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Episode 30

How an incentive program can be the key to increase caregiver retention and recruitment for your agency

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):

Hey, and welcome to another edition of Home Health 360, where we speak with home care leaders from across the globe. Today’s guest is an OG at AlayaCare. Kevin Mistry has spent time in the home health software market in Canada, the US and Australia as director of sales for all Eli Care, and he’s now ventured into a home care-based micro rewards company called Caribou Health as the VP of sales. Kevin, great to see you again and welcome to the show.

Kevin Mistry (00:51):

Thank you. Nice to be here.

Jeff Howell (00:54):

Tell me a little bit more about yourself and what’s led you to this point, Kev.

Kevin Mistry (00:58):

Yeah, so as you said, I spent a lot of time at AlayaCare, but maybe I’ll go back, go back in time a fair bit on what’s led me, what led me to that role and what led me to Caribou right now and into this industry. So, you know, I’ve heard the stories about how a lot of people get into senior care. A lot of them have been touched by, you know, a loved one that requires a service or something like that. I don’t have that type of story, but I do have a slightly different one. So this is going back quite a while, but my experience is more in the, like the agency recruitment space. I was back in school, I took economics in school and I still you know, live by supply and demand economics for most things. And back then I realized, I, I started an agency, a recruitment agency of my own, but quite different to anything that most of your listeners would’ve heard of. But I started a rent-a-goalie company way back, probably 20 years ago. I was an ice hockey goalie myself. I kind

Jeff Howell (02:11):

How to spot the Canadian, right, .

Kevin Mistry (02:13):

Yeah, exactly. It’s very Canadian. But yeah, I was a goalie myself. If anybody plays hockey that’s listening out there, they know that goalies are tough to come by. And so I kind of picked up on this and I guess the capitalist started to charge for my services and that became popular. I needed another goalie, another goalie, and I built up this little business in my twenties to about a hundred goalies playing games all over the Toronto area mainly. And that was my first kind of foray into agency work. I had no idea what that was, what that would be, or where that would bring me later. But I then got into the recruitment space, you know, staffing agencies working in-house as a recruiter. So, agency work matching supply and demand was my world for a while.


That eventually led me into this senior care space. I realized with that background, senior care was an industry where the same sort of dynamics was in a place like goalies, there’s a high demand for the product and not much supply. So it got me, that’s what interested me in, in this space. I spent a lot of time at AlayaCare. One of my last roles was diving deep into that supply and demand mismatch problem. And then I came upon this company Caribou, which I really thought was offering something very new to that specific problem. And it just got me interesting and started to dig a little bit more into the problems that we’ll talk about later and the solutions they had, And I just kind of fell in love with this little program. And it reminds me a lot of when we started AlayaCare. It’s a, it’s a smaller group right now, but tackling a very fundamental problem uniquely. And so anyways, that’s kind of what led me to this point. The long version,

Jeff Howell (04:26):

And I’ll shout it out right now, it’s caribou. care. Love the domain. I guess was probably taken

Kevin Mistry (04:33):

. Yeah. Yeah. So it’s

Jeff Howell (04:34):

Caribou.Care. So, Kevin, what’s your view on the caregiver shortage? Why does it exist in senior care?

Kevin Mistry (04:42):

Yeah, I mean, probably most of your listeners already know a lot of this information. But at the end of the day, I mean, senior care is, it’s a really hard job, right? It’s, it’s not glamorous, it’s tireless, it’s a tireless type of role. And that was before covid even happened. So you, you put Covid on top of that. And I mean, it was a perfect storm when it comes to why these shortages have now come to be. And you know, a lot of times in the past, these types of roles we’ve relied on foreign-trained professionals coming over c put a damper in that. So, you know, the last two, three years we haven’t had those workers immigrating, to our centres. And that’s hit us hard. Like that’s the reality of these, of this type of work.


So there are a lot of things. I mean, at the end of the day, also specifically in-home care, I mean, healthcare has been hit hard. I mean, the whole economy has been hit hard. There’s a supply shortage everywhere, but then you look at healthcare because of covid has been hit even harder. And then you drill down into home care specifically. And I think we are just, we’ve suffered the most from the market dynamics that exist right now. And that’s why, I mean, that’s why, again, it interests me because it’s such an important job. We must solve this problem. People must do this work, so we just, need to find these people one way or the other.

