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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)
Welcome to the Home Care Strategy Lab. I'm your host, Miriam Allred. On this show, I'll be putting high growth home care agencies under the microscope to see what works, what doesn't, and why. Through this podcast, the guests will be sharing formulas of their success so that you'll be able to listen, learn, and build the winning formula for your own success. In the lab, you are the scientist.
Today in the lab, I'm joined by Aaron Stapleton, the CEO of Trinity In-Home Care based in Cincinnati, Ohio. Aaron, thanks for joining me today.
Aaron Stapleton (00:35)
Hey, thanks so much, Miriam, for having me. I'm really excited to talk to you today.
Miriam Allred (00:39)
Likewise, we've known each other for some time now. We bump into each other at conferences. You've interviewed me, I've interviewed you. So you're really easy to talk to. I always feel that. And you're also really knowledgeable at both the micro level and the macro level. So I always get a lot from you and I think others do as well. So you're naturally you are top of mind to be an early guest on the show. So thank you for being up for it.
Aaron Stapleton (01:02)
It's always easy to talk to you like you said, and I'm looking forward to digging into some of the stuff that we do and industry wise, you know, some things that are happening and hopefully some areas that we're moving forward in. And just excited to have a conversation with you.
Miriam Allred (01:22)
Awesome. Well, let's start with Trinity's origin story. Some people may be familiar with you or your background or Trinity's background, but I think it's a good place to start to hear your origin story and weave in some of your personal background and personal highlights as well.
Aaron Stapleton (01:40)
Yeah, so I guess it's always interesting to ask that because you never know where to start. But I think for this conversation, probably the best place to start is before I started this company, I was working for a skilled home care company in Cincinnati, Ohio. And I recognize that there was a need for higher level care in the non-medical home care space.
And so I left the company that I was with and actually the people who owned that company were part of the investors and helped me get this started. And at the time was called Queen City Home Care. And really the focus again was to bring that clinical mindset for higher level care into the non-medical space. so it was the thought process was how do we care for our older adults better?
and how do we keep them safe in their home and give them the best day possible. And I think one of the things that I realized pretty quickly was that it was more about the leadership or my interpretation of the leadership of other companies that was lacking. It wasn't necessarily the caregivers themselves or the frontline workers. And it was also my job to help uplift and show the worth of
the caregivers and so that was one of the things that I think pretty early on was a driver of you know then Queen City now Trinity and and so that was what drove our our mission and so you fast forward 10 years and
we needed to change our name, number one, because there were a lot of Queen cities that were getting into the healthcare space in Cincinnati. That's our nickname for anybody who's unaware of Cincinnati's nickname, it's the Queen city. So I decided to change our name for that reason and also we wanted to grow, expand. So we came up with Trinity for a couple reasons, three to be exact, Trinity.
Number one is because we are a faith-based company. You don't have to have faith to work for us or get care from us, but we do like to put out there that we are serving a higher power that's asking us to serve others, right? And then the second thing had to do with my family heritage and a nod to them. And then third, we're our three pillars of care, customer service, and communication. And since day one,
Those three things drive our decision making, drive, you know, who we are and what we do. And in that time, now we're 13 years in business. We have expanded. now at three locations, Cincinnati, Dayton and Northern Kentucky, which Cincinnati is on the river of Ohio and Kentucky. so Northern Kentucky is just across the river, but around here, they say the river is wide. So you have to have a
a third location for that. that's really kind of brings us to where we are now. And, you know, I guess a 30,000 foot view of our origin.
Miriam Allred (05:02)
was perfect. I love that you also woven the meaning of Trinity. I remember when you rebranded maybe a couple of years ago and I think it's so powerful when you create a new name and brand for the company that resonates both with you personally, with the community and with the people that you serve. And so that was a great overview. I want to hear a little bit more about your business model. Again, as I go into this conversation, I think a lot of people get value understanding the
the framework of your business. And so if you could share a little bit more about your service lines and the people that you're serving and anything that you can articulate around how you think about your business model.
Aaron Stapleton (05:41)
Yeah. So to talk about that a little bit again, I'll go back to our origin story for the first 10 years or maybe even 11, we were really focused on private pay. And so I lump in long-term care insurance with a private pay because we use that more as a reimbursement to the client. We don't really accept that as a payment. And so
We were really focused on that. And then during the pandemic, we wanted to shift, not necessarily away from private pay, but we wanted to diversify the payer sources because we saw that there was a volatility, I guess, in private pay that, you you can go up and down and there's nothing really that kind of steadies the water. so...
We really got into the VA at that time. then Ohio is one of 14 states that has what's called AAAs or Area Agency on Aging. And so those are tax levies that the counties will provide for older adults to have care. And so the older adult will typically pay a much smaller fee to the county and the county will pay our fee.
for their care. And so those services are much shorter in length, but they are consistent and we drive through that a lot. And so the past two and a half years diversifying our payer sources has really helped us with growing the number of people that we can care for. And really that's why we got into this business is to care for people. And I say this all the time.
you know, with private pay, it's starting to get to the point where we're really caring for the top 5%, you know, top three, maybe even the top 1%, depending on how, I guess, proactive people have been in keeping their money and saving it, I guess, towards the end of their life. But a lot of people aren't saving to live to be 100 or 105, right? And so we are
you know, we got into this business to help more than just the top 5%. And so that's why we diversified our diversified our payer structure, and also why we decided to just be able to help as many people as possible. And it's something that we're actually looking forward to doing more of diversifying our payer structure here in the next
a couple months and a year.
Miriam Allred (08:28)
was great. It reminded me of one more thing that I want to ask you about, which is to my understanding, Ohio was a non-licensure state, but you and Trinity and your network have turned the tides a little bit in the state of Ohio. I think that's interesting and is an interesting part of your story. Can you share a little bit more about kind of the when and why behind that?
