Kendal Corp., one of the largest nonprofit senior housing providers in the nation, is making a push to expand its Kendal at Home offering, as part of a recently devised strategic plan.
Founded in 2003, Kendal at Home was an early example of a “CCRC Without Walls” program, in which members put down an entrance fee and make a monthly payment, and in exchange are guaranteed access to a range of wellness programs and health care services, for life. In a traditional CCRC, members live on a campus offering amenities and a continuum of care; in the “at-home” model, members continue to live in their own home.
There are only about 30 “CCRC Without Walls” programs in operation, according to data from investment bank Ziegler and professional services firm CliftonLarsonAllen; however, CCRCs have increasingly seen the appeal of offering them. One-third of non-profit CCRCs without an at-home program were considering adding one as of 2014, a survey found. Campus-based senior living providers view these initiatives as a way to expand their mission—and add another source of revenue—by taking their services into the community at large. This was the original goal of Kendal at Home.
“I think initially, the thought was that we would broaden our mission to serve people off-campus who wanted to remain in their homes,” Lynne Giacobbe, Kendal at Home’s executive director, told Senior Housing News.
While this mission remains the same, Kendal at Home is now broadening its scope through new partnerships and by serving more residents of Kendal Corp. communities, Giacobbe said.
The Kendal at Home model
Kendal at Home began as an initiative of Kendal at Oberlin, a CCRC near Oberlin College, southwest of Cleveland. The program got off the ground thanks to an investment from The Cleveland Foundation, as well as from Kendal Corp., the Kennett Square, Pennsylvania-based parent company that supports a portfolio of 12 senior housing communities across the country. In 2017, Kendal Corp. was the 12th-largest nonprofit senior housing provider in the United States by unit count, according to rankings compiled by Ziegler and provider association LeadingAge.
Some CCRCs see home care as a way to increase visibility and create a feeder system onto the campus, but from the outset, Kendal at Home operated at an arm’s length from the Oberlin campus. The Kendal at Home offices are about 25 miles away from the CCRC, and the client base—currently about 300 people in the state of Ohio—is scattered across the Cleveland metro area, as well as in the cities of Dayton, Columbus and Cincinnati.
This goes to show that the at-home consumer has had a different profile than the CCRC consumer, Giacobbe believes. The at-home consumer has tended to be younger and highly motivated to go on living in their long-time home, whereas the CCRC consumer has been attracted to the socialization opportunities and other aspects of campus-based living.
Kendal at Home is also accessible to people who might not have the means to afford a CCRC entrance fee, which can run to the six figures. The up-front fee for Kendal at Home varies depending on the profile of the consumer, but an average 75-year-old coming onto the “platinum” level of the program typically pays about $50,000, and then has a monthly fee in the range of $400 to $700, Giacobbe said. Many members have long-term care insurance, which can help offset the monthly fees.
In return, members receive access to the Kendal at Home network of care and service providers, as well as support from the program’s care coordinators.
The service provider network involves a wide range of partners, including private duty home care, skilled home health, skilled nursing facilities and rehabilitation, and transportation. When a Kendal at Home member uses one of these providers, the cost is covered by the program. While this is similar to the benefits offered by some long-term care insurance plans, there is no lifetime limit for how much Kendal at Home members can use these services, which differs from insurance, Giacobbe noted.
In addition, there are some unique partners working with Kendal at Home. For instance, there’s a facility management company that provides an annual home assessment, inspecting everything from the roof and foundation to major appliances.
The most important differentiator for Kendal at Home is the care coordination, in Giacobbe’s view. All members are assigned a care coordinator who helps them achieve their wellness goals and helps navigate the health care system when needs arise.
“Someone comes into the program and they’re healthy, and a care coordinator works with them to achive their goals, and [then] they have to have a knee replacement or some sort of surgery, that care cordinator has known them for a long time,” Giacobbe said. “They have a level of trust. If that person was relying solely on LTC insurance, they’d have their surgery and go home or go to rehab … and then they’d call their LTC insurance company, who might send someone out to evaluate them who doesn’t know them at all, and tells them you have a 90-day waiting period, call us back. When did that person really need help? On day one.”
