Care Unfiltered

Kunu Kaushal: Stop Being a Sitter Service + Redefine What Senior Care Delivers

Kunu Kaushal started Senior Solutions in 2010 with a laptop, a cell phone, and two caregivers. His grandparents were his first clients. Sixteen years later, his agency serves all 95 counties in Tennessee and 15 metro counties in Atlanta, and operates in roughly 1,000 homes every week. Senior Solutions is on the eve of launching a state-funded program placing Sensi’s AI-powered care intelligence in 500 complex Medicaid client homes to show how data-driven care can bend the cost curve for an entire state.

In a recent conversation on the Growth Operator podcast, Kunu and I sat down to discuss Senior Solutions’ growth. Here are five lessons he shares that are worth taking back to your own agency.

1. Get in the door early, even with minimal hours

“They may not be ready for 24/7 care. Wherever we can get engaged with them, we do.”

Most agencies optimize for the client with significant care hours right now. Kunu optimizes for the relationship.

His strategy is to engage families before they are in crisis. Whether that is through a Personal Emergency Response System (like Sensi), a single weekend shift, or a care coordination call. The goal is to establish a relationship with the family before they need a full care plan.

“A client doesn’t just need the services we provide, they need a professional,” Kunu says. “Many families are fearful. They live out of town and wonder what’s going to happen with mom now that she’s showing signs of having challenges. They may not be ready for 24/7 care. Wherever we can get engaged with them, we do.”

The payoff is lower customer acquisition costs over time. Families who have already worked with you before will call you when a crisis hits. For clients who are starting to pursue care needs, virtual tools like Sensi Solo Care can extend an agency’s presence in the home between visits. That technology provides a safety net at a fraction of the cost of additional caregiver hours. It’s a way for care agencies to engage possible clients and offer an affordable option for lower-hour clients, while still delivering value as the relationship grows.

2. Stop treating old leads as dead ends

“Most agencies are not thinking about the people who reached out three or four years ago. But that’s a different way of thinking about customer acquisition cost. There’s money you can’t just leave on the table.”

Kunu considers every client lead in their CRM as a seed for possible future engagement. It’s possible a family that reached out two years ago and went with a competitor may be unhappy with that care today. A neighbor of someone who called you last year might be the one who actually needs care now. As long as your agency is top of mind, you are in the conversation.

“Most agencies are not thinking about the people who reached out three or four years ago,” Kunu says. “But that’s a different way of thinking about customer acquisition cost. There’s money you can’t just leave on the table.”

Technology is what makes recycling leads at scale possible. A systematic, automated follow-up approach can turn a database of old leads into an active growth engine without adding headcount.

3. Build your brand before people need you

“Most people are not thinking about home care or a brand until they’re in crisis mode.”

Home care is a crisis category. Research shows most families plan for senior care in the midst of a crisis, when they are already overwhelmed. By the time they search for a provider, they aren’t evaluating options; they are going with the first name they recognize.

Kunu makes this point with a tire analogy. Nobody drives around thinking about tires. But when a blowout happens, car owners call Bridgestone or Goodyear because years of consistent branding put that name in their head.

“Home care is pretty tough about that,” Kunu says. “Most people are not thinking about home care or a brand until they’re in crisis mode. You want someone to say at a barbecue, ‘You know, a few years ago there was this company, Senior Solutions. I think they’re still around. They may be a really good fit.'”

Remember, they don’t have to be your current client for you to be their future agency. Your agency’s name just needs to come up when they need your service. Consistent presence in your community, in referral networks, at local events, on social media, is what puts you top of mind when it matters most.

4. Make technology decisions with your team, not for your team

“I make them make the decision with me. I think it honors them. I also want to hear the objections and the pushback early on.”

Kunu describes himself as a recovering “shiny toy” person. Early in his career, one good sales demo was enough to get him excited about a new tool. Over time, he built a more deliberate evaluation process, while also getting his team to use any tool the agency onboards from the start.

When Kunu is considering a new tool, he identifies the pain point he’s trying to solve, attends the demo with an open mind, and before anything is signed, makes sure the tool is demoed for his team. As part of the vetting process, Kunu encourages his team to ask the hard questions. When they meet with the vendor, he asks his team to push back and pressure test the tool with their workflows.

