Ep:40: How to Create a Caregiver Journey That Drives Engagement & Growth

Miriam Allred (00:09):

Welcome to Vision | The Care Leaders’ Podcast. I’m Miriam Allred with Activated Insights. My guest today is Dustin Distefano the CEO of A Place at Home, a franchise network originally out of Omaha, Nebraska. Dustin, welcome to the show!

Dustin Distefano (00:23):

Thank you. Thanks for having me!

Miriam Allred (00:25):

It is a real treat. Before this call, you just mentioned, you just got off the phone with one of your franchises, you know, talking about caregivers and the shortage right now, and the challenges that we’re facing. So today’s conversation is really going to be all about caregivers. There’s not enough we can say or do right now to, to solve the issue. But as you’ve experienced firsthand, there are things that we can do to create and enhance the caregiver experience. So that’s what we’re going to dive into today. So just to get us started, you know, talk to me a little bit about a day in the life of one of your caregivers at a place at home, what is their daily, you know, look like?

Dustin Distefano (01:02):

Yeah. So our caregivers day, I mean, I try to, I try to paint a picture for every situation, but a caregiver’s day is pretty similar across the board. They wake up, they have, they have a job to go to or a client to go to. So what a place at home really focuses on is we want to focus on that that morning. So one thing that I teach franchise owners and used to do as an agency owner is I would send a text message out every single morning to work to caregivers who are working that day and simply just say, have a great day. I wasn’t asking them for anything. I just wanted to acknowledge that I know you’re out there today. And then thank you. So that’s how I like to start their day off. It should give them as an owner of an agency.

Dustin Distefano (01:44):

It gives them that this owner actually cares. And in this day and age with caregivers and you said shortages and, and all the recruiting battles, all of our agencies are going out there. You have got to create that, that engagement from your caregivers. So if you can start that every morning, every single day, you, you can you get that engaged instantaneous engagement. So that’s, that’s the first part of the day. Then they’re going into their, their clients’ homes. And some days they just do their thing and leave some days there’s issues at some days there’s family dynamics, right? So what we want to be able to focus on is during that day, we always keep an eye out for changing conditions. We watched their care plans. We use a company called clear care, which everyone knows more than likely that listen to this podcast. And we look for those changes in conditions and we respond to them instantaneous.

Dustin Distefano (02:35):

So if a caregiver is having an issue, we’re not letting it the well and letting her letting that care. And I say her because a majority of our caregivers are females. We’re not letting her sit and dwell. Like if somebody didn’t get back to me, this is an issue right there. Their job is to take care of that con, that client not hunt us down at that headquarters to help them out. So we try to respond and react immediately to give them the support they need in their current position. I think that’s also very important and shows that caregiver, that we are there from that, and they’re not alone in that home. So if you were to set that, what a day in the life looks like, I think that’s the day in the life that we strive for and at the end of their shifts, you know, if you can say thanks at the end of the day. Great. I think the morning’s the best because everyone’s just starting to go at the end of the day. They’re really tired. So you send them a, Hey, thanks for your day. And they’re just like, yeah, yeah. And go on about their day. But if you can, if you can show recognition for things they do throughout the week, throughout the month, that’s, what’s going to keep them engaged with your, with your brand and location.

Miriam Allred (03:36):

Fantastic. One technical question on the logistics of sending the texts. A lot of your franchises probably have 50 to a hundred, a hundred plus caregivers. Is that an automated process or do you have admin staff that are helping support there? What does the technical side look like?

Dustin Distefano (03:53):

Yeah. So in ClearCare you can, you can select all on their, on their platform of caregivers and just set the message. Some of them will unsubscribe from text, but their emails still associated. Most of them won’t unsubscribe from the email because that’s how they get their schedules. So you can send a message to both. So literally just a quick message. Hey, thanks for all you do today. Have a great day. I sent it to all of them, even if they’re not working. Right. Cause it’s, it’s a, it’s a touching point that you have where you’re not asking them for something, right. Especially with caregiver shortages, like what, what people are attending to fall into is they’re constantly, constantly calling a caregiver and asking them for something they don’t focus on showing them appreciation or giving them that space. Like they say, they’re off on Tuesday. Don’t call them on Tuesday and see if they’ll work a shift, you’re going to burn them out. They’re going to think that you don’t respect their time and that’s where you lose them because they just got 20 phone calls in the last seven days from other home care agencies saying, why they’re the best place to work. And now you just disrespected their time that they told you that you granted by calling them on that day. And it may sound little to us as agencies, but it’s a huge thing for them, right?

