Friday Founder Stories: Amy Smialowicz Fowler
After 12 years of leading WNC Geriatric Care Management in Asheville, NC, Amy Smialowicz Fowler made the bold decision to close her thriving practice in 2023 to pursue a new chapter: therapy. Armed with her Master’s in Social Work, Amy's journey is a powerful example of allowing yourself to pivot.
At WNC, Amy built deep relationships with clients and became a trusted advocate, helping families navigate tough situations with dignity and grace. Her decision to close WNC wasn’t easy, but it was driven by her passion for connecting with people on a deeper level.
What can founders learn from her journey?
🌱 Recognize when it’s time to evolve.
💡 Prioritize personal and professional growth.
💬 Manage transitions thoughtfully—clients come first!
Shutting down a business doesn’t end the legacy—it opens the door to new opportunities.
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Transcript
[00:00:04] Ariadne: Welcome to this episode of the CareCraft podcast presented by Panacea. I'm here today with Amy Smialowicz Fowler who graduated with her Master's of Social Work from East Tennessee State University in 2023. She previously founded and operated WNC Geriatric Care Management in Asheville, North Carolina for 12 years before closing the practice to pursue Educational opportunities.
And so super excited to have you on today. Amy, how are you doing?
[00:00:34] Amy: I'm great. Thank you so much for asking me to be on.
[00:00:37] Ariadne: I'm really excited to hear your story because the theme of today is really talking about the decision to close down a care management practice, but more about the lessons learned, operating the business and everything you took from the experience. So can you take us back to the beginning, actually? And what inspired you to open WNC Geriatric Care Management?
[00:00:59] Amy: Sure. So I worked at a post acute healthcare agency for several years in Asheville, North Carolina, where I live. And my dad was diagnosed with early onset Alzheimer's at 59.
And I had heard about care management because care partners where I worked had a care manager. And when I did educational speaking through my career as a care manager, I talked about not being a calm and collected daughter when I called a care manager in Chapel Hill where my parents lived, but I was sort of that hysterical daughter because my dad's cognitive impairment was changing.
My mom wasn't sleeping or was trying to sleep with one ear open, and we realized that we needed to see a doctor. Some support for him. And so we hired a care manager in Chapel Hill and she helped us line up adult day. And my dad was a diabetic, so he needed to have nursing support at adult day. And it made me realize in that moment that while I couldn't be a care manager for my family, cause I was too close, that there was something about care management that was so sacred and important.
In the moment that we met with the care manager, one of the things that I loved was that in addition to asking me and mom questions, she really asked my dad questions. And even though he was changing in how he could respond, she valued his opinion and she wanted him to be part of the discussion. And it was sort of, you know, after reflecting on that time together with Meg that I realized this was really what I wanted to do.
And so I worked a little while for care partners in their care management project practice. And then after I had my son decided to open my own practice, cause if you can birth a baby, you can birth a business.
[00:02:43] Ariadne: That's a, that's a good life philosophy. So yeah, walk us through that journey. Like what, what was the process like for opening WNC and how did you get started?
[00:02:53] Amy: Sure. So I really am going to pitch the Aging Life Care Association, which is our national association. When I joined, it was a, it was a different name. It's now been rebranded for Aging Life Care, but they offered, ironically, during my maternity leave, an eight week class on how to start your own practice.
And so they talked about the hard things like liability insurance and billing and all of that. And so I had to work hard not to fall asleep because I was so tired with the newborn, but that was a great way to jumpstart my practice. I had the added bonus of my husband being an accountant. So I felt like the financial piece was really covered with him.
And that would be an absolute recommendation for new care managers is get an accountant on board so that you're not guessing you're getting good information and really, you can leave a lot of that scary stuff, if you don't love it, to someone who knows what they're doing and you can focus on the care management piece.
So Thankfully, I'd lived in Asheville a long time. I had a great network of folks. And I just, as soon as I finished the class, I got my liability insurance and dove in, just started making cold calls and reaching out to people.
[00:04:06] Ariadne: That's awesome. And so you operated that business for 12 years or a little over 12 years.
And how did the business change, but also the industry over that time period?