“I make them make the decision with me,” Kunu says. “I think it honors them. I also want to hear the objections and the pushback early on.”

Kunu recommends agencies practice evaluating tools by asking for demos of tools you don’t plan to buy. Building a habit of stress testing tools can help build employees’ muscle to consider workflow impact, user experience, and downstream effects. It’s a way to go beyond the default, “I don’t think this is a good idea,” when asking employees for their feedback after a tool demo.

Lack of technology adoption in home care is not usually a bad technology problem. “It’s always been a people problem,” Kunu says. Tools fail when teams are not prepared for the change, when communication or training is unclear and inefficient, or when no one has thought through the user experience for the people who need to use that technology every day. Build that tool-evaluating muscle before you need it.

5. You aren’t a sitter service. Act like the healthcare provider you are

“We’ve got to get out of being a sitter service. We have to be a healthcare provider.”

Agencies that provide care reports with real data that physicians and families can use, win referrals, secure payer partnerships, and build credibility that survives a competitive market. 

“We’ve got to get out of being a sitter service. We have to be a healthcare provider,” he says. “If you define what a healthcare provider is, they’re not just saying, ‘Oh, we hire people, clock them in and out, and bill you for it.’ There has to be a ‘so what?’ What is your agency going to provide to me?”

To provide data-first care reports Senior Solutions deployed Sensi across 500 state-selected, complex Medicaid clients as a way to show measurable reductions in ER visits and hospital readmission rates. At $135,000 per nursing home bed per year, the financial case for keeping seniors safe at home using data-supported care is not hard to make.

“You can make decisions and you can make an impact if you have the data,” Kunu says. “You have to have the tools that will help support and make it happen at scale.”

The silver tsunami is real. Agencies positioned to serve that wave are the ones building the relationships, the brand, and the clinical credibility now. The agencies that speak the language of outcomes, cost avoidance, documented trends will get a seat at the table where healthcare decisions are made.

Want to see how Sensi fits into your growth strategy? Book a demo and we’ll show you.

00:00:02 Romi Gubes: Wow! I’m so excited to be speaking to you today. I’m sure it’s going to be a hell of a conversation. So, thank you so much for joining me and joining the Growth Operator Podcast. We’re going to share a lot of lessons learned from the field, seeing your journey over the last couple of years. I think it’s super exciting and amazing to see that from the sidelines. I’m happy to share all these lessons learned with our community. If you can just start by telling us a little bit about yourself and your agency, we’ll dive in from there.

00:00:32 Kunu Kaushal: Absolutely. Thank you for having me. I’m really excited to share mostly what doesn’t work. I think that’s the true definition of experience.

00:00:41 Romi Gubes: I love it.

00:00:42 Kunu Kaushal: We’ve been in operations for about 16 years, and our organization really started with a laptop, a cell phone, and two caregivers. From a true ground-up perspective, it was just an idea. My grandparents were our first clients. Before I started this business, I was actually the administrator for a private duty nursing company. We took care of individuals on ventilators and provided care in the home. Before that, I was in home health and hospice sales. So, I went from sales in this post-acute world to really running operations for a pretty big clinical service.

I’m not a clinician. I grew up around a physician for a father and a nurse for a mother, so I’ve been in this geriatric world my whole life. I just have a passion for it. The concept of what we’re doing comes easily, and I love the innovation that’s possible. It’s always changing. I always tell people, if you’ve been in this business for however long, you’ve really been doing the way you do what you do now for a very short amount of time. We’re reinventing our businesses over and over and over again, and that’s what keeps it fresh. This is not the same business it was five years ago, and it won’t be the same in five years. We really enjoy the challenge and the struggles of it.

As far as the organization today, we cover the entire state of Tennessee—all 95 counties. We also operate in the metro 15 counties of Atlanta, Georgia. We’re a bit unique and not the typical agency, in the sense that we’re very payer-heavy. We work a lot with Medicaid and VA options programs. I’m sure we’re going to talk about why we are moving in that direction. It is the harder part of the business, and yet at its core, you’re doing the same thing. The edge elements are different, but it’s still staffing and scheduling, working with caregivers and clients, etc. Usually, the outcome or the intended work just focuses on different areas.

