Skip to content

Episode 19

The importance of clinical excellence and caregiver retention in home health care with Right at Home

Jeff Howell (00:01):

Welcome to Home Health 360 a podcast presented by AlayaCare. I’m your host, Jeff Howell. And this is the show about learning from the best in home healthcare from around the globe.

Jeff Howell (00:18):

Thanks again for joining another episode of Home Health 360, where we talk with home health leaders from across the globe today, we have LaNita Knote. Did I get that right? Knote

LaNita Knote (00:32):


Jeff Howell (00:32):

Knote I promise I even wrote it down. Okay, so we’re off to a great start. sorry, LaNita. She is the VP of clinical excellence with over 30 years experience in medical management, including utilization management, case management, disease management, quality assurance and call center operations. And she’s at right at home. She used to serve as the president of the American association for managed care nurses and is currently a board member and she joined the Omaha Nebraska headquarters of right at home in August of last year as the VP of clinical excellence. LaNita, welcome to the podcast.

LaNita Knote (01:13):

Thank you, Jeff. I’m thrilled to be here.

Jeff Howell (01:15):

And we also have Nikki Holles who joined Right at Home as VP of HR in December of 2019. In her role, Nicki focuses on corporate human resources, HR for right at home corporately owned locations and the employee experience. Systemwide Nikki brings more than 20 years of experience transforming HR departments into strategic business partners within the organization. Nikki, thanks for being here today.

Nikki Holles (01:43):

Yeah. Thank you. Sounds so old. When you say 20 years. My goodness.

Jeff Howell (01:49):

Well, the I heard a great saying the days are short in the years are no, the years are long and the days are short. Yes, no, no. Did I get that? No, the days are well, I’m, I’m really off to a bad start here. Cause now I’m even getting my normal colloquialisms mixed up but I do have to bring up that a few years ago, I visited Omaha and the bus that we were on, I think it was headed to a brewery and it of course drove by Warren Buffet’s house. And everyone was surprised that his home was smaller than what I thought the guest home might be. So I’m sure you get people say that to you all the time. Anyone who’s visited Omaha

Nikki Holles (02:29):

Yeah, he’s got a modest bode here. That is, that is true. But he’s definitely the icon of Omaha. Yeah. That’s how we refer to him.

Jeff Howell (02:38):

Well, Nikki, since you’ve been at Right at Home a little bit longer I did some research. I noticed you guys are in seven different countries. I thought that might be the highest global count of a franchise. I know you have over 60 locations in the UK. You guys are in Canada, Australia, China, Ireland, the Netherlands, Japan. Can you give us a sense of what the global entity looks like?

Nikki Holles (03:01):

Yeah, absolutely. I’m happy to. So lots of folks may not be familiar with, you know, with the franchise business model and, and really what it comes down to is yeah, we have presence here in the United States, obviously, and then our brand is in the seven different countries that you just referenced. And as such our, our brand is awarded by awarding what we call IMLS or international master licensees. And these IMLS in their respective countries are responsible for providing the support and the best practices and the resources that any franchisor here in the United States or overseas would provide to the franchisees that they then award within their countries. And so you know, lots of, lots of work that is I don’t wanna say duplicated, but is mirrored on how we work here in the United States. Lenita and I being at the corporate office here in Omaha, Nebraska, and providing support to the over 500 locations that we have here in the United States works very similarly globally. So our international master licensees in the UK, Ireland, Netherlands they will provide those same level of support to the franchisees that they’re awarding in their countries. So lots of great work across the brand for right at home that is happening globally. And, and we’re excited about continuing to grow those opportunities and, and expand into other countries as well.

Jeff Howell (04:44):

And I think I saw you guys are over at over 600 territories right now. Can you give us a sense as to saturation levels in different countries or you know, many territories that might still be open?

Nikki Holles (04:57):

Yeah, absolutely. So I, I don’t have any of the, of the specific numbers in terms of number of territories within each country. Mm-Hmm, that being said, I can tell you that they account for the international system comprises about 30% of our overall global F footprint. Okay. And accounts for about 20% of our right at home system revenue. So that, that gives you just a little bit of backdrop there on our, on our brand as a, as a global brand, that being said, you know, the pandemic of course, you know, put a, put a damper on the growth for a lot of businesses. We were not immune to that. There was a a period of time there, especially through 2020 where we saw a drop in revenue drop in hours not only here stateside, but also globally, that being said we’re really proud of the fact that every single one of our countries has rebounded and continues to see growth. And we see growth not only here in the United States, but across all seven countries that were in outside of outside of the United States,

Jeff Howell (06:16):

Was that just kind of a slow climb back to normal. And and the second question I have is this narrative around folks that say, well, COVID hits this, the demand for care in the home actually went up because we want to pull out all of our seniors from, from care homes. What did you guys see?

