Home » Sandy Jen: Rethinking Home Care @ Talks at Google (Transcript)


Here is the full transcript of Sandy Jen’s fireside talk: Rethinking Home Care @ Talks at Google conference.

Moderator: JORGE CUETO


JORGE CUETO: Hi everyone. Welcome to Talks at Google, and it’s great to have Sandy Jen, co-founder and CTO of Honor here with us today. Sandy founded Honor in 2014, and prior to that, she was co-founder and CEO of Meebo, which is a customer internet company that focused on connecting publishers and consumers socially. And she led their engineering team and then joined Google, actually, in the social team when Meebo was acquired in 2012. And before that, she also got her BS from Stanford University in computer science. So it’s great to have you with us today, Sandy.

SANDY JEN: Great to be here.

JORGE CUETO: I’d like to get started by having you tell us about what Honor is in your own words.

SANDY JEN: Sure. So Honor — our mission, basically, is to change the way that our parents age. I think aging is a topic that a lot of us don’t talk about with people, especially our own parents. There’s a bit of sort of child fear when talking about issues like that.

And so Honor’s goal, really, is to remake the way that folks can age at home specifically. So we really focus on non-medical home care, which means that we help folks with what we call ADLs– so Activities of Daily Living– things that you and I take for granted — brushing your teeth, getting out of bed, going to the bathroom. And we have a whole host of really awesome care professionals that go and do that work.

JORGE CUETO: And what inspired you and your team to start Honor?

SANDY JEN: Good question. So three of the four founders are multi-time entrepreneurs, and so we all kind of cut our teeth on social media. I’ve obviously been at Google for a little bit. And once we sold those companies and took a little time off and we really wanted to do another venture, we really wanted to think about, OK, well, what would make us really want to work hard — like really, really hard? Because startups are a lot of work. And we ended up thinking about what’s important to us, and we were a little bit older a little bit more mature. Some of us were having kids, and we really wanted to have impact. That was the biggest thing.

And so when we were getting together, we thought about, OK, what are big problems that we could solve? And we thought about unemployment, poverty, labor, childcare, health care, elder care. And then my co-founder from Meebo went home one day to Connecticut to visit his mother. And he likes to tell the story that she gets speeding tickets in Montana, which you just don’t get, because there’s nobody monitoring the freeways in Montana. And she was driving really slowly, so he started to get a little freaked out about, wait a minute, why are you driving so slowly? And she was like, well, it’s just getting a little harder. And so he was like, well, I live in California, you live on the East Coast.

When you’re older, what am I going to do? I don’t want to pluck you away from your house. And so that sort of spurred the idea. We really started to do some research in caring for seniors, and it’s a really, really big space. And then we really honed in on the non-medical home aspect of it, because it was very broken. And when you find something that’s really broken as an entrepreneur, you kind of get really excited, because you’re like, what can I do to fix this? And so we started to explore that idea.

JORGE CUETO: How do you feel like your experience working on Meebo in the social space has influenced your work here with Honor?

SANDY JEN: So I would say doing a prior startup to doing Honor was definitely a pre-req to do this type of venture. Honor is complicated. Home care — you’re touching people directly. It’s a very, very hands-on experience. And so in order to solve such a big mission, you need to know how to execute, how to gather resources, hire — a lot of the sort of nuts and bolts that I learned in my first startup.

And so my experience at Meebo really taught me generally how to form organizations, how to run a team, how to hire. There were a lot of mistakes we made at Meebo, which, as an entrepreneur selfishly for a second venture, I want to be able to not make the same mistakes twice. So it was a good opportunity to take all the learnings that we had gathered in our previous experiences and then really consolidate all that learning into a new venture. And so far, it’s worked out really well.

JORGE CUETO: And how long have you guys been available to consumers actually?

SANDY JEN: So we’re about three years old, but we’ve been giving care for about two. And so the first year, obviously, a lot of us didn’t know much about home care. I had some personal experiences with my grandparents, but really digging into the industry– it’s been around for a really long time. It hasn’t changed much in 30 years, but there are a lot of nuances and complications and considerations in home care that, without really doing it, you don’t really get exposed to it. And so the first year for us was a ton of learning, and then we started to take those learnings and execute on them.

JORGE CUETO: Prior to the interview, I was just reading on this market. And it’s actually a huge business opportunity in terms of how much money people spend on home care and elderly care every year, but it’s something that I don’t think tech has addressed up to this point. Why do you think that is?

SANDY JEN: It’s interesting, because people think technology, they think old people, and they’re like, they just don’t mix. And the way we thought about it is– if you think about your grandparents or your loved ones who are older, they use microwaves and toasters and TVs and cars. And that’s all technology, but it’s not in their face as technology. And so you have to sort of rethink about how you use tech to address needs for that kind of audience.

