Home-based care providers that are open to receiving employee and client feedback, and then open to acting upon that feedback, have a natural leg up on competitors that don’t do either.

In fact, providers that collected employee and customer feedback, and acted on it, were able to recruit 90% more employees, according to data from Activated Insights.

But employee recruitment isn’t the only benefit that companies like Tribute Home Care, Pinnacle Home Care and Homewatch CareGivers are seeing from feedback work.

Tribute, for one, takes several approaches to find out what staff and clients are thinking. On the client side, the company sends out a survey after the first three weeks of service. Additionally, the company sends out a more in-depth survey for clients every six months.

On the caregiver side, Tribute conducts an annual “caregiver happiness survey.” The company has also held focus groups over the years.

One of the biggest pieces of feedback that Tribute has received from caregivers was related to wage and volume of hours. The company has also heard about the importance of PTO and 401(k) matching from caregivers.

Caregivers have even voiced their thoughts about the company’s sartorial requirements, leading to improvements when it comes to staff uniforms.

“We have concentrated a lot on making sure the wage is really competitive, and making sure we get good competitive information on that,” Tribute CEO John Sneath told Home Health Care News. “We match our 401(k), and have seen a very big increase in participation. And people really love our uniform.”

Tribute also has someone in place who oversees caregiver excellence. This means that there is a role at the company dedicated to improving conditions based on the needs of these workers.

“That person reports to me and we talk about things, and then we decide the best way forward,” Sneath said. “Often, these problems are pretty complex, and involve more than one department. We typically will put together a group, and have somebody who’s in charge of project management. Then we first make sure we all agree on what the problem is. We’ve learned over the years that defining the problem is absolutely critical.”

Overall, Tribute has seen feedback collection have the biggest impact on the company’s turnover.

“We’re very consistently at 48% to 55% turnover, which is shockingly high, but not in our industry,” Sneath said. “Our characters tend to be very happy with us.”

Tackling caregiver consistency

At Homewatch CareGivers, the No. 1 feedback point the company receives from clients has to do with consistency in their caregivers, and who’s coming into the home, according to Todd Houghton, president of Homewatch CareGivers.

The company uses a third party to conduct these feedback surveys for them.

Plus, individual Homewatch CareGivers franchise locations conduct surveys roughly once per quarter.

To address caregiver consistency, among other things, Homewatch CareGivers rolled out Homewatch Connect, a technology platform that gives clients more access to caregivers.

“It provides consistent access to when their caregiver is not in the home,” Houghton told HHCN. “They have their caregiver coming in for X amount of visits a week, providing service, but they can virtually connect with that caregiver too. It really provides consistency and care for the customer.”

Before implementing this solution, Homewatch CareGivers – like many of their home-based care peers – were navigating client cancellations.

“There’s a high rate of cancellations on the customer client side, which resulted in reduced hours for the caregiver,” Houghton said. “There was frustration amongst caregivers, which resulted in call outs. That affected the consistency of delivery of care, so it kind of walks hand-in-hand. When we heard this, it was an ‘ah ha’ moment. We need to make sure that we have better consistency of care for the client, and the same caregiver coming day after day.”

Connecting a workforce

After receiving feedback from employees, Pinnacle has set its sights on making a workforce that isn’t all in one place feel more connected.

“We’re hiring people outside of our office footprint, creating more opportunities for new talent, which creates more remote-based employees,” Dan Kefgen, chief people officer at Pinnacle, told HHCN. “What comes from that is, as opposed to the staff member that comes into an office every day, and can be part of just different things that happen — whether it’s a potluck or a team lunch — that individual isn’t in the work environment. That feeling of connection and belonging, at times, can be a challenge.”

Similar to industry peers, Pinnacle utilizes surveys to learn more about what clients and employees want.

As a response, Pinnacle introduced an employee engagement app to give employees a vehicle to connect.

“Most times when I say, you have to meet people where they’re at, that’s going to be on their cell phone,” Kefgen said. “We focused on how we can leverage that opportunity to keep people connected, even though they may not be walking through your front door, so to speak.”

