Ep:24: What It’s Like Starting a Home Care Agency in a Pandemic

Miriam Allred (00:05):

Hey, this is Miriam Allred from Activated Insights, and you’re listening to Vision | The Care Leaders’ Podcast. The show where I chat with home care leaders about relevant topics, providers want to hear. My guest today is Howard Stein, the owner of Home Helpers in Monmouth County, New Jersey. Well, welcome to the show, Howard. We’re happy to have you!

Howard Stein (00:23):

Thanks for having me. This is really a pleasure to do this with you today.

Miriam Allred (00:27):

Absolutely. Well, if I understand correctly, you’ve been in the industry for about 10 months. Is that right?

Howard Stein (00:35):

That’s right. We started the franchise in February and kinda jumped in head first.

Miriam Allred (00:44):

Yeah. Well, today we’re going to talk about some of the surprises or challenges you’ve encountered in the first few months being in business. Like I’ve informed you, we’ve got new agencies on the show, experienced agencies on the show, but I think it’ll be fun to recap, you know, some of the highlights and the challenges you’ve experienced firsthand. So if you’re ready to go, let’s talk about those surprises. Okay, awesome. So the first one that we’re going to talk about is you, what are your first challenges was hiring an RN before you even opened your business? So tell me about that. How, how did you find them? What was the like hiring, you know, initially before you got started?

Howard Stein (01:22):

Yeah, I mean, that was like kind of the first hurdle you know, in terms of going on a path to get the licensure and you know, hiring a nurse to do kind of per diem work when you don’t necessarily have any work and you don’t have a real agency behind you or really a business behind you is, is somewhat of a leap of faith to, to do so, you know, the hiring process was basically a lot about what my vision was for the agency and, you know, trying to make a connection with someone that believed in that vision. And, you know, given that we were already starting to get into the, kind of the COVID you know, kind of limited contact situation, it was, you know, a lot of zoom video. And that was really, really difficult because, you know, if you think about how everything was transitioning in the beginning of the year from in-person to video.

Howard Stein (02:43):

So all of that was still kind of new to a lot of people. Some people struggled with that. And you know, trying to assess personalities over the phone or through a video is not necessarily something that’s easy to do. And I, you know, I think the one, this is kind of the lucky star for me was that I actually found someone that, you know, kind of believed in what we were trying to do and believed in the promise of in-home care. And, you know, she’s been with me since day one and it has been such great support. I was really very fortunate that I connected with someone great, you know, right out of the starting gate because that is such a critical piece. And, you know, her input has really shaped a lot of what we’ve done to date. You know, she was a person that I am still to this day rely on and trust and, you know, so I, I had a good experience there, but it was really difficult to kind of that, that position given, you know, COVID given not a hundred percent sure what that role is going to be, how that actually even works. And you know, you kind of have to get that first hire before you can even submit your application. So that was definitely a huge challenge.

Miriam Allred (04:29):

And how did you go about finding her? Did you just put out some pretty standard job ads, or did you have contacts in the industry that you turned to first, or what did that process look like?

Howard Stein (04:38):

Yeah, so, I mean, I, I had I had an, quite a number of personal connections in the nursing community. And that’s where I went first, but, you know, none of those panned out everyone was starting to get really busy given all that was going on. So I did have to go out to the public forums I wound up using indeed and had a pretty good response, but again, it was going through all of those responses, talking with people to, you know, kinda get that right connection and, and, you know, being able to articulate what my vision was for the agency and then having someone kind of buy into that believe in that and want to participate in it, given the kind of parameters that we have for a new business. And, you know, that’s also the challenge because, you know, people are expecting certain amount of minimum hours even for a part-time job. And that was not really something that I could even immediately do given that we were a startup. You know, that’s not something that I think most people are comfortable with or accustomed to when they’re applying for this type of position. So that is definitely a challenge.

Miriam Allred (06:12):

Yeah. And I think that’s a great segue into the next challenge that you’ve mentioned, which are the complexities of state licensure. Talk to me about you’re in the state of New Jersey. Tell me about what that looked like to, you know, start the business initially there in New Jersey.