And so for us, I think there’s just been that stigma in Silicon Valley– and just generally in technology as a whole– that seniors don’t do well with technology. I think it’s a mistake to kind of over-cater to a senior audience by having giant buttons and giant font and basically treating them as children without really understanding the problem you’re trying to solve. And so we definitely don’t think of ourselves as a technology company. Honor specifically positions itself as a services company, because at the end of the day, our product is a person. And I say this very often, that we are a human services company.

The person that we send to your home to help you do your activities and daily living– that’s our product. And so all the technology that we build is in service of that. So a lot of stuff that we build, the end consumer never sees, but it’s completely built to deliver the best care possible.

JORGE CUETO: What was the hardest part of the process as you were starting out with this company?

SANDY JEN: I think as technologists, you have this sort of want to automate everything and make everything really efficient. And so you come up with a bunch of assumptions. And so as engineers, we’re like, OK. We’re just going to build this thing, we’re going to build that thing. This is the way it works. You just go to visit, you do this, you do that. And then when you actually start to do it– we all ended up volunteering in your homes to help out.

And you’re like, wow, that’s not how it is. And so we had to basically learn to strip away all of our assumptions. And in the very beginning, we had folks who were running care and delivering care and working with our care professionals. They were doing one thing, and the engineers and product team were doing another thing. We were trying to build things for each other, but we weren’t really in sync as much as we should have been.

And I think that’s a common problem, because you make assumptions, you work one way. You make assumptions, you work one way. But at the end of the day, you really have to work together– like really, really together– to understand what’s going on. And so once we figured out that we were not building the right thing, that changed the course of how we did product development, which I think is different than what you’d find in a more traditional software or technology company. We really had to sort of rethink how we did that.

JORGE CUETO: You mentioned that you went to visit some senior homes. What else did you do in terms of use of research or validating the product and getting feedback on the product?

SANDY JEN: Yeah, so we knew we didn’t know anything, really. And if you think about home care, it’s basically two-sided. Actually, it’s multisided. You have the person receiving the care– so the care recipient who could be older or have different medical conditions. You have usually a family member, sometimes not, who might be the one responsible for helping care for the senior. And then you have the person who’s actually doing the care– the care professional. They’re traditionally called caregivers, but we really wanted to raise their profile. The work they do is really difficult, so we actually call them care professionals– and then care pros for short– to give them more of the respect that they actually deserve. And so we had to basically talk to everybody.

So we plucked ourselves out of the Bay Area, because the Bay Area’s kind of weird. As you all know, it’s a little bit of a bubble. So we went to different areas, talked to different care pros, asking them, what is it you do? What’s hard in your life? Why do you do this work? A lot of folks who at this wage level could literally make more flipping burgers at McDonald’s, but they choose to do this work because they really care. So it’s like, why are you making that decision? What are the hardships in your life? Why do you work for this agency and not that agency? So just really being open to understanding how they’re thinking. And then when you start to get the same answers over and over again, then you start to think, OK, now I’m seeing a pattern and a trend. And that can then inform the product that you build and how you want to create that interaction.

JORGE CUETO: Your comment about the wages that the caregivers are earning reminded me that I saw the CNN article that mentioned that in 2016 you transitioned from a contractor model to an employee model. Is that something that continues today, and why did you choose to do that?

SANDY JEN: I think in the beginning, we were like, all right, we’re just going to try the contractor model, because that seemed easiest. And so we started recruiting people. And then it turns out that there are certain restrictions in a contractor model, that you, for example, can’t train your folks very well.

There are certain limitations on the amount of personal interaction you can have with them. And so one of our core tenants has always been, if you could treat the care pro better and put them in a better place in their lives, they’ll be able to do their jobs better. Because if you’re not happy at home and you’re trying to make ends meet, you’re not going to be able to care for people very well. And so one of the things that we heard over and over again from care pros was that they might get a $0.25 increase in their hourly wage after staying with an agency for three years.

There’s no performance-based reward. There’s no way to know who’s a good care pro, who’s a bad care pro. And so one of the things that we thought would be really cool and that they were asking for was some way to develop your career as a care professional– as a caregiver. And so the only way you can really do that, though, is to give them signals as to what they’re doing really well and what they’re doing not so well– what they can improve on. And then you can train.

And so one of the key reasons we decided to make the switch to an employee model is that with employees you can actually train and develop and really invest in them as people and as workers. And so that was one of the primary reasons we decided to make that change, and they’re still employees today.

JORGE CUETO: So then you mentioned the value to caregivers. So if we look at this in comparison to traditional senior care centers or senior care models, what value do you add to the other key players — so then in this case, maybe the seniors themselves or also maybe the family members who are buying the care for their senior family members?

