Before COVID, there were 2.9 million front-line post-acute caregivers across the country. In early 2020, 15% of this workforce left the industry, with experts predicting a shortage of 1.8 million caregivers by the year 2023. In this episode of Raising Tech, our host Amber Bardon sits down with Charles Turner, Founder and CEO of KARE.
Often referred to as the “Uber of staffing”, KARE’s mission is to transform caregivers and nurses into heroes who can easily respond to the call from senior care communities to save the day. Learn how KARE is approaching the industry’s staffing crisis, how they differ from traditional staffing agencies, and the impact their service will inevitably have on the future of the senior living industry. Raising Tech is powered by Parasol Alliance, The Strategic Planning & Full-Service IT Partner exclusively serving Senior Living Communities.
Welcome to Raising Tech, a podcast about all things technology and senior living. I'm your host, Amber Barden. 2021 brought a fresh set of challenges stemming from COVID. The great resignation, as it's often called, almost no company or industry has not been affected. Today, this is our topic. We're gonna be talking about staffing and solutions around staffing, as well as challenges. Joining me, we have a guest Charles Turner, founder of KARE. Charles, welcome to the show.
I wanna talk about a couple of numbers, to start off with. Before COVID, there were 2.9 million frontline caregivers in the post-acute industry, and about 50% of that workforce has left the industry in the early part of COVID. And it's also predicted that there'll be a shortage of 1.8 million caregivers by the year 2023. Charles, you've come up with a really innovative solution to address this challenge in the industry. Would you start off by telling us about your founding story?
Yeah, sure. So my background, for, gosh, 15 years or so, I was a developer, owner, and operator of senior care facilities all over the Sunbelt. So all over, you know, Texas, Florida, Georgia, New Mexico, and we were blown and going very sort of tech forward, but not really technology for technology's sake. Really trying to figure out how we, you know, we always said, how do we do care better? How do we measure the quantity and the quality of care that we provide to somebody? And a lot of that stemmed from my background prior. Before I ever got into that industry, I used to be in the enterprise software space, having nothing to do whatsoever with senior care, stumbled into senior care after doing a lot of hospital and medical developments fell in love with the industry, realized there was a lot of room to improve an industry that had a really high, you know, EQ, but it needed a lot more input on how, you know, how we can do care better.
And so we developed an owner operator, and then that put me in front of a lot of executives doing a lot of talks in the industry. And so around 2017 or so, I was actually in the process of looking to put together kind of an HTEC fund. So the idea was we would put a fund together, led by, you know industry leaders and then backed by private equity. And in the process of doing that, we were really looking at the staffing crisis. Now this is obviously pre COVID. But we knew even then, I mean, there was, you know, a workforce shortage looming on the horizon and we knew we needed to figure out a way to solve that. So in that, during that process, I was actually advising another company kinda similar to what KARE is, but it was in the acute care in the hospital space, kinda underfunded under scope, but we work on an advisory basis knowing it had, you know, the concept was rudimentary, but it was interesting.
We improved the concept out, even though these guys had been at it for a couple years in the hospital space. We tried to either license it or buy-in or everything like that. Ended up, it didn't work out. And then we decided as kinda industry leaders to create a platform, which is now called KARE, that's focused specifically on the senior care of the CO/CQ care industry. So founded the company in April of 19, built the platform or the first version of the platform. It was supposed to be just launching two buildings in Houston and Austin. The last week of October of 19 ended up being about, I dunno, 17 buildings or so and then it just took off from there and then COVID hit. It's been a crazy ride ever since, but we were blowing and going pre COVID. Then of course, during COVID, we've been riding the ups and downs of that. But it's helped put the notion out there that we have to figure out alternatives ways of staffing. We can't just be paying overtime, and it can't just be hiring staffing agents.
How did you come up with a concept for KARE? And you, can you talk a little bit more about what the platform actually does?