Howard Stein (06:28):

Yeah. So, you know anytime you have to submit an application to the state and, you know, when you, like in my case, purchasing a franchise and making a substantial investment you know, the fact that you are making this investment without all of the necessary credentials that are required to execute the business and to be able to execute the business is a huge leap of faith. And, you know, again, with the COVID situation being what it is the fact that, you know we weren’t even sure if they were going to do an inspection, how they were going to do an inspection, how the process would even walk why are they even receiving applications in the, in the office? And, you know, granted, this is not a normal situation. So, you know, when you know, dealing with the department actually wound up being something that the COVID experience actually worked in my favor because it wound up being a remote situation.

Howard Stein (07:50):

And we were able to get a a virtual, a virtual inspection, which happened later on. But it kind of just simplified the process. I think a lot of what it for me became, you know, just the timing of it, when was this going to happen? And I I’ve heard, you know, that this is one of, could be one of the biggest, you know time delays in terms of actually getting the business started. But I actually wound up getting a little bit lucky the flip side of COVID because they, there wasn’t a lot of inbound applications and they were, they were more than willing to help me, you know, virtually and, and on the telephone. So we were able to get through that pretty quickly, but I would say, you know, for anyone who’s new or interested in doing this is to really ask those questions, you know, as, as you can in advance, once you’re ready to kind of get started. Because that can be a challenge. You know, I just got lucky in terms of the timing of it and was able to get that license pretty quickly which helped me get a jumpstart.

Miriam Allred (09:14):

Wow, you’re probably one of few that we’ll look back to 2020 and say, I, I started a business during that pandemic, you know, there’s lots of businesses that have remained in business, but you’re one of, probably few that have started a business during the pandemic. And like you’ve said, there were some blessings early on, but definitely some challenges. So let’s, let’s talk more about that. Starting a business during a pandemic there locally in New Jersey where you’re at, it sounded like there were a lot of applications for new clients, so the demand was there. But talk to me about the challenge of getting new clients and caregivers early on during the pandemic.

Howard Stein (09:52):

Yeah. So, you know, again, I think just the whole virtual situation, we’ve tried a lot of different things, but, you know, I think what I would say, even beyond the pandemic about hiring caregivers is, you know, one, I didn’t really understand, you know, what a good offering actually looks like. What does a good job offer look like when we struggled to get people to even, you know, come into the office just based on having a compelling offering. And that I think is probably the biggest lesson learned. And, you know, even now that we’re 10 months into this, we’re still towering what that offering needs to look like. What does a employee or a caregiver journey look like from application to, you know, first day start of care and having that vision, having that kind of clearly articulated in terms of offering an experience, I think is a really important thing that one needs to have very kind of clear in their mind, clear with the key staff that’s engaged in that process.

Howard Stein (11:25):

And, you know, because it’s not just offering a job, you’re really selling an opportunity you’re on there, especially when the demand is so high for caregivers right now. So that’s number one, number two, there was a lot of, you know, kind of distress over a COVID with respect to caregivers, are you taking COVID patients, right? So that it had of itself as a whole, you know, we can spend a half an hour talking about whether or not, you know, your agency is taking COVID patients, how you’re responding to that. What does that mean for employees? Do they have options? You know, so all of those questions are wrapped up into this as well. And then, you know, how do you get people to kind of come in to your office and ultimately get them onboarded? So, you know, there’s, there’s a lot in there, you know, that is clearly one of the biggest challenges I think, you know, we still continue to face is how do we meet the, how do we meet the demands?

Howard Stein (12:43):

How do we provide the right offer? How do we provide the right schedule? How do we show that we have the culture, right? And the agency that people would want to be a part of. And, you know, it’s one thing when you, when you have years behind you you know, sometimes that works to your benefit, sometimes it doesn’t, but when you’re an unknown, you know, how do you engage with applicants and potential new employees? I, you know, it’s a real challenge. And, you know, I think it kind of go back to what I said earlier. It’s really about being able to articulate that vision of what you have and, and having that person actually believe it, and then providing them that experience that enables them to get, to start off care day one, because getting them into the you know, getting them into the interview is really only the first challenge in the process.