Jeff Howell (06:18):

Yeah, I saw some data as well recently with great resignation and people reevaluating and changing careers. The home care industry had such a small influx of new people as well and you know, almost sort of at the very bottom of any industry that’s out there, unfortunately.

Kevin Mistry (06:35):

Yeah. It’s it can’t go on like this. We’ve got to, we got to figure this out.

Jeff Howell (06:41):

So you folks try to go about this, not on a macro level, but on a micro level. So how, how, what’s your view of the world of how we can go about trying to help solve the caregiver shortage?

Kevin Mistry (06:54):

Yeah, I mean, we certainly go about it from a micro level, but we look at it obviously at the macro problem. And we can’t fix that macro problem. We know this, the supply shortage exists. But then we start thinking, okay, what kind of new ideas can we come up with, to fix it? And for us, it has been, an incentives program. So, we look at it in, three kinds of pillars, right? There’s the recruitment side of it, there is the retention side of it, and there’s the actual performance end of things. So how we’ve come up with our framework is we want to incent micro-behaviours. So when we look at just recruitment, for example, there are referral programs out there that try to encourage referrals, but they only kind of reward the result, right?


Then, a new person starts, which is great and the main component of it. But we can boost that effort by rewarding the behaviours that lead to that outcome. So things like when you’re talking about recruitment and referrals, it’s sharing, you know, having care workers share their jobs on social networks, sending it to a friend things like that that eventually lead to the referral. So we reward that type of behaviour. And then even inside, the recruitment lens, you know, when I talk to a lot of our clients and people in this industry, it is it’s so difficult to just get people through the recruitment cycle from posting a job to interviews to then getting them through training, submitting their, their background checks, and then just getting them to work their first shift. You know, if you can get over that mountain, the person is a much higher chance of staying with the company.


So even re-rewarding them through that process, we’ve been thinking about, you know, as they complete training, as they submit their background checks, as they, when they work their first shift, they can get these micro bonuses through that process. And if we can even, you know, just that alone, if we can solve, get us to you know, a much better place. But then also once they’re hired, the retention piece, you know, recognizing them for a job well done. Having service milestones. So once they work a month, three months, or six months, rewarding them for those smaller achievements. Again, in the past, people sometimes have had these retention milestones, but they tend to be after a year, or after five years, which is great. But the reality is these days that if we can just get these people past the initial hurdles of taking their first shift, being with the company for a month, or two months, then again we see them, we see them, we reap the benefits down the line.


So it’s those kinds of smaller incremental rewards that we really think are, are, we’re seeing a lot of ROI from. And then just to finish off that thought, our last pillar. So recruitment, retention, and then on the performance end is really where it gets I think a lot of fun and interesting. And our companies are coming, our clients are coming up with a lot of different ideas on how we can reward smaller things that just lead to big outcomes. So, you know, things like working more hours in general. I mean, we need more capacity. We need people to be, to be working more. So just if they work a certain amount of hours, rewarding them for that. Incenting them to take harder-to-fill shifts. I mean, I know even from back in my goal rental days, at the end of the day as a scheduler, you spend 80% of your time filling, you know, that 20% of hard-to-fill shifts. If we could help that, that would be huge. So providing

Jeff Howell (10:59):

Midnight games in the middle of nowhere, that kind of thing. .

Kevin Mistry (11:02):

Yeah, exactly. So yeah, and then we, you know, filling out, completing surveys, whatever it is that a company is having difficulty with when it comes to their field staff, we can start to brainstorm and think about a way to incentivize that behaviour through the overall rewards program.

Jeff Howell (11:23):

Got it. Yeah. And I love the idea of the front end loading the dopamine hit of getting 500 points for celebrating your one-month anniversary.

Kevin Mistry (11:34):

Yeah, I mean, that’s the thing days it’s not about them staying for a year and five years. Like, let’s just get ’em past that three-month mark.

Jeff Howell (11:44):

Right. what would you say are the top use cases that you’re, you’re seeing your clients implement?

Kevin Mistry (11:52):

I mean, the recruitment end has been the easiest to see the ROI on right away. So most of our clients are using us for recruitment and to get better referrals. Most companies realize that referrals tend to be their best source of hire, not meant necessarily the mm-hmm. highest volume, but the ones that are retained longest that perform the best tend to be referrals. So if we can improve that number, they’re, they’re quite happy. So that’s usually one that’s adopted pretty quickly. And then also the retention. Things like milestone bonuses people have been liking. We’re, we’re still fairly new in our short history, about a year and a half old. So we’re getting to those more performance-based rewards like what we call power hours. So just increasing capacity, getting people to work more, in general, is something that that people are starting to look at more now.

