Miriam Allred (00:11)
Hey everyone, welcome back to the Home Care Strategy Lab. Thank you all for tuning in week after week. I hope you are implementing what you're learning from the show and I'm just grateful to have you here. Today I am joined by Jim Kimzey the co-founder of Full Bloom Home Care based in Northern Chicago in Lake Forest. Jim, welcome to the show.

Jim Kimzey (00:31)
Thank you. I'm happy to be here.

Miriam Allred (00:33)
Your name has got a really nice ring to it. Almost sounds like a famous person's name. Jim, are you famous?

Jim Kimzey (00:40)
There is a famous Jim Kimzey, but I'm not that one. He's one of the co-founders of AOL, America Online. Yeah, yeah, right.

Miriam Allred (00:42)
Okay.

Got it. Let's make you famous in home care though. The

real Jim Kimzey is here today. It's great to have you here. We've gotten acquainted recently. I've interviewed Paula Marks recently on the show and met your co-founders over the last couple of weeks. so I'm really excited to have you on the show and get you in the hot seat to talk about the model that you all are building. Let's start with your introduction. Tell us a little bit about yourself and overview your professional work history and home care.

Jim Kimzey (01:13)
Okay. I mean, I first got involved in home care and like I started my first company in 2009. It was a company called Tender Rose Dementia Care Specialist. I got involved in home care the way a lot of people do is I had a personal family experience. And so my mother had Alzheimer's. It was my job in the family to figure out what we could do to help my mom. And I did a bunch of research and in doing that research, I realized that, you know, as an adult child of somebody with dementia, there's a lot of other

adult children out there. And the thing that I cared about is how good would the home care agency be at dementia care? didn't care about anything else. And, you know, once that idea got in my mind, I just started thinking, well, maybe I ought to create a company. And then I couldn't find any other company that actually did that. And I was, you that was kind of a red flag for me. But the idea that entered my brain was if I do this, it'll help my mom. Everything I learned will help my mom. And then once I got that idea in my mind, I had to do it.

And so I started Tender Rose Dementia Care Specialist in 2009, sold it in 2020 to Home Care Assistance, thought I was gonna retire, ⁓ missed the home care industry, missed working with families, missed working with caregivers. So I came out of retirement a couple of years ago to start Full Bloom Memory Care in Lake Forest, Illinois with ⁓ my two co-founders, Andy Tysinger and Jennifer Muskat

Miriam Allred (02:36)
Amazing. Toot your own horn for a second. Was Tender Rose really the first of its kind in California, even nationwide?

Jim Kimzey (02:45)
It's well, I couldn't find at the time another home care agency that specialized only in dementia care. Of course, every home care agency does a lot of dementia care, but I couldn't find another home care agency that all of their clients had dementia. All their caregivers were highly trained in dementia care. And when Home Care Assistance was talking to me, they said they couldn't find one either. ⁓ Now I would say there's at least five, six or seven home care agencies in the country that are focused exclusively on dementia care.

Miriam Allred (03:15)
Okay.

Jim Kimzey (03:15)
Tender

Rose being one, because it's still around and still doing only dementia care, and Full Bloom being another one. And I know of at least probably four others now.

Miriam Allred (03:25)
Okay, as I've gotten acquainted with you, I've met a handful of other people that have cited Tender Rose and I think the model that you all built people are intrigued by and only so many people can implement this exact model. But everyone listening to the show is taking care of dementia patients. And so I want to unpack what traditional home care looks like in regards to dementia versus what you all are building and helping people just think differently about dementia care. And we're going to identify resources and

tactics and all sorts of things that people can take kind of slivers of and implement in their own business. So let's start there in your own words. When we hear dementia care in the traditional home care model, like what are people referencing? What does that look like? And then we'll explain, you know, what you're building and what that looks like.

Jim Kimzey (04:10)
Well, I mean, think everybody in home care knows what providing dementia care looks like because almost, I mean, every home care agency is doing it. I would say the difference between traditional home care and what we're doing at Full Bloom is we really focus on, I would say the biggest difference is we have relatively fewer clients who need more care over a longer period of time. They're willing to pay a premium for

expertise and they're looking for long-term care in the home. ⁓ On the caregiver side, we have relatively fewer caregivers who work more hours for us over a longer period of time. We invest in their training. We also give them a lot more support in the field and we're giving them excellent benefits, medical, dental, ⁓ 401k match, that type of thing, but mainly higher pay and consistent hours over a long period of time.

and the opportunity to make a big difference in a family's life. And so we actually partner with a lot of traditional home care agencies. And what my pitch to a home care agency owner is not like, me all your dementia patients, because that's the bread and butter for the industry. It's, pretty much say, give me the cases you wish you didn't have, right? And these are the ones that are verbally abusive, sexually aggressive, physically violent. Maybe they've got delirium.

or they've got some family dynamics that make it really, really challenging. And so a lot of times if you have a really challenging dementia patient in traditional home care, you're burning out your caregivers, you're burning out your staffing managers, you're taking on a lot of workers' comp risk, a lot of reputation risk, and we're built to handle the hard cases. And so we don't send our caregivers in to get beat up every day. We take the time and energy to figure out and work with the doctors and kind of figure out

What is the right mix of kind of care, changes to the environment, and if need be, some help from the doctor's prescribing pad to kind of get the behaviors under control. But the fact that our clients need more care over a longer period of time means that we can invest upfront to kind of figure that situation out.

Miriam Allred (06:23)
What percentage of a home care company, traditional home care company, thinking of your referrals are these really hard dementia clients? Like 1 % of their census or 10 % of their census? And is that reflective of the industry?

Jim Kimzey (06:35)
from other home care agencies?

Well, I'll tell you this, ⁓ if another home care agency calls and says, have a referral for you, we know it's gonna be really hard because nobody's given up a good high revenue client if they don't have to. And so, somebody's got 100 clients, we might get the hardest one that they have. I mean, it's probably...

one to 2%, it's not 20%.

Miriam Allred (07:08)
And that's kind of why

I ask. It sounds like it's the top 1%. And is that reflective of the dementia population holistically across the country, maybe 1 % is this like really extreme dementia case.

Jim Kimzey (07:26)
Well, you know, the funny thing is when you talk to an adult daughter or an adult son whose parent has dementia, they always think their parent is the hard one, right? And so there is, you we actually position ourselves as we can handle the hard cases and we do that for a lot of different reasons. You know, one of the most important reasons is we learn more from the hard cases than we do the easy cases and what we learn on the hard cases helps us with all of our cases. But...

Everybody thinks that they've got it hard, when you have a perspective of what hard really looks like, sometimes, you know, they're saying, my mom won't let somebody help her in the bathroom with, you know, get going to the shower or go in the toilet. I mean, that's just that's common. Right. That's not hard. I mean, it is hard for somebody who, doesn't have a lot of experience dealing with that or with the training to deal with it. It's kind of hard to say how many are in this extreme. Right. Because there's there's really

know, three things that you can do to manage the behaviors of somebody with dementia. And, you know, one is the kind of the quantity and the quality of the caregiving. The other is changes to the environment. You you just decluttering somebody's bathroom can make a big difference or decluttering their living room can make a big difference. But the third thing is, you know, drugs. Right. And so you can solve almost any behavioral problem with drugs if that's what you want to do. Right.

or if that's what you feel like you need to do. But when you start using drugs, every drug that is used to manage the behavior of somebody with dementia usually has a black box warning on it that says, is gonna increase the chances of death. But one of the things it's definitely gonna do is it's gonna make them more of a fall risk and it's gonna make them more sleepy and it kind of takes away a lot of the opportunity to give them a higher quality of life, right? And so, you know,

The gold standard in dementia care is engaging people in activities that bring them joy and meaning at whatever level they can still participate. And if they're sleeping all day, they aren't engaging in activities that bring them joy and meaning. They may be easier to take care of, but that person with dementia isn't having a high quality of life.

