Raising Tech

Amber: 0:05

Welcome back to raising tech, a podcast about all things, technology and senior living. I'm your host, Amber Bardon. And today we have two guests. Our first guest is Brandon Buster from Lee insurance agency. And then we also have our chief technology officer Ryan Preuss from Parasol Alliance . Welcome to the show.

Ryan: 0:22

Hi, thanks.

Brandon: 0:23

Thank you.

Amber: 0:23

Brandon, can you start us off with giving our listeners a little bit of an introduction about yourself? Tell us about your background, your role, and a little bit about Lee insurance agency.

Brandon: 0:33

Thanks Amber. So we are an independent insurance agency. We're privately owned. We're based in Iowa. We've worked in the senior living space for about 34 years and , we provide insurance and risk management solutions to our clients. So working with roughly 500 folks across the country in 20 states today, we feel like we have a good grasp on it. We partner strategically with our insurance carriers that have been in the space for a long time, and we truly want, you know, to find what's best for our clients from an insurance and risk management perspective. Me personally, I serve on our leadership team as a director of sales that really encompasses helping grow our organization organically, also looking at acquisition opportunities and in really leading , that charge as we look to continue to grow our organizational footprint.

Amber: 1:22

Excellent. And our topic today is cybersecurity, which is a very hot topic right now. There's a lot of things going on in the space with insurance renewals and, you know, potential security, risk events and things like that. So it's also, we're gonna jump into today before we do that. Ryan Preuss, can you give our listeners and introduction about you?

Ryan: 1:40

Sure. Well, I'm, as Amber said , the chief technology officer I've been with Parasol Alliance for seven years actually have been working in the healthcare industry for close to 12 years now. So, and have over 20 years experience in it, supporting all things, servers, network and security related .

Amber: 2:00

Excellent. So cyber security is a word we hear a lot, right. And it could be used in a lot of different contexts. It could be a buzzword, it can be a tactic to scare people. It can be , you know, used just in conversation, but what does cybersecurity actually mean? Can we define what that term really means and how does that apply to our clients? Ryan, do you wanna start?

Ryan: 2:20

Sure. I mean, you know, it's cybersecurity is definitely a far reaching topic, you know, in it's broadest sense. You know, you can break it down kind of , as the name implies that it's, you know , security or securing any kind of technology that you may have or come across with relation to senior living, it involves, you know, protecting your critical systems and services, compromise against data loss or theft, you know, and this generally involves all the normal things that you would hear about like, you know, antivirus software , um, web filtering, email filtering, backup , and disaster recovery, and, you know, patching, things like that, that, you know, all the normal stuff you'd expect to see in an it environment, but it goes a step further and also involves things like, you know, ensuring your community is compliant with regulatory standards like H IPAA, also things like, you know, educating your end users to make sure they're better equipped to identify and deal with, you know, potential threats before they actually become compromises.

Amber: 3:20

Thanks for that explanation, Ryan and we actually started taking a look a closer look at cyber security because we noticed a trend starting about last year, about last fall, around this time that suddenly , uh, several of our clients were having their cyber security insurance denied, or they had to put in a lot of new requirements. And so this led our company to take a little bit of a deeper dive into what exactly were the new requirements and how do they affect our clients. So, Brandon , can you share a little bit on what happened in the industry from your side of things that caused the changes in the cyber security renewals?

Brandon: 3:52

Sure, absolutely. I'd love to. So it's probably several years ago when you know, cyber security that buzzword started really coming around, we'd start seeing compromise or, or hacks to some large financial institutions, large hospitals, insurance carriers decided, Hey, there really is a true risk and true exposure here. Let's create a product that we can go and offer folks, you know, to help them protect from that exposure. So you start with Lloyds of London. One of the largest insurance carriers in the world , uh, came out with a couple products and then before long, we would see a handful of carriers jumping into the industry. Didn't really know how to price it because there's no empirical data to show what claims would look like. Right? So when you price an insurance product, that's you look at the exposure actuarily and then you charge a premium that you believe is adequate for that exposure. You know, there were no deductibles, early on premium was super inexpensive. You had carriers coming in trying to buy folks' business by offering just insanely inexpensive premiums. And then over the last couple of years, we have seen just a , a ton of, claims. So you have claims frequency and claims severity are two things that will drive a rate, right? Frequency is number of claims. Severity is the damage per claim, right, or, or, or the economic or non-economic damages or the, the amount that a carrier would have to pay out on behalf of a client for damage is sustained. And so in the last couple of years, we've seen an kind of an exodus of folks just getting out of the industry, cares that, that spawned up and start offering, you know, monoline, cyber, reliability coverage, their , they got handed. They didn't have it priced accordingly. They didn't really understand their product. And so they left and exited the market. And those that remain standing today believe that they've priced it accordingly from day one. But now, as , as you mentioned, Amber, they are implementing additional requirements. So as an example, some carriers would only ask three or four questions on what's called a supplemental application to put coverage in place several years ago. Some of those carriers, supplemental questionnaires are two and three pages today. Some of the carriers are implementing penetration tests. They're working with third parties , such as yourself to do some of those tests to actually run an assessment. And they're requiring that assessment to be provided before they'll offer coverage or before they'll renew coverage. So MFA , uh, is, is a big kind of a buzzword acronym. I , in the space that cares are saying if we don't have proof of MFA being implemented, we will not offer coverage. In fact, we will non-renew , and we can't even price policy for it without, without MFA in place. And so those are some of the things we've seen the last couple of years and quite honestly, our insureds don't really, truly understand the impact. So they kind of look to us from an insurance perspective. And of course, look to folks such as yourself from a security standpoint. So I think it's imperative today as we work with our clients, helping them understand the true exposure and then giving them the tools and resources to put in place. So we can then offer them the right coverage at the best price to make sure that you know, that they're covering that exposure.

Amber: 7:11

That's really interesting. I was actually really curious to kind of know some of that behind the scenes . So I was wondering, was the insurance agency reacting to a bunch of new claims and incidents, which you just indicated, or was it more like preparing for possible future risk? And it sounds like this was based on actual increase in claims and severity. Can you tell us anything about what those claims have come in at or what they were for?

Brandon: 7:35

Yeah. I actually have some claims scenarios as an example, some of the coverages that a cyber liability policy will protect is network security and privacy, privacy breach, response, business income, or loss of income. So if you can imagine your operating systems compromised, you can't bill, whether it's private bill, whether it's Medicare, Medicaid, if you can't bill to get your reimbursement that's revenue that you're losing while your system's down are compromised. And so those are some of the coverages that are provided multimedia insurance, extortion, terrorism, you know, as you guys know some of those buzz word buzzwords from your side, but as an example, you know, a network security and privacy breach, a financial institution's employee's laptop containing sensitive client data went missing. Multiple lawsuits are pending by individuals with data had been compromised. The Graham leach Bailey regulatory investigations ongoing as an example right now, total defense costs incurred 700 grand. Wow. Just, just because an employee lost his or her laptop that had sensitive data that required us to go out and hire a , a forensic auditor to, to try to dig in and understand where the breach happened, stopped the breach and put protection in place. You know, there's multimedia liability where an online manufacturer, accurately compared product to a competitive product. It was done online lawsuits ensued because it was done online. It was done from a website, was determined that it , it , it was a cyber security related cyber liability related offense , 375,000 for defense costs . Now, keep in mind. Most of the , the expense incurred is defending the policy holder or the insured from allegations or compromise that happen to their system. And on top of the defense cost would be that forensic auditing charge. And my understanding across the country, you're looking at three to $500 an hour for an forensic auditor to come in, you know and do their job to understand where the breach happened to do that analysis.

Amber: 9:41

Wow. That's really interesting to hear those specific examples. I wanna dive into what specifically communities can do to protect themselves and what , sort of the high touch items that they should ensure they have. But I'm just curious, do you have any numbers about the like percentage of increase in claims over the last few years?

Brandon: 10:00

Yeah, I , I guess I don't have anything factual, but what we try to do internally is we look at our client base and help them understand, you know, what we're seeing. So we're seeing probably about a 40 to 50% increase in frequency. So that means almost double so to speak. So if we had 20 claim before now, we're looking at 30, right? So about a 40 to 50% increase in actual claim frequency. And then the severity is actually becoming a little bit more expensive because of that forensic auditing amount of time required for folks to dive in and dig in and understand where the penetration occurred . So both frequency and severity are increasing and that's really year over year . So we run that data internally looking at the prior year, you know, assessing our client base. So that's a relatively small sample size, but I do think because of the breadth of our client base across the country, I do believe it does give us an adequate sample size to help folks understand what they can expect going forward from an insurance premium standpoint, we've seen some premiums go up to and 300% primarily because folks weren't adequately protected from the security side by implementing, you know, MFA as an example, or some of those other security measures. And they didn't have, you know, an approved assessment done on their behalf to show some of that security and or vulnerabilities to their system.

Amber: 11:28

Yeah, that's definitely in line with what we've seen from our clients. And what we did is we took multiple different insurance questionnaires and we put them together and we developed a score sheet of all the items that we wanna make sure our clients have at least discussed or aware of, even if they can't execute in all those items. So, Ryan, can you talk a little bit more about that and what are we seeing are the top items that are required from a technology perspective?

Ryan: 11:50

Yeah, so there's, there's a number of aspects, you know, really the best, the best way to go about it is to make sure you're being proactive. You know, there's from a security standpoint, you know, I mentioned it before, but you, you know, you wanna make sure your end users are getting adequate training around cybersecurity. Also, you know, you want to do regular vulnerability, penetration testing, which scans, you know, not just your external networks, but your internal networks as well. And that will identify, you know, security vulnerabilities or potential entry points, weaknesses in your networks and servers, things that you can, you know, actively address and resolve before they become a compromise, you know, from a , a regulatory perspective, there's the yearly HIPAA security risk assessments. You know, you definitely wanna be doing those, and those will help you identify again, weaknesses , um, in line with the HIPAA regulations and allow you to plug those holes. And then, you know, kind of in line with the proactive approach, you know, you wanna make sure you're doing routine auditing of just your security in general. So you want to either partner with somebody who knows the, the ever changing landscape of cybersecurity, or even potentially reach out to your insurer and find out what their standards are, what questions they're gonna be asking when, you know, it's time to renew your policy, because those things are always changing. So that's something you want to be doing at least once a year, just to make sure that you're keeping up with the evolving, you know, landscape of cybersecurity.

Amber: 13:20

That's really helpful. And definitely that proactive approach. And I think will help get communities set up to be prepared of the areas in which they may need to make some improvements. Can you speak to any of the specific technology that we've seen that we've had to implement such as the MFA and what is the impact of that?

Ryan: 13:36

Yeah. MFA is multifactor authentication. It allows technologies to kind of be more secure to technologies like VPN, you know, things that are, are generally targets for hackers, in a sense, it prevents the bad actor from, you know , easily gaining access because it requires a second form of authentication. Um, and that's, that's probably the most common, you know, the , one of the buzzwords you might hear more and more often, but , uh, there's other things out there like extra security around email, DNS entries, D mark , there's also security related things. Technology called S I E M , which looks for digital fingerprints or behaviors that would identify the elevated use of administrative rights on a network or on a server, you know, kind of, you know , newer technologies that really didn't exist five or 10 years ago that are allowing us a real high level overview of the, you know , technical environment in general and gives us , uh, early warning signs, if there's any kind of risk of compromise or signs of improper use of the administrative or technical systems.

Amber: 14:46

I think another thing we've seen that's really important is that end user awareness training. You know, you can make the analogy that you can have all the security that you want, but if, you know, somebody clicks on a link in an email they're not supposed to, that could compromise the whole system. So Brandon, what are you seeing in terms of requirements for that type of awareness or training on the end user side?

Brandon: 15:07

So from a care perspective, I mean , it's really the good carriers. I say, like the carriers that really, I believe, know what they're doing. They have the right coverages in place. They pay claims. They don't try to deny claims. They're really looking for that MFA because as Ryan mentioned that does help break down. I guess the amount of penetration, maybe not the frequency of penetration, but actually get through because of, of the way that's structured , carriers are wanting and desiring to see an assessment so they can look at and understand the vulnerabilities and then determine does their policy cover those vulnerabilities? And then what plan of correction is the, the , policy holder, if you will, or the insured, what are they willing to do from a plan of correction standpoint to implement some of those technologies or some of those , uh, software as an example, to offset the vulnerabilities that are found through an assessment. So it's kind of a slippery slope because the insureds don't, as I mentioned before, don't truly understand the exposure in the senior living space today with, with COVID and some other barriers staffing, you know, finances are pretty tight. And so we're , we're trying to help them and protect them. But then when we show some exposure through an assessment or, you know, getting an assessment from folks like you, we show that, and then we say, okay, you're gonna have to spend X amount for hardware for software. So then we can go out and, and get an insurance policy for you . That's hopefully gonna save you a few thousand bucks versus the tens of thousands you may have to, you know, from a CapEx to put in. So it's , it's a delicate balance, but I think communication is the biggest. So for us as an insurance agency, to understand what the carriers want and desire, and then help the insureds, understand how it's going to best protect them in the long run to help them justify that potential expense of, of updating and adhering to the assessment. Because really once the assessment's done, they have two choices, they understand what the assessment says, then they have to either adhere to it and put certain things in place so we can best protect them or not. And then that will have an impact on the premium or the amount of carriers that are willing to, to offer a policy, knowing that there's a vulnerabilities that they're not able to, to adhere to. So it is kind of a , a mixed bag. There's, you know, there aren't a ton of things that the carriers are requiring, but again, they do wanna see that MFA in place. And that's almost all insurance carriers today. And then also they would like, and really value and appreciate seeing a thorough assessment to understand where the vulnerabilities are or that certain things are in place against those

Amber: 17:36

Vulnerabilities. Yeah, that makes sense. So, Brandon , one of the things that we like to tell our clients is that when you're thinking about security, a lot of times it's a trade off between risk and convenience, right. And some of our clients do, they do choose to go with something that's maybe more convenient, but less secure. So, you know, even if they do everything right, you know, they could still get a cyber security event. Can you walk us through what would happen? Like what's kind of the high level step by step process of what happens if a cyber security event does occur?

Brandon: 18:05

Sure. Well, so one thing that we'll do is we'll ask to review any contracts that they have in place, whether they be vendor contracts, hospital contracts, anything in a contract that stipulates insurance related requirements or covenants of those contracts that they need to adhere to. And so when we review those, we're looking for things like, are you notification requirement, legal requirements? So inside those contracts, we'll see it. So as an example, if there is a notification requirement, then they need to know if there is a compromise, who are they required to notify and , and in what timely manner in fashion. So in , in healthcare, the senior living space, if there is a breach they're required to notify, you know, residents, residents, families, vendors that they're working with, whether it be pharmacy, food, service, therapy, obviously if they're working with a , a cybersecurity firm notifying them, but there are certain stringent notification requirements that they have to abide by. And as you are probably well aware, there's a cost to notification because of HIPAA. And because of the compliance from CMS that is placed upon these folks, there are certain requirements there from a notification standpoint. So system goes down, system's compromised. We want to be notified if , if we're working with them on , on liability. So then we can put the carrier on notice, help them understand we can reach out to partners that we have, or the carrier can reach out to make sure that we're getting the proper folks , uh, in place as quickly as possible to assess it. Cuz you guys may have heard of Chronos. There was a year-ish year plus and some change ago that is still having ramifications on some of our clients from an HR perspective, you know, in that business income. So it's then us seeing where's the compromise, what needs to take place today to mitigate any further penetration and then help them understand here are the next steps that have to take place to maintain and keep them up and running. So I know that's kind of a long winded Amber, I apologize, but it really is on a case by case basis. And based on the covenants of any contracts that they have, that we would then have a , a step approach. If this happens, here's how you respond. And we would recommend that they have that in their E.O.P or their emergency operating plan because they will, when , when survey comes in, states will go to that E.O.P and look and see, do have they done hazard assessments and what is their protocol, if and when a hazard were to arise, which also includes a potential cybersecurity breach.