Aaron Stapleton (08:51)
Yeah, so I think it really goes back to 2017 whenever myself and Doug Wilbur, who owns an Ohio agency up in Cleveland, started the Ohio chapter of the Home Care Association of America. And, you know, my focus was to bring licensure to the state, right? That wasn't the only focus of the starting the chapter, but that was my focus.
And ultimately, I think what happened was a mixture of the the
the need for caregivers during the pandemic. And it showed that our industry and caregivers as a whole were a industry that was needed during that time. But we had to, in the state of Ohio, and I believe in many other states, we had to fight for rights that I think a lot of other healthcare companies didn't necessarily have to fight for because they were seen as
a needed thing during that time. And a lot of that just had to do with not understanding what our industry did. And so between that and then also there was a legislator who was made aware of a client who had unfortunately been stolen from and it was, you know, unfortunately, a bad story that happened from
you know, a bad actor, but what that caused was a need for the start of home care being recognized as a licensure in the state of Ohio. And so in 2021, the work really started and HCAOA, the Ohio council and some other groups got together and started working together.
which was great for us to be able to be seen in that space. And then in 2022, licensure passed and we actually had everybody come on board there. So it was a great opportunity for us to be seen. And now we work very closely with the Ohio Department of Health, which is where we fall under. And I think it just shows that we are an essential service and it also shows that we are a part of that healthcare continuum.
Miriam Allred (11:23)
Yeah, thank you for sharing that. think it's just a huge milestone for you, for the state and a big part of your story and your background and just shows again that you're thinking at the macro level, making an impact outside of just your business, outside of just your market, but really care in the state of Ohio as a whole. And nationally, you you talk about the HCAOA and your involvement on that board and it's nationally, we need to draw more attention to home care and
shape the narrative ourselves and it's a lot of work and it's an uphill battle but it's people like you speaking up, pulling resources, getting people together and having those conversations. So I just wanted to highlight that because of how important it is. Let's get into the topic at hand today. So you and I sat down a couple of weeks ago. Usually I ask guests, you what are your strengths? What are your passions? And a lot of different topics surface but the one that bubbled up for us is
your caregiver career path. And so today I'm really excited to hear you talk about what it is, why you built it, the evolution of it, you know, the success that it's driven. And so the first question that I want to start with before we get into the actual levels and break down, you know, the roles and responsibilities of each, I want to ask, did you have a career path at the beginning when you started the business was that top of mind and something that you initiated out of the gate or
If so, you know, why was the top of mind? If not, you know, at what point did that surface and did you start to build one out?
Aaron Stapleton (12:55)
Yeah, and quite honestly, no, we didn't. And at the beginning, if we go back to the origin story, right, I think a lot of my focus was on the client care. And it wasn't necessarily, it wasn't that I didn't know that the caregivers and the employees weren't important. That was very paramount to me. But I think what I didn't realize was that
they weren't seen as important to everyone else in the industry, right? And I would say to the majority of the people in our area in that industry. And so they weren't recognized, they weren't appreciated. And this is just what I was being told. And so I think at that point, we, I would say within the first year, we had opportunities for people to advance, but I wouldn't have called it a career path.
right? We had the ability for individuals to go from caregiving to a lead or somebody who would be on call that we could trust, right? We had a few caregivers who then became schedulers. And it was, I will, in complete transparency, will tell you that because we didn't really have a solid structure of what that looked like,
we did fail a bunch in the beginning. We probably set people up for failure because we took a great caregiver and we threw them into a scheduling position because we said, you're a rock star here. We don't want to lose you, so we're going to make you an admin. And those are two different work types, right? Those are two different things that you have to work at. And so...
we didn't do a great job of setting that person up for success early on. And so there were little things that we had to tweak throughout the process. And you and I kind of talked about this a little bit whenever we were warming up for this call is we're still tweaking little things, the name of things, how we make sure that we are setting people up for success. What does training look like?
And at what point do we start to train you differently for something else? so this is, I think, one of the things that I hope people take from this call is you are going to fail, right? Like don't think that your failure is a reason to quit. That is really just a way to look at one way not to do it. And what are the obstacles? And then how do you make those work better in your favor?
And then once you start to get that process, then there are gonna be little things that you tweak that make it go faster, right? But you are going to fail at this. Like it's gonna happen, but don't give up on it. Especially if it's something as important that, like a career path, that's going to not only elevate your people, but also elevate your company and your community and the care that's being provided.
Miriam Allred (16:08)
I appreciate you being transparent about the early days and how loose it was because I think a lot of agencies are still in that arena of we have, you know, something defined. People can work towards the office or work up in training and it's just loose and it's undefined. And that is a huge disservice to the employees, to the caregivers themselves. If it's loose to you as the owner and you in the office, then it is very loose and very unclear to them out in the field. And so I appreciate
transparency there because I think that is the first place to start, which is defining this path, defining these roles and taking time to refine it, define it and articulate what that looks like because so often communication breaks down the further down of chain of command so that by the time it gets to the employees, they just have no idea what it is or how it works. So appreciate the transparency there. And the other thing that you mentioned is I think a common mistake is
is the office thinks, caregivers want to work up to the office. Like that is the only career path for them is all caregivers have the ability to become schedulers or HR or something in the office. I think you and I can both agree. Oftentimes that's not what they want. Oftentimes that's not what they're best suited to, but
we need to kind of unwire that of, you know, the place that they're going is from caregiver to office, because again, that's not often what they want and a common misconception I think people make early on.