Miriam Allred (09:32)
Wow, okay. You rattled off a minute ago a variety of things that like quantifies kind of a hard case. I'm curious what maybe like the top three are that are the common patterns between the hardest dementia cases that you've seen. Could you identify three?

Jim Kimzey (09:49)
Well, I'd say the most common thing that we see is the person needs care, but they don't realize they need care. And so we call it like resistance to care, refusal of care. And so I think for a lot of traditional home care agencies, they try with those, but like, what can you do? You send your caregiver to the front door, the person won't let them in, or the person tells them to go away, that caregiver doesn't want to come back. And so I think a lot of home care agencies lose.

what could be good long-term dementia cases because they can't figure out how do you overcome that resistance to care. And so that's probably the number one problem. If you can figure that out, you can actually open up a lot of new cases for yourself and good long-term revenue. And so...

Miriam Allred (10:33)
And that's

the client's refusal or the family's refusal.

Jim Kimzey (10:37)
No, it's the person with dementia's refusal.

Miriam Allred (10:39)
It's the client themselves, correct? Wow. Well, yeah, keep going.

Jim Kimzey (10:42)
Yeah.

Well, mean, so this was actually the first problem I ran into when I started Tender Rose. It's like four, three of my first four clients didn't want my help and they needed it and the families were willing to pay for it. And so I, you know, that was kind of the beginning of my journey to figure out how do we overcome this resistance to care? One of the first things I found out is there's this thing called anosognosia and anosognosia is basically it's

there's a change in the brain that makes people not realize that they actually need help, right? And so most people, most families think that it's denial. Like this person's being, you know, they're being difficult, they're in denial, but there's actually a physical change in the brain that creates a blind spot where they don't even see that they need help. And so the funny thing is that somebody with dementia will almost readily, always readily accept help.

for a physical problem. Let's say you fall and break a hip, you have a heart attack, you've got shoulder surgery, cataract surgery, they'll accept help in the home for the physical problem, but they won't accept help for their cognitive problems, very commonly, right? And part of the reason for that is most dementias are slowly progressing diseases like Alzheimer's. Today isn't that different than yesterday. Yesterday isn't that different than the day before.

And so for the person living with dementia, the fact that they may be majorly impaired cognitively, it just feels normal to them, right? But it's very frustrating for the family, because you can see this over like a six month period and go, wow, you really need help. And so ⁓ one of the stories I like to tell is one of my early clients at Tender Rose.

I was trying to figure out how do we overcome this resistance to care? And he would let me into the house. You know, I would show up with a Krispy Kreme donut and a cup of coffee and we would, you know, we would have a good conversation and you know, he'd go to the bathroom and I'd check the microwave and there'd be a plate of food in there that's probably been sitting there for three days. You know, the refrigerators got expired milk and all this kind of stuff. And I remember one time I asked him, said, what are you going to do this afternoon? And he said, well, I'm going to do what I do every day. I'm going to get in my car. I'm going to drive to the mall. I'm going to walk around and see my friends, have another cup of coffee.

and the man hadn't had a car for six months. mean, dementia is like there's no short-term memory, but also they just don't even realize they're impaired. And so we came up with an approach at Tender Rose. I we called it the eight steps to overcoming refusal of care. We actually published a document that outlines the steps that you can do there. And that document's available to anybody. I mean, it's a copyrighted document. You can't just throw your logo on it, but you can learn from it and use the steps.

⁓ So we spent a lot of time figuring out how do we overcome that resistance to care. And the thing is, for us, they have to be able to benefit from the care and the family needs to be willing to pay for the care. But there are ways to overcome that. I mean, we could go into more depth on that if you want to.

Miriam Allred (13:44)
Yeah, I think it doesn't make sense to talk about the eight steps of refusal or tease maybe like the first three and then we can leave people on the hook to go and read the rest.

Jim Kimzey (13:55)
Yeah, well, I mean, think, you know, I'll just kind of talk about them, you know, generally. But one of the common problems that we see with family members is usually they're frustrated. They're busy. You know, maybe they've got busy professional lives or taking care of their kids. And so they want to go into the house and have this we're going to settle this once and for all conversation. Right. This is, know, Mom, you have dementia. ⁓

you need a caregiver who's gonna be your best friend for the next rest of your life every day, or maybe this person's gonna live with you. And it's just like they're introducing this idea of drastic change, right? To a senior who thinks nothing's wrong, right? My kid's overreacting and all this kind of stuff. So one of the first things you gotta do is find one thing that the senior will accept help with, right? It could be housekeeping, it could be laundry, could be driving to the beauty parlor.

could be driving to the doctor's office, walking the dog. One thing they'll accept help with and start there, right? But don't go in with here's this whole plan to overturn your life. And so one of the key challenges is make the caregiver not a stranger because nobody wants a stranger in their house, right? But if you know this person and you like this person, you're willing to let them come in. The other is you kind of use the short-term memory to your advantage, like the problems with short-term memory to your advantage.

One of the steps is, you know, find one thing they'll accept help with. The other one is make the caregiver not a stranger. The other one is, I mean, you got to get the right caregiver in there. Like it can't be some task oriented. I'm here to do ADLs. Let me put my scrubs on. Let me come here and announce that I'm your caregiver. I'm going to follow you to the bathroom. You know, all this kind of stuff. It's like, what is the therapeutic story for why is this person in your home? Right. Could be a friend of my daughter's who's just stopped stopping by to take you to the grocery store or whatever.

And so the therapeutic storytelling is really important. And a lot of times families have a hard time with that because we've all been taught not to lie to our parents, right? But the thing about lying is usually when you're lying, you're lying to benefit yourself. And here, what we're recognizing is that this person needs help, they won't accept the help, and it's because they've got brain failure, right? They can't reason, they can't remember.

And so what we're gonna do is tell a therapeutic story that gets them to accept the help that they need. And so you get them to accept help with that one thing and then you get incremental commitment to more care over time. And at Tender Rose might take us usually, here's a client that could benefit from eight hours a day, seven days a week.

Maybe they're refusing all care. We could usually get them to accept eight hours a day, seven days a week within 30 days by using this incremental commitment. But it's hard because you've got to have the same caregiver going in every day. what makes this challenging is we've got to create good jobs for our caregivers. And it's very hard to say, let's have somebody go in two hours a day for five days in a row and then have the ability to expand that to, you know, 40 hours a week.

And so there's some logistical challenges and some scheduling challenges with it, but there is a way to overcome it. ⁓ One is you gotta take money off the table. Like they're aren't gonna pay for care that they think that they don't need. ⁓ And so either the adult child has to pay for it or they need to have access to the parents' funds like power of attorney to pay for it. And then part of the therapeutic story is this is a wellness benefit from your doctor's office. It's covered by your insurance. It's covered by Medicare. ⁓

every situation has to have kind of this customized, bespoke, therapeutic story about why the person's here and what they're doing here. And it's very much an interactive plan between us as the home care agency and the family members to try to implement this. So, you know, those are the main steps. mean, and then, you know, really focusing on person-centered activity-based care as opposed to I'm here to do tasks like.

you know, the ADLs, like I'm here to bathe you or feed you or, you know, things like that. It's like, you know, really focusing on things that bring them joy and meaning so they're happy to see you and, you know, like don't hover over them, you know, all day. So it takes a different kind of caregiver with a different kind of training with a different type of approach to providing the care. But that's...

