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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 (00:15)
Welcome to the Home Care Strategy Lab. I'm your host, Miriam Allred. I am extremely excited to be here joining you from a studio in downtown Dallas. And I am joined by a friend and colleague and industry expert fan, incredible person that hopefully all of you know, Bob Roth. And again, we're joining you from downtown Dallas in studio. Bob, you have been on countless stages.
and conferences and webinars and podcasts and I've been thinking about our conversation and rather than your typical talk track, I want to have a more personal tone to the conversation today. I want to hear about your personal philosophies, your journey into home care, your your view on aging and retirement from your own perspective and from your own lived in experience. So let's at least start with your personal story getting into home care. The what
the when and the why of you starting Cypress and taking care of your own loved ones. And then we're going to kind of dial through your journey. But let's start with the beginning.
Bob Roth (01:19)
I appreciate that and I appreciate the opportunity and I want you to know how proud I am of you Miriam. I mean the Home Care Strategy Lab is a great medium for our industry and you and I have talked about this offline. We don't get an opportunity to really get a lot of information as operators. You know we want to at least learn best practices. We want to learn what's innovative and what's new. What you've created here is so beautiful.
We need more but you have really taken which you have your knowledge your six or seven years of doing podcasting and created this beautiful medium So thank you for doing this for all of us in home care and thank you for having me on the show So my journey was not very different from many people that got into the space mine started in 1985 January 2nd, know, it's interesting in 1985. There was no such thing as assisted living
Miriam Allred (02:04)
My pleasure. Thank you, Bob.
Bob Roth (02:19)
And in 1985, there was no such thing as these in-home supportive care companies, otherwise known as non-medical home care. They didn't really exist. So January 2nd, my mother had a massive heart attack, spent two months in the hospital, 18 days in a drug-induced coma, and came out a very different person. My younger brother, Jonathan, was in his freshman year at University of Miami, and he had to take a semester off to be home to help care for my mom. And we learned.
by trial and error. mean, we didn't have resources. And mom came out a very different person. And even though she went on to live almost 18 years later, her deficits were cumulative, and she was very limited in what she could do. And you know, she lost literally two thirds of her hard working heart, and only a third of it was working. So mom and dad actually moved from Baltimore, Maryland, that's where I'm originally from, to
Arizona Scott stars on and my brothers and I we visited there for almost eight years and we would go out there for Thanksgiving and other holidays and just really loved that experience and We also realized that you know mom, know her journey wasn't maybe at the end But it was getting close and we should all probably descend into Arizona and we did between 94 and 95 in 1994 my brothers and I we stood up a home care company to be able to care for other people's moms and dads
My brother Joe ran it for nearly 10 years and I came aboard in 2003. And my goal was to take a lot of what I learned in the consumer product goods world, because that's where I came from. I worked for the Quaker Oats Company. I was responsible for the Gatorade business in the Northeast. And I also worked for Dole Foods. So I came and landed in Arizona to be close to mom. I was doing some consulting. I worked for a frozen dessert company.
My brother Joe ran the business and in 2003 he decided to do something differently and I took over. So I brought a lot of the stuff that I learned from the consumer product goods world into Cypress. I rebranded it. We came up with very thoughtful messaging that kind of resonated with what we did. And then I brought a culture of innovation. And in 2005 we launched a caregiver training lab. And I believe we were the first.
Inside a home care agency where we had a full-service training lab where we had two training centers and a training lab that had 18 pieces of assistive devices in there including a two life-size mannequins two hospital beds life-size and life-weight back mannequins and then Hoyer lifts and other ⁓ Other equipment that you would need that and that you would find in somebody's home
So we had that and we made national news on that in the industry. And in 2013, we created a dementia program. And that dementia program was really, really taken, you know, took by storm. Nationally, we got a lot of recognition and we were able to provide care in our community with people that had dementia, formalized dementia training. 2019, we took a leap of faith and we joined the Honor Care Network and for...
the listeners here today, mean, honored is the company that bought home instead. And they went through a number of iterations and one of them was partnership iterations. And we were one of the first partners and when we joined about 40 others joined after us. And it was an interesting experience. I learned a lot. ⁓ It didn't end exactly great for me. But at the same time, I took a lot of knowledge away from that experience. And basically what I did was reemerged in February of last year.
back out on my own and here we are. We're running full time, full speed ahead and as I shared with you prior to our show, we didn't have a whole lot of the stuff that we had in the past. We weren't beholden to the processes and the standards we were doing back in 2019 because we had shuttered those and we went all in with honor. Honor handled all our back office. So we had to reimagine and recreate that.
That's what we've done over the last 18 months and it's been a lot of fun.
Miriam Allred (06:31)
Give us a little teaser about the last 18 months because like you said, you literally reemerged as a business a year and a half ago, but you've been at this for 30 years. And so to reemerge at that stage is such a unique undertaking in and of itself. So just give us a little teaser of what the last 18 months have encompassed.
Bob Roth (06:50)
It was more than 18 months because we kind of knew that we were coming near the end with Honor. So we actually started doing some research probably close to a year, maybe about nine months prior to coming off the Honor platform and really studying how people were recruiting, how people were handling inbound calls. Honor did a lot of that for us and we knew and the CEO from Honor talked about machine learning and
and artificial intelligence for years before it became mainstream like it did. And we knew that they were using a lot of that behind the scenes. know, one of the things that we discovered was we had this training lab and we had this training center and we would do two orientations at least a week. You know, the March before I went onto the HonorCare platform in July of 2019, we oriented, hired, and
put to work 32 caregivers. I mean, that was kind of what we did. But, you know, in the new world that we're in post-COVID was very difficult. So we tried a bunch of things out before we left the HonorCare platform. And one of the things we discovered was caregivers weren't coming to us anymore. They just didn't have the time and they didn't, you know, want to make that experience and to make that commitment. So we were trying to go to them.
And we played around with texting. We weren't using any automation. So we text them the day before. We text them an hour before. We still get about 20 % no call, no shows. And I was sending people out to go meet with them, whether it be at a Starbucks, whether it be a senior center or a library. And we still have 20 % that didn't make it. So we looked to solutions. We looked for collaborators. We knew we couldn't develop that internally. And we looked for others to help us do so.
