The closure was cited as due to economic reasons, according to a notice filed with the state Department of Labor on Oct. 10.

The workforce reductions occur as the Louisville, Kentucky-based firm plans to discontinue all its home care services in order to concentrate on its senior living business. The company established its Nassau County home care agency to support the 30 assisted living facilities it operates across the state.

The home care business’s closure is reportedly unrelated to the industry consolidation of the Medicaid-funded Consumer Directed Personal Assistance Program (CDPAP) participants in New York next year. Atria does not accept Medicaid.

“After careful consideration, we have made the decision to discontinue operations at Atria Home Care in an effort to focus on our core business of social model senior living communities,” an Atria Senior Living spokesperson told Home Health Care News. “We are working with all home care customers and employees on a transition to other home care providers and are committed to supporting our employees and clients through these changes over the next several weeks.”

Founded in 1996, Atria Senior Living provides independent and assisted living and memory care facilities for adults with dementia or Alzheimer’s disease in more than 300 communities across 43 states and seven Canadian provinces, according to its website.

Atria’s portfolio of brands includes Coterie Luxury Senior Living, Atria Signature Collection, Atria Senior Living, Atria Park, Holiday by Atria and Atria Retirement Canada. The privately held management company employs more than 13,000 caregivers and has approximately 36,000 residents.

The post Atria Senior Living Closing Home Care Business In New York appeared first on Home Health Care News.

Less than a month before election day, the Democratic and Republican candidates for president are dueling over home-based care plans.

Vice President Kamala Harris announced on “The View” this week a proposal that would allow home care to be administered through traditional Medicare.

On the same day, former President Donald Trump and his campaign released a rebuttal, pointing toward home care-related policy implemented from 2017-2020, plus additional plans for a potential second term.

Harris’ proposal is a more lofty one. It would also – if implemented – create a massive tailwind for home care providers across the country. But, as LeadingAge President and CEO Katie Smith Sloan pointed out after the proposal, “we cannot overstate that without staff, there is no care.”

Trump, meanwhile, pointed to expanded supplemental benefits in Medicare Advantage (MA) as a way for seniors to access more home care-related services. His campaign team also focused on economic points that it believes will make aging in place easier for Americans under his leadership.

In this exclusive, members-only HHCN+ Update, I make the mistake of venturing into the presidential candidates’ plans for home-based care. Specifically, I examine how viable the plans are, and what they could mean for providers, if implemented.

Home-based care takes center stage

Home-based care providers were likely pulling their hair out over the predictable confusion that arose from Harris’ proposal Tuesday.

Home health care is already a robust benefit provided under the Medicare program, and generally includes services delivered to seniors after an acute health event.

Home care is not currently available under traditional Medicare, however, and generally includes non-medical services to help with activities of daily living.

The only place where home care is paid for under Medicare is through MA supplemental benefits, and MA pays for just a sliver of all home care provided currently.

So, yes, Harris’ proposal would be groundbreaking, if implemented. It would completely change the scope of the Medicare program.

As for the companies it would directly impact, pick a notable name in home care.

Currently, home care providers have a large addressable market: seniors with the ability to pay out of pocket for home care services; Medicaid beneficiaries in need of home- and community-based services (HCBS); veterans in need of home care, paid for through Veterans Affairs (VA); and a small portion of MA beneficiaries and long-term care insurance clients.

If home care were paid for by Medicare in the future, that would take the concept of “unlimited demand” to a new level. There are over 30,000 home care agencies in the country, almost all of which would have a new market opportunity if Medicare became another means to pay for home care.

The one potential downfall for providers would be former private-pay home care clients being able to use Medicare to pay for services. Private-pay home care doesn’t come without challenges, but it remains one of the most profitable forms of home-based care business.

Home health providers – which already provide care to Medicare beneficiaries, almost exclusively – would also see a business boon. Many of them already provide home care, and the ability to care for clients through one revenue source in both service lines would be massively beneficial.

After all, home-based care is responsible for one of the only successful Center for Medicare and Medicaid Innovation (CMMI) demonstrations of late. The Home Health Value-Based Purchasing (HHVBP) Model – now implemented nationwide – has already saved Medicare billions, and is likely to save many more billions moving forward.

“We think access to personal care services could at least double from six million customers today. By our estimate, the extra spending would expand the [total addressable market] by ~30% to $110 billion per year,” Macquarie Capital wrote in an analyst note this week. “Since Medicare covers home-based medical services, we expect a wider adoption of the integrated care model following added personal care services coverage. This could also expedite the transition to value-based care. Providers could benefit from aligned incentives, streamlined operations and cost synergies.”

Then comes the question of viability, however.

Harris is not the first person to propose such an idea. Home care stakeholders have suggested it for years, but so have other policymakers.

