Why Home Care Agency Growth Stalls

From the episode captions, lightly cleaned. Speakers are not labeled, and the text may contain small errors. Time links play the episode from that moment.

0:00 In MedTech, the difference between a good quarter and a great one isn't always the product. It's the friction standing in the way. Broken sales cycles, misaligned teams, deals that stall at the finish line. Every leader feels it, and the best ones know how to remove it. Welcome to Zero Friction, the podcast where we go inside the minds of MedTech's top commercial leaders to uncover the real barriers they face, the decisions they make, and the systems they build to keep the revenue moving. I'm your host, Terry Coutsolioutsos. Let's remove some friction.

Well, welcome to Zero Friction, a podcast where we try to figure out where all the friction and inertia is in the world of healthcare. And today we have a great guest. It's Julio Briones. Julio is really his passion and his mission is to try and fix the way home care is broken today, and he's helping other agencies do that. And he has a consulting group, Briones Consulting Group, that it's mission and purpose to actually help those agencies deliver better care, have a more viable business moving forward. And so, Julio, thank you for being a part of our podcast. With the aging population, home care is becoming more prevalent, and we see it every day in the lives, whether it's our own personal lives or our friends and family that are being impacted by it.

So, thank you for being here. Yeah, thanks for having me, Terry. You know, it'd be great to give you a little background. I know that you getting into this business was sort of a response or reaction to. So, why don't you tell us how you got into the home care business itself, and then give us a little background on on your business, cuz I know you're making a huge impact to those home care agencies in the market. Well, it for me it all started way back when dinosaurs roam the earth and I was 15 years old. You know, the I I was uh running around the streets of Queens and being a normal 15-year-old in the '90s, and my mother just wasn't having it. So, she had me come in after school and go work at the agency she worked at being a recruiter.

You know, so I used to I got to learn and understand what home care was and you know, what recruiting and all the challenges and everything that these caregivers used to incessantly complain about back then. And you know, fast forward a little bit, I went to the army, I opened up some clothing stores and unfortunately my father took very ill. You know, um we I was traveling a lot for work and you know, I just assumed because my mother's experience in home care and my sister also she used to work in health care at for many years, she still does as a matter of fact down in Florida. And they um you know, they had it handled and they had an agency in place and unfortunately the nobody was minding the store so to speak. And a caregiver decided that it was more important for her to sneak off with her boyfriend and left my father by himself. That was the last day my father was with us. Now, my father and I were

2:56 Very, very close. Okay, I very much admired and respected him as a human being and as as a man and you know, guided me through a lot. So, his death I took it very, very personally. Now, I got to clear this up because I get this a lot. Yes, he was going to die anyway. Okay, he was he was not in good health, I get that, but there's a big difference between dying and dying with dignity. And I think that's what that agency ultimately robbed him of by them not doing their job right. So, I I had a mid midlife crisis I guess if you want to call it, mental break, whatever it is, but I the best way I could handle this and what made sense to me was I sold my clothing stores. I you know, completely walked away and I took a $13 an hour job, you know, being a recruiter cuz that's the one thing I knew how to do in home care. And, you know, I I just said I I became mission-driven at that

Point. If I could stop one family, just one, from going through what I did with my father, then I could die a happy man. And that's when it actually got worse for me. I started seeing all the holes that well-established, well-run agencies were actually putting these families that have, you know, and time goes on, I jumped to a couple of other agencies, and I went to the world of franchising cuz I figured can make a bigger impact there by helping many agency owners. And that moved along, and I ended up ultimately taking on a client as a franchisor, working with them, and that ended during COVID, that contract, and I went full-time working with these agencies. But again, it's like you said, I'm mission-driven. I I believe very firmly that if your management sucks, the only people that are going to suffer are the people receiving the care.

You know, before we get into a lot of it, I think, you know, there's all sorts of home health care, you know, happening in today's market, and you're you're talking about a specific segment of home care, not home health care. So, it's not the nursing type of care, but let's want to we get that straight for our audience, and that way, you know, we we can we can create some clarity on that side. Well, so the big confusion that a lot of people have is what's the difference?

