Miriam Allred (00:10)
Welcome to the Home Care Strategy Lab. I'm your host, Miriam Allred. It's great to be back with everyone this week. Today in the lab, I'm joined by Neal Kursban the CEO of Family & Nursing Care in Maryland. Neal, welcome to the show.
Neal Kursban (00:25)
Thank you, I'm looking forward to being here today.
Miriam Allred (00:28)
It's been a while since I've interviewed you formally, but I have followed your journey and I think it was at HCA away this past fall that someone said, why haven't you had Neal on the show? Maybe it was your brother or cousin or someone in the business, but people have told me to interview you again. So better late than never. Here we are.
Neal Kursban (00:48)
Yes, I'm happy to be here.
Miriam Allred (00:50)
Awesome.
Well, let's start with your origin story. Tell everyone about family and nursing care and your kind of the founder story. And then when you joined the family business and then give us some details on kind of the profile size, shape, payers, geography of the business. So we can have that context going into the conversation.
Neal Kursban (01:10)
All right, sounds great. So Sandi Kursban, she's my mother, she founded the company in 1968. And what's neat is there wasn't really much of an industry. So often she's referred to as a pioneer in home care because back in the day people would stay in the hospital for weeks or months even before going home and didn't really have a need as much for home care back as much. So 1968, she founded it and her
Her goal was, I want to service our elderly population, charging them as little as possible, and I want the workers...
the caregivers we call them today, of course, to earn as much as possible. So her advisor back then, and I've asked her many times, was it your accountant or was your lawyer? And she doesn't remember, but her advisor said, well, good luck. Good luck staying in business. And back then, by the way, it was very uncommon for a woman to own a company. And I got some funny stories I could share about that. anyhow, and so they said good luck. And what the recommendation was by the
advisor was to have the workers be called, what they called it, contractors. Sandy, my mother, said, well, what's that? They said, don't worry about it.
So little did I know, or we know decades, 57 years ago that the term independent contractor is prevalent in today's, here we are today. And so part of our business is run with the term often is called a nurse registry. And then we also, in my years, added the employee, the agency model, later. So that's part of the Sandi story.
And then I joined the company in 1995. It was late 1995, so I'll be hitting my 30 year anniversary later this year. Just remarkable to think of it. This is what I'm doing for 30 years. And so, you know, my...
My journey was the first several years, again, I was in my 20s and I wasn't quite as mature as I am today. So I'm not sure if I was ready to be in management position. So it turned out to be very fortunate that I had the benefit of having done all the positions in the company. And so my title for many years was basically office floater, informally. And I remember I had the desk that I wasn't even in there that much because I would come into the office and if someone
was sick or on vacation or...
attorney leave or whatever it may be, my job was their job. And if everyone was there, I had projects stacked on my desk of things to do. I was a coordinator and I interviewed caregivers and I did orientations and I did accounting and interviewed office employee, HR, basically every aspect of the company for many, many years. Did on call, which was lots of fun. So having the benefit of having
lived it and then grown to where we are today, it's a neat story.
Miriam Allred (04:08)
Let me make sure I've got a couple things right. When you joined it was 100 % registry model and you helped introduce kind of the home care side, correct?
Neal Kursban (04:15)
Yes.
That is correct. Yeah.
Miriam Allred (04:21)
And the
business was how big, how many clients, what's revenue size were you when you joined in the 90s?
Neal Kursban (04:29)
I mean it was a lot smaller. So I was employee, office employee number 12 or 13, and today we have about 100. So we've grown substantially since those days. I mean granted, the rates were lower, so the revenue was much lower, and of course with inflation rates are higher. So it's probably like four or five million in revenue then, and now we're up closer to 65 million a year in revenue.
Miriam Allred (04:55)
And what about payers? What was the payer mix and what does the payer mix look like today?
Neal Kursban (05:02)
So the payer mix was people that would pay privately. So not Medicaid, not Medicare, not family Medicaid, not basically out of their own pocketbook, their own checkbook, and would pay for the service.
and even when I came and joined and things have not changed so even the agency employee model that I introduced later in my time also kept that same very narrow lane of private pay so it's just private pay.
Miriam Allred (05:32)
Okay, even to today. also make sure I have this right, today the registry home care split is about 50-50, is that right?
Neal Kursban (05:40)
It is. So again, it had a...
