For seniors no longer capable of everyday household tasks, as well as those with Alzheimer’s disease or dementia, the answer used to be short and not sweet: Time for a nursing home.
But even the nicest facility is no substitute for a person’s own surroundings, and so individuals and their families are increasingly turning to agencies for in-home services that include shopping and housecleaning to bathing, meal prep and companionship.
More than 10,000 people are turning 65 every day in the United States, Pew Research Center statistics show, and that’s going to continue for another 15 years or so.
Couple that with people now routinely living well into their 80s and 90s, and it’s easy to see the need for non-medical, in-home services for seniors.
Then mix in other homebound individuals, such as those recovering from surgery and even new mothers, and the rise in home-care agencies makes good business sense.
Even so, most in the industry will say that they got into it because they are drawn to helping others as opposed to making a calculated business decision.
For Steve McCharen, who owns the Antioch franchise of Visiting Angels Living Assistance Services, the idea for operating an agency sprang from issues with his own mother.
“Back in the mid-1990s she began showing signs of Alzheimer’s, but our father kept it from us,” McCharen says.
“When he died, there were some issues to be dealt with, and this kind of in-home company really didn’t exist. We hired someone privately to be with her, and that didn’t turn out very well. I wanted to get involved in something like this because it’s an industry that really does help people. It allows people to be at home, where they should be, and where they flourish.”
Visiting Angels is based in Baltimore and has more than 450 locations throughout the country. Its operators, like most in the care industry, run comprehensive background checks to address safety concerns clients may have, and also works to interact with family members and medical caregivers both inside and outside the home.
McCharen set up shop in Sept. 2013, and says he was drawn to the company through the personal experiences he heard from its operators, and thought it would be worth the risk. Several months in, he’s seeing a steady growth in clients, as well as a nonstop series of applications for employment.
“We get client leads through advertising, as well as from doctor’s offices, hospitals and different facilities that have to deal with people who want to go home,” he says. “Our information is passed along by a lot of discharge planning departments, because we can meet the needs those people have for help once they have left a doctor’s care, or a facility.”
On the employment side, he says he hears from “some pretty amazing people. They’re certainly not in this for the money, but they want to help people. But even so, we do a full background check, and I’d say that 80 percent of those who apply are ruled out because something comes up, even if it is very old.
“We have to be very selective, because we are sending people to work in someone’s home.”
That same vetting process is the order of the day at All About Care, formerly Tender Hearts, in Green Hills. President and founder Neil Amrhein began the company in 2008, and changed names in 2011 after finding unrelated firms with the same name operating in several other states. He now is licensing the All About Care name and model in other locations, most recently South Carolina.
Rather than a standard franchise model, All About Care grants naming rights through an agreement that sunsets after 15 months and must be reviewed. If either party is not happy, the deal will terminate.
“My emphasis is on serving families with higher expectations, and that’s why 81 percent of our caregivers are people who have a college degree, and are even working on a master’s,” Amrhein says.
“The industry is chock full of sitters and sleepover people, and we think the well-traveled, well-educated client is going to want more. They are at home and want to be engaged in conversations, and want someone with them who’s not just sitting there. That’s who we serve, and we’ve proven that there is a market for that type of caregiver.”
The financial side can create issues for both provider and client. Caregivers are usually paid for out of pocket by clients, as their services are not covered under traditional insurance, Medicare or Medicaid. (One TennCare program, Choices, does cover some sitter services, as does the VA, but not all agencies accept it.)
Long-term care policies began to be sold in the late 1970s, but those policyholders are just now beginning to age into that need, so those are not in play much yet, either.
Conversely, nursing homes and assisted living facilities are far from cheap, and often the cash outlay for staying at home can be lower, Amrhein says.
“In most cases, someone is leaving home because they can’t find a solution for one or two issues,” he says. “They need help with bathing, or rides to the doctor and grocery shopping. We have had clients with very basic needs that, once met, allowed them to decline over time at home until they passed away, or needed hospice care, which also could be provided at home. The nursing home was not the final chapter in their life, and they and their families were able to control the costs by deciding what services they did, and did not, want.”
The a la carte approach is becoming more and more popular as seniors and others who need in-home care for the short or long term, adds Cindie Markle, client care coordinator for Home Instead Senior Care in Nashville.
Her location has been open since 1998 and handles Davidson and part of Rutherford counties, but other franchises are in Murfreesboro, Franklin, Mt. Juliet and Goodlettsville.
Home Instead also runs all the required background checks and more, as well as provides ongoing training for its staff, but works to absorb those items so it can keep costs reasonable for clients.
“Cost has something to do with clients choosing us, because it is less expensive than entering a full-care facility,” Markle says.
“People also like the fact that we are going to give them a lot more attention in their home, where it’s a one-to-one relationship, than when they are in a facility and having to compete with other residents and are surrounded all the time by a lot of other people.
“We, on the other hand can provide anything from as small as a two-hour visit up to 24 hours of care, depending on the person’s needs,” she adds.
Even as these agencies grow, their operators say they still will be looking for the same qualities in employees as they expand their services and coverage areas.
“The people I know who are doing it, and those who work for us, really have the heart of a caregiver,” McCharen says. “They want to do something for a living that they feel has value. They know our clients have pride, and that they want to do what they want to do in their own home.
“As a society we are realizing that staying home is better, and our people are committed to helping our clients do just that.”
In time, they may benefit from additional sources of payment as well.
“I think there’s some lobbying going on regarding Medicare and Medicaid covering non-medical workers in the home, and with the performance metrics required by the Affordable Care Act, especially around reducing readmissions to hospitals, there are some solid arguments for us,” Amrhein adds.
“There are going to be concierge services for people who can pay private, but as more doctors and hospitals see the value, there may be other reimbursement models coming eventually as well.”