So that's the most common and that's the one that we worked really hard at to overcome, kind of figure out a plan to overcome that resistance to care. At Full Bloom, we've implemented similar approach and we recently had a client and a lot of times the family dynamics are also what's complicated. It's not just the person with dementia. mean, if it were only the person with dementia, life would be a lot easier.

And I was just so proud of our team. I we had a client, I thought, this is gonna be one of the hardest clients I've ever seen, know, Tender Rose or Full Bloom between her resistance to care, the family dynamics were pretty challenging, and she didn't have any care in the home. She was living at home alone. And they got her to accept eight hours a day, seven days a week, and about 10 days, which I was just, I thought, there's no way we're getting this contract signed.

very doubtful we're gonna be successful even in 30 days. And the team just did an amazing job. But anyway, that is one of the most challenging things. The other, we get really scary cases like physical violence, verbal aggressiveness, sometimes sexual aggressiveness. And you just have to have really highly trained caregivers that have a lot of support and you can't be afraid, right?

And the way you're not afraid is you take on the hard cases and you realize you can figure it out. You learn from those hard cases and then the next one's not so scary.

Miriam Allred (20:04)
Jim, my goodness, I am writing notes, I am processing all this in real time. This is fantastic. I have a few questions about everything that you just shared and these might, you know, catch you off guard. I don't know, but I'm curious this, like, I get this storytelling component. There's a level of dishonesty of, like, you know, adapting the truth for the benefit of the senior. Is that hard for you to do? Do you feel morally like that's a challenge or it's just the reality of the situation?

Jim Kimzey (20:12)
Okay.

I don't have a problem with it. ⁓ I've seen what happens when you try to tell the truth, and I've seen what happens when you get comfortable with therapeutic storytelling, and the difference in the quality of life for the person living with dementia is night and day, right? So this is all done for the person living with dementia. If we encounter a family that says,

We are not gonna tell a therapeutic story. We're gonna convince them that they need to pay for it. We're gonna convince them. And it's like, good luck, come talk to me after you've tried that with three other home care agencies because that ain't gonna work.

Miriam Allred (21:09)
That was going to be my next question is does the family knows the full truth and they have to be receptive to the therapeutic storytelling and that in and of itself is a challenge and that they don't want to be dishonest to mom or dad but you have to explain to them the value that this brings.

Jim Kimzey (21:26)
It's a, you know, a qualifier. Are you gonna be a good prospect? I mean, I'm not gonna waste my time trying to, I mean, you know, one of the things we do is we've been doing this a long time. We are the experts at dementia care. You're the expert in your family. And if you guys can't get comfortable with this stuff, then you're gonna have to figure it out another way. But we, you know, we're not gonna pretend like we have some magic wand that's gonna convince.

your loved one who has short-term memory problems and an inability to reason who doesn't think that they need help and we're going to be, you know, flat up honest with them. I mean, because...

Miriam Allred (21:59)
How many

families do you lose because of this specifically, the families not on board with the therapeutic storytelling idea?

Jim Kimzey (22:08)
I

don't think we lose too many. mean, usually by the time they're talking to us, they're pretty frustrated themselves. And they're just kind of happy to talk to somebody that actually has a different approach. Like they may have already worked with three traditional home care agencies who their approach was, let's throw caregivers at the front door and see what sticks, right? And every one that doesn't stick makes it less likely that the next one doesn't stick, right?

And so they've already, most of the time by the time we're talking to them, they've already experienced, let's not lie to them or let's, they're just happy that somebody has a different approach.

Miriam Allred (22:44)
Got it. Yeah, I think that's totally fair. Another thing that you mentioned was you want to make sure that this model, this type of care, this approach benefits them. You kind of mentioned that as like one of the qualifiers that you're confident that this will benefit them. Is there a population out there that wouldn't benefit from this?

Jim Kimzey (23:04)
Yeah, mean, let's say you've got a couple and maybe the wife has dementia and the husband's taking care of her. you know, if she were living alone, she might need 24-7 care, right? But he's actually providing a lot of care. And one of the things is, you know, the person without dementia doesn't want a stranger in their house either, right? And they're all worried about money. know, they're looking at how much is this going to cost? you know, they're feeling like, hey, I need to do something, too. And so

There are actually a lot of clients out there who might need like like in an ideal world They might need two hours in the morning and two hours in the afternoon or three hours in the morning and three hours in the afternoon like a split shift and it would kind of give the the Couple more alone time in their house and privacy and everything but they need that extra support the the challenge is is how do you staff that right because the caregivers that do this kind of hard work they don't do it because they enjoy hanging out with seniors or they're looking to

⁓ maybe get some new drapes for the living room, it's like they're trying to support a family, right? And so they need a real job with real hours, consistency, good pay, and all this kind of stuff. And so one of the challenges, and I think a lot of times, I've met a lot of home care agency owners that try to give the client what they need, and then they fail and they feel bad, and the client's mad at them, and they've hurt their brand image, and all this kind of stuff. It's like, if you only need two hours a day in the morning and two hours a day in the afternoon, and that's what would actually benefit the client, then...

you know, we're not built for that. Maybe there are some home care agencies that are built for that. I mean, maybe, you you've got a lot of caregivers, you've got a lot of geographic concentration of clients, maybe you can pull that off, but we're not built for that. I mean, we're built for clients who need a lot of care over a longer period of time. But I think there is an opportunity out there for people providing traditional home care to say, we can give you those short hours, but the thing you're gonna have to do is have a consistent caregiver come into the house every day. Nobody wants...

two hours in the morning, two hours in the afternoon by a different caregiver every week.

Miriam Allred (25:06)
Got it. Because you mentioned the goal is to, in the first 30 days, get them to that eight hours of care seven days a week. And that's assuming and finding the client that needs that, but also to protect and retain these caregivers. It's kind of like that's your ICP of they need high hours. You know they need high hours, but then also really to preserve and protect the caregivers and that this needs to be sustainable and worth it for them. And if it's not, this just does not make sense for them.

Jim Kimzey (25:16)
Right.

Mm-hmm.

Yeah.

This is one of the things I think is important insight and I learned this in my early days of Tender Rose ⁓ when I was kind of evolving to the model that we're doing now is I ⁓ had clients that needed a little you know four hours a day three days a week and that's what we would give them and then I also had clients that needed 24-7 care and What I realized is that it didn't matter how many hours a week that they were you know Contracting for care or what the hourly rate was they all had a really high standard

Like they all wanted an amazing person walking through the front door on a consistent basis that cared about them, that knew who they were, that knew the care plan, had been trained in the care plan, and that was trained in dementia care. And so just because one might be generating 7,000 a week in revenue and the other's generating 350 a week, they both had the same standards, right? And I could meet the 24-7 standard, I could meet the, you know.

four hours a day, three days a week standard, I had a lot of trouble meeting. And so I didn't get in this business to disappoint my clients, so I'm gonna focus on these long-term clients.

Miriam Allred (26:41)
So the question on my mind and everyone listening to this is how in the world do you find these caregivers that are willing to do this? To take the absolutely hardest dementia cases out there, how do you find people willing to do this and then how do you keep them? How do you retain them? How do you train them? Like how do you find them and then how do you keep them?

