Home Care U | How to Structure Service Hours to Increase Margins (Jessica Nobles Pt. 1)

[ 00:00:03 ] Welcome everyone to Home Care U, a podcast by Careswitch. I'm Miriam Allred, your host. It's great to be back with all of you. Thank you for those of you joining us live. Those of you listening to this afterward, it's great to be with you. Thanks for listening in. Quick introduction for those of you that might be new to the show, we've got new listeners every single week. So quick introduction, Home Care U is a free education series for home care owners and operators because nobody went to school to run a home care agency. Maybe one day one of you will. And when you do, please reach out to me because that's our slogan. And we have yet to have someone that has said they haven't.

[ 00:00:37 ] But the premise of this show is because nobody went to school to run a home care agency. And so we're bringing the free education to you. The show is brought to you by Careswitch, an AI-powered operating system for home care. The system is human-led and AI-assisted. And the AI can help you with things like data retrieval, compliance, scheduling and shift review, care planning, reporting, and more. So if you're interested in learning more about Careswitch, visit careswitch.com to learn more. Today, I'm really excited to be joined by an industry fan favorite, Jessica Nobles, coming to us from Chattanooga, Tennessee. Jessica, bringing you on the show is long overdue. So thank you so much for being here today. I'm really excited to have these sessions with you. Yes, I'm excited too.

[ 00:01:24 ] I'm a fan of the show. I listen. I'm an avid listener. Yeah, so it's time. It's time to have you in the hot seat. Everyone says that. And so I say, okay, disclaimer, you know, here we go. I'm about to get you in the hot seat and ask you a lot of questions. Like I mentioned before, before we jump into the session today, I want to give you some time and space to introduce yourself. I know a lot of people probably know bits and pieces of your background. But I want you to talk about your world pre home care, what led you to this crazy industry, what motivates you to stay in it year after year, give everyone, you know, just a couple of minutes about yourself and about your background.

[ 00:01:59 ] Yeah. So when it comes to home care, my journey started when I was 11 years old. So there's not much to pre-home care in my life. I was the primary caregiver for my grandmother, literally taken out of public school, put into homeschool, just so that I could help take care of family. So, and I know the struggles, the firsthand struggles of being a family caregiver, and what it does to families. So when I was 18, and it was time, you know, right, to get a real job. And I knew I always did. I was born an entrepreneur. But at 18 years old, I just enrolled in nursing school, worked a very limited time in the hospital space. And it was like, this isn't for me. I want the personal care.

[ 00:02:40 ] I want the solutions. I don't want to be the bandaid. And I don't want to be the person putting the bandaid on. I truly want to bring solutions. I want to bring healing. I want to bring unity. And I want to bring a true peace of mind, not just in messaging, but in action. And so I created my first home care agency. I don't even know if you can call it an agency. I was just like, I'm going to start getting clients. And I'm going to start hiring caregivers. And we're going to do this thing together. Our slogan was caregiver owned and operated. That's about as much as I thought ahead. And very, very quickly, I like, really learned there's a true need for true, honest, dependable care.

[ 00:03:21 ] Like, there can be 100 home care agencies, and there's still a huge need for that. So I started my business, and I did it. I did it the way I thought it should be done. And I call it the traditional home care way for many years. And I struggled. I struggled to get to a million. I struggled to maintain it a million. I always was at a capacity problem. I knew I was capable of doing more, but I was always maxed out. I was missing meals. I was missing time with my family. I was sacrificing a lot of the personal things of who I am. Hobby? I'm just now at 36 trying to find what my hobby is beyond creating more businesses within the home care realm.

[ 00:04:03 ] But after several years, and actually exiting that business, I started working on the franchisor side, consulting on how to create incredible experiences. And then finally, I was like, you know what, I'm going to create a business exactly like I want it. I don't care how much money I make or how little money I make. I'm going to go in, and I'm going to create a business exactly like I want it. I'm going to do what I know needs to be done to be a true solution, not only for our clients, but for the care providers that we employ. And so I started Nobility Care Solutions within the year. So I started in May. At the end of the year, we had made a million dollars in revenue. And I couldn't do that in seven years of my other business, trying to just be everything to everybody.

[ 00:04:54 ] So whenever we created Nobility, within three years, we went multi-million, multi-state. And we completely exited daily operations, installed managing partners to manage all of our territories and our agencies within Nobility. And then I was like, you know what, I want to do more. I want to make a bigger impact. I can only impact the people in my territories. But what if I were to reach out to home care owners who are impacting more families and more caregivers, then I can make a bigger impact. So we had, like, I'm, I am not in business alone. My husband, he's incredible. He's an operational methodologist for hospitality company and brought that over into home care. What really made our business go from struggling at a million to accelerating beyond my wildest dreams with systems, structure, and operations.

[ 00:05:46 ] Like marketing is great. Marketing is right there underneath. It's part of operations. You can't run a business without it. But to have a truly sustainable, scalable business, your operations have to be in line. So we created this Facebook group that everybody now knows it's home care owners' community. We just started talking with owners, and then bam! 2020 COVID happened. And all of our stuff was together. Our agencies were running fine. We already had PPE, like everything was going good. I actually missed it, I felt like I was jilted because I didn't have that moment of like, 'yes, I can say that I'm like all of that', you know, that frantic energy that happens when you're freaking out over something. But a lot of owners were.

[ 00:06:30 ] So we ordered literally a million dollars worth of PPE right before everything came to the States. We were able to furnish over 150 home care agencies across the nation with PPE, our local hospitals, our local hospice partners. And we started doing webinars. And that was the beginning of what people now know as Home Care Ops. We started doing free webinars, just talking about how we're navigating. Business during COVID and how we do scheduling and how we do marketing and how we do systems. And then we found out there was a really huge need that home care owners all across the industry were struggling. They were sacrificing their own personal life, really their own goals, just trying to get a shift covered or just trying to make ends meet or just trying to make payroll.

[ 00:07:20 ] And so we launched Home Care Ops and our Action Leaders. It's like a monthly coaching program where every month they plugged in and learn the small hinges that swing big doors and growth, those big structures that are simple to put in place, but truly changes their business. And so over the course of three years, we've had over 13,000 home care owners go through our training courses, our programs and, and our events. And it's incredible to see the shift and the messaging and the changing that's happening in the industry. And I love that. I love when our industry rises, we all rise. And that's like, I love seeing if you've ever been affected by a home care agency down the road that gave terrible service.

