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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)
Hey everyone, welcome back to the Home Care Strategy Lab. This is Miriam Allred, great to be back with everyone. Today I am sitting across from Scott Pierce, the co-founder of Coastal Care Partners in Savannah, Georgia. Scott, welcome to the show.
Scott Pierce (00:13)
Yeah, amen.
Hey, thanks, Miriam. I'm looking forward to chatting and super glad to be here.
Miriam Allred (00:18)
You are an all-star, think. We've just got connected recently and I just think so highly of you and your wife and what you've built and so naturally wanted to have you guys on the show to talk about your business model. And with you, I want to talk about the financial landscape, the decisions that you've made, how you've grown and scaled in a unique market, Savannah, Georgia, and where you're taking this model and the expansion plans and all of that good stuff.
Scott Pierce (00:25)
Thank you.
Miriam Allred (00:45)
Let's start with the origin story. Your background and your wife's background are both very different. And so how you maybe think about the origin story is even a little bit different. So talk a little bit about your background pre-coastal care and then kind of you getting into the business.
Scott Pierce (00:58)
Yeah, absolutely. again, first off, thanks again for having us here. We're not really that industry savvy and it sounds kind of goofy, I think, but we've been so heads down for the last eight years focused on building Savannah that meeting you and talking a little bit about and looking at your website and the podcast has been super informative. So really appreciate that. Yeah, my background, I'm a journalism major out of graduated college in early 90 and went to work in the television broadcast.
Miriam Allred (01:06)
you
Scott Pierce (01:28)
So I was a news anchor here in Savannah for about 10 years, which beat working for a living. It was a lot of fun, know, small town, like Savannah back then especially, you know, not a lot of, you know, family support there. You know, you've got to earn money to raise a family. And there wasn't a lot of that back then. So in 2000, I met someone outside of the broadcast business who was in the nascent cell phone software
technology world and he said listen you'd be fantastic working with customers and sort of running our account management side of the business and so I made the jump in 2000 over to the software world and that was great.
Love that and then in 2008 I had the opportunity to move to Atlanta to follow the same gentleman to a startup healthcare software company in Atlanta and So I moved up there so leaving my parents who were here in Savannah at the time in their early 80s here and No other family here. And so I'm up in Atlanta and you doing this great job of national accounts for this really great healthcare software company
So my clients were all the big guys. So I was at Brentwood sitting in the conference room at HCA. I was at Scripps. I was at Emory. I was at Adventist. I was at Caesar Sinai. You name it, Provident. know, name it, I was there. It was a blast. But during this time, as I'm in Atlanta, I met Amy, actually, in 2016, who lived here in Savannah.
I was home visiting family and friends and about the same time my parents really started entering some really challenging aging issues and I got a call from my dad in October of 2016 and he said, buddy, I'm not feeling well. I think I'm going to the hospital. So I dropped everything, drove from Savannah to Atlanta about five hours and I got to Savannah, met his cardiologist at the hospital. He said, Scott, it's going to be congestive heart failure.
We're gonna have to manage over time. So he was in the hospital for a few more days when he got discharged I met him at the hospital at the house and then Amy met me over there and at this point He was 82. My mom was 80 and my mom was already dealing with a lot of aging issues She had a Parkinson's tremor. She's very frail. She's in a wheelchair. She had early dementia ⁓ And so my 82 year old dad was caring for himself and my 80 year old mom
and now my 82 year old dad is in bed on oxygen and so I start to panic and Amy's sitting with me and and I really had a panic attack and I said you know I live in Atlanta you know who's gonna manage all of this you know I guess you know being naive I said I guess his primary care doctor is gonna handle all this and she laughed and she said yeah that's not the case you know the primary care docs have three thousand four thousand patients this is at 1950 doc Hollywood's not gonna swing by the house and make sure mom and dad are going away
Miriam Allred (04:24)
Okay.
Yeah.
Scott Pierce (04:35)
So, ⁓ you know, we had to deal with that. And so that was really the genesis for me for the idea around what we were going to start. Now, I also saw in my software world.
how broken the healthcare industry is. The insurance reimbursed healthcare world. And I saw it every day because I would sit at these conference rooms at these big hospital systems with the CMO on one side and the CFO on the other side and they would discuss their differing opinions about how healthcare should be delivered. And so that colored a lot of what I wanted to do with a company if we were going to create it. And then Amy obviously brought her experience as a
20-year RN working in the emergency room setting, working in the practice setting, working in hospice for a couple of years. She saw how families were entering the crisis ⁓ world. And so that's really the marrying of those two experiences led to kind of us getting off the ground in 2018.
Miriam Allred (05:38)
Isn't it so interesting? almost doesn't matter how much experience we have in healthcare or healthcare adjacent when when it comes down to your family and your parents and it's reality hits. It's almost like all of that context, all of that education and learning and knowledge doesn't matter because it's crisis for you and your family. And when you're sitting in the living room across from your parents and you just panic like you said, like you, you and Amy were equipped to handle a situation like this, probably better than many. But look what happened to you in that in that instance.
Scott Pierce (05:49)
yeah.
Yeah.
Well, yeah, because even though I was in the health care world adjacent to it, at least, you know, it wasn't aging care. And so, you know, as we all know, and I'm sure we'll touch on a little bit today, there's not a lot of resources out there for people that are adult children who are getting into this world. And it hits you like a two by four in the head when you start looking at this is how much home care costs. wait, mean Medicare doesn't pay for it? Wait, what? You know, it's it's a huge moment of, my gosh.
⁓ So yeah, it was a shock for me for sure. Yes. Yes.
Miriam Allred (06:41)
A lot of rude awakenings that just catch you by surprise. So you
will start Coastal Care in 2018 officially and Amy, to my understanding, kind of jumps on board initially as a nurse and doing care management. you leave your day job and join right in 2018 or was there a progression?
Scott Pierce (06:56)
⁓ so
there was a crossover, right? So I moved back to Savannah. ⁓
to be with Amy, but also to help care for my parents in late 2017, summer of 2017. And so really we started, the idea started percolating then that we wanted to start a company. So I would be flying out of Savannah to all of my national clients for my healthcare software company. And as my father's health declined through late 17 and then 18, and he ultimately passed away in April of 2018,
⁓ You know that really put a lot of things into perspective for me about what I wanted to do with the rest of my life and so in the late summer of 18 ⁓ You know, we really had the idea that we wanted to launch the company We'd actually incorporated probably six or eight months earlier, but didn't do anything with it. And then yeah, so Amy, you know started out as the first
nurse and then I was the business person. So in the background I handled everything, know, marketing, QuickBooks, ⁓ know, anything that was business related, email setup, know, Microsoft guru, ⁓ you know, it was a little bit of everything. So it was the two of us.
She was the care provider and I was the business guy. And ⁓ I was able to do both until about probably, probably about March or April of 2019. And that's when I stepped out of my other job and focused solely on Coastal Care Partners.
