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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. I'm your host, Miriam Allred. It's great to be back with you today. I am joined by Nate West, the owner of Heritage Home Care based in Scottsdale, Arizona. Nate, welcome to the show.
Nate West (00:13)
Thank you, Miriam. Thank you for having me. Happy to be here.
Miriam Allred (00:16)
Yeah, likewise. I feel like our names have bounced around each other and we're finally overdue for a conversation. So ⁓ thanks for entertaining me.
Nate West (00:23)
Of course, of course. Now I'll start by saying I found I think I found the podcast maybe nine months ago.
And I I I was excited to find it. I told my wife, I mean, I I really think you have a unique podcast here, because as an owner of an agency, I was looking for resources and looking for people kind of in a similar position to me, and there's just really not a lot out there, which is surprising given how big the industry is and how many players there are in this space, but for you to kind of bring it all together and it's just been incredibly helpful for me over the last few months. And so I I appreciate what you're doing because I've learned a ton from some of your previous guests. So it's kind of full circle to now be here today.
Miriam Allred (00:59)
Yeah, thank you. Well, people are about to learn a lot from you, so I'm excited to bring it full circle here. Let's start with your introduction. Tell people a little bit about your kind of life before home care and then we'll get into you buying Heritage and what that looks like.
Nate West (01:12)
Yeah, yeah. So born and raised here in Phoenix. ⁓ went to Arizona State, got a degree in finance, and then shortly after I graduated, I joined the Marine Corps. ⁓ I commissioned as an officer in the Marine Corps and I did that for about five years and ⁓ kind of bounced all over the world. But my wife and I knew that Phoenix was home, and so got out of the Marine Corps in 2018, ⁓ moved home, and I actually joined ⁓ a startup, a a a B2B SaaS startup by the name of Pluma, ⁓ shortly after getting out, and it was a virtual executive coaching platform.
And so kind of the premise there was provide one on one leadership coaching to business leaders and kind of democratize coaching since that was typically a pretty cost prohibitive ⁓ talent development service for f for folks. And so ⁓ was one of the first hires there and was on a sales team and and was really kind of tasked with just growing this thing as big as we can get it, as fast as we can get it. And ⁓
Grew that business pretty significantly. We exited that company in 2021. we sold out to a larger player in the space. And ever since 2021, I've really been focused on small business here. And so after getting out of the SaaS game, I I knew that I wanted to be more hands-on and more something local. And so I've been buying and and kind of fixing up and selling small businesses here in the valley ever since. I've done a couple of different random companies. I owned a FedEx business at one point, so I had 20 trucks on the road.
Every single day dropping packages off all over Phoenix and doing pickups and kind of polished that one up a little bit and sold that, got out difficult business to be in. It's hard to drive a FedEx truck when it's 115 here. ⁓ but after I had kind of bought and sold a couple of companies, my wife and I took a step back and I was like, you know, what do we really want to do? What do we want to do for the long haul here? ⁓ I was kind of getting in and out of companies within 18 months, two years, and I wanted something that I could just really focus long-term growth on and
⁓ started to look around and we really kind of just got pulled into home care. It's something that I would say is personal to me. I watched my my mom and the family become caregivers and taking care of my grandma. And my grandma, you know, I was 16, 17 years old, but she was, I'm not going anywhere. Don't put me anywhere.
Don't even think about it. I don't care what it takes. I'm staying home. And I think even at you know, at the age of 16, 17, I realized like, I don't want to go anywhere either. If I can you know, age in place and stay home, that's something that I want to do. But I also saw how much work goes into keeping people home, right? My mom was there seven days a week. I was helping out drive my grandma to cancer appointments and and trying to take care as much as I could, even though I was in high school. And so between the personal side there of being exposed to home care at young age, ⁓
And then if from a business standpoint, you know, looking at the Scottsdale, Paradise Valley, the Phoenix market.
We are in arguably one of the best markets in the country for home care. And so kind of the those those two things blended together and it was like, let's let's get into it. And so without any home care experience, without any healthcare experience, ⁓ I I bought Heritage Home Care about two years ago this summer and took it over from a gentleman that was getting ready to retire and it's been ⁓ yeah, it it's been our it's been a fun ride since. So we're about two years in, but that's that's my background.
Miriam Allred (04:30)
Amazing. Yeah. Thank you for sharing. And I was gonna say, like build or buy, you know, that's a really big decision. You had a lot of like leadership experience and and business experience. I'm curious, was that a big decision to not build from the ground up versus buy, or was it pretty obvious too, like we're gonna buy something established and accelerate quicker?
Nate West (04:46)
Yeah, I think ⁓ one of the biggest lessons that I learned just really about myself when I was at Pluma was that I am much more of a ten to a hundred guy than a zero to ten. You know, I I feel like I I'm
Pretty good at at just strapping the rocket boosters on and taking things to the next level, but getting that foundation set and getting to that that 10, not really my area of expertise. And so I was pretty set on buying versus building. And I would say for the most part, I've been really happy that that that's the path that we took because we had a foundation. You know, the agency when I bought it, it was it was a pretty strong agency in Scottsdale. And so we had kind of the framework, and I
just been able to focus on scale versus setting everything up from the ground up.
Miriam Allred (05:34)
Yeah, that's really
great self awareness. I think you even saying that you thrive from ten to a hundred, not zero to ten. I think we're all like learning that about ourselves. So I think that's like good self awareness that you had and even something that people can learn of like what stage of business are they best at and where do they bring in additional people or where do they pivot and make different decisions? I think a lot of people can even just benefit from you, like citing that that was your experience. Talk a little bit more about Heritage, like what you walked into. So you said they had a strong foundation. They've got, you know, had operations humming, people in place, like
When you walked in, you know, home care was new to you and this business was new to you, but share a little bit more about like the business that you walked into. What was going well and what were some of like the immediate challenges or bottlenecks that you identified pretty quickly on?
Nate West (06:16)
Yeah. ⁓ I would say, you know, when I started the diligence process before even buying the business, one thing that I I loved about it was the the owner, it was a husband and a wife. but the the owner, the husband that was really running most of the day to day, he was a prior Fortune fifty executive. And so he had retired
About 2010 and lasted about a month at home, and it was like this isn't gonna work. His wife had done mobile physical therapy. ⁓ she'd done kind of not not home true home care, but had worked in an adjacent space. And so they came together to build Heritage. And so I would say one thing that just really stood out to me that I loved was he built it like a real business. You know, I would say more often than not with small businesses and with family-owned companies.
They're just kind of built as you go. And so there's not a lot of structure always. There's not a lot of organization. Sometimes the books are not as clean, and people are just kind of figuring it out as they go, which is fine. But for Heritage, you know, he had an HR, he had an operations team, he had it built pretty much the same way that I would. And so that was one thing that I absolutely loved about it. He was a business mind. And so it was structured the same way that I would. ⁓ I would say we had a good amount of SOPs in place, right? We had processes that were
We'll g talk about kind of how I changed some of those processes, but but s there there was something there, right? Again, going back to my earlier point, instead of building from the ground up, I was just able to tweak and modify. ⁓ but I would also say that the business just had a really good reputation. You know, we we had a strong reputation in the community, had good referral partner relationships in place. And so all of that was going really, really well. And and the cash flow from day one, you know, was covering our operating costs. And so again, frees up the mental load.
Say how can we how can we grow this thing? What wasn't really going well ⁓ was ⁓ I've told people the company was stuck in the stone age. You know, we were printing every single thing that that went around the office, you know, new employment agreements in the handbook. We would print a copy of the handbook for for every person that we hired. You know, it's some points we're hiring 10 people a week. So you're talking a 50-page handbook plus all of the stuff.
Miriam Allred (08:12)
Yeah.
Nate West (08:32)
That they got sign the client agreements all printed, right? And so ⁓ one of the things that I did, which really didn't take much lift or effort, was let's digitize this stuff. People would rather sign a docu sign than sit there and scribble their initials on every single page anyway. that was one of the kind of the bigger changes that I made. We we didn't previously used to offer remote work or hybrid work. I'm a big believer in hybrid work for the right people, ⁓ for the right roles.
And I think it also helps you attract talent and really retain talent. And so I've rolled out a hybrid workforce. There's a couple of days a week where everybody's in the office, but there's majority of the time people are able to work from they're still in the valley because we're doing home visits and you know we're going out in the field, but they're able to work from home, which I think has been a really, a really nice addition for the workforce. And then the last thing I'll say, I guess two points, ⁓ lots of edge cases. You and I kind of talked about that.
When you're going zero to ten, you can make the exception, right? You can give a discount. You can say Christmas Eve is not going to be a holiday for you, but it's going to be a holiday for these other people. And so one thing that I really tried to focus on after taking over was getting everybody as close to the same playing field as possible. So that way we didn't have those billing one-offs. So that way we didn't have, again, you know, two clients, they're not going to pay overtime, but this client is going to pay overtime, but only if it's on a Sunday versus, you know, all that stuff.
Which at scale is just really, really difficult to track. And so that was one other thing that I kind of changed was just getting everybody to as close to the same playing field as possible. And the last thing I'll add, which is kind of related to what we're gonna talk about later, is they didn't really use technology. ⁓ again, it was it was built
in the Stone Age. And so not a lot of outside technology was coming in to support the the employees, but also for the client side as well. And so I was able to kind of take a step back, obviously with a background in tech, my first thoughts was how can we streamline this, make it a little bit more efficient, and what tools are out there to make our lives easier so that way we can scale without necessarily adding overhead every time you know we hit a certain checkpoint in our growth.
