From Hedge Funds to Home Care: How CareYaya Is Redefining the Future of Caregiving | The AgeTech Podcast S5E9 with Neal K. Shah
When you think of caregiving, hedge funds probably aren’t the first thing that comes to mind. But for Neal Shah, a former hedge fund manager turned full-time caregiver, that unlikely connection became the spark for one of the fastest-growing AgeTech startups in the U.S.
In this episode of The AgeTech Podcast, we talk about how CareYaya is reimagining home care by connecting families with student caregivers – and why empathy, innovation, and a touch of tech might just be the secret to fixing America’s broken care system.
Catch the full conversation on Youtube, Spotify, Apple Podcasts, or scroll down for the transcript (auto-generated, so pardon any oddities – the bots are still learning!)
Keren Etkin: Neal, welcome to the show.
Neal K. Shah: Thanks so much for having me.
Keren Etkin: Thank you for joining me. So Care Yaya is one of the fastest growing age tech startups today, and you have quite a unique
Neal K. Shah: Yes.
Keren Etkin: Proposition to clients and also to the caregivers who come work at Care ia. Can you share a little bit about the origin story and what even made you start this company?
Neal K. Shah: Sure. You know, I, I actually have a non-traditional career. Prior to starting Kaiah, I was a hedge fund manager. And in New York City, I, um, you know, through my twenties, I became a partner at a multi-million dollar hedge fund. And, uh, you know, by my early thirties, I started my own fund that I grew from 10 million to 250 million by the time I was 35.
During that time, unfortunately, I became a caregiver twice, you know, one for my grandfather through dementia and um, kidney failure cancer, and then end of life care, and then shortly thereafter for my wife through years of cancer. And, you know, it was like very difficult work. Really opened my eyes to how broken the care industry is.
Um, you know, and how underserved it is. You know, the care agencies I personally believe are failing at their mission, you know, to provide good care from good caregivers. And it creates a lot of burden and challenge on the family members. So, you know, I ended up leaving my hedge fund career, which I’d worked my butt off for 15 years to build uh, during my wife’s care journey, just to be her full-time caregiver.
And. It really opened my eyes to, and then during my grandfather’s care, my mom had done the same thing. She’d left her career to be my grandfather’s full-time caregiver. And, you know, I basically realized like how difficult it is, but also the opportunity in it, you know, um, in, in our own care journey, we had found, we had used everything.
We’d used care agencies, we’d found caregivers on our own. We’d used care.com. You know, we try everything possible both times. And actually the hidden secret. That is known among a lot of caregivers and support groups is go to your local college and post flyers at the nursing school. You know, people, there’s a very robust, informal care market in America.
Something like two thirds of the care market here operates in the gray market, you know, around the formal care economy. People just find caregivers on their own and within the gray market, students and specifically healthcare students is the best kept secret. So after, you know, my whole journey and you know, after thankfully knock on wood, multiple years of care, my wife finally had a recovery and has been in remission.
At that point I was just very obsessed with the care industry and I was like, okay, so many people are having these problems. I can do something to solve it, um, and help a bunch of people. Um, and that was the founding journey of starting Care Eye.
Keren Etkin: Fascinating. It truly is. So the, it, it has to be one of the best kept secrets in America that you can just walk up to your local college and post a
Neal K. Shah: Yes.
Keren Etkin: Saying that you’re looking for a caregiver and hire a nursing student to do that.
Neal K. Shah: Yes.
Keren Etkin: Does that. Translate from, okay, I have this secret. How do
Neal K. Shah: Yeah.
Keren Etkin: a startup on it? How do you then hire and train and retain, don’t know how many thousands or tens of
Neal K. Shah: 45,000 now. Yeah, yeah, yeah. So to give you a summary, after three years of running it, CareYaya is national. Um, we are operating probably one of the largest care workforces in the country. We have 45,000 students on platform. And we’re in over 15 different cities at most of the top, you know, 30 universities in America and expanding rapidly.
You know, I think how do you start is kind of like, you know, one step at a time, basically, you know, uh, we’re located in Raleigh, Durham, North Carolina, so here we started in our backyard. We happen to be fortunate where we have three major universities within 15 minutes. So Duke University, UNC, chapel Hill and North Carolina State University.
So we started in those areas. Basically the challenge that I, I found, you know, from caregivers who want to. Tap into this amazing gray market is, it’s a lot of manual work. You have to go find students yourself. You have to put flyers, you have to go talk to the nursing professors. You have to text message and run background checks on all of ’em and interview them and then schedule them because note, they’re full-time students, so they can’t do caregiving seven days a week.
So there’s a lot of manual labor that goes into it. And I would draw the analogy to similarly, when Airbnb started. The idea of like staying in somebody’s place in an extra room. It was an idea, but it was a lot of manual work for the user to actually do that. So as Airbnb kind of brought that into the formal economy by making it so much easier for you to do, by adding all the pictures, by adding all the online scheduling, by adding all the logistics, suddenly it became a massive opportunity and they actually expanded the market of travel stays.
