(Editor’s note: Machelle Thompson has grown Long Beach-based Keen Home Care from a company of two to a firm boasting 60 employees. In 2016, she opened Rossmoor Home, a board and care facility with 30 employees.)

LBBJ: What led you to found Keen Home Care in 2005?

Thompson: I am a physical therapist by background and worked as a director of rehab in skilled nursing facilities. I became a nursing home administrator and ran nursing homes. I saw that our health care system was extremely fragmented and the average consumer didn’t know how to navigate [it] or what their options were. I saw a lot of people who were prematurely institutionalized. So I got certified as a geriatric care manager and started Keen Home Care.

LBBJ: What was your vision for Keen, and do you feel you’ve seen that vision come to fruition?

Thompson: My vision was to help seniors stay at home or their preferred environment to the end, if that’s what they wanted. And that certainly has come to fruition. We do that, and we’re very good at it. Unfortunately, times have changed, and not a lot of seniors are now able, in California, to afford the care they need at home until the end.

When we first started, we were doing predominantly care management. At first, we started using other people’s caregivers and overseeing them for the client. But we found out that wasn’t the best strategy. The caregivers showed allegiance to their employer rather than communicating with us about the clients. So we figured out quickly that we needed to have our own caregivers so they would follow a similar belief and value system in how we do our work. It has turned out to be very prosperous for our clients and for the business.

LBBJ: How have you grown the company over the years?

Thompson: Part of our strategy has been to collaborate with our caregivers and our families as a team, as well as anyone who is involved in the team – that includes physicians, attorneys or CPAs. Through networking with a person’s entire support system, we have found that to be very valuable for the individual as well as the relationship development over time.

LBBJ: What sets Keen apart compared to other home care providers?

Thompson: I would say we’re a concierge home care business. We have a very integrated team where everyone on the management team knows every client and every caregiver. Every client has a care manager who oversees their care and partners directly with the caregivers. We have a very well oiled machine. . . . We look at the big picture needs for the client and what they can afford, what’s realistic and their desires.

LBBJ: The health care industry has for the past decade been the subject of major policy reforms and has become something of a political football. How has this affected your business?

Thompson: I’m used to this from my prior history working as a therapist and going through the changes in Medicare and managed care. Changes in health care are expected and needed. I am not afraid of that. I would say the frustrating thing that’s happened here in California is that when the Consumer Protection Act went into place, where agencies had to become certified as health care organizations and get licensed under the Department of Social Services, and then the caregivers had to get registered – I had been a big advocate of licensure because I believed the consumer deserves a minimum level of security and expectations when they hire a home care agency, as well as oversight. However, what’s happened as a result, [with] the exponential increase in cost across the board, is that a lot of consumers are hiring under the table. They don’t understand the risk associated with that. So [with respect to] the Consumer Protection Act, I have not really seen that come into fruition in terms of actually protecting the consumers.

LBBJ: How would you hope to see that addressed going forward?

Thompson: The regulators need to go down to the grassroots level of their constituencies and really understand how this is impacting the seniors, the developmentally disabled, as well as the caregivers and health care organizations that are trying to run above-board operations and do the right thing for the right reasons – and understand that the economics of the situation have driven a lot of people to go towards the very avenue that makes them most vulnerable. We need to find a way to educate the consumers about their vulnerabilities and offer them affordable and reasonable solutions.

LBBJ: As Long Beach’s population ages, what challenges do you expect the city to face in terms of meeting the needs of its seniors?

Thompson: Transportation and advocacy. There are a lot of seniors who are living in situations where they’re completely vulnerable. They’re on a fixed income, and maybe they had their water heater go out or they have a new medication that is expensive. And they don’t have any additional support system or resources to reach out to when they’re struggling. I would love to see an advocacy group developed in collaboration through the city and state, as well as providers like myself, for the most vulnerable population to have greater resources.

LBBJ: What are the biggest unknowns for you as a business executive in 2019?

Thompson: I would say it’s not competition, because competition is always alive and well. I would say the biggest unknown is finding a way to collaborate with the new and upcoming workforce of the Millennials and the younger generation to create an attractive option and opportunity for them to join into caregiving and health care.

LBBJ: If a startup CEO were to ask you for your most important piece of business advice, what would you say?

Thompson: Hire a solid bookkeeper immediately. That has been the best decision I’ve ever made, was hiring a bookkeeper early on. She’s fabulous. I still have the same one. She has worked with me for twelve and a half years . . . . The value in that for a start-up business is taking that pressure off you to keep everything in order, but then also as you go out to try to apply for loans . . . having your books in order and being able to produce those on a dime is invaluable.

LBBJ: What are some traits or skills every executive should strive to cultivate?

Thompson: Every executive I know is a visionary. There needs to be a balance between working in the business and on the business. Within that, developing systems and leadership skills to facilitate your team continuing to grow, always knowing what you’re growing towards and being prepared for that two steps in advance.

LBBJ: Is there anything you would like to add or emphasize?

Thompson: One of the most invaluable experiences I’ve had is becoming part of a business group, Women Presidents Organization. Being a business owner can be very isolated. You have to reach out to gain opportunities to network and collaborate about business practices, and feel safe to do that. That organization has been phenomenal. I have learned more from my peers in that group than every continuing education course I have ever attended. For a young person to have their sights on meeting the objective to join a group like that, the information they will gain as a young business executive or entrepreneur is completely invaluable.