Elder-Well CEO: Home Care’s Rising Costs Creating New Business for Adult Day Operators

Elder-Well, a non-medical social model for adult day care, has begun offering opportunities for entrepreneurs to franchise its service. The franchising play is yet another example of how adult day models are taking off across the U.S.

The Framingham, Massachusetts-based Elder-Well was founded in 2014 by home health veterans Kara and Ken Harvey. With nearly six years of experience at one location big enough for 14 guests, they decided it was time to expand.

The Harveys have now launched the Elder-Well Franchising System and are hoping they can onboard at least 10 franchisees in 2020.


The startup cost is $43,000 and the total investment estimate ranges from $53,000 to $149,000, according to Elder-Well. The company, however, is offering a discount startup cost of $37,000 for the first five owner-operators.

When the opportunity to expand came about, there were a lot of different potential strategies to explore, CEO Kara Harvey told Home Health Care News. But franchising seemed to be the best fit.

“I had to make the decision on [how we would grow],” Harvey said. “Put a big addition on the home or open another one? My husband and I are former franchisees, so we understood the ability of a franchise system to reach a greater audience instead of slowly adding another corporate-owned unit. We had such a great experience being franchisees that we chose the maybe unconventional way of growing it.”


Moving forward, the Harveys will have their share of competitors in the adult-day franchising world. Among them is Maryland-based Senior Helpers, the home care franchise giant that launched its own Town Square franchise model in 2018.

“I look at the adult day care industry and think that it is kind of like the home care market was 20 years ago,” Senior Helpers CEO Peter Ross said during an HHCN outlook webinar earlier this month. “There is a tremendous opportunity there.”

While the home adult day model is not new, Harvey feels like the non-medical, social day model market is largely untapped. That’s especially true as payers and health care stakeholders increasingly recognize the value of targeting social determinants of health.

“There’s just not a lot of us,” Harvey said. “There’s some independent [social adult day businesses] throughout the country, but it just really hasn’t been acknowledged that this is a new avenue to provide care for people, and to really enhance their life.”

Cost is one factor that Elder-Well and similar models have going for them. For older adults and their families, home care services can often check in at $20 or $25 per hour; adult day models can often cost about $75 for an entire day of care, according to the most recent Genworth Cost of Care Survey.

Elder-Well generally ranges anywhere from $14 to $18 per hour of care.

The pricing can be more manageable in the adult day model for some because one caregiver can take care of, say, six patients at a time, as opposed to private, one-to-one care.

For the Harveys and Elder-Well, the goal is to get into as many communities as they can in the next few years. Franchisees will be fully trained throughout the process by the Elder-Well team, and the franchising agreement will allow them room for flexibility, such as choosing the days that they want their business to be open.

Ten franchisees is the goal for 2020, though her husband is more bullish on their capabilities, Harvey said. By 2021, they’d like to double the amount of franchisees they sign on this year.

The Elder-Well model opens its doors to older adults with mild to moderate cognitive impairment or physical needs. The social aspect is one of the main selling points for the program, and patients are evaluated for fit based on interviews with their caregiver in addition to a week-or-so trial at the Elder-Well home.

The program relies on a curriculum for guests, divided into eight blocks throughout the day. It includes reminiscence activities, cognitive stimulation activities, physical exercise and outings to the community.

Additionally, Elder-Well provides assistance for participating family’s caregivers. It recognizes that some of the isolation that affects seniors also affects the people taking care of them in the home.

When impairment in the patients does progress, the company also advises patients’ families on the best next steps to take for their loved ones. Harvey is also a family caregiver consultant, which has added an additional revenue stream, one that she hopes the franchisees will be able to take advantage of as well.

Elder-Well sees itself as part of the future of health care. The Harveys think their model is scalable and will be of benefit to both potential franchisees and to members of the senior population.

“Home care is expensive. It’s getting unaffordable for a lot of people,” Harvey said. “We need to rethink how we’re going to deliver care and be innovative.”

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