The CCRC-without-walls model is a new twist on an old concept. Essentially, the at-home concept allows seniors to reap all the same benefits of traditional continuing care retirement communities (CCRCs) while still aging in place.
While the CCRC-without-walls model has slowly begun to gain traction in recent years, there are still fewer than 40 programs across the U.S.
One of these programs is Cleveland-based Kendal at Home, an affiliate of Kendal Corporation, a nonprofit senior housing provider with 13 communities across its eight-state footprint. The organization is one of the most established players in the space.
To learn more, Home Health Care News recently sat down with Kendal at Home CEO Lynne Giacobbe for our latest episode of “Disrupt.” Highlights from the conversation are below, edited for length and clarity.
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HHCN: You are officially our first CCRC-without-walls leader on the podcast. Before we dig into what you’re doing at Kendal at Home, what is a CCRC without walls? Can you describe the model?
Giacobbe: Some days, I’ve asked myself that same question, especially early on. I’ve actually been here for about 18 years. It’s been a learning process to really get a handle on what this means.
I think it’s really important to understand that CCRC is a continuing care retirement community. These programs are our retirement communities without walls. It enables people to age in place who would otherwise be looking to move.
Our clients are the folks who are probably visiting retirement communities all across the country. They love what those communities can offer, but just can’t pull that trigger and leave their home. They want to stay in their homes.
CCRC without walls really offers a lot of the benefits that you might find in a retirement community, but delivers them to people who are living in their own homes. This enables them to determine how this program might work for them individually.
Kendal at Home is one of the oldest CCRC-without-walls programs. Do we know, in 2021, how many CCRC without walls operations there were?
As an industry, I would say that the at-home programs are beginning to coalesce. That’s in part due to leadership from LeadingAge. Katie Smith Sloan and her team have really leaned in with us this year, to bring this group together.
There are about 35 programs at various stages of operations. Some of them have been operating longer than us and others are really just getting started. Some are operating independently and others are operating out of continuing care retirement communities. There’s one operating out of a hospital system.
There are various different models all across the country.
What’s Kendal at Home’s origin story, so to speak?
I actually came to work at Kendal at the end of 2003. We launched the program in early 2004. It was an initiative based out of one of our retirement communities, Kendal at Oberlin. They had a desire to serve people who wanted to remain in their homes, but had a strong connection to Kendal. It enabled us to develop this model.
In 2016, we separated from Kendal at Oberlin and became an independent affiliate of the Kendal system. That was out of a system-review process that identified a desire to grow the at-home program. In order to do that, we were encouraged to really grow up, stand on our own two feet and eliminate a lot of the shared services that we had at that time. Since then, we have really developed as an independent entity — like any other affiliate in the Kendal system.
The last time we spoke, it was because you had just taken the Kendal at Home model and expanded into Massachusetts. What does your overall footprint look like today?
Since then, we’ve now expanded across the state of Massachusetts and are centrally located. We have a team in the Boston market, and the program is really growing much more quickly. We’re serving all Massachusetts, and we’ve expanded across the state of Ohio. We are now in Northern Kentucky.
What does the typical Kendal at Home member look like in 2021? And does that person look any different than, say, five or six years ago?
There’s probably not a lot of difference.
I would say, the people that joined Kendal at Home in those early days, there was an element of bravery. They are what we refer to as “our pioneers.” They were really willing to take a chance on, not just a new program, but a whole new initiative.
When we started 18 years ago, no one had a clue what this program was about, including us. We were learning as we were evolving, and we worked closely with another at-home program and really modeled after them. There were unique characteristics of this program, and we had to learn, along the way, how to develop everything. I’d say, one characteristic of those early members was that they had a great deal of faith.
I can still remember the first two members, Doug and Shirley, as we were sitting across the table from them, fingers crossed that they would join. They said, “So how many members do you have?” I looked across the table and said, “Well, hopefully by the end of the day, we’ll have two.” I think about the courage that it took for them to become those first members. Just recently, we signed our 500th member.
The people that join this program are really involved in their communities. They are planners that maybe have experienced the long-term care of a loved one and know what a treacherous journey that can be. They also understand the financial implications – what providing care for a loved one can do to a family and what this hardship might look like.
About 40% of our members have long-term care insurance. You’d think, why would they join, when they already have a plan? They understand that long-term care insurance certainly has its benefits and advantages, in terms of what it offers. They’re really looking for that person who’s going to navigate their long-term care services as they need them.
Our focus is on wellness. Our members aren’t joining because they want to know they’re going to a good nursing home down the road. They’re joining because they want to stay independent, healthy, and remain in their home for as long as possible. We’re really proud to say that very few of our members ever go into a nursing home on a permanent basis.
Let’s say I’m a member, what specific services could I expect?
One of the benefits members value the most is that relationship with a care coordinator.
We have a pretty multidisciplinary team. We have occupational therapists, nurses, gerontologists and a geriatric physician who serves as our medical director. That team of specialists is the key to helping members stay independent and healthy.
We have lots of initiatives around wellness and fall prevention. We’ve recently brought in an organization that has a very specific personal-training program designed to help prevent falls, strengthen balance and those types of things. Many of our members are engaged in that.
Our first focus is helping members overcome obstacles and achieve the goals they have individually, as they age. As they need care, that care coordinator – who’s really gotten to know them, while they’re healthy and independent – is working closely with them to identify when services become necessary. It can be short-term, or it can be permanent. They’re working sort of as that general contractor to bring all the services together.
We have a list of services, and they include: companion care, home care, assisted living, nursing home care, and there are some transportation services involved. All of those services are the things that Kendal at Home coordinates, provides and pays for.
And if members can’t care for themselves on a daily basis, they also probably can’t care for their home. They can’t take care of the snow plowing, cutting the grass and paying the bills. All of those things are part of remaining in your home. We began to bring together all of those ancillary services that someone might need in order to stay at home.
We bring all of the service providers together – things like skilled home health, therapy and hospice services covered under the Medicare benefits our members have. They’re also services that we coordinate in conjunction with our members, their physicians or their surgeons.
Could you walk me through the fee structure?
The costs really depend upon a number of factors, and age is one of them. The older someone is coming into the program, the higher the cost would be. The daily benefit amount that someone’s choosing when they come into the program is also a critical factor in determining the cost.
Someone coming into the program at 75 is maybe looking for a $250 daily benefit that’s covering the national average daily cost of nursing home care. When you look at Massachusetts, the nursing home rate is almost double. The people living in areas where there’s a higher cost for care are probably going to choose a higher daily benefit amount. They can pay anywhere from $60,000, to $75,000, to $80,000, depending upon their daily benefit amount and their age.
Whichever plan they’re selecting is going to really drive the monthly fees. It can be $500, $600, or up to about $1,000 a month, depending upon the daily benefit amount. People who want a $450 daily benefit, they’re going to pay a higher entry fee and a higher monthly fee, as opposed to someone who’s choosing that $250-per-day benefit. As a person is aging in this program, that monthly fee may increase. Our average is right around 3% to 4% annually, but the daily benefit is increasing as well. With the pandemic, we’ve seen some significant increases in the cost of care.
COVID-19 has, of course, accelerated the shift of care into the home. With that in mind, where do you expect Kendal at Home to be in the next 12 to 24 months?
As I look ahead, a year or five years from now, I’d really like to look at ways that we can evolve this model to be able to serve others in the way we’re serving members today. The home programs appeal to a market of people that can afford this product. Those entry fees and monthly fees are not attainable for everyone.
The benefits that we can provide are things that so many who are aging at home can benefit from. I look at our PACE programs and what they’re able to do in order to help people stay at home.
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