Amber: 20:38

Yeah. That's really helpful to walk through that process. And then Ryan on the technical side, what is the typical response or what are the action items that can be done if a breach or an incident does occur and also can data be recovered? Should they pay the ransom? Can you talk about some of those things?

Ryan: 20:55

The answer here really depends on what kind of, what kind of measures were in place prior, what kind of prevention was in place prior to that compromise? You know, obviously from an it standpoint, the first thing you want to do is isolate any systems that were compromised, you know, remove them from any shared network resources or, you know, prevent them from being able to communicate with any other computers to kind of stop the spread. So that's the first step is kind of triaging, you know, identifying and isolating the infected devices. And from there it's evaluate what was affected, you know, what data was affected, if any, and how was it affected? Did it get copied off? Did it get encrypted? You know, and, and then you start taking steps to, to remediate clean up the infection, restore the data. You know, if, if you're , you know , checking all the boxes, you should have a backup and disaster recovery system in place. In which case, you know , the disaster recovery system could just potentially take over when you isolate those affected systems and you could have very little or no downtime and the backup system you can use to restore those affected systems. And if, if all the systems are set up and in place and, and working correctly, you know, you'll definitely minimize the impact and the cost of recovering from something like that. But on the flip side, if you don't have those protections in place, it can be a very lengthy and costly process to recover. It could ultimately mean a lot of downtime and a lot of lost revenue.

Amber: 22:24

So definitely prevention and awareness in that assessment front is really key. Absolutely . To minimizing the , the damage . Yeah . Yep . Well, Brandon Ryan, this information has been really helpful. I think this will be really useful to our listeners. Brandon, is there any final words of advice you'd wanna give before we wrap up? Yeah ,

Brandon: 22:40

Absolutely. Thank thanks for that. Cause I was gonna interject, but I wanted to let you finish. So just as I think through some of this, as I mentioned earlier, and I think you guys are aware , uh, a lot of facilities don't quite know and understand their vulnerability and their exposure, what I am seeing , uh, which is probably a Testament to what you guys are doing. That being Parasol and the industry is they're partnering with an it provider, a cyber security firm that's helping protect them. So one of the things I'm seeing is that a lot of folks believe that because they're partnering with the firm that they're protected and they don't necessarily need the cyber liability because it's extended through their contract. And so that's one of the contracts that I would review , uh, because there are what called first party coverages and third party coverages and not all policies offer both first and third party . So real quickly, a first party coverage is something that happens to you internally. A third party coverage is a breach that happens to your system through a third party access, whether it be a vendor. So let's say your partner with a pharmacy, you're doing electronic billing, the pharmacy's compromised. And then somehow through your connection with them, it penetrates your system. That is a third party coverage. And sometimes if third party coverage is , is deemed to be the culprit, an insurance carrier could deny claim because they're not offering third party coverage. And so it really is important to understand the difference between first party and third party . What is your it provider, if you're , if you're sourcing that or partnering with that, what are they covering on your behalf and what are you responsible for on your own independent of that contract? So I would just kind of close with that to help folks understand what they're contracting to entails. Are they getting a , a qualified assessment and make sure they're sharing that assessment with their insurance provider so they can get the best coverage for the best price , uh, as it pertains to cyber liability.

Amber: 24:38

Yeah, that's really excellent advice. And would you say that for most companies out there in the world in general that a cyber incident is not a matter of if it's a matter when

Brandon: 24:48

Absolutely. And, and the kind of the crazy thing, statistically speaking, there are more cyber incidences in smaller organizations than larger because most of those smaller organizations have an invested financially into being secure, but they think that they're, they're not targeted, but they are again, that's just from what we see , when I look at claims, we're seeing more claims from smaller entities than we are the larger corporate entities. We just hear about the larger corporate entities, more on the news because they have an appearance of a larger impact.

Amber: 25:23

Yeah, definitely. And that is something that we're starting to see that awareness with our own clients as well. I think for a long time, the industry maybe felt like they were immune or they were too small, but that's definitely changing. Ryan. Do you have any last words of advice you'd wanna give our listeners?

Ryan: 25:38

Well, sure. Yeah. From a technical standpoint, cybersecurity should really be a foundation, a major component of the it culture. You know, it's not something you want to just revisit once a year or think about after you've had a , a scare or an actual compromise. It should be part of every decision that's made from an it perspective and built into every process and system in your environment. Again, it goes back to that proactive component. You don't want to be reacting to cybersecurity cuz at that point it's too late. You want to be on top of things and you want to be proactive and, and be ahead of the game.

Amber: 26:12

Yeah, that's, that's great. And that is something I tell our clients a lot along with, you know, the security versus the convenience, but that we wanna really view all technology decisions through this lens of security so that we're ensuring that that's built into the foundation of what we're doing. Well, Brandon and Ryan, thank you so much for joining us today. This was really insightful and great information.

Ryan: 26:31

Yeah .

Brandon: 26:31

Thanks for having me

Ryan: 26:32

Happy to be here

Amber: 26:34

And listeners, thanks for joining us today. You can tune in next time for our next episode. If you have any ideas on topics you'd like to hear us discuss or you'd like to come on the podcast, please visit our website at parasolalliance .com and let us know. And thank you for listening.

Patrick: 0:03

Welcome to RaisingTech, a podcast about all things, technology and senior living. Today, we're mixing it up a little bit and giving our primary host Amber Bardon, a little break today. I hope to fill those shoes as best as I can. My name's Patrick Leonard, Chief Growth Officer at Parasol Alliance, the full service IT partner, exclusively serving senior living communities. We're excited to have Evan Friedkin from Roobrik joining us. Evan, welcome to the show.

Evan: 0:30

Thanks for having me Patrick.

Patrick: 0:32

I'm really excited about our conversation today as, as we were talking before the show, you know, as someone who grew up in the senior living industry on the operator side and as a family member of many who have gone through senior living and experienced it firsthand, I'm particularly excited about our session today because it's really where it all starts for prospective resident and their family members and their initial journey into exploring senior living options. But before I get ahead of myself and get too excited here, Evan , can you introduce yourself a little bit to the audience and, and tell us a little bit about how and why Roobrik was founded?

Evan: 1:03

Yeah. Happy to do that. And , so my name, my name is Evan. I am the head of business development here at Roobrik. And , so you can kind of think of Roobrik as a way to help folks who have to undergo highly complex decisions in a non pressured way to be able to be able to make those decisions much more efficiently, where the idea came from is when you think about a decision that is highly complex, usually medical, usually the search pattern is you go to whoever you think is gonna have the answer. First, when you go online, if you don't find the answers, your next step is to go to Google and you begin frantically searching phrases that you might think that you need to be thinking about. And Google's not really the friend of somebody who has to make this type of decision or any complex decision, because there is so much information that it's very easy to get sucked down that rabbit hole. And then you get information overload, you get paralysis by analysis and you just ultimately get stuck. And basically the founding of Roobrik was two founders who were found themselves in this exact situation. One was looking for a place for her mom and realized that there were not a whole lot of resources out there. And then the other founder actually had a preemie and realized that also there were a lot of decisions that needed to be made, but there was really no good one stop shop to get those answers, unless you wanted to talk to somebody directly. So they kind of thought to themselves and they said, well, what if there was a tool that asked you the questions that you should be thinking about? And then based on the responses to those questions, give you the resources that you need. And so that's kind of where it started. And fast forward to today, we've been in the senior living industry for about six, seven years. And that's what we've been doing. So helping older adults and family members get more educated on what is senior living and what options make the most sense for them.

Patrick: 3:06

That's awesome. Thanks for that intro. And it's , it's funny, you mentioned that the Google rabbit hole, which it could be a lot of fun when you're researching certain things, but not when you're looking for senior living options for y our loved one or for yourself. I never really thought about it like that. That's pretty good.

Evan: 3:21

Yeah. We're all familiar with the WebMD effect.

Patrick: 3:24

<laugh>

Evan: 3:25

Especially if it's medical, so I , I don't even need to describe it, everybody just chuckles because they know exactly what it is.

Patrick: 3:31

Absolutely. Absolutely. I love it. So one of the things that I think is really interesting about, about rubric is how you actually tie in the decision science model. And before I go and butcher that concept I'd love for you to kind of describe what does that mean? And can you tell us a little bit more about what that whole concept and why you guys incorporate that into your solution?

Evan: 3:59

Yeah. So this concept of decision science or motivational interviewing any decision you make, there is a process that you go through. There is a research phase, there's an understanding phase. There is you need to kind of first understand where are we today and then begin to understand kind of what's important to me what's important in this decision. And then we need to understand what are the different options that I have available. And once we're able to paint that picture and begin asking those questions, we all kind of know the best way to educate somebody is through really good questions. You can't tell somebody into their way of taking a next step. And so the importance behind this decision science is how do we take that person who is in this, in their own world and frantically trying to figure out what do we do? It's taking them, getting them to a point where they can just step back, go through these series of questions without feeling like they have to talk to somebody, but walking through that process that they need to be going through to make them feel comfortable, confident, educated, and motivated to be able to, to take that next step by the end of it. And so we really need to focus in on, are we asking the right questions with the right tone in the right way to be able to educate them as they go through the process?

Patrick: 5:23

Yeah, it's really interesting. It's really a much more helpful approach than kind of force feeding certain information down their throat that they're not necessarily looking for or need. That's just gonna confuse them and frustrate them more at that point in the process. So given, and I completely agree like the questions you ask, particularly at that stage in their journey are critical. And can make or break the rest of their journey a nd process in interaction with the tool or with that community. Can you tell me a little bit more about how you all come up with the questions that you're asking and what drives those decisions?

Evan: 6:02

Yeah. So the, the questions kind of first start off on the personalization side of things. We want to make sure that everything that we're asking them is personalized. That is the first thing that this audience is looking for. They're gonna , they're gonna say, or they're gonna be thinking things like, are they talking to me? And so early on in the, in our question flow, a lot of it is personalization and understanding where are things today? Then we, then we start moving into what is their background in the research. So have they looked other places? Have they looked into this before trying to understand what level of education do they have around their options. And then we move into those values and preferences. So what's, what's important to them. What is it that they're looking for in their next, in their next step? Then we move into, okay, what type of things may they potentially need help with? Or what do they need out of wherever they end up, we'll hit that. And then we move into timeline. So how shortly out are you looking? We get into a little bit of finances. So is financials gonna be a barrier for them or do they feel pretty good about it? And so everything that we're asking through this flow, we're also layering in that education. So we want them to understand why are we asking this? Because they are kind of slow to trust in this instance at the time that they're looking, they feel like everywhere they go, somebody's trying to sell them something. And so we're trying to, and o ftentimes the questions we ask it may actually be the first time they've ever even thought of that question. And so we try to layer in that education a nd say, H ey, here's why we're asking. Here's why it's important. These are some things to think about. And so ultimately, as you're layering in that education, it's building confidence. So it becomes easier for them to envision. What does that next step look like? So we're trying to layer one thing on top of another to really build up that confidence.

Patrick: 8:03

Yeah. That's awesome. And you know, really they're the ultimate benefactor of your tool when you think about it , the perspective residents and their family members in the way that you guys are able to, you know, have this undercoding of extreme empathy throughout the process is super critical for them. And , and I know it's much appreciated. So on the flip side of that, how do you if I'm a senior living community, you know, and I'm implementing this and putting this on my website for prospective residents or family members to interact with, you know, you have to have a healthy balance of, and you kind of alluded to it earlier, empathizing with their situation, educating, but eventually you're hoping to help make some progress, right? You're hoping to advance them along in their decision making progress, whatever that decision may be, of course. But how , how do you kind of tow that line? Right? That's a tough feat, especially when people are kind of at their most vulnerable state, they may not know where to turn and don't always know who to trust. You touched on a little bit. Can you expand on that from kind of a operator perspective, how you hope to provide that value to them?

Evan: 9:10

Yeah. So I think if we take a step back and we think about who the audience is. Let's say I'm an operator and I'm, I'm on the marketing team and it's my job to get as many high quality leads and I'm putting it in air quotes, but ultimately those leads are families over to the sales team so that they can get them the help they need. We need to be looking at the website and thinking, okay, what is it that my audience is looking for? There's gonna be a subset of people that are looking just to get in touch. They want to pick up the phone and call, or they want to fill out a contact form and they want to take that next step because they're already there mentally, but then there's this whole other audience. And we're watching this audience grow year over year. And that is, they're a little bit slower to trust. They're not quite ready to talk to a salesperson I'm guilty of this. I will do everything in my power to avoid talking to a salesperson until it is the last possible thing that I need to do to get me to the next step. So I kind of fall into this category and I , and historically I think , I think most of the audience that senior living served in the past didn't necessarily fall into that audience as much because it was a needs based decision. Now we're seeing that the shift to more of a wants based decision to get into senior living. And that means the buyer is changing. It's no longer the adult child or adult daughter looking for mom as much as it is the older adult themself . And the preconceived notion is that the older adult themself is not very technically savvy. That's not, that's not the case. I look at my grandparents and they are texting they're on social media. They know how to work technology. And so it's, it's shifting up, who are we talking to and shifting up the messaging in ways for them to engage? I think the biggest part of this is how do we let this audience, this specific group feel as though they are in control. So giving them options, do they want to fill out a contact form? Do they want to call somebody, or do you wanna do your own research? Which majority of them are in that phase where they wanna do their own research. And so it's, it's again, giving up the reins, letting them take control and being able to move through this process at their own pace, but with you guiding them. And I think that's the most important part is how can I have all these different tools that live on my website to meet people where they are and move them through that process. And so I think that's ultimately what, what marketers should be thinking about as they're going through this.

Patrick: 11:46

That's great. So right now in senior living, and I hate to even say it, because it's, you know, talked about so much, you think of two main issues out there, right? Obviously the staffing crisis and then occupancy is and always will be a concern regardless of COVID . So building off of the conversation we just had, where do you see your clients using this tool, if at all, to push the needle on occupancy or supplement other sales and marketing efforts that they may have at the community. People are always throwing different solutions to solve this problem while also making sure they're taking care of their residents. But at the end of the day, operators do need to stay full in order to provide that care and service. So how is your tool kind of complimenting these other tools out there to solve the sales and marketing? I won't call it a problem, but to, to provide that solution and that opportunity.

