Home Helpers Sets Sights on Medicare Advantage, International Expansion

Since joining Home Helpers as its president more than a decade ago, Emma Dickison has helped the Cincinnati-based home care franchise redefine its brand and achieve steady growth in an increasingly competitive industry.

After Home Helpers was acquired by private equity firm Linsalata Capital Partners in 2016, Dickison’s leadership propelled her into the CEO position. Today, the franchise company has over 300 independently owned and operated offices providing services across more than 1,000 communities nationally.

Filling out Home Helpers’ remaining white space in the U.S. market is one of Dickison’s top priorities moving forward, as is growing the franchise internationally and leveraging emerging technology tools to help clients age safely at home. The home care franchise network is also striving to become a preferred care provider for employers looking to help workers take care of aging loved ones.


In addition to serving as CEO of Home Helpers, Dickison — a former Blockbuster executive — sits on the Home Care Association of America’s board of directors.

Home Health Care News recently caught up with Dickison to discuss these topics, her leadership style, Medicare Advantage (MA) opportunities and several other industry trends. The highlights of that conversation are below, edited for length and clarity.

HHCN conducted its interview with Dickison before the Centers for Medicare & Medicaid Services (CMS) finalized rules on what supplemental benefits MA plans can offer in 2020.


HHCN: In February, Home Helpers announced you won the International Franchise Association’s 2019 Crystal Compass award, which recognizes outstanding leadership in the franchising industry. How would you describe your leadership style?

Dickison: I would describe my leadership style as collaborative and firm. I think one of my strengths is being good at bringing really smart people together and getting the best out of them.

I think it’s a very team-oriented approach, which you develop by creating a culture that fosters collaboration.

You were at Blockbuster during the company’s heyday when it saw rapid growth for a prolonged period. How has your background helped you since joining Home Helpers more than a decade ago?

I credit Blockbuster for where I am today. When I joined the organization, it really was in its heyday. There were about 150 stores when I started. When I left 14 years later, there were 8,800 worldwide. The organization at that time was doing over $1 billion in annual revenue.

It was an organization that had a great company culture. The mission wasn’t renting movies. The mission was about bringing families together.

Blockbuster was growing so fast that they, at first, looked toward internal talent to support that. If you had talent, you were going to have great opportunity. That was true for me. I had some terrific mentors in that organization, several of whom I’m still in touch with today.

I credit that organization for teaching me about culture, leadership and doing the right thing. It’s not always about the money, but rather treating people well.

How has Home Helpers grown since you came aboard?

It has been a great 11 or 12 years. I’ve been here for more than half of the brand’s overall journey. We are not the same company that we were when it was founded in 1997. We’re not even the same company that we were when I joined in 2007. We’re not the same company we were three years ago.

The home care space is very dynamic — and it is changing. We have been, I believe, a leader in those changes. Not just in franchising, but in home care. Our average growth rate over the last three years was 24%. We’ve outpaced the industry in that regard.

We have redefined the potential franchise owner we’re looking to partner with, increasing our standards in every part of the business. That includes everything from awarding franchisees and franchise development to training and marketing.

We’ve demanded great results and good people. I think that’s what you need to do as a leader to be relevant and continue to grow.

Who was your typical franchise owner in the past — and how are you now trying to redefine that profile?

When I joined the company, many of the franchisees that came in around that time were individuals who were looking for a job. It’s similar to what I saw from my early days at Sylvan Learning Center. They started their brand as: “We’re going to recruit teachers. They’re going to keep their day job, but open these centers after school and have teaching curriculum.”

That was similar to Home Helpers. The founder was looking for individuals who had a passion to provide care, but maybe this wasn’t a full-time endeavor for them. That’s not true today for us. This is now a full-time endeavor.

We have communities that have seniors — and others — who need 24/7 care. The need is growing. This is a full-time, for-a-profit business. We’re looking for individuals today who are prepared for that.

You mentioned changes that home care is facing. What are the biggest changes the industry is seeing, in your view?

Oh, gosh. Well, first of all, there’s a lot of competition that has entered the space over the past decade or so. When I joined Home Helpers, there were between 10 to 20 brands that were actually franchising in the home care space. Today, I think, that number is well north of 60.