[ 00:08:03 ] And now that is like trickling over to you because now clients are scared or they like, don't trust what you say. That's when it becomes an industry issue. We've got to raise the standard of quality. We've got to raise consistency. We've got to raise the amount of solutions going out into the home care industry as a whole. And that's what we're doing, one owner at a time, here at Home Care Ops. And I'm blessed to be doing something. I truly, truly love people; if you love what you do, you'll never work a day in your life. I always say that is so wrong. If you love what you do, you will work every day of your life to make it better and for it to make a bigger impact and it to provide the type of lifestyle that you want to live, and help other people to achieve as well.

[ 00:08:51 ] So here at Home Care Ops, that's what me and my incredible business partner and life partner, I love to do. And I love to do it. And I love to I got the chills several times throughout that. I'm so glad you shared all of that. I think there might be bits and pieces of that story that people don't know: you being a caregiver from the age of 11, starting your first home care business at 18, not failing, but having a really hard time like most do and restarting years later and growing a really successful business in a really short amount of time, like full circle; now serving, like you said, 13,000 owners operators. And it resonates with me. I'm so glad you shared all of that. I think there might be bits and pieces of rising tides lifts all boats. We really are elevating the home care industry and things are changing.

[ 00:09:31 ] Things are getting better. Things are getting harder, but things are getting better. And I agree with what you said. When there's people in markets that aren't providing great care, it affects all of us. And so it's our job to continue to elevate the industry together. So a lot of that resonated with me. Thank you for sharing. What an incredible, incredible story. And it's a perfect segue into the next question. The topic today, we could be here for hours talking about all things, operations end to end, but one of the things that you speak maybe most about and feel possibly the most strongly about is scheduling and structured scheduling. Scheduling is one of the pillars of a home care business, but it is also one of maybe the most challenging processes from day one to year three to year 10.

[ 00:10:20 ] It is always challenging because there's so many factors, so many, so many pieces to the pie that it doesn't necessarily get easier. But one of the things that you teach and coach on is structured scheduling. So I want to talk about, I really want to just like break down scheduling and talk about the inherent challenges, how you can create processes, efficiencies to make it easier. So I guess I want to just start with talking about hours and minimums from your early days running a business to after scaling, multi-million, multi-states. Thinking about establishing minimums and finding what your business does best. So do you think agencies should have minimums? And if so, why or why not? And does that change as you scale? Yeah.

[ 00:11:09 ] So, and I think that's a really good question because I think minimums really should be in every home, every home care agency. It should be practiced. And now I was a home care owner who didn't really have minimums for a really long time because I wanted to serve, right? If someone needed to serve, I wanted to serve. I wanted to serve. I wanted to serve. I wanted to serve. I wanted to serve. I wanted to serve. I wanted to serve. I wanted to serve. I wanted to serve. I wanted us and we could provide help. How could we turn them away? However, what I began to realize is that whenever you don't set a minimum, your clients or potential clients will oftentimes choose the minimum. Like, and they'll say, oh, well, we'll just start with one hour and see how it goes. And if we need more, we'll add more.

[ 00:11:47 ] So a lot of times I wasn't meeting their true needs. I wasn't being a true solution. I literally, no one would go, Hey, doctor, I'm having these issues. So I need you to do this, this, and this and prescribe me that, that, and this. Like we just wouldn't do that yet as an industry as a whole. And I'm not speaking for every home care agency out there, but a lot of times we always say, what do you need? What do you want? What hours do you feel like you need us? And we're literally waiting for the client who is probably already overwhelmed. The family doesn't know they've answered a hundred other thousand questions for some doctor out there, you know, like the, the diagnosis that they're dealing with.

[ 00:12:33 ] And here we are asking more questions rather than saying based off your need and our professional solutions, I would recommend us starting at these hours, these times of the week. So it's not about saying, oh, we have a four hour minimum, so we can't help you. That's not what a minimum is. It's about saying, oh, the minimum is there to do. The minimum is there to actually make sure that we deliver on our promise of being a solution. And whenever you get into just logistical elements of scheduling, having a four hour minimum is what we normally say is a four hour minimum. Having that creates a whole lot more consistency for your schedulers. It creates a whole lot more hours for you to be able to schedule. So it's not about saying, oh, we have a four hour minimum. It's about saying, oh, we have a four hour minimum.

[ 00:13:26 ] So if you're a VA or your Medicaid, you may have a two hour minimum, but the thing about it is, is know what your minimums are. And it doesn't mean that you say, oh, well, we have a four hour minimum. So we just have no choice, but to help you, but to turn you away. It's about saying now our practice is to have this four hour minimum. That's four hours a day, Monday through Friday, or whatever it is that meets your business. Mine has adapted as I've grown. It should adapt as you grow as well. But by me going in and being able to truly say, here's the plan of how we're going to do it. This is how the path is going to roll. But something that we have done that has been game changer.

[ 00:14:09 ] And for all of you listening today, if just remember this one thing, remember two weeks, two weeks, and any time that we discuss like what our minimum, our hours are, it's not about the minimum. We always go from it, from the solution. We always go from the solution. We always go from the solution. And say, based on the needs and our professional solutions, our professional solutions is a four hour minimum. Their need is the need that we go in and assess, but we tell them, here's the plan. Here's the care plan. Here's the scheduling of it. And for two weeks, we're going to evaluate this schedule. And in two weeks, I'm going to call you. And if you have a concern about a caregiver, if you feel like the hours need to be changed, if you feel like the scheduling is off, you feel like we didn't truly understand the need, our care providers are going to be making note of all the changes in the preferences.

[ 00:15:01 ] I want you to do the same. And we're going to reconvene in two weeks from now and evaluate, is this schedule working? I'm really confident that it will, but if it isn't, we're going to revisit this in two weeks. And it shuts down the whole, I don't think I really need those hours. Or what if we need these hours? It also shuts down caregiver complaints because we say over the course of two weeks, this is a learning and discovery period. You may meet multiple care providers. That is intentional. We know that it takes more than one person to take care of mom or dad. I'm sure you've experienced that. And it gives clear and defined expectations.

