Miriam Allred (00:01)
Hey everyone, welcome back to the Home Care Strategy Lab. I'm your host Miriam Allred. Today I am sitting across from Amy Pierce, the co-founder of Coastal Care Partners based in Savannah, Georgia. Amy, welcome to the lab.

Amy Pierce (00:15)
Thank you, Miriam, and I'm super happy to be here.

Miriam Allred (00:18)
You were a recommended guest, which are my favorite, honestly, from Jenny Johnson out in California. But she was just in your office a couple of weeks ago and she and I have spent some time over the last couple of months and she said, you've got to have these people on. And so I met you and Scott pretty recently, but had heard of Coastal Care Partners and had heard amazing things. And so I felt like this was long overdue for us to get acquainted, but also to have you on the show. So thank you for being up for this.

Amy Pierce (00:43)
Aw, thank you so much. And thanks to Jenny also. Jenny's doing amazing things also.

Miriam Allred (00:48)
Yeah, and I just love that when we're all connected in different pockets of the country and doing innovative things and nurse led businesses. There's just so much we have in common and so many things we don't have in common, so much to learn from one another. that's a great example of her and you and thinking differently about your model. let's go ahead and start with your background. Tell us a little bit about yourself and your healthcare background and then we'll get into founding Coastal Care.

Amy Pierce (00:55)
Absolutely.

sure.

Absolutely. You know, I would love to start off by kind of telling a story. So I'm a nurse and have been for over 20 years. I'm also a certified aging life care professional through the Aging Life Care Association. And about 15 years ago, I was working in a super busy, always overwhelmed, insurance-driven medical practice. And man, we were always every single day running behind.

And one day I saw this very sweet elderly woman coming in from the waiting room and she was walking in with a walker, moving really slowly and a medical assistant was bringing her back and every few steps the little elderly lady would look up at the medical assistant and smile and start talking to her and the medical assistant was kind of trying to move her along and getting a little frustrated and eventually she gets her back into an exam room.

And then she comes up to me and she says, gosh, we are never getting out of here. Could she be any slower? And you know, I thought to myself, gosh, the problem here is not this sweet lady that is moving too slowly to want to talk to us. The problem is that our system, our healthcare system moves too fast for aging bodies. And you know, that moment has stayed with me and...

I didn't know exactly what it was that I was gonna do, but after working in hospice and seeing how complex care navigation is for older adults and their families, and then also after walking along my in-laws' aging care journey, my husband and I, we decided to launch Coastal Care Partners, which is a company based around the speed and dignity of aging.

Miriam Allred (03:06)
Yeah, the speed and dignity of aging. so just high level share your healthcare background. What are all kind of the roles and functions that you've played leading up to then starting this business?

Amy Pierce (03:20)
Absolutely. So I've been in a lot of different areas as a nurse, which is a really cool thing about being a nurse. There's so much you can do. So I've worked in emergency room. I've worked on med surge floors. I've worked in oncology, spent a long time working in hospice. And, a lot of my career has been around working with older adults. I've worked in ambulatory surgery centers and I've worked in pain management and primary care.

and really just saw in every space how much need there is for helping our older adults with quality care and being able to slow down and give them all the things that they really need.

Miriam Allred (04:05)
You probably feel that way more than ever now, but think back to when you were in kind of the acute setting. Did you understand the post-acute setting? Obviously you had moments where you saw the lack thereof for these seniors, but does the acute setting still really not understand like the post-acute setting in the senior care space? And are we getting closer to them understanding that or are we still so far off?

Amy Pierce (04:31)
you know, I think we're still a ways off and know, healthcare is very, very fragmented and healthcare is broken in a lot of ways and it's really hard for anybody to navigate, but it's especially difficult for our older adults. And you know, like 20 years ago, you could, as an ER nurse, spend time with people when they discharge and you could make sure that they understood each.

appointment they need to go to and understand all of those follow-up instructions. Now there's no time. Now there's limits on how long you can spend with patients and it's all because of insurance and the models that are driven by the insurance world.

Miriam Allred (05:10)
Yeah. And like you and Scott, there's only so much you can do. You you as a nurse, and I'm sure you gave a lot and did as much as you could and, you know, pushed back against kind of the social norms, but there's only so much you could do. And so at that point, I guess at what point did you decide, like, we want to go out on our own and build something that we can control and that we can impact more lives?

Amy Pierce (05:35)
Absolutely. You know, I think that it's a combination of the professional experience and personal. So, you know, professionally, I was seeing it every day, especially in the hospice world. Families are struggling to deal with complex health issues. One of my loved one isn't eligible for hospice. How are we going to navigate all of this? And then at the same time, Scott's parents were going through complex health issues of their own. His mom was around 80 years old already.

on a decline with dementia and very frail in a wheelchair. His father had a new diagnosis of congestive heart failure. And at that time, Scott was living in Atlanta. They were here in Savannah. And so we walked through what's going to happen now. Who's going to help care for them once he gets out of the hospital? He's got a new pulmonologist, a new cardiologist, a new GI doctor. Who's going to manage all of this? And Scott.

will tell you he had kind of a panic attack of, I'm in Atlanta, what's gonna happen here? And so, you we like to say that Fred and Ruth Pierce, that Scott's parents were our first coastal care partners clients, because we managed the process of his discharge, his new diagnosis, and then bringing in care, and then seeing the lack of kind of services around. And we said, you know what, there should be a service.

for somebody with medical background can come in and just say, I've got this, I'm gonna navigate all of this for you. I'm gonna help guide you through next steps. I'm gonna coordinate your care. I'm gonna manage your medications. I'm gonna bring in a caregiver when needed, you know, and I'm just gonna help you understand all of it. And that was really the beginning of Coastal Care Partners. We launched here on Skidaway Island where we live in Savannah, Georgia, and I was the first nurse and,

just started caring clients. We put an ad out and got a few calls and word of mouth. And once I got up to about 10 clients and families that I was navigating their care, we then brought in the next nurse and the next nurse. And that's when we really started to see the need for high quality in-home care. And so, yeah, go ahead.

