Welcome to the Healthcare CEO podcast. Join us as Daniel Fernandez, healthcare leader and patient experience advocate leads dynamic one-on-one discussions with healthcare executives, consultants, and other industry experts. Listen in as they share actionable insights and unique perspectives into the day in the life of a healthcare CEO.
*The following has been adapted from our full-length interview, which can be found here.
Meet Mario D’Aquila
Mario is the COO of Assisted Living Services and Senior Vice President of Assisted Living Technologies, a family-owned and operated company that employs more than 400 caregivers across 50 townships in Connecticut. Recently, they’ve won three Best of Home Care Awards, for Best Employer, Best Provider, and Best Leader.
Origins of the Business
Daniel Fernandez (DF): Tell us a little bit about Assisted Living Home Care services and how it came to be.
Mario D’Aquila (MD): We’re a family owned and operated business. We started in 1996 — actually, sort of by accident. My great grandfather started to decline cognitively, and my mom was his primary caretaker. She was in that sandwich generation, so she had to take care of two young children and an aging grandfather. We started to notice that he was wandering, he was starting to make bank deposits and pay his mortgage at the wrong bank. He would leave wads of cash on the McDonald’s counter when he was paying for our lunch and things like that. And my mom said, he’s really starting to decline.
It really hit that pinnacle, when about 1 or 2 am on a freezing day, we were here in Connecticut, and we had about almost two feet of snow. My great grandfather wandered in the middle of the night, knocked on the back door of our house (we lived a couple blocks down), and he was just in his pajamas. And my parents said, “That’s it, he can’t stay home alone. He needs somebody here full time.” So, they were able to get caregivers to help care for him around the clock. A few years later, they started a company called Assisted Living Services. Now, we care for three to 400 grandmas, grandpas, and parents every day throughout Connecticut.
DF: So they found a need personally, and then fulfilled it for many other families as well.
MD: That’s how good businesses are started. It’s just to solve that need. And, when it’s personal, you really start to make it your life’s work. People see that, and they want you to help them out with their parents. Or, if it’s a product you’re selling, they want your product.
DF: What was that like? What are some of the earlier memories that you recall at the beginning of the company that stand out?
MD: So we had a cape-style home, and me and my brother’s were upstairs. It was a weird bedroom that was in between a bathroom and an office. And, I would have employees literally walking through my bedroom. The office would open at seven, eight o’clock, and all of a sudden I’d have employees walking through my bedroom to work in the office next door. It was just such a bizarre thing to see that as a kid. We’d have caregivers even stay with us sometimes. They would come from the New York or Massachusetts area. And, some of those times when they were between cases, they would actually sleep in one of the spare bedrooms, and we’d have them there for dinner. It was pretty cool. I’ll always remember that.
DF: It seems like from very early on you created this family-like environment for even the team. Even though they weren’t directly family members, you were treating them like family.
MD: Oh, yeah. I remember this one caregiver in particular, Jane. She was the primary caretaker for my great grandfather. But, once he passed, she still worked at the business. She was like an aunt. We’d have Jane over for spaghetti. It’s funny to think about now. When I look back at it, it’s very humbling to see how far we’ve come with such small beginnings.
MBA and Construction Background
DF: Before joining the family company, you were managing some large-scale projects for some pretty big companies. And, you also have an MBA. Are you able to apply some of those principles that you’ve learned to the family business?
MD: My background in construction has definitely helped, because it’s a very precise industry. Anything that’s off costs tons of money, because you delay the project, you order things that are very expensive, there’s litigious issues later on if the project gets delayed, there’s liquidated damages that sometimes you have to pay because of miscommunications. So, that kind of preciseness in communication has really helped. I couldn’t have done any of what I’ve done without that background, honestly. It might not be what people expect when it comes to construction, but you really have to be precise, especially when you’re doing field engineering or project management. Everything is very by-the-book, following the specifications and making sure that your vendors know what they’re doing. So, I carried that over to home care.
DF: It seems like some of the most innovative ideas in industries come from people who start on the outside of that industry and bring new things into it.
MD: What I found interesting when I came to run the business was that everybody working here — all the senior management and everybody that’s been here for a while — all have some type of healthcare degree. And, they have a healthcare mindset. But, when you have people come in with business mindsets, analytics, and project management skills, you get a real magic that happens. It’s very cool to have that diversity of skills added to our management.
Setting Audacious Goals and Finding the Right Talent
DF: With a company that is the size of yours that’s constantly looking to scale, are there frameworks you use for setting goals?
MD: We actually use an innovative style of growth strategy called OKRs, which stands for Objectives and Key Results. The objectives are aspirational in nature, whereas the key results are more or less SMART goals that are measurable. About three years ago, we all read this book called Measure What Matters by John Doerr, and it laid out how you can set goals that are audacious. These are really high-level goals for an organization, and then to get everybody to work towards that common goal at the end of every year or every period and really go for it. At its core, it’s simply set goals high, have fun with them, and crush your goals. And, at the end of that time period, you’ll be amazed at what you can accomplish. Many companies — especially Silicon Valley companies — adopted this framework or a hybrid model of it.
DF: So, OKRs are a little more challenging goals than your typical goal setting framework. Google has a belief that setting more challenging goals helps to enhance employee engagement. They have more of a bind, because they’re more of a challenge. Have you found this to be true?
