Episode 23: When Healthcare Meets Hospitality – Building a Legacy of Care
Hosted by Aaron Burnett with Special Guest Charles Bryce
In this inspiring conversation, Charles Bryce, CEO of Charlin Health Services, shares how his family-owned hospice and home health care company is redefining patient care in Dallas, TX. Starting from humble beginnings in his family’s living room, Charlin has grown into a thriving organization serving over 600 patients annually while maintaining its core values of faith, family, and exceptional care.
Charles discusses powerful insights about bringing humanity and hospitality to healthcare, scaling a healthcare business without compromising on personal touch, making difficult conversations about care more approachable, and building a lasting legacy in the community Charlin serves. His vision of creating an organization that will serve generations of Dallas families offers a refreshing alternative to the traditional exit-focused business model, while his practical approach to incorporating new technologies like AI shows how tradition and innovation can work hand in hand.
Listen & Subscribe:
Charlin Health Services Origin Story
Aaron Burnett: Let’s sort of start at the beginning. It sounds like you’ve got a really interesting background, interesting history that led you into this business. I’d love to hear about that background and hear about Charlin Health Services.
Charles Bryce: Yeah, it’s a crazy background. I grew up in Dallas, Texas in an immigrant household. My parents are from Nigeria, and you know, everything when I was a kid – they always said, not just them, but just Nigerians in general are huge for being a doctor or a lawyer. That’s just kind of the big thing. When I was a kid, I always wanted to be a doctor, just wanted to help people.
That was like my heart. As I got older, my parents actually started a home health company. My mom’s desire was to start a home health company where she could basically pass it on to her two boys, myself and my brother. She was a nurse, and she saw that at that time, the healthcare system was transitioning to a lot of private equity and changing the way patients were taken care of.
She was like, “I want to start something where I can hand it off to my boys and they could continue to do a good job.” It started in our living room. My mom would go see patients and then come home and chart on paper, and I would come home at 13 years old to shred paper in the living room and eat dinner. That’s just kind of how it started.
I never really thought I would be working in the industry as I got older. I went to school in St. Louis, did physical therapy, played soccer – I love soccer – and found my way coming back here in 2016. My mom called me and said, “Hey, I’m tired. I need your help.” I was like, “Ooh,” and my wife and I were uncertain. We prayed about it and decided to come back. I got thrown into it, didn’t know anything. My background was physical therapy – I worked at a regional hospital in St. Louis.
I enjoyed it, loved it. Going from bedside to administration was a big change, trying to understand how to scale in a way that’s healthy for patients and healthy for the organization.
Charlin’s Unique Business Model
Aaron: We also have seen private equity entrance into hospice services or retirement care. What’s the difference in the mission of Charlin Health Services versus larger PE-backed hospice services or retirement communities?
Charles: When you look at healthcare as a whole, for us, it’s more legacy-driven. We’re looking to be a staple in the area for generations to come, God willing. When you’re looking at PE and private-backed companies, there’s always an exit strategy – you’re investing one dollar to get ten back. What we’ve seen in Dallas is that this area is so saturated that the community needs consistency.
At Charlin, we’ve tried to develop the knowledge and mindset of what private equity does, but use it in a healthy way for patient care. We utilize the same skill sets and mentality while focusing on taking care of patients for the long term. I’ve seen it for the last eight years – studying the industry, studying the market, studying different companies. I look at what they did well, why they didn’t do well. Often it’s because they sold, and when they sold, a whole new change in culture and administration came.
The patients became just a number, not really a patient. With healthcare, especially with home health and hospice, these are people in vulnerable states. It’s very hard to get your ROI on a human being, you know? So we try to figure out how to take care of patients for a long time.
Aaron: Can you give us a sense of scale? What are the operations of Charlin Health Services? How many facilities? What sort of patients do you look after?
