One he has stuck with, however, is a constant commitment to searching for the next advancements in technology.

Between recruiting, onboarding and care management plans, Caring Senior Service have prided themselves on leveraging technology to stay ahead of the curve.

“Back in 2015, we recognized that most of the software providers out there were really forcing us to follow their way of doing business,” Salter told Home Health Care News. “We found that that wasn’t productive for the way that we wanted to assess and create service plans for our clients. We needed our software to be highly customizable, in a way that would allow us to be flexible.”

The San Antonio, Texas-based home care franchise company Caring Senior Service has more than 50 locations across nearly 20 states.

Almost a decade ago, Caring Senior Service created its own software that allowed the provider to curate more personalized service plans for its clients.

It was at that time when Salter believes he and his company made a considerable shift in philosophy.

“Around that time was when we decided to stop being what I consider order takers,” Salter said. “Instead of taking someone’s order like a server would at a restaurant, we started being actively involved in the planning for someone’s services.”

By leveraging its own technology and moving from analog assessments to a digital-first approach, Caring Senior Service and its caregivers were able to more deliberately assess.

And now, that swift progression in technology has only blossomed in recent years.

“When we launched it, we moved to a completely electronic format so that we’re sitting in front of the client with a tablet and were able to incorporate a smart algorithm in the assessment process,” Salter said. “Now we’re moving towards using AI to help us create the suggestions of what a service plan could look like for a client based upon what we’re discovering during those interviews.”

Home care providers are still tinkering with ways to incorporate AI into their operations. Providers have told HHCN they’re using AI for documentation, scheduling and marketing.

Caring Senior Service is also using it during the hiring process.

“We as an industry have created a bit of an arms race when it comes to acquiring caregivers,” Salter said. “Caring — and everyone else out there — is suddenly receiving a lot more applicants than they’re used to and it’s challenging filtering through those efficiently and effectively.”

Caring Senior Service is using AI in its chat bots to interact with applicants very early on in the hiring process as a way to better understand applicants in a speedier way.

“We’re investing in really smart chatbots that can interact with the applicants in a way that is very unique to the industry,” Salter said. “Using the AI technology, you can really have a regular, seemingly natural conversation to gain a lot more information about that applicant prior to them having to get engaged with in-depth questions.”

Salter clarified that it doesn’t use AI to filter out candidates. Instead, they are using it as a screening tool so that when real people in a human resources department take the lead, those employees are more informed on who they’re interviewing.

“That’s when we’re able to focus on those in-depth personality questions that give us a better idea if that person is a good fit for home care,” Salter said.

The post How Caring Senior Service Moved Away From Being An ‘Order Taker’ In Home Care appeared first on Home Health Care News.

For years, many industry advocates have pushed for more standardization across home care. Home care licensure is largely seen as one of the main avenues to industry standardization.

Though the majority of states in the country require home care businesses to have some form of licensure, the stipulations are different depending on the state.

“It is all over the board,” Caring Senior Service COO Jeff Bevis told Home Health Care News. “No two states are alike.”

For instance, some states stipulate that a nurse perform a client assessment or quality assurance, even when the company operates as an entirely non-medical agency. Some states – New York, for example – have an extensive licensure application process that can sometimes take up to three years to clear, according to Bevis.

A state’s political climate can also play a role when it comes to licensure requirements, according to Eric Reinarman, vice president of government relations at the Home Care Association of America (HCAOA).

“Generally speaking, if it’s a blue state, there’s going to be more requirements, as opposed to a red state, which may have fewer requirements,” he told HHCN.

Reinarman also noted that some states even call for home care businesses to have a specific type of training. For instance, Florida recently implemented licensure stipulations regarding Alzheimer’s training.

Bevis is a home care industry veteran with decades of experience under his belt. He noted that when he first got his start in the business in early 2003, only six states had licensure requirements.

Currently, 34 of 50 states have licensure requirements in place for home care businesses.

As for why more states have implemented licensure requirements for home care agencies, Bevis pointed to a few reasons why.

“You’ve got such an exploding senior population, states are paying more attention to protecting seniors,” he said. “They also see this as a revenue source, as far as application or licensure fees. States also see it as a growth area of business, creating jobs in their states.”

Despite the variations that can be seen across different states, there are some common stipulations that many state licenses have in place for home care businesses.

“You have basic information you have to submit, such as your articles of incorporation, your corporate documents, a franchise agreement if you’re part of a franchise system, typically your org chart, oftentimes resume or resumes of the ownership or key staff in that given office,” Bevis said. “You usually have to at least make some reference, in most states, to caregiver education or training.”

Ultimately, while some state licensure stipulations are improving the home care landscape and making care safer, others are restrictive and can lead to administrative burden for agencies.

“Something that’s been a good component is to require basic caregiver training, and that is present in many of the states,” Bevis said. “On the flip side, I’ll cite New Jersey. In terms of overreach, New Jersey has a process where every caregiver has to be registered with the state. You can only be credentialed to a state approved accreditation body. That ends up being a bottleneck, and takes away, I think, almost kind of the free market component to it.”

Bevis believes New Jersey’s licensure stipulation blurs the line between skilled and non-medical, and makes it more difficult for the latter to operate.

“It almost makes non-medical a branch of skilled in an unjustified way,” he said.

Additionally, some states have become notable for making it tougher for new home care businesses to become licensed.

“One example of ones that are really slow is the state of Delaware,” Bevis said. “I have a current franchisee who went over a year and still didn’t get their license. The state of Colorado right now is running six to seven months, and we’re still waiting for a license. Florida, historically, was one of the toughest ones. California, earlier this year, was taking five to six months.”

This is, sometimes, the result of inadequate staffing in the state departments that are in charge of the licensure process for home care.

