Deal Brings Home Care Assistance Onto Senior Living Campuses

Home Care Assistance, a non-medical home care company based in San Francisco, has taken over the in-home care operations for Episcopal Senior Communities (ESC) and entered into a preferred partnership agreement.

This deal comes at a time when a growing number of senior living providers are debating whether to launch their own home care divisions or partner with an established player. The Episcopal example highlights the challenges in starting a home care operation from scratch, and its new relationship with Home Care Assistance offers one example of how these different types of senior care organizations can work together.

ESC, which operates six life plan, or continuing care retirement communities (CCRCs), in California, is a nonprofit senior living provider that also owns six affordable housing communities in the state. Across its CCRCs, ESC has roughly 1230 residents, with between 10% and 12% using home care services in some capacity at any time. In a CCRC model, a resident pays an entrance fee to live on a campus with a full continuum of care, from independent living through skilled nursing.


HCA provides private duty home care, with more than 100 franchise locations in the U.S. and 32 company-owned locations in 2017, according to Entrepreneur.

HCA acquired Episcopal Senior Living’s one home care agency for an undisclosed price. ESC decided to sell its home care operations—which began four years ago at its Santa Rosa community—after realizing that getting a home care agency up and running at scale was a tough business. At the same time, the senior living provider saw an increased need for home care services for its residents.

“A lot of our CCRC residents prefer to stay in their apartment of origin and engage home care services to help them be successful and maintain their current lifestyle rather than moving into our assisted living component,” Ron Shaefer, CEO of ESC, told Home Health Care News. “We were supportive of that, which is why we wanted home care available to our residents. We did start that [home care] agency in Santa Rosa, and it was working very fine, but the time, resources and effort to replicate that in five other locations wasn’t going to get the help to everyone in a timely way.”


While the senior living provider was able to get its own home care operations up and running, the process took two to three years to get to a sustainable level of service, according to Schaefer. As such, ESC partnered up with HCA to offer home care services across its platform.

The decision to find a preferred partnership with an established home care company reflects the growing demand for home care within senior living settings.

“This is a shift in how people approach their aging,” Schaefer said. “They don’t want to be in the skilled nursing setting, not long term. They would much rather be in home, not in institutional settings. That’s where home care comes in to supplement what we are doing.”

The relationship developed during the recent wildfire season in Northern California. HCA, which already serviced some clients with ESC, was instrumental in helping senior living residents evacuate areas impacted by wildfires, according to Katie Roper, vice president of health care and strategy at HCA.

“Our team stepped up and helped them evacuate the residents to some of their other communities in the area,” Roper told HHCN. “We staffed caregivers to take care of the people who were evacuated.”

HCA was also chosen as a partner, in part because of their location overlaps with ESC, Shaefer said.

“They were one of the few [providers] that could be a single partner, rather than multiple partners,” Schaefer said of partnering with HCA. “In addition to that, we really got to know the leaders within HCA, and they are incredibly dedicated to the same principles we have.”

Under terms of the deal, HCA will provide some financial assistance to ESC residents.

“The partnership is structured with a small percentage of every relationship that [HCA has] related to ESC ends up in a fund that is then available to us to apply toward care that residents within our own communities may need,” Schaefer explained. “We use $2 million every year to help residents who have run out of resources to stay within our communities.”

Roughly 50 residents across ESC’s communities receive support, according to Schaefer.

“They are a nonprofit, and they do phenomenal work through their foundation,” Roper said. “As a way to nurture the relationship and thank them for their trust in us and the work they are doing, we are contributing to the foundation. And they can use it like any other contribution.”

Under terms of the partnership, ESC will refer residents in its independent living and assisted living settings to HCA for home care services, while providing skilled nursing residents with a longer list of recommended providers in accordance with Medicare and Medicaid requirements.

“They are the only people we recommend, though we give resources to find other home care agencies,” Schaefer said of the referral relationship. “In skilled, it’s more of an open market. [HCA] is one of many but we let residents know we have an established relationship with them.”

HCA will take over office spaces at ESC, though these spaces on the senior living communities won’t serve populations outside ESC.

“One of the interesting things about the Episcopal relationship is that we have branch offices in the communities for essentially all of their [locations],” Roper said. “The ESC offices will serve their populations, but not outside the walls, because HCA already serves the broader community.”

In addition, ESC can monitor the quality of HCA home care services, with access to surveys and customer feedback.

The sale of the home care agency to HCA was completed Dec. 15, with the operations and office effectively transferred to HCA, Schaefer said.

“It’s a very dynamic business,” Schaefer said of home care. “It takes a lot of constant tending to make a home care agency work well.”

This is a lesson that other senior living providers also have discovered, causing them to step away from running their own home care operations. On the other hand, some senior living providers are launching into home care, trying to create referral streams to their communities while meeting a growing demand for in-home services, as explained in the recent research report “The Home Care Opportunity: Big Risks, Big Rewards for Senior Living Providers,” from our sister news site, Senior Housing News.

Written by Amy Baxter

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