And you know, I think that this is the opportunity here that. A great informal market exists for people who are fed up with a formal market, which I personally believe is not doing its job. Most of these care agencies are doing a terrible job, no offense to anyone. They’re run by nice people, but the business model is they charge you $40 an hour and they pay the caregiver less than half, and then the care quality sucks.
Majority of the caregivers that are minimally educated, oftentimes they’re doing second shifts, third shifts at the grocery store to make ends meet. And they’re gonna be super tired and exhausted and you know, not bringing their best self when they’re caring for your loved one and you as the booker, you know, you’re the customer, the healthy family member, you’re gonna feel guilty.
So I think the care industry is totally, totally broken. And you know, as a result of that. You have all these people turning to the gray market and doing it on their own. Um, but I think similar to Airbnb, you need to make it easier for them. So, you know, we started with fully online, you know, do it for me, type of booking, where you can put in the days and times and you’ll get people.
We, uh, did all the, you know, it feels seamless on the user’s end. It’s, it was extremely manual. On our end of running background checks on everyone, running interviews on everyone. Managing, booking and scheduling oftentimes, manually. But we started initially, um, with a pilot in our area at the three universities of a couple hundred students each.
And, you know, that went really successfully for the first like six to 12 months. Learned a lot from it. And then gradually just through word of mouth, it started expanding across where we’re located in the southeast us and then within the last year it started expanding all over the country. So it’s pretty cool.
Keren Etkin: Wow. And so what are currently the alternatives? What do nursing students who don’t work for CareYaya, what do they currently do to bring in some cash to pay for school?
Neal K. Shah: Yeah, great question. And, and sometimes I feel like, you know, innovations are empowered by other innovations. So in our case, uh, a very robust gig economy and doing flexible part-time stuff around your schedule already exists. Unfortunately exists not in the care industry. So most of the students are doing, when we started, um, at the initial universities, they were doing DoorDash or they were doing Uber, believe it or not, you know, and yeah.
And you know, so we were like, okay, there’s already people robustly doing kind of gig economy, flexible hours, work around their schedules, but it’s not meeting their need of, they want to care for people, you know, that’s why they’re gonna healthcare careers. So how can we create and provide something for them?
So, you know, but yeah, before, and, and most of the places we expand, they’re either doing, you know, Uber, DoorDash, um, they’re sometimes doing campus jobs, like working at the local coffee shop, working at the local, you know, campus bookstore or whatever. So they’re doing other kind of like part-time flexible work and you know, when you can get them informed that, hey, this exists.
They’re like, oh, okay, this is interesting. It’s more in line with my long-term career, so why don’t I do that?
Keren Etkin: Absolutely. And you know, as I
Neal K. Shah: Yeah.
Keren Etkin: Preparing for this conversation, of the things that occurred to me is that of the side effects that Carea has is that you could actually be improved. The healthcare system overall because, you know, these students, they don’t just have, a narrow view of what it means to care for someone if you’re in a hospital or a clinic.
They actually know what it’s like when the person is discharged to their home and what the challenges are. So it might like inform their decisions when they’re caring for patients in the hospital or discharging them to their home.
Neal K. Shah: Thank you for bringing that up. Now that we’ve grown so fast and we’ve had tons of students successfully go on to graduate programs, the head of admissions at Johns Hopkins Medical School, you know, which is one of the most prestigious schools here in the us. I was meeting with them because they gave us a grant and on the side he said, Hey, I’ve interviewed some Aria students recently and I’ve admitted all of them into medical school.
And the takeaway was these, he, he was like, thank you for doing the work because you’re building so much empathy in these students, you know, better preparing them to be doctors. And you know, I think that’s really telling. And you know, I’m glad you picked up on the nuance because. Yeah, it’s kind of like an unintended side effect.
You know, we’re just trying to solve caregiving, but in reality, the students are learning a tremendous amount of empathy. They’re learning what it’s be like, uh, what it’s like to live with dementia, what it’s like on the family member, whether it’s the spouse or the son or daughter. All the challenges as well as all the joys that come with it.
You know, I think one of the, one of the interesting things about the path to clinical education in the US is a lot of times people will do shifts at the hospital. But you know, in the US, like a lot of the healthcare industry is run by the health insurance industry, and as a result, the, the, um, amount of time spent with patients is very short.
So in the doctor’s appointment, you’re in and out in 10 minutes, 15 minutes. If you’re working as a nurse aid at the hospital, you’re in and out in 10, 15 minutes. So you’re barely getting to know the people. When you go into somebody’s home and care for somebody living with dementia, care for somebody living with terminal cancer, you’re there for hours and hours.
And, you know, multiple times a week for months and years on end, you’re really getting to know the person as a individual person, not just as a patient, quote unquote, and all the joys and sorrows and hopes and dreams of the person. And I think that’s making people a lot more empathetic as they enter, um, healthcare careers.