A typical week for us looks like being in and out of about 1,000 different homes. We have anywhere from 500 to 600 caregivers, depending on where caseloads are at the time, and we work around the clock seven days a week. The whole standard really works. The difference, I think, in our business is that our length of stay is really long because of the payer business. The typical client right now gets somewhere between 25 and 30 hours a week, but they’ve also been with me for two to three years on average. Once you’re on with us under a payer, you will be our client for quite some time. There’s a longitudinal effect that happens. Compared to a private pay or hospice client, they might be a week, two weeks, or six months. Then we have others that started with short hours and have now gone to around-the-clock and beyond. We dabble in a little bit of it all.

That’s scary for some who are listening to this because, in their state, their version of Medicaid isn’t exciting. I get that; elements of that change. Some don’t want the complexities in their business, and that’s a bit different. We are typically looking for where we can win. I’m highly competitive in a good way—it’s like competition with a mission. We’re constantly saying we want to do a great job and be the best at it, and that’s what really pushes us.

00:04:30 Romi Gubes: You mentioned 1,000 clients and a very long length of service, which is incredible. Can you give me a breakdown of the portfolio right now? How many of those 1,000 clients are actually Medicaid vs. MCOs? Just give me the breakdown.

00:04:50 Kunu Kaushal: Yeah, the easy way to answer this is to say roughly 80% of our business is going to be in the payer worlds of Medicaid and VA. There might be another payer involved, like long-term care insurance or something to that effect, and the other 20% is private pay.

The other way to say this is we go into so many lines of business because, to me, first of all, we want you to be our client. I am not obsessed with the idea of how to maximize revenue from you immediately. We have maybe 200 or 300 people on just a PERS (Personal Emergency Response System) service alone with us. What we know is that we now have a foot in the door with the family. As they have needs, we’re going to graduate with them, and we want to be in that relationship. So, our client count is a bit higher. Most agencies are going to have a 1-to-1 client-to-caregiver function. I’d say there are 500-ish, close to 600 depending on the week, that we are actively providing personal care to.

When I started the business, we really wanted to understand this concept: a client doesn’t just need the services we provide; they need a professional. They may need some guidance. Many families are fearful. They live out of town and wonder what’s going to happen with mom now that she’s showing signs of having challenges. They may not be ready for 24/7 care. Wherever we can get engaged with them, we do, whether it’s PERS or a care coordination/care management type of service. We even try some services just for a weekend. A prime example of this: we have clients right now that we serviced three months ago for a very short amount of time after they were in the hospital for pneumonia or something else. To me, they’re still my client, and they will be a future client. We stay in their life for some reason, whether it’s checking in on them. Essentially, until they can’t be our client anymore in the most unfortunate ways possible, we look forward to serving them again, and I think we will.

00:07:07 Romi Gubes: It’s fascinating. I’m hearing you and trying to analyze your strategy. So, your strategy is basically “land grabbing.” You’re optimizing for land grabbing rather than immediate lifetime value, trying to get there as early as possible to create relationships from early on. Can you help me understand how you look at ROI in this funnel? Obviously, for all those clients you’re serving in the earlier part of the journey who do not require physical care just yet, the revenue coming in is lower. Yet, you have some kind of investment because you want to maintain engagement with them, right? How do you think about this model?

00:07:56 Kunu Kaushal: Yeah, I would reverse it on you and say I think there are a lot of people that talk about customer acquisition costs. They’ll spend some money on marketing or whatever it might be, but the truth is that the average home care agency does very little follow-up with a lead that’s come in. My competitor will get a lead—a family admits they need help or they’re curious about something—and let’s say they get to the in-home console. Although people can have pretty high close rates once they’ve been in that living room, my definition is you have to be able to sell them something. The base layer of that is selling them on another meeting, right? Another level is to get them appreciative. Another level is just to have a follow-up call in some capacity.

