I was working at JFK Airport in New York when the fire chief said “my wife and I have been having the same argument for the last 30 years”. The fact is problems exist everywhere. Most healthcare have the following two problems: staffing and missing appointments. For example, your caregiver does not show up for their visit and that will not change. If you are lucky, instead of complete no-shows, you get last minute caregiver cancellations. It goes something like this “my car broke down…” Of course, the excuse has to be reasonable. Something that can happen at the last minute just like they do not want to go to work at the last minute. The fact is their pay rate is low. For example, HHA most likely gets paid around $15 per hour and of course they are always struggling with their bills.

Get an Early Jump on Last Minute Cancellations

Here is the fact, you cannot increase their rate because if you do it for one person, you have to do it for everyone. Trust me, they all talk. Word of the new pay rate will spread within a day. What do you do? Use a software like On-call Ma to resolve this. Let them fight a computer that can talk to millions of people at the same time. Want to cancel your visit, not a problem. On-call Ma will find someone who is willing to work on that day. It solves the problem of last minute caregiver cancellations.

Patient and caregiver always will have their wants. Such as the patient needing a caregiver to live their life, using the bathroom, or getting their weekly food. Caregivers want to get paid more, but do not want to work for it. Even home care schools for certification have a hard time convincing their students to get the next certification such as CNA and increase their pay. Employers trying to figure out how we can come to a middle ground such as using On-call Ma. We all have problems, but somehow we need to meet each other in the middle ground. “My wife thinks that she won, but I know this battle is going to last until one of us dies. It is ok with me because I love her.”

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“I would have picked up another case if I knew I had a caregiver,” said the home care agency coordinator. Kit has been working in the industry for more than 15 years. She knows the ins and outs of the home care agency. Then there was I, who understands phone technology because I have been dealing with the phone for close to 15 years. The problem is clear, how can we find caregivers on the fly or in a short period of time.

Kit is not the owner of the company so she never looks at the problem from a business perspective. Of course, we can hire a recruiter to find a caregiver faster. Another option would be to increase caregiver’s hourly rate by an extra $1. I can guarantee you that with an increase of $1 for an HHA certified caregiver, you will have more than enough caregiver. Kit knows that $1 extra per hour makes a huge difference, but never asked herself why the business owner never increased the hourly rate or even asked herself what is Return On Investment (ROI) for a caregiver.

Computers solve repetitive problems, repeatedly

On-call Ma tackles this problem from the perspective of the business owner. That is, how can I increase my ROI? That is how can we increase my profit per case while keeping my operation cost the same or lower. This is where technology plays a big role. In my post – Computer Vs. CEO, give you some idea of what a computer is good vs. a human employee.

From my previous post, we know computers are good at doing repetitive tasks. In our case, are the tasks to find caregivers repetitive? Can a computer process this repetitive task? The answer is yes. In fact, there is a framework that can help to automate these tasks. In our case, the business process tasks. Automating business processes has been around for many years so it is something not new.

As I listen to Kit explain her process of finding a caregiver, we fall into many issues. If the problem was easy to solve then there would not be a problem. Each task has many rules and certain rules conflict with other rules. It is as if we are in an infinite loop. To make it worse, when we are introduced with another coordinator, their tasks and rules are different. For example, Kit’s would find all the caregivers within 10-mile radio using the CRM. Another coordinator may happen to know who is free to work. The difference is that Kit is working for a big caregiver agency and the other coordinator is working for a small agency. Now we know the problem really exists with the bigger company while in the process of solving the problem. Wonderful!


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“Are you listening to me?”. I go into auto-pilot and respond “yes dear, that is a good point”. Then my wife goes back to explaining something. I am sure many of us daze off sometime in our life, but that cannot happen when it comes to health care. As I work on On-Call Ma – finding on-demand caregivers, one of the problems I am trying to solve is monitoring after hour calls. More importantly, On-Call Ma must determine if should bring the the call to a supervisor’s attention.

There are many times my wife catches me “multi-tasking”. Personally, I am jealous of her sixth sense that detects and validates if I am listening. One of the ways is by asking “what did I say?” We can also validate if a call went well in the phone system world by doing a survey after the call ends. Usually, we ask at the beginning of the call if it is ok to call back for a survey.

Not All Call Surveys are Created Equal

The less question you ask the higher chance the client will finish the survey. It is important to follow the “don’t make me think” concept because the more work you force into your audience, the more resistance they will have and result in not finishing your survey. We can have tactics such as breaking down the audience in half so we can ask two questions and still get a high survey completion. It is important to not confuse principles with tactics. The principle concept, such as “don’t make me think,” must always be there.

