2024-07-18_chad.everitt_East & Canada Recovery Plan.docx

East & Canada Declining Sites Recovery Plan

Vancouver Recovery Plan

Causality of Decline:

Starts of Care with Vancouver Coastal Health: Traditionally, we average approximately 2-4 starts of care per week with VCH, but the last eight months have been different, with some weeks seeing as many as 7 starts of care. The increase in VCH starts of care can be attributed to several factors:

Hospital Overcrowding: Clients were sent home for convalescent care rather than staying in the hospital. These cases are often shorter-term, as clients are moved to “4 points of care” (one-hour visits) once they are deemed stronger, leading to deactivations.

Lack of LTC Beds: With no long-term care (LTC) beds available, clients were sent home to wait for LTC placement.

Increased Retention: We saw an increase in retention for 24/7 care clients due to the lack of LTC beds and LTC facilities not admitting certain clients, who then returned to the waiting list. For example, we had one client for over a year.

New Budgeting and LTC Facility Opening: VCH’s new budget renewal and the opening of a new LTC facility led to a push to place all 24/7 clients awaiting LTC beds. This began in late April and continued through May and June, with as many as 7-8 deactivations per week. Not all of these clients went to LTC; some were sent back to the hospital due to emergencies and did not return to us, either because they passed away or went directly to LTC. Others improved and required less or no care.

We have now returned to the norm of 2-4 VCH starts per week. Last Friday we received three 24/7 referrals. Unfortunately, two were hospitalized and one was discharged as the home was unsafe for caregivers. That said I'm confident we will rebuild revenue as it seems their capacity has tightened once again.

Expansion Goals:
Our goal is to work with Vancouver Coastal Health and Fraser Health to expand our relationship into other regions of Greater Vancouver. We know that a competing agency (Bayshore) holds significant market share for this 24/7 hospital discharge business within the Vancouver downtown market. We are in preliminary discussions to gain access to this market.

Project Castle:
Project Castle has allowed us to rebuild our relationship with Amica, particularly around our West Van office. Last week, we had two assessments and one start of care. Lions Gate Amica has a waiting list for residents, and the head of marketing has sent a list of recommended providers, including us. This is a positive development, as it was just initiated last week.

New Case Manager:
Our new case manager, Shellie, has strong contacts in Vancouver proper. Now that she is familiar with our operations, she will begin reaching out to support those communities.

Consumer Channel Decline:
Our biggest decline is still in the consumer channel, addressed in the action plan below.

Action Plan

1. SEO Project:

Rationale for SEO Ramp-Up Projections

With our move to TheKey.ca in February, our consumer lead flow has fallen by nearly 50%. This has resulted in 5 fewer consumer SOCs in June vs January.

Solution: Localized SEO Plan which will generate 15 unique articles / month across Canada (3/month in Vancouver). Our organic traffic and SOCs are expected to ramp up gradually for several reasons:

Initial Content Publication and Indexing: As we begin publishing high-quality articles regularly, it will take some time for search engines to crawl and index this new content. This initial period typically sees a slower increase in organic traffic.

Content Accumulation and Authority Building: By consistently adding valuable content to our site, we gradually build domain authority. Search engines recognize our site as a credible source, which boosts our rankings over time.

Based on industry benchmarks and our strategic approach, we project a slow initial growth in new clients from SEO in the first few months, followed by a month-over-month increase as our content gains traction and authority in search engines. Our first content drop expected on July 22nd

Anticipating 1-2 clients per month in August and September and 2-4 clients per month in Q4

2. Direct Mail Campaign:

• Distribution: Two distributions of 4000 seniors each (End of July and mid September).

• Redemption Rate: 0.5 - 1%

• Estimated Clients per Distribution: 2-4

• Execution Plan: Distribute direct mail showcasing brain teaser exercises, Track sign-ups and engagement through thekey.ca/quiz and convert sign-ups into potential clients through targeted remarketing.