We don’t leave an engagement with a client and just say, “Oh, we didn’t get any hours.” I think that’s the pure definition of saying: how are you taking all the investment that’s been made on any customer lead and making sure it doesn’t just go away, that you haven’t just given up because they didn’t sign up today? We have clients who go with another agency because they were shopping on price, and we still follow up with them in about a month. It’s not every case or every client, but there’s a reputation element to it, which happens when you’re a family-owned company. I own the company and started it, so I remember it from the very beginning. For us, we’re still scrappy, no matter how big we are. We don’t look at how big another organization is. I think when you still have that startup mentality, every client counts and every engagement matters. For us, it is not a waste of time.

I can’t tell you we have any “loss leaders,” which is another concept out there. We don’t give care for free. Pretty much the only thing we do for free is give advice when a family is not sure what the next steps might be. We do make sure that we’re the professional in the room, making it very easy for them, almost like a pre-sell if they want to talk to us again. There are no strings attached. We just tell them, “You may not be ready for care today. Please call us again. We’re going to call you again.” Because at this point, you’ve heard this family’s story. We’re invested with them in a different way, and we want to see and know what happens to them as they go downstream.

00:10:29 Romi Gubes: So, you’re basically looking at that from a customer acquisition cost perspective, right? You’re saying, “I’m able not only to reduce customer acquisition costs, because they are coming to me organically the minute they need care, but I’m already there beforehand, so I’m actually in a better position the minute they need care.” Right? I love it. I think it’s a completely different way to look at the market.

00:10:59 Kunu Kaushal: Well, and I’d say—not to change topics by any means—but we do a very similar thing with caregivers. That’s the mentality I have. We did the math because we imported them into the CRM the other day: we have over 40,000 applications that are still in our system. We may have screened them out or they may not have been good fits at the time, but if you think about it, I have 40,000 individuals in our CRM who have applied over the last 16 years of our business. Some of their lives are different now, right? Five years ago, they didn’t have dependable transportation; two years ago, they were still in school; or at that time, they were hoping to become a nurse and maybe that didn’t go the way they wanted, but they’re still interested in healthcare.

How we use data is the question of how you resurface that, but they’re all seeds that have been planted in some capacity. If you treat clients in that same way—most agencies are not thinking about the people who reached out three or four years ago—it’s a different way of thinking about customer acquisition cost. There’s also the money that you can’t just leave on the table by not revisiting some of those old things. You’ll have people write in the comments to this, saying, “Well, they may not need home care anymore.” Great! It’s about brand and reputation. They may not need care, but a member of their church does. So, are they thinking about Senior Solutions? There’s a different approach when you do that.

I attended this great marketing seminar where they were helping companies understand how to market and how to think of brand. They said you need to understand—and I’m going to age myself a bit here—billboards, and how people used to focus on that. Now they have digital billboards, but you have to have a billboard for a tire, right? How many times have you seen branding for Bridgestone or Firestone? People are not driving around going, “I need a tire right now.” It is the understanding that there’s brand reputation, repetition, and consistency. If I said “tire,” you probably thought about Bridgestone, Goodyear, or Firestone. They’ve done their job of putting that in your head so that they are the go-to company or a known organization.

Home care is pretty tough regarding that. Most people are not thinking about home care, a brand, or a company that can help them until they’re in crisis mode. If someone were at a barbecue saying, “Oh, I’m really struggling with my dad, he’s getting a bit forgetful,” you want someone else to say, “You know, a few years ago, there was this company, Senior Solutions. I think they’re still around. They may be a really good fit.” It may or may not have worked out for them directly, and they don’t have to be just a customer who used you, but you have to be top of mind.

00:13:58 Romi Gubes: It’s amazing that you’re saying that. This is one of our earliest lessons learned with Sally, where we triggered Sally on a very long CSV of many leads that were considered “dead leads.” We heard many conversations that started as, “You know what, I do have care right now, but I’m not happy with this care, and I’m looking to change the provider. I’m so happy that you gave me a call now.” Exactly. But I think the challenging part is really executing on that, right? Because how can you do that when you don’t have a scalable engine? You spoke about 40,000 candidates sitting over there, right? How can you follow up in a systematic way?