Nikki Holles (06:40):

Yeah, I, I think we absolutely saw that. Mm-Hmm you know, it was one of those situations where folks that were living in long term care facilities, skilled nursing facilities they found themselves in a situation where they were separated from family. So family wasn’t able to come visit you know, you, we saw those heartbreaking pictures of people visiting through windows. If somebody happened to be lucky enough to be on a ground level unit, that they were able to see some loved ones through their windows, but outside of that, it really brought to mind the importance and the significance of a someone being able to age in their home and allow for them to have a bit more control over who came into their home and how they came into their home and, and the safety there their, which, so it, you know, it’s one of those situations where it really highlighted the importance of somebody being in, in an environment that was safe for them.

Nikki Holles (07:44):

But as you know, as I think we all know that definition of safe is gonna be different depending on, on the person and that recognition of family support or, you know, those who, who act like family support. So family is, is what we make it. Right. So you know, that’s, that’s really what we saw. And so yes, you know, yes, we saw a decline in hours because for a while there people were, they stopped working. People stopped having to go into the office. And therefore there was more time for loved ones to take care of their own loved ones, as opposed to, depending on maybe agency caregivers. But then as folks started to go back to work and as folks were able to get out of those long term care settings and skilled nursing settings and go back into the home, the demand started to increase again.

Nikki Holles (08:35):

So then we saw that demand on the rise and really now the biggest governor on being able to provide care to clients across the globe is caregivers. So caregivers are in very, very high demand. That is, and I think we’ll talk about that here in a little bit, but that’s, you know, that’s no different in the United States than it is in Ireland or the Netherlands or, or China or Japan. This is, this is a pandemic in and of itself or an epidemic in and of itself is that caregiver shortage to really provide provide the care to the seniors that, that do want to stay in their homes as they age.

Jeff Howell (09:16):

Sure. And LaNita from a clinical perspective. So my understanding was that there was just this immediate need to relax the level of care because of the urgency of care. And you know, we saw things like zoom calls where at least temporarily allowed in some places, what were some of the kind of things that you were seeing?

LaNita Knote (09:37):

Yeah, I mean, there was creative thought processes into how do we continue care for people during the pandemic? Zoom calls, Facebook calls, things like that I think were embraced by the industry. I would say that we put things in place to make sure we could safely care for the people in person as much as possible. And we, you know, use the CDC protocols, we put everything in place to really just keep people safe and be able to still continually care for them because the majority of people really need us hands on to help them, you know, working from a zoom call is not gonna really do a lot for someone who needs someone in there to support, right. So we, what we could to, to support those that really needed us the most,

Nikki Holles (10:27):

I say to LaNita’s credit. I think she’s selling herself a little bit short because at all times, Lanita has had a, a presence of mind to ensure that yes, you know, we know that we need to get in, we know that we need to provide care, but it, but at all times safety was paramount and is continues to be paramount. Absolutely. for the clients and for the caregivers. And that really has been a very strong focus for Lanita and her group as, as we continue to provide support here in the United States and global, you know, and saying, this isn’t, this isn’t just about the dollars. This is not just about the revenue or the hours that we’re billing. This is about ensuring the safety and the wellbeing of both clients, their family members and our caregivers.

LaNita Knote (11:26):


Jeff Howell (11:27):

Yeah. The the caregivers had to run into the burning building, you know, while no one knew what we were really dealing with. What would you describe as the the, this sort of drop off or like staffing is a hard, hard to deal with, even in, in good times. So when, when the pandemic hit, what were you guys seeing from from your workforce?

LaNita Knote (11:48):

What we saw was a couple different things. I would say the first thing is we really dedicated caregivers. They do what they do because they love what they do. They care for our clients because they love our clients. So they did what they could to continue to care for our clients. Sometimes that puts us at a disadvantage because obviously we want people to support our clients, but we also want them to be well at the same time. Mm-Hmm so it’s, I would say, even as an industry, the pandemic just changed our thought processes about how you go to work. Like you need to come to work well, because we are taking care of very vulnerable people, but at the same time, it makes you appreciate how dedicated those caregivers are. We are no different than any other industry though. There are other people that were okay.

