Traditionally, home health services have often targeted older adults living in the broader community. Third-party management company LCS, however, has found a home health sweet spot within its vast network of continuing care retirement communities (CCRCs).
Started in 1971 as a subsidiary of Des Moines, Iowa-based The Weitz Corporation, LCS provides broad-based services for the management and marketing of the entire spectrum of senior living communities, operating mostly in the CCRCs space.
Currently, LCS oversees roughly 140 communities nationally, combining to serve more than 35,000 total residents.
LCS provides home health services within that network through a tight-knit partnership with Health at Home, a US CareNet company. Under terms of its partnership with Health at Home, LCS receives a 30% revenue share, Vice President and Director of Post-Acute Care Services Blake Gillman told Home Health Care News.
Through Health at Home, LCS has a home health presence across 13 agencies in a dozen states.
“It’s a unique structure … because it’s built primarily to service our own CCRCs, as opposed to going outside and servicing the broader community,” Gillman said. “We do a little [community home health services] in a couple of our agencies, but it’s really, very, very small.”
In general, teaming up with Health at Home helps LCS bring both home health and non-medical home care services to its senior living residents, helping them stay out of the hospital and emergency room.
To some extent, it’s yet another example of how the lines between senior living and home-based care are blurring.
“We need to have at least 50 to 60 clients on caseload in any given market to really be an active [home health] participant there,” Gillman said. “That seems to be the best sweet spot for us, internally.”
‘A delicate balance’
LCS has found success in bringing home-based care to its CCRCs and other senior living locations, which include independent living, assisted living and memory care communities.
But the company has also had to navigate its fair share of challenges.
For one, there’s “a home health agency around every corner” in most markets, according to Gillman.
“What is available in a given market really dictates the direction we have to go, at least at LCS and how we contract with our partners,” he said. “We may be in a market where there’s a hospital that predominately refers to themselves or their home health agency. We need to align with those types of situations, even though our own home health agency may be ready and available to do both [Medicare-certified home health] and private duty.”
At times, LCS has to turn to those non-partner home health providers as well, who may bring more expertise to the table.
“As much as we would like to believe that we could completely cover all of the services that are needed within our CCRCs with our own home health company, it’s virtually impossible to do that,” Gillman said. “There’s a delicate balance.”
Like it is for all home health providers, staffing is a struggle for the Health at Home agencies that LCS works with, though caregiver retention is somewhat aided by the comparatively lighter travel requirements that come from mainly servicing senior living communities. While a home health worker from an outside agency that predominately serves the broader community may travel several dozen miles each day, one working with an LCS community can quickly move from room to room.
In 2018, turnover for the home care industry reached an all-time high of 82%, according to the most recent Benchmarking Study by Home Care Pulse.
The demographic profile of the general CCRC resident also presents a challenge to LCS’s home health operations.
“Because we’re in the business that we’re in with CCRCs, we have a lot of residents who are able to afford private caregivers,” Gillman said. “Those private caregivers may have been — or will be — part of their lives for a number of years. They work either independently or for another agency.”
Revenue tied to the partnership with Health at Home is “a really small portion” of LCS’s overall revenue, he noted.
As a post-acute care expert, Gillman sees “a lot more upside” on the private-duty side of home-based care, as home health providers must transition into the upcoming Patient-Driven Groupings Model (PDGM) and deal with the biggest payment overhaul in two decades.
The bullish outlook is, in part, supported by home care carving out a newfound role in the Medicare Advantage program, too, thanks to a couple of major developed from the Centers for Medicare & Medicaid Services (CMS) over the past two years.
Gillman is similarly optimistic about the upside and importance of hospice services, though LCS has no plans to launch its own in-house operations at this time.
“We do that in most of our markets,” he said. “We partner with the preferred providers in given markets for those services. We essentially leave it to the professionals.”
Apart from particular segments or settings, Gillman has also been following the chatter surrounding a unified payment model for all post-acute care providers.
The Medicare Payment Advisory Commission (MedPAC) again recommended such a model in its June report to Congress, and draft legislation currently in the U.S. House of Representatives calls for a prototype by March 2021.
“With unified payment, … I think we’re in a really good spot. Primarily because — with the CCRC environment — we can move people around into different levels of care to give them the most appropriate treatment, opposed to going out and finding those levels of care we need to partner with,” Gillman said. “We can create our own ecosystem under that uniform system.”