Overall, many see home care state licensure, and regulation in this space, as important for the future of the industry.

“There’s a big gray market out there for home care, and we’re concerned about that,” Reinarman said. “There are agencies that, even in states where licenses are required, still engage in providing home care without a license. What does that mean? It means you don’t know who the caregivers are. You don’t know how trained they are. That’s not good for the industry as a whole.”

HCAOA has long been a proponent of home care standardization, including more uniform, licensure requirements across states.

“We’re in favor of regulation because it protects patients, and it protects home care providers as well,” Reinarman said.

Similarly, Bevis thinks that state licensure is a positive for home care.

“Licensure is really a good thing for the industry,” he said. “I think it raises the quality level, as much as we would complain about the process taking too long, it really is a good thing to give us uniformity and standards.”

Out of the 34 states that have implemented licensure requirements for home care, that leaves 16 states that haven’t.

“Those 16 states either haven’t discovered or don’t understand that there’s a need for a growing senior population in their respective states,” Bevis said. “There are providers out there now with an extremely low barrier to entry that could — not saying this is the case everywhere — lead to substandard care.”

Bevis also noted that some of these 16 states could have plans to implement licensure requirements in the future, pending their state’s legislative approval process.

States that have licensure requirements for home care agencies

1. California
2. Colorado
3. Connecticut
4. D.C.
5. Delaware
6. Florida
7. Georgia
8. Hawaii
9. Illinois
10. Indiana
11. Kansas
12. Kentucky
13. Louisiana
14. Maine
15. Maryland
16. Minnesota
17. Nevada
18. New Hampshire
19. New Jersey
20. New Mexico
21. New York
22. North Carolina
23. Ohio
24. Oklahoma
25. Oregon
26. Pennsylvania
27. Rhode Island
28. South Carolina
29. Tennessee
30. Texas
31. Utah
32. Virginia
33. Washington
34. Wisconsin *Only applies to Wisconsin providers working under Medicaid, not private-pay.

This list was made available through Polsinelli.

The post ‘No Two States Are Alike’: The Home Care Industry’s Road To Standardization appeared first on Home Health Care News.

However, getting buy-in from clients and patients in the home is a lot easier said than done.

Having patients use technologies like wearable devices, remote patient monitoring software and tablets can often feel like pushing water uphill.

“We didn’t expect seniors to fully embrace technology, but it was tough,” Caring Senior Service COO Jeff Bevis told Home Health Care News. “It was a lot tougher than we thought.”

A pilot plan that struggled

Before joining Caring Senior Service two years ago, Bevis rebuilt the Comfort Keepers brand from 2003 to 2008. Following that, Bevis and his son created FirstLight Home Care, a company that he ran for 11 years.

In 2018, Bevis and his team at FirstLight had the idea to send out 300 tablets into the field for caregivers, clients and their families to create core functionality in the home. At the time, FirstLight was one of the first providers to do this at scale.

Looking back on the experience now, Bevis called the pilot “semi-successful.”

“We didn’t get the rapid adoption by the clients and the families that we had hoped,” Bevis said. “We tried to use things like senior fitness, exercise, recipes as well as core communications. We had a family portal where families could use secured care notes. We thought we could build a pretty robust base and draw to those tablets. But we discovered there was a bigger technology aversion than we anticipated.”

FirstLight knew there would be a learning curve associated with these new technologies.

But one of the main lessons learned, Bevis said, was that the company tried to implement too many different technologies too quickly. Around that same time, FirstLight also piloted remote patient monitoring in homes, which also received a mixed response.

“We were truly trying to force too much technology, too fast, into the home setting,” he said. “Not to say they weren’t open to it in some way, but one of our takeaways was just that. The learning curve with a senior — and even with the senior and the caregiver working that technology together — is a daunting task.”

Bevis and his team were realistic with their goals as well. They didn’t expect 100% adoption during the pilot. Instead, they set their sights on between 35% and 40% adoption.

However, that number came in at about 10% or 15%.

“That did reinforce some of the findings and failings that we’ve had in our industry,” Bevis said. ‘We knew it was going to be a daunting task because the industry had always struggled to do this over the last 15 to 20 years.”

Technology growing pains

Bedrock Health at Home, a New Jersey-based home care management company, has been heavily investing in these kinds of technologies.

Under its portfolio is Bedrock at Home, a home care provider that takes care of about 3,000 clients per year.

Andre Gomez, the executive vice president of Bedrock Health at Home, told HHCN that his company has run into similar problems.

“Whether it’s remote patient monitoring, wearable devices, a pulse oximeter or even a blood pressure cuff, it’s unfortunate when some of the seniors don’t take these technologies seriously,” Gomez said.

But there have been encouraging signs recently. Bedrock has invested heavily in beta-testing wearables to track clients’ vital signs, hydration levels, falling risks and activity levels.

The investments being made are in consideration of what payers would like to see out, Gomez said.

“We have to be able to utilize technology in all aspects of care because payer sources — especially after the pandemic — realized that through technology, they can reduce rehospitalizations and they can really spend a lot less money on care,” Gomez said. “The key is really being able to see what works for some people and what doesn’t. Some of our patients do great with remote patient monitoring. Others don’t.”

Lessons learned

Looking back on some of the struggles FirstLight faced when implementing certain technologies, one of the main lessons learned for Bevis was to consider the long-term play.

“I would have gotten a much better commitment or alignment across the organization,” Bevis said. “You’ve got to go into it with a long-term view. It’s not a short game. It’s a three- or four-year process. You’ve got to get total buy-in from the franchise owners, the leaders and the executives of whatever provider you’re with and you all have to be on the same page. You have to all be committed, and we didn’t have that at FirstLight.”

Things at Caring Senior Service are much different, he said. Bevis joined the company two years ago and today, they have tablets in every home.