“When the Affordable Care Act was passed, a component similar to this was included and that ultimately was stripped out,” Tyler Giesting, a director of health care and life sciences at West Monroe, told me this week. “I think we’ve seen it fail in the past for reasons that come down to: can it be economically viable? The challenge would be getting something like this passed, in the way that it has been described so far.”

The Harris campaign has suggested that it would pay for the proposal, in part, by cutting Medicare payments for drugs. It estimated that the proposal would cost around $40 billion per year.

But other estimates suggest that it would cost closer to $400 billion.

Harris sees the proposal as a way to aid the “sandwich generation” – adults that have aging parents to take care of, as well as children. Those responsibilities make it tough to maintain employment.

For Harris, the key would be to convince the right stakeholders of the overall value of home care. It wouldn’t be enough to just prove that more Americans could continue contributing to the economy if they had additional help at home for their older relatives.

Harris’ team would need to instead pitch this as a long-term cost savings project. If more seniors had access to home care, less seniors would be driving up U.S. health care costs in hospitals, emergency rooms and more costly brick-and-mortar facilities.

That is already a battle home care providers face. They are regularly trying to convince payers that more home care equals less overall cost. But a concrete plan, and concrete evidence of those potential savings, would have to be laid out.

“It’s one thing to have this idealistic proposal perspective, and it’s another to actually put it into action with a detailed plan,” Giesting said. “Then, there’s also getting it passed and put into law.”

A detailed plan is key. Even if we accept the idea that more access to home care could ease burden on Americans, while also keeping overall health care costs down, the implementation of the proposal through Medicare would need to be tirelessly thought out.

For instance, New York’s Consumer Directed Personal Assistance Program (CDPAP) – which allows family members to be paid to care for loved ones in need of home care – has been a fiscal disaster for the state.

Self-directed care has potential. It allows unpaid caregivers to be compensated, and for home care recipients to direct their own care. But it’s also hard to oversee.

For what it’s worth, if the proposal did move forward, I think the best way to go about it would be to prioritize care from existing, quality home care agencies. Agencies that train and vet their caregivers, ones that have been providing care professionally for a long time.

Trump proposals

The Trump campaign’s home care proposals are more understated. And, like Harris’ plans, more details would be needed to project true impact – for potential home care beneficiaries and providers.

“President Trump will prioritize home care benefits by shifting resources back to at-home senior care, overturning disincentives that lead to care worker shortages and supporting unpaid family caregivers through tax credits and reduced red tape,” the Trump campaign wrote in a release, in preparation for Harris’ announcement this week.

The campaign also evoked MA supplemental benefits. MA supplemental benefits – through the primarily health related pathway and the Special Supplemental Benefits for the Chronically Ill (SSBCI) pathway – were created during Trump’s presidential term.

The benefit that allows for home care services is dubbed In-Home Support Services (IHSS). MA plans have pulled back on offering IHSS in 2024, however.

“The Trump administration provided new Medicare Advantage supplemental benefits that included modifications to help keep seniors safe in their homes, respite care for caregivers, transportation coverage, additional in-home support services and assistance and non-opioid pain management alternatives,” the release continued.

The campaign also pointed out other indirect factors that have led to home care inaccessibility of late, such as inflation, which it believes it can continue to bring down.

Spotlight and policy

Home-based care being in the nationwide spotlight is a good thing for providers and older Americans.

But it’s also worth taking stock of where that spotlight has gotten us before. The Biden-Administration has been laser-focused on home care, but mostly HCBS through Medicaid.

Meanwhile, home health providers have been left behind. Advocates are in the throes of a three-year long fight against continued rate cuts from the Centers for Medicare & Medicaid Services (CMS), as other home-based care proposals are taking shape from both campaigns.

Home health providers are seeing their traditional Medicare payments cut, while also receiving payments from MA plans that often don’t cover the cost of care. All the while, MA penetration continues.

In April of 2023, I wrote about why federal support for home-based care is missing the mark.

While proposals from both campaigns this week contain some good elements, that fact remains true.

As home-based care takes center stage once again, Medicare-certified home health providers are forced to stand behind the curtains, at a time when their margins are evaporating.

“I would also want to remind the Biden, Harris administration that the existing Medicare home health program is under assault currently, and has been since 2020, with billions of dollars in cuts that have diminished access to care, so I think that investment and a stabilization of the existing Medicare home health benefit is something that is also needed,” Partnership for Quality Home Healthcare CEO Joanne Cunningham told HHCN this week. “With this news, I would just offer that recommendation and reminder.”

The post With The Election Nearing, Candidates Battle Over Home-Based Care appeared first on Home Health Care News.

“To reach this milestone you’ve got to have a number of things,” Pete First, chief development officer of BrightStar Care, told Home Health Care News. “You’ve got to have a really solid system and a solid business case for what you’re doing and processes in place. BrightStar Care has been franchising now for over 20 years. To have that longevity, the history, and the reputation and the brand recognition — all of that feeds into growth. You have to have successful and happy franchisees. That’s one of the big difference makers.”

Chicagoland-based BrightStar Care offers personal home care, home health care and supplemental staffing.

In July, BrightStar Care reported that it signed 15 new franchisees in the first half of 2024. It also signed 24 new franchise agreements and opened 16 new locations during this period.

First noted that BrightStar Care was able to break into new markets, such as New Mexico and Nebraska, for the first time.

The company credits a combination of marketing and operational plans for helping it reach 400 opened locations.

“On the marketing side, we’re very fine tuned with our pay-for-click advertising in markets that we’re trying to get into,” First said. “We’ve got that dialed in with our advertising to look for new candidates. We have existing owners that are really wanting to expand. A number of the new signed agreements were with existing franchisees, so that was a big group that helped us reach that number. Then we’re getting a lot of referrals. Our referrals come from existing franchisees who love the business model, love doing what they’re doing and want to share that.”

However, the road to achieving 400 opened locations wasn’t without its challenges.

“The challenges really are territories,” First said. “Many of our major metro areas are already sold out, but we have markets in smaller suburbs, or different sized territories, that are available. It’s about working with and finding the right people for those territories, and usually it’s somebody that lives there. Let’s say we’re looking at a market that’s maybe 250,000 people, and it’s not in a major metro area, but it’s a great location for a BrightStar Care agency, it’s finding people that are already in that market and who want to make a difference.”

Ultimately, becoming an even larger franchise network will be leveraged to the advantage of BrightStar Care’s franchise owners, First believes.

“With the large footprint that we have, we’re able to negotiate better rates with vendors that the franchisees can use, so it helps to have that scale,” First said. “The big difference is we have a very robust national accounts program, where we have a team internally that provides access to national accounts for all of our franchisees through a central intake system. What that means is, the more coverage that we have across the country, the more opportunities and new national accounts we can open up for franchisees.”

The post How BrightStar Care Got To 400 US Locations, And Where It Plans To Go Next appeared first on Home Health Care News.

Broadly, the company captures detailed observations from caregivers in real time to identify client needs and predict unforeseen events.

The care coordination program depends on caregivers submitting weekly observations and reporting any changes in client conditions.

Community health workers (CHWs) also conduct a self-reported health assessment using the Centers for Medicare & Medicaid Services (CMS) Accountable Health Communities Health-Related Social Needs screening tool. This tool includes 24 questions about the home environment and access to eligible benefits and services. These questions help identify issues such as housing instability, food insecurity, transportation challenges, financial strain, safety concerns and lifestyle factors that can affect a client’s ability to achieve long-term health goals.

“We’re uniquely positioned, using the millions of hours we spend with our clients, to connect home care to health care through our innovative care coordination management programs and services supported by our value-based care philosophy,” Julie McCarter, president of care coordination at Help at Home, told Home Health Care News. “Through the launch of our health care coordination strategies that build on our longitudinal caregiver-client relationships, we’re addressing access to care, health-related social needs and unmet client health needs, advancing care as we improve quality and cost outcomes.”

The Chicago-based Help at Home is one of the largest home care providers in the country. It provides home- and community-based services (HCBS) via over 200 locations across 11 states.

In its first year, the program made one million observations and carried out 4,000 proactive interventions that had an impact on the health care system. These interventions included scheduling pulmonology appointments when there was a decline in breathing and mobility, activating mental health resources when there were signs of agitation or mood changes and connecting individuals with food resources when food insecurities were identified. The results of these interventions included a 31% decrease in emergency room visits, a 37% decrease in inpatient admissions compared to the previous year, and a 51% improvement in depression, among other positive outcomes, according to McCarter.

“Our caregivers serve as an extra set of eyes and ears in the home, and through the program, they can digitally capture physical, behavioral and environmental observations,” McCarter said. “Clinical teams can assess, act and prevent avoidable health events in real time to avoid unnecessary hospitalization or institutionalization.”

McCarter mentioned that the clinical care team supporting caregivers includes CHWs. These CHWs typically reside within the community they serve and share the same ethnicity, language, socioeconomic status and life experiences as the client population, allowing for the formation of trusting, organic relationships.

“The results of caregiver tools and care teams engaging populations with high-tech, high-touch wraparound clinical efforts are proving to reduce emergency room visits, inpatient utilization, close preventative gaps in care, increase primary care and optimize health care benefits and services,” McCarter explained.

Furthermore, Help at Home reports that caregivers involved in the care coordination program have higher net promoter scores, demonstrating the program’s ability to improve caregiver satisfaction and retention, making them feel valued and motivated.

“Caregiving can be a difficult job, so we are attentive to the caregiver and work to elevate the caregiver role by providing a village of support through care coordination clinical care teams,” McCarter said. “We’ve seen this lead to greater caregiver satisfaction scores and tenure. Not only does the program support client health and wellbeing, but it also focuses on identifying and supporting the caregivers’ needs. Through the program and that understanding, we’ve found that nearly 50% of caregivers expressed that having a better understanding of their clients’ conditions or needs and how they can be a part of the solution helps them to alleviate their worry and stress.”

Building on the strength of the company’s foundation, core service offerings and long-term relationships, McCarter said that the company is expanding its efforts. Caregivers now have a deeper understanding of a client’s overall health journey and how they can improve the quality of life for underserved populations who wish to age in place.

“We’re energized by the program’s results thus far and are continuing our journey to build on learnings and successes,” she said. “As we move to 2025, we’re excited about embarking on a broader clinical care delivery journey that furthers the value we can provide to our partners, clients and caregivers with value-based care and wraparound support programs to drive quality outcomes and total cost of care opportunities – further connecting health care to home care.”

The post Help at Home’s Care Coordination Program Prevents Hospitalizations, Increases Caregiver Satisfaction appeared first on Home Health Care News.

The biggest retailers were zealous in their pursuit of home-based health care initiatives. But there’s little evidence to suggest that pursuit has been successful, at least thus far.

This week, CVS Health (NYSE: CVS) announced that it was laying off 2,900 workers. Simultaneously, reports surfaced of Glenview Capital – a significant shareholder in the company – emerging as an activist investor.

Reuters then reported that CVS Health is exploring a potential breakup of its business. CVS Health has multiple segments, including retail, pharmacy, insurance through Aetna and health care services.

Health care services is where the company took a stab at home-based health care for the first time. In addition to acquiring the community- and senior-focused primary care provider Oak Street Health for over $10 billion last year, it also acquired the home-focused value-based care platform Signify Health for $8 billion.

“CVS’ management team and Board of Directors are continually exploring ways to create shareholder value,” a CVS spokesperson told Reuters. “We remain focused on driving performance and delivering high quality healthcare products and services enabled by our unmatched scale and integrated model.”

For payers, investors and retailers alike, home-based care looked like a worthwhile frontier to explore during the pandemic. For retailers like CVS Health and Walgreens Boots Alliance (Nasdaq: WBA) specifically, their success administering the COVID-19 vaccine to Americans gave them hope that community-based health care would be a somewhat smooth path forward.

That has not been the case, for Walgreens, CVS Health, or a slew of others.

In this week’s exclusive, members-only HHCN+ Update, I revisit the plight of retailers delving into home-based care, and consider who will be the beneficiaries of health care moving to the home.

Support in the home

The overarching idea is simple. The United States has an aging population, and more seniors than ever want to receive their health care in the home.

Plus, home-based health care tends to be cheaper than facility-based care. Traditional personal care services enable seniors to age in place and prevent further health problems related to activities of daily living struggles. Home health care ensures smooth transitions home from the hospital, keeping patients out of more costly brick-and-mortar settings.

Other home-based care is becoming popular too. Home-based care for younger Americans. Skilled nursing facility care in the home (SNF at Home). Hospital-at-home care. Primary care at home. Oncology care at home. Kidney care at home. In-home health assessments and evaluations.

Broadly, these types of care are more consumer-focused, a departure from the care that forced Americans to uproot their lives for a day, week or even months to receive the health care they needed.

For the sake of designation, I refer to Medicare-certified home health care and personal care services – through Medicaid, private pay or the VA – as “traditional” home-based care services.

As more non-traditional at-home care has proliferated, there was some sense of concern from traditional providers that more cash-strapped entities could disrupt two long standing industries.

That still could be the case, as home health and home care providers tend to be – on average – behind the curve on technology and future-facing business practices.

But in the last quarter of 2024, that disruption doesn’t seem any closer than it did in 2019.

Walmart (NYSE: WMT), which wanted to “support people aging in their homes,” has largely ditched its health care services plan. Amazon launched Amazon Care – which had an at-home care component – and then did away with it shortly thereafter. Best Buy (NYSE: BBY) is still mostly smooth sailing, but it intended from the start to be a technology partner more than anything.

Then there’s CVS Health and Walgreens, which both made massive bets – strategically and monetarily – on health care services.

Both began to shrink their retail footprints, hoping to become more health care providers than corner stores.

Walgreens invested over $6 billion in VillageMD, another home- and community-focused primary care provider. It also acquired CareCentrix, a post-acute technology company. An affiliate of the company was also a significant backer of BrightSpring Health Services (Nasdaq: BTSG), one of the largest home-based care providers in the country.

But then, earlier this year, CEO Tim Wentworth announced that the company would be undergoing a “strategic review of its assets.”

