Miriam Allred (00:16)
Today in the lab, I'm joined by Catherine Vergara, the CEO of CareFor based in Austin, Texas. Catherine, thank you for joining me today.
Catherine Vergara (00:52)
Yeah, thanks for having me. Always a big fan of yours and honored to be here.
Miriam Allred (00:57)
So people are about to hear for themselves why you were a top pick as an early guest for the show. I've only known you for less than two years, which is kind of crazy, but I've been so impressed with you and I've already learned so much from you. So I want to start with the origin story of CareFor 4. Can you go ahead and share that with us and then be sure to weave in your own personal highlights and your own personal journey into the origin story itself.
Catherine Vergara (01:22)
Sure, yeah, thanks so much. So CareFor is 25 years old this year. So we began back in 2000 under a different name. We practiced under Nurses Case Management. We were founded by Debbie Pearson, who is a nurse, and really through caring for her mother, dealing with Alzheimer's and her career history in home care and home health and in the acute care setting, really became integral in her mother's care as she aged at home with her dad.
kind of looked up and out and realized that there were a lot of people having the same types of challenges, figuring out how to age in place and navigate the complexities of the healthcare system. And she birthed Nurses Case Management, which was a care management firm. And she ran that as a solo practice out of her home for the first 13 years. And along the way, acquired quite a large pool of private caregivers that would work directly for the families. And she would help manage them and process their payroll.
And I joined in 2013. I was a pediatric oncology nurse. And as she was looking for her succession plan, she partnered with a private equity firm that recruited me to help grow and scale the business. So I've been a part of the organization now for almost 12 years. And during that time, we've obviously rebranded to care for. In 2015, we became a home care company and all of the caregivers began to work for us.
And we've really grown and scaled the footprint of the business. We have nine care managers that work for us now, and we serve north of Austin to south of San Antonio. And we have about 150 caregivers that work for us. And the business has also grown into the guardianship space, and we serve the medical power of attorney space as well. I would say the heartbeat of our business is care management.
that has a home care component as a part of it to care well for our patients. And we're growing into the hospice space this year, which is really exciting, but really the desire of the business is to provide peace of mind for the aging, injured, and mentally ill. And that's probably just like 30,000 foot view of how we started and who we are.
Miriam Allred (03:38)
That was perfect. Can I ask how old you were when you joined CareFor?
Catherine Vergara (03:42)
Yeah, so I'm 42 and we're approaching 12 years here. So I was just on the, just had turned 30, you know, was turning 30 right when I joined.
Miriam Allred (03:55)
The reason I ask is you were so young and so you have grown up in this business. And I think I've said to you before, I wish I knew you 10 years ago because that's right around the age that I am today. And I just think, I think so highly of you. And I'm like, wow, what were you 10 years ago? And look who you are today. And we're going to talk about leadership today. And I just think of like your personal journey.
Catherine Vergara (04:11)
Yeah, you know, I...
Yeah, I was young and they certainly took a shot on a 30 year old pediatric oncology nurse who had some conviction or fire in her belly that we could build a really, know, scale the foundation that was solid into a really meaningful business. But I've grown a lot personally and professionally. I mean, I was single. I'm now married with two children.
So a lot of life has happened in that time on the personal front, but very much this business has grown up sort of with me and there's like my nuclear family doesn't know me apart from CARE4 either. So that's kind of interesting as well, but there are some OG folks. There's a nurse that works with us that has been with us from the very beginning. My executive team has been with me from the very beginning.
They've been so gracious because the 30-year-old Catherine had whole lot to learn.
Miriam Allred (05:19)
your journey is so interesting. And I've interviewed you before and we've gone into the elements of care management and also the elements of private equity because like you mentioned, there was this, you know, this owner with a care management business, but then was ready to grow and expand and you came in with private equity. So we're not going to get into that today, but that is a huge part of your journey and a huge part of your success. But like we're already alluding to is this leadership.
component and building leaders and building an unmatched office team that stayed with you for years and years and years. So, before we get into that, I want to hear you, you already kind of talking about your business model and the pieces of your business. Can you articulate that a little bit more so people can understand like end to end your business model and how everything fits together?