LaNita Knote (12:39):

I, I guess I’m sick, I’m not going to work, or I’m just not going to work anymore. And I mean, and all of that has impacted the caregiver shortage even more so because now it’s, it’s a little more scary for people to say, oh, do I really wanna go into someone’s home and care for them? You know, what’s, what’s the risk to me? What, what is my risk to them? So, I mean, I think that as an industry, we’re just going to have to continue to embrace the changes that this has brought to us and work to keep our people, both caregivers and clients safe and healthy.

Nikki Holles (13:17):

Yeah. And it’s a little bit of a, you know, it’s, , it’s a it’s, it’s tough, I guess, is, is the word that I’m looking for. And, and there’s no really way to sugarcoat that because the, the poll is so strong to care for the clients. And the poll is so strong for, for the clients to want to have the, the familiar caregiver that they’ve been working with. And so there are times when it is it might feel attractive to say, okay, it’s just a tickle in your throat. I’m sure it’s nothing. I’m sure you’re okay. This client really wants, you know, you to come and take care of them. There’s a, there’s a pole to wanna do that because that’s what the, the client wants and maybe that’s what the caregiver wants. But on the other side of that spectrum, there has to be a very healthy level of respect for the virus and a healthy level of respect for the fact that this is a pandemic and especially early on not knowing what that meant and not necessarily knowing how long it lives on surfaces and how long, you know, can it be spread through, you know, just, just nose and mouth, or is there, you know, other means of spread.

Nikki Holles (14:32):

And, and so there was a long time there that, that there was just a lot of uncertainty and fear and concern that was also being, you know, levied with this, this desire to really provide care and receive care. And so there was a lot of, there was a lot of things that had to be taken into consideration and, and, you know, hindsight looking at, it feels like it’s been 10 years, but hindsight looking 18 months ago. Right. you know, there may be things that people probably thought was overkill or what have you, but when, when you’re dealing with a vulnerable population, in’re providing care, that is, that requires, you know, a close human contact face to face. Sometimes you gotta take those, you gotta take those extra precautions and, and really recognize where the where the risks are. Mm-Hmm

Jeff Howell (15:24):

. So you, Nikki had just been in your role right. At home for a few months before COVID hit, I’m curious that’s probably just long enough to get your feet wet and then , and then this pandemic hits.

Nikki Holles (15:38):

Yeah. Yeah.

Jeff Howell (15:39):

How did things change for you on, you know, we, you, weren’t gonna get out here without talking about recruiting and retaining caregivers, so, oh

Nikki Holles (15:45):

Yeah. Right. I mean, this has been just an absolute roller coaster ride for so many reasons and, you know, coming aboard and, and, and really, you know, having the opportunity to, to lead corporate HR and the opportunity to lead our employee experience initiative, which is our department who provides support to the franchisees in recruiting and retaining top caregivers across the United States, you know, we had all sorts of plans for proactive strategies and maybe some different technology and some different things that we could do. And then you’re right. And then all of a sudden two and a half months into my tenure, this, this global pandemic hits mm-hmm . And all of a sudden I went from being, I feel like the VP of HR to kind of school nurse. Right. and you know, and, and working with Lanita to really be able to provide franchisees with that support that says, okay CDC guidelines testing, what is an antigen test?

Nikki Holles (16:58):

What is a PCR test? What’s an antibody test. What do they all mean? When can you test, when should you test, what are the symptoms? So all of those things are just, you know, they’re going we were just going through so much. And then on the flip side of that, there’s caregivers that are fearful to come to work that are homeschooling children because schools across the United States have shut down. So now they’re unable, even if they want to work, they’re unable because they are now being teachers in their own homes. They’re caring for their own loved ones, maybe they have in their homes, folks who are medically frail with immune diseases. And so they, for, for those reasons, can’t go out into the world and risk bringing home an illness to their own family members. So we saw that pool of caregivers just overnight, absolutely overnight just tank it absolutely tanked.

