Thomas Sowers, vice president of community supports at 24 Hour Home Care, has been named a 2024 Future Leader by Home Health Care News.

To become a Future Leader, an individual is nominated by their peers. The candidate must be a high-performing employee who is 40 years old or younger, a passionate worker who knows how to put vision into action, and an advocate for seniors, and the committed professionals who ensure their wellbeing.

Sowers sat down with Home Health Care News to talk about how home care providers can start acting as “speed boats,” and not cruise ships, as they navigate change.

What drew you to this industry?

I was drawn to the caregiving industry as a result of a personal experience watching my grandfather navigate a chronic illness and ultimately be on the receiving end of care. My aunt (his daughter) was his caregiver and I quickly realized the value and importance of the family caregiver.

That led me to explore the industry and ultimately to 24 Hour Home Care where I have spent the past 10 years in the pursuit to radically improve the caregiving experience for the care recipient, caregiver and the community.

What’s your biggest lesson learned since starting to work in this industry?

One key lesson learned was balancing empathy with resilience. Caregiving requires deep compassion for both the care recipients and the tactical teams that support the delivery of excellent care, but over the years, I’ve realized that resilience is just as important.

Supporting people through tough times, like during the pandemic or in times of unexpected change, means staying compassionate while also helping teams remain strong, adaptable, and able to solve complex problems. This balance has allowed me to create an environment within my teams where we can make a meaningful impact even in the face of challenges.

If you could change one thing with an eye toward the future of home care, what would it be?

Drive laser-focus on the people – whether it’s the care recipient, caregiver or community – by providing simple, intuitive tools that deliver the information and solutions they need, when and how they need them. By making these tools easy to use and accessible, we can make the care delivery process frictionless, allowing families and caregivers to focus on what truly matters: giving and receiving care.

This would create a seamless experience that supports meaningful, person-centered interactions, empowering everyone involved to leverage their skills to make the biggest possible impact.

What do you foresee as being different about the home care industry looking ahead to 2025?

I think sometimes as an overall industry we can operate a bit like a cruise ship, slow to change course.

However, in 2025 and beyond, I think we’ll see some organizations operating more like speed boats. In my opinion, the next few years are going to be pivotal in defining the future state of the industry and that organizations should aim to be as agile as possible to capture the moment.

We need to embrace new tools that can radically redefine the ways in which we conduct and operate our businesses and impact more people.

In a word, how would you describe the future of home care?

Dynamic.

What quality must all Future Leaders possess?

Grit.

Grit is a critical trait because it fosters perseverance and resilience in navigating challenges. As industries evolve, leaders with grit will embrace change, drive innovation and inspire their teams to stay committed to a dynamic vision of the future. This determination not only helps them overcome obstacles but also cultivates a positive culture that encourages creativity and adaptability. In a rapidly changing world, grit is essential for leading effectively and shaping success.

To learn more about the Future Leaders program, visit https://futureleaders.agingmedia.com/. 

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Brad Harris has been appointed CEO of Home Health Care Solutions.

Part of Miller’s Health System, Home Health Care Solutions is a diversified in-home care provider that delivers services across the majority of Indiana. The company’s offerings include traditional home health services, along with behavioral health care, telehealth monitoring and more.

Harris replaced Home Health Care Solutions founding CEO Mahmood Iqbal on June 1, according to a local news report. Iqbal had served in the CEO role for more than a decade before handing over the reins to Harris.

As CEO, Harris will oversee the strategic direction and operations of Home Health Care Solutions on a statewide basis.

“Brad’s extensive background in health care administration and his established understanding of the organization’s values make him well-suited for this leadership role,” Patrick Boyle, president and CEO of Miller’s Health Systems, said in a press release. “Brad has been an integral part of our business lines inside of Miller’s Health Systems, and we have confidence Brad will guide our Home Health Care Division forward in each of the communities we serve throughout the state of Indiana.”

Harris began his career at Miller’s Health Systems in 1987.

“Home Health Care plays a crucial role in helping patients recover and maintain their well-being,” Harris said in the release. “I look forward to working closely with our talented team to deliver exceptional services to our patients and their families.”

Dina appoints new president

Chicago-based digital health care company Dina has named Sherman Sanchez as its new president.

Dina is a provider of digital network management and coordination solutions to help health plans and providers improve access to home-centric care. The company has raised millions of dollars since its formation, most recently closing a $7 million round at the start of 2024, led by venture capital investor First Analysis.

Sanchez has help leadership positions for health care technology firms including Pager, Cotiviti, HMS, BioIQ, NextHealth Technologies and MedeAnalytics. Prior to those roles, Dina’s new president also held business development positions at Health Data Management Solutions and Mercer.

“Sherman has a clear understanding of our market and extensive experience working with payers and providers that want to leverage digital solutions to improve home-based care,” Dina CEO Ashish V. Shah said in a press release. “He will be a valuable leader as we embark on the next phase of our growth journey, and we’re thrilled to welcome him to the team.”

Tim Coulter, who served as Dina’s interim president and chief operating officer, remains in his role as COO.

SCAN Group – parent company of SCAN Health Plan, one of the nation’s largest not-for-profit Medicare Advantage (MA) organizations – is also an investor in Dina.

Home health vet Tony Strange joins Care Advantage’s board

Tony Strange – the long-time home health veteran who most recently served as CEO of Aveanna Healthcare Holdings Inc. (Nasdaq: AVAH) – has joined Care Advantage’s board.

Strange’s home-based care background also includes founding Healthfield Inc. and serving as the top executive for Gentiva Health Services.

“Tony has shown himself to be an exceptional leader in the health care field through his unwavering dedication and relentless passion for growing health care organizations,” Care Advantage wrote in a company LinkedIn post.