Jim Kimzey (26:58)
Mm-hmm.

Well, when I first started Tender Rose, my big question was, how come nobody else has done this? I remember I talked to Steven Tweed. A lot of people know who Steven Tweed is as a consultant. He said, I don't know. There are facilities that do dementia care only. I don't know why there's not a home care agency doing this. And he said, maybe it's because it's hard finding caregivers that want to do this. And I think about that conversation a lot, because what we learned is there are a lot of caregivers that like doing this.

You just got, you you got to go find them. But there are people out there who absolutely love taking care of somebody with dementia, right? Most of them have had a family experience. They've taken care of a grandparent. They grew up around this, but it brings, it brings them joy and meaning to their life to be able to improve the quality of life for another person, particularly somebody who's vulnerable that has dementia. And so,

The reality is it hasn't been hard finding people that love this kind of work. And that's part of why I love doing it is because there are a lot of people out there that it brings joy and meaning to their lives to be able to create quality of life for somebody with dementia. it's like, you know, how do we find caregivers? I mean, we advertise on Indeed like everybody else, but maybe our ads are, you know, a little bit different. We're making it really, really clear. All of our clients have dementia. We're looking for people that

Miriam Allred (28:11)
So it

Jim Kimzey (28:23)
or want to improve the quality of life for somebody with dementia that understands something about person-centered activity-based care, like you aren't just doing ADLs all day long. But we also rely a lot on employee referrals. If you think about how many caregivers in this world, or in the US at least, have experience with dementia care, a lot of them, right? And some of them are really good at it, and some of them really love it. And so how do we get them? We pay them better, and we give them, you know,

good long-term schedules with clients that they can make a difference in their lives in.

Miriam Allred (28:56)
So having dementia experiences table stakes and honestly, like you said, everybody at this point probably has that. Do you entice them with pay, of course, also with additional training? Do you feel like that draws people to you? You highlight this extensive training that you have around dementia and you feel like that is interesting to these people or gets them on the hook?

Jim Kimzey (29:18)
Well, I mean, we provide really good training and a lot of it, but I think it's literally the higher pay. I mean, we pay $25 an hour in the Lake Forest area. I think other home care agencies are paying like 19 to 21. So I think it's the combination of the higher pay, the better benefits, and long-term consistent schedules. So if you can get $25 an hour, maybe working four 12-hour shifts, getting a little overtime in there, that's pretty attractive to them.

⁓ I think they don't come to us for the promise of the better training, but I think once they experience the better training, they appreciate it. what they like is the fact that they're not on their own in the house. Like we don't just send them, know, here's the address, show up, go find the care plan somewhere on the credenza and read it. It's like, we're training you in dementia care.

We've got a care plan with our clients. We're gonna train you on the care plan and then we're gonna make sure that you're successful. We're gonna introduce you. You're never on your own. We're always a phone call away and if you need us to come in and help you on site, we're gonna do that. And so we put a lot of effort into making sure that our caregivers are successful with each client and each client is different.

Miriam Allred (30:34)
You mentioned something to me on our prep call around, you've got your active caregivers that are actively taking care of your clients, but then you've got this like pool of caregivers that know about Full Bloom and are on your radar and have filled out some sort of form and you've actually got this like this pool of talent at your fingertips. Can you explain how you've done that?

Jim Kimzey (30:47)
Mm-hmm.

Yeah, in home care, in order to grow your agency, you've got to have, there's two things that have to happen. One, you have to have a sales engine that's bringing in new clients, right? And you have to work really, really hard to get your revenue to a certain level, and then you have to work just as hard to keep it there, right? But the same on the caregiver recruiting side. I mean, you can't have...

You without caregivers, can't have caregivers without clients, so you've got to have a recruiting engine that builds a roster that can support your clients. you have to work really, really hard to get that roster to a certain level and then just as hard to kind of keep it there because caregivers move away or they decide they don't want to do this or go into private caregiving or work in a facility and all these kind of things, right? So caregiver turnover. And so we started in the very beginning, we just said, we're going to make that recruiting engine run hotter than the sales engine.

Right? And part of the value in doing that is we're going to, we're going to, it's our goal to identify all the best caregivers in the North shore of Chicago area and get them in our database, train them, develop a relationship with them. And every time we have an opportunity that we think is a good fit for them, we're going to check in with them and see, are you ready to come over now? Right? Do is this a good fit for you now? Right? And so

Basically what we've done is we've invested heavily in recruiting and training caregivers so that we have a roster that anytime we get a new client or we need to pull a caregiver off of an existing client, we have multiple good options, right? And we can bring them in and kind of talk to them about the client. Like we're not just saying, here, go to this address and take care of this client. We're bringing them into the office and we're interviewing them about this client. Like, does this meet your needs or is this something you feel comfortable with?

because some of them are going to be really challenging. And caregivers can turn down work for lots of different reasons. might be the schedule doesn't work for me, it's too far away, they have dogs or cats or whatever, or I'm just, I'm kind of afraid of this client. I don't want to get punched in the mouth, right? But then there are others that say, yeah, yeah, I think I can deal with this. so...

Yeah, we just spend a lot more time recruiting and onboarding caregivers to make sure that we don't ever lose a client because we don't have enough caregivers. And having that big roster gives us a lot of leverage to hold our standards really high with the other caregivers. No caregiver can hold us hostage because the client likes them, right? I mean, we care a lot about consistency and reliability. one of the things we talked about in the prep call is for every caregiver, we're measuring on every shift.

Well, first of all, we publish our schedules in advance and we care about consistency. Like that's really important for anybody with dementia. And so what we're doing is we publish the schedules literally months in advance, right? But if in May you want to make a change to your schedule in June, that's fine, right? But when June rolls around, you don't get to make any changes to your schedule unless there's a good reason, right? You can't just call us up one day and go, hey, I've decided I want to take this Saturday off, deal with it.

It's like, no, no, in May you said you could do this. We're gonna expect you to cover that shift. And so what we're doing, mean, obviously if they have to do something, we're gonna find a replacement for them, but we're not, it's not like the norm. It's not like this is generally accepted behavior. And so for every caregiver on every shift, we're gonna, you did you cover your scheduled shift? Did you clock in using the app?

Did you clock in on time and did you clock out using the app and did you do your shift report well and things like that? And so we set a really, really high standard, but having that roster of really good caregivers that we can turn to just gives us a ton of leverage. mean, we're not gonna, we never fire anybody willy-nilly. I mean, we always coach them. We always give them a chance, but we let them know this is behavior that we will not accept. So either change your behavior or we're gonna find somebody else to replace you. And we can replace anybody on our.

anybody on any one of our schedules like in two days, no problem.

Miriam Allred (35:13)
So I want to make sure I really understand this. These people are coming to you via your, indeed, via your applicant sourcing. They're coming to you, correct, through all of these channels. And then once they're in, you have like a high qualification or screening process, you identify they're a right fit. What do you tell them? You say, don't have clients ready for you, but come and do our training and then we will let you know when we do? Or like, what exactly do you tell them to keep them on the hook?

