Here are all the questions submitted from last Hurricane Boot Camp in San Antonio!

1. How can we execute these great strategies with a small office staff? (i.e. 1 Director, 1 Manager/scheduler and 1 Owner)

The best way to execute successful direct referral marketing with a small office staff is to focus on a smaller number of accounts. Make a list of all the possible referral sources in your area and narrow it down to a top 10 to qualify. Then focus on 4-5 accounts. Foster the relationships there and once you start to get steady referrals you should grow your business enough to begin to hire more office staff or a full-time marketer.

In a situation where you are working with a small office staff, it is important to have the owner be the marketer so there is not a risk of relationships being built and lost when someone moves on to a different job. Time management is key. Begin by having all the staff members (owner included) make a list of all the task they are responsible for and eliminate any redundancies by making one individual the point person for each task and assigning someone else as the back up in case that first person is not available. Also pay attention to what tasks can only be done during “banking hours” (9am to 5pm), this allows you to prioritize what needs to be done when. If an owner or manager that is also marketing part time finds they are getting trapped in the office when they should be out in the field, it may help to restructure your day to do something after hours so they can be out marketing during normal business hours.


2. How do you go about adding an additional scheduler to your office staff?

As the business grows your staff will need to grow based on demand. The rule of thumb is to add a scheduler for every 500 hours once you surpass and maintain over 1000 hours a week. That being said, 500 hours spread over 10-12 clients requires more time then 500 hours spread over 4-5 clients. As you scale your staff it is important to hire in the areas where your office is weak. For example, if you have a strong scheduler but they are stressed out because you don’t have enough caregivers, it would be more beneficial to hire someone who can boost recruiting.

3. What is the best way to set up your office staff?

The secret to staffing your office is to staff to your strengths. As the owner find out what you enjoy doing, what you are good at and what only you can do. Then fill in the gaps. At the beginning, you may only have 1 or 2 office staff members and everyone wears many hats until you are able to grow. The most important thing is to have a point person for the phone, for caregivers, for clients and someone that is marketing. One person can do most of this but not all.

Owners who are new to business should think about hiring someone to man the office while they are out marketing and signing on clients. The office manager should be able to set up appointments for interviews, new client meetings, scheduling, etc. The owner should focus on marketing, and back office operations (making bank deposits, invoices, payroll, etc).

If you have been in business for awhile, having an office manager to handle the phones, a care manager or scheduler that can handle the schedule and oversee the caregivers from an HR standpoint, etc. A full time marketer or owner that markets, some office may require a nurse to be on staff. If you are looking to hire more staff the most important thing is to find where you are weak in your operations. For example: do you have trouble recruiting quality caregivers, do you have trouble retaining clients because of scheduling mix ups? Find your weakness and either redistribute tasks or hire to make that aspect of your business stronger.

4. At what point do I hire more people to implement growth for our business?

Hiring for growth can be a scary thing but if you find that you are having trouble breaking through a certain benchmark with weekly billable hours because once you get close or surpass it your office staff gets stressed out and things start falling through the cracks then it is time to add more office staff. Make sure the salary you are taking on is something that you can afford when you are at lower billable hours. It seems like a good idea to hire when you have a big week but if you have fatal monday you don’t want to worry you cannot afford the salary you just took on.


5. Does a full-time marketer do assessments and close business?

YES YES YES! Your marketer, whether they are full time or part time should be empowered and training to complete assessments and close business because at the end of the day your marketer is getting referrals because of the relationship they are forming with the individuals at the referral sources. If they like the marketer enough to refer them, the last thing they want to hear is that the patient will be meeting with someone else. Once the client is signed on the marketer should make an introduction to the care staff in the office that handles the scheduling etc so the marketer doesn’t get saddled with getting the business and managing that account.

In states where nursing assessments need to be completed, the marketer should still have the initial meeting and complete all paperwork to onboard the client before sending the nurse out. In time-sensitive starts, schedule the nurse to arrive 30-45 mins after the marketer arrives so the marketer has time to sell and close business. Then have the marketer introduce the nurse and leave or step into another room with the family to continue answering questions. This eliminates the client from feeling overwhelmed with a lot of people in the house or room at the same time.

6. How do you fill a referral fast? Especially same-day discharges from hospitals/rehabs? How can we promise to deliver on this?

Being able to staff same-day discharges is has a lot of factors and in some areas/states it is just not possible. If your state requires you to have a nursing assessment complete prior to start of care and you are not large enough to have a full time nurse, staffing a same day discharge is not always going to be possible.

