Chase Quality: Why Hummingbird Care Services Turns Away Business to Win It

00:00:03.040 Romi Gubes: Colby, hi! How’s it going?

00:00:04.500 Colby Bechtold: Good. How are you?

00:00:06.200 Romi Gubes: I’m good. It’s so good to have you here.

00:00:08.100 Colby Bechtold: Yeah, I’m happy to be here. Austin is a fun city to be in.

00:00:12.400 Romi Gubes: Thank you for joining me on the Growth Operator podcast. We’re going to have fun in the next 40 to 60 minutes. We’re going to speak about home care, diving deep into your lessons learned. I am super excited to tell your story to the world. I think people have a lot to learn from the way you operate your business.

00:00:32.500 Colby Bechtold: No pressure!

00:00:35.080 Romi Gubes: So, if you can just start by introducing yourself and introducing your agency so people will have some color into that, then we’ll dive right in.

00:00:44.200 Colby Bechtold: Sure. I’m Colby, and I’m a registered nurse. We’re based in sunny Vero Beach, Florida. Our agency is Hummingbird Care Services, and we’re currently the number one rated home care agency on the Treasure Coast.

00:01:03.100 Romi Gubes: Amazing. Where are you in your growth journey? How many clients do you have?

00:01:07.500 Colby Bechtold: Growth is a fun topic. In our growth journey, we’re hitting that ceiling where we either need to get more linear with our growth by creating more SOPs and growing vertically, or figure out what’s next. Our client base is hitting a max of about 100 clients in our main location. We’re opening up multiple secondary locations, and this is the time where we’re hitting that growth mechanism of, “What do we do next? What’s the next step in the journey?” The dream is always to get multiple locations, and that’s where we’re at, but we’re looking at that next step.

00:01:54.800 Romi Gubes: Entrepreneurs are never happy with the growth rate. We always want more. But I’m sure in order to get to these hundred clients and be top-rated in your area, you’re doing a few things right. Can you walk me through how you think about demand in general? How do you think about the different channels? What channel are you prioritizing more than others, and why?

00:02:18.400 Colby Bechtold: When we came into the industry, we looked at home care as something most people in certain age brackets are going to need eventually. We came in and wiped the slate clean. We said, instead of using all the information currently available on the market, let’s start from the ground up from the perspective of not only the client but also the caregiver and the agency.

A lot of people approach this from the agency perspective, building a profit margin and the building blocks of a business. We came in from the caregiver perspective. I used to be a caregiver, so I understand some of the concerns and woes. I was also a family member who had family members taken care of by home health, so I had insight from all sides.

We decided to build it from a perspective of quality of care instead of just profit margins. We drive our demand by not always being available to everybody, maintaining a more prestigious brand by saying, “I’m offering you the best care you could have, and it’s not just immediately available to you.” By offering that incentive, we created a high-quality product.

I always think of a Rolls-Royce—you don’t ask for a discount on a Rolls-Royce. You can’t just go buy one; you have to order it and be invited to buy it. In that sense, I never want to be unattainable for people, but I want to provide the highest quality care without people asking for a “buy one, get one free” or “buy two hours, get one hour free” situation. By building from that, and looking at what caregivers and families truly need, using those blocks allowed us to be completely different from anyone else in the market.

00:04:41.600 Romi Gubes: Your differentiation is basically around not thinking about just providing care, but providing quality care and the right care.

00:04:49.100 Colby Bechtold: Right, and making it adaptable to that person. A lot of people use a template and say, “This is the template we use for all of our patients.” You can’t do that because everybody is different, and every care need is unique. You have to look at somebody as a holistic person—physically, emotionally, spiritually—instead of just a template.

00:05:15.300 Romi Gubes: Both of us know that most of the time, your care managers will suggest one care plan, and the senior or family member will have a completely different thing in mind, whether financially or just because the senior may not be ready for care yet. How do you overcome that? It seems like you have a very thoughtful agenda on how you want to provide care, which I completely agree with, but how do you handle that in the field?

00:05:42.900 Colby Bechtold: It’s about being adaptable. If somebody approaches me, it’s a multifaceted issue. You’re looking at the budget, and whether the person is willing to receive care. My job isn’t to come in, slap down a template, and try to get them to conform to it. My job is to build a safety net around them that makes them feel safe and cared for.

Sometimes that creates more work on our side from a care management perspective because we have to handle the matchmaking process. Finding the ideal caregiver for a specific person isn’t a one-size-fits-all process. I have to ask a lot of questions and build a lot of Legos around this person. Sometimes those Legos fall down because it’s not perfect, and we have to start over and rebuild it. It’s about always adapting to that person.