Miriam Allred (10:47)
Yeah, super interesting. So obviously we're gonna focus on the tech side of this, but I wanna just address the point that you made before, which are like the edge cases. Like this is something I'm so fascinated by right now with home care is large agencies. We've talked about this problem scale and edge cases scale. So in my mind, a really established, well-run company, there's fewer and fewer edge cases. But I don't know if that's naive to think and that there's always gonna be edge cases, there's always gonna be problem, but like those should lessen and lessen the the the more that you scale, but
For a lot of companies that I see, these large home care companies that are really well established, like big hours, big revenue, it's like there's still a ton of edge cases. And that just blows my mind of like you should be trying to like limit those more and more and more. But as your numbers go up, there's like more and more edge cases. And so we'll talk more about that because I just think that's like super fascinating. Problem scale, edge cases scale. And you came in and you said Heritage was an established business doing really well, strong operations.
But there was still a surprising amount of edge cases, and I just find that fascinating.
Nate West (11:48)
Yeah, I I would say it's hard to stand on kind of your your minimums or your rate.
Or whatever your holiday or overtime policies are, it can be kind of difficult because you will sometimes lose business. You're you might lose a client who's gonna go somewhere where they're a little bit more flexible. But what I would argue is that's not your target client, right? we are trying to grow a very, I would say, high-end boutique agency in Scottsdale. And so I know the quality of the service that we provide. I know the quality of the caregivers that we hire. Our average caregiver right now is a seven to eight-year CNN.
You know, we're not sending in minimum wage, unexperienced, you know, folks. And so as much as it kind of can be difficult to stand on your hourly minimums and say, hey, you know, I'm not really willing to flex because it's not the service that I'm looking to provide. I don't believe we're going to be able to provide the quality of service that I want our agency to provide if we flex on this. You might lose a client here and there. But that also, I would say by flexing and bringing them on, they might not even be a long-term client in.
you know, anyway. They might just be looking for some fill-in shifts and they're probably gonna end up canceling and you're gonna do all the work to get them signed up and not make the revenue back on it once they're a client. And so ⁓ it's difficult. I think we've lost some business over the last couple of years by not being as flexible as as my predecessor, but we've also signed on a lot of our target clients, which is you know higher hours and folks that really want to age in place and not just technically use us for a short-term bridge.
Miriam Allred (13:18)
And we don't talk
enough about this in home care. We always put churn and turnover in this negative light, but there is healthy churn, losing bad clients, losing bad caregivers. It's actually best for your business. And so I guess I want to just ask you like, what do you do to hold yourself accountable and your team accountable to not budging or flexing on those minimums? Like in the moment, you're like, okay, we're gonna lose this client, we're gonna lose these hours. Like, what do you literally do to like hold yourself accountable to the minimums?
Nate West (13:49)
It's a question. ⁓ how do we hold ourselves to the minimums? I mean, I I think at this point
And I'm I'm super fortunate to say this, but I have a core leadership team that is absolutely incredible. And I think we operate on a level of trust. I would like to believe that I I have three individuals that really I believe are you know of of are my core leadership team. And so the four of us, ⁓ I think we just operate on this level of i
of trust and they know that if we if I I I'm thinking of one client in particular, it was a twenty four hour client, it was a twenty four hour couples care client. And we knew after doing the intake that this was going to be an incredibly difficult client. I mean, when I say difficult, every sense of the word calls all night long from the from one of the the the clients, you know, a lot of dementia. I mean I think both of them had pretty advanced dementia, so they would call at three o'clock in the morning every single night. Even with a care
were there. The caregiver would try to say, Don't call. They would be calling, hey, who's coming this morning? What when's the bill due? Just stuff like that. And we did our best to service them and we tried to sit down with them and say, hey, you can't be calling my my on calls for emergencies. But I ultimately ended up terminating the agreement with them. And it's hard to terminate an agreement, a 24-hour couples care agreement. I mean that's a lot of revenue. But I think my by doing that my team saw that you know I have their back and I'm I'm not going to onboard clients that are not going to be good clients for
us and so I guess that's doesn't necessarily directly answer your question but I think you know my staff knows that I have their back and I will give up revenue if it's creating more problems for us and it's it's taking our focus away from the bigger picture of scale but that's kind of how I think about it. We just we we we work as as as one team and sometimes this the operations team is going to get beat up a bit more
Sometimes the sales team is going to get beat up a little bit more, but we're all going to collectively kind of have each other's back.
Miriam Allred (15:50)
And just consistently reiterating
why the minimums are in place. You know, sometimes we lose sight of like, why is this minimum? You know, people start to question things that have been in place for a long time, but it's like there's a reason why we put these minimums in place. And then I think what you're saying and what I, you know, like would advise it's like history repeats itself. Remember when we took on this client and then it turned out to be this, like we can see a lot of patterns and parallels between this client we're about to take on and this client that we took on, and here's how it went.
we would likely be walking down a very similar path and and hopefully just like that pause and that like, okay, remember why we have the minimums in place and remember when we took on that that client. This is what happened, like that can stop us in our tracks and help us make the best decision in the moment.
Nate West (16:32)
Absolutely. Absolutely. I mean, I think about the few times that we've made exceptions. ⁓ and honestly, most of the time it just doesn't work out. It might work for a few weeks, but your your weekly minimum hour requirement is there for consistency on the schedule, right? I mean, you need to be able to find a caregiver or two, depending on how many hours there are, so that they know that their income is safe. When you flex on your weekly minimums.
you you can't staff it consistently. If somebody out there hasn't has a way of staffing it consistently when it's just ad hoc, please let me know because we haven't been able to figure it out. And so again, you know, the few times that we've made these exceptions, it it's creating hours of work in the office for a 10 hour a week client when we have a lot of 24 hour clients. And so it just it doesn't work in the long run.
Miriam Allred (17:21)
They become distractions more than anything. And I'll I'll say this here, but then we're gonna circle back to this. In my opinion, like ninety percent of your schedule should fit into your scheduled, structured, preset molds. Ten percent can be, you know, edge cases that you're working to get to the 90%, but really like 90% of your schedule should fit within the bounds and the minimums and the molds that you've set, not the other way around. And when it's 20%, 30%, 40% that are outside of that, like.
That's where you're in this chaos reactive mode and you can't get out of that. But you should everyone should be constantly striving to get into those get into those molds. And I I I asked you before, like I don't know if that's naive thinking, but it's like it's the way that this has to go to get out of the chaos. You're gonna burn schedulers out, you're gonna lose clients, you're gonna burn out caregivers, like you have to get out of reactive mode and you have to kind of build these minimums and molds and be striving to get ninety percent of it into there.
Nate West (18:13)
Absolutely. And what I would say too, what I would add to that is that our clients are reaching out to us for advice and guidance in addition to the care. Right? Nine times out of ten, they're overwhelmed. They they don't know what they need. They this is the first time they've ever talked home care. A week ago, they probably didn't even think that they would ever need home care, and now they need it. And so they're coming to you saying, Nate, I I don't know what I need to, you know, help me out. And so
Take advantage of that opportunity to kind of guide them into where what works for you. I tell everybody I talk to on the phone, you know, that's interested in services, I don't do swing shifts. I don't do 10 a.m. to 2 p.m. I don't do it in the middle of the day. You know, you need help in the middle of the day, we're talking six to eight hour shifts because if I do a swing shift, it's very difficult for me to get more hours for that caregiver anywhere else, right? But if I do eight to twelve, or if I do seven to eleven in the morning,
I can then ideally get an afternoon shift for that caregiver and get them to full time hours. So that way they're not, they're not turn turning on me, they're not leaving. And so I take advantage of that. When I'm doing an intake, it's like, hey, you know, if you want to do the four hour shifts, these are your options. And and nine times out of ten, they're like, Well, that that should work. We can make that work. And then it works for
Miriam Allred (19:22)
And
And the right
fit clients respect that. They respect your knowledge, your experience, your authority on that. You say, I have caregivers that have six, seven, eight years of experience. They're single working moms. Here is the structure that will work best for both of you to have the best level of care. And they're not burnt out and they're not tired and they're not, you know, like you just explain all of to that to them. And then it like it clicks. And then the match is significantly better and everyone's happier and the care is better.
And so it's just like explaining all of those pieces to them.
Nate West (19:57)
Yeah. Right. What what's in their decision making processes, they're talking to home care agencies, what what do they value most? And it's almost always consistency on the schedule.
Right, it's something that every home care agency struggles with. We're not perfect, but it I I can tell you 90 plus percent of my intakes, it comes up consistency on the schedule. And so I speak to it directly. Hey, you said you want consistency on the schedule. If your schedule is wonky and you're constantly changing it and it's short shifts.
It's gonna kind of difficult for us to get that consistency. But if you want that consistency, we can do it. This is what it's gonna look like. And then they're always like, Whoa, I want consistency. You're telling me how to get consistency, let's get let's get the consistency. Exactly.
