Helping leaders at early stage tech companies avoid mistakes in all aspects of growing their sales team | Advisor

Kevin has made 1000s of mistakes but that has made him successful. After building, fixing and growing sales teams at 8 startups and 3 liquidity events, he loves sharing these mistakes and learning lessons from over 25 years at pre-IPO tech companies so that you can avoid these mistakes and see faster success.

With KG, you get experience, not inexperienced opinions.

✅ 3 startups I’ve been with have had liquidity events (none fire sales)

✅ Helped build 3 businesses into Inc 500/Deloitte Fast 500 companies (that means fast revenue growth)

✅ Built sales teams at 8 Startups since 1997

✅ Built teams of 30 salespeople - 550 salespeople with GREAT gross margins

✅ Built multiple Inside Sales, SDR/BDR, Account Management and Enterprise Sales teams.

✅ Been in Sales Leadership since 1997

✅ Started 3 of my own businesses (Recruiting, Advising, Real Estate)

✅ Named to the AA-ISP Top 25 Most Influential Inside Sales Professionals 6 years in a row

✅ Made lots and lots of mistakes

Check out the recommendations section below to read what other people have said about me. 👇

Kevin Gaither

I asked one of my top sales women to apply for sales manager but she refused. 
 
But her reason for not wanting to apply for the job took me back. 
 
👎 "KG, I'm the #11 rep on the team so clearly I still have a lot to learn before I apply." 
 
We were at TopGolf in AZ and I was introducing her to others on the sales leadership team because I WANTED her to apply for sales management... 
 
But I couldn't believe what I was hearing. She was 11th best salesperson out of over 200 salespeople and because of that, she didn't feel she was ready for sales leadership? 
 
I was confused. Thankfully, I was having dinner with the great Lauren Bailey the next night and here's the pointers she gave me: 
 
➡️ Women won’t apply until they meet 100% of requirements. Men will apply if they meet just 60%. Reduce the amount of requirements in your job description. 
 
➡️ Check to make sure that women are represented on your company leadership web pages already. 
 
➡️ Make sure the language in the job description doesn't contain overly male-dominated language like "aggressive" and "quota crushing." 
 
➡️ Make sure the hiring process has an interview team that ISN'T all white males. 
 
➡️ Keep actively encouraging females to apply for the leadership roles even if they don't meet ALL the requirements. Seek them out on the floor and ask them directly. 
 
I'm not sure how many bottles of wine that Lauren, Steve and I consumed that night but the learning lessons were out of this world. 
 
💡 Learning Lesson: If you want to get more women into your sales leadership team, you're going to have to evaluate several aspects of your recruiting and hiring process to make it a place where women will WANT to apply. 
 
Oh and one more thing, if you're reading this and thinking, "why are we always talking about getting more women into leadership?" Get with the program. Lack of diversity will kill your company. 
 
What else can we do to get more women into Sales Leadership roles?

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Stock Option Course

Sign up for my free 10-email course here:

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And learn what the Founders aren't telling you about your stock options

77 Questions

Ready to hire A-player salespeople? Our free guide is your secret weapon, packed with 77 sales interview questions to help you crush the competition and build a powerhouse team.

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Hiring Bundle

Learn in one hour what took me 28 years to master. The Sales Leader’s Interviewing & Hiring Bundle (19 guides, templates, and 10 powerful lessons) helps CEOs and Sales Leaders hire top talent with confidence. Only $9.99, instant access. Link 👇🏻

https://www.insidesalesexpert.com/landing-page-hiring-bundle?utm_source=Linkedin&utm_medium=Post&utm_campaign=Hiring_Bundle&utm_id=FirstComment

Book Promo

100 Sensational Stories about Sales Leadership Screw-Ups and Big Wins

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VP of Sales Working Out

How to know in 30 days if your VP of Sales will work out....or not

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Mini-Podcast Series

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Avoid the mistakes that almost cost me my sales leadership career.

New Hire Training & Onboarding (not Pentis)

My free guide:  Best Practices for Onboarding and Training New Sales Teams
 
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It Happened on the Sales Floor

For 100 other sales leadership mistakes I've made, check out my book, It Happened On The Sales Floor: 100 Sensational Stories about Sales Leadership Screw-Ups and Big Wins. Link 👇
 
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Model Week

Great sales leaders intentionally manage their weeks. Check out my free guide, How Great Sales Managers Model Their Week, to see how they do it:

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Mini-Pod

3 raw, 10-min audio lessons from my biggest failures as a sales leader...the kind you’ll never read in a textbook.

Practical. Fast. Real Stories. Real Lessons.

Only $4.99 - instant access, money-back guarantee.

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Podcast Promo

Link to the podcast episode here: https://www.salesnotselling.com/1039468/episodes/18403715-episode-69-selling-to-your-customer-not-you-with-guest-kevin-gaither

Job Seeker Course

Free Trial: The No-BS Job Search Course. 
First 4 lessons are free. No credit card required

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Helping job seekers stop guessing and start getting interviews | Free Trial: The Job Search Course

I received a job offer including a savage non-compete agreement. So I had a lawyer review it and she said: 
 
🦈 "This non-compete has more teeth in it than Jaws. If you really NEED a job, go ahead and sign it. If you don't need a job, don't sign it." (wait there's more) 👇 
 
But when I told the CEO why I was declining his offer, he said: 
 
"This is standard language. You know it's not enforceable." 
 
🤔 When I asked him to remove it, he refused. 
 
So I declined and referred another friend who DID NEED a job and he got the job, signing the non-compete. 
 
🚫 And years later, when he left the company, they sued him. 
 
He spent $60,000 to defend himself and then the company dropped the suit knowing the non-compete was not enforceable. 
 
💩 They sued him just to mess with him AND to send a clear message to their current employees. 
 
This was 2008 and the FTC just banned non-competes in April 2024. 
 
How many other employees have been screwed by these vicious, legal instruments since then? 
 
Have you been screwed over or limited by a non-compete? 
 
If you liked this real story - here's something else that can help you. 
 
Check out my book which is a collection of 100 short, real stories about my mistakes and learnings from 28 years of building sales teams at tech startups. 
 
There's even a free sample to download. 
 
https://lnkd.in/gXftNAaw

Bad Sales Leadership: 
 
• It's my way or the highway 
• My reps aren't hitting goal, their fault 
• Sales is art, not science 
 
Good Sales Leadership: 
 
• Let's figure out the best way together. I'm likely wrong. 
• Sales is a combination of science and art. We should always be measuring and testing. 
• My sales reps aren't hitting goal, that's my fault. How can we improve? 
 
One more thing.... 
 
• My sales reps are hitting goal. That's not on me. They did the work. What a testament to their coachability and skills! How can we get even better?

There's a right and wrong way to lay people off. Unfortunately, I've had to do it 4 times in my career. Here's SOME OF the right and wrong ways to do it. 
 
Wrong way: take weeks and weeks to make the cuts. 
 
Right way: Do it quickly. The team senses it's coming and the rumor mills are distracting. 
 
Wrong way: so surgical and sanitized that people are wondering what the hell happened. 
 
Right way: take time to explain what's happened, what's happening and what will happen next. They deserve it. 
 
Wrong way: once they door hits them on their butt, you never see them again. 
 
Right way: Do your best to try to help them find new jobs through your extensive network. When things pick up again, you might even be able to hire them back! 
 
Just like breaking up with a significant other, there's no PERFECT time to do it or perfect way but there are certainly right and wrong ways to do it. 
 
Anybody else have any personal experience with this? 
 
With all the layoffs happening, it would be great to let leaders know how to do it properly right?

"I don't care about Dials, Meetings Held or Pipeline Generated, all that matters is reps hitting Quota!" 
 
Tell me you've never successfully scaled a sales team past 8-12 reps without telling me that you've never successfully scaled a sales team past 8-12 reps. 
 
I've made the mistake of saying this too early in my sales leadership career. 
 
I've also was convinced of this lie when I led an Enterprise Sales team. 
 
The fact is that you can't manage outputs, you can only manage inputs. 
 
With transactional/SMB/Inside Sales, reps must be held accountable for consistent talk time, conversations held, meetings held, and pipeline generated otherwise your outputs will be haphazard. 
 
With complex sales/Enterprise Sales, reps should also be held to Activities, Meetings and Pipeline. ESPECIALLY with expensive Enterprise reps and long sales cycles, if they're not being held accountable for pipeline generation, you're wasting company money. 
 
I know this from experience and screwing this up and then having to deal with the pain of change management.

You can skip your team lunches and "drinks with the sales leader." Here's a stupid-simple way to improve salesperson loyalty on your team. 
 
✅ As a sales leader, you can create loyalty by PROACTIVELY advocating for your deserving salespeople to get a raise, more stock options or a promotion. 
 
🎉 There's no better feeling one of your direct reports will have when you can surprise them with a raise, more stock options or a promotion. This goes way further to create loyalty than SPIFS or team lunches. 
 
Everybody knows that we live in an era where 'job hopping' is a common trend. Many believe that to get a significant raise or promotion, switching jobs is the only option. So, if you're proactive in advocating raises or stock options for your salespeople, you're not only demonstrating that you value their contribution but also showing that there's room for growth within your team. 
 
But remember, every action has an equal and opposite reaction. Advocate wisely, you don't want to create an environment where people expect a raise or promotions every few months. The goal is not to feed entitlement but to nurture commitment, devotion, and a strong work ethic on your team for those who truly deserve it. 
 
So take action today. Look at your team, identify the real go-getters, the silent performers and ask yourself, 'Who deserves a raise or more stock options?' Then, take action! 
 
For other tips on Sales Leadership, check out any one of my 10 free guides here: 
 
If you found this post useful - you might like one of my free sales leadership guides 
 
Get them here: https://lnkd.in/geVRveuC

2 days until the President's Club trip, contracts signed, $500k sent, some reps en route but I abruptly cancelled the trip. 
 
I was so torn. We made so many commitments already & I was going to have to explain my decision to our TOP reps. 
 
😖 This decision was going to be neither easy nor popular. 
 
At that time, there were no travel restrictions but we felt the risks with COVID were too high to continue. 
 
As leaders, we've all been there: 
 
• Tough decisions where you're being pulled in several directions 
• People you disagree with might be pissed 
• Explaining an unpopular decision to the masses 
 
At the end of the day, we cancelled the President's Club trip because it was the right thing to do. 
 
💡 Sales Leadership Learning Lesson: Do what you think is right regardless of the commitments you've already made and how many people you'll piss off. 
 
You'll rarely go wrong.

The contract is signed…but the bank account is still empty. Did the salesperson earn their commission payment?

Hot take: a signed contract means nothing if the cash never shows up.

I have seen teams celebrate deals that never turned into cash collected.

High fives and drinks on Friday. 

Silence 90 days later when invoices age and finance is calling the sales leader to find out where the payment is...

So here is the question I always ask sales leaders.

Did we actually win the deal, or did we just have a nice, fancy signature on a worthless piece of paper?

👉 I believe salespeople should get paid when the customer pays. Not when the ink dries.

This isn't about punishment or "turning our salespeople into collections agents."

Please, I've heard this all before.

What you need is alignment to the proper incentives.

A business that doesn't cash flow, dies.

It's just that simple and responsible sales leaders (and salespeople) should know this.

If your rep DOES become a collection agent, that's awful. That means you're a poor leader.

That is a broken system.

Great companies build tight processes between sales, finance, and ops.

✅ Clean, correct invoices the first time.
✅ Clear payment terms.
✅ Fast follow up.
✅ The rep owns the quality of the deal.
✅ The company owns the collection engine.

When both sides do their job, everyone wins.

I have lived both models.
✒️ I have been paid on signature.
💰 I have been paid on cash.

The difference in mindset is pretty huge.

When the rep is paid on cash, there's other teams that have to be held accountable to make it all work...and that's how it should be.

My lesson is simple.

"Revenue" is just an accounting term. "Bookings" look good on a dashboard someplace.

Your deal is not real until cash hits the bank.

If your comp plan rewards anything earlier, you're already mis-aligned to what makes businesses survive and thrive.

Fix it.

Should sales reps get paid when the deal is signed...or only when the customer actually pays the company?

If you could give your SDR team only ONE enablement resource (that's not a trainer) to make them 1% better every day... what is it?

I’m not looking for “read more books” or “use AI.”

I want specifics.

Exact book titles.
Exact podcasts.
Exact YouTube/TikTok/Instagram channels.
Exact software tools.

If you say AI, tell me the tool + the workflow.
If you say YouTube, tell me the channel.

My goal: build a short, sharp list of resources that actually move SDR performance and make them better, short of hiring a full-blown "SDR Trainer."

What’s the ONE that changed the game for you or your team?

Wanna hear my dead-simple way of measuring my salesperson hiring success rate? 
 
It's going to blow you away. Are you ready for it? 
 
After 6 months of hiring someone, ask yourself: 
 
"Knowing what I know now, would I hire that person again?"
 
Then document the result. Yes or no. It's just that simple.
 
Then optimize your hiring process based on what you learn. 

If you're consistently "yes" 80% of the time over many, many hires, you're in world class territory.

If you're at or below 50%, you're making expensive mistakes that are going to catch up to you if you don't fix it.
 