Miriam Allred (05:06):

Yeah. I love that. We’re always asking them for something, but what can we do to give what can we do on our end to not be asking, but just to be engaging with them for, you know, out of appreciation or recognition, I want to talk a little bit about touch points. You know, you mentioned the text, you mentioned, you know, helping put out the fires, what are some other daily or weekly touch points that you have with your caregivers to keep them engaged? And like you said, to not be asking, but what are some other ways that you can reach out to them without asking kind of on a continual basis?

Dustin Distefano (05:40):

Yeah. So one thing we try to do, and when I say try, because it’s not a hundred percent, it can, can be problematic is we try to meet the caregiver for their first shift, with a new client all the time. We have a field supervisor, who’s a CNA themselves, which is part of our career path here at a place at home for caregivers, they can become field supervisors. And that field supervisor is to kind of drop in sporadically. Or if there’s a new client schedule that pops up, we want to make sure we’re there during that first shift to give orientation to that client care needs, introduce them, right? Talk to them, get them engaged with the client. But also as an agency, I can, that field supervisor can see, you can pretty much see the uncomfortability or if this is going to be a hit, right?

Dustin Distefano (06:25):

If you go in and the caregiver’s just really, really shy and that clients just talking and talking and trying to get something out of her and it’s just not happening, it’s probably going to be something that isn’t going to be a fit. Now, maybe when you leave, she opens up a little bit, but that’s also an opportunity for us to call that caregiver and say, Hey, listen, how do you think the day went? Oh, wait, great. Just here’s a little bit of feedback. I just want to make sure you were comfortable because when we were there, you were kind of garden. And maybe that was just you getting there for the first time, but trying to understand, trying to give them coaching, but to understand how they’re feeling about that shift because of what’s going to happen the next day is they may not show up.

Dustin Distefano (07:03):

Right? They might say, I didn’t like that, but they, but no one called to ask her about it. So now she doesn’t show up the next day. Now you just got a no call, no show. And you lost that carrier. Right? So if you can be proactive and say, how was your day? And just be honest with me. And they say, I really didn’t like them. Great. I think that w Y let me get you to a different client. I can appreciate that opinion, right? Yeah. So that’s another thing where I think agencies can tend to falter is they just, they, they try to solve that issue and, and fill that void of schedules. But they’re not focusing on that caregiver at the same time and what she or he wants. So that’s w that’s one of the major touching points is that initial contact.

Dustin Distefano (07:47):

Then we also do a seven day phone call. We try to call all of our caregivers. Like we have a retention specialist as what we thought, and they will, their job is to call and contact and do the same thing I was telling you earlier and not asking for anything. It’s another family we do. What’s called it about me for them. We learn about them, right? If a caregiver calls out sick to a scheduler and says, my kid is sick, I want that retention person to know that. So that when they call a couple of days later, they can say, how’s bill do right. And show them that your kid that’s what they do. And so that works. That works very, very well. And that’s another touching point. And then we do things like employee of the month, caregiver of the month. We used to do a, what’s called a hero award which you get so many points.

Dustin Distefano (08:34):

We kind of went away from that because it was becoming more opinionated by our office staff. And we wanted more fact-based as you being a survey company, you can appreciate that. Right? And then we also, as a corporate level, as a franchise, or we do a national caregiver of the year, which if you go to our website, you can see our, our, our video on David Berg. He’s a caregiver out of Papillion Nebraska. In which we gave a thousand dollars to out of our corporate office. And we shoot a personal video of him and his client, where we sent a videographer to his client, video it, and then spotlight that person nationally throughout our whole system. So those are all the things we try to do to engage those caregivers.

Miriam Allred (09:14):

Great examples and great touch points. I kind of want to jump to, you mentioned a career ladder, you know, you’ve got this career ladder built out. We get a lot of questions around mentorship and what should my career ladder look like for a caregiver? And, and it varies, but I’d love to hear you break down what that career ladder looks like in the success you’ve seen from giving caregivers the opportunity to advance.

Dustin Distefano (09:35):

Yeah, so that, that’s, that I think is the number one thing that you can do in this day and age to show your recruits when you’re recruiting is not, you’re not just going to come in and be a caregiver, and that’s the, that’s the ceiling for you? Like show them a path, right? So here at a place at home, we have a path where you may start off as a homemaker and campaign. Okay. Now you may start off as a homemaker and companion. In some States you don’t have to have CNS do personal cares depending on the licensure per state. Right? So we actually have a partnership where we created four different specialty programs, which is fall prevention Parkinson’s care, dementia and stroke. So we certify these caregivers in that care. We have specific platforms to educate them, and they don’t have to be a CNA to take notes, but we can, so we can educate companions, homemakers on those, certified them and give them a little badge kind of like flair on the collar, you know, back in the day of TJ Fridays, I think it was right.