Evan: 12:48

Yeah. I love the question because it's not a linear process for a consumer or for this , the sales process is not a straight line it's , I don't, I wouldn't even wanna try to draw a shape because it's probably all over the place and what's great. So when we think about it, you can kind of think of it as this prospect or this consumer is on a highway and they're trying to get from point a to point B and they , they don't fully know exactly what point B is. They just know point B is gonna be to help alleviate some of their concerns. And along that road or along that path, there are different on ramps and off ramps that they're gonna take, they might be derailed, and they say, you know what? This is too overwhelming. I no longer , I don't want to go through this process anymore. They might just get off that highway, but they're still involved in to the salesperson. They're still, they're still there. They're gonna come back. Something is going to happen. That gets them back on the highway and begin getting closer to point B again. And so there are all these different initiatives and tactics that are, that are gonna be happening behind the scenes. So first database I'm sure sales teams have a database of leads that maybe haven't heard from the sales team in a while . They might, they may be getting some messaging from a drip campaign or something along those lines, but they may have been marked lost. They may have been disqualified for whatever reason, but there is a large database that is not getting the communication that they probably could. And I know there's a lot of talk around how do we mine the database for gold. I've seen a lot of webinars recently, I think with that subject or with that headline. And one of the things I always recommend to our clients is even though they might not have been a good fit for you a year ago, things change . We all know that. So why wouldn't you send a , send an email to all of them say, Hey, recently, things may have changed. You might be in the position where you're reconsidering your options. We've got this great tool to help you figure out what different options are available for you. Give 'em a hyperlink over to your ver to their version of the Roobrik assessment. Send it over. If you get 3% of them, re-engaging that is 3% that you already owned. You didn't have to pay somebody for you. Didn't need to pay to drive new web traffic to it. You just send it out and they re-engage - great. So that's one way, another way is they all have social media because they're trying to be a resource for the communities that they serve. This is another great tool that is that they can share with, Hey, we've got this great tool to help figure out what level of care either you might be a good fit, or you might know somebody that may benefit from it, feel free to share it. And so we'll see it being sent that way. We've seen it in news stories, through local news outlets being used for specific communities, but primarily it's from the website. And it's understanding that there are gonna be those people that want to just engage immediately. And then there's the ones that are kind of in anonymous browsing mode. Those are , that's kind of where we're ending, where we're really focused is how do we get more leads that are already on the website over to the sales team and from a downstream perspective, to get back to the conversion story that you had , or that you had brought up of, how does this impact occupancy? What we're finding is that audience that previously went unengaged is actually moving in faster than the ones that have already identified that senior living is what they want. So they're moving in a double, the rate of other digital leads and they've got they from what we're finding, have a 17% shorter sales cycle. So they're moving in faster.

Patrick: 16:16

Wow. That's interesting. And I didn't even think about all the different use cases too. You know, obviously the website being the primary driver, but I love the creativity that communities are using to kind of reengage and get the assessment out there. So that's fantastic.

Evan: 16:30

Yeah .

Patrick: 16:31

So can you talk to me, this all sounds incredible, right. And I just get excited thinking about it and the impact you can have on communities. Talk to me about practical implementation at the community level. Or corporate level, whatever it may be, who are you partnering with? What does that look like? You know, timeline, customization, adoption training. What does it look like from your perspective when you're partnering with the community? So our listeners can kind of understand on a real life basis.

Evan: 17:01

Yeah . So we recently heard from a few, so we're typically partnering with the VPs of marketing on the corporate level. Whoever is kind of in charge of the website that may be partnering with their marketing agency, could be , partnering with, if they've got the CRM, we'll do some integrations there, but a great quote that I've heard from a new new client is I loved it. Cause at the end of the demo, you said it was easy, but I was not expecting it to be that easy. I think that kind of summed it up, basically timeline from the time that they say, Hey, let's do it. It takes three to four weeks. It sounds like a lot but 99% of that time is on our end. All we need from clients is logos. Where do you want the leads to go? So who do you want the leads to go to? And then what phone numbers do you wanna appear on the top? Right? We do the rest. Usually most of those things they have in a file, they just share it with us. We'll set up the integrations on our end. We'll make sure everything's created. We get on a 20 minute phone call to review it. Make sure it all looks good. Everything looks good. We give 'em the line of code and they're ready to go. We'll, we'll consult on kind of showing 'em where on the websites, we recommend it being placed. We'll create a bunch of different tracking links for them to use in different campaigns. So in those emails and social media paid advertising, things like that. Other than that, that's really it. It does not take a whole lot of time. And it is one of the fastest things that you can do to , to get up and running.

Patrick: 18:20

I love it. Ease of implementation, very important, you know, with everything going on in the senior living community, all the different systems that they're working with. And that's that kind of segues actually into my, to my next thought or question for you, I guess, with any new technology implementation, two things I always hear come up first and foremost are integration and getting the data out of the system. So what types of systems does Roobrik integrate with at the community level? You have to go into specifics necessarily, but just the types of different systems and what types of useful analytics can be drawn from the tool itself.

Evan: 19:00

Yeah . So we integrate with all the major CRMs. So making sure that the lead gets over to the sales team with the responses, to all of the questions throughout the assessment . So that's first and foremost, it's making sure that that family can get the help they need as quickly as possible. So get 'em over to the sales team. We'll also send them through an email, but all the major CRMs will do the integration with marketing automation. So if the HubSpot, the active demands, all the, kind of the major marketing automation platforms, which allow marketers to create campaigns based on specific responses to certain questions so that they can send custom content to only the people that need it and really be super focused in their messaging. Ultimately allowing more of these people to move through the pipeline much quicker. So those are the two major integrations from a data standpoint, we have a lot of it. So we're going to on a monthly basis, send over monthly reports that basically will show you not just how the people who opted in or became a sales qualified lead for the sales teams answered the questions. We're gonna show you how everybody who completed the assessment is answering the questions, whether they wanted to talk to your sales team or not, we'll do that on the individual community basis. So across the provider so that they can see trends that way. But we also have a lot of industry wide data. So we can talk about kind of in different geographies. How does the buyer change different care levels? What does that look like? So there's all these different trends that we have access to just based on the sheer volume of people completing our assessment. So those are, those are some of the major, key data areas that we can dig into with clients.

Patrick: 20:40

I love it. That's super helpful. So what's next what's on the horizon for Roobrik. You guys have had quite the journey over the last six years. I think you said, you know, since being founded and obviously you can see the benefits for both, you know, the resident and family member perspective, as well as the senior living community operator perspective. Where you guys heading next?

Evan: 21:04

Yeah . So we, within the past year, we released a new assessment, which is, is it the right time to downsize? Which gives us the ability to work with more active adult and more independent living focused communities. It's less of a care needs score and more of a readiness score. So that's in about, I'd say 200 communities at the moment, our core assessments is it time to get help? And is it the right time for senior living? Are in about 1200 communities across the country. And we are probably by the end of Q3, beginning of Q4, gonna roll out a memory care specific assessment for those memory care only communities who really want something to dig in and much more focused towards those family members who are experiencing or who are going through the process of dealing with a loved one who has dementia or Alzheimer's or other other memory care needs that is going to be very different than all of our others, because the process has to be different. It's it's not a wants based decision it's needs. And a lot of it is not identifying does my family member have dementia. They usually know at that point, it's actually identifying more of where are you in your it's. It's really more for the family member to go through, not necessarily for the person with dementia, which is what our other assessments are designed for. It's really just kind of acknowledging what are the mental mental burdens that you're dealing with and just, and helping them get through that and giving them that catalyst that they need to take the next step. So it's gonna be released . So back to your question on what's next, it's releasing new assessments to become even more specific to help those people who are in these times of crisis, make good decisions and finding ways to do that more efficiently. So I mentioned back to the previous question, which was data. We get to see trends on at such a large scale that we can test out changes in real time , we make a change. So we've got about 20,000 people completing our assessments every month. The reason I share that is because it allows us to test something and see almost immediately the impact that that test had. So it allows us to change the wording of questions, to change the resources that we provide and see does that ultimately get more people ready to talk to the sales teams. So it's gonna be probably for the next year, really leaning into increasing the efficiency of the tool and ultimately getting more people over to the resources that they need to, to get 'em to help that they need.

Patrick: 23:26

I love it. Not only are you passing along and speaking to the data and analytics, you're passing along the communities themselves, but you're actually mining the data you're getting. From all of your users, taking those findings and incorporating it into your solutions and make 'em better. And, you know, with the initiatives you have through the next year that you mentioned with these additional assessments, you're taking a n already personalized solution and just p ersonalizing even more by doing these offsets for dementia memory care. T hat's really cool. I'm excited to see that.

Evan: 23:57

Yeah, no completely. And I've got a story that I think, I think the audience would probably like to hear, and mainly because they can take this story and do things on their end to make their websites more efficient. So now this, this test was run in the Roobrik environment across our portfolio. So of the 20,000 completes we did, this is how we did this test. So we looked at, we had this question that came up and we know 40 or 20 to 40% of the people who complete our assessment are going to become a sales qualified lead. So of the 20,000, just take 20 to 40%. That's how many leads we send over every month to the communities. But then we realize , okay, there's 60, 80% that said, no, I'm not ready to talk to somebody, but they did just answer 23 questions about the topic of senior living. So they're there, we just haven't gotten them to the point where they're ready to have the conversation. And we were wondering, well , why, what is what's missing? And so we said, all right , well, let's run a post assessment survey where we surfaced a popup that said, Hey, notice you didn't wanna talk to somebody why? And we gave 'em a few different options, 81% said, because they didn't know what it cost and they didn't know how to pay for it. So we took that information and we changed the call to action on our results page. So a little background for people who have not seen our tool before they get to the results page, after they've completed all the, as , or all the questions, there is a question that comes up that says, Hey, would you like to talk to somebody at the community? If they say yes, or maybe the next question's a contact form . And then that's when we send the lead over to the sales teams, but people are still given the ability to say, no, I don't wanna talk to somebody yet . And so it was those people that we raised this question to on the back end , if they have opted in and become a sales qualified lead, there's a sidebar that would be kind of community specific resources. But for the ones that said, no, I don't wanna talk to somebody that sidebar is a contact form. And so that contact form used to say, Hey, do you wanna talk to somebody at XYZ, senior living? So what we did with the data that we gathered, so the 81% that said, no, I , I don't know what it costs , or I don't know how to pay for it. We changed that contact form language or the CTA to , would you like to receive pricing from somebody at XYZ, senior living? What ended up happening was quite surprising. It increased our opt-in rates by between nine and 12%. It was the single largest increase in lead flow from our tool. And all we did was change three words. So what I would have for your audience that are listening is it's not necessarily giving the pricing to them. It's actually kind of demystifying the path that is coming up and it's giving them a clear path to be able to get what it is that they're looking for. So we are not giving them pricing. We're just letting them know, Hey, if you , if you fill this out, you're gonna get the pricing. And then we let the sales team kind of run it from there. So what I would do with some of their contact forms on different pages is maybe change that to, Hey, would you like to get pricing for this floor plan or something along those lines to help more people kind of take that next step? So that's the test we did. And that was single largest change we've ever made. Just off of changing three words ,

Patrick: 27:11

Three words, three words. That's amazing. It just shows you the power and impact of listening and mining the data and making decisions based on that data, opposed to having preconceived notions about what you think people want to be asked or want to hear. So that , I love that. Thanks for sharing that example. I think that's really powerful and it's a actionable takeaway our listeners can take today to start implementing. Well, this has been fun, man. I , I really appreciate you getting on the show with us. I think these are valuable takeaways for our listeners. Are there, are there any final thoughts or, or words of wisdom you'd have, I guess before we kind of part ways today?

Evan: 27:51

Yeah. Well first thanks. Thanks for having me. It's always great to great to reconnect with you. And, and I've been a listener you guys podcast for a while now. And, and so, yeah, I think actionable takeaways that I, I want everybody to kind of run with is try to stay away from assumptions. I think most of the time, it's really easy to fall into a rhythm and assume, you know, who your audience is and know what your audience wants. I always come back to that story that I'm sure most have heard, which is that world war II war plane that would make it back. And they hired these, these data scientists to understand kind of how do we, how do we protect these war planes so that more of them make it back. And they were looking at the ones that landed and they noticed that all the wings had holes in them . And so immediately looking at the data that they had available to them was, okay, well, let's reinforce the wings , the data set , or the data scientists that were brought in were like, well, what about the ones that didn't make it home? And so the same, what they realized it was the fuselage that was getting hit and they didn't make it home. And that's actually what needed to be protected, not the ones with the wings. And so the reason I'm sharing the story is because I think a lot of times marketing teams will look at the ones who moved in and then build their marketing plan based on the success stories. But what about all the people that didn't move in? Who are they, what are they concerned about? How do we learn more about them and create our marketing plans and sales tactics to speak to those people? And so that is kind of the story that I , I want this industry to take away is let's keep focusing on the ones that do move in. I think that's great, but then there's this whole other audience that has previously been unengaged. And usually they're called bounces when you look at websites and, and they are more than a bounce, they are , that is a family that's on the website looking for resources. And now we just need to figure out who are they? What do they need to see to get them the help that they need? So that's the big takeaway I'd give to folks and do with it what they want.

Patrick: 29:52

Awesome. Well, thanks for those final thoughts and words of wisdom for our listeners, Evan. Again, this was a lot of fun. I personally learned a lot. I know our listeners will as well. So listeners, thanks for tuning into this episode of RaisingTech. We'll see you next time with some more fresh technology insights for you . Make sure to follow us on social media and submit any topic, ideas or senior living technology trends you want to hear about in our website at parasolalliance . com. Take care.

Speaker 1: 0:05

Welcome to raising tech, a podcast about all things, technology and senior living. I'm your host, Amber bar virtual reality might sound like something that's far into the future when it comes to application in the senior living industry. But in fact, it's actually here and live in many communities. Today's show is featuring embodied labs. One of the companies that's bringing virtual reality to actual reality in the senior living space. Joining me today is Carrie Cuker , director of innovations and strategy and Yamin Dr. Endo head of marketing from embodied labs. Welcome to the show.

Speaker 2: 0:37

Thank you. Thank you.

Speaker 1: 0:39

So I am so interested to hear about how did Embodi labs come into being, what was the concept like what was the inspiration to bring virtual reality to senior living ? Can you talk a little bit about that?

Speaker 2: 0:52

Yeah, so the founder stories , really part of what I love so much about this company. Um, Carrie Shaw , who's our founder and CEO. Uh, she became a family caregiver at a very young age. Um, late teens, her mom was diagnosed with early onset Alzheimer's disease and in her early twenties, she became a full-time caregiver for her mom. Uh, and she didn't know anything about being a caregiver. So she was trying to understand how to keep her mom safe and give her great days and kind of work with what she had going on. And she realized that by using , um, she had these glasses, these goggles that she taped up with duct tape to , um, kind of mimic the visual deficit that her mom had. And when she put the goggles on, she could immediately see , uh , what her mom saw and understand that she had to protect her one side because she had a visual field deficit and she used this tool with , um, the home health, a who came in to help them really understand how to best care for her mom and why they needed to, you know, turn her plate so that she could actually see the rest of the food. It was really strange, you know, she was only eating exactly half her plate. Once they put these pieces together, they spun the plate and she would finish her meal. So it was really this very simple tool that grew into this idea of what, if we could allow people to actually step into the shoes of someone living with a visual deficit or living with dementia and really experience the world through their eyes. And so she was in her postgraduate degree at that point and was thinking about how could she, you know, make this a reality and connected with our co-founder Thomas Lehe to build this in a VR application so that when you put the VR headset on, you actually embody the person living with the condition, and that was the start of embodied labs. And now it's grown into this amazing library. We have over 550 , uh , minutes of content. So there's so much to choose from different life conditions. And , um, we're really just kind of helping to raise awareness throughout the aging spectrum.