Jim Kimzey (35:40)
Well, I we let them know that we don't have, like we don't have, like a lot of caregivers are very savvy. They're like, do you have a schedule for me next week? And a lot of caregivers need to be on a schedule. And so we're very honest with them to say, we're gonna have a new hire orientation. We have one every Thursday. Come in, we're gonna pay you for nine hours of in-person training, play, know, role play video. I mean, it's gonna be some of the best dementia care training you've ever had.

and it's gonna help you with any client you have with any agency or working privately, right? So it's valuable training no matter what. Then we're gonna pay you for 10 more hours of care academy training, right? And a lot of that's the compliance stuff for the state. So you're gonna get a lot of hours out of this at a really good rate of pay. I we don't pay $25 an hour for training. I mean, it's more like 16.50. ⁓ And then when we have a client, it's gonna be a really good client. Like it's gonna be...

full-time hours, consistent over a long period of time, but you have to be a good fit. Like the client has a say in this. Like we don't just throw caregivers at the client. We interview caregivers for each client. The client lets us know if this is a good fit for them. And so the opportunity is a good long-term career, but it isn't guaranteed that you get on a shift next week or the week after that, right? And so a lot of times we're putting to work people.

today, like maybe this week we start a new case, we might put somebody to work that we first trained four or five months ago, right? But we stay in touch with them all the time. Like we don't want them, you so it's a very different model than traditional home care where, the best practices, you know, can we reduce the amount of time between when they hit submit, you know, on their application and then they can be on a billable schedule. ⁓

and we're going to try to speed that up. I always think about how horrible that would sound to a family member. Like, hey, we're really good at recruiting. This person, we met them 30 minutes ago and they're already on your schedule. I that's not a great look for a client. So anybody who shows up at one of our clients' houses, we have met in person multiple times. We spent at least 10 hours, like nine hours in the office training them. And we've had multiple interviews going over the care plan and things like that. And so it really, it's optimized for

creating really good care for our clients and good long-term jobs for our caregivers. And a lot of them understand that. It's like, hey, I can keep filling my schedule with these three home care agencies that I'm on the roster with. Just let me know when you've got a client for me. But we don't ever, like if they say, hey, I'm quitting my job and coming to work for you, we're like, no, no, don't do that.

Miriam Allred (38:21)
This is fascinating Jim. So if I'm hearing this right you are paying to train caregivers. They're out working on other agencies dimes That is like mind-blowing to probably people listening to this But this is what it takes to do your model successfully is you have to find the very best dementia trained caregivers out in your market go above and beyond to train them and then keep in contact with them for months and then when the right fit shift

client situation opens up, then you match them together and then you're off to the races. But I think this is so fascinating that you're literally paying to train them and then just retain them in your pool. then, you know, hopefully within a few months, there's an opportunity for them to get working. But I love this. It's like you're so dialed into what it takes to do this successfully. And you understand the commitment and the investment and the ROI on.

finding these people and training them and retaining them for months before they even have their first shift. I just, I'm mind blown.

Jim Kimzey (39:26)
Well, I I talked about ⁓ part of our business model is we have relatively fewer clients who need more care over a long period of time. so every client to us is way more valuable on average than your traditional home care. mean, we sometimes get clients that need 24-7 care for years, right? And so they may generate

one to three million dollars in revenue. And so we don't want to blow that relationship up before it first starts by saying, let's take a caregiver that we've only ever met by phone, we hired them in two days and trained them online and send them into this house and hold our breath and hope it works, And it, you know.

Miriam Allred (40:11)
You mentioned

having schedules published months in advance. This is also not the norm in the industry. What is your policy? Obviously, you high expectations for these caregivers and shift changes. Do you have a literal policy that says you can't make changes 15 days out, 30 days out, 60 days out? Do you have something in writing?

Jim Kimzey (40:32)
Well, ⁓ mean, we're kind of constantly evolving on this. And so we actually do have things in writing. I don't actually know offhand like what's written down right now because it's probably changed last week. But the thing is, we're not kind of ridiculous about it. mean, life happens, right? What we want is if you're going to call out on your shift that you understand the impact that this has on the client.

the impact it has on your teammates, the impact that it has on the operation. And so don't do it lightly. Like if you have a really good reason to do it, then do it. But don't just kind of casually think that it's Thursday, I'm gonna call out on my shift on Saturday because I feel like hanging out with my friend or something. so one of the biggest challenges we have is that type of behavior is so accepted in traditional home care that they don't think there's anything wrong with it. And so...

We have a lot more in-person meetings with caregivers about what we consider our performance standards. And that's pretty shocking to them. Like, wait a minute, you want me to drive all the way into the office and meet with you? I don't have time for that. I don't want to do that. And we're like, yeah, you are coming in if you want to stay on the schedule. But we are going to pay you for your time to come in. But we got to get on the same page here about what's acceptable here. We don't just pay you more and give you good

consistent hours over a long period of time without expecting something in return. And it actually is one of our core values of our company is consistency and reliability. And we measure every employee and particularly caregivers on, you living up to our values on consistency and reliability? Do you understand what happens when you call out on short notice or even a week's notice? so, but it just requires a lot more.

interaction kind of from a human resources perspective. You know, we're not beating caregivers up. I mean, we're telling them what we like about them and just saying, you could just, and one of the things I'm very proud about is the fact that we work really hard to coach our caregivers to get them to meet our standards. I mean, we had one caregiver, like one of the things we do is we actually, we have a performance bonus. Like I told you, we measure.

Did you cover your schedule? Did you clock in on time? Did you use the app? Did you clock out on time? Did you use the app? Our caregivers get a 50 cent per hour bonus if they meet our standards for consistency and reliability. So some of our caregivers are making an extra hundred dollars a month just by kind of doing their job, right? But it gives us an opportunity to talk to the ones who are falling short and to say, did you realize you could have like if if you hadn't called out, you could have made 100 extra dollars.

And if you keep calling out, you're going to lose your job, right? Like, let's work on this. so, you know, we have, by measuring all this, if you're, you know, I'm a big believer in kind of the 80-20 rule, like 20 % of your caregiver is going to create like 80 % of your customer service problems. And if you know who those are, you need to either coach them to your performance standards or get rid of them. And it's just as simple as that. And by having that whole roster,

Miriam Allred (43:45)
Thank

Jim Kimzey (43:49)
People waiting trying kind of chomping at the bit to have a good long-term job with us We we have a lot of leverage on that but we always try to coach and you know recently we've had one caregiver client loves her She's amazing as a caregiver, but she calls out a lot. She's late a lot it ⁓ And we've had her come into the office a couple times. We just made it really really clear That this is the last warning and last month. I was proud to give her her

consistency and performance bonus, like $100, because she actually changed her behavior. And if she hadn't, she wouldn't be with us.

Miriam Allred (44:27)
So you said you have a lot of face time with these caregivers in the office and again, I think that's maybe different than the norm and that it's not uncommon to not see a caregiver for months and months on end, maybe even upwards of a year when you have these like really great long standing caregivers. How often would you say you're interfacing with the majority of your caregivers? Is it weekly? Is it bi-weekly, monthly? How often?

Jim Kimzey (44:53)
Well, for the ones that aren't a performance problem, that are just showing up and doing their job every day, we aren't gonna see them in the office that much. But we do have client care coordinators that go out into the field and visit with them in the client's home and check in with them there. We check in with them by phone. mean, coming into the office is not something somebody wants to do. mean, you know, because a lot of times they don't live that close to the office. And so it's not like coming to the office is a great thing for them. Like they're not looking forward to it.

but we do go out into the field and check in with them there and we check in by phone. But it's like, I would say there's probably not a caregiver that we work with that we're not talking to at least two or three times a month.

Miriam Allred (45:34)
When you talk about the norm being call outs happen, there's just issues with scheduling in every home care company. To me, the way you described it, it kind of sounds like a mindset shift and a lack of clear expectations and communicating those frequently. Is that what it chalks up to or what would you tell all the owners listening to this about how to avoid call outs? Is it communication? Is it expectation setting? What is it really boil down to that they can learn from?