Miriam Allred (20:49)
You're like here, here it is, served up on a platter. We know what we're doing here. ⁓ okay, let's let's
circle back around to tech. So you said that and you just walked into Heritage two years ago. There was nearly like no tech in place, which is mind-boggling. Like this isn't 10 years ago, 20 years ago, this is like just a couple of years ago. And so you overhauled the tech stack pretty quickly. I always find this fascinating and want to know what people are using. Can you just kind of dial through like your core tech pieces?
That were maybe in place if any are still in place today, but then really kind of what you layered in pretty quickly thereafter.
Nate West (21:20)
Yeah.
Yeah, so I I would say the only piece of tech that was in place, and it's actually what I used when I was helping build Pluma, so it worked out was Slack. So ⁓ the team was using Slack to communicate just about everything kind of day to day. We've definitely, I think, bolstered up use of Slack. I mean, we we definitely use it, I think a little bit more than it was being used previously, but we use Slack. ⁓ we use Vonage for our phones. ⁓ a tool that I used at Pluma that I loved is Asana. So for task management, I use Asana.
Sauna, it integrates directly into Slack, and so you can set reminders, you can set to-dos for folks, which is really, really nice. ⁓ as part of my shift into the digital age and to be able to enable the remote work, we use the Google Drive. So I run everything on Google, so that way all of our files, everything is stored there. So that way, you know, if you're home or if you're at a client's house, you can access it all. The agency had a local share drive ⁓ before I joined, and so you had to be on site to log in to get into it, which made hybrid work remote or remote work.
difficult. ⁓ we also use ⁓ Sensi within the homes. I have Caribou Now, which is an employee rewards platform that we're using, and then we use Phoebe, which is something we're gonna talk about a little bit more. So
Miriam Allred (22:34)
What about payroll
and then EMR? You didn't mention those two.
Nate West (22:37)
Sorry, yep. So WellSky we use WellSky and then paychecks for payroll.
Miriam Allred (22:43)
Okay, nice. So yeah, we're gonna kinda talk about like tech in general, but then also like AI specifically. And and AI has really been like hot on the scene since you bought the business. And so I feel like these two journeys are probably kind of like parallel to you of like overhauling the tech stack, AI is everywhere, and then like layering it into the business. So that's actually interesting to hear that A that Sensi was maybe your first AI play to bring into the business. Is that right?
Nate West (23:07)
It is, yeah. I mean I I didn't include Chat GPT. I use Chat GPT for basically everything except content writing. I think it it it writes pretty horribly, but
I use it for everything else. So SENSI really was the first, at least you know, outward-facing AI tool that we brought in. And like you said, AI is the buzzword now. It's everywhere in home care and in out. And so it's been interesting to see kind of some of these tools that have popped up. Many of them I don't really see it of value for, but some of them I absolutely do, as you as you can tell, because I'm paying for them.
Miriam Allred (23:41)
One of the challenges that's kind of like a precursor to being successful with tech is the people. So the owner was maybe a little bit older, you know, outdated in his in his like kind of tech forwardness. ⁓ what about the office team? Because here you come in and like overhaul all of these these tech tools. That can be whiplash for these office staff. That can be really tough. And so can you share kind of transparently like what what that looked like? Of did you have to have these hard conversations with this office and say, hey,
Nate West (24:09)
with this one 'cause it's a hymn.
Miriam Allred (24:10)
We've
gotta ⁓ we've gotta kinda get things up to date and we've gotta bring in these tools and either, you know, we'll take it slow and we'll train you and we'll do this together, or if this isn't a right fit, like we're gonna have to have a conversation.
Nate West (24:13)
today and we've got these tools and even you know we'll trade you and we'll do this together we if that's it.
Yeah, I I would say I was lucky in that ⁓ all but one person in the office, they were looking for tech. I mean, they were like, Nate, we've wanted this for a long time. And as much as you know, not to speak ill on the previous owners, because they did a really good job of of building the foundation, but they were like, Nate, we've been asking for this for years and like it we're just not getting any traction. And so most of the team was wide open arms, like, let's let's go.
I'll be honest, there was one person on the team and it was kind of a one of those situations where stuck in stuck in her ways and just resistant. And I think part of it was
Just an unwillingness to kind of learn because it was gonna t there is a little bit of a lift to learn. I think you and I can agree. You might spend five hours learning this process and it's gonna end up saving you 15 hours a week of work. And so it's a good investment, but not everybody can kind of see that long-term that long-term vision.
And yeah, you know, maybe it's the Marine Corps officer and me, but it's like, hey, the bus is going and you want a spot on it, there's a spot. But if you can't if you can't play by the rules, w the bus is leaving. And so the bus left. And and and she's moved on to something else and you know, we've stayed in contact. We we love her, but i you gotta kind of adapt with the times. And so I I I was lucky that most people on the team were like, Show me how to use this and I am I am a believer.
Miriam Allred (25:49)
Awesome. Yeah. And sometimes
it feels like lip service, like, hey, this will make your job better. This will make you three times more efficient. This will cut out the stuff that you don't like. Like, I feel like we're saying all the right things to the right people, but it can feel a little bit like like lip service. Do you feel like your team felt that way at all? Or have you truly been able to see them like embrace and adopt it? Or do you feel like there was this like distrust phase and you've had to work through that to this trust phase? You know what I mean?
Nate West (26:16)
Yeah, I would say out of all of the tech that I rolled out, it it's pretty easy. You know, it wasn't a a ⁓ huge shift
Operationally, they were just kind of supporting tools. It's not like I really flipped anything upside down. I'll take, I'll be honest, I took some sales calls to get us off of WellSky, and that would have been a huge shift. That probably would have been a may we gotta talk before we do something like that. But you know, rolling out Asana just so that we can track our to-dos and our checklists.
it it takes, I mean, it takes 15 minutes to learn the basics of Asana And so nothing that I was asking of them was really a significant lift. ⁓ the woman who had an issue with things, she was more HR focused. And so that was going away from the paper agreements to the digital agreements. Again, sending a docu sign takes 30 seconds. You know, just give me the opportunity to show you. But when you're not really interested in learning different ways, you know, it's more of a personality thing than anything. And so yeah
Yeah,
to answer your question, the the tools that I rolled out, there wasn't a lot of learning curve. There wasn't a big learning curve for for my team. And so they were within a week or two. I mean truly within a week or two, everybody was kind of operating on this new way forward.
Miriam Allred (27:32)
Yeah, I've kind of seen this
like interesting range. There's like there's the lip service, the owners that are like gung-ho, you know, want to get people on it. But then there's also this like the owners, like, this is way too complicated. You know, I want to protect and preserve my team and we don't want to want to adopt it. And I've seen like both extremes in home care, but I I think you're right. Like, obviously, I'm tech forward and understand these things. Like the technology should be simple and it is simple. And, you know, these are kind of like point solutions that we're layering in to solve specific problems and do specific tasks.
And it really isn't that complex, you know. I think we kind of like built it up in our mind that it was one thing, but it's really another. And so I love I love to see and I love to hear when people are like understanding that AI is like really down on the ground floor. It's not that hard to understand. And it really should very quickly make your job easier. And if it's not, then you should reevaluate. But it's like these tools are designed to solve specific problems. And if they're not in a short period of time, like, you know, reevaluate and look look elsewhere.
Nate West (28:27)
Yeah. And I I think it goes back to just operating on that level of trust. Like my team knows whenever I I can be a good idea fairy. I I mean I can be. I can be like, guys, I listen to Miriam's podcast and listen to what people are doing. We should try this. And and they know though that if it doesn't work
Within days. I'm not gonna say let's try it for six months, let's try it for a month. If if something is not immediately making our lives easier, we won't do it. We'll scrap it, we'll move on. And and I think it also helps. I'm pretty hands-on. You know, I'm in the office every day. I'm working side by side with them. I'm not getting into the weeds of the schedule. I'm not, you know, doing all of our intakes anymore, but I'm I'm there. And so I think with me kind of rolling the tools out, working with the same tools with them, I don't know.
your adoption rate's a little bit higher versus when you're just sending out an email, Hey team, I want you guys to start using this and good luck, tell me how it goes. You know, I'm I'm in in the weeds with them.
Miriam Allred (29:24)
Yeah, learning
on the ground floor right alongside them. So, a lot of people have come to me asking about Phoebe. You know, they're a sponsor of my show. I am just like thrilled about where this technology is taking operations. And so you I came to you, you have been using them for about six months and have had a really great experience. And so I wanna kinda walk through like the the three primary use cases of what you're using them for today and hear unpack kind of like what you were doing before and what you're doing now and the actual results of that. I think that's
Nate West (29:39)
Yeah.
Miriam Allred (29:53)
This is what people want. Like I was just at a home care conference a couple of weeks ago, and it was all kind of like conceptual AI. And it's like, no, people want like, what are you doing? What's actually working? How can we do this? And so I want this to be as like nitty-gritty as possible. And so let's talk through the three specific use cases and I'll just kind of explain them high level here. Shift confirmations, clocking in and out reminders, and then shift outreach, like actually filling open shifts using AI and what that actually looks like. So I want to talk through each of them because you had
versions of processes in place doing this like semi-manually with some automation with some of the tools that you've mentioned and now you've like plugged Phoebe in and the way that you've done it's really interesting and the results you've seen are great. And so I want to kind of talk through each of these. So let's let's actually start with shift confirmations. That's you know kind of like a a more simple one. I'm curious, were you doing that before Phoebe? And what did that look like?