While it’s still too soon to determine the impact of Pinnacle’s employee engagement efforts, receiving feedback has been integral to the company overall.

Ultimately, Kefgen stresses the importance of targeted feedback.

“There’s a fine balance, in terms of asking for feedback and asking for too much feedback,” he said. “You have to make sure that it’s purposeful, it’s targeted, and you can make time to do something with it.”

The post Where Client, Employee Feedback Surveys Are Taking Home-Based Care Providers appeared first on Home Health Care News.

The demand for personal home care services does not have a cap on it, and there will be more seniors than ever in the U.S. over the coming decade. But that doesn’t mean it’s an easy service to deliver right now.

In 2024, providers need to find business models that actually make sense – from their perspective, and from the client’s perspective.

For now, there are only a few primary payers for home care services: Medicaid, clients themselves (private pay) and Veterans Affairs (VA). Then there’s long-term care insurance and Medicare Advantage (MA), which tend to make up a smaller slice of providers’ revenue pies.

Staffing is one driver that keeps that demand out of reach. Providers can only care for as many clients as they have caregivers. On that end, Senior Helpers COO Mari Baxter recently said during Home Health Care News’ Non-Medical Home Care Webinar Series that there was a “light at the end of the tunnel” when it comes to staffing woes.

But then there comes affordability. One point that’s been driven into the ground is rising billing rates in home care services since the COVID-19 pandemic. As costs have gone up, there are less clients willing and able to pay for services.

Seniors and their families may need personal care services, and they may want them. But if they are unable to afford them, it does no good for a business.

That’s why providers are currently looking for sweet spots, or areas of business where they can deliver care, and also make a reasonable margin off that care.

That may mean finding the right Medicaid markets, too. Some of the largest and most successful providers have recently left states due to operating difficulties. Addus HomeCare Corp. (Nasdaq: ADUS) left New York this year, Help at Home left Alabama last year and Bayada mostly exited the Medicaid market in Florida in 2022.

”There are differences in marketplaces,” Tribute Home Care CEO John Sneath said during the webinar series. “We’ve discovered we need to get better at figuring out what those are.”

In addition to finding those sweet spot markets, providers are also looking for sweet spots in operating models, such as short-hour stays in private pay, alternative government models and value-based care models.

“I think you have to diversify,” Baxter said. “You have to look at all avenues. And we’re trying to get to all clients, not just the people that can afford care.”

This week’s exclusive, members-only HHCN+ Update explores how the business model behind personal care is changing, and why it has to.

Billing rates and short stays

The Maryland-based Senior Helpers is one of the largest home care franchises in the country. It was recently acquired by the private equity firm Waud Capital.

Baxter said that staffing is improving because of internal initiatives at Senior Helpers, but also just because of the market.

“I don’t feel the situation today is nearly as drastic as it was several years ago,” she said.

AccordCare CEO Brandon Ballew, also during the webinar series, said that the market has especially improved over the last 12 months.

Meanwhile, billing rates are plateauing in some areas, which is great news for providers.

Senior Helpers saw billing rates go up $4 to $5 per hour over the last four years, and in some cases, more than that.

“That probably slowed down last year, I think everybody kind of got to a certain level, and now it’s back to the smaller, more moderate increases,” Baxter said. “And I’m hoping that slows down further again.”

Still, a plateau doesn’t necessarily bring in folks that have already been priced out. There are many Americans who could once afford care that no longer can.

They are a part of the “forgotten middle.” They don’t qualify for Medicaid, but they also don’t have the ability to pay out of pocket for services.

Baxter says Senior Helpers has seen some clients pull back on care. She sees that as troublesome, because “if you need care, you need care.”

That brings us back to the core question of today’s personal care market: How do you tap into near-unlimited demand with the limited pricing options that exist?

Senior Helpers has responded with its flexHOME program, which is its short-hour commitment.

“At one point, you had to have at least eight or nine hours of care per week, or maybe even 20 hours per week,” Baxter said. “You had to have a minimum, and that minimum is no longer part of what we believe is the fair and the right thing to do. So we’re encouraging no minimum hours.”