Know the capabilities of your office staff AND your caregivers. If you have 1 or 2 caregivers that have been 100% reliable, can handle all different types of personal care and are normally your go to when you have a scheduling issue or difficult case – consider hiring them on a 40 hour per week basis to be on call. Guarantee they will be paid for 40 hours a week at minimum wage regardless of whether they work or not. For every hour they do work they will be paid their normal hourly rate or whatever the hourly rate for that case is. This builds loyalty, it is attractive to other caregivers in the organization and it allows you to have staff that you can call at a moments notice for not just same day discharges but also if you have a no show or some other scheduling issue. It is a good idea to have 2 people because not everyone can be available 24 hours a day. Choose someone that can be available during the day and someone that is available during the evening hours. Make sure they would be available on the weekends and express your expectations clearly that you may call them during the time they have committed to and they will be expected to pick up right then and go to a case. Also make clear that if you call them during their designated time and they are unavailable, the hours they turn down will be deducted from their check because it is time they are not able to work. This should all be outlined in an agreement signed by you and the caregiver.

Once this is in place you should market to your referral sources that you have caregivers on call to work at a moments notice and set an expectation of turn around town. Take into account distance from office etc, and let the discharge planners and social workers know that you can start a case with 4 hours notice, 2 hours notice etc. The most important thing is to make sure you can deliver on your promises. You will earn more referrals and more respect if you are honest about what you can do. Don’t be Maverick -> “Son, your ego is writing checks your body can’t cash” TOP GUN

7. How do you know what to charge for services?

Know your territory and average costs of services in your area.  You want to be on the higher end of the average cost. If you are charging the lowest rates in your area, you are going to have a difficult time getting/keeping caregivers because you will have to pay them a lower rate to make a profit.

Also, people know “you get what you pay for” to have quality services you are going to pay a higher price. Think about getting bids to have your kitchen remodeled. That is one of the most costly rooms in your home to update and you want to make sure the investment you are making is worth it so you aren’t going to choose the contractor that has the lowest price because we know we pay for higher quality work.


8. Should I have a sliding scale that changes as they need more hours?

Unless you are a newer business (under 500 hours), you really want to stay away from smaller hour cases as they are more difficult to staff.  If you are a newer business and you are accepting smaller cases, my answer is yes. You will want to charge a higher rate for shorter shifts so you can pay your caregivers a higher rate. Typically the price break would come for shifts over 4 hours.

For example, 1 hour case 50/hour, 2 hour case 35/hour…and so on. If you are an established company target the larger hour cases and adjust your rates for levels of care.  You wouldn’t charge the same rate for someone who is more of a companionships case as you would for someone who was combative and quite difficult. You will have to charge a higher rate to compensate your caregiver accordingly and ensure you will be able to staff it.


9. How do you get away from the 3-4 hour cases and do more longer visits?

This is where Specialty Programs come in! When you are marketing a specific client type (ie. Fall Risk, Orthopedic), you are teaching your referral sources the type of referral that you want.  If you are walking in and listing out every service that you offer, they won’t think of a specific client type or case for you. For example, if you list out several of your services (light housekeeping, transportation, personal care, and respite services) the one thing they may remember is you can provide transportation and send those client types to you.  On the other hand if you speak to them about the high probability of a readmission from someone who is a fall risk and offer a solution to prevent that fall, that is the client type they will send to you. Someone who is a fall risk isn’t a fall risk only two hours a day. These are cases that heavier hours are needed.

10. When does the marketer let go of the client and hand the relationship to the office?

This should be done at the consultation.  Once they have signed all of the documents, it is a good idea to give them a card with the main line to the office and let them know who (name/s) of who can help them. Transfer the trust you have built with them to the office staff.  I would always let them know that although they were welcome to call me, I was not always available to answer my phone. I may be meeting with another family or be out sick but the main line to the office was answered 24/7 and explained how wonderful all of the staff within our agency was.  Establish this in the beginning so it’s not something you are trying to correct down the road.


11. When doing events and costume marketing how do you make yourself known to get to the next step?   Or How do you take events and costume marketing and turn it into in-services and referrals?

