How Lily Sarafan replicates the success of Home Care Assistance nationwide

Lily Sarafan, president and COO, Home Care Assistance

Lily Sarafan got some angry phone calls at first. People wondered what her motivations were and what a home care company was thinking advertising its services with Google Adwords.

But for Sarafan and the owners of Home Care Assistance, the decision wasn’t about making waves. It was about making change.

“It’s funny when I think of it now, because almost every business known to man does some form of pay-per-click or online advertising,” says Sarafan, president and CEO of Home Care Assistance. “But at the time it was like, ‘This is a high-touch business. This is about people. How can you advertise online?’”

Being the first home care agency to utilize online search, even in 2005, is an early example of the unique approach Home Care takes to the in-home care industry — an industry that’s hardly painted as “innovative.”

The company has published a number of books about its care philosophies, which include offering classes such as senior yoga for clients and gourmet cooking lessons for caregivers. It also provides many of its caregivers with tablet computers so that they can log photos, videos and updates from a client’s home.

In the future, Sarafan hopes to have tablets in every client home, providing what amounts to a Facebook newsfeed for family members and friends.

As the only senior care franchisor headquartered in Silicon Valley, Home Care Assistance also strongly aligns itself with businesses that value innovation and entrepreneurialism.

“Being based here means that we’re not comparing ourselves so much to a Home Instead or a Comfort Keepers or typical home care agencies based in the Midwest as much as we’re comparing ourselves to Google and Facebook and all of these other amazing initial start-ups that were founded a couple of miles from where we are,” Sarafan says.

“We’ve used technology not just as a cool factor but to really push our business forward.”

But perhaps the biggest differentiator of all is the company’s growth model, which has allowed it to expand from its San Francisco Bay pilot office that opened in 2003 to 60 locations across 27 states, as well as four Canadian provinces and Puerto Rico — all the while preserving the quality experience its clients have come to expect.

So how do you replicate one wildly successful office across two locations or 10 or 20? Once you have the right growth model — Home Care Assistance uses an owner-franchisor model, where it franchises some stores while building company-owned locations — the first step is to carve out your road map.

Create a success blueprint

In 2005, the company aggressively launched its efforts to pursue the franchise avenue, selling territories to prospective owners while simultaneously opening its own locations nationwide. But after adding new locations in a number of territories, Home Care got a reality check from its new owners as they began implementing the company’s operational systems and processes.

“Everything seemed to be gung-ho,” Sarafan says. “We rolled it out across the network, and all of a sudden, it was like, ‘Wait a second. In Texas, we need to append care manager signatures. The system doesn’t allow for that. In Virginia, care notes need to be documented on a daily basis. You didn’t account for that.’ So it was a nightmare rolling out these systems and being all excited only to have everyone completely angry because they thought the system was inadequate.”

As successful as your business model is, you can’t duplicate that success if you don’t give others a format that they can copy. Because the company’s operational systems were developed and tested systems at its corporate site early on, they didn’t account for the diversity in it new locations. So they failed on a national scope.

“There are certainly a lot of business models out there that are successful, but when they try to replicate and open in other areas, they realize, ‘Oh wait, it’s different in different geographies,’” Sarafan says. “‘Or, ‘We didn’t actually codify this process correctly. Oh, wait, it only applies to this very first location that we opened.’

“The biggest part of the process of expanding our operations was coming up with tools and guides and operating manuals that reflect all of the practices that we think make this business successful anywhere.”

Some of it is basics — for example, updating your operations manual to include all of the best practices that have made your company successful so far. Information on areas, such as the company’s “balanced care method,” needed to be comprehensive and clear enough that anyone could pick it up and know how to handle a client issue step by step, Sarafan says.

When expanding quickly, businesses should also look at the way people access systems and processes.

“We realized that as great as all of these owners are, they were all very busy in their respective locations,” Sarafan says. “We can’t trust that the content that’s being delivered to their staff members or their caregivers is going to be uniformly excellent.”

After the experience of launching in disparate sites, Home Care Assistance made a number of investments in its site operations in the way of training and development. In 2006, the company launched a corporate intranet, giving employees and owners 24-hour access to corporate announcements, upgrades, tools, news and updates.

It also launched the first proprietary online university in the industry to train staff members and caregivers on how to execute the company’s model at any location.

Finally, Home Care Assistance has changed the way it rolls out new processes and systems. To make sure that operational systems work for everyone, the company uses a franchise “think tank” to help vet and test them before they are rolled out to the rest of the network. The owners represent a variety of geographies, tenures and operating models. Pooling feedback from the think tank has helped the organization launch new systems, such as its online university, almost seamlessly.

“People knew that we already had the buy-in, creditability and support of key owners within our network,” Sarafan says. “So we didn’t have that typical reaction, ‘What is corporate trying to do to us now?’ They knew that the leaders within the system already approved the system.”

Be selective

Another benefit of the company’s growth model is that it focuses on growth through territories instead of franchises — the standard franchising model. This allows Home Care Assistance’s owners to be extremely selective about new locations but also about the franchise owners it brings on to grow the business.

“We don’t have brokers out there who have a quota for a certain territory,” Sarafan says. “So if we don’t find an amazing, entrepreneurial, ethical, savvy, compassionate owner to develop a territory, we’ll just do it ourselves.”

The importance of carefully screening potential owners was a lesson the company’s leadership learned the hard way. With all of the initial excitement around expansion, Sarafan admits the company probably was a little too quick to bring on franchisees when starting out.

