Who Cares for Your Aging Family When You Can’t? (Hint: Not Robots)

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Like most people, I didn’t want to think about my parents getting old, getting sick, or needing help taking care of themselves. But a few years ago, I was face-to-face with this reality. My mom lives over 2,000 miles away and she suddenly needed regular care beyond what our family could provide. She needed in-home help… and fast.  

I quickly found a broken system. It was nearly impossible to understand our options or how payment or insurance coverage worked. I was dreaming if I thought I’d get any data from the caregiver about how things were going.  It was a mess. (Fortunately, my mom is in much better shape these days.)

Since that experience, I’ve watched closely as a few companies entered this complex and decidedly unsexy industry, including NYC’s own Hometeam. I recently sought out Hometeam’s CMO, Andrew Chomer, to learn how they are changing the home healthcare experience for the elderly, their families and caregivers alike.  

If you want to know about the future of who will take care of your loved ones when you can’t, listen here.

Josh: Let’s talk about what Hometeam does today and where you see things going over the next few years.

Andrew: Absolutely. Hometeam today is in-home senior care. Very simply, what we've built is basically a service that staffs HHAs [home health aides] as it's called or caregivers in our world, and then adding a layer of support, management, training and communication to make their worlds better. We do that using technology but we also do that using great resources around us. To answer your question: Today, we are all about empowering caregivers and really producing a better service. This past year we've really proven that to ourselves and the world, at least in New York and New Jersey. The next 5 years, our focus is largely understanding the impact that we can make and producing better health outcomes. So many of the issues in healthcare reside in this 20% of the population that's [age] 65 plus. That is our core focus. We are the company and the service and the people that are right inside the home, that are able to have that daily conversation to change behavior, to track that behavior and help the system, the insurance companies and the providers, and really start to change what is a very high cost for all of us that pay.

​ Josh: I'm going to dig into that a little bit. Thinking about producing better health outcomes, it sounds like you're moving to using technology to create more open conversations and get better information about what's happening in the home. What specifically are you thinking about?

Andrew: Yeah, and it's actually not... the thing that I don't want to mistake here, because it's such a human element that technology isn't really the driver. It helps enable certain things. I'll just go in one direction in terms of the industry. The industry, in terms of caregivers and HHAs are treated so poorly. And the bar is so low that there is an opportunity for Hometeam to really make a difference. That became core to our business, which is, if I actually go in with the mentality like I would with anyone, which is, as an employee, “what's a career path for this person look like?” What is really his support management look like? When they're not getting it anywhere else, then that changes that person's work behavior. And so, let's drill that now into the home and how we start to change that from a health outcomes standpoint. Day in and day out, if I have a happier worker that feels supported, then when they're actually in the home, then they're providing a better service. Better service could look like things like, taking medication, eating meals, exercising regularly. These are things that we take for granted in some of our days, is becomes critical for things in the senior care world. Now, technology really becomes an outlet. So much of what caregivers have to deal with is, if something goes wrong and they don't have a solution, they're sending out a response to whoever is managing them, and usually not getting a response back. What they're starting to do, and what we allow for, is immediate response. We have an application, we have an iPad that allows for an immediate response when there are problems that they can't solve. It's working through that problem and it's elevating it the right way. So technology enables those things to really exist a little bit more. And it allows them to feel supported when those things go wrong.

​Josh: I think a lot of times when we think about service industries generally and then sort of this talk about automation is everything, robots taking over, taking jobs, this is kind of the opposite, right? This is not like in-home robots taking care of your sick parents. This is just treating people well and giving them the tools they need to succeed.

Andrew: Simply put, it is, right? And I think we tend to overthink it in this world. But as we look at the future and the need for this population as it grows, there are jobs there, right? And we don't want crappy jobs for those people. We want real jobs that actually have support, that have growth, that have career development. That's becomes a pretty big need for the United States especially.

Josh: Yeah, that's really interesting. It’s one of the things I think about in this industry generally, is this idea that like my 92-year-old grandmother is going to figure out how to report things on an iPad, right? Or the self-service, older person uses technology to get this data to me or she's tracked with a camera. What's your view on that type of eco-system?

Andrew: Yeah. I actually did come from a company called Pager, where we were tackling the problem of navigation of healthcare. And everyone, all the big insurance companies and hospitals and health systems are really trying to solve really what is a chronic population, so their sickest populations. And largely that is an elder group, right? Elder adults. My belief is, getting someone that is not used to technology and changing their behavior at the age of 65 is a very difficult task. And that's why I think where we look at this in HomeTeam is, there's a couple of things. One is that you're covering the last mile. So when you're in the home, and you can effect change in the home, that's a huge step. And that's where everybody wants to be. Technology, again, really only could play a role as to tracking those behaviors or accountability. But I think it's really a misnomer to like think that we can actually change the behavior of a lot of people today, that they've never experienced it. Because guess what, vision's difficult. The ability to use a technology just isn't inherent. So like those things don't feel as realistic to me as using technology for the purposes of people that are used to it, and then placing it in front of those people, instead of really focusing on the individuals that we think are pretty difficult to change.