And we found a couple to do that. And it was really it's been a great journey for us because I'm here and we're in Dallas right now and I'm at the, you know, home care ⁓ home health care news futures conference. And I'm on a panel and we're talking about some of the stuff that we're innovating on. And that's what I love. I love about this venue and certainly your podcast where we can share best practices.
And to really zero in on what we've done is the amount of time that would bring a caregiver into the funnel and back out working for Cypress could take as much as three weeks, sometimes more in the old paradigm that we were in back in 2019. And we know caregivers, 90 % or more, live paycheck to paycheck. And they need to get in and through that funnel with the least amount of friction as possible.
And we have collaborated with two partners to do so using machine learning, which is really fascinating. And the quality is really there. And we have machines doing redundant and repetitive tasks where humans don't have to. And the best part about it is our humans, meaning our HR personnel and our schedulers, get to be more relational and more personal and more intimate with our caregivers and get to know them.
You know, the only thing we have as agency owners is our caregivers. And you know, anytime I've ever heard an employee talk down about a caregiver, they definitely, you know, got written up. And if it continued, they were let go because the caregivers are the backbone of every company. And, you know, we're in this era right now where everybody's using electronic communications. They're using text messages or they're messaging through their enterprise software solutions.
we need to be talking to our caregivers. We need to have a conversation with them. We need to connect with them. We need to develop relationships with them. And what I'm seeing today, 18 months in, is my team is getting to know our caregivers because they have more time to be intentional and to be authentic and to be real. So here we are. We've come out of this. We have about 220 caregivers now that work for us.
We are still filling that pipeline like everybody else. Our retention rate is really high. The piece that I struggle with, and I think everyone struggles with, is how do you establish culture? How do you bring meaningful culture to this group, which is the most important part of any home care agency? How do you establish culture when it's a remote workforce? So that's something that I'm continuously trying to do.
Miriam Allred (11:32)
I want to, this is really interesting to hear you talk about how important recruitment has been in this past 18 months as you've reinvented Cypress. But you all have been doing this for a lot of years. I'm curious from your perspective, there's only so many pioneers in home care that have been doing this for 10, 15, 20, let alone 30 years. Are the challenges that you experienced today with the workforce?
the same as they've always been or the challenges that you're up against different in that communication, call off, scheduling, there's a lot of just pillars to this workforce. Are the challenges that you're experiencing more of the same or does it feel like you're learning recruiting for the first time?
Bob Roth (12:11)
You know, I think the challenges are somewhat the same. The really big difference, Miriam, is the generational thing. And I'm not here to knock any of the generations, but each generation's really different.
So even millennials in Gen Z, we run into these incredible caregivers that do great work. And then literally, I have one just right now that just gone. Just gone. mean, not bad workers, but they just ghost you and then they leave. And I know that listeners here are probably experiencing some of the same thing.
Miriam Allred (12:50)
Which is net new ghosting is you didn't experience that 10 years ago.
Bob Roth (12:54)
No, no, we didn't. And, you know, I would say the lion's share of my workforce 10 years ago was in was more in the 40 to 50 year old category. And now, you know, they're 60 and 70 years old. And I will tell you, I won't take credit for this. ⁓ A good friend of mine who is an incredible entrepreneur wrote a book called The Potentialist. And that's one I recommend that you put on your list and our audience. It's written by Ben Lytle.
He's the founder of Anthem, which is the fourth largest health plan in the country. He wrote a book, and he talks about the workforce of tomorrow is going to be more akin to people my age group. And we're talking about working three day work weeks, two day work weeks. And because this generation is really, really thoughtful, they're responsible, they show up, and guess what? They're really relatable to our clients.
These are caregivers that could be very relatable. So I see that and we have some right now, but I see that as a concerted effort to really bring in high quality care because a lot of people think care is just changing adult briefs and it's not. So much of it is companionship. So much of it is relational and getting to know them and to have a 20 or 30 year old speaking to someone 70, 80 versus having someone in their 60s and maybe early 70s working with somebody I think is more.
going to see in the future.
Miriam Allred (14:24)
So what is the demographic of your 220 caregivers? If you kind of break down the demographic by generation, what are we talking? What percentage is up that maybe 60 plus? Ballpark though, like over 50 versus under 50?
Bob Roth (14:33)
I wish I
I would say that ⁓ over 45 probably represents probably two thirds if not more of our population.
Miriam Allred (14:46)
Okay. See, I think that's interesting. Yeah. Over 45. But yeah, and you talk about relationships and dynamics. It's like you have two different types of people, you have a lot of different types of people that you're working with, but two very different demographics, which is, you've said this to me, I don't know, 10 times in the last two days, home care is hard. It is hard. Because it boils down to this. are taking our workforce and even our client base is across so many different
Bob Roth (14:50)
Number 45.
Miriam Allred (15:16)
different demographics, different ethnicities, different backgrounds, and you have to manage very personal relationships, schedules, payroll, billing for so many different types of people and that the nature of home care is just hard.
Bob Roth (15:32)
The nature of home care is hard, but I will tell you, being around as long as I have been, it's amazing what has happened with technology, automation, and innovation. And I'll give you one case in point, revenue cycle management, That's the big buzzword, especially it was in home health for a long time. And I gotta tell you, as home care agency owners, I mean, we used to have aging that was out there forever, and it was really, really hard.
But you know, here we are. And I remember in 2018 and 2019, we were really pushing people to do ACH payments, right? We were wanting to get money right from their checking account and ACH account. And we were getting some resistance, but you know what? For the most part, we were getting acceptance to it, but we didn't have 100 % acceptance to it. We used to get all these paychecks or all these checks from these customers.
And they'd have to clear the bank. We'd have to take them to the bank. ⁓ Some of them got in arrears. mean, now it's this weekly billing. And literally, when we run our payroll and then we do the billing, two days later, all the money's in our account. That makes a big difference in our space. I mean, because we really do sometimes live paycheck to paycheck. Because if we lose a few hours, it's like, OK, we've
We've got to make up for it to keep the payroll going and take care of the bills that the agency owner has. It's hard. It really is. technology and innovation have made things a little bit easier. The biggest headwind that we have beyond the caregiver headwind is the cost of our services. And that's the biggest challenge, Miriam. And doing business from 2019 to 2025, our care prices are up 40 % plus. And consumers.
don't have that additional money to pay. And that makes things really hard.