Instead, Senior Helpers is going into communities and encouraging those who need it to get fractional care from the company, whether it’s after a surgery or during another time of need.

Baxter sees that as a home health-type model, in fact.

“They come in, they do 15 minutes, and then they leave,” she said. “It’s not an overnight process, you have to build it, you have to target neighborhoods that are over 55 communities. You’re not going to break even the first couple of weeks on this, it takes time to build up. But what we have seen is that most of these clients convert from 15 minutes, to 20 minutes, to 30 minutes, to several-hours shifts. You have to be patient.”

Most home care providers still carry a minimum requirement. It allows for a more smooth business operation, but could also be an impediment to future growth.

“​​When we do competitive analyses, … it is incredible how few providers offer short hours now,” Sneath added. “I think the number has shrunk. It’s really hard to do, obviously.”

Sneath’s Tribute Home Care is a home care provider that operates in Massachusetts, Maryland, Illinois and Northern Virginia.

AccordCare is likewise trying to take aim at that middle population, through shorter hours and also technology.

The company believes that technology in the home is one way to bridge the payment gap for those in the forgotten middle. A caregiver may not be affordable at all times, but with the right technology – the theory goes – a provider could still fill in the gaps.

“Can I marry that technology with the caregiver in order to still meet the needs?” Ballew said. “We’re still early in the innings, but I’m seeing that as being a viable solution for that mid group because that’s going to be a cheaper alternative than the full six- to eight-hour shift.”

The Atlanta-based AccordCare provides home health and home care services in Georgia, Alabama, Florida, New Jersey, New York, North Carolina and South Carolina.

Ballew admitted that the company has seen “nothing of great success today” with that strategy, only having dabbled in it. It will remain a commitment moving forward, however.

New models and standing out

The short stays, in their own right, are a more unique home care model. They’re unique enough that Seniors Helpers created the name flexHOME for them.

Ballew also said there’s some payer interest for those short-hour clients. That’s one reason home care providers have been turned off from Medicare Advantage (MA) in the past – the volatility and small number of client hours.

“Medicare Advantage is actually starting to be a faster growing group for us,” Ballew said.

There’s also the GUIDE Model, which is the Centers for Medicare & Medicaid Services’ (CMS) recently unveiled dementia care model.

That’s another area home care providers will be able to step into in the future.

“We’re looking at that as a real opportunity for us, and I think everybody is,” Baxter said. “You’d have to have your head in your sand not to.”

But while there may be excitement for the GUIDE Model, there’s a whole lot that home care providers can do to differentiate other than just that.

Home care standards vary by state, but the business model generally doesn’t. New models, new payer sources and new ways of thinking will be a major theme over the next five years.

“I am constantly amazed at how big and vast our market is, and how few points of differentiation most of us in the industry have,” Arosa CEO Ari Medoff said on the webinar series. “We need more creativity around business models. We need more companies to try different things, whether that’s short hours, [or] new service lines. I know that we have a tremendous opportunity with care management.”

The post Home Care Providers Looking For Care ‘Sweet Spots,’ Trying To Meet Clients Halfway appeared first on Home Health Care News.

John Sneath, CEO of Tribute Home Care, sees attaining market share as the biggest business opportunity for his company.

“At Tribute, before we’ve thought too much about other services, we still see enormous opportunity in the markets we’re in – just to grow the basic service that we offer,” he said during a panel discussion at a recent Home Health Care News webinar.

Founded in 2012, Tribute offers personal care, companionship care, housekeeping assistance, dementia care and more. The company operates in Massachusetts, Maryland, Illinois and Northern Virginia.

Sneath views Massachusetts and Maryland as markets where he thinks Tribute can double its size, for example.

He also emphasized the importance of really understanding the unique aspects of each new market the company enters.

”There are differences in marketplaces,” Sneath said. “We’ve discovered we need to get better at figuring out what those are.”

Untapped business opportunities

Taking on short hours is an area where Tribute is seeing untapped opportunity.