Care Advantage is a home-based care company with more than 45 locations across America’s Mid-Atlantic region. The provider is one of the most active buyers in the home-based care market, having closed close to two dozen deals over the past six years.

After Strange left Aveanna, he was replaced by former COO Jeff Shaner.

“[Strange] leaves an enduring legacy of building one of the nation’s largest home care companies in America during an unprecedented pandemic,” Aveanna Chairman Rod Windley said at the time. “Tony’s steady and stable leadership was a welcome gift during troubled waters within our industry. It has been an honor working side by side with Tony at Aveanna and the many other companies during our career together.”

24 Hour Home Care’s Simon Close lands aging-in-place leadership role

Simon Close, the president of community supports for California-based 24 Hour Home Care – will serve on the National Aging in Place Council.

The five-person board, according to a 24 Hour Home Care press release, oversees the senior support network that connects service providers with older homeowners, their families and caretakers. The organization itself has 10 local chapters in the U.S., with members being various types of aging-in-place stakeholders.

“Serving on the National Aging in Place Council Board is an opportunity to extend the impact of the core mission and values we have at 24 Hour Home Care – reaching more lives and supporting vulnerable populations on a broader scale,” Close said in a statement.

In his role, Close oversees 24 Hour Home Care’s Community Supports Division, which prioritizes care for seniors and underserved communities by providing access to in-home care for Medi-Cal recipients and other low-income people.

Close joined 24 Hour Home Care in 2020 as VP of senior care.

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To become a Frontline Honoree, an individual is nominated by their peers. The candidate must be a dedicated, high-performing frontline worker who delivers exceptional experiences and outcomes; a passionate worker who knows how to put their vision into action for the good of older adults and aging industry professionals; and an advocate for older adults, their industry, and their peers.

Home Health Care News caught up with Kirkendolph to discuss their time in the home health care industry.

HHCN: What drew you to this industry?

Kirkendolph: During the pandemic, I volunteered delivering “Meals on Wheels” to vulnerable people who couldn’t leave their homes. It truly opened my eyes that there were so many people that were alone, and waited at their door for me to come because that was the only interaction they had with others. I then discovered 24 Hour Home Care’s in-home care programs and knew that caregiving was my calling.

HHCN: What’s your biggest lesson learned since starting to work in the industry?

Kirkendolph: Caregiving is a humbling job. I have learned and grown exponentially in my empathy for others both at work, and in my personal life. It pushes you to accept people as they are, and to try to look deeper to understand their challenges and see what you can do to make their situation better. Caring for others gives me a deep sense of purpose every day.

HHCN: What’s your favorite part about your job?

Kirkendolph: I love making a difference in a client’s life by promptly assessing their needs and addressing them as quickly and seamlessly as I can. I love to see clients recover and make positive strides in their health both physically and mentally. When a client gets comfortable with me, it gives me confidence.

HHCN: What do you want society (or the general public) to know about your job?

Kirkendolph: I want society to know that in-home caregiving services exist, and that these programs aren’t just for people in hospice, palliative care, or other end-of-life care. We’re here to help people in various capacities and in all stages of life, including when people are discharged from the hospital, needing social connections, experiencing chronic illness or health challenges, and more.

HHCN: What may be one thing leaders don’t know, that you wish they universally knew, about your job?

Kirkendolph: I would like the leaders in our community to know that caregiving is important, and I would love to see them advocate for in-home caregiving because more people deserve access to these health services. In-home caregiving should be available to anyone and everyone. I think it truly enables people to get better because they are in their own surroundings — that is the power of in-home care.

To view the entire Frontline Honors Class of 2023, visit frontlinehonors.agingmedia.com/

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The erosion of non-solicitation agreements poses a significant challenge for home care providers, potentially undercutting their business models and profitability.

Non-solicitation agreements keep home care clients from poaching caregivers trained and supplied by agencies. In certain states with stricter rules against non-competes — like California and Connecticut — the lines between non-solicitation and non-compete agreements are being blurred.

“In talking to other agency owners — so this is not just my perspective alone — no one likes it and everyone is absolutely petrified of it,” Pansy Homecare CEO Jonah Francis told Home Health Care News.

Non-solicitation in home care

Non-solicit agreements typically specify the length of the restriction and may also include geographical limitations. However, it’s important to note that the enforceability of non-solicit agreements can vary depending on state laws and regulations, with some states placing restrictions on their use or enforcing them differently.

California, for instance, recently made changes to its state laws that make non-solicit agreements more challenging to enforce — aligning them closely with non-compete clauses — which are generally voided if they excessively limit former employees’ professional activities.

“Any kind of restriction on worker mobility over the last several years has really been under great scrutiny,” Angelo Spinola, the co-chair of the home health and home care industry group at the law firm Polsinelli, told HHCN. “The Biden Administration has wanted for there to be a ban on [non-competes] because the argument is that it limits the employee’s ability to earn a living and lowers the wage that a worker can get because they don’t have options.”

Some of the interpretations of that logic, Spinola said, have gone too far to one side.

The crux lies in discerning whether the agreement genuinely protects the company’s interests or if it’s aimed at limiting employees’ options. If it falls into the latter category, it could be deemed unlawful. Over time, the balance has shifted in favor of the employee, moving away from the employer’s advantage, Spinola explained.

In the context of home care, non-solicit agreements refer to contractual agreements between home care agencies and their employees that restrict the employees from soliciting clients or patients of the agency for a certain period after leaving their employment.

For example: a client’s cost for a personal at-home care is $32 an hour. The agency takes home an $16 margin while the caregiver is paid $16 an hour. A client can then do the math and say, “Hey, you’re getting paid $16 an hour. I’m paying $32 an hour. Why don’t I just pay you $20 an hour directly?”

In that scenario, the services of the home care agency are no longer needed.