Dustin Distefano (10:33):

We get, they get aware that line. And we honestly say, we say, you can use this at anywhere you go, do you want to get into nursing? Right. I’m all for you. Let’s get you into nursing program. I’ll like, I’ll write you a letter of recommendation. So not only are we focused on a career path or on a place at home pad, I can take him down a career, a career path into nursing if they want to do it, because they’re going to do it anyways. If they truly want to be a nurse they’re done to go to that school. And, and those people who are going into nursing schools, they can do two years, three years of nursing, and they’ll stay with you that entire three years. So you have that employee for three years, right? Yeah. You’re going to lose them after three years.

Dustin Distefano (11:13):

But the turnover rate in this industry, as, you know, if you can retain a good employee for three straight years, that’s a win in my books. So there’s that. And then you have the CNA for companions, they can go and get their CNA. And then we have there. Then after that CNA, and they’re doing a great job, we got great client feedback from them. They got the field supervisor position where they can come on and have more of a leadership role amongst their peers, right? The caregiver has an issue. They can call our schedulers or senior, or we call them senior services coordinators. They call our recruiters. They can call our retention people and retention specialist and say, Hey, I’m having this issue. And then we can use those field supervisors to go out and provide additional coaching into the field. So field supervisory, they go into, they can possibly go into one of two routes from that.

Dustin Distefano (12:04):

They can go into recruiting, right? I look for personality in recruiting. I want someone who’s fast paced. I look for someone who can connect with people really well. So those caregivers who are, I ha I, I, the best way I always put as bubbly, right? Those a high energy gals who love to talk, love to engage with people. Great recruiters. They’re great schedulers too, but that that’d be a path for them. Or they go down the scheduling route, which is our senior services coordinator. And I’ve had multiple caregivers hit that. And then we train them on administrative skills. So, and then after that, we can get them into office management. Now, office management, isn’t like, this is a stage where I’m gonna use an example. I have a gal on my staff has been with me for six years, who did this path started as a caregiver, went into scheduling, did recruiting.

Dustin Distefano (12:55):

Then she went in and I taught her how to do QuickBooks and billing and payroll in HR. And this is a gal who would start with me, I think at like 24, 25, her name name’s Danny, and didn’t have any college degree, right? Graduated with a high school with a bachelor’s degree, got on with us as a caregiver. And we taught her on. And by the, by the time where she’s at now, she’s teaching franchise owners, how to do QuickBooks. She’s teaching, not franchise owners, how to do ClearCare, she’s constantly supporting, and we just promoted her this month. And she starts on May 5th at the franchise or headquarters as a finance and operations support specialist. I mean, the opportunities are endless. We just have to make them available and we have to buy into them and show them that path to say, if you can hang with us, I’m going to, I’m a person that I’ll invest in you if you invest in me.

Dustin Distefano (13:48):

And if you can invest in me and be reliable, provide great care get great service get great feedback from clients. I’m going to invest in whatever you want. If your goal is to go into nursing, I will do that for you, but I need you to do this for me. And I think if owners can, owners of agencies can, can paint that picture and actually be genuine about it. Don’t do a smoke show, follow up and do it. You’re getting that’s. What’s going to make your agency survive during times like this during shortages, because caregivers are going to say these people care about me. And that’s what a place homes trying to do.

Miriam Allred (14:23):

Fantastic examples. I’m kind of putting you on the spot and I want to do it again. You you’ve kind of outlined, you know, the career ladder. And also you mentioned specialty training. Are you using those things in your recruitment efforts, in your job ads? You know, as you’re out there recruiting, are you using those things and is it working, you know, are you drawing people in because you have these advancement opportunities and they’re appealing to people?

Dustin Distefano (14:47):

Yeah. I would say that we are we, we, we made these specialty programs just this year. So we finally developed and further, we’ve always talked about it. We’ve always provided training, but it was nothing. It wasn’t really a, I wouldn’t say it was scheduled. It was more sporadic. Like, Hey, you can take five trainings a month and you get a 25 cent increase on your pay. That, that was working minimally. But then when we said, all right, let’s get them certified in certain specialties. I think that that’s played a, played a pretty big impact on recruiting applications, getting those right now. Isn’t, isn’t really the issue. We’re getting applicants form from our job ads. And yes, they’re on our job ads. It’s getting them on the phone. And once you have them on the phone, how do you connect with them right away and go into those specialty programs that explain career paths, how we’re going to better you as an individual, the pay.