You know, you have ABC Home Care and XYZ Home Health Care, and they all seem to do the same thing. On its face, that could happen. Because what ends up happening is a lot of people when they go into this business, they don't understand the difference themselves, so they name it what they think Google will like, okay? Or now, ChatGPT. You know, so what ends up happening is the reality is when you're talking about home care, you're talking about personal care, non-medical personal care. That's assistance with bathing, that's assistance with eating, cooking a a for someone, keeping them company. It's focus really is on two things. Number one is the ADLs, the activities of daily living, what keeps you alive. And the IADLs, the instrumental activities of daily living, which are what gives you a good quality of life, okay? That's home care. Home health care, even though it's commonly misused, is more the skill care. That's the nursing, the PT, the OT, the speech therapy, wound care, things of that nature. And while there's

6:14 A lot of similarities, you especially if if you're listening to this trying to figure out to find care for yourself, know the difference because it all depends on the scope of work. What are they legally allowed to do when they're caring for your loved one? Well, even in the audience is like for my purpose, I'm not in the market for one for myself, but you know, we all have aging parents and you know, it's one of the fastest growing segments in the market today and that's probably why there's, you know, want to dig into it later with you even though there's this huge aging population that's creating lots of demand for home care agencies.

It's also probably stressing the system out as well. And so quite a bit. Yeah. Probably a lot of and I just I'll go with my own personal experience of finding a home care agency and dealing with long-term care insurance and paperwork and all that stuff. It's a really complicated you know, it's not a couple phone calls and you're, you know, one and done. It's it's a continuous administrative process that that takes a long time to actually get kind of squared away with. Yeah. Yeah, I mean, look, it it's you're absolutely right on that. There the more time goes on, the bigger the strain, okay? And a lot of it is caused because this wonderful stat that's been thrown around for years, you know, 65 10,000 people turn 65 every day. What people forget is the other side of that equation. The other side is that most people start requiring home care between age 72 and 75. So, those people that turned 65, those 10,000, are turning

Also 72 to 75 every single day, you know, and that's causing a big strain because there's a lot of things with labor shortages and everything else going on in the country right now, you know, and it's not something that's going to be easily fixed. So, whether you're a private payer or Medicaid, if you're an agency and you don't have a good solid foundation operationally, you're you're going to feel the strain more than most. And I mean, especially now at the time of this recording anyway, with all the fraud investigations and everything going on, it's going to really strain the system even more because too many bad actors out there.

Yes, that's probably put a lot of stress on the money and people getting paid, too, by the way. I'm sure that the government has sort of you know, put some pause on, you know, what's kind of going out the door and that's probably putting a lot of strain on, you know, on the good actors. On the good Well, there's bad actors, but there's probably good actors suffering, too, by the way. Quite a bit. lines, too. I mean, they they throw them all in one bucket until they figure it out, right? So, Well, that's that's typically the government approach, yeah.

8:46 Yeah. So, it's How do you Shoot them all and sort it out later. So, what are the big friction points that that you're helping your customers, which are these home care agencies, what are the big friction points that you're helping them solve for every day? Well, the biggest the biggest thing overall is where their revenue's coming from. So, there's a lot of agencies out there that all do have a single payer source. They're worried about working with the HMOs to get Medicaid money cuz it's easier, okay? And just realistic, even though there's sales involved in there, it's not as much customer service attention cuz they you just go, you submit the authorizations, everything gets approved just to simplify the process, and eventually you get paid. A lot of them now are seeing the writing on the wall, and over the years, I always encourage people that you want to have a good payer mix. You want to make sure that you're not only hyper focusing on Medicaid. Yet, there's waiver

Programs, there's Department of Developmental Disabilities, there's the VA, there's private pay. And that's where my specialty comes in. I I work with people to make sure that they are able to take get through the plateaus, to deal with the labor shortages, and to increase overall their revenue. Cuz the reality is most agencies get stuck somewhere between 1.5 and 2.2 million in revenue, depending on where they are, and they can't seem to break it. They can't get past that, and they want to grow. And more often than not, it's very simple tweaks that will help you get beyond that. You know, and most of it is operational and and customer service side. It's getting more expensive to do private pay. The labor market is really driving driving prices northward really quickly. So, I mean, you have parts of the country right now that are charging $55, $60 an hour Right.

Private pay. And they can't help it. There's nothing they can do. If your caregivers are demanding $30, $35 an hour, you have That means your office staff is no longer content with $20 to $25 an hour, either. Cuz they don't want to make less than the caregiver. So, that means your operational costs and at that point retention for both client and caregiver become much more important. Well, I would imagine just, you know, client retention, patient retention, however you want to look at it. Like, you know, it it costs four times the effort of energy and money to go acquire a new client than it is to retain a new one.

Right. And it's the same with staff. Yeah. Right. And staff as well, right? And it's kind of funny, cuz I do remember going through the initial phases of assisted living, sort of just like interviewing different agencies and the costs that were associated on an hourly basis. I was like, "Wow." I was like, you know, it's Yeah. like 45 bucks in Florida an hour, maybe 50 in some places. And so it was a really, you know, interesting kind of concept on, you know, how that whole kind of transpires and then needing to make sure that it's not just the hourly wage, but then you have to guarantee them so many hours per week and, you know, so it's not really like, you know, I can she can come over for 2 hours for $40. Like, no, it's a 4-hour minimum. And Right. you know, and that's and that's a big part of the staffing retention thing, too. So, there's these your customers are balancing lots of their money trying to deal on a lot

12:05 Of different things, right? It's probably really hard. Yeah. See, your your average home care agency, let's just let's take Florida for example, okay? Cuz they have a lot of things to contend with. You you have a rising minimum wage, okay? You you definitely have rapidly increasing gas prices because of all the stuff going on. So, in order to compensate for that, these caregivers are also dealing with it. So, a smart agency, what they're going to do is they're going to price themselves in a way that a shift guarantees that caregiver to fill up her gas tank.

That's that's functionally what you're trying to do. I always use this analogy when I'm working with my clients cuz they they're like, well, I don't know what's a fair wage. Look at the price of gas. That's a fair wage. If if you're if you're going to send a caregiver that is going to make $15 an hour for 2 hours to a client, does does the $30 or actually about 20 24 $26 roughly after taxes, will that fill up her gas tank? If the answer is no, then that's not what they're going to look at as a fair wage.

See, people try like most agency owners, not most, but a lot of them, they're like my age group, you know, 40s, 50s, early 60s, you know, late 50s, right around there. And what what that generally means is that we look at things from the perspective of being in the '90s, being in the '80s, okay? Where it wasn't about what's in it for me as much as, you know, hey, this is I understand the role I'm filling and is the wage reasonable for the assignment I'm taking on. Today, uh people want when they're look out looking for work, they want to feel that not only are they able to I hate the phrase, but a fair living wage, all right? But they also want to feel that their their work is having an impact. So, you can't look at these younger employees with the mindset of how we grew up. So, one, are you solving their needs? It's the hierarchy of needs. Are you Are you able to provide for them? Food, clothing,

Shelter. That's your wage. Now, let's move up the pyramid here. Do they have a feeling of belonging? Do they have a feeling of accomplishment? So, are you planning and really matching your caregivers so that Chatty Cathy who loves to feel good because she talks to people all day, are you putting her with Mr. Jones who's a disgruntled old vet that doesn't want to talk to anybody? Right. that's a terrible mismatch. Your client's going to be mad. Your caregiver's not going to be fulfilled. So, it doesn't matter if you pay her $40 an hour, she's going to eventually leave you. to hate going to work every day, right?

14:46 Yeah. Right. And these These are the things that they're balancing on top of all the other operational costs and logistics whatever, right? Getting the whole thing. New regulations all the time and compliance and you know, and then your sales people and you know, all the Oh, it's just it's brutal. It's brutal. If they don't They don't They don't have good systems in place, they're going to suffer and They're The job it's going to start being a bid stop being a business and start being a job and everybody hates their job, you know.