“​​When we do competitive analyses, … it is incredible how few providers offer short hours now,” Sneath said. “I think the number has shrunk. It’s really hard to do, obviously.”

Last year, Tribute created a taskforce focused on implementing short hours as a service at the company. This included a recruiting campaign for caregivers who were interested in taking on this kind of work.

Although the taskforce didn’t result in short hours becoming an offering at Tribute, the company is still dedicated to trying to launch this service in a way that is affordable and consistent.

“We can make a much better offering to retirement communities, to geriatric care managers,” Sneath said. “We’re going to keep plugging away at that.”

Sneath noted that while he doesn’t consider short hours a direct revenue generator, he sees this service line as a way to solidify relationships and provide a more comprehensive solution. It creates more access to care for clients that only need limited service hours.

Currently, Tribute has to turn down roughly half of the referrals they receive for those seeking short hours.

For Ari Medoff, CEO of Arosa, care management is the biggest untapped opportunity in home care.

“We could, should and must double the number of care managers that we have in each market,” he said during the discussion.

Arosa is one of the largest non-franchised home care companies in the country, with 36 locations in 11 states.

Arosa has leaned into its integrated care management model as a means to make contact with clients earlier in their care journey.

“We are really focused and want more clients that find us before they ever need personal care and home care, but are coming to us for our care management expertise,” Medoff said. “We do that in-house. We have about 80 wonderful care managers across our three dozen offices. We want to have the strongest care management teams in every single market that we serve. We know how many families need care management.”

During the conversation, Sneath also found himself intrigued by the care management business opportunity, but did express some reservations.

“Our biggest market is Massachusetts, and an awful lot of our new clients come through geriatric care management services, so we wouldn’t want to cannibalize that, but maybe there are ways to carve out services,” he said.

Medoff believes that the risk of cannibalizing referral streams has held a lot of companies back from implementing care management services. He also pushed back on the idea that having both home care and care management under one roof is a conflict of interest.

“We always insist our care managers have total freedom of action to choose the best home care provider and situation for our clients,” he said. “98 times out of 100, it will be Arosa that’s in the best position to do a great job for that client on the home care [side], as well as the care management [side] because of the coordination, because of the communication.”

When the care management team decides to go with a different provider for a client, Arosa uses it as an opportunity to learn and grow.

“If [our care managers] choose not to use Arosa for one of our care management clients, the only thing that we insist upon is make sure our whole team understands why, so that we can get better, or maybe it’s growing into new geography or developing new training — whatever it may be that can position us to be that best provider going forward,” Medoff said.

Ultimately, Medoff believes there’s room for providers to expand their services lines.

“I am constantly amazed at how big and vast our market is, and how few points of differentiation most of us in the industry have,” he said. “We need more creativity around business models. We need more companies to try different things, whether that’s short hours, [or] new service lines. I know that we have a tremendous opportunity with care management.”

The post From Short-Hour Shifts To Care Management Services: Home Care CEOs Target Untapped Business Opportunities appeared first on Home Health Care News.

At a time when home care providers are constantly trying to bring new caregivers to keep up with the increased demand for care services, some companies have gained a reputation for having a highly selective hiring process.

Leaders at companies like BrightStar Care and Tribute Home Care believe that valuing quality over quantity has worked out in their favor.

“We do not hire to meet demand, and that’s hard to do,” John Sneath, CEO of Tribute, told Home Health Care News. “A lot of companies turn away clients, because they don’t have caregivers. The more selective you are, the bigger a problem that becomes, but at the end of the day, since our business is so much about relationships from referral sources, we don’t have a lot of opportunity to mess up. The quality of our caregivers is something we promise, and we have to deliver on that.”

Founded in 2012, Tribute offers personal care, companionship care, housekeeping assistance, dementia care and more. The company operates in Massachusetts, Maryland, Illinois and Northern Virginia.

Sneath explained that simply having a roster of caregivers was never the goal at Tribute. The company only hires about 2% of applicants, he shared.