00:14:48 Kunu Kaushal: Exactly. I’m telling you, all of these things that I’ll admit are strategic in nature, executing them is the problem. Almost every problem in our organization has never been the plan, the strategy, or the tools we may have had—it’s always been a people problem.

To define that: people have their own assumptions. Somebody who hears about 40,000 caregivers who applied immediately starts making excuses in their own mind: “Oh, they won’t have the same phone number. They probably don’t even live in the same place. Their email may have changed.” And it might be true, right? But then out of those 40,000, you might have 100 that will be relevant, so why not try?

That’s the exact example I use: we have a 24/7 client that just started who needs care. Maybe out of those 40,000, there are 4,000 that live within 30 miles of where we need them. I don’t need 4,000 caregivers; I just need four. The numbers are still on your side, but someone has to make the effort. Then you need to admit that maybe there’s a tool that will give us the opportunity to do this at scale, which fits into adjusting our strategy. We can’t execute on this manually, and I think that’s been the most exciting thing to watch. Partnerships with tools and technologies have been helping us level up and look under rocks that we just don’t have time for otherwise.

00:16:15 Romi Gubes: Yeah, and I think the strategy you’re implementing, you’re taking it for granted because for you it makes so much sense, but it is very unique. I’ll tell you that. I’m excited to hear that because when I’m looking at the market, if I were you and had a home care agency, I would look at it somewhat the same. Although you have a big market share in your area, it’s still limited, right? There is a set amount of people aging and a set amount of people willing to provide care—it’s not an endless pool. So, going back to the ones you know might now be relevant to your business is super strategic. It’s maybe the only way, in my opinion, to really grow exponentially.

00:17:03 Kunu Kaushal: Totally agree.

00:17:04 Romi Gubes: Yeah. And speaking about scale, what are your hopes for the next 12 months in terms of growth?

00:17:11 Kunu Kaushal: I think the biggest thing is our most recent program. We’ve got a partnership with managed care organizations (MCOs) in our state, very focused on the Medicaid department as a whole. Tennessee, oddly enough—I would never normally put them on a list for innovation and thinking out of the box—but the truth of the matter is that many states have programs that are really interesting. I’m so proud of CMS and also Medicaid programs around the country as they’ve had to evolve into EVV (Electronic Visit Verification) services and get electronic. They’re also realizing there’s a lot of data here, and this is a population that’s going to grow.

For typical home care, we think about what I call—and you’ve heard this—the “silver tsunami.” The gray-haired wave is coming, you’re going to have this older population growing, and we don’t have enough caregivers. How will we take care of them? I would say think about this from the perspective of CMS or a state Medicaid department: things are very expensive, labor is very expensive, and they have a lot of people who will spend down their money. There’s an entire population of folks that are not going to get care just because they have $10 million in the bank; they may need care for many years. The default of what tends to happen is that people go to a nursing home.

To set the stage for you as to why we’re even interested in this in Tennessee: every year they do a total cost analysis of how much it costs to have someone in a nursing home bed. This past January, the new number is $127,000 to have one person in a nursing home bed per year. Home and community-based services—which is not a new program—has a mission that asks: can we take care of more individuals in the home, outside of the nursing home, at a lower cost? And their bar is pretty low, by the way. They just need to be under the $127,000. Easy, easy. Then they’ll say a win is to halve the cost. The concept is, for every one person in a nursing home, can we take care of three individuals in the community at a lower cost of care? So, the total money spent is not less, but the impact and the reach are much more. In our scenario…

00:19:42 Romi Gubes: I want to stop you for a second because you said something I want to double-click on. You said that this is something new happening, something new where you find payers are more interested. What do you think has changed? Why suddenly? Because what you’re saying is a problem we’ve had for years. We all know that aging in a community, and specifically a nursing home, is much more expensive than aging at home. We know that all payers and everyone have pushed—or at least said that this is what they want to drive—and still, nothing happened.