Charles: We serve about 600 patients every year in the Dallas Metroplex, varying between home health, hospice, and veteran services. We have about 55 W-2 employees and then contract staff – contract therapists, occupational therapists, doctors, and nurse practitioners. We’re not the massive companies that you see, but our goal is to slowly and surely grow over a long period of time and help those providers have good stability. We create relationships with doctors and grow from there, come alongside them and help them.
Understanding Home Health Care
Aaron: Can you describe for anyone listening who may not know what hospice care is, what home health care is, and in what context you’re providing home health care?
Charles: Let’s break down home health first, because it’s easier to talk about. When we’re talking about home health with families, it’s like, “Oh yeah, home health, let’s get better.” There are different types of home health – people see it as home care, healthcare, or homemaker services. But when you’re looking at a Medicare-certified agency, it’s services provided in the comfort of a patient’s home who has Medicare. There are specific criteria needed.
For instance, say you have a loved one who’s weak and has been falling, or who just got out of the hospital after having heart valve surgery – they need acute care. That’s where home health comes in, usually for anywhere between 60 to 120 days. Your primary care physician oversees that and allows for services – the home health nurse, PT, OT, speech therapist – to come in and take care of them.
The goal is to help get that loved one back to what they used to do – playing pickleball, hanging out with the grandkids. If you had a knee replacement, you might be down for six to eight weeks. Home health is there to help build that back up, prevent infection, prevent hospitalizations. It’s a beautiful system when it’s done well, a great help for families.
Aaron: What’s the advantage of home health care versus needing to go in for an appointment, being seen at a physician’s office or at a hospital?
Charles: Home health works in combination with doctor visits to help the family. While the doctor might see you once every six months, your home health nurse might see you one or two times a week, along with therapist visits. Home health is meant to be an extension of care for that primary care physician. We work hand in hand with the doctor between those six-month visits, coordinating medication refills and changes. The home health nurse reports back to the doctor about what they’re seeing in the home, which is especially important since it’s often hard for seniors or anyone under home health to go see the doctor.
The Role of Hospice Care
Aaron: And then hospice care?
Charles: Yeah, hospice is a scary word. I was joking around – you don’t want to use “hospice” at a birthday party. You don’t want to say, “Oh, we’re having fun, hanging out. Oh yeah, my mom’s on hospice.” It brings the vibe down fast.
But when you look at hospice, it was created by Medicare as a resource and benefit for Medicare beneficiaries. Really and truly, when you’re looking at birth and death, these are inevitable parts of life. The healthcare system is meant to wrap around families during these two times. When someone’s pregnant and about to give birth, you see everyone coming around to help them through that process. It’s the same with hospice care and end of life – Medicare does a good job helping families through that process when it’s done well.
When someone potentially needs hospice, Medicare deems that they have six months or less to live. An order must be written by a doctor based on their clinical observations – nobody knows or controls the exact timing. The doctor will say, “Let’s do an evaluation for hospice care,” write an order, and send it to the hospice company. The hospice will send a nurse to evaluate based on the diagnoses and conditions, and then determine if the patient qualifies.
When you start hospice, it basically becomes your hospital at home. You don’t go to the hospital anymore – hospice comes to you. You don’t go to all your doctors anymore – hospice is your doctor, because there is a doctor who oversees that hospice. They coordinate all the medications, DME, prescriptions, supplies – everything needed. The goal is to keep mom, dad, uncle, aunt safe at home and comfortable. It’s a huge support for the family if they have questions – they have a nurse on call they can talk to at any moment. The hospice team is there to guide them all the way to the end. You don’t have to do it alone.
Aaron: For a family going through that process, you’ve described a relationship that sounds fairly intimate and frequent. Is there one nurse who is the primary caregiver? And how frequent is that relationship? Is this someone assigned to maybe one or two or three families only?
Charles: It’s a tailored approach. When someone’s on hospice, you usually have a primary case manager nurse, but that nurse has an on-call team for support so they don’t get fatigued. The National Hospice Association usually says one nurse should see between 11-13 patients as their caseload. It can be emotionally fatiguing, so you have an on-call team that helps support the nurse after hours.
