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Is there a single right way to run a home care agency? We sure don’t think so. That’s why we’re interviewing home care leaders across the industry and asking them tough questions about the strategies, operations, and decisions behind their success. Join host Miriam Allred, veteran home care podcaster known for Home Care U and Vision: The Home Care Leaders’ Podcast, as she puts high-growth home care agencies under the microscope to see what works, what doesn’t, and why. Get ready to listen, learn, and build the winning formula for your own success. In the Home Care Strategy Lab, you are the scientist.
Miriam Allred (00:01.292)
Welcome to the Home Care Strategy Lab. I'm your host, Miriam Allred. Today in the lab, I'm joined by Kevin Smith, the CEO of Best of Care based in the greater Boston, Massachusetts area. Kevin, welcome to the show.
Kevin Smith (00:15.928)
Thanks for having me, Miriam. Happy to be here.
Miriam Allred (00:18.864)
I feel like you were maybe one of the first guests that I interviewed on the Vision podcast probably five or six years ago. So full circle, we're back again. And naturally I wanted you as an early guest on this show. So a lot has happened in your business since the past five years. So that's really what I want to dig into today. So I'm excited to catch up and get into the decisions and acquisitions and really the changes that your business has undergone in the last several years.
Without further ado, let's just get right into it. I want you to start with your origin story and talk about the family business and your part in it all these years.
Kevin Smith (00:57.038)
Sure, so again, thanks for having me. It's nice to have a little full circle moment. I'm so happy for you to be launching this podcast and I'm really excited to be here and for you, honestly. yeah, to give you the quote unquote origin story, I really had no intentions of ever being involved in home care at all.
Miriam Allred (01:08.548)
Thank you.
Kevin Smith (01:22.538)
I did not know what I wanted to do, quite honestly. I grew up knowing that my father owned a home care agency, but like most kids, you really just have no clue what your parents do or what it all means. And then fast forward to me graduating from college and not having a job and not really knowing what I wanted to do or what I was going to do. you know, thankfully I...
talk to my dad and talk to him about maybe trying to work there just to see what it was all about. And here I am 18 years later and I've never left. And I have really sort of done all of the different things that you can do. I grew up there in many respects because when I started there, I learned on the fly. I learned by hiring people, by interviewing people.
by doing the payroll, by doing the billing. Occasionally when it was necessary I would go out and help out as a caregiver. I would go to the grocery store and get things that clients needed. And so I was trying to just do anything that I could to stay there. And I learned a lot about what I didn't really like.
about the job like most things you do them so that you can figure out what you don't like and what you do want to spend your time doing, what's meaningful to you. And I learned pretty quick that the communication, the thinking, the strategy, the ideas, those appealed and spoke to me far more than some of the more sort of task-based or operational requirements at a company.
Now, keep in mind, this was a much different profile of a company back then. In 2007, the company was still certainly mature for a home care agency. But we had maybe eight administrative staff and probably less than 100 caregivers and doing a little under $2 million in revenue. And so the company that I started working for back then was just something totally different than...
Kevin Smith (03:47.447)
than sort of what it has become today. So during that time, like I said, I did a bunch of different stuff and learned all sorts of ways and learned different things and ultimately had every job title. I became a vice president, a president, a COO, a CEO, and that kind of brings us up to date in terms of where I am today here in 2025.
Miriam Allred (04:14.66)
That was perfect. Let's unpack this business model. Like you said, 2007, you just kind of shared what the profile of the business was then. Here we are 2025, totally different size, shape, scope, unpack kind of the timeline and the evolution of the business model over the last decade or so.
Kevin Smith (04:33.783)
So again, when I joined that, the business that Best of Care was doing at the time was almost essentially and entirely Medicaid. We had sort of four, I think, contracts with state-funded entities here in Massachusetts, which are funded by Medicaid. And they're sort of quasi-governmental agency that purchases service from a network of providers.
and had a little bit of a private pay presence. And that was also back in the day where VNAs, regional and local VNAs had a much bigger presence and a much more impactful role in the continuum and the delivery of care. And oftentimes those VNAs would purchase a lot of staffing, a lot of home health aid service from companies like ours. And so
That was really it. And it was nuts and bolts kind of bread and butter home care service delivery. Short shifts. That was what was funded. And in pretty short order after working there, found myself more interested in the private pay business. Thinking about the opportunities that existed within it. Longer hours, 24-7.
more predictable staffing for our caregivers. But really what spoke to me most about it was like the, the relationshiping challenge that came along with it and building those relationships and those partnerships to the extent that I could find and convince people to, to work with me and that it was worth working with our company and finding my way as a representative and a face of the company that people could trust in and want to work with.
So that was then. In time, we added more services. we began adding more and more of a private pay business as I've alluded to, but then in 2018, excuse me, we launched a care management business. some of that was serendipitous, if I'm honest. I have to be honest because...
Kevin Smith (06:59.359)
Erin Lynch, who is the founder of our care management division, she was a home care scheduler at our company. She left, she took a job to be a nursing home administrator and then pitched an idea back to me while she was getting her masters in gerontology. And I had told her that I always had an open door. I really liked working with her and hoped that she would find her way back to us somehow. And she did with this idea.
And I am not a care manager. I'm a history major who happened to find his way into this family business that delivers home care services. within a couple of months of conversation, we agreed that she would launch this care management business through Best of Care. And we thought that it could be a unique way to speak to our existing audience of private pay clients and position this new service in front of them.
Miriam Allred (07:33.796)
Thank
Kevin Smith (07:58.452)
And that was really sort of that first seedling of a diversification sort of mindset and strategy. And really the strategy came after we launched it. It was like, yeah, I'm willing to take a flyer on this. Go ahead, try it. You run it, you do everything. You are the care manager, I'm not. I'm gonna support it and I'm gonna message it and I'm gonna publicize it and hopefully we can gain some traction that way.
That's 2018. I'll pause there and see if you want me to keep going sort of with the timeline and services and things like that or if you want to go, yeah.
Miriam Allred (08:36.132)
One question of, yeah, that's great. One question about care management. It's kind of a gray area a little bit. Sometimes home care businesses are doing a version of care management and they don't know it or they don't know what to call it. Was that happening? And was it a whole like paradigm shift once you tacked on this new service line?
Kevin Smith (08:56.811)
Yeah, and honestly we're still trying to think about how to talk about it. I've never seen an industry or a service that defies a simple elevator pitch or like a pithy sentence that can just be sort of like tangibly digested by the listener or the audience the way that care management does. And the way that we tried to explain it,
to our existing clients was.
Leave home care alone. They know what home care is because they're already paying us for it, right? Let's explain to them how we can sort of enhance that experience by adding a new layer of support by a super professional person who has the local resources, knowledge, and skill to be able to manage that person's care needs into the horizon. So.
We gave all sorts of examples to the geographically distant adult children, for example, right? That's the great hypothetical. The son and daughter who live in California and mom and dad are on Cape Cod. What are you gonna do when they go to the doctor? You want someone who can be a reliable narrator and someone who can document, transcribe, communicate that information, and then communicate it effectively back to the family.
You want someone who can do that on an ongoing basis, on an as needed basis, in perpetuity to make sure that so and so feels safe. And already I've just wasted what? A minute 38 of air on this pod trying to say that. So there you go, proof positive that it's still kind of like work in progress. But that's what we started doing was like, rather than try to explain it to the world, let's just start by explaining it.
Miriam Allred (10:40.355)
Okay.
Kevin Smith (10:55.981)
to the people who are already working with us. And so we gained a little traction in doing so. But it's still sometimes elusive in terms of trying to come up with the best possible way to describe that service. It's almost like you have to say what it isn't. It's one of those things and land on it that way.
Miriam Allred (11:19.584)
It's good to hear you describe this though, because as we go through this conversation, every time you tack on a new service line, this process restarts. Best of Care is no longer just home care, it's home care plus care management. And we're going to go through all of these other layers that you've added on. so, you know, adding on another service is adding on another revenue stream, but it's basically re positioning the company. And that's both an internal and an external effort that takes a lot of time and effort and communication and
struggling to kind of figure that out. And I think care management is a really good example of that process. So that's why I wanted to hear you talk through that. But let's keep going on the timeline. So this was 2018, you bring in care management organically with Erin. That took some time because your next move isn't until 2022 with moving mentors. So talk about the next acquisition and the reasoning there.
Kevin Smith (12:15.213)
Yes, so in 2022 we acquired a nearly three decade old, very well established, really sort of like one of the first in the industry, move management companies called Moving Mentor. And at the time when we started looking at Moving Mentor, again, I didn't know much about move management, but.
when I started to learn about it by speaking to the principal of that company, Barbara Perman, who is one of the really, really early pioneer figures in the move management industry, it gave me a great sense of trust knowing that someone who's been around for that long and established for that long has been able to build relationships with payers and partners to the extent that they understood what a move management could do for them. That's what gave me peace of mind and the diligence.
And, but what I saw, at least through my own sort of lens and perspective was, move management at its core allowed individuals into the homes and lives of often older adults who are going through this transitional period or moment in their life, mostly based around a move. And usually when that's happening,
it's motivated or driven by something that could be crisis, could be health, it could be preference or anything else. But the sort of like middle of the Venn diagram between home care and move management is we're in someone's home who is in a moment of vulnerability in their life. And that's where both services kick in. Now in home care, for all of our home care listeners, we know that to be
Friday at five o'clock when you get the discharge who needs 24 seven and mom can't go home until we have it. Can you help us? That's our version of the crisis. Move management, their version when they're in the home is either we need to declutter, we need to right size and downsize and readjust the floor plan so that someone can stay here safely or we need to move them out of this home so they can be safe in the next place. And so what I saw was that sort of overlapping moment and I said,
Kevin Smith (14:37.857)
Well, if we have a move management business and they are in the homes of people and they can be sort of educated around what the light bulb is for a home care intervention. And if our home care team can be educated for what a move management intervention might look like, you know, maybe we're scratching at something here and the existing private pay market that we were already serving seemed to allow for that.
In other words, it seemed like there might be some interest among that audience to say, well, yeah, we are getting home care, but maybe mom or dad could also use this so that they could move more safely around the home. Best of Care at the time was also working very hard to establish new relationships with independent living communities to deliver home care. Those communities by nature, by their very nature, have a lot of move-ins and a lot of move-outs.
So there was another piece of overlap there. Maybe we can take those partnerships with those communities at a new resource where we safeguard their moves in or out because nothing's more important to those places than occupancy. So some of these sort of things started to materialize and coalesce in our mind. And that's what led us to that acquisition. It was also the geography of it all where Movie Mentor had some
really key and long standing relationships that they worked hard to build and maintain in the western part of Massachusetts where Best of Care was very interested in gaining new market share for its home care business. And so we kind of chicken or egged it, know, whichever way you want to look at it. And that's what led us out there. And so we are a couple of years into it now and now we're working to try and scale that business in a way that
follows our home care business, follows our independent living partnerships, assists our care managers, and just fits in nicely into this holistic model that we're trying to build up.
Miriam Allred (16:43.874)
You didn't quite mention it at the beginning. Did you seek them out or did they seek you out? who's like, well, that question might answer my follow-up question, which is like, whose brainchild was this? Who initially had the idea of like a moving company? Because again, that's, you just explained how it fits together with home care. But for a lot of home care agencies listening to this, like that might not, that thought would never have even like crossed their mind. So whose mind did it cross and who sought who out?
