particular sector of private pay home care. And it's just another thing to deal with and to try to get their attention. And the regs are already written and they're trying to update their assisted living regulations or their nursing home regs, or the CMS came down with another mandate.

Neal Kursban (48:36):

And they're just, it's like a prioritization where, well, OK, you guys get a caregiver in the house and yes, they might be updated, but that's not our biggest hurdle right now, internally at the health department. So that's been, it doesn't mean we don't keep trying and we have, and state trade associations. Usually those states that have a trade association can usually communicate with whether it's the, the legislators and or the health department. And, and I, and I say this it's frustrating. We've had a lot of success, despite issue was a concern, but even then even what we agreed and was four or five years ago was already starting to have nega negative ripple effects as time goes on. So I, I think it's just a pervasive, you know, again, I think working through your state trade associations is probably the key to most of, and then hopefully the executive directors of those respective state trade associations are, you know, savvy enough to know how to navigate these borders. Cause it's not the easiest,

Erin Vallier (49:40):

I think that's good advice. So what I'm hearing you guys say is, you know, if you're not involved, if I'm listening this, I'm an agency owner and I'm not involved with my state trade association, that's homework assignment, number one for 2022 at some point, get involved and make your voice heard. And I think also just explore the technology options and lean on your partners to make sure that you have the support you need from the operational side to, to do what you gotta do.

Bob Roth (50:08):

You know, I, I I'll piggyback on what you're saying, Erin, what Neil said is that advocacy is so important and Neil you're absolutely right. We're, you know, we are better together than individuals and you know, your mom, you know, she was a trailblazer. And I, I would imagine that, you know, the legislators, you know, got to know her and they were like, Hmm, what are you talking about? Cause they didn't really understand our business, but it is so important for us as agency owners to come together with the trade association or the trade in general and to be active in our local government. It, you know, advocacy is so important and there's an old adage that if you don't have a seat at the table, you might just find yourself on the menu. And for us, we need to have a seat at the table.

Bob Roth (50:59):

And as much as I was talking about earlier, people don't really understand that work we're we do. We often get confused for home health and we get confused for home health, by doctors, by discharge planners, by social workers, you name it, they think we're one and the same. And we have to do our job of explaining who we are and the work that we do. So my, the listeners, you know, and I know our listeners are mainly home care agencies, please get involved in your state associations, please get involved in whether it be the home care association of America or the national association of home care and hospice, their P HCA affiliate, you have to be involved. Do you have, your voice has to be heard. So I, I just want to add bad to what Neil and, and you just said, Erin. So I think it's really

Neal Kursban (51:51):

Important. There's a 32nd on, cause I do think that I remember the first time through the state trade association said we need some providers to testify. So there's also over people of like, in those, that, and the formality and you know, having to get up and test it and state your position about why this, this particular bill needs to pass or not pass may be, and like anything else in the, or I'm talking to a state delegate. So you, we don't have go on and on about, but point being is that that is something that some people are more comfortable doing and you know, younger in I've testify. I, it, and you do things more enough times you actually get to

Erin Vallier (52:52):

Repetition is the mother of skill. For sure.

Bob Roth (52:56):

They put their pants the same

Erin Vallier (52:59):

Outta

Bob Roth (53:08):

Is if they're eight rules and regulation that we're not gonna like, yeah. So, you know what, it's, it's better to be known. And then when a crisis does happen, they're gonna call on us. They're gonna call Neil and, and his organization and other organizations and me and ask us for input. Otherwise they're gonna create laws and regulations that we're not gonna really like

Erin Vallier (53:31):

Absolutely not to be cliche, but a squeaky wheel does get the grace and guys, you know, I appreciate all the nuggets of wisdom you have provided in this last hour time flat, right? We've been talking for an hour. It does, but you both are very exceptional humans and you are out there just even beyond your own agencies, doing things, speaking, writing, before we get off, please tell the listeners, if they want to find you on social or otherwise, how can they reach you guys?

Bob Roth (54:12):

Neil, you go first

Neal Kursban (54:22):

Is moment. If you remember that you can just Google it then. But I have email I, you're my email address and my phone number and I'm on LinkedIn. And I do Bob's each other clearly just, you can tell from your dialogue and thank you by the way, Bob, you've been very, very gracious about, and, and you're being humble yourself. So but you know, I just, Neil KES band, family nursing care email at like, is there a way that you can post this on?

Erin Vallier (55:04):

Can we can certainly put it in the show notes for you? Yeah, absolutely.

Neal Kursban (55:09):

So,

Bob Roth (55:10):

So, so I'll add and, and just pick up on what's something I said earlier is that I find today this climate a lot different than it was before, where we need to work together. This is a problem for the trade and the, the industry and not so much disregulation, just even if you go down to the micro level and the markets that we serve because of these environmental and external forces that are challenging all of us, we, we need each other. I mean, you know, there there's Peter Ross from senior helpers uses the phrase frenemies. I mean, we're really not enemies. We're friends. And we all struggle with the same challenges. And, you know, if you get stuck with a case that you just can't staff on a weekend, or you need a male caregiver and you don't happen to have one that's the beauty of this space is that, you know, we're all in this because we're caring, SP spirits, we're kindred spirits.

Bob Roth (56:11):

We wanna make a difference in people's lives. Listen, if we wanted to make money, we wouldn't be doing this. I can tell you that right now, cuz I've got a lot of friends that are making a lot more money than I ever have or will, but we do this because of our emotional and our passion is just overflowing. We make differences in people's lives and that in of itself feels really good. And I feel great about doing that. So if you wanna reach out to me, I'm happy to talk to you. And I know Neil's the same way. Bobroth@Cypresshomecaredotcomorgouptocypresshomecare.Com. You can get a lot of good information there. I'm also on LinkedIn. Look me up Bob Roth. I think it's CHS back slash CHS, but I know Aaron will put this information up there as well as our phone numbers. I I'm happy to talk to any one bounce, any question off of me I love what we do and we make differences every day.

Erin Vallier (57:11):

That's awesome. It's clear that you guys like the passion, the history, the passion is, is just wonderful and we need more of you out in the industry. That's for sure. And it's been a play pleasure.

Bob Roth (57:24):

Well thank you Erin, for the opportunity. Thank you.

Jeff Howell (57:31):

Home health 360 is presented by AlayaCare. First off I wanna thank our amazing guests and listeners to get more episodes. You can go to alayacarecare.com/homehealth360 that's spelled home health 3 6 0 or search home health 360 on any of your favorite podcasting platforms. The easiest way to stay up to date on our new shows is to subscribe on apple podcasts, Spotify, or wherever you get your podcasts. We also have a newsletter you can sign up for on alayacare.com/homehealth360 to get alerts for new shows and more valuable content from AlayaCare right into your inbox. Thanks for listening. And we'll see you next time.