By offering transportation services, home care agencies can help clients get to important medical appointments and, at times, boost revenue. But doing so can also act as a powerful foot in the door when it comes to establishing relationships with hospitals and other community partners.
About one in five older adults give up driving after turning 65, according to a recent nationwide poll spearheaded by the National Aging and Disability Transportation Center, a partnership between the National Association of Area Agencies on Aging (N4A) and Easterseals. On an annual basis, that’s about 600,000 people each year.
“What we learned [from the survey] was striking — and a confirmation of what we had suspected, but hadn’t known for certain,” Virginia Dize, director of N4A’s transportation program, told Home Health Care News. “Most older adults and people with disabilities either drive themselves or rely on caregivers for a majority of their transportation needs. Whether they are planning transportation or providing the transportation themselves, caregivers clearly play a critical role.”
Roughly 3.6 million people — many of whom are older adults — miss their medical appoints each year as well.
For these reasons, several home care franchisers and independent companies have made transportation a focal point of their system-wide operations. They include Omaha, Nebraska-based Right at Home and El Segundo, California-based 24Hr HomeCare. Over the past 12 months, 24Hr HomeCare has coordinated more than 21,000 rides through business alliances with both Uber and Lyft.
Founded in 2008, 24Hr HomeCare has 16 locations throughout California, Arizona and Texas.
The demand and need for transportation services is clear, Gavin Ward, regional director of strategy and partnerships for the company, told HHCN. But implementing a transportation line of business is not necessarily a simple task.
“In order to truly have a transportation program or line of business, we believe that we have to have dedicated experts and staff who are able to handle the volume we have,” Ward said. “If you’re a home care company that wants to be able to provide these services, you need to invest in the infrastructure — and that includes dedicated people.”
Inside 24Hr HomeCare’s transportation line
Home care companies can launch transportation service lines in a variety of ways, but the most common avenue is establishing relationships with ride-hailing providers such as Lyft or Uber, complementing them with an independent fleet of caregiver and agency vehicles.
For example, 24Hr HomeCare started providing transportation services to clients when it first launched, pulling from its caregivers’ pool of cars and vans. It then began developing relationships with Lyft and Uber in 2015.
Today, the independent company brands its transportation offerings as RideWith24.
“For me, there are two big components, with one being the medical piece and allowing people to access health care and appointments in a much easier way — typically at a lower cost than a taxi or other means of transportation,” Ward said. “The second piece is geared toward socialization, helping clients get to religious functions or meet up with friends.”
When it comes to ride-hailing partnerships, 24Hr HomeCare passes Lyft or Uber transportation costs along to consumers, their family members or the facility requesting service. For those who are strictly using 24Hr HomeCare as a way to get from Point A to Point B, then agencies coordinating rides tack on up to $10 per ride.
That upcharge helps cover the cost of the three full-time community partnership coordinators 24Hr HomeCare employs, Ward said, adding that the average ride costs $17.41. About 32% of people using the RideWith24 program only use it for transportation and are not receiving home care.
“You have to invest in people, but you also have to invest in the accounting side,” he said.
Notably, roughly half of transportation requests come from contracted partners — 24Hr HomeCare works with dozens of acute-care medical centers — and are related to a discharge or medical appointment.
When home care agencies provide services to both regular clients and those who, perhaps, just need a one-time ride, they can be an important resource, said Dize, who also serves as co-director of the National Aging and Disability Transportation Center.
“Home care agencies that provide transportation to their clients are an important part of the solution,” she said. “However, agencies may limit their transportation services to clients who already receive home care assistance or offer rides solely to certain destinations, such as doctors’ offices. Consumers who can only afford to pay for a limited number of hours of home care assistance may also hesitate to use their hours for transportation which can be time-consuming.”
A foot in the door
Similar to 24Hr HomeCare, Right at Home also routinely teams up with Lyft and Uber. Its ride-hailing efforts began as part of a pilot program with about 25 owners in 2017 and have gradually expanded since, Kerin Zuger, vice president of business development and strategic partners for Right at Home, told HHCN.
Founded in 1995, Right at Home as more than 550 locations across the United States.
As part of the franchise relationships with Lyft and Uber, Right at Home owners are required to work with only one of the ride-hailing powerhouses. The transportation line is then marketed as Right at Home Transportation, with add-on language clarifying whether its “powered by Lyft” or “powered by Uber.”
Owners have flexibility in deciding how to pass along costs to clients. Not many Right at Home owners opt to mark up costs for coordinating an Uber or Lyft ride, Zuger said. When they do, though, it could lead to created revenue.
“Not a lot of owners mark up [transportation costs], but I recommend that they do, especially if there’s staff dedicated to transportation and coordination,” Zuger said. “If you have a person in your office doing dispatch, that takes time and effort, so you need to at least make sure you’re covering your cost on that.”
The biggest bonus to Right at Home’s transportation line: a foot in the door with hospitals looking to improve upon the patient discharge process.
“Home care owners have a tendency to think they … don’t bring enough value to be able to walk into a hospital and say, ‘I’m here, and I can help keep people out of the hospital and reduce cost,’” Zuger said. “What transportation does is it opens that door. We can say, ‘Hey, last quarter you spent $25,000 on taxi cab services. What about instead of using taxis, you just call Right at Home Transportation.”
As part of its appeal to hospitals and the discharge process, Right at Home alerts discharge nurses as soon as a driver shows up, while also letting them know when a patient gets home. Right at Home additionally ensures that patients don’t leave discharge paperwork in their ride home.
“We’ve identified that, yes, hospitals are going to be a major target for us moving into 2019 and beyond,” Zuger said. “We need to make sure that Right at Home is rolling off their tongue all the time.”
One reason for some cautiousness in touting the benefits of ride-hailing services: past research has questioned their impact.
In fact, a 2018 study published in JAMA Internal Medicine found that offering free Lyft rides to Medicaid patients for an upcoming medical appointment did not reduce the rate of missed appointments.
The study, which included nearly 800 Philadelphians who were patients with Medicaid at one of two Penn Medicine primary care practices, found that the missed appointment rate for those offered a free Lyft ride and those not offered a ride was practically identical: 36.5 % vs. 36.7%.
However, the study did not focus specifically on Lyft rides coordinated with the help of a home care agency.
Furthermore, the benefits of a strong transportation line extend past community partners and clients. Seamless transportation can also be a draw for recruiting qualified caregivers, who may not always have access to a vehicle.
About 6% of the rides 24Hr HomeCare coordinated in the past 12 months were for its own internal employees, Ward said. That’s about 1,300 rides in total, he said.