Family & Nursing Care CEO Goes After Gradual Growth

Maryland-based Family & Nursing Care is one of the largest private-pay home care companies in the Washington, D.C., area — and its notoriety doesn’t stop there.

In fact, CEO Neal Kursban often fields calls from buyers interested in taking the 50-year-old, family-owned business off his hands.

Among its selling points: Family & Nursing Care has a caregiver turnover rate of 14% and a slow-and-steady expansion plan for years to come.


Kursban discussed Family & Nursing Care’s recruitment and growth strategies during his recent appearance on the Disrupt podcast for Home Health Care News.

Subscribe to Disrupt via Apple Podcasts, Google Play Music, SoundCloud or your favorite podcast app.

Below are some highlights from HHCN’s conversation with Kursban, edited for length and clarity.


HHCN: I want to start by delving into your background because I think it’s really interesting. Your mom started the company when you were a kid. What was it like growing up in this industry?

Kursban: She actually started the company before I was a kid. I have two older sisters and then Family & Nursing Care came along — and then I was born. Often, she’ll say I’m her fourth child, not her third child.

Growing up in the company, the funny thing is, I was one of those kids that sort of played outside with his friends, and I didn’t really know what my mom did. I knew, but I didn’t know.

I knew it had something to do with people needing help and caregivers helping them. That’s the extent of what I knew.

Then I went off to college, and a few years out of college, my mom asked me if I would like to one day in the future run Family & Nursing Care. We agreed that instead of making a life commitment, why don’t we try it for a year. We’ll see how it goes, and then we’ll talk.

And 23 years later, we still haven’t talked yet. Well, we talk all the time, but you know what I mean.

So was taking over the family business always your plan?

It was not. I worked for Pepsi for a few years outside of college, and interestingly, my mother was asking, “How’s it going at work?” And I got promoted, and she was pleased to see that. She was asking for my reviews, and I was like, “Wow, what’s this all about?”

Little did I know, a few years later she would come ask me to join the family business. At the time, candidly speaking, I didn’t know a lot about elder care and [the] caregiving experience.

We sort of agreed to try it for a year and see how it goes, and here I am 23 years later and going strong.

In the past, you told me that Family & Nursing Care’s yearly turnover rate is about 14%. That’s an impressive figure when the industry-wide caregiver turnover rate hovers just above 65%. I’m curious: What does the company do to bolster its recruitment and retention efforts to make that possible?

Everybody thinks they have a really rigorous hiring process [and] that they have the best caregivers. I think the proof is in the pudding: Last year in 2018, out of the 100 caregivers that expressed interest in working with us, only 6% were ultimately hired at the company.

That alone shows the amount of time and effort and up-front work that we’re willing to put in. The most important part of our business is having outstanding caregivers.

How do we get them to come to us and why would they stay? We probably pay them more than what the market rate is. Money is not the only thing, but it’s a factor.

We have meet-and-greets every couple weeks. We have a number of caregivers who will come in, and we’ll ask them broadly speaking, “What can we do to make your experience with us better?”

If we hear any themes, we work to improve that.

We look for compliments, and we get a lot of them. We have a sizable budget that gives beyond [caregivers’] hourly rate of pay. Whenever they get compliments, we reward them, whether it’s with gift cards or gifts or whatever it may be.

Manage them with a carrot, not with a stick, so to speak.

Last year, Family & Nursing Care closed on its second location after 50 years of operating out of just one office. Talk about what drove your decision and any future growth plans you might have.

My COO is now the president of the company and handling essentially the day-to-day. For lack of a better word, I consult with him on a regular basis, and it’s also afforded me the time and the ability to expand.

We opened up a second office in the latter part of 2018. We are very close to opening up another branch office by late spring, early summer.

With these infrastructure changes I’ve made, it’s allowed us to be able to not just expand but to do it well with dedicated time, money, resources and effort [needed] to make sure that [things] do go the way they need to go.

Later in 2019, we’re going to be growing to yet another contiguous county.

We’re intentionally going to grow closer to home at first, then we’ll make our way outside of the state of Maryland and D.C., … and we’ll expand to other states eventually.

Looking ahead toward that growth, what’s the future of the company look like? What can we expect to see in the next 50 years? Will it remain in the family?

I get calls all the time to have my company bought out, and I politely say I’m not interested.

I have four children. … I know all the statistics say that it gets harder and harder the more generations, but my intent is to keep it within the family.

Philosophically, we’ll just sort of gradually grow. Instead of opening up in 10 places all in one year, we’ll probably open up … one to three new locations each year. In 10 years, we’ll have that many more locations.

When you add it up 50 years and a new generation, they may have a different mindset, so I can’t answer what we’ll be like in 50 years, but I have a pretty good crystal ball of what the next 10 years look like.

Companies featured in this article: