Bob Nations runs Senior Helpers, Napa, a three-territory operation covering seven counties north of the Golden Gate Bridge with around 350 caregivers in the field. For the last 18 years he navigated the shift from pure private pay to a diversified payer portfolio and built a team around the idea the best agency is also the best employer.
Bob sat down with me for a lively conversation on the Growth Operator podcast. We discuss what goes into designing a business built to last. Here are the five tactics he suggests you use, so your agency keeps growing.
1. Diversify your payer sources before you have to
“You can’t be too dependent on one source.”
Early in his business, 24-hour shifts made up about 30% of Bob’s revenue. Then California passed two laws in back-to-back years that eliminated that line of business. In two years, that 30% dropped to 1%. If his revenue stream came from a variety of sources, that drop wouldn’t have been so acute.
“It had a huge impact on my business,” Bob says. “Not only was it 30% of my business, but it was a huge revenue generator. And there was a scramble that had to go on to make up for that.”
Today, Bob runs what he calls a portfolio approach to payers: VA benefits represent about 50% of his business, supplemented by the PACE program, Cal AIM (California’s Medicaid program), the GUIDE program for dementia clients, long-term care insurance, and private pay. Each payer source brings a different client profile and a different risk profile.
When you depend on a single revenue stream, you are one policy change away from a crisis. Bob points to what happened in Texas, where VA rates were cut nearly in half in a single day, as a real-world example of what over-reliance on one payer can do to an agency’s entire business model.
“You can’t be too dependent on one source,” Bob says.
The earlier you build that payer portfolio, the more stable your business becomes when any one client stream shifts.
2. Technology is how you afford lower-margin payers
“What technology allows me to do is relook at those opportunities that have lower margins and say, well, maybe I can do those.”
Getting the right technology is the unlock you need to increase your payer sources. Government programs like Medicaid and Medicare-adjacent initiatives are increasingly available, but they come with tighter margins than private pay. Taking on government contracts won’t be profitable unless you can streamline your processes.
Bob uses technology to reduce operating costs so those lower-margin government-funded opportunities are viable.
“What technology allows me to do is relook at those opportunities that have lower margins and say, well, maybe I can do those,” Bob says. “I can’t lower my labor costs because I can’t go to my caregiver and say, I need you to take a pay cut. But I can look for ways to be more efficient on the back end.”
Each efficiency gain in scheduling, payroll, or caregiver comms lowers the cost floor, which makes more of the payer landscape accessible. For agencies looking to move into government-funded programs without sacrificing margins, this flips the question from “can we afford this payer?” to “how efficient do we need to be to make this payer work?”
Tools like Sensi in the home reduce the caregiver hours needed for lower-acuity overnight and monitoring situations, while still maintaining a meaningful safety net in the home. Additionally, the Sensi platform optimizes operations, serves as a growth agent, and helps the business scale.
3. Hire for the knowledge gap, not just the role
“She has a better understanding of how the PACE program works than I would have had. So she provides me with that insight.”
When Bob needed someone to pursue new payer contracts, he hired someone with a home health background, someone who came from the referral side of the business and already understood how programs like PACE and Medicare-adjacent payers work.
“She has a better understanding of how the PACE program works than I would have had,” Bob says. “So she provides me with that insight.”
He also asked her to go beyond generating referrals through the standard assisted living and hospital discharge channels; he wanted her to identify and pursue new payer contracts. That combination of domain knowledge and non-traditional scope paid off. She brought in the PACE contract, which opened an entirely new portfolio of clients the agency had not previously served.
The broader lesson is the skill set your agency needs to grow into new markets often does not exist inside home care. Consider adjacent industries and communities when you hire for positions that depend on growth skills, you might be able to tap into new perspectives.
4. Let AI handle the repetitive work so your team can do the human work
“The AI would be the first responder for the easy ones, and the person does the more in-depth thinking and relationship aspect.”
Bob spent years believing he was the best person to answer the phone when a family called in need. He knew the business, he knew how to listen, and he was empathetic when stressed children called asking about their mother’s discharge from the hospital.
Then he started asking himself if he was consistently the best person to answer the call.
“If I’m in the middle of a payroll project and I’m trying to focus on that, and that phone rings and that daughter’s in a stress moment because mom’s being discharged from the hospital, am I truly listening to her, or am I still back doing that payroll?” Bob says.
The realization that he might get distracted prompted him to consider AI for home care. AI answering an intake call does not bring the distraction of a difficult morning to the phone. It does not have a competing priority on its desk. And as Bob points out, it can switch to Spanish mid-conversation without missing a beat, speaking with families in the language where they are most comfortable.
“AI is as near perfect on that phone as you possibly could get,” Bob says.
The same logic applies to scheduling. Bob describes a scenario where 10 call-offs come in simultaneously. A human scheduler under pressure takes the first available caregiver. Technology can match each shift to the right caregiver based on skills, client needs, and geographic location, handling the straightforward matches automatically and freeing the scheduler to focus on the complex ones.
“The technology can help me do that because it’s a matter of: this person needs meal prep, and I know this caregiver is a great cook,” Bob says. “The AI would be the first responder for the easy ones, and the person does the more in-depth thinking and relationship aspect.”
5. Make it about the people, and the business follows
“The people you hire, the caregivers who provide the service. But it’s also those people you provide the service to. They come first.”
“You really have to make it about the people,” Bob says. “The people you hire, the caregivers who provide the service. But it’s also those people you provide the service to. They come first.”
For Bob, that means making business decisions based on what is right for the caregiver and what is right for the client, not just what is right for the balance sheet. He believes a happy caregiver produces a happy client, and a happy client produces a thriving business.
That philosophy also shapes how he thinks about competition. Bob knows his market has more seniors than he could ever serve alone. He wants good competitors because he needs them to help meet the ongoing demand.
“I can’t do it all,” Bob says. “My market has so many seniors in it, there is no way I could service every one of them. So I need really good competitors in the market to help me deliver good service.”
That is a long-game mindset. It is the kind of thinking that builds an agency with staying power.
Bob is positioned for the coming aging boomer population because he diversified early, built for efficiency, and kept the focus on people. The agencies that plan now are ready to grow with the gray wave as it arrives. If you want to see how Sensi fits into your business growth strategy, book a demo.