00:20:25 Kunu Kaushal: Yeah, I would liken it to when a city is growing and people know the roads are not going to be able to handle it. They have plans, thoughts, and say, “We’ll expand the roads.” Usually, what happens is you’re sitting in traffic for four hours and someone’s finally like, “Oh, we’re going to start construction next year.” That is the same thing that’s happening. What’s changed is they’re truly feeling the pain. The tsunami of the population of age that now needs help is truly starting to hit the system.

00:20:56 Romi Gubes: You feel like we’re at an inflection point?

00:20:58 Kunu Kaushal: Yes, and it’s going to just speed up more and more. I think so in this scenario. I mean, yeah, I think you summarized it well. This has been an issue for a while. In Tennessee, in just the last three years, we finally hit the point at which there were more people receiving Medicaid services who could have been in a nursing home, but were instead in the community receiving that service at a better cost to the state than those in the nursing home.

00:21:32 Romi Gubes: Yeah, and do you think that maybe an additional thing that happened is that payers became more and more educated about, first of all, the implications of home care—what it means to have home care in your house? And then also they realized, or slowly got more open to the fact, that home care has other tools to be supported with that might actually provide better care outcomes?

00:22:01 Kunu Kaushal: Yes, all of those. I think there’s also been a trend for states to say, “Oh, we’re not good at this. We should have managed care organizations.” So now you have health plans helping them be much more sophisticated and trying to solve the problems. The other side is that people are doing long-term planning, so you have a state thinking 5 to 10 years out and watching trends.

In almost every state, the most expensive program they run is their state Medicaid program. It’s not just for the elderly, but for anyone on the Medicaid program—children’s services, dentistry, all these things they try to cover. Right after that is education, right? So, these are the big spends of a state, and it’s not something they can just elect to stop doing. They have to find a better path to make it happen.

The most exciting thing for us is that we’re seeing innovation coming to the state. The programs are saying, “Bring us something new.” We’re really excited about a new funding opportunity we received to explore value-based services, where we, as an agency, get to show the state how we can help them save money. Part of this is being given a little bit of slack, where instead of the state sitting on things for three years, ideating just by themselves, and then launching it and expecting us to do it, they’re reversing it all. Which, by all means, is a great way to innovate: let the people who are going to do the work try to give you those ideas.

Pretty soon, we’ll be launching a program where we’re putting 500 individuals, who have been selected by the state as highly complex and having lots of issues, into a 12-month program to explore different things for COPD, CHF, Parkinson’s, and other challenges. Our number one tool we’ll be using is Sensi in all of those homes, along with other things. Our concept is that you can make decisions and you can make an impact if you have the data, right? You have to have the tools that will help support and make it happen to do it at scale. That’s probably the most exciting thing at the moment.

00:24:26 Romi Gubes: So, first of all, congratulations. It sounds incredible. It’s not like getting a grant for 20 or 30 people for 90 days; it’s something massive, and it’s really an amazing opportunity to show data at scale and how data really helps reduce a significant amount of money from the system. Thank you for letting us support you and choosing us to support you in this process. For me, it’s a very exciting opportunity to go to market with you on that. So, you would say that this is your main focus area for the next 12 months or so?

00:25:12 Kunu Kaushal: It is. I think part of it is because I think about the opportunity on a broader scale. 500 sounds like a lot, especially for the numbers you and I deal with every day, but the program we’re impacting has 14,000 total individuals on home and community-based services. They have an additional 10,000 in a different group of people who are at risk of going into a nursing home. Then we haven’t even talked about the ID population—people with behavioral or intellectual and developmental disabilities—where there’s an additional 10,000 at least.

Those 500, in their aspect, is very much an experiment. They’re like, “Oh, show us what you can do.” But this may define a new standard of care or something else. Even then, we’re talking about just one state, right? There’s so much more happening in a lot of places. So, I would say thank you to what you and the team are doing because you really have given us a capability to fight in a different way.

The most exciting thing happening a few years ago was a better EVV system to clock in and out—that was essentially it. We really are all leveling up with what they expect and what we can deliver. I am excited about our industry, not just in Medicaid or payer, but even with private pay clients and anyone else: we’ve got to get out of being a “sitter” service. We have to be a healthcare provider. If you define what a healthcare provider is, they’re not just saying, “Oh, we hire people, clock them in and out, and bill you for it.” There has to be a “So what?” What is this person going to deliver to me? What is your agency going to provide to me? As we level up, you’ll very quickly see that there will be people left behind because the basic service they’re offering won’t make sense anymore.