Jim Kimzey (45:51)
Mm-hmm.

Well, I think it's a mind shift really. I ⁓ had an experience at Tender Rose that kind of changed me around a lot of this stuff. And I know a lot of home care agency owners, one of the hardest positions in home care is the staffing manager, like the person who has to manage the schedule and to be on call. On call burns people out. And so we had...

a couple of staffing managers quit because they got burned out. My two best staffing managers were hanging on by thread and I knew we had to fix this problem. And so I made a deal with them. said, I will be on call three weekends out of every month until we fix this problem. so Friday night to Monday morning, I'm on call. And it was horrific. mean, I was like chained to my desk on the weekend. Sometimes I didn't have time to shave or shower. And I was like, no wonder these people are quitting. This is horrible, right?

And we'd have caregivers calling out at the last minute and so stressful and you're trying to cover two call outs at once and things like this. And so I'm really glad I did that because I'm just like, no wonder, like this job sucks and we need to make it so this job doesn't suck. And so it's like you start kind of looking at like, what are the root causes of this? Like, what are we allowing? What kind of behavior are we allowing and who's calling out and how often have they called out and all this kind of stuff? So that's why you learn things like you got to

You gotta measure this stuff. You gotta figure out who your problem children are and deal with them, right? And so I think part of the mind shift, ⁓ I mean, there was a book that I read, ⁓ like I know a lot of people in home care now talking about like hospitality, right? It was like a big thing. many years ago, I found this book called Setting the Table by Danny Meyer. He's the guy who started Shake Shack, but a lot of great restaurants in New York City.

And he had this management philosophy that somebody else defined for him. He was just doing it, right? But it was called the salt shaker theory of management. And when he was a young restaurateur, he was very frustrated because, you know, waiters weren't doing what he wanted them to do. The cooks weren't doing what he wanted them to do. The clients, you know, the customers weren't doing what he wanted them to do. And so a good friend of his came into his restaurant and basically said, you know, he said, here, you know,

let's do little demonstration. He goes, set the table. Now put that salt shaker right where you want it, right? And then he said, he put it where he wanted. Is that where you want it? Yeah, okay, that's where I want it. And then his friend just moved it a few inches off to, let's say the right. He goes, now what are you gonna do? He goes, where do you want the salt shaker? And so he moved it back and then his friend moved it again and then he moved it back and he goes, so the salt shaker theory of management, basically what it evolved is,

Where you want that salt shaker is your standards. You define those standards. You don't let your caregivers define those standards. You don't let your clients define those standards. You don't let your referral sources define those standards. You have your own standards and you stick to those. And you don't let anybody move your salt shaker. But you also don't let them move it like 20 times and then blow up at them. So the management philosophy was this idea of constant gentle pressure to do what you need them to do.

I think a lot of times in a lot of companies, but particularly in home care, the caregiver is a problem, you don't deal with it, the caregiver is a problem, don't deal with it, caregiver is a problem, you don't deal with it, and then you blow up and now you're mad, now you fire them and you just look like a jerk and all your other caregivers are like, you know, we've got a lunatic for an owner or whatever. ⁓ But with this idea of constant general pressures, every time they don't live up to your standard, you remind them of what your standard is. And it's this constant general pressure to go for them to adopt your standard.

And that only goes so far. Eventually you're going to say, look, we've been trying this for a long time, but you keep trying to implement your standard, not my standard. So we're to have to let you go. And so we kind of combine this philosophy of Danny Meyers, like salt shaker theory of management with some stuff that we learned in EOS or traction. Now the entrepreneurial operating system, I know a lot of home care agency owners are running that. We ran that at Tender Rose and we do it at Full Bloom as well. And one of the ideas in

for managing people in EOS is this idea that your employees, it's called GWC, like do they get it, do they want it, do they have the capacity to do it, right? And so when somebody's not clocking in on time or they're calling out, we bring them into the office and we use this thing called a people analyzer and it's basically just a form that comes from EOS and we're gonna talk about what they're doing well, what they're not doing well and what they need to do to get things on track and what the consequences are if they don't get things on track, right?

So that's our constant general pressure. It's like, we're really clear on what our expectations are, and we're also very clear on what's gonna happen if you don't meet those expectations. But we're not gonna fire you, we're not gonna mad at you and fire you tomorrow, but we are gonna fire you in three months or two months, whatever we've outlined here, if you don't change your behavior. So it's worked well for us. so it...

By setting those standards, like having that mind shift and setting those standards and holding to those standards, it solves a lot of your problems, Because it turns out that your caregivers are much more coachable than you realized, right? When I talk to home carriers and the owners about this, think I'm gonna have to fire half my staff. It's like, no, you're probably gonna have to fire 10 % of them. But guess what? Your staffing managers are gonna be happier. They're gonna stick around longer. Your clients are gonna be happier.

And even when you have clients who say you can't fire this caregiver, they're the best one. It's like, yeah, everything they're doing is impacting the team. It's impacting our other clients. We're going to set our standard. We don't let you set the standard.

Miriam Allred (52:03)
Yeah, if you let go the 10 % of your hardest caregivers, the 40 % of your issues walk out the door with them. ⁓

Jim Kimzey (52:11)
And

the others get the message that they're not fooling around here. You don't want to come into the office and have that conversation because you're not winning. It doesn't matter how much your client loves you or the adult daughter loves you. They're not afraid to fire you.

Miriam Allred (52:27)
I love this salt shaker philosophy. think that's so spot on the agencies that I see that are really struggling. Their clients and their caregivers are always moving the goalpost and they can't get a handle on anything because the people are dictating everything. And so what you're saying is every agency, every owner, every office team has to define the standards, has to define the expectations and the people.

Jim Kimzey (52:39)
Mm-hmm.

Mm-hmm.

Miriam Allred (52:56)
morph to the standards and the expectations and not the other way around. But the agencies that I see struggling most are letting the people dictate their lives and their schedules and the chaos. And then it's just perpetual and they can't get out of it until, like you just said, you have to make hard decisions. You have to let 10 % of your staff goes, which just sounds impossible, but your problems will walk out the door with them.

Jim Kimzey (53:20)
It makes such a difference because then you know your your staffing managers aren't dreading being on call You know, they aren't burned out, you know on Monday morning. I mean it just You know It's it makes a huge, know, it's scary at first but then once you do it you realize like wait a minute Why did why did we ever allow? You know every caregiver to kind of set their own standard on what punctuality is or? Consistency on the schedule and things like that

And I think it's, you know, there's such a caregiver shortage that people are worried that like, hey, if I, if I fire this caregiver, I'm not going to be able to replace them or the client lacks someone, I'm going to lose the client. But it's like, yeah, you know, it's a short term pain for a long term gain.

Miriam Allred (54:04)
Absolutely. So we've talked about the clients and we've talked about the caregivers. I want to talk briefly about referral sources and pricing for this model. I'm guessing a lot of people are wondering like, how are you interacting with specific referral partners to probably find these clients and then also semi-related but part two of just like pricing this level of care and how do you do that?

Jim Kimzey (54:13)
Mm-hmm.

Mm-hmm.

Mm-hmm.

Yeah, so, I mean, we charge $55 an hour, which is higher than most home care agencies in our market, and a lot of families can't afford that, right? And we don't apologize for that. like we're not, there are actually hundreds of excellent traditional home care agencies in the Chicago area that charge less and do the best job they can at dementia care, and some of them are doing a fine job, right? So we're not.