Miriam Allred (07:50)
What year

was this that you officially started taking these clients yourself? 2018. Okay. And it sounds like were you an aging life care manager before starting Coastal Care Partners or when did you get that certification?

Amy Pierce (07:56)
2018.

It was at the time, like the very beginning of starting Coastal Care Partners. So when I was still a hospice nurse and we were walking through Scott's parents aging journey, I started researching and I was like, know, because I saw kind of the lack of care coordination, you know, firsthand with our family. And so I started researching and I found the Aging Life Care Association and I was like, my gosh.

this is like putting words to what I'm trying to do here. This is perfect. And I just fell in love with everything that they're about. And the Aging Life Care Association, if you are a nurse or a social worker and have worked in a care management type field that could be like working as a discharge planner in the hospital or working in the hospice environment for like two years, then you're eligible to get.

want to get to study and take the test and get certified through the Aging Life Care Association. And so I did that. And it really helps because you get to, you have this group all around the country that you get to share ideas with and learn from. And so it's a great organization.

Miriam Allred (09:22)
So when you started, you said you as kind of a nurse

started taking these clients and you were doing the care coordination. So would you almost say you started out as kind of like more of a care management type business? You weren't doing the in-home care, caregiving part at the start.

Amy Pierce (09:38)
correct and you know at first we were referring in the caregiving so I would see the clear need for you know high quality in home care that my clients would need and so at first I was referring in companies and you know what we found was that the non-medical home care companies and there's tons of them they're doing you know great work out there what we found though is that it wasn't always reliable and

the quality that maybe that we wanted for our clients. And it was tough because it wasn't really our company. And so, we said, you know what, wouldn't it be great if we could have our own caregiving team that we could really have that, you know, connected experience with. And so also, you know, we really wanted to do it differently. So we got licensed by the state for in-home care.

And from the very beginning, we developed a recruiting philosophy that we call the Donna Rule. And Donna is my mom. And so our philosophy is that anybody that we hire at Coastal Care Partners, we would feel comfortable with them taking care of my mom. And so we have instilled that into our leadership team and our entire home care team. And so that really helped us to recruit the best caregivers and keep them.

and retain the caregiving team. And it's such a beautiful, beautiful relationship when we're able to integrate the non-medical home care with the medical nurse advocacy piece.

Miriam Allred (11:15)
Yeah, I couldn't agree more. I said this to you on our intro call a couple weeks ago. I'm just developing this bias towards care management. I just think it's so crucial to being successful in the caregiving. And like you said, with your own parents, all of us with our parents and grandparents, it's just so complex. these care managers, aging life care managers have the ability to organize, help support through all of that complexity.

Amy Pierce (11:33)
so complex.

Miriam Allred (11:43)
and then the caregiving, you know, it's just like, they're just this perfect match. I need to be careful, and my bias isn't that every home care company needs to do both, but partnering with them and incorporating that into your model, whether it's inside or outside, it just has to be a fundamental piece in order for home care to be successful. There almost like has to be that care management piece.

Amy Pierce (12:05)
I couldn't agree more. couldn't agree more. And whether it's in your own company or, you know, two separate companies, for us, just that continuity when you have, when it's all part of one company is just incredibly important. ⁓ We will actually create groups, messaging groups where the care manager and all the caregivers are part of one group and will be able to constantly be in communication. And so, for example, I'll give you a

great example that everybody in this space would relate to. It's four o'clock on a Friday afternoon, your client, Mrs. Smith, is starting to change, starting to maybe act a little different. The caregiver will pick up on that, you know, the subtle difference and know, gosh, this seems like it might be a UTI. You know, and at four o'clock on a Friday, if you're a non-medical home care company,

what are you gonna do? Because their primary care is not answering the phone at four o'clock on a Friday. And so most of the time they're gonna have to go to the ER, go to an urgent care, which is not the best place for an 85 year old to go. But at Coastal Care Partners, that caregiver will be able to reach out to the nurse and the nurse will be able to reach out to our medical team, will be able to get orders, will be able to come in and get a urine sample and...

be able to treat that UTI right there at home without that client ever having to leave.

Miriam Allred (13:35)
Yeah, it makes you self-sufficient in that, you know, there's all these boundaries around what home care can be, can do and can't do. But as you incorporate more of this healthcare piece, you're capable of doing more kind of under the full umbrella, which benefits everyone, the client, the family, the caregiver, the business. It's just when it's all built in, there's less boundaries because you're able to do more. So how long...

Amy Pierce (13:38)
Thank you.

for sure.

100%.

Miriam Allred (14:03)
just to get kind of technical, how long were you more of like a care management business? When did you decide, how many years in or months in did you decide to bring in caregiving in-house?

Amy Pierce (14:13)
It was pretty quick, it was about six months after doing the care management piece. And for me, it was just such an obvious move because I would try to refer in multiple in-home care companies and each time there would be a service failure or something would come up and then my client would be like, why did you refer this company? You know, like get mad at me about referring them in.

And so I really did not have any control over the reliability of the caregiving experience. And so one thing that I coach all of our nurse care managers on is that a part of their role is the experience of caregiving for that client. So our care managers are not necessarily managing at a like.

discipline type level of the caregiver because we have a home care manager for all of that sort of thing. They're managing the experience for the client, if that makes sense. And so it really helps the entire experience and the outcomes to be so much better.