Dustin Distefano (15:44):

Yes, but also that, that about me form is really big. Like I want to know about you, right? What do you see where a lot of people make mistakes too? And I’m sorry to go off the path a little bit is they assume what they want, what caregivers want. They never asked the question, right? Where managers fail in this world in any business is they assume their goals are their employee’s goals. We had a place at home. I, I, I try to teach, don’t assume, you know, what, what drives them? Ask them what drives them. Some people may say, I like gift cards, right? Some people say, I like little bonuses. Great. I think that’s where a lot of owners junk too, right out of the gate. Some people say, I like a day off. We’ll give them a pay day off awarded. Right? Some people say, I just want to thank you. I don’t really need anything. So give them a thank you. Right? So I had one gal, one story about an employee of ours at one of our agencies who said, I knew caregiver’s coffees or coffee orders. And I would randomly show up and give them that coffee order. Like she asks, what’s your favorite coffee? During that interview stage, writes it down, puts it on their file. And she made a point to go out and give them a coffee on a shift, just as a surprise.

Miriam Allred (17:00):

The recognition goes such a long way when it’s personalized. And I love that you’re hitting on that. It looks different for every caregiver and at the agency level, it’s easy to assume. It’s easy to assume that, Oh, they all want higher pay, but let’s get creative and find the recognition forms that they appreciate, that feel personalized will make their day and keep them motivated. And it looks different for every single person. So I like, you know, at the, at the management level, it takes time and effort, but it’ll go a long way when you start implementing it correctly. Exactly. So great points there. Let’s talk a little bit more about the training side. This is kind of off script, but continuous learning opportunities, you know, fostering opportunities for them to learn and develop as they go. You just talked about Danny. Who’s been with you for six plus years, but it’s because you were able to give all of these opportunities to develop. Are there any other, you know, just anything you want to add there on creating meaningful opportunities to keep them learning as they go,

Dustin Distefano (17:58):

You just gotta, you gotta make it available. Find what they want to do. Some of them may want to be a caregiver for the rest of their life. And that’s fine. That’s great. I’ll buy into that. How do I make you a stronger caregiver? Then that’s what I’m going to invest in. Especially programs, right? How do I keep you engaged in that? Some people want to go into, like I said, scheduling or recruiting. Some people want to go into nursing. Some people have a passion to go into business ownership. You know, if they wanted to some, you just, you can’t, once you know them, then you can kind of find different paths, right? You can, you can help them get quick flips training. You can invest in different programs. They can go to school. Right? We talked about doing right now where in discussion, because this is an issue about doing tuition reimbursement on for a caregiver who they would have to apply.

Dustin Distefano (18:49):

And we would review it here and award a tuition, reimbursement to someone they’d tried to better their education in life, right. Again, buying into them. I think you can, there’s never enough training and it’s once you don’t have something to offer them, that’s where they they’re like, I’ve hit my ceiling. I’m going to leave. I think that’s anybody in any career, right? Once you hit your ceiling, it’s like, what do I look at next that I’ve seen in franchising all the time when owners are like, I hit corporate America and I hit my ceiling as VP of this. And I just, I didn’t want to do it anymore. So now I want to start my own thing. Right? Same thing with caregivers. It’s not like the, if they’re 30 years old, odds are they have other aspirations find out what those are and then put a training behind or, or, or give them resources. So it’s not hard to do. It’s just those extra steps that you’re going to do to keep them engaged. And then they’ll stay with you for the life span of before they go and do that

Miriam Allred (19:46):

Kind of shifting gears to the management, behind it, from your franchises, do they, do they come at you and say, Hey, we don’t have enough budget where we’re scrapped for manpower to make these things happen. And I think a lot of times there’s this excuse of money. You know, we don’t have the money to do X, Y, and Z. Do you hear that? And how do you coach your franchises to kind of push past that mindset?

Dustin Distefano (20:09):

You can find many things that don’t cost a dime. Honestly, like we joined, we had a program we did for a caregiver. I’ll explain. We had, we joined a nurse coalition here in Nebraska where it’s basically a mentorship program. Didn’t cost us anything that we could, we offer to our caregivers. If you want to be a nurse, this mentorship program, you can join this mentorship program at no cost. And you’ll, you’ll be mentored by other nurses. And we just had someone, her name was Rita. She just, she just graduated, applied for nursing school and that mentorship program, her a letter of recommendation and she got in and I didn’t pay a dime for that. It was just time to find that nursing coalition the good thing is, is Google’s there, right? If someone says, I want to be an auto mechanic, I, that’s probably a bad example for this, but you could Google auto mechanics schools and say, Hey, here’s some options I found for you.