Nikki Holles (18:03):

And so, you know, we went from okay, you know, kind of status quo and we’re recruiting and we’re retaining to, oh my goodness. We have to understand the risks that our caregivers are facing along with the need to provide care to adults and their community. And so recognizing that restaurants are laying off that retail places are closing. Uber drivers are no longer having to provide rides to people that are, that are traveling for work. And so how can we utilize that population? That’s a population that is already comfortable and familiar with taking care of others, just in a different capacity. Mm-Hmm, , they’re, they’re serving others in a restaurant they’re serving others in a retail environment they’re providing support, but in a different way. So how do you take and leverage those folks who are out of work, but have been doing something different and, and make available to them, maybe this new career, or even just a bridge career until they get back on their feet in an, in an industry that they’re more familiar with into providing care for those in their communities.

Nikki Holles (19:19):

And that’s really where we created and worked. Our marketing department is amazing. You know, and really worked to create some, some promotional ways to get the word out there that, Hey, just because you’ve been doing this and now you might be out of work. Here’s something else you can do. That’s gonna be just as if not even more meaningful to you and, and what you do in a way to provide for your family, but also provide care to those in your community. So, so we found success in that. So a lot of different things that we were doing from a recruiting standpoint, but yeah, we had to think outside the box for sure. Mm-Hmm

Jeff Howell (20:00):

so we’re a couple years in now, are you guys starting to see some burnout with caregivers?

Nikki Holles (20:05):

You know, I would say in, in Lanata please feel free to, to chime in. Absolutely. Absolutely. We’re seeing burnout. Yeah. We’re seeing burnout with caregivers, but we’re also seeing burnout with the office staff that are within each of those franchise locations. Yeah. you know, we as an industry and, and these folks are called different things across the industry, but most probably commonly referred to as schedulers. Mm-Hmm , these are the folks that are scheduling care for, for the seniors. And they’re, they’re talking to both, they’re talking to the seniors and to the family members of the seniors who need the care. And then they’re talking to the caregivers on the other end, who are responsible for providing the care. And they’re, they’re dealing with caregivers who have to call off. And that might be because again, schools canceled have to do some things with my kids.

Nikki Holles (21:01):

My kids are sick, we have to quarantine I’m experiencing symptoms. It could be any one number of those things. And so that scheduler is really, oh my goodness, that, that heart, that they’re, they’re working with the clients on to who need the care, and they’re not able to find people to provide that care or they’re their struggling and, and just dialing for dollars to find a caregiver who can, who can pick up that shift. So, yes, we’re experiencing burnout from caregivers, for sure, for the very obvious reasons that we’ve talked about, but we’re experiencing burnout from those in the office too. And, and I think they’re kind of the silent ones that we don’t think about very often that are really experiencing burnout themselves.

LaNita Knote (21:49):

Yeah, I would totally agree.

Jeff Howell (21:51):

And would, and would you say most of your folks are actually getting back into the office or would you be including the people that are doing their office job from home?

Nikki Holles (21:59):

Most of the franchisees did not. They sent their staff home, their office staff home at the very beginning mm-hmm , but I, you know, risking of course not having talked to all 600 of the territories most of those folks, I would say a vast majority in the 90% are fully staffed back in the office were Fest working but again, there’s protocols there too, that you’re masking up every day. There’s the social distancing, there’s those that are still dealing with childcare issues or elder care issues of their own. But for the most part, I would say the franchisees have really worked hard to get that those office staff back into the office.

Jeff Howell (22:43):

Mm-Hmm any predictions on how the great resignation is going to play out. And the, the future, the near term future of the labor pool

Nikki Holles (22:55):

LaNita, I’ll take a breath here. I want you to

LaNita Knote (22:57):

Jeff Howell (22:59):

She gives you the hard ones Lanita

LaNita Knote (23:01):

She does. I do.

Nikki Holles (23:03):

But if you wanna talk about nurses and clinician staff sure. And then I’ll answer from another perspective.

LaNita Knote (23:09):

I don’t think any industry is immune from the great resignation people are looking for. I mean, just like every other aspect of the pandemic, it has really changed people’s philosophy on what you really want to do. And we, like Nikki said are not immune to the burnout and the COVID fatigue that we see in every other industry nurses being one of the big burnouts that, that is clearly in the headlines every single day. Obviously I have a huge network of that would agree that I, I’m not sure anymore that this is what I wanna do. I just, it’s just too hard, but I would also say that the, the network of nurses that we have right at home, and I think through the home care industry as a whole, we it’s different than working in a facility. And, and there’s less of that burnout.