Kevin Smith (17:12.705)
This is another example of someone working at our company giving us a great idea and making a great connection. So here's another one I'm happy to give the credit to people other than me. This was someone named Katie Krupka who works for us who at the time was working with Best of Care helping out with our home care team out in Western Mass and she knew the principal Barbara of Movie Mentor.
and thought that there might be just room for a conversation because she had heard that that business might be transitioning. And she called me and said, Kevin, I know you're always kind of looking at stuff like this. And so she assessed my personality to the extent that she thought that I might be interested in the conversation. She set up that introduction and from there the conversation started and the mutual levels of interest began to percolate.
between both parties and that's ultimately sort of like what started that whole thing. And now Katie is still working closely and helping identify referrals for moving mentor and vice versa for what she does for us. So yeah, it's another great example of a really smart and savvy and creative thinker working for our company, identifying the right opportunity for us and then.
having faith in me to try to execute it, I guess.
Miriam Allred (18:39.124)
Very cool. There's something to be said about your leadership and what you've built there is you've not only found and are like breeding this talent, but they know you and the business well enough to bring these ideas to light. And that's really cool. I'm glad I asked because I did not know that. And I think there's just a lot to be said about these people that you've brought on and fostering this environment where they can bring.
big lofty ideas to the table and it's not a pipe dream. It's like a, hey, here's a great idea. Let's talk about it. And then here you are years later having acquired that business and are building out these new service lines. So that's really neat.
Kevin Smith (19:14.593)
Yeah, yeah, I'm definitely proud of that because we're always trying to find the best possible people. And I've made it very clear as we're talking to people who we want to bring on or after they've just been hired that like, look, you may not be hearing from me every day. That's not the type of manager I am. I'm very, very, very, very, very hands off. Find the talent, let them do what they need to do and watch what happens. But the one thing that I make clear is like,
I don't have every idea, nobody does. And so if you have something, come to me and let's talk about it. They don't all land, but I absolutely want people thinking that way because those big ideas in an industry like this, that's job security. If you can find something that's gonna help develop this business and support your own personal and professional growth by bringing it to me and then seeing how I can leverage my resources to make that happen.
something meaningful can come from that and we've already talked about two examples where it has.
Miriam Allred (20:18.852)
It also takes a little bit of that weight and pressure off the CEO seat is you know Sometimes there's maybe that misconception of like the CEO has to have the ideas has to be driving the business forward has to be looking at like the 10-year plan But take some of that weight off and share it with the team. Hey, everybody bring ideas to the table Everybody be thinking about the five to ten year vision Everyone just be involved in that process take some of the weight off in a good way for you
So this is 2022 moving mentor, first acquisition. We've got a couple more acquisitions to dial through. So 2023, you all acquired a home care business. You were talking about like territory. You wanted to penetrate new markets in your area. So talk about the acquisition in 2023.
Kevin Smith (21:03.575)
So just about a year after we acquired Moving Mentor, we acquired Barton's Angels, which was a privately owned and operated home care agency in Western Mass, same sort of geographic territory as Moving Mentor. we had been sort of toiling away out in that area with just one state-funded contract that we would grow it and then
I would lose personnel to run it and then be just kind of like treading water and plateauing from a volume and revenue standpoint. And the way that that market is out there, after years of trying, said, you know what, I think we have to just sort of buy our way in. And I was able to reach out to the principal of that company, Nancy Whitley is her name. And in talking to Nancy, I just...
asked her what she was thinking about the future of her business. And we got to talking for a long time. And again, went through diligence. What we loved the most about Nancy's company was incredible retention and loyalty from her caregivers, which gave us a ton of confidence knowing that, you know, after the ink dried on the deal that people were gonna stick around. And also, again, longevity in the industry.
had been there almost 30 years and had some contracts in relationships with payers that we knew that we could slide in and take over seamlessly by hiring all those caregivers and keeping all those relationships intact, which we did. And once that happened, we were able to feed some more hiring resources and really expand that staff. And we have grown that business substantially.
since November 2023 when we bought it, I believe, and added more administrative staff, more nursing staff, and we've also followed that business out there with care management and move management as well. And so trying to get those disciplines and those services integrated in a new market with new people with different names,
Kevin Smith (23:30.252)
was nothing short of a challenge. so I'm really happy with where we've come with that, but it definitely brought us to the point where we needed a director of strategy to keep the internal and external communication and strategies aligned because I know what my strengths and weaknesses are. I'm not a great integrator at all. I have plenty of ideas, some of them stink, some of don't work.
That's more interesting podcast, right? When you talk about what the stuff that doesn't work looks like. But we brought in someone to basically educate all the different teams across all different regions, all service types. What one another, like what we do, what does this person do? How do they do it? Where do they do it? When should you call them? How should you talk to them? How should you talk about their service to someone who doesn't know about it?
Miriam Allred (23:59.14)
.
Kevin Smith (24:24.181)
what would saying too much about it look like? Because you don't want to overcook it, you want to pass it off nicely for a referral. so that brings us to the point where we really needed to just integrate everything. And as you said a couple of minutes ago, talk about how we're going to reposition all these new services and these new offices and locations in what I refer to as our family of companies. How are we going to...
put that together in a way that someone just doing a Google search understands what the heck we do. Because I know what we do. I can keep it straight in my brain. Trying to share that publicly can take a long time.
Miriam Allred (25:08.708)
I'm curious, you were kind of alluding to this, but I'm curious in hindsight, was this acquisition of another home care business maybe the most challenging or less challenging? I mean, each of these acquisitions is so different, so it's hard to compare them apples to apples. But it sounds like this home care acquisition was challenging, but also brought the need of repackaging, repositioning, hiring a director of strategy. The business with these service lines was to the point.