So yeah, it’s, it’s really an awesome unintended, you know, benefit I would say.
Keren Etkin: it’s amazing. So we’ve talked about the supply side of the equation, the caregivers themselves. How do you get the demand? Like how did you get people to know that CareYaya exists and that it is
Neal K. Shah: Yes.
Keren Etkin: different from existing home care solutions?
Neal K. Shah: Oh yes. Okay. Thank you for bringing that up. It was very hard and I think that this is a funny thing about kind of the naivete of being an entrepreneur. I just thought, oh, you know, when I started, this is amazing. Like, you know, ’cause I’ve done it myself. I’ve found great caregivers. As soon as this product is out, everyone’s gonna be line out the door.
It was hard, you know, it was really hard. And I think that sometimes there’s a learning in it of like direct to consumer marketplaces, and I’ve seen, I’ve studied the evolution of how other innovators in the care economy in the US tried to do direct to consumer online marketplaces and quickly just pivoted B2B.
And as I’ve, as you’ve seen, I’m sure with some of the other companies that have scaled over the last decade, and I think that my observation was initially I thought direct to consumer was gonna be a cakewalk because there was such an unmet need. It actually turns out, and we’re still learning, it’s a very geographically focused market here, that there is no real national strategy.
It’s a ground game in each market. So in Raleigh Durham, North Carolina, where we started. It took a while. Like one of the biggest initial barriers was, oh, students as caregivers, they’re not reliable. Oh, no, no. No one wants to be the first thing to, no one wants to be the first person to try out a new thing, so they’re like, oh, let me just wait until other people use it.
You know, it’s, ’cause it’s like, it’s not like buying a new t-shirt or you know, a new, like a water bottle or something. Right. It’s like, it’s basically like, okay, this is very sensitive and delicate. So it was hard and it was a lot of like building trust. What I’ve realized over time is it’s a lot of like building organic trust.
So we do zero advertising. You know, we don’t buy ads on Google, Facebook. We don’t play those games with AdWords, so we’re playing kind of like a slow game. But we’re like building kind of like a go direct to the people. So we do a lot of stuff on social media. Uh, we reach people a lot in the community. You know, it’s just like, uh, patience.
I would say, you know, now that we’ve been at it for three years, there’s an accumulated kind of buzz building and ultimately I think the biggest buzz building is just the quality, I would say. Um. People who experienced the care were so blown away with how good it was that they started telling their friends.
They started telling people in support groups. They started telling people at their church or you know, religious congregation, they started telling people, the doctors, the social workers. So word of mouth was prob was and still is the best strategy. And you know, I feel like that’s kind of counterintuitive for a lot of people who are starting kind of like.
Uh, care businesses. But yeah, I would say we’ve grown purely from product quality. All advertising and marketing, all that hasn’t really worked. And you know, we’ve done experiments, but it’s been a ground game and I think that sometimes that just requires like an incredible amount of patience.
Keren Etkin: Absolutely. So product led growth and word of mouth. but from, if I hear you correctly, if I understand you correctly, you have to sort of break ground in each local market to
Neal K. Shah: Yeah.
Keren Etkin: that you are known and that people sort of know and trust you. And then you have this little small group of people who are like the early adopters.
And then sort of starts
Neal K. Shah: Like there’s no, you know, for better or worse, there’s no hack, you know, as in like there’s no shortcut here. And I think it’s kind of interesting ’cause like in, in studying the evolution of the market, I think. And this is kind of like an interesting thing I think about often with like VCs and who funds kind of AgeTech innovation.
I think that some of the best and biggest companies are built with just patients and it builds on the timeline of the market, not on the timeline that the entrepreneur or the investor can kind of force into the market. So I think that’s kind of like an interesting observation here. Yeah. It’s just like product-led growth.
And it kind of grows on its own and then it suddenly starts growing very fast on its own. But anything you try to do to push it doesn’t really work. Or I would say, and this is why I very much hesitate on like any kind of paid advertising and marketing. It can sometimes backfire, you know? And I think that one of the biggest case studies in seeing, you know, why isn’t there an Uber for caregiving in the us, you know, or DoorDash or whatever analogy you wanna call it, is because I think there have been massive amounts of impatience and a, whether it’s led by the investors or the entrepreneurs, or the combination of both.
Just a desire to absolutely gun it and force the market. And I think when you force the market, it backfires and it backfires in low quality. And then that kind of becomes a vicious feedback loop.
Keren Etkin: It makes a lot of sense. So is there any advice that you, is there anything that you know today that you wish you had known three years ago when you just got started? If you could dip like the. Take a time machine and go whisper in a young Neal’s ear, what would you say?
Neal K. Shah: That’s a good question. I’d say, um, yeah, some of the things that, you know, I’ve, I’ve learned, one of the biggest things I’ve learned is, um, and speaking of product like growth. Other products constantly focus on developing other products to solve the unmet needs of the people that you’re serving. And that kind of like, fits into, you know, kind of like what we’re working on now is I think that both helps people solve their problems and grows the whole thing faster, you know?