Families usually have one or two nurses, but when it’s after hours, there’s a team that picks up that load to ensure support. They receive detailed reports from the primary nurse. The frequency could be once a week, twice a week, or daily based on how that loved one is progressing with their disease process.
It’s a beautiful tailored approach – you customize it for the patient and family. Some patients say, “We’re good, we have my nephew down the street who checks on Mom, just come once a week.” Others have no help, so we need to be there more than twice a week, have our aide come out more, have the nurse come out more because the family needs the support. Every situation is different, and every family dynamic is different as well. So yeah, that’s a great question.
Charlin’s Mission and Faith-Based Approach
Aaron: How do you think of your mission as an organization, particularly with regard to hospice?
Charles: We’re faith-based. As a kid, my mom talked about that, but as I got older, I understood what it means to honor God in your work. As an organization, we try to do that to the best of our ability. When we honor God, that means we’re taking care of people the best way we can even when no one’s looking.
When it comes to mission in healthcare, you have to think of the other person as better than yourself when you’re a clinician. Healthcare is about thinking of the other person before yourself. When we’re taking care of people, even doing this podcast, my heart is hoping this will help someone who’s thinking about going into the industry. It’s about other people. It’s about serving – that’s what healthcare was meant to be. It’s not like McDonald’s or Burger King where you’re just serving food – you’re serving people.
Hospitality in Healthcare
Aaron: When we were exchanging emails and chatting with Grace, we were talking about the topic of hospitality, exceptional care. What does it mean in the context of your work and your staff’s work to extend hospitality to the people you serve?
Charles: It’s essential because you’re putting yourself in their shoes. If you were sick, how would you want someone to come to you in a hospital room or at home taking care of you? You would hope they would be genuine, kind, excellent in their craft and skill set, and doing everything they can to help you get better. Or if there was no prognosis for getting better, that you would pass away with dignity, respect, and honor.
When you’re talking about hospitality, it’s huge in home health or hospice care because you’re taking care of people in a vulnerable state. They’re going to lash out, yell at you, be upset because they’re dealing with their own emotions. The hospitality is really about not taking offense to that. Sometimes we’re just punching bags – that’s just what it is. You can’t get offended. We’re in an industry where you’re going to feel that way because people are going through emotions.
When you’re talking about hospitality, it’s about the intentionality of how you take care of people. Being intentional about tone, about how you talk to someone, being respectful of all different cultures, races, sexual backgrounds – whatever it may be, they’re human beings. We’re going to take good care of them. That’s good hospitality.
Aaron: You know, hospitality is core to the way we engage with one another, with our clients. I like the definition of hospitality being the difference between when something happens to you versus when something happens for you. When it happens to you, that’s not hospitality. If it’s for you, that feels like you’re being cared for. I would imagine there has to be a lot of anxiety associated with hospice care in particular, or even home healthcare. I wonder how your team members, or maybe in your own practice before becoming CEO, think about creating a context where it feels like something is happening for the person you’re caring for.
Charles: I think it’s realizing that everyone’s human. We all have the same interests, the same things we enjoy, and that helps foster hospitality. I’ll give an example. I like to go to hospitals and meet with families who are potentially needing hospice care. Recently, I met with a family member with end-stage cancer. We went through all the medications with the social worker who was there, and they reached out to our agency.
When I met with them, you could tell the husband’s eyes were foggy – they had been married for 50-plus years. He was like a deer in headlights, having no idea what he was about to walk into. Instead of going into the jargon of what hospice is and benefits, I just started talking. I saw he had a shirt on and asked, “What school did you go to?” He told me the school, and I said, “Oh, I went to that school too – it’s a Jesuit school.” He was like, “What? My son went to this Jesuit school!” We started talking about football, track, and found out he’s a big Steelers fan.