Speaker 1: 2:55

It's so interesting how so many people who are founders came from an experience with the industry like that to go on and start a company to solve a specific problem. So tell me a little bit more about who is your target audience for embodied labs. And can you describe a little bit more about exactly what does embodied labs do and how does it help? How does it help improve care in senior living communities?

Speaker 2: 3:19

Yeah, so our target audience , um, is anybody who's going to have contact with an older adult. So it could really be pretty much anyone. Um, we started strong in the senior living space, but we've also expanded into government and academics and retail corporations to kind of prepare people for how to work with different individuals, you know, in their day to day dealings. So , uh , for example, my customer story, before I worked for embodied labs, I was a nurse educator at a long-term care facility. And we got this technology because our CNAs actually found it at a conference and said, oh my God, we need this. This is amazing. So anyway, we got the technology, we implemented it with direct care staff. And for the first time they were able to understand what the residents life felt like and what care felt like , uh , from their perspective. And it really changed them. Virtual reality has this weight of creating a perceived lived experience. So when, when you have this perceived lived experience, your brain thinks that it's actually happened to you and it creates a memory. And through that memory, it's developing , um, new pathways and a , a deeper understanding of what it means to have this condition and how to proactively care for someone , um , whether it's turning on the lights or muting the television or being aware of , uh , fall hazards or, or safety hazards in the home. You're aware of things that you wouldn't have been , um , without having this experience. And that's really been powerful as far as seeing lasting change with our caregivers.

Speaker 1: 4:59

Can you walk me through, what does it feel like when you put on this VR headset? What does the person actually experience and how is it different from just watching a video on YouTube? For example,

Speaker 2: 5:12

That's a really good question. So with our virtual reality experiences, we embody the person living with the condition. So for example, if you're embodying Alfred who has macular degeneration and high frequency hearing loss, once you are in the headset, you have this big black spot in the middle of your vision, you are hardly able to hear the people. In fact, it's funny because a lot of people will get in the headset and be like, can you turn it up? Something's wrong with the sound? No , that's just actually how the world sounds for you now experiencing life, experiencing the looks on people's faces when they're put off by something you've done or confused by a , you know, something that you're asking or a behavior that you're exhibiting, trying to navigate, even like a family dinner where you're just trying to grab your wine, but because you can't see you're knocking it over and causing this mess. And then how does that make you feel, you know, from a social perspective, what does that do to your self-esteem and your sense of wellbeing? So, you know, that's just one example of what people might feel when they're in the experience. We also talk about things like receiving a terminal diagnosis and having end of life discussions and the family dynamics that go along with that living as an older transgender adult. And how, how does that affect the care that you receive and just your quality of life when you've grown up in a time when discrimination was very real, you know, discrimination's still very real and how can we build a community that's a little bit kinder and more aware, and , um, how can we educate people on how to be an ally and, and be appropriate? Because a lot of times it's that people just don't know. Um, so we've really kind of run the gamut of, of these different conditions, social isolation, and , uh , Louis body dementia, and dealing with people who have a language deficit or who are struggling in some way with independence and how can we support them. So it's really, it's unlike anything I've ever experienced before.

Speaker 1: 7:15

That's such a wide range of curriculum. That's a lot of scenarios I've never even considered. How do you, what's, I'm assuming as you , uh , your , uh , title of director of innovation strategy, how do you actually come up with these concepts and what to train people on?

Speaker 2: 7:29

A lot of , um , the information, you know, our base foundational library with the macular degeneration and dementia and end of life . These are things that are, you know, very, very common in older adults. And this is the foundation for everything that we are creating now. And what's happened is we've kind of morphed and grown with society. Our social isolation lab came out right at the beginning of COVID , which was very timely. And it looks at life through the eyes of a recent widower and how, you know, he has kids and he's making efforts and it's , it's not really working out and how that isolation can become all consuming and really have some detrimental health effects. And it also shows the flip side, like what about when there are community resources and what about when families are engaged in the right way and able to really keep your life, you know, full of meaning and preserve your personhood, and what does that do to your physical health? So it's really this interesting dynamic. Some of our newer experiences are based on almost like a skill building curve, where I took things that I had noticed in , uh , my administrative role in the nursing home and thought about what do our caregivers really need? And a lot of what they need are these kind of problem solving communication skills and how do we allow them to practice some really difficult situations in a safe space. And so our customer service lab, you know, thinks about communication techniques with family and, and with coworkers and our elder safety and wellbeing takes a look at potentially dangerous situations with elder abuse and family members who are irate. And how do we diffuse a situation? So thinking about things like burnout of family caregivers, and the dangers associated with that, these things that we've really seen can impact , um, quality of life. And, you know, from a senior care facility standpoint, it impacts, you know, your, your state visits. And if you're getting dinged on this, that, and the other thing, if you have incidents with injury, if you have family complaints. So, you know, looking at all of those, like KPI measures and understanding how can we use our embodied technology to allow people to gain some of those skills and, and gain some emotional regulation, like a lot of new CNAs and nurses really struggle with end of life and postmortem care. So allowing them to go through the clay lab , they experience that. And they're a little bit desensitized so that they can be effective when the time comes to do that, you know, with a real person and a real family right there. So it's been exciting. And then, you know, the other pieces that our customers are sharing their wishes for content and their motivation, and we're doing some co-creations now. So we are just wrapping on one for social workers going into the home and how can a new social worker practice these home visits , um, assessing client capacity and their level of risk to make sure that people are safely aging in place that there's , um, the right resources implemented to make sure that they're getting their meals, that their bills are being paid, that their medications are managed. And again, allowing this to happen in a really safe space with , um, some interactivity and some problem solving along the way to , um, strengthen our, our home care fleet as more and more people are looking to age in place.

Speaker 1: 10:50

Can you tell me a little bit about the protocol and usage of the system? So is there a set of trainings that you do up front , or is it more of an ongoing training and what is your typical client like? Are you focused on a specific level of care? Is it really across the whole spectrum of senior living services?

Speaker 2: 11:09

We really focus on anybody who is interacting with the seniors. So it could be somebody in independent living or aging in the community. It could be somebody in long term care or hospital setting. There's a really strong interest right now in training first responders, to understand how to support someone living with dementia. So it really runs the gamut. And the way the library is built is that there is no prescribed curriculum. Um, people can really go in and utilize the pieces of the experiences that resonate with them. So for example, if you are supporting someone living with Alzheimer's, our Beatrice lab takes you through early, mid and late stage Alzheimer's, you might not need all three. You might already be at late stage, right? So, so there's a way that we can help , um, our customers kind of customize the experiences and the pathways that they're choosing to get the maximum impact in an efficient manner. The modules are meant to be consumed individually or as part of the larger story. So our character driven experiences, you can consume them part 1, 2, 3, but you don't have to, you can consume part two and still, you know, gain meaning and understanding of what the learning objectives are there. So, you know, we have the, the VR headsets and we also have a web immersive platform that has been really powerful to , um, to broaden our reach and to allow us to get this information to people who are at home and they don't have a virtual reality headset. So you can experience the exact same content in a web immersive format where it's a 360 video, you are still interacting. It's, it's the same experience, but it's web immersive as opposed to a fully immersive , uh , model. So that's been really exciting for us to, to get this into the hands of the people who need it,

Speaker 1: 12:58

Is this meant to be used along with more traditional training modules, or is this intended as a replacement for those other types of training out there such as reliance , for example.

Speaker 2: 13:08

Yeah. So reliance is great for, for skill building and knowledge checks, and they really, they're a great company. I have the utmost respect for Relias , what we offer that is unique. That's kind of our differentiator is this first person perspective and the ability to, to become someone else for a few moments and really experience their life and that condition, people care about things that touch them directly. And these experiences leave you with a memory of being touched directly by it what's happening, is that without even thinking about it, caregivers are naturally driven to have this actionable empathy and to, to really propel change and to advocate for better practices of higher standards of care, to preserve dignity and elevate the human above the condition. Um, so often we get lost in our task list and we end up thinking about, oh, I have to get these three people dressed today instead of, oh, how's Mary doing, you know, like what would give Mary A. Good day and being present in that moment? So our experiences, you know, give people that moment of ownership over the condition and to really like, have it resonate in a way where it does mean something and it does ignite action and, and change in a way that traditional learning formats typically don't,

Speaker 1: 14:30

That's really interesting. I didn't think of it from that perspective. I think that there is, you know, a trend overall in society to have some ageism against seniors. And I, I think it's really impactful that you're actually forming these em empathy , uh , memories, if you wanna call it that way, that's almost kind of shifting the way people think about older adults in our community . So that's really , uh , a great outcome. I know that some of our clients are using virtual reality for residents and their life enrichment programs is embodied labs focused on that. Or can you talk a little bit about the difference between virtual reality for staff and virtual reality for residents?

Speaker 2: 15:08

Sure. So embodied labs typically focuses on the people who are supporting the older adult , um, with the condition, our, our focus is not on the residents themselves. And, you know, if you think about it, if I'm going to put you, you know, behind the eyes of someone living with dementia and you have dementia that might be really scary , um, or confusing or disorienting, it's, it's not gonna be beneficial. Um, there's a company called mind VR that a lot of senior services use that is amazing, and they offer these virtual reality headsets that give you a breath of different experiences. You can visit the Eiffel tower, you can go underwater, you can go on a roller coaster through VR and for resident engagement. Those are the companies that , um, that's their focus and that's, that's their niche. So I think that there's , um , a ton out there endeavor is another company that does something similar. And what's been really cool is that you can have people in the headset, maybe someone's living in a senior community and they're in the headset. And you know, me as the granddaughter is at home and I put on a headset and we're able to talk and share this experience. So it's almost like we're there together. And that has been great for, you know, keeping people socially connected throughout the pandemic and just, you know, in ways when maybe it's not safe to be together in person, but to still feel like you're living this rich life. And it also gives people something to talk about like, oh, I just went skydiving before you arrived. That's amazing. Right now I have something to say instead of just, oh, I've been sitting in the chair, you know, watching TV or eating my snack. I just did something fantastic. And now I have something to add to the conversation. So it really helps people like, feel a sense of purpose and, and a sense of connectedness to the world in maybe ways that they're no longer able to physically be .

Speaker 1: 17:01

Do you have any specific outcomes or any stories that you can share from any of the clients that you work with?

Speaker 2: 17:08

So my favorite and probably because it affects me directly is that I did a caregiver support group using embodied labs technology. And it was a six week support group for people caring for someone living with dementia. And at the end of six weeks, we saw a 40% decrease in their perceived stress level. And to me, that was just such a profound outcome because being a caregiver is stressful and we all have other things going on in our lives. So it's not just being a caregiver, but it's also working a job and having a family and a house to take care of and bills to pay. So to be able to impact someone's perceived stress level in that profound way in six weeks was amazing to me. Um, so that is my favorite. I think overall, what we hear is that these experiences stick with people in a way. Um, we've had several comments from customers about, you know, oh, we did the Beatrice lab a year and a half ago, and people still talk about Beatrice and they still talk about, remember this, and you know, what about that? And it, it sticks with you. It leaves a little imprint on your heart and that has been consistent with our customers. It just, the experiences change you. And when you've been changed, it is reflected in everything that you do as a caregiver, as a human, the way that you interact with the world.

Speaker 1: 18:28

Let's talk a little bit about what a community would need to do specifically to get started with the virtual reality program. So what would you say are the keys to success? And can you talk a little bit about the ROI or the budgeting process, which I know is always top of my question for our clients when they're considering new technology.

Speaker 3: 18:46

So let me jump in on, on the question on , uh , on what a community would, would need to look at that. I think , um, it starts, I think with defining that use case and the goals and looking at, you know, the different ways in which embodied labs could be , uh , could be used for instance. So if you're looking to increase, let's say the number of move-ins or the number of professional referrals , uh , if you're looking to have community outreach , um, if you're looking to onboard higher trained staff. So all of those use cases are opportunities that embodied labs can definitely, you know, be , uh , in support of , in terms of demonstrating success in ROI. Uh , there's definitely a shift in how people care. Uh , we see the transformation, we see that they become way more proactive in their approach as opposed to reactive. So there is definitely a shift in behavior, a shift in, in the ability, a shift in empathy level. So being able to understand what , uh , the residents are going through and themselves, obviously, you know , being better prepared for that from a , uh , from a learning perspective, if we were to compare, you know, traditional methods over VR, immersive, or web immersive, you know, we can, we can say that it's, it's four times higher retention rate of learning that provides them with such greater confidence to perform their , their job on a day to day basis. And it's definitely, you know, it's definitely more , uh , impactful and transformative than , uh , than a traditional PowerPoint or even in person or even simulation teams. So those are all positive trends that we're , uh , we're seeing over and over.

Speaker 1: 20:22

I'm really curious to hear, I always ask all of our guests this, what do you think is next with virtual reality technology? What do you see is the future evolution of this type of technology in the industry?

Speaker 2: 20:34

I imagine there being almost like this marketplace for caregivers to go in the metaverse, to be able to , um, to get the support that they need to, to understand what, what is out there for them, and to be able to be connected with the world at times when they really need it. So, you know, for example, if you're, if you're able to go in and you need caregiver support, to be able to jump into a caregiver support community meeting, you know, forum, to be able to feel less alone regardless of the time of day, and to be able to connect with other real people, going through similar situations , um, to be able to get like caregiver 1 0 1 training in virtual reality, where you're actually interacting and physically practicing, like how do I transfer someone? How do I keep someone safe in the bathtub? Um, or, you know, in a shower chair, if they become combative, like how do I work through these things? We've seen so much as far as simulations , um , in VR for like surgical procedures and these really detailed, like medical procedures that are being done. And I think the caregiving piece needs to be next because we have so many people aging in place. And 80% of people who are family caregivers are the sole source of support for their loved one. They don't have other people coming in, they don't have a professional backing them up other than like their doctor visits. So being able to go into virtual reality and, and have the opportunity to practice with an expert facilitating this, you know, and seeing like how AI has come so far, as far as , um , being able to really like support people in just managing their mental health and being able to track things like, you know, depression or risk of falls or heightened confusion and speak to that in a proactive manner. I think it's just gonna , it's just gonna explode.

Speaker 1: 22:28

That sounds really exciting. Karen Yasin , thank you so much for all the great information, where can our listeners find you?

Speaker 3: 22:35

So thank you very much for having us , uh , Amber , uh , you can find us on our website. So www.embodilabs.com . Uh , you can fill in a contact us form or a request with us , uh , request a demo form , sorry. And , uh, and one of our , uh , one of our team members will , uh , will get in touch and , um , and take it from there.