Jeff Howell (12:58):

And overall, how would you say it’s all working? How’s it all going? Do you have some clients that have some good you know, ROI or case studies that you can speak of?

Kevin Mistry (13:06):

Yeah, I mean, early signs have been good. As I said, the end of the referral, which is probably the war that people adopted first, has seen incredible ROI. And then even on the, I talked about filling hard-to-fill shifts just recently, yeah, we had a customer interview with one of our larger Canadian clients and the manager there was saying his might get this quote slightly wrong but shifts short-term shifts or short notice shifts that used to take them a long time to fill are now gobbled up in less than 10 minutes. Hmm. Like that’s exact, that’s the one that I’ve been hit hard with me. And I think has been a huge yeah, a huge feather in our cap that we can start to affect those things. But as I said, referrals, you know, have been having exponentially gone up in the early ROI business cases that we’ve done.

Jeff Howell (14:06):

Mm-hmm. and those hard-to-fill shifts. How easy is it for someone to define what that is? Cause my mind went to evening and weekend shifts. Yeah. But then you raise a good point of these, the last-minute sub in for somebody else kind of a shift. How easy would it be for the coordinator or administrator or whoever’s trying to offer up the incentive? How automated is this? Is it just like baked right into a certain type of visit code or, I’m, I’m imagining it’s, there’s a, a simple way that it’s set up so it’s not creating any more work for the office staff?

Kevin Mistry (14:42):

Yeah. Good. Topic to bring up, because the automation part is pretty key for us. I mean, there have been rewards programs in the past but the reason that a lot of them fail is that it’s tough to, it’s, we can’t put anything more on the coordinator’s lap. Mm-hmm. , they’re already super you know, they have a high workload, They’re already, they’re already stressed enough. So for these rewards to work, we try to take them out of the hands of the coordinator and automate things as much as possible. So there’s a couple of different ways that we’ve been looking at it for, from the point of view of feeling hard to fill shifts, because you’re right, there are different things. There are short notice shifts, there are evenings and weekends, and there are shifts that are far away from your, from your location and require higher drive time.


So because of that, there are different ways, for each one. But we are big on integrating with the back-end system. So obviously all Eli Care, we’ve had a partnership for, for a little while. HHA Exchange has now come on board as well. So we integrate with the back office systems to digest this information. So it could be because of, a certain service code that a scheduler puts on it because it’s an evening shift. It could be a tag. It depends on how the back office system works. But even if we don’t, even if we don’t have an integration into the back office, we still can digest a payroll report as well to get most of our rewards. So there are a few different ways but we like to at least try to default towards the integration mapping so that it takes the onus off of the coordinator. Cause if we keep, you know, maybe for the short term, if we’re experimenting with a certain type of reward, it might require a little bit more manual intervention by a scheduler. But if we want these rewards to work over the long term, then we need to automate them in some way.

Jeff Howell (16:45):

Right. Got it. And you guys must be developing your own best practices where you can say, Hey, what other agencies have done is they’ve defined an undesirable shift. If, if it’s on a Saturday or Sunday, automatically assign 50 points. Exactly. And if the point of sending that offer to the caregiver versus the time of the shift start is less than 24 hours or less than 48 hours at another a hundred points to it. Something like

Kevin Mistry (17:14):

That. Yeah. Is that right? Yep. Exactly. And once, once the caregivers start depending on it in that way, that’s when we start seeing the most bang for your buck when they start looking at it as part of their compensation. They know every time that this, you know, I feel a weekend shift, I know I’m going to get these points and they count on it, and it becomes a differentiator for the agency. Right.

Jeff Howell (17:40):

And I’m curious how far you can take this. So, can this be baked into you know, progress notes or checking off your activities at daily living or reading a care plan? I’m, I’m curious about all the potential use cases that, not just promote better behaviour from an operational standpoint, but from a clinical one as well.