Miriam Allred (17:27)
What are you doing to combat that you're up against that that struggle every? What are you doing to calm?
Bob Roth (17:31)
Every single day. A couple things
we're doing, and this is one of the panels I'm on, and I think one of your guests tomorrow is on that panel as well, and she'll be talking about this too, is that we have to reimagine care. know, people can't get extended hour care at home because the cost is just too exorbitant. And I mean to give you an idea, 24-7 care at $40 an hour.
168 hours a week, 52 weeks out of the year, that's $350,000 with after-tax dollars. That's just not sustainable. Maybe somebody might be able to do it for a year. If you have an uber-wealthy guy, he can do it for a Right, so how do we package care? I mean, we are the tip of the spear. We see changes in the condition, and people want to stay at home. We know that 90 % or more 65-year-olds or older want to age in place. And we want to give them that right to be able to do so.
Miriam Allred (18:12)
It's not the norm, but the exception.
Bob Roth (18:29)
So we have to package care differently. And I'm on this panel, and what we're talking about is fractionalized care. And we can do this in highly concentrated areas where there are a lot of other care recipients, like in an ⁓ independent living community or in a NORC, which is a naturally occurring retirement community, or in a village, we can do those things. So we have three communities that we're working with right in Phoenix, Arizona.
It's a new in the last 18 months. yeah, and and what we're doing is we're able to one help the community out Because executive directors if you talk to them they have sleepless nights and if you ask them why they have sleepless nights because they have no idea who's coming in their building and Every single not every single one but a lot of the independent living residents. They bring their own caregivers in so they bring their own caregivers in Many of these communities don't know who these people are
You know, they haven't pulled an I-9. They don't know if they've been background checked. And they're milling around extremely vulnerable people. And guess what? If something really bad were to happen to that resident, it's on the community. And it's on that executive director. So you first have to get buy-in from the community itself and all the way up to the top. And what you do is you start out really slow. You don't do care by the minute, but you do care by like one hour visit. Maybe an hour and a half visit.
so you can establish some critical mass. And the goal is to be that on-site caregiving agency, to be able to deliver care at the end of the day by the minute. And in some of these fractional care communities that we're working in, we're doing 45 to 50 minute increments on average with the visits that we're visiting with the residents there. And you know, look, these residents, these executive directors will tell you they're coming in at a much higher acuity level.
because they're waiting too long. And they don't want to be in assisted living because if I go over to assisted living, I'm one more step closer to discharging to heaven. I want to stay in the independent, but I have some comorbidity that prevents me from staying there. Many of them are solo aging, about 70 % in that community are solo aging. And how do we accomplish that? So having fractionalized care in there, somebody to help them get started in the morning, maybe get down to the dining.
Remind them to take medication, maybe do a standby assist in a bath. mean, now we're fractionalizing. And instead of forcing a square peg in a round hole and telling somebody that they have to take four hours or else, it wasn't going to work for them. And that's why we never were able to do anything in those communities, because we always had those minimums. Now you station your caregiver there, and you have several as you build critical mass. And then you basically
deploy them to do the fractionalized care. It's somewhat of an art in science. It does take some time. we have a manager of care innovations, David Sachs, who's been heading that up. And we have a fourth one that's about ready to come on. So we're doing slow. But I see us having to reimagine care. We have to deliver it differently. One of the things I'm also doing and they're presenting here at this conference as well is I am using Sensei. And I've been using Sensei for
over 18 months now. And it's an extra layer of protection that I can give consumers, right? Because consumers now are trying to do more with less. And the Sensei, and I won't go into detail, but Sensei is an acoustic monitoring system that is embedded with AI that is really looking for changes in conditions and changes, know, anomalies in the patterns. And that's where you find out where some changes could be happening.
So it can detect a possible fall. It can detect a UTI if somebody's going to the bathroom frequently. I think the whole point of having Sensei and maybe some other type of remote monitoring in the home is to predict and protect that individual and keep them there. Because it's the least costly place to be. And it's the most desired place to be. So just wrapping things up, I am here now in 2025.
31 years into this business. I've been at the helm for 21 and It's been really exciting. I mean, it's been like drinking from a fire hose. Don't get me wrong, but Attaching a lot of this innovation and my message to our listeners and people that are watching here today is that you know, don't lose sight of the relational part We can do transactional work to really speed up the process I mean to give you an idea on the recruiting side. We're saving about 120 to 150 hours of
man hours or woman hours if you would, in the recruiting funnel because we have machines doing the laborious stuff, the repetitive stuff, the redundant stuff that they don't, people don't need to do. Machines can do that for us so that we can be present and we can be relational.
Miriam Allred (23:40)
you're such a good example of changing with the times that adapting and innovating because home care there's a lot of the same as of 20 years ago 30 years ago but so much has changed you talk about prices you talk about fractional care you talk about technology overhauling operations I love the way that you're painting this picture of home care is is and will always be relational but how do we bring in technology to do the manual tasks to take out a lot of the labor and
How do we position care differently now? That was gonna be my next question around aging. Do you think the way society perceives aging has changed significantly?
Bob Roth (24:21)
I don't think it's happened yet. I'm hopeful it will. I think we still live in an ageism society where people are feeling, how should I say, ⁓ slighted or just not there. They're ghosted because they're older. And I think we have a long way to go. And we need to get there really fast. And I know you've heard me give these data points, but it really is all about the math, Miriam.
The 55-year-old population is doubling between now and 2050. And the 85-year-old population is going to nearly quadruple. And our population in the United States is 345 million Americans. And in order to sustain that population, every child-rearing female needs to have 2.1 kids, and we're at 1.63. One-third of our population is solo aging, and that number is going to encroach on 50 % by 2050.
So we have a real problem that we need to address. And this problem has been known for a long time. We know that 10,000 people a day have been turning 65 since 2011. mean, we also knew back in the 1980s when Dr. Ken Dykewald wrote the book, The Age Wave, and he was telling the world that we were going the wrong way. coming. So the tsunami's already crested on us. So we have to figure out.
how we can care for this older adult population. And I mentioned ageism. I mean, I think we need to be more respectable of our elders. ⁓ I think that this problem solved may be the biggest problem of not only our generation, but it could be for humanity. And I think the world will look back to see how did we care for this most vulnerable population someday. And hopefully we'll get it right. Because I'm going to tell you, I sit in a lot of living rooms.
in a lot of kitchens, and they are the hub of any family. It's either the kitchen or the living room, and they're struggling. They really are. I we used to call cash pay. We used call private pay. We now call family pay, because individuals don't necessarily have the funds. So sometimes the children or extended family have to extend resources, financial resources, to provide the care. It's hard.
Miriam Allred (26:44)
I'm thinking we talk a lot about the adult daughter, about the kids, about their involvement in the care. Is that ageism that you talk about, it starts there? The children don't understand the aging process and that's where this starts to break down?
Bob Roth (27:00)
Well, you know, it's
interesting you say that because I think of ageism just the way, you know, the general population deals with us. mean, look at the commercials that are being running. You know, they're all young people, fit people. They're not, you know, people in their 70s and 80s. I mean, look, I have a client in a month from now is going to be turning 108. And this woman is phenomenal. mean, she does spelling bee. She does the New York Times crossword puzzle. She does word. She does all of these things every single.
Miriam Allred (27:29)
in
Bob Roth (27:30)
108 she's 107 and in November, so it's a month and a half Yeah, I said oldest client I've ever had but I want to go back to your question and that is you know, I do not think our country in our communities are ready for long-term care supports and I don't mean to be hyperbolic but I need to be and that is I Am so terribly disappointed
Miriam Allred (27:34)
You don't hear that.
Bob Roth (27:57)
when I can't help somebody when they don't have the resources. And I always tell the youth today, what have you done to plan? And like I said, being hyperbolic, mean, when you graduate college, you should probably think about having a long-term care fund. Because long-term care insurance is really expensive, and they don't have the products that they used to have. But Miriam, I disappoint at least half of my callers every single day.
Every single one of the home care agencies does the same thing because those callers think that Medicare pays for long-term care support. And when I say long-term care support, I'm talking about in-home supportive care, and I'm talking about assisted living. Independent living is cash too. I mean, guess what? The government's not there now, and I don't see it being there tomorrow. So there needs to be conversations happening. And you know what? Thanksgiving's just around the corner.
It's a great time to get that conversation started. And it's not a one-time conversation. It's a continuing conversation because the vast majority of Americans are not ready for long-term care support.
Miriam Allred (29:03)
So I want to talk about aging at maybe like the national and the global scale. And then I want to talk about like your market specifically what you're doing, because it's very much like positioning and a narrative. You and I both come with the marketing backgrounds. And so I think of how do we position aging in a way that people are more receptive to? It's like, do we, how do you create that narrative as a country, as a globe, there to a way that people understand aging? So you've spent a lot of time thinking about aging and ageism on a
on a large scale, what do we need to do or what can we do to rewrite the narrative around aging? You talked a minute ago about like the ads that we see online on the TV. It's a bunch of young, healthy, fit, active people. So our exposure to aging is minimal. is it an exposure thing? I'm just curious on your thoughts of how do we rewrite the narrative?
Bob Roth (29:55)
Well, I think it's an exposure thing. But I also think that I think we all have learned so much from the last generation. You know, I'm celebrating a birthday this week and I'll be 63. And I will tell you that I compare myself to my dad, and my mom and my grandparents, and I'm aging very differently. Because knowledge is power. We know so much today. And if there's a message that I could deliver to every American out there is
Getting old is hard, but you gotta do the work. And I was very fortunate that I didn't have to do the work till I was in my 50s. A lot came very naturally to me. I used to kill Susie, my wife Susie, she would be like, I work out really hard and you look, but now I have to. And it's part of my life and it's part of my lifestyle and I gotta put that in. mean, you know I do, I'm a yogi and I do yoga and I try to watch what I eat and I walk and I hike and.
and I do a lot of actuar activities, golf and tennis. ⁓ I think aging needs to be thought of very differently. ⁓ Retirement needs to be thought of very differently. mean, retirement used to be that you retired and then you sat in your Barclay recliner and just watched TV all day. That's no way to live. Retirement should be looked at, okay, now I've reached a
Where I don't have to work 40-hour weeks as I shared with you about Ben Lytle I mean I could work two or three hour weeks or two two or three day weeks instead of five day weeks 40 hours a week, you know We can do so much and I think what we need to do is all of us need to figure out What is it that motivates us? What is our purpose and you know mine is real simple I mean we have to find a need and we have to figure out how to fill that need and
For me, the biggest need out there is how do we handle all these aging people? And how do we care for them in the environment that they want to be in most and make their journey the best it can be? And that's the kind of stuff that keeps me up at night. So I don't know if I answered your question directly. That was great. But I mean, aging is a very different thing. And I think we need to talk about it. We need to talk about eating. We need to talk about exercise. I mean, we're learning so much.
Miriam Allred (32:09)
I think we need to talk about it.
Bob Roth (32:17)
and my friend Todd Allen, I know you interviewed him before, he's got this whole thing about medicine 3.0 and really talking about how care should be different in the sense that we're not doing sick care but we're doing healthcare and we're actually making people better. Having them eat the right foods, having them do exercise and having that care partner really help them through that journey.
Miriam Allred (32:41)
I think a lot of the change that's gonna come to ageism is happening naturally. We see people, meet people that are living to 107 years old. When you hear that, it just makes you think differently about aging. And also we see, you said your dad's experience to your experience, look how different it is, to your kid's experience, like how different it's gonna be. So a lot of this is just gonna happen organically and naturally, but also as this ⁓ workforce shortage,
and continues to increase with the numbers going up, there's this sandwich generation and they are seeing and feeling the effects firsthand. And so I think there's just going to be this very organic natural process where the narrative around aging changes because of just our exposure. And I think we just need to talk about it a lot more. You know, I said to you yesterday, talking to my own parents, talking to my own grandparents, it just, needs to be a conversation that's happening a lot more often and at a younger and younger age.
Bob Roth (33:41)
You know, this is my little Petri dish, right? The little microscope I have where we're at in aging. So my wife, Susie and I, our favorite place to go to is Maui. And I don't know if I shared this story with you, but in the post pandemic world, and all of us know that Hawaii shut down for two years. They didn't let anybody in. Well, they did, but you had to quarantine for 10 days and pay your own time at a hotel that they designated for you.