And you still have a number of independents at the local and regional level.

This is a home care industry that has seen a ton of competition. That competition, though, isn’t always from entities that do home care well. I think you’re going to see some level of consolidation in the next five years.

Additionally, the client is changing. The older generation — we’ll say those 80 and older — was more of a do-it-yourself group. Accepting care was a little bit of a challenge. We’re now starting to see the upper end of the baby boomers requiring care. The baby boomer age is more used to having things done for them around their home, whether that’s somebody coming in to clean the house or take care of the lawn.

We’re seeing a shift in client mindset. At the end of the day, though, what hasn’t changed is the care and people wanting to remain at home. Older adults want to live out their years at home.

On the regulatory front, changes are being made to help see that to fruition. The government and society at large recognize that it’s less expensive to keep older adults and loved ones at home. Plus it’s better from a safety and emotional standpoint.

Look no further than Medicare Advantage programs that are now funding home care.

Medicare Advantage is becoming more flexible in terms of covering in-home services and supports, along with services tied to social determinants of health such as isolation and loneliness. Has Home Helpers tapped into that opportunity?

MA providing some level of funding for home care services just began in 2019. This year is really a dip of the toe in the water for most. Of all Medicare Advantage plans, I think there’s something like 90 providing some level of home care benefits — and the benefits themselves are very limited. For example, 30 hours of home care and 124 transportation visits to-and-from doctors.

I think the MA plans are figuring out what the benefit needs to look like. Some are sitting on the sidelines for now.

I don’t think you’ll see Medicare Advantage be a strong funder of home care services until probably 2021 and beyond.

But we’re working with several of them as they’re looking to provide benefits. It’s mostly at the regional level where you see MA opportunities — three-state regions or something like that.

As opportunities become available, we certainly intend to tap into that more. At the end of the day, our aging population wants to be kept at home. Anything we can do to help support that is critical.

I’m also a board member of the Home Care Association of America. We have been working diligently over the last few years related to any legislation that helps support licensing initiatives for home care agencies, to make sure there are reasonable care standards in every state.

We get to connect with home care franchise companies on a regular basis. Some have outlined to HHCN how they’re looking to grow by pursuing a conversion model. Some are growing by rolling out new, specialized service lines for more complex patients. What’s Home Helper’s core growth strategy?

We rolled out our strategy in 2016 when I became CEO. We identified five main growth strategies at that point. Those haven’t changed. They’ve been refined somewhat, but haven’t changed drastically.

Our first goal is to support our existing offices and help them grow in their communities. We do that in a variety of ways, whether that’s by looking for MA opportunities or working with national provider partners. We’re also working a lot on employment assistance programs right now. U.S. employers lose billions of dollars per year as a result of employees having to be either physically or mentally absent to take care of aging loved ones.

We’re working with several top employee assistance programs to be able to be a preferred provider of home care services.

We’re looking at organic growth as well. We have a pretty strong network across the country, however, there are some markets where we have not awarded franchises. We’re looking for the right partners to fill out that white space.

We’re certainly planning to add additional services. We already have a nice breadth of care in the home, medical monitoring. We’ve added nutrition recently through a partnership. We’re doing what we call wellness checks in the home when we don’t have a caregiver in the home.

I can’t go into great detail, but we’re in a pilot that would really differentiate us in the home care space. It would be a great model for all-around client care.

We do intend to expand internationally, looking probably at the second half of next year for that.

Then there’s the technology piece. We have DirectLink, which is our medical alert suite of solutions. That uses technology in the home when we’re not there — fall sensors, personal emergency response, medication management. We’ve got some GPS technology and telehealth for clients who need weight and blood oxygen levels every day to feedback to medical providers. We have those pieces in place, but we’re figuring out what else we can add to that mix.

We’re always looking at different products and services.

Overall, what are the greatest challenges and opportunities in home care right now?

Staffing and being able to keep up with the growing care needs is the No. 1 challenge.

Opportunity wise, our industry is highly fragmented. I think in coming years we’re going to need to bring stakeholders together.

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