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Episode 96: Hamza Sikander

While at the NHI Music City Symposium, Josh and Lucas sat down the Hamza Sikander, Managing Partner at Comfort Care Senior Living to discuss culture and trends in rent and labor costs. They also dive into some of the differences of senior care in Pakistan and the United States.

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Lucas: Welcome to Bridge the Gap podcast with Josh and Lucas. This is the senior living podcast recording live from Nashville, Tennessee at the NHI Music City Symposium. And today we’ve got a young leader in the business. We have Hamza Sikander and he is from Comfort Care Senior Living. Welcome to the show.


Hamza: Thank you gentlemen. Thank you for having me. 


Lucas: Excited to sit down with you. We’ve heard a lot of great things about you from Cameron. We’ve done our homework so we know all the dirt.


Josh: Actually we don’t know any of the dirt, but we hope you’ll tell us. 


Hamza: Uhh let’s see. 


Lucas: Well we have a very diverse audience in the business. We have people that are core legacy people that have been knee to knee and shoulder to shoulder really doing the heavy lifting of the business, and then there’s a lot of newcomers out there that are getting into the business. And so you’re a young leader in the business and this is exciting to kind of sit down. We want to know your journey to getting to this point. Why senior living and why start this company? 


Hamza: So the way I got into senior living was actually by fluke. It was not something I planned on. I never thought in my life, I would be going in the healthcare industry, let alone senior living right? I graduated from Lincoln Memorial University right here in Tennessee and went to Saginaw, Michigan. I was looking at doing different things initially, got into started taking over the medical practices, acquiring them, and helping my uncle who happens to be a physician who I started with. And one of these days I was sitting at one of the practices and a patient came in and said we’re looking for some place for mom and dad and they’re having to move. So that was just one instance but it sort of happened more and more. So, naturally, I was young, and I said okay let me call a few builders and see if we can let them know that there is a demand for this, a lot of patients are asking for this. And at the time the economy was in the recession, nobody was interested. I said hmm, how about I start talking to the positions I was working with or know them and got a good group of initial Investors and started our first facility. And from there it’s history. 


Josh: So how long ago was that?


Hamza: That was 2013 in the summer when we first opened our doors, yeah. 


Josh: Okay, so tell me about the journey since the first one. How many do you have now? And what does that look like?


Hamza: We have nine operational buildings now. The first building was thirty units, we had about 450 beds online now. And we have three under construction for next year, one at the end of this year and two next year So we’re excited.


Josh: That’s so exciting. So tell us, you’re obviously here at the NHI Symposium, I’m assuming NHI’s played a big role in part of this partnership. 


Hamza: Absolutely. So going forward we are growing with NHI. I actually partnered up with NHI exactly 12 months ago.


Josh: Okay. 


Hamza: And there was a deal I did for the first two buildings and now we recently acquired two more with them. So that’s four buildings in our portfolio which we work with them on and we actually were just talking about the fifth one. 


Josh: Oh that’s exciting. So doing some deals here as well. 


Hamza: Absolutely. 


Josh: So before here in just a minute, I want to talk a little bit about what we discussed with the panel today or what we heard from the panel discussion, I know you were in there as well. So talk about some of that and how it impacts you guys and what your opinion is on some of those things they were talking about. But I’m just fascinated, so you’re from Pakistan. We just learned about this within the last 24 hours and I’m just interested from a cultural standpoint. What’s the difference in kind of senior care in Pakistan versus how it’s done here? 


Hamza: Senior living in Pakistan, there is no such organized industries so to speak. 


Josh: Okay. 


Hamza: Sort of how we have independent living, assisted living, skilled nursing, maybe far, few and between. There might be something that I have not heard of, but they don’t have anything organized. In southeast Asia, whether it be Pakistan, India, Bangladesh, Malaysia, most of these countries, you’re going to see more of family-oriented. When seniors, when your parents get older or when your grandparents get older they live with the kids and they provide for them typically. There is instances where they’re not cared for and they do have homes to go to but there’s no set industrial service.


