Juan Tuason: Why AI Won’t Save Home Care Unless It Saves the Caregiver First

0:00 Romi Gubes: Hi, Juan.

0:01 Juan Tuason: Hello.

0:01 Romi Gubes: How are you?

0:01 Juan Tuason: I’m good. How are you?

0:02 Romi Gubes: I’m very well. Glad to be here. Thank you for coming. Thank you for joining us. I’m very excited to have you on this Growth Operator podcast, home care growth. You and I are chatting a lot about all kinds of different topics when it comes to home care, and specifically with everything going on right now, we’re talking about technology a lot, and specifically the hot topic AI.

0:25 Romi Gubes: I know you’re trying so many things in the field, and it’s so exciting to have you here, sharing with the industry your lessons learned from that. If you can start with a quick introduction so the audience will get to know you, and then we can dive right in.

0:39 Juan Tuason: Sure. Juan Tuason. I founded a company called Paragon Home Care in Virginia, northern Virginia, in the D.C. suburbs. We are a private duty independent home care agency since 2013, I guess so. We’ve grown to a fairly—I think we’re now the largest independent home care agency in the Northern Virginia area. Recently we’ve expanded to also go into residential assisted living, but home care is my heart. That’s where I’ll always belong.

1:17 Romi Gubes: Sounds like your hands are full.

1:19 Juan Tuason: Yes, for sure.

1:21 Romi Gubes: I’m sure, I’m sure. And tell me, Juan, with all of that in mind, the residential aspect of that, but especially home care, can you give us current state of how you think about AI in your business?

1:36 Juan Tuason: Definitely. What I’m excited about with AI is maybe a step ahead of where we are today, which is not just how to make things go faster and cheaper by doing more with less, which is, I think, what the focus is a lot now. But it’s really: where do we gain capacity and capability that doesn’t exist or is impractical or improbable today?

2:06 Juan Tuason: The technology of AI, theoretically something with perfect recollection, perfect memory, and an infinite knowledge base or almost infinite knowledge base to reference upon, just opens up a lot of things. I think people don’t even know what it’s going to look like five years from now to be able to elevate the level of care, the quality of care that we’re providing to our clients.

2:36 Juan Tuason: To be able to pick people who truly—one of the biggest challenges in home care, and I had this on my website for many, many years, is we’re always looking for the capital C caregiver. It’s the type of caregiver that if they win the lottery, they’ll probably come back Monday and go straight back to work because it’s a passion, it’s a calling. That’s all theoretical and ambiguous; it’s hard to put that into an HR recruiter’s worksheet and say, “Here’s, if this, then that.”

3:12 Juan Tuason: But with the power of AI, we can get a lot closer to being able to identify those much more precisely than just through trial and error, which is a big cost in home care right now—hiring the wrong people, having the wrong type of caregivers, or matching the wrong caregiver to the wrong client. All those problems, I think AI will just give us—it’ll be a force multiplier for sure.

3:41 Romi Gubes: I love it, and I think many owners—and not just home care owners, but in general—the way we think about AI sometimes is, “How can we just save some costs and replace some specific repetitive tasks by AI?” when you’re saying, “I want to be more strategic about that and think, where are the areas I can actually do better with AI and not just replace the human side of it?”

4:05 Juan Tuason: Right. Correct.

4:07 Romi Gubes: Yeah, I think it is a super important insight. This is also how we look at things at Sensi: how can we prioritize first the areas in which we can do much better with AI. Do you have any specific example, not for a solution, but mainly for a problem? You spoke a little bit about the caregiver hiring, right?

4:29 Juan Tuason: Correct.

4:30 Romi Gubes: Where else in the business do you feel like introducing AI can actually 10x the performance?

4:36 Juan Tuason: Well, I think you guys, that’s what you built originally. We had caregivers in the homes; their focus is always on ADLs—activities of daily living: changing adult diapers, meal preparation, toileting, bathing. But their sensors weren’t on to capture anything else that could be helpful, which has always made this a reactive industry.

5:08 Juan Tuason: The Sensi services, by putting those listening devices in there and giving us that added insight, give us, for the first time ever, the ability to be a little more proactive. That’s what excited me about Sensi when I first learned of you guys—it’s allowing us to be a little more proactive.