“It’s almost like a best-kept secret in the industry, quite honestly,” Bevis said. “It hasn’t been easy, but the key here is that we’ve made it part of our core operating system. In home health, they’ve been doing it for years, but in home care, we’ve been lagging behind. We’ve been doing that here for four years and it’s become a mainstay for our clients and the caregivers.”

Treating home care visits like home health visits – where a tablet is part of every visit – is one of the many steps in acclimating clients to the technology.

“It’s going to take time,” Bevis said. “There are going to be bumps in the road. It’s not going to be a perfect scenario ever. So I think people need to be much more realistic about their goals and they need to be much more aligned in their thinking, and more committed to education and training.”

The post ‘Too Much, Too Fast’: Home Care Providers Still Face Uphill Battle In Becoming Tech-Enabled appeared first on Home Health Care News.

Ahead of that, home health leaders are still speaking out about the importance of advocacy – and what that advocacy has done for them and their peers over the years.

“There are so many different forms of advocacy, and considering there are tens of thousands of us providing care at home, that’s a powerful, unified voice,” Robert Love, executive director of Butte Home Health and Hospice, said at the National Association for Home Care & Hospice’s (NAHC) annual conference Monday. “Those tens of thousands of us represent millions of team members. If we can engage them, tap into their voice, have them share with their networks, we’re going to go a lot further with our message.”

The Chico, California-based Butte Home Health and Hospice has been around for nearly 40 years. Six years ago, the company made a decision to revamp its whole agency and rebuild with clinician experience top of mind.

As Love explained, internal advocacy became a focal point in the company’s mission.

Part of that mission involved a “Stop the Home Health Cuts Campaign,” where clinicians and other team members were active participants in contacting local lawmakers about the dangers of cutting home health reimbursement rates.

“You’ve got to be transparent with your staff,” Love said. “When costs are going up, when pay is going up and when these cuts are coming, it’s really beneficial to have an open dialogue with your staff.”

A focused legislative advocacy plan has shown real dividends already. Clinicians sent letters to lawmakers and shared messages with members of Congress that eventually turned into a meeting that Love believes had a real impact.

“Of course, we talked about margins and what a 4% cut means to an agency that has 4% leftover at the end of the year,” Love said. “By the end of that meeting, our local legislators were about as appalled about the cuts as our team was. It was a really, really successful meeting, but it never would have happened if we hadn’t harnessed the voice of our team. In the five years since we’ve restructured, we’ve learned that a happy, motivated and engaged team can do great things together for all sorts of causes.”

Advocacy comes in many shapes and sizes.

For Jeff Salter, the CEO of the home care provider Caring Senior Service, it was a cross-country bicycle tour.

In 2020, Salter biked over 9,000 miles, visiting 50 locations in 20 states to celebrate the company’s 30th anniversary.

The campaign started out as a way to celebrate the company but morphed into a home care advocacy tour. It raised awareness about senior care in the home and technological advancements being made in senior care and also helped raise money to help pay for grab bars in bathrooms for older adults all over the country.

Along the way, Caring Senior Service hosted local events that made the movement come full circle.

“We invited community leaders, senior care advocates, caregivers and the seniors themselves. We really listened to what they had to say and what their challenges were,” Salter said. “Our goal was to help them to inspire a change in their local community, because all of this is local. People care about their families, they care about their neighbors, they care about their communities and they want to see a difference. We discovered that our movement was not just about sharing a message, but about creating a platform for people.”

Whether those challenges or opportunities involved housing, funding or technology, Salter realized the trip became one centered on advocacy at the local level.

There was also a neatly tied metaphor in the trip itself. One Salter realized along the way.

“When you take a trip like this, there are going to be setbacks,” he said. “When you take on advocacy, there’s going to be setbacks. But it does require that you have dedication and perseverance and that you’re actually willing to step out outside of your comfort zone. There were many days I felt like I wanted to quit and I didn’t think anybody really cared if I just stopped and went home. But the reality was that many lives would have been impacted had I not completed the trip.”

The post Home Health Agencies Are Making Advocacy A Part Of Everyday Operations appeared first on Home Health Care News.

The list is based on last year’s global systemwide sales — total sales for both franchise and company units — performance.

In order to earn a spot on the list, a company needs to be a legal U.S. franchise. It should also own at least 10% of the company’s total units.

At-home care franchise companies Home Instead Senior Care, Right at Home and Interim HealthCare managed to crack the top 100 portion of the list, alongside big name companies like McDonald’s (NYSE:MCD), Dunkin’ (Nasdaq:DNKN) and The UPS Store (UPS:NYSE).

Home Instead Senior Care

— Rank: 44

— System Sales: $2,400,000,000

— Total Locations: 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.

Interim HealthCare

— Rank: 65

— System Sales: $1,288,000,000

— Total Locations: 655

— The Sunrise, Florida-based company – a part of Caring Brands International — provides personal care, hospice care, palliative care, pediatric care and staffing services.

Visiting Angels

— Rank: 90

— System Sales: $900,000,000

— Total Locations: 697

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

Right at Home

— Rank: 100

— System Sales: $778,386,711

— Total Locations: 712

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

BrightStar Care

— Rank: 117

— System Sales: $653,907,370

— Total Locations: 370

— 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.

Comfort Keepers

— Rank: 124

— System Sales: $625,000,000*

— Total Locations: 645

— Irvine, California-based Comfort Keepers is one of the largest personal home care providers in the U.S. It recently was acquired by The Halifax Group.

Senior Helpers

— Rank: 176

— System Sales: $387,243,000

— Total Locations: 327

— 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.

ComForCare Home Care

— Rank: 225

— System Sales: $238,000,000

— Total Locations: 223

— ComForCare is a home care franchise organization that has 270 territories independently-owned and operated in Canada and the U.S. ComForCare operates as At Your Side in Houston, Texas.