Right. The minute work becomes a job, you're going You're not happy. Sounds like a hard business to be in. Like it's, you know, It is and it isn't. Okay, I'm not just working on the periphery or on the outside. I've actually owned an agency in the past. Okay. And so I I understand where it can get overwhelming really quickly. And the issue is, and this is what fixes everything. It's and it's the hardest thing to do. You got to stop You got to get to a point where you're shifting out of that the mindset where I created a high-paying job for myself and start shifting into the mindset of this is a business I need to run. Okay? So once you can do that and you can wrap your head around it, let me tell you it it becomes night and day difference. Because at that point, you're not looking at you're not looking at doing your interviews of, "Hey, would I go out and have a beer with this guy?" Now you're looking at it as, "I don't

Care if I hate you, can you get the job done?" You know? Right. And you're putting yourself at a higher level and your staff becomes your staff. They have to get along, they have to do the job right, they have to care for the people that they're doing. They They don't always have to love you, but you have to treat them fairly. And once you get into that, now you're stopping to work in your business as an employee and now you're working on your business and a lot of the overwhelm goes away because your systems you've developed you've you're hiring better people and all of this helps the business run smoother and ultimately the the biggest benefit benefactor of that is the person you're taking care of. If your business is running smoothly, you're not having call offs, you're not having you know, you're not having miss shifts. These people aren't being abandoned. All of this stuff is being taken care of. Your Your staff internally is less stressed out because again, processes are being done

The way they're supposed to. Your sales people start meeting their quotas because they know exactly what's expected of them. Your management team again knows exactly what's expected and they can see the problems coming before they happened. And you as an owner can actually focus on what comes next. How can I improve everything down on the pyramid, down the pipeline, so that we can continually provide better care. Become an outcome focused person. That's really what you need to do. So, where do you think what are the biggest categories in terms of stymieing growth? Is it Is it Is it the operation that tends to hold the growth back, or is it the sales and marketing that tends to hold the growth back?

17:41 Equally. It's both of them equally. So, this This is a great philosophical question that we used to have in the franchising world all the time. Are we creating home care agency providers that happen to have a sales process, or are we providing a sales team that happens to provide home care services? Mhm. Okay? So, depends on the the mindset really of the people involved. Are you a super caring person that, you know, that hates sales, or are you a numbers driven individual who doesn't really care whether the person's happy or not at the end? And the real answer of this is you're both. If you're in the home care business, whether you're a corporate entity, PE you know, franchising, whatever it is, or mom and pop trying to just, you know, get by, the fact is you're both. You're a service provider and you're a sales team. So, as an owner, you have to take a really hard look at yourself. Right. Am I the bleeding heart that's that's going to get run over by

Everybody because I care too much about my client. If you are, there's absolutely nothing wrong with that. You're going to have the happiest clients in the world. You'll be broke, but you'll have a happy client. You have great retention. Yeah. But the thing is, you need to hire somebody in operations or sales that is going to be numbers focused. Same thing the other way around. If you're that hard lines number guy that that doesn't care about the end user, that all you care about is meeting your metrics, then please go find that bleeding heart that's going to help you.

Right. You know, and now when it comes to the biggest bottleneck overall, all the way around, especially in the private pay space, that stunts growth, more often than not, you have a lot of people that care about other people. And there you'll have they'll have the right team in place, but the sales, they they get terrified of it. Most people don't know how to manage their sales person. Forget the sales process. How do you manage your sales person? They're like, but I've never done sales. I don't know how to do this. You don't have to be a sales expert. You just have to know how to manage your people the right way to where they have freedom, but they feel like they're being managed and supported cuz the one of the biggest anchors in your organization will be your sales person. Your caregivers, they'll feel nervous if you're switching out your sales people too much because they they won't believe there's enough clients going to come in.

Right. Same thing with your scheduling team, your recruiting team. And same thing vice versa. If every time your sales person walks in the office, they hear, I don't have enough caregivers. I can't staff anything. They're going to not going to go out there and do their job. So, understanding how to manage is probably the biggest bottleneck more often than not. think most franchise owners are more skilled in care or more skilled in the sales and marketing side? I'm going to say it depends on the system.