5:33 Juan Tuason: Truly, as caregiving goes—and as you know, when we’re dealing with people in their 80s—their decline is a ladder. It’s no longer a curve where somebody goes to the hospital, and then they come back and they’re back to normal. An 80-year-old, when someone goes to the hospital, they reach a new level and that’s where they stay. The best-case scenario is that’s where they’re going to stay, if not continuously downwards.

6:03 Juan Tuason: So trying to prevent that next step down is crucial for their quality of life, their well-being, and their health span. So I think that’s where Sensi has made a big difference—potentially even more as we tie more things into it, and especially giving the caregivers the tools to become sensors as well, not just rely on those pods plugged into the wall.

6:32 Juan Tuason: That also has helped our caregivers; we’ve already seen it. We’ve seen our caregivers now, because they know what type of things we’re measuring and what we care about, they’re not waiting for us to call them about an incident that was reported by Sensi. Now they’re saying, “Wait, I should call the office about this because I know that they’re going to call me about it.” So it’s even training the humans to know what’s valuable information that they otherwise wouldn’t have known before, or just weren’t aware of.

7:06 Romi Gubes: I think you’re mentioning a few things here. You’re mentioning the memory aspect, right? That AI can actually save so much data that sometimes we tend to forget as people. The other is analyzing and putting together insights, and the third is informing and arming people to do their job better.

7:26 Romi Gubes: Do you think about anything that is more, I would say, internal to the agency, like all kinds of operational flows that you feel will be high priority for you if you need to choose one that will be the highest priority with the state of mind of growth? How can it help me grow faster?

7:46 Juan Tuason: To me, growth always comes back to the quality of the caregiver. So that’s where I’m focused on and that’s where I think potentially the biggest unlock would be for AI for home care agencies and operators specifically.

8:10 Juan Tuason: For example, one scenario could be if I have a way of scoring a caregiver—creating a weighted score based on what are the attributes that make a Paragon caregiver based on the highest-performing ones.

8:27 Juan Tuason: Theoretically, fast forward down the road. We also know that retaining caregivers—if you don’t give them a job in the first two weeks of onboarding, they’re gone. They don’t wait around and they can’t afford to; they live paycheck to paycheck. So we’ve lost many great caregivers, I’m sure, because they came in and they sat in our database waiting for a call or an assignment.

8:59 Juan Tuason: So in a world where we now have AI helping us on the onboarding, if I can get a score for a caregiver that walks in and we say, “Okay, if it’s a 90 or above score, that’s an immediate higher priority, we need to staff them.” Well, where do we staff them? Well, now let’s look at our clients and let’s pull our client ranking based on the caregivers that are working with our clients and their scores.

9:26 Juan Tuason: What’s the average caregiver quality score on my top hours clients—the clients with the most hours? And if somebody has a score of 76, we can immediately increase that score by putting this new hire in over time. There’s a lot that goes into that to actually make that happen, but theoretically, over time, AI can help us improve.

9:54 Juan Tuason: It’s a win-win-win. We’re increasing the quality that we’re providing to our most important clients because they have the most hours that we’re caring for them. We’re immediately staffing a great caregiver and locking them in as a Paragon team member.

10:13 Juan Tuason: And we’re increasing the overall level of our caregivers because, over time, we’re going to move away from the people who are just there because they’ve been there. Once we start measuring it and actively institutionalizing that, it also opens up a way for us to put ladders for our caregivers. It’s a very flat career right now, and being able to score and keep score—meaning it has to be dynamic—helps. If someone gets training and gets a certification, their score goes up. If somebody gets a complaint or some kind of an incident that was an avoidable incident, that will reduce their score and so forth.

11:11 Juan Tuason: Now we can put levels in where we can say, “Okay, this person is not just about how long they worked for us or whatever we think of.” This person has certified dementia training, so they’ll get a little bit of a bump in there. This adds more layers to the quality of the caregiver, and we can put step ladders to really reward the behavior and the characteristics that we’re looking for.