Josh: So I’m fascinated by that because I think one of the things that you probably heard and which I’d love to know your opinion on because you’ve actually seen that in the more of a residential model, is is the whole multi-generational concept or the intergenerational where you have old and young people living together, being cared for, more of a family kind of look. It seems like a lot of people think that’s a lot of what the future looks like in the states. What’s your opinion on that?


Hamza: So here’s the thing: the love and compassion that a family member can give, you will never be able to replace that. We always tell all of our families coming in, the best thing that you can provide is the love and compassion. Whether it be at our building or at home, but naturally because of the work culture, the environment in living in the US where I live now too, so there’s a lot of challenges. Typically both husband and wife are working, kids are going to school or there’s different challenges. So it does not make it possible for us. So in that instance the next best thing is Comfort Care Senior Living.


Josh: Absolutely. 


Hamza: We will provide the type of care that you would want for your loved ones. Whether that be your reference to the paneling there, and one of the things that I was just talking to Michelle over here from NHI, if you really focus on what they were saying, they are talking about the basics. The basics of being a human, having compassion, having care, having a commitment, and treating employees when they come in from the time you sign them up for the  application process, through training them and getting them going at your communities. It’s really being able to understand them, talking to them and having a connection with them. If they’re just a number on your profit and loss statement then you’re not going to get the performance. 


So I think the most successful thing that has worked for Comfort Care Senior Living is our relationships with our employees. To the best extent possible, we’re always discussing it whether it be me talking to my management team, them talking to the supervisors, and them talking to the caregiver staff, we try to promote it. 


We’re a growing company. As you grow naturally you have challenges as well. Going from one or two buildings where I’m always there watching out, looking, talking to employees, talking to residents, it’s a learning curve and that’s where partners like NHI play a role where you talk to them, they introduce you to other operators and you can discuss the challenges they’re going through like cultural changes, operational challenges, all of that.


Josh: And you brought up an interesting point, a lot of the conversation today it was a very transparent conversation with multiple operators, which was very awesome. That’s a great thing about our industry. It’s a great thing about the symposium that brings people together to have these conversations. But a lot of it was kind of an X’s and O’s to use a football analogy because Lou Holtz was here and he even made the point, you know in every one of his championship teams or a turnaround team, he was always instilling the basic fundamentals. And I think a lot of what we’re talking about here is those basic human fundamentals of compassion, of great communication, of treating people humanely, with dignity and with honor. And I think you know, it’s just easy as you said as you have robust and growing organizations, as you have regulations, as you have all these pressures to perform, some of that sometimes gets lost. So they framed this panel with an interesting graph and I’m sure you saw it as well. It was kind of alarming to see our rents, our average rents as a percent in independent and assisted living kind of trending down of what you can charge but the labor rates going through the roof as a percent. So what are some of the challenges maybe that are consistent with that that you guys are seeing?


Hamza: I think all of the things that were discussed whether it be rent or labor costs, is something that is happening. It’s something that we’re seeing in the market and the important thing is to remember is to stick to those fundamentals. There will be periods in any business where you are going to have really good years and then you’re going to have years where there’s pressure on your bottom line. However, you cannot do something drastic and start changing things up. As long as your basic principles are working for you stick to them. 


The economy is hot right now, the labor market is hot right now. It will eventually cool off so you don’t want to go back to 2008, but right now if you talk to any of the operators, everybody is hurting for staffing. I was just telling Cameron, last weekend I was actually going with a family friend and my family, we were just going down to about an hour and a half to go to the mall and between my house and that mall I I saw at least 60 now hiring signs flashed across all businesses. It’s crazy, right? It’s good in the sense that people have jobs, people are working but at the same time that gives the employer less of a pool to choose from but naturally when there’s a problem it autocorrects itself. 


Josh: Well, that leads to one of the focuses of conversation as we were hearing today, each one of those significantly sized organizations were talking about the shift in attention and intentionality and what emphasis they are placing on the I guess the employment, from recruitment through the interview and onboarding experience. And they’re placing as much emphasis on that as they would the the tour experience. Are you guys having some similar initiatives or thinking about the experience that way as well?


