Subscribe
Share
Share
Embed
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 (00:51)
We are live here at HCAOA and this is our first official podcast recording at HCAOA. What a fun opportunity. And I am sitting across from Carl, someone who I look up to, admire, have exchanged emails with over the years, and it's a pleasure to be sitting across from you. So Carl, tell everyone the company that you represent, the state that you're located in, and then maybe the size of the company.
Carl Bossung (01:24)
Okay, well, thank you. First of all, Maryann for having me. ⁓ This is a great event and appreciate everything you're doing. I represent Senior OneCare as one of the co founders is a family owned business located in Indiana. We have six offices in the ⁓ north and central to northern and eastern part of the state. ⁓ We have about 600 employees now. And we started on our kitchen table.
20 years ago and hired a couple of caregivers and said we're going to be in the business.
Miriam Allred (01:54)
20 years ago, I was gonna ask how long it's been, 20 years. Just briefly, what were you doing before home care?
Carl Bossung (01:58)
20 years.
I was a partner in the CPA firm and ⁓ the CPA firm had a mandatory retirement age of 65. And I was 61. I'm 81 now. I don't feel 81, but I'm 81. And I thought, what am I going to do in retirement? Because I have too much energy. I still have a lot of energy. So I said, I'd like to start a family business that I could teach my kids what I learned in the 20 years or in the 40 years I was in that CPA firm.
because when I started with that firm, it had 20 people, it had 6, 7,000 today. So I learned a lot. And I wanted ⁓ to impart that to my kids, but at the same time, I wanted to give back to community. And my mother needed this care, like a lot of other people who started home care companies. ⁓ Mom needed care, we couldn't find anybody that was decent and trustworthy to take care of her. So I also...
connected it back to my CPA days because I did a lot of strategic planning for companies. And I was always amazed at the baby boomers, how products and services change with baby boomers. And I was thinking, you know, if we could find something a baby boomers need, we wouldn't have to buy and sell it. They'd come to us. And then mom needed the care and, you know, put two together and said, well, let's try this.
Miriam Allred (03:18)
And it's family owned and operated to this day. You've got some sons and I think son-in-law is involved. Just give us a quick makeup of the family members that are involved in what each of them do.
Carl Bossung (03:27)
Well,
we started out, it was just Kyle, my son, youngest son who runs a business, he's the CEO of the business today. And my first wife, Jan, who was the X-ray tech at Notre Dame, she had some healthcare background. Unfortunately, she got diagnosed with pancreatic cancer about six months after we started. So we had to try to get the business off the ground and we were working, you know, trying to find help for her and cure for her. So then my...
My oldest son came down to help take care of her. He's I want to get in the business and my daughter-in-law or my son-in-law. He's like like to get in the business. I said, well, hey, there's not enough room. I've been in Indiana for all of us. We're going to to expand. so ⁓ over time, ⁓ my son-in-law and my daughter, my daughter, ⁓ they've both been in the business. My two sons are in the business. My sister, who is a ⁓ registered nurse.
has run our Carmel, Indiana office for years. She just retired. And then I got remarried 13 years ago and my my second wife has been in the business up until December 31. She retired, so she's she's been in the business for 13 years too. So it's totally family.
Miriam Allred (04:38)
Another time we're going to have to dive into the family dynamics because a lot of these home care companies can relate. They start with a husband and a wife and maybe a couple of kids and the dynamic changes. You've scaled this business massively across the state, multi-state and the dynamics change and having family involved, I imagine, can get messy at times and can be conflicting, but you have to work through some of those kinks along the way.
Carl Bossung (05:02)
Exactly. And we still get together for Thanksgiving and have a good time.
Miriam Allred (05:07)
Okay, I want to ask you one one question that I want to unpack for the next few minutes What is one decision or investment that took the longest to pay off but was worth it?
Carl Bossung (05:18)
Well, one investment that we made that has never paid off from a financial standpoint, in the bottom line of investments, we started our own CNA school. And it came about as a result of when I was in the CPA business and you set Senior Winker up and I said, you know, what I learned, one of the things I learned that if you're in a service business, you cannot separate the service from the individual person. That's true of the CPA business, it's true of home care. And I said,
What we need to do is find better people. Whoever gets the best people in their service business wins the game long term. And that's what we're going to do. So we reached out. At that time, I didn't know the difference between a CNA and a home health aide. And I spent about a month researching it trying to find out because I knew absolutely nothing about this business. And we came across a CNA school that was run by three older ladies, nurses, and we befriended them and I gave them some consulting advice.
and they let us come into their school. And we started hiring CNAs from day one. And we hired probably over a seven, six, seven year, eight year period, about 75 out of that school. And they came in one day and said, hey, you know, the state's changed the requirements. They've upped the requirements of what we have to prepare and teach our students. We're closing. And that was 11 years ago. It was a wow. We've hired 75 and they had trained about 3,500.
and for the community, our community needed this. And we said, we'll just take it over. So we took it over in 2014.
Miriam Allred (06:51)
Let me make sure I've got the dates correct. When you started, how many years in did you get acquainted with the CNA school? Immediately. Immediately. That was out of the
Carl Bossung (07:02)
We wanted
to partner. needed to get better people. We were mega trained people. so we started, that's one of the first things we did before we even got a client. Where can we find CNAs?
Miriam Allred (07:12)
Okay. And then what year into the business that you acquired?
Carl Bossung (07:15)
They
came in in 2013. We started in 2007. In 2013 they came in and said we're going close at the end of the year. So we really started January 1 of 2014.
Miriam Allred (07:27)
Okay. And let's talk a little bit about the acquisition. That's an unconventional acquisition, maybe for a home care company. You think of them acquiring other home care companies, but to go and acquire a CNA school, that was a first for you. You know, there's no playbook on how that's supposed to go. So talk a little bit about just like kind of that acquisition experience.
Carl Bossung (07:43)
Well, it really was a wouldn't be an acquisition per se. They were closing. I had met all the people who worked there. And actually, I had given them some advice. I did a strategy planning session for them and said, look, you you ladies are older. You need to get succession in him. And they said, well, OK, we will. They had a person that they thought could succeed them, which I had interviewed. And I said, no, it's not going to be the person I had picked the person.
who I thought was best and I told them. And they said, okay, we'll start working with that person. Well, they didn't do anything. They didn't change. And thus, ultimately they came in and said, they're gonna close. So I then reached out to that person who I knew. And I said, she was only working part-time. And I said, look, you know, you can run this school. We're gonna take it over. They're closing our doors. We want to keep it open. We want to keep jobs for the people. So she said, fine. And she's still with us today ⁓ running a school.
Since we've had this school, we've trained about 5,000 CNAs. ⁓ We only hire probably 15%. ⁓
Miriam Allred (08:50)
And what percentage of your census comes out, well you just said the percentage, yeah, I guess of your total census or roster, what percentage comes out of the school?
Carl Bossung (09:02)
We probably have about 50 % of our caregivers are CNAs, 40, 50%. And virtually all of them would come out of screen. I that's how we got them. so, you know, to answer your original question, we've never made any money, but we look at it that really the cost it would take to hire the kind of people we're hiring, the loss, small loss that we have in the school is well worth it because we'd spent a lot more time trying to find the quality people.
And the benefit is that we get to watch them in action. It's like an internship. You get to see which ones you want. And which ones are team players. And so it's just it's been a wonderful thing and we just feel good because the other 85 % are going out getting jobs. So we're doing something for the community. We're helping hospitals and hospice companies and nursing homes and assisted living. Because they're all they're looking for these people. All of them get jobs.
And we have a very, very high pass rate, about 98, 99 % pass rate. So we will make certain that these people taking the class pass.
Miriam Allred (10:08)
Just a couple of technical questions about the CNA operation. You just said that someone from the original business stayed on and runs the school. How tightly connected is Senior1 with the CNA school? Is it like synonymous? They're one in the same or it's run kind of like two separate businesses?
Carl Bossung (10:26)
It's run as two separate businesses, but there's a very close connection. ⁓ the person who leads it today is really part of our senior management team. when a student comes in to register and say, our nurses know what kind of people we're looking for. So we don't have to hire CNAs. So many times they're looking to make certain if that person is a Senior1Care caliber person.
We want to send them up to recruiting right away, even before they take the class. So we'll hire them before they take the class. Then we watch them, the ones who go through the classes, and the nurses there who teach the program, they understand what we're looking for. And they're looking for team players, they're looking for people with compassion, with a personality to deal with private pay business, because our business is primarily private pay. And ⁓ some of really good students we don't get because they want to fix work weeks.
They want an eight to five job. can't offer that. So they'll work for the hospital or something. And some very good students out there. We get a lot of college students that are, and actually right now we are really big in high school. We've probably got 400 high school students we're training this year. So we're looking for those kinds of people to come on board while they're going through nursing school or whatever they plan to do in college. We love those college students. So hire a lot of those kinds of people.
Miriam Allred (11:54)
What about ongoing training? So you put these, these CNAs through that kind of like initial schooling training upfront in home care, there's specialized training, there's, you know, ongoing training, CEUs type deal. Is, is the school also equipped to support ongoing training for existing caregiver CNAs out in the field? can come back and retrain or learn more.
