What It Really Takes to Scale Home Care Across State Lines

What It Really Takes to Scale Home Care Across State Lines

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Hello dear listeners, Welcome to CareSmartz360 On Air. I’m Dennis Gill, Senior Sales Consultant at Caresmartz. Today’s conversation is for home care leaders who know that scaling isn’t just about adding locations. It’s about building systems that hold up under pressure. So our guest today, Lisa Fausey, President at Home Helpers of Martinsburg, Winchester, Histown Sound, and Frederick, brings decades of hands-on leadership experience. Lisa joins us today to unpack what it really takes to scale home care across state lines from

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workforce realities and compliance to culture, accountability, and mission-driven growth that actually lasts. Welcome to the podcast, Lisa. >> Thank you so much. I appreciate it, Dennis. Oh, >> thank you. We are really grateful that you were able to take out the time today for our listeners and all the homecare agency owners who would be going through this session and I hope it’s a pretty fruitful session for them today. Right. So without wasting any time, I’ll straight away jump in with my first

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question for you. So Lisa, what operational systems must be rock solid before an agency even considers expanding into another state? >> Well, Dennis, I would say the first thing you must have in place is that you have day-to-day operations under control. You have the right support team in place. Um, you know, people first and then logistics second. Um, you must have your hiring down. You must understand um and have built a good culture within your organization. So that as you um have built those same systems in one

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market then you can move on to the other. Um there’s a lot of other parameters with that but the first thing is is to be strong in one place. >> Got it. >> And how do regulatory and licensing differences change the bay leadership approach growth not just the compliance part? >> Well um for me personally I began reading a lot and talking to other owners within the markets that I wanted to expand to. We started here in West Virginia. Um, and West Virginia is a non-licensed state for home care, home

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health, and hospice. We operate under a co if you’re a Medicaid or Medicare provider. But for a home care agency, starting off with private pay, there were no regulations. So, I went with what my brand, Home Helpers, taught me and then learned along the way. But when I went to Maryland, it was quite different. Maryland is a licensed state and so um you know it’s really reading and understanding what it takes to do business in that next state and what the opportunity is because you know that uh

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brings with it uh the lensure also brings with it opportunity not just oh I have to do this I have to do that you know to make meet the compliance to meet the regulations um it’s really about the opportunity um that it brings to your business because then you can also work with commissions on aging um you know you can become a VA provider you can become a Medicaid provider, various different things within the state. So, um, as I started reading and learning, I really wanted to know not only what was

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necessary, but what the opportunity was. >> Okay. Okay. So, self-learning and reading got be the core thing to start off with. >> Yeah. And I also um start a conversation with the lensure office. Um, you know, I found out who to speak with there um so that along the whole pathway they could guide me and lead me and direct me. I’m very much a rule follower other than I do speed a little and don’t follow that rule but I try to follow the rules you know and so I wanted to do things the right way and

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having that communication early on with the lensure office I think was really important but also respecting their time because they’re those offices no matter what state are very busy and they’re overseeing the entire state so I tried to show a little compassion for them as well and just have nice conversations and everyone was so willing to help which I really appreciated and it gave me some peace of mind through the process. >> Oh, perfect. Perfect. Good to know that. And uh what staffing and caregiver

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support strategies matter most when managing teams across multiple states? >> Well, I think um because we run everything centralized. I know different folks decide to do it differently. We run centralized. So um everything that we have before we started this process, we put all of our personnel records in the cloud. Um, we made sure that we’re we were able to access everything no matter where we are because if I’m working in a Virginia office or I’m traveling and I need to access

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something, why would I want a paper folder? >> Yeah. >> You know, that’s kind of 1980 >> going back to my high school days. Um, but uh I think that it’s really important that you have those systems in place and that you have a process for hiring. Um, you can easily drop in a different form. You can easily um adjust the process per the state requirements, but if you don’t have that uh hiring system in place first, it’s going to be real complicated to rebuild and

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replicate what you’ve already done successfully. So, we built all of that out and got everything ready for our caregiver journey first >> and then we just implemented it across the state lines as we’ve migrated. >> Okay. And currently, how many states are you operating from? >> Just three. >> Just three. Maryland, West Virginia, and Virginia. Okay. Maryland West Virginia and Virginia and uh Lisa, where do agencies most often underestimate the cost complexity or risk of multi-state

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expansion? >> Well, I think the first thing that I uh looked at in regard to cost, what was expensive and what changed things for me were required benefits in different states. Okay. >> So, here in West Virginia, you know, there’s no requirement for me to provide any type of real benefits. Now we do and we always have about from maybe year two that we opened. But um the cost to provide the workers comp, the cost to provide insurance, you know, our in business insurance is different in each

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state. Um also workers compensation as your organization grows and your workers comp is based on your salaries or your payroll. So as your payroll grows, you have to get ready for that. Um also the training requirements in each state are different. Some have no training requirements and some have so many hours a year or so many hours per quarter. So, you have to make sure that you’re planning for that. Of course, the cost for a license in Maryland is $500, but in Virginia, $1,500. And if you

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don’t meet um the leisure requirements, when they come to survey you, they will kick you to the line and make you pay the $1,500 again. So, you have to really know these things upfront because if you don’t know it, it can be a costly mistake. Um, and then office space. For instance, in Maryland, we’ve gone from one office to another, which we, you know, needed more size so we could use the space for different things. But originally, >> you know, I started off the first office in my house for a year, worked all by

