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42. Bonnie Castonguay: "What We've Always Wanted Was the Ability for More Seniors to Have Access to Home Care."

42. Bonnie Castonguay:




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Hannah Trum: I'm Hannah Trum, and this is the HIPAA Critical Podcast.  Almost overnight, the pandemic changed telehealth and how our most vulnerable populations receive the medical care they desperately need.  As many Americans start to take care of their aging parents at home or through an elder care center, they find navigating the complicated world of HIPAA and the American healthcare system to be confusing, expensive, and daunting.  On today's episode, Paubox founder and CEO Hoala Greevy interviews Bonnie Castonguay, co-founder of Ho’okele Health, on the effects COVID-19 has on in-home care, the positive changes telehealth has brought to her clients and their families, and how easy Paubox has made HIPAA compliance for her company.  Let's take a listen.

Hoala Greevy: How's it, everyone? Welcome back to HIPAA Critical by Paubox. I'm Hoala Greevy, and I'm the founder and CEO of Paubox. It's been several months since I've been on the pod. 

Today I'm speaking with Bonnie Castonguay, co-founder of Ho’okele Health. I saw Bonnie at the Pacific Club here in Honolulu, where we caught up over an open-air lunch. I asked her if she wanted to be a guest on HIPAA Critical, and here we are. So let's get started. 

Bonnie, can you give us some background on yourself and your company's focus?

Bonnie Castonguay: Hello! Ho’okele Health started in 2006. My business partner and I were both executives at Hawaii Pacific Health. There are two reasons [we started Ho’okele Health]. 

One is, you know, she and I always have worked together on projects. And we said, wouldn't it be nice to start a business and maybe not work in corporate America? 

Two, as leaders in HPH, we oversaw four hospitals. And with that, we saw the difficulties families faced as they were moving or transitioning from an acute care facility back into the community, particularly for the seniors. 

That's what the genesis of our business plan was. And so we developed that in 2006. The first offering we came up with was called Ho’okele Navigation. And what that was, was, we took that name because of the old-time navigators, like Hokulea. The navigators use the stars and the wind and currents to guide themselves from island to island. And so we took that name in order to say that we would help individuals navigate the complex healthcare system. And that's what we started off with. 

Later we, in 2010, had the opportunity to open up a home care agency. So we started in O’ahu in 2010. We provide in-home services with nurse aides with companion level and personal care level. We are licensed for that since 2019. We opened up our Maui homecare agency in 2016; we had an opportunity for that. We had the opportunity to open up the home care agency on Maui in 2016. 

Early in our business career, we found that we needed a way to gather all of our information consistently as we hired more staff. So we thought we would go out and find the software to use, and there was none. So two women thought, well, how hard could it be? 

So we decided to build our own, and it took us till 2015 to get a product and a lot of angel funds and investments, but we're there. So we have technology as well as as a backbone to our businesses. So all of us use that as our electronic record keeping and also a repository for our documents. 

Hoala: That company's called iHealth. Is that correct?

Bonnie: It's called iHealth Home.

Hoala: What's it like operating in-home care services on two islands? 

Bonnie: That's a challenge. You know you deal with cultures as well. So Maui was running as the home care agency for, I'd say, two years before we took over. They had their way. It took a few years for us to systematize the processes across both the O’ahu and Maui so we'd have the same systems. 

Of course, they're using our platform, which is called CNS, the iHealth platform. We have a CEO over there who's an RN who runs it, and they’re excellent. We have one admin and scheduler who just rock. They run the entire business. What we needed to do was just have consistency and systems. 

Now, as we have a little bit more staff on O’ahu, we're able to now assist them with certain functions so that we're not duplicating. The HR systems that we use for recruiting, hiring, and orientation are now done by an individual for both islands. We're hoping to systematize even more and maybe having some scheduling. 

Staffing is always a problem, especially after COVID. We're finding that there's more of an outbound of our residents to the mainland now. They can't afford it, so they're joining families on the mainland. I think in Hawaii, it's projected about 30% of an outbound movement. And we're, of course, seeing it within the population of caregivers.

Hoala: How has the pandemic affected your business?

Bonnie: When the shutdown came on O’ahu, I think we went through a sort of like a grieving process of leaving our offices because you're so acclimated to that, and it was just closing down and bringing files home, going well, how is this gonna work? 

We use Microsoft Teams. We've started to use Zoom. As the months went by, we're quite acclimated. I usually write the policies, as far as you know, any health medical issues, because I'm the RN. I would allow it to open at this point in time safely, as long as we have the appropriate barriers, but most of our admin staff have decided Zoom virtual is okay. So most of us will go in once or twice a week, like myself, or for a meeting, but not more than five in a meeting. 

For the business itself, the need did not decrease. In fact, it increased because many families did not want to place one of their family members into a home at any point in time or nursing facility during this COVID. And many of them were bringing them home. Because of the outbreaks in nursing facilities, they felt safer bringing their families home. 