SANDY JEN: Yeah, so the current industry is very fragmented. So if you think about– I think nationwide, there’s something like 40,000 or 50,000 agencies. It’s not because no one’s ever tried to make a large agency, it’s just really hard. You have a bunch of people on the demand side– so all of your seniors needing care. Let’s say your grandmother might have a bad hip and this chronic medical condition, and she’s allergic to dogs, and she requires someone who can lift someone out of bed every morning. Or my mother or grandmother might need to speak Mandarin, and she’s allergic to cats. And she has three sets of stairs, so you need somebody to be able to lift her downstairs.

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So the requirements for people are super heterogeneous. And then on the supply side, care pros are also very heterogeneous. This person might be able to lift 200 pounds, but this person may not. This person speaks this language. This person can only drive five miles outside of her home, because she has two kids that she needs to pick up after work.

And so there are all these stipulations on both sides, and so doing a match is actually really difficult. And so if you are a small mom and pop agency– which lot of these places are– you don’t have the logistical operational technology brain to do that, because you’re trying to do it all in your head. So you might have a staff of a few people trying to match all these things. And so a lot of it is also very analog, so care pros will literally have to take a telephone in the morning and say, OK, where am I going to go? They’ll literally take their notes per visit on a spiral bound notebook with a pencil, and they’ll leave it on the desk. And so we also talked to folks who run agencies– they’ll literally drive around to all their clients, pick up those notebooks, transcribe some of those notes into their own system, and then return all the notebooks back.

So it’s just very manual. And so one of the things that we hoped to bring and have been bringing is a more technology bent on this for that rote work. And so one of the key learnings for us was that you could try to automate everything, but we’re not going to send robots to do care. That’s not going to work. And so what we can do, though, is have computers do as much of the rote tasks– the matching algorithms, the GPS tracking stuff– and then let the humans do the really human stuff.

And so we can get there about 80%, and then let the humans do the rest. And so one of the things that we’ve been trying to do is actually just give more transparency into the process. So if I live in California, but my parents are on the East Coast, and I have a caregiver going every day, I can’t go and find that spiral bound notebook and have someone read that to me every day. So we have given an app to the care pro. We’ve given an app to the family. They can see notes right away. They can call in any time. Scheduling is a lot easier. The technology we use to then be able to track and give you progress notes on how the visit is going is amazing in this industry for a lot of folks. And so just trying to up the quality and transparency of care itself has been a huge goal for us– and definitely the ability to use technology to scale.

Because we have all this technology, we might require one human to do this instead of 10. And so when you have that, you can save a lot of that time to go do other interesting, innovative features to help with care delivery. Technology is definitely used to scale, to make better care, better quality. But at the same time, we have to recognize that it can’t replace humans. And so at the end of the day, the human to human experience is still the end product.

JORGE CUETO: You mentioned that you provide training for your care pros, so what does that training encompass?

SANDY JEN: It can vary to basic skill sets. Like how do you lift and transfer someone who’s bedridden out of bed into a chair? How do you take someone from their bed to a toilet? There are things like, OK, what is the best way to assist someone in this particular task? And so we can also do things like, oh, if this person has Parkinson’s, these are specific tools and techniques you can use to help maneuver them physically. If someone has dementia, here are techniques and generally accepted ways to communicate or to elicit feedback from those folks. And so a lot of it is skill-wise, but also, how do you basically interact with different types of people? Because a lot of our clients– their conditions vary greatly, so it’s not like one bucket fits all.

JORGE CUETO: And in terms of the composition of your audience, are you looking at mainly people who are soliciting care for their family members, or actually seniors themselves who are asking for services for themselves?

SANDY JEN: Yeah, it’s both. We thought in the very beginning that we’d have more what we call adult children. It’s sort of a child or a nephew or a family member then responsible for someone who is older. But we also have folks who just want care for themselves. They recognize that they want to stay at home. They don’t want to go to a nursing home or facility.

And so having a little bit of additional help is actually really useful. So yeah, it just really varies. But we definitely have more folks who are getting care for themselves than we originally thought.

JORGE CUETO: So that, again, goes to debunk that myth that seniors don’t really engage with technology, right? Because they need to have some understanding in order to reach you in some ways.

SANDY JEN: Yeah, they do have to find us. But at the same time, we don’t require any technology to use Honor. That was a very conscious point. So if you don’t want to touch a computer, you don’t want to use an app, you don’t have to. Most of our customers call us.

JORGE CUETO: So then you’re also seeing how maybe you can leverage old technology using new technology for the platform, but for the interface, relying on the older.

SANDY JEN: Yeah, and so those trends will change as well. So our current demographic– a lot of folks just want to call. And also, you think about if you’re an adult child, and let’s say your mom falls– which is a very common entryway into home care– you go from knowing nothing about home care to someone saying your mom needs eight hours of care a day. And you’re like, oh my god, what the hell is home care? And so you need to figure out what’s going on, and you’re in a very emotional state. And so when you’re in a very emotional state, you’re not going to pick up your iPhone and be like, OK, I want care, click click click.