Catherine Vergara (06:06)
Sure, so we have two core service lines. We have the care management service line and then the home care service line. We consider our guardianship work and our medical power of attorney work as an extension of our care management. So very simplistically, we bill for two different things. Our care managers bill in 15 minute increments and then our home care is billed traditionally sort of hour over hour for the shifts.
It all flows out onto one invoice. So I like to say that we are able to administer a very integrated model. And the only place where you see our service lines differently is on the invoice because it is a very cohesive team. our operations staff, HR, scheduling, even care management, they all have a primary role with an expectation that they're integrated well with the other service line. So on paper, it's very, simplistic, but the operations of integrating that I think are where it becomes challenging because it is two very different service lines that are achieving different goals.
Miriam Allred (07:15)
And just high level, you're expanding into hospice this year, which is a very large commitment and jump for the business. Explain just your thinking there, why the move now.
Catherine Vergara (07:27)
Yeah, so, you know, we've spent the last decade building infrastructure and capacity to scale and home care has changed a lot, especially since COVID as far as just the cost of wages and the cost of care. And when you think about diversifying, we have chosen not to go the acquisition route. And so when you think about organic growth and opportunity for the business, we've grown organically into a new market down in San Antonio, but we were really thinking sort of like,
not Blue Ocean in the sense that it's never been done before, but what's Blue Ocean for care for? What's something, what's a new service line that we could offer that's integrated seamlessly within what we already provide? And we care for folks, really, we discontinue care either because they've improved and healed through an injury or because we've carried them all the way through the end of their life. And in that final season,
CareFor is still very much involved on the care management home care side, but we're bringing in a new entity. And we have for a long time wanted to be able to extend that continuum of care for CareFor to be able to provide that hospice service to our patients. And candidly, we're in the private pay business. And when you think about meeting the needs of a larger population, tapping into the Medicare funded space, thinking about expanding
our quality of service, the way in which we approach patient care and meeting the needs of clients in that realm to a population that hasn't always been able to take advantage of CareFor's core business. That's also exciting as well. So those were kind of the things that we thought about from the patient side and how to serve them well from an opportunistic side and when is the right time. We just felt like we'd built enough capacity that we could take on something new and
step into a new sort of territory and service line for us.
Miriam Allred (09:25)
Super, super exciting. Well, to be continued, this conversation, we'll have to circle back in a year from now and hear how the journey has been.
Catherine Vergara (09:33)
Yeah, there'll be a lot to say. Sure we'll have most, I mean, we could have a whole podcast on all of our learns. So we have a lot to learn, but we are excited about it.
Miriam Allred (09:43)
And you're so good at articulating the journey of the progression of just how things have gone. So I'll be excited to hear how, how all that shakes out. So let's get to the topic at hand, which is building this rock solid leadership team, this rock solid office team, because all of your growth over the last decade has really stemmed from you building up these leaders to then provide service to the clients and to the caregivers and to their families. So, a couple of rapid fire questions. I know you were kind of sharing some numbers at the beginning, but I want to do kind of a few rapid fire questions to set the context before we really get into it. How many office staff do you have? then can you do kind of a quick breakdown of your org chart? Again, because your business is structured slightly different, I like to hear how your org chart is structured so people can kind of understand the lay of the land in the office.
Catherine Vergara (10:31)
Sure, so I'll talk about how we're structured and then I'll get into how many people we have. So my title is Chief Executive Officer, myself with the COO and our Chief Strategy Officer. The three of us make up our executive team. We then have three directors who the six of us collectively are the leadership team. And that's, have a Director of CareFor Management, a Director of HR and a Director of Finance. And then the ops team, the scheduling team.
They flow up into the chief operating officers as does finance. I have kept the care management side, the director of care management reports to me. Our care managers are mostly nurses, the director of care management is a nurse, I am a nurse. And so just the clinical arm has always kind of flowed up into someone that's clinical. And that's generally the makeup. Our ops folks, mostly it's kind of a division between the chief operating officer and the HR. We tend to stay very lean and then add leadership or layers in once we've sort of built that capacity.
