March 17, 2025 • 45 mins
In this episode, Stephen Tweed, Chairman and CEO at Leading Home Care, shares essential insights from the highest-performing home care companies, revealing seven critical lessons that drive success in today's competitive market. His extensive research and mastermind groups with top companies uncover the strategies that separate industry leaders from the rest.
Those strategies include:
• Crafting a strong culture based on leadership style, core values, and consistent behaviors
• Being purpose-driven and sharing authentic stories that create emotional connections
• Building amazing teams through sophisticated recruitment and development processes
• Thinking systematically with repeatable processes that enable scalability
Episode resources:
- EBook: Six Secrets of Selling Home Care to Your Ideal Client (50% off with promo code: ALAYACARE25)
- Visit leadinghomecare.com to subscribe to Stephen Tweed's "Thursday Thoughts" newsletter
- Case Study: Future of Home Care 2025
- Podcast: The top 3 causes of 90 day caregiver turnover
- Podcast: Unpacking the impact of positive work culture in healthcare
- Blog: 6 ways to create a culture of belonging to improve employee retention in home-based care
If you liked this episode and want to learn more about all things home-based care, you can explore all our episodes at alayacare.com/homehealth360.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Stephen Tweed (00:00):
Last year when we did the survey, the system that
was important to ourrespondents was caregiver
recruiting, followed bycaregiver retention.
This year it flipped a littlebit.
Caregiver recruiting is numbertwo, retention is number three.
Number one is caregiverscheduling.
So there's been a renewedawareness and thought processes
(00:20):
for that system of scheduling,which includes using software,
scheduling software or home careoperating system, and what all
is involved in making thatsystem work both for the client
and for the caregiver.
And how does technology comeinto play?
Erin Vallier (00:54):
Welcome to another episode of the Home Health 360
podcast, where we speak tohome-based care professionals
from around the globe.
I'm your host, Erin Vallier,and today I am joined by Stephen
Tweed.
Stephen is an internationallyknown home care business
strategist, award-winningprofessional speaker, published
author and strategic businessadvisor.
He has spent the last threedecades working with home care
(01:15):
companies that want to grow andwith home care leaders that want
to get ready for the future.
Currently, he is CEO of LeadingHome Care, a Tweed Jeffries
company, and founder of the HomeCare CEO Forum.
Stephen has authored orco-authored eight books written
specifically for the home careindustry.
(01:36):
Welcome to the show.
Stephen Tweed (01:38):
Stephen.
Thank you so much, Erin.
It's great to be with you againand looking forward to a
wonderful conversation.
Erin Vallier (01:44):
Oh, likewise I am, so looking forward to this.
I'm just imagining you have awealth of knowledge to share
with the listeners today aboutthe topic at hand.
I believe we're going to getinto some of those key learnings
that you have uncovered byworking with the top performers
in the home care industry.
So let's dive in Before we gettoo far in the weeds.
(02:07):
I'm wondering if you could tellour audience a little bit more
about your work with the HomeCare CEO Forum and this top five
mastermind group.
Stephen Tweed (02:17):
Sure, be happy to do that, Erin.
My company, Leading Home Care,started back in 1982 when I was
called by a friend to facilitatea strategic planning process
for the board of directors of ahome health agency in western
Pennsylvania.
That led me into the homehealth, hospice, home care arena
.
So for the next 20 years I dida variety of different things,
(02:39):
mostly around strategic planning.
Then, in 2012, my wife andbusiness partner, Elizabeth
Jeffries, and I introduced tothe home care industry the
mastermind concept.
Mastermind is a concept ofbringing people together to
share ideas, to solve problems,to support one another.
Elizabeth and I have been inseveral mastermind groups with
(03:01):
other professional speakers.
We started our first group inFebruary 2013, called it the $5
million mastermind group.
To be in that group, you had tobe doing $5 million in revenue
At that time.
That was a pretty big home carecompany.
We had five companies, eightindividuals at our very first
event and the invitation wascome and meet with us for a day
(03:23):
and a half.
If you like it, join the group.
If not, no hard feeling.
Well, all eight people stayedin the group and that group
still exists today.
Today we call it the top 5%group based on percentile of
revenue in the industry and thatdata comes from the Home Care
Pulse benchmarking study.
One of those five originalcompanies is still in the group.
(03:46):
Oh wow, the other four havesold their businesses and gone
on to do other things.
The 5% group has been aroundfor 12 years, 13 years, and then
in 2014, we started anothergroup and then another group and
another group.
So today the Home Care CEOForum has five mastermind groups
, about 55 companies, and eachgroup is made up of 10 to 12
(04:11):
companies.
No one in the group competeswith anyone else in the group,
so they're spread outgeographically and they're all
independents.
There are no franchises in thegroups.
At this point, We've looked atforming some groups of
franchisees, but up until nowthe members have elected to
limit it to independent homecare companies.
Erin Vallier (04:32):
I love what you're doing.
It started humbly and now it'sexpanded to something quite
sizable, and it sounds likeyou're providing a really nice
service to companies who justwant to come together and learn
as a group, learn from eachother.
I think you probably have a lotto share in terms of what
you've learned from these topfive percenters.
I think there's seven lessonsfrom our previous conversation.
(04:55):
There's seven lessons from megacompanies that you have
identified are key to success intoday's market.
Could you give us a quickrundown of these seven lessons,
and I'm sure we'll double clickon some of them as we go through
?
Stephen Tweed (05:09):
Yeah, I've been asked to speak at a number of
home care conferences around thecountry, and the topic that I
offered was seven lessons fromthe mega companies.
These are principles that wehave extracted from this decades
long work with these top tiercompanies and with the other
companies.
We have our top, thisdecades-long work with these
top-tier companies and with theother companies.
We have our top 7% group, ourtop 10% group and then two
(05:29):
groups that we call strategicgrowth groups.
Lesson number one is to have ahuge vision.
The thing that we learn fromthese leaders in the top
companies is that each of themsees themselves running a bigger
company.
Them sees themselves running abigger company.
They have a clear mentalpicture of what it is that they
(05:50):
want to accomplish, and havingthat picture in mind has enabled
them to move forward in thatdirection.
As I mentioned, this group is12 years old and some of the
companies have grown quitedramatically since then.
We also have had a number ofcompanies that have exited out
of the group because they havebeen acquired by other large
(06:10):
companies or by private equitygroups.
These leaders see themselvesrunning big companies and they
see themselves exiting at somepoint via the sale.
Closely tied to that is thesecond lesson, which is to craft
a strong culture.
When we talk about culture inany business, particularly in
(06:32):
home care, we define culture asthe way we do things around here
, and the way we do things, orthe culture, is influenced by a
couple of factors.
First of all is the leadershipstyle of the CEO, and clearly
the CEO sets the theme, sets theframework, sets the culture.
Second element are the corevalues that guide actions and
(06:57):
decisions within the company.
Over the years, we work with anumber of home care companies to
guide them through this processof defining your core values,
and what we've learned over theyears is that to be most
effective, you need to havethree, maybe four, core values.
I learned this lesson 15 yearsago from the CEO of one of the
(07:19):
large franchise companies, whowas speaking at a national
conference and he said we onlyhave three cultures because
people can't remember five, andI thought that was interesting
and so I've literally testedthat out.
If I've been with a companythat has five or six or seven
stated core values, I'll asksomebody off the top of your
head, list for me your company'score values.
(07:40):
They'll get three easily, maybefour.
Most people stumble at five anddon't get six or seven.
So if you can't remember morethan three, why have more than
three?
And so, as we've worked aroundthat principle and have gotten
folks to clearly define theirthree core values, then the next
piece is the behavior that youexpect.
And so we work around the corevalues to define behaviors.
(08:04):
What does it look like whensomebody is living this value?
Let's take excellence, forexample, and if excellence is a
core value, what does that mean?
What's the definition andwhat's the behavior that people
demonstrate when they'reproviding excellence?
And then the fourth element isthe behavior you permit.
So the leadership style of theCEO, the core values that guide
(08:26):
your actions and decisions, thebehavior you expect and the
behavior you permit.
I mentioned my wife and businesspartner.
Elizabeth Jeffries helped meorganize the CEO masterminds in
the CEO forum.
Elizabeth is a professionalspeaker and author, but she also
coaches C-suite leaders inhospitals and health systems.
She coaches physician leadersin academic medicine, and one of
(08:50):
the principles that Elizabethshares with her leaders is the
behavior you permit, you promote.
We see that all across homecare.
When you have peopledemonstrating unacceptable
behavior but you permit it, it'sin essence saying it's okay.
And so whether you get intopeople.
(09:12):
No call, no show.
People not documenting properlyall of the things that folks do
.
That is unacceptable.
If you permit that, then you'repromoting, and so those things
really lead us to this notion ofcrafting a strong culture.
So, lesson number one have ahuge vision.
(09:33):
Lesson number two craft astrong culture.
Lesson number three is tocreate distinction.
What is it that separates yourcompany from all the other
companies in home care?