Being in costume is going to make you known in itself.  When I would dress up and go around to my accounts, I wasn’t necessarily trying to talk in depth about my business.  I was ALWAYS looking for an opportunity to BMFM but I kept conversations light and used the visit in costume as a foot in the door.  I would hand out candy, take photos, and usually visit with the residents when I was there. It’s in the follow up visits that I would talk further about my business and build on those initial introductions.  If I took photos with any of the staff I would print those out, put them in an inexpensive frame and deliver it back to them. It was my reason to walk back in. It can be difficult to have a serious conversation dressed as a giant squirrel or turkey so just have fun with it and make it count when you walk back in.  They will remember you and most likely speak about how much everyone enjoyed it! It will definitely grab the attention of your activities director and you can schedule a time to get on their calendar to do a sponsored activity.

12. How to find clients/referrals?

This is going to take doing research for target accounts in your territory (ie, skilled nursing facilities, Independent Living, Assisted Living, Hospitals, Home Health, Hospice) and qualifying them to determine if they are a good potential for referrals. From there you will start to blanket the account (build relationships with several key contacts) and get involved within the account. You want to know as much as you can about them so you know how to align what you do/provide to their needs. We want to add value within the account.  We want to be able to set up an in-service over one of our specialty programs and ask for the business.


13. What are the best strategies to overcome “New Kid” on the playground mentality?

Use your “newness” to your advantage.  Being new to the industry or to the position as home care marketer has its advantages.  When touring a new account, ask for help. Let them know that you are new and learning important things about facilities including census, discharge rates, specialty programs or treatments to patients rehabbing.  Also, attending networking events in your community/territory will help you to identify other marketing professionals who you can start developing relationships with.


14. We may not have the talent, skill set, and courage to swim to the sandbar. We may want to swim but lack confidence and have too much fear. How do you address this?

Baby steps for sure.  Set small but measurable goals, such as attending networking events, schedule BMFMs to get to know people better, and to start to develop a relationship of trust. Be sure to tour accounts so that you are educating yourself on what the referral source has to offer.  Bring value into the account by offering to sponsor and activity or co-sponsor an event. We are here to learn about what they have to offer, and how we can support them. We can ask for business later during the in-service, but initially, we are in relationship and trust building mode.

15. If all of my referral sources only refer to VNA because they have a non-medical agency attached to them what should I do?

Find out who those skilled agencies are, then reach out for a meeting.  Let them know that the referral source recommended them/referred you. Get to know what they offer to their referrers and start to build a relationship where you can come in and support their efforts by being a back-up resource when they have a client they cannot staff due to reasons such as location, limited hours, caregiver availability, etc.

16. How long should it take to lock down a Power Partner?

Minimum of several weeks.  You want to qualify the potential power partner the same way you would a referral source.  What do they bring to the table? What is their census, do I like this person, does the organization have the same business and ethical values that my agency does, could I see myself co-marketing with this person every week?  It may take several meetings/lunches/coffees to determine if this person/agency is a good fit for your organization. We need to also determine if they have a good reputation in the community because you will be attaching your reputation to there, so do your homework first before agreeing or suggesting a power partner relationship.

17. How do you Power Partner if you are representing a Home Health or Hospice? With just Private Duty?  Or What are the best Power Partnerships for a Home Health or Hospice, other than Private Duty?

If you are an agency other than private duty, you can look to DME providers, Geriatric Care Advisors, Hospital Liaisons from SNFs, Independent Occupational Therapists.  Anyone that supports the patient through the continuum of care.


18. When working with 2 Power Partners, how do you ensure that everyone’s services are being promoted?

Co-marketing in all of its capacities!  This includes drop-in visits, in-services, community events, and sponsored activities.  Also setting up dual assessments so both modalities can collaborate on the best plan of care that will work in conjunction with the patient’s needs.  Discussing how PD wraps around the services of HH, and DME, Hospice, etc. Remember we are promoting a combined solution for better outcomes.


19. When setting up a Power Partner Group, how often should we meet? And what types of topics should we discuss?

A weekly meeting, to discuss co-marketing activities, and schedules.  Once a month to execute a sponsored activity or community event. Each member of the PP group has a responsibility to support the group.  Those activities can include securing a host site, securing a speaker, creating the marketing materials, sending out the invites, and community advertisements.

20. What if you are forming your power partner and you have more than one each industry? I can’t pick between which one. I don’t want the others to feel left out and stop giving us business

You can have up to 2 power partner for each modality (HH, hospice, DME) but you must not co-mingle both power partners in the same accounts.  Have each in a distinctive part of your territory. Those who you refer to and refer back that are not power partners, they are referral partners, and they would be a 3rd or 4th choice for referrals.