[ 00:15:37 ] And it truly positions us as an element of confidence, as an element of that structure that they feel like they're lacking right now when it comes to their loved one's care. And then it gives us the ability to actually a professional solution and provide that consistent care. A lot of really great points. I want to dive into the four-hour minimum a little bit further. So you're referencing this daily four-hour minimum. What about weekly? So say someone, you mentioned referenced a few different things, Monday through Friday, based off the needs. Say you have that four-hour daily minimum. Does that roll up into a weekly minimum or not necessarily? So I will tell you what we do, but I will tell you that the model the principle, don't model the hours and the days.

[ 00:16:30 ] But for us, we have a four-hour minimum, 20 hours a week. So that's Monday through Friday, four hours a day is our 20-hour minimum. I didn't start there. That like, depending on where you are in your business, in our action leaders, we say there is a, there is a churn part of your business where you're just like churning and burning, right? There's a flow part. And depending on where you are, you may start off saying, Hey, I'm going to, I'm going to have a 12 hour, a minimum per week, and it's delivered in four-hour shifts. But that really is, you're building a business by your design. Don't build a business like I did, but I will encourage you to use the principles that I've used and apply them to the business that you're wanting to build.

[ 00:17:16 ] Let's talk about different like shift combinations. And like you're saying, you know, you, you built it a certain way and you're not telling people to build it this way. It's more of just the principle. So that's four-hour principles here, but I've seen either firsthand through my own business or through other businesses, different shift combinations. You know, some businesses do shorter shifts, some do longer shifts, some have eight hour minimums. Like there's a lot of different combinations. So I just want to have you kind of talk through different combinations you've seen, and then maybe some of the pros and cons to shorter shifts and some of the pros and cons to longer shifts. Yeah. So with us, the way we do our structured model, is as far as the hours of the day is for our four hours.

[ 00:17:59 ] Obviously, if we were to ask our client, what hours do you prefer care? They're going to say 10 to two, right? So they just took a 40-hour caregiver, potential caregiver, and just reduced her down to a 20-hour week because we scheduled her right in the middle of her availability. So what we do is we do for our four-hour shifts, we do eight to noon. That gives her the ability to take a quick break, drive to the next client from one to five. And then we can also have a six to 11 shift. I will recommend if you're doing structured scheduling, I would start with your daytime hours and then add in evenings later. But we have seen that that has been the most effective scheduling for us.

[ 00:18:42 ] For some of you, it may be seven to 11, noon to four, and vice versa. But what it also does is we still have clients that say, no, no, no, I want 10 to two. We all have those clients. I love those clients because I've just added myself 10 more hours a week. And I will say, well, based off of your preferences, and obviously if we are needed directly in that 10 to two window, there's probably a need greater than just a four hour shift minimum could truly meet. So let's extend that a little bit and let's do a nine to three shift. So I just got six hours instead of four hours. It's a whole lot easier for me to keep a really good caregiver, giving them 30 hours a week than it is 20 hours a week.

[ 00:19:30 ] I've increased my profitability. I've increased my hourly count per client. And before every, some people probably just thought, 'Oh my gosh, I can barely get them into a grade of four hours.' Now I'm getting them to a grade of six hours. Whenever you do a really good care assessment and you ask them, 'What task are you needing help with? What is the area of concern?' Most of the time, the areas of concern are right there early in the morning, right after lunch, and then later in the evening to get them ready for bed or their clothes washed. Whenever you show them and literally in our Action Leaders program, we have like this diagram where they can just go in and check all the needs and it showcases throughout the day when we are needed.

[ 00:20:13 ] So, we can show them on paper based off what they said, this six-hour window of the day really would be something that truly provides a lot of information. So, that's the way that we do kind of the shorter shifts. Obviously, everybody loves a 24-hour case. No, I take that back. I have now determined a lot of people hate 24-hour cases. Either you love it or you hate it. It's controversial here. So, I like, good thing we're not talking about 24-hour cases because I love it. But every single like, every single 24/7 case has a care manager in our agency. So, it runs like fluid. They're wonderful to have. But if you're doing what I call traditional home care, the way it's always been done, they can be a really big headache.

[ 00:20:58 ] But we like doing them from like seven to three, three to 11 and 11 to seven. On the weekends, we tend to do 12 hour shifts instead of the eight hour shifts. Just because obviously, the less people that you have on your schedule over the weekend, the less issues and call outs that you're going to have. And so, and when it comes to structured scheduling, rather than trying to take what I'm doing and trying to model it, what we actually do is we recommend that you talk to your scheduler. You're like, your scheduler is going to be the one who knows what is the easiest shifts to schedule. Talk to your recruiter or team developer, or even your scheduler and ask her what shift availability do majority of our caregivers have and start there.

[ 00:21:50 ] Then we go, what is the most profitable clients that we currently have? Surprisingly enough, it's not 24 hour care because a lot of people like to give discounts. I'm not a big fan of discounts for 24 hour care, but for the shorter shifts, obviously it should come at a little bit more of a premium hourly rate. So shorter shifts can really increase net profit. But if you don't structure structured scheduling, the amount of stress that it will put on your office employees and on your scheduler will oftentimes take the momentum out of your business. It will cause frustration within the team and that will stall growth faster than anything. Because once again, you're running up into a capacity problem within the internal leadership of your office. Yeah.

[ 00:22:42 ] I love where you were going there with, it's almost like an equation of what is the availability, the most common availability of our caregivers. And then how do we map that to structured scheduling? And for you all, it was the four hour chunks. For a different agency, it could be two hour chunks. It could be six hour chunks. It could be eight hour chunks. It's almost like you just break down the day by the chunk of hours and then work that backwards to availability and needs based off the clients. Absolutely. I'll give a shout out to Misty Carver of Home Helpers. She took structured scheduling and, I mean, just ran with it. She is such an action taker, rolled it out all across the board.

