Survival of the Fittest: Why In-Home Care Providers Are Redefining Their Identities Amid COVID-19

Some in-home care providers have struggled to stay in business over the past few months. Yet others have thrived amid the coronavirus, creating new service lines from scratch and carving out niche roles with nontraditional partners.

Totowa, New Jersey-based The Senior Company falls into the second category.

Founded in 2018, The Senior Company normally provides private-pay home health and home care services across the state of New Jersey, caring for roughly 150 to 300 active clients on any given day. After the coronavirus evolved into a national crisis, however, The Senior Company also launched a dedicated staffing business to support local nursing homes.


And the company has nearly doubled its overall business as a result.

“We got a call from a major nursing facility that serves all the big New Jersey counties. They said, ‘Hey, we’re in trouble. Can you help?’” Steve Romano, president and CEO of The Senior Company, told Home Health Care News. “And we said, ‘Sure.’ We had literally nobody who worked facilities at that time.”

Since the initial outbreak at a long-term care facility in Kirkland, Washington, the coronavirus has continued to devastate nursing homes, along with their residents and staff.


As of June 2, more than 107,000 people had died from COVID-19 in the U.S., according to statistics from Johns Hopkins University. Newly released federal data shows that nursing home residents account for nearly 26,000 of those deaths.

“Nursing homes have been ground zero for COVID-19,” U.S. Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma said in April.

CMS and the Trump administration have taken several steps to control the spread of the virus in nursing homes, including the implementation of new reporting requirements and stronger infection-control protocols. Despite those efforts and other attempts to deliver personal protective equipment (PPE) and COVID-19 testing supplies, many facilities — often shorthanded — continue to report new cases on a daily basis.

That’s where The Senior Company jumps in.

After the in-home care provider received that initial call from a nursing home, it began an aggressive campaign to hire, vet and onboard dozens of new caregivers to deploy into nursing homes across New Jersey, according to Romano.

At the same time, the provider also put in an expedited request with the state for a formal staffing license.

“We got that approved within a day,” Romano said.

Doubling down

The Senior Company has experienced steady growth since launching in 2018. As is common for any new business, though, there have been bumps in the road that Romano and his leadership team have had to navigate. 

“We adapt really well. We learn really well,” Romano said. “When you build a company, especially a home health company or something that’s so intricate, it’s hard to get it all right immediately, so you need to be nimble.”

That ability to adapt on the fly has been essential for The Senior Company while launching a nursing home staffing business from scratch — and dealing with coronavirus disruption, more globally.

“I don’t want to say we were ready for the coronavirus,” Romano said. “But when it did come, I was happy to see that we were able to adjust so quickly because of our other experiences.”

Since agreeing to staff that first nursing home, The Senior Company has struck agreements with 17 additional facilities. To meet that demand, the in-home care provider has hired about 150 caregivers specifically for its facility staffing business.

That’s about how many workers The Senior Company has on the in-home care side.

In part, the in-home care provider has been able to find those new caregivers for its staffing business because of the competitive compensation it offers, Calvin Bynum, executive director of The Senior Company, told HHCN.

In most cases, The Senior Care offers pay that’s about 30% to 35% above the industry standard. 

The Senior Company’s hiring efforts have also likely been helped by record levels of unemployment, which isn’t expected to drop anytime soon.

The Congressional Budget Office (CBO) recently projected that the U.S. unemployment rate will be 11.7% in the fourth quarter of 2020. While that’s lower than what the unemployment rate was in April, 14.7%, it’s still higher than any point since the Great Depression.

“A lot of people are going out of work and filing unemployment claims. A lot of people aren’t able to pay bills,” Bynum said. “While that’s happening, we’ve ramped up pay. We’ve ramped up jobs. We’ve almost doubled our staff.”

Capturing caregivers

“Capturing a market of caregivers” to work inside nursing homes amid the coronavirus emergency was one of the most difficult things The Senior Company has had to do since its formation, according to Bynum.

To do so, it has focused on being transparent with staff and ensuring their protection inside facilities.

“[Creating a staffing team] was difficult at first,” Bynum said. “But we said we weren’t going to try to ‘smoke and mirror’ any employees. We were very transparent about what they were walking into.”

Before entering a facility, The Senior Company has managers sit down with caregivers to explain the situation inside the nursing home and verify that the staffers are comfortable with the job. Staffers then sign a waiver stating they’ve agreed to the assignment.

From there, The Senior Company provides its nursing home support workers with an initial package of PPE. As part of their agreements, the nursing home is then responsible for supplying all necessary PPE moving forward.

“Even some of the bigger home care agencies have had trouble with staffing because there’s a lot of different personalities to manage,” Romano said. “We had some pushback to do this, to go and help people in these facilities. But we really weighed the risk-reward in all instances, and we’re glad we did it.”

Even before the coronavirus, the health care staffing space was booming.

In fact, a 2019 report projected that the global health care staffing market would grow at a compound annual growth rate (CAGR) of about 5.2% from 2019 to 2026, reaching the market value of around $45.2 billion by 2026.

As its staffing line continues to grow, The Senior Company plans to maintain a robust in-home care department, Romano noted.

“We’re trying to prepare for the expected wave of discharged hospital patients coming home,” he said. “We have so many people who have been in facilities for so long. When they start coming home, they’re going to need help, and we’ll need to have the caregivers ready.”

Finding a niche

Toward the end of May, the federal government announced the distribution of almost $4.9 billion in COVID-19 relief funds directly to skilled nursing facilities, the first specific tranche of stimulus money for the industry since the start of the pandemic.

As part of the relief, each skilled nursing facility in the country will receive a baseline payment of $50,000, plus an additional $2,500 per bed, according to the U.S. Department of Health and Human Services (HHS).

The support might further fuel staffing arrangements with in-home care providers.

Alternatively, it could also prompt some nursing homes to keep services in-house.

“I think it could have two possible effects,” Bynum said. “One, a nursing home could get the money and continue to utilize our services longer. Or, two, they could take that money and raise the pay for their current employees, which would incentivize them to come back and start working, meaning they wouldn’t need us as much.”

The former scenario is the likeliest, the executive directed said.

Of course, it’s not just The Senior Company that has carved out an innovative, niche role amid the coronavirus. Sunrise, Florida-based Interim HealthCare Inc. and Cincinnati-based FirstLight Home Care have likewise found staffing opportunities within senior living communities and long-term care facilities, for example.

“We are probably running a 18% to 20% increase in hours per week purely from staffing requests from facilities,” FirstLight CEO Jeff Bevis previously told HHCN.

Peter Ross, CEO and co-founder of Maryland-based Senior Helpers, similarly noted during an HHCN webinar that his organization has found new roles linked to the coronavirus.

“We’ve seen new types of services that we’re doing in home care, where you now are servicing plants [using us] as the temperature-control checkers,” Ross said. “We are starting to see some of those services request ramp up, even different kinds of services that we weren’t doing before. It’s really not … gushing through through the door, but at the same time, it’s definitely picking up.”

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