You could tell he was relaxing, just enjoying the conversation. Then at that moment, he was like, “Okay, thanks. Let’s talk about what I need to do for my wife.” That’s the humanity. I think that’s what hospitality is – not just going in there and providing a service. It’s about making it for that person. Organizations in general, CEOs in general – it all starts with leadership. How do you figure out a way to relate to people? And then from there, provide the care.
Aaron: You run a faith-based organization. What does it mean that Charlin is faith-based? You talked a little bit about it. What does it mean in terms of the people you serve? I think there may be some misunderstanding about what it means to run a faith-based organization.
Charles: It’s all based on our core values – what do we believe and what’s our foundation? Our foundation is based on Christian core values, but it doesn’t mean we’re going to push a certain type of belief on families and patients. It is to let them know that this is the core of who we are and this is how we treat people.
We train all our staff to treat people with honor, integrity, excellence, human dignity, and trust. When we talk to families, we let them know that. Especially with hospice, there’s a component where our job is to coordinate with them spiritually. If they don’t have a spiritual faith, that’s okay – we just help them with counseling sessions and processing grief. But then we have families who are Catholic, Christian, Buddhist, Muslim, Sikh – all these types of beliefs – and we help coordinate with their belief system and their community to make sure they are appropriately grieving and understanding how end of life works.
When families say, “Oh, you’re faith-based,” – yeah, we are. It’s more like, we’re here to serve you. We’ve got to do what we’ve got to do, but we’re here to serve you from a faith background.
Aaron: So it’s more about who you are and not about who they have to be.
Charles: Yeah, a hundred percent.
Technology and AI Integration
Aaron: Shifting gears a little bit – I was talking with the Chief Digital Health Officer for the University of Washington weeks ago about the evolution of healthcare, but in particular, the implications of AI in healthcare and how it’s being used today, how he envisions the experience of a patient will change in the future. How, if at all, is AI impacting your work, your business operationally?
Charles: The industry as a whole, and this is just Medicare as a whole, is a government-funded industry. It’s not cash-based, doesn’t adjust for inflation, and is census-driven and population-driven. If it’s exhausted, it becomes exhausted. Each Medicare agency has to follow Medicare’s payment rates and budget accordingly. Sometimes they don’t pay more based on inflation – they just keep it the same.
With that, you have to figure out how to continue serving patients and families with no adjustments for inflation. Whether it’s through volume or cutting costs, what we’ve done is figure out from an AI perspective that there are many tasks that can be done via AI that will actually save overhead costs. We’ve incorporated that from marketing to intake to post-coordination with patient care.
We use a system in our agency that we’ve built to help – almost like an AI bot – to send out things that I would probably have to hire someone to do, but we can’t do that because of the way Medicare funds are specifically allocated. AI is huge when it comes to the home health and hospice realm. I see that as a huge benefit. Like you mentioned with the healthcare industry, it’s only going to keep getting more prevalent so people can really focus on patients while the back-end things can be done by AI if it needs to be done.
Aaron: That’s consistent with other conversations I’ve had with folks in healthcare about how AI is and isn’t impacting their operations and care. Can you give a couple of examples of the ways that you use AI today and how you envision that is going to expand?
Charles: Yeah, a good example is something simple as reminder tools for clinicians and their RN licenses. We built this system that shoots them an email and a text message automatically based on the date to say, “Hey, don’t forget, your license is going to be expiring in the next couple of months. Please make sure to do XYZ.” Those are just AI things that can be done – more clerical things.
Even caring for the team – we have automated birthday texts and emails, automated work anniversary messages saying “Hey, we appreciate you.” It’s about how you create that environment. Those are tasks that have to be done, but you can intentionally do that to care for someone. We’re utilizing that to care for our patients and our team. From a Medicare standpoint, there are a lot of tedious tasks we have to do to remind about HIPAA, OSHA, and several different things – we just automate those tasks. And we’re just getting started.
