Sandy Jen: Rethinking Home Care @ Talks at Google (Transcript)

SANDY JEN: I think in the beginning, we were like, all right, we’re just going to try the contractor model, because that seemed easiest. And so we started recruiting people. And then it turns out that there are certain restrictions in a contractor model, that you, for example, can’t train your folks very well.

There are certain limitations on the amount of personal interaction you can have with them. And so one of our core tenants has always been, if you could treat the care pro better and put them in a better place in their lives, they’ll be able to do their jobs better. Because if you’re not happy at home and you’re trying to make ends meet, you’re not going to be able to care for people very well. And so one of the things that we heard over and over again from care pros was that they might get a $0.25 increase in their hourly wage after staying with an agency for three years.

There’s no performance-based reward. There’s no way to know who’s a good care pro, who’s a bad care pro. And so one of the things that we thought would be really cool and that they were asking for was some way to develop your career as a care professional– as a caregiver. And so the only way you can really do that, though, is to give them signals as to what they’re doing really well and what they’re doing not so well– what they can improve on. And then you can train.

And so one of the key reasons we decided to make the switch to an employee model is that with employees you can actually train and develop and really invest in them as people and as workers. And so that was one of the primary reasons we decided to make that change, and they’re still employees today.

JORGE CUETO: So then you mentioned the value to caregivers. So if we look at this in comparison to traditional senior care centers or senior care models, what value do you add to the other key players — so then in this case, maybe the seniors themselves or also maybe the family members who are buying the care for their senior family members?

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SANDY JEN: Yeah, so the current industry is very fragmented. So if you think about– I think nationwide, there’s something like 40,000 or 50,000 agencies. It’s not because no one’s ever tried to make a large agency, it’s just really hard. You have a bunch of people on the demand side– so all of your seniors needing care. Let’s say your grandmother might have a bad hip and this chronic medical condition, and she’s allergic to dogs, and she requires someone who can lift someone out of bed every morning. Or my mother or grandmother might need to speak Mandarin, and she’s allergic to cats. And she has three sets of stairs, so you need somebody to be able to lift her downstairs.

So the requirements for people are super heterogeneous. And then on the supply side, care pros are also very heterogeneous. This person might be able to lift 200 pounds, but this person may not. This person speaks this language. This person can only drive five miles outside of her home, because she has two kids that she needs to pick up after work.

And so there are all these stipulations on both sides, and so doing a match is actually really difficult. And so if you are a small mom and pop agency– which lot of these places are– you don’t have the logistical operational technology brain to do that, because you’re trying to do it all in your head. So you might have a staff of a few people trying to match all these things. And so a lot of it is also very analog, so care pros will literally have to take a telephone in the morning and say, OK, where am I going to go? They’ll literally take their notes per visit on a spiral bound notebook with a pencil, and they’ll leave it on the desk. And so we also talked to folks who run agencies– they’ll literally drive around to all their clients, pick up those notebooks, transcribe some of those notes into their own system, and then return all the notebooks back.

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So it’s just very manual. And so one of the things that we hoped to bring and have been bringing is a more technology bent on this for that rote work. And so one of the key learnings for us was that you could try to automate everything, but we’re not going to send robots to do care. That’s not going to work. And so what we can do, though, is have computers do as much of the rote tasks– the matching algorithms, the GPS tracking stuff– and then let the humans do the really human stuff.

And so we can get there about 80%, and then let the humans do the rest. And so one of the things that we’ve been trying to do is actually just give more transparency into the process. So if I live in California, but my parents are on the East Coast, and I have a caregiver going every day, I can’t go and find that spiral bound notebook and have someone read that to me every day. So we have given an app to the care pro. We’ve given an app to the family. They can see notes right away. They can call in any time. Scheduling is a lot easier. The technology we use to then be able to track and give you progress notes on how the visit is going is amazing in this industry for a lot of folks. And so just trying to up the quality and transparency of care itself has been a huge goal for us– and definitely the ability to use technology to scale.

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