Part I: The Silence After the Phone Call
An older adult female is aging in an assisted living community right now, whose adult daughter calls her every Wednesday and Sunday.
The daughter asks how Mom is doing.
The mother says she’s “fine.”
They talk about the weather, about the grandkids, about nothing that matters because nothing that matters fits in a fifteen-minute phone call between someone drowning in guilt and someone drowning in loneliness.
After they hang up, both may sit in loneliness.
And somewhere in that silence, a caregiver from a private duty home care agency arrives.
And many times, they check the boxes – because it’s what the agency instructs.
All normal. All common.
The caregiver provides services. Then they leave.
The caregiver’s agency has a website that says “compassionate care.“
But the family, the daughter, the older adult in receipt of the care – they couldn’t even tell you the agency’s name if you asked.
Because the experience is so… average.
Nothing special, just… mashed potatoes.
Part II: The Research Has a Name for This
This is what the research calls a “casual friend” relationship.
Low affect.
Low intimacy.
Sporadic engagement.
No expectations.
It’s the neighbor you wave to but never invite inside.
It’s the gas station that happens to be on your route.
It’s the detergent you buy because it’s on sale, and you’ll buy a different one next week if the price is better.
Most Maryland home care agencies live in this comfortable space of mediocrity.
They don’t know they live here. They might think they’re building relationships.
And they may believe the perfunctory “compassionate care” emblazed across the hero section of their expensive website means something.
And they may think their families, their clients, who use their services, are loyal.
The families aren’t loyal.
And why should they be?
They’re just not actively looking for someone else yet.
Part III: The Uncomfortable Truth of Maryland Home Care
Here’s what I believe that most in the older adult, senior services, and healthcare industry wants to say out loud but cannot (for whatever reason):
Home care agencies have made themselves so unremarkable that the only thing left to compare is your price.
And then you wonder why families leave for someone who pays $2 an hour less.
They didn’t leave because of $2.
They left because $2 was the only discernible difference they could see.
That’s nothing more than a familiar… commodity.
Part IV: The English Teacher
I want you to sit with something uncomfortable.
Somewhere, right now, there’s an 81-year-old retired Montgomery County high school English teacher.
She taught school for 34 years.
She introduced three generations of teenagers to Shakespeare.
She wrote recommendation letters that helped so many young adults gain admission to colleges their parents couldn’t afford.
She kept a file cabinet of thank-you notes from students who came back years later to tell her she had changed their lives.
She has a master’s degree.
She has the most interesting take on Faulkner.
Her take on Hemingway is a different story.
She has a recipe for lemon cake that her mother taught her in the ’70s.
And the generic home care agency walks into her home, calls her “sweetie,” and asks if she needs help with her bath.
Do you understand what you’ve done?
You may have inadvertently reduced a human being with eight decades of accumulated wisdom, heartbreak, triumph, and memory to nothing more than a service recipient.
You’ve turned someone’s mother, somebody’s grandmother, into a task list.
And you’ve trained your caregivers to see her that way because you see her that way, because your entire business model sees her that way.
And it’s time to change.
The industry demands it.
Nothing less is acceptable.
Part V: What It Looks Like From the Inside
This is what a “casual buddy” relationship looks like from the inside:
The family doesn’t expect anything from you except that you show up.
They don’t call you when Mom has a bad day because it never occurred to them that you’d care.
They don’t tell you about Dad’s military service because you never asked.
They don’t feel anything when they see your invoice except a vague sense that this is expensive.
They will leave you the moment someone offers something cheaper, closer, or shinier.
And you will be confused because you thought you were doing a good job.
You were doing a job.
That’s the problem.
Part VI: A Daughter’s Grief
Let me tell you what’s actually happening in that daughter’s life.
She’s grieving someone who’s still alive.
Every Sunday phone call is a small funeral for the mother she used to have — the one who remembered her birthday without being reminded, who called with advice she didn’t ask for, who was the person she called when everything fell apart.
That mother is disappearing.
Slowly — in ways that are hard to explain to anyone who hasn’t watched it happen.
And the daughter carries guilt like a stone in her chest because she can’t be there every day, can’t fix what’s breaking, can’t turn back time, can’t be enough.
She hired your home care agency because she needed help.
She stays with your agency — because switching is exhausting and she’s already exhausted.