Aaron Stapleton (17:39)
Well, and you know, we're going through that right now. So we're taking our lead clinician and we're still keeping her out in the field, but we are adding a workforce development manager title to her where she's helping with create a lot of the ongoing education. She's helping oversee that. She's helping oversee orientation.
from a clinical standpoint, but also just being out in the field, understanding our clients and that type of thing. And so, you you kind of hit the nail on the head here is a lot of people who are caregivers or clinicians, they're doing it because they have the love of that one-on-one care, that, you know, that connection. And if you're bringing them into the office, you're taking that away from them, right? And so that can be a, you know, a negative thing.
And so for this specific clinician, like that was part of our deal. She was like, you can't take me from my clients. And we were like, no, we're not gonna do that, right? But I do think that a lot of times we see that as, hey, it's a promotion. We're getting you out of the field. We're getting you, but that's what I think drives a lot of people. And I will say from my standpoint,
Part of the reason why I started the company or what I love to do, I don't do anymore and I feel that whole little bit, which is I don't get out to see the clients as much as I used to and interact with the clients and the caregivers while they're out there and having that one-on-one, you know, FaceTime. But, you know, that's for me and that's something that I'm willing to make that sacrifice because I think that there's something bigger for me.
than those one-on-one interactions and helping grow things. But there are a lot of people who are like, no, this is where I want to be. And you can't change that DNA in somebody.
Miriam Allred (19:38)
I think that's a really good reminder as we go into defining your career path. I think that's a good reminder that likely a career path like this probably only applies to maybe 60, 70 % of your staff. That other 30 % or so, they have different goals. They have different objectives. They want something different that doesn't exist in this career path and that's okay and you need to acknowledge that. But again, the goal of a career path is to give them options and opportunities.
but then also help them think bigger. Think about, okay, here's where I am today, here's where wanna be in 10 years and that isn't defined. But again, it's opening the door to that conversation of what do you want out of your career and how do we help you get there? So let's dive into your career path. There's three levels and we're gonna talk a little bit about each. And I want you to share the name of the level or what you call kind of that person in that role. The tenure of that.
of that role and then also we'll talk about the training in that role. So let's go ahead and start with the first one, which is level one. And you call that role a personal care aid. Is that correct? And so let's, let's talk about the description of that role or I guess the first question I want to ask out of the gate. That's always interesting to people. Do you hire people with no prior caregiving experience or is it a prerequisite to work for you all that they do have experience?
Aaron Stapleton (20:47)
Yeah, yeah.
So it is a prerequisite that you do have experience. For the first eight years, you had to be a CNA or STNA. And like many other things that we had to pivot on, the pandemic kind of made us pivot from that because we had, I guess we didn't have to, but we felt that
to service our clients, especially the ones that were in independent living facilities, we did have to make the mandate for the vaccine. Now, we were very intentional with that. We didn't just come down with a mandate saying you have to, like we educated our employees, we helped them to understand what we knew about the vaccine at the time and also why we felt that it was best not only for our clients, but also for them. But we couldn't dwindle down that
that number that we were fishing from, right? In that pool to such a low number. So we said, okay, we now are just asking that people have experience, right? There are, we will be, I don't wanna say loose with that, but we also will take individuals who have cared for loved ones, right? Who are like, hey, I haven't done this as an actual.
job before, but I cared for my mom for 10 years who, you know, was going through dialysis or who had dementia or who had... Typically, we, if you don't have the state certification, which in the state of Ohio, we've got certified nursing assistant and state tested nursing assistant. If you don't have one of those, we typically will go through a little bit more knowledge-based class things that they go through in those.
But even the STNA and CNA, just because you went through that class and you took that test, we don't want to assume that you just know everything or that you know how to do it the Trinity way. So, yeah.
Miriam Allred (23:08)
That was great context going into this. So let's talk about how you define this level one then you're using the term CNA and STNA. This level though is called the PCA or personal care aid. What, how do you define kind of their role? What does that include?
Aaron Stapleton (23:25)
Yeah, so the PCA is really, it's the baseline of what we hire people on for, right? And so these individuals are able to care for all ADL assistants. So, you know, they're able to help you with properly bathing, how to, how to groom, how to dress, how to toilet, how to be able to safely transfer with a gait belt, making sure that we're helping with IADL care, right?
There will be so everyone who comes through our training or comes through our doors for orientation Everyone has a basic I believe it's two-hour dementia care training of you know what to understand about the About the disease how to best engage with someone, you know, if mrs. Smith says that the grass is blue Is it really that big of a deal to say? Yeah, the grass is blue, right?
So just little things that we can make sure that they understand the basics of not only care on a global level, right? Because we still want to have that personalized care that we go into on an individual basis, but the global care as well as what we call the Trinity way of doing things. And so that's going to be
you know, professional conduct, what to look like, you know, as far as, you know, wearing your scrubs, making sure that our fingernails are at an acceptable level, you know, your proper universal precautions and that type of thing. So really, everybody, there's not one person who's not coming on as a PCA. When you leave our orientation, you are a level one caregiver, unless
you have some of the other, I guess, if you have current certifications that show us that you're able to advance to or start as a level two.
Miriam Allred (25:31)
Okay, that was a great overview about how long do people stay in that role? You know, if someone's coming on and they start in this level one, is there kind of a timeframe typically that you would say they stay in that level or that tier?
Aaron Stapleton (25:45)
Typically, I would say the average is probably about a year. Most people, think, they're... So one of the things that we haven't talked about is our hiring model and the fact that we're not really a PRN or as needed hiring company. We're more full-time, part-time. So most of our full-time people, they want to get to that level too as quickly as possible.
because it also comes with a pay increase. so, you know, we do have a limit. It's like, okay, you need to show us for six months that you can properly care for any client that we put you in with there. And so that six to 12 month range is typically kind of where people fall into.
Miriam Allred (26:34)
Okay. Can we, can I ask about pay? Are you paying average? What percentage above average than your market?
