Why I left a job at Twitter to start a company devoted to home care


As I started writing this article a while back, my father was spending the night in the ER. When I heard the news, I felt a sudden urge to share my story. It involves helping my family navigate the muddy waters of home care, leaving a well-paid job at Twitter to start my own company, and watching my mother use software that I helped build to make sure my father doesn’t wind up back in the hospital.


The beginning

In 2010, my great uncle’s health began to decline. He was 92 years old and he decided to move in with my parents. They were still working full-time, so they started exploring home care services.

I pitched in by Googling home care options, but the results were unimpressive. Websites brought back memories of the earliest days of the Internet, and every company touted “the best employees” — but there was no visibility into what those caregivers actually did or how the companies measured success other than satisfaction and reputation.

The more I looked into it, the more I began to realize that caregivers were underpaid and overworked, outcomes-based performance was not measured, and companies were riddled with fraud and entirely absent of the strides in technology that had affected nearly every other industry.

At the time, I was working at Twitter, enjoying my life in San Francisco and surrounded by people employed by the next big startup. It was a real change of pace to dig into the details of the home care industry — it was possibly the least attractive thing I could think of doing.

The more I learned, the more questions I had. What would the industry look like if technology could empower caregivers to improve patient outcomes? Could software help prevent unnecessary hospitalizations and allow people to age gracefully in their homes, instead of expensive (approx. $240/day) nursing facilities? Imagine the savings to our health system.

My journey with Care at Hand

Ultimately, we couldn’t find a quality home care option for my great uncle, and he passed away in 2011. Before he died, I had already made up my mind to begin a health tech company. I traded in a steady job and income at Twitter for the unsettling waters of startup life.

It was difficult to get Care at Hand up and running. Thankfully, with the help of Rock Health and AngelList, we managed to attract a pool of investors and customers and gained some traction. Our software risk-stratifies patients and signals health decline between doctor visits and hospitalizations. We deliver short, targeted surveys written for caregivers, social workers, and community health workers to complete while they deliver their usual services to patients. Notifications are sent to clinicians who intervene and make recommendations based on alerts triggered by our algorithms. Since January 2014, we have prevented more than 2,500 ER visits or hospitalizations.

I believe I’ve found something of a calling. I feel a strong sense of purpose working on a product that I truly believe can make a difference in this world. I started the company so that I could help people age with dignity in their homes. And in the back of my mind, I had always believed that I was building this for my parents.

What I never expected was that my father would be a patient within Care at Hand while we were such a young company.


My father’s medical emergency

In March 2014, I got the phone call I had hoped wouldn’t happen for a very long time. My father was in the hospital. He had been unconscious for an unknown number of hours, and had to be resuscitated twice before his arrival in the ER.

The prognosis was not bright. He had no brain activity and several doctors told my family to prepare for the worst.

I went into shock. The flight from San Francisco to San Diego felt like an eternity. I arrived to find my father in a medically induced coma. His body was being cooled to allow his brain to recover from the incident. For the first time in my adult life, I felt truly powerless. The next few days were some of the hardest I’ve experienced. My mother and I faced the anticipated hole in our lives; we began sifting through finances while funeral planning, and spent a lot of our time crying.

Recovery

A few days after the incident, doctors began to warm up his body to see if he might be responsive. We arrived at the hospital after a long night and the nurse greeted us with amazing news: my father had responded to verbal commands by moving his fingers.

I was on an emotional rollercoaster. My father wasn’t in the clear, but slowly he started to show signs of improvement until finally he was awake and speaking to us. Before I knew it, nurses were preparing us for discharge, expecting a strong recovery.

It’s a surefire sign that our health care system is messed up when someone who has founded a health care startup can be so utterly confused by a medical diagnosis and discharge instructions.

I decided to have my mother use Care at Hand to make sure that things were going according to plan post-discharge. After a short training, my mother (who has zero clinical training) was able to submit daily surveys regarding my father’s health status which would deliver an alert (if triggered) to my colleague who is a registered nurse.

After several weeks at home with family, I realized I couldn’t put my life or work on hold forever. I went to New York for a few meetings, feeling confident that my father’s condition was being tracked by Care at Hand.

While in New York, I received a call from my mother. Symptoms that she captured using Care at Hand surveys were sent to my colleague as an alert, who worked to triage them. She advised my mother to have a nurse check on him ahead of his scheduled doctor’s visit because she was worried that he was developing a blood clot. The visiting nurse confirmed that was the case, and was able to coordinate with the doctor to address the situation. It was amazing to see how a simple survey could prevent a potential ER visit so close to his first medical incident. My father’s health steadily improved, and after a few weeks we took him out of the Care at Hand system.

Recently — over a year after his first incident — he suffered a minor stroke, and ended up back in the ER. My family decided it would be best if his health was more closely monitored, and my mother began logging daily Care at Hand surveys once again. Hopefully he’ll be able to stay out of the hospital for a long time now.

Reflections

One of the main reasons why I felt compelled to share my story is because I wanted to illustrate what it looks like when industries that are slow to evolve are suddenly infused with technology and innovation. We all have a tremendous opportunity to make a difference in the world. In people’s lives. In our parents’ lives.

If you’ve ever experienced a little itch telling you that you could be applying your skills to more meaningful problems, explore it further. As Jeff Hammerbacher said, “The best minds of my generation are thinking about how to make people click ads. That sucks.”

Thankfully, the health care industry is starting to change with government initiatives and attention from the tech community. Recent headlines have highlighted companies like Honor, Hometeam Care, and HomeHero as they challenge current incumbents like Kindred, HomeInstead, and Bayada to change the landscape of care delivery. I look forward to the future of health care and am proud to be a part of a community of people who devote their lives to serving our families and the aging population.


Thank you to all of my friends, family, and colleagues who provided (and continue to provide) emotional support during the difficult times — both work and family related. Special thanks to Hannah Levy for editing and giving my thoughts true structure!