“At first, you’re just very excited and you think everyone can do this and everyone is as compassionate and committed as you are,” Sarafan says. “So one of the early mistakes is jumping the gun and bringing in your initial owners, not really testing for that organization or cultural fit. That can cause some discontent along the way.”

It’s hard to say no when people want to invest in your company. But you’re setting yourself up for failure if you don’t make sure that you’re growing with the right people.

Today, the company is much more judicious in selecting new franchise owners. While it still looks at whether or not someone has the working capital and desire to lead a franchise location, it also considers his or her personality and values. Potential owners go through a rigorous screening process, which includes meeting with various members of the executive team as well as at least five different franchise owners. Finally, they’re invited to visit several company sites to learn about daily operations, job responsibilities and culture.

The more detailed franchisee screening process ensures that people don’t enter into the business without having a good idea about what the business is, what’s expected of them and what the company’s culture is like, Sarafan says.

“When someone’s on the phone and says, ‘I’m looking for a part-time gig. I kind of want to be an absentee owner,’ and they have five people on the phone saying, ‘In your first year, there is a huge time commitment and you really need to be involved on a hands-on basis,’ that self-filtering happens,” she says.

Who you have running your business isn’t the only thing you want to be choosy about as you add new locations. If you can, you’ll also want to take fewer clients — at least, at first.

Before you gasp in horror — why in the world would you want to turn away business? — think of it this way: You want to grow to reach more customers. To reach more customers, you need to build your reputation in new markets. And to build your reputation, you need to maintain high customer satisfaction for the customers you have.

Currently, Home Care Assistance has the best ratio of client to care manager of almost all of its markets. With a smaller case load of clients to manage, the company’s 4,000 caregivers can visit clients more often, have better status reporting with family members and be more responsive. On the customer side, the result is better client feedback on surveys, more client referrals and high client retention. On, the business side, the company’s average weekly invoice is three times the national average for its industry.

“So the fact that we’re very selective with caregivers, we have smaller case loads of clients and we’re focusing on a fairly niche client … all of that makes it so that our customers receive the gold standard of care,” Sarafan says. “Almost every single one ends up being a VIP client because we don’t need 500 clients to turn a profit.”

Keep an eye out

Home Care Assistance’s growing client base points to the fact that the company is well on its way. By 2014, Sarafan hopes to have 120 to 150 territories across the country and perhaps even overseas. But this future growth is dependent upon the ability of today’s franchises to execute to the company’s high care standards, she says.

A responsive field operations team is one way the company keeps franchise owners accountable to these standards. In addition to assisting owners with everything from emergencies in the field to new office openings and compliance, field representatives serve as strategic advisers, helping people evaluate opportunities and stay innovative.

For example, every owner enters activity at his or her location into a companywide CRM system, accessible through the cloud.

“We can log in in real time and see what’s happening,” Sarafan says. “And then we might say, ‘Did you know you had this great partnership with the Alzheimer’s Association, and they sent you leads? You’ve actually been able to help their clients through our in-home memory care program, but it seems as if you haven’t been in touch in 90 days. It seems like this is great partnership that you shouldn’t let go of.’ So we’ll be able to send those recommendations remotely.”

Being able to offer these kinds of suggestions keeps the company culture entrepreneurial because it gets the company’s employees and owners constantly thinking about partnerships or growth opportunities, many that they may not have considered. These are simple things that people coming from the outside can explore to take the company to the next level, Sarafan says.

“We’re really there to help them optimize and maximize the experience in their communities,” Sarafan says. “We’re going to go there to give them some of the out-of-the-box thinking that’s not as apparent when you’re involved in the day-to-day.”

As the company focuses on the next goal — expanding its global footprint — it will mean a lot of new development and innovation. But by taking the same balanced approach to growth as it takes with its client care, it’s literally putting its money where its mouth is as it aims to break the perception that it’s just another home care company.

“The challenge is that physicians sort of come up to you and say, ‘Home Care? Oh yeah, I know Home Care,’ because there are a lot of companies that exist within this space, and health care professionals — they think they know,” Sarafan says.

“But almost everything we do is something that’s never been done before. So it’s not just saying we’re going to have caregivers in the home, but we’re going to have the best givers. It’s going way beyond that. It’s about creating that possible service, and every day, we’re striving for that new category of services that maybe didn’t exist before.”

How to reach: Home Care Assistance, (866) 454-8346 or www.homecareassistance.com

Takeaways

  • Codify your systems and processes.
  • Be selective about who you work with.
  • Put in systems to hold locations accountable.

 

The Sarafan File

Lily Sarafan
President and COO
Home Care Assistance

Born: Tehran, Iran
Education: B.S. in science technology and society and M.S. in management science and Engineering, Stanford University

What would you do if you weren’t doing your current job?
Nothing, really. Anything else beyond my world at HCA that I enjoy or feel inspired to do, I already manage to do alongside my responsibilities here.

What is one part of your daily routine that you wouldn’t change?
Keeping a running list of all my ideas regardless of practicality or timing.

What do you do for fun?
All things culinary. I have a passion for gourmet experiences and enjoy food preparation and presentation much like an art or architecture lover studies objects or design.

Where would you like to go that you’ve never been?
Outer space. The perspective would be intensely humbling.

How would you describe your leadership style?
I’m personally very interested in transformation. … I think if you’re always pushing the envelope in a strategic way then not only are you going to have a lot of job satisfaction as a leader, but you’re probably going to see that your innovations are going to make a real impact, that will hopefully positively influence people’s lives.