I just updated my estimate ofthe number of companies in home
care and we estimate that thereare about 29,000 companies
(09:55):
providing home care in the US,including all of the home care
companies across Canada.
While there are only 30 statesin America that license home
care companies, there are 20states with no licensure from
our data tracking franchisesystems and from our data
tracking what we call affiliatedhome care companies.
(10:17):
Those are home care companiesaffiliated with a home health
agency, a hospice, a seniorliving community or a hospital
system.
We've organized this into someestimates of the number of
independent agencies, franchises, affiliated companies and the
number of registries and, ofcourse, in America, I'm not the
registries in Canada.
(10:38):
In America, registries arebasically a broker intermediary
between a client and anindependent caregiver, and I
just got some new numbers indoing some research with the
Home Care Association of Florida, so we're guessing there are
about 2000 registries in the US.
Yeah, it's very popular inFlorida and East Coast and
(10:58):
Georgia Florida actuallyincorporates registries into
their legislation, as doPennsylvania and Maryland, and
then there are other states thatpermit registries and states
that prohibit them, so it's avery interesting segment of the
population.
And so if there's 29,000companies out there, what is it
that separates your company fromall the others?
In most major metro areas inthe US and across Canada,
(11:23):
there's really a saturation ofhome care companies.
I think that creates confusionon the part of consumers as to
where do I start when I Googlehome care.
I live in Louisville, kentucky.
Pick home care in Louisville,kentucky and the proliferation
of agencies that pop up, how doyou differentiate yourself?
Too many options, that's right.
(11:43):
So we've done a lot of work andwe've identified what I call
the seven sources of competitiveadvantage and we dig deeply
into each of those and I'm notgoing to list them all, but
things like creating excellence,creating exceptional customer
experiences, narrow market focus, concentrating on what I call
your ideal customer, creatingspecialty programs around
(12:06):
disease states.
We have a number of our homecare mastermind members who have
created specialty programsaround Alzheimer's and dementia
or around Parkinson's and othermovement disorders, being highly
specialized in a narrow list ofdisease states and really being
the expert in providing care inthe home for those persons with
(12:30):
those diseases.
So that's creating distinction.
Lesson number four is to be onpurpose and tell your story.
What we've learned over theyears as as professional
speakers, is that stories andlanguage create feelings and
feelings spark behavior.
(12:51):
If we want somebody to behavein a certain way, if we can make
an emotional connection withthem and stories are a great way
to do that.
What I've learned over thethree decades of working in home
care is that pretty much everyhome care company owner has a
personal story about how theygot into this business.
Why they got into this business.
(13:11):
It was caring for a familymember.
It was seeing the need outthere.
Whatever the case might be,many people who have heard me
speak have heard my personalstory.
When my son was one year old, hewas having some issues with
movement and so we went througha series of doctors, ended up at
(13:32):
Pittsburgh Children's Hospitalin Pittsburgh, pennsylvania.
As I opened the story, I said Iwalked into the office of a
world-renowned pediatricneurologist.
It was a dark, gloomy office,but then he was a dark, gloomy
doctor.
He said to us, after being herefor 10 days and doing all the
(13:52):
tests that I know how to do.
I'm not 100% certain, but Ibelieve that your son has a rare
neuromuscular disease calledWernig-Hoffman syndrome anterior
spinal muscular atrophy.
He said it is very rare.
I've been practicing medicinehere for 30 years.
I've seen 12 cases.
I have no idea what causes it.
(14:14):
There is no known cure.
I believe your son willprobably live to be three or
four.
Take him home and love him.
Well, back then we did what thedoctor ordered, so we took him
home and loved him.
And there's more to the story.
But today my son, jason, is 54years old, he's married, he has
twins that are 22.
(14:34):
He owns his own company calledMediaStead, which designs and
produces websites and digitalmarketing for home care
companies.
Jason has the physical abilityto use the fingers on his right
hand.
Everything else he needsassistance with the activities
of daily living.
So he is a consumer of homecare on a daily basis, daily
(15:00):
basis.
And it is because of Jason andour family experience and the
impact of home care that we arecommitted mentally,
intellectually, emotionally tothe home care space, and we know
from our own personalexperience that home care makes
a difference for the clients,but it makes an even bigger
difference for the family, andso that's just a little tiny
piece of my story, but itillustrates why we do what we do
.
Erin Vallier (15:21):
Yeah, it's compelling.
It draws people in too.
Exactly.
Stephen Tweed (15:25):
So it brings us back to being on purpose.
We have learned that if everyhome care company and every
leadership team can get clearabout their story and purpose,
then it brings much deepermeaning into what we do and why
we do it, and people trust you.
Erin Vallier (15:45):
That's right.
They know or they feel that youhave their best interests at
heart.
Stephen Tweed (15:49):
Exactly.
I'm reading a book right nowcalled Story Brand 2.0, from a
marketing leader talking abouthow we take our personal history
and craft stories thatcommunicate the message of what
we do.
The more that we can usestories and emotions and have a
sense of being on purpose, themore we connect with families,
(16:13):
with clients and with highpotential referral partners and
the more we enjoy what we'redoing.
Right, Exactly.
So that's number four.
Then we go on to number five,which is to build an amazing
team, and it's very clear to methat the companies in the top
tiers of this industry haveleaders who see themselves
growing a big company.
(16:34):
They recognize the need tobring in great people and they
have developed a process foridentifying and recruiting and
attracting great team membersand then bringing them into that
corporate culture.
So we see how the pieces fittogether vision, culture,
creating distinction, being onpurpose, building an amazing
(16:55):
team.
And that leads to number six,which is to be a systems thinker
team.
And that leads to number six,which is to be a systems thinker
, and again, the top tiercompanies, the leaders are
systems thinkers and they'rethinking about how do we
replicate tasks, processes,procedures so that they're
highly repeatable, Becausethat's the secret to growing a
(17:16):
big company is having thatrepetition and consistency that
enables the team to do the sametasks over and over again on a
large scale.
And then that takes us to numberseven, which is to measure
performance and communicateexpectations.
What is it that we want theteam to do?
How are we doing?
(17:36):
How do we measure that feedingback to the team to again
continue to grow theexpectations of what we want to
accomplish.
So those are the seven andthey're broad lessons.
And then, as we have worked eachof our mastermind groups, we
are able to dig deeper into thedetails of how these processes
(17:56):
work.
So, for example, we said be asystems thinker, and we're just
now completing the 2025 futureof home care study that we're
doing and we identified 12systems that can be put in place
in a home care company, and theparticipants in our survey have
told us which systems are mostimportant.
(18:18):
So that report will be comingout in the next couple of weeks
and we'll be sharing that data.
But we learned a lot from these.
I think we had 250 some homecare leaders who participated in
the survey and gave us somegreat insights into what's
important to them the systems,the major trends in the industry
, the threats or the pain pointsthat are keeping them awake at
(18:42):
night.
So we continue to dig intowhat's moving leaders in home
care forward and what's gettingin the way of them growing more
quickly.
Erin Vallier (18:51):
That'll be a really interesting report to get
your hands on and learn somestuff.
You've mentioned several thingshere that really strike a chord
with me.
One of my passions isleadership and I speak on it and
coach people on it from time totime.
And some of your points herelike building a strong culture
and building an amazing teamthose to me seem very closely
(19:15):
tied together to having a reallystrong leadership team and
having the right mentality,being a servant leader.
And it's amazing to me, likewhen I talk to different
agencies.
I talk to different agenciesevery day and you'll talk to one
and they just struggle so muchwith getting people to even like
clock in and clock out to theirvisits and then you'll talk to
(19:38):
another who is like well, I haveno problem with that and I have
no problem with retaining myemployees.
I'm doing these things, thesethings.
It's like how are these peopleso different?
I think it has everything to dowith leadership and change
management and setting up thatstrong culture and enforcing it
and building an amazing team.
What do you say to those peoplethat are struggling in the area
(20:02):
of having a good culture, wherepeople want to be there, and
how to go about building thatamazing team, if that's what
they're lacking.
Stephen Tweed (20:11):
Yeah, I think you're exactly right, and as we
have identified these, I wentback.
We did a study back in 2016 onwhat we called the DNA of a CEO
and we used an online assessmenttool called the Trimetrics DNA
that measures behavioral styles.
It measures workplacemotivators, and then it measured
(20:32):
what the developers called DNA,or the 25 leadership
characteristics, and from thatwe identified the typical
behavioral profile of a CEO.
As part of that study alsoprofile of a COO we looked at
what motivates them and then welooked at these 25 leadership
(20:54):
competencies and we were able torank them in order, and so
we've done a lot of work withthe members of our mastermind
groups around helping themdevelop leadership skills and
just at our December meeting ofthe top 5% group or November,
I'm sorry we were all in Dallas,texas, for three days and as we
(21:16):
were talking about what we calltheir big burning issues what
are the issues that they'refacing, that they're working on,
that may be frustrating them,that they want to talk about,
and one of the things that theleaders talked about was
leadership development.
