Founder lived in a nursing home for 3 months to get his start-up off the ground | Hacker News Reader

Founder lived in a nursing home for 3 months to get his start-up off the ground

msn.com

207 pointswhocansay82 comments

Pretty shrewd "put up or shut up" offer by the nursing home owner. The healthcare industry is infested with rent-seekers and schemers angling to secure for themselves a thin slice of CMS or health system spending on the flimsiest of claims. A founder--with a strong background, even--who will live in a nursing home's conference room for weeks or months to prove his product's value is a world apart from 99.9% of the field.

He had direct benefit to the nursing home, and used them for use-case validation to better work product.

So the general model is, if you have a smart idea for e.g. fender-bender companies, and want to workshop it... cold call repair shops and be prepared to proffer something they value in context, to justify the engagement.

His particular use-case had residential qualities. Many ones won't have that. I guess you could ask to put a hammock in the spray booth, but if you've seen "blue collar" you wouldn't want to do that (somebody dies in there)

“Direct benefit to the nursing home”

That’s the problem with this in my mind. I saw the process that kicked into motion when my father had a stroke. Acute rehab is what patients need, but hospitals work hard to funnel patients into their in-network nursing facilities that offer half the therapy at higher margin.

Having doctors video into a patient home doesn’t sound like a recipie for success. Nursing homes are all about cheap CNAs and LPNs providing minimal services for minimal dollars. The doctor doesn’t really deliver care, that’s done by nurses, who don’t really exist in nursing facilities.

Frankly, this sounds like the kind of bullshit that prison medical providers do. Not patient focused at all.

As a grandson who's witnessing the complications of the old age of my grandparents I agree with 100% of what you've said.

There's an increase of dehumanization of ER services, and most of the times they don't need a diagnostic of a doctor - they need care and attention, plus to be worked on (rehab, nutrition, etc). They need support on their daily routines. They need human interaction.

The problem seems to be that sometimes nurses and caretakers work in the field for so long they create a callous surface that makes them sometimes inhuman (which is understandable) - and we, family members, don't have that neither should we have that emotional barrier towards our loved ones.

If elders with family support still have a hard time, imagine the massive group of elders who are alone and left to die.

Yeah my dad was in a long term care facility for a bit after he had a severe case of acute pancreatitis and they almost killed him. We had to fight with the insurance company to get him readmitted to a real hospital and he was days from dying when he came in. They did a second surgery and put him on another round of antibiotics and he’s at home and healthy for years now.

> Nursing homes are all about cheap CNAs and LPNs providing minimal services for minimal dollars. The doctor doesn’t really deliver care, that’s done by nurses, who don’t really exist in nursing facilities.

Absolutely this. As someone in EMS, a very large majority of nursing homes will have 1 RN on shift (and we're talking 200+ bed facilities), and a cadre of LPNs and CNAs.

Their liability insurance means that sometimes, anything more than a band-aid mandates a call to 911. And oftentimes when we show up, asking for a patient history, "Not my usual floor", "I just started shift", etc.

Meanwhile, the sign out front advertises "round the clock nursing care" and they're happily billing the patient, their families many thousands of dollars a month (sometimes easily into the five digits).

They play a lot of bullshit games with people. When my dad was transported for a minor infection, he ended up stuck for at an ER, incurring about $3k in expense (his insurance doesn’t fully cover ER visits without admissions) and about $900 for ambulance and $450 for medivan transport.

When a person is admitted with Medicare coverage, reimbursement rates drop over time. They want to kick out patients with lower lifetime value to get “fresher” patients, patients with assets to liquidate for long term stays, or rehab patients with private insurance.

What's super clever about this is going after nursing homes rather than generaly avoidable ER admissions. Trying to aim at insurers would have been probably next to impossible, even though that's where the big market is.

If you're interested in the opportunity, good read here: https://www.vox.com/policy-and-politics/2018/1/29/16906558/a...

I love stories like this. I learned to bust my butt when I was younger. And eventually I made a business work. I had plenty of support and help from people in my life, but no one was going to do it for me.

There may be minor issues with details of the story and missing plot holes, but the foundation is useful as a lesson in life and in business. Go for it, put everything you have into something, don't get caught up in appearances or require unrealistic responses or results, the universe owes you nothing. If you don't make it, you still get a great story to tell the grandkids and/or learn a lesson to help you succeed the next time.

That was surprisingly worth reading. I didn't have high expectations for startup content on MSN.com.