Not complicated and still most sales leaders are too lazy to do even this much right? 
 
PS: If you want to dramatically improve your chances of making an A-player sales hire, download my Sales Leader's Interviewing and Hiring Bundle for only $9.99.

Learn in one hour what took me 28 years to master. The Sales Leader’s Interviewing & Hiring Bundle (19 guides, templates, and 10 powerful lessons) helps CEOs and Sales Leaders hire top talent with confidence.

https://lnkd.in/gDDmYsJH

8 super annoying things your salespeople do when they're *playing the victim* 
 
Nobody ever writes success stories about people who *play the victim* but it can be hard for sales leaders to identify when their salespeople are doing it. 
 
Here's some to watch out for: 
 
• Blaming others for situations and circumstances 
• Assuming other people cannot be trusted 
• Believing that one does not have control over one's own situation 
• Refusing to take responsibility or accountability for one's role in a situation 
• Becoming defensive 
• Claiming things are "rigged" against them 
• Claiming "Everyone else agrees with me" 
• Making excuses 
 
What are some of the other telltale signs of your salespeople playing the victim?

So you've given your rep the training and you know they know what to do but they're just not doing it and basically resisting your coaching, what do you do?

So basically the rep is saying to you with their actions (and maybe even their words):

"My way is the best way and I'm not going to take your coaching, thank you very much."

My approach?

They have a very short leash. 

1/ If they're NOT producing the results AND they've gone through the training and know what's expected of them but they resist the coaching...OUT.

2/ But if they're producing the results and have figured out a different, better way of doing it, I'm going to look to see if there's something we can learn from them and replicate it.

Our training and coaching can ALWAYS be improved and sales leaders need to be humber enough to admit this.

But if a rep has been trained and is flat-out resisting your coaching and not producing results....well....

Ain't nobody got time for that.

I learned many of these lessons the hard way and those mistakes have made me successful. I write about 100 of these screw-ups in my book, It Happened on the Sales Floor.

Get a free sample in the link in the first comment below. 👇

How do you handle a rep who resists your coaching?

Over the last 4 years, I've read 100+ articles on remote work. 

Truth is, there are 6 indisputable downsides we can all agree upon that most sales leaders don't know how to solve for.

Here they are (and I'll even cite my sources):

1. Higher Rates of Depression

"Fully remote [is] associated with an increased likelihood of anxiety and depression symptoms compared to in-person work, according to an analysis by the Integrated Benefits Institute"

2. Hard Time Disconnecting from Work

2023 Buffer study found that while 98% of those surveyed wanted to continue some form of remote, 22% reported having difficulty unplugging from work—with 81% checking email outside of work hours.

3. Perception of Lower Productivity

A Stanford report found workers thought productivity was higher at home (~7% higher) while managers thought it was lower (~3.5% lower). Regardless of the reality, you may be 𝙥𝙚𝙧𝙘𝙚𝙞𝙫𝙚𝙙 as being less productive.

4. Increased Chance of Being Laid Off

A recent report from the Society for Human Resource Managers (SHRM) showed that remote workers are 35% more likely to face layoffs than their office-based peers.” Out of office, out of mind.

5. Bias against those not in the office

UC Davis study found that the amount of time you’re 𝙨𝙚𝙚𝙣 in office can affect your boss's perception of you. Not in the office & others are? Some bosses may be intentionally/unintentionally biased against you.

6. Some can't afford a killer home workspace

No research here, just my own experience. Working from the kitchen table sucks. When we went to remote in March 2020, many sales reps just didn't have the right home work space because they couldn't afford it.

Am I opposed to remote/hybrid work? Absolutely not. I think it's the future of work.

But that doesn't mean we've perfected it yet and I think we can agree on these downsides and that we have a lot of work to do to make remote work as great as it could be.

Have any of you seen work environments that have solved for all 6 of these?

This is common and it's a tough one, especially for inexperienced interviewers.

You scheduled the interview and confirmed it. But then the candidate flakes. No call-no show. Now what?

My move: find out if this is a pattern. Is this the first time they've been late or flaked during the interview process?

Did they miss any deadlines or interviews in any previous part of the interview process? You see:

👉 Past performance is a great indication of future behavior.

Yes, missing one time. No problem. Let's reschedule.

But another time? Now that's a pattern.

And sorry, not sorry...the excuse or reason for either miss is not important.

Regardless of the excuse or reason given for the first time missing an interview/deadline, I'll give them a second chance.

Frankly, I don't want to hear the excuse.

But the second time.

1/ I definitely don't care what the excuse or reason is and
2/ The candidate is showing me a pattern of behavior and that won't fly on my team.

💡 Remember, during the interview process, the candidate is showing you their absolute best self. This is the BEST that they will ever be.

So if they're showing a pattern of flakiness during the interview process, you have somebody on your hands that is most likely a flaky person.

And don't fool yourself. You might be making your own excuses for this person thinking that this is likely an anomaly. A rare event.

The chances that's true are low. This is a candidate to avoid.

Hiring is one of the most important skills to learn as a leader. And learning how not to get duped by a flake is part of that.

If you're ready to step up your hiring and interviewing skills, check out my Sales Leader’s Interviewing & Hiring Bundle. The link is in the first comment 👇🏻

I made such a rookie mistake. If you can believe it, I couldn't fire a rep, who missed goal 6 months in a row! 😕 Here's why: 
 
The rep had missed their goal 6 months in a row!! Time to let them go right? So I went to HR to get the paperwork finalized to fire them and she said: 
 
👉 "Does he KNOW that he's not meeting your expectations?" 
 
My word....how could he not? They've missed goal 6 months in a row!!! 
 
💡 My mistake: I never TOLD the team that missing goal consistently was grounds for termination. I didn't have ONE conversation with the rep warning them what would happen. 
 
The learning lesson here is 
 
✅ make sure your reps KNOW in writing what it takes to get fired from their job and 
 
✅ if they fall short of those expectations have frequent, documented conversations with them when they fail to meet your expectations. 
 
I created a simple Sales Leader's Checklist for Terminating a Salesperson. Learn how to fire someone with professionalism, using a smooth and respectful process. 
 
Download it here: 
 
https://lnkd.in/gfhJqHk4

When your sales leaders run to you with problems they've found, here's the power move I learned that's good for all involved. 
 
I like sales leaders who appear like they've thought through a couple of possible solutions and a loose solution before they come running to me and write on Slack "can we chat?" or "got a sec?" 
 
But here's the power coaching move when they come to you with a problem they've found: 
 
✅ "Thank you for bringing this to me. Now go back and put a deck together for me that 
 
1. identifies how BIG the problem is, 
2. has 3 possible solutions and 
3. your recommended solution." 
 