[00:04:18] Amy: Yeah, so I certainly learned how to work smarter, right? One of my real blessings is that once I sort of took off, I really didn't have to do much marketing. Now I love doing community education and so I would speak at churches and we have a local college for seniors called OLLI in Asheville and so I did a lot of classes there for different local people who were doing like how to age well, and I would be a speaker.
And then I also spoke at my alma mater, Mars Hill, it was college when I was there now university. And so because I wasn't having to spend time marketing, I had A lot of clients. And so I learned how to be creative, like, you know, voice texting while I was driving in between clients so that that was one less thing I had to do from a documentation perspective when I got home.
I feel like in my 12 years, the aging community. understood more and more that care managers are here as a support to all, not only the clients, but also the facilities and the home care agencies and that sort of thing, instead of it being a competition. In fact, one of my dearest friends and colleagues now worked at a large CCRC and she was very hesitant at the beginning to even have a conversation with me because she was the social worker for independent living.
And I think she thought that I was going to take her client, her, her residents away from her. And after having a conversation, she realized, Oh man, you know, Amy can do such a deeper dive than I can with 150 residents, say, and Amy has one or two of mine. And so we really worked together. So that was a really cool evolution to see of facilities and agencies and doctors and, you know, sort of everyone being like, Oh, that's what care management is.
And this makes a lot of sense and we can really work together. Well it also made a big difference. And I know that I'm not speaking out of turn when I say that we work with tricky clients and families, oftentimes the clients, not the tricky person that families are. And so I could really build rapport with facilities that had difficult clients and be that barrier between the difficult client and make sure that my client and their family were getting what they needed, but also hearing the issues from the facility or the care provider and see how we could best work that together.
Just being that third party made a big difference.
[00:06:55] Ariadne: Yeah. Well, one question that I like asking people actually about more the beginning of their businesses is how long did it take you to feel like you had hit your stride?
[00:07:05] Amy: Oh, gosh, that's a great question. I mean, probably like a year and a half. But I'm certainly, I'm a, I'm a pretty type A person.
So I don't know if in that moment, I believe that maybe looking back one really cool thing about ALCA is that I met some amazing colleagues across the country and especially in the Southeast chapter. And because we were not in the same market, we could share information and it was not a competitive relationship.
These are mostly women who had built these amazing practices. And so I had a really amazing bar to look towards as I was creating my business. So yeah, probably year and a half, two years before I felt like, Ooh, I got this. And I don't know if I ever got it right. Do we ever get life?
[00:07:52] Ariadne: Something's always changing for sure. So what were some of the successes that you are most proud of from your time operating WNC?
[00:08:01] Amy: Being a care manager is being on a sacred journey with clients and families. This is not a one and done situation.
These are deep, hard conversations often in a very tumultuous time where options may or may not be, but they certainly seem confusing and unsurmountable and that sort of thing. And so allowing dignity for the client and calm and ease for the families, I think were my biggest successes. I mean, I just think about just change in body language, people saying, Oh my gosh, I'm sleeping now because I'm not having to worry about my loved one.
Or I never would have been able to navigate all of this because I had the emotional piece and you really took the nuts and bolts that those thank yous, if you will, were my successes. I've sat with the families at funerals for their loved ones, like, at the, in the family, like pew, if you will because these were years long relationships.
It was not a short time together. We were, we were really building rapport. And so I have kept, and I still have it today, sort of a kind words folder that I've, that I would print out because on the days that were really hard and I'm like, Oh, what am I doing? This is really difficult. It was nice to go back to those emails and handwritten cards and be like, this is making a difference.
I'm advocating for these clients. I'm helping these families. And, and this is. This is this is what I'm doing it for.
[00:09:42] Ariadne: Yeah, that's a great idea to have that written down because on the hard days, it can be really hard, right? And having some sort of reminder of why you do it is really helpful.
So, in hindsight, and, you know, obviously hindsight is always 20 20. Are there things that you wish you had done differently in terms of managing or growing the practice?
[00:10:04] Amy: Yeah, absolutely. So I think I learned a lot about honoring my time. Some other care managers were really good about billing for travel time and really accurately billing for their time with clients documenting.
And I, I'm a little bit of a bleeding heart. And so I was more lax on that than I should have been. And towards the end, that was, that was very taxing. And so if I were to ever go back into care management again, that would be one thing that I would really structure differently and be honest from the beginning.