The other part of that is that a person is going to change. Their care needs will fluctuate; they get sick, or they get healthier, so we have to constantly rebuild the plan. Once you apply a template, you can’t just leave it. You have to constantly reassess, ask questions, and form a relationship with your clients so you understand what they need and they understand what you’re looking for.

00:07:05.100 Romi Gubes: Did it ever happen where you saw a specific client and thought, “This will be the perfect caregiver,” imagining them getting along, and it completely failed?

00:07:13.200 Colby Bechtold: Of course. I’m a bit of a jokester, so I always say finding a caregiver is like a dating service. If I think my friend is going to go great with another friend and I set them up on a blind date, that’s really what we’re doing. We’re setting these people up on a blind date and saying, “Okay, fall in love.” That’s hard to do sometimes. What I think might work might not work, and what I think won’t work sometimes does. You have to think outside the box a little bit and look at what they are truly looking for. A lot of times, clients are not going to tell you what they need or want right away.

00:07:54.400 Romi Gubes: Same for caregivers sometimes, right? They won’t always tell you what their favorable environment is. Can you give me an example of a specific situation you learned from and became better because of it?

00:08:06.300 Colby Bechtold: We had a veteran client who, once you got to know him, was a great guy, but in the beginning, he came off a little crass. We were having a struggle matching him with a caregiver because he would be very gruff towards them. We stepped back and asked what he was really looking for. I got to know him, and since his wife was deceased, I asked about her. He told me, “Oh, she was from New Jersey. She was loud and yelled at me all the time!”

I realized what was happening. We were pairing him with people who were more delicate to try and keep him level, but he needed a different dynamic. We found a caregiver who was fresh out of New York and had a lot of spice to her. We put her in there, and they became best friends. Now they don’t even call the office; they just say, “Leave us alone, we’re great.” I would have never thought to put those two together initially because I thought it would escalate. Thinking outside the box and looking at what a client is used to and where they come from is a vital aspect of that holistic look at care.

00:09:16.800 Romi Gubes: It sounds like it requires a PhD in psychology. You have to really understand people, the nuances, and what will work.

00:09:22.000 Colby Bechtold: That’s part of being a nurse. A lot of my staff are nurses, and being a nurse requires a holistic look at someone. It’s more than just a blood pressure reading and a pill; it’s finding the root cause of the problem. Looking at that holistic model helps you not only with direct care but indirect care. How is the family interacting with the client and the caregiver? What is the caregiver feeling about being in this home? Do they feel safe and comfortable? If you don’t look at it from all these perspectives, you’re going to have problems, short-term or long-term.

00:09:33.400 Romi Gubes: When we started Sensi, one of the things we wanted to put a lot of focus on was the caregiver-client match. We thought that having data in the home could help do this match on a more granular level because you know the person better. What we heard a lot of times from agencies is that they are just putting anyone wherever possible because of the caregiver shortage, and they don’t have the luxury of thinking through it. How do you think about that?

00:10:02.100 Colby Bechtold: Sensi is obviously a great tool to use for that. I always set expectations with every single one of my clients. If you’re calling me on a Friday at 5:00 p.m. right when the office is closing saying you need care right now, it’s not going to be the best match. I have to set that expectation. If you want somebody to come at 7:00 a.m. for one hour, it’s going to be whoever is available.

It’s the job of the agency to set that expectation. If you don’t, everybody is going to be frustrated. Part of that matching process is telling them, “I don’t mind starting care this week, but just so you know, it might be like oil and water with your caregiver because we don’t have time to do matching; it’s really about who is available. Starting in two weeks, we can build you an ongoing schedule according to data we’re getting from Sensi, from the family, or from the patient, and we can place people into those schedules who really mesh with you.”

If they call me and say a caregiver doesn’t work, we start from the ground up and rebuild those blocks. It takes time and a bit of trial and error; it’s rarely right the first time. Every once in a while it is, and it’s always a miracle, but we have to step back and set those expectations.

Make sure you’re communicating, because lack of communication is one of the biggest complaints I hear in any industry—whether in home care, when I worked in the hospital, or even when I worked as a car salesman. People don’t understand what’s happening. If you sit down and outline the path and the expectations, they feel safe and understand.