LaNita Knote (24:10):

I think it’s harder for us just to when, when you walk into home care to understand what home care is versus what we did in the past. And, but once we’ve learned that and embrace that, there’s so many other things we can do that I would say decreases our burnout that you’re seeing out there. Because of COVID, there’s other things, you know, there’s always stress in every job and responsibilities that you may decide you don’t want at some point in time, but again, people all over the world are re-looking at what’s my career path and what I wanna do. So we certainly are not immune to that.

Nikki Holles (24:45):

You’re absolutely right. And when it comes to what I would call corporate pieces you know, outside of the, the caregiver world this great resignation is, is impacting every single company, every single industry in every single level of professional, we’re seeing it at a corporate office level. We’re seeing it with our partners, our vendors. This is, you know, what, what really has happened is the world has become the recruiter’s playground and no longer are recruiters, you know, stuck looking for talent in a specific community where a company is located. They are now able to look all globally, but, but for sure, here in the United States and, and that’s, you know, looking more and more attractive for folks. So, you know, we talk about unprecedented. I’ve never in my 20 plus years of doing this have seen a shift in workers like I am seeing right now.

Nikki Holles (25:52):

Right. I think it’s easier to say right now that we all know at least one person who’s changing job if not career simply because they can, because it’s available to ’em now. So, so we see it, we see it from a a corporate support standpoint, like I said, from our vendors, from our partners, nobody’s immune to it. And the word that I use I’ll call it the word of the day, but I feel like it’s become the word of the year or the last two years is grace. We all need to provide each other with grace. We need to provide our partners. We need to provide folks in the industry. We all need to have some grace because every single one of us are experiencing some really challenging times and levels of support have started to suffer. And that’s just, that’s just nature of the beast. So it’s time to provide some grace and recognize that we’re all gonna have to work together to really realize really what, what the new normal’s gonna look like over the next six to 12 months.

Jeff Howell (27:01):

Yeah, sure. It’s probably been two years of this cloud of anxiety hanging over us. And what we’ve all been really robbed of is our ability to let some air out of the balloon. You know, like I, the, the, the analogy I draws that I missed the people that were not in my department at the office because no one has ever, you’re never, there’s never any conflict with them. , they’re just there to shoot the breeze. And right. You know, there’s all kinds of people that, you know, that sort of offer that a little bit of stress relief that, you know, if you’re working from home for two years, it, you just become someone who’s attending zoom meetings and getting tasks done and with inflation and you know, we’re at the stage where people can sort of move jobs, why not get a higher paying job elsewhere if I’m just gonna be sitting at home all day in zoom meetings. So

Nikki Holles (27:50):

You’re absolutely right. And, you know, I, I am gonna use this as an opportunity to, to plug one of my opinions. And I recognize that this is just an opinion. But one of the statements that you just made really resonated with me in this regard and that’s, I can do my tasks. I can do my tasks at home. Mm-Hmm, what I think we all have to remember is that our jobs and what we do specifically in this industry are more than tasks. And yes, we can do our tasks sitting at home, sitting in front of our computer. But at the end of the day, we are here to serve a greater good, and a lot of times that’s going to require a lot more collaboration and networking and teamwork that that is gonna need to happen in the office. So I really wouldn’t be surprised again, this is my opinion. I wouldn’t be surprised as in the next 12 months, we start to see a shift back. Because I think folks are gonna realize that yes, I can perform my tasks. And some of those jobs will always be that way. There’s, there are millions of jobs that are task driven. Our industry, I don’t believe is one of them.

Jeff Howell (29:08):

Culture happens in person.

Nikki Holles (29:10):

It happens in person and collaboration happens in person. And and it happens accidentally at the coffee maker in the break room. So you know, it’s, it’s more than tasks. And and I think someday you know, I think we’ll see a shift coming back to that,

Jeff Howell (29:29):

Anita, as we move more towards a value based pay world and you know, especially expedited with COVID so that virtual visits and telehealth and remote patient monitoring, there’s more attention put to it. What are your thoughts on what does the future hold for right at home to help deliver better outcomes through some kind of like remote you know, better outcomes or what, what sort of things are you guys working on to, to try to help improve outcomes?