Aaron Stapleton (26:43)
Yeah, so we are above average. I think it really depends on where you look. So we're about a dollar. So we start about a dollar over more than what was in last year's benchmark study from Activated Insights. We also kind of do our own, you know,
education on what the average is based off of things like Indeed or Career Ladder. And also, you know, we just ask like, hey, what's everybody else paying? From what we understand, we're typically about 50 to 75 cents more on the level one. I think what people see is the ability to
to increase and typically with each one of these levels is a dollar increase.
Miriam Allred (27:48)
Okay, okay. Yeah, great. I was gonna ask that as a follow up. One other question, are you using this career ladder in your recruitment efforts? You mentioned your onboarding and your recruiting. Is this something that you lead with out in your recruitment efforts? Or is it something that you mentioned in onboarding? Or where does this become like effective?
Aaron Stapleton (28:11)
Yeah, so it's more, it's a part of the interview process. You know, I sent you over our training program and what it looks like. It's somewhat lengthy, so it is a little tough to put in a job board. But whenever we're having that conversation, we want to make sure that we are leading with this because most people are looking for the opportunity to, you know, to not just be in
one place and you know, how do they grow and also why should I work for you versus Susie down the street, right? And so this is something that we want to make sure that we lead off on because anytime we're interviewing a potential employee, we understand that, you we're selling our company to them. I think sometimes people are interviewing and they think that the caregiver is interviewing
for the position, really we're the ones, mean, there's some back and forth there, but we have to sell them for them to want to come to us.
Miriam Allred (29:19)
I love that. It's a great feeling when your employer in your interview is talking about your future. It just is a good sign that they care about where you are today and what you want to become and how they help get you there. I love that. Bringing this up in the interview as a differentiator, but also just as a conversation starter of, know, where do you want to be in three years or five years or 10 years and how do we help you get there? How can we be a stepping stone or a landing pad to be able to help you get there? I think that's...
a really great sign in the interview. One more question I want to ask before we talk about the level two. Some people may get deterred to implement something like this because it does take work. is an additional tag or something in your software and take some of the administrative burden to be able to kind of organize and manage all of this. So I just wanted to ask kind of on the backend how you manage this? there...
something in your software that makes it easy to do this? Have you created your own system or is it an Excel or how do you keep track of these different levels and then how is that implemented?
Aaron Stapleton (30:26)
Yeah, so I would say it is so we use access care and we're able to tag them in in the system to. So like I said in our previous call, we just kind of rebranded these names right and they were tier one, tier two, tier three. And so that's really the tags that we have in the in the system.
And so we also that allows us to be able to better match our our clients and our caregivers as well because we don't want someone who has You know a high functioning or I shouldn't say high functioning a in stage
Diagnosis, I'm wanting to say dementia, right? Like a person who has behaviors, a person who has, we don't want a level one caring for that person, right? Because that would just not be successful on the care side or we would most likely lose that caregiver as well. So we do have those tags that we use to help not only from a...
pay structure and where they are, but also from a matching, how do we make sure that we're connecting the right client to the right caregiver?
Miriam Allred (31:52)
That's great. I think the important thing to call out here is just systematizing this. Again, it's not that hard to define and to systematize, but making sure that you do so that it's top of mind for your schedulers, for your HR team, for the clinical team, so they can see these tiers when it comes to things like matching and pay. It's just very top of mind and being able to systematize that is super important. So let's talk about the level two. What do you call this level and what is the
the responsibilities of this level too.
Aaron Stapleton (32:23)
Yeah, so level two is called Senior Care Assistant. And again, we try to make sure that our clients understand that we're coming in to assist them. We're not coming in to take away their independence. And so that's part of the reason where we feel level two is much better at personal care techniques. They're able to better understand
the care plan and not necessarily say, this person needs this task to happen. It's how do I and the client across from me, how do we work together to make this task happen, right? So I like to use the dressing, and this is a very low level, don't make fun of me for this one, but I like to use the dressing example in this because
Most caregivers who have just gone through the these are the things that you have to do. They see dressing and they go, OK, I'm going into Mrs. Smith's closet. I'm getting her red pants and her blue shirt, and we're to get her dressed so that way we can get her to the activity that's happening at 9 a.m. Right. But what happened there was you took away your your your clients independence. And so now they're wearing clothes that they didn't necessarily want to wear because they wanted to wear their
You know, they're they're Notre Dame gold because Notre Dame was playing that night, right? Or they wanted to you know, they wanted to wear certain earrings or whatever it is but we took away that independence because of the the task getting done and doing so in a quick manner right and what we consider to be efficiencies and so these individuals are
more about assisting, they understand, taking time, building the relationship over that efficiency. And really, in a six, eight, 12 hour shift, a lot of times even in a four hour shift, which I think most people have, that's our kind of standard minimum in our industry, I don't know how much efficiency we need to have because that means that there's downtime and
A lot of times downtime means that we're not providing that companionship, that care. It's more, you're sitting here doing something, I'm sitting over here doing something. So that's part of the reason for that name. There is some increased dementia best practices, about another three hours of that. then really understanding
your surroundings and it's about understanding what to look for. And so it's not just about caring for the person's diagnosis, it's also about caring for the person as a whole, as a person. And I think a lot of times we kind of get lost in that. So those are really some high level things that we focus on. But it's also about
managing yourself as a caregiver, right? Communication skills with family members that, you know, sometimes the family member is harder to deal with than the client. And understanding how to set yourself up for success with that. Understanding when to recognize that you are having, you know, a need for care.
and being honest with yourself about that. it's about not only making sure that our people are doing a great job with our clients, it's also about kind of shaping them into a more well-rounded, I guess, caregiver and team member.
Miriam Allred (36:28)
I'm hearing that a big part of this path is training and elevating their understanding both on the care side, but also on this interpersonal side. I want to ask, how are you all delivering training? Do you have an online training provider? Then do you go above and beyond that? Is there proprietary training that you've built to tackle some of these more interpersonal or less clearly defined?
skills that these caregivers need.