That we've done a lot of workwithin the group and typically
in our mastermind group, thepeople who attend are the CEO
(21:40):
and the COO, and some of ourmembers are family-owned
businesses.
We have a couple of husband andwife teams.
We have a family business withthe father, son, another son, a
son-in-law, a daughter, and soat that level they've learned a
lot and they've come back andsaid well, what we'd like to do
now is develop a leadershipcurriculum for our middle
(22:02):
managers.
And again, these companies atthe top 5% range in size from
$10 to $30 million.
So a $25 or $30 million homecare company has a fairly
significant leadership team,including a large group of
middle managers, and so we're inthe process of working with
them to take this informationfrom the DNA of a CEO study and
(22:29):
look at how we develop aneducational curriculum so that
we can develop the competenciesat the middle management level
and then carry some of thosesame competencies down to the
frontline supervisors andschedulers and those kinds of
folks.
Leadership is a big piece andmost home care companies have
not really done a whole lot interms of developing their middle
(22:53):
managers.
A lot of owners and CEOs go tooutside programs run by maybe
their state home careassociation or run by their
franchise organization, butthere's not a lot available for
that middle management group.
Erin Vallier (23:09):
Yeah, and they need a lot of attention.
They have a direct impact onthe people who are doing the
actual work in the field.
So, yeah, that's important.
Stephen Tweed (23:20):
And, of course, we know that turnover has been a
huge issue in home care and weknow from other research that I
think it was a Galluporganization that did some
research and one of theirconclusions was people don't
quit companies, they quit theirmanager.
Yeah, that's right, and so ifwe have a high level of turnover
, we need to look at what's therelationship between the
(23:41):
caregiver and their immediatesupervisor.
And again, that builds backinto the corporate culture piece
, but it also builds back intoleadership skills and leadership
competency 29,000 plus agenciesacross the US.
Erin Vallier (24:05):
That's a lot.
That's a lot of competitors outthere for you to make yourself
stand out against.
So I'm curious.
You mentioned a few ways thatpeople can do that by building
specialty programs.
But let's just break that downa little bit.
How can a home care company goabout thinking about making
themselves a standout amongstthe masses who are all providing
basically the same type ofservices?
Stephen Tweed (24:28):
That's right.
Yeah, there's 29,000 companies,and we know from Home Care
Pulse now activated insightsthat the median size company
last year was 2 million andchanged like 2,009,000 and
whatever, and so that means thatif there are 29,000 companies,
there are 14,500 companiessmaller than $2 million in
(24:49):
annual revenue.
So that's a pretty smallcompany.
And so, again, they all beginto look alike.
And so how do we createdistinction?
And, as I mentioned, we've donesome research and had lots of
conversations, and I'll mentionjust a couple of them.
Probably the top two that we'veseen people build on are number
(25:10):
one, creating exceptionalcustomer experiences, which
really goes back to the consumerprimary family caregivers and
referral partners.
And so we look at, well, what'sthe experience that the
consumer is having, what's theexperience that the primary
family caregiver is having?
(25:31):
And our data show that 60% ofthe time the primary family
caregiver is the oldest daughter, and so we've labeled that the
oldest daughter syndrome is theoldest daughter, and so we've
labeled that the oldest daughtersyndrome, and then 20% of the
time it's another daughter, andthen other 20% it's another
relative, in-law, or it might bea third party, like a bank
trust officer.
And so what is that family ofthe client experiencing.
(25:55):
What's the communication likewith the home care company?
What's their level ofsatisfaction?
What's the communication likewith a home care company?
What's their level ofsatisfaction?
Home Care Pulse now ActivatedInsights has their client
satisfaction management processthat they use, and they have
lots of data around what clientsand families expect from home
care company.
We did a lot of researchearlier on about what the
(26:17):
individual consumer says theywant, and what we learned from
our focus groups and from ourqualitative research is
consumers tell us they want twothings Reliability, that is they
want a caregiver that shows upon time every time, and
continuity, that is they wantthe same caregiver every time.
And so if that's what theconsumer expects, then is that
(26:38):
being delivered and what's theirlevel of satisfaction and so
creating that exceptionalcustomer experience?
Then we go over to referralpartners and what's their
experience?
And I think so many companiesfocus on what they do for the
client that they lose sight ofwhat they do for the referral
partner and what their issuesare, what their problems are and
(26:59):
how does working with ourcompany benefit that referral
partner, whether it's adischarge planner in a hospital
or a social worker in a rehabfacility or a bank trust officer
.
We've done a lot of work aroundhelping home care companies
increase their income by sellingto bank trust officers and
(27:20):
other trusted advisors, and thedata show that the dollar value
of a client coming from thosetrusted advisors is much higher
than the dollar value of aclient coming from that
traditional healthcare continuumhospitals, home health, hospice
, skilled nursing facility, andso understanding the customer
(27:42):
expectation.
Another example is creatingwhat we call caregiver quality
assurance and that is reallyfocusing on the whole process of
attracting, retainingcaregivers, and what we're
seeing is a trend and it's theearly phases of it.
But we're seeing a number ofleading companies who are making
(28:02):
a conscious choice to shiftfrom a client or customer first
culture to a caregiver firstculture and they're saying how
do we adjust what we do to takecare of our caregivers?
Under the premise that if wetake care of our caregivers,
they will take care of ourcaregivers, under the premise
that if we take care of ourcaregivers, they will take care
of our client.
(28:23):
And sometimes that means sayingno to a client because what the
client wants is in conflictwith what the caregiver wants or
needs or finds important, andso an example of that is
reducing the number of shortshifts or setting minimum hours
per week.
And so a client calls up andsays I want three hours a day,
(28:45):
two days a week, and the companysays, no, we can't do that
because we can't staff thatshift, because our caregivers
want stable, steady schedule,certain number of hours a week,
and so we're going to focus onwhat our caregivers need
involved, and that means thatthe client may need to fit their
schedule into what's best forthe caregivers, and that's a
(29:07):
sort of 180 degree mind shiftfrom what has happened in the
past Kind of goes back tosetting that strong culture.
Erin Vallier (29:15):
That's exactly right.
So what I'm hearing you say interms of being able to create
distinction is that you reallyneed to understand all of your
customers.
So you have the recipient ofthe care that's a customer.
You also have their familythat's a customer.
Then you have your internalcustomers, your schedulers, your
caregivers and all of thepeople that are making this
(29:37):
whole machine run, and then youhave all of your referral
partners that are customers aswell.
So you got to really understandwho all those people are, what
their problems are and be a partof the solution in order to
make it super easy for them todo business with you and make
your company attractive.
Stephen Tweed (29:58):
And we have really dug deeply into that and
looked at how home carecompanies can identify their
ideal client Gotcha and we'velooked at how they use their own
data.
And so at the end of I guess itwas the third quarter of 2024,
I released a new ebook calledSix Secrets to Selling Home Care
(30:21):
to your Ideal Client and itworks through how you identify
your ideal client and how do youbuild the relationships, and
I'm happy to offer that to yourlisteners and readers.
If they want to look at that,they can go to leadinghomecare.
com and click on the storebutton and you will see that
(30:42):
ebook Six Secrets for SellingHome Care to your Ideal Customer
.
And we put up a coupon codejust for this podcast.
Awesome.
The coupon code is ALAYACARE25,A-L-A-Y-A-C-A-R-E 25, and that
will get them a 50% discount onthat ebook.
(31:03):
Fantastic.
Erin Vallier (31:05):
That's a wonderful resource.
We appreciate that.
We'll make sure that the codeand how to get to this ebook is
in the show notes so people cantake advantage of that offer.
Thank you.
Stephen Tweed (31:15):
I think people will find that very useful and
helpful to come back to lookingat this principle of narrow
market focus when you're clearabout your ideal customer and
you're clear about whichreferral partners tend to bring
you your ideal client, and thenwhat the ideal client is
concerned about in terms ofcaregivers and how we can
(31:38):
recruit caregivers who arecomfortable caring for that
ideal client.
So the pieces of the puzzlecome together and it means you
grow your business larger,increase your revenue, have more
hours per client per week,longer length of stay, your
caregivers have a regularschedule, your schedulers are
less stressed, your recruitersare less stressed because you
(32:13):
don't have as much turnover andall the pieces of the puzzle
come together quote internal andexternal customers to get them
motivated and bought into yourstory and your way of doing
things.
Erin Vallier (32:24):
Can you talk a little bit more about that and
how to leverage the individual'sstory throughout company
communications and throughoutcommunications to the referral
network and clients?
Stephen Tweed (32:34):
Well, two of the other sources of competitive
advantage or sources ofdistinction are personal
relationships and relationshipselling, and I'll share the
difference.
So, in personal relationships,the owner, the CEO, the leaders
of the company are out in thecommunity building relationships
, particularly with highpotential referral partners, and
(32:56):
for them being able to usetheir own personal story about
why they started their company,what are the impacts, who are
the people that they were caringfor, what are the stories?
And, as we said, stories andlanguage create emotions or
feelings, and feelings sparkbehavior.