Beat us, May. Hawaii is one of our favorite places up in Kanepali. So we went to this West Westin vacation resort, had seven restaurants between the three resorts there. And during this post pandemic stage, it was like 10 months after they opened up. Only three of the restaurants were open and they were open up for limited hours. And I asked the bartender at the pool, you know, when you're on vacation, you're going to the pool and
I think it was football season, so I got to know the bartender and we were watching the games. And I asked him, said, what's the deal with the restaurants here? How come they're not open? He said, we can't find the people. I said, well, where were the people before? Where did they go? And he said, they went back home. And I said, well, can't you get them to come back? And he goes, home, meaning the mainland. When they shut down the island, they went back home. And I said, well, have you talked to them? And he goes, some of them are my good friends, yes.
And I said, why aren't they coming back? He didn't know I was in health care. He said to me, because they were needed more at home with their moms and dads than coming back here. So they needed to stay at home. And I think that is really what's happening right now all across this country. And you talk about the sandwich generation. We've got people that are raising their children, and they're seeing their parents need some assistance.
And because the advent of technology and certainly travel, mean, children have left the nest and now they're feeling like they either need to come back or they need to bring the nest back in with them, bring their parents in with them. So I think over the next 10 or 15 years, you're going to see a lot more of that. And I really hope and I think this is really good for the good chicken soup for the soul for these families to have this generational living.
situation where you can have grandparents and you can have their children and in the daughter son-in-law and their grandchildren in the same building. mean, culturally it's being done across the world. And I think that's the way it was done in the last century early part. And I think that's the only way we're going to problem solve universally. Not everybody is going to be able to do that. But I think we need to really go back to that generational living.
Miriam Allred (36:33)
Let's talk about your market specifically. So we're talking on a large scale of how do we rewrite this narrative around aging. Think about Cypress in the Scottsdale, Phoenix, Greater Phoenix market. How do you control this messaging locally? Who are the partners, the companies, the marketing tactics that you deploy to kind of shape the narrative on aging locally?
Bob Roth (36:56)
So I think when you look at a lot of the successful home care agencies in each of their markets, they not only run a great home care agency, but they are involved in their community. And I think that's the secret. mean, look, from day one when I started 21 years ago, I got involved with the Alzheimer's Association. I was on their board. I was on their golf committee. I wanted to get involved. And I think any one of us that are in the home care space
⁓ have that servants hard, right? Have that empathy and they want to help out people. And I think, know, home care's hard, but you also need to develop your allies. You need to be able to be, ⁓ you need to be a community partner because, you know, home care may not be the only solution for that person. So you need to know where those other resources are.
So I mentioned the Alzheimer's Association because literally a third of our clients, maybe more, have dementia or Alzheimer's. You we get involved with the Parkinson's organization. I've gotten involved in a lot of social service organization in my market. One's Duet Partners in Health and Aging. Another one is All Thrive 365, which used to be Foundation for Senior Living, been around for 51 years. I mean, you want to get involved. You want to be active in these not-for-profits.
you want people to know who you are. You want them to know that you have that caring spirit, that you're not just a business person. And it's not all about dollars and cents. Because if it is, then you're in the wrong business. Because this business is about help. And it's about empathy. And it's about helping to find solutions. So for me, it's the partnerships we've made. mean, I'm really privileged to have a great partnership with organizations like Hospice of the Valley.
which is coming up on almost 50 years. They're the largest single location hospice in the country. They have like a census of over 3,000 and I'm not the only one partners with them. A lot of other home care companies are, but I have a really, really strong partnership with them. I have a partnership with a couple of the hospital systems. And I will tell you, mean, look, the costs of our services are really expensive. And literally one in maybe 10 could possibly afford our services that are getting discharged from our hospitals.
because of the cost. But the secret sauce for me was I spent 10 years on the board for the largest healthcare system and the largest employer for the state. while I didn't get any benefits in terms of direct benefits of that, I got to know everybody and they got to know who I was. And some of my best referrals were benefactors to their foundations. ⁓ That makes a big difference because the benefactors to the foundation are board members.
all have those types of resources. So, you know, I think in your marketplace, you need to get involved in your community. You need to volunteer, you need to work beyond just running your home care company, you want to show people that you have that servant's heart, you want to show people that you have empathy, and you want to demonstrate that in the time capital that you put in, and certainly financial capital. And I'm not here to say you need to write tens of thousands of dollars of checks, I mean,
write a thousand dollar check, five hundred dollar check, they don't really care. They want you involved. It takes a movement. It takes the community to do so. And I've often said you need to be your expert in your market. And because of that, it's not just 31 years, but when something hits the news, I've been called to make an appearance at the news station about something that happened in the aging world. And that's a nice feeling to have that.
And also, I will build even a little bit more Miriam, is get involved in advocacy. Because the legislators need to know who you are. Because even to this day, people don't know home care exists. They don't. And you know, all my friends, I've been on the boards of, know, HCOA, and I was on the board of NAC, the National Association of Home Care and Hospice. All those franchisors, thank you. Thank you Home Instead. Thank you Bright Star. Thank you Visiting Angels. Thank you to
motto, whoever's running these commercials, because you're not only helping you, you're helping all of us, because you're demonstrating to consumers that there are there's an option to be able to stay at home. Because most people think that home health and home care are the same. And it's crazy, not just the lay person in the community, but professionals, social workers, doctors and nurses still think that they're saying we have a lot of work to do. But I think
The best days for home care are ahead of us.
Miriam Allred (41:44)
I love I love that you just cited that example of all these franchisers pumping money into advertising because because it is general awareness. You know, we're talking about your market and the community partners and getting in front of people. But it's it still is just an awareness issue. Not enough people know about home care that home care exists. What is home care? Like you said, so many people call in and say, Medicaid is going to pay for this. Like there's just so many stigmas and misunderstandings around home care that we still have to demystify. And
we're still just creating that general awareness. And I was going to ask you about, work with all these community partners, they do a lot of events, they do a lot of advocacy. How do you and they get in front of the consumer? In my experience, it's a lot of events where friends, family, the seniors themselves are at these events, but how else are you getting in front of consumers via your community partners or in other ways?