Kevin Smith (25:25.719)
Yeah.
Miriam Allred (25:38.434)
where it needed more attention and organization and structure. But that was brought about by this home care acquisition that maybe just made everyone think a little bit differently.
Kevin Smith (25:47.758)
So yes and no. The mechanics of that deal and bringing it live and making it all happen were seamless. It was actually really, really encouraging how well that went from the moment, I I think we maybe lost one caregiver in that transition. It was like a 99.9 % retention rate. Everybody came on board.
After that is where things got tricky. So it wasn't that specific deal or the integration of those folks in. After that, when we realized like, okay, what do we have here? I've got a new home care agency in Western Mass that Best of Care just acquired, but it's still called Barton's Angels. And I'm trying to explain to everybody who gets an invoice from me why it's coming from this part of the state and it says Barton's Angels from a new email. And so that's where it was like, you know what?
I'm out over my skis. I need to figure out a way to just think about this thing in a far more simplified, streamlined way so that names make sense to people. It's just a simple thing to say, But like, you know, when you get an email from someone at Best of Care, why does it say Barton's Angels in the email signature? And that's what people were asking me I'm like,
I didn't think about that. just didn't know. You don't know what you don't know. Until you've gone through that, you don't know. But that's what I was talking about in terms of that need for some real strategy and sort of like a forensic look at the way that we talk about ourselves to one another as well as externally. And you think about that as marketing or even advertising, but it's something other than that. I don't know what it's called necessarily, but...
it definitely fell squarely onto the lap of our director of strategy. Her name's Arona and she's been amazing with it.
Miriam Allred (27:51.012)
Let's finish the timeline. know we're going long here and I'm interjecting, but this is great. Let's finish the timeline with this last service line that you integrated, I believe in 2024, which is private pay nursing. Talk a little bit about the thinking and the integration there.
Kevin Smith (28:06.475)
So private pay nursing for us is sort of like the final frontier of where we can go with the type of company that we are. We're not a we're not a VNA. We're not Medicare certified. We don't deliver skilled nursing. But to me there is just this huge unmet need of. Let's call them patients because when they're working with.
skilled nursing and a certified organization, they're patients. But when the VNA discharges after 60 days, on day 61, it's not like they're just magically better. And so on day 61, let's use that hypothetical, they become a private client of ours. Oftentimes they still need some level of support by an RN or by an LPN. And that could be
anything from follow through and assistance with their medication to make sure that it's organized, that it's there, that it's being taken, that it is being either delivered or picked up from the appropriate pharmacy, and that the dosages are appropriate. It could be something as simple as assistance with or guidance around someone using insulin. It could be wound care.
it could be just general supervision of someone's movements and return to their lifestyle after a rehab stay and then getting discharged back home. And so I see and we see this opportunity to pick up where they leave off and.
There are very few organizations who do that, and if they do, I'm not sure that there's a great deal of formality around it, or if there's a great deal of publicity around it, quite frankly. And for us, not only do we see that need being unmet for when a VNA moves on, but in a lot of our partner communities where we have a preferred provider status and an independent living,
Kevin Smith (30:25.185)
A lot of folks in those communities benefit from the presence of a nurse as well. Or even in some assisted living facilities where they may have a nurse, but it's almost exclusively in a supervisory or an assessment-based capacity and not delivering any sort of hands-on level care. And so we're pretty bullish on the idea that there is a need and people are still learning, A, that they need it,
and B, how to access it, how to ask for it, what it's called, what it looks like, and what it entails. And so we wanna make sure that the partnerships that we look for are, we wanna talk to VNAs first and foremost because if they're leaving, who do they suggest people talk to if a family asks them about that? Because a lot of these VNAs no longer have a private pay arm. A lot of those have moved on.
And then we're also, like I said, trying to position it within the community. So I'll pause there, but that's where we are with PrivatePay nursing. And then of course, not to mention adding it as a supplemental piece to our existing private payers or to brand new PrivatePay folks who come on board with us and making them aware that they can use this service if they need it.
Miriam Allred (31:40.58)
That was perfect. A really good summary of this service line and how it's been integrated. That takes us to today. We just dialed through the last, since really 2018, all of these changes. I want to zoom out a little bit and ask some high-level questions about your role and how you've thought about this and your interaction in the day-to-day. The first question I want to ask is about your time. Think back to 2018 at the start of all these big changes.
How involved were you in day-to-day operations and how has that changed over the last five years? How much time do you spend kind of in the business versus on the business and how has that molded over the last several years?
Kevin Smith (32:25.837)
basically a total 180. 2018, I was about as involved as you could get with the day-to-day business in doing some basically critical tasks that if I wasn't doing them, no one else was. So I'm trying to think back to what those might be, but I know for a fact I was on call and I know that my wife and family remember that too because there's nothing worse than, you know.
during a blizzard or snowstorm around a holiday, know, on call for a home care agency is just an absolute bear. It's nightmarish. And yeah, I was on call for a long time. And somewhere around 18, 19 is when I really started to be able to delegate. COVID helped me a lot because people were working at home and I trusted people.
or found new ways to trust people, guess is a better way to say it, without having to approach them in an office and ask them to do something. It was like, we all knew that we were at home and I found ways to just start delegating stuff to people and realized that I should have been doing it a lot sooner. And that includes like high level operational stuff, as well as HR functions, finance functions, all that stuff that I was so hands on with.
giving people your trust and giving them the time and space to do it in their own way, oftentimes better than I ever could, changed everything for me. And so my day to day is spent.
much differently. I don't know how deep we want to go into like, you know, what the day in the life looks like for a guy like me, but it's just so much different picking and choosing what you want to be a part of meeting wise, team wise, work group wise, seeing people set up meetings for one another that don't include you was like, Oh my God, this is happening. There's a company that exists without me here. And it was so, so encouraging and uplifting for me to see that. And so now,
Miriam Allred (34:13.145)
Thank
Kevin Smith (34:41.387)
My job is mainly all communication. It's talking to people internally, externally, and it's basically synthesizing information that's given to me in scheduled formats, in bits and pieces. And I've now gotten to the place where a lot of it is being given to me without me even asking for it, because people now understand what I wanna see when I wanna see it and what I consider to be meaningful.