“Typically, when we’ve expanded from 2% to just 3%, that has resulted in much higher turnover three to six months down the road,” Sneath said. “We just feel the pain of poor quality immediately, and we feel like so much is at stake.”

At BrightStar Care, its company-owned locations hire less than 10% of caregiver applicants.

“For visual visualization purposes, I like to think of it as a funnel,” Leslie Waddell, senior vice president of talent experience at BrightStar Care, told HHCN. “If you have 100 people applying for a particular job posting, only about half will have the experience or qualifications that we’re looking for. Of that, how many make it to the interview and really meet our core values? I don’t think being picky is a bad thing. At BrightStar Care, we prioritize thorough screening and rigorous vetting of potential caregivers to ensure they meet our high standards of excellence.”

Chicago-based BrightStar Care is a provider of home care, senior living and supplemental staffing services. The organization has been deliberately increasing its company-owned footprint of late.

Waddell describes BrightStar Care’s hiring process as being a comprehensive and supportive one.

“From the hiring side of things, we want it to move swiftly, but with all of the important things that we’re looking for being identified through that process,” she said. “We know that caregivers are always on the hunt. They’re always looking for the next best thing. We know that we need to show them through the hiring process, what it means to be an employer of choice.”

The process begins with thorough screening and background checks to verify qualifications and ensure safety.

BrightStar Care focuses on its core values during the process, as well as making sure the applicant’s skills match the needs of the company’s client base. Making the hiring process feel more personal is also important to the company.

“We don’t try to make everything move through like an electronic path,” Waddell said. “We know that our caregivers need that personal touch. We don’t just have them fill things out online, and then hire them and then get them scheduled. We make sure that we’re aligning with that caregiver and looking at not only their skills or their qualifications, but also what is their commitment and compassion towards what we do.”

‘The value of the process’

Someone looking to become a caregiver at Tribute begins by filling out an application that’s about 10 or 11 questions long. This gives the company enough objective information to determine who moves on to the next round in the hiring process. This is followed by a short screening call, which typically lasts about 15 minutes, and is meant to confirm the information in the application.

Applicants that move on to the next round have to complete two additional interviews.

“It’s a pretty lengthy process for most caregivers in home care who haven’t been through something like this,” Sneath said. “Every time we think about shortening it, we have seen the value of the process. It gets people to become more and more comfortable, and therefore open up and be more themselves. That’s helpful for them, but it’s also helpful for us to really see if this is going to be a great match.”

There are four performance qualities that Tribute is looking for during the hiring process. The company wants caregivers who are excellents communicators, caregivers who have the ability to build connections, and people who are reliable and flexible.

“We screen for the qualities that we think will lead to those behaviors,” Sneath said. “We really try to zero-in on if a person has what we call a heart-driven desire to care for others.”

Along these lines, the company is looking for people who, specifically, want to work in home care.

“Somebody who is indifferent to the setting that they’re in, it’s not always a bad sign, but it can be a big red flag because home care is different,” Sneath said. “One-on-one is very different from caring for 10 or 15 residents or patients. It’s much more focused on relationship development, and really getting to know somebody.”

Retention benefits

At BrightStar Care and Tribute, having a highly selective hiring process has led to strong retention.

Tribute’s turnover rate checks in at a little less than 20%, and Sneath credits the company’s effective hiring process. BrightStar Care retention rates for its non-clinical staff sits at 54.1%.

Both companies also have robust professional development and support programs in place to ensure that once the work of finding and hiring the right caregivers is complete, employees have the space to continually improve their skills.

For example, Tribute tries to create an environment that allows employees to be open about the challenges they face on the job.

“You’re already working at a physical distance from your team,” Sneath said. “If you have a client who’s so challenging that you’re not going to be able to do my next visit, it can be hard faith and to convince yourself that you can pick up the phone, and speak to somebody and not have it sound like failure. We really talk a lot about that and try to create an environment where you can talk to us, and we’re going to try to help you solve that problem.”

On its end, BrightStar Care offers a variety of different disease state learnings. At some of the company’s locations, they are able to help caregivers get their HHA certification, or their CNA certification.