Hamza: Absolutely, actually, very recently as we’re growing we’ve added someone in a role to focus on developing and just slowly focusing on what the culture is, how we can keep passing it, how we can maybe reduce the time frame of offering the job, to bringing them on board, for the same things they were talking about in there as well as making sure there’s a culture there because we are seeing a big turnover then there has been historically and more right now because the job market is so hot. They can literally get one building, go to the next one and get hired. So what can we do differently, and we have been focusing on. 


Josh: So practically speaking, if you don’t mind sharing with our audience, that’s why we created this platform kind of like to take the information that you guys and what you’re doing well, and what you see or working. So this position for example that you created is that kind of the corporate level position or is that at the community level or is it both? 


Hamza: So it is both. This position is hired at the corporate level, which we call the central office level, but they go to each community, sit down with each administrator and work and do surveys and discuss what are different things we can do, whether it be the bonuses we have to offer for referral, whether it be giving them employee of the month, whether it be giving them gift cards, whether it be just because they’re helping you out, pick up shifts, which you needed help with, giving them above and beyond what they would be making. Sort of a $20 gift card, a thank you for being there for us. Sort of our way of appreciation, in fine monetary terms but also speaking to them, letting them know how you are. 


Josh: Sure. So is  there anything that has been kind of a secret sauce that you guys have that has really been very meaningful to your bottom line or two-year attrition rate from a labor standpoint? Is there something that you can pinpoint and say that is something that we as a team have done that has been most impactful? Put you on the spot there. 


Hamza: One thing is hard to point out, but I can tell you a couple of things that we have done. One of the things that Cameron really likes about what we have done with NHI after talking with many of their operators is a software which has helped our employees a lot. It’s Seven Shifts which we use, historically somebody calls in and you’ve got to pick up the phone, go through your roster and see who can come in and so on and so forth but with technology you can do so many different things. Everybody gets a text message, who’s interested in the shift, whoever bids on it and says I’m interested. As the operator we’re looking at who’s overtime, who is not overtime and so on and so forth, and who’s looking for a caregiver. This process historically used to take 30 to 45 minutes for every time you’ve got to fill up a shift. Now we’ve cut that down and of course employees are happy because every time there’s a shift available everybody knows and if they’re trying to make a little bit of extra money because they have a trip coming up or something they can bid on it. So that’s one of the many things that we’re done. 


Josh: So we’re hearing that a lot as we’re talking with people, that people are implementing technologies and things like that to try to help, has that been a fairly affordable tool to use?


Hamza: Actually if you really look at it, we’re really saving money by doing it because it takes me longer as an employer to pay somebody to try to find cover that shift, whereas with a few clicks within less than five minutes you’ve got the shift covered and you’re happy. And keep in mind that you were going through multiple communities using these tools. Let’s say nobody at that specific community wants to go to pick up that shift, might be in your community you’re starting  and you only have a very few handful of staff members, you can blast that to other communities as well hey there’s a shift available if anybody is interested and they can bid on it from all over. So for us we are at about 700 employees right now. So if need be we can hit send a message to all 700 and see who is available to pick up the shift. 


Josh: Wow, that’s fascinating. I love to hear about that. Well thank you for spending some time with us, being so open to talk about what you’re doing talk about your journey into our industry that we love. Lucas, I know we’re going to have to let him go. He’s got a fun night ahead. A lot of festivities here planned at the NHI Symposium. 


Lucas: How’s your golf swing?


Hamza: Uhh I don’t know about that. 


Lucas: Better than mine. I can assure you. 


Josh: So yeah, I think we’re headed to Topgolf next and it’s fun even if you don’t like golf so looking forward to seeing you over there.


Hamza: I’m actually looking forward to it too, thank you so much for having me. My pleasure.


Lucas: Very impressive Hamza, we thank you so much. We’re going to connect with you in  the show notes and your organization so that our listeners can follow you and see what you guys are doing. So, we really appreciate that, appreciate your time. Safe travels and thank you everyone for listening to another great episode of Bridge the Gap.



Thank you to our supporting partners NHI, RCare, NRC Health, TSOLife, ERDMAN, TIS, and Sherpa.

Episode 96: Hamza Sikander