Pieces like these are generally significantly written by the company, and less so by the journalist.

Why did he live in the nursing home and not with his parents who lived nearby to the nursing home

Because the nursing home would only agree to work with him at all if he stayed on site.

Also: This seems to be a YC company. He was flying back weekly for YC events.

Yes, Call9 is S15

Having spent years working in such facilities, I see some potential here, primarily because they are supplementing telemedicine with the use of local care specialists, and not just relying on the facility’s nursing staff. The issue becomes, who pays for it? Regulations require the facility have a medical director to help them set procedure and policy and to be able to provide overall care if the pcp is not available. So they are already paying for the medical director who they expect to be able to perform this task - even though the commitment of the director varies greatly from facility to facility. Many facilities also hire nurse practicioners now to help manage patients acute medical issues that arise within the facility. And finally there are times the patients really need to go back to the ER - if as a hospital you are trying to push them out in the shortest amount of time possible, you shouldn’t be surprised by this. Personally I think , in the era of value based care, the entire concept of skilled nursing and how it is paid for and regulated, needs to be completely reworked.

> even though the commitment of the director varies greatly from facility to facility

Right, in many places the regulations require laughably little oversight. "Offline review of patient care records at least monthly" (even quarterly) suffices as "medical direction" in some states.

"And that's when he saw a note from Peck via his website's contact form, offering to solve his problem." .. sounds like he could have used amazon turk. Still, this is all good, if probably sensationalized a bit.

The part where he like, saved a persons life is pretty cool. Shows the value of having very deep expertise in your startup is important.

Plus this is the future, which is great. My guess is that this write-up happened because of his investors trying to tell a story. I've been a part of startups, a huge part of the value add of the VC is their ability to plant these stories in MSM / Techcrunch / etc because they have cred with reporters.. Certain aspects will naturally get exaggerated to make the creation story sounds good.

> sounds like he could have used amazon turk.

Could you clarify how mechanical turk could have helped?

This must be sponsored content?

Why?

It reads like an advertisement.

Yeah, it's astroturfing for sure. But it's very well done astroturfing, which makes for entertaining reading. Anyone who doesn't realize this doesn't read very critically.

From the HN guidelines:

Please don't impute astroturfing or shillage. It degrades discussion and is usually mistaken. If you're worried about it, email us and we'll look at the data.

Thanks I hadn’t seen that.

That guideline refers to commenting on comments on HN. Some of them may be astroturf, but it's of no benefit to discuss that possibility, because usually that means a fellow HN person will be upset.

The possibility that TFA is astroturf, or perhaps a more apt term may be "submarine", is entirely appropriate for discussion. If it weren't, we'd be really handicapped in evaluating anything that gets posted to HN.

While the guideline may be explicitly directed at comments, its purpose is to discourage people from defaulting to positions of bad faith. This is equally true for articles. With accusations such as this, it's particularly pernicious because they're hard to defend against: once you tread down the path of assuming bad faith, any argument against it is likewise assumed to be in bad faith: you've already dismissed them as untrustworthy. That's why the bar is so high with respect to comments: you need to have proof. I think it's perfectly acceptable to hold a similar standard when discussing submissions.

I appreciate your position, but we simply disagree on this point. If you're interested, I'd recommend re-reading PG's "Submarine" essay. One can smell the sickly-sweet odor of PR on this headline, before even clicking through to TFA, at which point one can barely smell anything else.

After reading TFA, we may conclude that this company is developing a telemedicine product, and that they had some sort of arrangement with a nursing home on Long Island. Concluding anything else, positive or negative, based on obvious self-reportage is not "faith", it's credulousness. It would even be a mistake to fault this company for using obvious PR; every successful firm does the same.

Thanks for the thoughtful response. I have similar reservations about PG's piece† it's application on HN suffers from overuse, compounded by invoking it has the cover of being authored by PG himself. I do think there's room for disagreement, though, and I'm confident we have the same goal: earnest, quality discussion here on HN. Cheers!

† I don't disagree the phenomenon exists, is problematic, and something to be on the lookout for, just that I don't think it's as interesting as its many references may suggest.

Grzm, there a lot of great telemedicine startups[1]. I think they should live and die on the merits of their technology, not their founder stories or plant in MSN.

I think if this article spent some time highlighting those competitors and briefly discussed their advantages / disadvantages over this one, I would have been less skeptical.

But, it didn't. And you have to ask yourself why.