Ultimately, Waddell believes that having higher standards impacts all areas of a home care business.

“If you’re not selective, not only does your turnover continue to churn, but your client turnover will churn,” she said. “You won’t have happy clients. It’s all about making sure that when you’re hiring people, that person is someone you’d want to take care of your loved one.”

The post ‘I Don’t Think Being Picky Is A Bad Thing’: A Look Inside The Most Selective Caregiver Hiring Processes appeared first on Home Health Care News.

That’s why Tribute Home Care’s CEO, John Sneath, has largely focused on perfecting the wheel rather than reinventing it.

Tribute was founded in 2012, as the brainchild of Sneath, who served as president and COO of HouseWorks for nearly a decade. The company operates in Massachusetts, Maryland, Illinois and Northern Virginia.

Sneath believes that one of the biggest components of delivering quality care is the caregivers. At Tribute, making sure that the company is able to recruit and retain efficient caregivers is paramount. The company has spent the years building an enviable employee benefits page, and compensating caregivers at rate higher than others in the markets it serves.

Sneath recently joined Home Health Care News for its latest episode of the Disrupt podcast. During the conversation, he also explained why Tribute is doubling down on its private-pay business model, how the company is working to improve the customer experience and how he has seen caregivers change over the years.

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HHCN: Within your private-pay model, how do you manage volatility if a few clients happen to leave the company at the same time?

Sneath: The way we’re managing it, and I think we’re probably late to the game here, is that we’re making sure that every market has a full-time dedicated salesperson.

For years, we’ve been wrestling with that, and really relying on the director of our marketplace to also do the sales work, thinking that the quality of our service would sort of speak for itself, and create enough word of mouth, but the marketplace is competitive enough. We’ve seen this volatility enough that we want to try and smooth the waves. By having dedicated salespeople, we’re able to generate a more consistent flow of leads, so when those drops happen, it’s not quite as shocking and hard to overcome.

You’ve been in the business a long time. What do you think has changed the most in home care, since you entered it?

Overall, service quality has improved, I think competitiveness has driven that. Agencies seem to be – from everything we can tell – better at hiring, using better systems. Prices and wages since we started have basically increased. That’s been very good for caregivers, not great for customers, but as it turns out, I think we were all leaving money on the table. I think people that need home care are willing to pay more than we used to think. There are much larger entities than there were when we started, and those are getting better and better at scaling, although not so much at scaling de novo, more through acquisitions.

I would say, [in terms of] the fundamental service itself, nobody’s really come up with a game-changing or disruptive kind of approach to the service. It’s still very much about the caregiver, very much about the service, and leadership. I don’t see that changing anytime soon.

What are your main priorities for 2024, or even 2025? What are things that you think Tribute needs to get better at?

One very big priority this year is to take another look at our brand, and how we talk about our brand with the language we use, and then make sure that the brand is showing up at each critical touch point. We have a working group that focuses on this all the time, which we convened a couple of months ago.

How do we take a first call? What do we want that experience to be like? How do we respond to an inquiry? How do we do the assessment when we go into the home? What’s the start of care like, when problems arise? How are we resolving those? At each of those places, where the customers are likely to assess how things are going, we want to make sure that’s a very Tribute experience. More and more, we want tribute to stand for something. It’s hard to brand what we do. We’re not selling widgets, and it’s not something you can touch or taste, so it’s hard to brand. It’s all about language, so trying to get that language right.

Secondly, volume growth, particularly in our two newest markets. We grew at about 15% last year in volume, and we’re looking to do a little bit better than that this year. Part of that is the sales force I talked about, making sure that in a niche market, we’ve got a head of sales. In fact, we’re hiring a head of sales for the company as well.

Third is caregiver quality. Always focusing on making sure that we’re offering caregivers the right kind of professional development and support so they can get better at what they’re doing. Making sure we’re hiring enough people. That’s always our biggest problem, and probably always will be. Leadership and professional development at all levels, we want to develop leaders from within as much as possible, particularly leaders that can run markets. We’ve got a program that does that. That’s our focus for the rest of the year.