Miriam Allred (08:29)
Okay, okay. and your parents were really the first clients, know, Amy said that as well. Your parents are the first people that you took care of, essentially your first clients, and then it's, it's grown and scaled significantly from what it once was. So you guys are just eight years in. And so I want to just kind of talk through your financial and kind of payer mix, because we're going to talk about financial decisions that you've made, you know, risk averse versus risk tolerant and what you've done at different stages. And
Scott Pierce (08:49)
Sure.
Miriam Allred (08:57)
building out this like integrated care model and what it looks like financially from the infrastructure perspective. And so let's just kind of go through, you know, what the business looks like today. First and foremost, you are a hundred percent private pay, correct?
Scott Pierce (09:12)
We are on the home care and the nurse care management side of things. And we'll talk about it, but we also have a medical side of our company that it's all integrated, but they're different payers. We do accept for home care and nurse care management, let me rephrase that. We do work with a lot of clients who have long-term care, but we don't accept assignment, right? It's the patient responsibility or client responsibility to settle up with us. And then we help them by providing them the necessary
information to file their long-term care. So we are adamant that private pay is the direction we want to be because we do not want to be constrained by a financial relationship with a big organization like an insurance company or something like that. Our financial relationship is with our client and that allows us to deliver for the client in a way that the market votes on us every single month. They either stroke a check and send it
us or they don't. And if they don't, then we have to look at why and we're able to change our methods and improve and get better ⁓ so that we stay lockstep with what the aging care market wants from us.
Miriam Allred (10:26)
And what's really interesting,
you're a very large kind of single site operation. ⁓ So talk about kind of weekly hours and then also revenue coming out of a single site location.
Scott Pierce (10:31)
Yeah.
Yeah, so and it's funny as I mentioned earlier, we have very limited knowledge of the industry, right? And so I finally took a step back about three months ago and started looking at it. All right, I need some national benchmarks. I need to know where we stand. And so I got the I guess this activated insights is the really the only one out there to get information from. And so I started looking at their information, got the report. And so what we do is in Savannah, we do it varies, as you know, a little bit of ebb and flow every
week but we do between 6,500 and 7,000 hours a week of home care and it's all private pay and then we launched over in Bluffton, South Carolina back in October and we'll talk a little bit about that. We haven't put the medical piece in over there yet so it's just home care and nurse care management and we're doing right at about 400 hours a week over there now. So what I had no idea you know to us I knew that we were bigger than the other home care companies
I
don't consider us a home care company, right? We're an integrated healthcare solutions company because the way that Amy and I focus on it, home care, care management, medical interventions as needed and primary care. for us, home care is one piece of the puzzle. It's an important piece because it's a huge revenue driver, but it's one piece of the puzzle. It's not the final picture for us. So I needed some relevance about where we were
home care world and when I started looking at the numbers and I saw that the average home care company does about 900 hours a week I was like wait a minute seven thousand nine my god you know we're doing something really crazy right here ⁓ and then I saw the revenue you know we're this year I think you know we're going to do probably close to 13 million in revenue and I saw that the the national average was like two million or something like that and I was like my gosh and so it really kind of leapt out at Amy and I both ⁓
Miriam Allred (12:19)
Yeah.
Scott Pierce (12:39)
you know that you know kind of what we built and the response from the community has been fairly unique you know compared to the rest of the industry and you know we we we don't see a ton of patients we have about 170 home care clients that we see in a month and that varies and we have we have very acute cases because we are integrated and we have nursing and we have medical we're not home health and again want to make that very clear we're not insurance reimbursed home health again it's
private pay, except for maybe some of the primary care where we will accept, you know, visit insurance for that. But we have very acute cases and people come to us because they know we have fantastic physicians. We have a killer chief medical officer who is just super well renowned in the community and he guides what we're doing. Doesn't see patients for us, but he guides what we're doing from a clinical standpoint. And then the great home care and the great nursing that we have. you know, 170 patients on the home care side.
and
we have about a hundred to hundred and five nurse care management clients and about fifty percent of those cross right so fifty percent of our nurse care management clients also have our home care services and then of that total mix you know we have probably total of twenty five percent of our clients interact with our other services and because we have a medical component this is a piece that we haven't touched on in our neighborhood we have a
Miriam Allred (13:47)
Mm-hmm.
Scott Pierce (14:09)
Care center so a brick-and-mortar care center that is an urgent care But you know it's more like sick visits for elderly folks in the neighborhood to walk in and come get care and then we also have a primary care concierge practice actually two of them and So all in we touch about four thousand people a year and Why is that important? It's because four thousand touches is a lot more Than a simple home care company is going to see in their business
So because we get so many interactions with Coastal Care Partners and our philosophy of urgency, customer care, massive support on the back end. A home care company, a traditional franchise company might have one person in the office dealing with the caregivers and the clients, right? We've got over 15 people just focused on that piece. That's not counting our nurses. That's not counting our caregivers. So we've got this huge support system of actual home care care coordinators.
Miriam Allred (15:09)
Mm-hmm.
Scott Pierce (15:09)
and
customer service people that we deliver an experience that the community has finally realized is just light years better than what a thin company can do. And so the 4,000 touches leads to, we know Coastal Care Partners because so-and-so uses them for primary care or so-and-so had them come in and do some care management or my neighbor uses them for home care. And we've got a walk-in care center where it's so great. Miriam, we have a little lady
because
we're very near a senior living community, they'll take their, they'll go on their walk and they'll walk into our care center not needing anything except a little bag of cookies from the counter and they'll wave to all the people they know in the can, they'll walk back out. The beauty of that is they know Coastal Care Partners and so when they do need care they give us a call.
Miriam Allred (15:49)
hehe
not gonna lie, I love the naivete. Look, you built something for eight years and you're like, how are we doing against the industry? Like maybe we should poke our head up.
Scott Pierce (16:05)
Yeah, not a clue. Not a
clue. You know, we actually hired someone about eight months ago or a year ago that worked at one of the other
Franchise home care companies in town and of course, you she was bound by confidentiality So she couldn't you know share their their secret sauce but you know, she was able to hand around and give us an idea of You know what we were doing and she said Scott you have no idea it's it's light years different than than what the franchise guys are doing and I was like I guess I need to educate myself and so we've been down that road for a few months and I'm like, yeah and and we're having this conversation today all because of you know, we're starting to
to gain a little insight as to what the market's like and what aging care, the future of aging care looks like. And ⁓ we're excited to be a part of it.
Miriam Allred (16:56)
want to get a couple more numbers on the table that I think are interesting. You mentioned about 170 home care clients. You've pulled these numbers and I want to highlight them because I think they're interesting. What's the average weekly hours for a client? And then also if you know that for employees too, what are we looking at for these high acuity clients?
Scott Pierce (17:12)
Well, for, I think we're almost 40 hours a week.
for the clients, I think the national benchmark is like 15, if I remember. ⁓ And so that tells us, right there that we've already got high acuity comorbidity patients that are dealing with a lot of complex care issues. ⁓ I don't, maybe you see it in the paper, I can't remember offhand for the caregivers ⁓ exactly what it is. We've got about 280 caregivers in the Savannah market ⁓ and we keep them very busy.
to
have a hundred more, ⁓ you know, but you know, I think we're pretty happy. yeah, absolutely.