11:39 Romi Gubes: So you’re basically saying, “If I had a magic wand, an infinite group of people and resources, this is how I would build my HR processes,” right? I would look very strategically into how am I rating my caregivers, how am I matching my caregivers, and how am I building improvement plans.

11:58 Juan Tuason: Yes.

11:59 Romi Gubes: Yeah, which is super interesting. I know that there are so many AI products out there right now, and each one of them is solving a different angle within home care, or aiming to solve a different angle within the home care business. Some are coming to that from the HR and recruiting aspect, some are coming from core ops or scheduling, or sales calls. So there are so many opportunities within home care, and every vendor is coming with a different solution.

12:31 Romi Gubes: What we’re seeing at Sensi is that owners and agencies are becoming a bit overwhelmed. We’re feeling a little bit of this “deer in the headlights” kind of reaction of standing still and not doing anything, which I can totally understand.

12:47 Juan Tuason: Yes.

12:48 Romi Gubes: How do you feel about the assessment process? Did you develop any kind of an assessment process of how you think about implementing new technologies? Because I know that you specifically try out many different things; you at least give them a close look. So how are you assessing all those things on the intake and assessment process?

13:16 Juan Tuason: I think AI has been a useful tool for really making assessments more robust. It used to be that, depending on the account manager or the nurse that made the assessment, you have different levels of quality of information that gets collected. Some people end up talking too much with the client, and then they get back to the office and realize, “I forgot her date of birth, and I forgot to ask about the medication.” So then they’re going back and forth, or we’re missing information and somebody has to collect that.

13:56 Juan Tuason: Whereas with AI, something as simple as asking them, “If it’s okay, we’ll just have our AI transcriber here,” and then just having a conversation feels more natural. It’s not going through step-by-step questions, because oftentimes that leads to information getting missed because you’re going down a list. The minute you get off that script, everything kind of falls apart and everything’s missing after that. Whereas in a conversation, you go back to the office and you pull it.

14:32 Juan Tuason: What we haven’t done yet—and other vendors are out there that say, “Okay, download this AI transcript and we’ll automatically put all the information into your technology system that you’re using”—we haven’t gotten there because I think you’re right. That’s exactly where I am: deer in the headlights. Just too many options. Every one of our vendors is offering an AI plug-in, and then on top of that, there are outside vendors that say, “This will help you with whatever tech stack you already have, or add this to this and we’ll integrate it somehow.” It’s just so many options.

15:21 Juan Tuason: But all of them are solving for that first level that we talked about earlier, which is, “This will help you make your life easier.” Unless someone builds something from the ground up, I think, and intentionally builds an operating system that has an AI-native platform, we’re always going to have that problem of: “How do we make this one talk to this one?”

15:52 Juan Tuason: “Well, yes, technically we can, but we didn’t capture this data over here.” So even though we have the capability on this side, we can’t do it because for the past 5 or 15 years, we’ve never captured that certain piece of data. So starting from scratch and having an AI-native platform, I think, is what I’m waiting for. And that’s to me where AI is really going to maximize its ability to really supercharge things. Other than that, I think we’re going to be chasing around how to fix things, and something’s always going to come that does something a little bit better, a little bit more, and we’re going to be nonstop just layering things over one another. So that’s what I’m waiting on Sensi for.

16:47 Romi Gubes: It’s almost like you know our roadmap.

16:50 Romi Gubes: And I think it’s a very important lesson learned or an insight for the industry to think about because I heard a few things from you now. One is the puzzle of technology that can be overwhelming on the teams as well, right? Multiple login credentials, many tabs open, six dashboards at one time.

17:15 Juan Tuason: Exactly.

17:16 Romi Gubes: Six dashboards, many mobile apps, many vendors to get training from, and all of that. Then you have the disconnected workflows, right? Things not always speaking to each other the way you want them to, and then some of them are missing some context, which creates friction. Then—you didn’t speak about that, but I will mention that—I think the cost also adds up, right? Because you’re paying this vendor a few hundreds of bucks, this vendor a few thousands of bucks, and then your tech stack becomes a massive expense for your business.

17:53 Juan Tuason: Yeah.