1. https://www.google.com/search?q=telemedicine+startups+for+nu...

I completely agree. I think pointing out those other other startups as well as pointing out additional information you'd like the article to address (perhaps adding more information you may have) as you've done here are great additions to the discussion. Going around in circles discussing possible but unsubstantiated underhandedness is less so. As is elongating this thread for that matter, so I'll do my part in refraining from further additions.

I thought it was a great story. Why must it be sponsored?

It's poorly written, glowing, and has very little substance. It's a good bet that the company ghost-wrote it or paid to have it published.

95% of news media is poorly written, flowing and has little substance.

I found it interesting. I highly doubt that’s the case.

While that may be true, 95% of news media is not also promoting a company without doing much (or any) research to balance out its positivity.

Does that mean most of the puff pieces about companies are written or bought by the company they're about? Yes. In that, almost everything you've read by a "Contributor" on Forbes.com fits under that category. The firewall between editorial and advertising at most media companies has fallen apart.

This isn't that, though. This is some weird PR thing that doesn't even seem to appear on the normal site, as far as I can tell.

I don't think it is sponsored, but I would bet money that the writer (Christina Farr) has good connections with the YC network.

I genuinely enjoyed it, he's got more hustle than most people and willing to slum it in a nursing home, worth a chuckle

It's a neat story but for those that don't read:

1. He's a doctor with a Harvard degree.

2. The nursing home he stayed in was close to his parents... "When he needed a shower, Peck — who was 35 at the time — would drive to his parents' home, which happened to be nearby."

I'm not knocking the significance of things- it's a cool read and a reminder how painful it is to work in and around healthcare with all the bureaucracy and how sad it is he contacted 2000 institutions and only three got back to him.

Worth the read- just a tiny bit sensationalized IMO.

Edit: added quote

1. The Harvard part of the degree is completely irrelevant

2. His parents’ home happen to be nearby, but note that was a semi-lucky coincidence. He was living in Silicon Valley when he cold-called all of those institutions. One of the few that actually answered was near his parents’ house.

Here is the relevant passage: “So he cold-emailed and called more than 2,000 facilities across the country.“

This guy will succeed because he was willing to cold call 2,000 places despite having a Harvard degree. He was willing to live in a conference room despite having a Harvard degree. He will succeed at whatever he does and it wouldn’t matter if he went to Cal State Fullerton.

In my opinion this story is intrinsically sensational because he is such a stud. A guy willing to go this far is a guy YC is lucky to have.

You’re saying nobody has ever cold called 2000 institutions and failed to succeed ? What evidence do you have for this ?

What evidence do you have that I made any such assertion?

At 100 calls a week (super doable) that's only 20 weeks. This is not some Herculean task

That sort of misses the point. It is pretty soul destroying to cold call that many people.

...And yet articles about call center grunts probably don’t garner front page interest in the same way that “founder” does.

Most call center grunts aren’t also tireless, gutsy, visionary, MD/businesspeople. Also they get a guaranteed salary; he didn’t. Source: am former call center grunt.

There are plenty of people who have inside sales jobs that are commission only. Most sales reps at recruiting firms with split desks would laugh at the notion that 100 calls a week is soul crushing. Most of them are placing 120+ cold calls a day.

5 months of your life calling nursing homes? Not Herculean, Sisyphean.

But this worked, Sisyphus never won.

>1. The Harvard part of the degree is completely irrelevant

Except It's a pretty good indicator of his socioeconomic background and the numerous opportunities that were made available to him in his life that others didn't have. Apart from that yeah..

Oh and also the copious networking opportunities it gave him and access to circles that others don't have. yeah.....

Instead of past opportunities, his Harvard degree gives him future opportunities. As in, something to fall back on when the startup fails. That gives him the advantage (risk tolerance) that other people don’t have (eg. single mom). So, agreeing with you but for different reasons. Harvard degree matters.

Not knocking his persistence and really like that his company helps people instead of doing facial recognition emojis.

Anyone can apply to Harvard, and they all have to be good enough to create the opportunity to be accepted in the first place.

Except realistically, 80% of harvard grads come from high income households.

So at least 20% don't? Given the high standard of qualifications which are obviously easier to meet when you have more resources, that's pretty good. We're talking about the #1 school here, which is also free for any low-income families.

Yeah, 20% come from families under 65k family income.

stanford is #1

Maybe it's more like 80% from the families that value education in general, and not surprisingly this leads to higher income?

