Why Home-Based Care Providers See Value in International Footprints

While the majority of their services and energy is concentrated in U.S. markets, a number of home-based care providers are continuing to see the value in participating in international markets.

By providing services to countries around the world — whether directly or through franchisees — several U.S.-based companies have taken advantage of demand overseas by implementing what already works at home, integrating services efficiently while expanding their brands.

“The ingenuity and innovation that happens in each of these different markets all become part of the collective intelligence of the whole network,” Home Instead CEO Jeff Huber told Home Health Care News. “It gives us a deeper and richer and broader base of knowledge.”

Providers and franchisees who serve international markets have said that although domestic growth is still generally prioritized, casting a wider net can broaden a company’s reach and also enrich company culture.

The Omaha, Nebraska-based Home Instead is one of the largest home care providers in the industry. Years before Huber took over the role as CEO, Home Instead opened its first operation on international land in Japan in 2000.

Today, Home Instead – now owned by the home-focused technology company Honor – operates in 13 international markets with over 1,200 franchises. While Huber was hesitant to say that international markets are used as testing grounds for certain services or other aspects of home-based care, he did say innovation happens on a global scale.

“Innovation happens throughout our global network,” Huber said. “Interesting things are being piloted by different markets all the time.”

For example, the Home Instead franchises in the U.K. are trying to find a role for home monitoring sensors. In Switzerland, the franchises are attempting to centralize some of Home Instead services. And in Germany, the company is looking at how it interacts with certain care insurance programs.

“There’s lots of innovation that’s happening in these markets all the time and they learn from each other in our shared courses,” Huber said. “The collective intelligence of the Home Instead network is extremely powerful.”

Differences in international markets

Aging is a universal experience and the need for home-based care services is mostly the same from one international market to the next. However, there are certain differences when it comes to operating abroad.

For Home Instead, the payer source is one of the main differences. In the U.S., Home Instead uses primarily a private-pay model. That tends to change from country to country.

“We do some work with some government programs and some long-term care insurance in other markets,” Huber said. “In those other markets, the government is the primary funder or the payer source. That’s been the primary difference, and that of course leads to some operational changes depending on how the government reimburses. So that’s really where we see the greatest variation.”

The home care franchise Seniors Helpers does most of its business in the U.S., but also has about 20 locations in Australia and a handful of locations in Toronto, Canada. Co-founder and CEO Peter Ross told HHCN the main differences stem from the forms of government in different countries.

“For us, we call everything senior care,” Ross said. “In Australia, they call it aged care, so there’s even different terminology for what we do. In Australia they use broker networks to help to broker care for individuals and the governments involved with that. Then you’re also talking about two countries with universal health care, which we obviously don’t have here in the U.S. unless you’re over 65.”

Caregivers in Australia, Ross said, are also paid a lot more on average than in the U.S.

“Australia has basically mandated how much you pay your caregivers,” Ross said. “So the rates for our private payers for some of them are much, much different than they are in the states.”

Getting started in international markets tends to be more work up front as well. Integration could take a little longer, but in the end the investment pays off, Huber said.

“As we enter a market, the first objective is really to get a small operation started so that the new international franchise partner can learn the business instantly. Then their goal is to bring it to scale,” Huber said. “We’ll see a fairly predictable growth pattern in their early years as they’re bringing on new franchises. We’ll have years of pretty tremendous growth, then markets tend to mature and so the growth rate will slow down a bit.”

There is generally a much longer runway to profitability, Tony Buccheri, the director of International Operations for Right at Home, told HHCN.

“Entering into a new international market involves a heavy lift up front from the franchisor in terms of human resources, professional fees, establishing trademarks, travel costs, etc,” Buccheri told HHCN in an email. “There is also the matter of building brand recognition in a foreign market, and for a business as intimate as providing care in a vulnerable adult’s home, it can take time for a new company to build a reputation and trust.”

Right at Home is a home care franchise company has more than 600 locations in the U.S. and seven other countries.

Fortunately for Right at Home, Buccheri said the experience the company has gained over the years has reduced its learning curve, and as they open up more international shops, profitability can be met more quickly.

Most growth focus still in U.S.

The benefits of being a global company are – to some extent – obvious. Getting a company name out there and in international markets is good for business.

“I think the overall benefit of international markets is brand awareness,” Ross said. “You’re able to bring your brand across to more and more people in more markets.”

However, for Senior Helpers, the immediate and short-term focus will still be on domestic growth.

“One of the biggest opportunities for Senior Helpers for expansion over time will be internationally,” Ross said. “I’ve tempered that excitement because of our opportunity here in the States. Even though we’re one of the largest home care companies, we still have almost 500 territories still available here.”

Not even a year into the Honor acquisition of Home Instead, Huber said the early stages of that deal have taken up a majority of the company’s integration efforts and domestic growth is still a top priority as well.

However, when it does look to expand elsewhere, Home Instead is looking at new ways to enter international markets, knowing how time consuming starting one from scratch can be.

“We think we can advance the process a little by perhaps partnering with existing networks in place and bringing them onboard to the Home Instead model,” Huber said. “We’re evaluating that as a possibility.”