“We are now meaningfully looking at the entire portfolio of assets that we have to ensure that everything we have is going to drive the growth that we aspire to deliver,” he said at the time.

The company shuttered 160 VillageMD locations after aggressively expanding in years prior.

The investment firm KKR also acquired Walgreens’ remaining shares in BrightSpring.

Both CVS and Walgreens have had multiple leaders look over their health care divisions over a short period of time.

While CVS owns Oak Street Health and Signify Health – a similar portfolio to Walgreens’ backing of VillageMD and CareCentrix – it also purchased Aetna for $70 billion back in 2018.

Aetna’s leader was also recently ousted by CVS Health.

While Glenview Capital – the rumored activist investor – said it was not pushing for a breakup of the company, other news outlets reported that CVS’ board has already discussed that option.

Not long ago, CVS Health was considered a potential buyer for some of the remaining standalone home health companies. It had an obvious interest in home-based care, and also owned Aetna. Humana Inc. (NYSE: HUM) and UnitedHealth Group (NYSE: UNH), two of Aetna’s top competitors, own home health assets of their own.

“I think, over time, we’ll look at what other assets [we need],” CVS Health CEO Karen Lynch said in 2023. “As you think longer-term, around the corner, there might be additional opportunities in the home.”

Now that idea appears to be off the table.

Walgreens and CVS Health both wanted to become health care services players, and they are. Thus far, though, they’ve stumbled. They are not yet successful players, nor successful home-based care players.

What it all means

Legacy home-based care providers love the industries they’re in, and they know there’s plenty of future opportunity.

But they also know all the challenges that come along with reaching that opportunity: staffing woes; the delicate intimacy of providing care in the home; turbulent payment environments; and the barriers to growth and scale.

There are over 10,000 home health agencies in the U.S., while there are more than 30,000 home care agencies, according to best estimates.

Consolidation has been projected for more than a decade, but has never come in a significant way.

Payers like Humana and UnitedHealth Group own two of the largest home health companies in the country in CenterWell Home Health and LHC Group. But that still only grants them access to a small slice of the home health pie.

For instance, after UnitedHealth Group acquired LHC Group, it then agreed to purchase Amedisys Inc. (Nasdaq: AMED), another one of the top home health providers. But even with both agencies under its belt, the company will likely have less than 10% of market share in the industry.

There is more startup activity in home health care and home care than ever. A couple of those businesses may have a shot at disrupting.

But, for now, the large health care companies taking a shot at home-based care have failed to make waves.

That could be because of their size, or because of the complexities that come with delivering good home-based care.

Either way, for now, most of the opportunity that lies ahead still remains for the taking. And the legacy operators have as good of a chance as anyone to capitalize.

The post Health Care Giants Are Falling Short Of Home-Based Care Disruption appeared first on Home Health Care News.

Specifically, Edison Home Health Care of New York and Preferred Home Healthcare of New York allegedly failed to pay full wages and benefits to over 25,000 workers, according to the New York State Attorney General’s office.

The two agencies and their former operators will pay $7.5 million out to the over 25,000 workers. They will also pay $9.75 million back to Medicaid. It represents the largest wage parity settlement ever secured by the Office of the Attorney General and the Eastern District of New York.

Help at Home acquired both Edison Home Health Care and Preferred Home Healthcare in 2022, but a spokesperson for the company told Home Health Care News that the violations occurred prior to the acquisition.

“Home health aides provide crucial care to our most vulnerable neighbors and loved ones, and they deserve to be paid for their hard work,” James said in a statement. “Edison and Preferred cheated employees out of years of pay and cheated New York taxpayers by defrauding Medicaid for their own benefit. This is a tremendous victory for our ongoing efforts to protect hardworking New Yorkers’ rightfully earned wages.”

The New York Wage Parity Act, which was established in 2012, “was created to ensure home health aides receive fair compensation and benefits for their hard work,” a press release on the settlement read.

The investigation found that the two agencies failed to pay workers the full benefits they were owed under the Wage Parity Act, instead using those funds to purchase medical “stop loss” insurance, “which is a type of insurance that acts as a safety net for employers that are paying for their employees’ medical claims.”

What’s more, “individuals and entities” related to the two agencies received millions of dollars in dividend payments from that insurance, which “effectively served as a means of siphoning away funds intended for employees.”

“Edison and Preferred then continued to seek and receive payments from Medicaid for care performed by home health aides, while falsely representing that they were in compliance with the Wage Parity Act,” the release read.

As part of the settlement, Edison Home Health Care and Preferred Home Healthcare will revise company policies and procedures. They will also “regularly report staff wages and policy implementations” to the attorney general’s office for three years.

If the agencies fall out of compliance, the attorney general has the authority to bring further civil action against them.

Of the $9.75 million that will be paid out to Medicaid, $5.85 million will go to New York state. The other $3.9 million will go to the federal government.

