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Keep Safe Care History, Evolution and Disruption
By Jeffrey Fry, Founder of Well Beyond Care, Keep Safe Care and Three Phase Health

Here is a little history of how Keep Save Care came into existence from an idea about changing the way care is delivered in America by Jeffrey Fry


The current caregiving market in America

First, I need to set the stage for the private duty, private pay in-home personal care services marketplace. As of 2012 in the US, Private Duty / Private Pay Home Health Care is a 125 billion-dollar per-year industry, with 8.1 million people hiring a private duty agency and receiving on average 20 hours per week of care at a rate of $27 per hour. In addition, the fastest growing segment of this industry is franchise sales. At present (2022), franchises represent only 15% of the private duty market share, but that has doubled in the last five years and is expected to reach 30% in the next five years. Even with this explosive growth, the private duty industry has two pervasive and chronic problems: Truancy (where a caregiver does not show up on a scheduled day), which stands at 25% on any one day; and turnover, which has reached a historic high of 83%, according to the 2020 Home Care Benchmarking Study by market research and education firm Home Care Pulse. There is a myriad of reasons for why both of these issues persist which I highlight below.

Another factor pushing the private duty industry is the fact that 64,000 Americans are retiring everyday (4 million per year) and that will continue for the next 20 years as the baby-boomers continue to turn 65. In addition, life expectancy has increased from 67 years to 83 years over the past 50 years, adding an increased demand for caregiving, with an expected increase of 1.7 million people needing care per year. Forecasts estimate that as early as 2050, one quarter of the US population will be over 65 years of age, creating a silver-tsunami. Add to the fact that due to the dramatic increase in costs of assisted living and retirement communities, more and more people are seeing aging-in-place with an in-home caregiver as the most affordable option when taking care of their aging parents.

What happened before Keep Safe Care and why I start Help Find Care and Well Beyond Care

With all these demographics in play, why did I start Help Find Care and then Well Beyond Care? First, it was because I had to take care of my late mother. After doing so, I saw that there was a pressing need to disintermediate the private duty space due in part to the depressed salaries caregivers receive and the huge markup private duty agencies can charge clients. As of 2016 a personal health aide made $8.25 per hour, and clients are charged $25 per hour with a minimum of 20 hours of care per week on average. Of course, in more expense areas like San Francisco and New York City, the caregiver wage approaches $15 per hour, but then again, clients are charged $35 to $45 per hour for care by private duty agencies. In all locals across the US, creating these direct-to-consumer marketplace not only increased wages for caregivers by 25% to 40%, but also save families purchasing care between $10,000 to $30,000 per year in care costs.

Phase 1: Direct to consumers              

In our first rendition of the company, we partnered with two private duty agencies (which were franchises in Austin) and developed software that was able to reduce their overhead costs by 50% and almost double their capacity to recruit and retain caregivers. At this point, we thought that one of these two franchisors would welcome this new service, but incredibly, both told us that they were under contracts from other software vendors and could not bring in any new vendors in to compete. While the door was shut to us partnering with large private duty agencies, we still knew that partnership with other groups, such as non-profits, assisted living facilities, and skilled nursing facilities would be a possibility, but we first had to prove our software was robust and reliable prior to delving into those partnerships. Thus began and ended Help Find Care. It was my first attempt to crack this nut, and while not successful, it was a learning experience.

With these developments, we had to go another route, and that was direct to consumers. This was our first line of attack for finding paying customers. We knew this would be a riskier venture as our target audience was older, less computer savvy, and weary of hiring individuals through a new internet service. Still, in order to get to the next phase of this process, we had to prove that 1) our software was a robust and integrated system;  2) that we could indeed attract caregivers into our system; 3) that when a caregiving match was made, that we could manage all the hiring, contracting, messaging, scheduling, billing, and payroll requirements; and 4) that we could scale on a nation-wide level. We also needed to prove that our careseeker-caregiver matching process and the ability for caregiver administrators such as adult children not living in the same location as loved ones, combined with nurse curators to guide users, would provide the basis of a successful business.

After launching Well Beyond Care in February 2018 and over the next four years, we were able to onboard over 60,000 caregivers and 8,250 careseekers into its system scattered throughout 50 States and in over 500 cities, and had proven that the minimal viable product of its software was robust and could scale. While these numbers are somewhat impressive, we knew to grow rapidly and reach a critical mass to make it profitable, the company would either must spend tens of millions on advertising, partner with some caregiving organizations, or develop a better way to add paying careseekers, and therefore revenues, into the system. As John Wannamaker once said, “I know half of my advertising is wasted, I just do not know which half,” and we felt that raising money to just advertise would not be the best use of funds. As such, since Well Beyond Care could not sustain itself as a stand-alone business, the decision was made to close the Company in March of 2022 and focus instead exclusively on Keep Safe Care, the private duty option I started. We still needed the caregiving recruitment developed for Well Beyond Care. It was at this point that Well Beyond Care was closed, and the software was purchased by Keep Safe Care and rebranded to Keep Safe Care Direct. At this point, a pivot was made to expand into caregiver recruitment and expending our private duty component thru licensing.