Making Healthcare Discussions Accessible
Aaron: In your marketing, even in the educational information that you create and publish, particularly video, you often look to remove the weight, the stigma, the gravity that otherwise might be associated with home healthcare or hospice. You’re trying to make it not morbid – it’s just a reality and it’s okay to talk about it out loud.
Charles: We’re trying to make it comfortable to talk about, and fun, and normal. I think that’s the thing – it’s life. Like, a couple years ago, I saw something about Shaq having a hip replacement. I was like, “Yo, let’s talk about that!” He had a hip replacement – what does it look like to have a hip replacement? That’s a big deal. That’s a normal part of life when you get old, especially being an athlete.
We talked about the Mike Tyson and Paul fight – Mike Tyson is 58 years old. We have patients who just did hip replacements, and he was out there punching. We talk about those things and try to relate it to where people can say, “Oh wow, I can have a stent put in and still go back to work in two weeks? I didn’t know that!”
That’s life. A lot of times, the stigma of healthcare is like, “Ooh, don’t talk about it.” But everyone has a car – you have to change the oil, you have to change your tires, you have to talk about the car. So why don’t we talk about our car, which is our body? That’s the heart behind it.
Aaron: Does that same ethos or sensibility translate into the care that your caregivers provide?
Charles: Yeah. People won’t listen to you until they feel like you care about them – until they know in their heart, “Okay, you care about me, I’m going to listen to you.” A patient has to be able to understand before you walk in the door that this person has their best interest at heart. They know what they’re talking about, they’re skilled and professional, they have a good game plan based on what my doctor is saying.
Before you do any of that, you better have the best bedside manner. You better be friendly to them. You better help them understand that you’re here because if you don’t, you could be the smartest nurse and the smartest doctor with the best SAT score, but it doesn’t matter if you don’t have that bedside manner.
Aaron: I’ve been through hospice with family, and I would imagine there’s a point at which, when you’re sick, you just want to be treated like a person, not like a sick person.
Charles: Yeah. We had a patient a couple years ago who was a die-hard Cowboys fan. I had a buddy who worked at the Cowboys, and he was like, “Let’s get her tickets and everything.” She was so excited, but she passed away right before the game. But we watched the game at her house – it was cool. She loved the Cowboys, even though I don’t think they were doing that good at the time.
Working With Family
Aaron: I have to ask – I know you work with your wife and your mother. What are the challenges and the delights of doing that?
Charles: Oh man, both my mom and my wife are nurses. My wife is amazing, by the way. We went to school in St. Louis and that’s where we met. I was in PT school, she was in nursing school, and we were dating. All we ever knew was studying together. We would study some of the hardest classes in healthcare, going to the library – that’s all we did.
When we got married, we ended up working at the same hospital. She would be on night shift and I would be on day shift on the same floor. We just know how to work well with each other. Not everyone can work well with their spouses, but what I’ve learned is about tone. When you’re frustrated with work, I let her know it’s not her, it’s work, and I’m frustrated. Can I just vent a little bit? It’s a safe space.
We got this from a mentor of mine a long time ago – him and his wife were married for 60 years – every month without fail, we always go to a staycation or we go away to a hotel just for one weekend. The kids are watched by someone or my mom or a babysitter, and we just reset once a month. We’ve done that for 10 years, and that’s really helped us.
With my mom – you know, she started the business, and I’ve had to learn how to be humble. The ideas that I have – I’ve had to help her honor what she’s done for so many years and take that history and add my own flavor to it. You have to honor those who’ve laid down the ground before you. I’m constantly learning that. A lot of it is just honor and respect.
When a new employee comes in, if she walks through, I say, “Hey, this is my mom. She started the company and I want you to meet her.” It’s the honor factor. It’s not easy – I pray every day. I’m not kidding, man. But it’s legacy. Like I told you, it’s for legacy years to come. That’s why we do what we do.
