Posted by Matt Register

Terri Gerke, RN and Bonnie Smith, RN, BSN of Reach Healthcare Services provide unique services for in home healthcare options.

Please excuse any typos in this hasty transcript.

Matt Register: Welcome back to the show, Texas Business Radio, is the website, 844-814-8144 is our 24 hour call-in line, 24 hour line, that means call in now, call in later, call in at three o’clock in the morning. I really don’t have an opinion on it. We’re going to get the experts in here to get those questions answered.
We have a studio full of folks today. I’m your host, Matt Register. Normally, Jay Curry’s sitting over there in the co-host chair. He ditched us for this segment. We have a studio full of folks that we’re going to talk about healthcare and some of the changes going on now in the healthcare industry. It is a chaotic market. There is government intervention, regulation, all kinds of crazy things going on in that market. But there’s some folks who have figured it out, and figured out how to have profitable businesses within that, and in areas that are growth areas. This is going to be a fascinating, fascinating segment.
Let’s go ahead and jump right into it. Reach Healthcare Services, we have Terri Gerke and Bonnie Smith here in the studio from Reach Healthcare. They are a home healthcare services provider. Ladies, welcome to the show.

Guests: Thank you.

Matt Register: Terri, go ahead and get it started. What is Reach Healthcare? What do you do? Who do you do it to?

Terri Gerke: We’re a full service home healthcare company. We do traditional home health, which is considered skilled, so it’s RNs, LVNs, physical therapists, speech therapists, occupational therapists, home health aides, and medical social workers.
Then we have another side of the business that we call the private duty side, which has nurses around the clock if needed, or any in between. Then caregivers, who are unlicensed, from any level from just companionship all the way up to self-directed, actually medical care.

Matt Register: Interesting stuff. I’ve been going through this with my family lately as well. I had a grandmother that fell and broke her pelvis, and ended up some time in the hospital and came back home. Part of your business is just … Because of these folks just need the help cooking, cleaning, that kind of thing, and you do that?

Terri Gerke: Mm-hmm (affirmative).

Matt Register: But you also bring in like the skilled medical, doing medical services to some of these folks, which is kind of the same business, but a different business. Is that correct?

Bonnie Smith: That’s correct. Take your grandmother, for example, when she goes home, she could benefit from physical therapy services to regain strength, learn to prevent falls, do a home assessment to check for risk factors, and remove those risk factors for falls, in addition to caregiver services to help her prepare her meals, do her personal care and so forth.

Matt Register: Now in the industry, I find this very … I mean, the medical industry is a weird industry overall as far as you kind of do the work and then figure out what you’re going to get paid for it, right? But the goal is lately to push … Hospital care is the most expensive flavor of care, right? So they want to get folks home as soon as possible. What are some of the benefits of helping these folks in their house versus helping them in the hospital?

Terri Gerke: Well, this is a really exciting time for home healthcare because we finally have empirical data that supports what we’ve known and believed all along. That is that everybody wants to be home. It is by far the least expensive option for post acute care. We have measurable the best outcomes.
What that means is that you’re going to get better quicker at home, less expensive, and with much better patient satisfaction. Some of the reasons for that are people do better in their own environment. There’s studies that show that on the average, get an hour more sleep than any other healthcare setting. You get an hour more of exercise, which is very important at this age, and you have socialization with your family.

Matt Register: Your family and friends and everything else in that area. Not only does the patient want to be home, but that now becomes the cheapest option, so the government and the Medicaid and Medicare folks are much more willing to pay for those type of services than they have been in the past, is that accurate?

Terri Gerke: Yes, that’s absolutely true. We’re seeing much more movement in that. In fact, Medicare’s actually even consider expanding their coverage for some non-skilled care. It’s really wonderful to have both, to be able to have the unlicensed staff, as well as the traditional services that we associate with Medicare.

Matt Register: Now there are times, and I’m just thinking about with my experience. There are times that the unskilled stuff is going to be less expensive, right, than the skilled. But there are times that if they just need a IV switched out every once in a while or something that they can have unskilled care. Then have a skilled person to show up for an hour and do something and leave, is that what you’re seeing some of your patients are doing?