We see this all the time when people go to the hospital and sit in a waiting room for an ER visit. Nobody knows what’s going on or what the next step is. When a nurse takes a minute to say, “Okay, this is what’s going to happen, these are the steps you’re going to go through, and you might have to wait for a bit,” it changes things. In an ER, if you’re waiting, you’re not dying, so you’re good!

00:12:12.500 Romi Gubes: Exactly, looking at the bright side.

00:12:14.100 Colby Bechtold: Exactly. It’s all about communication, setting expectations, and learning about your patients beyond the surface level. If you’re going in and doing an assessment in 15 minutes, you’re not learning your patient. You have to spend a couple of hours there to learn them, find out what they like to do, what their favorite flavor of ice cream is, or if they are lactose intolerant. If you don’t do that, you’re doing a disservice to yourself, your client, and your caregivers.

00:12:52.400 Romi Gubes: This is a super interesting topic. Working with thousands of agencies across the country, we are seeing some common parameters among agencies that are growing faster and are more successful. One of the things we noticed is that when an agency positions themselves as an advisor for the aging journey, and not just as a service provider taking orders, they become much more successful over time. Their clients are happier, word of mouth spreads, and they create more credibility in the market.

One of the challenges in doing that is it has to be a top-down approach where the owner understands this positioning, as you’re saying. But another challenge is training the care managers to do the same. Those are sometimes tough conversations to have with the senior and the family—like saying, “I know you need someone tomorrow, but it’s actually better for you to close that gap for a few days so I can bring you someone who will be much better for you in the long term.”

00:13:58.700 Colby Bechtold: Again, it’s setting expectations. It’s not only communicating to the families and the patients, it’s also communicating to your team what the expectations are. When you put it in a personal way, it clicks. When I talk to new people onboarding with us, I always ask, “What kind of care would you deliver to your mother? What kind of care would you deliver to your child?” Put it into a way they can really understand. “Would you want somebody to walk in, throw a random person in your home, say ‘peace out,’ and only talk to them once a month when they send a bill?” They say, “No, I want to understand what’s happening, know who’s coming into my home, and make sure it’s the right fit.”

Exactly. We have to do that for the people we’re serving. It is way beyond a transaction. The transaction is just the basis of it. It’s about that holistic care model where we’re looking at everything from the inside out—spiritually and emotionally—to make sure everybody is whole. That’s where a lot of places are lacking because they look at it as a transaction, and then they’re done.

00:14:56.410 Romi Gubes: Do you feel that your care managers who are doing the assessments in the field are where you want them to be in terms of having those tough conversations and setting expectations?

00:15:06.200 Colby Bechtold: It’s definitely a learned model. For a lot of people, it’s easy to be transactional. It’s easy to walk in and say, “Yes, this is what we provide. Please sign here. Okay, they’ll be here tomorrow.” That’s the easy way out. Teaching somebody to take the hard way at the beginning for a long-term reward is extremely hard. I have a teenager, and it’s the hardest thing I’m trying to teach him right now.

00:15:28.100 Romi Gubes: It’s a little too late for that now!

00:15:29.900 Colby Bechtold: Yeah, a little too late! But teaching them that it’s a long-term reward for everybody involved is key. It might save you an hour today, but it’s going to cause you weeks of headache in the end if you just treat it as a transaction. If you take the time today, you avoid that because you know your patient and what their likes are. You find out more about them on a molecular level where you can match them with a caregiver—like finding out a caregiver really likes knitting, and the client likes knitting, so let’s put them together and see how they do.

That long-term work is where I think people fail to see because they operate on a “I’m clocking in for my shift today, I’m going to do my transactions, and I’m going to clock out” mindset. That’s why all of my care coordinators are on a salary basis; there is no clocking in and clocking out. You do the work until it’s done, and it’s all about emotion. I’ll ask them questions: “Tell me about your patient. What do they like? What do they dislike?” If they can’t answer those questions, they need to go back out and do another assessment because they need to spend more time with them. It’s really important to get to know them on that molecular level.

00:16:44.200 Romi Gubes: You expect your care coordinators to know their clients very well, and you’re enforcing that as the routine. You’re trying to train them to think long-term instead of just short-term. Is there anything else you’re doing with your care managers to ensure this DNA is maintained through all levels?

00:17:01.320 Colby Bechtold: Not really. We do a holistic training for all of our caregivers. Obviously, like every business model, we have financial rewards, goals, and KPIs, but any business can do that. It really comes down to me as the owner, or my executive team, walking through and asking these hard questions. All the executives in my company are nurses, so we all ask, “Tell me about your patient.” If you can’t tell me about your patient, you don’t know them, and if you don’t know them, how are you caring for them?