“That caregiver and client relationship continues and the agency is completely left out and has no remedy for that,” Spinola said. “Agencies aren’t going to stand for that. They’re not going to allow that to continue to happen because they’re losing money left and right.”

Providers response

Francis said that he hasn’t yet had a lot of personal experience with the problem.

“That’s not to say that it’s not happening, but it’s just not happening as much as we fear,” Francis said. “It’s just that we all fear that it will happen, it can happen and [when it does] there’s no repercussions for it.”

Hartford, Connecticut-based Pansy Homecare is a mostly private-pay agency, but the company also has a contract with the VA, as well as a contract with the Medicaid waivers program.

Alongside his role as CEO of a home care agency, Francis serves as the vice chairman of the Homecare Association of America in Connecticut, where he advocates on behalf of providers.

Connecticut recently tightened its non-compete regulations. It requires employers to review and update existing agreements for compliance.

Francis said most providers don’t have an issue with the new non-compete regulations. Non-solicits are where the issues lie.

“We don’t want the money, time, effort and education that we’re investing in a client and caregiver to go down the drain,” Francis said. “Because, let’s face it, there are smart clients and there are smart caregivers and it has happened to us. They’re going to have that conversation. They’ll start here and have a conversation on the side with a caregiver. Before you know it, you’ve spent anywhere from $1,000 to $4,000 to start up a new assignment and you have no way to recoup that.”

With that said, it still is a rare enough occurrence that Francis is still mainly focused on simply making Pansy Homecare an employer of choice.

“The biggest step we took was when we started asking the question about value,” Francis said. “How can we continue to give value above and beyond that of just placing a caregiver with a client? I think every agency has to continue to ask that question of themselves.”

If a provider is going to lose sleep over regulation changes, then they may be focused on the wrong things.

“On the non-solicit side, from my perspective, if that is worrying you then I think you have bigger challenges within your organization,” Ryan Iwamoto, president and co-founder of the California-based 24 Hour Home Care, told HHCN. “Because regardless, if it’s someone that was in your organization that is poaching your clients, your caregivers or other staff, anyone else can do that, right? So for us, I’d rather focus our energy on things we can control.”

There’s always a chance an agency can lose a caregiver or client. That risk is always there, regardless of state non-solicitation rules.

“I might be a little naive but our perspective is, ‘Let’s just focus on the stuff that we can control and things will fall into place,'” Iwamoto said. “I would rather focus on that side of things. How do we improve our delivery of service and experience so that we get that right? How can we be a better organization in order to keep our clients and our employees?”

The post Where The Erosion Of Non-Solicitation Agreements Keeps Providers Up At Night appeared first on Home Health Care News.

These leaders are part of a larger ecosystem of organizations that make up the home-based care space. In a sea of providers, the best leaders are the ones who are able to recognize which of their home-based care peers are standouts.

The ability to identify what works, and why, is evidence of a keen understanding of the business.

Home Health Care News recently caught up with five founders and CEOs to find out which leaders they believe are innovating home-based care.

***

In my observation, Alex Bonetti and Daniel Gottschalk, the founders of Family Tree Private Care in Houston, Texas, have emerged as industry leaders in innovation within the home care sector. The dynamic duo’s remarkable accomplishments have set them apart and inspired admiration from peers and competitors alike. Their ability to scale a home care agency to a multi-state, multimillion-dollar operation within a relatively short timeframe is a testament to their innovative approach.

There’s lessons I have learned from watching Alex and Daniel and their company revolve around the power of diversification and strategic growth. Their addition of private duty nursing and care management as additional service lines demonstrates an innovative mindset, providing a comprehensive approach to addressing the needs of their clients. Furthermore, their success in scaling the entire operation through an aggressive yet attainable organic and M&A growth strategy showcases the importance of a balanced and forward-thinking approach to expansion.

Overall, Alex Bonetti and Daniel Gottschalk’s achievements exemplify the power of strategic diversification and calculated growth as key elements in leading innovation within the home care industry.

— Qiana James, CEO and Founder of Friendly Faces Senior Care

***

In the home care industry, where innovation is key, I believe David Baiada stands out not just as a CEO, but as a true leader in our space.

His approach at Bayada is a remarkable blend of traditional values and forward-thinking strategies. David has masterfully continued the legacy of the “Bayada Way,” yet he’s always pushing the envelope, bringing fresh, innovative ideas to the table, such as investing in and testing different software.

What I particularly admire about David is his ability to balance a people-first philosophy with the demands of a rapidly evolving home care industry. He has done an excellent job integrating core values within everything Bayada does, ensuring the organization continues to be a model for home care.

As a fellow industry professional, watching David lead is both inspiring and a learning experience. He’s setting the example of what it means to be a leader in healthcare. And he is doing it with a ton of humility! Much respect.

— Ryan Iwamoto, president and co-founder of 24 Hour Home Care

***

Mike Trigilio is a leading home care CEO. The path that Mike has placed HouseWorks on from the moment he began seemed to be predicated on revenue diversification. It could not have been easy for a very large, exclusively private-pay company to shift their focus towards the acquisition and implementation of Medicaid-based companies.

All capable home care executives acknowledge that service volume engenders diversification. With enough caregivers, organizations can pivot or explore different service lines, support a variety of funding sources/revenue funnels, and essentially use educational upskilling and training to recruit from within.

I have learned a lot about strategic thinking relative to Medicaid and private-pay business and the way that these divisions coexist and support one another from Mike throughout the course of his career.

— Kevin Smith, CEO of Best of Care Inc.

***

Peter Ross, the CEO of Senior Helpers, is someone that I’ve looked toward for innovative ways or offerings to consider for our home care franchise system, Always Best Care Senior Services.