“Home health aides work long hours at difficult, often thankless tasks to ensure that the vulnerable individuals who they provide services to are properly cared for,” Peace said in a statement. “These aides deserve the hard-earned benefits guaranteed to them under the law and my office will ensure that they are accurately compensated.”

In acquiring Edison Home Health Care and Preferred Home Healthcare, Help at Home made an entrance into New York for the first time.

The acquisitions added 10,500 new clients and 12,000 new employees to the company’s portfolio.

“As the leading provider of high-quality, Medicaid home- and community-based services, Help at Home has a 50-year history providing high quality, in-home personal care services in the communities we serve,” Help at Home told Home Health Care News in a statement. “The matter outlined in the agreements took place prior to the 2022 acquisition of Preferred Home Care of NY and Edison Home Health Care. We approached these matters with the utmost seriousness, implementing new rigorous protocols and benefit compliance processes, ensuring the companies met and continue to meet Help at Home’s best-in-class standards. We remain committed to our deep-rooted ‘caring for the caregiver’ culture and providing person-centered care that enables our clients to live as independently as possible in their own homes.”

Based in Chicago, Help at Home provides home- and community-based services (HCBS) to over 70,000 clients monthly across 11 states and more than 200 locations.

The post 2 Home Care Agencies Agree To Pay $17.25M Settlement In Historic Wage Violations Case appeared first on Home Health Care News.

The collaboration between BrightStar Care and Medically Home is one example of this.

“More care is moving into the home, and higher acuity care is moving into the home,” Shelly Sun Berkowitz, founder and executive chairwoman of BrightStar Care, said during a panel discussion at Home Health Care News’ FUTURE conference in August. “I think that’s exciting, but home care providers that have been more on the non-medical side need to start thinking about how they transform and move into higher levels of acuity. I think that’s where a lot of the opportunity is going to be.”

Chicagoland-based BrightStar Care offers personal home care, as well as supplemental staffing and home health care. It has over 400 franchise locations across the U.S.

On its end, Boston-based Medically Home partners with organizations to help them deliver hospital-at-home services, as well as emergency department services in the home. The company coordinates in-home visits, sets up the proper technology and equipment, and pulls together all of the necessary resources.

Medically Home and BrightStar Care have been partners since 2018. At the time, the former was in “startup mode” and was attracted to BrightStar Care’s approach.

“BrightStar came in with this entrepreneurial approach to our work together,” Dr. Pippa Shulman, chief medical officer at Medically Home, said during the discussion. “It was immediately, ‘How can we solve the problem that you have, and not be constrained by our idea of what home care medicine looks like?’ It was really future thinking. Now, we’ve both grown. We’re both different organizations, and we’ve really committed to partner together, and when we need new nursing services, BrightStar is our primary partner going forward.”

Shulman is a hospital-at-home pioneer, and previously told HHCN that “the tipping point is coming” in relation to that type of care in the U.S.

In 2023, BrightStar Care expanded its higher-acuity care services by rolling out primary in-home clinician and transport services in Arizona.

“We’re a franchise organization, so we went and bought back several of our franchisees, made a multi-million dollar investment in Arizona to own the territory, control the territory,” Sun said. “We believed hospital at home would be so important for the growth of our brand and the transformation of health care in our country. We wanted to make sure we could spend the money, get the vehicles right, meet all the expectations of a great partner, but we felt like that’d be difficult to do, if we were relying just on a franchisee.”

Sun noted that this strategy allowed the company to work out the kinks before pulling in franchise owners.

“It’s a great way for us to be able to take a company-owned marketplace, spend our capital – not a franchisee’s capital – and figure it out, get the bumps out, and then once it’s ready, roll it out to our network,” she said. “I think we learned a lot together, built a great program there … and continue to make lots of impact for our franchisees across the country. As a good franchisor, I don’t want the franchisees having to spend their hard earned capital figuring it out. I have a much greater capacity to do that as a franchisor.”

Since then, BrightStar Care — in partnership with Medically Home — has expanded this effort.

In April, the company rolled out these services in California and New Jersey, and they’re offering this care in six states.

Ultimately, Shulman believes that the home should be the center of health care in the future.

“I’m not saying we don’t need hospitals,” she said. “We do, but we need ICUs, and surgery centers and a place for traumas [patients] to go. Almost everything else we can do at home.”

The post How Home Care Providers Can ‘Transform’ To Ride The Hospital-At-Home Wave appeared first on Home Health Care News.

“We are excited to have the opportunity to serve CDPAP consumers and personal assistants,” Maria Perrin, chief growth and strategy officer at PPL, told Home Health Care News. “Consumer direction programs are all we do as a business. For years, we’ve not only been operating throughout several states, but we’ve made it our purpose and mission to advance access to consumer direction and make these programs stronger, sustainable and more culturally competent. This is a great opportunity for us, and we are really excited to be partnering with our [fiscal intermediary] partners.”