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myself, so there was very little cost. >> But now, when I look at my P&L and I’m like, we owned a b a building in West Virginia. Um, and then we have rental space in Maryland and we have rental space in Virginia. And then I look at that on the P&L, I’m like, “Oh, now I see what the real cost is.” So, um, while it wasn’t all at one time, um, time, you really do need to plan for those costs and, um, like in Virginia, you’re required to have a physical office and you’re required to have

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signage and you’re required to have a person in your office during designated office hours. So, um, you know, that was a difference for me as we were looking at Virginia because in Maryland, yes, we have an office, but we didn’t always staff it. It is staffed now. Um, but we didn’t always staff it then and we just used it as we needed it. Kind of a dropping off point or a place you could stop it and use a PC instead of an iPad or a tablet. So, um, now though, we have, um, our CPR classes are all done

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in our Maryland office. Um, we do some of our other training up there. Our nurse sometimes will meet with people in different offices as they as she’s assessing caregivers and their skills. So we have all the classrooms set up for our training lab with a hospital bed, mannequin, hoyer, you know, wheelchairs, all those things in the different offices. And so those are all some of the costs that over time you have to look for. >> Oh, great. Uh I think this would be really beneficial for the listeners who

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are if they’re thinking of opening up in Maryland or Virginia specifically. So it must be very very very very fruitful for them. >> Well, and we’re not even the most regulated states. So I’m sure that there are probably even some more costs in some of the areas in which you know we all operate across the country. Um and I don’t think it’s really different. I just think that you just have to know what you’re getting into. >> Got that. Got that. Got that. And how should in home care leaders evaluate AI

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tools when scaling up what generally supports multi-state operations versus adding noise? >> Well, I think that when we come and we’re still learning AI, I’m telling you this, it changes every day. You know, I’ll read a newsletter and there’s something new out there that you know, you oh, well, let’s try that. Let’s consider this. Um, I think where we see that we’re using it the most is really in our ongoing, uh, communications with referral sources. So, um, you know,

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using a CRM that has built-in AI tools and automations that you can build, >> um, and you can build them out per your locations. So, for us, because we’re in three different states, uh, we actually have three different websites. >> On each website, we have, um, a chatbot there that is human managed. just with Aidquest. Many people in the home care space know AidQuest um where it pops up and then a human actually comes on and interacts with the person on your site. But I think using AI it I don’t know

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that the consumer or the person visiting your site would really know much different. We also um on our hiring side, we have an AI screening that actually um we call her Ruby and Ruby um is through CareWork and Carework uh will pre-screen uh with AI any applicant. So we’re screening out right away those individuals. And just imagine if you’re a company getting 300, you know, applicants or 500 applicants in a month. If you had a human that had to sit there and call every one of them uh to

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pre-screen, um the AI is able to actually help with that. And then we can focus on those people who are really the ones that we may want to hire. >> Um so to me, that’s probably the number one tool. um it finds something AI that can help you with pre-screening your applicants and um you can build it out to where over time it understands um Ruby does anyhow understands the different markets that we’re in. So, if it’s talking to someone in um a county in Virginia that we don’t work in, for

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For instance, it actually will let the um person know that while they’re talking to them. And as I interacted with it, it could answer questions that were >> not real specific questions, but they were mostly the general ones that we get asked from people that are looking for employment here. So, I think that’s a really good thing. And then of course um the website side for um being able to screen or help the website capture that information data from someone visiting

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your website. >> Yeah. And as you rightly said AI is definitely changing every day as we learn one thing I know three new things is coming on but yes this person has to be on foot on that that they are pretty well versed with all the AI features AI tools that are coming up. >> Mhm. And lastly, uh, as we are already into 2026, so what operational or compliance shift, uh, do you believe multi-state home care agencies must prepare for now to avoid falling behind? >> Well, I think one of the things that I

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try to prepare for um, as we look at each year and as things change over time, first off, we’re always watching um, wage and hour laws. We’re always watching um minimum wage changes. A big change that we have coming forth in Maryland um they are going to be one of the states that’s offering paid family leave. And so they have a program called family fa and um come 2027 all employers and all employees even with only one employee in the state must contribute and their employees must contribute in a

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percentage of the pay into the family fund. And then in 2028, the employees will be able to withdraw for specific reasons um that they would need paid family leave such as the birth of a child, the adoption of a child, um uh caring for a dependent, etc. And um I believe they can take out up to 13 weeks of um paid leave uh from this fund. And there’s still a lot of questions and things around, but being aware of changing um regulations within each state is really something you have to get on the newsletters from the uh

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workforce in each state. Get on the newsletters from any other organization that you’re part of. And a lot of it’s information you may not need, but sometimes there’s just one little paragraph and you’re like, “Oh my.” And that’s how I learned about family. I saw it in one of the newsletters um you know from the aging network in um uh Maryland. So I really think that it’s important to participate. It’s also important if you have a state chapter uh for the home care association of

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America, please participate with it. Um we have been able in West Virginia to affect some changes here. We have another topic we’re working on. Actually, we were just working on scheduling a meeting with someone in our state later on in the beginning of April to um get some clarification on some code. And then also um you know, if there’s no chapter in your state, go to the HCAOA and ask them how you chapter >> and um it really has been beneficial to our organization and to my personal

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understanding of home care in general. >> Oh, perfect. Perfect. No, no, good to know that. Good to know that. many new things that we came to know about these three sides specifically and our listeners also and uh it was lovely lovely talking to you Lisa I know it was a small session in future we might have to schedule another session with you for more detailed conversations I would love to have that yeah thank you thank you >> Sure anytime Dennis >> no thank you for your time and it was

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great talking to you and thank you for my listeners also I will be back shortly thank you.