Healthcare SaaS & Operations: GPS Tracking, Franchising, and AI-Driven Care

[00:00:16] Ghazenfer Mansoor: Hello, and welcome to Lessons from the Leap. I’m your host Ghazenfer Mansour. On this show, I get to sit down with entrepreneurs, founders, and business leaders to talk about the bold decisions, pivotal moments, and innovative ideas that shape their journeys. This episode is brought to you by Technology Rivers.

At Technology Rivers, we bring innovation through technology and AI to solve real world industry problems. We primarily work with healthcare organizations, helping them create HIPAA Compliant software, products, web and mobile apps, as well as working with healthcare service businesses, helping them improve operations through AI and technology that includes clinical workflows, automation, and AI agents. 

If you like to learn more about us and over to technology rivers.com and tell us more about your project today on lessons From the leap, we are joined by Ramzi Rihani, a former music critic, playwright, published author who went on to co-found and scale Options for Senior America, a premier home healthcare organization that operates across 15 states before returning to his passion for writing.

Ramzi , welcome to the Lessons from the Leap. Tell us, who you are, your background, anything you wanna tell. Give us, give our audience some background. Sure. And then we’ll go from there. 

[00:01:39] Ramzi Rihani: Thank you Ghazenfer for having me on the show. I was born and raised in Lebanon. , and I went to school and then I went to university, the American University of Beirut in Lebanon.

And then I moved to the states to pursue graduate studies and to work and since then I’ve stayed here. , before I came here for about four or five years, and then I took a trip, I took off for six months, took a trip around the world and published a book, a travel book..Came back here and in 1989, I started a company called Options for Senior America, which is a home healthcare group to provide home care for senior citizens in their own homes.

[00:02:29] Ghazenfer: Thank you. So, what year did you start that business? 

[00:02:32] Ramzi Rihani: 1989. 

[00:02:34] Ghazenfer: 1989? 

[00:02:36] Ramzi Rihani: Yes. 

[00:02:38] Ghazenfer: So since 1989. For, for 35 years, you primarily focus on that. Can you share more about the journey? , of the Options. 

[00:02:49] Ramzi Rihani: Absolutely, mind you Ghazenfer my background is not in the medical field. My background is in management and organization behavior.

, in 89, 19 89, , my mother was in Washington and she was in a wheelchair. We needed home care for her. , around the clock by way of a live-in nurse. And at that time we called all the home care companies in the Washington Metro area and none of them could provide this kind of service. So we thought there must be a niche in the market.

I mean, I’m sure there are a lot of people who are wheelchair bound who are fully dependent on another person. So I was surprised that that service was not offered. So we decided to start a company and provide the service and sure enough, the minute we announced that we provide live-in care, that means 24/7.

The aid would be with the person who is taking care of 24/7. We were getting calls from 50 miles, a hundred miles and 150 miles away here in Washington. We are getting calls from Baltimore, from Richmond, Virginia, all the way. And we knew that that niche needed to be filled. And the growth path of the company at the beginning looked like a vertical line.

You know, we were growing at the rate of a new office, a new territory every 18 months. So this is how we started the company. This is how we grew it. There was a niche in the market and we hit it at the right time, I guess. 

[00:04:27] Ghazenfer: Cool. And. You grew the business to 15 states, what were the main hurdles that you came across when it comes to growing through these multiple locations, multiple states?

[00:04:42] Ramzi Rihani: We are located in Montgomery County, which is a suburb of Washington DC in Maryland. And as we grew, we felt the need that if we want to operate in say Leesburg County in Virginia, it’s hard to fulfill it from Montgomery County, so we need to have a presence in Leesburg, Virginia. Same thing in Richmond, same thing in Baltimore, Delaware. You know, we started growing. We went to Cleveland, Ohio. We, we, we started growing, , to Florida. We started growing and, and providing the service in different places because we knew that there was a niche. If there’s a niche here, there’s a niche everywhere for people who are wheelchair bound.

For either physical or mental condition. And we needed to provide that kind of care. So the growth was a very natural growth. It’s just a matter of need until such a time. In 2005, we decided to franchise it because we developed a program that is very duplicable and scalable around the country. And at the time we consulted with the three gurus of franchise in the country.

And they looked at our training program that we had devised for our own managers, and they told us, you guys are ready to franchise because you have a training program developed and tested and successful. And that’s the main need for franchising. So we started franchising in 2005. And again, more states were covered through our franchises.

[00:06:20] Ghazenfer: Oh. As you are growing this, I’m sure the tech played a big role in that. So how did your company use software to track those complex logistics of home care across multiple states? 

[00:06:34] Ramzi Rihani: Sure, of course. At the beginning, in 1989, we’re not using any software. I remember the first person we interviewed. I had a piece of paper, , in the living room of our house and, and What’s your name?

Write down the name, you know, and, and write down all the information on our cv as we progressed further, we started with a very basic software program, which was Microsoft Access at the time. And we used that until such a time that we, , got more and more and we made it a, , program that is, , based, , , you know, that’s a live program that people can use from anywhere that you don’t have a computer, you can just log in and and use it and this is how we grew the program. 

[00:07:21] Ghazenfer: Oh, Microsoft Excel still works great, a lot of people are still using it. 

[00:07:26] Ramzi Rihani: Yeah. 

[00:07:26] Ghazenfer: Maybe a cloud version now, but it still is one of the most commonly used tools in every company. I would say 

[00:07:35] Ramzi Rihani: about 10 years, 15 years. Yeah. 

[00:07:37] Ghazenfer: Yeah. Cool. Yep. , so I think now from tech, we’re also now into AI.

And then everything is being impacted. How do you see AI is impacting your industry? 

[00:07:57] Ramzi Rihani: Sure. AI will definitely have a big impact on the industry, specifically when it gets to the back end of it, the, the, the, the work that is done. At the office by people either software programs or scheduling nurses or you name it.

Anything that is done manually in the office AI can take over and, and improve the system. The only place where AI cannot touch is when it comes to the hands-on care that is provided in the comfort of their homes when the nurse is caring for an elderly person. And the care includes things like feeding and, and you know, toileting and moving from wheelchair to bed, then AI cannot touch that. You still need a han to provide care for another han. 

[00:08:55] Ghazenfer: So, , and how do you make sure that hanve experience, obviously as you’re working with these patients, they need a lot more personalized care than like any other place I would say any other type of service. So how do you make sure your team is providing the care that patients need and they’re excited about?

[00:09:20] Ramzi Rihani: That is a very, very key question, and that’s where the key operation is. , we can sit down and promise a new client, the world, , and at the end of the day, we’re as good as our nurse or as bad or as the nurse that goes there, everything is basically gonna be judged by the performance of the nurse. And this is why we take a very keen and dedicated screening process that we train all of our care coordinators who hired the nurses , a very elaborate training process that is a 13 step training process step by step.

Until all of the steps are covered and we believe we have the right nurse,  do we make mistakes? Of course, sometimes there are mistakes, but at least we knew from the 13 step program that we developed throughout the years that we apply in recruiting nurses, that we can reduce these mistakes to a very, very bare minimum.

So also, we have feedback from the families that we serve. And the feedback is computed on a quarterly basis. You know, hundreds of families. We have a questionnaire or three page questionnaire covering all aspects of the service from the quality of the service that the nurse is providing.

Quality of the service that the back, , , background offices are providing the, , punctuality of the nurses, the attitude of you name it, , you know, everything. And we compute these, , on a regular basis. And for the last years, we have been running an average system, average rating. On a scale of one to five, we’ve been rated between 4.4 and 4.8, which in our industry is extremely, extremely high because anything can go wrong any minute, and you’re gonna get that one point rating out of five that would reduce it to, to less.

But we were very proud that the feedback from the families that we serviced, , was keeping us in the top. Four, , rating 4.5, 4.7. A couple of times we hit 4.8 and 4.9 quarters to evaluate our program. And this is why when we moved to franchising, we received many awards based on the quality of services that Options is providing.

And many of the awards were based on. Family ratings, you know, that are rated on the internet, on Google and other places. 

[00:12:15] Ghazenfer: Awesome. No, thanks for sharing that. That’s so great. So Options is described as a premier group. So in this crowded space, and you talk about it, the quality, getting all those awards, but how did you use innovation to keep your brand at the top in all these years? Are there any specific things you have done? 

[00:12:38] Ramzi Rihani: Right. I think the main thing, as I mentioned before, Ghazenfer is ensuring that we are hiring the right people. Again, we can have the most sophisticated software program in the background, in the, in the office as a support program. We can have the most sophisticated schedule program and all of that, but at the end of the day it is the nurse that makes it or breaks it now.

Software wise, we created something. We developed a program for our own use. For example, I’ll give you just a small example. Before we developed that program, we were relying on the nurse going into the house and to check in. She would have to call, not from her cell phone, from the landline of the family where she’s to say, I’m checking in at Mrs. Smith, it’s 8: 45 and when she leaves, I’m checking out. It’s so and so. And from that telephone as we progressed and cell phones became the main mode of communication, we did not want to rely on a cell phone because someone can be in The Bahamas, say, I’m, I just checked in at Mrs. Smith in DC and you can’t tell. So we developed a program whereby each cell phone that is used by a nurse. Has a built-in GPS that kicks in at 15 feet from the house where she’s entering. Once she enters the house, it’s live and we can tell, you know, when she entered the house. This has been very good in maintaining punctuality, for example, of the nurses, and it becomes a legal doctrine in case there’s an issue.

There’s a legal record that this nurse was at this place at such and such a time. So all of these, you know, programs that we developed internally and specifically exclusively for Options were very attractive at the time of selling Options and, and attracting franchises as well. That this program was, you know, a state of the art compared to what was available, , in, in, in the market at that time.

[00:14:46] Ghazenfer: Well, no, thanks for sharing that. So many entrepreneurs struggle with imposter syndrome when switching industries. Did you feel like an outsider coming from an arts background into healthcare? How did you overcome that? 

[00:15:02] Ramzi Rihani: Well, my background professionally is not in the arts. That’s, that’s my heart, is in the arts and music and, and poetry.

My professional background is in management. And , organization behavior. And you needed that in a home care atmosphere. Yes, we are not medical people, but we are not providing the care ourselves. It’s the nurses who are providing the care. So the key thing is how to recruit and manage the nurses.

That’s how we train our, , new office, new branches, new managers, and this is how we train our new franchisees. It’s a matter of managing your human resources. If someone excels at that, you are likely to succeed. If someone cannot do that, you are likely to fail.

[00:15:50] Ghazenfer: Thanks. , if, if you were starting a healthcare company today in 2026 

[00:15:58] Ramzi Rihani: mm-hmm. 

[00:15:59] Ghazenfer: What is the first piece of technology that you would invest in? 

[00:16:03] Ramzi Rihani: I definitely would get a, , the best available software in the area, in, in the field that has to do with recruiting and scheduling care providers. , which is, , it’s easier said than done because people can say, well, there’s so many programs out there.

Yes, so many programs, but a little difference makes a big difference in this field because at the end of the day , you are providing. A han to provide service for a han, anything can go wrong. If that person is only 30 minutes, some major issues could happen. That person needed to get out of bed, and the nurse was late 30 minutes, she could see that person cannot get out of bed. So things like that. So we would focus on what is the most comprehensive state of the art program, a program that gives you minute by minute. , you know, not control, but, but knowing what’s going on at the house of the care recipient and where the nurse is at all times.

[00:17:10] Ghazenfer: Okay. So, and if you were to start a new business now, would that still be home healthcare the same, or have things changed since you started 35 years ago? Where do you see the future of home healthcare going? 