Speaker 1: 22:55

Listeners, thank you so much for joining us today. If you have ideas and topics you'd like to hear featured on the show, please visit our website parol alliance.com and go to our resources page to submit a topic. You can also follow us on Instagram at Paris Alliance or in LinkedIn by searching Paris Alliance. Thank you for listening.

Amber 0:20

Welcome to Raising Tech, a podcast about all things technology and senior living. I'm your host, Amber Barden. 2021 brought a fresh set of challenges stemming from COVID. The great resignation, as it's often called, almost no company or industry has not been affected. Today, this is our topic. We're gonna be talking about staffing and solutions around staffing, as well as challenges. Joining me, we have a guest Charles Turner, founder of KARE. Charles, welcome to the show.

Charles 0:46

Thank you.

Amber 0:47

I wanna talk about a couple of numbers, to start off with. Before COVID, there were 2.9 million frontline caregivers in the post-acute industry, and about 50% of that workforce has left the industry in the early part of COVID. And it's also predicted that there'll be a shortage of 1.8 million caregivers by the year 2023. Charles, you've come up with a really innovative solution to address this challenge in the industry. Would you start off by telling us about your founding story?

Charles 1:11

Yeah, sure. So my background, for, gosh, 15 years or so, I was a developer, owner, and operator of senior care facilities all over the Sunbelt. So all over, you know, Texas, Florida, Georgia, New Mexico, and we were blown and going very sort of tech forward, but not really technology for technology's sake. Really trying to figure out how we, you know, we always said, how do we do care better? How do we measure the quantity and the quality of care that we provide to somebody? And a lot of that stemmed from my background prior. Before I ever got into that industry, I used to be in the enterprise software space, having nothing to do whatsoever with senior care, stumbled into senior care after doing a lot of hospital and medical developments fell in love with the industry, realized there was a lot of room to improve an industry that had a really high, you know, EQ, but it needed a lot more input on how, you know, how we can do care better.

And so we developed an owner operator, and then that put me in front of a lot of executives doing a lot of talks in the industry. And so around 2017 or so, I was actually in the process of looking to put together kind of an HTEC fund. So the idea was we would put a fund together, led by, you know industry leaders and then backed by private equity. And in the process of doing that, we were really looking at the staffing crisis. Now this is obviously pre COVID. But we knew even then, I mean, there was, you know, a workforce shortage looming on the horizon and we knew we needed to figure out a way to solve that. So in that, during that process, I was actually advising another company kinda similar to what KARE is, but it was in the acute care in the hospital space, kinda underfunded under scope, but we work on an advisory basis knowing it had, you know, the concept was rudimentary, but it was interesting.

We improved the concept out, even though these guys had been at it for a couple years in the hospital space. We tried to either license it or buy-in or everything like that. Ended up, it didn't work out. And then we decided as kinda industry leaders to create a platform, which is now called KARE, that's focused specifically on the senior care of the CO/CQ care industry. So founded the company in April of 19, built the platform or the first version of the platform. It was supposed to be just launching two buildings in Houston and Austin. The last week of October of 19 ended up being about, I dunno, 17 buildings or so and then it just took off from there and then COVID hit. It's been a crazy ride ever since, but we were blowing and going pre COVID. Then of course, during COVID, we've been riding the ups and downs of that. But it's helped put the notion out there that we have to figure out alternatives ways of staffing. We can't just be paying overtime, and it can't just be hiring staffing agents.

Amber 4:12

How did you come up with a concept for KARE? And you, can you talk a little bit more about what the platform actually does?

Charles 4:18

Yeah, that's a good question. So, you know, again, I put my operator hat on. Three things that we hate, right? I mean, one of the things that we hate, you know, we hate staffing agencies because we can't really control the costs. We also hate paying overtime. I mean, as an operator, I'm still an owner in these buildings. Now, the first thing I do when I get them, I look at my overtime line and that kinda tells me a lot about how that building is running. The idea was that we can't just continue to pay overtime. We can't continue hiring staffing agencies. And of course then during, obviously during COVID like the number of staffing agencies that are coming outta the woodwork, who just price gouging and sort of cornering the market have been pretty severe. So, you know, we looked at other industries and we were like, why can't, you know, the transportation market has Uber and other other industries have, you know, oil and gas has, you know, rig-up, things like that.

There's no reason we shouldn't reduce the same thing for us. And so the concept is very simple. The three things we all hate about staffing agencies are, one, they're far too expensive. We can't control the pricing. Two, you have no control over who comes through your front door. The staffing agency will sit whomever they have, whether they're good or not. And last, if you like that worker, you actually can't hire them. Staffing agency male you contractually prevented from doing so. We solve those three problems. So, we're not a staffing agency. We're a labor marketplace. Meaning we prequalified tens of thousands of frontline, healthcare workers, nurses, CNAs, med tech, LPNs, and RNs, things like that, to make sure they're qualified to work on the platform. We actually qualify facilities as well, that they're kinda debit licensing, good standing as well.

Then they're qualified to work on a platform. So the, the, the communities themselves set the pay rates, we don't set the pay rates, our rates, you know, we, we put a small per hour fee. And our rate is the same. Whether you wanna offer a dollar an hour or a thousand dollars an hour, we, you know, we don't care. Well, you're not gonna get a shift filled for a dollar an hour, but you can offer it. So the community set the pay rates, and then one to many, we call 'em heroes can apply to work that shift. Which leads to the second piece where, why we're so successful is, if I'm a community and let's say two people apply, you know, one's a 4.9 star. One's a 4.2 star. I get to see this reliability score, which is an algorithm that predicts how reliable they're gonna be.

You get to see all the information you get to see every review they've ever had on every shift. So I get to decide who comes in my community, and the good news is, if I give that person a four or five star rating, they're gonna get paid the next business day. If not, they've got to wait a week. So they're highly incentivized to do a good job. If I work for a staffing agency, I just have to do just enough not to get fired, cause I'm gonna get paid regardless. With us. It's different. If there's a bonus you wanna put on the shift, that person doesn't get a bonus unless they get a four or five star rating. And the last, if you like your hero, is you can hire them. We actually want you to hire them. We use companies all the time, use this as a platform to talk, you know, kind of a try before you buy, instead of, you know, hoping people show up for an interview. People come to work in your community. If they're looking for a full-time position, you can hire them. We encourage you to do that.

Amber 7:22

Since you started care, I've heard of other platforms that are similar out there in the marketplace. Was KARE the first one? And can you talk a little bit about how KARE is different than other options out there?

Charles 7:33

Yeah, that's a good question. To say we're the first one is yes and no. So we always tell people, a staffing agency with an app is still a staffing agency. So there are a lot of what we call digital staffing agencies out there, meaning that they, if you look at their contract, they tell you how much they're gonna charge you. They're ones where either they send, or one of their workers can basically kind of name it and claim it, whether that community wants them or not. And then you still can't hire them. So they don't have the benefits that we do. A lot, some of 'em still are also based on a subscription model, which never really works in senior care. Generally speaking, unless you're an EHR platform, your CRM or your financial system, maybe your nurse call system, nobody wants to sign up for a, a recurring expense. They may or may not use. So, we're kind of a pay as you go model, but so there's no one really has a model quite like ours. Most of them, you know, I'd call them digital staffing agencies. We've gotten the point now where we know our customers really do love working at our platform because of the transparency that a marketplace adds, where all the information is in the marketplace. And they really don't like a lot of other folks that they're basically a digital staffing agency, just with a technology wrapper,

Amber 8:59

When you mention the same day pay rate, I imagine that must be a little bit of a disruptor to the space. How do you address that? And is there other pushback that you get from the providers on using your app?

Charles 9:02

Are you saying, how has next day pay, our next day pay benefited? So, it is, our primary person who works in our platform is someone who has a full time job and they use the KARE app to make extra income. That's really what it was designed to do. We're not looking for people that wanna work on our app full time. We know that around 50%,cause we actually survey this, about 50% of the people who work on the KARE platform, work less than 40 hours a week. I'm not talking just with KARE. I'm just talking in general, their work lifestyles, like they work less than 40 hours a week. So one of the things that we know that's been extremely disruptive is that, you know, where state right are clamoring cause you can't workers because while you've gotta be a W2 employee and work at a facility or you gotta work for a staffing agency well, if a lot of workers can't right.

So because they can't commit to that level of fixed schedule, they need flexibility. So one of the things we know to be true, we're bringing people off the sidelines and on the margins who normally can't have not been able to work cause they can't commit to one of those things. And we're adding that labor capacity to the labor workforce. And we've seen that, especially like certain things where you get, you know, everybody's bad, but some are worse. It's like Denver, Colorado's really, really tough market. We've seen it where we've taken people who are kind of on the margins, who couldn't work, and bring them in. So people who like maybe there were school nurses and they couldn't work in the school. So that LPN came in and that would work. Or other caregivers who worked in other settings or they had family issues or they had kids at home cause they couldn't go to school.

Well, they now have a way to work and add that labor capacity back in the marketplace. We have, a lot of folks do love the next day pay aspect of itt. It's one of those things where, I encourage operators. We do a ton of research on the folks who work on our platform. So because we're the only few places where you actually have that amount of just, you know, a rich research base where you can actually ask frontline workers a bunch of questions. And we do know one of the things they really love is about next day pay. And then the flexibility we know that. 

I coach a lot of operat a lot of times like, look at your schedule, like look at your pay, look at your schedule. And there's no reason you couldn't do the same thing. Don't be beholden to an ADP just because that's how they do it, make money off of floating your payroll. Look at your staff scheduling. Like, do I need to do the 6-2, 2-10, 10-2 routine like everybody else does or are there other creative ways of staffing that may actually be more productive, in it would add more labor hours at peak times and fewer labor hours at lesser times. You know, our app gives this flexibility to do that.

Amber 11:53

We're all competing for talent right now. And that was the reason KARE was founded, was to be able to provide that solution to senior living. But I'm curious, how are you recruiting staff? What does your recruitment process look like and how are you able to find workers that's different than providers locally?

Charles 12:09

Yeah, lot of it goes back to what I said before. There's kind of two things, the next day pay and a lot of flexibility. When we go into a market, we spend a ton of money when advertising on job boards and a lot of digital marketing and things like that. And then over time it just starts to go viral. Like in the state of Texas, we don't spend any money on recruiting at all. And, and we're in all the major markets, secondary markets, and most tertiary markets. And we don't spend any money because we don't need to cause the app starts to go viral. But ultimately that's what folks, the vast majority of folks who work on our platform, they probably have a full time job, and they just use this as extra income. Like I think our average hero works a shift and a half a week on the KARE platform. So it's not like they're doing, you know, full 40 hours or so. They're just doing it to make extra income. So that's the big selling benefit of it. And again, by doing that, it adds extra labor capacity to the labor workforce.

Amber 13:07

Can you talk a little bit more about the benefits to the providers? I know that you do the direct hire, but if the majority of the workers are doing this as a side job, how does that process work for them to transition from a gig worker to direct hire? Or how frequently does that happen, and what are the benefits you see on the provider side?

Charles 13:26

Yeah, I mean, it happens all the time. It's funny. Like, well, we can't track it cause it doesn't, there's nothing to track. Right? Someone comes to the building, you want to hire them, hire them. We see it all the time where someone gets hired full time at a community. And then, you know, a week later on their weekends or days off, they're picking up extra shifts some other place back on the app. That's where, you know, one of, I know if I put on my operator hat, I know we had about 700 some odd frontline employees, and we knew about 2/3 to 3/4 of them had some form second job. As operator, I would rather my workforce have an app like KARE. So like, you know, I'd rather they work in another community or work at, you know, Amazon or Walmart  or something like that. It would conflicts, my PRN would have to balloon because my shifts would conflict with their shifts.

Well, if they didn't have those other shifts, they could pick up extra shifts whenever they want to. Well then I don't need my big PRN pool as much anymore. The folks that work for me can pick up shifts where they want. The other thing that we've seen was an interesting, especially early COVID, when and the skilled side on the rehab side, when these, you know, elective surgeries or quasi elective surgeries, sort of nonexistent. This census of a lot of these communities would decline and employers were having to shed workers. Everyone was trying to get 'em back now, but you know, if you remember, people are trying to shed like the first six months of COVID and what a lot of communities were doing was smart. They said, Hey, please, don't leave us.

I can't give you 40 hours. Stay with us, work, don’t  go over 28, but work on the KARE app, work someplace else, until I can bring you back on. So we actually had a lot of communities that would recommend that their employees download the KARE app to do that. We actually have a lot, we have several companies, not just communities, companies that are actively giving our stuff to their own workforce to make sure they get extras, so they don't leave. Like the workers, like their communities, but, you know, it's always like, oh, the extra dollar down the street or whatever. And so they're actually encouraging them to work on the KARE app, to work some other place, to make extra income and not leave a place where they're familiar.

Amber 15:46

Do you have any information you can share on the cost model from a provider perspective of using KARE versus traditional staffing and recruiting?

Charles 15:53

Yeah. So a typical staffing agency you know, it's kinda like a hundred percent market typically, right? So that's their model hire. They hire a handful of workers. And let's say if I'm paying about workers, say an index of a hundred, I'm charging the facility 200. What a typical staffing agency does, they'll mark up a worker about a hundred percent. So if they're paying them a hundred, they're gonna charge the facility 200. For us, we're much more simple. So we encourage our customers to pay our heroes about the same as they pay their own employees. So let's say it's a 15 hour employee, put $15 on our app. Our fee is gonna be you know, $5 for most cases, $5 an hour, $7 for certain nurses, but that's it. So it's $15 plus a $5.

So you're, you're in for $20. You're far less than a staffing agency. You can add a bonus to the app and if someone really needs because you need someone, a hurry, you, you can offer to pay a bonus. You know, it's like your discretion. And that helps people, especially last minute when you need people. And you can also for a $5 fee, promote it to anybody in the marketplace who is qualified to work that shift. That message will go out to everybody in that marketplace who really needs somebody, but that's it, it's pretty simple. There's no subscriptions, no long term contract, but simple terms of service that everybody has signed. And usually it takes 10 to 15 minutes to get a community up and running. And we're working with, you know, multiple hundreds of companies right now and all of  the facilities that those companies represent because the models basically, it's very simple. It's very clear. It's very transparent.

Amber 17:40

Can you walk me through what a provider would do to get started using KARE, and what happens if they're in a state where you're not yet having services?

Charles 17:48

Yeah. So the easiest way to get started, it's pretty simple. So we actually have two apps, right? We have a KARE heros app and we have the KARE community app. They can either download the KARE community app and hit the sign up button or they can basically go to our website or call us. And then all we do is we send you a simple form. You enter in all of your kind of desire to pay rates and a little bit about your community. Just like a picture of it, your logo, a few other things. And then we'll open up an account for you, send you a signup link, and you need to upload your state mandated documents, kind of orientation documents like resident bill of rights, infection controlled policies, things like that you have to have. And then boom! You're ready to go. You're posting shifts. Usually we’ll sit of people, when we meet with a person and it's 10, 15 minutes and they're having shifts filled within 15 minutes. So, it's really exciting. If they're not, if they're in a market where we're not yet, we are getting there. That we will be a nationwide, maybe with the exception of a couple of states, but we should be nationwide, at least in the major markets in every state, by the middle of this year. We're greatly accelerating our growth into those markets, which is exciting. And then you know, we'll be, we're fanning out from there. So we're in most, most kind of NBA cities in NBA, NFL cities now with the exception of California, but then we'll be, you know, all 50 states and most secondary cities by the end of the year.