Miriam Allred (17:49)
Yeah. But a lot of full-time work for the caregivers, probably working, averaging 40
hours a week.
Scott Pierce (17:56)
Yeah, absolutely. And just like any of the companies and we'll talk about it, you know, overtime is a real issue. ⁓ And, you know, there are a lot of levers that you pull as a home care company on how to deliver the continuity of care that you want to deliver. And, you know, if you've got Ms. Smith that wants, you know, a caregiver to be their caregiver, ⁓ you know, that works as long as it's amount of care that equals 40 hours a week or less, right? But when it exceeds that,
You have to ask the caregiver. Hey listen, do you want to you know engage more and Then you can use home, you know over time as a way to do that You can introduce additional care team members and which we do a lot of that as well We'll go to Mrs. Smith and we'll get listen your caregivers great, but but she only can work about 40 hours You need you've got 60 hours of care in a week ⁓ Let me introduce you to this other caregiver and you know in home care. It's a very intimate personal relationship, right? So it's not all
perfect fit. So we tell all of our clients give us a week or two you know we've got a lot of caregivers and we will work to match the right skill set the right personality for you and so we pull the lever of you know we can we can pay for it with overtime a lot of times the client is willing to pay for that overtime. They say no no I want all of my 60 hours delivered by this caregiver like all right well that's 20 hours overtime they're fine you know I'll deal with it. So yeah so that's kind of how
Miriam Allred (19:16)
Mm-hmm.
Scott Pierce (19:26)
that works.
Miriam Allred (19:27)
And last thing about retention, what you've built, we talk a lot about churn in this industry, but I think the strongest companies, you're up in like top one to 2 % of this industry, your turnover has got to be low, right? Do know client turnover, caregiver turnover rates?
Scott Pierce (19:30)
Yeah.
Yeah, I think the client national benchmark is like 50 to 60 % turnover, maybe 75%, I think. And we're in the 40s, low 40s. ⁓ And we have caregivers that have been with us for years. In fact, got a caregiver that I was just talking to yesterday that's been with us since 2019, since we started Home Care. Because we started nurse care management in 2018, and then we rolled in the Home Care in March of 19. ⁓
So, you know, and I know the other home care directors that are home care owners that are listening to this can understand this, you pre-COVID, you know, it was horrible what caregivers were getting paid. And, you know, our model, the way Amy and I launched this was we were talking to a few caregivers right when we started and said, what do you guys get paid? And this is Savannah, Georgia, 2019. And we had CNAs that were telling us they were making $10 an hour, $11 an hour.
criminal and so we said all right I'm not the smartest person in the world but I said you know if I can pay a caregiver more we might have our pick of the caregivers in the community and so I said all right what what's home care charging this is back in 19 and back then in Savannah home care was generally the fee was like 21 bucks you know 22 bucks and they're paying caregivers $10 or $11 and we said all right
what if we did five dollars different and we charged five dollars more and we use that five dollars to pay the caregiver instead of nine dollars we paid him 14 instead of ten dollars we paid him 15 but instead of charging 21 dollars we're charging 26 dollars and you know the community didn't bat an eye and and people bought into that idea and we had the caregivers come to us and you know we've been able to retain them obviously our our pay has increased our fees have increased you know post-covid it's a completely different world we charge
you
know between I think $32 an hour right now weekday and 34 on the weekends and our average pay is around $21 an hour now. So we've really been able to lift up.
and be a big part of lifting up the caregiving community in Savannah. And that's been a big part of it for us. So that helps, obviously, with retention. We invest a lot in education. We created our own training program last year called Coastal Care University. It's a 100-hour in-class training program. So it's not some vaporware 100 hours. It's real 100 hours in the classroom. We pay for the caregivers to come into and
Miriam Allred (22:20)
Yeah.
Scott Pierce (22:26)
sit in there for 100 hours. It's book learning. It's a lot of listening to great speakers. We have partners that come in from the community, not only our fantastic leaders, but also senior living communities, hospice communities, hospitals, other adjacent healthcare and aging care solutions, Alzheimer's Association. They come in and they talk with our caregivers about what the rest of the aging care continuum is like out there. And ⁓ so it's been fantastic.
That program has really helped us ⁓ grow our caregiving community and give back to them. And that's one of the other big things that helps us a lot in retention.
Miriam Allred (23:08)
And the other thing is, you this integrated care model, your caregivers have all of this additional like clinical support. And so a lot of times the job satisfaction is they're on the job, they're unprepared, they call the office in a crisis and they don't get a response and nobody's helping them. And so you have the nurse care managers all the way to all of that clinical support layer. so job satisfaction is higher because they're more supportive and they have the help that they need in those moments of crisis, whereas in other agencies,
Scott Pierce (23:14)
Yes.
Yeah.
Miriam Allred (23:37)
they don't have that support, therefore they're ready to...
Scott Pierce (23:37)
No one and I.
Yeah, and we talk about
that a lot. They're out there by themselves. And during our orientation, Amy and I try to get to every single orientation when we have new caregivers coming in. We explain to them, you're not by yourself. caregiving is the tip of the spear. They're the ones in the home. They're real time. And they can provide us so much information. I know the big payers obviously realize that. The big payers are, oh my gosh, we want the home care because they will tell us about pre-admission stuff and all that. We do the same thing.
caregivers report to us anytime Mrs. Smith is not acting the same as she normally does or if she has any symptoms that we need to know about they can engage our nurses they can engage our doctors it's a beautiful actually it happened during the pandemic is how this all came about we had patients that couldn't go see their doctors during the pandemic and the doctors would call us and say hey listen they call Amy Amy I know you've got nurses please send a nurse to see Mrs. Smith she's 94
years old, she's very frail, she's reporting to me she's got some issues, she can't, I can't have her in the office, it's just too dangerous. So our nurses would go in and then they would facilitate telehealth visits with the doctors because a 92 year old has no idea how to work Zoom or FaceTime. So our nurses would take in the iPad, set up the iPad, the physician could stay remote, and then our nurses could take vital signs in real time. They could carry out the doctor's orders, they could look around the house to see what was going on.
is unbelievably amped up what a telehealth visit was. And that is so fantastic for the caregiver because they don't have to sit there and struggle to know what to do about Miss Smith if she's, you know, showing signs of a possible UTI infection on a Friday at six o'clock in the evening. There's nowhere to help. The only solution in the normal scenario is to take them to a hospital, which is not really what you want to do. You know, you want to stay at home if you can. So we're able to bring in the
nurses, our doctors can intercede. It's just been a wonderful marrying of that integration.
Miriam Allred (25:46)
Yeah, and I can't overstate
how important this is for retention. You know, I think of the makeup of a lot of these home care companies. It's all about supporting the caregivers. And the second they feel like they can't get answers from the administrative team or from the owner, there's other agencies that can. And so that's just super, super important. ⁓ I want to shift gears a little bit and talk about your financial decision making and
Scott Pierce (25:50)
Yeah, well that's what it's all about.
