Total Care Connections Leverages Diversified Revenue Mix, Staffing Investments to Grow in the Southwest

Emerging out of the last recession in 2009, Daniel Stringer decided it was time to change careers.

Formerly in finance, Stringer’s line of work had taken a huge hit. He was eager to find a place where his business would be recession-resilient — if not recession-proof.

That’s when Stringer entered into the home care space, under somewhat unusual circumstances. He was not driven by a personal aging story of a family member, like so many others in the industry are. In reality, he didn’t know much about home care at all.


What Stringer did know was that it offered a chance to make a greater impact with his work — and a chance to survive the next inevitable recession. That’s why he founded Total Care Connections.

A decade later, that recession came. But instead of having to look for work again, Stringer is focused on growing Total Care Connections to keep up with the skyrocketing demand for its services.

“At that time, I was looking for opportunities to move into an industry that would be driven more by people’s needs, versus just what they would like or what they want,” Stringer, the founder and CEO of Total Care Connections, told Home Health Care News. “Something that would be recession-resilient and allow me to make a greater impact.”


Arizona-based Total Care Connections began in Tucson, Arizona, and is now headquartered in Mesa. Soon, it will be based in Tempe. The company has about 300 caregivers that serve about 500 clients in Arizona.

The company is owned by Stringer and his wife, who currently serves as Total Care Connections’s director of nursing.

Stringer built up a good enough relationship with the local VA early on to begin servicing veterans in Arizona. The agency now serves hundreds of veterans on a weekly basis. Managed care organizations make up another important stream of revenue for Total Care Connections, which initially launched as a strictly private-pay home care business.

Total Care Connections has been included in Inc. Magazine’s list of the 5,000 fastest-growing companies in the U.S. for five straight years. In 2021, its goal is to hit $10 million in sales.

“I wanted to create a business that would stand the test of time for many decades, not just a few years,” Stringer said.

The opportunity in 2009 was to enter into an Arizona market that was the “Wild West,” as Stringer put it, referring to the state’s lack of licensure requirements.

“I recognized there was a lot of opportunity back then to offer greater transparency and greater quality of care through using technology that a lot of providers hadn’t used up until that point,” Stringer said. “An example of that was GPS-enabled clocking in and out — that was something hardly anyone was using.”

Focusing on staffing

Adapting to caregivers’ needs and focusing on staffing best practices has put Total Care Connections in a position to grow after one of the most turbulent years in recent memory.

For one, the company offers full benefits to its caregivers. It also recently instituted daily pay, which was especially helpful to workers amid the pandemic.

“The reality is they’re earning the money,” Stringer said. “But traditionally, you don’t have access to your money until payday. And so this is just allowing for people to access the money they’ve already earned — whenever they need it.”

Daily pay has been both heralded as a panacea to the caregiver crisis in home care and also been undercut as a faux magic bullet.

But particularly during a financially volatile time for all Americans, daily pay has enabled caregivers to access their earned money when they need it most. It also ensures that they don’t have to borrow money from predatory lenders.

Benefits and daily pay are just two components of Total Care Connections’ strategy, however. And as the company grows, it will look back and draw from the lessons it has learned on its path thus far.

When the company acquired a few smaller agencies years ago, the quality of the seller’s staff was not weighed into the equation. That caused headaches.

“From an entrepreneurial perspective, you think you’re buying the client base and the revenue stream,” Stringer said. “But the reality is that the most important thing is the quality of the caregivers and quality of the staff. And we ran into issues with that because we didn’t vet it very well.”

With that in mind, the next two steps will be relocating its headquarters to Tempe, Arizona, and opening up shop in Colorado Springs, Colorado, in March.

The reason for changing bases to Tempe again goes back to staffing. While Total Care Connections implemented a remote and in-person work rotation for its caregivers during the COVID-19 crisis, it still invested in brick-and-mortar offices.

The Tempe office will serve as a hub for caregivers and come with a new-and-improved training facility.

“We really want to invest heavily in our caregiving and their training and their experience coming on board,” Stringer said. “It’s a place for them to continue training and [learning], and we feel like we need a facility to do that.”

It also creates a space for comradery for caregivers in a job that can often be an isolated one.

Growing amid a recession

After Total Care Connections opens up in Colorado Springs, it hopes to continue growing into Denver over the next year.

That would put the company firmly in two states, with ambitions to continue growing in the Southwest. At a time when home care franchises are gaining a lot of traction, Stringer feels like the structure of his family-owned business has been beneficial.

“It has been a differentiator for us,” Stringer said. “Because people recognize that there’s more control over the quality and what’s happening. … We’re on the ground.”

When a worker or client is being infected with COVID-19 nearly every single day, being on the ground is especially important. As of Feb 3., Arizona was in the top-five for states based on infections per 100,000 people.

“I told our team members, ‘The way that we handle this year and this pandemic will pay dividends in years to come — not necessarily in dollars — but in goodwill, relationships and integrity,’” Stringer said.

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