20:29 Right. It really depends on the franchise system. But in my experience, I have I have seen a decent mix. A lot of people, again, it depends on the part of the country and on the franchise system itself. But you'll find more people with an investor mindset because they had to dump a lot of money in up front. Right. So, they're paying anywhere anywhere from, you know, like 15,000 15 to 18,000 for, you know, certain types of systems all the way up to 60, 70,000. Okay. And you know, they're paying that up front just for the use of a name, okay?

They get support. I I won't go into my rant about franchising. I think franchising is very good for certain people. I think it's phenomenal for certain people, not so much for others, you know, but for those that it you're a good fit, the support is really what they're paying for. All right, and they'll thrive under that condition because they get to have the experience of being a business owner but with the hand-holding. And that's kind of where, you know, people like in my position come in. They give independent We give independent donors that that comfort.

So, you're consulting them on operations, hiring, sales, Sales, hiring, logistics, the whole thing. Right. And how do they find you? Like, how do they like, you know, how you know, I know you're on the speakers, you know, bureau, but I mean, how do they, you know, if they weren't at a conference, how would they find you? Do you, you know, is that pretty much where you find people? Well, no, thankfully, you know, knock on wood, um probably about 60% of my clients come from other clients, okay?

You know, people trust me, they they like the results they get by working with me, and they'll refer me to other agency owners. Also, just generally, people will find me on my website at the brionesgroup.com, right? And also, lately, they've a lot of people are finding me from my community platform, the homecareownerscorner.com, where you know, they go in, they get a free account, and eventually so that curiosity brings them to me. So, you provide information, you educate, you you webinar, you speak. Yeah, a lot of free resources, a lot of information. I have a YouTube channel that people find me a lot through as well, where they can get a lot of free training on there. And that's under Briones Consulting Group, too, right?

Under homecareownerscorner. Okay, homecare. The actual name of the channel is homecareownerscorner. Okay. That's a great thing to do, too. I think that, you know, always being a resource and providing information and guide is always a great way to to a community around things. Yeah, I I uh I I've always always done this when I had my agency, when I was out there doing consulting with the franchise. I always try to teach people the same thing. Don't don't go reading off of your brochure. People don't care about that. You know, what people actually care about is the outcomes you're going to bring. I wish I could make could take credit for this, but I heard this many, many years ago. The fact is every single one of us on Earth are playing the same radio station in our head, WIIFM.

23:33 What's in it for me? Correct. You know, so if if you're not able to answer to the person in front of you, hey, how do you benefit from talking to me? Then, you know, there's there's no credibility there. And in today's world especially, like just again, a little side rant here, there's a lot of scammers out there that are claiming to be consultants, a lot. COVID brought the worst out in people in on this side of the business, and over years it's, you know, so many scammers have become so lucrative, you know, it's become such a lucrative business that especially now in the world of AI, people think they can just turn around and sell policies.

I'll just look it up on a on ChatGPT or Claude while I'm talking to you, and it's it's not that simple. Pe- Most people figure out really quickly who actually knows what they're talking about and who doesn't. I try to keep the guesswork out of it. Right. Yeah. You know, shooting straight is always a great thing, too, you know, I think. And they just, yeah, a lot of times in just my own personal experiences, you know, on the other side of it, like it's a very foreign thing for Mhm. you know, whether you are, you know, the the person getting cared for and or interviewing a home care agency, or whether you're supporting your parents, like there's something that it's it's a stressful situation anyhow. You're not doing it cuz you want to do it. You're not doing it because things good, you know, there's a situation that's caused stress or panic or worry um that's causing you to go into that interaction.

And so, you're helping to sort of help others alleviate that pressure and take a little air out of the balloon, right? So, Yeah. It's got to be a big relief for your for your customers. It is. What's what's new and next for you on your horizon with your business? What do you What do you What do you see, you know, Mhm. the consulting group moving forward and your community, by the way? Well, the right now our, you know, our consulting group, we we are making some plans for the next year, you know, where where where going to be moving back into multi-state organizations. All right.

You know, we've we've been focused heavily on consulting with, you know, agencies and that are in that $2 million to $5 million range right that are just stuck in trying to grow beyond that. You know, we're we've also been working a lot in the M&A space. On fortunately, with all the fraud stuff, we're shying away from that a little bit. That market's a little soft. And we're going to be going So, what we've been doing and we're going to really push heavily on this is a lot of stand-alone training for smaller agencies. Maybe the agency that can't afford a large engagement with us, you know, that is just looking to understand better how to grow their business short and short spurts at a time. And you know, again, just trying to grow that community on Home Care Owners Corner.