And, and by that I mean, it’s kind of counterintuitive, you know, like usually many, um, investors and advisors would suggest just put your head down and focus on what you’re building and don’t get distracted. I’m the king of distractions, uh, kind of like ADHD person. So, um, actually, and, and so in the last like year, we’re just kind of like, all right, if it’s product like growth and people are liking the product, why don’t we just develop other products and solve people’s problems?
So one of the things we did, I actually recently wrote a book about it and launched a big innovation about it, but here I’ll show you. Okay. The book’s called Insured to Death, how Health Insurance Screws Over Americans and How We Take It Back. Uh, it’s actually become a bestseller on Amazon in health policy.
And you know, one of the biggest problems we observed is a lot of older adults and their family caregivers are dealing with health insurance battles. And it’s kind of a uniquely American problem. But a lot of the insurance for people above 65 has been privatized in the last decade. You know, Medicare as the government insurer used to be the payer for everybody above 65.
And, you know, it was a nice program. And you know, they typically, if you need something, they’ll give it to you. Like the denial rates are very low. Uh, over the last decade or so, it’s been privatized with what’s called Medicare Advantage. These for-profit plans, and now over half of older Americans above 65 are on these plans.
Unfortunately, when you cut through all the marketing, I think the program is really Medicare disadvantage. You know, people get on it when they’re a healthy 67-year-old person thinking, Hey, there’s fringe benefits and perks. Like, oh, they’re gonna pay for my gym membership and things like that. But really the way cost control works and the way the insurers make profit.
Is by denying care. When something bad happens and when then you’re 75 and you become ill with cancer, you have a hospitalization, you break something, suddenly they start denying a lot of things and then you’re like, wait, why am I, why am I on this? You know, it’s not an advantage. So, you know, we found a lot of families caring for older adults are fighting denied insurance claims, and that’s consuming a lot of time and stress.
So we decided to do something about it. So we launched an AI product to help people programmatically appeal and streamline the whole process. You know, an unsolved problem we found is 99% of people who have denied claims don’t appeal. And believe it or not, one in five older Americans has had a claim denied within the last year.
So it’s a real issue. It’s a real issue from a healthcare perspective, healthcare access. And also financial toxicity perspective that either you had a stroke and they’re not gonna pay for your physical therapy to recover. So you’re either gonna pay out of pocket and end up spending thousands of dollars, or you’re not gonna get it, or you’re gonna delay it for a month or two, fighting it out, in which case literally your condition’s gonna get worse and your odds of recovery you’re gonna be lower.
So, you know, we basically realized in this battle, regular people don’t have a chance. You know, family caregivers are very stressed. You know, unless somebody’s a doctor or unless their brother or sister is a doctor, how are they gonna write this appeal? So, you know, we built an AI system, trained off thousands and thousands of appeal to help people fight back.
And it was just kind of like a, you know, internal tool, uh, that people were using. And then it just blew up. It just absolutely blew up and it’s gone absolutely viral around the country. It’s actually become a hot product that people are using on its own beyond just caring for an older adult. A lot of, uh, family caregivers are using it for themselves.
They’re using it for other family members, like the claim denial epidemic has now affecting 60 million Americans. You know, which is kind of crazy how big the unsolved need is. So that was kind of a cool lesson of like classical startup theory as laid out by investors or VCs might be. You don’t do that.
You know, you focus on your, you know, kind of caregiver matching thing. But the reality of market is you see a big problem people are having and you just obsessively create products to solve that problem. And actually it creates a growth flywheel where that is resulting in our core product growing faster and a lot of people knowing about it, that product itself is growing faster.
And overall, just more and more people are thankful that you’re solving real problems that they’re having. So I think that’s like one advice that, you know, I shifted my internal mindset about a year ago. And, you know, initially against a lot of pushback and, you know, thought it might be a distraction and it’s actually turned out to be a blessing.
And I think that’s like informed my mo. So if I could go back three years and tell my old self that, you know, embrace the distraction, not a complete distraction, but, you know, embrace the idea of solving other problems, not just laser focused on the one product that you’re doing. And I think that’s like kind of counterintuitive.
Keren Etkin: Absolutely. And like you said if the other product that you’re building is a. Flywheel and the growth engine for your core offering, and it
trust and goodwill with potential clients, then why not go ahead and build it? So where can people access this AI tool?
Neal K. Shah: Yeah, uh, it’s available to anyone. They can go to counterforce health.org. You know, we have its own name, um, so C-O-U-N-T-E-R-F-O-R-C-E health.org. Or, you know, they can hit us up on LinkedIn or anything and we’re happy to show ’em. But it’s actually been a real blessing where, so first family caregivers of older adults are using it, you know, through hospitalization, stroke, recovery, things like that.