[ 00:23:21 ] And then whenever we sort of, I don't know, I don't know, I don't know, I don't know, talking to her about how did this change? And she was like, game changer, the number one biggest game changer across all of our offices. They had multiple offices. And she started telling me that she's a really, she's a one hour and two hour minimum. That's what she is. Cause she's, she does a lot of Medicaid. She does a lot of VA. Obviously she does private pay as well. But if you're servicing Medicaid and you're servicing VA, it's a whole lot harder to say, oh, well, I'm going to four hours or bust. And we want to be a solution. But because she said, absolutely, we can take that. We do that in a structured approach to give you the more consistency of care.

[ 00:24:02 ] And she just tells them how they're going to be structured. And she puts that structure in place. And because of that, she's rolling with those one and two hours and scheduling isn't stressful for her. I'm sure she has days where her scheduler is like, 'yes, it is.' But it's not the number one stressor in people's business. Like scheduling often is. When you look at most home care agencies in general. I think the key word here is structure. There is structure. You know, I see businesses and you do too of every size that scheduling is still shotgun. It's like, there's this need and I'm going to throw it on the calendar and I'm going to try and find a caregiver. I think the key word here is actually not scheduling, it's structure.

[ 00:24:43 ] So you can have a structure with one to two hour minimums with eight hour minimums with 12 hour minimums. Like you, you create the structure and then there's structure. For the scheduler, for the clients, for the caregivers, for the office, for the owner, there's just a plan in place and everyone, you know, can move forward and row in the same direction because there is a plan. But when it's all haphazard, that's where the stress, the fires, the never-ending chaos pursues. Yeah, absolutely. And it's one of those things where the first time that I did my home care business, I honestly think that scheduling was my biggest downfall because it kept us; it's like we were constantly putting a jigsaw puzzle together and being thrown pieces from other puzzles constantly.

[ 00:25:27 ] So we were always focused on what caregiver we're going to hire to cover this shift. And I'm like, I'm not going to go marketing today because I've got these three clients that are open, but man, if we don't get hours for these other four caregivers, they're going to, they're going to quit and they're not going to be available. Like people talk about being on that seesaw; And I think the seesaw comes really from scheduling. We call caregivers the heartbeat of our agency. A lot of people say, you know, I care. Caregivers are a heartbeat, and they are emotionally invested, but logistically, scheduling is the heart pumping, making all those gears of operations rolling. So if you've got a loose cog or a stuck or a stall happening in your scheduling, or you have a lack of communication in your scheduling, a lack of clear and defined expectations in your scheduling, it's going to affect every aspect of operations, therefore profit, and satisfaction.

[ 00:26:23 ] Mm-hmm. 100%. You mentioned 24/7 and live-in. I want to dial in there a little bit because, like you said, everybody wants it, but then as you scale, I've seen this time and time again, as you scale, it becomes this controversy. Either you love it or you hate it. Either it's your bread and butter or it's your Achilles heel. There are pros and cons. I want to let you speak a little bit more about the pros and cons. And then you also mentioned, you know, for your business, having a care manager, there is just this, there's added elements. Of complexity with longer, longer shifts. And so what are some of like the pitfalls that you maybe went through to then learn, okay, we need an additional person.

[ 00:27:02 ] We need different expectations, like just talk through, you know, some of the complexities that you could break down for longer shifts. Yeah. So the, the, I guess probably the most obvious thing that owners run into very first when it comes to longer shifts is a lot of times the level of care and the skill required as is sometimes a little bit more, you know, a little bit more of a, you know, a little bit more of a more than what it is for a shorter shift client. That's why they need us around the clock or for longer hours. So, if you're not training your staff to really meet the skills required, and if you're not training your staff to truly be team players, then there can be, can some inconsistent, almost unprofessional care being given from caregivers. And then there also can be drama on the changing of the shifts.

[ 00:27:49 ] We don't like to, we act like that doesn't happen, but we all know that we're not going to be able to do it. And so, you know, we're going to have to the drama that happens whenever caregivers are working on a shift and changing shifts and they don't know how to communicate effectively. They don't feel that personal significance because they kind of get lost in the sea of all the other care providers that we put on the schedule, but don't connect with. So that's usually the first things that we run into when we're doing longer shifts. And the second thing is just the detriment that it can be to really focus on longer shifts and then lose two or three clients who are those big money clients, right? I mean, if you've been in the industry for more than four or five years, you've probably had a week where you've lost 700 hours of care all in one wham.

[ 00:28:33 ] I mean, we've experienced that. And it's because we were doing a whole lot of marketing, a whole lot of catering to those 24 hour clients, those longer clients. So that's one of those things that monetarily can be a big challenge. And then also with those longer shifts, the communication, that's going in and out from the team to the families and the families to the team back to the caregivers can be more taxing on the office support. So there has to be some really good communication flows happening, some good systems for communication when it comes to those 24 hour or those long hour shifts. So, and you spoke to the care manager and like we, we teach something, we have structured scheduling and then we have structure.

[ 00:29:23 ] Profit and in structured profit, which anyone who's been to the home care event for home care owners, like we talk about this in detail. And I think it's the one event that if you're a home care owner, it should be a must to attend because we walk through those structures, but we talk about structured profit, how to structure your profit and really what it is. It's structuring the different types of scheduled clients. It's we have something called quick care visits. I'm not going to go into. That's basically a care membership, basically where caregiver goes out Monday through Friday. It's task-based, not time-based; they're in and out in less than an hour, and people pay by the week. So it's really attractive. That's a pro level move.

[ 00:30:08 ] I wouldn't recommend that to someone who hasn't got structured scheduling down first, but we have that and then we have what we call our structured scheduling where it says four hour minimums or two hour minimums, and it's Monday through Friday. Okay. And we don't offer nights and weekends care, unless you utilize our service for 20 hours or more. And I can hear the gasp of some people of disbelief. But if they don't need us 20 hours or more than the week, they're probably going to be okay over the weekend. And it's not cutting into our profitability because we know that it, it does take more. It just takes more office work. It takes more overhead to manage and staff those weekend clients. And.