Amber 19:21

That's awesome. Congratulations.

Charles 19:23

Thank you.

Amber 19:24

What do you see is the future of this type of technology? Where do you think it can go? What's the next level?

Charles 19:31

I mean, for us, it's gonna be, we'll expand out into other food groups, you know, meaning, you know, the therapy side of the business. We're already in the hospitality side of the business in Texas and Georgia. When COVID hit, we actually had a partnership, Hyatt Hotels. When they were furloughing so many employees that they encouraged them to download our app and sign up. So we actually got a lot of like cooks and maintenance and housekeeping and things like that. Certain markets will expand more into that. It's easier said than done, but, you know, we still are only kind of the tip of the iceberg on where we go, but we've gotta good runway ahead of us just to keep going on, doing what we're doing. And then probably at some point we'll we'll pick our head up and figure out what we wanna do next, but we'll most likely be in Canada and Western Europe within 12 months, if not sooner. 

Amber 20:31

What are your predictions on the staffing market shifting? What, like what percentages do you see from traditional hires versus something like KARE in the future?

Charles 20:33

I think the traditional hire will always be there. I think a lot of operators will get smart on how they provide the benefits that KARE does in terms of frequency of pay and flexibility. But I do see over time the traditional staffing agency model becoming significantly more minimized, and then other kinda labor marketplaces you know, ascending. So there's no reason with technology now. Yeah, the reason a staffing agency existed is because, you know, if you're a community, you don't have the time to recruit people for swinging labor, and you don't know who these people are, and that takes time takes resources. Well, now we have technology that does it for you. So, why do you need that person who sits in a cubicle, that just goes down a spreadsheet and figures out, you can come in.

The technology does that for you, and it directly introduces you to people you would not have otherwise met. I mean, it just only makes sense that this happens, and it's already happened in other industries. So why not in ours as well? So I think that's where you're gonna see it going, as you're gonna see people there is a tendency to wanna call it a gig worker. And there, you know, there are a lot of obviously gig aspects to this, but at the same point in time, I think this will just become the nature of supplemental labor, right? It's not, we’ll think of it less as a gig worker and more of a it is a platform where we find people and, and we don't need a staffing agency anymore

Amber 22:08

For providers that have a really strong internal company culture. How does the addition of gig workers, or part-time workers impact their culture? Have you had any feedback about that side of it?

Charles 22:21

Yeah, that's actually a really good question. There's, you know, one of the first questions we got, especially pre COVID, I think with COIVD that concern became less and less as acute need for staff has risen, but we still get it.  If I do this, bring people in, will it affect my culture? The beautiful thing about what we do, again if you go back to we're not a digital staffing agency, we don't send anybody, you choose who comes in. So the first line is like, okay, if I'm a community I'm posting shifts and like, you know, three or four people apply, well, I'm gonna pick the one at least based on ratings and not only just ratings, but they're actually different aspects of their work. Like, you know, are they personality driven or are they punctuality driven and things like that. Right? First and foremost, the community decides who comes in their building. They don't know that what eventually happens is that they find that people that have worked in their community that work well and fit their culture, and they feel that are part of their team. And they essentially become like a digital PRN pool, right. That PRN pool goes from being sort of fixed to being virtual. But they find those people that actually fit their culture, so one of the things, that was kind of a happy surprise for us, but as well as our customers, is they like it because of that concern, right? Is that unlike any other staffing agency they're picking and they're managing who comes in that door to, to fit their culture.

Amber 23:50

Do you have any success stories that come to mind where KARE has really been able to transform a community that was hurting from a staffing perspective?

Charles 23:59

Yeah. I mean, actually every day we get people who thank us. And that's one of the things, like I'm proud of our growth and I'm proud of our technology. But mostly, again, our partners come from the industry. I'm proud of what we've been able to do during COVID, because we've been able to, you know, administrators and management are burned out. I mean, they're just, with all things COVID, all things staffing, they’re burned out. We get calls and emails every day from people that are just thanking us for like, oh my God, you saved us so much. One of the ones that comes to mind is that the community, actually here in Houston, early COVID, where they had very strict protocols, a visiting outside nurse came in the building, visited a bunch of residents, did not follow their protocols.

And then called in the next day, and said, Hey, guess what? I'm COVID positive. That community had to send all of their workers home, quarantine all of their residents, and their regional called us and said, we'll take whatever you can give us. Got 'em quick, very, very quickly loaded up in the app. And they were posting, we ended up filling multiple, multiple hundreds of shifts for them. And they had no relationship with staffing agency, their assisted living community had no need for staffing agency up to this point. So they were eternally grateful for the fact that they could, you know, there's all the tools that we put into the app itself that could help drive more people to work which they were eternally grateful for. And so, their CEO is now one of our biggest proponents, kind of tells everybody about us because of what we are able to do. And then, we get a lot of stories about how much we've helped hiring.

You hear all these stories all time, put a job on Indeed. I had 93 people that applied for it, and 80 were qualified. We called all 80 of them. And then only 19 picked up the phone. And all 19 said they'd be in the interview. And only one person showed up for the interview. You hear that story all the time. And then for us, it's like, we love it. People come in, they work and then we hire them. Perfect. That's exactly what we want do. So those are the kind things that really make us happy. When we can at least partially alleviate some level of stress that goes on in the community, especially with staffing around COVID.

Amber 26:20

I'm curious to hear your thoughts about technology in the industry in general. So beyond KARE, what are you most excited about in terms of technology in the industry, in the future?

Charles 26:31

Yeah, I mean, it's one of the great things about COVID. If we can say that, it's greatly accelerated a lot of things that we’re really slow to adopt. You know, I've done a lot of talks on kinda, you know, age, the intersection of aging technology over the years. That was always a huge proponent of telemedicine and telehealth. And it was just very, very slow to adopt. Now we're seeing a huge adoption of that. I think that's gonna change the dynamic of how we do care. I mean, I'm hoping that it'll start to reduce the, oh, well, this is Jones is a mild rash let's send her to the ER, and go through that trauma. So, that's one of the things that I'm really pumped about, you know, the other thing is I was very much, let's say cynical about, you know let's call resident engagement technologies, pre COVID.

And the reason is, you know, that typically would fall into the activities bucket on someone's budget. And I think that budget's usually 4 to 6% of the entire community's budget. And everyone was trying to chase that dollar. I think there's only so many of those dollars to go around. Plus, at the time, you know, I have a, I have an adage of when it comes to care with technology and senior care, never ask a resident to do something they're not already doing. So you know, having them like, oh, I know I've never been a big fan of like, iPads for residents or anything like that, that they're not already using. I think resident engagement platforms have definitely, the adoption was forced, but probably it's gonna have a lot of positive repercussions going forward. You know, I think where  we're starting to see things get integrated, people asking questions about integrated data, data systems, normalization of, you know, the resident profile across disparate systems.

Like we've never had this notion of middleware. Other industries have had it for 30 years. And, and now we're just having these conversations like, oh, we have a nurse call system on a EHR, have got a management system, we've got a door lock system and like, okay, how do I manage that? Like what questions can I ask the data? The other piece I think is really interesting is there's always been a notion in senior care, the legalistic side. So I don't want technology in my building because if something bad happens, and I have the technology I'll be held liable for. Well, what's interesting is now, because the technology has become more prevalent, the case law is now saying that you can't hide behind not having technology in your bill. You can't use that argument more. It has become predominant now where you should have had, whatever it is, whether  its camera sensors or whatever. You have the ability to regionally implement this in your building, and you didn't and therefore you're actually can be held liable cause you didn't have the technology in your building. So that's kind of all happening at the same time. I think it's gonna be really fascinating the next, I dunno, five years where the stuff that the industry been fighting for a long time is gonna start seeing some adoption in different ways of thinking

Amber 29:42

Comment about telehealth. I'm curious, have you ever considered having KARE, provide those resources for telehealth since you've already got a remote platform built.

Charles 29:49

Provide telehealth resource, like from a, like on the KARE end or from a technology?

Amber 29:58

Well, using the staff that work for KARE to provide those telehealth services?

Charles 30:03

A little bit, yeah. I mean, we still need the infrastructure to do that. We actually have done some stuff with COVID. We actually staffed some COVID vaccine kinda stuff, but then that's an interesting question. I mean, hadn't thought of it, but it would take a little bit of pivot on our platform, but we could potentially invite workers who want to schedule tele-remote telehealth and have a ubiquitous platform to, to be you know, to kinda be the last mile between the resident and third party care.

Amber 30:33

Yeah. You've got the staff, so it would give them an option to provide remote care.

Charles 30:37

Yeah. Yeah. It's true.

Amber 30:39

Any final thoughts you wanna share with our listeners?

Charles 30:43

Oh gosh. Any final thoughts to share with your listeners? No. I mean, just, you can go to our website, if you wanna find out more. It's doyoukare.com. That’s KARE with a K. If you're interested, either caregiver or community or company, let us know. We’ll kinda show you what we do.

Amber 30:59

Yeah. And we'll list that information in the show notes as well. Thank you so much for joining me today.

Charles 31:04

A pleasure.

Amber 31:05

And listeners tune in next week for more fresh technology topics. And thank you for listening.

 

Amber Bardon

Welcome to Raising Tech, a podcast about all things, technology and senior living. I'm your host, Amber Bardon. And today our topic is all things smart home. To facilitate this discussion we have Keith Stewart from K4Connect with us. Welcome Keith.

Keith Stewart

Hi, Amber.

Amber Bardon

Keith, can you tell our listeners about K4Connect and your role there. 

Keith Stewart

Sure. Well again, my name is Keith Stewart and I'm the Chief Growth officer at K4Connect. I'm responsible for sales, marketing, and business development. I've been at K4Connect for about three years. But formally I was running worldwide sales for the IBM Watson Internet of Things division and broadly speaking, my entire career has been focused on technology disrupting different industries. And I think this industry in the last couple years in particular, but has really been on a big evolution and smart home has been a big part of what's been driving a lot of the change. K4Connect is a mission driven health tech company integrating the best in technology to serve and empower older adults and those living with disabilities. So we're really here providing powerful enterprise and analytical tools to drive efficiencies, better outcomes, new services for operators, providers, and payers.

Amber Bardon

Thanks for that background. I'm really excited to talk about this topic today. I think smart homes are a buzzword. You hear a lot, but maybe people don't always understand what exactly does that mean or what does that involve? So we’re really excited to dive into this topic today. To start off with, can you give us a little bit of insight into the marketplace trends? What does it look like in the marketplace and what is the appetite for smart homes that you see from your perspective?

Keith Stewart 2:02

I mean, broadly speaking, whenever we've talked about IOT, you can see some really eye-popping numbers. Just the amount of things now that are being connected to the internet. This proliferation is happening that by 2020, there were more devices connected to the internet than people. When you start mapping out that progression line, you'll see by 2050, it’s just gonna be unbelievable the amount of things that are connected to the internet. You then overlay the older adult demographic. There's a lot of supportive tailwinds that are happening there. More and more of the average older adult has been using smart phones for 10 plus years. They not only have email addresses, but they have high expectations on using technology. Those two trends combined are really driving a lot of this change.

Keith Stewart 02:59

And then you've got all sorts of devices that are just, again, proliferating. Whether it be things around the environment, lighting and thermostats and general things like blinds and fans and switches, all the way through to facilities types of things. Is your oven on, for too long? Maybe it needs to be turned off or energy surge protection or moisture and leak detection. Obviously we are seeing so much, happening in the wellness categories around just tracking your, your pulse or your heart rate, the number of steps, how well you're sleeping, oxygen levels. And really the big next big frontier is medicine and medicine dispensing and all of those things as it pertains to telehealth. So very exciting. And it's all happening now.

Amber Bardon

And that's a great point. A lot of people use terms like smart homes and telehealth, and they kind of toss those around and there is, there is a difference, but they are related to each other.

Keith Stewart

Absolutely.

Amber Bardon

Let's talk a little bit more about the application of smart home technology in the senior living space. Can you walk me through, what would it look like for a day in the life of a fully equipped, smart home senior in a community?

Keith Stwart =

Well, let's just start with waking up. And so I might wake up, I might look at my tablet, or ask my Alexa for what's for breakfast or just start my day before I even get out of bed. But then when I do get out of bed, I potentially, you know, it might still be dark. So I might have a lit path to it at the bathroom. I don't want to have a hundred percent lighting on me like a spotlight, but I want enough to where I can see as I'm walking into the bathroom. And that might be turned on through a responsive environment, through motion being detected or what have you. But once I get up then I want to know that the coffee is getting started. So that could again be triggered by motion or timed from, some sort of scene that you've set.

Keith Stewart 05:08

I might also walk into the kitchen and see that my morning medicine has been dispensed. But after that, I might then think, okay, “well, I'm gonna go, go for a walk.” I can start seeing that my steps are being counted, my heart rate being monitored or any other health metrics that I care about are being tracked. I might then have forgotten to turn off the coffee pot, or I might have forgotten to close the garage door or lock the door. And I'll have peace of mind to know that if I did do any of those things, the devices themselves are smart enough, or there's a routine that's actually going to make sure that those are close. The other fringe benefit here might be that, you know, when you've left your thermostat just adjusts to go into energy savings mode.

Keith Stewart 05:56

But ultimately through the day, my activities are starting, are being tracked. My behavioral data is being understood and I'm starting to trigger scenarios based on what I'm doing in real time, but also I'm adding to, and working with my trends data. At some point I'll return home, it could be in the afternoon or already into the evening. There might be any number of different scenes around your lighting, your temperature, or the music that you're creating, just for driving a mood. All the while my environment is responding to me, that environment is learning over time, based on that behavior.

Amber Bardon

That sounds like a really amazing experience for communities to offer to their residents. One thing I'm, I'm sure that our listeners are thinking about as they're listening to the description of this is what is the reimbursement model for this type of technology? I'm curious to know if you could talk about how is this structured in a community, and then alternatively, is this available just outside of a traditional community in someone's home?

Keith Stewart

Okay, well, let's take that one step at a time. In terms of reimbursement, I'm not really seeing much in the way of that. What I am seeing though is through different programs like the American Rescue Act and the Cares Act, there is funding that's being allocated specifically focusing on infrastructure. There are definitely ways that you can get started and find budget for these things with some, you know, local or federal assistance with that. And then the other thing that we often talk about is just if you're an operator and you're trying to differentiate, if you're looking at the sales and marketing side, this is a major differentiation. And really could boost levels just on the virtue of having this where a potentially a competitor down the street might not have that.