Kevin Mistry (18:04):

Yeah, I mean, it gets very interesting, I just had a meeting about this on all the different possibilities here when it comes to the clinical aspects of filling in care notes and completing your ADLs. It’s, it gets to be a lot of fun. It’s a bit hard actually to keep us arraigned in and concentrating on just the ones that we know are delivering high ROI right now. But the sky’s the limit in terms of what we’d like to do in the future. But it also depends, again, we want to make sure that things are automated. That doesn’t put any onus, on the coordinators, so we’ve got to hold back a little bit. But there’s just, there’s a ton of different rewards that we could start playing with

Jeff Howell (18:49):

Mm-hmm. . Yeah, I mean, strictly the referral piece, especially if your clients are getting an incredible ROI right now, that in itself is a huge win. And it’s so exciting to hear about your ability to bake an endpoint that is so niche and specific to our industry, whereas large established reward companies are very industry agnostic and they, you know, they would never be able to tie into systems and automate points for caregiver specific activities.

Kevin Mistry (19:19):

Yeah. I mean, that’s the thing. Our industry, we are just so much more hard up. This problem is just amplified so much more that I think there’s a lot of room for us just in-home care you know, or at least senior care for now. We’ll see what the future brings, but it’s such an acute problem in this specific industry that has so many nuances of its own that yeah, we’re, we’re bullish on it.

Jeff Howell (19:45):

And can you describe to me what the mechanism is? I’m, I’m imagining a few different potential ways that the caregiver can get their rewards. One would just be straight cash added to their paycheck. Another would be an automated email with a gift card. And then the third potential way is they have a portal to log into and they can kind of do some shopping there or, or whatnot. But I’m just curious if there are multiple ways or if you guys have one standard way that you get that compensation in the hands of the caregiver.

Kevin Mistry (20:21):

Yeah, I mean, you, you get it. It’s similar to other reward programs that way. So there is a cash bonus that can be put on the that can be put on their paycheck. There’s a, and then there are gift cards pretty much. But gift cards these days can be very close to cash, like a Visa gift card or a gas gift card are the two ones that are probably most popular. But I think the key component here like I try to steer clients away from just doing, a cash reward on their paycheck. Because if the incentive dollars just get lumped into payroll, you see less effect from that reward. It’s keeping them separate, or I mean, even if they did want to make it cash, they have to somehow distinguish it from regular pay. And that’s how you get more.


For every dollar you put into a rewards program, you get more productivity than every dollar you put into payroll. So, you want to distinguish the two. And so gift cards do tend to be a better way of doing things because it’s more, it’s easier to distinguish the two, even though sometimes, you know, some of our clients might want to put it into cash or caregivers might think, you know, cash is king. But what we’ve seen is just you do get more bang for your buck by distinguishing them. And so gift cards is a, is a great way to do it.

Jeff Howell (21:51):

Yeah. There’s something about the dopamine you get with a gift card where it just feels like it’s free and it’s fun. Right. It’s funny that you now want to go spend ,

Kevin Mistry (22:02):

That’s the thing. It’s just something extra, right? That’s not wages. And this is also the thing that’s interested me for a long time, but just non-monetary compensation, although this can be quickly tied to, money if it’s a gift card, still not your regular payroll. It even, you know, way back another story from my past, but I used to work on some cruise ships down in Toronto Harbor, and I remember our boss used to give us free beer. I mean, we were in our early twenties, and we got a couple of beers after work. And like, just how far that used to go in motivating us was incredible. Like, I can believe the stuff that he would make us do, but we loved the job because of that small extra gesture. Right. And so I mean, in your twenties yeah, getting a couple of beers is, is big. But for a healthcare worker, or a home care worker, getting a gas gift card is the same type of thing with gas prices the way they are. Right,

Jeff Howell (23:01):

Right. Yeah. Yeah. I mean, nobody helped any friend move over a case of pop, but a case of beer you’re in .

Kevin Mistry (23:10):

Yeah, for sure.

Jeff Howell (23:12):

So how do, how do you guys factor in your pricing? How does that all work?

Kevin Mistry (23:16):

Yeah, so I mean, we’re a SaaS platform. We have a SaaS fee that ends up being, you know, somewhere between two to $3, something like that depending on the size of the company. And then there are the actual reward amounts that the company wants to want to dole out. That’s the bulk of it. I mean, at the end of the day, it depends on the reward types, you know, how, how involved the company wants to get in this type of program. But in general, what it usually ends up being is something like 0.5 to 1% of an agency’s payroll could be allotted to compensating and incentive caregivers in this way. Okay. So it’s a, it’s a pretty small amount of overall payroll, but again, if you want to get bigger, you know, we’re more than happy as a company. And like I said, it’s quite clear that every dollar that you put into an incentives program like this just gets you a lot more ROI than a straight raise of the same amount of 0.5%. Yeah. You know, most companies are increasing salaries by 5%, 10% a year later. And it only necessarily gets you a certain amount of added productivity versus this, you can very easily see how it ties to, increased motivation increased productivity, and better outcomes.