Phase 2: Caregiver recruitment for Organizations: Help Find Caregivers

Quickly after this software acquisition and with the plethora of caregivers in its system, Keep Safe Care launched its Caregiver Recruitment and Curation Service has Help Find Caregivers as a much more cost-effective offering than Indeed, Glassdoor or ZipRecruiter. This platform is configured for the needs of organizations such as non-profit caregiving agencies, assisted living facilities (ALFs), skilled nursing facilities (SNFs), rehab facilities, long-term care, hospitals, private duty agencies or any other organization or entity that hire caregivers either full-time or part-time. It is also the only platform focused exclusively on hourly caregivers.

Phase 3: The Ultra-Lite Franchise® model: Licensing

Private duty is currently the primary way in-home, non-skilled care is delivered in the US and we know at some time we would have to revisit servicing this market. With our Private-Duty-in-a Box® online software system tested and well established, Keep Safe Care is in a strong position to offer a disruptive solution addressing the private duty franchise market. Furthermore, the private duty industry is ripe for a disruption on how services are delivered and that there is a need for improving the cost inefficiencies in running an agency. Our third line of attack for finding paying customers was to create what we call an Ultra-Lite Franchise®, Keep Safe Care Affiliate program. Keep Safe Care will disrupt the private duty franchise model in two ways.

First, a Keep Safe Care Affiliate Ultra-Lite Franchise® license will cost significantly less than purchasing a traditional franchise. The traditional franchising model presently involves paying a franchise fee of between $50,000 and $125,000 per location, and a monthly royalty of between 4% to 6% of gross revenues, along with additional advertising fees assessed at between 2% to 4% of a franchisee’s gross revenues. Across the 97 franchisors in the US, these fees are 8% of gross revenues on average. As an alternative, the Keep Safe Care model instead sells a software license for $5,000 and an location license between $10,000 and $15,000; and then charges a small monthly fee of $1,000 to $3,500 based on the size of a franchisee’s 30-day census. Essentially, a Keep Safe Care Affiliate licensee receives the same service as with another other franchisor with our Private-Duty-in-a Box® system, but with substantially lower startup costs and lower recurring royalty payments. In addition to reducing costs associated with purchasing a private duty franchise, operational cost savings generated using the Keep Safe Care’s Private-Duty-in-a Box® will also be realized with Keep Safe Care Affiliates. These Affiliates will be able to differentiate themselves in the marketplace by paying their caregivers more (we call it The 2/3 Rule®), matching Careseeker’s needs with caregiver’s abilities and location, and operating a private duty agency with one half the overhead of a traditional franchised agency. On top of that, these affiliates will be able to operate with fewer employees and be able to make 25% to 50% more in profits in comparison with traditional franchises. The number one difficulty in running a private duty agency: caregiver recruitment, curation, management, scheduling, and payroll, will be offloaded and automated by the Keep Safe Care Private-Duty-in-a Box® software. This will allow Keep Safe Care affiliates to focus more on marketing for new careseekers and less on chasing caregivers.

Putting it altogether

How can Keep Safe Care disrupt an industry? We looked at the whole infrastructure in private duty care and created a system that addresses and rectifies the major issues in this industry. We have reduced truancy and turnover to levels approaching 1%. In addition, we have discovered how to more effectively and efficiently run a private duty agency, adding capacity while lowering overhead costs. Together, these factors play into our three-pronged attack in this space. When we go direct to consumers, we save families $10K and $30K per year in caregiving costs. When we manage caregivers for caregiving organizations, we lower costs and add capacity. When we go head-to-head with private duty franchises through licensing our Ultra-Lite Franchise®, we let people start their own companies at a fraction of the cost of the existing franchising model and improve caregiver salaries by $5 to $8 per hour. While in the short term, Keep Safe Care licensing will most likely be our growth engine in adding revenues, in the long term we expect the vast majority of people will use Keep Safe Care Direct as do-it-yourself for consumers, allowing them to find and receive better care at a much more affordable price. Between Keep Safe Care, Keep Safe Care Direct and Help Find Caregiver, our goal is to own 50% to 70% of non-clinical caregiving industry with this disruptive new technology and methodology.