Absolutely.
Yeah.
Okay.
Miriam Allred (26:12)
The thing
that I want to start with is before you went to Activated Insights and looked at all of these kind of national benchmarks, I'm curious before then to get to where you were, what were you most focused on? What financial metrics to get to where you were, what were you focused on? Hours? What else?
Scott Pierce (26:25)
Hours,
Yeah, just it was was primarily hours, right? To us, I think that is one of the biggest.
Probably the biggest thing. Revenue is important, obviously, but hours, you can control the revenue to some degree, but you have to have the hours to be able to pull those levers, right? If you don't have the hours, you can't do it. So for us, it was all about growing the hours. ⁓ when we started, we were all in. And so Amy and I took what personal savings we had and we threw into it. were fortunate in that we could get an SBA loan when we
started out and so that helped to drive it a little bit because listen I read some of these national Facebook pages and you know I look at all these people that you know the new home care owners that are getting in that maybe don't didn't have some of the advantages that we did your wife's a nurse right we had some savings that we could use ⁓ and you know I see them I see how they're struggling and you know for us it was all about we've got a little bit of a base you know financially let's build what we want to build and
So it started the first six months and I'm sure Amy probably explained this.
it was the nurse care management. Amy was managing clients. And once we introduced that concept to Savannah, because Aging Life Care Association, wow, wonderful group. Amy's a part of that. But there really wasn't anything back then in Savannah. There were no Aging Life Care managers in Savannah. So was kind of a new concept. And that took off. We are in a retirement hotbed in Savannah. There's a lot of people that retire from the North and all over down here.
⁓ So, you know, it's been great in that regard. ⁓ But what we did is we then said, all right, we're going to make sure that we're delivering it the way we want to deliver it. And then six months in,
Amy had had her fill of referring in other home care companies where we couldn't control the outcome, right? And there's no ability to control the caregiving quality, the call outs, the response to the call out. So that's when we got licensed in 2019, early 2019. And the economic decisions for us were all in.
We're just going to put everything we can in to keep growing and keep growing and keep growing. Listen, everybody's got to make an income. And as anybody on that glide can tell you, any of the owners, early on, it's a little tougher. But once you get up to a scale where you've got enough revenue coming in that your income is OK, ⁓
then you've got a lot more flexibility to make decisions about improving your company. And early on for us, I do feel like we're not very risk averse. We're not risk averse. ⁓ We'll throw what we can at a problem because for us, and this is going to sound trite, but for us, much more important, and I know at the end of the day, it's going to send people to go, yeah, whatever.
Google reviews, responses from the community, testimonials. If we can secure those at that elite level, all the other stuff will follow. And that's been born out for us in our eight years of existence, 100%.
Miriam Allred (29:56)
Yeah,
hours and then like quality assurance, like making sure you're delivering top tier care so that the reviews do come and then it all feeds itself.
Scott Pierce (30:02)
Well, yeah.
Well, and because we have such a heavy medical and clinical, you know, arm to our business, you know, we've got fantastic nurses. Amy is a fantastic nurse with a lot of experience. Early on, we brought on a chief medical officer. Nobody in home care has a chief medical officer. And, you know, it was a doctor that we met in town in 2020. This was right before the pandemic started. Thank goodness timing that we had him on staff. And he was just an entrepreneurial doctor that we hired. He's an ER doctor.
and he still is an ER doctor so he only spends probably about half his time overseeing what we're doing ⁓ but we have that lens of quality is number one and you know everybody talks about quality and health care but for us because we're private pay we can make sure it happens you know I don't have to worry about what is Medicare what is this insurance company going to reimburse for this visit I don't have
that constraint. We can deliver what we want to deliver and what we want to deliver is whatever it's going to take to get those five-star reviews and raving fans and so that's what kind of drives the machine.
Miriam Allred (31:17)
So there's two primary ways to grow hours, which is add new clients, add new hours, or grow hours with your existing clients. And so has your focus always been high acuity, high hour clients, or did it take time to get to this point where you can only kind of take on high hour clients?
Scott Pierce (31:22)
Yep.
Yes.
You know, I think it evolved, you know, and I'm trying to remember, you know, that's a little anecdotal. I don't have straight metrics on that, but I think it evolved in, listen, the beginning, we take whoever we could get, right? But because again, we were a company with nurses and nurse care management at the core, I do think families with higher, clinical needs, gravitated toward us. And then as our reputation began to grow in the community for
you know, specializing in the very complex, almost hospital at home type cases. You know, more and more of that comes to us now, but we still get, you know, the ⁓ clients that just want us to have a companion caregiver to watch Jeopardy at night. You know, that's all part of it. ⁓ But I do think that it was a probably simultaneous growth. You know, we were adding...
clients at the same time adding the hours for clients and as we became more robust the individual hours per client increased as well.
Miriam Allred (32:43)
Do you have a, today, you have a shift hour minimum or a weekly hour minimum?
Scott Pierce (32:49)
⁓ You know, I think the industry, you know, gravitates to that four-hour minimum. ⁓
for our base price, yes, we stick at four hours. so that for that $32 that I mentioned earlier, you know, that starts with a four hour shift, but we will do an hour shift, we'll do a two to three hour shift, and we just have a higher price point for that. And we do have, you know, we used to have more and it's interesting, I need to understand why we have less now, but we used to have more people that would aggregate to that one hour, they just wanted someone to come in and help mom, you know, get going in the morning, maybe help with breakfast, get a shower, but that's
all they needed. They just wanted help getting going. So we'd have people that would buy an hour from us ⁓ and maybe it progressed to where they liked our care and maybe they bought more hours after that. ⁓ yeah, kind of the way I look at it is would I want somebody to tell me that you have to buy four hours? No.
I don't want to hear that. I want what I want, you know. My mom only needs an hour, you know, and so I only want an hour. So we set a price point. I think back then it was $50 an hour and we paid the caregiver, I think $28 an hour because kind of throws off their shiftness, right? Because they're like, all right, so I got to do this one hour. Where am I going to pick up the rest of my income for the day? So we tried to make that one hour, you know, resonate for them too. And so that's it, but it's a small piece of what we do and most people generally when
they call in, we'll go. All right, I'll go ahead for the four hours.
Miriam Allred (34:20)
Okay,
but it doesn't sound like you're hyper focused on this and not to make you doubt yourself, but I see as as operations scale, they get more strict on schedule structure and hours because the retention and the turnover and the complexity of short shifts is not sustainable. But it sounds like you you have some of that going on, not a lot of that going on, but you're not so fixated on we need to avoid this at all costs.
Scott Pierce (34:24)
Yes.
Yeah.
Yeah.
Thank you.