Well, see 2007. So it's been 18 years of us running the agency. And I guess the other close to 40 years plus the last 18 years of running the registry. So yes, the agency has definitely caught up. The model has caught up and there's we could have a whole other session on the pros and cons of both and having run both and live both and still today living both models. There's certainly pros and cons. But but yet as we as I sit here and speak to you today in 2025,
They are now about equal size.
Miriam Allred (06:14)
And we're not going to go too far down this path, but in short, like what is your philosophy around that? Today it's 50-50 split. In, Neal's ideal world, would you like it to be all home care, all registry, keep the mix? Like in short, what does ideal look like for the business?
Neal Kursban (06:30)
Great question. ⁓
I don't have a vision on that. I'm very much what does the client family, what does the customer want?
And we find that some customers, and we're very open about here's the two models and which is your preference. So we get into, without confusing them too much, we do explain that we have two models. But, and at the end of the day, the register, mean, for simplicity purposes, I would just to keep it simple, it's about $5 less per hour if you're a client that gets care on the registry side. And the caregivers actually make more money per hour, but there's other things that they're not getting. But their hourly amount tends to
be a little bit higher than what the employees make on their agency side. wait a minute, does that answer your question? Yes.
Miriam Allred (07:19)
Yeah, so it's all about the clients. You don't feel
strongly about it being more home care heavy or more registry heavy. It's what your market needs and you're able to deliver.
Neal Kursban (07:28)
Right, it's what they, yes. And that also holds on the caregiver side as well. some caregivers prefer the independent contractor status and others prefer an employee status. And again, I don't have a dog in the fight. It's just whatever the client and caregiver feel is best for them.
Miriam Allred (07:48)
Well, we're not going to go too far down this registry side, even though we could, because I think that's really interesting. Today, what I want us to focus on are really like your three differentiators. Like you mentioned, your mom, Sandy is a pioneer in home care. Not very many home care companies can say they've been doing this for 50 plus years, but you were one of the few that can. And so there's kind of three differentiators that you've helped me identify that you believe set Family & Nursing Care apart. The first being
service obsession, the white glove experience that you're delivering to these clients. The second is caregiver sustainability. We're going to talk about how you're paying these caregivers so much and some of the foundations and programs that you've built to keep caregivers for years and years and years. And then the last thing we're going to talk about is being a family owned and operated business for this long. You've been approached by PE, you've got a lot of outside interest and money coming your way, but you've decided to keep the business.
independently owned and operated. And so we're going to talk about that as a differentiator as well. So just wanted to kind of preview the three areas we're going to talk about. Let's start with the service obsession. You explained to me that you want your business to deliver an experience compared to maybe like the Ritz Carlton, you know, like the top tier experience that these clients can have in home care. And so the question I want to ask,
Neal Kursban (09:03)
Right.
Miriam Allred (09:06)
Every home care business says that I offer premium care, quality care, like we're the best in our market, but you truly have built that. And I want to know what does that look like in practice? How are you and the team delivering that experience over and over and over?
Neal Kursban (09:23)
Okay, it's a loaded set of questions you asked, I'll often say we are in, we're not in the home care business, we're in the service business. Because again, private pay, family's clients paying 35, $40 an hour, whatever the going rate is in their respective market. And if you do the math very quickly, mean just.
30, let's keep the numbers simple, $40 an hour, four hours a day. Four times, it's $160, times that by five or seven days. The math adds up very quickly. It's not like when you get your cable bill or your phone bill and it's 100, 200, whatever. I mean, this is a lot of money. And if people are willing and able to spend this kind of money, I myself would expect.
that in return. I would expect to have a service experience that's gonna wow me. And so that's our job at Family & Nursing Care So that's a little bit buzzwordy, so we'll get into the specifics, but it's a philosophy. Well, actually I do gotta go a step further, and this is a bit into the weeds, but so every week we have an all-hands huddle meeting with all 100 of our employees. It's 15 minutes.
and every week we go through one of our guiding values. have 15 guiding, we have a mission and then 15 guiding values. And we go through each and every one of them, I'm sorry, we go through one of them that week and then we give an example, an employee will give an example of how they lived it that particular week.
And so it's just a constant reminder. of times, and we used to have this on the wall, and there's our guiding values, and this is what we all are supposed to know, but we live it every week, and we remind people, then 16, the mission plus 15 guiding values every 16 weeks, we start all over again. So anyhow, it's constant. It's just constantly dripping in who we are, how we are, how we do, what we do, when we do, what we do.