Bob Roth (42:40)
You know, it really is via the community partners. It really is difficult for us as home care agencies to go to these exhibits, if you would, because, know, and that's a conversation you and I had yesterday. And I really think that, you know, the whole concept of these conferences is going to change because, you know, nobody wants to be Nemo. And Nemo is the people that are coming through those conferences. And everyone that's behind those tables that are representing those
Entities whether it be software services or whatever it is. They're carnival barksters and they're trying to get you to come in I think the world is going to change and we're gonna do things very very differently So I mean for me it's all about the community partners. It's about having a digital presence ⁓ and as you know not only being the expert in the community and and Being involved in the community in terms of volunteering time and joining boards You know, I have a podcast in a radio show
I got a face for radio, but I've had that for 13 years. And I write a column and I've been writing a column for 16 years. So it's getting out there, but I don't think it's running these big shows or conferences where you have a lot of consumers. I think it's getting to those people that are trusted by their clients and their community so that when that need comes, that they'll refer you. I mean, it's all about
the power of recall, right? mean, you branding is not a, it's not a logo. It's that innate feeling you get from that brand. And my goal is to get that message out there and in very, in a very intentional way. And you got to do it very differently, depending on who your audience is, and getting that message so that it promotes recall so that when they need it or someone they know needs it, yeah, call Cypress Home Care, you want to call Bob Roth. I mean, that's the way we get our name out there. And
That's really how I've done it at Cypress.
Miriam Allred (44:40)
and its consistency for years over years over years. I think of all these newcomers in home care, they are at it for a year, two years, three years, five years. You've been doing this for 21 years and now people know Cypress, people know Bob Roth, but it is because you have worked tirelessly to be out in front of the community in a lot of different channels, capacities. You doing the radio show, it's not like everyone can go out and do that, but...
come up with the formula for yourself to get out in front of consumers, but be prepared to do it consistently year over year for a long period of time before you really start to see the benefits.
Bob Roth (45:16)
Well, and you know what, it's something that you can't expect to take off right away. I know some of the best home care companies out there that'll tell you it took them nine months to get like their first sale. And it just takes a little while. It really does. And so you need to be patient. But, know, I think and this message is to the home care agency owners that are out there right now. And I'm learning. I mean, I am drinking from a fire hose. mean, I've only been back at it 18 months now, but the operational part.
And I'm going to tell you that because of the cost of private care being so high, ⁓ we have always had Medicaid. we're looking, I now got a designated person working on the Medicaid business for us. And we had been approved for VA for a long time. And we're finally getting traction. took a while. And the secret sauce is really getting in with one of the case managers and just takes one. And if you do a really good job, then
one tells the others and it grows from there. And I know you did a really great podcast with Reggie that's doing VA and I learned a lot. mean, that's what I love about this podcast that you're doing is that, know, Strategy Lab, I mean, it's all about, hey, how do we do things differently? And for me, it's like, okay, when you have Medicaid and you have VA, they are great pillars to build on. And the reason why I say this is you get an authorization for Medicaid,
and you get them on a monthly basis. I have two Medicaid clients that have been with me like 12 years or more, and I got another one that's been with me 10 years. And I am telling you, it is like an annuity. As long as you do the job and do it right, you know you're gonna get those hours. So as you're building your home care company, be mindful to have those pillars because private care can go like overnight. Two weeks ago, we lost almost 800, 900 hours.
I mean, it happens. mean, you don't just lose one. And if we didn't have those pillars, I mean, that would have been detrimental. It really would be. you know, I think as you build the business and it's hard work, it took us over 18 months to get established with VA. I mean, we were approved by getting our first referral. But, you know, once you get it, then you got to capitalize on it. And the same thing with Medicaid.
So I mean, those are two anchors that I think every home care company and a lot of people say, you know, I don't want to do Medicaid because the reimbursement is really lousy. I truly believe the government is going to figure it out. I mean, I really do because of the data, the numbers I gave you. mean, they're staggering, right? And you know what? People don't have the resources and they're going to find themselves being able to qualify for Medicaid. Now, the big beautiful bill.
It's all really scary and I know, you know, a lot of us are just waiting for shoes to drop, but we'll see what happens. But I would urge you to at least pursue being a provider and then go slow. Don't turn this picket on and try to take it all at once. Go slow, see where it goes. But I would imagine in the years to come, it's going to be hard to become an approved provider because they're going to close that door. And they have in many other cases.
or in many cases in other states.
Miriam Allred (48:34)
Great, great comments, Bob. I wanna shift gears a little bit and talk about you. Can we talk about Bob? You have taken care of yourself and you said you're coming up on 63. We talked a little bit about retirement and what retirement is and looks like for different people. I think there's no end in sight in you. You're gonna keep going as long as you can, as best as you can. How the nature of home care is hard. We've said that time and again.
Bob Roth (48:39)
for sure.
Miriam Allred (49:01)
How have you prioritized taking care of yourself? This business is stressful. You've had sleepless nights. You are thinking about this 24 seven. How have you taken care of yourself? Because this is relevant to other home care owners listening to this. We hear time and again people that don't prioritize themselves. They're busy taking care of other people, that their own health, their own family, their own wellbeing slips. How have you struck that balance all of these years and prioritize your own wellbeing?
Bob Roth (49:28)
Well, I mean, it's not been easy. I think the best thing that happened to me was about two and a half years ago was I had my nephew join. And he's our chief of staff, Spencer Roth. I know you've had a chance to meet him. Maybe some of you have as well. ⁓ Having a fresh mind, having family with you ⁓ is everything. It really is. And for me, know, I used to be the only guy.
There were times where I would sign checks and then leave them for my financial manager to fill them out while I was gone. mean, this was old school. now we can do things electronically. But I was worried about payroll. was worried about getting stuff paid. I really don't have to worry about that anymore. And a lot of it has to do with tech and the way we can do things remotely.
But the other part is running the business day to day, I can take more time for myself. So I intentionally work out every morning. I least try to. 6 AM yoga, I try to get that in. I walk my dog. And ⁓ I try to spend more time with my wife, Susie, playing tennis, going hiking, ⁓ having that work-life balance. And it's hard. mean, it's been really, really hard.