You’re going to want to call somebody. And so we have a dedicated team of people who answer those calls to make sure that people can walk people through that process. At same time, though, if you have gotten care for a while, you know what home care is, and all you want to do is press some buttons, you can do that as well. So there are different options. And that will probably change.

One of our goals is to make Honor take care of us when we’re old. So obviously, when we’re older, the times may be that no one wants to call and everyone wants to use an iPhone or an Android phone or whatever. So we can kind of see the trends coming into the industry, which is a nice side effect of not working in younger social media stuff. Because I don’t know what the next 17-year-old wants on her phone, but I do kind of know what the next 50-year-old wants. So that’s been kind of an interesting change.

JORGE CUETO: And in terms of scaling– so I see this in-home elderly care as being something that requires a lot of trust built over time and something that people really have to open themselves up to and be comfortable with. So how, as you’re scaling, do you maintain that sense of trust and comfort?

SANDY JEN: Yeah. I think the biggest thing you can do is also always frame your product and your team in the right way. So when I said we don’t think of ourselves as a tech company, but we think of ourselves as a services company, that’s the core. That’s the mission.

And so trust is huge. I think a lot people are like, oh, why don’t you just do childcare too? Unlike childcare, where there’s usually a hand-off where you’re physically present, you give your child to a babysitter or a nanny, and then at the end of the day the nanny returns the child to you, that doesn’t always happen with senior care because you generally don’t live with your parents at this age, or you’re across country, or you’re not in the same area. And so the trust part– it’s kind of both human and tech.

So on the human side, you have to have a great care pro. If the person coming to your home is terrible, obviously the trust just goes down the toilet– so being really good at hiring really good care pros, having the right kind of vetting process, the right kind of training process, interview process.

The other part is just supplementing that with technology. So we have GPS turned on for our care pros when they use the apps. We can tell if they’re there, right? That’s also to protect the care pro, because we do have a lot instances where the client’s like, oh no, the care pro never showed up, because they didn’t want to expose something to a family member. But they were like, well, no, they were there. And so it’s a dual-sided thing, where if you just come with tech, it’s too robotic. It’s too cold. But if you just come with humans, there are a lot of non-verifiable, anecdotal things that–

JORGE CUETO: Or inefficiencies.

SANDY JEN: Yeah, or inefficiencies or he said, she said things. And so you can kind of couple those together and then have a better package to then improve on that trust metric.

JORGE CUETO: Also related to scaling– so I saw that you guys are available in California, New Mexico, and Texas right now. How did you pick which cities to go into first? And then how do you think about a new city that you want to go into?

SANDY JEN: So a fear of ours is actually just going too fast. You hear these stories about other companies who have really expanded, and they had to retract. And we don’t want to do that, because if you retract your service– this is a thing that’s life critical for a lot of people. And so every new market that we did currently was an experiment. So LA was like an hour flight away.

Can we do that? Texas was, OK, it’s a couple hour flight away. Can we do that? Different time zone, and I’m sure all the engineers are like, oh, time zones, that sucks. So we had to kind of figure out how to do that. And then Albuquerque was a smaller area– a less sort of dense urban region. So we’re like, OK, can we handle that? And so we definitely wanted to learn, and the best way to learn is by doing.

And so we really carefully figured out what markets would give us the best learnings to then be able to take our model and scale out. So yes, eventually, we’d love to be nationwide. In terms of the next market we’ll go to, again, it will probably be a combination of are there good partnerships, what’s the demographic look like, services level, what can we learn from that particular market– things like that.

JORGE CUETO: And you were at Google for about a year in 2012. Maybe you could tell us if there’s anything that you learned while at Google that has helped you with Honor.

SANDY JEN: I learned I didn’t want to be at Google. But it was really interesting, because I think from the outside, Google is this big, amazing, monolithic technology company. And so it was very interesting for me personally to learn how that worked. When you come in, it’s like, OK, how do they form their organizations? How do they make a product? How do they make decisions? What are the roles that they hire for? How do they hire? And so for me, that was really enlightening, because it gave me a different perspective on how I did my team building. And so just being here learning, OK, well, this team operates this way, and they set goals this way.

Or they hire this way, or they structure this team this way in order to create these incentives to get this goal done. That was really useful so that then I can incorporate that into Honor and think about, OK, when I’m building the team now, how do I want to do it? I have learnings from Meebo. I have learnings from Google. How can I combine those the right way?

JORGE CUETO: And throughout these first few years, what do you see as something that your team has done really well at Honor?

SANDY JEN: We execute a lot and crank out a lot of stuff. I think one of the things that we did really well was not rush the build, and also having the realization that we needed to be completely open-minded, because none of us are from health care.

And so because the team stayed small and nimble and we were very focused– I think focus for startups is key. Most startups die from suicide, not homicide. And so for us, we just had to stay laser focused– OK, what are we building? And because some of us have worked together before and we were very picky about hiring, having really high-bandwidth communication really excels your timeline to be able to build something. So most home care agencies tap out at a certain scale, which is why the industry is very fragmented. And so within three years of our inception, we are probably one of the largest home care entities in the Bay Area– maybe the largest.