Miriam Allred (35:09.508)
you
Kevin Smith (35:11.275)
I've got some nice layers under me now.
Miriam Allred (35:14.146)
I might be putting you on the spot with this question, but I'm curious who your mentors are and who's been the sounding board through all of this because like many CEOs, executives listening to this know it's lonely up at the top, but what you've built and what you're doing is not traditional. There's not a lot of businesses with your exact profile in this country, let alone a single other one. What you're doing is different. Who are you going to? Is your father still involved?
Have you looked outside of the industry for mentors or who is your sounding board through all of these big changes that you've undertaken?
Kevin Smith (35:51.054)
I jokingly told someone recently I'm either early, insane, or both on some of these concepts that we're doing because anytime someone's like, wow, I've never seen any other company do that, I'm like, oh great, I don't know what that means. It's very lonely, I gotta be honest with you. I started doing this when I was 23 years old.
as a young guy, it was predominantly female driven industry too. So I was almost like this outlier type person. And I also started running the company at a relatively young age too. So I've always felt somewhere outside of the curve a little bit in terms of, and I'm also peerless, right? So like, don't know, I don't, I turned 40 next month. And so I don't have a ton of people.
in my sort of like exact age group who are where they are with their companies yet. But I also have the benefit of this legacy behind me where I had a really, really strong footprint to walk into. So yeah, I don't have a ton of people, but.
I have made a ton of connections, super meaningful and positive through the work that I've done with my trade association here in Massachusetts, the group that represents home care agencies. I was the president for four years. I think I'm the first two term president because nobody wanted to run again during COVID. So they said, just let him do it again. But that connected me with basically every business owner in the state who does this. And I've also been on any number of work groups, webinars, panels now.
Miriam Allred (37:24.878)
Yeah.
Kevin Smith (37:37.382)
and through conversations like these and with other people. I've just made friends who are in the industry, not just in mass, I'm part of a, every few months, I'm part of a group of people who are from Indiana, Pennsylvania, parts unknown to me in terms of doing business there, but it's just great to break bread. then the other place has been super helpful and someone who I've developed a really strong relationship and friendship with is
Helen Adhiosan from Care Academy, founder of Care Academy, who I got introduced to back in 2018. My company was her first client in Massachusetts. So we share a lot in common and I'm on their advisory board now. And so I've been able to connect with a lot of like-minded thinkers, not necessarily business owners. And that has given me kind of some solidarity amongst the ranks, but you're definitely right. mean...
I don't always have someone to turn to, even in my own personal life, because I don't have a ton of people my age who do what I do to begin with, let alone on the scale that we do it. But I do still have my dad, yeah, he's still working. He lives on the Cape now, and he will go into our office on the Cape and kind of do what he does in there and stay connected to the pulse of the thing through that little microcosm. And that's really special for him to still be connected to the mothership through me.
He's excited to hear about all these things that we're doing.
Miriam Allred (39:07.82)
I really appreciate the transparency and the vulnerability. think a lot of people, myself included, see Kevin Smith, Best of Care, see you in this light and think of your business as this really robust, incredible organization. But it's good to hear you kind of like lift the curtain. It is lonely, it is hard, it is vulnerable, it is uncomfortable. I think a lot of CEOs listening to this can relate to that and feel the same.
Kevin Smith (39:25.761)
yeah.
Miriam Allred (39:34.69)
I don't know that as an industry, we talk enough about that is just how hard and lonely it is at the top. And then especially through evolutions like this, where you're no longer just a home care business and you're layering in these different services and you're introducing new people and new parties, like it becomes something unique and maybe does not exist elsewhere. And it's hard to navigate that both personally and professionally as a CEO. So just appreciate your vulnerability and candidness there.
Kevin Smith (40:03.255)
Yeah, thank you. And, you know, don't forget too that the people who you are soliciting advice and feedback from day to day, they're on your payroll, right? So like you have to be cognizant of that too. like, it's also important to get some people who will either say no to you or say that that's a bad idea. Like that's among the most refreshing thing that you can get. And so I've been able to find a little bit of that now as we hire people is like,
I want ideas, but I also want people to tell me, no, that's not that. That's a bad idea. Don't do that. Or let's think about that a different way or something. But I think you have to be vulnerable about it. mean, there's, there's really, there's no reason to be so guarded about what we do. Everybody knows that there are days where you're either just lonely, scared or both. It's just some varying degrees of which one on which day and hoping that the thing doesn't just crumble apart on
Miriam Allred (40:55.137)
you
Miriam Allred (41:01.774)
So another question I want to ask is about where you are today is probably not what you had in mind five years ago. And the reason I want to ask you about this is a lot of CEOs are sitting at kind of this crossroads of wanting to grow, wanting to introduce new service lines, but it's kind of this like black box or it's just like gray and hazy in front of them. You know, there's not like a business career path for home care agencies when it comes to acquisition and growth. And so
take yourself back to 2018, 2019. Again, you probably didn't have this vision of what the company was going to become, but what were you thinking in those moments? It was like take one acquisition at a time, or did you have a vision of what you wanted the business to become, or where that headspace of the start of what this was about to become, what were you thinking?