So like this summer, I got a chance to do two vacations, one in July, one at the end of August, early September. I took 10 days and went to Colorado. And I took 10 days and went to Kauai. And they were incredible days. And I pretty much fully unplugged. And I urge people to do that. I mean, I've been fortunate to do that because I have a chief of staff now. In the past, I wasn't able to do that. And I realize that I think about it. And I don't mean it to be so ⁓ depressing, maybe.
know, 63, I don't know how many more birthdays I have. You know, and I don't know how many more summers I have. I'm hoping my condition, my health, I can do a lot of things. I still would love to, you know, hike the Grand Canyon, you know, and there's some other places I want to go and do. So I'm trying to make that a priority. It's a work in progress, Miriam, and it's not easy. I mean, like this trip here, you know, was intentional to be here for the home health care news.
Futures Conference and I'm actually on a panel for that conference and I'm also on a panel for the Home Medical Equipment Business Conference, which is going on at the same time, which is really interesting. But you know, I took the time to come out a little bit earlier so I could spend time with you and spend some time with a couple of our other colleagues in the industry and taking a Cowboys game and you know, go have dinner and really, you know, talk about the world and don't feel like you're under pressure and
And really, you know, we have our families, but we also have our work family. And our work family is not just my Cypress work family. I feel like my community is home care. And I love these conferences. I don't love being barked at, you know, with the exhibits, but I love the sessions. But more than I love the sessions, I love the ability to have some very thoughtful conversations talking about what's working for you, what's not working for you and learning.
from others and meeting new people all the time. Because most of the people that are in this space are in it for the right reasons, not the wrong reasons.
Miriam Allred (52:56)
Yeah, it's so important to take time off and to take care of yourself to be able to recharge. And I think it's interesting to hear you talk about it sounds like what was holding you back before was maybe a lack of like infrastructure and team and trust. You felt like you had to be involved all the time because you didn't maybe have the infrastructure to be able to take two weeks off a summer and to come to a conference like this. And so that might be what's holding a lot of owners back is having a team and infrastructure and processes
place to where you feel like you can take time off.
Bob Roth (53:29)
And Spencer's really helped me do that because we have everything pretty much systematized now. But I will say this and you know, I've spoken about this publicly before and I'm happy to share this as well. You know, my my superpower is also my kryptonite. And and I think many of us that are in this space have the same problem. And as my superpower is that I'm a caring, compassionate person. My kryptonite is that too. And, you know, I have had people on my team
that I really probably needed to part ways with sooner than I did. But I had feelings for them. And it's just like, I can't let this person go because this person's got cancer. Or I can't let this person go because they have a family. I got to do what's right for the business. And I care sometimes too much. And that's hard. It really is. And it's a learned trait. ⁓
I remember a book that when I attended the National Association of Home Care and Hospice, it was written by Herb Cullen, who was a world-renowned negotiator. Matter of fact, he had been at Camp David and tried to negotiate some of the Middle East accords that were taking place. But he wrote a book and said, but don't care too much. And I think I got to learn a little bit more from that. I do care, but sometimes I care too much. And I think I've come a long way.
We've gone through some personnel changes, you know, just recently, not major, but some. And I think I've learned to do things a little bit faster than I used to. And I'm a work in progress. I mean, I'm not perfect and I make mistakes. And you know, I want to come full circle and you know, a lot of people will say to you, you know, so Bob, you know, what'd you think of the honor experience? Was that a mistake? And I don't say it's a mistake. It was a great learning. I mean, I wouldn't be where I am today. I would be stuck.
in the old processes and the old way I was doing business. And the one thing I said to the CEO of Honor was, the one thing I'm really thankful of is the people that they hired. Because I think my intellectual capital is up at least 10x. Because I was around some really bright people and I was learning. I'm a continuous learner and I'm learning a lot and this is a whole new world and I keep using the metaphor of fire hose, but it really literally is.
A lot of stuff is coming at us and we have to be really mindful of those things that we need to pay attention to and those that we don't. And really try to keep an eye on the ball, keep the eye on the prize.
Miriam Allred (56:01)
All this being said, think back to yourself 21 years ago when you started at Cypress. What advice would you give to that Bob? If you could, knowing all that you know now, all that you've done, all of this innovation, all of these lived in experiences, looking back, what would you tell Bob 21 years ago?
Bob Roth (56:19)
⁓ You know and I would say that I wish I had probably spent even more I did make time for my family But I wish I spent more time with my family and I feel like you know when things got really rough, you know, Knuckled in and I you know got you know, I was all in and would really you know probably I made some personal sacrifices. I think we all do and I think that
I would say that really focusing on what matters, family. And I probably would have done a better job of taking care of my health. like I said earlier, I didn't really need to until I was in my 50s. The other thing is I probably would have tried to maybe see if I could bring another family member in. Spencer's been, and it may have been Spencer, maybe I would have gotten him to come in earlier, but it's been really nice to have somebody to be able to bounce things off of because a lot of times I felt like I was alone.
And having someone to share that with is really good. I'll say this too, I don't think I collaborated with a lot of other home care companies like I do today. COVID was a good thing in a lot of ways, bad thing in a lot of other ways, but good thing in the sense that I kept my podcast going and I was doing remote podcasts and I was bringing in people from all over the country and they're all home care agency owners and we were all commiserating together.
And we were all trying to figure out how do we get PPE and how do we do this? How do we apply for PPP? mean, it was really, to me, was a collaboration of people that we were all in the same boat and we cared and we wanted to learn and we wanted to figure out how to get through this. ⁓ I don't think I could have gotten through it without their support. And I won't call out some of these people, but I consider them my mentors.
Even some of them who have left less experience than I do I learn all the time and I think you know the message You know to many of the listeners out there is that you know be a continuous learner, you know ask a lot of questions What is new today will be old tomorrow and you know listen to this podcast because the home care strategy lab I mean I'm learning a lot and I really love that the people that you're bringing forward and for me, you know Fractional care works for me
I don't know how big it's going to get but it's a way to reimagine care. know, Sensei is a solution. It's not the only solution. It's one that I've adopted and they're innovating even more and I'm excited to see what else they're going to bring. But there's others that are out there and I shared some of those with you over lunch that I'm talking to and I love the imagination. I love the ingenuity and I love people that are forward thinking trying to solve problems and
At the end of the day, isn't that what it's all about? I mean, what motivates us is to figure out how do we solve this problem and what's the best way to do it. And like I said, I don't think there's a bigger problem than figuring out how to care for our elderly because that is, I think, the biggest problem of not only our generation, but of humanity.