[ 00:30:53 ] And then it goes into what we call our core care, and our core care is those people needing eight-hour, you know, eight hour more shifts, 12 hour shifts than our 24 seven caregiver support. And then we have our 24 seven care management, and just the profit itself leans to consistency. It leans to higher profitability. It leans to higher satisfaction. So when it comes to scheduling, you can make it really complex. But where you simply, you can simply start and you just build on one tiny little hinge that can swing big doors at each and every level is first just determine what is your shift minimum. What is it? What, what value per client do you need? Sometimes we spend over $1,200 just for one lead. That's not including converting them.

[ 00:31:45 ] And then if they only need us for three hours a week, how long do we have to keep that client before we even make the first time? Right. I'm not all about the money, but I will tell you the more profitable you are, the better life you can give your care providers, the more you can afford training, the more that you can afford enhancing the lives and the work and the communication of your care providers that overflows into your clients every day. So scheduling really is your profitability metric in your business. I know I want to lean in here a little bit. I know we're not totally going down like the profit side. Of scheduling, but I want to a little bit, a couple of your comments ago, you,

[ 00:32:27 ] you kind of like hung up on the word, like discount a little bit, you know, because I think that's another kind of controversy here is, you know, you're offering solutions at a cost, maybe at a premium and to discount it, you know, kind of says something about how you may feel about your services. But I want to talk about, you know, when you're establishing a minimum, when you're coming up with your, your method of structured scheduling, profit and profitability are a huge part of that equation. It's not uncommon to be losing money on shifts, maybe even a lot of shifts if you don't have the proper scheduling in place. So talk about the, the factor that is profit when it comes to scheduling, how do you factor in profit when you're building out these structured schedules?

[ 00:33:11 ] Yeah, absolutely. So it's whenever you're determining the profitability of each and each, every individual client. Honestly, that would probably seem a little overwhelming unless there was some type of already automated calculator out there that would help each person do that. But if you have your minimums already set, you already know what the profitability is going to be on that. And that's also why for our, for our shifts, I'm just using this as an example, I know rates are everywhere, but our, our hourly service rate may be $30 an hour for hours, or what we call core shifts, which is eight hours or more. It may be $32 an hour for our structured scheduling. Like we, we have it listed out to what is the value per client. That's what we do.

[ 00:34:07 ] Like, we need to know what is the value per client per week that we need to make to make this client profitable. And based off of that, we then determine this is what our minimums need to be. This is how we need to structure these different tiers of scheduling and service delivery. And it makes it to where we're not looking at our numbers at the end of the month thinking, oh my God, you know, that's really super challenging client that we barely could get staff. Can you believe that we made 23 cents per hour on that client? And I mean, we've all been there. So it's why it's good to do the work on the front end and understand how to structure scheduling, how to look and know what is profitable, what isn't.

[ 00:34:57 ] I did not do that for the first seven years of my business. I was just like, if they need us and I'm paying a caregiver $15 an hour, if I'm making $18 an hour, I hope it's, I hope I'm clearing the bank. Right. I found out it don't work that way and it don't always go to the bank. And I give a lot of care away. I gave a lot of care away thinking that at least it wasn't costing me and someone was being helped. Yeah. And this can all be mapped. You know, we've talked about a lot of different schedules, structures. You can map all of this out. And obviously, depending on your size, it can be less complicated, less complex at the start. And I can get more complex as you go.

[ 00:35:38 ] I like how you've called that out, you know, taking on weekends, taking on nights, taking on, you know, kind of one hour shifts like that. Those are, you know, like the pro level. They scale. But there's, there's this piece, which is profitability. And I know, you know, I know you're kind of like teeing me up for this and care switch. We have the ability for schedulers. Well, let me take a step back. The office can set targets in the software, you know, gross talk targets, net targets, lots of different targets for different geographies, different shift lengths. You can create all these targets. And then at the time of schedule, the scheduler will actually see if the caregiver is making them money. If they're losing them money above the target, below the target, you call it out.

[ 00:36:22 ] It's oftentimes that you're looking historical. Okay. This last month, we lost X amount of revenue. Why, how, how do we avoid that going forward? Now we're trying to empower schedulers to be thinking about profit, to be thinking about revenue, to be thinking about how this shift impacts the bottom line. And so to your point, it's just a matter of mapping all of this out. What are your, what's your structured scheduling? What are the hours? What are the rates? What are the margins on these shifts? And then how do we capitalize? How do we maximize those opportunities? And how do we avoid, you know, the, the opportunities of the areas that are losing us money? All that being said, I think the question I want to ask you is, and it sounds like it is possible to master several different structured schedules, master several different shift structures.

[ 00:37:11 ] At what point do you start to add, add different schedules? You know, you mentioned overhead and cost. And, and scaling. At what point in time do you feel like it's a good time to start adding new schedules? Yeah, I think it's one of those things. It's, it depends on how strategically and how much prep work on the front end that you're doing it. If you're like listening to this podcast and you are going to like go to your team tomorrow and be like, 'Hey team, guess what? We're doing structured scheduling.' And they're going to be like, 'what?' No, just, just no, just give her, give, give him a few days and he'll forget he even said that. Um, then I would say, start with whatever.

[ 00:37:47 ] Your minimum is start with your minimum and structure that, um, and you can structure it with clients like new clients moving forward. If you don't want to, you know, to test it and you don't want to roll it out with all your existing clients. So, but when it comes to structuring your scheduling, it's not about structuring your scheduling in multiple ways. If you are structuring the profit of your business, and I say this now is though every home care owner out there should. No, duh, you've got to structure your profit. You literally have to have structured profit. You have to, we are not just a home care agency delivering one product. We like to think we are, yes, we deliver care. We deliver it hourly. No, we don't. We deliver short shift hours.

[ 00:38:37 ] We deliver core shift hours. We deliver 24/7 care hours and we manage them differently internally, whether we realize that or not. So everybody out there, if you have a short shift, if you have a client doing eight hours a week or day, and you have a client doing 24/7 care, you already have three different tiers of clients in your home care business. Now you need to strategically know how to structure that. I did not know that. And that was my huge downfall. Now in the industry, like Clint is the operations coach. He's an operational methodologist. He's amazing. That's what he does for me. I really focus on net profit strategy. That is my zone of genius now, because I look at it and say, okay, I know the structure.