Medication denials. Then a lot of people started using for, for themselves. Then patient advocacy groups started using it. And then the coolest thing in the last couple months is tons of clinics around the country are using it. That’s amazing. Like, you know, it’s, clinics are drowning in these claim denials too, and for many of the doctors, nurses, you know, administrative staff, social workers, it’s a real ordeal because they don’t have hours and hours to fight back.
So they’re like, oh, there’s an AI that does this for me in two minutes, and it’s high accuracy and it’s has a higher win rate. You know, then people are able to achieve on their own. That’s like a win for all. So that’s been pretty cool. So yeah, anyone’s open to accessing it on the site and, you know, we welcome any users and we wanna help more and more people.
And now we’re like getting inbounds from hospitals, which is kind of like even more surprising. So,
Keren Etkin: Wow. That is awesome. Well,
Neal K. Shah: Yeah. Thanks.
Keren Etkin: Can we talk a little bit about the technology that you use internally at CareYaya? I assume you
Neal K. Shah: Yeah.
Keren Etkin: AI in the backend to. Help with, I don’t know, handling a 45,000 people workforce.
Neal K. Shah: yeah, there’s quite a bit of AI in the backend and it’s, I would say it’s like, it’s kind of not the, you know, glamorous AI that a lot of people kind of like would talk about which I think actually the insurance appeal AI is quite glamorous where it’s doing a lot of work for you and generating things.
This AI is like just much more practical of like intelligent automation and intelligent machine learning and kind of like data science, you know, pattern recognition. So, you know, we are running interviews on so many caregivers. We have ridiculous data on, on time percentages, um, ratings of like how the family rates, the caregiver rates, the family, you know, were they late, did they do all the tasks they were supposed to do, you know, et cetera. And then just kind of like, you know, even, uh, experience of like in between shifts, how the communication was. You know, between the caregiver and the family. So you can analyze a lot of that data and now start predicting based on, okay, like right now, um, it’s the start of the fall semester at Campuses across America.
So we’re anticipating probably in the next month we’ll have maybe eight to 10,000 new applications, right? How are we gonna process that? Our team is not very large, so we can process that first pass very intelligently and programmatically through AI of watching a lot of the video interviews. Looking for patterns, seeing how those patterns correlate to prior caregivers and how they ended up doing.
And then using that to predict, hey, this is the top 20% batch, next 20% batch, et cetera. And then on top of that, overlaying kind of like human in the loop. So there’s been a lot of AI in terms of like vetting and educated, guessing how someone’s likely to do on the care side. Similarly, on the family side, there’s also been a lot of like intelligent like use case of ai, uh, really just kind of like data science and machine learning of saying how is the care likely to go?
Is it gonna be in line with expectations? We really, uh, I’d say unlike a lot of other, uh, care providers, we focus a lot on the care experience for the students. You know, we wanna really wanna make sure that the care is aligned with what they like doing, that the, um, people receiving the care are treating them very well.
It’s actually interestingly, a lot of the care companies will just overly focus on whatever the, um, client wants and then just throw the caregivers into a difficult situation. We don’t do that. Like we will deactivate clients as rapidly as we deactivate caregivers. Um, so interestingly, by keeping it very, very high bar on how the care experience is for the caregiver, the platform becomes filled with better caregivers.
You know, so I, I think that’s something that’s counterintuitive that I’ve learned. But a lot of this can be done or at least accelerated in the early days through ai. And then, you know, you have somebody in the loop.
Keren Etkin: Absolutely. How does training work for new caregivers? Because it is a very demanding job, both physically
Neal K. Shah: Yeah. Yes. Yeah. Yeah. So that was actually part of the reason I was at Johns Hopkins is in our early days, we want a really big training grant. Speaking of ai, like we actually, I forgot to mention that, that we ended up building an AI program to personalize and customize caregiver training for, you know, thousands of healthcare students.
And, you know, the idea was basically how do you meet people where they’re at? This is Gen Z, right? So, you know, they’re not necessarily, especially when they’re doing gig economy stuff, gonna have the patients to sit there and do a hundred hours of training in advance. So we were able to build an AI system, effectively an app to quickly figure out.
What have you done in the past? Who are you going to care for next? And what are the next three bite-sized, two to five minute training videos that we can give you to upskill you and increase your confidence level? And then after each session, we kind of keep upskilling you. So it’s kind of like. Almost like, um, you know, in our grant we wrote the duo lingo, are you familiar with that product? Duolingo, the language learning. So we kind of like, we were like, well, let’s build a du lingo of caregiver training of like bite-sized training modules to gradually upskill and increase confidence. It’s actually been working reasonably well. So that’s been pretty cool. So that’s one way we manage, you know, the training and upskilling of, you know, a large workforce.
And then the second way we manage is we actually focus very much just on lower acuity. So we don’t allow bookings of people with like slightly higher acuity. Um, and you know, I feel like one day we may enter into that market, but we did a lot of research with AARP and we’re part of the age tech collaborative.