This usually results in 3 outcomes: 
1. They don't bother doing the work 
2. They do the work and realize it's not a big enough problem themselves. 
3. They come back to me with a well thought out set of solutions and their recommended solution. 
 
Either of these 3 options are fine by me especially relative to running to me and expecting me to always solve the problem. 
 
What's your go-to way of handling your employees coming to you with problems and expecting you to solve them?

Once again, our US education system has let job seekers down. You spend 10s, even 100s of thousands of dollars for a fancy degree and this is what it gets you:

"Unemployed Americans with four-year college degrees hit a record in January, at 36.6% of those 25 and older, per Bloomberg"

Job seekers are really hurting and they need real help. And honestly, they have no clue how to conduct their job search.

But it's not the job seeker's fault.

Nobody taught them the right way to do it. The system failed them.

We got those fancy degrees from those expensive colleges but these colleges never taught us how to search for jobs, interview and negotiate offer letters!

But that’s why I built the No-BS Job Seeker Course.

19 lessons. Free trial. No CC req'd.

Link in first comment 👇

I used to hire based on gut instinct.
Charisma. Confidence. A great resume.

And more often than not, I paid the price.

But it wasn't my fault, nobody ever taught me how to hire great salespeople with a good repeatable process. As a result...

Some hires did great (actually the number was 30%).
Most flopped (the other 70%).
And the cost? About $400k PER mis-hire.

I realized that making bad hires WAS my fault and they're really expensive.

Let alone having to fire the ones that don't work out.

I felt guilty as hell and it WAS ALL MY FAULT.

So I made a change.
I didn't buy some sort of fancy tool.
I didn't go find "better recruiters who get it."
Just one major shift:

I documented the entire hiring process.

From how we screened resumes...
To the exact questions in every interview...
To a simple scorecard that forced clarity over charm.

Suddenly, hiring wasn't random.
It was consistent.

We knew who to hire.
We knew who to pass on.
And we moved fast...without second-guessing ourselves.

I’m not saying it was perfect.
But our success rate jumped to nearly 80%.

Because we stopped gambling.
And started implementing a repeatable interviewing and hiring process.

Here’s the kicker:
Most founders and sales leaders say they have a process.
But when I ask to see it?
Yeah, nothing. "It's in their head."

You can’t scale what you haven’t written down.
And you definitely can’t improve what’s not measurable & repeatable.

Your next 10 hires will either accelerate your growth…
Or cost you $4million when you screw them up.

Which side are you betting on?

👀 Learning Lesson: If you want to win in sales hiring, stop winging it. Build a clear, written process you can follow every single time. It’s not sexy...but it works.

PS: Hiring salespeople is hard. I know, I’ve screwed it up a ton. 

But that’s why I created the Sales Leader's Interviewing and Hiring Bundle Learn in one hour what took me 28 years to master. The Sales Leader’s Interviewing & Hiring Bundle (19 guides, templates, and 10 powerful lessons) helps CEOs and Sales Leaders hire top talent with confidence. Only $9.99, instant access. 

https://lnkd.in/g-3wryFJ

Most people think senior care is boring.
I think it’s the most interesting industry nobody talks about.

I’ve spent fifteen years here. 
Worked the floor, did the sales, ran the consulting projects. Saw what works and what doesn’t. Mostly saw what we all pretend works but just burns everyone out.

Now I’m seeing, AI land in senior care whether we’re ready or not. Some operators are figuring it out. Most are drowning in vendor pitches and don’t know what’s real.

That’s where I come in.
Think of me as your AI wingman for eldercare. I help you separate signal from noise and figure out what’ll actually move your numbers. Not the conference presentation version. The Monday morning version that works in your building naturally.

I’m not just consulting on this. I’m building it.

I run Burst Medical Billing. We’re creating AI technology that helps SNFs recover Part B revenue they’re missing. 

Raised $1.5M and integrated with PointClickCare. 
We’re launching the first AI-powered revenue stack built specifically for skilled nursing facilities in 2026. So when I talk about what works and what doesn’t, I’m not guessing. I’m testing it in production.

What you’ll find here: 
Honest takes on the AI landscape in senior care. 
Strategies you can actually implement. Occasional rants about things nobody wants to say out loud. Sometimes a joke, because this work’s hard enough without being miserable.

I’m building toward something bigger. 
A future where senior care isn’t healthcare’s afterthought. 

Where operators have tools that don’t require heroics just to function. Where the people doing the hardest work get the support they deserve.

If you want to talk AI strategy for your operation, get paid for your Part B supplies, or book me to speak, let’s connect.

Senior Care’s #1 Super Fan | CEO & Managing Partner, Burst Medical Billing | The only person who finds both Medicare Part B and machine learning genuinely fascinating

ERIC HANSEN

The federal government wants to fix nursing homes by telling them how many people to hire. 

I need to say upfront that this is not a terrible 
idea. It is, in fact, the kind of idea that sounds 
so reasonable you feel like a bad person for questioning it. 

More staff. Better care. 

Who could argue? 
Try arguing it at a dinner party. 

Try saying “actually, the staffing mandate 
might hurt the people it’s designed to help” 
and watch the table look at you like you just 
advocated for kicking puppies. 

I’ve done it. (Not the puppy kicking part)
I was roasted.

But there’s just something outsiders don’t get. 

Try any GD policy you like.
Mandate ratios, minimums, 

Set floors so high the industry has to pole-vault to clear them. Fine. Do it. I’m not against it. 

What I’m against is writing the requirement on 
one piece of paper and the funding on another 
and then losing the second piece of paper, 
which is what the federal government has 
done with nursing home regs for 30 years. 

Sooner or later you stop calling it 
oversight and start calling it intentional.

A staffing mandate without money behind it 
doesn’t land as “hire more staff.” It lands 
as a sorting mechanism. 

The facilities that can afford the bodies 
(the ones with enough private-pay residents 
to subsidize the gap) they’ll clear the bar. 

The facilities that can’t, the ones running on 
Medicaid in towns where there aren’t enough 
aides within driving distance to fill the shifts 
even if the budget existed, 

those facilities don’t hire more staff. 
They close.

Think about who lives in 
the ones that close.

Not the private-pay residents in the suburbs. 
The Medicaid residents. The ones who already 
had the fewest options and the least leverage in every conversation about their own lives. 

The mandate will move them. Out of a building 
that was understaffed into a building that’s 
farther away, or more crowded, or both. 

Some of them won’t survive the transfer. 
That’s not rhetoric. There is research on what 
happens to elderly residents when their facility 
shuts down. 

They die at higher rates in the months after. 
Their bodies remember the room even when their 
minds don’t, and being moved to a new hallway 
with new sounds and new smells is not a neutral 
act. 