Miriam Allred (59:31)
couldn't have said it better myself there's there's no more need to learn in a silo and home care you know again back to the pioneers that were doing this 20 30 40 years ago you were siloed in your markets you had no one to turn to but that's part of my personal mission vision is we can all learn from each other there are innovators
and incredible owners, operators in every single market. And that's what I love about home care home, everyone is so willing to share best practices, frameworks, formulas, and to serve and support one another.
Bob Roth (1:00:01)
so much
business out there. mean, when we look at Maricopa County, right, the political pundits call it the largest suburb in the country. I don't know if it is. It's one of them, but it's not the largest. But I will say that there's 4.6 million people that live in Maricopa County. Over a million are 65 and older. And we're happening and having happened in Arizona, it'll be the first state that in 2030, we'll have more people 65 and older than we have will have 18 and younger.
And it's gonna happen for the country three years later, but it's happening in our state because of the demographics in our state. So if there's a million people 65 and older, and there's approximately 700 home care companies that exist in Maricopa County, there's not enough. There's not enough. So there's enough business for everybody. So it's really lovely that I have this relationship with so many of my colleagues. know, Peter Ross refers to them as frenemies and not, you know, I them frenemies, but they really are my friends and
And we collaborate, we problem solve together, sometimes we help staff cases together. ⁓ I just had a podcast two weeks ago with Debbie Gross, who's from home instead. Her story's amazing, she's only been in the industry four years and my gosh, mean, I just love her and I love what she's doing and I think she's just raising the bar, raising the awareness of home care and it's gonna lift all of us and it's that old adage, rising tides lift all boats and I think,
Our best days are ahead of us, I really believe that.
Miriam Allred (1:01:30)
When one wins, we all win. The more people we can take care of, the more families we can help, the more caregivers we can employ, we all win together.
Bob Roth (1:01:36)
So
my message to you and our listeners, viewers too, is how do we get that message out there? How do we get our care recipients, because we all want to get reviews. And yes, get those Google reviews. They're big. But how do we get video testimonials? How do we get all of this stuff that we do every day to our legislators about the work that we're doing?
In the state of Arizona, the teachers, 50,000 of them about four years ago, descended on the capital in Phoenix, the capital of Arizona. And they got what they wanted. They got the raise and the rates that are the wages they were getting. And they got a lot of things. And I know some of them haven't come to fruition, so I don't want to say that it's all complete.
I think there may be still stuff going on, but I can't get caregivers to go down there in that number. And why can't I? Because they're caring for people. So we are, we are the ones that need to deliver that message. We need to package that up in a way and we're not doing a good job with that. And I think collectively, if we can get some messaging and when you have a chance, like right now, Congress is out of session. We need to get them to come down.
to our clients' homes. When they're back on Thursday, Friday, Saturday, Sunday, or they're back for a couple weeks because there's a break in session, we need to get them to visit some of our clients. They need to see what's going on. They need to hear what's going on. Because I know the government's not going to be there to save all of us, but they might think twice about some of the components that they put into the big, beautiful bill that could have a disaster effect.
Miriam Allred (1:03:29)
We could just keep going so many good comments from you. my goodness It's been my pleasure to spend yesterday with you to spend this hour together talking about home care. Did we already? Your passion is palpable and I just want to say thank you You have done so much in your market but also for this industry as a whole you cited some of the boards that you've served on some of the capacities that you've served and you are one of a Handful that have really had a lasting impact on home care. So, thank you
Bob Roth (1:03:39)
passionate
You know, I have this honor coming up November 9th and I'm kind of I don't know I'm a little taken back because I don't want the spotlight to be me I want it to always be Cypress and you know Cypress has been fortunate to win a lot of awards and that's one of the things I really urge a lot of our listeners like the Better Business Bureau Award for business ethics the torch award is a big deal. It's the only Consumer watchdog that is in my state of Arizona and we not only got nominated twice, but we won it
I mean, it's a prestigious award that no other home care company has had so I love getting Cypress out there in the front But this one social service organization duet and it's been around for about 44 45 years and it was created by Reverend docia Carlson it was born out of the church of Beatitudes and they work with volunteers we have over 2,000 volunteers and what they do is they help drive to appointments to grocery stores they
help grandparents raising grandchildren. I mean, it's really amazing. And it's all based on grants and philanthropy. I've been involved in this organization for 20 years, six years on the board. And right now I'm on the advisory council for the Meeting and Hope Institute, which is something that was written by Dr. Pauline Boss. If no one has read Dr. Pauline Boss's ⁓ Ambiguous Lost Book, you will be amazed. And it will help any one of your
clients that are going through this journey of caring for someone that has dementia or Alzheimer's. And that ambiguous loss book will definitely resonate with you. So we do these support groups and I'm on their council and we're doing it nationally. And they created this award last year at the big event that they do every year. And they do ⁓ brunch in the garden and they gave it to Dr. Pauline Boss last year and this year they're honoring me and I'm just so humbled.
And it's so taken back and you know, I don't know what to say. I mean, it's this is just what I do. I do to help. And and I ask our listeners and other home care agency owners get involved. Help your community help lift up your community. We all need it. And the numbers speak for themselves. So thank you for having me. Thank you for having the home care strategy lab. I love what you're doing. Keep bringing some incredible guests. I've never heard of some of these people and
You talk about palpable. Reggie was palpable. And some of the others have been palpable. I I've really learned a great deal. And I'm one of those guys that's a continuous learner. And I encourage every one of your listeners to do the same.
Miriam Allred (1:06:32)
Thank you so much, Bob. You put a lot of books on my radar the last couple of days, including Ambiguous Loss so that's on my list. And we will include all of these links and resources in the show notes because you've cited a lot of things today. But also my last invitation is Bob practices what he preaches. You love to connect with owners and operators. And so people that don't know you are maybe hearing about him and about his story for the first time, reach out to him, connect with him on LinkedIn. Find a time to meet with Bob because you've been doing this for a long time. You've learned a thing or two, but you're also thinking differently.
about home care and so people have a lot to learn from you so my my invitation is to connect with Bob apart from this podcast and we'll wrap here thank you for joining me in the lab Bob thank you conversation
Bob Roth (1:07:12)
Thank you. Great to visit with you and great going to the Cowboys game. We got to go to another one. We will. All right. Thanks, Bob. Take care. Bye.