Aaron Stapleton (36:59)
Yeah. So we do use Home Care Pulse, well, Activated Insights for, you know, for the, it's going to take me a while to get used to that. But we do use them for the online training. And then we have our, our own training site. We actually took the first floor of our building and made that a training site. And so,
Miriam Allred (37:08)
That's okay, it is for all of us.
Aaron Stapleton (37:27)
that has everything from you know a Hate to call them dummies, but you know an anatomically correct dummy that has you know all the all the things but you know from a a calf of you know a drain But we've got the hospital bed. We've got the Hoyer lift. We've got the Sarah left We've got you know all the things that we want to make sure that people are able to do
themselves right and so it's it's I don't want to say it's easy to do these you know to answer questions on a paper but I think sometimes we answer questions on a paper and we're like yeah I've got it and then we get into the real world and and we try to do the thing and it was like well I know that this is what I'm supposed to do but you know it doesn't feel right or it's not so we like to have both because I think it gives us both
It's working both our muscles and our brain. And, you know, I'm a big sports guy and muscle memory is key, right? The more you do it, the easier it is. And so if we're putting people through the process and they feel comfortable and confident to ask us the questions whenever they're in the training room, then we feel comfortable and confident whenever they're in with a client by themselves that they're going to say, you know what, I've got this.
Miriam Allred (38:55)
And then what about this other piece, which is the communication, the interpersonal side, like you said, maybe one of the hardest parts of the caregivers role is that communication piece with the family. And how do you teach? How do you train? How do you help them on that side? You know, that maybe it's still kind of a mystery that we're all figuring out, but how, how do you support them with that interpersonal and with that communication piece? For some, it may be inherent and it may be a skill or a strength, but for some it's not. So how do you support them on that front?
Aaron Stapleton (39:26)
Yeah, I think some of it is learning from our previous mistakes and learning from, know, it seems like every month, quarter, year, whatever, you get a new story, right? And if we're able to use those stories, not just as, that happened, we got through it, we're all better, but okay, that happened, how do we make sure that it doesn't happen again? And using that in the training, you know, we have a...
client whose daughter wants to have everybody's phone number. Okay, if she asked for it, you you let us know but the answer is no, we don't give out our phone numbers. If the daughter wants that, we're more than happy to put a cell phone in the client's home where she can text whenever you're working. But outside of that, like she doesn't need to reach out to you outside of that, right? And that's one example.
We try to make sure that we're learning from our lessons and then we're teaching it to everybody else to make sure that moving forward. So in 13 years, we've come up with a lot of lessons and that's not to say that in 13 more years, we won't have a thicker book, but it gives us an opportunity to at least try and be ahead of the game. But you always have to be nimble and flexible and on your feet. And so...
We're trying to teach on what we know and whenever something new happens, then we say, okay, this is how we're going to address it now and we're going to add it to that book and then we're going to make sure moving forward that we continue to teach that so that way it's not going to continue to be a problem.
Miriam Allred (41:10)
Yeah, I love this book concept of just documenting all of these things because, the things that you've seen and heard over 13 years, the things that we've seen just across the industry, we've seen a lot and heard a lot, but it's documenting that. But then you're saying closing the loop. We bring that up in orientation. We bring that up in onboarding. We bring that up when it happens again, and we continue to learn from that.
And being proactive with the caregivers, letting them know that someone in the office is always there to take the call when they need help, when they need support, when they have a question, and then the team is prepared and ready to answer that. think that is so important.
Aaron Stapleton (41:49)
Yeah, and you know, the thing that rings true in my mind, is success happens in processes, right? And so if you don't have processes, it's the same thing that we tell to our caregivers whenever we tell them that they have to document their shift, right? If you didn't document it, didn't happen. Well, if we tell that to our caregivers, but as people who run businesses, we don't document things, then we're, you know, we're trying to...
speak out of both sides of our mouths. So it's very important that we realize that success happens in those processes and you document things and you go, okay, how do we take this problem and turn it into a solution? How do we make it something that we can teach from and then we get better from, right? Yeah.
Miriam Allred (42:39)
Exactly. And the word that comes to mind is buy-in. know, documentation feels so tedious and so mundane and why do we have to do it over and over and over? But like, you just, you know, you just sold it. It's like there is success in process. There is success in documentation and there's reasons why we do these things and bringing even down to the caregivers, bringing them around to understanding why we do all of these things is really important. So I know we're veering a little bit here, but I feel like this is a really good conversation that we're having about how long
Aaron Stapleton (43:03)
Yeah.
Miriam Allred (43:07)
Typically, does someone stay in that level too? Is there kind of a timeframe that you see people in that level?
Aaron Stapleton (43:13)
Yeah, so typically this level is where a lot of people kind of level off, I guess, is where they stay. I would say if there is a change, it typically will happen within six to 12 months again. So most of the time you're going to get, know, so again, 100 % of the people come in as a level one, right? I guess I shouldn't say 100, but probably no less than 95.
A level two is typically going to have, you know, maybe 50 to 60 % success rate. And success is not somebody came in and they didn't follow through on it. It's more just that somebody decided this is the place that I want to go, right? And then again, another six to 12 months.
they're saying, okay, I want to move forward, right? And I would say that that's probably, you know, I would say around, we're not quite half of the individuals, but it's probably because it does fraction off a little bit because level three, there's a couple different areas that you can go in level three. And so I would say it's probably
maybe 50 % that some individuals will go to the care team lead, but then other individuals will go more towards the specialized training, right? So true specialized dementia care, right? And we're talking, I think it's 14 or 15 hours of dementia care, end of life care, how to properly care for somebody at end of life, how to give them that comfort care because we do.
that end of life care, how to process that, all the way to Parkinson's as well, right? So there are different specialized trainings that we would consider as the level three. So it kind of branches out a little bit there, but I would still say that the amount of individuals that go that way, if we started at 100 % and then
We took about 60 % of those individuals in level two and then probably, I would say about 20, we'll say 25 % in that level three.
