Interim Pursues Hospice Growth Across Franchise Network

Each year, roughly 1.4 million Americans living with a life-limiting illness receive hospice care, according to the National Hospice and Palliative Care Organization. With demand for end-of-life care only projected to increase in coming years, international home-based care provider Interim HealthCare Inc. is now looking to grow its small-but-valuable hospice line across the franchise system.

Sunrise, Florida-based Interim HealthCare, part of Caring Brands International, provides nursing, home care and hospice services across more than 530 franchise locations in seven countries. Currently, a group of 19 Interim owners operates 38 U.S. offices offering dedicated hospice lines, Tammy Fox, national director of hospice services for Interim, told Home Health Care News.

“Right now, overall, all of our Interim hospices serve about 1,550 total patients per day,” Fox said. “The amount that we’re growing — both in number of programs and in patients served — has been phenomenal.”


The near-term goal for Interim is to have 45 to 50 offices offering hospice care up and running by year-end of 2019, according to Fox. That includes adding hospice throughout Interim’s existing network, in addition to opening up entirely new locations that provide hospice care as their primary business line.

To some extent, Interim’s strategy of prioritizing hospice as a predominantly home care and home health franchise system bucks industry trends, as most hospices are operated as independent agencies or part of larger multi-leveled companies, such as LHC Group (Nasdaq: LHCG) or Amedisys (Nasdaq: AMED). That’s especially true when it comes to the biggest hospice providers.

Of the 100 U.S. largest hospice providers in 2017, as defined by LexisNexis, hardly any were franchise companies. Interim, however, checked in as the 47th largest hospice provider in the country, capturing about 0.25% of the market.


Miami-based Vitas Healthcare, the Chemed Corporation (NYSE: CHE) subsidiary regarded as one of the top two or three largest hospices in the U.S., had a market share of 4.52% in comparison, according to LexisNexis.

“That market share may seem small, but even the top, very largest hospice operations in the country are only at 4% or so,” Fox said. “This is something that Interim decided a while ago to get on board with and make it part of the franchise package, to provide standardized policies and procedures and things like that.”

Hospice helps ‘keep that revenue flowing’

Interim Healthcare of Northern California, located in Redding, just south of the Oregon border, was among the first Interim franchises to offer hospice care.

More than anything, the agency did so because of an obvious need within the local community, owner Cindy Seawright, a registered nurse (RN), told HHCN. The agency opened in 1995.

“When I started the [hospice] program in 2006, we were already doing home health care,” Seawright said. “In our community, there was only one existing hospice program, which had been around for 20-plus years. We were seeing patients being put on waiting lists anywhere from two weeks to a month before the other hospice could get them on service.”

At the time, Seawright and her co-owners, also RNs, had to launch the hospice line “pretty much from scratch,” she said, adding that the roll out probably took close to a year to finalize.

Today, about 20% of Interim Healthcare of Northern California’s revenue comes from the hospice line. Besides serving an important need, adding hospice care to the agency’s revenue mix has helped stabilize the agency’s broader business.

“That’s been one of the things that we’ve benefited from in offering all of various product lines,” she said. “One may be slow, but another may be busy. It keeps that revenue flowing.”

Referral opportunities and educational challenges

Besides diversifying Interim Healthcare of Northern California’s revenue stream, the addition of a hospice business line has also enabled the agency to better meet consumer needs by offering comprehensive services, so that patients and families don’t have to seek out new, additional providers as needs change.

In fact, about 10% of the agency’s hospice patients come from internal referrals, Seawright said.

“Continuity of care helps us with our hospice business because people get to have the same staff members, which is really important to them,” she said. “They get to have the same nurse who knows them and their needs as they progress through these different levels of care, or the same home health aide, the same social worker.”

That idea of care continuity and capitalizing on internal referrals is a key reason why Interim as a franchiser is targeting hospice growth, Fox said.

“Anytime a particular owner in his or her territory or area can offer the whole gambit, the whole continuum of care, you’re going to be much better off than referring out to somewhere else,” she said. “Most of the time when somebody is referred to Interim, whether it’s personal care and support, home health or hospice, they may need one of our services for the rest of their lives.”

Although Interim Healthcare of North California has been able to grow its hospice line into a valuable part of its operations, barriers are preventing the agency from achieving further gains. Challenges include a lack of hospice knowledge in the general public, as well as a hesitancy with physicians in terms of referring patients.

“We would like [hospice revenue] to be much higher, but we’re finding it difficult to grow our hospice, mainly because a lack of community education,” Seawright said. “We’re constantly trying to educate the community – educate doctors – on the value of hospice and how it’s not something to be afraid of.”

Franchise benefits

On a macro scale, hospice admissions have experienced a several-months-long run of growth. Compared to the same period in 2017, the number of hospice patient admissions increased by 3.9% in the first quarter of this year, according to the latest data from Excel Health.

Interim HealthCare of West Michigan, Interim HealthCare of the Upstate in South Carolina and Interim HealthCare of Colorado are also among the franchise locations that have opened hospice lines.

While somewhat uncommon, there are advantages to providing hospice care under the franchise model, Fox said. For example, as opposed to the “cookie-cutter approach” that some corporations may take, the franchise model allows for customization depending on the wants and needs of a given community.

Interim may offer a standard process and procedures, plus help with hospice compliance, but it’s ultimately up to the owner to decide how he or she wants to run the agency.

“Each hospice is uniquely owned and operated, so they have that connection with the community,” Fox said. “We might have information on starting a massage therapy program or specialty volunteer programs, such as a tuck-in or vigil volunteer. We have the materials available, but they can look at their own community and see what, you know, matches what their communities’ needs.”

Written by Robert Holly

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