It is an injury that doesn’t have a deficiency code. 
Nobody gets cited for it. Nobody fills out a form. 

The resident just arrives in an unfamiliar bed and
something in them, something the care plan 
never captured and the regulation 
never weighed, breaks.

I want more staff in nursing homes. Desperately. 

The word “understaffed” has become a 
euphemism the way “food insecurity” is a 
euphemism for hunger. 

What I want even more is for someone, anyone, 
to stop mandating things without funding them 
and then acting surprised when the gap 
produces harm. 

The mandate is coming. The money isnt. 
The rule has mass. 

And the underpaid CNA on the night shift 
can already feel its gravity.​​​​​​​​​​​​​​​​

-eh

faketie

chart-star

Medicare Part B’s Best Kept Secret | Senior Care + AI | Speaker | Founder & CEO

Ernie has a stunning beach bod.
But it isn’t meant for the office.

Medicaid pays for 6/10 people in nursing homes. 
And it pays eighty-two cents on the dollar. 

Medicaid is Ernie.

$0.82. 
I want you to hold that number for a moment
because everything that follows depends on it. 

Eighty
two 
cents.

Not a slim margin. 
Negative 18%.

Some facilities get less than seventy cents for
every dollar it costs to keep a person alive, 
clean, fed, and turned every two hours so 
their skin doesn’t open into a wound 
that lets you see what people look 
like on the inside.

You cannot run a building on seventy cents. 
You can run a version of it. A thinner version. 
Fewer aides. Longer wait times. Call lights blinking like tarmac lights.

Congress used to require states to pay based 
on actual costs. Then they gave states flexibility. 

Then they repealed the last federal 
floor on payment adequacy. 

That was 1997. 

The floor was removed. 
Nothing replaced it.

The facilities on the thinnest margins serve 
the most Medicaid residents, operate on half 
a percent profit, and are concentrated in the 
poorest communities serving disproportionately black and brown residents. 

Your zip code and your insurance card 
decide which building you die in.

Drive twenty minutes in any direction from a 
facility running on fumes and you’ll find one 
with twice the staff, half the turnover, and a 
lobby that doesn’t smell like the 70’s. 

One building has enough Medicare residents 
to subsidize the gap. 

The other lives on $0.82 per $1.00

And now Congress is cutting nine hundred 
and eleven billion from Medicaid over the 
next decade. 

The residents can’t organize. 
They can’t march. 
Many can’t speak. 

That line is closer than any of us think. 

Six out of ten of us will cross that line. 

When it’s your turn, look down and
hope your tummy isn’t showing.

-

🔔 follow for irreverent content on #SeniorCare 

DM me to learn how much your Part B supplies are worth each month.

No alternative text description for this image

Okay... I'm fired up today. Excited and angry. 
Because something is finally being done.

*Pulse rising*
Think about what it actually takes to run one of these nursing homes. You are managing one hundred human beings at the most vulnerable point in their adult lives. 

Your staffing grid has three open shifts and the agency wants $67 an hour to fill them. 

A state surveyor is coming Thursday and the pressure ulcer documentation on Room 114 is giving you indigestion.

A family on the second floor has called four times this week and there's always 5 too many expletives. 

You have a dining complaint ("too much salt"), a serious med error to investigate, and you're covering for a tour in 20 minutes with the sweetest (and slowest) 104-year old woman and her daughter.

Somewhere in the middle of all of that, a Part B supplier just walked through your door. 

*Blood pressure rising now*
He has a delivery. Supplies for several of your residents. He has a CMN (a Certificate of Medical Necessity) for each one. 

Four sections. The supplier filled out his parts already. He just needs the attending physician to sign Section D. 

The physician signs. The supplier leaves.

You never saw the paperwork. 
You never saw the claim. 
You won't see it ever. 

NOT
EVER

*Starting to sweat*
Because while you were managing those hundred people, that supplier billed Medicare for items delivered inside YOUR building, to YOUR residents, under YOUR care. 

He collected the reimbursement. 
The one that belonged to YOUR building!

*Mad now*
Imagine hiring a contractor to renovate your kitchen. You pay for the materials, schedule the work, supervise every nail. 

Then you find out the contractor also billed YOUR homeowner's insurance separately (for the same job) and kept the check. 

You didn't know you could file that claim yourself. 
Nobody told you. The contractor counted on it.
And pocketed the money anyways.

*Pulse slowing*
That is what Part B suppliers have been doing to nursing homes for thirty years.

The nursing home provides the care. The nursing home carries the liability. The nursing home employs the staff. And the nursing home 
always had the legal right to bill for those supplies itself. 

*Breathing easier now*
The supplier exploited a billing architecture complex enough that a two-person billing team couldn't track it in real time, and walked out with your money.

*Feeling vindicated*
This month the federal government launched CRUSH and froze new enrollment for the entire Part B medical supply category for Part B suppliers. 

Nationwide. 

Six months. Because in FY 2024, these suppliers carried a 21.4% improper payment rate. More than triple the Medicare average. 

They built an industry on the assumption that you would never figure it out.

Some of them were right. 
Until now.

PS. You can bill for these. Ask me how or follow me to join an upcoming webinar where I teach you exactly how to do this yourself.

#burst

A nursing home gets cited for a fall.
Not a bad nursing home. 

A facility running short because the state 
reimburses $198 a day for a human being 
who needs round-the-clock care. 

(That’s less than a mid-tier hotel room).

So the surveyor writes it up. 
The facility writes a Plan of Correction. 

New fall prevention protocol. 
New documentation requirements. 
New staff training module. 
New audit schedule.

Nobody asks where the time come from.
(They come from the floor and admin team).

The CNA who was already covering 22 residents 
now spends thirty minutes charting what she used to spend on care. 

The nurse who caught the early signs of a behavior last month doesn’t catch it this month. 

She’s in a care plan meeting about fall risk 
documentation with the leadership who worked 
70 hours last week.

Three weeks later, someone gets a UTI that 
goes septic. 

New citation. 
New protocol. 
New documentation.

The cycle doesn’t announce itself. 
But it’s there. 

Pressuring everyone with more compliance.
More checklists.

Every rule makes sense on its own. 
Every corrective action looks responsible 
on paper. 

But each one pulls staff time away from the work 
the rules were written to protect. 

And when care suffers because the staff was 
busy proving they provide care, the system 
doesn’t pause to ask why. 

It adds another requirement.

I call this Compliance Gravity.

It’s the slow, cumulative, one-directional force 
that bends a facility’s entire operation toward 
compliance as its primary function. 

Not care. Compliance. 

The weight only accumulates. 
Regulations stack. They almost never subtract. 

And the pull gets stronger the fewer resources you have to resist it.