Miriam Allred (15:20)
Mm-hmm.

Yeah. Speaking of the, what did you call it? The Donna philosophy in that you hire elite caregivers. What are your non-negotiables? How do you find and retain these elite caregivers? Thinking of kind of the Donna principle, what are your non-negotiables to finding them and keeping them?

Amy Pierce (15:49)
Sure, absolutely. So of course we love if somebody has caregiving experience, that's great. But it's more than that is a willingness to learn a yes first mentality. We actually have a saying at Coastal Care Partners, which is we make yes happen. That's our phrase. know at Chick-fil-A you're gonna hear it's my pleasure. At Coastal Care Partners it's we make yes happen. And so you will almost never, as long as it's ethical,

hear us say no to anything. We're gonna make yes happen. And so that philosophy is very important when we hire anybody that they believe in that and that they understand that and they're willing to do that. So if we hear anything in a interview like, I don't really do this, I don't really do that, that person is not a good Coastal Care Partners employee and fit. And so that's super important. know, also in the state of Georgia,

the required training for caregivers is fairly minimal. And so I knew that at Coastal Care Partners, we really wanted our training to be much more robust and I knew outcomes would be better. And so we have created what we call Coastal Care University. And this is a 100 hour training program that our caregivers go through, much more robust. And when our caregivers

graduate and it's like a three month process from Coastal Care University. They're clinically stronger. They really are the elite caregivers. They have personal development and also mentorship skills. And my husband likes to say they're the Navy Seals of caregiving and they really are known in our community as the elite caregivers. And so that's just a huge difference maker. We pour into them and you know,

they want to stay. So it's a great, it's a win-win.

Miriam Allred (17:49)
And like you said, when you're seeking them out, when you're recruiting them, you have kind of a high expectation because what I hear oftentimes is you offer all this training, all this specialized training, all of these additional resources, but nobody takes advantage of it. But if you find the right caregivers that are hungry, that do want to learn, they probably will take advantage of it and will actually do the training. Is that what you found? It's more important that you get the right people on the team and then they actually will do this training so that you're

Or are you still hearing a lot of like pushback of or disinterest in the training that you offer?

Amy Pierce (18:21)
Now we're very excited at the buy-in from our caregivers. know, our Coastal Care University, can take about between like 20 and 30 at a time, and we always see our newer caregivers saying, when can I get in the next class? When can I, because it's, mean, we have a graduation at the end that's a big deal, and we all speak at it, we give out diplomas, we have a party, caregivers bring their family members.

Everybody's crying. It's like a big deal. And so it's just, I believe that a rising tide lifts all boats. And when we pour into them, they're gonna stay.

Miriam Allred (19:04)
I'm curious in your experience, have you had caregivers that go on to be CNAs, nurses, even above and beyond because they're more exposed to that in your business?

Amy Pierce (19:14)
absolutely. Yeah, for sure. And we have some great, ⁓ you know, like Savannah State and different colleges here that they will go on. And what's great is they can continue working for us while they're going to school. And so that's awesome. They also they just get along so well with the nursing team. And, know, we coach our nurses to be a leader for the caregivers and to really the best way to.

that positive experience is by creating a great relationship with the caregivers. And so it really is beautiful when they're working together.

Miriam Allred (19:49)
So let's kind of explain the lay of the land of how your company operates. So you started out as kind of like the nurse led care management and then you brought in the home care piece, the caregiving piece and now you've layered on this additional medical oversight. can you explain, in your own words, like the flow of care for a client and how all three of those services fit together.

Amy Pierce (19:52)
Thank you.

Absolutely, you know, we brought on probably about, I would say a year and a half, maybe two years into doing the care management and home care piece. We saw the big need for having like a medical oversight team. And at first we brought on a chief medical officer and Dr. Sanjay Iyer, he's phenomenal, ER physician, just a great guy.

And we brought him on initially to write orders for the nursing staff as well as like clinical oversight. And, in the, like the example I gave with the lady with the UTI at four o'clock on a Friday, we saw a lot of things like that happening and the need for just a physician to write orders. And so that was the initial thought. And from there, it turned into a much more robust primary care offer.

know, offering to where now we have two primary care practices. We have an orthopedic practice. We're doing physical therapy. We have three physicians, three nurse practitioners, and we're getting ready to hire a fourth nurse practitioner. And it's just incredible when all three pieces are able to work together to support the client.

Miriam Allred (21:35)
And what do you call it? Integrated care? Is that what you call it internally and externally?

Amy Pierce (21:37)
Mm-hmm.

Yes, it's an integrated model. I like to say we, a lot of aging care is fragmented. And so it's going from a fragmented model into an integrated model.

Miriam Allred (21:54)
And I like I said to you before I want to I like to expose you know all of these home care professionals to new models like there's not very many models like yours out there and that it's home care plus care management plus this entire medical staff but again you saw the need and wanted to solve it yourself rather than referring out the primary care the PT the OT it's like how do we bring that all in-house and offer it end to end so

Think of a specific client, maybe a recent one in the last week or two. What does their journey oftentimes look like when they find coastal care partners? Did they start in home care and then care management and then the medical site comes a few months in? What is the typical flow across these services for a client?

Amy Pierce (22:41)
Yeah, sure. It can be different a lot of times. So sometimes you'll have a client that comes on with home care first and then, you know, we bring in the nurse care management and sometimes we'll bring in the medical and sometimes we'll start with nurse care management and the nurse will build that relationship and then bring in home care. ⁓ I'll give you a recent example that I think is pretty relevant for the home care space.

