Building Long-Term Client Relationships with Jennifer Halloran

On the latest episode of the CareCraft podcast, we were joined by Jennifer Halloran, who runs Everybody Needs a Nurse, a patient advocacy firm in the Triangle region of North Carolina. By combining persistence, personalized care, regular communication, and a clear understanding of their professional boundaries, her firm has successfully served the elder community for nearly two decades. Jennifer shared invaluable insights into building and maintaining long-term client relationships in the elder care industry. Here are some key takeaways to successfully building long-term client relationships:

Persistence and Genuine Interest: Jennifer emphasized the importance of persistence and showing genuine interest in clients’ lives. By regularly visiting clients and engaging with their personal stories, her firm builds a foundation of trust and connection. Jennifer illustrated this with a story about a client who repeatedly shared anecdotes about being left-handed, highlighting how these personal details can help assess mental health over time.

Regular Communication: Frequent contact is crucial. Jennifer’s firm requires sees clients weekly, which helps in building extraordinary levels of trust. This regularity also ensures that caregivers are top of mind when families need assistance. Writing detailed family reports after each visit keeps families informed and reassured. It demonstrates the firm’s commitment to transparent and continuous care.

Overcoming Initial Resistance: Jennifer shared how persistence and finding common ground can help overcome initial resistance. For example, connecting over shared interests, like TV shows or sports, can open up reluctant clients.

Identifying Red Flags or Poor Client Fit: Jennifer noted that clients who question the value of the services or frequently request price reductions might not be a good fit. It's essential to recognize these red flags early. Her firm does not handle certain areas like benefits, insurance, or mental illness, referring clients to specialists in those fields instead. This ensures that they focus on what they do best and provide the best possible care within their scope.

Learning from Pitfalls: Jennifer acknowledged that explaining what they do was initially a challenge. Over time, they’ve learned to better articulate their services and value proposition.

Balancing Business and Care: Having a partnership where one focuses on clinical supervision and the other on business operations has been crucial for their success. This division of labor ensures that both aspects receive adequate attention.

Exploring New Approaches: To expand their reach, Jennifer’s firm is experimenting with telehealth, though they value the insights gained from in-home visits. This adaptability is key to staying relevant and growing the business.

Listen to the full episode here

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Transcript

[00:00:04] Ariadne: Welcome to the CareCraft podcast today. I'm super excited to be joined by Jennifer Halloran, who has been running her patient advocacy firm, Everybody Needs a Nurse, for years, serving the Triangle region of North Carolina. And so she's brought her expertise to numerous conferences, which is where I got to meet her.

And now she's joining us on the CareCraft podcast. So thank you so much for being here, Jennifer. How are you doing?

[00:00:29] Jennifer: I'm doing great. Thank you. It's great to be here today.

[00:00:33] Ariadne: I really look forward to learning about how you've built your business. Can you share a little bit about your background and, you know, what started you on this journey?

[00:00:44] Jennifer: It's very much about a typical senior care trajectory, which is a winding road.

This company was started by my mother, Diane Halloran who's an RN and MPH. And she started this business. after retiring from a 40 year career of nursing. Through that career she ended up as the coordinator for outpatient education for UNC hospitals. She saw the gaps of what people were leaving the hospital with. You know, it was, when she started, it was the copy of the copy of the care instructions that was crooked and had blotches on it.

And even when it was nice and could be printed out, it was just something that people put on their coffee table or their, their kitchen table and never looked at again. So she saw that people were suffering needlessly because of this gap, that they just didn't have the knowledge to know what to do next or what to ask.

Both of my parents, my mom and my dad were nurses. And so we grew up talking nursing at the dinner table you know, the philosophical sort of nursing from my dad, who was a professor. And then the boots on the ground, oh my gosh, you never guess what kind of patient I saw today from my mom.

And I responded to that in the only sane way I knew how, which was my version of running away to join the circus. So I got a PhD in English literature. And did that career for 15 years and got so sick of it. And that was at the same time that my mom retired and started this business.