Well-funded facilities absorb it. 
Medicaid-heavy buildings get crushed by it.

Worst of all, the system’s own response to 
failure is the catalyst for the next failure.

Low on resources / staff / cash -> 
Mistake -> 
New POC / reg / fine -> 
More documentation -> 
Less time for care -> 
Even less resources / staff / cash -> 
Mistake -> 
Repeat ♻️

What Is Compliance Gravity?

There is a 68 year old woman in Alabama
A retired school administrator, 
Spent forty years saving carefully.
And cannot afford to get old.

Not the way people mean it at cocktail parties. She’s not worried about gray hair or crows eyes. 

She has $180,000 in the bank and a house worth 
roughly the same, and a body that has started 
requiring more than her body can manage alone. 

She needs assisted living. 
The kind with a nurse aid nearby and 
someone to help with the things she 
can’t do anymore without falling.

The place her daughter likes 
costs $6,400 a month.

Her savings will last about two years. Maybe three if she’s doesn’t buy the AARP subscription or pay for the Lyft rides to her stylist anymore.

After that, Medicaid. 
Except , wait, Alabama doesn’t pay for 
assisted living. So after that, what?

A nursing home.
Or a different kind of facility. 

Definitely a longer drive for the daughter. 
A room that fits a twin bed, a tv, and a recliner.

That’s basically it.

This is the forgotten middle

The several million Americans who saved too 
much to qualify for assistance and not nearly
enough to buy their way into the places built 
for people who saved more. 

They are too wealthy for the safety net and 
too poor for the market, which has spent the 
last decade building memory care units with 
wine bars and concierge services for the people
a smidge above them while the people below 
them got Medicaid beds and the people in the 
middle got a bureaucratic line in the sand with 
no name and no product and no plan.

Now some operators have a plan. 
Strip out the wine bar. Pull the concierge. 
Cut the fine dining program and the lobby 
that looks like a Marriott.

Build something functional. 
Price it at $3,200 and cater it to the middle.

The industry calls this a no-frills model. 
Critics call it warehousing. 

Both sides are describing the same building. They just disagree about what it 
means that the building exists.

Here’s what I think, for whatever it’s worth. 

The argument about amenities is the wrong 
argument. It is a debate about the furniture 
inside a structure nobody is questioning. 

The structure is this: we have a population that 
needs care, a market that cannot profitably 
serve them at a price they can afford, 
and a government that has 
declined to bridge the gap.

The no-frills operator didn’t create that structure. 
Neither did the luxury operator. 

They are both rational responses to a 
market that was handed to them busted.

The woman in Alabama doesn’t need a wine bar. 
She also doesn’t need a warehouse. 

She needs a place that can afford to staff, 
which requires a margin, which requires 
a price she cannot pay for more 
than thirty-six months.

The math doesn’t care about the amenities.
It never did.​​​​​​​​​​​​​​​​

-eh

🔔 Follow if you’re looking for a 
different kind of LinkedIn post. 

One that doesn’t 
sound like AI slop.

PS. Dm me if you’ve ever wondered whether 
your part b supplies are reimbursable?

“Spend your life savings if you want our help.”
That’s the rule. Not a misprint.

The Rule.

You want Medicaid to pay for your mother’s 
nursing home, she needs to be broke first. 

Savings gone. 
Investments gone. 
The car if it’s worth too much. 

The money she set aside for forty years 
because she didn’t want to be a burden…

Gone. 

Asset limit in most states: $2,000.
Two thousand dollars.

I want you to sit with that number for a 
second before we move on.

Got it? Next…

Care costs run $7,000 to $10,000 a month. 
Medicare covers about 100 days if she 
qualifies, if the paperwork holds, if the stars align. 

The thing people don’t realize,
the thing I didn’t fully understand 
until I started pulling the thread

is that the spend-down doesn’t just wipe her out. 
It wipes out what she was trying to hand you. 

The house she raised you in. 
The account she never touched. 
The inheritance that was supposed to help 
your kids start somewhere instead of nowhere. 

It doesn’t evaporate. It goes to the facility. 
Then it goes to zero. Then Medicaid arrives.

After she dies, the state may come for 
whatever’s left. Sometimes aggressively. 
Sometimes quietly.

Either way, the option exists, sitting there in the 
statutes like a guard dog on the other side of 
the door… waiting.

The numbers are just the numbers. 
16.4% of nursing home residents spend down 
their assets and enroll in Medicaid during their 
stay. 

After four years, 61.8% of people who entered 
as private-pay have made the transition. 

Median savings of an older American: $36,000. 
Annual nursing home costs: up to $288,000. 
Do that math once. It’s easy. Do it.

Somewhere (we actually know where) 

A decision got made, that public money should 
only reach people who truly can’t pay. 

Which sounds like good stewardship until you 
understand what “truly can’t pay” requires a 
family to go through first.

There’s got to be a word for a safety net with a 
hole that size. I keep coming back to trapdoor. 

Most families don’t know it’s there. 

They find out the same way everyone finds out 
about the things that were always waiting for 
them.

On the way down.

-eh

——

🔔 Follow if you’re looking for something different on LinkedIn. 

DM me to learn how we help nursing homes recover their Part B supply reimbursements 
the compliant way.

Grab a nursing home penalty notice off the shelf, would you? The weight of it tells you things before you read a word. The formality of the letterhead. 

The dollar amount in bold, always presented as though it were the final word on the subject.

It never is.

CMS imposed $202.9 million in nursing home fines last year. Hold that number, because what happens next is more interesting than the number itself. 

Seventy percent of penalties get reduced before a dollar is collected. Waive your appeal rights and the system hands you an automatic 35% discount, like a coupon for getting caught. 

A hundred-thousand-dollar fine quietly becomes 
thirty-five thousand before the check is written. 
Not that size alone indicates accountability. 
Many large fines are performative theater.

But there is that matter of where the money goes.
Money has weight. In this case, I'd say each piece
of paper is 120 to 212 pounds.

Ask anyone who works in the business office of a nursing home running on 1.8% margins.

Follow it past the headline. The Medicare portion flows to the U.S. Treasury. 

Not to CMS. Not to residents. To the general revenue account, the "Fines, Penalties, and Treasuries" account, where it vanishes as miscellaneous receipts. 

The Medicaid portion goes back to the state for reinvestment. Grants capped at five thousand dollars. No capital improvements allowed. 
No technology. No core services.

Is there any rationale for believing this reaches the residents it was taken from? 
(I'm not convinced).

Eleven states are sitting on more than $190 million in accumulated penalty funds they haven't 
spent. North Carolina holds $42 million. 

Enough for a $5,000 grant every day for twenty-two years. 

The money just sits there while the facilities it was extracted from cut second-shift staffing to make the quarter work.