Not too long ago, a few months ago, we got a client referred to us from another home care company. And that other home care company couldn't staff this case. And caregivers were refusing to go. It was a difficult client, a challenging client. And the client had some mental health issues as well as mobility issues that were, and the client required 24-7 care. And, you know, our caregivers,

were going in as well and telling us, you know, the client is rude, the client is making some abusive comments. And so what we're able to do is in this case, we brought in a nurse care manager to sort of be the lead and the nurse care manager brought in our medical director

Miriam Allred (23:46)
You're fine, you're fine.

Amy Pierce (23:57)
And our medical director was able to talk to the client and explain that we needed to get a psyche valve. And we needed to bring in some other services to address some of these issues that were going on, some of the anger issues. And so the client, because the medical director went in and talked to this client in their home, the client was receptive. Our nurse care manager was able to

get that psych eval and then implement at home. And so the caregivers feel that they're being understood and that they're escalating something and responding to it. And so we're able to create a success plan for this client.

Miriam Allred (24:42)
And it takes so much pressure off the caregiver. In another world where they don't have even the care management team, let alone doctors and PTs on staff, the caregiver bears a lot of that burden. They may think this client needs additional help, but who do I turn to? I might call into the office and they may kind of talk me down, but they can't provide real tangible solutions from like a clinical standpoint. And so this model takes a lot of

Amy Pierce (24:45)
Okay.

Miriam Allred (25:12)
the pressure off the frontline staff and that they have all of this clinical infrastructure in the background to help them.

Amy Pierce (25:19)
100%. We tell our caregivers in orientation, escalate, escalate, escalate. They're the tip of this spear. They're in the home. They're seeing things firsthand. And we always want them to feel completely confident to escalate because we have an entire nursing team, an entire medical team that we can bring in and we can handle almost anything. And it really is all about preventing.

And so we're able to go in and prevent something from escalating.

Miriam Allred (25:53)
Let's talk about something that is universal is communication. So you have more kind of hands in the cookie jar for each client. And so in just the home care setting, it's oftentimes, the care coordinator with the caregiver, with the family, with the client, with maybe, you know, someone on the leadership team, like there's already, but you're adding in like even more people to that and communication can break down and get complicated.

How are you guys keeping communication flowing smoothly between all parties?

Amy Pierce (26:30)
That's a great question. And you know, I mean, we're certainly not perfect. And I always tell everyone, anytime there's an issue, it always comes down to, we didn't communicate well on this. You know, so just like any company, we're gonna have issues that happen because of communication. We do a lot to try and prevent that. So one thing we have is a weekly client experience meeting. So our home care team and our nursing team get together.

and talk about the clients. so that, like, and they'll go through each client and say, this is what we're seeing, caregivers are telling us this, nursing team, what do you think about this? And so that helps us to really have our finger on the pulse of what's going on within each family. And so that's huge. But, you know, also, my job a lot of times is to lead the team into integration. And so if,

home care is trying to do something too much on their own, I will come in and say, hey, this looks like a good opportunity for our nurse to go in and see if we can help kind of settle this before it becomes a big issue. And so I say, don't be siloed. Let's work together.

Miriam Allred (27:49)
So how do you notice those things? Obviously some of this is innate and you've been doing it for a long time, but what are the indicators that you're looking at that you know that communication is starting to break down or people are starting to operate in silos? What are the little indicators that you see happening?

Amy Pierce (28:06)
Sure, you know, we have an amazing team of schedulers. We have schedulers, some in-house and some that are virtual, that our phone is answered 24-7 by a real Coastal Care Partners employee, whether they're in-house or virtual.

we have a great system of notes that goes in for every single phone call. And a lot of times I read every note that comes in. And so a lot of times I can tell from a note that's coming in, I can say, this family needs a nurse. This family needs more than we're giving them right now. And so a lot of times I will reach out to our client experience team and say, have we thought about this?

And that's how I can help. Also, we have an incredible new leader, senior leader, who we brought on. Her whole role is, she's the senior director of care delivery. Her role is to kind of tie everything up in a bow. And so really help each division to be talking and to make sure that everyone's in communication.

Miriam Allred (29:17)
You're the second person I've talked to recently that has a function like this, literally someone that's like relatively high up that is manually going through notes and phone calls and documentation. And I think in smaller operations, there's not enough proactiveness and bandwidth to be able to do that. But in larger operations, you understand how important it is that someone's manually looking over all of these notes, all these calls. And with the eye of finding things that are going well,

to reward and recognize the team, but also the things that are slipping that can then turn into much bigger issues down the road if you don't solve for them. But I just find this interesting, again, talk to another large operation and they had someone dedicated to this of just going through all of these notes and being really dialed into what's going well, what's not, how do we mitigate this from escalating for this individual client, but it's also an indicator of the operation as a whole. If there's this like,

patterns of behavior that we need to nip in the bud. And so you, Amy, though, you are co-founder, like you're at the very top, you're still doing this, probably because you're passionate about it and you want to pulse on the clients, but also you have the eye for detail. But I'd imagine, you know, at some point you'll need to like offload this. And is there someone else, your clinical staff, can they do this just as well?

Amy Pierce (30:35)
Absolutely. And I'm definitely not the only one doing it. So our senior ⁓ director of care delivery is doing it. We have a director of nursing who is incredible and she's doing a lot of it. You know, our director of in-home care and our director of nursing are incredible and they're doing a ton. But you know, they can get stuck in the weeds of the everyday what's happening in that moment where I have the ability to kind of have a step back and look at

at kind of a higher level, because I'm not dealing with that day to day what's happening in this moment. And so I think that's part of it.