We don't apologize that we're not all things to all people. What we are is we're providing a premium level of service. The positioning really is we can give your loved one a quality of life that you didn't even know was possible, and you can't get anywhere else. You can't get it by hiring privately. You can't get it by hiring another traditional home care agency. You can't get it by putting them into a facility. We can give your loved one a quality of life that you will get in no other way, right?

But it's not cheap and it's not cheap because we have to pay our caregivers more and we have to give them better training, give them better benefits and give them support. Like none of this stuff happens. Like there's this myth of the, you know, the magic caregiver. All's we need is one magic caregiver. It's like, no, you need a whole team that can, like things change in dementia care over time and you need a team that can adapt to that. So we have to have a team that can get a case started successfully and then.

run it smoothly, and then when things get out of whack, get it back to where it needs to be. ⁓ So understanding that we're not for everybody and that we are a premium service and we charge a lot and people are gonna need at least 32 hours a week of care and a lot of them want a lot more, we're targeting wealthy families that can afford the best, right? So we have to target referral sources who serve wealthy families, right? And so we don't get to go out to,

every referral source and say, me your dementia patients. We got to find out, like, do you ever interact with families that can afford our service? Because we're wasting our time and your time if you're not, right? I mean, and we actually get a lot of calls from families who cannot afford our service. And we always take a deep breath and say, how can we help this person? And so that's what makes us a good partner to other traditional home care agencies is sometimes they don't have dementia, sometimes they can't afford us.

but we're always trying to help them solve their problem. Like who can we turn to, who can we refer them to? Is it our neighbor down the street that is willing to do four hour shifts five days a week? Because that's what they need. ⁓ But as far as referrals versus, we've talked a little bit about this. I I think about it in terms of like a two by two matrix. ⁓ maybe on the horizontal axis you've got.

how many people with dementia does this person see? Or how many families do they see? Kind of going low from high. And then on the vertical axis, how many families, wealthy families, do they see low to high, right? And the sweet spot for us are the ones that see a lot of wealthy families and see a lot of families that are struggling with dementia, right? And so, you know, in that upper right-hand corner would be referral sources like geriatric care managers, other home care agency owners.

⁓ Concierge doctors, ⁓ doctors at academic medical centers that have like a memory care unit. mean, because a lot of wealthy people that have challenged behaviors end up at these academic medical centers like Northwestern or in the Bay Area, UCSF or Stanford. And so, we're not targeting every referral source that ever sees somebody with dementia. We're targeting the ones that see wealthy families that have dementia.

and we have a different pitch for them. And our best clients are ones that have already had a bad experience with either private care or traditional home care. And we already know what problems they're gonna have. gonna say, you it might be they were great Monday through Friday, but they could never staff a weekend. the person, you know, was fine until my mom needed personal care, and now that person can't get my mom to bathe or can't get my mom, you know, my mom won't let them help with.

toileting, things like that. And so they're kind of predictable, or they don't speak English, they don't drive, they're inconsistent, they're late, they create drama, they argue with my mom, things like that. And so there's a lot of things that we're very familiar with, our best referral sources are the ones who know dementia really well. And so this is one of the marketing challenges for anybody trying to kind of market themselves as good at dementia care.

is guess what? Every home care agency says they're the experts at dementia care, right?

Miriam Allred (59:16)
And how do you overcome that obstacle? How exactly

do you do that? Because that is the question.

Jim Kimzey (59:21)
And so, ⁓ I'll get to that in just a second. But think about that, like these referral sources, everybody's coming at them saying we're the experts in dementia care. And so when you walk in and say we're the experts in dementia care, you are just more noise, right? So you can't just talk a good game, you have to walk a good game, right? And so part of what we do is we go to these high value referral sources and we say,

Miriam Allred (59:27)
Okay.

Jim Kimzey (59:50)
Why don't you give us a try with one of your most challenging clients? And so we prove ourselves on the hard cases. And they might have a lot of home care agencies saying we're the experts in dementia care, but they don't have a lot coming in saying, you've got somebody who's physically violent, you've got somebody who's refusing care, let us have a crack at that. Because that's what we do. And so we prove ourselves on the hard cases. Then they know, like, ⁓ they don't just talk the talk, they walk the walk. And they can do this.

And that's, the more of the hard cases we do, the better we get at it, the better our caregivers get at it. You know, we end up, like one of the great values of taking hard cases is that's where you will identify your superstar caregivers who have potential to grow into care coordinators or even higher levels of management. you know, one of things I was very proud of at Tender Rose is a lot of the people who ended up in senior management.

at Tender Rose started out in entry-level positions, either as caregivers or staffing managers, and they grew within the organization and took on more and more responsibility. And part of how they proved themselves was the really hard cases. And so, like a future superstar on a really hard case, identify, they show you who they are by, they don't complain about the client, they show up to work even when it's hard.

and they actually help their teammates get better. They don't like hoard the information, right? They share, this is what's working for me. And they're looking for ways to make life better for the family, looking for ways to help the company succeed, looking for ways to help their teammates succeed. There are a lot of toxic caregivers out there who think I am the very best at what I do and I'm not telling anybody else. And usually they're not that good anyway, but.

Miriam Allred (1:01:40)
So you take the the very hardest cases, but then you put into practice everything that we've covered today. It's that you take the hardest case, but then you're on the hook to deliver. And that's where a lot of these agencies falter is you over promise your dementia care expertise. And then it comes down to these really hard cases and they just they fail. They can't manage the level of complexity that exists. But what you all do differently is you take the hardest cases and then you deliver exceptionally well. And then that referral source.

is in your back pocket whenever it comes to that right fit client that you're looking for.

Jim Kimzey (1:02:16)
Right, well then they're more interested in who else can you help me with, right? And we don't want only your hardest, cases. mean, we can make, we can improve the quality of life of any person with dementia by our approach. And we haven't really talked about that yet. And I think it's important for your listeners to understand, like, we didn't figure this out all by ourselves, right? ⁓ When I was first starting, ⁓

Tender Rose Dementia Care Specialist. I was doing research and I found a book that was published by the Alzheimer's Association. And it has kind of a funny name and I'll, let me read it to you, but we're gonna provide a link to this. But this was published in 2009, so it's 17 years old. It's called Dementia Care Practice Recommendations for Professionals Working in a Home Setting Phase Four. But what it does is it's a,

Miriam Allred (1:02:57)
in the show notes, absolutely.

Jim Kimzey (1:03:11)
It's a 65 page book that is very comprehensive and very prescriptive. tells you what to do and how to do it. And it's basically, for me, this is what got me into dementia care. As an adult child, as somebody with dementia, you hear a lot of messages once your loved one's diagnosed, like it's gonna be hard, the doctor's clinical, your friends kind of remind you how difficult it's gonna be and family members. And so you kind of, you're dreading what the future is like for your loved one and for me, for my mom.

And there was a paragraph in there that said something like, no matter where the person is in their dementia journey, they still have the possibility for a high quality of life. And that quality of life will be determined by the nature of the relationships that person has with their family, their community, and their home care provider. And so for me, that was the first message of hope that I had ever seen for my mom. And so said, let's read this book. Let's implement what's in there for my mom. It actually worked. And what the book does is it talks about person-centered activity-based care.