21. What is the best live-in strategy?

COACH 1:  I currently use a 3-2-2 model, Caregiver 1 – 3 days, Caregiver#2 & #3 – 2 days. One thing I have learned is the family likes one of the caregivers and they are willing to pay overtime for one of them to keep consistency. Also, quick note – if you look closely at the law, you could go down to 14 hours a day instead of 16 because it says caregivers must receive a 2 hour break. This is how I have gotten around not charging extra overtime for caregiver #2 & #3 staying late.


COACH 2:  For live in we use a “simplified pay agreement” based off something Steve shares with me. In the agreement we make it clear that the aid is responsible for letting us know if she is not getting adequate break and sleep time. We outline what her break and sleep time should be. In instances where someone is not getting enough sleep at night we have brought in a night aide for 8 or 9 hours. Still cheaper for the family then 2 12 hours shifts and easier for our staff to schedule rather then changing a bunch of different live ins. Not sure if it is a federal law or state but I was told if a caregiver works less then 5 days in the house they cannot be considered a live in and would have to be paid for the full 24 hours each day they are in the house. That is another reason we try to just keep one aide in.

22. Objection from a SNF Social Worker- No one can afford private pay! What do we say?

One good way to reframe the objection is to say, “If our services were free, would you recommend them?”  Following that up with a conversation about how they don’t even need to feel obligated to discuss cost or payment options with a family.  That is something that we do with them at a consultation and then let families decide what priority they want to put on additional care in the home to help keep their loved one safe.

Another good way to address this is by saying, “You are right!  Not everyone can afford private duty care in the home. You may send us 10 referrals and of those, maybe only half would have the money to spend on extra care but it is responsible for us to educate all people on what resources are available to them so that they have the option to decide what they have the funds for.”

23. What do you talk about during a LNL?

During a lunch and learn, you present your specialty program of choice (i.e.  Fall Prevention, Cardiac Care Program, Dementia Care Program, Transition to Home Program, etc….)  Go over the concerning statistics associated with the specific topic (PROBLEM) and how you work to address them (SOLUTION).  HINT: The solutions you discuss are all part of your standard operating procedures – home safety assessment, individualized plan of care, caregiver training, QA checks, etc.

Don’t forget to break the ice with the group prior to getting started with the in-service.  Connect with individuals as they introduce themselves and share WHY they got into the healthcare industry.  Also remember to know the communities rehospitalization rate (as well as your own) and talk about how your specialty program reduces the risk of their patients re-entering the hospital.  At the close of your lunch and learn, ASK for a trial period to send you referrals who would benefit from the specialty program that you presented.

24. What are some of the most popular questions referral sources ask and what are the best answers? (top 5)

Q:  How quickly are you able to staff a case?

A;  Answer honestly as you don’t want to promise something that you are not able to deliver.  However, the answer to strive for is to be able to staff a case within 24 hours.


Q:  Can you do 1-hour bath visits?

A:  Again, answer what your organization is set up to do.  If you have an hourly minimum and are not able to service a 1hr shift, you might respond, “In our experience working with clients if they need assistance with bathing or showering, they likely need additional help in the home as well.  During our consultations we meet with prospective clients and family members to identify some potential other areas of need. If they are still only looking for a one hour bath aide a couple of times a week, we have contacts within the community that we can make a referral to get them the help that they need.  (NOTE: You should have relationships with some of the competition that you can utilize for referrals such as these.)


Q: What makes you different?

A: Have your 30sec pitch ready, with 3 things you know matters to them


Q: Can you provide transportation?

A: Yes, but we charge a premium and mileage, Instead – we like to take advantage and possible take the family to the mall or walk before/after their appointment. (KEY!!! This gives us an opportunity to show the resident what a caregiver can do!)


Q: Do you take insurance?

We take LTC insurance and VA benefits, however, most of our families pay “out of pocket”. (Personally, I hate saying the word “no”)


Q: Can you provide Therapy or work with tubes?

A: Our caregivers provide personal and companion care services. For example … We partner well with Home Health/Skilled for the OT/PT/Therapy services. (Again, I hate saying “no” I also hate the word “non-medical” – Steve too!)


25. How do you handle those referring partners that say you are one of their chosen companies and that they regularly give out your name?

Thank them.  Treat them to special goodies every once in a while.  Support them with sponsoring activities, promoting their events and attending their community events.  Always, ALWAYS keep them updated on their referrals – both as a thank you and update right as the referral is made and how the assessment when AND at the 30-day mark so they are continually reinforced as to why you are their go-to….you kept their patient out of the hospital!


26. Steve said social workers are expecting us to close when we get a referral but what if they keep referring potential clients that can’t afford the services?