And in that program we realized that 61% of the cumulative man hours of care. Is companion level care only, not the higher acuity tasks. So we’re like very, very laser focused on that market. So the student’s expectation, uh, and the family’s expectation and, and we really screen on that is no medical things will be done, you know, during the care session.
Keren Etkin: That is a very important I guess, expectation to set with families because I
Neal K. Shah: Yes,
assume
Keren Etkin: that many of them who come onto your website and see that you are
Neal K. Shah: yes.
Keren Etkin: Medical students or nursing students assume
Neal K. Shah: Yes.
Keren Etkin: gonna do the medical stuff.
Neal K. Shah: Yes. And that’s one where we are very clear in the FAQ, but nonetheless, you’re right. Like people have, you know, it’s really a sad thing. I’d like to solve that problem. I don’t think it’s like in the product roadmap currently, but one day I’d like to solve the problem in the next, you know, two to three years because we’re pretty transparent in FAQ, you know, that these are students, they’re not gonna be doing clinical stuff.
Yet people try and people book and then they’re very disappointed when we turn them away. And I think the unmet need there is massive. People are facing very high costs and very much difficulty in finding people. And what people are experiencing there is despite the quote unquote training of someone, like, let’s say, um, in the traditional, uh, care industry, somebody might help with bathing or somebody might help with insulin injections or things like that.
They are trained on those tasks, but the relational aspect of care is really missing. So the families are like, I don’t really like that, and the cost is ridiculous. So a lot of people can’t afford it, and a lot of the family members end up doing it themselves, and these family members aren’t trained. You know, if you’re like a 75-year-old spouse of someone with dementia and you have to give them insulin injections or you have to, you know, bathe them or you have to do other things, unless you were a nurse, this is the first time in your life that you’re learning how to do that, you know?
So I think it’s kind of like, it’s an interesting contradiction in the care market. I mean, even when, when I was managing my wife’s cancer care. You know, there were several things I had to manually do, including administration of medications, uh, injections a lot of like quasi medical procedures at home.
And I had no prior training in that stuff. So it’s interesting how the care industry is like regulated and operates in the US that 63 million Americans. Are effectively doing nursing level work for their spouse or adult parent, but yet you cannot formally connect ’em with another caregiver who do the same thing without going through a ridiculous amount of, you know, formalized training.
Uh, and I think that’s kind of a gap. Like I, I have a lot of theories on so many people are complaining about caregiver shortages. Well, I think it’s like structural. It’s structural because of the industry, the industry and the industry overregulation, um, is almost like a kind of like regulatory barrier to entry is causing the caregiver shortage.
Keren Etkin: Absolutely. So well, speaking of the regulatory barrier that CareYaya AI is available nationally, does this mean that you had to get a license in all 50 states?
Neal K. Shah: We operate as a care registry, so it’s not a care agency. You know, it’s kind of just a connecting platform and it operates very similar to, I don’t dunno if you’re familiar with care.com, it’s kind of like the biggest, like the OG in the care industry. It’s also an online care registry, so. That’s the way care.com operates.
And you know, as a result of that, there’s some pros and cons, but it’s like there’s a limitation to how much directly, you know, we can be involved. And we are not an employer. It’s like an online marketplace, which I think is, has its pros and cons. We’re always talking with like state regulators, like we’re very close with like in our home area, in North Carolina, department of Health and Human Services.
And in the early days of starting, it was very much transparent of like building a relationship with the government, being very transparent of, Hey, here’s what we’re building, want your support blessing. And ultimately they loved it to the point where I’m the only private sector care company in our state that serves on the steering committee on aging.
So it’s kind of like pretty cool. A health and human services. We’ve had a lot of dialogue with health and human services now at the federal level. Um, so I think they’re very aware and interested and supportive of what we’re doing. A couple of weeks ago, I was just at a big conference, uh, where there were a lot of leaders from Health and Human Services and, you know, they proactively invited Carry Eye and I, I was like, okay, this is very interesting that they’re interested in our work.
So I think that government and at the top level as well as at many of the states level are realizing there’s a problem and I think a lot of their constituents are pushing back. So I expect a wave of like, deregulation to happen here. So yeah. That’s my cautiously optimistic tone. ’cause the problem, if you think about it, is okay, the care industry wants to keep regulatory barriers, right?
So they can kind of keep their market position, but. The people on the ground are the voters, and whether it’s the older adults, their spouses, or the adult children, and a lot of the voters are getting pretty frustrated when it comes time to caring for someone that there’s minimal support. There’s an extremely expensive market, um, that has a pretty low quality care, and people are just like, what am I supposed to do?
And there’s, unfortunately in the US the government doesn’t really help you, so you’re out of pocket paying. So it’s, you know, Medicare covers a lot of stuff. Medicare covers. $35,000 dementia drug that has, you know, less than 20% efficacy, but it covers $0 if you need a caregiver to help out with mom and dad.