Jeff Howell (24:42):

I love it. And I love how you guys are creating your case studies of what was the state before, and then you came in and then yeah, you come up with the best practices of, you know, for every referral you get 500 points. If they get hired, you get a thousand points. If that person stays for a month, you get another thousand points coming up with all kinds of different ways to rack up all of your rewards. Yeah. And getting right down to those micro-actions, during the shifts. You know, like there’s constantly a way for you to be scoring points. Everyone loves gamification.

Kevin Mistry (25:21):

Yeah. . It’s the future. I mean, and that’s, that’s another key part of it that I talk about as well is just the importance of having multiple reward types contributes to the consistency over time. If you just do referrals and then end it there, great. It helps with referrals. But people and caregivers don’t necessarily look at it as part of their compensation or as a big perk of working for that company. You must be changing things and adding rewards over time, which is great because you’re just seeing, you know, more benefits because every reward is tied to a specific behavioural benefit to the company. Mm-hmm. . Right. But that’s a key component because like, we want to make sure that it’s consistent over time and that caregivers look at it as part of their compensation. And that’s and that’s where you get most, the most efficiency.

Jeff Howell (26:17):

Well, Kevin, I’m sorry you didn’t think of this when you were running rent a goal and you could have recruited hundreds of more goalies and to the points tied to their shutouts or showing up on time and ,

Kevin Mistry (26:31):

It’s funny, of both AlayaCare and now Caribou, I could have tied rent, oddly enough,

Jeff Howell (26:38):


Kevin Mistry (26:40):

It’s amazing how that came full circle.

Jeff Howell (26:43):

Yeah. And by the way, I’m assuming that you guys would entirely qualify for map and any state-specific funding. I don’t see why this is not right up your alley.

Kevin Mistry (26:58):

Yeah, it’s, it is. I mean, that’s where we’re concentrating the most effort right now is the states that are, that are using FMAP funding more heavily. So, New York, Pennsylvania, and Massachusetts are, are really, are bread and butter right now because a lot of our clients are just using the FMAP funding, and it is Sure. 100% of Caribou qualify, for that funding. So, it makes it a much easier decision that way as well.

Jeff Howell (27:28):

Oh, it’s a win-win. Yeah.

Kevin Mistry (27:29):

Yeah. Yeah. And

Jeff Howell (27:31):

Well, I’ll get you out of here on this. Go

Kevin Mistry (27:33):

Ahead. Sorry. Just the beauty of it is that it’s a program where most of the money that you put into it is going directly to the front line through those FMAP funds, which is

Jeff Howell (27:43):

Great to see. Yeah, for sure. Yeah. Well, I’ll get you out of here on this. How do, we mentioned the website in the beginning, I’m assuming people can go to the website, What do they do next?

Kevin Mistry (27:55):

Yeah, I mean, they can go to the website. So, they can contact me, Kevin, at all the usual channels, LinkedIn, everything like that. We’re trying to put a lot of content out there. We’re going to start putting more content out there. And we’re on the trade show circuit as well. So, we usually have a booth at most of the association trade shows. So come say hi, if you’re around.

Jeff Howell (28:18):

Well, speaking of which, I look forward to seeing you in person at our user conference next week. And sounds like you guys are up to some really exciting things. So, I look forward to seeing, the software a little bit more in action. And thanks for coming on today.

Kevin Mistry (28:34):

Thank you. See you next week.

Jeff Howell (28:38):

Home Health 360 is presented by Eli Care. First off, we want to thank our amazing guests and listeners. To get more episodes, you can go to Health 360, that’s spelt Home Health 360, or Search Home Health 360 on any of your favourite 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.

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Home Health 360 - Episode 30

Episode Description

Kevin Mistry, VP of Sales at Caribou, shares how incentive programs can be the key to help caregivers shape their behaviour and help curb the challenge of caregiver recruitment and retention. He discusses how rewarding behaviours with performance-based rewards can lead to bigger outcomes down the line for agencies. “For every dollar you put into a rewards program, you get more productivity than every dollar you put into payroll.”

Listen to learn more about how Caribou has changed the home care industry with performance-based rewards to combat employee recruitment and retention challenges.

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