That’s the basis of it—building my holistic model around this patient and telling me everything about them. If you walk up to one of my care coordinators and ask what religion a person is and they don’t know, how do you know you’re matching them with the right person? Religion is a huge thing in people’s lives. Tell me about their family. If you don’t know about their family, there’s a whole dynamic there that you’re missing.

It is so important to learn, and it takes time. I have to take the time now even though I’m super busy and have 500 things to do. I need to stop and take the time to learn this one person. A lot of times people will say, “Well, they only want two hours once a week.” Right now, yes, but when I’m getting to know them, I might see they need a lot more than two hours once a week, and we can build a model around what they can afford so it’s mutually beneficial.

00:18:41.300 Romi Gubes: With that thought in mind, do you know what the average length of service is in your agency?

00:18:47.800 Colby Bechtold: We still have people on service from when we first opened. The average length of service for our agency is nine months, but that includes hospice patients and patients who are recovering from a temporary surgery, so it depends on what aspect you’re looking at. If you’re looking at true long-term care, like people with dementia or long-term issues, it’s years. Once they get established with an agency that truly cares about them as a whole, why would they leave?

We’re reducing hospitalizations, keeping them safer at home, engaging them, and keeping them alive longer so they get to spend more time with their families and feel more like a person. They would never leave that and say, “Well, we’re going to go with Agency X because they’re a dollar an hour cheaper,” when that agency isn’t going to engage them or care about them. It’s rarely about money in the end; it’s about the quality of care that you deliver.

00:19:52.110 Romi Gubes: Have you ever had a situation where there was a bump in the road with a client, they weren’t happy for some reason and said they were leaving for another agency, but your team stepped in, solved the situation, and kept them on service?

00:20:07.400 Colby Bechtold: Typically, if somebody wants to leave for another agency, I’m never going to stop them. I’m going to educate them. I’ll say, “Hey, if you feel like the other agency is going to serve you better, then I wish you the best, but here are the things that you need to look for.” I make sure to set them up with the knowledge and tools to evaluate them.

Nine times out of ten, those people come back to me within six months. If I give them a checklist of all the things they need to ask the other agency—especially when I know those agencies are not delivering holistic care—they actually pull that list out and realize, “Wait, they didn’t ask my mom what she likes. You didn’t do any caregiver matching.” They go down that list and realize they need to call Hummingbird back because the $12 they are saving is not worth it.

I don’t try to “save” people; I try to educate them so they can make an informed decision on what’s best for them and their family. The biggest problem we have is a lack of communication because people aren’t educating. As soon as a client says they want to go to another agency, companies scramble and say, “I’ll do anything to keep you,” or they just say, “Okay, bye,” ending the transaction. In a holistic care model, if you feel another agency will serve you better, great. Here is the information and education you need.

00:21:52.800 Romi Gubes: You’re planting the seeds by educating them on what the best care possible looks like, and it’s almost a promise that they will come back at some point.

00:22:02.500 Colby Bechtold: Yeah, because it comes down to whether you are looking short-term or long-term, transactional or growth-oriented, siloed or holistic. At the end of the day, if you’re doing the right thing for that patient and truly being a caregiver, you’re going to get that reward back. But it all ends when you’re just being transactional.

00:22:24.000 Romi Gubes: It’s super interesting. I think we have a few ways to look at growth: there’s the demand side of things—how we bring more clients in—and then retention, which is a huge piece that is under-spoken in our industry. How can we make sure clients are not leaving us when they don’t need to leave? Obviously, there is unavoidable churn for all kinds of reasons, but there is a lot of avoidable churn where we can make them stay with us longer. It’s huge to solve this leaky bucket that many agencies have.

I know that you are providing amazing care in your market, so I’m not surprised that you have that long length of service, but it’s very uncommon in the industry. As you said, the average is around nine months, with or without hospice. This is a super challenging aspect. Do you see a difference, by the way, in length of service between private pay coming from homes versus referral sources?

00:23:09.860 Colby Bechtold: No. We do things a little differently. We don’t do a lot of paid referral sources like you see a lot of in the industry. Ours is mostly word of mouth and going out to educate the community. You’ll see me doing a lot of speaking engagements, and I rarely say, “Hey, call me at Hummingbird.” I’m usually saying, “This is what to look for in an agency, whether you choose us or not. This is the holistic care that you should be getting.” By educating the community, physicians, and nurses, they remember that high-quality care model over the transactional model, and that’s how we get our influx.