Josh: I'm wondering, you said you came from a company that was addressing this in a very different way. Did you have a mindset shift at some point or did you see that the problem was needed to be solved in a different way?

Andrew: I did. It became much of the opportunity when I came here, whereas, we were working so hard to solve how we could get someone to actually make this... press this button or do this thing, when the reality is, right in front of us was an individual who was already doing that, who was already in the space and who could see exactly what was happening. And so having that asset and that individual right there changed the game for me. And it just made it more of a reality that like, as hard as we push on some things as an industry to really change, unless it's inherent to that individual. I mean, here's the thing about, like, you and I, I don't know how old you are, but I assume we're probably around the same age, like we've developed behavior. But my kid is 2 years old and can press any button on a phone. So he, it's already inherent to him. But changing that behavior so much later in life it's just not feasible. So I think it became like, let's just be realists about this a little bit instead of trying to like buck this trend and hit our heads against the wall on something that was going to be so difficult to change.

Josh: Yeah, so you've been here about 5 months, is that right?

Andrew: Yeah.

Josh: What surprised you about this approach or about the way that you've been trying to tackle it in the time that you've been here?

Andrew: Yeah, I think the biggest thing that surprised me about HomeTeam, and part of the reason why I joined because, is, when I got here, I thought, hey, from an outsider's perspective, these guys have a technology, they're dealing in senior care, and that seemed to be like a point of differentiation. But once I really got here, the empowerment of the caregiver and the focus of that, that became like so apparent to me. And it was just something you didn't see from the outside. It was also why I thought, joining this company and actually changing the brand was a huge opportunity. We haven't even scratched the surface on that just yet, because our focus has really been, how do we start to take on new populations. That's where it was such an eye opener to me, that I became so passionate about the idea that there is a group of people that are basically treated unfairly. There's this growing population in need which is a need for employment as well. And we are providing this amazing service that really looks at it differently. And that just was not... I didn't have that until I sat with [Co-Founder and CEO Josh Bruno], I didn't get that. I didn't get that from their website. I didn't get that from their advertising. And so that was a pretty awesome thing when I got through the door.

Josh: And so one of the things you're going to start thinking about and focusing on is telling that story. How do you think about that? You’re clearly going to want to tell that story to people who are going to be providers, right? Because that's a benefit for them. It's something that's tangible and exciting and they're going to want to... I don't care what industry it is. If you're saying I differentiate on, it being great to work with me, right, of course people are going to be drawn to that. Do you think about that from the consumer side too?

Andrew: I do actually. It's interesting because I think, we want so badly to say, to make the leap to say, I'm better than this other individual at X service, right? Or here is my product and it's better. So much of what we're doing, the way we kind of rise above that essentially is saying like, guess what, like, we're really focused on empowering all the employees in this room. And a caregiver is just like every single one of these employees, but our goal here is to make better leaders. And like, when you say that, the way that changes the environment, and it just, it captures people - whether it's providers who are also partners in referrals, whether it's individuals, or like, listen, these guys treat their employees so much better than what's out there, that it like, it changes the game and how you brand and market. And I think so much of it we're trying to fight this battle down here, when the opportunity is actually up here and it's in front of us.

Josh: Well, that's really interesting. This is a hard business, right? Heavily regulated.

Andrew: Supply and demand, and regulation.

Josh: Yeah. What's drawn you into it? You've been involved in it for at least a few years.

Andrew: Yeah. I've been in healthcare, I've been in start-ups for a while now. And what drew me to this company, first and foremost was the leadership team. There was a phenomenal group of leaders that are here and you feel when you walk in the door a different type of energy. So obviously that's a little different. I think in terms of the industry, it was just purely like an opportunity and a need. As you look at the growing need for seniors in the United States and the growing costs, that just became abundantly clear there was a huge opportunity here to really solve something big.

Josh: Is this a US-specific problem?

Andrew: It's not. I think it's a global problem for the most part. I think US has a massive glaring need for it. But... and to be honest, I think even within New York, where we're focused largely, there is a massive problem that we're only scraping the surface of. A lot of people in the start-up world make the mistake of like growing so quickly that they're not ready for it, as you probably have seen. But for us it's a game of focus and discipline. And I think if we can really master a market like New York and grow it the right way, then we'll be a force to reckon with.

Josh: You touched on regulation a little bit. How do you think about living in a regulated environment and how that impacts the decisions that you make and how do you talk about your business, how you structure your business and things that you try to do?