And so you could probably argue that we could make a good case for some other director level folks or some, even some managers in those spaces, but we have chosen to stay lean for multiple reasons, but it seems to also keep us pretty nimble and allow us to adjust with the needs of the business as things change or we think we see opportunity. And candidly, we're pretty particular about the type of leader that we believe is appropriate to lead at CareFor. And so that has been most effective with a really intentional smaller group of people.
Miriam Allred (12:25)
And just to add to that, the team that you just outlined is managing about 140, 150 caregivers. Is that accurate? Awesome. And talk a little bit about your retention numbers, because that's one of the things that drew both of us to this topic is your team and your numbers speak for themselves. Like you just mentioned your leadership team, the three of you have been together for 10 years, which is incredible and unheard of. But beyond that,
Catherine Vergara (12:35)
Correct.
Miriam Allred (12:54)
Has most of your office team been with you for several years or what are some of the other retention numbers that you can share?
Catherine Vergara (13:00)
Yeah, so, you know, our overall workforce, caregivers included, which that is in its own, has its own sort of like turnover churn. We have 31 % of our team that's been with us for over five years. And, you know, the largest retention space is in those nurses that we've retained to be care managers. Over 45 % of those have been with us for over five years. And five years for us is kind of the mark just.
From when I joined, like the business is 25 years old, but for 13 years it existed with one person. And so when we think about the growth, the other four care managers, it's not that there's been all this turnover within those roles, it's just the positions have been added as the business grows. So I would say care management is where we've seen the highest percentage of retention outside of the executive team.
And then the lowest retention where we've seen more turnover, I don't think anyone will be surprised, is in that scheduling role. And we'll talk about it later, but we've done some things, I think, to think differently about how to increase that retention. But that's kind of how we sit right now. And most of the new, most of the numbers are,
where they're lower is because of expansion of the business and there just have been newer positions that we've added.
Miriam Allred (14:29)
Let's get into that right away because again, I think that's not uncommon for anyone listening to this is that that scheduler role probably second to the caregivers themselves has the highest churn and there's a lot of reasons to unpack there. But I did want to ask you is, is that, or are there any other structural changes that you have made to the office team that have helped improve retention?
Catherine Vergara (14:51)
Yeah, so really kudos to our Chief Operating Officer Meg Lohan. She's worked really hard at thinking just strategically and differently about creative solutions to solving for the pain points within staffing. And when you think about a scheduler sort of having a life cycle of about two years, that's really discouraging when
we pride ourselves on having a business where people wanna come and really stay. sort of instead of accepting that as sort of like that's, well, we're just gonna get like, we're gonna maximize the two years. What can we do to differently to think different, to create a job that would not only recruit folks that we believe with align, that align with our core values, but really retain them and give them a really interesting career path. So the more recently, you know,
we expanded our work day from five in the morning to 10 at night, seven days a week. We've been a seven day a week operation for quite some time, but expanding those hours and staggering their shifts to, you know, we have the traditional sort of nine to five Monday through Friday, who, as we all would expect, is the most tenured, you know, scheduler who's been with us for a very long time. But.
plugging those holes with other very qualified, competent individuals who are eager to serve in the scheduling space and are comfortable with a more alternative schedule. I came from the hospital space and so I worked with a lot of people that liked working weekends or liked working nights and sort of that like shift work mentality. And if you can expand their shift and give them fewer days or shorten their shift and give them more days.
You can come up with something that's more customized. We say a lot at CareFor that if the job, if you're working more than 20 % of the time to make the job work for your life, that it's not a long-term sustainable fit. And when we talk about scheduling, that role just has such a high burnout through what the expectations are and the demands and the challenges and the availability and the on-call.
that if we can create a schedule for them that more naturally fits with their personal life based on preference of schedule and needs of the business, you can keep them longer and they're more content and it meets their needs and the needs of the business. So that's what we've been doing on the scheduling side and so far it has been successful. It gives you lot of opportunity to think about how you're gonna handle communication and handoff and.
to really allow them to be on when they're on and off when they're off. You need to be disciplined about that. But so far, it has been well implemented and well received.