It’s great to talk a big game, but you have to deliver that high-quality care. How are you educating your caregivers? How are you supporting your care staff to deliver that high quality? Are you educating them on what holistic care actually is? There’s a common phrase in the industry: “Are you putting a warm body in the home, or are you putting a caregiver?” Because those are two completely different things.

00:24:32.400 Romi Gubes: Everything you’re saying connects to what you mentioned at the beginning about considering opening a new territory to grow. From what I’m hearing—correct me if I’m wrong—you’re not playing a quantity game, but a quality game. You’re narrowing your market intentionally, deciding to provide best-in-class concierge care, and whoever thinks it’s not for them because they’re just looking for the cheapest price isn’t the right fit for you either.

00:25:01.200 Colby Bechtold: Correct.

00:25:02.100 Romi Gubes: With this decision, it entails that the target market is narrower since not everyone is looking for that. Now you’re looking to open another territory in order to grow. Do you have a number in mind when you speak about growth, or specific ambitions for the next 12 months?

00:25:17.600 Colby Bechtold: The sky’s the limit. In our territory, we just opened up another location, and we have another location planned after that. Our growth strategies focus on expanding our core care coordination staff throughout our service areas, because it’s hard in Florida. It’s a big, long state, and a service area can easily stretch 200 miles, which is a two-hour drive. It’s hard to service somebody at the other end of your territory if you have nobody physically there. How can I maintain a holistic model if I’m calling them on the phone and doing everything virtually? It doesn’t work. You have to have boots on the ground in those areas.

There’s a graph I saw when I was in college—I can’t remember where it came from—but it showed that if you chase quantity, your quality will go down. If you chase quality, your quantity will go up. It’s an inverse relationship. If I’m chasing the number of clients and hours, my quality of care is going to go down because my sole focus is numbers. If I’m chasing quality, my number of hours and clients will go up because they are looking for that quality of care. We maintain our focus there. I tell my team, “Don’t tell me how many hours we have. I just want to know that we’re delivering quality care.”

00:26:56.800 Romi Gubes: And how do you measure quality?

00:27:00.000 Colby Bechtold: Usually it’s word of mouth. We also do pop-in visits, and executive teams will go out to do supervisory visits where we just drop in. I was a night shift nurse for years, so many times I’m awake at 1:00 in the morning and I’ll show up at a client’s house who is receiving overnight care to check in on my caregiver. If you aren’t physically there, you don’t know what’s going on.

00:27:26.500 Romi Gubes: How often are you doing that?

00:27:28.100 Colby Bechtold: Every once in a while—once a month or once every few weeks when I can.

00:27:32.400 Romi Gubes: I see how you’re doing late-night emails and going to check on your clients, but that means you’re always working!

00:27:37.800 Colby Bechtold: Right, but the purpose of that is to ensure executive presence. It’s very easy as you grow to lose touch with your care models because you get wrapped up in business operations. If you’re not boots on the ground, going out and meeting your clients to say, “Hi, I’m Colby, I’m the CEO and owner of the company, how is everything going?” you lose that connection.

First of all, the shock on people’s faces is great—”Oh my god, the CEO came to my home!” They get so excited because they feel special, but they are also going to tell you exactly how they feel about the care. In the beginning, it was a little rocky trying to teach everybody how to properly execute a holistic model, but now when I go out to meet my clients, they tell me they couldn’t be happier. We’re getting that direct feedback. I don’t want to just do surveys; I want to talk to you, sit down, and have coffee with you.

When I look at my computer system and see that my care coordinator noted Mr. Jones loves vanilla ice cream, and I show up as the owner of the company with a little pint of Häagen-Dazs vanilla ice cream, do you know how much of a connection that makes? They’re amazed that the owner came and brought their favorite ice cream. Doing little things like that means the world to people. If we execute a holistic model like that, it means everything.

00:28:49.000 Romi Gubes: I admire that, I have to say. Operating Sensi, the first thing I think of is that it’s not easily scalable—you as the CEO cannot visit that many clients at 1:00 a.m. But it’s an amazing method for quality control to feel the field and see where things might have been misinterpreted so you can fix them. The way I do that is by listening to calls all the time just to make sure we’re aligned. Dr. Michelle Ranken said it nicely: “We all sing the same song.” Just to know that we are all in harmony.

So you’re saying you’re looking into opening another territory. With that quality-over-quantity approach in mind, what is your end game? Where are you looking to get to eventually with the agency?