[ 00:39:25 ] I know the operational structure. So how can I not just make more revenue? And that's something that we specialize. We can go in and help a home care owner that is at $4 million, not increase his revenue. And you would think, oh, wait. So you go in and like people pay you to help them and not even increase their revenue. Yeah. But like Mike in North Carolina, he increased his net profit by 271%. 271% increased his net profit. That's completely life-changing. That's money going home in the bank, right? That's money that he can then take and invest in other things, invest in his team, invest in a complete support team that now he's completely exited. Operation is now just working on innovation. So do we help him grow? Do we help him grow his revenue after that?

[ 00:40:18 ] Absolutely. But who wants to grow more of a problem? Who wants to grow more of a cancer? And so a scheduling is that place in your business where the most obvious need for improvement, right? Because that's where most people are complaining, feeling overwhelmed, feeling like that sounds good. But I'm over here still just trying to get this shift covered for today. So and that's why knowing the structures of your business structure profit is great. And structured scheduling is great. They work hand in hand. You can have six, seven, eight different types of structured scheduling, but not unless they're within structured profit. Otherwise, your entire team is going to be confused. You're going to go out in the field and try to sell what sounds like six different products to your clients because you don't understand what you're really trying to do.

[ 00:41:14 ] And what you're really trying to do is one, you're trying to sell a product. You're trying to calm the chaos in scheduling. You're trying to truly deliver the consistent delivery of service. And you are there to be the professional solutions. My doctor, I do not walk into my doctor's office and walk in with a hurt leg. And he tells me how he can treat me for cancer too. He doesn't list every one of his services. He tells me exactly what he can do for me based off the need that he has seen based off what he's done for me. And he tells me exactly what I have told him that I am wanting and struggling with. And as home care agency owners and operators, we have to think about this as a professional solution.

[ 00:41:57 ] I hate the word 'sitter services.' I correct people when they say 'sitter services.' And I say, no, sir, we don't pay our caregivers to sit. We come in to truly be that peace of mind, the extension of the outcomes that you want. And we help you navigate the aging process of your loved one without overdoing it. We help you navigate the aging process of your loved one without overdoing it. That doesn't sound like a sitter service to me. The value has to start within the office. It has to start within our structure. It has to start within our scheduling. And then the value trickles out through our care providers to our clients. And that is the way that success becomes scalable and repeatable. And us home care owners ain't laying in bed at night thinking, 'Oh my God, I hope nobody calls out tonight because I have no one to cover the shift.' Yeah, I could leave you on this soapbox all day.

[ 00:42:49 ] I think you're just knocking this out of the park. I want to ask you a couple of like kind of tangential questions that impact scheduling. One of them is availability and managing availability. I want to hear your take on that. And then just so you're aware, what's coming is overtime, like how to think about and structure maybe overtime. So let's start with availability. One of the big pieces of this puzzle, and I want to hear your take on it like through structured scheduling, is managing availability, caregivers' availability, changes daily, weekly, all the time. And so how do you factor in, how do you manage availability kind of holistically for caregivers? Yes. And I love that you answer that, ask that.

[ 00:43:28 ] Because when it comes to all success in business, but I'm going to apply it to this, there's three things that you have to practice all the time. All of the time. Number one is transparent communication. We can promise hours and we can promise that we can be there. And we can say, 'say we're going to work with your availability.' Can we, do we know that? No, we cannot guarantee that. I like, I remember years ago saying we can't guarantee hours. We are at the mercy of the needs of our clients. Now, I can't believe I said that for years, but it did feel like that. We were always waiting for clients to tell us when they needed us. So, transparent communication is key. The second one is clear and defined expectations.

[ 00:44:08 ] Whenever we hire caregivers, and we can, we say, 'we practice structured scheduling.' That means that majority of our hours happen between 8 a.m. to 5 p.m. That does not mean that if you have other availabilities that you will not get hours, but it does mean that we are not going to yank you around all of the time and that we are better positioned to give you the amount of hours that you want. We know most of our caregivers are probably working for other agencies or have in the past. They are doing that because they are not getting the hours that they need at one home care agency. So they work for multiple. By telling them, what is your availability first?

[ 00:44:47 ] I want you to write down what your ideal preference of availability is, and then tell us what hours you would be available if really needed to meet the hours that you prefer. So that way we have both, and we tell them we will work hard to work within the desired amount of hours. As long as you can tell us that you're committed to also working within the availability needed. Just a little bit. Transparent communication. So we don't have as many care providers coming in saying, I only need a few hours a week. If we do, we ask them, why is it that you only need a few hours a week? And a lot of times they will say, because I'm working elsewhere.

[ 00:45:29 ] And we ask them, is coming over and working for one company, something that you desire to do. 90% of the time they say yes. As long as it works within my schedule for us to be able to say, here's our structured schedule flow. We have eight to noon and one to five, which would get you the 40 hours that you're wanting on a weekly basis. We also have our nine-to-two perfect for our parents who have kids in school and they want to drop them off and pick them up. And then we have our longer extended hours that are eight hours, 10 hours, 12 hours throughout the week and throughout the weekend. So let us know which one of those structures that most appeals to you.

[ 00:46:09 ] And also check which ones that you would be willing, willing to work. And then frequently or occasionally we are availability sheet for our care providers. Whenever we hire them, they do it. Once they've been with us for two weeks, they do it. Once they come in for their 60-day, just, we call them a care connect's just to connect with them. They do it. And then every six months it goes out to our caregivers, whether they've been with us for a year or for 10 years, we're constantly asking them their availability. So we don't have, we don't have a lot of that like constantly shifting our caregivers, constantly calling into changing availability. We do the flip side with our clients. Our clients cannot call in and change availability all the time.

[ 00:46:56 ] They know that if they want to change the availability, we give them a two-week window of evaluation and we'll tell them what is the reason for this change, unless it's they're needing to increase more hours because care has heightened. Then we don't go, go ahead and shift the times all around unless it's something that truly was a need. So some clients like to say, 'Hey, I want to shift the hours to this thing.' So my mom can go golfing tomorrow. We'll just go ahead and do it for the rest of the week. We don't allow that. And we're very transparent with our communication and we'll tell them if we can work with you, we can, but we know at the end of the day, what you really want is the consistent delivery of service.