I replied to my wife “you were talking about your students. Wow, you really care about your students.” My wife continues expressing her thoughts, which means she confirms that I am listening. In the phone system world, we take the survey data and create some type of algorithm or call survey formula that gives a number that we can understand. For example, you scored 9/10 on your quiz, and the passing grade is 6/10. This means we have to answer at least 6 questions correctly.

Call Survey Responses Have Their Own Formula

It is important to know that in each industry, the passing grade may be different. A delivery logistics company expects a higher call success rate, compared to a collection agency. One way to find the passing grade in an unknown industry is to get the average result for a few months and use that as a base. Here is an example with a two-question survey: “Would you recommend us to others?” gets a Yes response (pressing 1 for yes) 800/1000. The follow up “Did the representative answer all your questions” with a yes response 850/1000 where 1000 is the total survey completed. Any week if we exceed a 800/1000 ratio, then we are performing as expected or better.

I should admit that my wife usually knows whether I am listening or not. She has mastered all my tactics to cover up my answer. She certainly has higher accuracy than a survey. Artificial Intelligent Tone Analyzer also has higher accuracy than a survey. IBM Watson is an example of a Tone Analyzer. What this product does is use speech to text to convert a call. Then analyze the words to determine if the person has anger, fear, joy, or sadness. As previously explained, we need to come up with a call survey formula that gives us results such as anger is 100/1000 where 1000 is the total calls for 3 months. Then we can see the performance in real-time.

“Why did I marry you, I will never know”, that is the response I get from my wife when I fail my performance test – “what did I say?”. In the business world, we give a bonus based on performance. If the performance is below expectations, then we need to make changes. The same applies to getting a divorce. I am happy to say that I am not divorced :0).

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God said, “Let there be light”. In my previous posting, I talked about what a computer can and cannot do, such as come up with truly random numbers. The Terminator movie series attempts to explain the limitations of Artificial Intelligence (AI). AI cannot just figure out how the unique gift that God gave us, the right to choose, works. It is unpredictable and random on so many levels. The movie The Devil’s Advocate explains even God’s son, the Devil, could not predict the nature of human beings.

As I help develop On-call Ma, I face the problem of predicting scenarios to find caregiver replacement. There are many scenarios and randomization. For example, On-call Ma text caregiver if she wants a job. The caregiver decided to respond back 3 days later, but by that time we already had found a replacement. We have to teach our AI chatbot about predicting scenarios.  Teach it to send a “?” text after a few minutes to remind the caregiver to respond to us. There are factors such as motivation paying a major role. The post Caregiver: Where is my MONEY explains a little.

These challenges I face to solve on-demand caregiver replacement problems is one out of many reasons to give up. As I face one problem after another, I must remind myself that “Life Is a Journey, Not a Destination.”

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Outsourcing.  Remember when that was a hot topic? If it is not clear, COVID-19 gave a huge push toward remote working. As we all know, software development is the next generation mutation. The enforcement of remote work made new generation business owner re-think about hiring people outside of the country. Of course, many types of job is not possible to source for security reason, time zone issue, and so on. This type of job that can be outsourced remotely is listed on websites such as and These sites are for freelancers. Most of the jobs that are time-consuming and repetitive are more cost-effective to outsource to another country.

Here is the reality of outsourcing, just as the USA can outsource to other countries, other countries can outsource to the USA as well. A perfect example is Zendesk. I was recently introduced to Zendesk when I needed to upgrade my ticketing system. Zendesk stock publicly trades  in the US.  Compare this to Happyfox, not a USA company. In fact, they are based in India and are more expensive than Zendesk. I ended up picking Happyfox because they provide better customer service. The point is, a company is able to sell software at a higher cost when they provide a better service. The reality is that remote work will force our economy to take advantage of global resources such as outsourcing. We are not forced to do this in the past.

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One of Spock’s famous lines from Star Trek is “that is quite logical”. We are in a modern age where Artificial intelligence (AI) is mastering the art of logic. Many people do not understand AI, and even the programmers who are developing AI do not understand the logic AI producing. For example in On-call Ma software, we are using AI to determine if we need to find a caregiver replacement, we are not sure how AI is using the data to figure out when to start the process of finding a replacement. According to our statistics, we know the accuracy is improving over time. The more AI listens to the conversation between on-call coordinator and the caregiver or the client, the more it improves on to determine when a call-out or canceled appointment happened.