Yeah, that's a good question. So, you know, again, I put my operator hat on. Three things that we hate, right? I mean, one of the things that we hate, you know, we hate staffing agencies because we can't really control the costs. We also hate paying overtime. I mean, as an operator, I'm still an owner in these buildings. Now, the first thing I do when I get them, I look at my overtime line and that kinda tells me a lot about how that building is running. The idea was that we can't just continue to pay overtime. We can't continue hiring staffing agencies. And of course then during, obviously during COVID like the number of staffing agencies that are coming outta the woodwork, who just price gouging and sort of cornering the market have been pretty severe. So, you know, we looked at other industries and we were like, why can't, you know, the transportation market has Uber and other other industries have, you know, oil and gas has, you know, rig-up, things like that.
There's no reason we shouldn't reduce the same thing for us. And so the concept is very simple. The three things we all hate about staffing agencies are, one, they're far too expensive. We can't control the pricing. Two, you have no control over who comes through your front door. The staffing agency will sit whomever they have, whether they're good or not. And last, if you like that worker, you actually can't hire them. Staffing agency male you contractually prevented from doing so. We solve those three problems. So, we're not a staffing agency. We're a labor marketplace. Meaning we prequalified tens of thousands of frontline, healthcare workers, nurses, CNAs, med tech, LPNs, and RNs, things like that, to make sure they're qualified to work on the platform. We actually qualify facilities as well, that they're kinda debit licensing, good standing as well.
Then they're qualified to work on a platform. So the, the, the communities themselves set the pay rates, we don't set the pay rates, our rates, you know, we, we put a small per hour fee. And our rate is the same. Whether you wanna offer a dollar an hour or a thousand dollars an hour, we, you know, we don't care. Well, you're not gonna get a shift filled for a dollar an hour, but you can offer it. So the community set the pay rates, and then one to many, we call 'em heroes can apply to work that shift. Which leads to the second piece where, why we're so successful is, if I'm a community and let's say two people apply, you know, one's a 4.9 star. One's a 4.2 star. I get to see this reliability score, which is an algorithm that predicts how reliable they're gonna be.
You get to see all the information you get to see every review they've ever had on every shift. So I get to decide who comes in my community, and the good news is, if I give that person a four or five star rating, they're gonna get paid the next business day. If not, they've got to wait a week. So they're highly incentivized to do a good job. If I work for a staffing agency, I just have to do just enough not to get fired, cause I'm gonna get paid regardless. With us. It's different. If there's a bonus you wanna put on the shift, that person doesn't get a bonus unless they get a four or five star rating. And the last, if you like your hero, is you can hire them. We actually want you to hire them. We use companies all the time, use this as a platform to talk, you know, kind of a try before you buy, instead of, you know, hoping people show up for an interview. People come to work in your community. If they're looking for a full-time position, you can hire them. We encourage you to do that.
Since you started care, I've heard of other platforms that are similar out there in the marketplace. Was KARE the first one? And can you talk a little bit about how KARE is different than other options out there?
Yeah, that's a good question. To say we're the first one is yes and no. So we always tell people, a staffing agency with an app is still a staffing agency. So there are a lot of what we call digital staffing agencies out there, meaning that they, if you look at their contract, they tell you how much they're gonna charge you. They're ones where either they send, or one of their workers can basically kind of name it and claim it, whether that community wants them or not. And then you still can't hire them. So they don't have the benefits that we do. A lot, some of 'em still are also based on a subscription model, which never really works in senior care. Generally speaking, unless you're an EHR platform, your CRM or your financial system, maybe your nurse call system, nobody wants to sign up for a, a recurring expense. They may or may not use. So, we're kind of a pay as you go model, but so there's no one really has a model quite like ours. Most of them, you know, I'd call them digital staffing agencies. We've gotten the point now where we know our customers really do love working at our platform because of the transparency that a marketplace adds, where all the information is in the marketplace. And they really don't like a lot of other folks that they're basically a digital staffing agency, just with a technology wrapper,
When you mention the same day pay rate, I imagine that must be a little bit of a disruptor to the space. How do you address that? And is there other pushback that you get from the providers on using your app?