Keith Stewart 8:07

The other thing, we all know about the staff challenges that we're facing, and that growing challenge. You can think about the staff efficiency gains that you can get through the use of data. And, just understanding through the scenario that I talked about before. If you start to see certain trends that are troubling, it might drive behavior on how you're providing care. And so there, there's certainly opportunities for staff efficiency and really driving focus where you need that focus. Another element that you could think about is, through the proactive management of lights and your temperature controls. There's an opportunity for energy savings. Again, these are things that you would think about if you're building a business case and, you know, some sort of return on investment and payback model. And then a big one really is just the, the very concept of risk reduction and cost avoidance.

Keith Stewart

If you take the scenario through leak and or fire detection, if you're turning the oven off or you're proactively going in and finding water leaks through moisture detection, you're very likely preventing very large, expensive, maybe even catastrophic damage. And then again, I was telling you about that lit path to go to the bathroom. If motion is what's triggering that, you might have scenarios where you're doing, situational awareness, much like that staff efficiency game. If somebody went into the restroom in the middle of the night and you didn't see motion coming back out you might be able to rapidly respond and come in and potentially find somebody who's in the bathroom a lot sooner than you would've otherwise. There are all sorts of opportunities to drive very compelling business cases when you're starting to think about that growing list and types of sensors that are available. Very much on the business cut case side of things is very helpful.

Amber Bardon 

When you talk about the monitoring, that actually brings up a question that I frequently get asked by our clients about the whole concept of smart home technology. One of the things that I've heard people say that they see as a potential risk or liability with this type of technology is who is checking that monitoring. And if something is detected through monitoring like a fall or a refrigerator sensor or something like that, does that actually put the community more at risk because they didn't catch it soon enough for the monitoring should have told them. And I'm curious, from your perspective, what is your answer to that and who is actually doing this monitoring?

Keith Stewart 10:57

Well ultimately we're not actually taking any responsibility away from anybody who would already be caring about that. What we're doing is providing better information for that person to be able to do what they're already supposed to be doing. Kind of an adjacent part, everything that you're talking about is this concept of security and privacy. I think a lot of people like the idea that, they've got a digital safety net, they just don't wanna feel monitored. And so they don't want cameras in the bathroom or anyone watching them, but if it's pure data and it's contextualized by time and things like that, then you're really looking at it as triggering use cases. In the case of, from 6:00 AM to 9:00 AM I'd like to know that there's motion in the room, because that way I know that they're up and about, and that report can be sent to somebody who's responsible for tracking morning check-in. I would turn your point around the other way.

Keith Stewart 12:06

A lot of people are using very manual error-prone techniques for doing morning check-in such as, scanning the breakfast room just to make sure that they can visually verify that everyone's there;  very prone to human error. You would look at other scenarios where it's things like dialing a phone number in the morning, or pressing a button in the hallway, not really a natural behavior that people would think to do every morning, and so oftentimes they forget to do it. And if you're just really having that extra data to help you drive action, I would argue that it's, it's a lot safer than the other techniques are probably more prone to failure. Now, the other part of that being the security and privacy, of course. This is contextual data based on timing; just light went on, light, went off, that's not really a privacy or security risk, but when you start building out that model over time, and you start to get that behavior data with the context, you can anonymize that and secure it and just make sure that it's not in any way giving any HIPAA related information away. 

Amber Bardon

Keith, can you tell us what market segments are you seeing the most adoption of this type of technology in?

Keith Stewart 13:32

I think primarily when we were talking about the early adopters, we were really seeing kind of the higher end communities that were really embracing this. Oftentimes it would be the nonprofit providers that had a little bit more money, were focused more on differentiation and recruitment. But you're really seeing a lot of the for-profit moving into this space. They do look at OPEX probably more than they do at CapEx. And they're justifying these as either part of budgeted for new builds or differentiation and recruitment. You're really starting to see the trend go more and more to mid-market just purely on the basis of the of business cases are starting to add up. The cost of the sensors are getting less. Wifi is becoming much more prominent and just the fact that we've got such a challenge with staffing,you really need that digital safety net and, and that little extra support.

Amber Bardon 14:34

And I'm assuming you can and implement this just in part of a building or in certain units, it doesn't have to be a whole community implementation.

 

Keith Stewart 14:43

Sure. Yeah. I mean, we're, we're really seeing people drive this in a lot of different ways. The amenity element of this, the smart home is certainly something that you can do on a room-by-room basis. It might be upgraded during a room turn, if it's a retrofit. It might be an opt-in scenario based on, you offer it as a amenity upgrade and a resident might choose to go ahead and add the that on. So fro that side of it, the smart home amenity piece definitely on a room turn. If you're trying to drive core business practices like automating your morning check-in you would really want to try to standardize that across an acuity setting or like a hallway or something like that. So that you're not trying to mix and match based on who has smart home capabilities versus who doesn't.

Keith Stewart 

And we've even seen scenarios where they've put in the basics where they've got an edge device, like a control box, and maybe some motion sensors where they're able to do things like morning check-in and trend analysis in the room, but they're not really investing into the rest of smart home by adding smart fans and blinds and thermostats and all the other things that you could potentially go for. But there's really a lot of different possibilities there. And something that we're very accustomed to having conversations and driving based on need and budget.

Amber Bardon 16:12

Yeah. That's good to know, because I have a feeling for a community who is just starting down this path, it may feel a little bit daunting or overwhelming with so much that's out there and available. So given that, can you tell us where would a community start if they're interested in implementing smart home technology, what should they know? What are the key factors they should consider and how should they go about planning?

Keith Stewart 16:34

Well, honestly, just for the point that you just raised, there are so many options and, my number one advice that I give to anyone is just get started. This is the type of thing that will continue to run away from you if you just wait. Each year everything's getting faster. There's more device that are coming out all the time. Just get started. Just start to try it and have your own experiences with it. I would also say that you want to work with partners that have experienced in the space. There are so many different strategies that you can take, and certainly there are some better than others. I would also say don't try to do everything in the first go. The famous adage that Rome wasn't built in a day really applies here.

Keith Stewart 17:55

It's about just kind of tiptoeing in, getting some use cases going, understanding it. But when you get started, you need to have a longer term time horizon for what you're thinking about. So I'm starting today, I want to  get going, but I want to think about where do I want to be in two years and in five years. And that's not to say that anyone's going to be able to predict what technology will look like in five years, it’s just knowing that technology is gonna keep evolving, so get started now and think about that five year plan. The one thing that you know, is that you probably are gonna need very good internet. You're going to need enterprise, wifi, and you need to have a strategy that can scale. You need to have a, you that is extensible and, you know, just know that it's gonna grow with you over time.

 

Amber Bardon 18:13

That was one of the points I was going to bring up is I know from working with K4 on some projects and other systems that having that WIFI that's really comprehensive is really a key base of anything that you want to do around smart home technology or other artificial intelligence type telehealth systems. What else would you say are the key findings that you've had as takeaways from your implementations that make an implementation really successful?

Keith Stewart 18:42

Sure. Well, I mean, great point spot on can't under underline that point enough. Very good WIFI is always at the the root of all of this. But when you think about this, this is business transformation. And like anything with business transformation, you certainly need a champion for that program, so somebody in that community needs to really wake up in the morning and feel ownership of that. They need to be part of that transformation. But equally you need the residents on side as well. So if you think about the concept of a resident champion. I could go to the residents all day every day and just tell them how great this is, and they'll listen to me, but they'll certainly be a healthy measure of skepticism in that. But if their peers are starting to adopt it, if they're the ones talking about it, you start to build a little bit of that, keeping up with the Joneses, and there's more trust. There's more believability. They see themselves and their peers in the hallways, and maybe go over to their room and see that when they get up the lights come on or they're adjusting the thermostat with their voice. It just starts to grow in and of itself. And then the other thing is you need to expect that this is going to  continue to grow. And so whatever strategy you have just think about that continuous improvement element of that. 

Amber Bardon 

This is so much great information. I am so excited to we're here to share this with us today. Is there anything else that our listeners should know?

Keith Stewart 20:16

Yeah. I mean, I think it's all within the points that I was just saying, but, there's really no way that any of us could understand what the next big thing will be. The advice that I would give to anybody is whatever solution you pursue, whatever area that you try to get started on, think about your strategy with ease of integrating and ease of extending that solution. The other thing that we always say is that the Internet's not a passing fad, the Internet's here to stay. What's happening with the internet internet is just about making that investment and good WIFI. And then ultimately it's about just getting started. You need to get started. And where you begin is really up to you because you're going to be that much further on in a year than you would've otherwise.

Amber Bardon 

Thank you so much for your time today, Keith, and for coming on the show.

Keith Stewart 

Absolutely. It's my pleasure. And look forward to being on again at some point

Amber Bardon 

Listeners, thank you for tuning in to this month's Raising Tech episode, and we will see you next month with more fresh technology insights. Thank you for listening.

Amber Bardon

Welcome to Raising Tech, a podcast about all things technology and senior living. I'm your host, Amber Bardon. Today we have two guests with us, Anthony Columbatto from John Knox Village and Deepak Gaddipati from Virtusense. Welcome to the show.

Deepak and Anthony

Thank you. Thanks Amber. Thanks for having us.

Amber Bardon

Deepak, let's start with you. Deepak is the founder of Virtusense, which is a company you may have heard of. Virtusense has created a revolutionary falls prevention technology that uses artificial intelligence and innovative sensors. Tell us more about your founding story and how virtue sense came to be, Deepak.

Deepak Gaddipati

Yeah, so my background is in mission vision and artificial intelligence. So 15, 16 years back, I developed the first airport security scanner, that you you go lift your hands and looks for explosives. So we practically put in every airport across the globe and I took a break, wanted to do something different in life. When I was 26, I moved to New York city. So while I was there, I got a call from DOE to develop some technology. So I ended up working with the US Army for about six years. And while I was doing that, my grandmother who was 68 years old, she fel and broke her hip, and died as a result of a fall within 10 days from the day she fell. So that's what got me into trying to figure out what can we do to prevent falls. And that was my calling and I started Virtusense in 2013. 

Amber Bardon 01:43

Anthony. Can you tell the listeners about yourself as well and about John Knox village?

Anthony Columbatto

Certainly I'm the Vice President of Health Services here at John Knox Village. We're located in Lee’s Summit Missouri, which is about 20 minutes outside of Kansas City. We are the second largest single site life plan community in the country. And so we provide services from a range of independent living, assisted memory care, skilled. We have our own home health agency, hospice agency and our own ambulance service that we provide for residents both on campus and within our broader community.

Amber Bardon

Anthony and Deepak. Can you tell me the story of how you came to work together and how did you meet?

Deepak Gaddipati 02:25

So it is really interesting, right, Anthony? I mean, I didn't give, I'll give you a little bit of overview about Virtusense products, because I just said about why we started, so you can put the context together. We provide, we are the number one fall prevention solution in the world today. We take care of our 1.2 million seniors just in the US. We are in about 4,000 post-acute care sites. We are in about 40 health systems across the country and rapidly expanding our footprint. This was almost five years plus back, when we were just getting into the market. There is an insurance company called Caring Communities Insurance that actually is a captive insurance for quite a few not-for-profits. And John Knox village was one of the members. And at that time we we got connected with Caring Communities through a affiliation with Ziegler, and they were looking at our technology from fall prevention because 70% of the claims that happen in senior living industry are fall related. Anthony, you wanna take the story from there?

Anthony Columbatto

Yeah. So I mean, from our perspective, we've been trying to navigate the world of fall prevention for a very long time and our industry has not been able to move the needle a single bit. And so as we started to do all these different interventions and we did, we introduced new call lights and we did pressure pads and a variety of other things. And it didn't work. We at John Knox Village, we've always felt like we were trying to be on the cutting edge of new technology, new interventions to improve the lives of our residents. And so Jim Caldwell, the CEO of Caring Communities came to us and said, “hey, I’ve become familiar with this technology that I think is right up your alley.” And so Deepak came out to do a presentation. I think it was in 2017. And I think within 30 minutes we were all sold that this was the company we were going to partner with to actually prevent bad outcomes for our residents.

Deepak Gaddipati 04:43

It was really a very funny story. I was pitching and Jim Caldwell, and then obviously CEO at Caring Communities was with  JKV with Anthony and me, and he said, “hey, I'm willing to pay for this technology.” It was the balance, the assessment system back then, the first one. And and I still remember Rodney and Anthony said, “no, no,” it has enough ROI that we can buy it on our own. So it was very interesting when when they really saw a clear ROI for the residents and as well as my financial standpoint. And I, after that, I mean we deployed a VST balance and assessment system that in under 90 seconds figures out, who's at risk for falls based on balance, gate and function deficits. And it designs a care plan customized for each resident and tracks to see who's getting better and who's not, and it's starts de-risking the seniors. 

Deepak Gaddipati 05:43

The seniors. So that was our first engagement with John Knox Village. And right after that, I mean, the relationship went to the next gear. So during the presentation, I mentioned that we were developing a technology that is in room based that also is focused on preventing falls in skilled nursing and memory care. We said, I mean, we are here or a couple of years out in developing that. And we were focusing a little bit on the hospital side. So Anthony being Anthony, a man who is a very innovative leader, he said, “hey, can we get this in senior living? I, I need this like tomorrow.” I mean, he kept pushing us and we finally, even the same time we were testing us in hospitals, we had it like two years from the roadmap to get into senior living, but Anthony put quite a bit of pressure, they said, “I really need it. I really need it.” So we just got it in into JKV.

Anthony Columbatto 

I think if I remember correctly, I had it on my calendar to call you every three months until you would commit to me when we would be able to have it installed, because it was that exciting.

Amber Bardon 07:00

I love that persistence. Anthony, you said a few minutes ago that you, there hasn't really been any company that's been able to move the needle on falls technology. Tell me a little bit about what Virtusense actually does. So what does it actually look like from a resident's perspective or from a caregiver perspective and what are the benefits?

Anthony Columbatto 07:17

As Deepak mentioned there's two different applications that we're using right now. So let me, let me talk a little bit about VS, I'm gonna go backwards and talk about VST alert first which is the in room sensor that will notify our staff. If a resident is starting the process of getting out bed. We, through Deepak’s research and some of our own, we know it takes on average about a minute from the time that a resident starts the process to get out of bed till the time that they're actually out of bed. And a minute may not seem like a long time in the real world, but in our world, that's a lot of time for us to really get in there and help. As Deepak mentioned with the story of his grandmother, we societally do not know if someone's a fall risk until after they've had a fall, and that's really backwards if you think about that.

Anthony Columbatto 08:10

And there should be some ways for us to understand, you know, what puts someone into that high risk, medium risk, low risk category. We installed 11 sensors onto our rehab unit that was our highest area of fall prevalence and our highest area of claims that we had. And so we picked 11 rooms to do this pilot program with Virtusense over a six month period. And in that six month period, we saw almost an 80% reduction in falls from the previous year, which is substantial. And so I think, and Deepak would admit, we were the first, we were the guinea pigs. We helped them work through a lot of challenges, but it was, and is a really good partnership and learning opportunity. At the end of the day, we were able to prevent falls and, and that is something that we were not able to do on our own.

Amber Bardon 

Where do the sensors, are they on the residents? Are they in the rooms or how does that part work?