(33:18):
And if the behavior we want isfor people to buy what we're
selling, then we need to sparkthat behavior by making that
emotion connection.
And so home care owners andleaders are out there in the
community building thosepersonal relationships.
Relationship selling is thesame principle, except that
instead of the owner being outthere doing that, it's a sales
(33:40):
professional or a sales team, abusiness developer, and we have
a couple of examples in our top5% group of companies that grew
dramatically because the ownersand CEOs were former sales
professionals.
They knew how to sell, theyknew how to recruit salespeople,
they knew how to manage them,and so they would build a team
(34:03):
of sales professionals that wereout there and again using story
and making personal connectionsto persuade those referral
partners that this is thecompany that's going to do the
best job for your clients.
And part of that personalrelationship is understanding
(34:24):
the needs and wants of thereferral partner.
As I think I mentioned earlier,most companies do a good job of
explaining what we do for theclient, but most companies don't
do a good job of explainingwhat's the benefit to the
referral partner of using ourcompany versus any of the other
companies across town.
What's in it for them?
All of those people have thatlittle radio call sign stenciled
(34:47):
on their forehand W-I-F-F-M.
What's in it for me?
So, as we have thesesalespeople, learn to really
understand the business of thereferral partner.
So if it's a hospital dischargeplanner, what's important to
that discharge planner?
If it's a social worker in anursing home rehab unit they've
(35:09):
got people being dischargedpretty much every day what's
important to that social worker?
If it's a bank trust officerwho's working with high net
worth clients who have largetrusts in the States, what's
important to that bank trustofficer?
And I think most home careleaders have not sat down and
really developed those kinds ofrelationships and thought
(35:33):
through how does what I do in mycompany, benefit, that
discharge plan or that socialworker, that trust officer.
Erin Vallier (35:41):
That's an important exercise.
I know that when I was on theprovider side, we spent some
time really thinking about howwe could serve our referral
partners better, and we werealways on the cutting edge, the
leading edge of new programs ofmaking their lives easier.
Maybe we set up shop in the ALFand we have an office there so
they can just come, tap us onthe shoulder and we partner with
(36:03):
them in different ways in orderto make it more synergistic for
both of us and get the job donewith less resources and a lot
less paperwork and headache.
So it's worth the effort to sitdown and think about what your
referral partners really needand how you can give it to them
in a way that nobody else hasever thought of.
So get creative there, whichprobably leads to some of the
(36:26):
systems that you've mentioned.
You say be a systems thinkerand there's roughly did I
remember correctly about 25different systems that you guys
have identified.
I know you're going to releasethat paper in a little while to
expand on all of those things,but I'm curious from your
initial learning from that study, what are the most important
systems for home care companiesto develop in order to scale
(36:49):
their business?
Can you share?
Stephen Tweed (36:52):
We've actually identified 12 systems.
The 25 we talked about earlierwas the leadership competencies
of CEOs Gotcha the leadershipcompetencies of CEOs Gotcha With
systems.
We've identified 12 systems,starting with a sales system, a
marketing system, a conversionsystem to convert callers to
(37:12):
clients, a recruiting system, aretention system, right through
the business.
We came up with 12 of them, andso I'll give you just a quick
sneak peek of what we learnedfrom this survey.
Last year, when we did thesurvey, the system that was
important to our respondents wascaregiver recruiting, followed
by caregiver retention.
This year it flipped a littlebit.
(37:33):
Caregiver recruiting is numbertwo, retention is number three.
Number one is caregiverscheduling.
So there's been a renewedawareness and thought processes
for that system of scheduling,which includes using software,
scheduling software or home careoperating system, and what all
is involved in making thatsystem work both for the client
(37:56):
and for the caregiver, and howdoes technology come into play.
And then there's a whole othersection of the survey on
technology and we're looking atthings like where does
artificial intelligence comeinto play and how does
artificial intelligence getbuilt into scheduling software,
(38:25):
into scheduling software, andhow do we teach schedulers to
use the software and theartificial intelligence to
improve the scheduling system.
When we talk about systems,there's two parts of it.
There's the process, that isthe step-by-step process that we
go through, and there's thepeople, and the people that have
the discipline to follow thesystem, to document the things
that take place, to recognizewhen the system has a flaw and
(38:47):
we need to fix it, and so it's acombination of process and
people that makes these systemsthat are repeatable and
consistent, and there's 12systems.
We know that most home carecompanies can't deal with all 12
of them.
And there's 12 systems.
We know that most home carecompanies can't deal with all 12
of them.
So it's a matter of where doyou start, and by having this
data from 250 home care leaders,we give folks a clue on where
(39:10):
to start, what to focus on, whatto work on.
So scheduling, recruiting,retention.
Number four on our list thisyear is home care marketing, and
it's interesting because lastyear home care sales was up
there and we know that sales isa subset of marketing, but it's
specific.
And then number five is billingand collection looking at
(39:31):
systems, and, of course, whatwe're seeing is more and more
home care companies thinkingabout other revenue streams and
other payers beyond private payor beyond Medicaid, and so
there's a lot of veryinteresting data that's coming
out of this study, and so we'llhope your listeners will be
looking for that.
(39:52):
One of the ways that they canlearn about the research that
we're doing at Leading Home Careand that we're doing with our
various partners in the industrywould be to subscribe to my
weekly newsletter.
I have a weekly newslettercalled Stephen Tweed's Thursday
Thoughts.
It comes out every Thursday at7 am Eastern time and it's a
(40:12):
little short story or example,but when we're releasing new
information we'll write about itin the newsletter.
So when this wait paper comesout, I'll do probably a whole
issue of Thursday thoughts onsome of the lessons that we've
learned from this research.
Erin Vallier (40:31):
Fantastic.
We'll make sure that thelisteners have that also in the
show notes so they can sign up.
Sounds like there's a lot ofgood information that you're
passing around.
You've got me excited.
It sounds like a lot of thesesystems that need to be in place
involve technology.
I heard you say artificialintelligence, being able to bill
and being able to streamlineand all this stuff.
So there's an intersection oftechnology with people there,
(40:55):
and I always enjoy hearing aboutthat and working for a
technology company, I know thatwe've butted up pretty much
against our time.
This has been a reallyinformative conversation.
There are some resources thatyou have mentioned and we'll
make sure that people haveaccess to those in the show
notes, but I'm curious ifthere's any parting wisdom you
(41:16):
want to give or just another wayto get in touch with you to
have conversations about, ormore targeted conversations
about, how you might be able tohelp a business grow and thrive
or how they might be able to getinvolved in some of these
groups that you've got going on.
Stephen Tweed (41:33):
Well, thanks for asking, and in 2025 is an
interesting year.
As many people out there know,I formed the Home Care CEO Forum
in 2012, grew that for 12 years.
I sold that business in Januaryof 2023 to my friend and
colleague, jensen Jones, who wasone of our top 7% mastermind
members, and I had a two-yearagreement with Jensen to
(41:54):
continue to run the 5% group andto do some other things within
the CEO forum.
So that agreement has come tocompletion.
We're going to continue to dosome other things together.
But I sort of stepped back and afriend of mine sent me an
article called I'm not retiring,I'm rewiring, and I love that.
(42:15):
I said that's me.
I'm not retiring, I'm going tostick around own care, but I'm
doing some things differently.
I love it.
And so I thought about it andprayed about it and talked to
some of my advisors, and so myfocus going forward will be
three things.
One is serving on some boardsof directors of home care or
(42:35):
home care related businesses.
The second will be to shift myfocus as a strategic advisor to
work one-on-one with a handfulof CEOs who really want someone
to walk side by side and be asounding board and be a resource
to help them strategicallythink through where they're
(42:58):
going.
And then the third is continueto do industry research, and I
love doing research andgathering data, and so I'm going
to continue to do some of thaton my own through Leading Home
Care and for third-partyorganizations that come to us
and say I need to know moreabout whatever.
So the 2025 Future Home CareStudy is an example of that kind
(43:20):
of research, and so, if yourlisteners are looking for a
board member or in some caseswith closely held companies that
have only on their board, theyhave an advisory board of
experts who know the home careindustry, and so I'm putting
together a couple of advisoryboards for member companies.
(43:40):
I'm putting together a coupleof advisory boards for member
companies, and then I'm alsoworking one-on-one with some
CEOs to be that strategicadvisor, walking side by side.
So the website'sleadinghomecare.
com and there are the threesections on that website.
Also, the store has that ebookSix Secrets to Selling Home Care
to your Ideal Client, and thecoupon code ALAYACARE25 to get a
(44:06):
50% discount.
So there's also a spot.
If somebody wants to just havea conversation, they can fill
out the form at the bottom ofthe page and we'll respond and
set up a time to talk.
Erin Vallier (44:17):
Fantastic.
Thanks so much for sharing yourknowledge and for letting
everybody know how to get intouch with you.
I really do hope that a bunchof people listening to this
today will take advantage ofyour offer for the ebook and get
involved in what you got goingon in some way.
So thank you so much for comingon the show today, Stephen.