Miriam Allred (45:55)
Okay, this is perfect. You're getting, you're moving on, but I like how you're thinking through these numbers because this is really useful about how many people progress to the next level and what that looks like. if I'm hearing right, it kind of sounds like after level two, there's kind of two additional paths. One is in level two, more specialized training. They vocalize or have interest in specializing. And then there's also this level three, which is what you call the care team lead.
Let's talk about that role, the care team lead. What are the roles and responsibilities of that individual?
Aaron Stapleton (46:30)
Yeah, so the care team lead is really the individual who can help support, mentor, and be a supervisor for other caregivers, right? And so they can do anything from help with meet and greets. So whenever we have a caregiver start with a client, they're there to help with that initial introduction. They can help with if somebody's out in the
in the field and they say, I have worked with dementia clients for 20 years and I cannot redirect Mrs. Jones, right? That's part of what they can help with. It's also being able to be out and support caregivers on an as-needed basis and just being out there and making sure that our caregivers are professional, that they're doing what they're supposed to be doing and...
overseeing that. there's really a lot of ability for those care team leads and they're the ones who make sure that they are supporting on a hands-on basis with our caregivers out in the field.
Miriam Allred (47:46)
What's an approximate ratio? How many caregivers approximately would be assigned to about one care team lead?
Aaron Stapleton (47:54)
Yeah that's a good question. I would say that it's probably about... that's a good question. Somewhere between 35 and 50. We focus more on even though they're overseeing the caregivers, kind of they're more connected to the client, right? But I would say that
It's about 35 to 50 per care team lead.
Miriam Allred (48:25)
Okay, that's great. And that's good to hear you even reference that they're attached to the client because then the client may have multiple caregivers. So there's kind of different like trees for each client and they're assigned that way. Makes sense.
Aaron Stapleton (48:37)
Yeah, and also, know, caregivers, there are going to be times where a caregiver will go from Mrs. Smith and, know, for whatever reason, caregiver and Mrs. Smith aren't getting along and so caregiver needs to go instead of having that, that care team lead bounce from one person to another and go it just from a continuity standpoint, it's always it's been easier for us to at least set them per client.
Miriam Allred (49:06)
You mentioned this before, most of these care team leads are probably still providing care and doing some of this mentorship. I know it probably depends on an individual basis, but if you had to break down their time about how much time are they spending still caring for their clients versus this additional leadership position.
Aaron Stapleton (49:30)
Yeah, I would say it really depends per care team lead, but I would say our sweet spot, like whenever things are going really well, it's a true 50-50 split. So if they're able to still give that care to a client and then they're able to do a little bit of that leadership piece, then they're kind of getting the best of both worlds. And what we try and do is
is sometimes make sure that they're doing that maybe even at the same time, right? And I don't mean the same exact time, but like if they're caring for a client from 8 a.m. to 12 p.m., right, for a four-hour shift, and then they have some time from 12 p.m. to 4 p.m. to do their leadership, then they kind of have that full day, right?
or if they're a nighttime caregiver coming in a little bit early before their 12 hour shift and seeing some of the other caregivers that might be in that facility or in a close general area or after their shift. So we try and get them to work to where they're not completely separated of like, today's my care day and tomorrow's my lead day.
Because I think then you just kind of get exhausted and you don't feel like you're you're getting any time off
Miriam Allred (51:06)
Mm-hmm. They're multitasking just like the rest of us. Earlier we talked about wages and you mentioned a dollar increase with each of these levels. At this care team lead, do they have two different rates? A rate that they're providing care at and a rate that they're providing their like mentorship and leadership at or do you have just one rate that they're at in this level?
Aaron Stapleton (51:09)
Yeah.
just
one rate because if I tried to do it the other way, I think our payroll person would hang me. No, we've tried to do that before. We've tried to do different rates and it just gets confusing. And then you also have people who are then like, they feel torn because they're like, if I have to, I want to care for somebody but...
Miriam Allred (51:38)
And I... yeah.
Aaron Stapleton (51:56)
You know, I'm getting less money than I am whenever I'm in my care team lead role So it just for us It's not necessarily about the the role or the action that you're doing at that time It's about the time and effort and energy that you put in to get there, right? and it's not a Okay, you've been with us for X amount of time. It's
You you were intentional in the growth of yourself and we believe that the growth of you is helping the growth of the company. And so we want to thank you for that. And that's really what we're doing the increase for.
Miriam Allred (52:41)
I love that and keep it simple. There are a lot of agencies out there that have multiple rates for every caregiver and wow, that's a lot to manage. And not that there's not value in that, but I think keeping it as simple and clean as possible. And what you're saying is they're, they're providing even more value as they elevate themselves that benefits both you and benefits them as an individual and you as the business owner. So it's good to reward them and value them through their compensation.
Earlier we were talking about, I know it's kind of knocking on not all caregivers make good schedulers, but I imagine over your years you have had people move up through this ladder and start to work in the office. Can you share any success stories or maybe there's a lot of people in your office that started as caregivers? Can you just share some numbers or any success stories that come to mind there?
Aaron Stapleton (53:31)
Yeah, I mean, I would say most of our office staff have been caregivers at some point in their career, right? They're not necessarily caregivers that were ours, that we took through that career path completely. But I would say that we've had a lot of success in having people who understand what our
you know, what our current caregivers are, you know, are going through and what the expectation is. You know, our current field supervisor who kind of oversees our care team leader, leaders, she was a caregiver with us. Let's see. So she's now been with us for six years.