3. BD Market Manager Proposal:

The proposed BD Market Manager would target the major Senior Residence chains and hospital C-Suites to secure partnerships. They would be the hunter to break us into new accounts. They would have a background/experience in sales leadership in an effort to support/assist the Hybrid CSM program to refine their sales approach and strategies. The Hybrid CSMs would be the farmers of the existing accounts.

In the interim, Sharon (GM) has completed her project castle visits and the relationships in our top referral sites remain strong. We are currently focused on Amica which has three SLC in Greater Vancouver. These accounts produced last year under the previous HCL and we're working diligently on rebuilding this referral channel.

4. Expanded Contracts:

Discussions have begun with VCH on expanding our relationship outside of West and North Vancouver into Vancouver Propper which could be significant. Sharon and I are fully focused on getting this deal done.

5. Improved Retention:

Now that we have a full team of 3 CSMs (two RNs) we can support our private pay clients and adhere to the SLA. In addition, we can ensure our VCH clients receive proper clinical oversight which should reduce hospitalization rates. With this in mind, we are expecting an improvement in our retention rates and Medallia scores which we have already seen improve in June and July.

6. VCH Growth:

VCH has returned to their normal referral pattern since their capacity has tightened up again. Revenue for July is projected at $942k up from $872 in June.

• New Clients per Month: 10-15

• Churn Rate: 75% / month

• Net Increase: 2.5 clients per month

• Monthly Revenue per Client: $29,309.71

Summary

The action plan provided above offers a rough financial projection for the remainder of 2024. The combined impact of SEO, direct mail campaigns, VCH referrals, expanded contracts, and improved retention will get us back on track for a solid 4th quarter.

SE Florida Recovery Plan

Causality of Decline:

In Q2, SE Florida had a total of 72 discharges and 39 starts. Of the 72 discharges, 54 of which were Tier 1 & 2. The clients on the list who deactivated for reasons outside of mortality and/or moved were contacted by our GM Dawn Peluso directly to touch base with and see if restarting services now or in the future. Of those contacted 2 resumed and the general feedback was clients were satisfied with service and would/will return if there’s a need. They ended service and matched their short term intention. At this time, we are taking cheetahs and bees to drive any revenue we can if we are able to staff without constraint. Of those discharged in Q2, 3 were related to perceived service failures. 72 discharges: 37 tier 1, 17 tier 2, 10 tier 3, 8 tier 4

Seasonality

Seasonality impacts FL as reflected in the discharge list. Of those clients who relocate north in Q2, we anticipate 64% returning, equating to approximately $134k in returning revenue for Q4 based upon prior utilization trends.  The below chart highlights SE FL decline alongside the company and the uptick compared to the company in the winter months.

Implementation of existing client SLA across all sites in SE FL who were not performing under the operational expectations. With the implementation, we are seeing improved intra office communication to reduce service failures and improve cross platform referrals to our skilled nursing business. We have increased hours with several clients by preventing hospitalizations through nursing oversight. Daily stand ups to review client experience and opportunities for improvement have improved cohesiveness between leadership, CSM, and CGM. There are several operations team members being placed on corrective action for failing to adhere to operational expectations and leadership direction. Accountability is in place to ensure our services provide the level of white glove touch to explain the value of our price.

We reviewed our key accounts that show significant decline. The biggest loss was our partnership with 5 Star Boca, a lifetime revenue of $2.75 Mil and 12 months, $1.5Mil, we lost out to a competitor, Firstlantic. They were able to promise the facility services we were unable to compete with such as they can act as a placement agency in addition to providing an RN for their Wellness Center 8am-6pm X 7 days. Additionally we have seen a decline from JFS. Jaime Cittadino is attending a meeting with the JFS CEO to understand the reduction in referrals even with our monthly donation to the JFS Foundation and to collaborate strategic growth for us both. Additionally, as a referral partner Advocare, has seen a decline even with the daily stand ups, collaborative work environment, and improvement internally. We are actively working to hire a new GM for this part of the business and work closely with Kelley Richard to build both businesses as the referral decline correlates with the revenue decline with Advocare. The Carlisle is another top account that has reduced significantly with the preferred provider in the building now Senior Helpers who are priced $3/hr less. With Senior Helpers in the building, they have not referred any clients to us. The new ED of the community 5 Star Hollywood has a close relationship with the head of sales for Senior Nannies resulting in all client referrals to Senior Nannies.