(44:37):
It's been a real pleasure.
Stephen Tweed (44:38):
Thank you, erin, best wishes.
Have a great rest of the year.
Erin Vallier (44:41):
Thanks.
Home Help 360 is presented byAlaya Care and hosted by Erin
Vallier.
First, we want to thank ouramazing guests and listeners.
Second, new episodes air everymonth, so be sure to subscribe
today so you don't miss anepisode.
And, last but not least, if youlike this episode and want to
learn more about all thingshome-based care, you can explore
(45:05):
all of our episodes atalayacare.
com/ home health 360 or visit uson your favorite podcast
platform.
Last year when we did the survey, the system that
was important to ourrespondents was caregiver
recruiting, followed bycaregiver retention.
This year it flipped a littlebit.
Caregiver recruiting is numbertwo, retention is number three.
Number one is caregiverscheduling.
So there's been a renewedawareness and thought processes
(00:20):
for that system of scheduling,which includes using software,
scheduling software or home careoperating system, and what all
is involved in making thatsystem work both for the client
and for the caregiver.
And how does technology comeinto play?
Erin Vallier (00:54):
Welcome to another episode of the Home Health 360
podcast, where we speak tohome-based care professionals
from around the globe.
I'm your host, Erin Vallier,and today I am joined by Stephen
Tweed.
Stephen is an internationallyknown home care business
strategist, award-winningprofessional speaker, published
author and strategic businessadvisor.
He has spent the last threedecades working with home care
(01:15):
companies that want to grow andwith home care leaders that want
to get ready for the future.
Currently, he is CEO of LeadingHome Care, a Tweed Jeffries
company, and founder of the HomeCare CEO Forum.
Stephen has authored orco-authored eight books written
specifically for the home careindustry.
(01:36):
Welcome to the show.
Stephen Tweed (01:38):
Stephen.
Thank you so much, Erin.
It's great to be with you againand looking forward to a
wonderful conversation.
Erin Vallier (01:44):
Oh, likewise I am, so looking forward to this.
I'm just imagining you have awealth of knowledge to share
with the listeners today aboutthe topic at hand.
I believe we're going to getinto some of those key learnings
that you have uncovered byworking with the top performers
in the home care industry.
So let's dive in Before we gettoo far in the weeds.
(02:07):
I'm wondering if you could tellour audience a little bit more
about your work with the HomeCare CEO Forum and this top five
mastermind group.
Stephen Tweed (02:17):
Sure, be happy to do that, Erin.
My company, Leading Home Care,started back in 1982 when I was
called by a friend to facilitatea strategic planning process
for the board of directors of ahome health agency in western
Pennsylvania.
That led me into the homehealth, hospice, home care arena
.
So for the next 20 years I dida variety of different things,
(02:39):
mostly around strategic planning.
Then, in 2012, my wife andbusiness partner, Elizabeth
Jeffries, and I introduced tothe home care industry the
mastermind concept.
Mastermind is a concept ofbringing people together to
share ideas, to solve problems,to support one another.
Elizabeth and I have been inseveral mastermind groups with
(03:01):
other professional speakers.
We started our first group inFebruary 2013, called it the $5
million mastermind group.
To be in that group, you had tobe doing $5 million in revenue
At that time.
That was a pretty big home carecompany.
We had five companies, eightindividuals at our very first
event and the invitation wascome and meet with us for a day
(03:23):
and a half.
If you like it, join the group.
If not, no hard feeling.
Well, all eight people stayedin the group and that group
still exists today.
Today we call it the top 5%group based on percentile of
revenue in the industry and thatdata comes from the Home Care
Pulse benchmarking study.
One of those five originalcompanies is still in the group.
(03:46):
Oh wow, the other four havesold their businesses and gone
on to do other things.
The 5% group has been aroundfor 12 years, 13 years, and then
in 2014, we started anothergroup and then another group and
another group.
So today the Home Care CEOForum has five mastermind groups
, about 55 companies, and eachgroup is made up of 10 to 12
(04:11):
companies.
No one in the group competeswith anyone else in the group,
so they're spread outgeographically and they're all
independents.
There are no franchises in thegroups.
At this point, We've looked atforming some groups of
franchisees, but up until nowthe members have elected to
limit it to independent homecare companies.
Erin Vallier (04:32):
I love what you're doing.
It started humbly and now it'sexpanded to something quite
sizable, and it sounds likeyou're providing a really nice
service to companies who justwant to come together and learn
as a group, learn from eachother.
I think you probably have a lotto share in terms of what
you've learned from these topfive percenters.
I think there's seven lessonsfrom our previous conversation.
(04:55):
There's seven lessons from megacompanies that you have
identified are key to success intoday's market.
Could you give us a quickrundown of these seven lessons,
and I'm sure we'll double clickon some of them as we go through
?
Stephen Tweed (05:09):
Yeah, I've been asked to speak at a number of
home care conferences around thecountry, and the topic that I
offered was seven lessons fromthe mega companies.
These are principles that wehave extracted from this decades
long work with these top tiercompanies and with the other
companies.
We have our top, thisdecades-long work with these
top-tier companies and with theother companies.
We have our top 7% group, ourtop 10% group and then two
(05:29):
groups that we call strategicgrowth groups.
Lesson number one is to have ahuge vision.
The thing that we learn fromthese leaders in the top
companies is that each of themsees themselves running a bigger
company.
Them sees themselves running abigger company.
They have a clear mentalpicture of what it is that they
(05:50):
want to accomplish, and havingthat picture in mind has enabled
them to move forward in thatdirection.
As I mentioned, this group is12 years old and some of the
companies have grown quitedramatically since then.
We also have had a number ofcompanies that have exited out
of the group because they havebeen acquired by other large
(06:10):
companies or by private equitygroups.
These leaders see themselvesrunning big companies and they
see themselves exiting at somepoint via the sale.
Closely tied to that is thesecond lesson, which is to craft
a strong culture.
When we talk about culture inany business, particularly in
(06:32):
home care, we define culture asthe way we do things around here
, and the way we do things, orthe culture, is influenced by a
couple of factors.
First of all is the leadershipstyle of the CEO, and clearly
the CEO sets the theme, sets theframework, sets the culture.
Second element are the corevalues that guide actions and
(06:57):
decisions within the company.
Over the years, we work with anumber of home care companies to
guide them through this processof defining your core values,
and what we've learned over theyears is that to be most
effective, you need to havethree, maybe four, core values.
I learned this lesson 15 yearsago from the CEO of one of the
(07:19):
large franchise companies, whowas speaking at a national
conference and he said we onlyhave three cultures because
people can't remember five, andI thought that was interesting
and so I've literally testedthat out.
If I've been with a companythat has five or six or seven
stated core values, I'll asksomebody off the top of your
head, list for me your company'score values.
(07:40):
They'll get three easily, maybefour.
Most people stumble at five anddon't get six or seven.
So if you can't remember morethan three, why have more than
three?
And so, as we've worked aroundthat principle and have gotten
folks to clearly define theirthree core values, then the next
piece is the behavior that youexpect.
And so we work around the corevalues to define behaviors.
(08:04):
What does it look like whensomebody is living this value?
Let's take excellence, forexample, and if excellence is a
core value, what does that mean?
What's the definition andwhat's the behavior that people
demonstrate when they'reproviding excellence?
And then the fourth element isthe behavior you permit.
So the leadership style of theCEO, the core values that guide
(08:26):
your actions and decisions, thebehavior you expect and the
behavior you permit.
I mentioned my wife and businesspartner.
Elizabeth Jeffries helped meorganize the CEO masterminds in
the CEO forum.
Elizabeth is a professionalspeaker and author, but she also
coaches C-suite leaders inhospitals and health systems.
She coaches physician leadersin academic medicine, and one of
(08:50):
the principles that Elizabethshares with her leaders is the
behavior you permit, you promote.
We see that all across homecare.
When you have peopledemonstrating unacceptable
behavior but you permit it, it'sin essence saying it's okay.
And so whether you get intopeople.
(09:12):
No call, no show.
People not documenting properlyall of the things that folks do
.
That is unacceptable.
If you permit that, then you'repromoting, and so those things
really lead us to this notion ofcrafting a strong culture.
So, lesson number one have ahuge vision.
(09:33):
Lesson number two craft astrong culture.
Lesson number three is tocreate distinction.
What is it that separates yourcompany from all the other
companies in home care?
I just updated my estimate ofthe number of companies in home
care and we estimate that thereare about 29,000 companies
(09:55):
providing home care in the US,including all of the home care
companies across Canada.
While there are only 30 statesin America that license home
care companies, there are 20states with no licensure from
our data tracking franchisesystems and from our data
tracking what we call affiliatedhome care companies.
(10:17):
Those are home care companiesaffiliated with a home health
agency, a hospice, a seniorliving community or a hospital
system.
We've organized this into someestimates of the number of
independent agencies, franchises, affiliated companies and the
number of registries and, ofcourse, in America, I'm not the
registries in Canada.