What will be the biggest challenges? What’s going to keep you from achieving those goals, if anything?

The number of caregivers, for sure. We get about 1,300 applicants, system wide, a month. We end up hiring 19 or 20, there are probably five to 10 that we’re not hiring because either we’re focused on the wrong thing, or we just miss something. We’re trying to bring an objective assessment into the process. We can get better at defining exactly the qualities that drive success and then how to find those.

We also simultaneously work on turnover and that fluctuates between 45% and 55% in spite of everything we do. But we’d like to keep bringing that down. That’ll be a big challenge. As you mentioned, smoothing out the growth curve, reducing the big swings that we see. Then leadership, making sure we’ve got the right leaders in the right place moving us forward, particularly in revenue growth.

Do you think growth in the future will mostly come from organic or inorganic means? In other words, do you see any acquisitions in your future?

Some of the people I talked to, almost all of them in fact, have done acquisitions over the years, we haven’t.

I suppose the reason is the culture of our business, the quality of the service, is so critical we just can’t sort of see our way how that would work. We really haven’t looked at that too seriously. We might at some point, but I would imagine five years from now it’ll be the same story.

We’re growing internally, and maybe we’ve added another market to start from scratch. It takes expertise to be good at acquisitions, and it’s just not our expertise. We don’t have any experience doing that, and I worry about the distraction and the challenges associated with that.

You’re pretty certain that you want to go even deeper with private pay. When did you make that decision, especially given that so many other providers are diversifying? Did you see an opportunity almost to zag?

No, it’s been that way from the beginning. It even goes back to when I started an adult daycare business in my 30s. I wanted to focus on private-pay, particularly because I like the idea that if we can provide a great service, then we can charge for a great service. If we can charge a premium, we can pay the people that do the service, and pay them fairly and offer the kinds of benefits that people want. That’s been the case at Tribute.

We’re typically $2 to $3 higher than anybody else in the marketplace. That’s been critical to our ability to attract great caregivers, and offer them the kind of pay and benefits that everybody’s looking for. We have a program called Tribute Secure, which about a quarter of our caregivers are in. It salaries caregivers, so they get paid, whether they’re on a client or not. That’s actually not that costly, but there are costs associated with investing in that and setting that up, so I just liked the flexibility that private pay gives us at the end of the day.

Have you noticed any behavioral changes among caregivers? Do they want things now that they may not have wanted five to 10 to 15 years ago?

PTO would be one. Way back at HouseWorks, we didn’t offer PTO. We didn’t offer it when we started Tribute.

We sort of started with health insurance, in addition to wage, and we realized, and through survey work and talking to caregivers, how valuable the paid time off was. This typically gets somebody who’s working full-time hours about two weeks of paid time off a year. Many of our caregivers are per diem, so they can take other time off unpaid, but that’s a benefit that had we thought more about it, we would have gotten to where we are sooner. People work really hard at Tribute and they deserve time off. We want to give it to them and not have it be a financial burden. We added 401(k) match two years ago, and that’s been well received. One of the indications, for us, that people are making a living wage is if they’re able to save money. A good chunk of our caregivers are in that 401(k), and that number is climbing.

What’s a prediction that you have, over the next five years, for the home care industry at large?

I think there will continue to be more consolidation and focus on revenue growth. From a competitive standpoint, what excites me about that is to some extent it’s at the expense of quality. Our experience is when we have had strong competitors, and they’ve been purchased by a big company doing roll ups – we tend to not hear about those agencies after they’ve been purchased. By and large, these roll ups have hurt quality, but that’s given us an opportunity.

I think the diversification happening with the payer mix will continue to happen, because private pay is really hard.

I don’t see the caregiver situation changing much, unless we do something about immigration, and for sure, we should be actively working to increase immigration for caregivers.

We think a lot about what would disrupt the service delivery model, and we come up short there. That’s why we just keep focusing on the very basics of the service. I think for the foreseeable future, it’s going be all about the caregiver. That’s what clients want, and that’s the most important aspect of the service. We got to just keep working on getting that better and better.

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