And so it was an academic and a nurse running a business, which we thought was going to. You know, we were going to open a website and the hordes would pour in and we would just be so busy and have, you know, all this stuff to do. And we did not realize about marketing, about asking people to trust us with going into their homes and taking care of their parents.

And so it was been more of it was more of an uphill climb than we had anticipated. But we have had a blast doing this. We still work together. My mom is the clinical supervisor of the group and I'm the director of operations and we just love it.

[00:03:23] Ariadne: That's quite the journey. So I know you guys call yourselves patient advocates but how do you distinguish? Because frequently, I feel like there's so many titles in the space and a lot of them are used interchangeably. So, like, how do you distinguish between the work you do versus care managers or case managers or any of the other plethora of titles?

[00:03:43] Jennifer: Yeah, that's a really good question. And there is some overlap when we started. We actually, the 1st thing we called ourselves was patient education consultants, which was mouthful and we quickly realize that that wasn't what little marketing understanding we had. That wasn't really a good title.

So we decided to call ourselves patient advocates, sort of picking a name that we had heard the most about. And I have since become a board certified patient advocate.

One of the things that people often ask us, what is the difference between what we do and what a geriatric care manager does because we do focus on elder care.

Patient advocates tend to be more focused on one specialty or one area and we're focused on the health of the client as opposed to aging life care professional or geriatric care manager, other kinds of care managers that are dealing with the, you know, Psychosocial, the housing benefits. We don't do anything with money insurance Medicare, any of that stuff.

[00:04:57] Ariadne: So very much physical health,

[00:04:59] Jennifer: Very much physical health. And so we're in a very small niche, but it's a really important niche for any kind of quality of life. If you don't have your health, you don't have any of those other things.

[00:05:11] Ariadne: Your organization has been going on 20 years now in operations. You guys started with no marketing experience or very limited marketing experience. How have you figured out how to build those long term client relationships going from, you know, day one to where you are now?

[00:05:31] Jennifer: Well, I really have to credit Diane for that because the idea of the long term relationship was baked into our system. And so we have developed it over the years, that we expect to have a long term relationship with our clients. When we set out in the contract and verbally, we tell people that we generally see our clients for months or years, often until either they pass away or they move away. One of the reasons that I think we've been so successful in terms of continuing these long term relationships is that we see clients on a weekly basis.

When you see somebody, when we say about 50 times a year, you build up an extraordinary level of trust, and that's been something that I've been really proud of and excited to see in our clients over the years. We come in we listen to their stories, we ask them about their lives, we ask them about their careers and their children, and how, what it was like growing up, and we get to hear all their stories.

Some of our clients children have written us and said that, you know, their parents are telling us stories that they've never been told, on one hand. And on the other hand, Sometimes these are stories that they've heard 10, 000 times, and they don't want to hear again, and we love listening to them. So if you want to tell the same story, we have a client right now, it's just a sweet, sweet lady, who every time she sees Diane write something down, she says, You're left handed?

Left handed. And then they go into this whole loop about how she never got Even though it was a long time ago, they never made her right with her right hand and they let her be left handed and how happy she is that she's always been left handed. And we can hear that little story five times in a visit.

And it's, it's, it brings happiness to her. It also is an opportunity for us to hear how somebody is. It's getting their words. If they're, you know, Oh, she, we only did the left handed story twice today. So the loop is longer. Oh, now it's six times. And so it's shorter. How is, how is their mentation going with that kind of story?

The other part of how we maintain these long term relationships is that we communicate. Okay. regularly with the families. We write a family report after every visit home visit, doctor visit, whenever we see the client, we write a family report. And that keeps the families, that keeps us top of mind with the families. It keeps the families in the loop. They know what's going on, but they also know that we're doing the work and we're there for them.

A lot of our prospective clients start off by going, well, weekly, that seems like a lot.

Can we do it every other week? Can we do it once a month? When we started, we had clients who said, you know, we really don't want to do every week.

Can we do every other week? And we thought, okay, we'll give it a shot. Right. Let's see what happens. So we had this lovely visit with this lady who had had dental surgery and was, we're talking away about you know, maintaining her mouth health and caring for the wounds and how the dental surgery went and all these things and had a good visit.