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It took us three years to get there when it usually takes 15. So it kind of speaks to a combination of good teamwork, the right technology, cutting edge stuff, and then really understanding how to learn from things. I think one of the downsides of the industry is that there are so many well-intentioned people, but they don’t have the means and the technology to learn and iterate. And so getting data is really hard for them. Everything is in spiral bound notebooks and things like that.

And for us, we can get a lot of data. We have so much data about how care works, how do you do matching, what are the trends, what are we seeing in terms of shift lengths, and days, and areas, and markets, and pricing, and wages. And so all of that you can use to learn and improve the service, when I think the current industry has a hard time accessing that.

JORGE CUETO: And as you were deciding whether to jump back into doing a startup or not, what were some factors that you were considering?

SANDY JEN: That decision is always very personal. So obviously, I was at the age where I wanted to have kids. And so I was like, well, it would be really nice to just stay at Google, because they have really good maternity leave and it’s really comfortable. And I can have a very routine schedule. At the same time, though, I think I had that need to do more I think Meebo was great, I mean, I had a great time. But it didn’t have the impact that I think when we got older we really wanted. And a startup’s average lifespan– I say this a lot– is about seven years to some sort of event or pivot.

And so I was like, well, do I really want to dedicate another seven years and have kids while I do that and all that stuff? And so the allure of working with my co-founders again, it was just really good timing in terms of the senior space. No one had really made a big play in it before, and we were like, we can really solve this. I use this analogy a lot, and my co-founder does as well.

But a lot of problems that entrepreneurs run into that are big, if you think about it like an onion, is that you peel back one layer and you’re like, oh, I could solve that. You peel back another layer, you’re like, I could solve that. And then at some point, you keep peeling, you hit this hard core. And you’re like, crap I can’t solve that.

There’s a regulation, or it would take like 10 years to build, or I had to get government approval, and would take like six years or whatever. But in the home care space, we kept peeling. We couldn’t find anything that was super hard. We were like, oh, we could solve that, we could solve that, we could solve that. And that was just really exciting.

And so jumping back in, we’re like, all right. Let’s just do this. Because you basically have to commit 100% or zero. You can’t half do it. And so we all kind of said, all right, let’s just buckle up and do it– have kids all along the way. And so the decision to do it was actually a quite easy one when we thought about it that way. And so far I’ve seen no regrets.

JORGE CUETO: Yeah, that was a really comprehensive answer. I think now we have time to open it up for the audience questions.


AUDIENCE: Hi, Sandy. I have a question about– I think what you’re doing is fantastic. I think you have a great product and everything you’re doing for the senior community. A couple of years ago, I went to the National Association for the Deaf conference. It was in Atlanta. They also had one in Phoenix as well. And I met a lot of members from the deaf community who are aging– specific groups of seniors helping people find a place to go. Do you have any involvement with the deaf community with your product or your services– something that would be accessible for the deaf community?

SANDY JEN: So specifically, we don’t have anything specifically targeted towards the deaf. But like I said before, our audience and the client demographic, it’s very heterogeneous. So we have people with all sorts of conditions. And so we don’t say, OK, just because you have this condition or that condition, we can’t serve you. It’s really dependent on the kind of care the person needs.

And so let’s say someone is deaf, they have a bad hip, they require more lifting and transferring out of bed, then we would just try to find the right caregiver to then service that person. So we do have partnerships with more disease-specific organizations– so the National Parkinson’s Foundation and cancer organizations. But in the future, obviously, we’d hope to partner with more people. But again, there’s no specifically targeted service for deaf, but just because you’re deaf doesn’t mean you can’t have home care.

JORGE CUETO: Here’s a question from Dory. Besides Honor, what are key technological improvements that you believe have improved elderly care? What other technological improvements would you like to see in the space to improve the experience for both the caretaker and the elderly?

SANDY JEN: Yeah, I think the biggest thing is probably just access. There are a lot of devices in market, a lot of technologies that are, like I said, really specifically targeted for seniors. But they’re taking a very non-granular stance. So like I said, the bigger buttons, the big fonts. And if you talk to a lot of older adults, they don’t like things dumbed down for them. They’re like, I’m perfectly capable of using a regular device. So I think there needs to be a change in the attitude, I think, more than the actual devices. Because if you sort of rethink the way you frame technology, you can– I know plenty of seniors who use iPhones and Android phones in a very expert manner, and there are some folks who don’t.

And so I think if you change the way that you target seniors, I think that will be a big difference. Things that I think have been really helpful for folks are– more educational tools for folks who help seniors is probably a good step. So the fact that we have an app for care pros is actually a huge, novel thing for the industry. But it makes them better enabled to help people who require help. I would say one thing is that a lot of the physical access things that you and I take for granted, like walking upstairs, going through a door, remembering a lock code, those kinds of things could probably be improved as the senior population gets larger.