I think it's hard for us social work types to bill for our services, right? This is a different model than you know, when you're working in traditional social work where you're working for an agency or even a private practice, care management is still such a new thing and people are paying privately for this and you want to make sure that they feel like they're getting what they paid for.
So, you know, and granted, I'm older now too, right? I think I have a little bit more oomph and gumption to be like, this is, this is how it's going to be. That's a piece that I would change.
[00:11:13] Ariadne: You described it as taxing, like what specifically about it was taxing.
[00:11:18] Amy: So I made a decision not to grow my practice and most of my friends and colleagues had multiple care managers working for them. And so that meant the buck stopped with me, which made vacations complicated because I was never really off duty.
And I loved that, but that was also exhausting. I mean, I had a family and I wanted to have a life. And so trying to balance that, I was never able to find the right fit for growth. And it may be because this was a season of my professional career that care management was just a time and now I'm to go on to something else and to maybe it's better that I didn't have employees.
But I think that having a team with whom you could share a call would make a huge difference. I never felt like I didn't have colleagues that I could reach out and talk about hard cases with. That was, I didn't live in a vacuum in that sense, which was such a blessing. But having, having a deeper bench would have made a difference.
Not only to be able to serve, and I feel like I was able to serve everyone appropriately, but I was growing, growing, growing. And that would not, if I'd stayed in business, that would have not been sustainable. Just for the enough, the amount of hours we have in a day.
[00:12:36] Ariadne: So was it a conscious decision to not grow the team
[00:12:41] Amy: I think it was because of my own controlling.
It's interesting. So maybe it was because of my own controlling, because it was my business, right? I mean, I think there's a piece. It's like, this is my brand. This is my name. And there were several people that I talked to, but it just didn't ever feel like the right fit. And now, again, like you said, hindsight, I'm looking back and thinking, well, perhaps it was because I didn't need to grow, right?
Because I was going to be going in a different direction and I didn't even know it. And I want to be sure that I say that, you know, none of my clients sacrificed because I didn't have a team, right? I was able to serve. Who I needed to, but I, towards the end of my career, more and more folks were hiring me proactively.
It was the baby boomers who were, you know, I feel like that generation is looking at aging so much differently than their parents did. And so lots and lots of people were hiring me for down the road. So I would meet with them and we'd have a deep dive and then I would Touch base with them either quarterly or every six months.
And I started thinking, Ooh, they're going to be a lot of people who potentially have a crescendo at the same time. And how am I going to be able to manage that? Well, so had I stayed in business, I absolutely to serve my clients would have needed to grow.
[00:14:02] Ariadne: That's really interesting. Do you think it was just the generational change that kind of had shifted your client profile, or was there maybe more like marketing or something that you had intentionally done to get those proactive cases?
[00:14:16] Amy: Right. I mean, I, you're, yes, thank you for acknowledging that. I think it was probably some marketing as well. Again UNC Asheville has a wonderful program called the OLLI Center. It's the Osher Lifelong Learning Institute, and several cities across the country have it. And it's really an opportunity for people to come and learn about all sorts of things.
And so I spoke at so many different classes that I was engaging with people who were already thinking about aging differently, and As they heard me, really, I was not doing a pitch for my services. It was more about education and understanding the nuances of healthcare. They were saying, Hey, I think this would make a big difference.
And by the way, my adult children live across the country, across the globe, or I don't have children or I don't have a spouse or partner. And so they were thinking more proactively and so would say, Hey, could we sort of be your just in case client? I also feel like ALCA was really describing that demographic more in educational opportunities and we were all sort of talking about it.
So I think it was a, it was a mix of all of those things.
[00:15:24] Ariadne: Yeah, that's really interesting. So what ultimately led to your decision to close down WNC when you did
[00:15:32] Amy: so one of the things that I loved doing was holding space for people and having hard conversations, especially about end of life choices.
And You know, even in college, I took a death and dying class as an elective, right? So there's always been a piece of me that's been interested in those deeper conversations. Healthcare is tricky. You know that. Your audience is going to know that. The resources that we have in the area can be good, but sometimes they're not awesome.