Home Helpers Home Care

— Rank: 230

— System Sales: $231,856,454

— Total Locations: 304

— 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.

Synergy HomeCare

— Rank: 236

— System Sales: $223,257,894

— Total Locations: 417

— 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.

Always Best Care

— Rank: 245

— System Sales: $212,591,506

— Total Locations: 232

— Roseville, California-based Always Best Care is a home care franchise company that operates across 225 territories in 30 states and Canada.

Homewatch CareGivers

— Rank: 246

— System Sales: $211,550,548

— Total Locations: 224

— 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

— Rank: 251

— System Sales: $199,100,000

— Total Locations: 178

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

FirstLight Home Care

— Rank: 257

— System Sales: $188,207,247

— Total Locations: 195

— 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.

Assisting Hands Home Care

— Rank: 299

— System Sales: $124,305,162

— Total Locations: 175

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

Caring Senior Service

— Rank: 475

— System Sales: $35,050,000

— Total Locations: 51

— San Antonio, Texas-based home care franchise company Caring Senior Service offers personal care, meal preparation, transportation, companionship, housekeeping and more.

The post 16 Home-Based Care Companies Earn Spots On The Franchise Times’ Top 400 List appeared first on Home Health Care News.

Personal home care and home health care are both branches connected to the post-acute care family tree. As such, home care leaders believe that there are numerous ways that their organizations can help alleviate home health provider pain points.

One major pain point that can be seen across home health care are referral rejection rates. Last year, the industry had a 76% referral rejection rate, compared to 54% in 2019, according to data from WellSky.

Jeff Bevis, chief operating officer at Caring Senior Service, sees home care as a natural ally for home health providers that are struggling in this area.

“It’s been a matter of time [that we] partner with them,” he told Home Health Care News. “[One way we do] is by trying to limit the hours, or the time, that the home health nurse is spending with their client. In other words, when the home health nurse is with a client for 15, 30 or even 60 minutes, home care workers can pick up more of the non-medical client needs to keep them happy and healthy in the home.”

The San Antonio, Texas-based home care franchise company Caring Senior Service has roughly 50 locations across nearly 20 states.

Bevis noted that this kind of arrangement gets to the heart of the referral rejection rate problem. It allows the home health agency to take on more referrals without making new hires or having to stretch their existing employees.

Currently, Caring Senior Service is collaborating with two home health agencies in rural Illinois to help lift the burden on these providers.

“We assigned a care manager to each of those home health agencies, and they’re meeting with those agencies once a week to talk through the patients that are most in need of non-medical home care activities and services, in order to reduce the amount of time and pressure on the home health agency,” Bevis said. “It lets us pick up a larger part of that slack for them, and makes more efficient use of their home health nurses.”

On its end, partnering with home health providers has been a referral boon for Caring Senior Service.

“It’s reinforcing existing referrals,” Bevis said. “In some cases, it’s in strengthening new or early referral source relationships.”

Griswold CEO Michael Slupecki pointed out that home health bonuses and penalties are tied to areas that fall under home care’s direct purview.

“The OASIS-based measures all center around the ability to self-care — from grooming, dressing, bathing, toileting and eating — all things that we address with the home care model,” he told HHCN.

The Blue Bell, Pennsylvania-based Griswold is also a home care franchise. It provides personal care services via more than 170 locations in 30 states.

At Griswold, helping prevent hospital admissions is the main area of focus when it comes to partnerships with home health providers.

“We have tremendous ability, in a non-medical way, to help prevent admissions,” Slupecki said. “We can ensure that the home is a safe environment, we can assist in transfer. On the heart failure side, just monitoring weight gain or loss. On the UTI side, which is a big reason for admissions, just monitoring the frequency of urination. Home health is designed to be curative, where we view our services more on the wellness side.”

Right now, Griswold is partnering with a national home health provider through its company-owned locations.

“The way we talk to them is by having them introduce us to their clients,” Slupecki said. “We’re going to help them on their scores, because they’re impacted by client satisfaction scores. They’re impacted by acute care hospitalizations or ER visits. We feel like we can be the eyes and the ears.”

‘Boots on the ground’

Synergy HomeCare is no stranger to partnering with home health agencies.

In 2021, the company teamed up with Compassus in a deal that offered both companies’ clients access to each other’s services.

“We were focused on care coordination, and just ensuring that all of the patient’s needs were being addressed holistically between our two organizations,” Rich Paul, chief partnership officer at Synergy, told HHCN. “There was also a cross-referral relationship, so that as the acuity of our client increased, we could refer them to hospice care, and provide wraparound home care services as needed, and vice versa.”

Synergy is a Gilbert, Arizona-based non-medical home care franchise that operates more than 400 franchise locations nationwide. The company offers companionship services, in addition to personal assistance, housekeeping, live-in care and 24-hour home care services.

The company still sees significant value in these kinds of collaborations.

“Home care rounds out that continuum of care very nicely,” Paul said. “We are kind of the boots on the ground that are in the home for extended periods of time. I think because of that, we can be a good partner for home health providers.”

Moving forward, Synergy is looking to form more partnerships with home health providers at both the local and national level.

Paul believes that there needs to be more partnerships between home health and home care providers, but payer challenges are still a hindering factor.

“I think the greatest challenge in creating partnerships between home health and home care is finding a payer source,” he said. “Most of our examples of care collaboration occur with clients receiving Medicare on the home health side, and using private-pay on the home care side. In some cases, there may be a funding source like an ACO, but more often than not, because Medicare does not cover home care, it does become a little more challenging.”

The post ‘Boots On The Ground’: Why Home Care Provider-Home Health Agency Partnerships Work appeared first on Home Health Care News.

“I see the Caring Senior Service story as kind of a best kept secret,” Bevis told Home Health Care News. “I think that we can grow it, and build awareness to really expand the network across the country and, at the end of the day, help more seniors with our services.”

The San Antonio, Texas-based home care franchise company Caring Senior Service has roughly 50 locations across nearly 20 states.

Bevis’ new role at Caring Senior Service will allow CEO Jeff Salter to focus on other aspects of the business.

“It frees me up to do some things that I haven’t maybe had the opportunity to do over the last few years, as we’ve been growing,” Salter told HHCN. “It’s a tremendous opportunity that I felt lucky to come across.”

Indeed, Bevis has a proven track record. Bevis founded FirstLight Home Care with his son, Devin, in 2009. Today, FirstLight is one of the most successful home care franchise companies in the U.S.

When FirstLight was under Bevis’ leadership, he spearheaded an initiative to convert independent home care operators into its franchise system. He was also an asset when it came to navigating the pandemic, creating innovative technology partnerships and building a bridge towards Medicare Advantage opportunities.

Bevis’ tenure as CEO of FirstLight ended in late 2020.

Looking ahead to the next chapter of Caring Senior Service, Salter is looking to lean on Bevis’ vast expertise.

“As I look at expanding our business and adding to the team, it’s rare to find someone that has the experience in both franchising and in non-medical home care that Jeff brings to the table,” Salter said.

One thing in both of their favors is the long-standing relationship — or “mutual appreciation,” as Salter puts it — that exists between Bevis and Salter.

“I’ve actually known Jeff Salter, and Ian Klaes – [Caring Senior Service’s] VP – for many years. … I’ve always had great respect for the brand and how they conducted business,” Bevis said.

In his new role, Bevis has a few key focus areas in mind. No. 1 on the list is growth.

“We’ve grown at a pretty consistent rate over the last several years. I think the growth potential can be accelerated,” he said. “Second would be leveraging our great care offering, which I think, again, is a best kept secret. It’s kind of our way of doing business, a way of providing a higher level of care.”

As the company continues to grow, Bevis is also prioritizing technology adoption across Caring Senior Service’s franchise network.

Additionally, the company has a number of projects that aim to improve the client experience, as well as the caregiver experience, this year.

More broadly, the company is battling some of the same challenges that its home care peers are also facing, such as caregiver recruitment.

“I do think with the learning management system, and technology platform here, we have some really strong tools to combat that challenge … and to be able to recruit more quality caregivers at a faster rate,” Bevis said.

As far as turnover is concerned, Caring Senior Service is checking in between 50 and 56%.

Ultimately, Bevis believes there’s a great opportunity for Caring Senior Service to improve and further enhance the profitability of the company’s franchise owners moving forward.

“We see ways that we can help coach our franchise owners, both new and existing, to achieve even higher profitability,” he said. “That’s a key additive that I see for 2023 — to really focus on our franchisees.”

HHCN Managing Editor Robert Holly contributed to this report.

The post FirstLight Home Care Founder Jeff Bevis Joins Caring Senior Service As COO appeared first on Home Health Care News.

For someone who covers both the home health and home care sectors, 2023 was a very interesting year.

Much of my time and energy was spent on covering potential home health payment cuts after the U.S. Centers for Medicare & Medicaid Services’ (CMS) release of the proposed payment rule. Even after the final rule was published, the threat of continued cuts persisted.

Time focused on that subject matter was well worth it. After all, the home health industry could look entirely different in five years if CMS does not back off its methodology that could lead to billions of dollars of cuts for agencies.

But all the while, the home care industry – non-medical home care, that is – was dealing with its own existential crisis.

Due to necessary wage hikes and extremely high inflation in the U.S., home care providers across the country are at an inflection point. The question is whether to stick to private pay and continue to care for the most well-off patients as prices rise, or to find another way to gain market share and care for more people in the home.

Most industries struggle when demand tapers off. For both the home health and home care industries, demand has arguably never been higher. That’s what makes each of their struggles so fascinating – and disappointing. Even unfair, frankly.

Regardless, providers will need to innovate to find a way to keep their heads above water. The country’s infrastructure depends on it.

In today’s exclusive, members-only HHCN+ Update, I break down the troubles in home care specifically, and observe how some providers plan to get through them.

Home care’s inflection point

The cost of home care has been steadily rising at an alarming rate. Inflation in 2022 made it even worse.

That has shrunk the serviceable market, particularly for those that deal primarily in private pay, despite the growing number of seniors who could benefit from home-based care services.

“Our strategy has really gone from trying to serve everybody to now focusing on this small population of people and doing it really well,” 24 Hour Home Care President Ryan Iwamoto told me in November at Home Health Care News’ Home Care Conference.

The Los Angeles-based 24 Hour Home Care offers home care as well as intellectual and developmental disability (IDD) services across California, Arizona and New Mexico.

Iwamoto said that the cost of care had risen anywhere from 20% to 40% for the company based on the market, “literally overnight.”

Margaret Haynes – the CEO of the Omaha, Nebraska-based Right at Home – said her company’s cost of care had risen by about 25%. Jeff Salter – CEO of the San Antonio-based Caring Senior Service – suggested he had seen about the same. While 24 Hour Home Care is not a franchise, both Right at Home and Caring Senior Service are.

But like a volcano bubbling just below the surface, the real issue with the rising cost of care may be that it’s not necessarily noticeable. Let me explain.

For most franchisees, for instance, their profits went up over the last year, despite the rising cost of care. Even if a smaller percentage of the population overall was able to pay for home care, that didn’t necessarily affect owners’ bottom lines.

Salter touched on this exactly, also at the Home Care Conference.

“I think more what I’m looking at is trying to understand how someone else in this industry that’s innovative is going to come in and undercut and provide a high level of service,” he said. “That’s what I worry more about and what I’m trying to talk to our owners about, and others in the industry about. We’re [focused] on keeping that 50% margin, trying to maintain that, which seems to be what everyone is still doing when the rates go up that much. I have conversations with our owners, like, ‘What does your margin need to be?’ It’s great having more profits pretty much across the board. All of our owners are more profitable this year than last year. And they’re doing less work.”

From the independent owner or franchisee perspective, it’s hard to understand why there’s a problem.

Weeks later, during HHCN’s virtual Franchise Forum, Griswold Home Care CEO Michael Slupecki brought up the same point.

“There are some folks that have reached their level of contentment with their income,” he said. “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.”

The Blue Bell, Pennsylvania-based Griswold Home Care provides personal care services via more than 170 locations in 30 states.

Mitigation strategies

To some extent, the market is dictating this phenomenon. It’s hard to mitigate market forces. It’s also hard to convince business owners – franchisees or otherwise – that their business is in grave danger while their pockets overflow.

But for those looking with a bird’s-eye view, it’s worth paying attention to, and getting ahead of.

On Salter’s end, he started Caring Senior Service in 1991. Therefore, his level of concern certainly carries more weight than mine would.

There are a few ways that agencies could go, knowing what they know now. The first is to change their rate structure.

“Historically, you charge twice as much as you pay, but I think there’s a time where that’s got to evolve,” Slupecki said. “And we can’t see necessarily, without looking at [franchisees’] numbers, whether it’s a rate versus volume equation. With the wage inflation that we’ve seen, we have to be really cognizant of that hourly piece, because it’s all about market share. Are we growing our market share, not just growing our revenue? I think that’s really critical to keep an eye on.”

It’s also worth mentioning that many owners, operators and workers in the home care space are not in the business strictly as a means for profits. They understand the need for home-based care and want to help satisfy that.

That’s why some companies that have traditionally played in the private-pay space are diving into other payer sources, such as Medicare Advantage (MA) or Medicaid.

The aforementioned 24 Hour Home Care is an example of that. Just this week, the company announced that it would meaningfully enter into the Medicaid space for the first time with the acquisition of Inteli-Care, a home care provider with 500 clients in New Mexico.

“We’ve always been on the private-pay senior care side, but that population is getting smaller and smaller based on who can afford it on a long-term basis,” Iwamoto told me. “We’ve always wanted to get into the Medicaid world. … So now, being able to expand our footprint into New Mexico and serve this population, it really does [fit in] with our why of just impacting more lives at a greater scale. And not just on the private-pay side or the IDD side, but with people that really need it on the underserved Medicaid side.”

Others are looking at MA as a means to combat this structural change in the business.

For instance, I’ve chronicled BrightStar Care CEO Shelly Sun’s quest to engage with MA plans over the last few years, and her ongoing struggle to get more franchisees on board with the mission.

For now, meeting those MA beneficiaries where they are has even led to private-pay business down the line for BrightStar Care, at least about 5% to 10% of the time, according to Sun.

“Private-pay rates have had to increase just because of labor, PPE, and recruiting and retention costs, which have increased anywhere from 30% to 45%, on average,” Sun told me at the Home Care Conference. “And that makes home care far less affordable than it used to be a few years ago. We’re mission focused, and we want to make sure we can help more people stay in the home, and Medicare Advantage is a great way to do that.”

For franchisers, it may be hard to convince business owners a change needs to be made. For independent owners, it may be hard to change course.

But more than ever, home care providers are having to think deeply about that proposition, given the realities of cost of care in today’s world

The post More Profits, Less Market Share: The Home Care Industry’s Silent Killer Comes To Surface appeared first on Home Health Care News.

Whether to engage with Medicare Advantage (MA) plans or not is one of my favorite topics of discussion in home care right now. And that’s for a simple reason: Not everyone agrees on the answer.

The MA debate is one we’ve been discussing on Home Health Care News for a long time now. In fact, there is a similar debate going on in the home health care industry simultaneously.

I first laid out “The Case For and Against Home Care Provider-Medicare Advantage Relationships” in June. That piece positioned Shelly Sun – the CEO of BrightStar Care, and someone who is extremely determined to contract with MA plans – against other leaders that are far more skeptical.

Essentially, with MA membership growing so steadily, Sun believes that it is imperative that BrightStar Care and its franchisees begin working with plans now in order to capitalize on those members when their benefit hours are up. She also believes that early adopters of MA will eventually be the benefactors of closed networks down the line.

At the same time, those that are more sheepish on MA believe it is currently not a financially viable option. As of right now, the pay is too meager and there are too few hours. With MA growing and home-based care needs growing, many of those in this school of thought believe if the MA dynamics change in providers’ favor, there will be time to engage later.

In other words, there’s time to sit on the sidelines and wait things out.

I invited Sun to further explain her case at HHCN’s Home Care Conference Wednesday. We dug into her hypothesis and strategy around MA.

Throughout the day, other provider leaders were happy to agree with her or respectfully disagree.

In this week’s exclusive, members-only HHCN+ Update, I share the highlights of this ongoing debate from yesterday’s event in Chicago.

Investing now

Since MA plans became allowed to offer at-home care through both the primarily health-related and Special Supplemental Benefits for the Chronically Ill (SSBCI) pathways, participation has markedly increased each year.

“In-home support services,” in particular, have been a benefit rising in popularity over the last few years. Those services are defined as services to assist individuals with disabilities and/or medical conditions in performing activities of daily living (ADLs) and instrumental activities of daily living (IADLs) within the home to compensate for physical impairments.

A new report released by the Better Medicare Alliance (BMA) and Milliman on Thursday reaffirms that.

“In-home support services had the largest growth in plan prevalence among these benefits, most notably from 2020 to 2023,” noted the report, which focused on the primarily health-related pathway.

Specifically, the in-home support services benefit is offered by plans in 42 states, making it the most widely available of such benefits from a geographical standpoint. In contrast, according to the BMA-Milliman report, the adult day health services benefit is only available in Arizona and California through just 35 plans.

Generally, almost all home care providers viewed supplemental benefits as an opportunity when they first became available in 2018 and 2019. Since then, some have backed off.

One provider even said yesterday that its MA engagement has only led to two private-pay conversions over time.

But Sun maintains laying the groundwork now will ultimately end up giving the Chicago-based BrightStar Care – which has 365 franchise locations across the U.S. – a competitive advantage in the end. It has been diving into the MA business since 2018, a tactic that hasn’t always been well-received by all of its franchisees.

“I think it’s the same reason that consumer brands spend so much money on the younger segment where brand loyalty is seeded, right?” Sun told me on stage Wednesday at the Home Care Conference. “If we’re not with our seniors as they begin utilizing their Medicare Advantage benefit, we’re going to miss the opportunity to be with them when they exceed the hours Medicare Advantage pays for and they need private pay.”

In order to test this theory – one that she backs whole-heartedly – Sun has increased BrightStar Care’s company-owned footprint to put her money where her mouth is.

Sun also said that since working with MA plans, her team has been able to get BrightStar Care rate increases, both through establishing relationships and proving value through data. Right now, MA doesn’t pay as much as private pay does, of course, but she said it’s a break-even proposition across “most markets in the country.”

In 2018 and 2019, the company was losing money, but that has changed. In some cases, it even makes money on MA clients.

“I think that it’s really important that we have a seat at the table,” she said. “We’re seeing that about 5% to 10% of our Medicare Advantage enrollees from two years ago are now coming back and becoming private-pay clients. So those successes are starting to occur.”

That conversion rate takes time, anywhere from 18 to 30 months, Sun said.

“I believe it’s about two years. And in 2021, I took 75% off our royalties for franchisees to get them to try it,” Sun said. “We had some participate with us. And then we have our company-owned locations. Now we’re seeing some conversions to private pay. I think that two-year lag time will be similar to what it will take for us to gather enough data, publish the studies and influence behavior with the rest of our franchisees.”

She also believes that for the mission-focused organization BrightStar Care, engaging with MA is a necessity.

“Private-pay rates have had to increase just because of labor, PPE, and recruiting and retention costs, which have increased anywhere from 30% to 45%, on average,” Sun said. “And that makes home care far less affordable than it used to be a few years ago. We’re mission focused, and we want to make sure we can help more people stay in the home, and Medicare Advantage is a great way to do that.”

Sun certainly isn’t alone. FirstLight Home Care, 24 Hour Home Care, Homewatch CareGivers and many others have also been a part of the MA rush from the start.

“We are one of those companies that has been leaning into Medicare Advantage,” FirstLight President and CEO Glee McAnanly said at the Home Care Conference. “I agree with Shelly on the fact that there are going to be a certain number of providers that are going to fill up that pipeline, and once it’s filled, you’re then going to have to wait in line. And so we have made a decision to really test the waters with Medicare Advantage.”

The other perspective

Particularly as a long-term view, Sun’s perspective makes a lot of sense. But the other side makes sense, too.

For smaller providers – and those that have to work with a franchisee network – diving into MA as a revenue stream is a tough proposition when it’s not much of a revenue stream at all, but still takes operational work.

It could be just that BrightStar Care has the capital, the network and the capability to take on the MA risk now, where others don’t. But there are also philosophical disagreements.

“We’re a little bit on the sidelines and watching,” Right at Home President and CEO Margaret Haynes said at the Home Care Conference. “We certainly are dabbling in a couple areas where it makes sense, but it really does come down to the reimbursement rate.”

The Omaha, Nebraska-based Right at Home has more than 600 franchise locations in the U.S. and seven other countries.

“You have to have scale in order to do that at really thin margins,” Haynes said. “As a small business owner or local owner, sometimes that can be really hard. … If I’m paying the caregivers now, but I’m getting reimbursed maybe 30 days, 45 days later, you know, cash is king. You have to have enough amassed capital to really play in those kinds of programs.”

Some providers haven’t seen the private-pay conversions come to fruition. Sun, on the other hand, says that BrightStar Care has.

It could be that the investment that BrightStar Care has put into MA is the reason for its success on conversions, even if those conversions are still not that sizable.

But for companies like the San Antonio-based franchise Caring Senior Service, it does not want to invest now without knowing for sure that MA engagement will pay dividends in the end.

“Until any of these pilot programs could show us that the clients on these programs use your services after the benefit is up, we’re not interested,” Caring Senior Service CEO Jeff Salter said at Home Care Conference. “It’s too much work. You put so much work in new client set-up and it just causes stress on your teams. Right now, it’s just not worth it for us.”

The post Home Care Providers Starting To Convert Medicare Advantage To Private-Pay Business appeared first on Home Health Care News.

Shifting health care payer trends have home-based care providers stuck between two battling business decisions: “adapt or die,” or sustainability.

Those two decisions may look like one in the same to outsiders, but for home care operators grappling with whether to engage with Medicare Advantage (MA), they sometimes posit providers on different sides of the aisle.

The tense relationship between the home health care industry and MA has been covered extensively on Home Health Care News. Providers are trying to fight back – as MA grows its market share among Medicare beneficiaries – against what they feel are unfair reimbursement rates from plans for home health services.

Conversely, we’ve often written about MA involvement as an opportunity in non-medical home care for providers in that industry. To some extent, it still is. Primarily health-related benefits and Special Supplemental Benefits for the Chronically Ill (SSBCI) offer a new revenue stream and client base for providers.

But not all home care agencies view MA as just another opportunity or revenue stream. After all, they deal with similar issues to the home health care world when it comes to working with MA: rates are meager and, additionally, the resources it takes to staff those cases is sometimes not worth the yield.

On the other hand, some providers think that engaging with MA now will be worth the return on investment down the line.

In this week’s exclusive, members-only HHCN+ Update, I try to paint the whole picture on the MA conundrum through the perspective of home care leaders.

The case for MA engagement

Potential profit from working with MA plans is currently not there for home care providers. Hours are few and far between, and pay is not near what it is with private-pay clients. Add in staffing concerns, and there are a lot of reasons why some agencies are staying away.

But BrightStar Care sees the situation differently. Shelly Sun, the CEO and founder of the company, believes that some of those tricky bottom-line issues with MA now are just the cost of doing business.

“We’re leaning very heavily into Medicare Advantage,” she told me last month. “I think that’s going to be a big change in how home care must evolve over the next three to five years. We’ve benefited over the last 10 years, up until the change in Medicare Advantage, from consumers just coming to you through marketing or through hospital discharge, right? If 7 out of 10 new Medicare enrollees are enrolling in Medicare Advantage, and 50% of Medicare, will be Medicare Advantage in the next 10 years, well, that means that every single enrollee that is accessing their benefits is going to start with hours of personal care being paid through the Medicare Advantage plan. Only those additional hours beyond that will be private pay.”

The Chicago-based BrightStar Care is a home care and medical staffing franchise. The company’s network includes over 365 locations and more than 15,000 caregivers.

Sun believes if you’re not around during those MA hours early on, you won’t get the hours – potentially thousands of them – of private-pay services from that prospective client later on.

Dealing with the MA plans now allows you to form relationships with those potential clients, she believes, so that they choose you when they need more home care down the line.

So, the initial hours from MA may not be financially sustainable in a vacuum, but she compared it to having a sales team – or any other front-end, operational cost. And she’s right that no one would argue that having a sales team is not a worthwhile investment.

Where others – who we’ll get to – see the MA model as financially unsustainable, Sun sees not engaging with MA plans now as financially unsustainable. If those connections aren’t made now, the theory goes, there will be 30% or so fewer clients to service later on.

“I think it’s critical [to get involved with MA],” Sun told me. “I think you have to look at it as a client acquisition and the cost of doing business. Two years ago, I would have had more franchisees with dedicated salespeople that would’ve been calling on hospitals for discharges. That took a salesperson. You didn’t know if you were ever going to have an ROI on a salesperson. Now, I have a built-in mechanism for having our franchisees get referrals through Medicare Advantage.”

In fact, as BrightStar Care is building up more company-owned locations in its network, Sun is most focused on buying out the franchisees that are unwilling to engage with MA plans. 

“We have to realize that the paradigm of client acquisition has completely changed with Medicare Advantage,” she said. “That’s what I’m preaching to our franchisees. Where they’re not participating, those are the ones I’m most interested in buying out, because we will absolutely participate in a company-owned market, and that’s how I’m prioritizing where I want to be and why I want to be there.”

The case against MA engagement

Other home care companies do not see MA as vital to their future, at least for now.

“Not in its current structure – I wouldn’t touch it with a 10-foot pole,” Caring People CEO Steven East told me this week. “We’re all dealing with supply shortages on the labor side. So you’re telling me I’m going to use my limited supply on a very low-margin business? That, to me, is a recipe for disaster. When that model changes in a way that incentivizes us a little bit more, then we can re-engage in those conversations. But for now, we’ve stayed away from that.”

Caring People is a home care company that is a part of the portfolio of the private equity firm Silver Oaks Services Partners. It operates 18 locations across New York, New Jersey, Connecticut, Florida, Texas and Massachusetts.

I asked East what would have to change, specifically, for Caring People to re-engage.

Firstly, he still doesn’t believe all MA plans have a total grasp on the value home care agencies provide. This tends to be generally true, as supplemental benefits – and the idea of the two sides working together at all – is still relatively new.

“That’s why they don’t quite understand that you can’t give business to private home care companies at 20% margins, especially when I have a client down the block who’s willing to pay us at 40% to 45% margins, right? It would be one client with eight hours per day as opposed to five clients doing two hours per day. So, unless their per-unit reimbursement goes up significantly, there’s really no attraction to that product for us.”

Caring People is not a franchise, so it’s different from BrightStar Care in that aspect.

But Caring Senior Services is. And its CEO, Jeff Salter, believes he cannot in good conscience recommend his franchisees get involved with MA given the current structure of those relationships.

“We’re being really careful with our recommendations on how to pursue those contracts and work with those organizations,” Salter told me. “Because the benefit amount is so low, it’s a challenge for businesses to have to service those low-hour clients with minimum benefits. If you’re a company trying to provide a high level of service – with high-touch and great caregivers – and then you end up with a client payment source that’s only giving you a few hours per week, that can be tough.”

The San Antonio-based Caring Senior Service has about 50 locations across 20 states.

It’s hard, for instance, to make supervisory visits and maintain a high level of care and standard with those clients, while also managing the cost in a way that turns a profit.

And Salter doesn’t want to reduce the standards of care that Caring Senior Services has or lead his franchisees down a financially turbulent route.

The company is investing in technology and software in order to make achieving that standard of care more seamless, which could change the equation. But still, for now, he thinks organizations have to be all in or all out.

Interestingly enough, that almost validates both Sun and East’s thought processes.

“I think I’m a bit of an outlier on it,” Salter said. “But if you want to set your business up to service those clientele primarily, then I think you can make a business out of it. But I think you have to focus on that.”

The post The Case For and Against Home Care Provider-Medicare Advantage Relationships appeared first on Home Health Care News.