17:54 Romi Gubes: I think we hear that across the board from many owners, by the way, for a long time now. It even started before AI, but I think the AI revolution actually accelerated that because it’s so much easier to build solutions now. The transcriber that you just spoke about, it can take a tech vendor a few weeks to build it these days. So I think, yeah, we are experiencing an AI boom in our industry, which is an opportunity and a risk at the same time.

18:24 Romi Gubes: So when you are looking into a new technology, what are the things you’re looking into? You spoke about integration, right? You want to know that it integrates to your entire tech stack. You talked about how it can improve your day-to-day—not just make it easier, but actually improve your performance. Anything else you’re looking at?

18:49 Juan Tuason: Well, I don’t want to minimize the value of the economies of scale and the efficiency that AI brings, because I do think that’s just a given. I think we will be able to do more with less; I expect to do that. It seems like just yesterday the revolution was virtual agents or remote agents—hire a care coordinator in the Philippines and it’ll be 30% of the cost. Everyone was moving in that direction to be able to basically service more clients with fewer employees.

19:35 Juan Tuason: Now that’s the starting point for AI. But I think what’s coming is going to be more than that—it’s really adding more to our capabilities that currently are just impractical right now, in my opinion.

19:54 Romi Gubes: Yeah. I had a question here on how do you think strategically about your tech stack, but I think you already answered that from many different angles.

20:04 Juan Tuason: Yeah, thinking strategically, that’s how we got to that point where we started to get frustrated with too many things. Our HR manager came and begged us—I won’t name names, but there’s a very well-known engagement technology out there that helps us stay engaged with our team and also helps with recruiting. And then our sales team wanted better. We have so many of them, and now literally my executive director just put together a spreadsheet because we wanted to make sure we’re in compliance with HIPAA across all our technology.

20:54 Juan Tuason: Literally, it took him three weeks to collect all the legal documents and things because he wanted to have a spreadsheet and a file with every agreement that we have with every vendor, with all our BAAs for each one. It is overwhelming. And that’s why we’re at the point now where we’re saying, “Let’s reduce our tech stack, let’s simplify things, and let’s not jump at every next whiz-bang product and service that comes out.”

21:28 Romi Gubes: It’s fascinating what you’re saying, because I’m listening to you and I’m envisioning the disruption we’re going through and how home care will look a few years from now with all of those advancements coming into play. I just heard recently a podcast with Marc Andreessen, one of the leading VCs in the States, and he compared the transition we’re going through right now to other evolutions we’ve gone through in the past.

21:59 Romi Gubes: He said that everyone is concerned about job loss, where actually what they need to think about and speak about is task loss. So the jobs won’t go away; they will just change, and the tasks we’re going to handle are different tasks. This is what you describe right now if you think about your executive director. Back in the day, she didn’t need to go through this well-thought-out process about technologies and think about if everything covers HIPAA or not, because there were just a few technologies out there and it wasn’t that much of a big deal. She didn’t hear from all kinds of different team members every day about a new solution they want to implement.

22:42 Juan Tuason: Right. Traditionally, we were a very low-tech industry—very low-tech. When I started, many smaller agencies were using Excel to manage their schedules and that’s it. That’s all they needed: pen, paper, and an Excel spreadsheet. Now, for every task, there’s a vendor, and for every vendor, there’s now AI that they’re layering on top of it. And then there are new AI vendors separate and apart from that. So there is a flood of it.

23:09 Juan Tuason: I just saw an article someone sent me about Optimus and how we’re going to be having robotic caregivers pretty soon.

23:16 Juan Tuason: So we joked and I said, “Well, let’s be on the list to order the first batch of them so we’ll be the early adopters offering robotic caregivers.” We’re joking now, but I’m sure that if we meet here in a few years from now, we will be talking about that. It’s coming. It has to; there are not enough people. It’s getting harder and harder to find really good caregivers.

23:56 Juan Tuason: Just to show you how hard it is now, I have one caregiver who is a rockstar caregiver who is 83 years old. She still has regular clients, and she works probably between 30 hours, sometimes 40 hours. Obviously, she’s not a caregiver that I would put with an agitated dementia client, but she loves the work and she is incredible at caregiving. I have a couple of those; she’s the most extreme example.