00:29:11.190 Colby Bechtold: When I started out in this arena, I was an ICU and ER nurse—the “cool guy” nurse—and I never expected to be in home care. It only started because of my grandparents and wanting to deliver high quality to them. When we started this, it wasn’t just about doing it locally; it was about changing the culture of home care on a global scale. At first, you think, “I’m starting my little agency, how am I going to change the world?” But we see people change the world by putting one foot in front of the other and starting a change slowly.

I want to change the culture of home care by doing it instead of just talking about it—by showing them that this is how we operate. Our agency only opened in 2023, and we’re already the number one rated agency on the Treasure Coast. That growth doesn’t happen because I have a magic wand; it’s just about quality. If we prioritize quality, respect our caregivers, and take their voices into account when we’re doing things, it all comes together and works. You just have to do it in a way that’s holistic instead of transactional. Everybody else is looking now and saying, “Wait, they’re doing this holistic model, why can’t we?” I think that’s wonderful. Please copy what I’m doing, because it only benefits everyone. It’s our job to change the world, set expectations, and raise the bar on what those expectations are for everybody involved.

00:31:05.900 Romi Gubes: Do you see yourself one day covering the entire Florida area?

00:31:08.500 Colby Bechtold: Maybe even more than that.

00:31:09.900 Romi Gubes: I’m just trying to understand your vision.

00:31:11.100 Colby Bechtold: The sky’s the limit. I get scared when I hear other agency owners say, “I’m gonna own a nationwide home care agency.” How are you going to manage that? It’s a scary concept. But as you grow bigger, you get more people on board who have the same mentality and holistic mindset.

I don’t have to go out to every single patient at 1:00 a.m. myself because some of my temporary nurses and managers do it. They’ll tell me, “Hey Colby, last night I went to check on so-and-so on the way home from dinner with my kids. We stopped by and checked on them.” They’re doing exactly what I’m doing. It doesn’t always have to be the CEO, but you have to create the culture where that is the expectation. That’s what I would do for my grandmother, so I’m going to do that for all the people who are part of my business family.

00:32:07.620 Romi Gubes: That’s amazing. I’m very excited to be a part of your journey and to see the path you’re taking. I know that you’re also very excited and passionate about technology and AI specifically. How do you look at that when it comes to quality? How do you think we should think about AI in general in order not to hurt quality, but actually empower agencies and up the quality?

00:32:31.900 Colby Bechtold: Whether people like it or not, there’s a paradigm shift towards technology. If you think back to when everybody rode horses and these weird motorized contraptions started running around on the roads, everybody said they were a fad that wouldn’t last. Look at where we are today.

We are in a paradigm shift where everything is changing. We’re also facing a shift where the demand and need for care are growing while the available resources are not meeting it—specifically the amount and quality of caregivers we have, because education has unfortunately taken a bit of a nosedive recently too. How do we fill that gap? The only way is to use the tools available to us.

AI is a wonderful tool that we can use for both operations and care. People get very concerned with it and think it’s taking over the world, but I think it’s taking over the world in a good way because it allows us to reach out and touch our patients a little bit more. We have more touchpoints and more information being shared between the care team and the client. Because we have all these tools available, it creates an even more solid, holistic shell around that client and the care system so we know what’s going on.

Back in the 1980s, people were writing on paper forms. How was I supposed to know what someone documented until they turned their paper in, and then I had to go find it and read it? Now, technology has shifted everything to electronic documentation. It takes me two seconds to go through all my patients, skim their care notes, and find out what’s going on in the blink of an eye. That technology is incrementally improving the quality of care and the things we have to do behind the scenes. Utilizing a technology-based resource is only going to make the quality of care better. Higher quality leads to more growth. If you focus on quality, quality will naturally increase your quantity. It’s a rewarding system.

00:35:14.300 Romi Gubes: I know you’re constantly looking into different technologies and it’s very important for you to stay educated, which I very much appreciate in our relationship. You’re always looking to get everything new delivered to you, and I send you frequent emails as often as possible. Can you tell me about a product or a concept—without mentioning any vendor names—that you looked into and decided not to implement because you were concerned it might hurt quality?

00:35:41.360 Colby Bechtold: You have to look at a care system as a whole. I’ve seen a technology implementation in the past where someone got discharged from a hospital and they were given this big iPad that they had to log into and check in on. I looked at that and thought, you’re asking people who maybe aren’t the most adept with technology to remember to log into this system at a specific time. It was too complicated.