So basically, I think that my biggest thing is not specifics, but more of the attitude change I think is probably more important than the actual physical things that are being built.

JORGE CUETO: And related to that, have you thought about maybe expanding your sphere of care into providing support services for the family members who are maybe learning about working or supporting their family members who are becoming elderly and maybe developing additional needs that they didn’t have before?

SANDY JEN: Yeah. So home care– generally speaking, people don’t think about it until they really need it. So home care is usually triggered by an acute event, usually a fall or a surgery or something medical. If we had the conversation a lot earlier, we could actually then introduce care in a more lightweight manner, so then that way the transition into home care is less jarring.

In terms of family members, we do have a lot of family members who get home care for their spouses or their parents as respite care. So they are the primary caretaker. They live with the person receiving care. But they might need a day off, or they might need three days off every week, because it’s kind of a full time job. And so they supplement with Honor or home care to help with that.

And I think the other part of it is that a lot of people who are in this situation feel very alone. There aren’t social networks for people who are giving– who are receiving home care for their family members. And no one talks about this on Facebook or whatever. It’s not like you’re saying, oh, my mom got care today. No one talks about it.

So opening up the conversation, having more community around that is one of our goals as well. And also, just the transparency. It’s like having the peace of mind to get home care, because it’s scary. It’s like you’re letting a stranger into your home and take care of your mom or dad and doing very intimate things, like going to the bathroom or getting out of bed. And so the support network, I think, needs to be there.

Because almost everybody we talked to has a personal story, but they never share it, because it just doesn’t come up. It’s a very taboo subject. So hoping to open up that dialogue is one of the things that we’re trying to do, which is why I think we frame Honor in a very positive light. A lot of agencies or senior related products on TV you see are the help, I’ve fallen, and I can’t get up, or it’s very fear-based. We chose amber as a very bright color, very positive color. We talk about it in a very positive manner. We have positive images, not images that instill fear or the more scary side of that.

JORGE CUETO: How do you reach new clients and convey values of trust and safety in non-tech cities where people have not heard of Honor and may rely on word of mouth or local searches?

SANDY JEN: Yeah, so health care, traditionally, is very local, so word of mouth is extremely powerful. And you can’t just win home care market share by advertising on Google or Facebook, because that’s not how you reach people. And like I said, a lot of times, home care is triggered by an acute event.

And so you’re not paying attention to anything in home care or in the elderly space or health care space until something happens. And then our job is to be there when that happens. So addressing the part where someone who’s not very tech savvy or they don’t really know much about Honor– the one thing that we have to portray is that we are human. And so prior to any home care set of visits, we send a person, one of our care advisors, to your home to do a consultation. They talk you through the plan. They talk you through what your needs are. They listen to what you need, because a lot of times, people just don’t know. It’s like, OK, my mom fell. What do I do? You need someone to actually walk you through that process. And so basically instilling trust via a person is still a great way to do it, and so that’s something that we do definitely employ.

And then also just being a knowledge expert. So again, when you’re emotional, and you’re scared, and you don’t know what you’re doing, you want someone to tell you it’s OK. I’ve done this before. I’ve seen this before. Let me listen to you. I can help you through this process. And so that’s a very, very serious thing that we take very seriously to make sure that when people come into Honor and when people think about home care, they think about Honor as a very calming, expert voice. That’s something we strive to propagate.

JORGE CUETO: You mentioned that a lot of the seniors that solicit care for themselves reach out to you via phone. So how do they find you? Do you also advertise in traditional media as well– Yellow Pages, all those?

SANDY JEN: Yeah. So it’s been a bit of a challenge to find out where those things are. A lot of times, like I said, word of mouth is most powerful, so reaching the influencers within a community– so like a local pastor, a local senior organization, a discharge nurse at a facility happens to know all the community members, the mayor– whoever is sort of a community influencer. So that’s one way to do it.

The other way is just basically to provide care and then have referrals. So if someone has a great experience with us, they will tell their friends. Because generally speaking, if you were getting care, you probably know other people that are getting care. And then, obviously, you try to advertise in the normal channels. But those are a little bit less effective, just because it can be generally not in your frame of mind when you need to. And then the other part is to partner with other people who deal with seniors. So we opened up a partner network to work with existing home care agencies.

We work with systems– so hospitals and facilities, nursing facilities, discharge facilities– to help spread the word so that they know that Honor is an option and that we’re differentiated from the rest of the other agencies around, because we have all these benefits.

JORGE CUETO: So then even these traditional organizations are willing to work with you? They’re not scared that somehow you’re going to take over or encompass some of what they’re doing and take business away from them?