[ 00:47:38 ] Knowing your care provider is going to be there every day when they say they're going to be there. And if we begin throwing, the inconsistent schedules that are our care providers, they'll start throwing inconsistent schedules back at us. And we don't want that. And so we're very clear with trans transparent communication, clear and defined expectations and supportive accountability. The supportive accountability is always supportive. But if we have clients shifting out hours, we will tell them I'm going to bring out a little supportive accountability and just remind you of what we're doing here. And with the caregivers, we do the same thing. We say, 'Hey, like you continue to change your hours.' This is what you said that you wanted. Why has that changed? And we have that transparent communication.

[ 00:48:24 ] And so we don't have a lot of call outs and we don't have a lot of ship changes. And it all comes down to not structuring the scheduling. Structuring the schedule is just a benefit of you being really committed to the consistent delivery of service. And being a professional solution. So our caregivers are very much. If I was to walk into Walgreens and they never had the items that I needed on the shelf, or they were always in a different location and I was always searching, I wouldn't keep going back. I don't want to compare a caregiver to a product on the shelf, but when you're in home care, like at the very bottom of it, all our care providers are, the product, they are the commodity, but they are also, they really are the heartbeat.

[ 00:49:18 ] So we can't just treat them like they're a product or like they're a thing. We have to first be transparent with what it is that we can offer them. We can offer them the consistent delivery of a schedule, but in return, we need the consistent delivery of them showing up and working their shifts. I've heard you say this several times that you didn't have a lot of call outs. And I think everyone's ears perk up of how, how is that possible? But you just answered that question, which is one that I wanted to close with was, was how do you prevent call-outs? And it all comes back to this transparent communication, clear and defined expectations, supportive accountability. Like those are like the pillars of a business, especially a home care business.

[ 00:49:59 ] Because like you said, you keep using this word like structure and consistency. And when those two things get rocked, everything gets rocked. And so it's just really laser-like in and focusing on those; same thing with managing availability. You know, I, I talked about like, like haphazard scheduling, haphazard availability. If that's, if that's the expectation that was set, no wonder your caregivers are going to come to you every week, every day, every month, trying to change their availability is because there is no structure and they can get away with that because you haven't established the structure. Yeah. And that really leans to call-outs like call-outs happen. Like I haven't found the magic structure or magic peel for totally doing away with call-outs. If so, it would probably well play.

[ 00:50:42 ] And I'll be on some Island somewhere and wouldn't be like, I wouldn’t even be available today, but there isn’t because people are people and life is life and life happens to us all. I get a flat tire. I get sick. My kid gets sick. It happens. We want to be supportive when that happens. Not like I can’t believe you called out one more call-out. You send me a doctor’s note or you’re out. I don’t even agree with it, but different day, different conversation. But when it comes to call-outs, so our call-outs are a whole lot easier to manage with structure scheduling. Cause when we know we can look back over six weeks and know when is the hot pocket for calling out and who are the repeat offenders, right?

[ 00:51:25 ] Oddly enough, our call-outs was Wednesday morning. Who would have thought I would have told you had been a Friday night or Saturday or Sunday, Wednesday morning was a hot pocket. So we created an own call team, just like we have structured scheduling and structured profit to support structure scheduling. We also have structured profit to support structured scheduling. We also have structured team. We structure our team. So our team gets a lot of training and they also have the ability to become care leads and they make a dollar an hour or more. And they get some benefits and additional training, but they also get the benefits of being on the own call team and receiving an own call retainer. If they don't show up, they still get paid. Now, when they show up, they get paid the retainer.

[ 00:52:08 ] Plus, they get paid for the hours or the minutes that they work. So we have a lot of training and they also have the ability to become care And that sounds a lot like what other people are doing. But whenever you create team structure that comes with benefits that it comes with, I mean, who doesn't want a retainer, right? It makes them feel like a lawyer. And we understand what benefits they're looking for, what benefits would drive them to want to be on the on-call team. Then we started with an on-call team on Wednesday morning. Because I felt like that is all that I could afford at the time or figure out how to even make work. And then we got that. And then we got that. And then we went to, okay, it's going to be Wednesday morning and it's going to be Friday from five till Monday morning at 8:00 A.M.

[ 00:52:50 ] Right. So as we grew, as the business grew, as our team grew, we eventually got it to where we had on-call all the time. And then we had two teams of on-call, and then three teams of on-call. And as our agency grew, the structures supported the growth. Way too often. And I did this for years. We feel like we need growth to put in structure, but if you will put in structure, it will support the growth and you won't run into that capacity problem or that burnout problem or the just, 'Oh my God, don't add anything to me.' I don't care if it is like a multimillion-dollar strategy. I just, I just need a survival tool. That's all I need for today. And it will help you to avoid that.

[ 00:53:36 ] You heard it here first. We cannot eliminate call-outs. I know we all want to, we all try to, but we, we can significantly reduce them with strategies that Jessica is talking about. So all of you out there, we can’t eliminate them, but we can reduce them with the things that we’ve talked about today. I know we’re almost out of time here. The last thing I mentioned is just overtime. You know, are you able to avoid overtime or what does overtime look like in terms of structured scheduling? Yeah. So with structured scheduling, we actually have very little overtime. The structured scheduling does help with that because we don’t have a lot of those like, Oh my gosh, this new client who is asking for this weird wonky time in the middle of the day or night.

[ 00:54:16 ] Right. And so we're like pulling our unicorn caregivers who are already working 35, 40 hours somewhere else to cover this really just non-standard client. Right. But for overtime, I think like most agencies rarely have we ever gone over 2% in overtime. We always try to keep overtime below 2%. And it's not a practice that, that we have done as far as having a lot of overtime. Most of the time, our overtime comes from either our, our care leads or care managers training additional caregivers as they come on board. They may have already been scheduled 38, you know, 40 hours out in the field and they're training. But overtime is just not something that I have a lot of now before my, like first time, like traditional home care method.

[ 00:55:07 ] I had a lot of overtime. And it was always, always that thing where sometimes it was clients preferring a certain care provider. So then I would sometimes pass it over, you know, the overtime over to them. And sometimes it was because I just needed a good care provider that was going to be at that client. So I wouldn't have a headache that night and I would have to eat all that overtime. But once you, once you put structure into place, if you really get committed to the consistent delivery of service, being a professional solution, that doesn't happen by accident. It happens by having a, a truly operational framework for success. Once again, the operational framework for success is out there. It's already built. It's already created.