She was a caregiver with us for two years and you know brought her to care team lead And then you know brought her to field supervisor and so now she oversees that you know those those level three caregivers and so that's I think the people Both look up to her because they understand the the work that she's put in and trust her because
you know, she has built relationships with them over that timeframe. We have our, we have, so my longest standing employee outside of myself has been with us for, so like I said, we're gonna be coming up here in just a couple days celebrating our 13 year anniversary on April 2nd. And our admin assistant,
has been with us for 12 years and eight months because she was an excellent caregiver. We kind of worked her into an admin position and has just been with us since. so those are, just, about two weeks ago in our Dayton location, we just.
brought a person to a field supervisor role and one to a clinical role in Dayton. So we have a lot of success stories. We have failures as well, right? We've had people that we've put into positions and you know, it's you can't I think
in the admin role, like it's hard to unwind that. If you bring somebody in and it doesn't quite work out, it's hard to put them back in the field. It's very tough to do. we've had a lot of successes and I think people see that we care about them and we care about their growth and we care about just valuing them.
And I think that's one of the things that helps us succeed.
Miriam Allred (56:44)
That was so well said. A lot of success stories and I love to hear those. And I even like you just kind of alluding to like not every person that came to the office was the right fit. But like you said, they understand that you're both trying. You know, I've even heard of some agencies do kind of like an office rotation, you know, give them a taste of the different roles in the office and let them see and explore and say, that looks interesting or no, I definitely don't want to do that. Or let me give it six weeks. And then I think, my gosh, I don't want to be a scheduler.
You know, it's just, it's a conversation and it's opportunities and it's opening doors and it's giving them options to think about whether they like them or not, or whether they want to take them or not. It's just a good conversation to have at different milestones. I know we're almost at time here, but I want to ask about advice that you would give given all your experience building out this career path. And like you said, it's still evolving.
And we've talked a little bit about like some of the mistakes made or pitfalls, but what advice would you give to new owners that don't have a plan in place that, you know, what advice would you give them to put one in place or what are some of the early steps that they should take?
Aaron Stapleton (57:52)
Yeah, I think start small. There's nothing wrong with starting small and and try things out. I think what I would say is make your employees a part of it. Don't try to give them something that they don't want. And that means, you know, like like we kind of talked about before, originally my thought was, OK, you know, the the top of the mountain is
caregiver getting to be an admin right and and that's because I didn't involve our our staff in the process and so you know I would say get a get a small percentage of your staff 10 % whether that's two people whether that's you know five people whatever it is get a get a small percentage have them sit down with you at some point and
and just have the conversation be curious about how you can help them and they're gonna tell you right as long as they feel like they can trust you and And from that you can build something I think
Our team members, our employees, they want to be heard and they want to feel valued. And the best way to do that is to give them your time and be able to show them that you do care about them. It's not about giving them the stuff. It's about being heard. It's about listening and then going, okay, here's how I think we can do that, right? And so that would be the big thing that I would say is get a few of your people
take them out for breakfast or bring them in for lunch or whatever because food is always a yes and just have a conversation with them and then start small. I think sometimes we think of these grandiose ideas and either one, we don't do it because it's like, how do I start eating this elephant? Or number two, we...
We don't follow through on it because there's too many moving parts, right? If we start small, we build off of it, I think you can create something pretty cool.
Miriam Allred (1:00:14)
think people might be pleasantly surprised about what they hear from their caregivers as well. I mentioned this quite a bit, but I had the opportunity last year to help with the caregiver award through the HCAOA. And I read and talked to a lot of caregivers across the country. And this was one of the questions that I asked them. What do you want out of your career? And the answers were across the board. It was fascinating. People want to be teachers. People want to become RNs. People want to...
get back to taking care of their children and they want a path to be able to do that. And I could go on and on. The list was not linear. The list was not only healthcare related. The list was just vast and interesting. And as an employer, it's good to be aware of those things. What are these people's goals and objectives as humans? And how do we be a stepping stone for them to get to their greater goal and objectives?
Aaron Stapleton (1:01:09)
Yeah, I think what I would say there is far too often we are concerned about losing our employees. And I would say don't be concerned about losing your employees. Be concerned about how you lose them. If we are setting our people up for success and they ultimately reach their dream because of us, we're going to get the riches of that.
And so far too often it's like, this is something that I need to keep close to me. And I would say that we have to stop thinking that way. Like we have to set people up for success and sometimes success is outside of our own four walls, right? It's outside of our control. But if we truly care about others and we show them
how to get to that success and sometimes we can help them with that and other times it's just showing them the path, right? But if we're able to help them with that, again, I think the riches will come.
Miriam Allred (1:02:15)
I'm glad you addressed that because a lot of people do worry, we're going to work them out of a job and then who are we going to have left? But that's a good problem to have because again, you're helping them grow into the individuals that they want to be. And like you're saying, you will reap the rewards. There will be referrals. There will be success stories and testimonials that draw people in. Like it's a win-win for both you and for them. In our last couple of minutes, I want to zoom out here a little bit, Aaron. You have the opportunity to see things at a macro level across Ohio and across the country and the different boards that you sit on.
And something that we're talking more and more about is professionalizing the role of the caregiver. Again, we're talking about career pathing and future planning for these individuals. And I think we still have a ways to go on professionalizing this role. What would you say we're doing well? You know, what is some of the progress that we've made? And then I want to hear, you know, where is the improvement left to be had? How can we continue to professionalize this role?