No, because again, you know getting back to it so if any investors are listening to this, know They're gonna hate what I'm about to say and go well, there you go. I'm not concerned about EBITDA, right? I mean, that's not what I'm looking at what I'm looking at is if I can grow hours and if I can grow our reviews and our raving fans all the other stuff is gonna work itself out and so We try to be responsive to what the community wants I don't want the community to be responsive to how our business should be structured
You know, we have a saying in our company we make yes happen because in health care you rarely hear yes, you know, it's behind the glass door No, sit down, you know, or I'll get to you insurance says I can only do this. No, you know you call the doctor's office Hey, can I get my records and then? Most likely won't hear anything back and then in you may be in three or four weeks You'll get your records sent over and what what Amy and I stress is unreasonable
And
that's a great book if you haven't read Will Guidaras Unreasonable Hospitality. But that is our view of things is we want to create the company that provides that unreasonable level of service. people will hear the word unreasonable, especially employees sometimes when we do interviews, they'll go, what do you mean unreasonable? That's unreasonable, Scott. You're asking me to do something unreasonable. Yes, I am. Because that's what I want as a customer. And that's what we focus on for our clients.
Miriam Allred (36:06)
Yeah.
Scott Pierce (36:15)
well.
Miriam Allred (36:16)
And when we're
on the receiving end of unreasonable hospitality, it like puts a smile on your face. It makes you think differently. It makes you feel more positive about the world and about society. And so it's interesting word unreasonable, but it's like to the point where people notice and it's memorable.
Scott Pierce (36:31)
Yeah.
⁓ It
helps a little mom and pop grow to 7,000 hours a week in home care is what it does.
Miriam Allred (36:41)
Exactly. So I want to take this a little bit further. A couple of large operators that I've been talking to recently, even at scale, talk about this cycle of you lose 10 clients, you gain 10 clients, you lose 10 clients, you gain 10 clients. Like that is the reality of home care. How have you all, how do you think about that? And how have you tried to like break out of that? And is it purely just feeding the sales pipeline?
Scott Pierce (36:53)
Sure. Yeah.
Yeah, I mean it is a sales pipeline, it's bringing people in. again, you know, don't, and maybe I'm naive, again, I'm a babe in the woods, as you said, you're right, I don't know what these big guys know. You're not gonna break out of it.
That's the nature, maybe 10 to 10 you'll break out of, but you're always going to have in home care, especially as a company like us that deals with very complex cases, people come to us at the end of life and they come to us with two weeks of life left or they come to us with two months of life left. ⁓
you're not going to keep that person for two years, right? You're not going to keep them for three years. So it's a combination of both. You have to keep the funnel active because you're going to have someone who's going to come in and consume a lot of hours. We have a lot of this, Miriam. We have a lot of clients that will come to us with this massive diagnosis. They'll get discharged from Mayo Clinic in Jacksonville. They'll come back here. They'll have, you know, basically the doctor said, hey, listen, this is it. You've got, you
two months, three months, four months. We're gonna go through these treatments, but the outlook is not great. And so we help them through that process, and we put our nursing in, we put our home care in, but that's just the nature. I think it's a cycle of the aging care continuum. Now on the other side, when I was pulling some of these numbers a month or so ago, actually this was probably about three weeks ago, all of a sudden a metric hit me, and I'm sure other operators go, duh, that's a key metric.
wonder what some of our longest clients have invested with us. And all of a sudden I looked and I saw that we have several clients that have spent, current clients that have spent over a million dollars with us. And to me that just, that hit me. And I'm like, my gosh. And they've been with us for four or five or six years. So I think that it is a combination. I think that if you are delivering very acute complex care, those patients unfortunately aren't gonna be with you as
long, but if you're doing the right side and you're providing great care management and great home care and maybe they want your primary care too, the other side will be with you for a long time. So I don't know if that gave you a great answer for what you're asking about, but again, don't, yeah, it's never gonna be 10 in, 10 out, right? You'll fail if that's your model. For us, it's a few out and more in.
Miriam Allred (39:27)
Yeah
And like you said, it might be the reality of home care, people that you have for two weeks, two months or two years. And, and if you want to, if owners want to get technical, it's like, can do the math on a two week client, a two month client, a two year client, a revenue comparison across the board. But I think what you're saying is you don't fixate on any one of these. You, like you said at the beginning, you've touched 4,000 patients in a year. You want impact and you want to meet everyone where they are and help everyone. And you just know that it.
Scott Pierce (39:45)
Sure, absolutely.
Mm-hmm.
Yeah.
Yeah.
Miriam Allred (40:08)
it all kind of like works itself out.
Scott Pierce (40:10)
Well, from a revenue standpoint, I mean, if you've got a complex case, you know, if you just look at the timeframe, yes, they were only with us for three weeks. Well, that can't be very rewarding. Well, guess what? They were 24 hours a day for three weeks and nurse care management three or four hours a day during that timeframe. So yeah, they were impactful financially to our company.
Miriam Allred (40:32)
And it comes back to the reputation and the reviews. If you take care of someone and give them the utmost best care for three weeks, their neighbors, their family, their spouse, everyone around them will know that Coastal Care Partners just took care of them in the most vulnerable moments of their life.
Scott Pierce (40:37)
yeah.
Yes.
You know, I don't.
you know, sometimes I get very passionate about this topic. I don't dislike the model of traditional home care and the franchise home care. don't, they serve, it serves a very, very important part of the market, right? I think I saw that in looking at these insights, 30,000 home care companies is, is what I saw as a benchmark and only the largest of those companies, one largest of that company only serves 2 % of the market, right? So it's,
important, right? And there's a lot of, you know, ⁓ fragmentation out there. But for us, it's all about, we've got to, we're different. And it's not different because we're better. It's different because aging care, clients need so much more than just home care. And I think that you've got everybody out there 30,000 companies chasing this same sliver of the pie.
And know, some of you will have, you know, I'll get reached out occasionally on Facebook from these brand new people they're getting into home care. my gosh, how do you get private pay? What do I do to different? And you know, what should I do? I'm marketing to these referral sources. I said, wait a minute. Does it make sense to you to try to do the same thing 30 other companies in your market are trying to do and just tell people that you're better at it? No.
That makes no sense to me. Create something different.
Miriam Allred (42:19)
Mm-hmm.
Scott Pierce (42:22)
don't be like the other 30 in your community, right? Because if you're doing hand-to-hand combat with a 30, the big franchises are just gonna beat you on the head, right? They're just gonna clobber you because they've got so many more resources. Of course, you can maybe have a great relationship with one referral source and they'll give you a few clients. But at the end of the day, you know, it's 30 companies trying to convince the market that they're the best out of the 30. And somebody will be the best, of course. I you're gonna have one through 30. But our model was never to try to compare
Miriam Allred (42:30)
Yeah.
Scott Pierce (42:52)
in that frame, right? We want to create a different company that's competing in a market of one and that's what we've been able to do.
Miriam Allred (43:01)
love that. This is like a full circle moment for the podcast is you're preaching to the choir and that a lot of people listening to this are trying are or trying to become their market leaders. And it's all about differentiation and home care is more and more saturated. You look at these metropolitan thousands of agencies and a single Metro. And if you're getting into this, assuming you can go and do it better than some of the incumbents, like you're wrong. And so you've got to build something different. And that's why I love you and Amy and what you're building. And I just think
Scott Pierce (43:04)
Right.
