‘We Can Be the Largest Provider in the Country’: Fastest-Growing Home Care Companies in the US

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Elder Care Homecare, HomeWell Care Services, 24 Hour Home Care and Georgetown Home Care (GHC) are four of the fastest-growing aging-in-place providers in the nation.

Revenue diversification, cross-continuum partnerships and niche service offerings have allowed each home care business to maintain strong growth over the past 18 months, even during a pandemic that has triggered staffing shortages, client-volume swings and regulatory confusion.

Executives from those four home care companies, which all ranked on this year’s Inc. Magazine list of the 5,000 fastest-growing businesses in the U.S., have big plans for the future as well.

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“Regulations that continuously come out can be extremely challenging, just because they’re highly administrative,” David Gilberg, the president and CEO of Elder Care Homecare, told Home Health Care news. “I think there’s definitely things that are coming down the pipeline over the next couple of years that could inhibit growth and our patient focus, shifting focus toward the regulatory and compliance aspects of home care. That’s our biggest fear.”

Despite these and other challenges, Gilberg and leaders from the three aforementioned home care companies each have high hopes for the future of their own businesses — and for home care overall.

Doubling down on health system partnerships

Georgetown Home Care has gotten to the point where it has extremely valuable and successful partnerships in the areas it serves.

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Based in Washington, D.C., GHC is a home care agency that provides personal care, respite care, senior companionship services and senior transportation services. It also serves patients in Montgomery County, Prince George’s County and Northern Virginia, with around 460 employees in total.

Over the past three years, GHC’s growth rate has been 115%, according to the Inc. 5000 list.

Its most significant partnership is with Medstar Georgetown University Hospital, a relationship that began in 2019. Since then, GHC has been assisting the hospital in several ways, such as reducing costly readmissions.

“We had always concentrated on partnering with the hospitals in our area, which is really hard to do,” John Bradshaw, the CEO of GHC, told HHCN. “It takes years to develop those relationships. It’s not something where you can just kind of walk in and say, ‘Hey, I’m here, and I’d like to be your partner.’”

MedStar Georgetown University Hospital is part of the broader MedStar Health, a $5.6 billion, not-for-profit, regional health care system based in Columbia, Maryland. MedStar Health had over 133,500 in-patient admissions in 2018 while also delivering over 300,000 home health visits.

GHC has similar health system partnerships, too, according to Bradshaw.

“They’re big systems, and they’re hard to navigate,” he said. “And we just decided that we were going to be really patient and take our time to develop the relationships the right way. And it took years. But we’re finally at a point with a handful of hospitals where they get our value and understand how we can be helpful to them.”

In 2019, GHC’s hospital readmission rate was just 4.7% — the lowest it has ever achieved. It was able to prove its worth to MedStar Georgetown University Hospital when it launched a pilot program three years ago that resulted in 44% less readmissions for the hospital’s spinal surgery patients.

“There are so many little things that we did early on that were just phenomenally stupid, but I feel like we have been really lucky in that we got a lot of the big things right,” Bradshaw said.

For instance, at first, GHC looked for referral partners anywhere seniors may go, like pharmacies. The net gain was not what the provider desired, however, so that’s when it turned to larger potential partners.

“I wondered why I was walking around pharmacies when the [hospital] had this enormous number of people coming out of there, and so many of them were looking for help,” Bradshaw said. “So we stopped focusing on the little places, and we went to the place that desperately needed our help, but just didn’t know it yet.”

GHC’s biggest barrier to continued growth: staffing shortages.

Unemployment benefits, caregivers’ child care obligations and general COVID-19 fear have exacerbated historic staffing issues. To keep up with its obligations to hospital partners, GHC has enlisted other home care agencies to help handle cases it cannot staff.

“We started handing out shifts to other home care companies and handling the cases together,” Bradshaw said. “We’ve become the first call for these hospitals. Even though we aren’t getting the entirety of the business, we’re still getting a portion of it, and we are still able to get that person discharged quickly.”

Elder Care HomeCare believes in the demand

Based in Westchester, New York, Elder Care HomeCare serves anywhere from 150 to 200 patients at a time all around New York state. It served close to 500 total patients in 2020 — and it hopes to hit that number by this year’s end.

Ultimately, the goal is to enter into New Jersey and Connecticut, then expand even further from there. Over the past three years, Elder Care HomeCare’s growth rate has been 429%, according to the Inc. 5000 list.

“I think what we focus on with private-pay concierge home care, it’s such a niche business,” Gilberg said. “So trying to make sure that we always keep the quality and not grow too quickly is imperative for us.”

Gilberg believes that, although cliche, putting the client first has set Elder Care apart in some ways. Finding creative solutions to always make sure clients are able to get the help or care they need in the home has served Elder Care Homecare well, he noted.

But operating out of New York comes with inherent challenges tied to legislation, especially on the home care side, Gilberg said.

The mandatory vaccine policy in New York for home care workers is one of those challenges, though Elder Care supports it. Another challenge is the elimination of certain COVID-19 lifelines offered up during the pandemic.

Whether it’s over the next couple years or the next decade, Gilberg is confident that the demand for home care will be enough that any fears over regulations or competitors will eventually go by the wayside.

“There’s significant competition, but there’s more than enough patients in need,” Gilberg said. “I find that if we provide a high quality of service, it kind of builds on itself. I don’t find that there’s a need to focus on the competition, making this about us versus them.”

24 Hour Home Care exploring Medicaid opportunities

24 Hour Home Care’s plan is simple: to be the largest non-medical home care provider of its kind in the U.S. Specifically, the company wants to be a unique blend of private-pay senior care, Medicaid and disability services.

The Los Angeles-based 24 Hour Home Care currently has over 20 locations spanning California, Arizona and Texas. It employs over 10,000 caregivers across its footprint. Its three-year growth rate has been 78%, according to the Inc. 5000 list.

“The private-pay senior care is obviously a big part of our business, as are disability services,” Ryan Iwamoto, the president and co-founder of 24 Hour Home Care, told HHCN. “And then it’s about getting ourselves in Medicaid. We work with Medicaid in California, but there’s opportunities out there in other states that we want to get into.”

Expanding significantly into other states — and further into Medicaid — is a major next step in the evolution of 24 Hour Home Care, one that could make it a national player in the coming years.

“I think if we apply the same operations to Medicaid, we can be very successful,” Iwamoto said. “If you look across the country, there’s no non-medical home care provider that does all three of those segments very well. Usually it’s more about sticking to [one segment or another]. We feel like we can be — with our track record — strong in all three of those areas.”

HomeWell’s franchise business booms

HomeWell Care Services, a part of parent company HomeWell Franchising, landed on the Inc. 5000 list for the first time ever this year, with a 60% three-year growth rate.

Based in Burkburnett, Texas, with a network of about 50 locations across the U.S., it has seen its growth kick-started by both the pandemic and the recession it brought with it.

“We’ve actually been franchising for almost 20 years now,” Casey McCleskey, HomeWell’s CFO, told HHCN. “At some point, you get a little stagnant in your day to day. But there has been this rejuvenation from our rebranding in 2019 and a focus on building up the infrastructure and franchise services of our owners.”

In 2019, HomeWell Senior Care became HomeWell Care Services as the company sought to further expand its services and “gain access to new markets and customer segments” across the country.

As the company moves forward, McCleskey said that he does not see many impediments to growing into new markets and finding new franchisees.

“When a recession hits, people want to move away from corporate grind and ladder, and we saw a lot of new interest,” McCleskey said. “And we also had several existing owners sell their businesses to new franchisees, and that’s not something we’ve had a lot of in the past. For us, it was a great turning point.”

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