Miriam Allred (31:09)
Mm-hmm.

And how do you approach constructive criticism? So say you do start identifying patterns, behaviors that need to be corrected. How do you approach that, taking that back to the team?

Amy Pierce (31:29)
Yeah, you know, I think that it's, again, open communication is huge. And I think both Scott and I are pretty open on our leadership team, where in our meetings, everybody can say whatever it is that they want to say and feel. And so we're open with our team, and they're open back to us. And so if we need to have a conversation with one of our leaders, we would just have an honest conversation about something we're seeing.

and they're all fantastic. And so, it hasn't been a problem.

Miriam Allred (32:07)
What about, I'm going to keep prying here a little bit because it's hard when for a single case, a lot of people are involved. And so it can start to become easy to point blame. know, this person's responsible for this piece, but then there's overlap on this piece. like, do you find that it's hard to nip some of these problems in the bud because so many people are involved? And do you find people casting blame or?

Amy Pierce (32:10)
Yeah, sure, you're fine.

Miriam Allred (32:35)
How do you mitigate that when it does start to get little bit messy on identifying the issue and then solving the issue?

Amy Pierce (32:41)
You know, we were talking earlier a little bit about EOS and which is entrepreneurial system, organizational system of how to run your company. And I would say before EOS, we were a little bit of a mess when it came to things like this because Scott and I have never run a company this big. You know, we were like, I'm a nurse. He's a journalism major. We're like, my gosh, you know? And so we brought on EOS.

to really help us have ⁓ more of a defined, organized way of running. And so now our leadership team functions on a weekly 90 minute EOS style meeting. so part of that meeting is called a section called IDS, which is where you identify, discuss, and solve issues. And that has been a huge transformation for us because instead of coming into a meeting and complaining for an hour, an hour and a half about stuff and nothing gets done,

Now there's a system. And so we will discuss an issue, solve it, then a to-do will come out of that, and somebody will take that and just get it done.

Miriam Allred (33:51)
And I am a fan of EOS and understand this model. think something that more home care companies are trying to figure out is like defining issues because sometimes that's hard to do. You're just operating and you're reactive and you're just kind of trying to manage the chaos and move on to the next thing. But identifying issues is kind of a skill set and then helping empowering your team to define issues like

Amy Pierce (34:03)
Mm-hmm.

Miriam Allred (34:19)
It's like, recruitment's hard, ⁓ sales are slowing down. A lot of hyperboles, that's not helpful. It's like, what specifically in this process or in this relationship or in this communication, really getting tactical of what the issue is and being able to define that and then bringing that to the team, therefore you can solve it. But I think sometimes there's just all these generic fires and it's like, okay, let's define them, therefore we can tackle them.

Amy Pierce (34:44)
Mm-hmm.

I agree, it's huge to be able to specifically name this is what the issue is. And you I think something that was very helpful for us in the South, especially, it's not easy to just say something. And especially if it sounds a little bit like a criticism, you know, of something or something somebody's doing. And so EOS helped us to be able to just be authentic and be real and say, hey, this...

this just isn't working this way, you know, let's discuss, figure out what really is the issue, because usually it's kind of a deeper issue, and then solve that.

Miriam Allred (35:27)
Yeah, I want to ask you kind of a generic question, but I'm curious where you want to take this is what are some of the things that you, the most important things that you've learned like in your tenure? And I know that's open ended and loaded, but think of some of the things that you've been through and that you've learned and that you would tell, you know, Amy 12 months ago or 18 months ago, like what have you been through that you wish you could?

tell someone else like I've been through this thing and it was really hard but here's how I think about it now like what are maybe let's let's talk about maybe two or three of those of like what you've been through and you wish you would have known earlier on.

Amy Pierce (35:57)
Sure.

You know, I think that a big one is it's okay to take risk. if you see something and there's a gap in the system and you see, oh gosh, I could feel this gap by doing this, go for it. when you think about if you're a home care company or you're a care management company,

and you see how adding another service could be great, go for it and figure it out because we like to say like we're building the airplane while we're flying it because it doesn't have to be all perfect. It's just one step after the other and you figure it out. ⁓ That's one thing.

Miriam Allred (36:43)
Because you didn't know

that this was what Coastal Care Partners was going to turn into. It's like organically become this business with these service lines. And so taking the risk, was, wow, there's a gap and someone else could fill it for us or we could go fill it ourselves and let's take the risk and try and do it ourselves.

Amy Pierce (36:49)
No.

100%. And, you know, we started in 2018 with just me and Scott. Now we have over 340 employees now. We're the largest single site home care company in the state of Georgia. And, you know, all of that came from seeing a gap and not really knowing exactly what I was doing, but being willing to put myself out there and figure it out.

Miriam Allred (37:35)
And what have been some of the, well, let's keep going, but like some of the keys to success, like hiring good people and trusting them, what getting from where you were to where you are, it's like, wow, there's so many things that you've had to learn the hard way. Like what, have some of those been?

Amy Pierce (37:50)
for sure, you know, I am without a doubt, I'm a gut person. And I insist on being in every interview at Coastal Care Partners for any nurse that comes on any leadership role and Scott and I go to the caregiver orientation so that we can meet our new caregivers coming in. And, know, it is one of the things that I think is the

most important thing to Coastal Care Partners success is bringing on the right people. We have just incredible people that we like, I'll get teary-eyed thinking about like how honored I am that they have come to join us because they're just an amazing team and you're nothing without your incredible team. And so the talent and you know that everybody, this is more than just a company, it's a mission.

and it's a philosophy and people will join Coastal Care Partners because they believe in the mission, you know, so that's super important.

