Even though I had the attitude that my company didn’t have any competition, we of course, did. I competed with families that couldn’t pull the trigger. I competed with other care giving agencies which could be a mom and pop business, an independent Care Manager that outsources care giving services or the care giver underground network. There is also the occasional franchise that pops into town.
Oh, I love a good franchise. I love to meet with the newbie in town. I like to be one of their first meetings. I take a very Peggy approach to them. I actually give them all the ins and outs of the city and the contacts. I give them all the information they will ever need. I like to give them my biggest contacts. I know how loyal my referral sources are and I just give them a heads up when the newbie will be knocking on their door.
There are a few reasons why I am so generous. At the end of the day if they are going to be successful or crash and burn it will have nothing to do with me. I just like to gage where they are coming from. If they are strong, then I want to assist them and form an alliance any way I can. If they are weak then they are on their own and it will just be a matter of time when their true colors will shine through. The proof is in the pudding. There is not a lot of in between in this industry. If you do great job your reputation will get out there. If your business is weak, it only takes a couple of screw ups in this industry and you might as well close shop and save yourself the time.
This senior care industry is growing. Whether you took an economics class or not, you know that when demand goes up, so does the supply. From a business perspective and opportunity you can assume that this would be a good venture in some capacity to be related to senior care or health care. But here’s the thing, it can’t always be just about business, money and your model. It’s about people. I like to take an interview approach to get to know my new competition.
I have met very charismatic and entrepreneur minded individuals. I have met developers that have built some amazing communities. I have seen independent Care Managers marketing their services like crazy. I have seen people with great expectations and I have seen them fail time and time again. They don’t have the core piece of the business down. They don’t understand the needs of the end-users. They aren’t educated enough to understand the nature of their behaviors. They really don’t understand because they don’t care about that. They see this industry mostly as a business and if you are not in touch with the end users and what they need you will never make it. Also, everyone in the industry will know it and they will not support you. They may not say anything bad about you, but they won’t recommend you either. That’s how it works.
Let’s talk about franchises, because they are coming to a town near you. They get support on the marketing components like advertising and collateral. They have standard operating procedures and like any other franchise they appear to have a national presence. It’s like going to any other McDonald’s in that sense. You can’t really tell one from the other, yet there are different owners on a local level. Basically, it comes down to how that local franchise is being operated. Some are better than others and they generally have a good reputation.
Let’s look at Mom and Pop businesses. Or not. I really rather not look at them, but as long as we are talking about them you should know that it is totally buyer beware. Sometimes people like to go this route because they have a neighbor or friend that knows somebody that uses them. I don’t want to totally knock it because there can be really good ones, but you better find out if the employees are insured and bonded. Is the business paying for workman’s compensation? Are they doing the appropriate payroll taxes? What kind of screening are they conducting? Do they do criminal background checks and DMV background checks? How far back are they looking? Do they test for TB? Do they do reference checks? Most importantly – where is their oversight? Who is watching them?
This brings us to independent Care Mangers which I have some mixed thoughts about as well. I think a lot of that has to do with the geographic location you are in and that will determined how professional and educated they really are. I think what you need to know about independent Care Managers is that there are a select few that don’t have any specialized education and degree, but they consider themselves experts regarding geriatric care. Independent Care Managers typically outsource the care giving component and just so you know, they can’t supervise those care givers because they are not their employees. They can only monitor the care plan that they put in place.
Here’s the other thing about independent Care Managers. They generally charge about anywhere from fifty to one hundred and fifty dollars an hour. They bill for their time and that’s how they make a living. What if the Care Manager bills you for just leaving a message on your phone? Some will do that. By the way, where the hell is their oversight? Who is watching them? Where is their back-up? What if they are sick, on vacation, or tied up with a client? I really just roll my eyes when I hear about an independent Care manager that also has another full-time job or part-time job. I really want to toss my cookies when I find out that they also have a position like a Discharge Planner at a hospital. Makes you wonder how they get their leads?
My point is, do your homework. Cheaper is not always less expensive. You find that out the hard way. You get what you pay for and for some people they don’t have a lot of resources, but for an extra dollar or two you really have to see what it is that you are paying for. That’s the part that really kills me. The people that want to save the extra money and they make arrangements with an independent contractor and then they are totally shocked when that individual steals their jewelry, medications, and takes over as durable power of attorney.
It might interest you to know about women that prey on elderly men and take them for all they are worth. You might not know this, but there are organized mafias that train and recruit individuals solely to prey on the elderly and manipulate them into signing everything over to them. I would go into greater detail, but I really value my knee caps.
I happen to live near one of the wealthiest communities in North America. You would think that the there would be a plethora of business do to the financial resources. However, the wealthy like to hire their own employees. This works out just great until the employers’ level of need increases to the point that they require someone that can handle personal care or has more expertise with an aging individual. It’s kind of a bummer when the illegal employees that have been working for room and board and maybe a salary have to suddenly find a new home and source of employment. It’s true.
Here’s an interesting story. A local Trust Officer contacted my organization to conduct an assessment for their clients. The clients had made their own care giving arrangements. The clients finances were now going to be managed by a Trust Officer and they typically will not work with or make checks to independent contractors. They will, in general, require the clients to use an established agency. Our Care Manager met with the Trust Officer and she completed her detailed findings.
Our Care Manager had determined that the cost of a live-in care giver for two people that required a high level of care and Care Management oversight would probably cost around eleven thousand dollars per month. Does that seem like a lot to you? It’s not really. Not in a wealthy neighborhood in California. An estate attorney will tell you that a typical range for the same level of care will probably run you between ten and twelve thousand dollars per month. What would be another option for those individuals? Probably a skilled nursing home that costs around two hundred and fifty dollars a day for a private room. You do the math and also consider if you would like a skilled nursing setting or one-on-one care in your own home.
So maybe you are a little blown away at the price tag? What is so interesting is what these people were paying on a weekly basis for the previous five years. They were paying about six thousand a week. A week! The Care Manager billed about eighty five dollars an hour for her time. However, if one of the care givers did not show up for a shift she would cover for them and charge her rate, instead of the typical care giver rate that was close to twenty something an hour. Oh, it gets better. After we had incorporated services we had to turn away the parade of vendors that would show up to the home. The vendors like the plumber. You know, the plumber that arrived when there were no plumbing issues. If not apparent it you I will just lay it out there. The Care Manager created another revenue stream for herself that involved faux repairs and was probably getting some kick back from the vendors or at least making her friends some money.
Here is the part that is really going to slay you. After we brought this to the attention of the adult children they still wanted to know if there was a way to keep the independent Care Manager as part of their parents’ care plan. They said their parents really bonded with her and they didn’t want to upset their parents and take her away from them. Our Care Manager and the Trust Officer highly advised against it.
I am not sure if the Trust Officer and my company would have worked with the family if they decided to stay engaged with the independent Care Manager. We certainly didn’t want to be associated with someone that could be considered a financial abuser. Seriously, you have to wonder what is going through peoples’ minds sometimes. I wonder if when they run out of wood for their fireplace if they just use stacks of dollar bills.
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