[00:17:28] Ramzi Rihani: Home healthcare goes parallel and hand in hand with institutionalized care. When I say institutionalized, it could be assisted living facility, independent living facility or nursing home but it has been known and, and recorded, Ghazenfer that people. 

A lot of people, not everyone who is an independent living facility really should be in an assisted living facility. And people who are in assisted living facilities really should be in nursing homes. And people who are in nursing homes really should be in hospitals.

So people stay where they are and their physical and mental condition deteriorates at the age of 80, 85, 90, and then they stay and they drag the time of the family. Before they move to the next institution, if someone is in good mental condition and that’s the only key, then they’re always better off at home rather than assisted living facility or independent living facility or nursing home.

The only time where they should go to the hospital is when home. The nurses at home, of course, cannot, medically cannot , provide that service. Now, if someone is, has full blown Alzheimer’s. Then being at home or being in an assisted living facility is the same because they don’t know any difference. But we’ve seen many people who are in good condition, mental condition, but not good physical condition.

Their family took them from home, put them in an assisted living facility, and soon enough, their condition deteriorated. You know, they start going downhill very quickly. We recommend bringing them back home. Once they brought them back home, soon enough, their condition improved because it’s normal.

People want to be home. I’ve been to some of the most luxurious assisted living facilities. Really nice. I think I wanna live there, you know, but if I give you a free ticket to Ghazenfer to be at the four seasons of the Best City, you’re gonna enjoy it one day, two days, one week, maybe two weeks.

But you can’t enjoy it for the rest of your life. Who wants to live in a hotel for the rest even though it’s luxurious, but you cannot, you, you as a han, you’re not gonna enjoy that. You need your own thing. You need your own pictures. You need the family pictures. You need your own bed, your own sheets, your own cutlery, your own.

You need to be home. Nothing is like home again. The prerequisite for that is that someone is in good mental condition. And we’ve seen that, and this is where our program comes very, very handy because of the live in program. So even if someone wants 10 hours of care a day, we can provide that care and keep that person at home in their own home rather than move them to a facility.

And this is where you make a differentiation between institutionalized living and living at home. The only place that we believe institutionalized living is, , is justifiable. If someone has full-blown Alzheimer, they don’t know the difference between this and that. 

[00:20:53] Ghazenfer: This is a really good point. A really good point. Yeah. Home is home, so there’s nothing better than that. And that also, I mean, even the social part, like the family having their own kids, grandkids, that makes a huge that’s more than half the battle. 

[00:21:09] Ramzi Rihani: Absolutely. Absolutely. 

[00:21:11] Ghazenfer: Okay, lastly, what is one hard truth about scaling a service business, , that you wish someone had told you in 1989 when you were starting 

[00:21:23] Ramzi Rihani: The one challenge, I don’t wanna say hardship challenge, when we were growing our business organically before we start franchising is the one major challenge is hiring the right person. I’m talking at the office, not at the nurses hiring that manager in that office that is away from the corporate office, whether 10 miles or 600 miles, whether in Cleveland, Ohio, or whether in Baltimore, Maryland.

They are still operating on their own. We train them and we give them support from the corporate office. But when you hire a manager, you stand 50, 50% chance that that person is gonna work out or not. And you only can tell after two, three, sometimes four months, you can’t tell from the first day. So if they’re not the right person, you’ve wasted three, four months and then you start again with another person where again, you, you stand the chance of 50, 50%.

So this is the main challenge. If you have, and we’ve seen it. So crystal clear that an office that is successful, , we’re  not to get the credit, is the manager who gets the good. Yes, we train the manager and we give them all the support, but a day-to-day operation and an office that’s not successful is the manager who did not follow the system that was offered to him or her. So that’s the thing. 

[00:22:50] Ghazenfer: Okay, so I’m gonna switch gear to your book. So you, your new book that just came, , it’s Scenes From a Dream. What is your inspiration? Can you talk more about this one? 

[00:23:07] Ramzi Rihani: Yes. This has nothing to do with Options for Senior America. These are poems that I’ve been writing and publishing in different magazines and poetry magazines and literary magazines.