So I think as a result of the financing of the care market in the US of just like heavily out of pocket, I think people are like really putting pressure on their state and federal government of like, we need better solutions. So I actually think, I think it’s gonna be one of the biggest issues over the next five years with our aging population.
Keren Etkin: Absolutely. I think it’s, and when we see that the caregiver population and the older population is growing,
Neal K. Shah: yeah.
Keren Etkin: it impacts more and more Americans. And yeah, you’re
That this should be a topic on which elections are like decided.
Neal K. Shah: Yeah. I think, I think on that note, I think in the next five years or less even, uh, I would be surprised if even in the 2028 election it becomes a big issue. And here’s my kind of hypothesis, why. The probability of getting dementia goes to about 30% if you live to 80. You know, so it’s like if you’re fortunate enough to live that long, there’s a chance that you’ll get, you know, some cognitive decline.
The baby boom in America, well, I guess around the world. The baby boom really started after World War ii, so 19 45, 19 46. 80 years plus is 2025. Right? So we are just hitting the wave of the initial baby boomers hitting 80, and in the next five years, a ton of ’em are gonna hit 80. The dementia rates are skyrocketing.
Uh, you know, in our state, the number of people living with dementia, it’s expected to double in the next four years. So it’s like, uh, eye-opening and the care industry. Is going the other way. There’s been a reduction in number of caregivers available. There’s been a reduction in number of people working in senior living, assisted living facilities.
The cost of care is skyrocketing. So I actually think it’s gonna become, I was surprised it wasn’t a big hot button political issue in 2024, but I feel like it was like on the early cusp of that. But by 2028, it’s gonna be really obvious. And I think now societally, I think one of the most encouraging developments is looking in the last like six months to one year.
Bruce Willis, the very famous actor, his wife, has now come public about caregiving and all the challenges and ups and downs. Bradley Cooper, another famous actor, put out an entire documentary on caregiving. You know, we collaborated a lot with PBS on like doing a bunch of screenings for that. Um, and then recently Taylor Swift came out talking about caregiving for her own father.
So I think it’s like hitting that social consciousness where a lot of middle aged people are gonna go through this suddenly. The celebrities are kind of like, you know, if you think about Taylor Swift, I mean, she’s a brilliant business person beyond just being like a talented singer. And I think she’s great at spotting trends.
So, you know, it’s kind of interesting, the trend. And I think as a result there’s gonna be a lot of, you know, just the number of people going through this. It’s one of the most undercover issues, I think, in American media of how many people go through caregiving compared to how much it’s discussed openly in pop culture or media.
And I think that’s about to change very quickly.
Keren Etkin: Absolutely. So my last question to you today is the vision that you have for CareYaya, if you. out your crystal ball and the best case scenario. Where is AYA in five or 10 years?
Neal K. Shah: Yeah, ultimately the vision for Aya is I would say, you know, building an Amazon, you know, building kind of like an amazing, and I, and am, you know, I know some people have a controversial take, so let’s say Costco, you know, but whatever you wanna call it is kind of like a. Price and quality leader that scales and makes a huge impact in the market and creates kind of like the, you know, the benefits of some of these amazing innovations are almost like they’re playing for economies of scale.
And I think that in the care industry have yet to see that many care operators playing for economies of scale. It’s like a huge market that is very siloed in a cottage industry. Hyperfocused on individual geographies and hyper focused on scaling. Kind of high gross margin business models. And I think that there has not been a genuine attempt to scale extremely low.
And I know this kind of goes counterintuitive to a lot of investors. I don’t really care. You know, this is my theory, is that literally the margin is the opportunity just undercut ridiculously on margin. You have to be very focused on managing your cost, but if you scale an extremely low markup or low margin business.
In a $500 billion care economy, you can build a very scale player that is delivering very high quality at the most affordable prices possible. And I think that’s really the gap that I actually think that a lot of people have gotten. The business model of caregiving wrong. Most of the care companies are capturing more than half the value, um, and the caregiver is capturing less than half, and the caregiver is doing 99% of the work.
So I think if you actually build a care company where the value captured reflects the value delivered, which is razor thin and you go for maximum scale and you keep a very high focus on quality, I think you can build, you know, a huge, like why isn’t there a $5 billion care company? Why isn’t there a 10 billion?
Why isn’t there a hundred billion dollars care company? And of course it’s not just gonna provide caregiver matching. I think there’s an opportunity. To enter the market through caregiving and then kind of like we did this with this insurance product, rapidly iterate and build other products. You know, whether it’s helping people, you know, uh, age safely at home, whether it’s monitoring, I mean, a lot of stuff that in the age tech ecosystem.
There’s individual point solutions doing, but there is an integration of that, believe it or not. One of the biggest inbound calls carry ags, like we get called in from a lot of AgeTech companies is, oh, can you push your product you know, their product through our marketplace? And I’m like, okay, great.