Nate West (30:47)
Yeah, so before Phoebe, ⁓ we weren't really doing shift confirmations. I would say if we were if we had the capacity, if my scheduling team had the capacity, they would try to, you know, confirm that first shift with a new caregiver after a hire. ⁓ holidays we would definitely confirm some weekends, you know, Fridays if we had the time, we would confirm Saturday and Sundays, but we really didn't do shift confirmations. And I would say ⁓
I don't want to jump ahead here, but one stat that I think is just defines Phoebe for me in one of the ways. In the first half of 2025, last year, we had eight no-call no shows across all of our shifts. We've had one this year in the first half of the year. And the way the shift confirmations again used to work, if we did them, it was manual. It was one of the schedulers calling, hey, just want to make sure you're still good for tomorrow. Okay, great.
Sometimes we'd add the note to WellSky shift confirmed, but but again, as you're as you're growing, it's hard to kind of stay on top of when you have hundreds and hundreds of shifts in a week. And and now Phoebe sends out a text in the morning, ⁓ you know, every morning at 9 30 to confirm tomorrow's shifts. And so our caregivers get a text, hey Miriam, just confirming that you're still good to work tomorrow from 10 to 6 with so-and-so. And the caregiver just gives a thumbs up or says, I'm good, I'm going.
And we know that they're good to go to work. And so again, eight no calls down no call no shows down to one. And I I'm a firm believer in the Phoebe being maybe not the only driver there, but a a really, really big driver there.
Miriam Allred (32:25)
Yeah, I find that agencies either are doing it or
they aren't doing it. Like an obvious maybe that's obvious, but it's like either they are doing shift confirmations and understand the value and see it or or they aren't because it's manual and cumbersome and how in the world could we do that? But now it's like that can be automated for you. I think one fear that people have is like, say you have a lot of longstanding caregivers and it feels ⁓ like repetitive or like almost like a lack of trust and that you're confirming these shifts.
Was that a was that a concern for you when you started implementing this?
Nate West (32:57)
There was five, six, maybe seven caregivers that were like, I've worked for you for five years. I've never missed a shift. Why are you babysitting me now? And and for most of them, I, I called them and it was like, look, I know you go to work. I appreciate it. This is just a process that we're rolling out. It's making our lives easier for everybody else. All it takes is five seconds for you to give it a thumbs up, you know, to just say, yes, I'm going.
I get that you go to work. I'm so grateful that you that we don't ever have issues with you. But just be a good team player. I also will add that
We have rolled out a whole bonus structure for our caregivers. So every six months, our caregivers are up for a performance review, they're eligible for a raise and they're eligible for a bonus. Part of their bonus is how they leverage our tools and how they use our tools. If they call us every day to clock in and clock out instead of using WellSky, you're adding work to my office, I'm probably not gonna bonus you as much. If you're not confirming on Phoebe, I'm not gonna bonus you as much. And so we are able to directly point to you wanna get paid more money, you gotta get on the again, you gotta get on the bus. The bus.
is moving and so ⁓ people want to get their bonus people want to get paid and so it doesn't take long to give a thumbs up if it means you're gonna make a few hundred bucks when you walk into the office for your review.
Miriam Allred (34:13)
And this is what we were talking about before, like sticking to your guns on some
of these processes and on some of these minimums. Those five or six caregivers that have been with you for years, you could have you could have easily make made the edge case and said, you know, for you, you don't have to do this. Like that would have been super easy to do and also like valid, you know, like you've been working with me for three plus years or five plus years, like you don't have to do this. But instead, it's like, no, there's a reason why we do this. I'm curious though.
Fourth, did you make any edge cases? Because you can, if I'm not mistaken, Phoebe, like that's dynamic. You can turn it on and off for specific employees. Did you make any edge cases or were you able to bring them all around and kind of like stick to your guns on that?
Nate West (34:51)
So here I am dying on this hill that I hate edge cases. Yeah. No, we we made, I think there's three caregivers that that we don't make them confirm because again, they're with 24 hour clients. They've been, we're fortunate. I think our longest tenure caregivers been with us for eight years, like full time for eight years. And so we have some people that have been with us for a while. Same, you know, clients too. We've had clients that have been with us for a long time. And so I did make a couple of edge cases. ⁓ but
Miriam Allred (34:53)
I know. I'm teeing you up.
Nate West (35:20)
made it abundantly clear, you know, if you no call no show your shift because we're not confirming it, we are going to have a huge problem because you've given me your word and I've given you mine. So I'm
Miriam Allred (35:29)
Yeah, I don't mean to I don't mean to make
you feel guilty. This is real real life, real time. Like this is this is this is what it is. ⁓ the only thing that I could think of to like convince them is not like the right word, but like, you know, help them see what the value in this is like on the off chance that something does come up, like and things do come up, even if you they've been working for you for eight years, like life happens, things come it, but it's it's just like it's just like a safety net, you know, and it's it's a two way street. It's good for you to have the safety net, it's good for us to have the safety net. And so
Nate West (35:33)
It is.
Miriam Allred (35:59)
Just trying to come up with like verbiage that resonates with them and helps them see the value rather than just like, yeah, forcing it on them.
Nate West (36:05)
Yeah, no, I look, I take the time to explain and I don't blame our caregivers for this, but their world is their world. You know, the client that they work with is the one client that they work with, and that's all they really care about, and that's fair. They shouldn't care about everybody else. But I take the time to explain it to them. Look, we have o well over a hundred and twenty five caregivers on our roster. We've have hundreds of shifts every single week. We do thousands of hours of care. And so you're you're a very important piece to this puzzle, but
Take a step back and think about the big picture. How am I supposed to know that all 80 caregivers that are supposed to work today know that they're going to work today?
And again, most of the caregivers are Nate, that's a good point. Holy smokes, I had no idea. Wow, that's a lot there's a lot going on in the office. And they appreciate the context, right? It takes two minutes to explain it to them. And I think they value that. I think instead of just saying, here's a tool, you gotta use it, give them, give them the why. It doesn't take a lot of time to explain it to them. And again, all but I think three ⁓ came around to it. And when you tie it to a bonus too, let's be honest, people want to make money. And so it's you might not agree with it.
But I know you like money and so just thumbs up the message and we'll pay you more money and they do.
Miriam Allred (37:18)
Yeah,
yeah. I think that's smart to tie these things to to bonuses because yeah, behavior like rewarding good behavior. Like that's you know, we're all humans, like that's that's how we think and how we operate. let's transition into clock in and out reminders. This is another one that's like really simple but super powerful if done right. And you explained to me, and I want you to explain, you guys had a ⁓ kind of automated process of of sh clock in and out reminders.
Nate West (37:26)
Yeah.
Miriam Allred (37:46)
Tell me what you guys had in place and then we'll transition into like what you've built and how it works today.
Nate West (37:51)
Yeah, so ⁓ previously what would happen is
If if a caregiver did not clock in or clock out, we would get a WellSky notification. It's integrated into Slack. And so it it you know pops up as a Slack notification and it lets my team know that somebody is either not clocked in at work or that they have not clocked out. At that point, we're pounding the phones. You know, it's it's trying to get the caregiver on the phone to make sure that they are there. As everybody in this industry knows, most of the time they show up and it's crisis mode, and the the spouse or the daughter, whoever it is, is like, my.
Gosh, thank you. You're so glad you're here. We need to go straight to dad. And they set their phone down and they're in the middle of working and you're blowing their phone up, and then you start panicking. Is anybody there? ⁓ and but every once in a while they're not there, right? Every once in a while it is a no-call, no show. And so that's how it was before, very manual. You know, we had to watch for WellSky notifications and call, and it was just tedious. It it it a lot of caregivers would just you know show up three minutes late, four minutes late, it would ping the notification, we'd call.
I just clocked in and it was just manual work.
Miriam Allred (38:58)
Was this your scheduler doing that, or what role in the office was responsible for that?
Nate West (39:02)
So during the days, you know, if it's business hours, it's the scheduling team would be watching it. Obviously, we all had access to it. And so if I saw it or, you know, if my recruiter saw it and they knew that the scheduler schedulers were on the phone, we we kind of have just to help each other out mentality. But the schedulers primarily were the ones calling. And then everybody in the office is on call. We rotate the on-call phone. And so whoever was on call, you know, it's on their, it's on them to kind of make sure obviously people are clocking in and out and getting to work.
Miriam Allred (39:32)
Okay. And did you say that rem that WellSky notification was how many minutes after the shift?
Nate West (39:40)
I think we had it set for ⁓ eight minutes, eight or nine minutes after the start of the shift. So if the shift was at eleven AM, by 11:08 I think we were getting the ping that the caregiver had not clocked in.
Miriam Allred (39:52)
Okay. And just 'cause I'm curious, did did you guys like refine it to that eight minute mark or did you always have that eight minute mark set or did you kinda like work your way there like that's the time that made the most sense?