That's it. Yes.
Miriam Allred (43:28)
This is a perfect example of thinking differently, building something different that's unique to the market and clearly there's demand for it.
Scott Pierce (43:36)
Yeah, you know, private pay is a big part of that. And I get it, know, 90 % and maybe even higher of the population, private pay is hard to afford. And I get that, right? But there is that 10%, whatever the number is, 8, 10, 15%, whatever the number is, that can afford it. I read another, this is a fantastic metric that I came across last week. In the next 20 years,
There will be wealth transfer of $128 trillion, wealth transfer from the boomers right now to their kids. These families have the financial resources to support private pay. They may not want to, they may not be used to it, right? They're used to their healthcare being a $40 copay their whole life. So the concept of private pay might be kind of like, but if you give them a product that is valuable,
right? The money is there for private pay and I think we're an example of that.
Miriam Allred (44:41)
I want to ask you earlier, you said you are not risk averse, you're pretty risk tolerant, which is interesting. Have you always been that way or as you have more profitability and sustainability, do you feel like you've gotten more risk tolerant?
Scott Pierce (44:57)
Again, I think it's, once you establish that you can live on a certain amount of money, you every month, we've all have mortgages, we all have kids in school, we all have cars, right? Once, you know, once you establish, at least our motto is, once we're paying for that, ⁓ then I think you can become more risk tolerant. I think we're always willing to try something, but I mean, we're not completely dumb. I mean, we would slow down if we said, wow, if this completely fails,
then, we might have to the house, right? You know, so, you know, we would limit ourselves to some extent, but never to, I never had to make it make sense, on a piece of paper or a calculator. And now we're blessed that we can really go try stuff. The beautiful thing, and I'm sure you know this, and I'm sure the people listening know this.
The sky's the limit in aging care right now. ⁓ It's really, if you build it, they will come. I mean, that is the reality of the market. You have to be good. You have to have quality. You can't just throw something out there that's just junk. But if you build a great, solid, unreasonably satisfying company, say this with a grain of salt, failure's gonna be really hard to make happen.
because people need aging care and all the metrics support it. know, all the 10,000 people a day are reaching 65 years old and it's, you know, the boomers are trying, everybody knows the metrics. And so, yeah, I think the market makes it a little bit easier right now to be, you know, risk tolerant, you know, if you're happy with what you've got on the back end.
Miriam Allred (46:42)
Talk about one of the paths you went down though that was unsuccessful. And I want you to share this because I've heard of other operators thinking about this, which is becoming a DME supplier. Talk a little bit about that.
Scott Pierce (46:45)
Yeah. Yeah.
Absolutely. And I want to be careful how we quantify it because unsuccessful, unsuccessful is, I would say, unsustainable with all the other business we had going on. It actually was profitable. yeah, right, 2020, we, you know, we're just starting with home care and a lot of our clients are telling us they're having trouble getting hospital beds, they're having trouble getting wheelchairs and roll laters and insurance doesn't reimburse. And I had some friends that are in the supply side of DME and they were telling me the same thing. my gosh, Medicare is cut.
like all out and then as we looked across Savannah we saw that the three or four or five DME insurance-based stores were down to one because the market was so tough so we said all right we're gonna open a brick-and-mortar retail no insurance DME store and so we did and it was actually a lot of fun it was great we had lift chairs and wheelchairs and you know canes and walkers and everything scooters I mean it was great ⁓ and you know we got going about eight months to
year and we turned our first profit, know, all our expenses at the of month, we actually made more money than we spent and that was great and you know we could have stayed with that but...
the other side of our business was exploding. The in-home care, everybody, the revenue for home care is great if you do it well. The nurse care management and the medical side. And I knew that if I hired a manager to go run the business, that then we were gonna take a step back and then we're gonna be $80,000 in the hole until we build up more sales.
I just didn't, it wasn't that I wasn't risk tolerant of that. I just didn't want to deal with it. And so I looked at the numbers and I said, my time is much more valuable focused on Coastal Care Partners rather than coastal care mobility. And it was a great business and we had even to this day, I think we closed down in 2022. So we're four years later. I still have people that reach out former customers and Hey, where can I find this? And so I'll point them the right direction. I also think in reality, ⁓ and maybe people won't
hear this, but I think Amazon does a great job of filling that niche. If people just knew, if you're going to pay retail for something, the pricing on Amazon is great. Now, the downside, and we always marketed to that, was, you can't try it out, you can't see how it fits, all that. ⁓ But yeah, I think it's a tough world for DME right now, and I enjoy doing it. It was a lot of fun, but ⁓ yeah, it didn't have near to me the scalability that the other side of the business had.
Miriam Allred (49:24)
Yeah, and there's
shiny object syndrome in home care. You you get into this space. There's other industries that have a lot of shiny object syndrome, but even here providers get exposed to all of the different adjacent lanes of home care and new operators think, I think I could do that better. I want to try this. And so that's a perfect example of like you went on the path, were relatively successful and could have been successful, but it was a distraction. was dividing your time and you had to choose your priorities.
Scott Pierce (49:26)
Yeah, for sure.
Yes.
Yeah.
Yeah. Yeah.
Yeah.
Yeah, and the margins on home on DME stuff is not great either, especially with Amazon out there. So, you it was you have to sell a lot of rollators, you know, to cover for, a couple of hours or one client of home care or nurse care management. So, yeah, I think there is shiny there are shiny objects out there. And I still to this day will say, you know what, because we've got a lot of we've got two brick and mortar locations. You know, maybe I could put a couple of rollators in here to help our clients out. And then it's like, you know, no, they're, you know,
They'll find what they need if they need it. We can get it for them, but not something we focus on
Miriam Allred (50:25)
What are some other distractions that you've had over the years? Whether it's other service lines or other payers or other markets, what are some of the distractions?
Scott Pierce (50:28)
Yeah. Well, I mean,
completely as we got more into the medical, ⁓ we started thinking beyond just aging care. And that was for us a distraction. I would say probably three, four years ago.
we got a reach out because we do have such a great reputation as Savannah for the medical that we do and how we provide it the unreasonable service. We had a pediatrician that came to us and said, hey, would you manage my practice? And would you do this wonderful pediatrician? So we're like jumping at the opportunity because we wanted to be partnered up with this fantastic pediatrician. ⁓ But once we did it for about a year, we're like, it's just it's just not us. It's not what we do. ⁓ Pediatrics is great. It's its own completely separate world. Right.
So yeah, so that was a distraction for us, you know getting more involved in the medical ⁓ That wasn't directly related to aging care and in our primary care that we do, you know Some people might say well you do primary care that can't be no it's it I would say probably 90 80 percent of our primary care patients are over the age of 70 ⁓ And we're concierge primary care, right? So we're charging a membership as well as building some insurance for the visits the membership gets you the niceties
of calling and talking to the doctor after hours, same day visits, you know all the things that Concierge membership gets you, know expanded activities, but the actual clinical side, the visits we bill through insurance and because of our reputation as an aging care solutions company our members tend to be you know the elderly folks over the age of 70.