That’s not loyalty. That’s surrender.
Part VII: What Loyalty Would Look Like
Do you know what would likely lead the adult daughter to feel something about your home care agency?
If you saw her.
Not her mother.
Her.
If someone at your home care agency understood that when the adult daughter calls your agency to check on her mother’s caregiver’s schedule, she might be calling because she needs someone, anyone willing to listen, to tell her she’s not a terrible daughter.
If your intake process asked about her mother’s life, not just her mother’s limitations.
If caregivers reported something other than tasks completed — if they said “Your mom told me about meeting your father at the dance in 1967, and she lit up when she talked about it.”
That’s not a service.
That’s a relationship.
Part VIII: You Can’t Market Your Way Out of Your Problem
Here’s the thing about the “casual buddy” zone:
You can’t market your way out of it.
You can’t rebrand your way out of it.
You can’t add “we truly care” to your website and suddenly mean it.
Because families can feel the difference between a company that provides care and a company that cares.
They can’t always articulate it.
But they feel it.
And when families feel nothing, they compare prices.
And there’s really nothing more complex about it.
Part IX: What “Committed Partnership” Actually Means
The research says that “committed partnerships” are characterized by love, intimacy, trust, and the commitment to stay together despite adverse circumstances.
Despite adverse circumstances.
That means when you make a mistake — and you will — a family doesn’t leave your agency.
They call you.
They’re upset.
They give you a chance to make it right.
Because the relationship is bigger than any single failure.
Do you have a single client who would do that?
You might. I don’t want to be presumptuous.
Or would they post a one-star review and call your competitor?
Be honest.
Part X: An Honest Question
I’m going to ask you a question, and I want the home care agency industry to answer it before it keeps reading.
Don’t answer with your mission statement.
Don’t answer with what’s on your website.
Answer with what’s actually true.
Why should anyone choose you?
Not what services you provide. Everyone provides services.
Not how long you’ve been in business. That’s not a reason to choose you. That’s just a fact about your incorporation date.
Not your coverage area. That’s geography, not purpose.
Why should anyone choose you?
What do you fundamentally believe about caring for aging parents that you would defend even if it cost you money?
What do you believe that ChatGPT hasn’t written for you?
What makes you angry about how this industry treats older adults and families?
What would your grandmother think of how you run your agency?
Tell me that story. Because whatever else will pale in comparison.
If you can’t answer that — really answer it — then you understand why you’re stuck in the casual buddy zone with families and clients.
You haven’t given anyone a reason to like you.
And you have to do better.
Part XI: The Home Care/Healthcare Super Networkers
I need to tell you about something I see every month in Montgomery County. In Frederick County. In Howard County.
At nearly every healthcare and senior services networking event, every senior services mixer, and almost every “community partnership” breakfast in Maryland.
The same home care agencies.
At every event. Working the room.
The marketing professionals memorized the circuit; they’ve got it down to a science.
They show up. They shake hands. They hand out business cards.
They say, “We should grab coffee sometime.”
Sure, we should grab coffee. Okay.
They smile. They work the room. They leave.
And they bring nothing of substance to that familiar presence.
Repeat cycle.
I don’t mean they bring nothing physical.
Oh, they bring plenty, of course: brochures; pens; notepads with their logo; candy bowls; branded hand sanitizer.
All the gee-gaws and little knick-knacks that end up in a drawer or a trash can before the week is out.
I mean, they bring nothing real.
I don’t need another pen. It doesn’t make me feel anything. Maybe the pen writes well, great. That solved my problem at the moment. Thank you.
But a pen, no matter how nice it writes, tells me nothing about who they are and why they want to serve older adults.
Maybe it’s none of my business. Fair enough.
But the moment healthcare marketing professionals demand our attention, they make it our business.
And we’ve earned the right to demand purpose with presence.
That’s a boundary we have to draw if we want to elevate this industry.
Why Are You Different?
Here’s what happens when I talk to a lot of home care marketing professionals:
“So, what makes your agency different?“
Them: “Well, we really focus on quality care and matching the right caregiver with each client.”
That’s not an answer. That’s a word salad of nothing.
That’s what every agency says.
That’s the verbal equivalent of their website’s stock photo of a smiling caregiver holding an older adult’s hand.