Miriam Allred (38:57)
And you're saying how amazing

they are. I can just sense how amazing you are and it's reciprocal. They want to join you and Scott because they feel something when they're with you. I feel it just talking to you, just like this passion that's so much bigger than yourselves. And so all of you come together and you're like in it together chasing the same dreams. But it starts, it starts with you and Scott and the passion and the heart that you bring and people wanting to be a part of that as well as you wanting to join forces with them.

Amy Pierce (39:25)
Thank you.

Miriam Allred (39:26)
Apart from hiring good people, what else? You think of operations and growth and infrastructure. What else have you gone through the growing pains of that you can part to other operators?

Amy Pierce (39:43)
⁓ yeah, would definitely say make sure that you, you know, you're hiring the right people and in line with that if you bring somebody on and you determine that they're not the right person and don't be afraid to sooner than later part ways with that person. It's tough to talk about, but you know, it's, it's amazing how that one bad apple can spoil the bunch.

And especially, when we're talking about somebody within our leadership team or somebody within our clinic staff or some, you know, that maybe just you know is not the right fit, then don't be afraid to part ways with that person. Because what we say, you know, at Coastal Care Partners and also in EOS is that you, in order to be successful, you need everybody rowing in the same boat in the same direction.

Sometimes you'll have somebody kind of sitting on that one assistant in their own boat over here and it's just you're never going to be able to move the whole company in the right direction if everybody's not rowing together.

Miriam Allred (40:50)
Think of someone that you let stay on the boat for too long. What was holding you back? Because that's the lesson I think people need to hear is what was holding you back so that if people are listening to this and something's holding them back, they can have the courage to let that person go. What's holding you back in that instance?

Amy Pierce (41:09)
For sure. We've had an instance in the past where we had somebody on the leadership team that actually made our meetings awkward. And so, you you couldn't feel free to be yourself and to say what needed to be said. And so we literally weren't getting out of our leadership meeting all that we could just because it was the wrong person in the wrong seat. And so it's not easy. And I mean, especially I am...

It's funny because I tell Scott all the time, I am not a conflict person, like at all. And I've been put in a position where I have to be in conflict kind of a lot, you know? And so I'm like, okay, so guess it's the universe telling me this is what I need to learn to do. But, you know, we have to make hard choices. And that's the calling of leadership is you have to be willing to make the tough choice that is the best for your company.

Miriam Allred (41:50)
Yeah.

And what I've heard holding people back sometimes is they can be really good at their job, but then they can be toxic. And that is usually the hardest scenario to solve for is, wait, they're a really strong salesperson or they're a really strong scheduler, but there's some gossip or some drama or some toxicity. And what do do in that case? Because you don't want to lose their skill set. You don't want to lose their output.

but they're causing more harm than good from like an office satisfaction standpoint. And that's a really tough one to solve. Have you been in that position before and how do you push through that and what do you do?

Amy Pierce (42:43)
Yes. ⁓

for sure and you know we've thought in instances like that, maybe we'll just move them to this area, you know, or maybe they'll do better over here. We've walked through that before moving somebody that we knew was a little bit of a toxic person from one area to the next area hoping it would be better, you know, and it wasn't. And so I think that you're looking at the whole person and if they're not right for your culture,

it's better to just go ahead and impart ways because honestly it's better for them too because they need to find their right place that's perfect for them and it just it may not be here.

Miriam Allred (43:24)
Mm-hmm.

Yeah. What about leveling yourself up as a leader? ⁓ You know, you had all this incredible clinical experience, but becoming a CEO of a growing scaling home care company, you're becoming something completely different as a person and as a leader. What resources or courses or influential people have helped you level yourself up? Because oftentimes leaders

can become the bottleneck and kind of stunt their own growth, but you have to be growing as well. What has helped you over the years, you know, in recent years to better yourself as a leader?

Amy Pierce (44:03)
For sure, that's a great question because like I said, I'm a nurse. I didn't go to business school or anything like that. So I have sought out ⁓ mentors, I've sought out EOS to come in and help. And our implementer, Sandi McCann was a great resource. She did some one-on-one work with me for leadership, which was fantastic. And I've had a couple of different leadership style.

business coaches that I've worked with as well. I'm an avid reader, so I'm constantly reading either an entrepreneurial book or usually I'll have like entrepreneurial book going on and a fiction book over here going on. So, you know, I'm always learning. That said, I'm sure there's a ton more that I could learn and I learn by doing. ⁓ We make mistakes and figure it out.

Miriam Allred (45:02)
I've also learned by doing and surrounding yourself with good people. Like in your community, there's other business leaders. In the industry, there's other business leaders, but learning by doing and learning by talking to people that have done it and have been successful and just like bouncing ideas off of them and then coming together and implementing based off what you've heard.

Amy Pierce (45:23)
Yeah, for sure. Yeah, all of that is great. If you've never read any of Jesse Kolb's books, he's the owner of the Savannah Bananas here. He's got some incredible books on business and leadership and his style. And it's really, he's got a book that's all about how to create ⁓ raving fans. And we have implemented some of his ideas into Coastal Care Partners.

in that it's, you know, we get so much more jazzed up about five star reviews than we do about numbers or, you know, because we know that when we are delivering premium experience, then, you know, all the numbers will follow. And so that was a book that was very influential for us.

Miriam Allred (46:09)
Yeah, that's a great example. Again, too, of something that's like outside of healthcare. It's like just a philosophy or principles that are like really tangible that apply to home care and what that looks like for coastal care partners. How do we create all of our help our employees be raving fans, our clients be raving fans, their families? Like we want everyone to be raving fans of our business, but how do we do that? And then how do we measure that? And then how do we get more of that ongoing?