Through CDPAP, a Medicaid-funded home care program, people seeking care are allowed to hire a caregiver of their own choosing. This often means informal caregivers, which are paid for their services through the program.

Roughly 700 businesses currently serve as fiscal intermediaries, many of which are home care providers themselves. The state is looking to save $1 billion annually by appointing one administrator.

As part of the agreement, PPL must work with four local organizations, and a network of 30 home care agencies.

“Our approach to this was to make sure that we put together a partnership with existing CDPAP fiscal intermediaries and with the independent living centers,” Perrin said. “That would make sure there’s ample capacity from a volume standpoint and from a linguistic standpoint, making sure that people who are not english speakers continue to be served. That people who have disabilities, or cultural or religious considerations, would continue to be served. At this point, we have over 30 existing CDPAP fiscal intermediary partners that we’ve identified, in addition to the 11 independent living centers, who will continue their work.”

Perrin noted that with state approval, PPL is open to identifying and partnering with even more organizations.

PPL will also relocate its headquarters to New York. The move will create over 1,200 jobs, according to a press statement.

Additionally, The Chinese American Planning Council will aid in managing the program in Long Island, Westchester County and New York City.

Uncertainties around CDPAP

With these changes to CDPAP, Emina Poricanin, founder and managing attorney of the New York-based Poricanin Law, believes that many providers will be weighing their options.

“As far as the providers are concerned, this is just additional uncertainty about their future as a business,” she told HHCN. “A number of them are, even more expeditiously, exploring other lines of personal care services that they can offer in New York State because they have no choice but to pivot from this program.”

For some, this means transitioning patient care hours into a traditional licensed home care services setting and out of CDPAP, Poricanin noted.

In addition to fiscal intermediary restructuring, Poricanin pointed to the significant decrease in reimbursement rates as another area of concern for providers.

“[It] takes out, largely, any incentive for a provider to be in this program,” she said. “Irrespective of what happens with PPL, or any single statewide fiscal intermediary, there’s simply very little money in this program. Therefore providers, regardless of what happens with the single statewide [fiscal intermediary] restructuring, should and are looking long term into what they can do with this line of business.”

Poricanin also believes that the state may see additional lawsuits, specifically ones that challenge if the appointment was a true competitive bidding process.

“The number has not been released, but based on my own knowledge of the market, I assume there were at least 200 applications that were submitted to New York State, and yet they were able to turn those around from mid-August and send out rejection letters yesterday,” she said. “How did they get through all of those applications that quickly, if they were actually reviewing the applications and giving each applicant a fair opportunity to apply? That is probably going to be the subject of some litigation — that the process was not conducted fairly.”

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At Comfort Keepers, the Ensuring Access to Medicaid Services rule is top of mind. Specifically, the rule’s 80-20 provision, which requires providers to earmark 80% of reimbursement for home- and community-based services (HCBS) to caregiver wages.

That provision is set to go into effect – barring challenges – over five years from now.

“The 80-20 rule is kind of hanging like this big cloud over us all year long,” Ramzi Abdine, chief operating officer of Comfort Keepers, said during a panel discussion at Home Health Care News’ FUTURE conference last month.

Irvine, California-based Comfort Keepers is one of the largest personal home care providers in the U.S. The company has more than 600 locations, and about 70 company-owned locations.

Indiana’s transition to managed care for certain Medicaid services is another factor that Comfort Keepers sees as a challenge.

“The switch in Indiana caused some issues for some of our Medicaid folk in Indiana,” Abdine said. “To give you an example, when the reimbursement was from the state directly, it took seven days to get the money. Now, if everything goes to plan, which never does, it’s 21 days. This just puts more stress on the working capital requirements of our franchisees.”

As a majority private-pay company, Nova Leap views staffing shortages as its biggest growth barrier.

“We’d be a lot bigger if we had more staff,” Nova Leap President and CEO Chris Dobbin said during the discussion.

Nova Leap is a Canada-based home care organization that has been growing in the U.S. The company has operations in Nova Scotia and 11 different states.

In addition to growth barriers, leaders are also focused on managing client retention as home care billing rates continue to increase.

“Being primarily private pay, we do lean heavily into the clients that are able to afford in-home care,” Melissa Reyes, president of the west division at TheKey, said during the discussion. “We are very transparent and upfront with our clients from the very beginning, around our annual rate increases due to inflation, pay pressure and other competing market pressures. We have found that just by having that conversation early – and making sure they understand the methodology behind what we’re doing – really has paid off for us in the long run. Our economics show that our clients today are long-tenured clients that use a high volume of hours.”

Delray, Florida-based TheKey provides home care, memory care and specialized care services in more than 100 markets throughout the U.S., Canada and Australia.