Nate West (40:03)
Yeah, I'm kind of embarrassed to admit this, but that's just the way it was. That's how the previous ownership did it and it it made enough sense to me. I hate people that are late. I shouldn't say it that way. I hate being late and I it really drives me up a wall when people can't get somewhere on time. Maybe it's the Marine Corps in me, but it's just like show up on time and get ready to work. ⁓ I think if you're two minutes late, one minute late, you're late. But eight minutes
Miriam Allred (40:07)
Okay.
Nate West (40:31)
gives you a little bit of flexibility if it's hard to find parking and again, we would still coach it, you know, even if they clocked in before the alert came in at eleven seven, we would still coach it with them and we would still hold them accountable to it, but we just wouldn't end up getting the notification.
Miriam Allred (40:46)
I believe all of your clients are private pay. And so like there is some leeway, people that are doing long term care or VA, like the minutes matter. And there's like a lot of rules and regulations around that. And so I just interject with that so people understand. Like there's leeway, you wanting people on time is like everybody wants that, but it's like in some scenarios, like it's it's a must have. ⁓ let's talk about what you've transitioned to with Phoebe now. You've
You brought Phoebe in, but you've kept WellSky and you've got a s slack. Kind of talk about like the increments that you have now for the clock in and out.
Nate West (41:20)
Yep, so the way it works now with Phoebe is if somebody doesn't clock in to work on time, I think it's three minutes after the hour or after the start of their shift, Phoebe will send them a text.
And it's as easy as hey Miriam, I saw your shift started a few minutes ago. Let me know if you've if you've arrived ⁓ or go ahead and clock in in the app. Phoebe can now clock them in for them. And so if the caregiver responds and says, hey, you know, I got here two minutes ago or three minutes ago, Phoebe will just go ahead and handle that clock in in WellSky. So that way the caregiver doesn't have to do it, and then we never get the notification. Same thing on the clock out. If they don't clock out at the end of their shift, they automatically get a text a few minutes after the end of their shift telling them to do that.
If they don't respond to the text and they also don't clock in in WellSky, they get a phone call from Phoebe.
Phone call goes out a few minutes after that point, you know, right around the seven minute mark. And that phone call is, hey Miriam, it's the same thing, right? Hey Miriam, you should be at work right now. You should be clocked in. Why aren't you clocked in? And if the caregiver answers and says, you know, I got here two minutes ago, whatever, tells them, then Phoebe goes ahead and gets them processed in WellSky. If they don't respond to Phoebe and they also do not clock in in WellSky, then we get the notification still ⁓ right around the eight, nine minute mark after the start of the shift.
But I would say, one in three missed clock-ins clock-outs is now being handled by Phoebe. And so the number of WellSky notifications that we get in Slack for a missed clock-in or clock-out have gone down by a third. And for better or worse, we now know if there's a WellSky notification that comes in, that means that the caregiver has not been responding to Phoebe. And so it's a heightened level of we've got to take action because Phoebe's already done her part.
And the caregiver hasn't responded. And so now we need to start pounding the phone. So at that point, we go back to kind of what our old process was and we start blowing people up. We typically will call the client pretty much immediately. Cause at that point, you're 10 minutes after the start of the shift. They're probably wondering where the caregiver is if they haven't shown up, you know, already and they're not there working.
Miriam Allred (43:26)
Something we
haven't talked about, what has the response been from your caregivers? They know it's AI, they it's Phoebe, they it's a tool that you're using. What are what have you heard from them so far? From and maybe a two parter text and phone call. Like what specific feedback have you gotten?
Nate West (43:41)
Yeah, we we have such a high response rate to the texting that we really don't use Phoebe for the phone calls. ⁓ I I to hit a stat that just I mean
7.1 minutes is the average response time on any of the texts that go out with Phoebe. And so whether that's a shift, which we haven't talked about or confirmation, whatever, seven minutes they're getting back to us. And so ⁓ they they like it. I mean, it they love they love when we page out. Again, we're gonna talk about shifts here shortly.
But they like being able to get some context about the shift and it not always being a phone call because as much as I hate to say it, they're checking their phones while they're at work. They might be working at a you know a facility right now and working for us in the evenings. And so they like being able to pick up work while they're at work somewhere else. Maybe they're with their kids. And so overall it it's been, I mean, the caregivers love it. They they they they they enjoy it. We don't have to call them to confirm, they can just hit a thumbs up on a text and it saves them some time.
Miriam Allred (44:46)
Yeah. W i is it safe to say were you doing a lot more call volume before? Like obviously you had this whole like tech rollout, like was there just a lot more call volume and less text volume and now it's kind of like reversed? Or has there always been a lot of text and messaging? It was just more manual heavy.
Nate West (45:03)
It's almost we went basically from being only calling people to now ⁓ I would say eighty percent of our communication with caregivers is via text. I mean our call volume has dropped significantly.
Miriam Allred (45:07)
Mm.
And
And it's and it's demand driven. It's like that's what your employees want and respond to. It's like if there there might be a portion of everybody's, you know, roster that's like they want the phone calls because they're an older demographic of caregivers, but I think like majority want messaging and here we were, here you were, like calling them when it's like they didn't want to be called, they wanted to message, they wanted
More like real time answers and response time. And you can do that with text. With phone call, you just like literally can't do that because you only have so much bandwidth in the office to where there's just lag with phones. Whereas texting and with AI layered in, it's like it's all real time. And who doesn't want like real time answers?
Nate West (45:45)
Yeah,
It's ⁓ I mean my my field staff and my office staff jump for joy. I mean they just it it it enables a scheduler in my office to be having three conversations at once with three different caregivers via Phoebe.
And texting back and forth. When we would text before, we would send it through WellSky right? So you're going into the caregivers profile, and then you're clicking into their number, and then you're typing the message, and then you're hitting send, and then you're going back into WellSky to see when they respond, or maybe it comes in via an email, and it's just like, my gosh. And now with Phoebe, I mean truly, our our schedulers can be coordinating a doctor's appointment, confirming a shift, and paging out a new shift, all at the exact same time. And so it's just opened up the bandwidth.
on on our team more than I ever could honestly ever could have imagined.
Miriam Allred (46:45)
Yeah, the way that I think about it, it's like
this like live feed of like all of the communication, all of the interactions that are happening in the office. And the scheduler is now just like this like air traffic controller, pilot. I don't know what the analogy is, like sitting there and just like monitoring the feed and can see all the communication happening, can interject, can step in when they need to, but it's like they can feel so much more because they're just like watching this live feed.
Nate West (47:07)
But it's like you can feel so much more.
Yeah, and I would say too, I mean that that's spot on. I think air traffic controller is a really good analogy there. But I would also say the benefit too is that I can log into Phoebe right now and have access to all of the same conversations that my entire team does. And so when somebody's jumping in on call, you know, if my recruiter's on call tonight and he's not necessarily in the weeds with scheduling, if something comes up, he can pull up Phoebe and Slack, because we really do put still put a lot of information in Slack, but you can pull back, you can
read the text thread about the client or the driving instructions on where to go or whatever the case may be and everybody has access to the same knowledge base which is invaluable. I mean again as you add more and more clients and more hours to the schedule I don't expect everybody in my office to know every single caregiver and every single client like the back of their hand. But when you can pull up Phoebe real quick and say, hey give me a minute let me let me take a look and you can see what another scheduler had said two hours ago or a day before it just it it empowers everybody.
And it's probably not selling what I said is when it was
Miriam Allred (48:15)
And this probably goes without saying, but I'll say it is when it was
all over the phone, that was all ambiguous. Who knows what the scheduler's saying? Who knows what the client was saying? Nobody knows what anybody was saying now when it's all via text and it's all monitored and tracked. It's like there is full transparency into every single conversation. And there's just a lot of power, especially as an owner. It's like now I know what's happening any moment of any day. And I can go in and verify these things.
Nate West (48:20)
Who knows what the schedulers are, who knows what the client was saying, nobody knows what anybody was saying now.
And there's a lot of power, especially
Exactly. Exactly. No, and I mean, you can point back to stuff with the caregivers too, right? It it helps us hold people accountable because it's like, no, I'm looking at the text thread where we said this and you said this. And I hate to say that that's the reality sometimes, but it is. And so to have stuff documented, it's again, it's invaluable. I mean it not only has it just opened up capacity, but our record keeping I think has gotten a lot better because we have a a place that we can always reference. We have that library of of communication.
Yeah.
Miriam Allred (49:10)
Yeah, I
want to interject with this before we get to kind of the third use case, because you mentioned this to me. Like you are or thinking about like bringing on another scheduler and you mentioned to them that you have this tool called Phoebe and you explained to them what it was. What was their reaction to that?
Nate West (49:23)
⁓ I mean it's like when can I start? I mean they I actually I even I rehired a scheduler who had worked with us before and then before we rolled out Phoebe and she was like, Well you know what's new, kind of what what changes she's like, I know you like to make some changes, what changes have you made? And I was like, You're not going to believe this. And she was, I think, pretty committed to coming back, but then after I told her about Phoebe, she was like, ⁓ but
I I I accept, can I start today? Like this is that sounds that sounds legit. So yeah, no, it's been I mean truly when I interview folks, even our like I said, our recruiter, you know, our recruiter's on call. And so when I was hiring our recruiter recently and I was talking about the on-call responsibilities and paging out shifts, it was like, you don't gotta worry, man, because this is how we do it. And so if there's a call out, it you know, and we can maybe talk about this stat when we get to the next point, it's taken us an average of nine minutes to get a shift filled. And so
So nobody likes being on call. Nobody likes covering the phones. But when you know that on average you're gonna be able to get a shift filled in nine minutes, like kinda takes the sting off of being on call because you know you're not gonna be pounding the phones all night trying to find coverage.
