Large Senior Living Organizations See Home Care As A ‘Top Priority’ Service Line

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Prior to 2020, older adults had already started to rethink how and where they wanted to age, with a growing preference to age in place.

The COVID-19 pandemic accelerated that trend. To connect with potential residents sooner and diversify their business lines, many senior living operators launched home health or home care service lines, hoping to capitalize off that trend.

Today, those organizations are beginning to reap the benefits of those investments.


“During the pandemic, in regards to primarily private duty care home care, senior living operators were exposed to a very powerful business model that they hadn’t been exposed to before,” Mark Goetz, president and CEO of HomeCare Advocacy Network (HCAN), told Home Health Care News. “There was a window where it caused them to think, ‘Why aren’t we in that line of business?’”

The Omaha, Nebraska-based HCAN offers a business format to senior living operators looking to add home care service lines.

Even though many of the pandemic-era investments made by senior living providers are in the early stages, Goetz said the ones who had the infrastructure in place are seeing positive ROI.


“We’re probably still at the front end of being able to answer that question of whether those investments have paid off,” Goetz said. “But I will say that the ones that did make those decisions, they would largely at this point have — at a minimum – their beginning infrastructure in place where they’re starting to achieve and see breakeven numbers. Many are really just starting to experience some success in that market.”

Investments slowly paying off

In 2021, the Olathe, Kansas-based Bickford Senior Living decided to team up with HCAN to roll out a home-based care service line.

At the time, Alan Fairbanks – executive VP of operations – and his team realized that while they were primarily focused on assisted living, there was no reason to limit themselves within those four walls.

“We have grown our capacity and capability to care for seniors and feel like we do a good job of that,” Fairbanks told HHCN. “We launched a private-duty home care business in certain markets where we already have a Bickford and a brand name established.”

Bickford currently has five home care programs in addition to the 55 senior living and memory care facilities. The progress made with Bickford’s home care programs was a slower build than anticipated, but Fairbanks said that was mostly due to the nuances of learning the business on the fly.

Despite that, he said revenue has continued to grow. Plus, adding home care capabilities has been a tailwind in other areas, too.

“It’s helped from a staffing component in our markets where we have Bickford communities because we’ve been able to help our assisted living communities by essentially having our own home care offices act as an agency staffing source for us,” Fairbanks said. “We have been able to hire from a home care perspective due to the flexible nature of what those caregivers want.”

Bickford’s home care goals have not changed.

“First and foremost, our goal is to provide care for seniors and meet their needs wherever they are,” Fairbanks said. “If that’s in an assisted living community with four walls, that’s where it is. If it’s in a home, we want to meet their needs there and we want to keep them in their home as long as we possibly can, hopefully forever.”

Between enhanced revenue diversification and staffing solutions, adding a home care component has also forced Bickford to fine-tune its overall culture.

Embarking on a new endeavor has forced the entire staff to become more detail-oriented.

“As you start that business and as it gets rolling, it helps raise the tide for the entire organization,” Fairbanks said. “Maybe there are new technologies you’re looking at, new ways to hire, new ways to retain. I think it helps to hone your overall skills in many ways when you start a new business from the ground up.”

Starting now

Although her company got into the home care business during the height of the pandemic, it is a brand new adventure for Annette Greely, the president and CEO of American Baptist Homes of the Midwest.

American Baptist is a Minnesota-based senior housing provider with seven campuses across the Midwest. Greely took over as CEO a month ago.

Of the seven campuses under American Baptist’s umbrella, two have private-duty capabilities and two more will be up and running in the next year or so.

Greely said she’s confident the home care investments made by American Baptist are good ones, due to two reasons: policy and economics.

“When you look at state budgets, we don’t have an infinite amount of dollars to put into more institutional and traditional styles of care like nursing homes and assisted living facilities,” Greely said. “The expense components to those for people who might need Medicaid services is going to loom large for many state governments, and you can see them already starting to make policy decisions that are going to provide more support for people who are going to stay in their homes.”

Recognizing the trend is the first step, Greely said. She is thankful that former CEO Jeff Hongslo made the decision to partner with HCAN in the first place.

Plus, no home care provider will assert that every senior needing care is fit for home care. There will always be a space for senior living providers in the care continuum, Greely said.

“Home care is fantastic, but people also have to have a level of realism,” she said. “We might not be able to help somebody stay in their home until they pass away. Every piece — nursing homes, assisted living, independent living, home care — plays a role in the continuum of care and you cannot eliminate anybody. Home care plays an important part in the whole system, and it has to work within the whole system.”

Looking ahead

The senior living providers that have invested in home care generally believe they’ll continue to make more investments in the future.

Fairbanks said that once the home care programs get more established footings in the markets they’re in, Bickford plans to add three per year over the next five to seven years.

For American Baptist, home care is considered a “top priority” in the future.

“That’s the nice thing with new leadership is that we know we want to reevaluate the strategic plan with our board, and we know home care is going to be a top priority moving forward,” Greely said. “Then, it’s all about making sure we’re putting the focus and resources in ensuring we have great leadership at every site, getting things developed and then continuing to work with Mark and HCAN on the expansion of it at all of our sites.”

Still, Goetz said many senior living operators still do not understand the home care business.

They don’t understand how to make home care service lines sustainable or how to staff them.

“Some senior living providers still question whether or not home care can be viable,” Goetz said. “They’re still really in the dark in terms of the business format, which [can be] so successful.”

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