Are you saying, how has next day pay, our next day pay benefited? So, it is, our primary person who works in our platform is someone who has a full time job and they use the KARE app to make extra income. That's really what it was designed to do. We're not looking for people that wanna work on our app full time. We know that around 50%,cause we actually survey this, about 50% of the people who work on the KARE platform, work less than 40 hours a week. I'm not talking just with KARE. I'm just talking in general, their work lifestyles, like they work less than 40 hours a week. So one of the things that we know that's been extremely disruptive is that, you know, where state right are clamoring cause you can't workers because while you've gotta be a W2 employee and work at a facility or you gotta work for a staffing agency well, if a lot of workers can't right.
So because they can't commit to that level of fixed schedule, they need flexibility. So one of the things we know to be true, we're bringing people off the sidelines and on the margins who normally can't have not been able to work cause they can't commit to one of those things. And we're adding that labor capacity to the labor workforce. And we've seen that, especially like certain things where you get, you know, everybody's bad, but some are worse. It's like Denver, Colorado's really, really tough market. We've seen it where we've taken people who are kind of on the margins, who couldn't work, and bring them in. So people who like maybe there were school nurses and they couldn't work in the school. So that LPN came in and that would work. Or other caregivers who worked in other settings or they had family issues or they had kids at home cause they couldn't go to school.
Well, they now have a way to work and add that labor capacity back in the marketplace. We have, a lot of folks do love the next day pay aspect of itt. It's one of those things where, I encourage operators. We do a ton of research on the folks who work on our platform. So because we're the only few places where you actually have that amount of just, you know, a rich research base where you can actually ask frontline workers a bunch of questions. And we do know one of the things they really love is about next day pay. And then the flexibility we know that.
I coach a lot of operat a lot of times like, look at your schedule, like look at your pay, look at your schedule. And there's no reason you couldn't do the same thing. Don't be beholden to an ADP just because that's how they do it, make money off of floating your payroll. Look at your staff scheduling. Like, do I need to do the 6-2, 2-10, 10-2 routine like everybody else does or are there other creative ways of staffing that may actually be more productive, in it would add more labor hours at peak times and fewer labor hours at lesser times. You know, our app gives this flexibility to do that.
We're all competing for talent right now. And that was the reason KARE was founded, was to be able to provide that solution to senior living. But I'm curious, how are you recruiting staff? What does your recruitment process look like and how are you able to find workers that's different than providers locally?
Yeah, lot of it goes back to what I said before. There's kind of two things, the next day pay and a lot of flexibility. When we go into a market, we spend a ton of money when advertising on job boards and a lot of digital marketing and things like that. And then over time it just starts to go viral. Like in the state of Texas, we don't spend any money on recruiting at all. And, and we're in all the major markets, secondary markets, and most tertiary markets. And we don't spend any money because we don't need to cause the app starts to go viral. But ultimately that's what folks, the vast majority of folks who work on our platform, they probably have a full time job, and they just use this as extra income. Like I think our average hero works a shift and a half a week on the KARE platform. So it's not like they're doing, you know, full 40 hours or so. They're just doing it to make extra income. So that's the big selling benefit of it. And again, by doing that, it adds extra labor capacity to the labor workforce.
Can you talk a little bit more about the benefits to the providers? I know that you do the direct hire, but if the majority of the workers are doing this as a side job, how does that process work for them to transition from a gig worker to direct hire? Or how frequently does that happen, and what are the benefits you see on the provider side?
Yeah, I mean, it happens all the time. It's funny. Like, well, we can't track it cause it doesn't, there's nothing to track. Right? Someone comes to the building, you want to hire them, hire them. We see it all the time where someone gets hired full time at a community. And then, you know, a week later on their weekends or days off, they're picking up extra shifts some other place back on the app. That's where, you know, one of, I know if I put on my operator hat, I know we had about 700 some odd frontline employees, and we knew about 2/3 to 3/4 of them had some form second job. As operator, I would rather my workforce have an app like KARE. So like, you know, I'd rather they work in another community or work at, you know, Amazon or Walmart or something like that. It would conflicts, my PRN would have to balloon because my shifts would conflict with their shifts.