You have to look at the system as a whole: Can this person adapt to this technology? Are they receptive to it? It’s the same thing I ran into with my grandmother; she would never wear her emergency response button. What’s the point of the technology if it’s not accepted or utilized?

Finding technologies that are passive allows for a better experience for the client because you’re allowing the technology to do what it does best without demanding, “I need you to log into this iPad at exactly 1:15 and check in with the nurse.” That doesn’t work. You have to have a passive way of knowing what’s going on in the house without them having to log into a portal.

When I’m begging these systems, I step back, put my 85-year-old man shoes on, and ask: What would I be receptive to? What could I, from a technological standpoint, actually utilize? We had a client whose daughter bought him a blood pressure cuff that you have to put on and connect to Bluetooth. I’m sitting there looking at it in my 30s thinking, “I’m confused, I don’t even know what’s going on.” That might be a great concept for a 30-something-year-old to check their blood pressure, but somebody in their 80s is never going to utilize that. It’s too confusing, and expecting them to overcome that big hurdle for a new technology frontier is not going to happen. It just creates stress for them. We have to adapt to that and understand what is comfortable for them. A lot of technologies out there have the best intentions, but the actual implementation isn’t quite there yet.

00:38:22.400 Romi Gubes: When it comes to the senior and their family members, adoption and usage are everything. As you said before, it’s an entire ecosystem that includes the caregiver and the office staff. When it comes to your office staff, I know there are many AI technologies popping up now offering services.

00:38:38.700 Romi Gubes: Did you look into any solutions that you decided would ultimately hurt quality, leading you to choose not to implement them?

00:38:49.380 Colby Bechtold: I don’t want to overload the team. Tools are great, but if I walk into a shop and there are 5,000 wrenches to pick from, it becomes overwhelming. You have to approach it from that same quality-versus-quantity aspect. I need a single system that is going to handle everything all in one. I don’t need ten different systems with ten portals to log into to complete one task.

There were some AI tools we looked at for tracking client KPIs. It was very visually appealing to our care coordination staff, but it required a lot of manual task work to sit there and constantly update these bar graphs. It was too much. Looking back at that holistic care model, what is this actually allowing me to provide to the client? I understand the idea—it allows upper management to monitor lower-level quality—but the implementation is a huge drain on resources. At the end of the day, how is it benefiting the client if my staff is spending an hour tasking and filling in KPI data?

That was an example of an up-and-coming AI technology that we demoed and almost trialed, but at the end of the day, I felt it would have hurt our quality rather than supported it. It focused more on monitoring my lower-level staff rather than actively providing quality care.

00:40:41.200 Romi Gubes: It’s interesting because we’re seeing a lot of owners who are a bit overwhelmed with all the different technologies and are unsure how to assess them. I was interested to reverse-engineer your approach. You mentioned a few key factors: utilization, adoption, and now the burden that point solutions can place on a team.

00:40:53.420 Romi Gubes: If something takes time and manual effort from your team and isn’t automatically connected to your data sources, it’s something you probably want to avoid, even if it provides some value. You want to keep everything within the same context and systems and, as you said at the beginning, passive for all the stakeholders.

00:41:15.100 Colby Bechtold: One of my idols is Elon Musk. Back in 2015, I remember going to watch the rocket launches, sitting on the hood of my car, and just being so amazed. It’s such a great experience. Looking at his approach, he vertically integrates everything. Why pay this person to do one thing and another person to do something else when you can have it in one system?

If I can find a technology that handles everything I need in one vertical stack rather than having 15 systems and 15 portals to log into, why wouldn’t I do that? It creates an easier process for my team, meaning they are more likely to engage with it because they aren’t jumping from portal to portal or forgetting logins. It creates a better holistic environment for my team, clearing them up to execute the care model they need to do. If they are so bogged down with task work that they can’t go out to meet their patients, it will never work.

00:42:39.200 Romi Gubes: Obviously, you’re preaching to the choir here! I totally agree.

00:42:41.730 Romi Gubes: Last question I’ll ask, just because you’re such a visionary leader: How do you see the home care space 3 to 5 years from now?

00:42:52.300 Colby Bechtold: I feel strongly that people who don’t truly adapt to technology are going to phase themselves out. The people prioritizing transactions over quality are going to phase themselves out without meaning to do so. Someone who is extremely KPI-driven and only looking at profit margins and patient numbers is struggling severely right now because they don’t realize that quality is left in their rearview mirror. It takes a lot to turn around and say, “I’m going to turn my back on my KPIs for a little while—I’ll have people keeping an eye on them, but my main focus will be quality.”