You know, not really that interested. You know, we’re in early stages, but if you kind of ultimately think about it, why not, right? Like, why not? If you are running care delivery in thousands and tens of thousands and eventually hundreds of thousands of homes around the country. Why not use that as a touch point to either in-house, do a lot of innovations, or bring third party innovations in, and then kind of almost recreate what might be a tech enabled instead of going into senior living, recreate that experience at home.
You know? So I think the, the long term goal would be, I think technology’s advancing very fast. I think labor force solutions are needed, and I think if you can pull it off right. You don’t have to have the move into a assisted living facility or you know, kind of nursing home. You can keep people healthier and happier and aging at home longer and do it in a very affordable way that reduces the burden on the family caregiver.
I think if you pull that off well, um, you can build a hundred billion our company.
Keren Etkin: Absolutely. That is a wonderful vision
Neal K. Shah: I, yeah we are already picked out the IPO ticker on the Nasdaq, YAYA. You know, I, I think there’s a cool path to IPO this thing, and I think that, you know, previously I was hedge fund manager, and I think, obviously I’m like very mission focused and like a, I would consider myself a social entrepreneur now, but I really observed from even the, um, financial markets.
There was a huge hunger and a desire to kind of buy a tech enabled caregiving or aging focused solution. I think a lot of people in the public markets recognize the trend of aging of America. I think people are looking for solutions and I just think that something hasn’t been built yet, you know, that is off that scale.
But I think ultimately, you know, the goal and the vision for Carry Eye, let’s see, over the next, if within five years we’re not public, I will have failed, you know, uh, at the mission. So I hope, and of course, like even post public, I would like to keep running it. You know, I have a lot of ideas on product roadmap.
But yeah, I think that’s kind of the opportunity.
Keren Etkin: That is a fantastic analysis of the market and yeah, I can’t wait to have this interview in five years when care AI is public and see how. It all came about.
Neal K. Shah: Yes. Yeah. Thank you.
Keren Etkin: My last question. Is there anything that we didn’t talk about that you’d like to add? Any call to action to entrepreneurs in the audience?
Maybe.
Neal K. Shah: Yeah, I mean, I think call to action. I, I, I love, um, when other entrepreneurs enter the industry, I think that this industry is, there’s so much opportunity. You know, I think that, um, you know, I have had. Unfortunately difficult experience of going through caregiving myself. Um, you know, I, I wouldn’t wish that on people unless they’ve been through it.
It’s very difficult. But I was unaware of kind of, the need and the opportunity and, you know, I hope that more people enter because I think beyond just kinda like the business opportunity and all that, I think there’s a big social opportunity that, you know, how many more apps do we need? To do AI powered sales agents or social media apps or automation of this and that.
You know, I think, you know, it’s good that people are innovating in this stuff, but the amount of brain power going into some of these industries compared to kind of what is the impact on society and compared to how much competition there is and kind of just a waste of time to me is kind of absurd.
Same with funding, you know, the amount of funding going into some industries to me just doesn’t make sense. Where it’s like, what’s the point? And I think meanwhile here, it’s kind of a circular where more funding should be going to this because it’s a big unsolved problem and a big unmet need. But I think it’s kind of circular because enough really aggressive and talented and motivated people are not going into entrepreneurial opportunities here.
As a result, the funders are like, yeah, why should I fund? So I think you need kind of like more talented people going into this field, solving problems that creates a flywheel that attracts investors and capital, and then you really build a awesome ecosystem, which I think there’s early inklings of that happening over the last couple years.
But you know, I think that, yeah, the advice would be jump in. Um, I think it’s awesome. I think, uh, you know, uh, putting my investor hat on, it’s easier to enter markets where there’s large need and less competition. And if I was a tech focused entrepreneur right now. Like, why would I enter some other markets?
There’s ridiculous amount of competition and you’re fighting over scraps. You know, I think this is an opportunity where there’s so much unmet need. I mean, whatever it is, it doesn’t even have to be caregiving, it just be helping people with earlier di you can’t even imagine like earlier diagnostics of a dementia.
There’s a million opportunities, you know, digitally as well as like through, um, you know, uh, science, um, I think, um, therapeutics, you know, uh, tons of opportunity rehabilitation, post-stroke. I mean, there’s just like. Insane amount of opportunity that if I wasn’t doing this, I’d be doing another startup in this field.
Um, but the opportunity set compared to the competitive landscape, I think, um, calls for way more people to enter. So yeah, that’s what I’ll leave entrepreneurs with.
Keren Etkin: Thank you for this inspiring call to action. Neil, I really appreciate it and I
Neal K. Shah: Sure.
Keren Etkin: you joining me on the show today. It was an absolute pleasure chatting with you.
Neal K. Shah: Thank you so much for having me. I really appreciate the time and yeah, I hope this inspires people and if anyone wants ideas, hit me up. I have like a laundry list of ideas that I would build otherwise that I’m happy to just give away to people and I hope somebody builds them.
Keren Etkin: Awesome. Thank you so much, Neal.
Neal K. Shah: Thank you.