Kevin Smith (41:53.816)
I don't claim to be a visionary, I'm not. Some of that vision that you're talking about, about what the company has ultimately become, was just revealed to me one opportunity at a time. And that's really, the way that I approach things is I am a relationship builder by nature. If you build honest and strong and positive and supportive relationships where you do something that,
literally helps another organization or community or person, the more of those you put together, the more opportunities will find you. And I'm not trying to be karmic or cosmic about that in any way. But we wanted to, in doing this and building these relationships, you know that you're going to build goodwill so that when the opportunity arises, because something changes in their life, I want to be their first call.
I want to build my relationships and my service delivery and my reputation with you to the extent that we are super reliable. We do what is asked of us when we say we're going to do it. So that when something changes, again, we're that first call, give you an example of that, right? So you went back to 2018, right? We launched care management. That was not my idea, but we're rolling with it. And
In that period of time, we have some relationships with our state funded partners. We're doing well. And all of a sudden I get a phone call because this other provider says, we're just closing. We're giving three months notice to this contract. We're giving away all 200 of our clients and we need to relocate 50 employees. This contract called me first and said, hey, can you hire 50 people with 200 clients and make sure that they don't miss service? And I said,
Yes, don't make any other calls. And so those types of opportunities, which are basically just as good as acquisitions, honestly, also happen. And so where I'm going with this is those sorts of things happen along the way as you are scaling out your relationships, which doesn't sound like a thing, but it really is. You have to cast a wide net because not everything is going to pan out. so those sorts of goodwill opportunities found us.
Kevin Smith (44:17.549)
And that's what ended up shaping the vision because all of a sudden you pick up 50 new employees in this region. Wow, great. Now I have 50 new employees who I can introduce to private care in addition to the state funded care. Let's hire some care managers there. Now we've got a little bit of a footprint and a little bit of a foothold in that region. And so the vision sort of just unlocked itself through these opportunities that I built through these positive relationships, which again,
If there are super analytical minds listening to this who are hoping for some formulaic, robotic, algorithmic response, I don't have it. I'm not that guy. But I've never been like a super five-year, 10-year plan person in home care. That is absolutely worthless. Unless you are dealing with a financial fortress of capital behind you, things are gonna change on a dime.
and you're subject to the whims of the caregivers who may come or go and things like what we're seeing today right now in this climate with changes to the workforce and changes to Medicare and Medicaid. yeah.
Miriam Allred (45:29.826)
I want to push you a little bit. You talk about finding and building these relationships. What does that look like? Are you taking these people out to lunch? Are you inviting them to the office? I want to hear what your role in it is because we both know that what happens out in the field, these great caregivers taking care of these clients, they're the ones building the reputation. But what is your role in that look like? Are you seeking these people out? Are you taking them out to lunch? How are you finding them? Who are they?
Kevin Smith (45:32.033)
Go ahead.
Miriam Allred (45:59.138)
Get a little bit more specific on how you're doing that and how you've done that successfully.
Kevin Smith (46:04.973)
Yeah, if you were to go through my emails and just do a targeted search for the phrase proof of concept, you would probably find that more than like any other phrase in there, right? In my sent email folder. And that is something that I have come to hang my hat on basically. And so what I like to do is maybe there's a little more formula that I'm giving myself credit for, but.
Miriam Allred (46:32.853)
I knew there was a formula in here somewhere. Come on, give it to me.
Kevin Smith (46:34.957)
Yeah, so to me, I have been able to effectively use proof of concept presented in a way that I know will satisfy or resolve a need or a problem that is inherent to either a payer, a partner, a community, or an individual. And oftentimes it doesn't even require a launch. Sometimes it might, but...
But what I like to do is make a very personalized introduction to people to show that I am a person with a name, a face, a personality, a beating heart, and not just some sort of cold email from someone working for me with some sort of nebulous job title. You're never gonna get that from someone like me.
In fact, I like that they see that the CEO of this private company is actually reaching out to them, a sales and marketing person at a living facility. It's like, whoa, why is this person reaching out to me? That's kind of the human nature thing. And from there, you want to make very clear what your purpose is. Here's what we do with some of these other communities, but more importantly, I wanna learn more about what's going on over there.
I drive by it all the time. My kids play a game over here. Find a personal something or other and dig into that. And once you can establish that, that's when you can get people to open up about what's going on, where they are. Newsflash, you probably already know this, but if you can get them to articulate it in their own words back to you and then present them with a solution using their own words, usually makes them feel pretty good too. So.
What we will do is sort of start by building that relationship. Oftentimes I'm using it on LinkedIn. Anybody listening to this who knows me, sees me on there constantly talking about, you know, sharing an opinion or talking about something that we've done. I do that very strategically so that when I introduce myself to someone and they look me up, they can see that there's proof of concept. okay, this person just bought this company. They expanded to this place.
Kevin Smith (49:00.119)
They actually are who they say they are instead of just this person who just hung a shingle who wants my business. I don't reach out looking just for your business. I'm looking to try and see how we can form a really lasting, meaningful partnership secured by a contractual, formidable and excuse me, what's the right word I'm looking for, formal relationship.
And when you are using proof of concept and success backed by media stories, press, podcasts, proof that you've done what you say you can do to others, you make yourself a little more compelling and inescapable than the other folks in the room or in the inbox. So I'll pause there to see if that makes any sense and to make sure it's not too dense or heady or something like that.
Miriam Allred (49:53.908)
No, that was great. It was good to just hear how you think about this because it's different for everyone. I think you're exactly right. You want them to know that you're a face and a human, but then you also want to be backed by social proof online. That's a whole effort in and of its own. Earlier, you were alluding to what is your day-to-day? Part of your day-to-day is personal branding.