Amy Pierce (46:14)
Yeah.

sure.

Miriam Allred (46:37)
I wanna shift gears a little bit here in last 10 minutes. You are facing chronic conditions every single day. And there are the most common conditions that we talk about in senior care, but there are also the less common conditions and also maybe newer conditions, not newer conditions, but conditions on the rise, I guess we could say.

⁓ I'm curious how you all have approached like care for conditions. A lot of companies focus on Alzheimer's and dementia because there's clearly demand for that and that's a good place to start. how all how have what's been your kind of progression of adding in conditions, focusing on conditions, specializing in certain conditions? What's just been kind of like the evolution for you all and where you've started and how that's progressed?

Amy Pierce (47:12)
That's huge. Yeah.

I think this is probably the biggest area of where I see the marriage of non-medical and medical being so incredibly important because, I mean, obviously dementia, Alzheimer's, Parkinson's, we have many clients with congestive heart failure, diabetes management, hypertension. ⁓

arthritis, inflammatory issues, long-term COVID, and then post-hospital discharge, even things like medication mismanagement, mobility, chronic UTIs, there's so many things. And where if it's just a non-medical home care company, obviously they're incredibly important in what they're doing.

But managing this chronic disease process, takes lots of checking in on the client and it takes a lot of coordination. And in order for the outcomes to improve, in order to reduce unnecessary hospitalizations, you really need that strong clinical component, being able to go in and frequently assess the client and see things that are happening from a clinical kind of view.

if that makes sense.

Miriam Allred (48:53)
So there are so many conditions. Do you just kind of start to accumulate these conditions based off client needs or are you more intentional than that of like, we have five clients with congestive heart failure. We're gonna go seek out more and kind of like bucket that and train more on that. Is it more... ⁓

like formal and organize how you approach these conditions or it's more just like as the clients come in with these conditions, we are just equipped to be able to handle them all.

Amy Pierce (49:26)
I think it's a little bit of both. ⁓ know, in the caregiving world, we have, you know, parts of Coastal Care University specifically devoted to conditions like, dementia care, end of life care, things like that. Our nurses are, you know, incredible. Most of our nurses have worked in ICU and ER. We love to bring ICU and ER nurses because they've seen it all.

You know, and they can, you have to be very autonomous to be a nurse care manager and be equipped to handle anything that you walk in and see in somebody's home. And so, you know, most of them are, prepared for all of these disease processes and being able to manage them. Also, this is where our medical team is so important because our nurses, anytime a question comes up,

we're able to bring in, call Dr. Eyre and say, hey, what do you think about this? And he'll give us guidance on how to manage that. If there's ever a question on, do you feel like this is something that really needs to go to the hospital or could we help manage this? Dr. Eyre is great about helping us look at that as well.

Miriam Allred (50:42)
And I just think back to the caregivers again taking some of this pressure off because some of these conditions are complex and and they have training and you've given them resources and access to things but a lot of questions come up in the day to day they encounter something that they don't know what to do about and again in another setting who do they call to get answers to those questions whereas here they've got the nurses but then all the way back to even doctors that have hopefully seen and experienced a lot of this that they can give them good advice.

Amy Pierce (51:10)
⁓ absolutely. And you know, the other thing that we haven't mentioned is that our nurses are, you know, care managers, but we're also licensed for private duty nursing. And so what that means is that our caregivers can kind of switch hats. mean, excuse me, our nurses can switch hats. And if there's a skilled need where you need to lay hands on a patient to do something like wound care, IV.

⁓ tube feedings, any of that sort of thing, our nurses can also handle that in the home as well, which is super important and really gives us that integrated ability because there's a lot of restrictions on a non-medical home care company, especially like, we recently had a client with a terminal cancer diagnosis, had to have a stomach surgery, had to have a feeding tube when they got home.

And we were able to combine the private duty nursing with managing those two feedings with our home care team as well there. So that's a beautiful integration.

Miriam Allred (52:15)
Yeah, being able to do all of the needs for these clients. What are maybe the five most common conditions that you're treating? And again, the top few are probably obvious, but I'm curious in your mind, think of all of your clients right now. If you had to kind of think of like the top five conditions that you're seeing, what would they be?

Amy Pierce (52:18)
Mm-hmm.

Thank

Definitely dementia, Parkinson's. I mean, the neurological disorders are huge. And you know, I think that I probably didn't even realize how big it was until I became a hospice nurse and saw, you know, as a hospice nurse, what was coming in the hospice is a huge amount of dementia and Parkinson's and neurological. Also a lot of congestive heart failure, a lot of heart related things.

cancer, we see a lot of in-stage cancer, a lot of post-hospital. So we get a lot of, and this is lot of times a more short-term thing with coastal care partners, but somebody goes to the hospital with, ⁓ has to have a hip replacement and will come home in need, maybe a stint, and we'll be able to have nurses checking on them as well as caregivers to help.

Miriam Allred (53:29)
And I'm curious in all of your experience are there conditions on the rise? I mean you just said maybe you've been surprised at how much neurological disorders are out there. Has that been on the rise in your career? Are you surprised to see that on the rise or are there other conditions that are coming up and like as prevalent as these neurological disorders?

Amy Pierce (53:56)
I think so, I think that for sure the neurological disorders are on the rise and I think a lot of it is that we're living longer and so there's more time for chronic disease to happen. But we do see a lot of heart disease. A lot of, I mean that's on the rise as well.