That’s where we’re going to be in five years. Agencies like mine, and a few of my friends in the industry who are prioritizing that quality of care and holistic model, are growing exponentially because people don’t just hear about it; they see it in their family members. We have so many testimonials where people say, “My mom was on death’s door, and then she came to you guys, and now you’re taking her out to do things.” You see this sunshine coming from the clients and their families. It’s a wonderful thing to see. If I can inspire just one other agency to adopt this quality care, holistic model using the technological tools available to them, then I’ve done my job. Even one person makes it worth it, and we’re doing it for thousands of people. At the end of the day, it makes me so happy because we are truly changing the culture of home care.

00:44:48.500 Romi Gubes: If I understand correctly, your tip for owners listening to us is to look at where the trajectory is going. In order to stay relevant and grow your business, figure out how to implement tech to its full potential without hurting quality. Have your team focus on quality care and relationship-building, and shift the transactional work over to tech and AI. This is the winning scenario, right?

00:45:15.600 Colby Bechtold: Yes, exactly. And in that, you will see exponential growth. We’re already seeing the transactional people struggle because they don’t understand why their KPIs and hours are nosediving. It’s because clients are realizing, “I’m paying for a transactional service when I can get that same transaction over here, but with so much more value.” It all comes down to technology and that holistic care model.

00:45:41.200 Romi Gubes: Super interesting. One last thing—if it’s okay, could you share a bit more structure regarding this holistic care model? We’ve spoken about it anecdotally, but could you map it out a bit more?

00:45:55.300 Colby Bechtold: Sure. My care model is very simple. I used to be a part of a big nationwide bank, and whenever I called, I hit a call center. You don’t know who you’re talking to, and it’s frustrating. Now when I call a service, I want my specific person.

When someone calls us for care, they are placed with a dedicated care coordinator. That coordinator is the person who leads them through the process, does the assessment, and talks to them about all the services. They are their partner through the entire journey, so the client always knows they have an advocate in their corner. That’s the first pillar of quality care: having one direct advocate. They will introduce you to other people who help along the way, but if you ever need anything, you call your person. Instead of approaching a panel of people wondering who to ask, you call John Smith because he is your care coordinator on speed dial.

00:47:06.100 Romi Gubes: Right, exactly.

00:47:07.500 Colby Bechtold: And you have their cell phone number so you can text them if you need to. That relationship is how we become part of their family. We’ve seen instances where an elderly client who perhaps lost a child attaches to the care coordinator as if they were their own, saying, “I felt lost because I didn’t have anybody in my corner, and now I have you as my advocate.”

The holistic care model is simple: it’s about creating deep relationships. People don’t want 15 shallow relationships; they want one meaningful relationship where they can say, “I’m receiving care from this agency, and this is my person.” All the other elements—like our quality assurance nurse who drops in to ask a few questions—are great, but the client always knows who their main point of contact is.

The best part about it as the owner is that I can call any of my care coordinators and say, “Tell me about this person,” and they can open a book and tell me exactly what Mr. Smith likes, his daughter’s name, and her cell phone number from memory. They know these people inside and out. When a client passes away, our coordinators are crying because they lost a member of their family; they go to the funeral and show up exactly as a family member would.

Yes, it takes more time. Yes, it takes more energy. But how is that person feeling at the end of the day? Do they feel loved? Do they feel taken care of? Do they feel safe? If it’s just a transaction of, “Can you please come to my house and sit on the couch just so I have a warm body here?” that isn’t going to work. I need somebody who sees them as a whole person. We have to educate our caregivers to ensure they aren’t just going into a house, sitting on their cell phone, and watching the clock for 12 hours. It’s about engaging the client. It’s a highly conceptual model, so it’s hard to build a rigid step-by-step checklist for it, but it’s entirely about doing the right thing and taking a holistic approach.

00:49:50.000 Romi Gubes: I’m embodying this vision! Please open a location in Austin so I can move my parents there by the time they need it.

00:49:58.200 Colby Bechtold: You never know!

00:50:00.100 Romi Gubes: We’re waiting for you. Thank you so much for sharing your knowledge with the industry, for being a part of Sensi’s community, and for letting us serve you through your journey. These are exciting times, and we’re looking forward to what’s ahead.

00:50:15.500 Colby Bechtold: Absolutely. Thank you for having me, it’s been a pleasure.

00:50:18.100 Romi Gubes: Thank you.