‘We’re Looking for the Best of the Best’: Why Dementia-Focused Home Health Provider Tender Rose Cherry-Picks Top Caregivers

As the number of Americans living with Alzheimer’s and other forms of dementia rises, more in-home care providers are rolling out specialized services lines focused on memory care and disease-specific needs. Some providers are even building their entire businesses around dementia.

One such in-home care company is Tender Rose Dementia Care Specialists, which has been the largest one-on-one dementia care provider in its market since 2009.

“All of our clients have dementia. All of our caregivers are highly trained memory care professionals,” Jim Kimzey, the company’s founder and CEO, told Home Health Care News. “Our mission is to improve the quality of life of people living with dementia and their families. It’s not just about keeping them safe and taking care of their physical needs.”


San Rafael, California-based Tender Rose’s service lines include personal assistance, companion care, “couples care” and live-in care. The company — launched by Kimzey and his siblings after their mother passed away following her own battle with Alzheimer’s disease — currently has eight locations across the state.

Nationally, there are more than 5 million people age 65 and older living with Alzheimer’s disease — a number that is estimated to grow by roughly 14 million by 2025, according to statistics from the Alzheimer’s Association. Alzheimer’s disease is the most common form of dementia, with others including vascular dementia, Lewy body dementia and more.

While dementia is prevalent across the general U.S. population, it’s especially present in the home-based care space. One home care provider, for example, recently told HHCN that almost 80% of its clients have a primary or secondary diagnosis of Alzheimer’s or another form of dementia.


As the CEO of Tender Rose, Kimzey believes that there’s value in a company that specializes in delivering dementia care in the home setting. When it comes to caring for seniors with dementia, Tender Rose takes what it calls a “person-centered, activity-based care approach.”

“The biggest difference, I see, between what we do, and what traditional home care does is … we get to know the person who has dementia,” he said. “We engage them in activities that bring them joy and meaning, at whatever level they can still participate. What traditional home care tends to do is focus on the physical needs of the client. Everything is about activities of daily living (ADLs) or instrumental activities of daily living (IADLs).”

One example of keeping a person with dementia engaged, Kimzey said, might be introducing an activity that’s both task-oriented, but one that also allows the individual to flex his or her “creative muscle.”

That kind of approach is generally far more effective than dictating commands or carrying out a random assortment of activities to simply pass time, according to Rachael Wonderlin, a dementia care consultant and author.

“I’m thinking something small, like bringing a little wooden birdhouse to your client’s home and saying, ‘Hey, we’re going to be putting this out in the garden. I could really use your help painting this,’” Wonderlin told HHCN. “That’s a whole hour-long activity where they’re engaged, doing something fun and purposeful. There’s a clear reason why they’re doing it.”

Although home care providers frequently serve individuals impacted by dementia, their expertise is sometimes limited. In fact, in cases where a senior living with dementia doesn’t suffer from any physical limitations, traditional in-home care can fall short.

“One of the things that happens is the person with dementia may actually be physically healthy and they don’t need that much help with ADLs,” Kimzey said. “If a traditional caregiver walks through the door and thinks, ‘My job is to help you when you need to go to the bathroom, bathe, eat or get dressed,’ the person with dementia is like, ‘I don’t need help with any of that. You can leave.’”

The majority of Tender Rose’s clients have had previous bad experiences with traditional home care agencies or with the private caregivers who they’ve hired. Specifically, issues arise when the caregiver hasn’t received training to deal with dementia, according to Kimzey.

“The caregiver who isn’t trained in dementia care — one who doesn’t really focus on quality of life or person-centered activity-based care — has a much higher probability of triggering agitation that creates behavioral problems,” he said.

While many companies have dementia-education programs for their caregivers, these programs are not always comprehensive.

“Giving one day, or half of a day, to a slideshow about dementia is not enough to actually teach people and encourage a dementia-positive environment — or even the ability to market [that an agency has] trained in dementia care,” Wonderlin said. “A two-hour presentation on dementia is not enough for somebody to be able to go into a situation and provide care.”

To that end, Tender Rose trains its caregivers based on methods popularized by Teepa Snow, the owner of Positive Approach to Care and a thought leader in the dementia care space. Positive Approach to Care is an Efland, North Carolina-based company that provides dementia care training, services and products across the globe.

Snow’s methods emphasize the importance of in-person and hands-on training that utilizes roleplaying and interactive discussions.

For Tender Rose, training is only a small part of differentiating itself from traditional home care providers. Tender Rose is also highly selective when it comes to recruiting its caregivers.

“Our labor strategy is to cherry-pick the best dementia caregivers in the industry,” Kimzey said. “We’re looking for the best of the best. We’re not looking for housewives who want a part-time flexible job to get a little extra spending money. We’re looking for professionals who need to work, who love doing dementia care and are good at it.”

In order to retain caregivers, the company offers a higher-than-average pay rate of $23.62 an hour. In comparison, caregivers earned a median hourly wage of $12.80 in 2019, according to PHI data.

Additionally, Tender Rose’s benefits package for caregivers includes health insurance, 401(k) plans, paid-time off and consistent hours with long-term clients.

For providers looking to truly take on dementia care, Kimzey reminds them that it’s crucial to constantly work to improve these care services.

“No matter how good you are at dementia care — you still have room for improvement,” he said. “We’ve been doing this for 11 years and we think that we do it better than just about anybody. And we aren’t nearly as good as we’re going to get. Don’t ever get complacent about how good you’re doing.”

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