SANDY JEN: Yeah, so it’s been interesting with that particular partnership network. Like I said, a lot of current home care agencies have a hard time growing, because they’re like, I have two people. It’s all in my head. I don’t have technology. It’s really hard for me to wrangle care pros and hire care pros and match care pros. I get calls at 2:00 AM when a care pro can’t make it, and I have to go and do the care of myself. And so they have to deal with all that, and they don’t tend to grow a lot. So one of our benefits is that we’re really good at the care pro part. We’re really good at the recruiting part.

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We have technology to help us do all that stuff. And so if we can take that burn away from them, they can actually grow. And so it’s actually a really good partnership, where we both benefit from that. We both have the same mission. We’re trying to help people. But they’re good at one part, we’re good at another part. So if you put it together, it’s actually really good.

JORGE CUETO: So I think this is actually really cool to see, because I think so much of the newer service-based economy– you look at maybe Uber or these other startups– people see them as supplanting an existing industry. And there’s a lot of pushback and conflict between the traditional industry and the new tech company. Whereas here, I think it’s sort of you’re trying to work together and make it more of a mutual relationship.

SANDY JEN: Yeah, definitely. Initially, people are a little bit skeptical. They’re a little bit like, wait, what? You’re from Silicon Valley, what are you guys doing? But when you explain how we work, why we’re doing this, why we’re mission focused, things like that, then they start to be like, oh, wow. If I really partner with you, we can really make a better difference, a bigger difference, and help more people. Because a lot of these people who come into the industry are genuinely there just to help people.

They could make more money doing other things, but they really like the work, because they get to interact with clients and talk to people and help them through these things. And so when they find a willing partner like Honor who has all these skills and tech and teams that they don’t have, it’s actually pretty exciting. So it’s a new way to innovate on an existing model, I think, that both sides are pretty excited about.

JORGE CUETO: Another question from Dory. What are some key technology or product decisions that had to be made to ensure that Honor is friendly both to the elderly users and also to the family members who are on different panes of technology familiarity?

SANDY JEN: Yeah. So like I said before, we don’t require anybody to know anything about apps or phones or websites to use Honor. So they could completely do everything by phone if they wanted to, because we know that’s a huge part of our audience. At the same time, though, we do want to push the envelope a little bit and give folks the option of using technology to see the benefits of it. So all the technology is optional for the care team of a particular care recipient.

So if the family member chooses to use the family app, they can. If they don’t want to, they don’t have to. If they want to log into the website and see all their bills and see the care notes and get emails, they can. But if they don’t want to, they don’t have to. So we are trying to be very respectful of the way the current industry works and how some people just don’t want to touch– it’s just too complicated to touch tech.

At the same time, though, if there are folks who really want to take that leap, we’re there with them as well. The one thing we do require our care pros have is the app, and they actually love it. So we do push the technology on the workforce. But it definitely makes them more effective, more aware of what’s going on, better enable them to find more jobs, find more work, and earn more money. So that’s sort of our balance. But yeah, if you don’t know anything about tech, you can just use a rotary phone and call us every day if you wanted to.

JORGE CUETO: Elderly care by non-family members is common in the US, but in some other countries like the Ukraine, it is not culturally accepted. But there is a huge market for it. I wonder your thoughts on how to help make a service like Honor be acceptable in such a culture.

SANDY JEN: Yeah. People have reached out to us from different care organizations from different countries wondering when we’re going to expand to their country. Obviously, we’d love to do that one day, but obviously not right now. Culturally, you have to respect the way that care works. But I think the trend of more and more people moving to more urban areas, more and more people moving out of their city that they’re born in, tends to consolidate a lot of the same types of concerns around senior care. So if you don’t live in the same place as your parents, moving your parents to where you are can be rather expensive if you live in a more urban area.

Real estate is tighter, houses are smaller, transportation is harder, especially in accessibility. So if someone has a 90-year-old mother who can’t do stairs very well, but you live on the sixth floor of an apartment, that’s a really difficult thing to have to deal with. And so even though culturally, people may have different expectations, I think a lot of the trends are moving towards the same direction. And so I think in the future, we have to just find that balance of obviously respecting the current tradition, but also pushing folks to understand the reality of what’s happening. And then maybe all the caregivers in the particular country are very different from the ones in the US.

Maybe they’re different, maybe they’re not. If we can introduce a way of doing things, maybe that spurs a new kind of trend or movement. But at the end of the day, I think, generally speaking, a lot of countries are migrating towards the same problems.

JORGE CUETO: Words matter in the space that you’re working in right now. How does your messaging change between the patient versus the family member or caregiver to communicate your value proposition? What has resonated the most and the least? Who’s usually making the purchase decision?

SANDY JEN: So generally speaking, it’s usually the adult child that’s making the purchase decision, and so it’s an interesting conversation. So the most effective communicator is usually the family member to the senior. But sometimes it’s not. So we do have care recipients who are resistant to care. So they don’t want someone in their home, they don’t want care even though they need it. And sometimes they would rather talk to us than their family member, because they don’t want to expose some of their needs to the family member.