(10:38):
In America, registries arebasically a broker intermediary
between a client and anindependent caregiver, and I
just got some new numbers indoing some research with the
Home Care Association of Florida, so we're guessing there are
about 2000 registries in the US.
Yeah, it's very popular inFlorida and East Coast and
(10:58):
Georgia Florida actuallyincorporates registries into
their legislation, as doPennsylvania and Maryland, and
then there are other states thatpermit registries and states
that prohibit them, so it's avery interesting segment of the
population.
And so if there's 29,000companies out there, what is it
that separates your company fromall the others?
In most major metro areas inthe US and across Canada,
(11:23):
there's really a saturation ofhome care companies.
I think that creates confusionon the part of consumers as to
where do I start when I Googlehome care.
I live in Louisville, kentucky.
Pick home care in Louisville,kentucky and the proliferation
of agencies that pop up, how doyou differentiate yourself?
Too many options, that's right.
(11:43):
So we've done a lot of work andwe've identified what I call
the seven sources of competitiveadvantage and we dig deeply
into each of those and I'm notgoing to list them all, but
things like creating excellence,creating exceptional customer
experiences, narrow market focus, concentrating on what I call
your ideal customer, creatingspecialty programs around
(12:06):
disease states.
We have a number of our homecare mastermind members who have
created specialty programsaround Alzheimer's and dementia
or around Parkinson's and othermovement disorders, being highly
specialized in a narrow list ofdisease states and really being
the expert in providing care inthe home for those persons with
(12:30):
those diseases.
So that's creating distinction.
Lesson number four is to be onpurpose and tell your story.
What we've learned over theyears as as professional
speakers, is that stories andlanguage create feelings and
feelings spark behavior.
(12:51):
If we want somebody to behavein a certain way, if we can make
an emotional connection withthem and stories are a great way
to do that.
What I've learned over thethree decades of working in home
care is that pretty much everyhome care company owner has a
personal story about how theygot into this business.
Why they got into this business.
(13:11):
It was caring for a familymember.
It was seeing the need outthere.
Whatever the case might be,many people who have heard me
speak have heard my personalstory.
When my son was one year old, hewas having some issues with
movement and so we went througha series of doctors, ended up at
(13:32):
Pittsburgh Children's Hospitalin Pittsburgh, pennsylvania.
As I opened the story, I said Iwalked into the office of a
world-renowned pediatricneurologist.
It was a dark, gloomy office,but then he was a dark, gloomy
doctor.
He said to us, after being herefor 10 days and doing all the
(13:52):
tests that I know how to do.
I'm not 100% certain, but Ibelieve that your son has a rare
neuromuscular disease calledWernig-Hoffman syndrome anterior
spinal muscular atrophy.
He said it is very rare.
I've been practicing medicinehere for 30 years.
I've seen 12 cases.
I have no idea what causes it.
(14:14):
There is no known cure.
I believe your son willprobably live to be three or
four.
Take him home and love him.
Well, back then we did what thedoctor ordered, so we took him
home and loved him.
And there's more to the story.
But today my son, jason, is 54years old, he's married, he has
twins that are 22.
(14:34):
He owns his own company calledMediaStead, which designs and
produces websites and digitalmarketing for home care
companies.
Jason has the physical abilityto use the fingers on his right
hand.
Everything else he needsassistance with the activities
of daily living.
So he is a consumer of homecare on a daily basis, daily
(15:00):
basis.
And it is because of Jason andour family experience and the
impact of home care that we arecommitted mentally,
intellectually, emotionally tothe home care space, and we know
from our own personalexperience that home care makes
a difference for the clients,but it makes an even bigger
difference for the family, andso that's just a little tiny
piece of my story, but itillustrates why we do what we do
.
Erin Vallier (15:21):
Yeah, it's compelling.
It draws people in too.
Exactly.
Stephen Tweed (15:25):
So it brings us back to being on purpose.
We have learned that if everyhome care company and every
leadership team can get clearabout their story and purpose,
then it brings much deepermeaning into what we do and why
we do it, and people trust you.
Erin Vallier (15:45):
That's right.
They know or they feel that youhave their best interests at
heart.
Stephen Tweed (15:49):
Exactly.
I'm reading a book right nowcalled Story Brand 2.0, from a
marketing leader talking abouthow we take our personal history
and craft stories thatcommunicate the message of what
we do.
The more that we can usestories and emotions and have a
sense of being on purpose, themore we connect with families,
(16:13):
with clients and with highpotential referral partners and
the more we enjoy what we'redoing.
Right, Exactly.
So that's number four.
Then we go on to number five,which is to build an amazing
team, and it's very clear to methat the companies in the top
tiers of this industry haveleaders who see themselves
growing a big company.
(16:34):
They recognize the need tobring in great people and they
have developed a process foridentifying and recruiting and
attracting great team membersand then bringing them into that
corporate culture.
So we see how the pieces fittogether vision, culture,
creating distinction, being onpurpose, building an amazing
(16:55):
team.
And that leads to number six,which is to be a systems thinker
team.
And that leads to number six,which is to be a systems thinker
, and again, the top tiercompanies, the leaders are
systems thinkers and they'rethinking about how do we
replicate tasks, processes,procedures so that they're
highly repeatable, Becausethat's the secret to growing a
(17:16):
big company is having thatrepetition and consistency that
enables the team to do the sametasks over and over again on a
large scale.
And then that takes us to numberseven, which is to measure
performance and communicateexpectations.
What is it that we want theteam to do?
How are we doing?
(17:36):
How do we measure that feedingback to the team to again
continue to grow theexpectations of what we want to
accomplish.
So those are the seven andthey're broad lessons.
And then, as we have worked eachof our mastermind groups, we
are able to dig deeper into thedetails of how these processes
(17:56):
work.
So, for example, we said be asystems thinker, and we're just
now completing the 2025 futureof home care study that we're
doing and we identified 12systems that can be put in place
in a home care company, and theparticipants in our survey have
told us which systems are mostimportant.
(18:18):
So that report will be comingout in the next couple of weeks
and we'll be sharing that data.
But we learned a lot from these.
I think we had 250 some homecare leaders who participated in
the survey and gave us somegreat insights into what's
important to them the systems,the major trends in the industry
, the threats or the pain pointsthat are keeping them awake at
(18:42):
night.
So we continue to dig intowhat's moving leaders in home
care forward and what's gettingin the way of them growing more
quickly.
Erin Vallier (18:51):
That'll be a really interesting report to get
your hands on and learn somestuff.
You've mentioned several thingshere that really strike a chord
with me.
One of my passions isleadership and I speak on it and
coach people on it from time totime.
And some of your points herelike building a strong culture
and building an amazing teamthose to me seem very closely
(19:15):
tied together to having a reallystrong leadership team and
having the right mentality,being a servant leader.
And it's amazing to me, likewhen I talk to different
agencies.
I talk to different agenciesevery day and you'll talk to one
and they just struggle so muchwith getting people to even like
clock in and clock out to theirvisits and then you'll talk to
(19:38):
another who is like well, I haveno problem with that and I have
no problem with retaining myemployees.
I'm doing these things, thesethings.
It's like how are these peopleso different?
I think it has everything to dowith leadership and change
management and setting up thatstrong culture and enforcing it
and building an amazing team.
What do you say to those peoplethat are struggling in the area
(20:02):
of having a good culture, wherepeople want to be there, and
how to go about building thatamazing team, if that's what
they're lacking.
Stephen Tweed (20:11):
Yeah, I think you're exactly right, and as we
have identified these, I wentback.
We did a study back in 2016 onwhat we called the DNA of a CEO
and we used an online assessmenttool called the Trimetrics DNA
that measures behavioral styles.
It measures workplacemotivators, and then it measured
(20:32):
what the developers called DNA,or the 25 leadership
characteristics, and from thatwe identified the typical
behavioral profile of a CEO.
As part of that study alsoprofile of a COO we looked at
what motivates them and then welooked at these 25 leadership
(20:54):
competencies and we were able torank them in order, and so
we've done a lot of work withthe members of our mastermind
groups around helping themdevelop leadership skills and
just at our December meeting ofthe top 5% group or November,
I'm sorry we were all in Dallas,texas, for three days and as we
(21:16):
were talking about what we calltheir big burning issues what
are the issues that they'refacing, that they're working on,
that may be frustrating them,that they want to talk about,
and one of the things that theleaders talked about was
leadership development.
That we've done a lot of workwithin the group and typically
in our mastermind group, thepeople who attend are the CEO
(21:40):
and the COO, and some of ourmembers are family-owned
businesses.
We have a couple of husband andwife teams.
We have a family business withthe father, son, another son, a
son-in-law, a daughter, and soat that level they've learned a
lot and they've come back andsaid well, what we'd like to do
now is develop a leadershipcurriculum for our middle
(22:02):
managers.
And again, these companies atthe top 5% range in size from
$10 to $30 million.