Having observed Peter, and Senior Helpers, it is clear the organization is regularly testing technologies to bundle with or add on to their services. An area in particular that I have noticed and even discussed with Peter, relates to the various ways to leverage virtual care. With the continued challenges of the industry to maintain a workforce to keep up with the demand of business, innovation is going to be key to successfully delivering the care required for our aging population.

As Peter has said, “With the demand for services and the supply of caregivers in the workforce, we need to find a way to change the caregiver to client ratio where it makes sense in the future.” This forward thinking, along with a focus on technologies and innovation, will be key for any home care company’s future. Whether through virtual care or other technologies, all home care leaders should be investigating and evaluating ways to address the workforce challenges, while still maintaining the highest level of care for the clients.

— Jake Brown, president and CEO of Always Best Care

***

The LTM Group has a very unique and succinct approach of using data and real-time analytics to make patient-care decisions that simultaneously engage referral sources, internal clinical teams, and primary care physicians’ offices. Their continuous projects and alignment with WellSky sets a standard of referral sources responsiveness and referral, to EMR, to integration that will ultimately become the hallmark and expectation of our home health care service providers. I have personally spoken with David Kerns, CEO of the LTM Group and am encouraged by his innovative insights and focus on data and information infusion into all aspects of home health care and hospice decision-making.

— Cleamon Moorer Jr., president and CEO of American Advantage Home Care

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At 24 Hour Home Care, there has been a move towards funded programs, as that cost of care has continued to increase.

“The cost of labor is through the roof, which means the cost of care is really challenging for us,” Ryan Iwamoto, president and co-founder of 24 Hour Home Care, said during a panel discussion at the Home Care Association of America (HCAOA) national conference on Monday. “As the cost of care has gone up, the cost of alternatives hasn’t gone up to the same clip as private-pay home care. That gap has gotten wider and wider.”

Los Angeles-based 24 Hour Home Care offers home care and intellectual and developmental disability (IDD) services across California and Arizona.

Iwamoto noted that 24 Hour Home Care still operates under a private-pay structure, but that working with other programs, like Medicaid-funded home- and community-based services, allowed the company to make more of an impact.

“By adding more breadth to our services, we can impact more lives, and not just for people that can afford it, but for people that may need it even more so,” he said.

For home care providers looking to scale, it’s important to make strategic trade-offs, according to Iwamoto.

“If you try to do everything, you’re not going to be able to do anything,” he said. “For us, it is [about] finding the things that worked well, the bright spots, and putting time and energy towards those bright spots,” he said.

Matt Kroll — president of personal care services at Bayada Home Health Care — believes that scaling private pay now is all about nailing the “business rhythms.”

“Specifically, understanding what our pricing strategy is, understanding what are the KPIs that matter,” he said during the panel discussion. “We still see huge demand. We just don’t want all of it. We realize that we’re much better at taking cases where they need 40 hours a week plus.”

Moorestown, New Jersey-based Bayada is a provider of home health, hospice and home care services. It has over 360 locations across 23 states and six other countries.

Bayada is looking to plant its flag in five new markets annually, but the company has perfected its strategy for growth expansion, according to Kroll.

“We’re not very good at planting new flags in the states,” he said. “What we’re good at is, if we’re in Chicago, we could probably divide Chicago in different parts, and location matters. We think about how we can divide up the markets we’re in and get hyper-local, so we can continue to scale our business.”

On its end, Family Tree Private Care discovered that the best way to enter new markets was through M&A expansion. This also means retaining or hiring staff that is familiar with that market.

“If you can’t entrust other people to grow and develop, it’s just really difficult,” Daniel Gottschalk, president of Family Tree Private Care, said during the discussion.

As a company, Family Tree offers concierge-level caregiving, private nursing and care management services in Texas and Colorado.

Iwamoto also believes in the importance of having the right people in place. In fact, he has taken the Trader Joe’s model, and ran with it, at 24 Hour Home Care.

“It’s hard to find someone that does not like Trader Joe’s, and their secret sauce is competitive prices and quality goods, but I think how they win is through their people,” he said. “We win, not just by our caregivers, but the people behind the caregivers. They’re a little bit more engaged, better trained and better paid than our competition. I believe that is the reason why we’re here today.”

The post The ‘Strategic Trade-Offs’ Private-Pay Home Care Providers Are Making To Grow appeared first on Home Health Care News.

April Stewart, the vice president of access and innovation at the Los Angeles-based 24 Hour Home Care, has been named a 2023 Future Leader by Home Health Care News.

To become a Future Leader, an individual is nominated by their peers. The candidate must be a high-performing employee who is 40-years-old or younger, a passionate worker who knows how to put vision into action, and an advocate for seniors, and the committed professionals who ensure their well-being.

Stewart sat down with HHCN to talk about her path to home-based care, the rise of value-based care, quality of life considerations and more.

HHCN: What drew you to this industry?

Stewart: Key experiences in high school inspired me to pursue a career in home- and community-based services. I met my now lifelong friend who has a developmental disability in 9th grade. He never let his disability get in the way of full community inclusion.

As his friend, I became part of his circle of support and learned how big an impact person-centered care can have in empowering people to live the life they choose — which is most often in their own home and community. He now lives in his own apartment with support staff who help with instrumental activities of daily living.

The opportunity to make a difference every day through empowering this level of independence and choice for people with disabilities with onsets at any age is my life passion.

What’s your biggest lesson learned since starting to work in this industry?

Policy and regulation plays a huge role in access to services and person-centered flexibilities in care. I learned the importance of involvement in health care advocacy to ensure policy, regulation and funding levels line up to enable value-based, culturally competent and accessible care.

If you could change one thing with an eye toward the future of home care, what would it be?

I would love to see caregiving and home care services be more integrated into the health care community.