Miriam Allred (50:30)
And I'm biased, but this is home
care in 2026. Technology is your competitive advantage. Two years ago, Heritage straight up on fax. You trying to go out and like hire a scheduler or a recruiter, and you're like, you have to come into my office and fax. I w personally I'd be like, sorry, but no thanks. But it's like now technology, AI, your tech stack, they are your competitive advantage over a lot of other like legacy agencies out there. And that's a perfect example with that.
That scheduler of like, let me tell you what our new scheduling tech stack can do for you. They're gonna walk away from their current agency like easily.
Nate West (51:11)
Yeah.
Yeah, no, I mean it it goes back to kind of retention, right? How d how could I retain the the people on this team that I wanted to work here? Part of that's having some hybrid work because most people like having some flexibility there and then giving them the tools to to be able to do their jobs. And I think all of that goes back to the overarching theme that I've hit on of trust, right? They can see that I'm putting my money where my mouth is, that I I will buy tools if it makes their lives easier, because again, in the long run, I need to retain and and keep the good folks.
And so enabling them, empowering them, and making their lives easier and a little bit more comfortable if they can work from home from time to time, that's how you you build an A-team. I mean, that's how you get winners on your team in my experience.
Miriam Allred (51:53)
hundred percent. You're preaching to the choir. I love this. Let's talk about the third and maybe the most like juicy, which is open shifts and filling open shifts with AI. I think everyone's kinda like, wow, is this really possible? Is it really working? I'll just say it is. And I want you to explain ⁓ you know, this workflow. I I guess you could kind of just like highlight I think everybody kind of knows like what filling shifts looks like and entails and the hot mess that it is, but
Nate West (52:16)
Yes.
Miriam Allred (52:19)
⁓ you know, maybe some of the key components of your workflow before and now kind of what it looks like with Phoebe
Nate West (52:24)
Yeah, so so prior to Phoebe, ⁓ the way that we would fill shifts is we'd use Carefinder in WellSky and so that would be kind of our starting point.
But it was a very, very manual process. I would say one thing that I think sets us apart from some other agencies, at least from what we've been told, is that consistency on the schedule and really getting a good match from the jump. We spend, I would say four to six hours with most of our clients before their first shift.
Getting to know them, building out the most comprehensive care plan that we can, and really trying to suss out what their preferences are. And so we're super diligent on that matching. that's expensive, right? It takes a heavy lift, a labor load to do that, but it sets everyone up for a win. And so prior to Phoebe, it was a hands-on process. We would start with CareFinder to kind of just see people's locations. We use the match criteria within WellSky, both for our clients and caregivers, so that way we can eliminate.
folks that don't have the right experience.
But it pounding the phones. I mean, it was one by one working down a list of, hey, these t are the ten that we think would be a good fit that have the availability. Let's leave voicemails for them. Let's send them a text on WellSky say, Hey, can you call us back? We have a client we want to talk about. ⁓ and let's see who's interested. We then in Slack would kind of keep tabs of, all right, so for this client that's getting started next week, these are the three folks that sound like they're interested. And then we would pare it down until we staffed it. ⁓
And and that's how it was. I mean, it was a very manual. As you know, when you call people, I mean we our phones ring all day long with spam. And so most people just don't answer their phones. I would like to believe that they have our number saved in their phone because we tell them to during orientation, but they don't. And so they don't always answer. And so most of the time, you know, you're leaving a voicemail and then you're sitting there waiting and you're waiting for the callback. now with Phoebe.
It's it's it's a breeze. We send out a text, you know. Same same match criteria is being used, location is still a factor here, and we can get into the weeds of how Phoebe does it. ⁓ but now we use Phoebe to page out shifts, whether it's an ongoing or an emergency or you know, just a fill-in, and it sends a text to everybody that that is an appropriate fit based on the match criteria, the fit and all the parameters that kind of we've set, also the stuff that Phoebe has learned about that caregiver and the client, and it sends out a
Text and it says, hey Miriam, I've got a client ongoing. These are the days, these are the times, this is where they live. And the caregiver one can ask questions of Phoebe about the care plan, can ask questions about the schedule, the home, everything that's in the care plan, Phoebe's able to reference and share. And so this dialogue can happen between the caregiver and the and Phoebe. And then the caregiver is like, you know what? I'm interested in taking those shifts. I want to do it.
Meanwhile, my schedulers are taking care of other things. They're out doing a home visit, they're out doing other stuff, and then they come back and it's like, all right, great, these five caregivers had a conversation with Phoebe and they're interested. And now we can pick which one out of the five makes the most sense for that client given the human knowledge that we have that that isn't is not kind of fully translated over into AI.
Miriam Allred (55:39)
You know, we're home care nerds when this stuff gives us chills. It's just like, ⁓ my gosh, we're getting somewhere finally with scheduling. Like it's been so reactive and so hard for so long, but it's like we're finally getting somewhere. And this just like it shouldn't give me excited as as it does, but it does. It's just like it's amazing. It's amazing what AI is capable of just like aggregating all of this information. Like, you know, Carefinder like one point this is like five point of just like
Nate West (55:42)
All right.
Miriam Allred (56:07)
all of that qualitative and quantitative information, then can go out and actually have the conversations and then surface, surface the the right fits. And then the scheduler today, you know, 2026, the scheduler today can still come in and make the final decision. We're gonna get to a point where AI can make the decision and like we're gonna get there pretty quickly where it can do all of that. But today the scheduler can make the final judgment calls based off all of that information.
Couple couple things I wanna unpack. I do wanna get in the weeds a little bit because I think matching is where people can sometimes get hung up on the AL AI. Like, can it do that really well? Can it read a full on like care plan and assessment and look at a caregiver profile and can it accurately like give you accurate matches? Have you helped like refine the criteria that it's prioritizing? Or do you feel like or do you know that it like it has all the information?
And it's doing a good enough job and then you're just kinda like fact checking it, or or do you have more hands on of like the criteria and how it approaches matching?
Nate West (57:10)
I think it all comes down to spending time at the intake and just building the care plan. But if you build out a super robust care plan and if you have everything that's in your brain saved in WellSky, I mean Phoebe Phoebe's capable of processing that better than I can. And so I would say and and to backtrack too, Phoebe can assign a a caregiver. So we have it set so that we have the final say that the the human comes in and approves it, you can set Phoebe to do all of it.
And and it can automatically confirm a caregiver says they want to work, they get assigned to the shift and they're confirmed to go to work. We just like having kind of that final say, the human touch. ⁓ but if you if you take the time and again it's it's labor intensive, if you take the time to sit down with your clients and get to know everything about them and all of that gets translated into the care plan in WellSky, Phoebe's capable of doing it all. I mean I
Miriam Allred (58:04)
Was your
team good at that pre Phoebe? Because sometimes there's this like period of time where you have to go and like enrich all of the data. Were you guys already good at that? Or was there s this period of like, We need to get better at documentation so that the AI can thrive?
Nate West (58:17)
I'm I'm fortunate to say that one of the strengths of the agency was the care plans, the quality of the care plans and the the quality of our onboarding experience. ⁓ it's very, very high touch and it's expensive. I can think of some clients off the top of my head, it it took ten, twenty hours to get onboarded and they worked for with us for a couple of weeks before they decided to move into a facility and it's like, well, shoot, that was a
huge investment to get them onwarded. But for the most part, ⁓ the care plans have been super, super, you know, I would say detailed and and comprehensive. And so the only thing that we had to do was we had to add ⁓ the cross streets to the care plan, the major cross streets, so that Phoebe could reference those. And then we added in the care plan explicitly whether the client lived in a facility or community or lived at home.
Because that was a common question of our caregivers was, you know, do they live at home or do they live in a community? A lot of our clients live in communities and and they live in the aisle side or or even memory care, and we go in and supplement. And so we did have to update care plans with that information, but that took an hour. I mean, it it it was pretty quick. Phoebe, I think is they're working on getting the technology there where it can just reference the address in the WellSky profile and then identify cross streets based on that.
But as of a few months ago the the tech wasn't there yet and so we just put the cross streets as at the bottom of the care plant and again, super easy for for us to do.
Miriam Allred (59:49)
And just one thought,
like you said, it takes a long time to get all of this this data and information from the client. But in my mind, like that's time well spent. And now now it's not time lost in the office doing the manual scheduling and and this op filling shifts. Now it's like time well spent with the client, with the family. All of our time should be FaceTime with clients, families, and even caregivers.
And now technology's to the place where it can be doing all of the manual work in the background. And so you are already spending a lot of time. But now it's almost like you can go out and actually spend more time with them, which is what we're working towards.
Nate West (1:00:20)
Yeah, which I look, when you are asking people to let you into their home to take care of them and also asking them for a lot of their money, let's be just totally honest about that, that there needs to be a level of trust that i is so deep.