In June 2015, Kendal Corp. selected Sean Kelly as its new CEO, and the next year, the company went through a strategic planning process. Expanding Kendal at Home emerged as one goal, to make the program a national model for the Kendal system and beyond, in how to deliver continuing care at home. This is being accomplished, in part, by rethinking how the program can complement CCRCs.
When Kendal at Home first launched, if a member moved to a Kendal CCRC, that individual would have to withdraw from the program, and there was a financial arrangement to return some of the money they had put down as the upfront fee.
“Then we got a little bit smarter and thought, do they have to withdraw?” Giacobbe said. “Now, we have eight or nine people living at Kendal at Oberlin who are still members [of Kendal at Home].”
There are special contracts developed for these cases, given that the Kendal at Home members have already paid a fee to receive life care benefits through that program. Within Ohio, Kendal at Home is exploring a partnership with Kendal at Granville, an entrance-fee CCRC east of Columbus.
There are also some Kendal communities that operate on a different model. The Lathrop Communities, located in the Pioneer Valley of Massachusetts, include two communities that are strictly independent living. Here, there’s an opportunity to offer Kendal at Home as an additional benefit to provide more continuity of care and potentially extend length-of-stay for IL residents.
A task group is working out the logistics, and the goal would be to also offer Kendal at Home to people not living in the Lathrop Communities, Giacobbe said.
In addition, there are some out-of-the-box initiatives in the works, including a potential partnership with Collington, a Kendal CCRC in Maryland. This would not be a CCRC-at-home program, but would be an aging-in-place support system done in conjunction with the state’s Department of Aging.
These initiatives highlight some of the business objectives that CCRC providers hope to achieve through an at-home services program, such as raising the organization’s profile in the community while also meeting increased consumer demand for at-home care.
At-home programs could also help make senior housing providers more attractive partners to health care systems and payors. These organizations are increasingly operating on population health models, and looking for partners who can help control costs and improve outcomes for the patient and beneficiary populations.
Kendal at Home has been able achieve some of these goals—for instance, the rehospitalization rate for its members is below 3%. Nationally, hospital readmission rates for some common diagnoses such as heart failure and pneumonia were between 17% and 22% for Medicare beneficiaries as of 2014.
Yet, providers that offer CCRC Without Walls programs have pointed out that the economics can be challenging. Kendal at Home posted about a $1 million loss from operations in 2016. However, this number reflected some non-recurring expenses related to the program expansion and the start-up of a Supportive Services division, which included hiring 22 new staff members. Ultimately, the program growth should help on the financial front, Giacobbe said.
“As we expand this program … the more members we have, the greater the benefit to everyone,” she said. “[We] can keep our costs down for current members, our monthly fees down, and we’re always looking at growth and how to sustain the program financially in that regard.”
There are some promising metrics already: In 2016, the program added more new members than in any year since opening, and achieved the lowest cost per new member it had seen in several years, according to Kendal’s 2017 annual report.
There are some challenges to expanding Kendal at Home. The model is not a fit for every Kendal community, and there have already been some instances when early partnership talks ended with a decision to go in different directions, according to Giacobbe. The patchwork of state regulations governing at-home life care programs is another challenge.
There can also be trepidation on the part of CCRCs because they are used to viewing home care service providers as competitors.
“I’ll be honest, one of the big concerns that retirement communities have is that fear that a program that’s designed to help people remain in their own homes could impact occupancy in the retirement community,” Giacobbe said.
Though she understands this fear, Giacobbe is also confident that bringing in the at-home option won’t deter residents from moving into Kendal CCRCs. Even though some Kendal at Home members have gone on to move into a CCRC, in general these two consumers remain different—those joining the at-home program probably are familiar with the CCRC model but have decided they would prefer to remain in their own home.
“These aren’t the kinds of programs likely to impact occupancy, but it will take some time to prove,” she said.
Written by Tim Mullaney