Miriam Allred (13:48):

Yeah. So you’ve hit on the demand for caregivers, let’s shift gears and talk about clientele, you know, as you started up, are you working with a lot of professional referral sources or how are, how are you getting new clients right now?

Howard Stein (14:06):

So definitely using third party referral sources, we use that right out of the starting gate you know, and that will continue to be a big part of our acquisition strategy. You know, and the other half of it is you know, internet. So you know, pay per click advertising and then social media marketing and, you know, given the pandemic, that’s not, you know, I, I would say that those things are not just limited to client acquisition, but also how we’re pursuing our networking our network and our business partners, our referral sources as well.

Miriam Allred (14:53):

How have your billable hours shifted over the last 10 months? You know, when COVID first started, you were first getting started, but how have, how have those billable hours ebbed and flowed over the last, you know, six to eight months?

Howard Stein (15:08):

Yeah, so we’ve been really erotic in our billable hours and part and parcel is because a lot of, a lot of what it had to do with is not hiring the right people, not having reliable people, making, hiring mistakes early on. So I think that that’s had a big part in it. You know, now that seems to have somewhat normalized, we’re getting better this process and it, it is an ongoing process. A lot of it has to do with the offering. But you know people just generally can come and go at any time. And which is where I disruptive when you’re at the kind of initial stages one client could represent, you know, a significant percentage of your business, and that creates a lot of turbulence you know, in the staff. And it works both ways.

Howard Stein (16:14):

You know, you can have, if you have can I go over attrition and you can lose a client over that or vice versa. So, you know, it has been a Radic, but I think at this point we’ve somewhat normalized. And I think coming into this time of the year with Thanksgiving, just being behind us, I kind of expected it to low a little bit. But it’s been pretty busy the last week. Especially coming after that, the holiday season, a lot of people, you know, did talk or meet with their family members and, and many of them have identified a new need. So we’re seeing a slight uptick right now.

Miriam Allred (17:05):

Yeah. That’s great to hear. And with resurgences locally, are you seeing a pretty big resurgence with COVID and how is that impacting demand?

Howard Stein (17:16):

So I, you know, we’re only seeing demand increase, I think the resurgence, we are definitely feeling it, even though we have wheat kind of where the first, you know, New York and New Jersey were really the first dates that got hit hard early. We were, you know, kind of level at one point, but now we’re seeing a spike up. So I definitely expect the next, you know, three months to six months to continue to be problematic with respect to COVID, but for the in-home care business. I do think that that is advantageous to us with the respect that, you know, people would prefer to remain in their home if that’s an option to them versus a facility given all the challenges of, of facilities with COVID.

Miriam Allred (18:19):

Yeah. Great responses to those questions and very relevant to everyone listening. Let’s talk about, I understand you had experience kind of in the corporate world as an executive before you came to home care. So you had business experience obviously, but tell me about entering this industry specifically. How was it, you kind of use the phrase learning to fly a plane when you’re first taking off. Talk to me about diving into home care and how that experience has been over the last few months.

Howard Stein (18:53):

Yeah, so, I mean, I definitely brought some knowledge with me in terms of, you know, care management and insurance. But in-home care is a specialty business. And when you’re starting a new business like this, and you’re, you have to learn the business, you have to learn the lexicon, you have to learn all the platforms, whatever technology you’re using. You had really, you know, only a few people that you can engage with to get information. You’re unsure of how to do certain things and even certain simple things like you know, onboarding a caregiver or, you know, billing or payroll or all of those things are so new and you kind of get thrust into this you know, while, you know, so it is like, you know trying to learn the plane when the plane is already going down the runway, you know, it’s a really, there’s no another analogy is drinking from the fire hose, right.