Our caregivers are the eyes and ears in the home, and already actively notice and take action on change of conditions, ensuring care plans are followed, etc. There is so much potential to be a more integrated part of managing chronic conditions with improved data exchanges and communication with our clinical partners serving mutual clients.

What do you foresee as being different about the home care industry looking ahead to 2024 and beyond?

I think like most health care, we are moving from a volume-based to a value-based system. COVID-19 showed the health care industry and our communities the critical role home- and community-based care plays in capacity-building for the system and care outcomes.

I think we will start seeing more innovative and integrated programs that encompass home- and community-based care as key elements. I believe we will start seeing a higher demand for data and outcome-based reporting versus. task-based reporting in the near future.

In a word, how would you describe the future of home care?

Transformative.

I think we are experiencing a high level of change industry-wide in home care. The market is very different than it was when I joined the industry 15 years ago. Health care is moving away from focusing on deficits — bathing, transfers, getting dressed, etc. — and towards creating quality of life.

It’s more common now for people to want to talk to us about their goals. Goals are typically about independence, socialization, community inclusion and preserving personal identity while managing a chronic condition. Personal care becomes an input into personal goals and overall health rather than consistently getting a bath being the end goal of our services.

I think we are going to see innovative care models, staffing solutions and goal-based care plans to provide better value and outcomes to the people we serve.

If you could give advice to yourself looking back to your first day in the industry, what would it be and why?

Don’t be afraid to specialize or take an untraditional career path. When organization leaders used to ask what future roles I was interested in, early in my career I would say what I thought they wanted to hear. Or I felt like I had to say something that fit into a traditional bucket of “realistic” opportunities.

For example, there were clear paths to becoming a sales or operations leader as new territories were launched. I always had an internal fear of being bucketed into a specialty too early and struggled to admit that I wanted to do something different than our typical growth paths. What I didn’t realize is that these fears held me back from having genuine conversations that could have supported company and personal growth.

Since becoming more open about what I want to do and the impact I want to make in my career, I have been empowered to take on a unique role leading service access and innovation. The health care innovation role is becoming more common as a focus area in health care organizations interested in staying on top of a rapidly evolving health care market.

If you have a special interest or an opportunity where leadership is actively asking for your input on your career path, take the risk of saying what is truly on your mind and heart. It may just lead to your dream job and ability to make a unique impact.

To learn more about the Future Leaders program, visit https://futureleaders.agingmedia.com/.

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The cost of out-of-pocket home care services in the U.S. has steadily risen. As a reaction to that, some providers are proactively relying less on their private-pay revenue streams.

While costs have gone up, so has revenue. Private-pay home care providers generally bill two times more than what they pay caregivers, meaning they can hand off rising costs to the client. But home care providers ultimately see that as an existential threat to their businesses.

While there may be more profits now, handing off those rising costs to clients could mean less market share later.

Some providers believe a completely different business model is in order, like Arosa CEO Ari Medoff.

“The reality is that two times that bill rate is too expensive for probably 95% of Americans, or American families,” he told Home Health Care News last month. “Yet the need for the service that we provide is universal. So 100% of the population needs what it is that we offer, and maybe 5% or 10% can afford to pay out of pocket. … I think there are a lot of structural issues with that business model.”

Anecdotally, provider leaders have told HHCN billing costs have risen anywhere from 20% to 40% over the last couple of years. They’ve also said that they’ve seen shorter lengths of stay from their clients. Most of them presumed that was due to rising costs.

HCP's Benchmarking Report HCP's Benchmarking Report

In an effort to provide services to a larger patient population – and to insulate themselves from that existential threat of rising billing costs – many providers are beginning to focus more on home- and community-based services (HCBS) through Medicaid.

“The cost of care is just continues to go up,” Ryan Iwamoto, the president and co-founder of 24 Hour Home Care, told HHCN. “That addressable market continues to shrink. I think you’re going to see it more on the coasts, and then I think it’s going to [converge] on the middle U.S. down the road. The length of stay of our clients is shortening, and we’re losing them to alternatives. We’re seeing a pattern of that as well.”

Based in Los Angeles, 24 Hour Home Care operates in California, Arizona, New Mexico and Oregon. In addition to home care, the company also provides IDD services.

In December, the company acquired Inteli-Care, an HCBS provider located in New Mexico. That was a sign of things to come, as 24 Hour Home Care is now more focused on growth in its Medicaid business than ever before.

Iwamoto said that more Medicaid-focused M&A is in the works, though he could not provide specifics.

“The market of people that can actually afford [home care] on a long-term basis has shrunk over the last couple of years,” Iwamoto said. “We haven’t given up on it, we’re still doing it. But a lot of our focus and our growth is projected toward the Medicaid space.”

A focus on HCBS has been accelerated by states expanding their programs and providing better reimbursement rates for those services.

That support – from the states 24 Hour Home Care operates in, as well as the Biden administration – gives Iwamoto confidence that his company is in “the right spot” with its future growth plans.

On the other side of the country, the same trend is taking shape. The Boston-based Best of Care has benefited from these Medicaid rate increases, too.

The rate for home health aide services in Massachusetts have increased by as much as 22%, according to Best of Care CEO Kevin Smith.

“Our approach is to have this holistic model, we’re trying not be too over-reliant on one stream or another,” Smith told HHCN. “But we find ourselves in this position now where our private-pay rates are not that far off from our Medicaid rates.”

Best of Care has eight locations across Massachusetts and over 400 employees. In total, the company serves about 1,500 clients. It also acquired a moving company – Moving Mentor – earlier this year as another way to both differentiate itself from competition and diversify revenue.

Whereas 24 Hour Home Care is a private-pay provider diversifying into the Medicaid space, Best of Care started as a primarily Medicaid-based provider trying to get more into private pay. Since Smith became CEO four years ago, the company has gone from being 95% Medicaid to just 70% Medicaid and 30% private pay. 

