Homecare By Design, LifeSpire Blurring Lines Between Home Care and Senior Living

As the U.S. population rapidly ages, senior care providers are becoming increasingly more innovative to keep pace with consumer demand and preferences. For some, that has meant blurring the traditionally hard lines between senior housing and home care.

Among the providers that do not fit neatly into the “home care” or “senior housing” boxes, for example, is Lafayette, Indiana-based Homecare By Design.

In 2012, the home care agency expanded its service mix and opened a clubhouse to host events and keep its members socially engaged. The idea behind the “senior community without walls,” according to Homecare By Design founder and President Traci Goudy, is to give older adults the choice of becoming a member and experiencing the community comradery without having to move into a senior housing facility.


On a high level, the clubhouse service bridges the best aspects of home care and the senior housing industry at a time when more seniors are choosing to age in place, Goudy told Home Health Care News. Currently, one of the biggest knocks against aging in place — and the home care services that enable it — is the danger of social isolation.

“How can we start thinking outside of the box, be more creative and come up with solutions?” Goudy said. “How can we tie all of those pieces together and be able to reach a broader market of people — and do it more affordably? How do we do that from an aspect of home care — with those similar amenities of senior living — and blending them together?”

As a part of Homecare By Design’s unique service, the clubhouse is open to its existing home care clients. The clubhouse offers a seniors fitness studio, as well as room for educational seminars, brunches, bible studies and dementia support groups.


The clubhouse is also open to Homecare By Design’s caregivers, with an on-site training space that replicates the look of an apartment, giving them the opportunity to learn in a space similar to clients’ homes.

Broadly, educating caregivers and making sure they’re prepared to enter clients’ homes for the first time is a big part of successful retention strategies, experts say.

About 15% of Homecare By Design’s revenue comes from the membership to the community center and other ancillary services, with the home care-senior living hybrid’s overall annual revenue averaging between $1.6 million to $2.1 million over the past decade, according to Goudy.

Adding the clubhouse element to a home care agency adds a community and social component that is often missing from home care but is touted as a benefit in senior housing, she said. Targeting isolation and loneliness has become a main focus for stakeholders throughout the U.S. health care system, as mounting evidence continues to show the true cost of social determinants of health.

Being lonely roughly has the same health impact as smoking more than a dozen cigarettes a day in terms of overall mortality, past research has found. That’s partly why insurance giant Humana Inc. (NYSE: HUM) has made loneliness and other social determinants of health a priority.

“When I worked in assisted living or retirement communities, so much of the time the social aspect was the reason for moving there,” Goudy said. “[Seniors] were lonely or had just lost their spouse or a lot of their friends. They needed that social aspect, as well as the activities [that senior housing offers] to keep their mind stimulated. When you have home care, you don’t have that. You have one-on-one care.”

Homecare By Design, though not contractually, works with local senior living providers to leave the offer of senior housing on the table.

“The senior wins either way,” Goudy said. “They can stay home for life, and we will layer in home health or hospice if needed, or help them move into the community they chose as part of their pathway. It is simpler for the consumer and their family to transition physically and psychologically.”

LifeSpire of Virginia’s home care crossover

Another example of a senior care provider that’s changing the landscape of senior living and home care is LifeSpire of Virginia.

In February, the Richmond-based senior living provider — which manages four continuing care retirement communities (CCRCs) throughout the state — launched Lakewood at Home, a continuing care at-home membership program.

Through the program, older adults living at home in the Richmond area will be able to stay in their homes, paying a one-time membership fee along with consistent monthly fees to receive long-term care, which includes home care and other services.

“What’s innovative about [Lakewood at Home] is that it combines an insurance type product with care coordination,” Tammy Mackey, executive director of Lakewood at Home, told HHCN. “We don’t do the home care ourselves … we have home care agencies that partner with us to provide those services, and we are part of a continuing care retirement community.”

Currently, Lakewood at Home has partnered with four home care agencies. Mackey declined to name the specific ones, however.

In 2018, LifeSpire and its communities had total revenues of $83.5 million, with an average of about 1,100 residents.

Costs to live LifeSpire’s communities vary based on the type of contract an individual chooses, but generally, entrance fees range from $100,000 to $500,000 — and monthly fees average $2,000 to $5,000.

The program is similar in nature to a long-term care insurance program, but its utilization of care coordinators that arrange care options separates it, according to Mackey.

“The huge thing that makes us different from long-term care insurance is care coordination,” she said. “We have a care coordinator that gets to know our members very well, conducts visits with them and designs an individualized care plan. When people join they have to be healthy and independent to join. We look at medical records, history. We do a cognitive assessment. As they age and needs arise, our care coordinator who is familiar with them helps them proactively get the care that they need.”

While this program was formed to help clients age in place, Lakewood at Home allows for fluidity in service for members that may eventually need to move into a LifeSpire community, offering “bridge options” and discounts.

Lakewood at Home is fairly new and, as of now, has only 20 members. But there is strong potential for growth, Mackey said, since it allows LifeSpire to reach older adults that prefer to age in place rather than move into the company’s properties.

“There are around 30 of these [models] around the country, and if there is a steady stream each year, as it’s proven that it works, it’s something that will continue to grow,” Mackey said.

Another example of the blurring of lines between senior living and home care: a pilot program unveiled last year between national home care franchise company Right at Home and Knoxville, Tennessee-based Dominion Senior Living.

“I think to some extent, [this kind of service is the future],” Mackey said.

Additional reporting by Tim Regan

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