The number of people living in the U.S. with Alzheimer’s disease or dementia is expected to double over the next four decades, new research from the Centers for Disease Control and Prevention (CDC) has found. To prepare for that rising wave, many home care agencies have started investing in specialized business lines entirely devoted to dementia care services.
Some providers — including Phoenix-based Cypress HomeCare Solutions — are already seeing the investment pay off.
“We figured we could create a vertical specific to home care with a dementia focus,” Bob Roth, co-founder and managing partner of Cypress, told Home Health Care News. “Since starting the program about three years ago, that vertical has seen a lot of success and high gross margins.”
Founded in 1994 by Roth — along with his brothers and father — Cypress’ main business lines include in-home personal care services and dementia programs. Cypress also offers home visits from a trained therapy dog.
Similar to other home care agencies, meal preparation, light housekeeping and mobility assistance are among Cypress’ more standard personal care offerings. Cypress differentiates itself from competitors, however, with its dedicated dementia programs, which connect seniors with memory loss to expertly trained caregivers and provide paid educational support to family members.
Roughly 80% of Cypress’ total business revenue is currently from private-pay sources, according to Michelle Cornelius, the agency’s director of memory care programs. Medicaid makes up the remaining 20%, Cornelius told HHCN.
Cypress’ dementia care service line accounts for about one-fifth its overall revenue mix, she said. The service line’s gross margins typically hover above 50%.
“Working in the home setting gives us the opportunity to care for people earlier in the disease process, to educate family members and provide needed support,” Cornelius, who has more than 25 years of experience working in the memory care field across various settings, said. “We wanted to be a solution when it comes to dementia care.”
Roth and Cornelius spoke to HHCN at the 2018 Home Care Association of America’s Annual Leadership Conference in Washington, D.C., held Sept. 22 through Sept. 25. Cornelius gave a presentation that highlighted Cypress’ dementia care program at the event.
Cypress did not provide a raw total revenue figure to HHCN.
Maintaining staff, client relationships
About one-third of Cypress’ 150 caregivers have gone through the agency’s specialized dementia training program, Cornelius said during her conference presentation. That training includes at least five hours of online courses followed by additional time spent in a classroom environment, plus up to four hours of individual client training.
Caregivers are compensated for their time throughout the training process, though at a lower rate compared to when they start actively applying their skills in seniors’ homes.
A chunk of training focuses on what dementia is and how it changes the human brain, according to Cornelius. Beyond that, Cypress caregivers are taught how to improve the quality of life and daily experience of a person living with a form of dementia. Additionally, caregivers are instructed on keeping seniors safe and managing often intense situations in a calm fashion.
Dementia caregivers make about $2 per hour more than Cypress’ non-trained caregivers.
“We try to get folks through [training] pretty regularly,” Cornelius said. “We’re doing these dementia classes once or twice per month usually.”
Because Cypress’ dementia caregivers tend to make more after they’ve completed training, they generally have lower turnover rates as a result. That’s also a benefit to Cypress’ business operations and bottom line, as the costs associated with losing a direct care worker are estimated at several thousands of dollars.
“Those dementia caregivers still have a level of turnover, but we do have a fairly low level of turnover with [them],” Cornelius said. “We know within the first few months that those caregivers will stick around.”
When Cypress first launched as a company, dementia care represented about 20% of its census, according to Roth, who previously served on the board of directors for the Banner Alzheimer’s Institute. Today, dementia care represents more than half of its census.
Cypress calculates that its dementia care services allow seniors to stay in their homes between six to eight months longer before transferring into a more intensive care setting. Increasing that time spent in the home is good for the senior, for his or her family and for Cypress, which gets to continue billing for services provided.
“Six to eight months can be an eternity in the dementia and Alzheimer’s world,” Roth said. “To be able to do that and potentially keep a family unit together, for us, is really important. The hardest think is having to say, ‘We’ve gone as far as we can go.’”
Supporting distressed families
Cypress charges about $5 more from its base rate for personal care services specialized for a person diagnosed with dementia — and slightly more than the base rate for dementia-related services for individuals who display symptoms but lack a formal diagnosis.
Its dementia care business line just doesn’t bring in money when care is provided, though, as Cypress also charges a fee when it provides educational supports and services to families.
“There’s a whole other revenue opportunity there,” Cornelius said.
Presenting a lifeline to distressed family members is a somewhat overlooked but critical component to dementia care, Roth said, as loved ones frequently overwork themselves and shrug off their health needs.
Caregivers who are themselves seniors are at a 63% higher risk of mortality than non-caregivers in the same age group, according to a study by University of Pittsburgh researchers published in the Journal of the American Medical Association.
Establishing connections with the family of a senior living with dementia can also lead to eventual home-based caregiving opportunities down the road. When families know about Cypress and its expertise, they’re likelier to turn to Cypress’ caregivers for their loved ones instead of transferring them into a skilled nursing facility or assisted living community, Cornelius said.
Successfully expanding into dementia care
After home care agencies launch a specialized dementia care program, there are several steps they can take to ensure success.
For instance, it’s important for agencies to establish themselves as expert sources within their communities by demonstrating their capabilities to local recreational centers, church groups, state agencies and dementia-focused associations, according to Cornelius. Along those same lines, agencies shouldn’t market to end users, but instead direct their outreach efforts to trusted advisors, such as doctors, attorneys and financial representatives.
“They need to know who you are,” Cornelius said. “They need to know they can have confidence in what you’re doing.”
The science and knowledge surrounding dementia is constantly changing, too, so agencies need to constantly be on the lookout for the latest training methods and caregiving tips.
Perhaps most importantly, agencies with dementia lines need to define their client and set boundaries for when to recommend the stoppage of service, Cornelius said. Cypress will only keep a person home as long as it’s safe, she said.
“You need to know how far through the disease process you want to be a resource to help someone,” Cornelius said.
Written by Robert Holly