At that time, our hotels were locked down. Many of the hotel workers also have a background in caregiving, housekeeping, and all of that. We're able to tap into more staffing. We're able to maintain that during the pandemic and as things have opened up, and hotels have opened up in our staffing level. It's difficult again. Our challenge is recruitment.

Hoala: I noticed you folks have Ho’okele Neighborhood Care. Is that related to what you're alluding to about things that are happening in the pandemic?

Bonnie: Yes, yes. 

Actually, the genesis of that was we have been doing what I call very short shifts. Normally you have a minimum in the homecare industry of anywhere between two and four hours. That's required as basic because you're traveling, and you're having a nurse travel and go to a home. 

So we've been doing it since probably 2012 in a retirement community where we can go up and down buildings and do 30-minute shifts. That's a scheduling challenge. We've gotten the algorithm for that. What we've always wanted was the ability for more seniors to have access to home care. 

Number one, number two is because of staffing, we thought could we create neighborhoods, or pods/regions on O’ahu, where we could get a car, place a Nurse Aide in the car, and provide services within that neighborhood. 

For the Nurse Aide, we looked for a higher level and a lot of customer service skills and initiative because they would have to be able to critically think because they're going to be managing a group of clients, and they would be driving from home to home and just providing the service that's required or the task. So there were no minimums. 

For the Nurse Aide, it was a higher pay, and it was a car. It was 40 hours, very attractive, so we're able to recruit quite a bit, a lot more into our neighborhoods. We started off with three neighborhoods; we wanted to go out west because, for my navigation services or care coordination services, I found many of the west sides, families weren't actually wanting to spend money on home care, so they take care of their family members. 

So some of them would even set them up for breakfasts, and then go to work to come back for lunch, and then feed them, give them their meds, make sure everything's okay. And they go back to work. Well, there came a point where they burn out, and at night, if they have dementia, they’re probably up at night. So family members would say, I can't manage this anymore. And so they start to place [within the elderly care system]. That's where I'd get involved. 

I noticed that a lot of them were on the west side. So we started the services on the west side. So we started for three neighborhoods, and now we have seven.

Hoala: I really liked the way you took that opportunity and made a different revenue channel out of it. I think that's very interesting.

Bonnie: You know, there are no minimums. In actuality, per hour, it's a little higher, but when you look at it, on a monthly basis, it's much cheaper than the traditional. So if you don't need a lot of those hours, you don't need a Nurse Aide there for four hours; you just need an RN there for 20 minutes to make a meal, shower, meds or do a little bit of housekeeping. That's enough. 

So what you can do is start services a lot earlier with the seniors. You have extra eyes in there to triage issues, and so they can stay home a lot longer. Then you have the consistency of the staff member. So you'll always see this person, and that helps a lot with individuals with dementia. It gets very confusing when they change staff.

You have happier staff. And the reaction we're getting from the community who have experienced neighborhood care is very, very positive. 

We think it's a great innovative model that we'd like to expand here on the islands. Next, of course, would be Maui; once we're successful on O’ahu and building there, then we'll go to all Maui would be the next Island and hopefully the other islands as well. Then off to the mainland.

Hoala: Yeah, California is the largest population. I think it's the closest state by a distance even though it is a far distance. 

You folks have been Paubox customers since our early days, back in 2015. If you can remember, what was your workflow was like before Paubox?

Bonnie: Before Paubox? God, we were so worried, you know, when we started Paubox in 2015. So, we had the home care already but mainly our nav. What was happening a lot of times as we're dealing with clients with both of those business entities coming back from facilities, hospitals, rehab centers, nursing facilities, we still do, but at that point in time, a lot more of the communication, because you couldn't do it over email and save a lot of things that we knew that so we would do a lot more calls. And then, if documents had to be shared, it was by fax.

Hoala: I understand you folks were using code names to get around the PHI trigger. And I thought that was very interesting at the time. Then as we got to get more customers, I would hear it pretty often. Staff forgetting the code name of the patient and getting them mixed up and all this.

Bonnie: Especially if you're dealing with a volume, right?

Hoala: Yes, yes. And then, so can you tell us more about what your workflow is now with Paubox and our HIPAA compliant email solution? 

Bonnie: So much easier. We can communicate very confidently over Paubox. It’s so transparent. It's just part of our whole life right now. We share documents that way as well and feel really good about that, as well as our own technology, which is totally safe encrypted. We've passed all the HIPAA requirements. So we're able to do a lot, but Paubox is very seamless for us. 

Hoala: What do you think is the, now that we're starting to come out of this pandemic; it's mid-April, well, fingers crossed. What do you see as the future of your business?

Bonnie: Future of our business? I think several things have come about that I don't think will go away. 

One is, I think, will be a hybrid business. So that means that we will have people who want to be in the office, who can be in the office like our scheduler has been in the office from the very beginning. She has the equipment and things that she feels are more accessible to her. 