So a $25 or $30 million homecare company has a fairly
significant leadership team,including a large group of
middle managers, and so we're inthe process of working with
them to take this informationfrom the DNA of a CEO study and
(22:29):
look at how we develop aneducational curriculum so that
we can develop the competenciesat the middle management level
and then carry some of thosesame competencies down to the
frontline supervisors andschedulers and those kinds of
folks.
Leadership is a big piece andmost home care companies have
not really done a whole lot interms of developing their middle
(22:53):
managers.
A lot of owners and CEOs go tooutside programs run by maybe
their state home careassociation or run by their
franchise organization, butthere's not a lot available for
that middle management group.
Erin Vallier (23:09):
Yeah, and they need a lot of attention.
They have a direct impact onthe people who are doing the
actual work in the field.
So, yeah, that's important.
Stephen Tweed (23:20):
And, of course, we know that turnover has been a
huge issue in home care and weknow from other research that I
think it was a Galluporganization that did some
research and one of theirconclusions was people don't
quit companies, they quit theirmanager.
Yeah, that's right, and so ifwe have a high level of turnover
, we need to look at what's therelationship between the
(23:41):
caregiver and their immediatesupervisor.
And again, that builds backinto the corporate culture piece
, but it also builds back intoleadership skills and leadership
competency 29,000 plus agenciesacross the US.
Erin Vallier (24:05):
That's a lot.
That's a lot of competitors outthere for you to make yourself
stand out against.
So I'm curious.
You mentioned a few ways thatpeople can do that by building
specialty programs.
But let's just break that downa little bit.
How can a home care company goabout thinking about making
themselves a standout amongstthe masses who are all providing
basically the same type ofservices?
Stephen Tweed (24:28):
That's right.
Yeah, there's 29,000 companies,and we know from Home Care
Pulse now activated insightsthat the median size company
last year was 2 million andchanged like 2,009,000 and
whatever, and so that means thatif there are 29,000 companies,
there are 14,500 companiessmaller than $2 million in
(24:49):
annual revenue.
So that's a pretty smallcompany.
And so, again, they all beginto look alike.
And so how do we createdistinction?
And, as I mentioned, we've donesome research and had lots of
conversations, and I'll mentionjust a couple of them.
Probably the top two that we'veseen people build on are number
(25:10):
one, creating exceptionalcustomer experiences, which
really goes back to the consumerprimary family caregivers and
referral partners.
And so we look at, well, what'sthe experience that the
consumer is having, what's theexperience that the primary
family caregiver is having?
(25:31):
And our data show that 60% ofthe time the primary family
caregiver is the oldest daughter, and so we've labeled that the
oldest daughter syndrome is theoldest daughter, and so we've
labeled that the oldest daughtersyndrome, and then 20% of the
time it's another daughter, andthen other 20% it's another
relative, in-law, or it might bea third party, like a bank
trust officer.
And so what is that family ofthe client experiencing.
(25:55):
What's the communication likewith the home care company?
What's their level ofsatisfaction?
What's the communication likewith a home care company?
What's their level ofsatisfaction?
Home Care Pulse now ActivatedInsights has their client
satisfaction management processthat they use, and they have
lots of data around what clientsand families expect from home
care company.
We did a lot of researchearlier on about what the
(26:17):
individual consumer says theywant, and what we learned from
our focus groups and from ourqualitative research is
consumers tell us they want twothings Reliability, that is they
want a caregiver that shows upon time every time, and
continuity, that is they wantthe same caregiver every time.
And so if that's what theconsumer expects, then is that
(26:38):
being delivered and what's theirlevel of satisfaction and so
creating that exceptionalcustomer experience?
Then we go over to referralpartners and what's their
experience?
And I think so many companiesfocus on what they do for the
client that they lose sight ofwhat they do for the referral
partner and what their issuesare, what their problems are and
(26:59):
how does working with ourcompany benefit that referral
partner, whether it's adischarge planner in a hospital
or a social worker in a rehabfacility or a bank trust officer
.
We've done a lot of work aroundhelping home care companies
increase their income by sellingto bank trust officers and
(27:20):
other trusted advisors, and thedata show that the dollar value
of a client coming from thosetrusted advisors is much higher
than the dollar value of aclient coming from that
traditional healthcare continuumhospitals, home health, hospice
, skilled nursing facility, andso understanding the customer
(27:42):
expectation.
Another example is creatingwhat we call caregiver quality
assurance and that is reallyfocusing on the whole process of
attracting, retainingcaregivers, and what we're
seeing is a trend and it's theearly phases of it.
But we're seeing a number ofleading companies who are making
(28:02):
a conscious choice to shiftfrom a client or customer first
culture to a caregiver firstculture and they're saying how
do we adjust what we do to takecare of our caregivers?
Under the premise that if wetake care of our caregivers,
they will take care of ourcaregivers, under the premise
that if we take care of ourcaregivers, they will take care
of our client.
(28:23):
And sometimes that means sayingno to a client because what the
client wants is in conflictwith what the caregiver wants or
needs or finds important, andso an example of that is
reducing the number of shortshifts or setting minimum hours
per week.
And so a client calls up andsays I want three hours a day,
(28:45):
two days a week, and the companysays, no, we can't do that
because we can't staff thatshift, because our caregivers
want stable, steady schedule,certain number of hours a week,
and so we're going to focus onwhat our caregivers need
involved, and that means thatthe client may need to fit their
schedule into what's best forthe caregivers, and that's a
(29:07):
sort of 180 degree mind shiftfrom what has happened in the
past Kind of goes back tosetting that strong culture.
Erin Vallier (29:15):
That's exactly right.
So what I'm hearing you say interms of being able to create
distinction is that you reallyneed to understand all of your
customers.
So you have the recipient ofthe care that's a customer.
You also have their familythat's a customer.
Then you have your internalcustomers, your schedulers, your
caregivers and all of thepeople that are making this
(29:37):
whole machine run, and then youhave all of your referral
partners that are customers aswell.
So you got to really understandwho all those people are, what
their problems are and be a partof the solution in order to
make it super easy for them todo business with you and make
your company attractive.
Stephen Tweed (29:58):
And we have really dug deeply into that and
looked at how home carecompanies can identify their
ideal client Gotcha and we'velooked at how they use their own
data.
And so at the end of I guess itwas the third quarter of 2024,
I released a new ebook calledSix Secrets to Selling Home Care
(30:21):
to your Ideal Client and itworks through how you identify
your ideal client and how do youbuild the relationships, and
I'm happy to offer that to yourlisteners and readers.
If they want to look at that,they can go to leadinghomecare.
com and click on the storebutton and you will see that
(30:42):
ebook Six Secrets for SellingHome Care to your Ideal Customer
.
And we put up a coupon codejust for this podcast.
Awesome.
The coupon code is ALAYACARE25,A-L-A-Y-A-C-A-R-E 25, and that
will get them a 50% discount onthat ebook.
(31:03):
Fantastic.
Erin Vallier (31:05):
That's a wonderful resource.
We appreciate that.
We'll make sure that the codeand how to get to this ebook is
in the show notes so people cantake advantage of that offer.
Thank you.
Stephen Tweed (31:15):
I think people will find that very useful and
helpful to come back to lookingat this principle of narrow
market focus when you're clearabout your ideal customer and
you're clear about whichreferral partners tend to bring
you your ideal client, and thenwhat the ideal client is
concerned about in terms ofcaregivers and how we can
(31:38):
recruit caregivers who arecomfortable caring for that
ideal client.
So the pieces of the puzzlecome together and it means you
grow your business larger,increase your revenue, have more
hours per client per week,longer length of stay, your
caregivers have a regularschedule, your schedulers are
less stressed, your recruitersare less stressed because you
(32:13):
don't have as much turnover andall the pieces of the puzzle
come together quote internal andexternal customers to get them
motivated and bought into yourstory and your way of doing
things.
Erin Vallier (32:24):
Can you talk a little bit more about that and
how to leverage the individual'sstory throughout company
communications and throughoutcommunications to the referral
network and clients?
Stephen Tweed (32:34):
Well, two of the other sources of competitive
advantage or sources ofdistinction are personal
relationships and relationshipselling, and I'll share the
difference.
So, in personal relationships,the owner, the CEO, the leaders
of the company are out in thecommunity building relationships
, particularly with highpotential referral partners, and
(32:56):
for them being able to usetheir own personal story about
why they started their company,what are the impacts, who are
the people that they were caringfor, what are the stories?
And, as we said, stories andlanguage create emotions or
feelings, and feelings sparkbehavior.
(33:18):
And if the behavior we want isfor people to buy what we're
selling, then we need to sparkthat behavior by making that
emotion connection.
And so home care owners andleaders are out there in the
community building thosepersonal relationships.
Relationship selling is thesame principle, except that
instead of the owner being outthere doing that, it's a sales
(33:40):
professional or a sales team, abusiness developer, and we have
a couple of examples in our top5% group of companies that grew
dramatically because the ownersand CEOs were former sales
professionals.
They knew how to sell, theyknew how to recruit salespeople,
they knew how to manage them,and so they would build a team
(34:03):
of sales professionals that wereout there and again using story
and making personal connectionsto persuade those referral
partners that this is thecompany that's going to do the
best job for your clients.