Dustin Distefano (21:08):

You should call them right. Push them. Some people just need a nudge, right? You have to, you have to push them to go outside their comfort zone. They have things they want to do. And I, I, I’ve learned this more and more franchise people looking into starting a business. A lot of people want to do it, but then they hit that point where that it’s time to like, it’s time to make a decision. I’m going to do this or not. And they get scared and they, and they, and they retract, right? Because they’re in a comfort zone. They’ve never, they don’t know what they don’t know on that other side of the coin. And so my job is as the franchise owner and CEO with our, with our owners is I push to the limits to go outside your comfort zone and I’m, and I don’t stop pushing you until tell you at least try.

Miriam Allred (21:51):

I’m a big advocate for that getting outside of our comfort zones. And you, you mentioned it at kind of the management level, but even the caregivers, you know, they’re getting outside of their comfort zone on a daily basis with the clients and challenges that arise. And it’s healthy. You know, it’s healthy to be pushed and keeps our lives and our jobs fresh and exciting on, on a daily basis. I love, I love those concepts. Just kind of shifting gears, you know, we’re kind of wrapping up here back to the caregiver. You know, we’ve talked a lot about engagement and improving regular and ongoing engagement and communication. Any other challenges or trends that you want to highlight that you’re hearing from your franchises and across the industry that, that you want to speak to and how you guys are addressing to get there at a place at home.

Dustin Distefano (22:38):

Obviously, with, with the current state of you got tax returns, stimulus checks, unemployment bonuses, you know, it’s appealing for somebody that that’s the commonality. Like I can’t compete against this. I can’t compete against this. And what I say is that, well, you’re looking at it from a monetary. You can’t compete from a monetary value. So you’re assuming that these individuals are only concerned about money and they don’t want to work. Now that may be the case for a lot, right? Sure. But eventually that stimulus Jack’s going to run out. Eventually that tax return is going to run out. It’s a bad investment on the, I, I would, I, I feel bad for those individuals who do that because it’s not a way to invest your money. You don’t just spend it and use it and not have a job on top of it. Like if you took that $2,000 stimulus check and put it into the us stock market right in and grow that money, right?

Dustin Distefano (23:32):

Put it in the high yield savings account, grow it. Now I know stimulus checks are used. I want you to put it back into the economy, putting in the, into the stock market, using your money to make more money does put it into the account, right? So that’s another level of education you can give your caregivers. Did you get your stimulus check? I’d love to talk to you about some things you can do with it. But ultimately you make that choice, right? It’s going to run out. Unemployment will go down eventually. I don’t know why, but they’re going to have to see it. And when that happens, we’ll get through this. Right? So what I always tell my owners is when the pandemic happened back in March and April, everyone panicked, right? Clients started canceling services. Everyone was worried about, Oh my God, I’m going to lose all this revenue. And it’s amazing literally a year from that, we’re on the other side of the coin saying, Oh my God, my demand is so high. I have to figure out I have no supply to meet that. I had no caregivers to meet that. We got through the pandemic and grew as an organization by over 150%. You guys did that. If we can do that, then we can figure this caregiver situation out now. And it all starts with everything I’ve just talked to on this podcast, like focus on these things and they’ll, and they’ll follow you.

Miriam Allred (24:45):

I agree. It all comes back to the caregiver experience. It comes back to creating a place and environment, a career ladder that they want to be a part of. And, and just like you said, we’ve, we’ve talked about a number of points today. And if agencies can just implement these things on a continuous basis, you know, they’ll, they’ll start seeing the results and we’ll be able to get through this. So, Dustin, thank you so much for taking the time today. It’s been a treat to have you on the show.

Dustin Distefano (25:13):

I appreciate it. Thank you.

Miriam Allred (25:16):

Hey, thanks for listening to this episode with Dustin Distefano. To learn more about what your caregivers are saying about your agency, your training, their experience with clients, or whether or not they’d even recommend your agency head over to our website, homecarepulse.com to find out more about our experience surveys and how they could benefit your agency. And as always, you can reach out to me directly, miriamallred@homecarepulse.com for any additional information, or if you want to join me on the show. Thanks again and we’ll see you next time!