24:34 Juan Tuason: But eventually, they’re not going to be here, and they’re not being replaced. There are not enough new ones coming on board. So I think that’s another opportunity AI can give us: as this becomes more scarce—caregivers become more scarce—it’ll have to become a more well-regarded profession in our society.

25:01 Romi Gubes: I agree, and I think that you also touched on a very important thing, which Marc Andreessen also said in the same podcast: AI is actually now saving us because the population shrinks and we know that there is a high demand for so many jobs out there that we cannot fill. So we can actually be embracing AI to help us grow our businesses and serve more clients. I tend to agree with that. Now, with that in mind, if you think about building a moat for your business with AI taking so many things and the human resources focusing on different things, how are you defining that moat?

25:46 Juan Tuason: Culturally, our focus and what we’re all about is the caregivers. We truly believe that if we have the happiest, most job-satisfied caregivers, that translates into the greatest care. What I’ve learned in the 15 years of doing this is not a lot of other agencies pay attention to that. It should be common sense, but it isn’t. So any technology advancement where we can take better care of our caregivers is a win.

26:24 Juan Tuason: I think I told you what sold me on Sensi was the insight that it gave us to be able to pat great caregivers on the back that we might not otherwise have visibility on. Probably within the first week of us turning on Sensi for one of our clients, I see a red alert saying “suicide ideation.” Of course, I had to listen to it, and it was one of my long-time clients saying, “Lord, I just want to die. Take me away, please, Lord, take me away.”

27:01 Juan Tuason: And I hear in the background a long-time caregiver who’s been working with the same client for a long time as well, saying, “Now, Miss Mary, you know the Lord still has a job for you, or else he would have taken you away already. So now let’s think of something good to do. What about card sharks? You love cards.” And you can hear Miss Mary say, “I love you so much,” and then they start laughing.

27:26 Juan Tuason: That’s a caregiver that—it dawned on me—it’s been probably three years since I talked to her because nobody ever complains about her. She has that client managed really well and she’s taking excellent care. But because of Sensi, I was able to give her a pat on the back, send her a gift or two, and just call her and say, “Thanks for everything that you do. You’re so great.”

27:51 Juan Tuason: So to me, that’s the focus of the moat. Before I got into home care, I was in finance and I worked for Fannie Mae before Fannie Mae almost ruined the financial system. But I remember when I first started working there, I felt like I was now part of the few, the proud, because very few get in. Once you get in, it’s usually because you know somebody or you’re a really good, high top performer, but everyone in there walked with a swagger and was really proud. My wife worked at Capital One and they had the very same culture—they’re very picky and really pick the best of the best. That’s what I want to build. I want our caregivers to feel proud of having the logo on their chest because they know that this is where everybody else wants to go, but we got chosen.

29:17 Romi Gubes: Yeah. I think you’re touching on a topic that is very close to my heart. This was obviously one of the main motivations for us to build Sensi. Sometimes when we work for so many years in this industry, we take it for granted, but it’s so complicated to manage a workforce like that that is constantly in the field and we have no visibility into what’s going on. They’re taking charge of such intimate, complex, hard situations, and we actually have no clue what they’re doing during their shift aside from the shift notes or anything that is more tactical and transactional. I heard a sentence from one of our clients that I really like: they said they’re treating their caregivers as if they are their clients. I love it, and I think not many are implementing that approach.

30:19 Juan Tuason: No, that’s what we say for our operations team. We tell them we have two stakeholders: our client and our caregiver on equal footing. One is not higher than the other.

30:29 Juan Tuason: Similar to a swear jar, we make a big deal of it. It’s well-known that my executive director and I, what we tell our team in the office is, “If we walk around and we can tell that you’re speaking down to a caregiver and not a client, that’s going to be a problem.” They should have the same tone, the same level of respect and courtesy.

31:01 Juan Tuason: Talking to a caregiver who’s calling out on a Friday at 4:30, no matter how frustrating it is because it’s going to mean an extra 30 minutes of work that you might have to stay late to solve, you never lose sight of the fact that they’re the reason we’re here. They’re the reason we have a business—they’re doing the work out there.