Miriam Allred (52:08)
And what about home health and hospice? You have nurses and you have the nurse care management. Do you do some skilled care in the home and is that a path you've considered or gone down?
Scott Pierce (52:11)
Yeah. Right.
Yeah.
Well, we do private duty nursing and in Georgia, private duty nursing is under your home care license. So it's not home health, ⁓ it's home care. And with private duty nursing, you have to have an order from a physician. And so whether it's our physicians that can give an order or the client's own physician, our nurses can then deliver that based on those orders. Home health is not, again, insurance. not something I want to, I don't want anybody telling me
Miriam Allred (52:28)
Okay.
Scott Pierce (52:50)
that I can only send a nurse to a home one time a week. That's not our business. I want to send the nurse as much as the client needs them, right, and as much as the client wants them. So we stay away from home health for that reason. Again, needed for the healthcare continuum in the insurance reimbursing model, not in our world. And then hospice, ⁓
You know, I actually come back to this one every now and again because we do care for so many end of life patients. And I think the market in Savannah alone, I think there are 22 or 24 hospice companies now used to be one. And so I look at that and I'm like, am I going to do hospice better? I think I probably might. Maybe not better than the top one or two that are in town, but maybe most. I've already got the other resources. I've got doctors, I've got nurses, I've got caregivers. You know, maybe I could, you know,
But ⁓ regulation and oversight in that business is really intense. Not sure I want that headache ⁓ when there are some partners in town that do it really, really well.
Miriam Allred (53:58)
One more question back to kind KPIs. You focus on hours more than anything. What about margins? Are you thinking about margins regularly between your different service lines?
Scott Pierce (54:06)
Not really.
Not really. mean, obviously that at the end of the day leads to your profit. And again, for us nowadays, our profit is, hey, we want to go start a physical therapy office. And so we got to pay for that out of cash flow. You know, again, we're a mom and pop. We have no investors, right? So there's no big money bags, know, uncle money bags sitting around the corner anytime we want to do something. you know, we have to pick and choose our projects, not about risk aversion, but about do we have the cash flow to support it, right?
So the only time I think about margins is when I think about, gosh, it sure would be nice to buy an X-ray for our urgent care or something like that. And I'll be honest, when we were starting, the home care revenue pays for a lot of the stuff that we start up. And so that's the ATM for us starting these other service lines. Now these service lines stand on their own and actually make their own profit. But anytime we start something up, like we launched over in Bluffton, ⁓
South Carolina back in October and we haven't put the medical over there we're just doing home care and the nurse care management and we paid for that completely out of the cash flow from Coastal Care Partners Savannah. So those are the times that I think about you know margin gosh you should I go up from 32 to 33 dollars because one more dollar and if we're doing 30,000 hours a month you're right that's 30,000 profit so yeah.
Miriam Allred (55:27)
Gets us a long way.
So let's talk
about this decision of going to Bluffton. So you hit about 12 million single site in Savannah over the course of seven, eight years. Are you tapped in Savannah and that's why you're gonna go to another market? Or what's your mindset?
Scott Pierce (55:35)
Yeah.
You
know, I don't think we're tapped. ⁓ You know, it's interesting. Private pay is a lot of unknown about private pay. And as we've already stated, I know probably the least of anybody in the industry. ⁓
But I did spend a lot of time with AI doing research and using multiple tools to try to understand what the available market is and how do we look at the available market for private pay. And my limited, know, naive research came up with in a market the size of Savannah, 400,000 people in the metro area in the county and some of the surrounding edges of the other counties, 400,000 people. ⁓ Probably
only about 4,000 to about 2 4,000 people a year can, and I'm really afraid to say, will choose to afford to pay for private pay. And so, you know, we in our home care alone, we interact with about 500 of those in a year as people come in and go. And so I think there is available market out there for us.
But again, we're mom and pop and for us to really get out to some of the edges, I think we would have to hire more salespeople and more community referral people. I think that will continue to grow as our reputation grows. So for us, to me and Amy, the quicker line to go is, hey,
we love our model so much and we firmly believe in this unified integrated model. Let's go to some other communities that don't have this model and let's see what we can do. so Bluffton being right across the river made it real simple for us because it's only about 45 minutes, actually from downtown Savannah to Bluffton, it's only about 30 minutes. And your Bluffton then has Hilton Head Island, which a lot of retirees are there, Palmetto Bluff, lot of retirees there. Margaritaville is right there as well. So you've got,
know, Jimmy Buffett Margaritaville, lot of, you know, retirees there and Sun City, Hilton Head, which again, target rich environment, ⁓ you know, fish where the fish are, as the saying goes. ⁓ And so by being only 30 minutes away from downtown Savannah, about an hour from our office to our door to door, we could support it a lot during that transition. And some of our caregivers do, you know, make the trek across the Savannah River into South Carolina. So that gave us some advantages, you know,
starting a ⁓ market over there. So that to us just kind of made sense. Yeah.
Miriam Allred (58:22)
Okay, that's what I was going to ask. So you
cross state lines, but it's about 45 minutes to an hour away. Do you feel like your reputation has carried that far already?
Scott Pierce (58:32)
Yes, yeah, yeah, I do.
But primarily with the referral sources, ⁓ know, the entities, the organizations that know what we do here because there is some crossover, not a ton, but there's some crossover between Bluffton and Savannah and some of the healthcare organizations. Now with the individual consumer, probably not as much. You know, we've done a great job of building our brand in a market with the actual name of Coastal Care Partners in Savannah for the individual consumer, not so much in Bluffton. So we've got to catch up in that regard.
Bluffton is a saturated market. mean, we're not, you know, we're not the smartest people in the room. So everybody else is going, you know, to Bluffton as well. ⁓ So again, where it's helped us is in some of the rehab hospitals, the skilled nursing facilities that share resources between the two, they know us from here. And so when we walk in the door and we say, hey, we're Coastal Care Partners, ⁓ I know what I'm getting, you know, with Coastal Care Partners. So that's helped us.
Miriam Allred (59:29)
And because your model is so unique, you probably haven't really considered the acquisition route in going up and buying existing agencies.
Scott Pierce (59:36)
Somebody asked me that question a couple of weeks ago and I go, what am I buying? Right? I'm caregivers basically and maybe, you know, hundred clients, maybe, maybe 50 clients. But then I've got debt associated with that. ⁓ Whereas what we've already seen in Bluffton is we've gone in there and in six months, you know, we're already up to almost 500 hours a week and I don't have that debt, you know, and so I don't have that issue. You know, I think investors love the idea of
buying a book of business and hey, that's great, I'll jump start you. Yeah, but then you've got debt. They don't mind the debt, I mind the debt. Even though I'm not risk averse or risk whatever, I am risk tolerant. I don't wanna make a dumb decision of just piling on debt when I feel like our model is so unique and valuable. Just give me a minute, give me some runway and we'll get it on our own.