One of the issues that On-call Ma have that we as human beings also have is making an assumption. Sometimes we draw a conclusion based on listening to only part of the communication. For example, a caregiver calls in. They leave a message their car is not working and cannot make their appointment. Most coordinators know that caregivers usually use the car scenario to cancel the visit because they do not want to go to work. However, there are cases where caregivers would call back, state the car is fixed, and able to make the visit. By the time the caregiver notifies the agency of their status, On-call Ma already found a replacement.

This type of assumption can cause issues where the client feels they are receiving poor service. However, On-call Ma is still young and it has a lot of time to learn. As Spock would say “live long and prosper.”

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“Are you saying that if I could find a caregiver at the last minute, you are willing to pay half of your profit?” She replies, “Yes, because I am losing the money on the visit anyway.  If a caregiver calls-out or cancels the visit for the client, there is no profit”. That is one of the reasons why I started developing the On-call Ma application. Owners of a home care agency had a problem and were willing to pay for a solution.

Start and Stop Development? No Pain, No Gain

It was clear to me that the problem could be solved, but not sure about the details. As a system engineer, I am aware that creating software is like writing a story. We know what to write about, but we do not know all the sentences within a paragraph. In fact, we do not know all the paragraphs we need to write or the exact amount of paragraphs we need to write. It is a journey with uncertainty. It is important to mention that once we start the journey, we cannot stop. Either we come up with a solution or all the time spent is wasted.

Another way to look at the journey is the movie Sanctum made in 2011 and directed by Alister Grierson. The move is about “an underwater cave diving team experiences a life-threatening crisis during an expedition to the unexplored and least accessible cave system in the world.”

If there is a cave next to the ocean, any cave driver knows that underwater usually always has a path to the ocean. However, there are, most likely, multiple paths. In the movie Sanctum, one of the main characters, Frank, one thing is clear is that once you enter a cave, either you exit on the other end or go back. However, Frank’s cave driver team did not have the option to go back. Either they exit the other end or die. That is not far from the truth when it comes to software development. Either we stop development or release software.

Another knowledge to keep in mind is that software has a cycle. We revisit our first draft and modify the writing on the next round to make the story better.

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The feeling of a father taking his first son to kindergarten registration is something hard to explain. Any feeling is usually hard to explain because it does not match up with logic. We all know emotion and logic do not go side by side. That is not far from the truth when it comes to developing the software for years.

“Mylul, your father is taking you to school today.” I did not understand the smile of my father’s face, but I did feel his happy mood when he took me to school that my sister attended. My dad paid 500 taka for registration, which is about $7 dollars in the US. I am assuming it is a joy only a father could understand. One thing that was clear is he did not care about the money. Raising a child and developing software does have some similarities. It almost seems as the software becomes the programmer’s child. The same could happen in a job where the employee puts enough emotional effort into the work they do.

Software Developers following their Intuition

As I am working on On-call Ma for home care agency, I am beginning to see extra details programmers insert that I did not request.  Sometimes the programmer changes certain detail from the requirements. For example, the programmer may  feel a report is important and adds an extra tab to display it. Experience programmer knows very well that “no good deed goes unpunished” is common. That is because programmer awareness of emotion and logic become concert.

There was I toward the end of my kindergarten year where I was getting hit with a bamboo stick on my hand by my teacher because I did not do exactly what I was told to do like standing up when the teacher enter the room to show respect.

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“Matt, why do you have a cell phone if you never answer?” That is what I tell Matt, all the time. He always responds with “you call at the worst time”. However, he responds to all the text message I sent him. Sometimes right away. Statics prove that over 90% of all SMS recipients read a text messages within 3 minutes of delivery. It is also clear that texting is protected by FCC so it does not become the next voice broadcast.

There is one interesting difference between a phone call and text message. When someone makes a call, the phone system knows if the other end picked up, even if the answering party says nothing. By design, phone system technology confirms a connection between parties. However, that is not the case with texting. Texting was not designed to get confirmation if the other end received the text. You may send out 1000 text messages and receive confirmation that all of them went through, but that is not 100% correct.

Unfortunately, I learned the hard way when one of my previous bosses felt deceived when I told him that I texted him. He felt I was not truthful even after showing my phone screenshot. Later on, he apologized after receiving the text in the future. It is true that the chance of text not going through is very low, but it can happen.

Add your stories and comments, too! 👇

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