If they are continually referring potential clients that are unable to afford your services, perhaps the account wasn’t fully qualify the during the initial tour – does this community primarily service Medicaid or primarily lower income individuals?  If so, then they should not be on your Top 20.

If the referral source does have the potential to send you well-qualified referrals, then it is your job to educate the team on what makes a good referral.  You can do this through a lunch and learn.

Another possibility to look at is your sales process.  Perhaps the families really could afford services but the value wasn’t properly created for them at the initial INQ call or follow-up assessment/consultation.


27. How do you persuade an “at home senior” that “doesn’t need help” that they do?

If family is involved – Tell the senior, you are doing this for your “daughter” not for you. She is worried about you. Let’s just try it so she can sleep at night knowing you are safe.

No family involved – Do you like being here at the facility? What brought you here in the first place? If you don’t have someone look out for you, you may end up back here. Let’s try it just for a week (as you know that is the most likely time to return).


28. How do you get community clients (retirement living) to commit to 20 hours per week of care?

4 hours x 5 days = 20 hours.

Walk through a day and describe what the caregiver can do. Get you up in the morning (30 min.) Shower (30 min). Dressing (30min). Food prep, meal and wash dishes/Taking them down to dining room (1 hour). Toileting (30min). Washing clothes/Light housekeeping (30min-60min). Plus: Transportation, errands/shopping, medication reminders, etc.


29. How can we increase our retention of caregivers?

  • Pay the caregivers more
  • Caregiver appreciation: awards, bonus, recognition
  • Provide education/training (Ex. CPR, Dementia/Alz, CNA training, etc.)
  • Ask them what they want
  • Get them working immediately
  • Promote the best to senior “caregiver”
  • TIPS – if the caregiver is referred by a friend they will most likely stay
  • TIPS – if you have good leadership the caregiver will stay


30. What scheduling software should we use?

Honestly, there is not a great one out there. The most popular is ClearCare.


31. For training caregivers, is it best in person or online?

Depends on what your goal is: Participation, Retention, etc. Offer both and see what the caregivers come to. Advantage of in person is you get to meet them and evaluate them in person. The advantage of online training is better participation.


32. I am setting up my own power partner group with our top referral sources. Do you have an agenda of topics to discuss throughout each meeting and how often would you suggest meetings as a group?

If you can meet 1/week that is great if not 1-2x/month.

Agenda topics: New laws affecting the industry, News and notes from your area, New staff at facilities/communities in your area, Set up a joint event, Set up times to ride along, Discuss hospital discharges, Discuss SNF discharges, Discuss State ratings comparison, etc.


33. How do you get hospital referrals?


Here is my standard answer … It takes time! As Steve says it will take 6months to start getting referrals.

  1. The best way to increase it, find a power partner that is already established in the hospital and go with them.
  2. Go often and try different times.
  3. Make social media your friend: LinkedIn – maybe you have a friend that works there that can help get you in. – learn what their strengths and weakness are. Hospital Website – learn about upcoming events. Follow the hospital on Twitter, Instagram, Facebook, etc.
  4. Follow any of your families that go to the hospital, work with the social worker there.


34. Who is the target audience of an event? How do they benefit from attending?

Discharge planners, nurses, social workers. You need to offer them something that they will benefit from. Either education, CEU, incentive.


35. What are some ways to promote an event to get people to attend?

Make sure the invitation is professional. Deliver, drop by, use it as an opportunity to be in the building. Invite everyone you can. Ask administrators for ‘permission’ for the SW to attend. Have your PP advertise as well, so some people will get multiple invitations. Give them a reason to attend – education, CEU, good food, etc.


36. How does an event benefit a potential referral source such as an ALF, ILF, CCRC, SNF or hospital? What is the goal of an event from the marketing perspective?

It gives them publicity, people come in and they offer tours. They have a budget for events and by hosting, they’re using the in house cook, they already have chairs, etc so it’s cheaper to host than to do an event at a venue


37. Can private care work with children and how would it work?

Some states offer this. Primary caregivers become employees so they can get paid. Look into the legal aspect of this first.


38. What are the possible job titles for a marketing rep in an ALF, ILF, CCRC, SNF, or hospital?

Communications director, Marketing Director, Community Liaison.


39. What is a preferred provider network and how does it differ from power partners?

It’s a group of power partners, where you all work together as a team, not just individual relationships.


Want these questions answered in even more detail? Sign up for The Next Hurricane Boot Camp!