I think maybe one or two others will decide that they prefer to be in the office, but many of us will be hybrid, will work from home virtually, and then spend some time that way. That's one. 

Number two is for our clients. We've had to do a lot of telehealth, for me, too, with my own physicians. I'm happy about that, too. It's a long time coming because that's always been a possibility. 

However, for someone who's 88, 89, or 90 years old, can you imagine how much it will take for them to get out of their house with a walker, with a wheelchair, be transported to the doctor's office, and then visit the doctor and have a wait time and then come home. They are pooped; they are tired. 

So they usually do like a quarterly visit where maybe you can see the doc twice so that he can really examine you, listen to you, and all of that unless something's happening, that you need to be seen physically. I think telehealth works really well. So I think I see a lot of that.

Hoala: Yeah, I agree with the elderly patients, especially in the rural settings, which I think, if I'm not mistaken, most of the neighboring islands would be classified as rural. I think telehealth is a slam dunk for growing populations. 

Bonnie: In fact, you can do remote monitoring, you know, blood pressures or other stats. Everything can be linked in now. As long as everything's encrypted and safe, you can pass that along as well. Many times we're able to pass on some information prior to a doctor's visit, especially a telehealth visit, and they're looking at that data.

Hoala: Finally, what gets you fired up in the morning? What gets you excited these days?

Bonnie: What gets me excited? I think the passion is being able to provide great services for our clients, and that excites me. I still have a client basis smaller, and I have nurses who work with me, of course, for the navigation side of it. But that’s, that's my passion. 

And growing this business and neighborhood care. I think neighborhood care is a new way of looking at homecare, that that can be beneficial for both sides, one for the home care agency from staffing side to provide it to more seniors, and then the seniors themselves will have more consistency and quality that you look for because you have a consistent caregiver who knows you well and becomes a sort of like a family friend to you. And that's what we're seeing. A neighborhood is a great name for it because it's like neighbors.

Hoala: We've got 10,000 Americans retiring every day, which puts burdens on the health care system, which then causes more people to work in the health care system. And this neighborhood programming folks have built, you're essentially making it more affordable. 

For example, they may not think they could afford it because, for an outsider like me, that's for rich folks, right? If you can make it for the middle class and affordable, they're not spending three hours a day driving [to give medication]. Now, I really like that.

Bonnie: That's the population we're gearing for. See, because the poor have Medicaid, right? The ones who don't have the financial wherewithal have Medicaid, and then you have those who have the disposable income who can afford it. So Medicaid has always paid for community long-term care, sort of services like home care. 

But what's coming up now is Medicare, and they're looking at Medicare covering some of these home and community-based services. Now, you haven't seen a lot of everybody jumping into that because they can see Pandora's box and the cost for this. So they've kind of poked your toes in it and said, Okay, well, maybe we'll do a little bit of this, but I haven't. I haven't seen the full growth of it. But the Medicare Advantage plans, are they have a timeframe in which to go ahead and implement this type of coverage.

Hoala: Bonnie, any last thoughts or observations?

Bonnie: We enjoy Paubox. We're longtime customers. And we'd love to see any of your new enhancements.

Hoala: Bonnie, I want to thank you again for being a guest on HIPAA Critical

Bonnie: Thank you. 

Hoala: It's been a real pleasure. Thank you.

Hannah: For more information about HIPAA compliance, telehealth, or email encryption, head to for articles, guides, and educational pieces to help your organization level up at cybersecurity.  Mark your calendars. Our next free webinar will take place on June 2. Our panelists include Travis Taylor, account executive at Paubox, and Tony UcedaVélez , CEO and founder of VerSprite, will sit down to discuss the ever-evolving threat landscape and healthcare.  This webinar will be moderated by Paddy Padmanabhan of Damo Consulting.  If you'd like to attend, please send me an email at or head to Have you attended one of our Zoom social mixers? Every month our customers and noncustomers get together to share their experiences, career advice, and cybersecurity tips over a free adult beverage of their choice that's delivered to their door the day of the mixer.  If you're interested in attending, please email me at , and I will get you registered.  Here's Tony Cox, CIO of Henderson Behavioral Health, answering an attendee’s question, “How do I demonstrate the value of Paubox to the C-suite of my company?”
Tony Cox: Are we lucky that our 700 users didn't click on something? Or can we point to Paubox screening those things out and filtering that inbound? You know that inbound security working is the reason why none of that stuff is happening.
Hannah: As always, you can listen to every episode of the HIPAA Critical podcast on or subscribe via Apple Podcasts, Spotify, iHeart Radio, Stitcher, or Amazon Music. Thanks for tuning in to another episode of the HIPAA Critical podcast. I'm your host, Hannah Trum, signing out. SEE ALSO:  HIPAA Compliant Email: the Definitive Guide

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