“What do you believe about caring for older adults?“
Blank stare.
Then: “We believe in compassionate, client-centered care.“
They’ve said a sentence. They haven’t said anything.
It means nothing.
If you’re providing care for older adults, we need to know why.
Because it’s my grandmother and my grandfather, whom I picture as recipients of your unremarkable passion.
Yes, I’ve made it personal.
Because we should.
Here’s what you should know about me: I’m just an ‘ol Western Maryland boy with a public school education.
I’m nobody special. But I listen. And I listen very carefully.
Here’s what this ‘ol Western Maryland boy can tell you: you’re wasting everyone’s time.
You’re wasting your time driving to these events.
You’re wasting the organizer’s time who planned them.
You’re wasting everyone’s time who talks to you, and you walk away with nothing except a business card they’ll throw out.
You have been to forty-seven networking events this year, and you have not said a single memorable thing.
That’s… exhausting.
There is absolutely nothing that you said today that we’ll take with us, other than your familiarity.
And here’s what makes it worse: This is an industry that lives and dies on feeling.
Everything we do in the older adult, senior services, and healthcare industry is about how we make people feel.
It’s the terrified daughter. It’s my mother.
It’s the adult son who feels tremendous guilt. It’s my father.
The exhausted spouse. It’s my stepfather.
The older adult who’s scared of losing their independence. That was my grandfather.
This entire home care industry is emotional bedrock.
Why do so many home care agency owners send “marketing professionals” to represent them who cannot access a single authentic emotion on command?
Just because they can do the job doesn’t mean they should.
Who Trains Marketing Professionals? The Mid-Level Cogs?
I watch marketing professionals, development directors, whatever title, it’s all the same, and I think:
Who trained you?
Believe me, I’ve had direct supervisors who couldn’t find a coherent sentence if you gave them a spotlight and a magnifying glass.
And somehow, they’re still in charge of marketing professionals.
My God.
Who told healthcare and home care marketing professionals that “touching base” and “staying visible” are coherent marketing strategies?
That’s not a strategy.
Who told healthcare marketing professionals they should visit up to 10 different healthcare facilities a day for “presence”?
That’s why so many people left a particular Maryland home health agency.
I’m too nice to name names, but we know. We know who that one supervisor is who tracks down marketing professionals at their homes to make sure they’re hitting the 10 accounts they need to see a day, to check a box.
To enforce mediocrity like a prison warden.
Hey, Just Checking In!
“Just checking in!”
“We brought cookies!”
Why?
For what?
What are you checking in on? That you didn’t get a referral, and you think you deserve one?
Your cookies are store-bought; they taste generic and stale.
But go ahead and leave the trinkets with the front desk person, and make sure you log your stop in real time in your Zoho CRM so your manager can pretend to understand how to mine the data.
When you hire mediocre people, you’ll get mediocre results — especially managers.
Generic. Stale. Unthoughtful. Emotionally crippled.
These are the same managers and supervisors who send healthcare marketing professionals to bother busy case managers and social workers.
And they’re stealing those overworked folks’ time with unnecessary check-ins.
Please stop doing that. It’s a failure of critical thinking.
And who told healthcare marketing professionals that handing out fifty business cards at an older adult services breakfast mixer was the same as building fifty relationships?
Who told them that showing up was just enough?
Meaningless Familiarity
So here’s what I think happened:
Someone told the home care/health care marketing professionals that marketing was about “getting your name out there.”
So you got your name out there. You got it out there at every event in three counties.
You got it out there until everyone recognizes your logo; no one knows what you stand for.
Congratulations, Sport; you’ve achieved meaningless familiarity.
You’ve confused being known with being chosen.
Allow me tell you what the discharge planner is thinking.
“Oh, there’s [Agency Name] again.”
That’s it.
That’s the whole thought.
Not “I should refer to them” or “I trust them” or “They really understand what families need.”
Just: there they are.
Again.
You’re furniture.
You’re background noise.
You’re the neighbor she waves to.
And the worst part? You could be more.
You work in an industry where people’s parents are at stake.
Where families are making impossible decisions.
Where trust matters more than almost any other purchase a person will make.
You have access to stories that would break hearts and change minds.
You have caregivers who witness courage and love and grace every single day.
You have a front-row seat to what it actually means to age with dignity.