Aaron Stapleton (1:03:12)
Yeah, it's great question. And I think what we're doing well is we're getting started, right? And again, this is a big train that you have to, you just got to put some coal in the fire and you've got to get the wheels moving. And I think we are moving the wheels. We're moving forward in that. I think a lot of companies that made me start the company 13 years ago,
have started to see now that the employee base is important, right? And I think the pandemic helped that. think the ongoing caregiver shortage that we're now calling a caregiver crisis, or we have been for a few years. And you're even seeing this with other areas. Your nurses are in a shortage. And so I think that we're seeing the importance
finally in an industry that retention is key. And so there is some focus on caring for the caregiver and caring for those frontline workers. And I think we're also starting to see that our industry is being noticed in the healthcare continuum. And so we're starting to get into conversations that we weren't.
10, 15, 20 years ago, whenever there are conversations about how healthcare works or if a hospital system, just about a month ago, I was able to have a dinner with six of our local hospital agencies in town and talk to them about why it is important to include
non-medical home care in your discharge planning. I think, also educate them on what non-medical home care is. We're still educating, right? And so, but I think that it's starting to stick. Whereas five, 10 years ago, it wasn't sticking. You would say home care and people be, they'd be like, yeah, home health. and, but it's starting to stick. So I think it's, it's moving and we're educating, we're getting at the table.
We're having the conversations, which is great. And we are becoming more professional as an industry. We mentioned it before, Ohio was the 30th state to become a licensure state for non-medical home care. That means we have 20 more states that, in my opinion, should be licensed. If you have to be licensed to give a massage,
you should have to be licensed to care for an older individual. If you are assisting somebody and laying hands on them and helping them with personal care, there's no reason that we shouldn't have licensure. Now, you know, do I think that licensure needs to be constricting? No, I think, you know, it needs to be guardrails and we need to make sure that we're setting appropriate boundaries. to me, that also helps with
setting this as a professional industry that people want to come into. And then I think career paths are a big part of that. We have to show people that it's not just a job, it is a profession. And that's what professions are. Professions are, have the ability to grow. I have the ability if I want to. Not everybody wants to. Some people are just like, I want to get into this and I want to stay at this level. And there's nothing wrong with that.
But if we're not giving people the opportunity to grow, then our industry is not gonna grow. We're only gonna be as strong as our weakest link and we have to be able to show people that they have the ability to grow with us.
Miriam Allred (1:07:19)
That was so well said, Aaron. There's a reason why you're the CEO and why you're on all of these boards. I love the soapbox and I love the passion behind this. You're right, we're on our way. Home care is being recognized. We're getting that seat at the table. We're talking about home care. We're defining ourselves in this continuum. It's not an easy nut to crack. It's a long process. We're talking years and years in the making, but...
Aaron Stapleton (1:07:24)
But.
Miriam Allred (1:07:44)
That's what drives all of us, I think, is where is home care going to be in 10 years from now and how are we inching towards those goals? We're talking about career pathing for the caregivers. It's like, we're also career pathing for the industry. Where do we want to be in three, five, 10 years and how do we get there? It starts with these conversations. It starts with making an impact.
Aaron Stapleton (1:08:03)
Yeah, and you know, I think my dream, my vision, whenever we talk about, you know, I would love to see those individuals who do want to stay in healthcare, but you know, are going to work out of out of the caregiving and become an LPN, an RN, a PTA or a CODA. You know, I think that there should be something to to, hey, I was a caregiver for Trinity In-Home Care. And you know what Trinity works with? You know, these
skilled home care agencies or these hospice agencies and they know our reputation. So I should be able to get a job with that company because they know the kind of worker that I am, right? I think that that's a part of it as well as being able to set our employees up for success if they do go outside of the scope of work that we can do.
You know, I would love to see that as an industry. Like I would love to see us to be able to set our employees up for other healthcare jobs if that so happens, because from my standpoint, that one caregiver that you just lost is gonna tell her five, 10, 15 friends. And instead of them being like, well, I can work my way up in Amazon or McDonald's or whatever, they're like, you know what?
This job has meaning and that's nothing against anybody who is working in those other jobs. But I work in the healthcare industry because I feel like I am making a difference in people's lives. And I think a lot of healthcare workers feel that way. And so we need to show people that have that heart to care for people. We need to show them why they should be here and not in other industries.
Miriam Allred (1:09:53)
I love that concept of tapping the network of the business. You have all these referral partners, you have all these connections, you have all of these doors exposing them to your caregivers. Okay, here's our hospice partner, here's our hospital partner, here's our assisted living partner. If you want opportunities in those different areas, we can help you get there because we have those relationships, we have this network that's not just beneficial to us as a business, but it's
beneficial to all of our employees as well. think that's really well said. then just highlighting those, that's probably happening to some extent, but how do we get it to happen more? And then how do we tell those stories so that other employees, so that the industry can see those successful career paths that these caregivers have gone down?
Aaron Stapleton (1:10:37)
Yeah.
Miriam Allred (1:10:39)
Exciting, Aaron. We'll go ahead and leave it here. This was so insightful. Thank you so much for being willing to share about your career path. Again, there's so many topics that you and I could talk about, but I love that we landed here and that you have built this career path and that it's evolved over time. Maybe we'll have to check in a year from now and hear how it's evolved because that's how this works. This is how home care works. There's no one right way to do it. It's always evolving. We're always fine tuning and finding new ways and ideas.
executing differently. And so I appreciate you sharing all of this and appreciate all the work that you do for your business at the state at the national level. We'll all look forward to the conference in Dallas this fall, but thank you for all of your service rendered across the board.
Aaron Stapleton (1:11:22)
well, thank you, Miriam. And honestly, I really appreciate all you do and being able to get our industry out to as many people as possible. And it's always great to talk with you and it's easy. So I really do appreciate it. And anytime that I can be of service, please let me know.
Miriam Allred (1:11:44)
Thanks so much, Aaron. Well, thanks for joining me today in the lab. Again, this is the Home Care Strategy Lab podcast. You can listen to it wherever you get your podcasts and we'll look forward to another episode again next week.