Miriam Allred (1:00:29)
And you said you've got the home care piece up and running in the care management and the primary care model will follow. Do you feel like that's just going to happen organically and you're kind of letting it just happen organically or is there more of like we need a year to get established on the home care piece and then.
Scott Pierce (1:00:36)
Yeah.
it.
You know, I'll be honest, it's financials. mean, doctors are expensive, right? And to hire a good doctor. I you can hire a Joe Schmo doctor, you know, but we don't hire Joe Schmo's or Josephine Schmo's. We hire fantastic doctors and they're expensive. And so, you know, as I said, we're just a mom and pop, you know, we don't have a lot of back end, you know, it's just, just our earnings. So the cashflow has to pay for it. So I think, we'll get to that tipping point where we have enough cashflow to say, Hey, do we have an extra
Miriam Allred (1:00:49)
Okay.
Scott Pierce (1:01:16)
$30,000 or $40,000 a month ⁓ to sustain opening a medical practice over there ⁓ for seven or eight or nine months until we build up our patient load. ⁓ What's interesting about our primary care, because I want to make sure listeners understand, we're not a 3,000 patient primary care. We're not insurance-driven primary care. We are a small
boutique concierge practice. have between, we have two practices. One is a startup, we started in August and it's already up to 200 patients. Our goal is to get to 400. And then we have another established practice that has 800 patients and that's it. She's CAP, the doctor. So for us, it's about building that very intimate relationship with our patients. But it's not just about opening a primary care office. Our model is a neighborhood care center.
And so anybody listening, what does that mean? It means you're not opening up this office in some strip mall in the middle of town, right? We're strategically targeting it near the communities that we want to serve. So for instance, in Savannah, all of our care activity is on one of the big islands that has a huge 10,000 person retirement neighborhood, right? And so our care center is strategically low.
so that the little old ladies can walk in and grab their little chocolate chip cookies and just wave so they know us. And it's part of the neighborhood. so because we allow walk-ins, so like again, I call it urgent care, but it's more a very simple stuff. But because we allow anybody to wake up at eight o'clock in the morning, anywhere in Savannah and call us and come in to be seen and also have the same providers providing for
membership base, it gives us that really neighborhood feel and that we're part of the community. And so that's our model. So in Bluffton, we're strategically located sort of very, very, very close, golf cart riding distance from Sun City and Margaritaville. And so as we layer in our neighborhood care center, again, opening the door for anyone to walk in.
Miriam Allred (1:03:29)
You
Scott Pierce (1:03:40)
The beauty of that, and now I'm addressing the home care owners out there, how would you like to have an establishment where people come to your door and come in to learn about what you do rather than you always having to go out and telling people about what you do? That's what our care center is designed for.
Miriam Allred (1:03:57)
Yeah, Scott, this is fantastic. If I were an operator in another market, I would be coming to your door to ask you more questions about this. I said it to Amy and I'll say it to you. It's just, I feel like this is where home care, senior care needs to head in that you think of the fragmented broken health care system and you think of the aging population and the needs that they have. how do we solve that? It's an integrated model like this. And you are living proof that it's
possible. You know, when I first met you and I hear you're here hiring a doctor full time, it's like, how can any home care company go out and afford a doctor? Like how? But you are proof that there are margins. And if you focus on the right things and the quality, like it is possible. And this model is sustainable. And now here you are about to go kind of take it to a new market. I just think this is so fascinating and incredible.
Scott Pierce (1:04:35)
Yeah.
Miriam Allred (1:04:52)
And I hope that this is where the whole industry is headed, a version of this. Again, not everyone can do this. Not many people can do this correctly, but some can. And we should all be kind of like rowing in this direction.
Scott Pierce (1:04:58)
Sure. Right.
Yeah, I couldn't agree more Miriam and that's kind of why we're evangelists about this. You know, we do feel it's the direction that people should be going in the industry and for the home care operators, right? So differentiate yourself. You know, don't be one of 30 or 40 trying to just be the better one. You know, do something actually different and I think it would resonate with the community.
Miriam Allred (1:05:25)
Last question, Scott,
what motivates you? You're so optimistic and you're so energetic and I can just, I love that about you and Amy. What personally motivates you to keep going? Because this is hard, like you're buttoned up and you're optimistic on this podcast right now, but it's really hard and some days and some nights are long, but what keeps you going?
Scott Pierce (1:05:36)
Yeah, it is. It is.
You know, it is all about the testimonials. mean, it sounds trite. I get it. Nothing gives us as much of a pump up as getting someone doing a testimonial or calling in or sending letters, you know, that people reach out to us and tell us, my God.
You know, we couldn't have done this without you. I walked into a grocery store two weeks ago and walking out was one of our clients' wife. Very, very complex situation. And as soon as she walked out the door and saw me, she burst into tears.
And so did I, right? And it was because she just came up home and she said, I couldn't have survived without y'all. And so that, of course, that's it, right? Of course, everybody wants to make revenue. Everybody has to pay the bills, but that's what really gets us going and what just energizes us. Because yeah, now listen, I mean, you know, some of the questions that we were going to talk about that we didn't get time to talk about was, you know, what was the first thing that broke? What's really hard? Staffing home care early is hard, right? And in dealing with the
complexities of the ins and outs and which goes where and who goes where and this shift and that shift that'll drive that'll give you gray hair and you know it's a challenge ⁓ but so at night yeah Amy and I will literally be watching TV at night go what are we doing right yeah they work this is crazy but at the end of the day it's it's the relationships we've built and the families that we've been able to help and and the stories that they tell that's what does it for us
Miriam Allred (1:07:17)
And it's a good reminder of even an operator of your size is still very close to the patient and close to the care because the further you get away from that, the more just disconnected you become and your focus changes and you get maybe too hung up on the numbers. You know, we've talked a lot about the numbers in the financials today and it's like, I almost don't want you to go, go down this path. And I don't think you will, but over focusing on these numbers because you've built something so special. And it's like,
Scott Pierce (1:07:22)
yeah, for sure.
Yeah. Right. Yeah.
Miriam Allred (1:07:42)
You can continue to build something special if you're focused on the right things, the business can grow.
Scott Pierce (1:07:47)
Yeah, have to be because nobody's going to carry the flag like the owners are. mean, as long as the owners stay close to it. It's your baby. if you want your baby to grow up, have to nurture it, you have to feed it, you have to make sure it's taken care of. And yeah, you have to stay close to it.
Miriam Allred (1:08:03)
And you and Amy set such a great example to the entire company. Scott, thank you so much for joining me in the lab. I hope everyone has enjoyed this conversation. I hope I maybe opened the floodgates to you and Amy for people to reach out to you and learn from you because you're so gracious and sharing more about every interworking of your operation. so thank you for being here. I encourage people to reach out to you and just hope the best for you and hope we can stay in touch throughout your growth journey.
Scott Pierce (1:08:30)
Yeah, absolutely, Miriam. Thank you so much and just love the opportunity. Thank you.