Andrew: Over the past couple of years, [having an] understanding of things like HIPPA and PHI, and exposure to those things. I think it just becomes kind of the nature of the business now. Almost every business feels like it should have some layer of privacy and understanding. I also I think just being in this world, from this personal standpoint, I think everybody has access to my information, so I don't care much. But I know that in a communications standpoint and marketing specifically, there's an idea of like understanding privacy and understanding the sensitivities around it. I think in this world, it has its challenges, always, because I think we're working so hard to be compliant on every level. I don't know where the bar exists in this world, but regulation is every bit a part of this world as we see it.

Josh: Have you seen the Uber policy example, and actually, Uber's an interesting story when you think about policy and how they live in a regulated environments and positions they have taken that have been public facing versus what's going on behind the scenes, which is entirely different. Are you finding in this industry that there are either people - I'm not asking for you to name anybody, obviously - but are there some that sort of take the brazen, we're going to barrel in type of approach, or is it a little bit more measured because it's healthcare?

Andrew: You know what, I think we [as an industry] probably sit on the brazen side sometimes, more than we do on the measured side, because we sit on a fine line of not actually providing healthcare to providing health services in a way. But as we continue to expand, Medicaid is a recent expansion tool, the more and more we get into these areas that are heavily regulated by the relationships with the insurance companies and the payers and providers. It is an everyday part of our life right now. So we started to add the layers of compliance and privacy in teams that are really focused on these things. Regulation's an interesting thing. I think one of the things that's an opportunity for us is, and I have no idea where Trump sits, but it's going to be what it's going to be. We still solve a massive need in the industry. When it comes to things like employment regulation and opportunity to create change there, that's a huge opportunity for us.

Josh: You mean, employee versus contractor distinctions?

Andrew: Yeah. We hire full-time employees which is not necessarily normal in the industry. We pay benefits. It's huge opportunity for kind of a part of change, but obvious it goes further beyond that.

Josh: Sure. And I think that it's interesting, the companies that have actually gone and publicly talked about that. It is a differentiator. It goes to what you were saying before about how you want to treat people and your values. And it's not necessarily a judgment call on the values of people who decide that they want to go contractor route, but you're certainly saying we're going to spend more money on this, we're going to treat these people differently. But we're going to bring them in as full-time people.

Andrew: I think it's not hiding something that investors and everyone else looks at it like, okay, so you're going take a little below the margin for what you do. And it goes back to that statement of values. We know what we stand for. I think on the flipside of it, we also know that we can negotiate. If you provide a better product, far and away, then you also have the opportunity to negotiate through with that value based on business cases. So that's where I think we go as a company: once you carve a line in the sand and say, we're going to make a difference and here's what we stand for, you stick to that line, but then once you're starting to provide better outcomes and things like that, then you can also negotiate more in the industry.

Josh: What's a story that you've had shared with you or that you'd seen firsthand since you've been here that's helped this resonate with you?

Andrew: Yeah. Even before I started, I went to a couple of different gatherings. We do a lot of work with geriatric care managers and elder law attorneys. It's a great referral source for us. So we have these f these get-togethers, and caregivers come to get-togethers as well. And I happen to have a conversation with a caregiver and I asked, what do you think about Hometeam? You've probably worked at other places before. And she just gave me a very small example that the biggest thing about Hometeam is that you actually get back to me. And that tells me you care. [She] had a case at another company, and something had gone wrong with [her] client, and [she] lodged a complaint. And it took them two weeks to get back to [her]. And with Hometeam, [she] was able to get a response from something wrong within minutes. That's empowering. It started to just hit me, that I was like, wow, people have no support in this industry. The little things that we're doing, building teams and building in layers that add support, that changes the game.

Josh: Is there something that you read everyday or something that you look at everyday that you think more people should read or should look at?

Andrew: I’m into a lot of motivational stuff in general. I read through a lot of motivational articles, whether I'm flipping through LinkedIn and I stay up on the news through things like NPR and all that stuff. I do meditation every morning and it helps me. I wake up at 5 in the morning, every morning. I live in the Hudson Valley. And my focus is always on the day, and so it helps clear my mind, and that's how I set the game for every single day. And things that help resonate through the day with me are, whether I read a motivational article here or there, I love business books like, The Five Dysfunctions of a Team. Because it helps me again prioritize just how everybody can just do a better job. I don't get too involved in too much news, to be honest. I try and take the highlights in NPR, so it's kind of my routine.

Josh:  I meditate every morning on New Jersey Transit, which is a very difficult thing to do.

Andrew: That's great.

Josh: How did you get into doing that?

​​Andrew: You know what? I had a business partner. He helped grow Adobe and Lotus. And I had started meditating. And this guy was the opposite of meditator. He was like 58 years old and a former CEO. And we sat there, and I just said, listen, Bob, you got to get into meditating. And this guy, still today, sends more emoticons than I've ever seen in my life for a 58 year old man. But he went out that day and then we had a lot of trust with one another, and he found Headspace. And he started like downloading, and a week later he came back and he was like, you told me to meditate, I found this app, I dug it, and now I'm a huge advocate. And then he's like, you’ve got to try it. And so he's actually flipped it on me. And that's how I got started.