Well, if they didn't have those other shifts, they could pick up extra shifts whenever they want to. Well then I don't need my big PRN pool as much anymore. The folks that work for me can pick up shifts where they want. The other thing that we've seen was an interesting, especially early COVID, when and the skilled side on the rehab side, when these, you know, elective surgeries or quasi elective surgeries, sort of nonexistent. This census of a lot of these communities would decline and employers were having to shed workers. Everyone was trying to get 'em back now, but you know, if you remember, people are trying to shed like the first six months of COVID and what a lot of communities were doing was smart. They said, Hey, please, don't leave us.
I can't give you 40 hours. Stay with us, work, don’t go over 28, but work on the KARE app, work someplace else, until I can bring you back on. So we actually had a lot of communities that would recommend that their employees download the KARE app to do that. We actually have a lot, we have several companies, not just communities, companies that are actively giving our stuff to their own workforce to make sure they get extras, so they don't leave. Like the workers, like their communities, but, you know, it's always like, oh, the extra dollar down the street or whatever. And so they're actually encouraging them to work on the KARE app, to work some other place, to make extra income and not leave a place where they're familiar.
Do you have any information you can share on the cost model from a provider perspective of using KARE versus traditional staffing and recruiting?
Yeah. So a typical staffing agency you know, it's kinda like a hundred percent market typically, right? So that's their model hire. They hire a handful of workers. And let's say if I'm paying about workers, say an index of a hundred, I'm charging the facility 200. What a typical staffing agency does, they'll mark up a worker about a hundred percent. So if they're paying them a hundred, they're gonna charge the facility 200. For us, we're much more simple. So we encourage our customers to pay our heroes about the same as they pay their own employees. So let's say it's a 15 hour employee, put $15 on our app. Our fee is gonna be you know, $5 for most cases, $5 an hour, $7 for certain nurses, but that's it. So it's $15 plus a $5.
So you're, you're in for $20. You're far less than a staffing agency. You can add a bonus to the app and if someone really needs because you need someone, a hurry, you, you can offer to pay a bonus. You know, it's like your discretion. And that helps people, especially last minute when you need people. And you can also for a $5 fee, promote it to anybody in the marketplace who is qualified to work that shift. That message will go out to everybody in that marketplace who really needs somebody, but that's it, it's pretty simple. There's no subscriptions, no long term contract, but simple terms of service that everybody has signed. And usually it takes 10 to 15 minutes to get a community up and running. And we're working with, you know, multiple hundreds of companies right now and all of the facilities that those companies represent because the models basically, it's very simple. It's very clear. It's very transparent.
Can you walk me through what a provider would do to get started using KARE, and what happens if they're in a state where you're not yet having services?
Yeah. So the easiest way to get started, it's pretty simple. So we actually have two apps, right? We have a KARE heros app and we have the KARE community app. They can either download the KARE community app and hit the sign up button or they can basically go to our website or call us. And then all we do is we send you a simple form. You enter in all of your kind of desire to pay rates and a little bit about your community. Just like a picture of it, your logo, a few other things. And then we'll open up an account for you, send you a signup link, and you need to upload your state mandated documents, kind of orientation documents like resident bill of rights, infection controlled policies, things like that you have to have. And then boom! You're ready to go. You're posting shifts. Usually we’ll sit of people, when we meet with a person and it's 10, 15 minutes and they're having shifts filled within 15 minutes. So, it's really exciting. If they're not, if they're in a market where we're not yet, we are getting there. That we will be a nationwide, maybe with the exception of a couple of states, but we should be nationwide, at least in the major markets in every state, by the middle of this year. We're greatly accelerating our growth into those markets, which is exciting. And then you know, we'll be, we're fanning out from there. So we're in most, most kind of NBA cities in NBA, NFL cities now with the exception of California, but then we'll be, you know, all 50 states and most secondary cities by the end of the year.
That's awesome. Congratulations.
What do you see is the future of this type of technology? Where do you think it can go? What's the next level?
I mean, for us, it's gonna be, we'll expand out into other food groups, you know, meaning, you know, the therapy side of the business. We're already in the hospitality side of the business in Texas and Georgia. When COVID hit, we actually had a partnership, Hyatt Hotels. When they were furloughing so many employees that they encouraged them to download our app and sign up. So we actually got a lot of like cooks and maintenance and housekeeping and things like that. Certain markets will expand more into that. It's easier said than done, but, you know, we still are only kind of the tip of the iceberg on where we go, but we've gotta good runway ahead of us just to keep going on, doing what we're doing. And then probably at some point we'll we'll pick our head up and figure out what we wanna do next, but we'll most likely be in Canada and Western Europe within 12 months, if not sooner.