Howard Stein (20:09):

It’s just so much information. It’s a lot to take in and you know, there’s the gotta get the job done. And, and, you know, when you’re a new business owner it all rests on your shoulders. You are kind of a one man band doing everything. And that is certainly a challenge. And even 10 months into this, it’s the challenge hasn’t dwindled at all. You know, we’re still trying to scale, so the, of the work still rust on my shoulders although I will say, you know, in terms of like information, you know, you, you gain experience as you go along each time, you do, you know, a business operation or you know, you learn and you get more proficient as you go along. But certainly in the beginning months that was everything just took longer. And, you know, you made you’re bound to make mistakes and, you know, being comfortable with that is, is not, you know, it’s not something that anyone really I think can ever be comfortable with. It it’s an uncomfortable position, but that has also kept me motivated to, you know, get through this, you know, kind of initial, initial stage

Miriam Allred (21:39):

I’m curious, kind of another piece to this question is why did you go the franchise route versus the independent route? You know, we are in such a specialty unique industry where there there’s that option. So talk to me about why you went with a franchise?

Howard Stein (21:56):

That was like the easiest question that I answered very early on. And we wanted a system, we wanted something that had a proven methodology, and we also wanted to deal with people that we felt comfortable with and, you know, home helpers was amazing in that regard. And we know that we made the right right decision, but I think to the right to the core of, of your question is for me, I did not, I think it would have been a much more drawn out process if we were developing all of these practices from scratch. If we had to, you know, choose our technology, if we had to choose our integrations, if we had to, you know, write all of the systems and not have any of that experience or institutional knowledge that a franchise that’s been in business since 1997 has, and to me that was the right decision because that is an accelerant. Yes, there’s a cost to that. But I, in my mind, the cost is well worth it. The cost is well worth it because, you know, we, we feel that it’s an accelerant to that to us and there’s value in the brand. And that’s the reason why we went this route. I don’t think we would have been nearly as successful and the amount of time that we’ve had, if we went any other way.

Miriam Allred (23:52):

So we’ve covered a lot, you know, we’ve gone through these five surprises, you hiring your first employee, the complexities of state licensure, starting a business during the pandemic business operations, client, caregiver, requisition. Is there anything further you’d like to elaborate on or any other challenges or surprises that you’ve experienced over the last 10 months that you’d like to share?

Howard Stein (24:11):

Yeah, I mean, I think, you know, again the only other thing that we didn’t really kind of dig into a little bit, it is on and is on the networking side and, you know, on the referral sources, I think that that is traditionally been an in-person event, an in-person relationship building, visiting people in their various facilities developing those relationships over time through visits. And, you know, my time in this business has not had that opportunity right there had there have been no in person events. There have been no, you know, handshaking going to the office and dropping off, you know, literature and talking about you know, opportunities for referrals flowing both ways. So having to do all of that digitally and virtually has been something that I think is new to many people I’ve always been comfortable with working within a digital contact.

Howard Stein (25:27):

So, you know, I think that’s been something that’s actually worked to my advantage. So using tools like, you know, LinkedIn you know, and other things too, to kind of get that going. But I think, you know, if you talk about what the playbook was historically versus, you know, for, for, you know, identifying referral sources and, and getting those referral sources to actually make that first referral those in-person opportunities were, were really key, but, you know, as an industry, we haven’t had those. So how do you, you know, make those connections? How do you use the tools that we have today to make things work, because that is such a critical part of the business. You know, so learn a lot of learning there as well. And that’s definitely been one of the I would definitely include that in, and the challenges of 2020.

Miriam Allred (26:33):

Definitely a ‘lot of learning’ is an understatement for this year, a lot of learning across the board, but I think it’s good that we’re, we’re on an equal playing field. You know, this is a situation for a lot of us in switching to technology and the communication via technologies has been a learning curve for everyone. But you having started this year and experiencing that firsthand from the get go will probably prove to be a reward in the longterm. So appreciate mentioning that. Well, that’s all we have time for today, Howard. Thank you again so much for joining us on the show. Appreciate you sharing your experience and we’ll look forward to connecting with you again in the future.

Howard Stein (27:10):

Thank you so much. I really appreciate it and had a great time today. Thank you so much.

Miriam Allred (27:18):

Thanks for listening to this episode of Vision. If you’d like to learn more about Activated Insights, and how we help individual agencies visit our website homecarepulse.com. Thanks again and we’ll see you next time!