00:27:18 Romi Gubes: I love to hear how you think about things, and you are competitive, right? It’s very evident. You’re not stopping at 500; you’re thinking about the big goal, which I very much appreciate.

I want to shift gears a little bit, staying on that track because it’s a massive part of your strategy, but what it entails is actually the need to be very efficient on the back office, right? Because we all know that the rate is lower and the margins are lower when it comes to payers compared to private pay. Sometimes with the VA it’s a bit different, and there are exceptions depending on the market, but still, margins are not as high as in private pay. How do you keep your operations lean but still provide top-quality care? Because I do know that this is also something you care a lot about.

00:28:16 Kunu Kaushal: Yeah, I would tell you we went through an exercise within our teams where I talked about “must-dos” rather than blockers. You have to do these things, and there’s no magic to it. If you were to talk to a client and ask why you’re better, they are not going to care about how efficient your payroll system is, how accurate your billing is, or how great the data is when you do care plans in your system. They are important, and you have to do them.

What we really have been very conscious of is asking: how do you systemize or make things better through technology? We’ve been reaching out to our EMR and looking at tools. I couldn’t count the number of times we’ve looked at our tech stack and constantly asked how to make it more efficient. A prime example of this: I ask a very clear question to our team constantly, “How long does it take to process payroll?” At one point, it used to be two days, and then I would just dig into why. Show me the workflow that happens. They’d say, “Well, we have to look at care notes, and then we take the paper and do this.” Then I would get hyper-focused on it and say, “Why do we have paper?” “Oh, some caregivers just want to do it that way.”

We took a lot of work and said, starting in six months, every caregiver has to use the EVV program, right? It doesn’t matter if it’s payer or private pay or whoever, you must clock in and out electronically and use it to your benefit. They said, “Well, we have caregivers that won’t do that.” Well, that means they’re not willing to learn, grow, or be taught something. I wouldn’t say that we cut them out of the business immediately, but we did recognize that as we hire new caregivers, a simple requirement to work at Senior Solutions is that you have to have a smartphone. It sounds silly to say today, but five years ago, that was like, “Well, a third of our caregivers may have a problem with that.” That was a lie we were telling ourselves, and it ended up being less than 5%, right? Everybody had a smartphone; they just didn’t want to use it because they had never been asked or told they had to. People get stuck in what they’re most comfortable with.

I kind of tell the story about our industry for EVV and things: the people we should thank the most are the ones who invented Candy Crush. Every caregiver who is bored out of their mind on a shift—and I would always tell our team when they said they’ll never do this—I would ask, “What’s the number one complaint about our caregivers?” “They’re sitting playing on their phone.” Right now, let’s make it productive. They can not only clock in and out, but then it turned into: why aren’t we pushing them religious training or whatever LMS micro-training you have? If they’re going to play on their phone, it can at least be productive. Not that we’d encourage that during active care, but if you’re on an overnight shift or you’ve done everything in a long case and don’t have much to do, there’s an opportunity there.

00:31:39 Romi Gubes: Super interesting. Speaking about the tech stack, I do know that, on the one hand, you are very passionate about technologies—you want to stay educated, and you see the massive opportunity with technology. On the other hand, you’re very thoughtful when it comes to implementing new technologies. I’ve seen you bring in and out many technologies over the last couple of years, and you have a very specific decision-making process. Can you share a little bit about how you look at the new “shiny toy” coming in? How do you assess technologies? If you have any concrete examples of things you looked into, decided to implement and then took out, or decided not to implement from the get-go and why—without sharing specific names, just concepts.

00:32:41 Kunu Kaushal: Yeah, that’s a great question. Many years ago, I realized I was a “shiny toy” person. On one sales call, I was convinced and would go, “Oh, this is going to change everything.” So, my evolution went from being an early adopter outside of that—

00:32:58 Romi Gubes: Yes.