What are your predictions on the staffing market shifting? What, like what percentages do you see from traditional hires versus something like KARE in the future?
I think the traditional hire will always be there. I think a lot of operators will get smart on how they provide the benefits that KARE does in terms of frequency of pay and flexibility. But I do see over time the traditional staffing agency model becoming significantly more minimized, and then other kinda labor marketplaces you know, ascending. So there's no reason with technology now. Yeah, the reason a staffing agency existed is because, you know, if you're a community, you don't have the time to recruit people for swinging labor, and you don't know who these people are, and that takes time takes resources. Well, now we have technology that does it for you. So, why do you need that person who sits in a cubicle, that just goes down a spreadsheet and figures out, you can come in.
The technology does that for you, and it directly introduces you to people you would not have otherwise met. I mean, it just only makes sense that this happens, and it's already happened in other industries. So why not in ours as well? So I think that's where you're gonna see it going, as you're gonna see people there is a tendency to wanna call it a gig worker. And there, you know, there are a lot of obviously gig aspects to this, but at the same point in time, I think this will just become the nature of supplemental labor, right? It's not, we’ll think of it less as a gig worker and more of a it is a platform where we find people and, and we don't need a staffing agency anymore
For providers that have a really strong internal company culture. How does the addition of gig workers, or part-time workers impact their culture? Have you had any feedback about that side of it?
Yeah, that's actually a really good question. There's, you know, one of the first questions we got, especially pre COVID, I think with COIVD that concern became less and less as acute need for staff has risen, but we still get it. If I do this, bring people in, will it affect my culture? The beautiful thing about what we do, again if you go back to we're not a digital staffing agency, we don't send anybody, you choose who comes in. So the first line is like, okay, if I'm a community I'm posting shifts and like, you know, three or four people apply, well, I'm gonna pick the one at least based on ratings and not only just ratings, but they're actually different aspects of their work. Like, you know, are they personality driven or are they punctuality driven and things like that. Right? First and foremost, the community decides who comes in their building. They don't know that what eventually happens is that they find that people that have worked in their community that work well and fit their culture, and they feel that are part of their team. And they essentially become like a digital PRN pool, right. That PRN pool goes from being sort of fixed to being virtual. But they find those people that actually fit their culture, so one of the things, that was kind of a happy surprise for us, but as well as our customers, is they like it because of that concern, right? Is that unlike any other staffing agency they're picking and they're managing who comes in that door to, to fit their culture.
Do you have any success stories that come to mind where KARE has really been able to transform a community that was hurting from a staffing perspective?
Yeah. I mean, actually every day we get people who thank us. And that's one of the things, like I'm proud of our growth and I'm proud of our technology. But mostly, again, our partners come from the industry. I'm proud of what we've been able to do during COVID, because we've been able to, you know, administrators and management are burned out. I mean, they're just, with all things COVID, all things staffing, they’re burned out. We get calls and emails every day from people that are just thanking us for like, oh my God, you saved us so much. One of the ones that comes to mind is that the community, actually here in Houston, early COVID, where they had very strict protocols, a visiting outside nurse came in the building, visited a bunch of residents, did not follow their protocols.
And then called in the next day, and said, Hey, guess what? I'm COVID positive. That community had to send all of their workers home, quarantine all of their residents, and their regional called us and said, we'll take whatever you can give us. Got 'em quick, very, very quickly loaded up in the app. And they were posting, we ended up filling multiple, multiple hundreds of shifts for them. And they had no relationship with staffing agency, their assisted living community had no need for staffing agency up to this point. So they were eternally grateful for the fact that they could, you know, there's all the tools that we put into the app itself that could help drive more people to work which they were eternally grateful for. And so, their CEO is now one of our biggest proponents, kind of tells everybody about us because of what we are able to do. And then, we get a lot of stories about how much we've helped hiring.
