By Jay Greene | Crain’s Detroit Business | Published August 05, 2018
Ypsilanti-based Care One Inc. is one of those firms that has enjoyed double-digit growth the past six years as it helps companies fill holes in their workforces with temporary staffing.
As a recently certified LGBT business, Care One owner and founder Steven Cook says his 25-year-old company hasn’t changed much in philosophy or customer service over the years, even as the health care industry it serves has gone through many changes.
But Cook says “the whole industry, home care and health care staffing, has changed completely” as hiring and purchasing contracts have, in some cases, gone to large national companies and placement of temporary employees has led to more permanent hirings.
Specializing in health care, Care One finds nurses, home health aides, dentists, social workers, surgical and lab technicians, pharmacists and others for companies needing short-term, long-term or per diem workers.
“We have experienced pretty substantial growth in the last five to six years by honing our skills and marketing techniques because we are in a strange business,” Cook said. “We have clients on both sides. We place employees at companies, and then the provider becomes a client as well as the facility.”
Some 20 years ago, 30 percent of temp employees would eventually be hired at the company. The majority would work a few weeks or months, then be placed at another company.
But now, 80 percent to 90 percent of temporary employees, on average, eventually become a full-time employee with the company with which they are placed, Cook said. Generally, the placement lasts 13 weeks to six months.
“There is an advantage for firms to use temporary employees. Companies that hire temporary employees benefit because they don’t spend money unnecessarily training employees,” he said.
How Care One began
In 1993, Cook started Care One with 14 employees. He was the general manager for an air freight company and when the firm was acquired, he wanted to be his own boss. So, Cook took his severance pay, did some research, and picked the health care industry.
“Everything pointed to health care because baby boomers were getting older,” Cook said. His first contract was W.A. Foote Memorial Hospital, which is now Henry Ford Allegiance Hospital.
“When we started, nobody was doing temp services in Jackson,” he said.
Now, Care One has nearly 250 employees and Cook projects revenue to come close to $6 million this year. “We have had substantial growth. It’s been double-digits, 13 to 16 percent, the past few years,” he said.
“Everything became very digital. There is no face-to-face communication. My competitors take in resumes and forward them on to health care organizations. We don’t do that. We have lots of face-to-face and telephone communication. Because health care is so personal, you have to be personal,” he said.
Many health care companies, including those in long-term care or residential assistance, are struggling to find new employees to meet minimum staffing requirements. RNs, LPNs, nurses’ aides and charge nurses are in high demand, he said.
“There is a combination of turnover and growth. In Jackson and really Michigan, we have an aging of the workforce, and the amount of new facilities that have opened up in Jackson, companies are trying to staff those positions. It is not a job everybody wants to do.”
While hospitals had been a chief source of contracts, Cook said the hospital market changed in the last three years. Instead of hiring through human resource departments, hospitals turned over temporary staffing to purchasing departments.
“I still don’t fully understand it. We had very successful placements at hospitals through HR, but hospitals now use group purchasing organizations to get lower-cost contracts,” Cook said.
For example, a hospital or health care system issues a request for proposal for nursing services with a group purchasing organization of which it is a member and staffing companies, usually national, bid for the contracts.
“Hospitals now put our RFPs for nurse services same as Band-Aids or laundry services, like widgets,” Cook said. “This removes the personal touch. People are placed without ever meeting them. Now hospitals deal with fairly large suppliers. Sometimes (GPOs) contract with agencies like ours, which is what we are trying to do.”
Cook said the GPOs are contracting with national staffing agencies and shying away from hometown agencies. “We know our people, but placements are becoming less successful. If I were a nurse, I would be hesitant to send my resume to a staffing agency that is not based in the area I live,” he said.
Besides health care staffing, which includes nursing homes, hospitals, residential care, dentists and psychologists, social workers and nurses, Care One focuses on health care staffing with the Michigan Department of Corrections.
“Corrections is a big area. We are 14 years into corrections and currently in our third contract,” Cook said. “We are one of six agencies who provide staff for the entire state.”
Personnel placed include dentists, medical assistants, registered nurses and licensed practical nurses.
“Corrections is not really what people perceive it to be. A lot of nurses go into it a little hesitant, but once they get into the arena they are very pleased,” Cook said. “Eighty-five percent of placements are taken full time.”
Of the approximate 111 temporary jobs, Care One places 45 percent, or about 50, of the current total, said Lia Gulick, health services administrator with the MDOC, which employs 1,466 full-time equivalent health care workers.
Gulick said of the 50 temporary workers Care One places, 26 are registered nurses.
“Temporary staff fill in for vacations and in places where we can’t recruit,” Gulick said. “They cover for gaps when we can’t fill a position, or people go on military or FMLA leave.”
Gulick said she doesn’t have statistics on how often MDOC hires temporary workers. “If they like the job we would hire them,” she said. “They are a good source to fill out our positions. It gives us the ability to see them, see how they work.”
MDOC also contracts with Corizon Correctional Healthcare, the state’s in-prison health care provider, for physicians and psychiatrists and some pharmacy services.
Cook said turnover in corrections is mostly due at the MDOC to an aging workforce. “They are losing a lot to retirement. Some changes with the (union) contracts. Some people get out before the new contracts kick in,” he said.
Cook said he sought certification last year from the National LGBT Chamber of Commerce because an increasing number of state and local governments view gay and lesbians as a minority.
“There are many state and federal contracts out there, and they are very open to using LGBT businesses,” Cook said.
The national LGBT chamber verifies that eligible businesses are majority-owned by LGBT individuals and grants the designation as part of its supplier diversity initiative.
“It puts you in the same advantage as a woman-owned or minority-owned business,” said Cook. “A majority of health care organizations have large numbers of LGBT employees and this has given us the ability to go after contracts we probably wouldn’t have done before.”
Cook said because Care One is smaller it can’t give as large as price breaks as larger national companies. “It gives us a boost in scoring and an ability to get us to the next level. It has opened some doors to the possibility of moving forward and puts us in touch with more employers,” he said.
But Cook said it is too early to tell if Care One will do better financially because of the certification.
“It has no impact on our temporary employees or recruiting,” he said “We have always been LGBT-friendly and that never has been a barrier to people coming to work here.”
Cook said it is hard to tell if more LGBT people are applying for jobs at Care One. “People in the area have known about us for years because of the events we sponsor and just who we are,” he said.