LaNita Knote (29:56):

Well, I’d say we always strive to improve the outcomes for our clients and collaborate with partners to increase those outcomes. We all know technology is changing and advancing at a very rapid pace. Unprecedented pace actually, and we’re, we will always be leaning into what that care technology would look like in the home. But to that point we’re involved in several pilots focusing on using technology to compliment our care in the home, but keeping in mind too, that the whole reason that we have an industry is to care for people. So you can’t replace the care of a person with another person with a technology, but you can support people with a technology and, and they’re, and as an industry in itself, I think we are really looking to how do we, how do we supplement, how do we compliment the care that we give people every day, hands on with an, with another mechanism?

LaNita Knote (30:58):

We haven’t found the perfect way to do that yet. I, I know that we won’t stop until we do as an industry let alone as right at home, but in the meantime, we’re gonna strive to improve outcomes. In other ways, we, for example, for us, we utilize very strong quality care standards, and we reinforce those with our network all the time with a defined scope of services that supports both the personal care services. That’s our core that, that personal care companionship and homemaker services, but also supports our specialized nursing services umbrella. That, that goes more into what type of services we could keep doing for someone that kind of steps over the line a little bit into home health, but staying true to who we are and our core services, just giving that extra support, maybe that’s maybe that’s a little bit of our end delegation maybe to do medication management, maybe it’s, I need to a nurse in there to help support tube feedings or catheter care, but whatever that is finding that right mix and doing that in those offices that can do that. And for those offices, we encourage accreditation with a home care body that helps keep those standards consistent and those quality levels high mm-hmm , and then our own best practices that we’ve found successful in our right at home corporate owned offices. We share those with our network at every opportunity to keep them and center.

Jeff Howell (32:29):

Yeah. Is this private pain nursing, or do you guys, do you do any Medicare?

LaNita Knote (32:34):

We do not do Medicare. We do do medicine, Medicare advantage. We have a couple of Medicare advantage contracts, but for, from a Medicare perspective, what we do for the most part is custodial. It’s not reimbursed by CMS. There’s really no reason for us in our core to have a CMS certified anything, to be honest even some of the, the nursing services that we support are still considered custodial. They don’t sound custodial. And, and I would tell you, any nurse would say, that’s not how we look at it, but from a CMS perspective, it still remains custodial. They’re doing a lot of experimenting their they’re working with the Medicare advantage programs to try to find a way to support us better in the home with those services which is why we work with some of the Medicare advantage partners same with the Medicaid waiver partners, but at our core, we’re a private pay company, but we’re always embracing and looking for new funding sources to assist our clients that as they manage the care in their home.

Jeff Howell (33:37):

Yeah. What percentage of the business in the us and be Medicaid?

LaNita Knote (33:42):

I don’t know that I have a percentage on that. It’s, it’s not high, I would not say,

Jeff Howell (33:47):

But it sounds like you’re two thirds of your business or three quarters, or even more strictly personal care, private pay.

LaNita Knote (33:53):

I would agree with that. Mm-Hmm

Jeff Howell (33:54):

would that be the, about the same in the other markets that you guys are in your mostly personal care private pay?

Nikki Holles (34:02):

Yeah. yeah. And I wanna give a shout out I’ll take this opportunity to give a shout out to our director of international operations, Tony B Carey who does a great job supporting our international master licensees who then in turn support their franchisees and their respective countries. And, and if you were to ask him, he would say, yeah, the, the model and the business mix is very, very similar mirrors, really the United States where it’s the companion care personal care. And then of course, some of those skilled or higher level nursing services that are offered, of course, each country Lanita. And I talked about this, each country has their different regulatory bodies and, and what can be done under each of those kind of scopes of services. But the business model itself is, is mirrored across all countries.

Jeff Howell (34:57):

Sounds like Tony’s the international man of home care

Nikki Holles (35:01):

Yes, he is. And he has years and years and years of experience in doing it. He’s he’s terrific. Great.

Jeff Howell (35:07):

Well, we’re almost up on our time here, so I’ll get you outta here on this last question. Give us a reason to be optimistic about the, about future of care in the home.

