In a crowded home care ecosystem, companies are constantly looking for ways to stand out.

For some that means putting innovative solutions in practice that will enhance operations and care services. For others, that means developing deep local roots to strengthen services in various communities.

On top of this, home care companies are rolling out services that will help differentiate their care delivery model from that of competitors.

Ari Medoff — CEO of the home care company Arosa — recently touched on the greater need for ingenuity in home care.

“I am constantly amazed at how big and vast our market is, and how few points of differentiation most of us in the industry have,” he previously told Home Health Care News. “We need more creativity around business models. We need more companies to try different things.”

HHCN recently heard back from six home care leaders on the aspects of their companies that they believe separate them from the crowd.

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Home care faces significant market pressures typical of its growth shakeout phase, where market differentiation is necessary for survival. At Home Assist Health, our strategic response focuses on deepening community commitment through a person-first approach, evident in our person-centered care planning and employee-centric programming that prioritizes clients and staff.

We’ve integrated innovative solutions like Automation Edge’s bot for streamlined back-office tasks and Tap Root Ella’s AI for dementia care, enhancing care quality and efficiency. Recognizing increasing rates of chronic disease, we’re prioritizing health independence by expanding community health worker services and promoting self-management of health skills. Partnering with an Arizona non-profit, we’re providing diabetic-compliant meals to eligible members.

Our focus on workforce centers around students who are not only experts in what attracts them to a profession but are also our primary target for growth. We’ve expanded partnerships with high schools, community colleges, and Arizona State University, offering internships, apprenticeships, scholarships, and student-led HR consulting to nurture talent and enhance capacity.

We operate in the human services industry, where placing people at the center of everything we do is fundamental. Our goal is to promote and enhance human potential at every level. This guides our operations and ensures resilience during industry shakeouts.

— Sara Wilson, president and CEO of Home Assist Health

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To differentiate ourselves in the home care market, we leverage advanced technology and maintain strong human connections. Our primary competition isn’t other agencies, but private caregivers. Since leaving the Honor Care Network, we’ve partnered with Hellohire and Homecare Pro to streamline our hiring process. This automation reduces onboarding time, ensures thorough vetting and maintains high-quality care. According to the 2024 Home Care Pulse annual benchmarking report, our hiring conversion rate outperforms the top 5% of agencies.

Our innovative approach improves efficiency, reduces costs and allows us to deliver top-notch care while considering our clients’ fixed incomes. By integrating technology into our operations, we enhance accountability and remain competitive. Despite our technological advancements, we emphasize the human element by conducting in-person interviews and orientations to build trust and ensure we hire the best caregivers. This blend of technology and personal interaction sets us apart in a parity market.

By embracing innovation and prioritizing human connections, we remain efficient, relevant and committed to serving our community effectively. And, at the same time, the bonus for Cypress is the reduction of the costs of human capital, and the bonus for caregivers is the speed to hire increases exponentially. Our approach ensures our clients receive the best possible care. As our business manager has said for over 20 years, ‘He or she who has the caregivers wins.’ Having quality caregivers available is how we differentiate ourselves.

— Bob Roth, managing partner at Cypress HomeCare Solutions

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We believe that deep local roots are essential for home care companies to differentiate themselves from competitors. In practical terms, this means leveraging our community knowledge to provide clients with the resources they need at any time of day. If you require a reliable and trustworthy caregiver to spend that very night with an anxious, hospitalized loved one, we are the answer. Hand-in-hand with local knowledge is a strong base of exceptional caregivers. Their dedication and expertise will establish and maintain our reputation for quality, compassion, professionalism and reliability while building trust with the people we serve. These qualities matter most to those seeking home care services and can make or break an agency. Plus, they are a big part of our quest to reshape the meaning of personalized caregiving. Unlike large companies that struggle with local knowledge and small agencies that lack resources, we are unwaveringly focused on our communities and caregivers. This unique approach, tailored to the specific needs of the people we serve, sets us apart and helps us break the parity barrier.

— Doug Markham, CEO of Avenues Home Care

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At Senior Helpers, we differentiate from other home care companies by looking at outcome data for the families we serve. We utilize a proprietary LIFE Profile Assessment app with our clients that applies more than 18 years of data to create a customized care plan for each client. We then measure our client’s improvements and track any hospital readmissions or ER visits. We believe our services are non-clinical and highly skilled. Our caregivers are trained to care for clients with chronic illnesses such as Alzheimer’s, Parkinson’s and much more.

Most home care companies focus on private pay, or government payers such as Medicaid. At Senior Helpers, we excel in both these markets along with the underserved middle market. The middle market has the largest number of seniors, but it is very difficult to service. The seniors in the middle market don’t have the financial resources to afford traditional home care and they have too much money to have the government help pay for home care. Senior Helpers has developed customized fractional care programs called flexHOME, utilizing home care and technology to meet the needs of this growing market. We want to serve as many clients and families as possible and we need to be resourceful on how we serve them now and in the future.

— Peter Ross, CEO and co-founder of Senior Helpers

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Family & Nursing Care Select stands out with our expertise navigating all aspects of long-term care insurance (LTCI) for our clients. Our LTCI management team provides unparalleled, comprehensive, hands-on support and advocacy ensuring each and every client maximizes their LTCI benefits. We provide guidance and support with all the paperwork, troubleshoot issues and uncover potential additional policy benefits, thereby maximizing the value of each policy. We consistently receive raving feedback from our clients about our proactive communication, and how supportive our LTCI team is from the first discussion when initially setting up care through the entire life cycle of a client.

— Neal Kursban, CEO of Family & Nursing Care

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I believe that to differentiate yourself in the home care industry, organizations need to prioritize humanized experiences over transactional ones. At Nurse Next Door, our Happier Aging philosophy embodies this belief by delivering personalized and connected care. By nurturing relationships and empowering seniors to pursue their passions, we enhance their emotional, mental and physical well-being, celebrating aging as a vibrant stage of life. Our focus extends beyond our clients to our caregivers through our Caregiving as a Career initiative, aimed at industry transformation. We provide growth opportunities, guaranteed hours, and foster a supportive culture that attracts compassionate professionals. Valuing our caregivers ensures they feel fulfilled and appreciated, establishing Nurse Next Door as a caregiving career destination in home care.

— Cathy Thorpe, president and CEO of Nurse Next Door

The post ‘We Need To Try Different Things’: How 6 Home Care Providers Stand Out In A Crowded Market appeared first on Home Health Care News.

Poof — a caregiver has just vanished into thin air.

The caregiver hasn’t shown up to care for their client during the shift, and they’ve left the home care agency without giving any notice.

Generally, this is what’s known as caregiver ghosting, and it continues to be a challenge for home care providers.

Recently, Victor Hunt — co-founder and CEO of caregiver engagement platform Ava — highlighted this industry-wide pain point in a post on LinkedIn. Hunt noted this was a problem, and a growing one at that. 

Specifically, Sheila Davis – the senior vice president of area operations at Always Best Care – believes that in the past nine months caregiver ghosting has gotten worse.

“It’s something that we’re all noticing, and there seems to be an uptick,” she told Home Health Care News.

Ghosting has a detrimental impact on home care companies, according to Erika Ehlers, HomeWell Care Services’ senior director of learning.

“It has that immediate impact on the safety and wellbeing of the client,” she told HHCN. “But then there’s also the longer-term negative impact that it’s going to have on your reputation, revenue and, potentially, your profitability.”

There are a number of different factors that contribute to caregiver ghosting.

Davis pointed out that one of these factors is caregivers leaving for what they believe to be a better job opportunity.

“Caregivers may find a better job opportunity after applying with us, or even after getting a job with us, and then they just don’t communicate that they’re leaving,” she said. “That is one of the main factors that we’ve seen — caregivers would at least give notice, and they just leave without even telling you anything anymore.”

Ghosting providers

At Nurse Next Door, Veronica Tissera, vice president of customer experience, was once made aware of a situation where a caregiver had to choose between putting gas in her car or feeding her children.

Tissera explained that this is something the company would not have known if they didn’t make the effort to get curious about why ghosting happens.

Nurse Next Door has since implemented a number of policies aimed at curbing caregiver ghosting. This includes holding clients to a 12-hour minimum for service hours.

“One of the reasons why caregivers ghost is that they work for several companies,” Tissera said. “If you have a company that offers a [one-hour shift] versus a company that says, ‘We have eight hours,’ caregivers will choose the one that can offer eight hours.”

This offers caregivers more stability, and enables them to earn a higher wage. Nurse Next Door also offers wages that are above industry average and a comprehensive benefits package.

Similarly, Always Best Care also put strategies in place meant to combat caregiver ghosting. One of these strategies is constant communication, especially when it comes to new hires.

“We’re regularly following up with the caregivers, after that initial contact, to keep the lines of communication open,” Davis said. “We’re keeping the lines of communication open after the orientation process, even when they are given their first scheduled shift. We are contacting them the night before just to remind them. We are also making sure that communication is clear and concise. We [lay out] what the expectations are during the hiring process, and make sure that the caregivers avoid any misunderstandings. While we don’t like caregivers calling off shifts, we would much rather have them call off than abandon the shift or ghost the shift.”

One of the biggest factors that leads to ghosting are burned out caregivers.

While HomeWell has largely avoided the impact of caregiver ghosting, Ehlers has still seen the value in tackling caregiver burnout head on.

“We’ve launched a personal development learning track in our learning lab that includes topics like mental wellness, time management, stress management to help owners be able to identify the signs of burnout, and then also be able to provide support and resources to help prevent it,” she said.

Ehlers also stressed the importance of a robust onboarding process for new caregivers.

“It can’t be overstated,” she said. “Our franchise services team noted that the possibility of ghosting on a shift increases significantly when that new caregiver hasn’t had expectations clearly defined, or been properly prepared. They’re basically left to walk into a stranger’s home without any support. It’s really important to ensure that caregivers feel they’re valued members of the team, and that they’re recognized for all the compassion and care that they’re bringing to their work every day.”

The company also believes in setting up its franchise owners to cultivate strong employee engagement.

“We provide these tools to our owners,” Ehlers said. “We have a caregiver connection newsletter, we have award and recognition templates focused around our core values, and we encourage our owners to make use of those to increase communication and engagement with our caregivers. We really weave retention into all of our learning opportunities, so that we can prepare our owners with the skills and resources they need to be able to build a really positive culture and employee engagement.”

The post How Home Care Providers Are Addressing The Growing Challenge Of Caregiver ‘Ghosting’ appeared first on Home Health Care News.

In order to be ranked on the list, a franchise company needs to be courting new franchisees in the U.S. or Canada. Companies that made the list also need to have had at least 10 units open and operating as of July 31, 2023, with at least one U.S.-based franchise.

Factors such as franchise cost and fees, size and growth, network support and brand strength determined each company’s evaluation.

Companies like Interim HealthCare, Home Instead and Senior Helpers ranked the highest of the home-based care franchises that managed to grab a spot on the list.

Interim HealthCare

— Rank: 59

— 2023 Rank: 55

— Units: 655

— Based in Sunrise, Florida, and a part of Caring Brands National, Interim is a franchise that provides home health, hospice, palliative care and other services across locations in the U.S. and Saudi Arabia.

Home Instead

— Rank: 149

— 2023 Rank: 155

— Units: 1,217

— Home Instead is a Omaha, Nebraska-based personal care franchise company that has locations in over a dozen countries. In 2021, the home care technology company Honor acquired Home Instead.

Senior Helpers

— Rank: 172

— 2023 Rank: 172

— Units: 361

— Maryland-based Senior Helpers has a national personal care network, as well as adult day centers. The company was acquired by Advocate Health Enterprises in 2021.

Homewatch CareGivers

— Rank: 222

— 2023 Rank: 208

— Units: 222

— Denver-based Homewatch CareGivers is a home care franchise company that operates in over 30 states and seven countries. The franchise employs over 4,500 caregivers.

Griswold Home Care

— Rank: 252

— 2023 Rank: 267

— Units: 186

— The Blue Bell, Pennsylvania-based Griswold is also a home care franchise. It provides personal care services in 30 states.

ComForCare

— Rank: 254

— 2023 Rank: 402

— Units: 229

— ComForCare is a home care franchise organization that has hundreds of territories independently-owned and operated in Canada and the U.S. ComForCare operates as At Your Side in Houston, Texas. ComForCare operates under parent company Best Life Brands. Another Best Life Brands company, Blue Moon Estate Sales, also ranked on the Franchise 500 list.

BrightStar Care

— Rank: 279

— 2023 Rank: 141

— Units: 373

— Chicago-based BrightStar is a provider of home care, senior living and supplemental staffing. The organization has been deliberately increasing its company-owned footprint of late.

Assisting Hands Home Care

— Rank: 280

— 2023 Rank: 229

— Units: 193

— Assisting Hands Home Care offers both medical and non-medical assistance for seniors, including meal preparation, companionship, chores and more.

HomeWell Care Services

— Rank: 283

— 2023 Rank: 347

— Units: 136

— HomeWell is a Burkburnett, Texas-based home care franchise that operates across the U.S. The company offers companion care, personal care, as well as specialty care.

Right at Home

— Rank: 318

— 2023 Rank: 260

— Units: 716

— Omaha, Nebraska-based Right at Home is a home care franchise company with locations in the U.S. and six other countries.

Nurse Next Door

— Rank: 418

— 2023 Rank: N/A

— Units: 183

— Vancouver, Canada-based Nurse Next Door is a home care franchise system that operates in the U.S., Canada and Australia. As an organization, the company provides personal care, companionship care, homemaking services, dementia care and more.

FirstLight Home Care

— Rank: 438

— 2023 Rank: 327

— Units: 197

— Cincinnati-based FirstLight Home Care is a provider of non-medical home care. The company also has a specialized care program aimed at seniors with dementia.

Synergy HomeCare

— Rank: 449

— 2023 Rank: 483

— Units: 453

— Synergy is a Gilbert, Arizona-based non-medical home care franchise. The company offers companionship services, in addition to personal assistance, housekeeping, live-in care and 24-hour home care services.

Home Helpers

— Rank: 475

— 2023 Rank: 396

— Units: 308

— The Cincinnati-based Home Helpers is a home care franchise that provides personal care, nutrition and companionship services, among others. It serves over 1,000 communities in the U.S.

Visiting Angels

— Rank: 479

— 2023 Rank: N/A

— Units: 692

— Bryn Mawr, Pennsylvania-based Visiting Angels is an in-home senior care company that provides companion care, personal care services and more.

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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.

The post Top Home Care Trends For 2023 appeared first on Home Health Care News.

But that doesn’t mean there are no roadblocks to said ownership.

However, this is beginning to change, as a number of franchise companies are working to open the door for a variety of owners, including former caregivers.

At Nurse Next Door, opening the door means the “front line to franchisee” program. Essentially, the aim of the program is to make home care business ownership more accessible to caregivers and nurses.

“For those of us who have been in health care — we’ve always known that we have a dedication to those that we serve, a tenacity and great work ethic,” Michelle Greer, agency director at Nurse Next Door of Raleigh, North Carolina, said earlier this month at Home Health Care News’ Franchise Forum event. “Nurse Next Door has recognized that these traits transfer really well to agency owners and to being a great leader.”

The Vancouver, Canada-based Nurse Next Door is a home care franchise system that operates roughly 200 locations across the U.S., Canada and Australia. As an organization, the company provides personal care, companionship care, homemaking services, dementia care and more.

Though Greer wasn’t part of the “front line to franchisee” program, the inspiration behind it was people like her, a former caregiver and nurse.

As part of the program, participants receive a discount on the initial franchise fee. 

“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,” Greer said.

Lowering startup costs

Similarly, HomeWell Care Services also recognized that startup costs can be a barrier to entry for many of the people that would make successful owners.

In July, the company announced that it would drop its initial franchise fee for new owners throughout 2022.

The initiative also allowed new owners to reinvest these funds back into their business once their franchise location officially opened.

“This is one of those businesses where you can grow fast or slow, you can do it in a lot of different ways; it is very customizable,” Eli Collier, a HomeWell owner in Hendersonville, Tennessee, said during the panel discussion. “Not having that franchise fee allows people to come in and get started, and do it with a lot less input from the beginning, so that they have time to build on it until they’re making that income.”

HomeWell is a Burkburnett, Texas-based home care franchise that has 50 locations representing over 100 territories across the U.S.

Collier and her husband run the Hendersonville, Tennessee, HomeWell location together. Collier didn’t enter through the company’s current zero franchise fee initiative, but she and her husband often work with new franchise owners to help set them up for success.

Prior to being a franchise owner, Collier worked on the operations side at a test preparation company for 17 years. She’s been working in the home care business for four years.

Caregiver to owner

Lori Henderson, the owner and administrator of FirstLight Home Care of Western Slope, is part of this larger trend of more caregivers becoming franchise owners.

FirstLight Home Care is a franchise with about 150 locations across the country.

For Henderson, it took her direct manager stepping up and advocating for her career advancement.

“I began as a caregiver in October 2015, working about 20 hours a week, and started off making $9.50 an hour,” Henderson said during the panel discussion. “My manager at that time saw something in me that I didn’t see in myself. She pushed for me to better myself. She took me out of the field and threw me into the office. She was a huge blessing to me.”

Once Henderson was out of the field, she worked in many of the office positions at FirstLight. This taught her the ins and outs of the business. She would eventually purchase the FirstLight location where she worked as a caregiver.

“My corporate office was so supportive, and the previous buyer financed it for me, which was amazing,” she said.

While HomeWell and Nurse Next Door set up formal initiatives, and FirstLight has focused on mentorship, most home care franchise companies are already in a strong position to offer the support needed to aid newcomers to ownership status.

“You have a community, and that’s something that we found we really appreciate,” Collier said. “It’s not just the corporate side, we have other franchise owners that we can call and everyone is willing to share and help, and they will all jump in. I like to say that being part of a franchise system helps you not fall in the holes that somebody else already fell in.”

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In recent months, a number of home care franchise companies have seen a surge in interest from front-line caregivers and nurses who want to make the transition to the franchisee-ownership level. There has always been an interest in becoming home care owners among the front-line workforce, but the COVID-19 emergency has accelerated this trend, industry leaders told Home Health Care News.

“I think it’s an ideal next step for those who want to transition out of the day-to-day patient care but are still committed to servant leadership and improving patients’ lives in their communities for the better,” Jennifer Sheets, president and CEO of Caring Brands International and Interim HealthCare Inc., told HHCN.

In addition to Interim, Caring Brands International includes the U.K.-based Bluebird Care and Australia-based Just Better Care. Interim is a Sunrise, Florida-based in-home care franchise company with more than 300 locations across the U.S.

At Interim, 65.83% of the company’s ownership groups have an owner or operator who is a registered nurse (RN) or a licensed practical nurse (LPN), according to Sheets.

Nurse Next Door, another large in-home care franchise company, has likewise seen several front-line workers turn into owners. And when the company noticed this trend picking up, it moved to create an official pipeline.

Today, it even has a “front line to franchise” campaign designed to bring more caregivers and nurses into the ranks of home care ownership.

“Three years ago, we really started talking about caregiving as a career,” Cathy Thorpe, CEO of Nurse Next Door, told HHCN. “How do we elevate that role in the industry and the community?”

Vancouver, Canada-based Nurse Next Door operates roughly 200 locations across the U.S., Canada and Australia. As an organization, the company provides personal care, companionship care, homemaking services, dementia care and more.

The overarching goal of the Nurse Next Door campaign is to make home care business ownership more accessible to front-line nurses and caregivers, Thorpe noted.

Broadly, the franchise business model allows an individual or franchisee to buy the right to sell products or services under the brand of an established company. Ongoing franchise fees are a crucial part of most franchisers’ business models.

One way Nurse Next Door’s “front line to franchise” campaign lifts barriers is by waiving the initial franchising fee, allowing new owners to eventually pay this off after they’ve started their business. Nurse Next Door’s fee is $58,000, plus an $8,000 tech fee in the U.S.

“We know there’s a lot of them who would have started a franchise business, but that initial fee is what held them back,” Thorpe said. “We have said, ‘Let’s not ask them for that fee up front.’ We know that they’re going to bring their blood, sweat and tears into the business.”

Home care franchising fees vary depending on the company. Typically, franchise fees range from $20,000 to $50,000, according to the U.S. Small Business Administration. That’s not the total overall startup cost, however.

In addition to postponing the initial franchising fee, Nurse Next Door’s campaign supports new franchisees by placing them in an extensive training program prior to launch.

Although the campaign has only been around for two months, Nurse Next Door has already had thousands of interested parties reach out about participating. Thorpe hopes that the company’s industry peers will follow in their footsteps.

“I know we are disrupting the industry in terms of putting the focus on the caregiver,” she said. “Caregivers and nurses are the most dedicated and passionate people and this program is allowing us to recognize that and put them in a position to use those strengths and really create a very meaningful business for themselves.”

Similar to Nurse Next Door, Interim has made it a priority to elevate the role of the caregiver. Creating a path to home care ownership is one avenue for doing that, according to Sheets, a former hospital ICU nurse.

“We look to help people,” Sheets said. “Where do you want to go next? Maybe you want to go down the business-ownership route or the operations route. Maybe you want to further your clinical career.”

Generally, caregivers and nurses already have a number of qualities that position them to be successful business leaders, Interim’s CEO explained.

“Everything that I learned in my nursing career — things like empathy, problem-solving, communication and advocacy — are all attributes that I use every single day in my role as a CEO,” she said. “[My background] taught me that good leadership is a commitment to service and a call to impacting the world for the better. I always say I don’t want to ever forget what it was like to work in the ICU at night on Christmas Eve.”

Sheets believes that this new class of leaders, given their previous experience, also has the potential to help solve some of the issues that have long plagued the home care industry. Those issues include retention challenges.

“I think there is absolutely a recognition of the value that somebody from the outside brings in,” she said.

The median caregiver turnover rate for home care providers was 64.3% in 2020, according to data from Home Care Pulse. While this rate isn’t as dire as the all-time high of 82% in 2018, turnover is still a major pain point for companies.

Looking ahead, it’s likely that the home care industry continues to see caregivers and nurses move into leadership roles for years to come.

“It’s not only the ability to lead and have a real impact in your community, but you also have the ability to connect all the dots,” Sheets said. “I think that is why clinicians are attracted to begin with. I think we are going to continue to see this.”

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Vancouver, Canada-based Nurse Next Door is a home care franchise system that operates roughly 200 locations across the U.S., Canada and Australia. As an organization, the company provides personal care, companionship care, homemaking services, dementia care and more.

Arif Abdulla, Nurse Next Door’s vice president of global franchise development, believes that interest in home care franchise companies is at its peak.

“There has never been more interest in home care franchising, and I’ve been a Nurse Next Door for 15 years,” he told Home Health Care News. “It’s a very unique time for this industry.”

Overall, the company is on track to add about 150 locations by the end of September. Of the new locations, 60% will be in the U.S., with the other 40% will be split between Canada and Australia.

In the past, interest in joining a home care franchise system largely stemmed from the financial opportunity it presented for entrepreneurs. The average profit for senior care franchises is $135,625 annually, according to Franchise Business Review. 

The public health emergency has shifted this away from being a strictly financial opportunity, according to Abdulla.

“Now, what we’re seeing is a lot of people that have been touched personally over the last year throughout the COVID-19 [emergency] by health care and home care,” he said. “They have this purposeful interest in our business. I think that’s what’s unique about this moment in time. The interest isn’t only financial; that’s certainly part of it, but it’s based on personal experiences that people had.”

Nurse Next Door has also seen a change in the kind of people interested in entering the franchise systems.

“We’ve seen a significant rise in interest from front-line caregivers and nurses that want to get into the home care business, because they’ve seen the impact it can have or they’ve seen what has played out in institutional settings,” Abdulla said. “They have that desire to be a part of it in the future.”

In response, the company has built an entire campaign that focuses on making home care business ownership more accessible to this group.

“We launched this ‘front line to franchisee’ program because we know how effective and how strong front-line health care workers can be if [they have business support],” Abdulla said. “We’ve had a lot of success with that recently.”

Nurse Next Door’s ‘front line to franchisee’ program reflects the company’s broader efforts to ensure franchisees are supported, especially with recruiting and retaining caregivers.

In order to do this, the company has heavily invested in technological tools that automate the hiring process and make it easier to recruit and onboard people. This includes a digitized applicant tracking program as well as online caregiver training.

The team at Nurse Next Door’s headquarters has also taken charge of the initial intake of prospective caregivers.

“We take that process on behalf of our franchisees, as opposed to simply forwarding them to our website or sending them to a franchisee,” Abdulla said “We’re saying, ‘How do we get these people that are qualified into our system as quickly as possible?’ That’s a service that we provide to our franchisees at no cost to them.”

Ultimately, Abdulla believes that Nurse Next Door’s efforts in regard to supporting its franchisees have been the key to the company’s growth.

“We put a lot of focus and energy into maturing the way caregivers are treated, creating employment that is rewarding, lucrative and attractive, and helping our franchisees invest into that,” he said. “How do we pay our people competitively? How do we build the right margin? How do we make sure caregivers are cared for in a meaningful way?”

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Since 1980, the annual list has evaluated the strength of franchise opportunities in industries across the board. To create this year’s rankings, the magazine reviewed more than 1,000 companies. For each, editors weighed “five pillars”: costs and fees; size and growth; support; brand strength; and financial strength and stability.

Founded in 1966, Sunrise, Florida-based Interim attributes its ability to climb the ranks to its strong fundamentals: providing quality care using top-of-the-line caregivers.

While those qualities have long been paramount for Interim, the franchise giant recently increased its storytelling efforts to better highlight company strengths, Senior Vice President of New Franchise Support Steve Turner told Home Health Care News.

“Our corporate marketing team has focused on supporting our franchise owners and getting our message out to the right people at the right time,” Turner said in an email. “Interim HealthCare has amped up its social media, public relations and content marketing efforts to share the value of our home care services and franchise opportunities.”

Additionally, in 2018, the company introduced new programs to position itself for future growth. Some include programs for dementia, specialized care and a franchise owner network.

The Franchise 500 news comes during a time of transition. On Monday, Interim announced it named a new CEO: Jennifer Sheets, who most recently served as a chief clinical officer and senior executive of clinical operations, innovation, education and quality at Bayada Home Health Care.

While Interim beat out its competitors, home care overall ranked lower on the Franchise 500 list than it did in 2018.

This year, Interim came in at No. 144, as opposed to No. 102 last year. Meanwhile, Right at Home, which led the home care pack in 2018 with an overall ranking of 49, took the No. 211 spot in this year’s rankings.

Overall, 18 home care franchise companies appear on the list this year, as opposed to 16 last year. Other highly ranked home care companies on the 2019 list, which Entrepreneur has now compiled for 40 years, include:

• Visiting Angels (No. 2 in senior care, No. 169 overall)
• BrightStar Care (No. 3 in senior care, No. 184 overall)
• Nurse Next Door (No. 4 in senior care, No. 190 overall)
• Senior Helpers (No. 5 in senior care, No. 192 overall).

The top-ranked 2019 franchise opportunities are McDonald’s, Dunkin’ and Sonic Drive-In.

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Nurse Next Door’s Melbourne expansion marks its first international deal, with the company’s Australian master franchise going to locals Amber Biesse and Matt Fitton.

“We’ve been pretty methodical in how we’ve wanted to approach international,” Cathy Thorpe, Nurse Next Door’s president and CEO, told Home Health Care News. “We spent a lot of time looking at the different markets, and we felt that Australia was very aligned with North American, and we’d be able to adapt our system very easily there.”

After opening the corporate location, Biesse and Fitton will start looking for franchise locations in three to six months, Thorpe said. From there, the goal is gradually add locations, growing to 75 to 100 Australian franchises within the next five to 10 years.

Nurse Next Door’s international plans, which have been in the works for about five years, don’t stop there.

“We do want to be aggressive going forward and we plan to expand into three to five new markets in the next 12 to 18 months,” Thorpe said.

Targets currently include the United Kingdom, where there’s no language barrier; Germany, which offers an entryway to mainland Europe; and China, where the aging population is growing without the infrastructure to support it, Thorpe said.

She advises other agencies considering international expansion to adopt a global mindset and ensure their domestic business is secure, uniform and scalable.

Caregiver career-pathing

While international expansion is a big priority for 2019, Nurse Next Door hasn’t lost sight of domestic goals, such as improving caregiver retention and adopting innovative technology.

“I want as an organization to disrupt how the industry sees the caregiver role as a casual job,” Thorpe said, naming career path development for caregivers as one of Nurse Next Door’s focuses for 2019.

In doing that, the company hopes to satisfy workers, thus lowering turnover, which industry-wide hovers just above 65%, and combating the industry caregiver shortage, which has long been identified as a top concern among home care agencies.

“We’re actually hiring caregivers full-time,” Thorpe said. “We’re guaranteeing hours for them, so for the first time they actually know how much their paycheck is going to be [and] how they can plan for their future.”

For most locations offering the benefit, full-time caregivers are guaranteed 30 or more hours per week.

Nurse Next Door started testing full-time caregivers at its corporate-owned location about 18 months ago, and the initiative continues to roll out on a larger scale, with franchises following suit on a discretionary basis.

By 2020, the goal is for all locations to offer some form of guaranteed hours, higher wages and benefits, Thorpe said.

“It’s not just about going in and adding hours to their week,” Thorpe said. ”What are other career aspirations people have, and how are we able to help people get to those places?”

Tech advancements, domestic expansion

Using technology to improve business operations is another 2019 priority for Nurse Next Door.

“By and large, I think the home care industry has been behind in technology, so I think it’s refreshing to see some of these companies like Honor,” Thorpe said. “You can ask, ‘are they disrupting home care?’ I think they’re actually helping us move forward, and it’s forced us to really look and say, “What does our platform look like? How do we continue to invest in our platform?”

Over the past two years, Nurse Next Door has incorporated technology into its strategy on a larger scale and will continue to do so in 2019, Thorpe said.

Finding technologies that make scheduling easier, removing client-caregiver friction and making the online user experience easier are all at the top of Thorpe’s list.

Finally, other goals include continued growth across Canada and the US.

Priorities for Canada include growth for comparable store sales, while Nurse Next Door plans to open 50 to 60 new locations in the U.S., Thorpe said.

Written by Bailey Bryant

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Following her career at The Gap, Thorpe became a consultant for small and mid-size businesses before a personal experience introduced her to Nurse Next Door. She joined the Canada-based franchise company in 2014 and took on the CEO title two years later.

During her time with Nurse Next Door, she has helped lead the company’s expansion into the United States, including through an innovative partnership with a California health system. And she has brought the skills she honed at The Gap to help Nurse Next Door define the “one best way” to do business across its platform of about 150 franchises.

Subscribe to Disrupt via Apple Podcasts, Google Play Music, SoundCloud or your favorite podcast app. Below are some highlights of Thorpe’s comments, edited for length and clarity:

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