Carl Bossung (12:14)
Actually,
⁓ going back, the name of the school is Legacy, was called Legacy CNA Training. And the name came because of the legacy these three ladies left, of which one of which is still working for us. And I think she's 88 and she's still working in the CNA school and we love her. ⁓ So basically, we have changed the name now to Legacy Medical Academy, because we're teaching more
than just the CNA school. So we're ⁓ teaching QMA as an example and other courses that relate to CPR and those kind of injections as we're teaching in the program. So we're looking at that and then in addition to that, we're using the capabilities of the nurses to train our people.
relative to transfer and the things that people would need to bed baths and the things that they would need to adequately service their clients.
Miriam Allred (13:20)
A question that's probably on everyone's mind is technology's role in training. I think I maybe talked to one of your sons a number of years ago about kind of AI and VR, like virtual reality and baking that into training. Did that take off or what is the tech integration in the CNA school look like today?
Carl Bossung (13:39)
There's not been, what you're talking to is with Kyle and he's big into the technology arena, much more so than I am. But he hooked up with a virtual reality company that we do virtual reality training for our caregivers where you put a headset on and look at the screen. And it's amazing what some of that technology can really do. So there's, we have courses on dementia where you're using virtual reality.
macular degeneration, which I love that, to show up a spot where you can't see. And I had the CEO of a major hospital come in and I showed him the information on that macular degeneration. He says, wow.
Miriam Allred (14:23)
You're stepping into their shoes.
Carl Bossung (14:24)
Yeah,
and he said, son, my son has doesn't have macular degeneration has something similar. I've I never have known what he has been going through. Wow. So yeah, the training and technology is going to be huge in the training room.
Miriam Allred (14:40)
Yeah, I think it's like everything. It's just finding that balance. What can the technology do exceptionally well? But where and where does it just supplement what the humans can do exceptionally well?
Carl Bossung (14:51)
I mean, we've done the basics several years ago where we took up, there's 72 different procedures in Indiana that a CNA asked me learn. And we do that in one week. It's a cram course. They have to learn these procedures and then they have to spend a couple of weeks in a nursing home with practicing those with ⁓ parents. So during COVID, we put all of those on video. So the course doesn't have to be in person to me. People can take the CNA course.
and do a virtual video, which is incident another reason why the investment we're talking about the investment, not paying off financially, but it's a huge recruiting tool, the CNA skin, because we tell people coming in, hey, you want to be a CNA? Oh, I'd love to. Well, if you prove yourself and you'll be with us for three to six months and no call offs and you you do the job, we'll put you through for free. And so we have we train a lot of existing.
people that we hire who aren't CNOs by giving them that often.
Miriam Allred (15:52)
Yeah, so knowing, talking about the investment and it, are you breaking even or I don't know what can you share in the?
Carl Bossung (15:59)
We're
getting close to breaking even this year. Okay. Yeah, we're getting close to break even. But, you know, it hasn't lost a lot of money. We may have lost $50,000 to $100,000 in some years.
Miriam Allred (16:12)
And knowing what you know now, would you do anything differently?
Carl Bossung (16:14)
No,
we would do it. We would do it again, again, and again. Actually, before we even bought the school, we sent one of our nurses to approach the yet to be a programmer through the state schools, two, three day course. We sent one of our nurses there thinking we could do this ourselves. And we found out that there's too much complexity. And so they knew the rules. They knew the regulations. Had the regulations, had the relationships with
the regulars as Indiana State Board of Health. And so it's been a wonderful, And I told Kyle the day that ⁓ we closed the deal with him, said, know, remember this day, because this is going to be significant in the life of Senior1Care And it has been. And it will be in the future.
Miriam Allred (17:03)
Well said. My last question though, think of all these home care owners listening to this. They may not all have the opportunity to buy a CNA school, become a school, but at the minimum they can partner with CNA schools. Is that your advice or what would you advise these people in regards to what you've done if they can't pull it off?
Carl Bossung (17:22)
I would, if I had to go back again, I would never try to do it on my own. I would either find a school that I could buy or partner with the school. Because the complexity of what you're dealing with ⁓ in training these people and all the reporting that I see today, it's more than we in home care, think, to spend that kind of time to really do it the right way. And so, yeah, I would partner or I would try to bag a school.
Miriam Allred (17:51)
Carl, this has been a pleasure. Thanks for joining me live at HCAOA in the hot seat. Carl Bossing. Fantastic.
Carl Bossung (17:57)
Thanks for having me.
you