Nikki Holles (35:17):

I mean, honestly, I, I don’t know why anyone wouldn’t be optimistic about care in the home. I, this industry has been around now for over 27 years. We’ve been right up there with the first ones to the market. We have shown over and over again, how we can care for someone and, and really put us in a better place with them. Meaning I, I wanna age where I wanna age and that’s what we are designed to do is to help you age there. Some of the hardest transitions in an adult life is when they have to make those really hard decisions for their parents and their grandparents. And I’ve had to make some of those. And they’re, they’re very painful and they, I am so optimistic that we can do more. And the more that we can add in to support people to stay in their homes.

LaNita Knote (36:13):

I mean, when I look at it, I look at it as just for myself. It’s like, I don’t wanna, there’s a reason that we have long term care and I embrace the reasons that we have it, but it’s not that just because I’m getting older and I can’t do everything for myself that I need to go into a long term facility. There’s so much that can be done to support me in the home, both from my family, from a paid caregiver perspective. And that’s, that’s what people should really be exploring and, and embracing to see what really works for me. And that’s obviously my clinical type opinion on that. I I’ve been in this industry for almost 10 years now. And that’s, that’s how I’ve always felt about it. And when it’s my turn, my daughter’s very clearly been schooled on, on where that actually looks like and what, what we need to do. And I would say that to any other of my loved twins, too, for the same reasons. But Nikki, I’ll let you see if you have additional, you wanna chime in on that one?

Nikki Holles (37:15):

Yeah, no Lanita. I completely agree with you. I don’t know why someone wouldn’t be optimistic about this industry. This is, we are coming into a time right now from a, from a psychology perspective. You know, we’re looking at the, the next generation of seniors coming in as the baby boomers. And these are folks who have from, from when they were young, these are individuals who have been independent and who have been able to make decisions for themselves about themselves. And they’re very bullish on what they want when they want it. And so we’re gonna be looking at a generation here that is going to say, no, no, no, not so quick. I am not ready to go to a long-term care facility. I love my home. This is where I raised my kids. This is where my family became a family, and I wanna stay here for as long as I can.

Nikki Holles (38:13):

And so therefore let’s have a plan about what that can look like to allow that to happen. And so I think the more conversations that children and grandchildren can have with their parents and grandparents, and, and really creating that plan and understanding their wishes we’re just gonna see, we’re gonna see the industry, boom, but again, not because it’s good for dollars and cents. Not because it’s good for revenue, but because it’s good for our seniors, because this is, this is what they want when it comes to aging gracefully in place, this is what they’re looking for. And it’s our responsibility as a community to support them and then endeavor. And baby boomers are the biggest generation that we’ve got out there. And so we’re just gonna continue to see this need this need increase. So next, I think, I think really the next battle is recognizing the caregivers for what the caregivers do. And really elevating that role because of the significance and the importance that they play in this entire, in this entire piece.

LaNita Knote (39:24):


Jeff Howell (39:26):

Yeah, that was really well put. And you’re right. There’s a place for long-term care, but every research study I I’ve ever seen, it’s ne it’s a necessity, but it’s never anyone’s choice. You know the dominant numbers are people obviously want to age in place and die at home.

Nikki Holles (39:42):


Jeff Howell (39:43):

Well, ladies, this was amazing to learn a little bit more about right at home and nice to meet you both. We will sign off for now and I want to thank you for being on the show today.

LaNita Knote (39:54):

Thank you so much, Jeff.

Nikki Holles (39:56):

It has been such a pleasure. Love talking about something. We all have such great passion around. Thank you for inviting us. Yeah,

Speaker 4 (40:01):


Jeff Howell (40:04):

Home health 360 is presented by AlayaCare. First off. I want to thank our amazing guests and listeners to get more episodes. You can go to that’s spelled home health 360, or search home health 360 on any of your favorite podcasting platforms. The easiest way to stay up to date on our new shows is to subscribe on apple podcasts, Spotify, or wherever you get your podcasts. We also have a newsletter you can sign up for on to get alerts for new shows and more valuable content from AlayaCare, right into your inbox. Thanks for listening. And we’ll see you next time.

Listen to episodes on your favourite platform:


Episode Description

On this episode, we had the pleasure of chatting with LaNita Knote (VP of Clinical Excellence) and Nikki Holles (VP of HR) from Right at Home that has many franchises all over the globe from the North America to Japan.

These two industry experts talk about the challenges and growth of the franchised home care industry, and dive into important topics such as achieving clinical excellence across all locations, how Right at Home has coped during the pandemic, and what type of solutions they’re looking into regarding the caregiver churn crisis with home care software.

Episode Resources