[ 00:55:48 ] Every time someone comes to the home care event for home care owners, we send it to you in the mail. You do it with us based off your agency. We've done it for years now. I would say start there because we've already done the really hard, really wrong, really complicated way of doing it. And then we've simplified it down. But overtime is not something, something that we have to calculate in our PNL, even on a weekly, monthly basis. We're oftentimes saying, you know, that things aren't the silver bullet or aren't the crystal ball. Jess, I think, I think structured scheduling is the silver bullet. I think it's like the, the denominator, the common denominator for all home care to elevate; is really getting intentional about building structured schedules. And then everybody wins.

[ 00:56:36 ] Everything wins: less overtime, less call-outs, better care, consistent – it's just like the, the accumulation of all of the inherent challenges in home care can be reduced significantly through structured scheduling. So I'm super glad we had this call. I'm super glad that you speak so openly about this topic regularly, because I think everyone that hears this probably for the first time is thinking like, wow, this is, this is what I need in my business. And, and the nice thing is it's applicable to everyone. Those getting started, those two years in that are struggling to scale or hit that next level. People that are years in business, you know, I've, I've worked with people that are going on maybe 10 or 15 years and they still are struggling to get a really good grip on scheduling.

[ 00:57:19 ] And so I think no one can really escape the importance of this. And there's always room for improvement. I want to just thank you for the hour of your time. I know you are busy and I know you've got a lot going on, really briefly. What's the best way for people to get in contact with you? Is it by way of the Facebook group or just talking about some of the ways that people can engage with you personally and, and with Home Care? Yeah, I think probably just the simplest way is for, if they go to homecareops.com, they'll see everything that we have going on. We have free masterclasses and we have the Home Care Event for Home Care owners is coming up very soon.

[ 00:57:51 ] So they can get plugged into that, and it's something that we have every year. I seriously like it's, it's almost no cost at all because if I could just send a flyer out to every single home care owner and be like you must be here you must be here It's that But for the home care owners something that I feel like they need is it's really easy to feel like you're an island on your own It's really easy to feel like no one understands you It's hard to find someone that you can ask a question to and get a really legit real experienced answer And so if you use Facebook in any capacity which I know a lot of people don't but if you do go join home care owners community it's a community that we we have a community manager in there and they're keeping it a safe space There's no sales There's no scams.

[ 00:58:42 ] There's no spam. There is no judgment. We speak openly. We try to protect the home care owners in there, their sanity, their safety, and really give them the little pick me up. Sometimes that they need just throughout the day, hour by hour. Sometimes you go in there and be like, Oh my God, I ain't got it that bad. I'm good. And other times you go in and say, Hey, I'm really struggling with this. I would love your insight and you'll get 15, 20, 30 people to comment. And say, Hey, I've been there. This is what I did. Or have you thought about this? And I think it's really good to have that network. That's easily accessible. So either place home care ops, what can you, it'll lead you to it all.

[ 00:59:21 ] The Facebook group home care owners community will lead you to individual peer-to-peer support. And then on I'm on LinkedIn as well. I am not the pro on LinkedIn. Like you are Miriam, but I do love getting on there and seeing the innovation and the new influencers and the, just the incredible happenings that's happening within our industry right now. You're the, you're the Facebook queen. So own it. And I'll, I'll take LinkedIn. My quick tip, my quick tip on the Facebook group. There's a search bar. I think this is underutilized. There's a search bar on the page. So if you have a topic that comes to mind, instead of scrolling back endlessly, because there's so much content on, on their Facebook group, go in and use that search bar, search a keyword, search software, search anything, burnout, scheduling, structured, scheduling profitability, like search, search those keywords.

[ 01:00:09 ] And then you'll get access to the post where people have talked about that because there is years of content and topics on that page. So utilize that search bar. Good tip. Because I will tell you, I literally just Googled structured scheduling this morning and preparation of coming on here, just to see what people were talking about. They share the challenges of making it happen. It happened. The like complete godsend of doing it, how they started it. Everybody shares their hours and how they're different. It's really good. Just to go in, they are type and structured scheduling and see what everybody else. I make it sound really good and easy. It's not easy. It is simple. The concept is simple, but like anything worth doing, it's not easy. You'll want support.

[ 01:00:50 ] You'll want to like kick around different ideas. You'll want to see other people's challenges and successes with it. That's a really good place just to get it all at your fingertips whenever you want it. Exactly. The thing that I love about you, Jess, and you talked about this is transparent communication. Every interaction that I've had with you online in person for the last five years, is so transparent. I think that's why people gravitate towards you and Clint is just honesty and openness. And we need that in home care. This is hard. This isn't for the faint of heart. There are call outs. There are, you know, fires to be put out, but you always bring this really honest, transparent take and know that I appreciate that.

[ 01:01:25 ] And I think the industry at large does as well. And that's why people are, are gravitating towards you really quick here at the end. Jess is back with us again next week. Same day, same time. We're going to talk about burnout. Another topic that that Jess feels really strongly about and talks about frequently is burnout. No one can escape burnout. Everyone will encounter it at some point in your business journey. And so Jess is going to talk about identifying it, managing it, coming back from it, pushing through it. We're going to really get into the kind of honest, transparent communication when it comes to burnout. So Jess, thanks for being here, and we'll look forward to seeing you again next week. Absolutely. It's been a pleasure. All right. Take care, everyone. We'll see you again next week and have a great rest of your week. Take care.

How to Structure Service Hours to Increase Margins (Jessica Nobles Pt. 1)

Show Notes

Structured Scheduling in Home Care FAQ

What are minimums in home care, and why are they important?

How do I determine the right minimums for my agency?

What is structured scheduling, and how does it benefit my home care agency?

What are some examples of effective shift combinations in structured scheduling?

How do I handle caregiver availability changes and minimize callouts with structured scheduling?

How does structured scheduling impact my agency's profitability?

Should I offer discounts for longer shifts or 24/7 care?

How can I learn more about implementing structured scheduling and other operational best practices for my home care agency?

Transcript