00:32:59 Kunu Kaushal: —to learn to protect myself from myself. Now, I like to have the first call because I really want to understand it with an open mind. I think there are people on my team who, not that they are naysayers, just don’t have the authority to make the big changes that may have to happen in order to give that thing a shot. In that way, it does roll up to me. I go, “Okay, if I have the ability to turn dials in some way, let me look at it with fresh eyes. Does this mean it’s something we have to do?” So, I’ll usually do that first call and dig in. I’m very well aware of the other systems and the challenges we have in the organization.

I think the first step is understanding your team and being engaged enough that you know what the pain is—not just that a thing doesn’t work, but why it doesn’t work. Is it the modality? Is it a specific element of it? For example, we had a lot of issues with caregiver communication. People would say to use a phone system, because nobody’s really excited about phone systems today. We had this kind of in-house Cisco phone system thing. Oh my God, as we were scaling and growing in different locations, managing this hardware was a nightmare, the phones weren’t working, and people had this whole challenge when calling. The first vendor I talked to, I was so excited about them. What I didn’t know is that there are so many more vendors in this VoiceOver IP business.

The first vendor I finally got to, by the way, came through an RFP mindset. It’s like, well, we’re going to get three companies and ask them how they are different from each other to really try to uncover it. There was one company out of the three that said, “We do this whole thing where you have no hardware at all. You can take your headset, literally plug it into a USB, and your entire phone system is on your computer.” And I thought, I can’t imagine that. How many years ago was it? This was in 2019 that we were doing the conversion over to RingCentral for our phone system.

So, we go over to RingCentral, and think about change management—my entire team was like, “I like a handset. I want to be able to pick this up. I can’t push them on hold.” We eventually got people over to it. The irony of it all is within about a year, COVID hit. If we were still depending on that handset in the physical office, we would have been stuck, but instead, we were working from home or on the road. That happened to work out in our favor. We were early adopters at the time, and then everybody started going to those systems.

From an evaluation standpoint, I would say I like to know what our pain is before we ever go look at a thing. I don’t try to create problems, but I’m open-minded to saying if there’s a challenge, if it makes us faster, or if it’s on-trend with where the industry is probably going, we need to catch up to it in some way. We evaluate it a little bit deeper, and I bring in some very strategic individuals in our company pretty quickly.

00:36:20 Romi Gubes: This was actually one of my next questions.

00:36:22 Kunu Kaushal: I make them make the decision with me before I’ve signed anything. I think it honors them and shows I respect their opinion. I also want to hear the objections and the pushback early on, and I want them to talk to the vendor: “Go ahead and just ask that, because I really don’t know what you’re worried about or what your challenges are.” Selecting those people involves a sense of coaching. I don’t want you to come into this saying, “We’re not going to make a change.” Assume we are, and help me understand where the downstream problems might be.

They’ve become very good at that, and they have started to think the way I think, which is that we’re just evaluating it. To build trust, one thing I’d recommend for somebody listening to this is to evaluate a system you know you’re not going to buy anyway. Go evaluate some postcard company that mails postcards. It may not be a thing you even do, but build that muscle within the team. Go say, “Let’s just evaluate this. What do you guys think?” Get onto the vendor call, watch the demo, etc. Let the team say, “I don’t really know about this,” and then you can say, “Okay, I respect that. I think this might be hard; we’re not going to do this right now.” It gets people to trust you back and understand that you’ll listen to them and value their input. But it also forces you to say, “I need to hear more from you than just ‘I don’t think this is a good idea.’ Give me the why. What operational workflow is going to be impacted by this? Where will customer service be a problem?” Teaching members of a team about concepts like customer experience and user experience, which are not typically part of their workflow, is really important. It’s a skillset that makes them better leaders as well.

00:38:23 Romi Gubes: No, I think it’s a very important point you’re raising here. I think that many people do not have this muscle developed, and then every new thing brings a sort of panic: “What do we do now? It sounds exciting, but what do I do now? Am I making the right decision or not?” Then, usually, what we see is that they’re looking for peer advice, which is always very important, but I think not many people know how to assess if it’s the right fit for them specifically—considering other markets, other agency sizes, different challenges, different staff members, and the DNA of the company.