31:26 Romi Gubes: So you spoke about one thing you’re doing differently with caregivers, which is obviously being very thoughtful when it comes to recognition, whether it’s through Sensi or other processes. What other tips do you have on how to better support your caregivers?

31:53 Juan Tuason: Well, we’ve done it naturally in our area. Northern Virginia is known to be a driving town; it’s not easy to get around if you don’t have transportation. So we always offer Uber rides to our caregivers to the degree that we can; that’s part of our overhead cost. We’re probably the only ones that we know of that have always given interest-free loans. If someone needs an advance, we’ll pay for people’s cars to get repaired, and then we just take a small repayment so that they pay it over time and they don’t get this big shock and lose their whole paycheck, ending up in a downward spiral.

32:50 Juan Tuason: We’ve paid for people to fly back home for funerals when their family members have died; we just do that. But probably the thing that helps us with building the culture is trying to build an awareness that it’s the moments in between the ADLs that we care about most.

33:23 Juan Tuason: Every home care company out there that I know of, if they’re still in business, they have to do ADLs well. But that’s all they focus on in their training, and that’s why you find a lot of complaints in the industry saying, “My caregiver just sat here on her phone or on his phone.”

33:48 Romi Gubes: Maybe the most common, right?

33:49 Juan Tuason: Yes. They’re constantly on their phone or they go to the kitchen and wait for their client to ask for help. The only way you change that is by showing what success is, modeling the behavior, and then spreading it out. So we created an internal Facebook page that all of our caregivers join, and we use it a lot to highlight kudos.

34:24 Juan Tuason: People will send videos like, “Look, my client brushed her teeth, even though she has agitation and advanced dementia, because I learned this trick: if I sing a song, she suddenly becomes happy and she brushes her teeth while she’s humming and I’m humming.” You see she was so excited; she wanted to share it and we posted it. She was sending it to us because she was so proud of that moment, but by posting it, we also showed everybody else what they should be doing.

35:05 Juan Tuason: Pictures of them just laughing, playing cards, or giving them tools so they can engage. We’ve created playing cards that have conversation starters in them. We tell our caregivers that’s part of your onboarding—bring it to every client. In between ADLs, play cards. You don’t have to play poker; you can just use them and just ask your client to pick a card, and it’ll have a question. Ask her or him that question and just have a conversation, keeping them engaged. By doing that, we’re trying to embed into our caregivers that that’s important—that’s what takes us from excellent to exceptional. Hopefully, AI can help accelerate that as well.

35:58 Romi Gubes: Wow, I love it. I never heard such a creative idea. So you’re basically creating a community of your caregivers, which is something they are missing in a way from the way they work—it’s very siloed and they’re alone most of the time with their client.

36:13 Juan Tuason: Right. You hit it—the community is missing in this profession. They get hired and then they’re treated like a piece on a chessboard: “Okay, you go there now,” and then they’re forgotten. They never hear from the home office unless they’re late or something goes wrong. That’s unfortunately usually the only exchange they have with corporate.

36:45 Juan Tuason: We hear it all the time from our caregivers: “Wow, this is so different working for Paragon. I can’t believe you guys remembered my birthday.” Sometimes we’ll even bring flowers to the caregiver at work, and they’re just shocked because they’ve never been treated like a colleague or a teammate.

37:16 Romi Gubes: I love it. People always say that being a CEO is a very lonely profession, but when I’m comparing it to a caregiver, it’s not as lonely, right? You have your team, you have your clients, you have your board, you’re a part of a community. When you’re a caregiver, you’re actually all by yourself.

37:46 Juan Tuason: Yes.

37:47 Romi Gubes: I love it. So if you need to paint a picture of how home care will look like in three to five years, how is Paragon going to look like in three to five years? How do you think about that—with or without robots?

38:05 Juan Tuason: Let’s say robots will come later—that’s ten years from now. I think three to five years out, the home care agencies and the companies that provide dignity to caregivers and make it a profession that people want to belong to are the ones that are going to succeed.

38:34 Juan Tuason: As the population shrinks and we’re not getting new caregivers attracted to this profession, the people who treat caregivers the best and attract them are the ones that are going to thrive and succeed. I think that’s about the three-year mark. And then the five-year mark is hopefully where we, as a culture, start recognizing the value, the necessity, and the importance of the role and put it higher in the totem pole of work as a profession. It’s the only way we’re going to attract more good people to do this work; there are just not enough younger people coming in.