But, given the aforementioned trends in both private pay and Medicaid, the latter is also going to be Best of Care’s main focus moving forward.

“We are prioritizing Medicaid because of the unprecedented increases we’ve seen in the reimbursement,” Smith said. “We’re also trying to remember to keep the same focus on private pay. Because, again, when you think of this thing as a continuum, we know that there’s an opportunity whereby some folks who are currently on private pay could potentially transition into a Medicaid situation at some point.”

Staffing in HCBS

Part of what makes providers bullish on the Medicaid business is the ability to better staff there with reimbursement hikes.

“We finally, through this breakthrough, have some real meaningful leverage with pay rates on the provider side to start recruiting people that we never thought would find their way to home care,” Smith said. “So, we are really pouring a lot of dollars into job posting and recruitment initiatives.”

Iwamoto added that staffing on the Medicaid side has been easier because of the consistency of work compared to private pay. Workers have better scheduling consistency and are less likely to have their hours cut once a client stops service.

But the future of HCBS is not entirely rosy.

A Centers for Medicare & Medicaid Services (CMS) proposed rule, released in April, has the potential to upend HCBS tailwinds for providers. That rule – which would be phased in and is yet to be come final – would require 80% of all HCBS reimbursement to go to workers.

Providers believe a blanket rule could have adverse affects on HCBS access, if implemented.

“I am concerned about that,” Smith said. “I think that it’s this is an overly prescriptive approach that does not consider the state-by-state ramifications.”

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His journey is an unlikely one. Not only did he not come up in personal home care, he also isn’t originally from the U.S. Now that he’s got three years under his belt at 24 Hour Home Care, though, he has plenty of opinions on what the company – and the industry – can do better moving forward.

“My first impressions of the home care industry, I would say… was that it was very behind,” Close told Home Health Care News. “In terms of the approach, the strategy and selling as a whole. Even the sales enablement tools that were being used.”

The Los Angeles-based 24 Hour Home Care provides personal care as well as intellectual and developmental disability services. It has over 20 locations in California, Arizona and New Mexico. It entered New Mexico through its recent acquisition of Inteli-Care, a Medicaid-based home care provider that allowed it to further diversify its mostly private-pay portfolio.

Close is a veteran of the pharmaceutical industry and also worked in life sciences. He was initially approached by a recruiter to work with 24 Hour Home Care. He first ignored the advance, but then was won over by the company’s president and co-founder, Ryan Iwamoto.

Iwamoto – like many other home care executives – had already considered that his industry may be behind in aspects like sales and technology. But hiring someone like Close with outside experience could be a way to begin advancing things.

“He was looking for somebody who could come in and look at how we operated, look at systems and processes, look at elevating those, but then also build a structure that could scale,” Close said.

Close thought many of the systems and processes that existed when he came to the company were fine, but simply wouldn’t be good enough if the company were to scale.

And that was a problem, given 24 Hour Home Care’s growth plans. Those growth plans, in part, were why the company finally agreed to take on financial backing in early 2022 when the Alpine Investors-backed TEAM Services Group acquired it. The company is now a part of TEAM Public Choices, specifically.

“A lot of the things that were in place when I first came on board that we did change were things that, if we suddenly catapulted in terms of our growth, wouldn’t sustain,” Close said. “So I do think [my past experience] helped, but if Ryan hadn’t seen that, it would not have been valued.”

What needed to evolve

The demand for home-based care services is unlikely to decline anytime soon. Therefore, a sales strategy isn’t always top of mind for providers in the space.

That was one thing Close wanted to address. The sales strategy tended to be more of a “scattergun” one, as he put it, where the agency was just taking any business on that it could.

Instead, Close wanted to take the company to a place where it felt “truly confident” walking away from business.

“I would say that a lot of companies in home care that I’ve spoken to don’t have a strategy,” Close said. “It is, ‘We’ll just take whatever we can, where can we get it from,’ but then you spread yourself too thin.”

Instead, Close wants the sales strategy at 24 Hour Home Care to be about changing behavior.

“To do that, you need consistency and frequency,” he said. “Without having the space to get the frequency of those conversations, without changing that mindset, you will be limited in terms of the sales you get. Whereas, if you narrow down your focus, but go in there, build the relationship and get more frequency with the right messaging, you’ll change behavior.”

He compared home care providers’ sales strategies to startups’ sales strategies: taking whatever you can to build up that revenue.

But, at some point, both need to become more strategic – and Close felt as if 24 Hour Home Care had reached that point.

“And I’ll be transparent, it’s not a surprise to say that a lot of these functions within, they work siloed,” Close said. “But my job is about: How do I truly look at them as one team? And how do they truly look at themselves as one team? And that sounds simple, but it’s not simple to deliver upon.”

‘New operating reality’

Moving forward, Close and 24 Hour Home Care believe there are differentiators to tackle as well. The first is being able to match the right caregiver with the right client.

“I do think one of our key differentiators has been the match between the caregiver and the client, right?” Close said. “Do I think we’ve done that well, do I think any company does that well? Well, in the home care space, I would say no. I think, basically, people are just trying to fulfill a shift … we want to evolve and make that part of our offering.”

As the amount of people that can afford private-pay services dwindles due to bill rates rising, those services need to become premium services, he said.

At the same time, the company is looking to care for a wider population, through the aforementioned acquisition of Inteli-Care and otherwise.

But one thing that Close feels sure of is that, as he and 24 Hour Home Care embark on these initiatives, the same headwinds will remain.

“I think we spoke a lot in the industry about headwinds through COVID,” he said. “And three years later, they’re no longer headwinds, it is the new operating reality. So I think what I want to look back on with pride is how we stabilized ourselves to the new norm post pandemic. And I think we’re well on track to do that.”