And part of that personalrelationship is understanding
(34:24):
the needs and wants of thereferral partner.
As I think I mentioned earlier,most companies do a good job of
explaining what we do for theclient, but most companies don't
do a good job of explainingwhat's the benefit to the
referral partner of using ourcompany versus any of the other
companies across town.
What's in it for them?
All of those people have thatlittle radio call sign stenciled
(34:47):
on their forehand W-I-F-F-M.
What's in it for me?
So, as we have thesesalespeople, learn to really
understand the business of thereferral partner.
So if it's a hospital dischargeplanner, what's important to
that discharge planner?
If it's a social worker in anursing home rehab unit they've
(35:09):
got people being dischargedpretty much every day what's
important to that social worker?
If it's a bank trust officerwho's working with high net
worth clients who have largetrusts in the States, what's
important to that bank trustofficer?
And I think most home careleaders have not sat down and
really developed those kinds ofrelationships and thought
(35:33):
through how does what I do in mycompany, benefit, that
discharge plan or that socialworker, that trust officer.
Erin Vallier (35:41):
That's an important exercise.
I know that when I was on theprovider side, we spent some
time really thinking about howwe could serve our referral
partners better, and we werealways on the cutting edge, the
leading edge of new programs ofmaking their lives easier.
Maybe we set up shop in the ALFand we have an office there so
they can just come, tap us onthe shoulder and we partner with
(36:03):
them in different ways in orderto make it more synergistic for
both of us and get the job donewith less resources and a lot
less paperwork and headache.
So it's worth the effort to sitdown and think about what your
referral partners really needand how you can give it to them
in a way that nobody else hasever thought of.
So get creative there, whichprobably leads to some of the
(36:26):
systems that you've mentioned.
You say be a systems thinkerand there's roughly did I
remember correctly about 25different systems that you guys
have identified.
I know you're going to releasethat paper in a little while to
expand on all of those things,but I'm curious from your
initial learning from that study, what are the most important
systems for home care companiesto develop in order to scale
(36:49):
their business?
Can you share?
Stephen Tweed (36:52):
We've actually identified 12 systems.
The 25 we talked about earlierwas the leadership competencies
of CEOs Gotcha the leadershipcompetencies of CEOs Gotcha With
systems.
We've identified 12 systems,starting with a sales system, a
marketing system, a conversionsystem to convert callers to
(37:12):
clients, a recruiting system, aretention system, right through
the business.
We came up with 12 of them, andso I'll give you just a quick
sneak peek of what we learnedfrom this survey.
Last year, when we did thesurvey, the system that was
important to our respondents wascaregiver recruiting, followed
by caregiver retention.
This year it flipped a littlebit.
(37:33):
Caregiver recruiting is numbertwo, retention is number three.
Number one is caregiverscheduling.
So there's been a renewedawareness and thought processes
for that system of scheduling,which includes using software,
scheduling software or home careoperating system, and what all
is involved in making thatsystem work both for the client
(37:56):
and for the caregiver, and howdoes technology come into play.
And then there's a whole othersection of the survey on
technology and we're looking atthings like where does
artificial intelligence comeinto play and how does
artificial intelligence getbuilt into scheduling software,
(38:25):
into scheduling software, andhow do we teach schedulers to
use the software and theartificial intelligence to
improve the scheduling system.
When we talk about systems,there's two parts of it.
There's the process, that isthe step-by-step process that we
go through, and there's thepeople, and the people that have
the discipline to follow thesystem, to document the things
that take place, to recognizewhen the system has a flaw and
(38:47):
we need to fix it, and so it's acombination of process and
people that makes these systemsthat are repeatable and
consistent, and there's 12systems.
We know that most home carecompanies can't deal with all 12
of them.
And there's 12 systems.
We know that most home carecompanies can't deal with all 12
of them.
So it's a matter of where doyou start, and by having this
data from 250 home care leaders,we give folks a clue on where
(39:10):
to start, what to focus on, whatto work on.
So scheduling, recruiting,retention.
Number four on our list thisyear is home care marketing, and
it's interesting because lastyear home care sales was up
there and we know that sales isa subset of marketing, but it's
specific.
And then number five is billingand collection looking at
(39:31):
systems, and, of course, whatwe're seeing is more and more
home care companies thinkingabout other revenue streams and
other payers beyond private payor beyond Medicaid, and so
there's a lot of veryinteresting data that's coming
out of this study, and so we'llhope your listeners will be
looking for that.
(39:52):
One of the ways that they canlearn about the research that
we're doing at Leading Home Careand that we're doing with our
various partners in the industrywould be to subscribe to my
weekly newsletter.
I have a weekly newslettercalled Stephen Tweed's Thursday
Thoughts.
It comes out every Thursday at7 am Eastern time and it's a
(40:12):
little short story or example,but when we're releasing new
information we'll write about itin the newsletter.
So when this wait paper comesout, I'll do probably a whole
issue of Thursday thoughts onsome of the lessons that we've
learned from this research.
Erin Vallier (40:31):
Fantastic.
We'll make sure that thelisteners have that also in the
show notes so they can sign up.
Sounds like there's a lot ofgood information that you're
passing around.
You've got me excited.
It sounds like a lot of thesesystems that need to be in place
involve technology.
I heard you say artificialintelligence, being able to bill
and being able to streamlineand all this stuff.
So there's an intersection oftechnology with people there,
(40:55):
and I always enjoy hearing aboutthat and working for a
technology company, I know thatwe've butted up pretty much
against our time.
This has been a reallyinformative conversation.
There are some resources thatyou have mentioned and we'll
make sure that people haveaccess to those in the show
notes, but I'm curious ifthere's any parting wisdom you
(41:16):
want to give or just another wayto get in touch with you to
have conversations about, ormore targeted conversations
about, how you might be able tohelp a business grow and thrive
or how they might be able to getinvolved in some of these
groups that you've got going on.
Stephen Tweed (41:33):
Well, thanks for asking, and in 2025 is an
interesting year.
As many people out there know,I formed the Home Care CEO Forum
in 2012, grew that for 12 years.
I sold that business in Januaryof 2023 to my friend and
colleague, jensen Jones, who wasone of our top 7% mastermind
members, and I had a two-yearagreement with Jensen to
(41:54):
continue to run the 5% group andto do some other things within
the CEO forum.
So that agreement has come tocompletion.
We're going to continue to dosome other things together.
But I sort of stepped back and afriend of mine sent me an
article called I'm not retiring,I'm rewiring, and I love that.
(42:15):
I said that's me.
I'm not retiring, I'm going tostick around own care, but I'm
doing some things differently.
I love it.
And so I thought about it andprayed about it and talked to
some of my advisors, and so myfocus going forward will be
three things.
One is serving on some boardsof directors of home care or
(42:35):
home care related businesses.
The second will be to shift myfocus as a strategic advisor to
work one-on-one with a handfulof CEOs who really want someone
to walk side by side and be asounding board and be a resource
to help them strategicallythink through where they're
(42:58):
going.
And then the third is continueto do industry research, and I
love doing research andgathering data, and so I'm going
to continue to do some of thaton my own through Leading Home
Care and for third-partyorganizations that come to us
and say I need to know moreabout whatever.
So the 2025 Future Home CareStudy is an example of that kind
(43:20):
of research, and so, if yourlisteners are looking for a
board member or in some caseswith closely held companies that
have only on their board, theyhave an advisory board of
experts who know the home careindustry, and so I'm putting
together a couple of advisoryboards for member companies.
(43:40):
I'm putting together a coupleof advisory boards for member
companies, and then I'm alsoworking one-on-one with some
CEOs to be that strategicadvisor, walking side by side.
So the website'sleadinghomecare.
com and there are the threesections on that website.
Also, the store has that ebookSix Secrets to Selling Home Care
to your Ideal Client, and thecoupon code ALAYACARE25 to get a
(44:06):
50% discount.
So there's also a spot.
If somebody wants to just havea conversation, they can fill
out the form at the bottom ofthe page and we'll respond and
set up a time to talk.
Erin Vallier (44:17):
Fantastic.
Thanks so much for sharing yourknowledge and for letting
everybody know how to get intouch with you.
I really do hope that a bunchof people listening to this
today will take advantage ofyour offer for the ebook and get
involved in what you got goingon in some way.
So thank you so much for comingon the show today, Stephen.
(44:37):
It's been a real pleasure.
Stephen Tweed (44:38):
Thank you, erin, best wishes.
Have a great rest of the year.
Erin Vallier (44:41):
Thanks.
Home Help 360 is presented byAlaya Care and hosted by Erin
Vallier.
First, we want to thank ouramazing guests and listeners.
Second, new episodes air everymonth, so be sure to subscribe
today so you don't miss anepisode.
And, last but not least, if youlike this episode and want to
learn more about all thingshome-based care, you can explore
(45:05):
all of our episodes atalayacare.
com/ home health 360 or visit uson your favorite podcast
platform.
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