The road to becoming a startup: Health at Home – the caregiver service platform for giving at-home care to the elderly and patients to look out for specialist and trustworthy.
It is undeniable that Thailand’s society will soon become a full-fledged “aging society”. One of the problems to look out for and one that everyone is likely to encounter is the issue of taking care of the elderly or patients. This is a particular concern, considering that the majority of the family members have to work outside of the home, but feel uncomfortable with leaving their elderly relatives by themselves at home. At the same time, finding caregivers whom are trustworthy and have a good knowledge and understanding of the elderly’s needs and who are patient enough for the task is an equally difficult feat.
Let’s take a look at Health at Home
, a startup company that offers to resolve this issue, via an interview with its co-founder, Mr. Adison Charoensuk (Win).
As we all know, startups are often created from the resolution of a particular issue. In terms of Health at Home, what is the issue that you wish to resolve the most ?
Health at Home was founded in December of 2015. There are three co-founders, myself, Dr. Tum (Dr. Kanapol Bhumirattanaprapin), and Dr. Rat (Dr. Rat Panyowat). It all began when we realized that our friends’ elderly relatives needed to be taken care of, but that they did not know where to find someone to help, and even if someone is available to do so, there was doubt as to whether such person can be trusted and actually has a good understanding of how to provide care. In some cases, hiring a nurse is out of the question due to the high costs involved. Dr. Tum, a physician who specializes in providing healthcare for the elderly at Bangkok Hospital, often gets asked this question: “once the patient can return home, how should he/she be taken care of and is there anyone that you would recommend?”
Dr. Tum would always responded, “No, unfortunately, I do not have anyone to recommend to you.” No matter who we had approached, not a single person was able to recommend a certain company or service provider that would put people’s minds at ease. This is why we wanted to come up with a product that clients trust as being a reliable platform for searching for the information on caregiving to their family members. The city lifestyle requires the younger family members to leave the home to find work. Moreover, they are bound by a number of obligations and, as a result, are unable to stay at home on a full-time basis in order to look after a patient or the elderly. In addition, many families still adhere to the Asian traditions. That is to say, if we ourselves would not want to be sent to live in a retirement home in the future, then our parents or elderly family members would most likely feel the same. Therefore, we do not want to send our loved ones to stay at a retirement home. The problem that we want to solve the most is how to provide care to patients and the elderly at home and feel at ease and comfortable doing so.
How did you plan out the startup? How does technology contribute to Health at Home’s work ?
Before we even think about the technology required, we must first know exactly what it is that we are trying to achieve. If we develop a technology but it fails to respond to our needs, then it would be a complete waste. During the initial stage, we began with the development of a minimum viable product (MVP) (when a product is produced using very little resources). I had asked my family relative’s caregiver to create and publish advertisements in LINE groups and Facebook in order to reach out to the public. We wanted to convey that we specialize in caregiving for the elderly, and wanted those who were interested to contact us. Subsequently, we found that a number of people had contacted us about the potential opportunity. As such, we felt as though there is an actual demand for this service. At the time when we first began sending caregivers to different families, we had barely used any technology. It was very basic in nature. We published nice posters and took all of the phone calls ourselves.
In the beginning, we were very confident in the persons that we had sent out because they had previously looked after my own relatives. Over time, by word of mouth, popularity spread and we began sending other people instead. The relatives of those clients often feel uncomfortable and asked us where the caregivers are from. We then sent the clients (family members of the patient or the elderly) the employment history and profile of the caregivers before they begin work so that they would feel more at ease.
The turning point was when we were no longer able to take the phone call from each and every person due to the large number of clients. This was when we began to introduce technologies to the process. We established a database for storing the information of the people who had applied for work opportunities with us. If the family members are able to find a caregiver, this information would also be recorded in the system. We then matched the caregiver to the client based on his or her particular needs.
Mr. Adison Charoensuk (Win)
What is the difference between the initial Health at Home product and the product offered now? Have improvements been made since then ?
It’s very different. Instead of just simply “sending” a caregiver over to a client’s home, now clients can check the background history of or the previous match of such caregiver in the system. We also apply the ‘best practices” from satisfied clients in order to further improve our services. For example, hospitals and clinics usually store the information of the patients, e.g. blood pressure, body temperature, pulse, the color of the feces, urine, or whether a person drinks water every evening or not, in a database. All of this information changes the caregiving plan and allows physicians to better understand their patients. Usually, when patients return home, their follow-up appointment is scheduled for a date in two months’ time. This is where we think improvements can be made. By developing an application that records this information, we are, in actual fact, developing a technology that addresses the various issues as we come across them.
In terms of pricing, the service fee that we charge is in accordance with the market price. Nurses or doctors’ assistants already have their own standard rates. In Thailand, the rate charged by other caregivers or non-specialists who do not have a particular degree in caregiving may be along the lines of a housemaid, or slightly higher. That is difficult to manage because Health at Home is the platform that acts as the intermediary between the people who work for us and follow our practices, the procedures that we had determined, and the clients. We adhere to the principle that if people are happy with their work and receive appropriate income, the quality of the service would naturally improve. We increased the pricing in exchange for higher-quality services. We now offer a wider variety of options compared with the initial stage. At first we charged a monthly rate of over ten thousand Baht. We now offer a daily service rate of THB 1,200. If a client wants to use the service for a month, you would multiply that daily service rate by 30, but we will offer a discount in return.
How does Health at Home create credibility and trust ?