Kevin Smith (50:08.365)
Correct.
Kevin Smith (50:18.082)
Yes.
Miriam Allred (50:18.728)
and company branding as the CEO. And that takes time and effort. There's more about that online right now about building your own personal brand and things. But I think a lot of CEOs should be thinking through that lens is like, here's the company, here I am. How do those things fit together? And what am I doing to represent the company and to appeal to these broader audiences? And I think you're a really good example of that. I'm just curious today.
How many relationships would you say you're thinking about actively? When you talk about being in front of these people and building these relationships, just conceptually, are you thinking of maybe 10 key relationships, 50 to 100 relationships that are in the back of your mind? Or just to help us understand how many relationships are you thinking about currently?
Kevin Smith (51:05.781)
Yes, I was just doing the mental back of the envelope math for you and the listeners. There's always at least 12 to 15 key ones that live and breathe every day. And those are the people who are actively engaged with us, who are supporting us and we're supporting them. They're paying us or purchasing something from us. And we are, you know, delivering a service for them. But beyond that,
It's no less than 50 at any given time that I'm thinking about. And if I, could, I could easily write them all out, but that's what my, that's, that is my job is to think about those things and look around and see what types of opportunities are out there. And then what relationships need to be built to support those. What proof of concept do I need to target by way of either acquisition or organic growth?
to make clear to this person or this place that they should consider us. And so when I talked about trying to scale your relationships, that's really what it is. If you want to scale your business, some of what I'm talking about has to be inherent in that because we're not builders, right? We're not buying real estate or commercial property and demonstrating our value through this portfolio of communities that we've owned and built. It's all human relationships.
We're a human service provider at the end of the day. That's what we need to demonstrate to everybody is that whatever you need at your specific place or for your group of clients, we will cater to that without ego, without preference. We will do what you need us to do, however you need us to do it, because that is what we do best at my company. You tell us and we'll find a way to do it.
Not every person or every personality type is able to bend and is able to do that. But you've got to do it carefully because you don't want to, you don't want to sacrifice the way that you do business. You don't want to sacrifice the way that you deliver service or you don't want to compromise on your hiring standards. But you need to find a way so that whatever that partnerships version of you needs to be, you can deliver that and you can deliver it with confidence.
Kevin Smith (53:32.225)
We've been able to do that now to the point where we can use that at scale, if that makes any sense.
Miriam Allred (53:37.622)
Yeah, thank you for contextualizing that. think even just the numbers you threw out is really useful for other owners to hear is that maybe 12 to 15 key relationships, but probably a broader, maybe 50 relationships that are always swirling in your head. Earlier, I know I used the buzzy phrase of like in the business versus on the business, but I think a CEO of your tenure and of your business size, that's a huge-
Kevin Smith (53:51.051)
Absolutely.
Miriam Allred (54:03.382)
if not the sole responsibility is managing, thinking about, strategizing those key relationships and how they impact the business today and how they're going to impact the business in the future. This is kind of a curiosity question. We're off script here, but I want to ask about technology's role in all of this as a business of your tenure scales and evolves. And you even mentioned yourself how important communication is in all of this. Technology has kind of like an underlying
Kevin Smith (54:08.033)
Yes.
Miriam Allred (54:32.918)
maybe not underlying, maybe an overlying impact in all of this. I want to hear you just kind of explain the evolution of technology through all of this. If it's weighing you down, if you've made some key decisions and it's accelerating your growth, or how do you see technology fitting in everything that we've talked about.
Kevin Smith (54:54.603)
I'm somewhere in the middle of where you see people on the spectrum, you know, kind of publicly talking about how technology impacts home care, right? You see some people who are convinced that they can solve, you know, home care, the riddle of home care with AI, right? Okay, maybe. And there are some people who are, you know, kind of much further out in terms of their embrace of technology and
how they communicate with clients and family members and things like that, where everybody's talking on the phone all day, as opposed to sending emails or texts or a patient portal or something like that. We're somewhere in between, right? Because as I mentioned a few minutes ago, when you have the different types of people paying you to deliver service the way that we do,
we're stretched in so many different directions. We have these different kind of like constellations of communication because with our Medicaid business, there is some clear guidance on the way that that communication should look and feel and how it's sort of structured in terms of what you can do and what you can't do in terms of talking to those clients and their family members and with the case managers and the partners. Whereas in our private pay business, every
Every client is different. Some want a weekly summary email. Some want this. Some want nothing. Some say just talk to the attorney. And then with our care management business, they're using a different platform, a different software. So within our company, at this moment in time, people are gonna think I'm insane, so that's why I'll share it, just to make people feel better in case they're in this spot too. My care managers are on one platform.
My home care business in Western Mass that we bought, Barton's Angels, is transitioning off of whatever they were using for home care. Best of Care is transitioning from its existing home care platform onto a new one to comply with the state's EVV requirements and mandate. And my move management business has their own. And so we're certainly not averse to technology.
Miriam Allred (57:13.38)
Thank
Kevin Smith (57:15.051)
Now we're trying to see what we can do to consolidate all these communications. Because, you know, as I'm saying this, I'm thinking like, I don't know how my finance team does it and spits out a bill every week, you know, from all these different systems. So we do what we have to do based on industry and client preference. But for the most part, we are, you know, we're happy to use technology to our advantage wherever possible and however possible at our company. I think it's...
you know, I'm a millennial, it's just sort of inherent in us that there's always gonna be brand new technology and you sort of follow it, you know, and you use it while it's there and then it moves on to something else. So I'm not too cynical about it, but that's where I am with it. for the real answer is basically I'm running my company from an iPhone. How's that?