I built a slide deck that takes this machine apart gear by gear. 
The intake valve. 
The erosion funnel. 
The splitter. 
The reservoir. 

The self-reinforcing loop where penalties shrink budgets, budgets shrink staff, and fewer staff produce the next citation. 

(I'll be sharing more of it over the coming weeks).

Because at its most basic we are only discussing a penalty system. 

But you'd do well to remember we are also talking about a broken machine. 

And broken machines don't fix themselves.

#LethalBenevolence

The Anatomy of a Broken Machine and the Quiet End State

What do nursing home administrators feel 
when they hear "staffing mandate"?

Dread. Anger. 
Indifference.

You can test yourself like this:

First:

Do you know exactly how many hours per resident per day you're required to hit?

Do you know what it costs you per shift 
when you can't fill the floor?

Do you know what a deficiency citation 
costs you on top of that?

Do you know what your turnover rate does 
to your answers?

Second:

(How’d that math go?)

Good? If so, you’ll be okay.
Bad? Now you know where to start.

Now ask yourself the real question. 

Would you rather have sticky fingers forever 
or dusty Cheeto fingers forever?

Hope this finds the right person today.

— eh

#LethalBenevolence

The agency nurse costs more than the 
administrator’s car payment. Per shift.

That number sits in the back of every 
operator’s brain like a bad tooth. 

You don’t forget it. 
You just learn to stop thinking about it.

Here’s what it means. 
It means the facility already lost. 

Not tonight, months ago, maybe years ago, 
when the staffing math stopped mathing and 
the only options left were leave the hall 
uncovered or call the agency. 

The agency nurse costs $69 an hour.

The permanent nurse she replaced cost $44.

That $45 difference doesn’t come from nowhere. 

It comes from the cash flow sheet, which means
it comes from the family down the hall who 
doesn’t know they’re subsidizing it, which means
it comes from whatever’s left of the margin after that, which means eventually it comes from somewhere it was supposed to go instead.

A repair. A well-deserved raise. 
The third aide on the overnight 
that never got hired.

Operators don’t choose agency because they 
like it. They choose it because the alternative

the empty shift, the uncovered hall

has consequences the agency bill doesn’t. 

You can absorb a bad month of agency costs. 
You cannot absorb the lawsuit, the citation, the 
immediate jeopardy tag that follows the night 
you left the building short.

So the math becomes: pay the premium now or 
risk a cost that makes the premium look cheap.

It’s really more of a hostage negotiation with your
own balance sheet than it is a staffing decision.

Oh, and it compounds!

The agency nurse costs more and knows less, 
which means more incidents, which means more
documentation, which means more nursing time
on paperwork and less on the floor, which means
the permanent nurses burn out faster, which 
means more vacancies, which means more 
agency.

(Oof… that was hard to write)

The industry has a name for this. 
They call it the agency trap.

And I think it stinks!
It’s just stinks!

-eh

I think some of you are fibbing to me.
I asked everyone how much their premiums
were going up in 2026.

Nearly half of you said not at all.

I have to scratch my head at this because the odds are next to zero that 44% of you would not see premium increases.

Even under normal circumstances where we weren’t in the middle of a political quagmire, premiums go up year over year to accommodate for inflation.

What am I missing here?

Mine went from $1,247/month to $1,453.
That’s a 16.5% increase.

Some friends saw their premiums jump from $500-$800. That’s a 60% increase.

Now, I know political tensions were ripe with fear because of the shutdown and people were digging their heels in but which of you out 
there really saw no premium increases?

Because if like your reps number. 

Thanks 🙏 

-eh

Medicare Advantage costs the federal 
government roughly $2,500 more p/yr/per 
enrollee than traditional Medicare. 

The care isn’t better. 

They’ve just mastered the art of getting paid 
for sickness.

They upcode. 

They enroll healthier patients and bill as though they’re sicker. 

MedPAC, the nonpartisan agency Congress 
created to advise it on Medicare, estimates 
MA overpayments will hit $76 billion this 
year alone. 

Did that stick? 
$76 Biilion in OVERPAYMENTS.

14% more than it would cost to cover the same people in traditional Medicare.

Three insurers now control nearly sixty percent 
of the market. Up from a third in sixteen 
years. 

That’s an 84% relative share expansion through
organic enrollment growth, aggressive M&A, 
and sustained regulatory arbitrage.

They use lobbying and litigation to block every
reform that would slow the money down.

The star rating system that’s supposed to keep this honest? 

MedPAC says it doesn’t reliably indicate quality
and has led to unwarranted bonus payments. 

Fifteen billion in quality bonuses flowing to plans
that figured out how to score well on paper.

Meanwhile, every Medicare beneficiary

including the ones who chose traditional Medicare

pays higher Part B premiums because of MA overpayments. 

The people who opted out are subsidizing the system they rejected.

Over the next decade, MA overpayments are projected at $1.2 trillion. 

That’s not a typo. 

That’s the cost of a payment formula that 
rewards documentation over care, in a system 
where the entities with the most lobbying power
capture the most resources and the populations 
with the least power absorb whatever’s left.

The money isn’t missing from American healthcare. 

It’s in the wrong waiting room.

I’m not a policy researcher, but I get through six or seven regulatory reports a month. I don’t read them to study the system. 

I read them because after fifteen years in elder care I can’t stop. 
Yet there is a learning process going on. 

Every report has its own lesson, and quite often the bad ones 
teach more than the good ones.

When I was selling medical supplies I visited a facility in rural 
Missouri that had just been hit with a $40,000 penalty. 

A building running on margins so thin the administrator kept a 
whiteboard next to her coffee mug to count days of operating 
cash. 

The staff cared so much it made your chest hurt. But the fine 
that was supposed to fix things was about to make both 
problems worse. 

It was terrible, actually. A system populated by paper-thin logic 
and outlandish assumptions about what punishment accomplishes. 

The penalty money wouldn’t go anywhere near the residents it 
claimed to protect. For me it was the regulatory equivalent of a 
smallpox vaccination: I have never, so far as I know, looked at a 
CMS fine and assumed it was doing what the press release said. 
Maybe one day I will.

Almost everyone in elder care can remember the first time they 
watched the system punish a struggling building and thought: 
this isn’t fixing anything. This is making it worse. And I think I 
understand why.

One learns most clearly what not to do by studying bad policy. 
One building like that is worth a semester at a good policy 
school.

Because here’s what they don’t teach in policy school. The 
Medicare portion of every nursing home penalty flows directly 
to the U.S. Treasury. Not to CMS. Not to a quality improvement 
fund. Not to the residents who were harmed. 

It vanishes into general revenue as miscellaneous receipts. 