Is that unrepresentative of performance in K12?

So I will never know the answer to this question- but I would love to know if his parents knew the admin staff or two degrees away (or if he, himself, did).

I don't find is coincidental that it ended up being close to his folks.

I would imagine a backstory something along the lines of "I've got this solid idea for fixing a big problem, let me reach out and find some partners" and of course he tells his parents. As things progress on (and perhaps tend to fizzle) he or his parents push a little harder on "coming back home" and working local. Don't get me wrong, there is absolutely nothing wrong, bad, etc etc here, I just bet something like this is how we got here.

As for sleeping in the conference room... well he's building tech to be used onsite- and I would expect a not insignificant amount of the types of medical issues he's working on providing this service for happen through the midnight hours and whether he chose to be on-site it shows real dedication to what he's trying to do, for sure.

As for the degree- you're not entirely wrong- it's pure conjecture without knowing more- but I don't think we can assume having a top name education doesn't help with funding, YC or not.

Edit: fixed complete miswording on my intention

Yeah, well, exactly 0 would probably have contacted him if he didn't have the degree. He's not that much of a stud, most founders would die for an opportunity like that.

Also, mass emailing a list of 2000 isn't exactly cold calling. Odds are good he actually called this one and did the full press because his parents DID live nearby.

That all being said, the moral of the story is still very sound.

I think the Harvard part matters at least a tiny bit. A Harvard medical degree means your opportunity cost to do the startup thing is (marginally imo) higher than if you had a Cal State Fullerton medical degree. And obviously the storyline "ZOMG he has an elite degree and still does thus" is more interesting for the random reader.

>The Harvard part of the degree is completely irrelevant

When Venture capitalists and angel investors decide to invest, brand name helps decide who they invest in.

Is not everything, but its not nothing either.

The Harvard doctor part actually makes it much more impressive because it means that he had in his back pocket the option to just go be a doctor and make $300k+. I would have quit a lot earlier.

> When he needed a shower, Peck — who was 35 at the time — would drive to his parents' home, which happened to be nearby.

Why didn't he then just live with his parents for the 3 months? He still could have go there to get that 'invaluable knowledge'. Nice outcome but the story feels a bit like click-bait...

That was explained: the agreement Peck had with the nursing home way that he stayed there to assuage the owner of the nursing home who thought it was risky adopting their solution.

I about the title being a bit click-baity, but maybe it’s just because I’ve heard too many romanticized stories of founders doing something like this out of financial necessity instead of essentially dogfooding.

It's in the article, the nursing home owner wanted him to be on-site.

Being on-site != lived in

The whole point of the service being 24/7 availability, I can see why he'd stay there overnight

I’m fed up of these “dog learns to speak” miracle stories when it comes to startups.

No wonder it’s a dysfunctional society if it selects for the most lunatics when it comes to change-makers.

Another rich weirdo on Twitter is complaining about people not “compelled enough” to quit their day job to work on their startup (in USA, which means no more health insurance for you and your family, if you have one.)

What kind of crazy, self harming culture is this? It’s not even Darwinian when it suggests to take huge disastrous gambles to chase rare unicorns!

I tell you, it’s this shit that’s holding back humanity. How many are just locked back into uncomfortable routines because of this barrier?

Is it perhaps the signature of a conservative society, when change requires grotesque sacrifice stories and is controlled by a small elite of gatekeepers?

The guy is a doctor enrolled in YC. I doubt he'll end up on the street if his startup fails. A large part of other founders are engineers that can walk into a six figure job on relatively little notice.

For all the talk of risking everything, most founders risk time and foregone salary, but not their future. If microsoft had failed, Bill Gates would have re-enrolled at Harvard and graduated a little late.

Your average Joe or Jane that dreams of owning a coffee shop and has to put up their own capital is another story.

>>For all the talk of risking everything, most founders risk time and foregone salary, but not their future.

Not always true.

Missed salaries (and therefore savings) early in life translate to massive losses later when you take into account lost compound interest over 30+ years.

The other thing is that working insane hours to get a startup off the ground can cause depression, burnout, a host of health problems, etc. Some people never recover from these regardless of their credentials or any additional opportunities they come across.

You’re inadvertently making the parents posters point. The reason why most founders stem from a demographic that allows them to either find a solid paying job or fall back on (parents, spouses, ...) financial support is that he current way of doing startups selects harshly for exactly this. No one else can afford that risk and gamble. If you’re single, your startup fails and you have to move in to your parents place for a while, that’s tough luck. If you have a family, a few kids and maybe parents that rely on your financial support, a single dry month without income may spell disaster.