On the way out the door, she said, Oh, right. I forgot. I fell two weeks ago and was in the emergency room. And it was like the record scratch. What? That, wait a minute, we've got to go back and talk about how you fell, why you fell, what happened, what they said in the emergency room, all of this stuff that had just been missed because we missed a week.

And we also weren't at top of mind with the client or the family. Nobody had thought to contact us and let us know that she had fallen and been in the emergency room. So what we took away from that is that it's easy for things to get missed if it's less regular. And so I think that for somebody starting a patient advocate or care management business, seeing your clients as often as you can, on a regular basis, we'll build that trust and also keep you top of mind as things happen that the family or the person will reach out to you to be able to give feedback and help them with what's going on.

[00:10:34] Ariadne: So you really touched on two points there, right? Like the frequency of the contact and then the communication and making sure to always keep the family in the loop to, to develop that trust over time. Just clicking into that what has been most helpful in when you're starting out in a relationship, right? You talked a little bit about maybe some resistance around the frequency or, or like, how do you get to the point where everyone is on board that this is, you know, the right thing and the right relationship and everyone has that trust there.

[00:11:08] Jennifer: Yeah, that's a really good question because it can take a little while. So we had in the beginning, one of our clients. was a couple where the man had a big diagnosis of frontal lobe neuropathy and his wife had Alzheimer's and we were brought in by the Children because the parents were not happy with the Children doing the medical stuff and filling pill boxes and things.

And so we came in and They were very resistant. And our nurse was in the kitchen, doing the pillboxes, and they were in the living room watching TV. They'd sit with their arms crossed when she'd come in and have a chat and they'd give one word answers.

And she said, you know, I, I understand that you're not, you don't really want me here, but I'm hired by your children. I have to do this. I have to do this this work. I'm here to fill your pill boxes. And so they kind of, okay, you know, and the next time she started she did the pill boxes and then came in and noticed they were watching Andy Griffith on TV and said, Oh, I love Andy Griffith. What episode is this? This is a good one. Started talking a little bit about that. They unfroze a little bit. So meeting them where they were. And then a couple of weeks later, they all went to the doctors and that was a huge turning point. The wife had Alzheimer's and so she, it wasn't a good idea for her to sit in the waiting room with everybody, but they wanted her to be there.

And so the nurse asked us if there was somewhere else they could sit. So, they got moved to a VIP section that was just them, and they were thrilled about that. And then, when the doctor came in, the nurse talked a little bit about what had been going on, you know, in the house, in the home, that she couldn't express herself, and we would help the husband kind of talk about what was going on.

And while we had been waiting for the doctor, the nurse noticed that he was wearing a Chicago White Sox baseball cap. So she said to him, well, you're a Southern boy. How did you get so interested in the Chicago Cubs? And he goes, well, that's a story. And he starts talking about how his father would go travel to Chicago for his job and bring back stuff from Wrigley Field and they would talk about the games and they would plan to go to the game someday and all of that.

And it was like the magic spigot turned. And so between talking about what he was really interested in, finding out his story about that, and what happened in the actual doctor appointment. He said, Oh, now I know what you do. Now I know why you come to our house. And then we all go to the doctor together.

And so he, he really loosened up after that. And they became good pals. A real relationship that got formed there and the resistance went way down. So I think that, you know, just kind of sum it up persistence, not in a hostile way in a open way. Asking people about their lives. And showing what you do when you go. Those are the three things that I think would help people really overcome that resistance.

[00:15:04] Ariadne: Hmm. That's a great summary. What, I guess, how do you train for that? Or how do you get better at that over time?

[00:15:13] Jennifer: There's a certain amount of persistence that you, you need to have in a certain sense that you are helping, even if they don't know that you're helping.

And again, not in a pushy way. But in an internal way, it's understanding what your role is there. I'd say that that's the biggest thing, is asking people about their lives. People are, you know, When, when people are older and what we see are older people who with illnesses, they talk about health all the time and talk about their sickness all the time.