39:43 Romi Gubes: So if you’re looking at the market share in three years from now, you’re saying that the agencies that do the bare minimum in order to just survive will probably be the ones that will get less market share moving forward, because AI will be table stakes, right? AI will be able to do the bare minimum, and the ones that will really put focus on relationships and caregiver support and management will be the ones that will get most of the market share.

40:17 Juan Tuason: Yes.

40:18 Romi Gubes: So the difference between the bare minimum and the very strategic, driving-for-excellence kind of agencies will become bigger.

40:27 Juan Tuason: I think so. Right now, there has been a huge influx of new agencies, and it’s fueled the growth of franchises. The franchise companies that pay attention to the quality of their franchisees and their owners are the ones that are going to survive.

40:59 Juan Tuason: As things get more challenging, a lot of the people who came into this were thinking, “Well, should I get a home care company or should I get a Jimmy John’s or a Subway shop?” It was really an economic decision; it wasn’t a mission-driven thing. They weren’t necessarily out to take care of seniors. In three to five years, those types of people are the first ones that are not going to be here anymore, because as it gets more difficult and potentially the economics change, they might go back to a Jimmy John’s, and they won’t know why it’s not working. I’ve started seeing it already where caregivers just aren’t working for certain types of owners because they’re focused on the wrong priorities.

41:53 Romi Gubes: Yeah, I cannot agree more. When you look at prices moving forward—the price of the home care service—do you see any change in that moving forward, for good or for bad, speaking about AI?

42:12 Juan Tuason: It’s tough because, as you know, the core cost is labor. You can’t attract more people when there’s already a shortage by reducing pay, so I don’t see the labor costs going down. For physical care, you can’t combine two people’s houses.

42:33 Juan Tuason: That’s partly why I got into assisted living. Congregate living is going to start becoming more prominent. I’ve already seen a lot more families now converting their garage into an in-law suite so that they can start supplementing care, because either they can’t afford to or they don’t want to fully outsource the care to a home care agency.

43:08 Romi Gubes: I wish my parents would have been accepting of that if I were to offer.

43:13 Juan Tuason: What, to move in with you?

43:14 Romi Gubes: Yeah, to move in with me. Your parents weren’t?

43:16 Juan Tuason: No, they weren’t.

43:17 Romi Gubes: Me neither.

43:18 Juan Tuason: My mom moved all the way to the Philippines to avoid letting me take care of her. But I’m seeing that a lot more. I think we’re going to have to go back to those cultural, generational homes.

43:32 Romi Gubes: Yeah, yeah. Anything I didn’t ask you that you wanted to share?

43:47 Juan Tuason: No, I think I can’t think of anything off the top of my head, although I do have one ask or an idea. I was talking about the conversational cards. One of the things I was envisioning using those for—and I have to get through modifying our service agreements and making sure we get permission—but what I would love to do is for AI to capture these conversations with my clients so that it’s building a history and a record.

44:32 Juan Tuason: Sadly, as all clients eventually pass away, I would love to pull an AI record and gift the family members with a memoir. “Here’s six years of us taking care of your mom, and some memories and some stories that she told.” Those are the things that AI makes possible that we just couldn’t do manually. Imagine what a gift that would be to the families, just to capture all that conversation that happens there naturally.

45:18 Romi Gubes: Capturing this is very creative thinking. Usually, most people very naturally will think about operational workflows, repetitive tasks, and how we can automate those areas of the business. But the way you think about that gives even me—day-to-day, this is what we’re doing—a broader thinking on how AI can really support the aging journey as a whole, not just the nuances of a business, which I really love. So thank you so much.

45:54 Juan Tuason: You’re very welcome.

45:55 Romi Gubes: Thank you so much for spending the time with us and being an amazing partner.

45:59 Juan Tuason: My pleasure. Thank you for all the work that you guys are doing; it’s always impressive, and I can’t wait to see what else is coming.

46:04 Romi Gubes: Thank you so much.