Miriam Allred (54:18)
Yeah, and just curious, just thinking of all the conditions that are out there, we're aging longer, and we're literally aging longer. so there's all of the standard things that we've seen, but we're just curious, in your opinion, are there new things that we're seeing, or is it just more of the same, and are we getting better at treating some of these conditions that have been around for a long time?

Think about like innovation, I guess, and you've got all these doctors and RNs on staff. Like, are we getting further along in how we think about and treat these things?

Amy Pierce (54:59)
don't know that we're getting further along on that. I do think that there are lot of advancements right now happening in the neurological world. mean, there's a lot going on with infusions, a lot of exciting kind of advancements in that arena that I think that we could see coming soon. So I'm very excited to see how that progresses. But you know, I think as much as prevention is the key.

Miriam Allred (54:59)
That's a loaded question.

Amy Pierce (55:29)
And as much as people could get outside and exercise more, walk every day, pay attention to what you're eating, and socialization. Walking with a friend is great because you're getting your exercise and you're socializing. So the more that we can do to prevent these disease processes, the better. Because I do see, I live in a neighborhood that has ⁓ a huge golf community, and there are certainly

80 year olds that are playing golf every day and are not suffering from these chronic diseases. So, you know, take care of yourself.

Miriam Allred (56:10)
Yeah, you heard it here. we could beat that drum all day long, the prevention. And look at you, you sit on both sides. We we see the good examples, but then here you are taking care of the people that need support. And it's like, is it too late at that point? Like that's the challenge for you is like, you know what these people should be doing, but then you're also taking care of them when they haven't been doing those things and just being humble and patient and helping them the best that we can.

Amy Pierce (56:12)
Thank you.

Miriam Allred (56:40)
I ask you about innovations and are we getting better at treating these things? We're hopefully better at caring for these people. You have helped so many clients and families with dementia that you've seen so many things. The thing that we can get better at is how we see these people, how we treat them and how we care for them. And I think that's what really matters, right?

Amy Pierce (56:47)
Yes.

100%.

Yes, absolutely. I mean, I get really jazzed up about outcomes, about client outcomes. And, I see just at our team at Coastal Care Partners, I can see us every year getting better and better and our outcomes are better at, caring for these clients and making sure that we are meeting them where they are and really helping them to be able to age in place, age at home and age well.

Miriam Allred (57:29)
So one last question here to wrap up. Where do you want to take Coastal Care Partners? You've accomplished so much in like not very much time and what the business is is probably already so much bigger than you could have imagined. I guess what's on your personal roadmap this year for you to accomplish? Is it to kind of double down on what's working well? Is it expansion into new markets? What's on the horizon?

Amy Pierce (57:31)
Sure.

Yeah, so expansion into new markets is where we're going and we are really excited about taking our integrated model into new markets. So we launched in Bluffton and Hilton Head about eight months ago and that's growing really well, growing steady there. We are looking at the Ponovedra Jacksonville area as our next market. You know, we kind of learned that

We, for us to be successful in a market, we really need to have an area where there's a lot of retired people, but also a large city next to it where we can pull employees from. And so we're looking at areas that make sense for expansion so that we can help more people.

Miriam Allred (58:43)
Amazing. what I, the idea that I guess I want to plant in your head is I want this model to become like a model of care around the country. And so I want people listening to this to reach out to you and ask you more kind of tailored questions to their market and to their businesses, because I think what you've built.

can be replicated elsewhere and can become a model that's implemented and integrated into other communities around the country because I think there's just so much value in what you've built and how you've built it and the infrastructure and marrying the medical and the non-medical. Like we just need more of that everywhere. And so my hope is that people listen to this, get excited and more people can aspire to this type of model. And it's not for everyone and not everyone needs to build this, but...

Amy Pierce (59:04)
Sure.

Sure.

Miriam Allred (59:29)
in the markets where it is feasible and for the leaders that want to accomplish something like this, you all can be mentors to a lot of other people.

Amy Pierce (59:36)
Yeah, for sure. We're happy to help. That's kind of what we did with Jenny when she came down and we kind of spent a day with her showing her how we're doing things and we're really excited about that. We believe that integration is the future of aging care and we like to say we're an aging care solutions company. And so, we're excited about that. We're happy to help.

Miriam Allred (1:00:01)
Yeah. And I think of the words like holistic and patient centered and like, you know, full picture care. It's like this, this is that model for, for senior care is a full comprehensive model that's integrated across, across the spectrum. And so it just makes me hopeful. I, you know, I'm young and, and I want to see care improved in my lifetime. And so that's part of what motivates me personally is people like you that are thinking differently, building something that, you know, if you said to another home care owner right now, you know, we hired

doctors, we hired RNs, like we hire high paid salaried positions. Other home care leaders might think like, that's impossible. How could I ever do that? I could never accomplish something like that. You're an example of you figured out a way to build a business where that is possible. And so just opening people's minds to what is possible and in hopes of us creating new models that take us into an era of just better care.

Amy Pierce (1:00:56)
Absolutely, yeah. I would say just be open to the idea of bringing on new service lines and collaborating with other people out there in the medical space, for sure.

Miriam Allred (1:01:09)
Yeah, and back to what you said that I love is being willing to take risks. If you see gaps, be the one to solve the gap and being willing to take that risk. You're a great example of that. Amy, thank you for being patient. I know I've taken this down different paths here, but I feel like we've gotten some really good nuggets out of here and more than anything, like understanding your model and some lessons you've learned the hard way and, you know, where you're headed. It's just amazing. So thank you so much for joining me.

Amy Pierce (1:01:12)
Yes.

100%.

Thank you.

you

Aw, thank you for having me. This has been so much fun.

Miriam Allred (1:01:36)
Awesome.