I want to be clear: I am not irritated at marketing representatives.
They’re doing what they were told.
They’re working the circuit because maybe their agency told them that’s how you “get out there.”
They’re saying nothing because no one ever gave them something to say.
No, my indictment is towards the executives, the agency owners; it’s the people who built these agencies and never bothered to figure out what they believed.
Because if you don’t know what you stand for, how do your marketing professionals demonstrate the necessary emotional intelligence to communicate the depth and gravity of the services you provide?
You cannot delegate your soul.
Here’s a challenge: Don’t attend the next networking event.
But instead, sit in a room with your team and answer this
What breaks our heart about how older adults are treated, and what are we doing about it?
When you have an honest answer — not a marketing answer, a real one — then come back to the networking circuit.
Come back with something to say.
Come back with a point of view that makes people lean in.
Come back with a story that makes the discharge planner put down her coffee and actually listen.
Or keep doing what you’re doing.
Keep showing up.
Keep handing out your business cards.
Keep saying “we should grab coffee.”
Sure, okay; we’ll grab coffee.
Keep being the neighbor everyone waves to.
Keep wondering why no one ever invites you inside.
Part XII: Why This Is Personal
My grandmother, Maureen, died this July after a 15-year battle with Alzheimer’s.
She was 92.
In her last year, our healthcare and care system failed my grandmother categorically.
Marketing professionals looked my family in the eye and lied to us.
Healthcare providers left my grandmother in darkness — sometimes literally.
The people who promised to care for her didn’t.
I watched it happen.
And I’m pissed. I can’t say it any other way.
And I’m not going to let it go.
Ever.
It’s my mission now.
I don’t think people understand what that does to you.
It doesn’t make you cynical.
It makes you certain.
Certain that when systems fail the people we love, we have to fix them.
Certain that someone has to say what everyone else is too polite or too tired or too complicit to say.
I’ll spend the rest of my life on this. Until the day I take my last breath.
Not because it’s a good business opportunity. Not because it’s a marketable niche.
Because Maureen Hann deserved better.
Your grandmother deserves better.
Your grandfather deserves better.
That generation gave us the world.
We have a sacred obligation to get it.
Part XIII: What I Believe
Here’s what I believe for healthcare and senior services professionals:
- That caring for someone’s aging parent is a sacred trust, not a service contract.
- I believe that every older adult has a story worth knowing, and that our job is to learn it and honor it.
- I believe that “compassionate care” is meaningless noise and that authentic compassion looks like remembering that Mrs. Patterson doesn’t like to be called by her first name because she was a high school principal for 22 years and she earned that title.
- I believe that the generation we’re serving put men on the moon, marched for civil rights, built the middle class, and taught us how to read.
- I believe we owe them more than task lists and fifteen-minute check-ins.
- I believe dignity isn’t a program. It’s a promise.
Part XIV: The Choice
You can stay in the casual buddy zone.
It’s crowded there.
Everyone competes on price.
Margins are thin.
Turnover is high.
Families leave, and you replace them, and nothing ever gets better.
Or you can decide that this work means something. That older adults and their families deserve more.
That you’re going to build something worth being loyal to.
But here’s the part no one tells you: You can’t fake it.
You can’t hire a marketing agency to manufacture a soul.
Either you actually believe something — something real enough to guide every decision, every hire, every interaction — or you don’t.
And if you don’t, families will sense the emptiness.
They might not be able to name it. But they’ll feel it.
And they’ll treat you like what you are: The neighbor they wave to. The gas station on the way. The detergent on sale.
Regular. Unextraordinary. The same as everybody else.
Is that what you built this for?
This essay is part of The Senior Soup’s series on dignity in aging.
If it made you uncomfortable, good. Discomfort is where change begins.
Ryan Miner, MBA | Co-Founder and Podcast Host | The Senior Soup
Hi, I'm Ryan!
I co-founded The Senior Soup Soup with Raquel Micit in September 2022. Together, we host The Senior Soup Podcast.
I am a community relations manager for Ennoble Care in Maryland, where I am responsible for marketing our home-based primary care healthcare practice.
I have over 15 years experience in healthcare, senior services, senior care, marketing, public policy, and search engine optimization.
I have a MBA from Mount St. Mary's University and a BA from Duquesne University.