And it was hard to continue to provide a list of options to people knowing that there were lots of potential issues with those resources. And so I was getting tired, really, about trying to make things work in a lot of ways. And I realized I really wanted to connect with folks on a deeper level. And so I found the program in East Tennessee, which is only an hour away from Asheville, and it specifically focuses on training therapists.
And so I decided that that was the right direction that I wanted to go in.
[00:16:39] Ariadne: That's awesome. And so what did that process look like when you made that decision handling the clients that you did have, maybe, you know, people that were in your pipeline?
[00:16:49] Amy: Right. So for my just in case clients, it was a much easier sort of breakup, if you will.
It was providing information about local care managers that they could choose. I did provide my personal recommendation, but I offered a list of several so they could pick. choose who they would prefer to work with. Some folks I ended up keeping, in fact, my last client just passed away this February.
She was extremely old when I had her and I thought for sure that she would have passed away a lot longer, but she lived to be 103, so good for her. I ended up, she was my, she was my final client that I kept. But with my active clients, I had a phone call and an email communication with them, and then made sure I did a warm handoff with whomever they chose for their care management follow up.
You know, it was, it was probably a several month process anyway. And again, like my client who just recently passed, there were some folks that I sort of staggered and as they passed away, that would be the end of the, the relationship.
[00:17:54] Ariadne: Got it. So it was really, I mean, it sounds like maybe a multi year process that you went through.
[00:17:59] Amy: It was. Yes. Yes.
[00:18:01] Ariadne: Were there any particular lessons learned and how your, your clients responded to the news or, you know, anything that you had to do with the, the admin side of your business and how you manage that?
[00:18:16] Amy: You know, it, I mean, it really went smoothly, you know, without sounding vain here.
I had a lot of people really disappointed that I was leaving the profession and I was, I had such great families and clients that I worked with. I mean, there was a lot of sadness for me and grieving for me as well. So we were able to sort of just have a little love fest with each other, talking about how we were sad that we weren't going to be working together.
I think the thing that made all the difference is the individual that I recommended. I trust so much and I knew that she would be a really good fit. And although we have different skillsets, she's a nurse and I'm a social worker. And, and we look at things a little bit differently. She has such a similar rapport and kindness that I did with my clients, that I knew that they would be in great hands.
Again, they can make their own choice. I want to be clear about that. But that made a big difference because I knew that they were going to be okay and they were going to be fine. And in fact, I ended up hiring her in 2022 after my mom had a stroke. And She again, I was not the calm, collected daughter, right?
And even though I was a former care manager, I was the crazy daughter and she really helped me through. So it really reinforced that I had made the right decision of who needed to be with my folks.
[00:19:37] Ariadne: Yeah, that's I mean, it's interesting that you mentioned that, because I do think there is a difference, right?
When it's your own family member versus having that external perspective. And. You know, such a testament to the profession. Is there advice that you would give other care managers who might be considering scaling down or thinking about transitioning out of their practices?
[00:20:01] Amy: So I'd really say it can be done.
I mean, I got a little panicky when I was thinking that I was wanting to change gears and how would I do this and what I'd be letting people down. And you know, it's the first thing as pretty much any difficult decision is you need to take a deep breath first. And so you know, be transparent, have a plan about what you're going to want to do, and hopefully you're in an area that has another care manager with whom you have trust and respect so that you can provide options.
You know, it's really important that we're not leaving families hanging because they've really come to rely on you and really we have an ethical responsibility to make sure that they have that continuum of care. So. just sort of, you know, outline what your plan is going to look like. And again, this is a time where talking to folks in ALCA who have already done this, or thinking about doing this, there is just such a wealth of information and that group of folks not only from the educational opportunities that they have with the conferences, but the colleagues that you can make, and then the online resources.
I mean, it's just wonderful. So it can be done. And there, I mean, there may even be a webinar specifically on how to close your practice. I can't remember.
[00:21:17] Ariadne: And you know, you made the decision to wind down the business, I guess, had you considered selling the business? Business or that wasn't something that you were interested in,
[00:21:28] Amy: you know, that's it.
So again, I my Mind is so not a business mind and so I don't even think I even knew how to Package that what that would even look like and I again with it just being me and not multiple people I think that would have been a very different thing. I know that people have sold their practices and it's been successful before.