To combat the decline in key accounts, leadership have been visiting all accounts with the HCL. GM Dawn, RMO Jaime, and RDBD Earl have all been in front of top referral partners to take their feedback around where we can improve and issues, they experienced previously that resulted in a lack of faith. The visits have been productive in improving our reputation and their trust in us. Additionally, we are leveraging flex care in communities to replicate successful sites in the Southeast Region to help elevate SE FL. The team has all been trained on CINCH and are offering pop in visit as a differentiator from our competitors. Earl has spent 1 week with each new in role HCL SE FL to observe them in front of referral partners and gain feedback. 

Bre Hurley is our most tenured HCL and has been the only HCL in SE FL for over a year in over 3 years. The turnover has impacted our ability to make good traction in other markets of SE FL like Broward, Dade, and Palm Beach. Losing 5 Star Boca and The Carlisle to a competitor has resulted in a significant decline in her peak revenue YoY.

Growth Plan

To further compensate for the decline in accounts we historically performed well in, we’ve begun to increase our focus on several other SLCs communities and explore other channels for growth.

The following are accounts we’ve seen positive response within the SLC community:

Devonshire- 43.69% increase over the previous 3 months (Currently hosting Mindfit)

Vi @ Lakeside- 3.58% increase over the previous 3 months (Flex site begun 7/8)

Wellington Bay- new account opportunity, just received first client referral

As we’ve experienced a decline in referrals from Advocare, Brie hosted a meeting with stakeholders (7/16/24) from Mobile Solutions, Advocare and TheKey to discuss strategic partnership to increase patients to Mobile Solutions which will help drive growth for both Advocare and The Key.

We also began a comprehensive strategy with each HCL targeting a minimum of 10 Wealth Advisors in the Palm Beach & Broward market and joining the local Estate Planning council for the county. Trusted Advisors historically provided clients with high LT intention and hgh lifetime revenue. The channel represents less than .5% of our business for the Region and believe with greater focus and intentionality, would be a value add to diversifying our portfolio.

Finally our newest HCL for the Miami market has an effective start date of 7/29/24 and has an established book of business we can immediately leverage.

(Charts below depict both accounts with revenue increases and revenue declines over the past 3 months)

Northern Virginia Recovery Plan

June revenue - $1,109,345 - avg daily bill rate $36,978

Projected July revenue (as of July 15th) - $1,248,311 - avg daily bill rate $40,268

YTD AEBITDA - 21.7% vs goal 26% - last 3-month average 22.9%

Starts vs. Deactivations:

25 New starts:

1 client deactivated as no longer needs service

10 discharges:

Moved To Care Facility		2

No Longer Needs Care		5

Other - Client Deactivation	3

Concerns - 1 HCL supporting the entire region and had lost some GCM referral business as well as declining revenue from Flex sites.

Action Steps:

Added 2 new HCLs - 1 rehire started May 2024. 1new HCL scheduled to start 7/29 with field start date late Aug-early Sept once training is complete

Expanded service area to include Loudoun County as of May 2024

5 declining accounts - INOVA hospital, Eldertree, Harmony, Encompass & Capital Caring have been targeted and resulted in 3 new opportunities since June.

New flex site to start with The Virginia - start date TBD due to some facility setbacks

100% completion of Protect the Castle for NoVA

July projecting approximately 8% MoM growth as of 7/15/24

Maryland/DC

June revenue - $459,030 - avg daily bill rate $15,301

Projected July revenue (as of July 16th) - $505,696 - avg daily bill rate $16,312

YTD AEBITDA - 17.2% vs goal 14.5% - last 3 month average 19.5%

Starts vs. Deactivations

5 new starts

0 deactivated

8 discharges:

Chose Other Provider		1

Deceased			1

Moved To Care Facility		1

No Longer Needs Care		4

Other - Client Deactivation	1

Concerns- Recent loss of 2 HCLs leaving only 1 for entire state. Current GM was moved from DON to GM - not a growth driver

Action Plan:

Confidential search for GM

New HCL hired for lower Montgomery county/DC area to start 7/29 with a field start of late Aug/early Sept

Moved DC clients & CGM to NoVA for better growth management of this area.

6 declining accounts identified and targeted resulting in 4 opportunities and 3 SOC

New Jersey Recovery Plan

June revenue - $1,723,365 - avg daily bill rate $57,445

Projected July revenue (as of July 15th) - $1,744,621 - avg daily bill rate $56,278

YTD AEBITDA -19.1%  vs 21% goal  - last 3 month average 20.3%

Starts vs. Deactivations

25 New starts:

8 intended long term starts deactivated as no longer needs service

1 deceased

2 hospitalized

1 other client deactivation

34 discharges

Deceased- 7

Hospitalization - First Admission- 2

Hospitalization – Readmission- 2

Moved Out Of Area- 1

No Longer Needs Care- 10

Other - Client Deactivation- 12

Concerns - excessive HCL turnover in 2023 led to difficulty in hiring and left positions open.  Pricing for live-ins exceeded competition and prevented from acquiring new live in business as in past and prior acquisitions.

Action Plan:

adjusted live-in rate in May - seeing some rebound in June and will continue to monitor

2 new HCLs hired - 1 in May 2024 and 1 to start 7/29 with a field start date of late Aug/early Sept, bringing HCL headcount to 4

Establishing skilled nursing accreditation to expand skilled services

Connecticut Recovery Plan

June revenue - $2,634,957 - avg daily bill rate $87,831

Projected July revenue (as of July 15th) - $2,719,365 - avg daily bill rate $87,721

Starts vs. Deactivations:

18 new client starts:

2 deceased

2 no longer needs care

1 on hold

42 Discharges:

Chose Other Provider- 5

Deceased- 7

Dissatisfied- 1

Hospitalization – Readmission- 1

Moved Out Of Area- 1

Moved To Care Facility- 9

No Longer Needs Care- 6

On Hold- 7

Other - Client Deactivation- 5

Concerns - 2 open HCL positions since 2023.  Regulatory changes in Oct 2023 limiting the level of care to companion/personal care only which has resulted in turning away business that was previously serviced.  Complaints to DCP halted price increases until settlement approved by DCP.  Large loss of opportunities identified in early 2023 due to pricing

Action Steps:

Filed Home Health Aide agency application to expand service type

Implemented pricing scale for high volume-long term and live in clients

Sales working on partnerships - Anthology scheduled to start flex care

100% compliance on Protect the Castle with both GMs actively continuing visits to referral partners as we continue to source for additional HCLs

Identified Greenwich area for growth - currently sourcing for a seasoned HCL in this are

9 declining accounts identified and targeted resulting in 4 opportunities and 2 new SOC

Discharge Reason | Action | Resumed | Left VM | Happy, Would Return | Dissatisfied

"No Longer Needs Care" | 28 calls made by GM | 2 | 6 | 17 | 3

Discharge Reason | Total Q2 | Plans to Return | Unsure | No Plan to Return | Pending Response

Moved Out Of Area | 11 | 7 | 1 | 2 | 1

Discharge Total | Deceased | Moved Out of Area | Moved to Facility | Improved, Would Return

72 | 22 | 11 | 8 | 17

Service Failure | Finances/Pricing | Refused Care | Resumed Care

3 | 8 | 1 | 2