ComForCare Sees ‘Gray Area’ of Private-Duty Nursing as Big Opportunity

Earlier in December, international home care franchiser ComForCare announced plans to roll out a private-duty nursing program across its sprawling franchise network. The strategy is yet another example of the blurring of lines between home health and home care labels, ComForCare officials told Home Health Care News.

“Most people want to try to put agencies into a bucket of home care, which typically people think of the personal care services or non-medical services,” Emily Wiechmann, clinical program manager for ComForCare, told HHCN. “Or they want to put you into that certified, CMS home health and hospice agency bucket. But really, as a private-duty nursing agency, we’re in a little bit of a gray area in between both of those.”

Bloomfield Hills, Michigan-based ComForCare has more than 200 franchise locations across the United States, Canada and the United Kingdom. About 13% of ComForCare’s offices currently offer private-duty nursing, but the franchiser’s goal is to bring that closer to 100% within the next three to five years.


Since joining ComForCare at the start of 2018, CEO Steve Greenbaum has pushed to diversify the franchiser’s home-based care offerings. Adding private-duty nursing services, in particular, across the franchise network will help ComForCare provide high-quality care to a more medically complex patient population, Wiechmann said.

“Private-duty nursing, by nature, is more of a long-term service,” she said. “We’re dealing with more chronically disabled and medically complex clients, people who have tracheostomies and feeding tubes, ventilators. A lot of these people require hourly nursing services in their homes for the rest of their lives.”

What ‘private-duty nursing’ really means


Wiechmann, a registered nurse (RN) with a bachelor’s in nursing, has helped develop private-duty nursing programs in three different states throughout her career.

Doing so requires a lot of education and outreach among franchise partners, she said, as well as presentations and training sessions. One of the most important factors for rolling out a private-duty nursing program is “good clinical mentorship,” Wiechmann said.

One of the prevailing misconceptions people have about private-duty nursing is that “private-duty” is synonymous for “private-pay.” That’s not necessarily true, Wiechmann said.

“I think the best way to describe private-duty nursing is that it’s hourly, shift-based care that is provided by a skilled nurse, such as an RN, licensed practical nurse (LPN) — licensed vocational nurse (LVN) in certain states — or home health aide,” she said. “They provide these services under the direction of a physician.”

Typically, the need for private-duty nursing is precipitated by some sort of client condition. Additionally, private-duty nursing clients tend to be pediatric clients more than adults, a trend that may present new business opportunities to home care agencies that more commonly work with older adults.

The primary payer source for private-duty nursing is a non-private-pay scenario, where there is actually an insurance benefit of some type that pays for the services, Wiechmann said.

Implementation challenges

ComForCare’s goal is to eventually roll out private-duty nursing services across its entire franchise network, but that doesn’t mean the franchiser expects to be rigid in working with franchise partners on implementation.

Instead, ComForCare plans to take a “tiered approach” and allow owners to “pick and choose” their level of involvement in the program, Branden Worback, director of operations at ComForCare, told HHCN.

“Like most systems in franchising, you’re going to get 20% to 30% of your early adopters who are very excited from the get-go,” Worback said. “Then you’re going to get 20% to 30% who are slow adopters that want to take a wait-and-see perspective to their business. Everyone else is somewhere in between.”

Overall, ComForCare’s private-duty nursing line will have similar sales and marketing strategies and margins compared to the rest of its business offerings, Worback believes.

ComForCare is not alone in trying to diversify its services to care for more clinically complex populations, as many other home care franchise companies have branched out to launch specialized dementia care programs.

Written by Robert Holly

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