MD: That has made the biggest difference for us. Giving people not just like an intrinsic, feel-good purpose based on helping people, but actually striving to get somewhere, to do something. OKRs give you measurable statistics that you could say, hey, look at how I’m doing here. You go home at night, and you say, hey, I’m either hitting my goal, or gee, what can I do tomorrow to work towards hitting this goal, so that at the end of the quarter, I can say, yep, I hit it, I did this, and I’m proud of myself? And, we see that in every single role here, from receptionist all the way to the CEO. We all have OKRs that we need to hit every quarter and every year. So, it’s super exciting for people to help measure themselves against themselves.
DF: With a company such as yours, it’s also about scaling and getting your team to buy in. How do you source and, ultimately retain, this talent?
MD: We’ve made our mistakes in the past, but what we’ve learned is that finding great talent is the most important thing that a company can do. Because it’s very expensive to get the wrong talent. It could be from a bad cultural fit — you hired somebody, they look good on paper, they’re great in the interview, then they come in, and they’re just not meshing well. It’s like when you’re cooking. You put something in that dish that just doesn’t taste right, and it can ruin the whole dish. When that happens, the most important thing to do with that is to recognize the mistake and act on it quickly.
As for sourcing and retaining the talent, we use a framework called TopGrading. There’s a great book that introduced me to the concept, called Who? by Jeff Smart and Randy Street. TopGrading helps you ask questions to learn who the person really is. Not just if they’re good at QuickBooks or are a team player. It really gets into the core of who the person is. And, I kid around with my HR director that it helps me stare at the person’s soul to see if they’re a great fit in the organization. It works wonders. It takes a lot of time and practice, but when it’s utilized well, you start to see some success in your hiring.
Leveraging Technology
DF: So, you also have a technology division. Where did the concept idea come from to start adding technology to the company?
MD: That’s one of our core differentiators. There’s a bunch of home care agencies around, but not many home care agencies also own a technology subsidiary that offers home care technologies to seniors and people with disabilities all throughout the country. Assisted Living Technologies is the subsidiary of Assisted Living Services. It was the brainchild of my dad, Ron, who’s the CEO, and the President of Assisted Living Technologies. He said, “You know that there’s got to be more out here. There’s all this technology, but there’s really no central place to get technology for seniors. Everything is siloed, and there’s no hub.” So, we wanted to create a hub to get all these technologies together and implement them with our home care clients, to reduce the chances of a fall, wandering, or med errors. So, the company was born. Again, it’s its own separate company, and it runs autonomously.
It dovetails really nicely with the home care, because if we get a client who is a fall risk, or a wandering risk, one of our directors or coordinators gives Technologies a call and says, “Hey, we have a Care Plus client for you (meaning care plus technology). Can you go do an install over at this client’s home to reduce the chances of that fall or wandering event?” So, it works really nicely. We specialize in remote monitoring, medical alert systems, and med management systems. And, we also do kitchen and home safety devices, which can shut the stove off when you’re not paying attention and keep you from burning things when you’re cooking.
DF: Do you find that the people purchasing these products are the seniors directly or family members of the seniors?
MD: It’s almost always adult children who are buying it for their parents or their grandparents. They’ll notice an issue, like mom’s kind of forgetting things on the stove quite often. Let’s get one of these cooking devices to help shut it off so that we don’t, you know, have a smoke or fire issue to deal with. Or, they start wandering or they start noticing falls, and they say yeah, we need probably a medical alert system or some remote monitoring in the home.
Final Thoughts
DF: Do you have a favorite book or a book you’ve read recently that you would recommend other than the ones you’ve already mentioned?
MD: I love the book, MONEY: Master the Game, by Tony Robbins. It’s a beast. It’s more than 600 pages long, but I would say he’s the best business coach in the world. And essentially, this book tells you everything that you need to know about finance, especially if you’re somebody who may not know anything about finance. So, for those of you who are always wondering, should I get into stocks? Should I get into mutual funds? Should I get into index funds? What should I do with my money? Read this book. It’ll change your life.
DF: Do you have a favorite quote?
MD: I do. “If you want to take the island, you need to burn the boats.” What that means is, don’t look back, just commit. Don’t even allow yourself to turn back. Burn the boats.
DF: The last year has been challenging for all of us. What has the last year taught you personally?
MD: I’m going to revert to the quote a little bit because that’s what last year really taught me. If you have to make a change, if you must change your business or your life, you will. If you have to do it, you will get it done. Or, you won’t, and then your life or your business won’t do well. And, it’s really amazing what you can accomplish when you have no other choice. We saw that last year with COVID. We needed to adopt a better way to do work from home — not being in the office. Before COVID, we had no idea how to work remotely. And, we went from not using Zoom or Teams and those things to using those things in two weeks. Before that, we just had a regular phone in the meeting room, and that was it. It was really an amazing feat to transition that quickly. My brother, who is the CIO here, helped implement all of those things. I don’t know what we would’ve done without him.
DF: There were obviously a lot of lessons learned over the last year. What bit of advice would you give them, in closing?
MD: Embrace change. And, change quickly. Get it done, burn your boats, and just move forward. And, that’s all you can do.
Learn More About How Mario and Other Healthcare Leaders Are Shaping the Future of Healthcare
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