Shoshana Owner and President Tom Voiles stands outside the company's headquarters that are located in a shed and farmhouse on the grounds of an old Ann Arbor farm north of town.

It's a well-worn Silicon Valley fairytale that some of the world's biggest and best tech companies started in garages. In the Midwest tech ecosystem, which is growing quickly in towns like Ann Arbor, there is still a bit of this bootstrapping in action. Case in point, home healthcare tech company Shoshana, which was founded almost 30 years ago in a shed on a farm north of Ann Arbor near the Washtenaw Food Hub. The team is now a dozen strong and fill a space that is mid-renovation, so there are multiple monitors and young people milling around a building that still doesn't have walls. A young developer knits in front of a lit screen in the back room at a standing desk next to a colleague. An old wood stove still sits in the middle of the main room, even though the building now has HVAC and heat. "There is a fallow field behind this yard," Shoshana President Tom Voiles explains, pointing past a yurt and barn through some trees. "Sometimes we do team circles there. It's very peaceful." We can see why he likes the setting. We met him in tai chi sword class in Ann Arbor, and he carries this peaceful, kind vibe with him at all times.

Team member Renee poses at her desk in front of the old wood stove that used to heat this shed before it was converted to traditional office space.

Tom Voiles and his wife, CEO Linda Teaman, manage the team that now serve dozens of clients around the U.S. and Canada. Together they have weathered a massive change in the tech that powers home care management. "Healthcare tech is a huge space, an $8 billion industry," Teaman tells us, "but out in the field [in-home healthcare] used to be recorded on pieces of paper. With mobile tech, expectations have been changing for data collection."

Shoshana's Rosemark system helps home healthcare service providers keep track of services outside hospital settings. Voiles says that there is a growing appreciation in the medical industry that certain support services even as simple as keeping people hydrated helps keep them from being readmitted to hospitals, so there is a new push to offer and track home health services via cloud-based care monitoring services such as Rosemark. "Medicare started penalizing hospitals with readmissions within 30 days," he explains, "so there is an incentive to keep people out of hospitals longer and give care at home, whether that's fluids or medications for depression." With an aging population and fewer younger people going into the caring professions, Teaman adds, along with a clamp down on immigration, there is a shortage of caregivers that is supported by tech to fill the gap and track caregiving more efficiently.

President Tom Voiles and CEO Linda Teaman pose in the company conference room in front of the tank of tropical fish.

Rosemark has 3 front ends for users: a desktop interface for staff, a web portal for staff and families, and a mobile app. Voiles says caregivers clock in, record tasks, and receive their schedule through the app. "But there are many roles in a healthcare agency that would use this," Teaman adds, emphasizing the complexity of monitoring home healthcare these days, "from HR to a business owner to receptionist, payroll, office manager." She says it's difficult to show everything that the Rosemark system does because it's so comprehensive serving multiple sides of the caregiving process, all the way from companion care to full nursing care.

What's next for Shoshana? "Stage 2 growing pains is an exciting but scary place to be," Teaman tells us. "API partnerships are really important now for us to connect services," Voiles adds. If a company's service for background checks integrates well with sharing information from the Rosemark system, it makes it that much easier to find partner companies, and, Voiles says, those integrations are getting easier as companies' tech interfaces much better with each other these days.

A map shows Shoshana/Rosemark client locations in the U.S., not including Canada.

As we leave the Shoshana offices, a customer care person is on headset cheerfully talking a client through an issue, and the developers are hard at work again. The tropical fish seem just as home here as the barn in the back yard. It's an unusual setting, to be sure, but as we walk through the shed and the house, the developed office spaces are coming along one at a time to keep up with company growth. "This used to be a dirt floor in here," Voiles laughs of the company conference room where the fish tank resides. Is it silly to be nostalgic for this kind of one step at a time bootstrapping culture? In a way it's barely keeping up with company growth and isn't where you bring the VCs, but on the other hand, this is how it always is when a tech company is focused on client services above appearances. It seems the perfect setting for such a peaceful team working to make home caregiving easier on everyone.