Right. You know, i they they have to have all of the confidence in the world that you're gonna be able to deliver on the things that you say you can. And so it is a good investment, you know. It it before we even have our first shift with most of our clients, they are so fully bought in. I've had I've had people offer to write a review before their first shift because they've just had such a good onboarding experience, which I think really speaks to the team that I have doing that. I don't do a lot of those, you know. I I answer the phone, I don't do a lot of intakes because I have an amazing woman who do who does most of them.
⁓
but but like you said it's all time well spent and and it sets us apart. You know, there are a lot of agencies out there that it's a wham bam, get in there, get the agreement signed, get started, and we'll adjust as we go and we'll learn more about you as we go. But you know, I'm asking my clients to spend upwards of six, seven thousand dollars a week with me. And and so you need to have that level of trust. It's just such a personal service and expensive.
Miriam Allred (1:01:38)
Mm-hmm. And the the
flip side of the matching is all of the caregiver preferences and profiles and data and information and and maybe arguably mock maybe that can be harder to keep accurate and up to date. Has was that a challenge for you before, just making sure like availability and preferences and schedules were always accurate on the the caregiver side? Was that a challenge before? And has that been made easier with Phoebe?
Nate West (1:02:02)
That's a good point. I I would say match criteria and all that stuff we were already doing a really good job of. Unavailability we were not. And so it was kind of funny because after we rolled Phoebe out, we had a handful of actually a good amount of caregivers that were like, You guys are offering me so much work and I'm getting texts all the time. And and you know that I work at the hospital Tuesday, Wednesday, Thursday. And so why are you even reaching out to me? It's like, well, according to WellSky, you're available.
You have it there. And so that's a good point that I actually hadn't thought of. We have had to really kind of work with caregivers to keep their unavailability blocked.
They can do that in the WellSky app. And so during orientation, you know, we tell them keep going to WellSky and keep it updated. Remember to check it, because on the flip side, I've had people call me like, you guys aren't offering me any work. And it's like, well, you you have all of your availability blocked. And they're like, well, I w I don't work there anymore. Like it's like, well, we didn't know that. But going back to what I said earlier about bonuses, part of their bonus is using the apps.
And so keep your own availability, you know, up to date in the app. And that that is a lever along with Phoebe and and our other tools to get you paid. So ⁓
Miriam Allred (1:03:16)
So I've seen different agencies
approach this differently. It sounds like you let the caregivers update their availability and schedules on their own. I've seen some agencies where they give the caregivers the autonomy and some agencies where they say the office has to do it. Sounds like you err on the side of letting them do it themselves.
Nate West (1:03:31)
We highly, highly encourage them to do it themselves. Most of the time we end up doing it. So after caregivers go through orientation, they sit down with the scheduling team one-on-one to go through their availability and hopefully get work. We typically block their availability for them while they're in the office, but we highly encourage them to stay on top of it after that.
Unfortunately, we do a lot of it, but it it's not, you know, it's not that big of a pain, but we do ask them to to keep it up to date, especially if you don't want to be bothered, right? Like we have a lot of single moms that work for us. They can't do overnights. We should never be paging out an overnight to them because they th they're never gonna be able to do it. And so block it and we won't we won't bother you with it. And then we also, you know, the scheduler is not gonna be sitting there waiting for a response from you when the response is always gonna be no, you know.
Miriam Allred (1:04:22)
Phoebe can do all of this, which is they say, you're offering me all this work, but I'm unavailable on Tuesday Thursday. Now there's this memory layer. Like we talk about like, you know, tribal knowledge, like all of this like information that lives in the scheduler's head. Now all of that is coming through Phoebe, this filter, and now Phoebe can store all of that information and actually like do stuff with it. Okay, they're unavailable Tuesdays and Thursdays. We are not going to offer them another shift on a Tuesday and Thursday until that caregiver comes back comes back and says, I'm no longer working at the hospital.
Like now talk about like live feed type. It's like all of those conversations translate into this memory layer that Phoebe has access to. And so it's it's constantly up to date and updating. Whereas, I mean, you kind of said it, you struggle to like keep up to date with availability. I see this in agencies, how hard it is to keep hundreds of caregivers availability up to date day after day, week after week. Like that's next to impossible. So now all of the communication traps all of that.
puts it in a stored memory and now all of the communication and conversations are taking into account all of that real time information. And that is like the magic in my mind.
Nate West (1:05:30)
That's the power of AI. I mean, and I would add on top of that, a perfect example is, you know, last week we had a call out for a Sunday shift. Okay. Paged it out to all the caregivers. And a woman named Maria picked it up. She picked up the Sunday shift. This week, same client, same shift call out. Phoebe automatically will recommend Maria because Maria picked it up last week. So Phoebe's taking into account the the continuity that we're looking for.
Phoebe knows that Maria was available last Sunday, so chances are she's probably available this Sunday. And so Phoebe's learning as caregivers are picking up. And if the caregiver is continuously getting scheduled with that client, obviously it seems like a good enough fit because they keep going back. And so Phoebe is able to leverage all of that. I don't remember that Maria picked that shift up. We have hundreds and hundreds of shit. I can't remember that stuff. But Phoebe does. And so when you go to page out that shift, Phoebe is like, hey, Maria worked it last week, let's start there. And
I think, shoot, I didn't I didn't remember that, but now I do. Maria did work there, let's start with her. So it's it's incredible.
Miriam Allred (1:06:32)
Yeah, it's a it's amazing.
And I wanna I wanna clarify for a minute because sometimes we we lump in call outs and open shifts as the same thing. And we see a lot of these AI point solutions like focusing on callouts. Don't get me wrong, we all want to solve for call outs. We want to eliminate call-outs, we want to avoid them at all costs. But really to me, open shifts, Phoebe's Phoebe's not just focused on callouts, it's
Any open shift. So a scheduler opens up the schedule on Monday, on Tuesday, whatever day, opens it up and is looking at okay, what's open this week, what's open next week. A lot of schedulers are operating kind of like seven to 14 days at a time. Now Phoebe is already attacking open shifts. I see schedulers with Phoebe now. We're looking at 30 days out, 60 days out scheduling. And that was never even possible a couple of months ago or years ago. Now it's like
Phoebe is proactively working a w on open shifts, which is really like eighty to ninety percent of the the effectiveness and the productivity increase is is not just the call outs, which are, you know, one or two or ten, depending on your scale. It's actually like proactively filling open open shifts, like doing the the day to day work of a scheduler that's really powerful.
Nate West (1:07:49)
I I would say, and I'm I don't know if I'm kind of embarrassed to admit this, but anybody in home care has been there. When I took over, it was sometimes a twenty four to forty eight hour fight. I mean, I remember my first week
And it was a Monday or a Tuesday and we had opened shifts on Thursday. And I was like, we're not leaving the office until we figure this out. Like this ain't 48 hours out. We don't have anybody scheduled. And the team was just like, Welcome to home care, man. Like we'll we'll figure it out. Shifts do not go unfilled. Someone's gonna fill it, but that's a tomorrow problem. I'm like, that's a tomorrow problem. Then we're 24 hours out from the shift. And so now, I mean, they're you know, I'm I'm fortunate.
I have an incredible administrative team as well behind Phoebe. But now there are times where we're ten, fourteen plus days out. And it it just it enables them to be
better at their jobs, right? Your back's not up against the wall. You're not constantly in firefighter mode. And you're able to really be diligent about who's going to be a good fit here. It it also has enabled them to be out in the field more, to be able to go do home visits because we're not trying to fill a shift tomorrow morning. We, you know, we're filled for the next five, six days. Let's go out and see our caregivers in the field. Let's go make sure our clients are taken care of. And that again, it sets it, it's what separates, you know, agencies. When you when you're able to make FaceTime and drop off flowers
on the client's birthday and things like that, because you have these tools freeing up your time, it's just a win for everyone.
Miriam Allred (1:09:23)
That that's literally what came to my mind. It's a win, win, win. Win for the clients, win for the caregivers, win for the office. And like and that that sounds cliche, but that's like actually what's happening. The continuity of care, the communication for the caregivers, and less burnout for the office. Like that is what we're striving to. And now these tools are unlocking the ability to actually feel that. And I love what you said. And I appreciate the transparency of like 24 to 48 hour scheduling to now like five to seven day scheduling.
Nate West (1:09:29)
Yeah.
Miriam Allred (1:09:49)
And I think I was thinking in terms of like these like kind of seven day schedules that people are in are now getting to the 14, now getting to the 30. It's like that's the goal ultimately to like be scheduled as far out as reasonably makes sense to where the clients and the caregivers, like what employee doesn't want a 30 day schedule? What care client doesn't want a 30 day schedule with like, you know, assurance that that's what's gonna happen? Like that's what we're trending in that direction. Whereas not long ago, 48 hour scheduling, like that is insane to me.
Nate West (1:10:05)
Right.
Yeah, we I mean honestly, so WellSky has the family room and that's where families can log in and see schedules and see who's, you know, invoices and things like that. Pretty early on, I was like, We should not be offering the family room because it's just gonna draw questions and and it it would. Clients would call and be like, you know, why is next week still open? And it's I would be like, Well, it's only Tuesday, so relax. We're gonna be fine. Obviously, I couldn't say that.
Miriam Allred (1:10:42)
Okay.
Nate West (1:10:45)
But but we stopped offering the family room because the schedule more than a week out didn't always have people on it. And and now we're at the point where we're comfortable offering the family room again because if there's an open shift, it's just one or two that we're you know we're providing coverage for versus we have no idea who's gonna be working next week because we're just focused on tonight's you know open shift.