26:23 And it's so far, we've gotten a lot of good feedback. A lot of people really enjoy the the community aspect of it, where they can just go somewhere, hang out for free, and ask people without getting sold to all the time. Yeah, that's probably a pretty good idea, too. It's just good community. People can lean on each other. You know, you as community owner, you're not you know, you can let the community kind of take care of stuff a little bit, too, probably. And And you probably a great avenue for learning on your side, too, as a consultant like uh being really close to problems and understanding what is happening in the marketplace and especially things has changed as fast as they do in health care as well.

Yeah. What do you say what do Go ahead. Well, I was going to say yeah, I've definitely definitely hearing people's complaints about stuff does keep keep me on edge and on the pulse of what's going on. So how does AI have a place in home care? Not in your business but but in home care In home care in general. Yeah. I think honestly anyone who is not trying to adapt or some sort of technology for their business is going to be left behind. I mean I I can't tell you how many people I run into that are still using Excel spreadsheets to manage their schedules. You know, I'm talking about with 200 caregivers are still trying to do this.

Okay, so just from a efficiency and you know, perspective I think AI has a great place to catch things that are missing. There's a lot of a lot of ways for and a number of tools out there that are built into like a lot of these scheduling softwares and CRMs that really do a good solid job of finding holes and plugging them a lot faster than set of eyes can. You know, there's a lot of great products out there also that you know, they're like for in-home monitoring. So as a supplement to what the home care agencies are already doing they're able to bring in these different there's a number of platforms that are just fantastic out there. I'm not going to mention plug anybody out there but there's there's one company for example that the agency can buy a bunch of tablets and keep the tablets in the client's home and it provides additional caregiver training. It provides you know, it provides extra bits of

Communication, helps the family communicate with you know, the client things like that. There's other products out there that just connect to any TV and it creates almost like a live stream conversation with the office or with or with their own family members. So, Right. it allows for extra monitoring without the added cost of having a person in the house 24 hours a day. And then there's other products out there that they're they're almost like those home nest things kind of like Yeah. Alexa or something like that, but they're specifically for senior care where they just kind of background passively listen and send alerts and reports to the agency, changes in breathing or you know, different changes in routine when the caregiver's not there, things like that.

29:23 So, it allows the family and the agency to be aware of what's going on. The those are all very, very important tools that that ultimately they're going to help benefit the client experience or the patient experience and that's extremely important. As I said, I'm I'm a big big proponent of it. There's there's a lot of really good use cases for AI and other technology in the senior care space and the agencies that don't I I like I said, I I really do believe they're going to ultimately be left behind. They're so afraid of it.

Some people think they think that they're is going to replace aspects of the job. It's not. They're tools. They're here to enhance the job. Right. You know, I love the analogy I heard not too long ago. Back in the 1920s when Henry Ford started cranking out cars, all the horsemen or shovellers in New York thought that it was the apocalypse. But what ended up happening is it made for a better work environment and you know, it it modernized technology. Those that adapted moved on and found other ways to improve to improve their own lives. The ones that resisted it are the ones that crashed and burned. I think we're at that point with AI and with technology in general, especially in the senior care space.

Well, that's a great place to leave it. Julio, it was great speaking to you today. It's been wonderful meeting you, learning your story, and just understanding that home care is an explosive, you know, growing marketplace because they have that aging population, and we appreciate everything you're doing to support it. So, thank you for being here today. Yeah, thank you for having me, Terry. Great. That's a wrap on Zero Friction, the show built around one simple idea, remove the barriers and the revenue will follow. If today's conversation was valuable, please subscribe and share it with somebody who needs to hear it. That's how we will grow this community. I'm Terry Coutsolioutsos, a revenue architect powered by AI. Come find me at my website, myrevRX.com, and let's talk about what friction is costing you and your organization. Until next time, keep removing the barriers and keep the revenue flowing.