So, you know, if you've got a larger practice, heck yeah, do it. But in my case, that didn't seem to be the right thing. That doesn't mean that if you're a solo practitioner, you couldn't. It just, it just wasn't the right avenue for me. Yeah.
[00:22:03] Ariadne: Makes total sense. And you know, looking back on your journey, are there any kind of final thoughts that you would like to share with other care managers that might find themselves in a similar situation?
[00:22:16] Amy: So I absolutely 100 percent believe in the value of care management. And I still have friends and colleagues call me and say, I know you're not a care manager anymore, but will you help me with this?
And of course I'm happy to do that. I am very clear that my knowledge of specific resources has changed in the last several years, and so I don't want to lead them astray, but you know, some of the general conversations about aging, I'm happy to have with them. I so believe that this is a needed piece of the human experience in dealing with the healthcare system.
And I really am hopeful that more and more younger folks get involved in care management. When I looked around at the ALCA participants, at least, You know, several when I was in this business, a lot of the demographic was older folks. And now that I'm, I'm not as I'm not active in the, in the organization, I'm still a member, but I haven't been to conferences.
I'm seeing more and more young faces and that is really encouraging because I feel like we need to keep growing this profession. And also I think it's going to be really important that people are able to balance their life with their work because it's hard. And again, it goes back to that piece of having an on call system or a team or some way to make sure that you're not so overwhelmed with the tasks that you are trying to provide for families.
I think boundaries are a really important thing in this making sure, you know, You're not texting people late at night because then they'll text you late at night, you know, having some real structure around that and perhaps the younger generation is better at that than I am anyway, that work life balance
[00:23:58] Ariadne: Do you feel like towards the end of running WNC that you were like burning out?
[00:24:04] Amy: I think I was, I think I was getting to that point. I don't think it was until I completely finished that I was like, Oh my goodness, this is, I'm tired.
And again, I, I did not receive that feedback from my clients. So they were now my family, then a different litmus for that. But yeah, it, it was, it was requiring a lot of my time. And I wanted to make sure that I was preserving myself in this and not losing myself in it to the, that boundary piece.
I think, again, and I'll hush about ALCA, but, you know, connecting to that organization, connecting to local resources, at least in our area, we have a local unit that meets and even though we were competitors, it was an opportunity for us to help market care management in general to the community. That made a big difference.
I mean, there are lots of ways to get connected. Even if you live in a region that doesn't have an active chapter or local unit, the national organization has great ways to engage. And so I would say that's a big piece. And also just have your local champions, have your facilities and home care agencies and doctors and move managers and you know your, your team of people that you work with that you refer to and they refer to you and you guys can work as a team.
Because it could have been really lonesome to work as a solo practitioner. And gosh, it wasn't. I was constantly interacting with so many different people. And not only were we colleagues, but I felt like we became friends because of the hard things that we were doing. And that made a big difference.
You know, you weren't working in a vacuum.
[00:25:49] Ariadne: That makes sense. And sorry, I think there was maybe a third thing on your list that you were going to say about final thoughts.
[00:25:55] Amy: Well, I mean, I guess it would just be, like I said, if you want to be a team, if you want to be a solo practitioner but you know, overall it's, it is a wonderful profession to be a part of, right?
I believe that my time doing it was really a season for whatever's next. I don't know if I'm going to end up doing aging or end of life. I'm currently doing a grief certification. To see if that might be something that I'm interested in diving into with care management, not with care management, with therapy, there will always be a part of me.
That's a care manager, right? I'm never going to get completely away from it. And, and when I get those calls from friends and colleagues, I mean, I really do just roll up my sleeves and I'm like, all right, let's figure this out. So. You can't, you can take the care manager out of, I don't even know how you would say that, but you don't want it.
[00:26:49] Ariadne: That's interesting because there have been several people actually on this podcast that, you know, also run a therapy practice and a care management practice kind of side by side and you know it's sometimes the same clients that need both services and Sometimes not, but I, they're certainly very interrelated.
So I'm very excited to, to see what ends up being the next chapter in your own journey. And you know, when you figure it out, maybe we'll have you back on the podcast to talk about whatever that is.
[00:27:21] Amy: That sounds great. Thank you for this opportunity. I love that y'all are doing this. This is a great opportunity for folks to learn more about care management and understand the business pieces and the nuances of it.