And then talk to their families who already know all the stories and don't, you know, whether they do or not, the parents often think they don't want to hear it again. And so being able to bring that out of people and, you know, we've had amazing stories. That's really one of the best parts of this job is getting to hear the interesting lives, hear about the interesting lives that our clients have had.

You know, we had a client that loved to talk about growing up on the farm and all the animals that they had and the, you know, indoor dog and the outdoor dogs and which one got to be inside and, you know, just the kind of minutiae of life and what they remembering is actually really fascinating, and so it's being open to that and asking. You know, I noticed this picture over here. What was that occasion? Everybody looks so dressed up.

Bringing in their lives into it, showing your own humanity and hearing theirs, especially for our clients with memory loss

I would say that that kind of inquisitiveness, but, you know, again, not in a pushy way, respecting people where they are, and yet seeing what you can bring out in people, that's something you can practice with your family and friends.

And if that's, you know, something that you have. And then I just, you know, let it let it out.

[00:17:24] Ariadne: How do you determine if potentially someone's condition has progressed or you know, the situation has changed. I know you were saying that frequently your clients are are with you until they move or until they pass away. But are there instances where you have to re evaluate that relationship and determine that it's no

[00:17:49] Jennifer: The reason that it would no longer be a fit would be that their disease has progressed to the point where hospice needs to be involved, or they would benefit from being in a memory care unit. Something that where their disease has progressed to the point where what our services are can't really support them anymore.

If you're doing your work there. people will feel better because you've been visiting. And that can be because you have ideas about their care and how they can get better care. Or it can be that you, that they have unburdened themselves and they don't feel that kind of level of stress. And so because people generally feel better when they talk to us.

They don't usually after a while go, oh, this isn't really working for me anymore. So it's usually because something progresses to the point where we can't. They need more help than we can provide.

[00:18:58] Ariadne: That makes sense. And what about in context where, you know. Maybe there was a lot of resistance and you were never able to overcome it, or maybe you just realized there's, you know, potentially something on their side, right?

That that's not in the best interest of your organization. How do you determine if, you know, that's it's really not working out and kind of have that, that conversation?

[00:19:24] Jennifer: That's a great question. Yes, I think that in the beginning, there's some red flags over the course of time, we have learned the hard way that if someone is not happy, happy to pay you for your services that they're not a good fit, that they don't value what you do.

And so, when I start hearing people talk about, well, you know, this is pretty expensive, and can you come less often, or can you give us a break on the price. That usually is a signal that, that they are not that interested or invested in the services we provide.

If you give somebody a, a cost break on their services in the beginning, It's not like they'll go, Oh, good.

Yay. I got 10 percent off. That's, that's enough. They continue to ask you to kind of chisel away at your prices in various ways. So that's one red flag on kind of a business level.

There are, have certainly been people who have, And this is not a good fit. Either they're asking for something that we don't deal with.

You know, so having a really good idea of your parameters, the parameters of your business. Like I said, in the beginning, we don't do anything that has anything to do with benefits or insurance or hospital bills. So somebody calls with that, we refer to our network people that we know who cover that sort of thing.

We really don't deal primarily with mental illness. Having a, a wide network. We know so many people in the elder care industry in this area and really around the country patient advocates who deal with all kinds of situations and and clients. And so when somebody calls and they're not a good fit, I don't have to say, you know, see around, good luck to you. I have leads about where they can look.

But also, listening to what they're saying. And if this sounds like something that is not a good fit. It's not in anybody's service to try to put a square peg in a round hole. It wastes their time, it wastes your time and is, you know, will result in people being unhappy. Better, even though it's hard to sometimes hard to turn away business, it's better to send somebody along to someone who actually can help them.

That shows goodwill for everyone. And there are people out there for your client, for your potential client who you can't help. There are people out there who'd be happy to help them. So that's what I recommend. It's like in that initial discovery phone call, the Really clear about what you do and listen to what they want.

And if they're not the right fit, send them on their way.

[00:22:24] Ariadne: That's great advice. Clearly you've built the business over a long period of time. And I'm sure through many different challenges and, and potholes along the way. What, what are some of those potholes that you've encountered?

[00:22:39] Jennifer: Oh, there's too many to name.

Ha, ha, ha. Because we really did not know what we were doing to start with. But I would say that one of the things in the beginning that was tricky is, is actually explaining what we do. People are used to a list of services. Especially in elder care you know, home care. If you work with a home care agency, they'll give you a pamphlet or a website with a list of 75 things that they do.

With patient advocacy and the kind of work we do, we don't work off a list. So it's about using our judgment as, you know, educated, experienced, professional people to walk into a situation and figure out what needs to be done which is hard to describe to people.

 I've worked very hard to kind of craft a message and to explain to people how we operate and what we do. It's a process I am not there yet. I would love to be able to jump inside people's heads and show them the, the wonders of Everybody Needs a Nurse and patient advocacy.

And I have not figured out how to do that yet, but I am getting better at explaining what we do and realizing that people are giving you a lot of trust. and a lot of responsibility for the people they love the most in the world.

And it requires a good degree of understanding that that's where they are. And, you know, support even in the onboarding process to be able to say, yeah, this is a big jump you're making. to bring in a patient advocate into the family dynamics, into what's going on with your parents. And we take that as an honor and a privilege and are, are, you know, and, and can help, we can help the situation.

So that kind of messaging is really hard to do.

I also think that a lot of pitfalls and one that we avoided but I think people have is you know, the way that patient advocacy works right now.

There are kind of two options, there is either going to work for an institution like a hospital or insurance company, and then you're not an independent patient advocate. You are an institutional advocate, and you kind of have to have agree to their ground rules about what you can and cannot say and going into practice as a solo practitioner.

And so there's a real divide. Between having an institution that kind of guides what you say, and you can't necessarily always give your best first advice and being out on your own, and having to pick up business as a as an element of what you're doing. When you're wanting to care for the client, but what you're doing is business stuff.

And one of the things that I think one of the main reasons that we've stayed in business this long is that we have a partnership. Diane is the clinical supervisor. She sees the patients. I focus on the business part. And so we have that kind of breakdown and also have somebody to talk to.

You know, even to this day, Diane will see a client and call me right after and tell me, you know, what happened. We talk through issues.

And I think a lot of people who go into business alone don't have anybody that they can talk to about these things.

[00:26:42] Ariadne: It's a lot for one person to take on, especially if, you know, they haven't been in a context of running a business in the past, right? And getting off the ground, there's always a ton of work from a marketing perspective, from a sales perspective let alone from the actual, you know, client care perspective.

[00:27:02] Jennifer: Exactly. I'm currently teaching In the Cleveland State University Online Patient Advocate Certification Program that prepares people to take the the National Certification Exam for Patient Advocates. and I see people coming in from all walks of life, caring, considerate, Smart people who really love the idea of taking care of their clients.

And what can happen, and we're trying to prevent this, but what can happen is that people go off into business, they're overwhelmed by the business side of it, and they give up. And then those caring, professionally trained, really, really smart people are not in the pool anymore because the business part overwhelms them.

[00:28:01] Ariadne: That's a great call out. How have you guys expanded your business or is it still the two of you most days?

[00:28:09] Jennifer: There have been times where we've had other nurses that have worked with us. And times where it's just been the two of us you know, I am still looking for an opportunity to kind of stabilize and grow. I would like to do that. I would like to be something that is kind of a regional presence that people know about us. We're also looking into at this point, doing some things over telehealth.

Up until now, our system has really relied on in home visits, and I think that there's a real benefit to in home visits. You get to use all five senses to see what's going on. You know, walking into a home and going, Whoa, something smells a little weird. Or, what have you been eating? Let me look in your refrigerator.

That can bring, bring real tangible benefits that you don't get over telehealth. But it limits the, the territory that we can cover very much. So, we're experimenting with some, some new approaches.

So that's part of it too, as a business owner and a small business owner, we have the ability to be nimble like that and change what we're doing, change our approaches.

[00:29:30] Ariadne: That's awesome. Well, thank you so much for being on the podcast today. We really appreciate it. And yeah, thanks again for your time.

[00:29:38] Jennifer: Thank you. It was great to be here.