You hear all these stories all time, put a job on Indeed. I had 93 people that applied for it, and 80 were qualified. We called all 80 of them. And then only 19 picked up the phone. And all 19 said they'd be in the interview. And only one person showed up for the interview. You hear that story all the time. And then for us, it's like, we love it. People come in, they work and then we hire them. Perfect. That's exactly what we want do. So those are the kind things that really make us happy. When we can at least partially alleviate some level of stress that goes on in the community, especially with staffing around COVID.
I'm curious to hear your thoughts about technology in the industry in general. So beyond KARE, what are you most excited about in terms of technology in the industry, in the future?
Yeah, I mean, it's one of the great things about COVID. If we can say that, it's greatly accelerated a lot of things that we’re really slow to adopt. You know, I've done a lot of talks on kinda, you know, age, the intersection of aging technology over the years. That was always a huge proponent of telemedicine and telehealth. And it was just very, very slow to adopt. Now we're seeing a huge adoption of that. I think that's gonna change the dynamic of how we do care. I mean, I'm hoping that it'll start to reduce the, oh, well, this is Jones is a mild rash let's send her to the ER, and go through that trauma. So, that's one of the things that I'm really pumped about, you know, the other thing is I was very much, let's say cynical about, you know let's call resident engagement technologies, pre COVID.
And the reason is, you know, that typically would fall into the activities bucket on someone's budget. And I think that budget's usually 4 to 6% of the entire community's budget. And everyone was trying to chase that dollar. I think there's only so many of those dollars to go around. Plus, at the time, you know, I have a, I have an adage of when it comes to care with technology and senior care, never ask a resident to do something they're not already doing. So you know, having them like, oh, I know I've never been a big fan of like, iPads for residents or anything like that, that they're not already using. I think resident engagement platforms have definitely, the adoption was forced, but probably it's gonna have a lot of positive repercussions going forward. You know, I think where we're starting to see things get integrated, people asking questions about integrated data, data systems, normalization of, you know, the resident profile across disparate systems.
Like we've never had this notion of middleware. Other industries have had it for 30 years. And, and now we're just having these conversations like, oh, we have a nurse call system on a EHR, have got a management system, we've got a door lock system and like, okay, how do I manage that? Like what questions can I ask the data? The other piece I think is really interesting is there's always been a notion in senior care, the legalistic side. So I don't want technology in my building because if something bad happens, and I have the technology I'll be held liable for. Well, what's interesting is now, because the technology has become more prevalent, the case law is now saying that you can't hide behind not having technology in your bill. You can't use that argument more. It has become predominant now where you should have had, whatever it is, whether its camera sensors or whatever. You have the ability to regionally implement this in your building, and you didn't and therefore you're actually can be held liable cause you didn't have the technology in your building. So that's kind of all happening at the same time. I think it's gonna be really fascinating the next, I dunno, five years where the stuff that the industry been fighting for a long time is gonna start seeing some adoption in different ways of thinking
Comment about telehealth. I'm curious, have you ever considered having KARE, provide those resources for telehealth since you've already got a remote platform built.
Provide telehealth resource, like from a, like on the KARE end or from a technology?
Well, using the staff that work for KARE to provide those telehealth services?
A little bit, yeah. I mean, we still need the infrastructure to do that. We actually have done some stuff with COVID. We actually staffed some COVID vaccine kinda stuff, but then that's an interesting question. I mean, hadn't thought of it, but it would take a little bit of pivot on our platform, but we could potentially invite workers who want to schedule tele-remote telehealth and have a ubiquitous platform to, to be you know, to kinda be the last mile between the resident and third party care.
Yeah. You've got the staff, so it would give them an option to provide remote care.
Yeah. Yeah. It's true.
Any final thoughts you wanna share with our listeners?
Oh gosh. Any final thoughts to share with your listeners? No. I mean, just, you can go to our website, if you wanna find out more. It's doyoukare.com. That’s KARE with a K. If you're interested, either caregiver or community or company, let us know. We’ll kinda show you what we do.
Yeah. And we'll list that information in the show notes as well. Thank you so much for joining me today.
And listeners tune in next week for more fresh technology topics. And thank you for listening.