Deepak Gaddipati 09:12

The, yeah, let me explain how the technology works, Sam. So the in room technology uses a technology called LIDAR. This is basically what you see in your autonomous cars that figures out in 3D (CUT) what Google does on the autonomous cars or Ford’s autonomous driving cars, so it figures out in 3D, (CUT) where is the bed? Where is the chair? Where is the IV pole? Where is the patient? Where is the hand wash station? So it knows the surroundings. And there are AI chips built in on the system itself that take all this data 30 times a second, it captures all this data. We use two and a half millions such hours of data, trying to figure out what do people do before they get up from the bed?  And before they get up from the chair. because traditionally all you know is after. There are a bunch of things that tell you they have fallen or they have already gotten up from the bed, so it's too late. So using this AI, today we know 30 to 65 seconds before they get up that they're going to get up, with very few false alarms

. 

So as a result, when the system talks back with the resident in the room in a bunch of different languages, so it says, please don't get up, someone will help you. And at the same time alerts the nurses and the CNAs and techs on their phones or endpoint devices and in the central console and the nursing station. All this happens simultaneously that extra time of asking them to wait in their room, gives you an extra minute or two. So as a result, most, a lot of times when clinicians walk in the residents or seniors are still in their bed or in their chair and they're waiting.

 

Deepak Gaddipati 10:53

So that's how we are preventing significant amount of falls. And it's, you don't need, it's a super lightweight system. It's like that small. It just fits in your hand and it goes on the wall. And the most important thing to note is it's not a camera. It works both in night and dark. It uses like how do you think of a radar in submarines that uses Doppler and ultrasound and all that, this uses just light. It’s completely privacy centric. You don't know if it's a male or a female or a skin tone, nothing. And even all that data is only just processed and discarded. So we don't keep any of that.

Amber Bardon 11:32

That one minute response time seems like a short time window. How do you present this to caregivers in terms of being constantly aware and looking for these alerts to come in and what is your - what is the response like to alerts?

Anthony Columbatto 11:46

Our strategy was really to focus on the nurses. We know at any given time throughout the day, a CNA could be tied up in a room with a resident and that could prevent them from leaving that person in a vulnerable position to help another one. Our communication strategy was aside from the fact that, you have the opportunity to prevent a fall when a nurse has a fall on her shift, there's a lot of work that goes into that. Even for a non-injury fall. They have about three hours worth of paperwork to complete. They have to notify a family member. They have to notify the physician. They have to do 72 hours worth of neuro checks on the patient. In our mind it was okay, you have this device on you, you see the alert, it is worth dropping whatever you are doing to go help this resident, A, to prevent a fall, which is most importantly, but B all the after effects that, that come after the fall. And, and I think that was the, the key to get a lot of buy-in.

Amber Bardon 

What is the resident and family response to this? What are their thoughts on this platform? And do you encounter any resistance to this type of technology?

Anthony Columbatto 12:55

We have not encountered resistance. I remember the first time we deployed it, we had a daughter that we were informing about the sensor and what it could do. And I remember that the daughter ended up in tears because she said, “I can't even at home, get my mom to stop falling. And for the first time I have home hope,” and I'll never forget that story. We have them sign a, a waiver, just letting them know that there is a sensor in the room that we are going to be working with a a software vendor to monitor and to send alerts and things like that. I've yet to get anyone that did not want to sign the waiver that did not understand what we were doing. I think everyone has been very supportive.

Amber Bardon 

Deepak, can you talk a little bit about the growth of VirtuSense? How many communities are you in? How many residents are you serving today in the senior living industry?

 

 

Deepak Gaddipati 10:53

The bulk of our installations are in senior living. I mean so we had exponential growth in 2020, 2021, and so when we were working with Anthony, probably we were in about about a hundred, 200 communities. And so what happened after that is the assessment product VST balance got a very, very wided option because of the outcomes. So we started, so if you think about it, everything today in falls is reactive and everyone reacts after a fall happens, whether it's in a nursing home room or even in an AL or IL, everything is reaction based after you fall. So when we identify these deficits ahead of time, all of a sudden physical therapy, contract rehab providers, a lot of them got us into, they bought thousands of systems from us and put them in these communities where they were reducing falls significantly.

Deepak Gaddipati 

They were able to generate new revenue streams by identifying MED B residents. As a result of that, we expanded to almost about 4,000 facilities with the VST balance product. And on the VST alert side, we've been growing very consistently. We are in few thousands of beds in postacute side. And the same VST balance actually is also used now in primary care. It is used during annual wellness visits by primary care physicians, so quite a few health groups. Anthony, I don't know about you, but at least in central, we have quite a few health systems rolling this out, across all primary care in Chicagoland and quite a few places. Yeah.

Amber Bardon 

That's amazing growth. Congratulations.

Deepak Gaddipati 

Thank you.

Amber Bardon 15:32

Can you walk me through when you're having these initial conversations with a community, what are some of the benefits that you highlight? How do you talk about the ROI and the cost model and what are some of the other key things you think that community should know?

Deepak Gaddipati 15:46

Yeah. Obviously depending on what kind of community the ROI is different. For example, if you're looking at a just let's start with skilled, because that's where the toughest place where a lot of falls happen, right? So to give you a perspective, as I said before, 70% of the claims that happen in skilled nursing are fall related. So if you keep that in perspective, the industry numbers are average across the country. An average, hundred bed skilled community has about 1.3 settlements in a given year. I'm sorry, 1.5 settlements in a given year, and the average settlement costs is about $250,000. So if you think about it, they're spending about $375,000 a thousand dollars a year, and 70% of those claims are false. So when we did this study with Caring Communities Insurance, and what it came down to is we were actually eliminating the complete, we were reducing the claims by 70%.

Deepak Gaddipati  

This is almost, if you think about it, it's about a quarter million plus savings in a year, that's the first thing, The second thing is now your quality ratings, your star ratings go up. I mean, we've seen this in quite a few communities. I mean we actually did a case study in a different community where we reduced falls with injuries by 96% within a quarter of implementing this. And the nurse to patient ratio is something off late. We are seeing a big jump because we are going to be enabling pressure ulcers. We are already doing this in few hospitals now. So as a beta program, Anthony, so what it's gonna do is, I mean, if patients don't turn a bed, it's going to talk back with them and say, “please turn to your right side, or please turn to your left side.”

Deepak Gaddipati 17:41

And if they're not compliant, then it alerts the nurse. So as a result, we will be reducing about 70 to 80% of pressure ulcers that happen in any clinical setting. When you are doing all this in a highly automated fashion where your nurse doesn't have, or CNA doesn't have to go in every 30 minutes or an hour and check on the residents because we are checking them every 30 times a second. That really helps you provide care for more people with less resources. We are seeing this in both hospitals and post acute care. So these are some of the three big benefits, right? I mean, reducing costs, the liability legal costs. Enabling more, I mean, actually there is, if you are a using a physical therapy provider to use our balance system, then what happens is you also generate new med B therapy revenue, and you almost have a five to six ROI on that system right away.

Deepak Gaddipati 18:40

So that's why a lot of contract rehab providers use our technology today, right? So between all this and then day one, when we go and flip the switches, we actually, it's a ROI positive thing. It's immediate new revenue, cost avoidance, as well as quality metric improvement. And quite a few communities use this as a marketing differentiator like John Knox Village. When you want to put in your, let's say your mother who is 78 or 80 years old and visit three or four communities, everyone says the same thing. I mean, plus or minus 10% change in pricing. But you can say, put them through a quick assessment when they walk in, and show your mom is a high risk, and this is the technology we're going to use. This is how we're going to take care of them. And if they don't get better, then we put these sensors in their room to make sure we take care of them without falling. It’s a very simple decision for a family member to make.

Amber Bardon 19:36

Anthony, can you talk a little bit about how you implemented the program at John Knox? What are the things that you think were the keys to success and what are maybe some things you wish you would've known or lessons learned that you could share?

Anthony Columbatto 19:49

Well, yeah. And I said, I was going to go backwards and talk about VST alert first. I'll stick with that. That, that was a program that, I think we knew going into that,being the first, you have all the benefits of being the first community to have that you have all the pitfalls as well, right? Because we're all learning things together. I think I don't really have anything that I would've done differently with that implementation. Virtusense and the team were out here routinely on the phone with us as we worked through and learned together, and so that was a really good relationship. I'm a personal believer that, you know, we're not a customer, we're in this together. And we have always been treated like a partner which has been fantastic. 

 

Anthony Columbatto 

On the VST balance side, the reason I went backwards is even though that was on our campus first, it actually took longer to get that integrated into the culture. And that I think more so is, we didn't really understand the long term ramifications of using a product like that. And so very recently we've started to use that product more routinely. And as Deepak has said, we have seen a incredible increase in the amount of referrals for outpatient therapy that the group that is doing the VST balance and the outpatient therapy group are now meeting on a weekly basis to find out who did their VST balance system and who would benefit from therapy? We've told our residents that our goal is to have them do the VST balance every six months or so, because it will track them over the course of their lifetime.

Anthony Columbatto 21:26

It'll show if their gate speed has slowed down or their time get up and go is different, or their balance has just changed as they've aged. And it was funny. We're now starting to walk around campus and we'll hear, “well, hey, you’ve got to go get your balance test done. And so the residents are finally starting to embrace it because they want the same thing that we want, which is for them to age and place as long as possible, and to receive healthcare where they want to receive healthcare, as opposed to being forced to move through the system.

Amber Bardon 

What do you see are the real possibilities to take this technology to the next level in the next couple of years? What do you envision how Virtusense will look in the next three, five years in terms of outcomes in new products in, and tell me what you're most excited about.

Anthony Columbatto 22:10

I think historically senior living has been so far behind other interest industries from a technological standpoint that we're now starting to see a lot of companies flood the industry with a lot of different solutions. For us, we’ve had to carefully pick and choose because you can't do everything right? And so we've had to be very strategic with our partners. I think what I'm looking for is to partner with organizations that can continue to automate some systems and some processes for us and really to augment our workforce because we've all experienced tremendous workforce challenges, even pre pandemic, they're getting worse I feel like almost every day. And so we have to figure out like other industries have how to utilize technology to help us augment care, deliver care, whatever system that is, because that is going to be where the future is. That's where we're very excited to continue to partner with a very forward thinking organization, like Virtuesense so that we can continue to kind of look through that crack crystal ball together to predict what the future's gonna look like and how we can create a different future for seniors and a better one.

Deepak Gaddipati 23:25

So just to add on to that, Amber exactly what Anthony was telling. So when we started our collaboration relationship with JKV, Dan Rexroth, who is the CEO of John Knox village, Anthony and Rodney. They were the three pillars who saw what we were doing and where we are going with it. Right. I mean, it's not just the falls I mean, it was about the pressure ulcers and and it's about enabling care. So what happened during the pandemic is, it’s becoming very hard to get hold of specialty physicians to really help residents in a nursing home. And on top of that, you don't have enough staff to actually care for these residents. What we are doing now is, and we are already doing this in the hospital side where we are enabling telehealth. What we mean by that is, when a resident has, for example symptoms that are not getting better from a physical standpoint or pain standpoint, we can bring in a physiatrist onto the system within a matter of 24 hours.

Deepak Gaddipati 

So like that. And they can schedule a call and they come in and they provide care. And there is no cost to the facility, and physicians will bill directly through telehealth and they'll take care of the patient. And in most cases, there's not a lot of cost to the patient either because they're all covered to insurance site. We are not only just provide being predictive. We are being the ecosystem that connects and deliver care pretty quick. So Anthony, one more thing, there is a new partnership we formulated through which you can designate one room where we’ll put our hospital grade VST one inside the nursing home. And if you have any patient that has a stroke, within 90 seconds, you switch the system on you will get a stroke neurologist to evaluate the patient. So today if you think about it, you drive the patient to the ED and the ED it's about 20 minutes, 

Deepak Gaddipati 25:31

And then there is a stroke neurologist that needs to see them. The point is not all EDs have stroke neurologists. There is a huge shortage. So the company we are working with, they actually partnered with us on the ED side in the hospitals. And then we said, why should we wait another 20 minutes to make the call? Why can't we do this in the nursing home itself, or in senior living where all they need is and access to a nurse? So if we can get access to a nurse, they can do initial triage rather than waiting and putting them at a 70% mortality risk. Can we reduce that to 10 to 20% by identifying, by intervening ahead of time? These are new care delivery, enabling mechanisms through telehealth that we are doing. And additionally, we also did decent amount of work with Anthony and his team on vital monitoring.

Deepak Gaddipati 26:25

So we have FDA approved patches. These are like stickers that go on the chest that automatically measure all the vitals like heart rate, respiration rate, pulse, core body temp, PCG, and blood pressure. And the AI automatically looks at deterioration and would alert the nurses if the patient is deteriorating. So you don't have to wait to get vitals every eight hours, or 12 hours. COVID cases, you have to get vitals every two hours. So you don't have to use PPE or the mask. The system was automatically doing all this for you. And now we are working with Anthony to get it more into, independent living. A wearable that goes on your arm that can monitor these vitals pretty much real time. Like once every 15 minutes, it's like a small iPod. If you remember the iPod nanos that go on your shoulder it's exactly of that size. So there is quite a bit of innovation coming in healthcare and especially to be, our focus is to be proactive, right? We just don't want to tell after something happens, because there's already people who know what to do when a person has heart attack or respiratory failure. We want to find these out ahead of time. We want to find sepsis ahead of time. We want to find pressure ulcers before they happen, falls before they happen. So that's the pathway for Virtusense

Amber Bardon 

That sounds really exciting. I'm excited to see what comes next. Anthony and Deepak, is there anything else you want our listeners to know?

 

Anthony Columbatto 27:54

I think as dark as the last two years have been for our industry, I really do believe that we are headed for a very bright spot, and I think we've talked pre pandemic even about how this next generation of seniors, they're going to want to age differently. They're going to want alternative choices. And so now fresh off the pandemic, I think we're at a point where we are going to have some very significant offerings for them, and we're going to meet the consumers where they meet and want to be met, which is exciting for both parties.

Deepak Gaddipati 28:31

So just to wrap up on that, Amber, I think, I mean, I can't echo more. The last two years have been really, really tough on healthcare. But senior living, you had the toughest problems and least amount of dollars on the other side, which made it even worse. And typically healthcare is not only just senior living. In general healthcare, we have always been very a reactive society and always we threw people at problems. And this is the first time in the history where we don't have people to throw at problems. So this is where the key for, I don’t want to use the word, autonomous care, but to the level that we want to be predictive and augment the capabilities of clinicians on the floor, you can't expect them to run around and do everything and do all these original 20 things, and it causes burnout, stress and all these things.

And you need to take, senior living communities will have to make some technological investments like core base. You need to have a very minimal working WIFI for any of these technologies to work, right? So those are some of the investments they need to make on the infrastructure side. On top, they need to pick technology partners that can truly transform care for them and make some bets. You’ve got to move. You can't just drag, wait for miracles to happen. Because I mean, if anything that got thought in the last two years, unless you act, you'll be in a tough spot,

Amber Bardon

Great summary and wrap up. I love it. Thank you so much for joining me today. Deepak and Anthony. Thanks

Anthony and Deepak

Thanks for having us.

Amber Bardon

And listeners. Thank you for tuning in to this month's Raising Tech episode and we will see you next month with more technology insights. Thank you for listening.