Miriam Allred (1:11:08)
Yeah. And I just I don't
know, this is also like generic speak, but it's like the old way and the new way. Like the the previous era of home care. Like I said to you before, like Heritage home care, fax to Phoebe in two years. Like there was the old way and fax wasn't that long ago. And now there is like literally the new way, like the new era of home care. And I don't I don't say that lightly, but I like genuinely believe it. When I hear you share these like stats and figures and the comments that your caregivers are saying or your schedulers are saying, like
This really is like a new era and is opening up opportunities that we never thought possible. And I am just like so excited to see where this takes us. Like I want the best agencies to rise to the top. And and I think that unlocking like this productivity to spend more FaceTime with the clients and caregivers, like this is really how we get there.
Nate West (1:11:57)
Yeah I I can summarize what you just said by saying if I got rid of Phoebe, I think some of my schedulers would try to go find an agency that had Phoebe.
Because that's how powerful it's been for them. I mean, I I'm serious. I think that they would be like, I love you, Nate, but I'm going somewhere where I can use Phoebe. Because to your point, it's such a seismic shift from how we used to do things. Who wants to go back to pounding the phones for an hour, leaving voicemail after voicemail, waiting for someone to call you back? Now you you are on the phone with a caregiver who finally answered, and then that one caregiver that you really wanted to pick up the shift, now they're calling back, but you're on the phone with this other. Who wants to go back to that?
And so I think Phoebe's been such an improvement, you know, across the board that I honestly might lose employees if if I if I got rid of it. So I I never planned to. But it's yeah, I mean the new era is it's a win. To your point, it's a win for everyone, for the clients, for the caregivers, and for everybody in the office. And so for me, I'm screaming from the mountains from it. I mean, I love it.
Miriam Allred (1:13:00)
I love it. I love it too. ⁓ you said I think you shared the
stat already, but now the the average response time to fill an open shift, nine minutes. Is that what you said?
Nate West (1:13:09)
Yeah, so median r just response time that includes the confirmations and all that is seven point one minutes. The median ⁓ shift fill is nine point seven minutes. So in less than ten minutes we're sho we're filling shifts and that both includes you know emergency coverage and long-term ongoing shifts.
Miriam Allred (1:13:27)
Yeah. And what about touch points? Like AI touch points. You think about all this text volume, some of that call volume, like how many touch points are is your team having with AI at this point?
Nate West (1:13:38)
Phoebe's been averaging ⁓ 850 a week, give or take. So 850 times that my my schedulers are not having to pick up the phone or send a text. It it I mean, it's incredible. It again, it goes back to that the time saving. it's wild. I mean, it's really it's I I did not know the numbers before preparing for talking to you about it. I knew it was a lot, but I did not realize it was as much as it it's been.
Miriam Allred (1:14:03)
Yeah. And and we're just trending in this direction of like schedulers used to be these task managers. Like they're just like pounding the phones, you know, just like tasking all day long. And now we're like slowly but headed in this direction of like redefining the scheduler role and helping them be more relationship focused, helping them become like relationship managers. And I I heard this at the conference that I attended. Our, you know, every role in the office, we're
We were focused on like specialties, like every person in the office, especially as you scale, it's like roles become more specialized. With AI, it's actually really interesting. Like, are they becoming more like generalized? I think in home care they're becoming more like relationship focused and more like person focused, which is the ultimate goal and what we have to do every day, but like taking off a lot of the tasks, almost pulling them like in a good way out of their specialties to be more like well-rounded and more holistic.
And kind of managing, you know, like that feed is helping them be more relationship driven and more holistic in their role. And and so I really think like the the roles and the dynamic in the office is gonna change as we continue to unlock like what's possible and where everything fits with AI. What's your take on some of that?
Nate West (1:15:15)
Yeah, I I I absolutely agree. I think the way I would summarize it is that my schedulers have gone from being firefighters to being truly like strategic thought partners, where where they are not just focused on pounding phones to fill shifts and now they can take a step back and okay, you know, what clients do we have an opportunity to increase hours with? You know,
I've scheduled her now who's helps with some of the marketing material because she's has capacity that's freed up so she can help make marketing collateral for us or go out and do hiring events. And so it it's it's just been a beautiful shift from ⁓ truly pounding phones and trying to fill shifts and confirm shifts to now how can we all collectively make the client experience better and make the employee experience better too. It every interview I do when I help out with the interviews and orientations, I tell people, my office team is here to.
Work
for our caregivers as much as we are to work for our clients. You know, we we're nothing without good caregivers. I mean, they are the bread and butter for what we do. And so, how can we retain their talent? How can we enable them? And so, again, you know, Phoebe has enabled my team to take a step back and think more of the big picture instead of just who can we find to go to work tomorrow morning? And that's just a it goes back to the win-win-win, right? It's a better experience for everyone.
Miriam Allred (1:16:30)
Yeah.
Yeah. So when you think about Heritage
in two years, three years, five years, like what do you start to envision? Like now that you get a taste of like wow, what's really possible? Like if you think a couple of years from now, what do you what do you hope for for Heritage?
Nate West (1:16:47)
Yeah. I we we recently got approved with the VA.
And so we are a private pay, but we we did get recently approved with the VA and being a Marine Corps veteran myself, it's something kind of near and dear to my heart. And so I I really when I'm looking at the second half of this year and into twenty seven, I I'm really gonna try to grow out our our veteran programs and and and offerings, but it it's just it's doing what we're doing at scale. You know, it's we're gonna bring on a couple more marketers and community liaison folks and and just getting the word out. I I think I opened with this Scottsdale Paradise Valley.
the market is huge. You know, the pie is big enough for for kind of everyone here. And so it's continuing just brilliance in the basics is something I learned in the Marine Corps. And if you can if you can do the the the basics the right way ⁓ it's an exciting time. I mean this is when I was selling pluma and we were doing the virtual coaching and stuff and then COVID hit I mean it was gas on the fire. And it's kind of an uncomfortable thing for me to say because COVID was it was and can still be such a horror
Horrible thing for so many people, but for our business, transparently, it took off. I mean, it it absolutely blew up. And but we stayed doing the same things really, really well. The core functions of what we did didn't change. And I'm hopeful that with Heritage, it's the same thing. I I am so lucky to have the team that I have. I mean, I I would put my administrative team up against anything in home care, outside of home care. And so I think with the right people, if you have the right people behind you and you have the right tools.
It sounds so cliche, but the opportunity is endless. But truly in Scottsdale and Paradise Valley, the opportunity is endless. I mean, I I can't take care of all the people here, And and and so long-winded answer to your question, I really want to grow our VA ⁓ initiatives because it's something that one, it's just a great channel, but it's also something that I I care about and just keep putting the rocket boosters on and and and getting this this company to a place where I I really think that we can thrive and and continue to to provide services.
Miriam Allred (1:18:50)
Super cool. Nate, this has been so fun. I hope you've enjoyed this as much as I have. You know, this is us just like talking about things that we love and are passionate about. And I feel like we've gotten, you know, in the weeds on just like technology and Phoebe and what's possible and and hopefully just painted this like this accurate picture of what what agencies are doing with AI right now. Because honestly, if you're not doing this type of stuff, you're gonna get left behind. You know, there's Nate and lots of other like market leaders in every in every major metro in every state that like
They're tapping into this technology and they've got their rocket boosters on and they're about to leave everybody else behind. And I and again, I I I don't say these things lightly, like I see it firsthand and I believe it myself. And I'm, you know, along for the ride as well. But I I just get really excited to think about like where this is headed and this new era of home care, you know, with technology and with AI, like it's it's super exciting. So Nate, thank you for joining me. This has been awesome. We'll stay in touch and continue to just kind of follow your journey as you execute on these things.
Nate West (1:19:43)
Awesome. No, thank you so much. And like I said at the jump, I've learned so much from from your podcast from others. And so I hope this was helpful for for some folks. ⁓ it's it's it's the new way that home care is going. And at the end of the day, it's win for everybody because it provides a better service. And that's hopefully why everybody's in this business. You know, we're here to take care of folks and however we can provide that highest quality of care, it should be the win. So I appreciate you having me on and ⁓ happy to be happy to have have done this with you.
Miriam Allred (1:20:10)
Yeah, I hope we open the floodgates and people that this resonated with, like you, your style, kind of where you're at in your business, I hope people reach out to you because yeah, nobody should be doing this alone and people should be reaching out to you and asking you questions. And so there's a lot of great leaders out there listening to this. I wanna just kinda throw that out publicly that if if this resonated, like reach out to Nate, have a conversation and learn more from each other.
Nate West (1:20:30)
Always open and network. I I I love sh learning from other people and and sharing my wins and a lot of losses too. I mean this podcast, we focused on the wins and all the great things that we've been doing. Anybody in home care knows it ain't all rainbows and butterflies. I mean it's hard. It's a really hard industry to be in. And so I'm happy to be be a resource for folks and ⁓ hopefully learn from them as well.
Miriam Allred (1:20:43)
Mm-hmm.
Sounds great. Thanks, Nate. We'll wrap here. Appreciate it.
Nate West (1:20:53)
Thanks, Miriam.