The country as well as in different countries, UK, Ireland, , Belgium, Romania, , India, China, , South Africa, Canada, , but mostly in the United States. And , you know, I started sending these poems and they were published and I was told. Why don’t you put them all in a book and publish them in a book, and this is why I’m doing it now.

And the book is slated to be published, , and available on Amazon as of next March as you know, we just, , the publisher just finished composing the book cover and it’s a collection of poetry books and has four sections. One on love, one on reflection, one on war and peace and one scene from life.

[00:24:18] Ghazenfer: Interesting. Thanks. Thanks for sharing. Then you, you also wrote, , the other color after a six month journey around the world. Can you talk more about that and how did that global perspective influence how you build businesses in America? 

[00:24:34] Ramzi Rihani: That was a while ago. I was in my late twenties then. I was working here in Washington, DC nonstop, , taking one day off per year, which is Christmas day. And then I thought, this is getting too much, , I need to take off. So I took off for six months and went around the world. And at that time I was writing for one of the major newspapers in the Middle East called Nahar Newspaper.

I was their music critic at that time. So the editor told me, since you’re going, why don’t you write to us from where you are? Just write us your impressions on your trip. And I thought, okay, you know, I’ll write them. I don’t, I don’t think they’re gonna publish them. And sure enough, the first article that I wrote, they got published, the second got published, they published them all.

And when I returned, they told me, we’re gonna publish them in a book. We need your approval. I said, sure , no problem. And it was published in a book called The Other Color, and the trip concentrated in, , was a Washington to Washington trip. At that time, Pan-American Airlines had two tickets. One number one, one, number two, number one goes around the world this way, east to west.

And number two goes around the world, west to east. So I took number one, which is east to west, and I went from Washington to Europe to the Middle East and concentrated on Southeast Asia. You know, Iran, Pakistan, India, Nepal, Thailand, Myanmar. At the time it was Burma. It was just open to the, to the.

To the tourists. You know, I was one of the first who were in Burma out of nowhere, and they’ve never seen anyone out of Burma coming into the country and all the way southeast Asia to Australia. Went around the world from the other side, knew Caledonia, Haiti, Hawaii, LA, and back to Washington. So that was the trip.

[00:26:39] Ghazenfer: Oh, that seemed like an interesting world tour. Cool. So what’s next for Options and what’s next for you? I mean, you, you are retired but can you just still talk a little bit more? 

[00:26:52] Ramzi Rihani: We sold Options for Senior America in 2024 April, 2024. , we had had many offers during the last five, six years.

But a lot of them were from companies,  you know, private investors who wanted to buy a company, build it up for two years and resell it. We did not want that. We wanted people who bought it, owners, operators, and we lucked out with two gentlemen, who moved? One from Pennsylvania, one from Colorado, moved to Montgomery County, , when, when they bought the company and they operated their owner operators and we are still in touch with them on a regular basis if they need anything.

They got our support , and they’re doing great. 

[00:27:44] Ghazenfer: Awesome. Thanks a lot Ramzi . This is a really good insight. So thanks for your time, a lot of nuggets for our audience. , one last thing before we hang up, I mean, how would the audience, if anybody wants to get in touch, any advice? Do you have any ways people can connect or do you wanna send them to Options website or how 

[00:28:11] Ramzi Rihani: For people who are interested in home care, yes, I would encourage them to go to Options website, which is Options co.com. On a personal level, they can reach out to me. I’m perfectly all right with that. If they want to talk about poetry, music, you know, that’s, that’s my thing. Yeah, 

[00:28:30] Ghazenfer: we, we can include your LinkedIn, , link, , with our podcast. Yes. So 

[00:28:35] Ramzi Rihani: LinkedIn would be the best place. 

[00:28:37] Ghazenfer: Cool. Cool. Thanks a lot. Thanks for being on the show. It was great to have you. 

[00:28:43] Ramzi Rihani: Great talking to you guys. Take care.