The current way of doing things self-selects for types willing to put in crazy hours and with access to money.

> The current way of doing things

Is there a realistic alternative? Sure, universal basic income eventually, but that's not practical at the moment.

Is there a realistic alternative?

I read a lot on entrepreneurship during 19th century and early 20th century US. My limited understanding: in those days entrepreneurs came from much wider range of demographics. In other words, entry barriers were much less during those days.

I mean many people start bodegas, restaurants, etc. I imagine that's more akin to 19th century entrepreneurship and still is by far the most prevalent form of entrepreneurship today (only like 1.3% of businesses are created in the Bay area and 1.1% of the population lives there).

Scandinavian countries? Entrepreneurship thrives when you can afford to try without risking absolutely everything.

See: https://www.inc.com/magazine/20110201/in-norway-start-ups-sa...

Very good observations. I think it partly explains why innovation is so hard in places where people live hand to mouth. It is simply excludes those demographics from participating in innovation and changing status quo.

This just in: having kids reduces your life-maneuverability, precluding you from embarking in some kinds of projects! :P

> If you have a family, a few kids and maybe parents that rely on your financial support, a single dry month without income may spell disaster.

Sounds like you are asking for all companies to be stable and reliable sources of income. That wouldn't make any sense.

I actually agree with a lot of what you're saying. I'm working at a non-SV start up, and we've made many efforts to create a "normal" work environment: paying everyone at least enough to stay alive and out of debt, leaving at 5 and trying to reduce the ammount of extra-time people have to put in...

But we also realize the ways in which this is limits us, and I totally understand that when someone needs a breakthrough innovation or to fix a very hard problem, extraordinary sacrifices may have to be made. I know other startups working in the more SV/crunch style and honestly it probably makes sense for them.

Being willing to go this far for what you believe (or may be for the money you expect to make) has value.

Being able to go this far of course is very dependent on your lot in life (which is something we should work against, with a social safety net that enables people from all wealth levels), and also on the decisions you made before (like having kids; which I don't know we can be doing all that much about).

(I hope I made any sense, mondays are bad for my english-writing skills.)

Agreed. When I quit my day job to start a company, I had savings to last me another 2 years. My plan B was to get back into a 9-5 job if things didn't pan out.

You do hear horror stories (like that indie developer who quit his day job to make a game and went broke), but that has more to do with little to no planning for plan B.

Being able to save for 2 years alone is a massive endeavor for most people. This usually means one or more of: 1. living far below means for years 2. delaying life events (marriage, house, grad school, etc.) 3. having low enough unexpected expenses to make that fund last for 2 years.

I basically couldn't make it work for various reasons related to being married and needing to have some health insurance that costs over $1.1k / mo. Meanwhile, if my spouse has the privilege of a job with decent health insurance, the expense plummets to $400 / mo which makes a huge difference.

The more realistic route for most people is to work part-time on your projects perhaps taking years longer than if you were to have quit and worked full-time and to quit your job when one of them pans out to being viable. This approach tends to work substantially better for non-business ventures like writing, performance art, etc. Look at all the middle-class / lower income writers that worked awful jobs for years to make ends meet but kept writing. Most of them had 9-to-5 jobs but for a lot of software jobs that pay into the six figure range, they are far, far more demanding of you mentally than waiting tables (although physical exhaustion absolutely affects mental ability, too). This level of work, however, is probably what it takes to be an entrepreneur without much means given that even those with means oftentimes have to work so much for even a small chance at a business opportunity.

the most successful startups (in term of numbers that don't fail) are those where you sack your boss and do a better job, not where you create a new industry or disrupt markets.

That's why your boss makes you sign a non-compete, specifically banning you from starting a competing business :)

when the boss knows what he's doing :)

I'm at the point with my side project where there aren't enough hours in the day to do everything that needs doing. I work 9 hours a day, then come home and have a long list of product development and hamfisted marketing tasks, which I can never get done.

Early on, when it was all just code, my spare time was enough. Now, I would seriously quit the day job if I could (still at $0 Revenue after 6 weeks of being up and running - trying to get the word out, but it's harder to get noticed on the internet than it used to be), but I have a family (who needs health insurance). So, I'll keep sacrificing sleep.

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