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That’s just one dynamic that could change the way home care agencies do business in the new year.

At the same time, providers are also investing in what they believe to be differentiators, whether that’s through Medicare Advantage (MA) business, technology, care coordination or alternative home-based programs.

Below are all of the home care trends HHCN believes should be on providers’ radar in 2023.

Curious what we predicted for last year? Revisit our 2022 trends here.

HHCN published its home health trends for 2023 last week.

Caregiver-client poaching will pick up

Caregivers leaving their agencies to work directly for clients, perhaps for steadier hours or higher pay, has long been an industry trend. Unfortunately for agency owners, HHCN expects this trend to pick up in 2023.

At the federal level, the Biden administration’s Federal Trade Commission (FTC) is seeking to ban employers from imposing noncompete agreements on their workers. Some states – such as Connecticut, which in 2019 specifically sought to ban home care noncompetes – have attempted to do this at the state level in the past, with mixed results.

FTC is currently asking for public comments on its proposal, which, if finalized, could increase U.S. wages by nearly $300 billion per year, according to the commission.

“The freedom to change jobs is core to economic liberty and to a competitive, thriving economy,” FTC Chair Lina M. Khan said in a statement. “Noncompetes block workers from freely switching jobs, depriving them of higher wages and better working conditions, and depriving businesses of a talent pool that they need to build and expand.”

At the same time, the demand for home care services continues to rise while the supply of quality caregivers continues to shrink. In 2023, clients who value particular caregivers who go above and beyond may be emboldened to hire them directly to secure their ongoing support.

To protect themselves from this trend, home care operators will have to continuously invest in their workforce-retention programs, including training initiatives, rewards programs and more. Clients may be able to compete on wages, but they’ll be hard-pressed to compete on all the other employment benefits an agency can offer.

For what it’s worth, HHCN anecdotally heard from some owners about caregiver-client poaching already picking up toward the end of 2022.

Home care providers will be forced to choose a lane

The cost of care is getting more expensive. The increase has been stark.

Many home care agencies are considering this an existential threat. While the private-pay bottom line may be growing with cost of care – which will cause many to be complacent – market share will likely shrink.

“There are some folks that have reached their level of contentment with their income,” Griswold Home Care CEO Michael Slupecki said during HHCN’s Franchise Forum in December. “And I think sometimes they’ll go, ‘Look, it’s been an easier year for me. I can make my target income without working so hard. I love this.’ So, as an organization, we’ve got to try to keep pushing through that. Because while they could be doing better, they could be losing market share. And that’s not something we want to do in any market.”

Agencies are reporting cost-of-care increases of anywhere between 15% to 40%.

That is why HHCN predicts a forthcoming fork in the road in home care. With the cost of care as high as it is, even if it levels out, agencies will have to decide between two propositions: going for the wealthiest clients and committing to private-pay business or diversifying revenue streams through Medicaid, MA or other means.

Take 24 Hour Home Care, for example. It is seemingly taking the latter route.

Its president and co-founder, Ryan Iwamoto, recently told HHCN that cost of care rose for his company by 20% to 40% “overnight.” Traditionally a private-pay company, it recently acquired a Medicaid-based home care provider in New Mexico.

In 2023, it will be interesting to see if others do the same.

Bill rates will level off

Despite the above-mentioned cost-of-care hike, agencies do believe that rates will hit some sort of ceiling in the year ahead.

“Every time I say I don’t think pay rates can go higher, they do,” Matt Kroll, Bayada Home Health Care’s president of assistive care services, told HHCN in December.

That trend has been consistent throughout the U.S.

“With private-pay rates, it seems like recently you can’t find the top of the market, which has always felt disturbing to me, because it’s not cheap to pay for care in the home,” CareAdvantage CEO Tim Hanold said in the fall.

Because bill rates were mostly level from the early 2000s to about 2015, home care experts believe the industry as a whole has been in a catch-up period and hasn’t taken the time to reevaluate the sharp and sudden rate increases.

Despite that, many home care providers expect rates to hit some sort of peak in 2023.

“If the bill rate cools off, then wages have to cool off,” Hanold said. “Maybe we’re not there yet, but there does have to be a leveling out. The macroeconomics reality is that these things have to level off.”

Franchise-system tensions will intensify

Home care franchises and their franchisees were at odds in 2022.

BrightStar Care and its franchisees quarreled over whether committing to MA was worth the effort, as well as a new “call option” included in the franchise-franchisee agreement. All the while, BrightStar has been building up its company-owned locations.

Home Instead, another one of the biggest home care franchises in the country, is having similar issues, though over slightly different matters. Since Honor Technology Inc. acquired Home Instead in 2021, there’s been a transition period that has caused tension between leaders and the franchisees. In this case, the disagreements are mostly centered around the implementation of Honor’s technology.

These two cases are a microcosm for not just franchise systems, but the larger home care ecosystem itself. Industry dynamics are changing, and there’s disagreement over how to – or if to – adjust operations because of that.

In 2023, there will undoubtedly be an even further push on things like MA business and the implementation of technology. There will be more resistance, too.

Even when it comes to cost of care, for instance, agencies will have to convince franchisees that growing revenue with a shrinking market share could be a bad thing.

“We do collect our revenue off of the top line,” Slupecki said. “So, with the wage inflation that we’ve seen, we have to be really cognizant on that hourly piece, because it’s all about market share. Are we growing our market share, and not just growing our revenue? I think that’s really critical to keep our eye on.”

More home care franchise companies will embrace company-owned locations

Over the past few years, a number of home care franchise companies embraced company-owned, or corporate-owned, locations. These companies utilize these locations for a variety of purposes aimed at improving the overall organization.