Miriam Allred (58:07.588)
That was a good way to sum it all up. Again, I appreciate just the transparency, even you sharing that you haven't consolidated, you're still figuring it out. think everyone wants to sort out technology and tech stacks and what does that look like, but it takes a lot of time and a lot of effort. There's different platforms that have different strengths and there's not silver bullets when it comes to technology, especially with complex service lines like you have just outlined.
Kevin Smith (58:19.233)
Yeah.
Miriam Allred (58:35.278)
Kevin, I'm struggling to figure out where to wrap this up because you've shared so many good information and boy, could I just keep drilling you with questions. But I think the last question that I want to end on, we've talked so much about your history and this journey and these key relationships. The best I think I can come up with is what are you thinking about for the next two years, the next five years? I know you're not a visionary, but like you just said, you're 40 and this company
has grown so much and there's more ahead of it. What excites you in home care and what, if anything, are you cooking up for best of care? Those are two different questions, but maybe they intersect in your mind. I'm not sure.
Kevin Smith (59:15.565)
Yeah.
Yeah, maybe they intersect a little bit. What I'm super interested in right now is trying to learn more about the adult day space, the social model for adult day. I guess I already said this when I was talking about private pay nursing at the outset. I said that's the final frontier, but maybe there isn't a final, maybe that's just a frontier, not the frontier, but I'm definitely interested in that.
I'm interested in the staffing ratio that it takes, you know, from a business perspective. You can serve more people with fewer staff. So immediately there's some sort of appeal intrinsic to that model. But also, you know, given the types of professionals that we employ with all of our family of companies, my wheels start to spin where it's like, hmm, okay, an adult day.
Imagine if we were supporting that with our existing caregivers who already work for us. If we were scheduling that with our existing schedulers. If we had our care manager managing the sort of higher level considerations of the participants who are there. Imagine if someone who was scheduled for home care service had their caregiver call out. So instead we provided them transportation to the adult day so that their needs are met.
and everything stays within our billable ecosystem from a business perspective, that's pretty appealing to me. And it's not just any old mom and pop adult day at that point. We are able to supplement those folks with a lot of different service. In the home, onto the van, to the place, back onto the van, back home, high level. What if they need to move?
Kevin Smith (01:01:09.985)
We've got a move management company. So you can see how my wheels spin there where it's like, you know, maybe that would be something that holds great appeal. And maybe we already have a partnership with a certain living community or living communities who.
might want to introduce people who don't live there to their space and bring people in actively and bring in folks from the community for presentations and programming and education and all sorts of other entertainment. yeah, think that there's a way that we might be able to find a soft landing for a spot like that within our ecosystem. So I'm thinking about that for sure.
You can probably tell I've given a lot of thought based on the borderline rehearsed, right, that statement. So yeah, that's sort of where I'm at because I think that you see everything sort of come together under one roof in a very, very unique way and perhaps a way that helps people who can't afford 12 hours a day of home care.
Miriam Allred (01:01:56.834)
you
it.
Kevin Smith (01:02:19.575)
find a solution when the middle class is disappearing and the private pay market cap finally lands on us at some point in the future.
Miriam Allred (01:02:29.72)
Okay, I can't help myself. My last, last question, the flip side of that, what keeps you up at night and what really scares you or makes you nervous about the future? You we talk about shortage of caregivers. We talk about payers, government oversight. Like there are some big looming challenges. I'm curious which of any really do keep you up at night or make you nervous when it comes to the future of home care.
Kevin Smith (01:02:57.523)
I have so much faith and confidence in the people that we employ and the caregivers who represent us and the skills that they possess and the support that we give to them through education, through supervision, through resources, through benefits, through opportunities for upskilling, but also just opportunities for more work because we have so many ways that we can position available hours in front of people. The demand of it all, meaning the...
the robust and huge group of people who are going to be aging together right now, starting now, into the next 10 years, who all wanna be at home, whose disease states and conditions and mental health conditions and things that...
maybe the home care workforce hasn't been fully educated or trained on yet, are going to be expected and demanded to not only know, but also implement and use and just sort of be ready for those on the job is scary because...
It is so hard to provide great care to your clients with skilled and educated and highly trained caregivers, because you can only hire them so fast. And you can only educate them so much based on what's available to them. So thinking about the demand and the expectations collectively that's about to be thrust upon us as an industry, that is a pretty big concern to me because
You don't want to see anybody getting hurt. You don't want to see any clients not getting what they need or having an emergency and someone not be equipped to help. That definitely scares me, especially when you think about it sort of over a wide network wide or projected scale like that. I'm saying that with full-throated confidence in the people that we have and the way that we go about training and vetting and hiring people.
Miriam Allred (01:04:59.14)
Really good response. Kevin, I've had you in the hot seat, I think for long enough, but boy, have you delivered. That was so much fun and so insightful. A lot of that was off the cuff, but I've learned a lot and really enjoyed this conversation. For anyone listening to this, if you're not following Kevin online, you're behind. Make sure you're following him on LinkedIn. We were talking about this before. You've got a lot of great content coming out of Home Healthcare News about your business and the success and the stories and the...
Kevin Smith (01:05:09.259)
Yeah.
Miriam Allred (01:05:26.884)
service line, so make sure you're following him and his company. Kevin, thank you for joining me in the lab today. This has been so fun and so insightful, and I'm likely going to be asking you back to dive into some of these other subtopics deeper, but thank you for being here. Thank you for coming prepared. Thank you for all you're doing in your market and across the industry. I think you're a great example, a great leader for more than just your business, but really for the industry as a whole. So thank you.
Kevin Smith (01:05:52.417)
Thanks Miriam, really appreciate it. This was awesome.
Miriam Allred (01:05:56.586)
Awesome, I'm gonna hit stop.