Right, so the person centered part is getting to know the person and what's always brought them joy and meaning. The activity based part is engaging them in those activities that always brought them joy and meaning at whatever level they can still participate. And that changes over time, right? Because as the disease progresses, so it's up to us as an agency and up to our caregivers to kind of monitor where they're at.

you know, take seriously. Like our goal is to make every day a good day for the person living with dementia. We do that by engaging them in the activities that always brought them joy and meaning and adapting our approach to their changing care needs. Right. And so this book, I mean, it just told us what to do. And that was the blueprint for how we started Tender Rose. I would have never started Tender Rose without this book. ⁓ And I just reread that book, this book the other day to make sure we're doing all this stuff at Full Bloom. And there's

It's 17 years old, there's a few things out of date. There's a couple of things like wandering programs that no longer exist and faulty information on the current state of which drugs are available for behaviors and altering the course of the disease. all the stuff that affects how you take care of a person with dementia in the home is still accurate, still good, and it's been proven by 17 years of practice and research since then.

What I would encourage anybody to do is like if you're a home care agency owner that wants to be good at dementia care, download this book, read it and try to do what's in this book. if, you know, it's not easy. you know, being good at dementia care isn't hiring a copywriter to say you're good at dementia care. It's actually doing things differently, right? It's actually hiring caregivers that want to engage with the person.

starting with who they are and what they're about. And it isn't about the activities of daily living. Those are important, right? You need to make sure they're fed and they're bathed and their clothes are changed and all that. But the real magic happens when you can make them happy by engaging them in activities that bring them joy, meaning they're happy that your caregiver's there and they maybe don't even view the caregiver as a caregiver. They think it's this friend. Sometimes they think it's their daughter, late in the disease. ⁓

Anyway, I would highly encourage you to read this book. I've been doing this, I don't know, 2009, mean, 17 years, and I read that book and say we still have room for improvement. And so there's never a time, I think, when any home care agency owner should just say we figured this out, we can rest on our laurels. There's always room for improvement.

Miriam Allred (1:06:35)
17 years.

I'm so glad you mentioned this book. bet most people listening to this have not heard of that, but it sounds like a gem of a resource. So we will absolutely be linking to it. Jim, you're a stud. You're such a straight shooter, which I love so much about everything that you're saying. I could just sit back and listen to you all day because I feel like you're just so spot on with all of your comments. And this is exactly what so many people need to hear. Even though we're talking about your model specifically, these are just like fundamental principles that you've talked about today that I think

home care is just lacking in some of the depth on these best practices and you've articulated them so, so well. My last question for you really is you came out of retirement to do this. You have been doing this for 17 years and it's really, really tough. And I've talked about this on my LinkedIn recently, but does it get any easier and what keeps you going?

Jim Kimzey (1:07:23)
Mm-hmm.

Well, mean, what keeps me going is I tried retirement and the thing is a lot of what I enjoyed about my professional life was interacting with employees and interacting with families and solving challenging problems related to dementia care. And so when I retired, I didn't have any of that, right? But a friend of a friend would call and say, my mom's got this going on. And I would spend an hour with them talking on the phone.

And then I would realize like, that was the best hour I had in the last two weeks. Like, why am I not doing this like every day? And so, you know, even when you retire, you got to have the purpose, right? And so for me, my purpose is helping more people with dementia have a higher quality of life and creating more good jobs for caregivers and all of our employees. And that's very satisfying to me and all this. And so you say, does it get any easier? mean, think, you know, having experience in home care always makes it easier.

Right, because there's a, I mean, I remember when I was first getting started in this, there would be problems that would come up and you would have to go, how are we gonna solve this? What do we do? And so it takes a lot of mental energy to solve every problem. But after you've seen enough problems over a long period of time, it's just kind of automatic. It's like, okay, here's the problem, here's how we solved it the last 10 times, let's just solve it that way again. Right, but part of what I love about business is,

know, business is just one long obstacle course. It's all about problems and solving problems, right? And so the sooner you kind of get that into your head is that the problems are never going away. They will always be there. It's your job to solve them and just get better at solving problems. You'll enjoy your job a lot more. And so now when I get problems, I'm just like, good, another problem to solve. I mean, it's not like, when will the problem stop? They're never stopping.

Miriam Allred (1:09:34)
And surrounding yourself with people that have that same mindset. You mentioned Jennifer and Andy at the top of the hour. They have the same drive, same motto, same belief system that you have, and you're all solving these problems together.

Jim Kimzey (1:09:49)
Yeah, and then, you know, having really good employees, I mean, it's not just Andy, Jen and me. I mean, we have other really good employees, you know, shout out, you know, Nancy and Debbie and Colleen. I mean, they're they're really, really good at their jobs. And, you know, when you have strong people that you can count on to make good decisions like that, like one of the things I don't want to be involved in every decision. I think that was, you know, when we talk about scaling, I think a big part of

scaling is realizing that you can't be involved in every decision. You've got to let your people make decisions and they may make different decisions than you would, but still that's how they grow as leaders and managers. It can be pretty exhausting. I would have employees come to me and say, here's the problem, what do want us to do? And pretty early on I realized, I just don't have the...

the bandwidth or the brain power to kind of solve all these problems. So I just kind of defaulted to like, what do you think we should do? And they would tell me what they think we should do. I said, why don't you go try that and see if that works. And that would, that took a lot of burden off of me, but it also helped them develop as leaders and problem solvers. Cause it's like, you know, I'm not micromanaging how they solve the problems. And that's how they got really good at it. And that's how a lot of them, like I say, rose from entry level positions to leadership positions that the company is they were solving problems.

I wasn't telling them how to solve the problems.

Miriam Allred (1:11:20)
Fantastic. Jim, last question. What's your goal with Full Bloom? Where do you want to take this?

Jim Kimzey (1:11:26)
Well, I mean, right now, I mean, our goal is to just get really, really good at it in the Lake Forest area. Then we want to go into other markets. And that was actually at Tender Rose, that was always kind of my dream is to roll this out into multiple markets. And so, I our goal would be to be in 10 different markets over the next 10 years, helping lots of families create a higher quality life for their loved one and creating a lot of good jobs for caregivers and our other staff.

Miriam Allred (1:11:54)
and educating everyone on this level of dementia care and the hope that exists. I love what you said a few minutes ago about when you read some of those paragraphs about your own mother and your own situation and it instilled this sense of hope. There's so many families out there that don't have faith or hope that this can get better for their loved one, but you're a testament that they can and that there is a path forward.

Jim Kimzey (1:12:16)
Yeah, yeah. And that's what kind of, I think, keeps us all going at Full Bloom is it's fun to see that when it happens, right? You know, almost every family comes to us in crisis and to see them kind of get past that crisis and have a much higher quality of life and, you know, see that their loved one is enjoying a quality of life that they thought had, was gone. Like they can't, you know, there was no more possibility of that. And that's kind of what keeps us all going.

Miriam Allred (1:12:42)
Yeah, Jim, thank you. Feels like an understatement to wrap up this conversation, but thank you so much for everything that you've shared so transparently. You know me, I love when you're open and honest and shoot straight and I feel like you've done an exceptional job at that today. So thank you for joining me in the lab. It's been an absolute pleasure. I want to just recommend everyone listening to this to reach out to Jim. You know, I don't want to open the floodgates on you, but.

If this has resonated with you or if you've learned something, at least give Jim a thank you, but also ask him questions. Like he said, he's a problem solver through and through. so if you've got problems that you could tee up to him, don't be a stranger and reach out to him. So Jim, thank you so much.

Jim Kimzey (1:13:18)
Yeah, thank you for having me on.