The Medicaid portion goes back to the state, where eleven 
states are currently sitting on more than $190 million in 
accumulated penalty funds they haven’t spent.

The money leaves the building. It does not come back. 

That administrator in Missouri with the whiteboard next to her 
coffee mug? She lost $40,000 from an operating budget that 
was already underwater. The government collected it, split it, 
and sent it somewhere that has nothing to do with the people 
living in her building. 

And then we wonder why the same facilities show up on the 
same lists year after year.

#LethalBenevolence

The Director of Nursing at New Jersey's worst-rated nursing home had a license that expired in 2007. (This is a true story)

It had been suspended after an arrest for forged prescriptions. 

When investigators asked for documentation, someone submitted what appeared to be a fabricated RN license

(the number on the document belonged to someone else entirely).

Nobody caught it for years.

The man listed as the facility's owner hadn't visited in years either. 

When investigators asked how much he paid 
for it, he said "I don't know, I don't remember. 
I think it was nothing, almost." 

When they asked who owned the building, he said "I don't know, it's all Steve's things." 

He had, by his own admission, "absolutely no" involvement in running the place.

He was the licensed operator of record.

Two other men ran everything. They ran it through companies they owned, which contracted with the nursing home they also controlled, at prices they set themselves, for services investigators would later find they failed to provide.

On 75 randomly selected days across a two-year review period, the facility was understaffed every single day. Not most days. Every day. 

By nearly 50 percent on average. Some shifts had zero qualified staff on the floor. Yes, zero.

Of 34 resident files pulled at random, 12 had no care plan at all. Zero documentation of what each person needed, what they couldn't eat, what medications they were on.

A state surveyor found a resident weeping in bed, in a hospital gown, unable to reach anyone in social services. The resident had moved there four months earlier and still hadn't received their belongings.

This facility carried a one-star rating — the lowest possible — for over a decade. It kept receiving Medicaid funds the entire time.

From 2018 to 2021, the two men who controlled it allocated $45.5 million in profits to themselves. 

The facility reported $4.8 million in losses over the same period and was functionally insolvent by 2022.

The New Jersey Office of the State Comptroller released its findings in December 2024. The owner and both operators have been suspended 
from the Medicaid program. The investigation is ongoing.

A man who knew nothing owned the license. Two men who controlled everything owned the profits.

The people who lived in the building paid for it!

Thanks Michael Wasserman for sharing this story. You can read the full article by visiting his original post here: https://lnkd.in/dfA_zK7V

#burst #LethalBenevolence

Pay attention sales people.
Blair is giving you pro tips for free
(straight from the pianists mouth) 

Say that five times fast
Guaranteed laugh.

What stinks Blair, is you’re asking the bare minimum here. When Shawn Barron and I teach this sales stuff, your suggestions are the freshman level curriculum.

This is what every sales person should do
And yet… 90% do not.

They feel the pressure to sell.
To hit quota and they believe (incorrectly)
That they should press hard.
Get straight to the pitch.
Push to get the sale.

What they don’t realize is this is one of those
“Slow down to speed up” scenarios.
Meaning, you close more deals faster by avoiding the high pressure sale.

Funny thing. It’s never been harder to be in sales
(Because prospects are awash with AI-BS and the pitch fatigue is real).

But it’s also never been easier
(Because you just need to be authentic and human).

Who would have think that with all of this advancement the best way to sell is not New school.

It’s Old.

Vice President of Operations | Senior Living/Senior Care

View Blair Quasnitschka, LNHA, FACHCA’s profile

Sales…the approach works as a vendor and operator. 

So when a sales representative comes to me assuming they can solve my “problem” - you’ve already lost. 
1. Assumption - how do you know I am struggling in the service line you are selling?
2. Bandwidth - in the vast litany of focuses and initiatives an operator is dealing with, I likely have prioritized already and you possibly do not fit at this time. 
3. Connection - if you have done nothing to research me or my organization, you have no chance. Honestly, treat it like your resume needs to stand out in the stack of thousands. 

The solution:  do some homework and CONNECT first. Ask where our pain points are. Ask if we are considering what you solve for in the next 6-12 months. 

I think about it when our Lifestyle Advisors who consult with seniors every day - they don’t dive straight in assuming we have the solution to their life’s next chapter in an attempt to beat them into submission to our doorstep. We connect first and determine does our individual Community’s experience align with their individual journey, at that time, down the road, or never. 

Treating sales like a sprint instead of a marathon likely leaves you losing whatever damn race you’re running.

In 1966, an economist named William Baumol 
noticed something about string quartets. It took
four musicians forty minutes to play a Beethoven
piece in 1826. 

Still took four in 1966. 

The labor hadn’t gotten more efficient. 
It couldn’t. Labor was the product.

He called it cost disease. 

In most industries, technology makes workers
more productive. 

One farmer feeds thousands now. 
Wages rise because output rises. 

But some work resists mechanization. 

You cannot automate a classroom. 
You cannot batch-process a violin concerto.

And you cannot build a machine that turns a 
ninety-year-old woman every two hours with 
the kind of attention a real person delivers.

Nursing home care is Baumol’s disease in its purest form. 

It takes the same number of human hours to 
bathe, feed, and reposition a resident today 
as it did in 1980. 

But the wages that aide needs to survive have 
risen, because rent and groceries and the 
entire economy around her have gotten 
more productive and more expensive while 
her job stayed exactly the same.

The thing that gets me… scares me a little.

Most states set Medicaid rates using general 
inflation measures. But general inflation tracks 
an economy where productivity gains push 
prices down. 

Nursing homes exist in the part of the economy 
where that never happens. 

Even if you closed the gap today (set rates at 
full cost this afternoon) by next year they’d 
already be falling behind. 

The index they’re tied to measures an economy nursing homes don’t belong to.

That’s why this argument never ends. 

Advocates push for higher rates. 
Legislators occasionally deliver. 

The rates cover costs for a year, maybe two. Then the disease does what it always does. 

The cost of labor rises. 
The index doesn’t keep pace. 
The wound reopens.

We’ve been having this same fight for thirty 
years. We’ll have it again next year. 

And the year after. 

Because the fix is indexed to the wrong economy, and nobody wants to say that **** out loud.

The quartet still takes four musicians and forty minutes. 

The bath still takes one aide and fifteen minutes. 

The economy moves on. 
The work stays the same.

-eh 🐼

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Kevin Gaither

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taplio

The Battle

Kevin Gaither

ERIC HANSEN

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Performance Score.css-goub6s{font-size:var(--chakra-fontSizes-md);font-weight:500;color:var(--chakra-colors-gray-600);display:block;margin-top:var(--chakra-space-1);}Kevin Gaither's LinkedIn Performance

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Performance ScoreKevin Gaither's LinkedIn Performance