Given that Health at Home is a service provider relating to caregiving, trust is an extremely important factor. I am lucky that the market in which we had initiated the project did not have any clear leaders. A factor that positively contributes to our credibility is the fact that we have a very clear identity. We have our own office, with two doctors as the co-founders, police background checks of our caregivers to ensure safety, and conduct physical tests to ensure that the caregivers that we send to the clients actually know how to provide care to the patients and the elderly. In this test, for example, a candidate is asked to show us how they would do tube feeding or remove phlegm using a machine. Candidates would then be scored by a professional nurse.
We are taking measures to ensure compliance with the standards of JCI (Joint Commission International)
, which is an ISO for the field of healthcare. Hospitals in Thailand are also endeavoring to meet these same standards. We aim to obtain JCI certification for home care, as the first of its kind in Thailand. JCI would send representatives to conduct inspections and reviews to determine if there are any issues relating to the work, how the processes can be improved, whether the patients’ information is reliable, and whether there are any loopholes. We are trying our best in order to comply with the standards and create trust. We expect to be granted JCI certification at the end of this year.
Moreover, we also provide real-time data collection. In other words, at the end of every shift, the caregiver would record information such as a patient’s blood pressure that morning, what foods the patient had eaten, or his or her body temperature. This information is then presented in a graph. If the caregiver assigned to that patient on the following day is a different person, that caregiver would then have access to the patient’s information in advance.
At present, are there many service users ?
We started this project a little over a year, and now have 200 families (clients) who use our services.
Have you ever encountered a challenge or something which you wanted to continue to develop ?
Yes, but this is actually a good thing. There were many people who came to us because they had been taking care of the elderly or their parents themselves for ten years, and now want to get some rest. These clients know all of the details relating to that particular family member, they know what time he/she needs to be given something, what time he/she needs to be turned over in the bed, and his/her dislikes. In actual fact, these persons find it difficult to let go and often aren’t happy with the caregivers that we assign for their relatives because the care that the caregivers provide does not quite match how they themselves had cared for their loved one. In these cases, we often notify them of the characteristics of the caregiver that we had assigned and discuss things over with them in order to establish a mutual understanding.
Are there a lot of investors who are interested in making investments in your business? How is finding a partner in a different field important ?
In the past, there have been a number of generous investors and partners. Personally speaking, I think that startups should not solely focus on finding investors. They must understand that investment capital also entails various responsibilities and obligations. For example, you open a new restaurant but do not have sufficient funds, so you ask your friends to invest in your business. Afterwards, you would have to report the results of the business to that friend, and have to make sure that the business goes well. You have a duty to report what you are trying to achieve and how the circumstances are, so that they do not feel as though their investment was not a waste and that it will yield good returns.
I think obtaining investment capital is good, as it will help a business during its initial stage, when it is still not strong enough to generate sufficient income. But more importantly, I think that we should focus on the product first. If the product is good, then I think that there will be people who will want to participate in ensuring its growth, including people who will think of how to generate income from the product.
We want to partner up with insurance providers. In Thailand, at present, when we go to hospitals, we can get reimbursed from insurance providers, regardless of the case of an in-patient or out-patient. Once we return home, however, we have to bear all of the costs ourselves. I want to make improvements to the quality of our product (service) so that it will one day be included as part of an insurance policy. To put it simply, once patients return home, they have access to Health at Home, which can be reimbursed from insurance policy providers.
Management-wise, when do you know that your startup has reached the point where there is sufficient liquidity ?
I think that startups and SMEs are not that different from one another. In both cases, the income must be higher than the expenses, and the expenses must go out slower than the income gained. As a result, we do not require a high percentage of funding from investors. I think that is where we want to be. Alternatively, if we do source investment capital, such capital would be used for business expansion rather than solely for ‘filling in gaps’.
Even though the payment aspect of my business is not as stringent as e-commerce businesses, but if clients decide to use our services, they would need to use a funds transfer system. This means that we have to supervise the online financial transactions, as well as the process of paying the caregivers. Given that they are freelancers, we want to ensure that they are paid on time.
Many people view that once a startup business reaches a certain point of success, it should be sold to a new owner. What is your view on this idea ?
I think that this is only the beginning. We are far from “success”, but I believe that we are on the road to a bright future. With respect to whether or not we will be selling the business, this is really up to one’s personal preference. For me, right now I want to focus on building a good business that generates income, and, most importantly, provide valuable services to the service users and those who work alongside us. Moreover, a startup, by its very nature, requires us to design an automated business – that is to say, one that will continue to function even without our involvement. If it is indeed a good business with a positive outlook, one day we may realize that we need to consider whether to sell it or to keep working on improving it. Personally speaking, I have no intention of selling right now and want to improve its potential first.
What is your intended future or plan for Health at Home ?
We need to meet the high-quality standards. We currently only provide services in Bangkok and the metropolitan area. In addition to sending caregivers and effectively storing the relevant information, if we are certified by JCI, we would have two options: 1) expand to other provinces; or 2) take a more in-depth approach to the services that we currently provide by placing more emphasis on making the process of storing information on home care more efficient, or introduce new equipment or technologies (e.g. beds that can turn automatically, or sensors for recording blood pressure and pulse, which do not need to be carried out personally). In fact, there are many home care innovations available on the market, especially in Japan. In Thailand, SCG is also developing its SCG Elderly Care innovations, but there is a lack of users to adapt further. The Thai market primarily focuses on beds, measuring instruments, and oxygen tanks. Many people are unaware of the technologies available and how they can be used. In the future, we don’t want to simply send caregivers to our clients. There are many other aspects to home care. We aim to become a knowledge center for home care in the future as well.