On his end, Abdine has noticed a slight slowdown in billing rate increases, compared to two years ago.

“That’s also a function of the inflation, which is kind of like leveling off,” he said. “We are very methodical about our rate increases, so we work closely with our franchisees to make sure they are basing those on market research. We know exactly where we want to be.”

Likewise, Dobbin believes that the rate of rising billing rates will continue to come down.

“We’re trying to be 20% below the very top, or something like that,” he said. “I do agree, though, that the pace of increases is probably going to slow down a bit, which probably ties directly into what’s happening with inflation.”

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That contract language, dubbed a non-solicitation agreement, is a widely used clause in home care contracts to protect providers’ businesses.

On its end, the Irvine, California-based Comfort Keepers is a large franchise that offers non-medical in-home support, including meal preparation, companionship and personal assistance.

The company required each client to execute a care agreement containing this language before receiving services. California Attorney General Rob Bonta concluded that this agreement violated California law by restraining worker mobility, as caregivers could not be hired by any Comfort Keepers client, not just the client to whom they were assigned to provide services.

In a statement issued to Home Health Care News, Comfort Keepers wrote, “We value Comfort Keepers caregivers, who are the heart and soul of each of our franchises and the Comfort Keepers brand. “As a service-based company, the quality of our care is rooted in the dedication and expertise of the caregivers who serve as employees. We invest significantly in their development to ensure the success of our services, the satisfaction of clients and the wellbeing of the caregivers. While this investment comes at a cost, we believe protecting the caregivers who become invaluable to our clients through their training and expertise is essential. Comfort Keepers is not seeking to limit or restrict any employee’s ability to earn a living; rather, we believe in a business’s right to protect its assets, ensuring the continued excellence of the care we provide.

Comfort Keepers maintains that direct hire provisions do not hinder workers from finding future employment. These provisions are designed to provide service-based businesses with compensation when the care recipient elects to hire a caregiver vetted, background-checked and trained by the agency in the form of a reasonable amount for the placement services it provided.

This is standard practice with service-based businesses across many industries. Furthermore, this is part of a larger and evolving issue being scrutinized by the U.S. Chamber of Commerce.”

Angelo Spinola, home health, home care and hospice chair at the Polsinelli law firm headquartered in Kansas City, Missouri, was involved in the case and told HHCN he thought the attorney general was incorrect in his position.

“They are applying a law that applies to non-compete agreements with employees to a client service agreement,” he said.

Non-compete and non-solicit agreements

In general, Spinola said that restrictive covenants are divided into confidentiality, non-compete and non-solicit agreements. These agreements are based on state laws, and certain states limit their use.

Non-solicitation agreements in home care are meant to prevent clients from hiring a caregiver directly and cutting out the agency. These agreements protect the agency’s business without restricting the caregivers’ mobility, providers believe. If the contract is violated, the agency may seek legal action and sometimes request damages.

“I can absolutely understand why [an agency] would want [an agreement] because there’s such a strong incentive to hire aids and home health care workers,” Jolie Apicella, partner at Wiggin and Dana Law Firm, told HHCN. “This is a time when staffing is already critically difficult after COVID-19. It’s never been harder to find good people who are qualified, who meet all the regulatory requirements and who you can really trust to go into people’s homes, which is the most intimate and vulnerable place. To lose those people… your whole business model would be canceled out if they’re able to be hired directly by patients and families.” 

Nearly one in five workers in the United States is bound by a non-compete agreement that prevents them from finding a new job or starting a business in their field when they leave their employer. Non-competes are currently governed at the state level, and research shows that they suppress wages, reduce job mobility and stifle innovation.

California, Minnesota, North Dakota and Oklahoma have completely banned non-compete agreements. Thirty-three states plus the District of Columbia restrict their use, according to the Economic Innovation Group. Recently, the FTC unsuccessfully tried to ban non-competes nationally.

However, non-compete agreements and non-solicitation clauses are not interchangeable, and the latter should not affect a caregiver’s mobility, according to Spinola.

“The non-compete is the most restrictive covenant,” he said. “For example, the term for which a non-compete applies generally might be shorter – a year instead of two years, like a non-solicit agreement. The territory in which it applies will be limited to the territory where the business operates.”

When they can be used, non-compete agreements are generally reserved for executives who could harm the business if they left and worked for a competitor. Non-solicit agreements are more commonly used for caregivers and other individual contributors.

“Non-solicit agreements shouldn’t impact the caregiver’s ability to work wherever they want and even for whomever they want to,” Spinola said. “If a client reaches out to a caregiver and says, ‘I’d like you to work for me,’ that’s not a violation of a non-solicit agreement. If the caregiver calls the agency’s client and says, ‘I want you to get services from me instead of the agency you’re with,’ that would be a violation.”

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