Aaron: Yeah, that’s a great question. I can imagine it’s challenging. I would imagine there are times when it’s less clear that you’re the CEO and maybe more clear that you’re the son.
Charles: A hundred percent. Yeah, it’s totally humbling, but at the same time, the reason why I’m here is because I felt led – God led me to come and help my mom. So that’s why I’m here.
Aaron: That’s great. So what’s your vision for the organization? Where do you want to be in five years or 10 years or, forget the time horizon, where do you ultimately want the organization to be?
Charles: Yeah, this is year 21. I’ve been the administrator for eight years. I feel like I’ve probably been the administrator for two years because the six years was me learning everything and trying to figure out everything.
I think my vision for the company is a combination of what private equity can do and what I’ve seen it not do. I just want to be in Dallas. I just desire to be in Dallas, not expand outside of Dallas, but just saturate the market. When you’re talking about care, there’s only so much footprint that you can have in terms of the culture. When you’re talking about hospice and home health, it’s very hard to expand too broadly.
They say the next 10 years, Dallas is going to be like New York in terms of the amount of people moving here. So we’ll just take care of people here, provide good systems, good values, and that’s it. My goal is that it becomes a place where people know, years and years to come, even when I’m gone, that Charlin is a place where their mom and dad can be taken care of at any stage in life. That’s my heart. That’s my vision.
Definitely going to have to use some type of more investing, but the goal is that the primary ownership will be the family or the privately held company. That way the vision and those margins can be done healthily and not through a whole takeover, because I’ve seen the takeovers too many times and it’s different. It’s just very different. That’s my heart.
Aaron: Is there anything I haven’t asked that we should talk about?
Charles: I think everything was covered. We broke down home health, we broke down hospice. The dynamics of working with my mom and wife is a huge thing because I think people don’t understand how to run a family business. Man, I’ve learned a lot. I told JT and Tina, I’m definitely gonna write a book here soon because you have to do it in honoring of the patriarch.
Whoever started it is a big deal. If you don’t honor them, you can’t go anywhere. But then you have to be able to understand what was the purpose behind why they started the company. If it aligns with what you’re doing, then do it. But if it doesn’t, there’s some children that it doesn’t align with and they won’t work with the business. There’s no problem with that. It happened to align with me, and I was like, “Oh yeah, we could scale this now in a different way because the mission and vision is still the same.”
Aaron: I can imagine it’s pretty complex and delicate at times.
Charles: Delicate is the word, Aaron. The battles between my mom and my wife over the last several years have been very interesting, but we’ve all come out victorious, that’s the best way to say it.
Aaron: Well, having gone through that and hopefully been able to resolve those conflicts, I can imagine that creates kind of an efficiency, a shorthand in communication now so that each new conflict is resolved more quickly, resolved with less drama.
Charles: One hundred percent. I’ve learned even though I’m like, “Oh wait, wait, wait, I don’t need to be offended in this area. This is just her saying this, okay, cool.” It’s more emotional intelligence when you’re dealing with two women that you love – wife more than mom, cause that’s my wife, right? But at the same time, it’s my mom. So it’s about learning that dynamic of valuing all of their opinions but also making decisions based on that.
Aaron: Yeah, there’s this notion I’ve found helpful called neutral thinking. In any context, it means remaining neutral without necessarily having an opinion about what’s good or bad, or where things are headed. I’m going to remain neutral for as long as possible and consider the possibilities: that I’m totally wrong, that I’m totally right, or something in between. I’m still gathering information, and I’m not getting my ego or emotions involved – which is super hard to do. It’s a nice thing for me to try to anchor to, particularly when I can feel myself getting offended by something, to back off and say, “Okay, I got to remain neutral here.” When I’m really offended, I find there’s actually a better than a 50% chance that the person is saying something that has some truth.
Charles: I’m with you on that. Oh man. That’s a very good statement.
Aaron: Well, I really enjoyed talking with you. I appreciate it.
Charles: Likewise, man. Likewise. Thank you for your time.