Because what happens is that when you expose that, you are exposing a lack of control, and that’s really scary. And so a lot of times, we’ll have this interesting dynamic where a person getting care doesn’t want to tell the family member all that happened. But they’re willing to tell the care pro, because the care pro’s helping. So again, it’s all dependent on the situation. For the most part, we do do a lot of communication through the family member who is the one responsible for the care or the billing relationship. But a lot of times, when the care recipient is the actual account owner, then we directly communicate with them.

JORGE CUETO: Can you tell us about how you train your care pros? Is it in-person training, or mostly online?

SANDY JEN: So most of it right now is in person. That’s usually most effective, because a lot of it’s physical stuff that we’re teaching. We are hoping to expand to more online things, but for now, a lot of it is physical in the office, on the job, and also through the app or phone or text communication. We talk to our care pros a lot so that they’re in constant communication with us on what they need to do.

JORGE CUETO: And then how many families are you currently helping?

SANDY JEN: So that’s not a number we’d generally expose, but our canned answer to that is that we serve the entire bay area, LA, Dallas-Fort Worth, and Albuquerque. And we started in Albuquerque, New Mexico, so it kind of gives you a general idea of the market sizes. But we don’t actually expose the actual number.

JORGE CUETO: And then related to the idea of expanding potentially to areas where it’s not culturally common for non-family members to take care of the elderly, how do you think about not just expanding into those areas, but maybe creating materials to help people in those areas who maybe don’t necessarily interface with your business directly, but maybe you just provide resources?

SANDY JEN: Yeah, so that goes back to the point where just being a knowledge expert is actually really helpful. And not just having an online presence, but going and getting into the communities is actually a really, really positive thing. So when you go to a senior center, or you go to a local event, you can just be there and then be a familiar face. So then when people have questions, they’re like, oh, you should talk to this person. They kind of have a better idea of how the elderly space works. Then you start to embed yourself better. And so part of the way to get better word of mouth is just taking advantage of the fact that health care and home care is very local, and so you have to respect that.

You can’t just be like, I’m this giant national entity. I’m just going to go and spread ads everywhere. That doesn’t work. You have to really go in and participate and talk to people and actually be in the community to really make a dent, so that’s generally the tack that we’ll probably take.

AUDIENCE: So what’s the pricing structure look like in this industry, and where does Honor place itself?

SANDY JEN: Yeah, so pricing generally is by shift length. So it’s hourly, because the care pros get paid hourly. We’re kind of right smack in the middle with most of the industry in terms of our pricing. Certain areas are a little harder to serve. So for example, if you are a care pro making minimum wage or a little bit above, a $6 bridge toll from the East Bay to the peninsula is a lot of money for you. And so it’s much harder for you to get from East Bay to, let’s say, Palo Alto.

And so in certain harder to reach areas– so Palo Alto, parts of San Francisco– prices can be a little higher because we have to be able to pay the care pro more. That’s generally more of a common trend with home care. But generally speaking, we’re very much market prices. And our hope is that because we can take a lot of the manual work out the process, we can maybe at some point charge a little less, pay a little more, and be able to take those gains because we have a little more efficiency within our system.

JORGE CUETO: And since you’re using the employee model, does that mean that care pros have to work a certain number of hours or certain shifts during the week?

SANDY JEN: No. With W-2s, you don’t have to enforce a certain hour. We have some folks who work with us on more of a part time basis, or they just pick up shifts in the evening or on the weekends because they have another job. We have other folks who use this as their primary gig. And so we are their primary employer, and they take most of their work from us. It’s more flexible, I think, than people think about when thinking about employee model.

But we do realize that care pros have a lot of restrictions in terms of what they can and can’t do. Folks at Google generally don’t have– when you have trouble with your car, it’s like, oh, it’s really annoying. But when your car is the only thing that is really providing your work conduit, it’s a lot harder. And so we just make sure that we’re respectful of that and we provide enough options of types of work for our care pros.

JORGE CUETO: And wrapping up, I have one question about any specific technology or product that you’re excited about in the near future.

SANDY JEN: I would say the–

JORGE CUETO: It can be more than one.

SANDY JEN: Yeah. I guess just related to Honor, there’s much more attention now to seniors. I think that’s awesome. Before Honor, there was no funding in the senior space. And now we have companies really, really focusing on how to cater to seniors– not just building devices or technology, but really thinking about it from an offerings perspective, just because the baby boomers and the senior population is just going to explode in the next 10 to 20 years. So I would say maybe nothing specific, but anybody really investing in not just seniors, but demographics of audiences that are not traditionally invested in I think is awesome. And that’s what I’m really excited about.

JORGE CUETO: Great. Thank you so much, and thank you for coming today.

SANDY JEN: Thanks for having me.

JORGE CUETO: Thank you everyone for coming here.