Bonnie Smith: Very much so, the skilled side, it goes from the elderly who have wound care. Say they have peripheral disease, and they have wounds, ulcers, and so the nurses going in to do really complex wound care is very much needed now. Also, infusion therapy, that can be much more cost effectively done at home than in the hospital.

Matt Register: But you don’t need to pay the ultra skilled person for 24 hour care. You can have 24 hour unskilled care and just periods of skilled care to come in and change dressings or do whatever they need to do, and then leave. Is that accurate?

Bonnie Smith: Yes, that’s accurate.

Terri Gerke: We call that continuum care, and it’s really important because people go up and down on whether or not they need skilled care. Sometimes in the beginning of a new diagnosis, the nurse will come in, and she’ll explain, make sure the family understands what’s going on and the patient understands what’s going on, and if there is a caregiver that they understand. Then things might be stable for a while, and then something else might change, and the skilled people might come back in again. The physical therapy might come in and set up a home exercise program, and teach the caregiver how to work with the patient.

Matt Register: How much of the demographic changes? I would imagine the big wave of baby boomers getting to the point that they need this care, has it already hit, or is it on still on the leading edge, or are you right in the middle of this?

Bonnie Smith: I think it’s on the leading edge. Let’s see, if we do the math, baby boomers started in ’46, I mean in 1946. So they turned 65 in 2011, they just started turning 65. As those are aging, we’re really only seven years into them turning 65, so I think we’re on the leading edge.

Matt Register: What do you think? What do you anticipate that doing to your business over the next 15 years? It’s not getting smaller, right?

Bonnie Smith: Huge growth.

Terri Gerke: There’s unprecedented growth in home health right now. All the way down through the post acute care continuum, patients are being discharged sooner with more morbidity, sicker. Needing more services. Then technology is also a factor because there are things that can be done at home now that didn’t used to be done at home.

Matt Register: Is the healthcare industry, as an industry, prepared for what’s coming? Or are they ill-prepared for what’s coming in your opinion?

Bonnie Smith: I think they’ve been preparing. There still continues to be a lot of changes and realigning and rethinking things. That keeps the industry in flux. We’ve always tried to be diversified to meet those needs, whatever the government decides is the best move to make at that time.

Matt Register: We talk about the wave of baby boomers coming in. It is not impossible that the pool of people that need just for instance your type of care. If that number triples, do we have enough folks to handle this?

Terri Gerke: It’s sort of interesting, Matt, because the industry has been dominated with what people call mom-and-pop agencies, the little tiny agencies. Then there’s a few, very large agencies, but very few, like 10% of the businesses are that size. The scalability and being able to grow and have management expertise to manage larger size is going to be the challenge in home health. There are lots of players, but are they able to do more than a few patients?

Matt Register: Well, and the number of players in the industry, a lot of them don’t have a lot of longevity do they?

Terri Gerke: Exactly. We’ve been in this business for 30 something years. Bonnie and I have been partners for 30 years. We’re both nurses as background, which is unusual. Trying to maintain the clinical expertise and the financial piece, which is very complicated sometimes, and then the regulatory side. That’s a lot of management for a very small company. We are unique in that we have the right size to do that.

Matt Register: No, absolutely interesting stuff. Now somebody wanted to learn more about Reach Healthcare or they have somebody that needs home care, what’s the easiest way for somebody to learn more you guys?

Bonnie Smith: I would say go to our website, which is They can also, to just learn more about home health in general and our services. Then always call our office at 713-500-0000, an easy number to remember.

Matt Register: Yeah, no kidding. I’ll tell you what guys, we’re going to have that website linked right there from, we have Terri Gerke, who’s the CEO, and Bonnie Smith, the VP of Sales and Marketing, for Reach Healthcare Services. Unfortunately though, we’re out of time and we got to go pay some of our own bills. Thank you very much, ladies, for joining us. Interesting stuff. We’ll be back right on the other side of the break with a whole lot more of Texas Business Radio. Don’t go anywhere.

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About the Author
Matt Register

Matt Register

In addition to hosting "Texas Business Radio," Matt is an investment banker and serial entrepreneur from Montgomery, Texas. He is the owner of RREA Media and Register Real Estate Advisors and a Managing Director and Principal at Corporate Finance Associates. He has a BS from the United States Military Academy at West Point and an MBA from Rice University in Houston. You can read more about Matt HERE.

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