In 2019, Right at Home began strategically adding company-owned locations to its overall portfolio. The company was using these locations as “test kitchens” for paperless processes, technology and best practices for the organization at large.

Right at Home’s test kitchens have allowed them to avoid implementing the wrong things company-wide.

“When you test anything, sometimes things work, and sometimes they don’t,” Jon Searles, vice president of corporate-owned operations at Right at Home, told HHCN in May. “Franchisees are busy people. We’ve been able to slow the pace down a bit and try something, but not waste the time of some of our franchisees by bringing something to them that we don’t think is developed enough yet, or just that will not work.”

Similarly, Griswold Home Care has been able to test the launch of new software and the company’s mentorship program. Company-owned locations have also allowed the company to perfect its phone script.

For BrightStar Care, company-owned locations have been part of the organization’s strategy since 2002.

“Our first three locations ever were company-owned locations,” Shelly Sun, founder and CEO of BrightStar Care, told HHCN in June. “Having company-owned locations is how we had the ability to document all the policies and procedures for growing a successful home care company that we then franchised.”

BrightStar Care has seen comparable margins between its company-owned locations and franchise locations. This has also opened the door for the organization to further embrace MA opportunities.

“We will be more focused on growing revenues and are willing and able to accept lower-margin business, such as Medicare Advantage,” Sun previously told HHCN. “We evaluate businesses based upon the dollars rather than the percentages so while margins overall may come down as we expand our Medicare Advantage volume, the overall dollars will go up — both top line and bottom line.”

Senior Helpers has also long-held company-owned locations.

As those franchise-system tensions do intensify and companies look to implement future-facing strategies and technologies, it’s likely that the company-owned route will become more traveled.

Ownership pipelines for caregivers will become more common

‘Elevating the caregiver’ has been a long-standing idea in personal home care. The idea is that, if caregivers see a clear path to career advancement, they will be more likely to want to stick with a company long term.

“The lack of career pathways within direct care jobs — and from direct care into other fields— prevents direct care workers from assuming new roles with elevated titles and higher compensation,” New York-based advocacy organization PHI wrote in a report. “This scarcity of career paths also affects retention.”

One of the ways home care companies have been creating a path forward for caregivers is through initiatives like Nurse Next Door’s “front line to franchisee” program. The program aims to eliminate barriers for caregivers who are trying to become franchisees.

“The program helps to support the idea of caregiving as a long-term career by breaking down one of the biggest barriers to ownership, which is startup costs,” Michelle Greer, agency director at Nurse Next Door of Raleigh, North Carolina, said last month during HHCN’s Franchise Forum event.

While not solely focused on caregivers, HomeWell Care Services also made moves to get rid of the initial franchise fee for new owners for 2022.

At a time when providers are looking to strengthen their retention efforts, prioritizing career advancement will be crucial. Providing leadership and ownership opportunities is a way to do that.

Care coordination takes precedent for larger providers

Home care companies believe they are capable of doing more in the home.

Agency leaders have talked about their willingness to do more, and the pandemic has offered opportunities.

Take Help at Home, for example. In October, the Chicago-based personal home care company launched a new segment that will focus on care coordination.

When it launched the pilot of its care coordination arm in three states, the company found what it had anticipated: that its clients had a laundry list of complex and unmet needs, whether those be physical, behavioral or environmental.

“We have an opportunity to capture, in a really simple and digital way, observations that our caregivers can make across physical issues and behavioral issues,” Julie McCarter, Help at Home’s care coordination president, told HHCN. “Those simple observations flow into our clinical platform and create alerts for our broader clinical care coordination team. This, to me, is really where the holistic approach can start.”

Plus, as client needs evolve, so do caregivers’. If a caregiver feels like they are making a true difference in their clients’ lives by doing more, that creates a level of satisfaction that is tangible.

“It creates longer tenure of our caregiver employment, creates longer tenure with our clients,” McCarter said.

In addition to care coordination, personal home care is positioning itself as a potential “quarterback” for programs like hospital at home, ED in the home and others.

With a larger seat the table than they had prior to the pandemic, home care owners will be able to leverage their at-home expertise with other partners in health care.

Senior-focused in-home care startups will scale back

Home-based care was gaining momentum prior to 2020, but the COVID-19 pandemic turned that steady jog into a full-on sprint. And as the U.S. health care system shifted care into the home, senior-focused in-home care startups garnered plenty of investment interest.

Examples of such companies include Sprinter Health, MedArrive, DUOS, Papa, Naborforce, Biofourmis and so many more.

In 2023, economic uncertainty and more conservative approaches from investors will cause some of these startups to scale back, whether that means updated growth goals or downsizing. Papa already started preparing for a different investment climate when it cut 15% of its job force in July.

“It was tough, but the circumstances were that it had to be done in order to extend our runway to be able to support our health plans and our members,” Papa CEO Andrew Parker told HHCN during an episode of Disrupt.

The idea of startups scaling back in 2023 due to economic pressures and less investment activity isn’t exclusive to home-based care. San Francisco-based digital health venture capital and advisory firm Rock Health recapped the trends, and their impact, in its latest quarterly investment report.

“For the digital health sector, 2022 was a downhill ride — one that we think signals the tail end of a macro funding cycle centered around the COVID-19-era investment boom,” the report explains.

Overall, according to Rock Health, 2022’s total funding among U.S.-based digital health startups amounted to $15.3 billion across 572 deals, with an average deal size of $27 million. Last year’s annual funding total was just over half of 2021’s total of $29.3 billion – and barely over 2020’s total of $14.7 billion.

There will still be investment interest in senior-focused in-home care startups this year, but HHCN anticipates fewer splashy investment rounds from investors and more measured growth from companies.

Contributions from Joyce Famakinwa, Patrick Filbin and Robert Holly.

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