‘It’s Water Grinding Away The Stone’: Senior Care Providers Face Common Challenges In Continuum Expansions

Home-based care providers are no longer content delivering a standard set of care services.

Instead, leaders at in-home care organizations are working strategically to enhance services, creating a more integrated care delivery model – a continuum of care.

At Intrepid USA, this means pairing the company’s home health and hospice services more closely together.


“Let’s pair up our hospice program everywhere we have home health. We include the palliative programs,” John Kunysz, president and CEO of Intrepid USA, said during a panel discussion at the Aging Media Network Continuum conference. “Not from the standpoint of a separate service line that’s profitable, but primarily for identification of patients that were hospice eligible.”

Intrepid USA is a Dallas-based home health and hospice provider with more than 60 locations across 17 states.

John Kunysz, president and CEO of Intrepid USA

Strategically, creating a continuum of services allows providers to maintain relationships with clients and patients longer – before their needs become acute, all the way through to end of life. In turn, from a business perspective, this creates revenue stability and increases appeal to payer partners.


“All of those different pieces that we’ve added are upstream of hospice, but they’re all really designed to help people have a better experience when they’re experiencing either a decline, an acute illness, a serious illness,a chronic illnesses, or an end-stage of illness,” Susan Ponder-Stansel, CEO of Alivia Care, said during the event.

Alivia Care is primarily a provider of home health, hospice and palliative care services. The company operates across 32 counties in North Florida and Southeast Georgia. The organization’s roots are in hospice, but under Ponder-Stansel’s leadership, Alivia has pursued diversification to best serve patients.

Susan Ponder-Stansel, CEO of Alivia Care

That task has been a gradual process, Ponder-Stansel explained. And for in-home providers that are trying to build out a continuum of care, the road isn’t always easy, she noted.

“It’s the risk involved: the capital that you need, the tolerance for failing, but also I see regulatory barriers,” Ponder-Stansel said.

One of Alivia’s most recent continuum efforts – and an example of the challenges associated with such a build – is its expansion into the Programs for All-Inclusive Care for the Elderly (PACE) model. Standing up a PACE arm has taken “three years of losses and hard lessons,” but now, Year 4 of the initiative, Alivia is seeing a positive margin with it.

Another barrier to building out a continuum of care at a home-based care organization is having a “silo mentality,” according to Kunysz.

“There’s almost the nostalgia to go back, and there’s a resistance to innovation,” he said. “It’s hard to deal with.”

Salmon Health, an organization that has seen success when it comes to building out a full continuum of care, has also encountered challenges along the way.

Namely, the idea that the organization’s focus should be providing value to health systems.

“We’ve really turned our focus away from what we can do, in terms of adding value into that part of the health care system, to looking at the value that we can provide for the residents that reside under our roofs,” Matt Salmon, CEO of Salmon Health, at Continuum. “With the advent of adding home health, hospice and private-duty, the company has grown to adding our skill and expertise to people living under their own roofs.”

Salmon Health has a full continuum of senior care that spans independent living, assisted living and skilled nursing to home health, private-duty hospice and even childcare. The Milford, Massachusetts-based operator reaches about 1,000 older adults in its communities and another 1,000 in the surrounding area.

Matt Salmon, CEO of Salmon Health

“People are starting to realize that it is worth it to pay for those services to stay at home,” he said.

With this in mind, Salmon Health is looking to aggressively grow its home health business. The main hurdle to clear on that front is consistent staffing constraints, however.

The company is also looking at innovative models, such as continuing care at home.

“[We’re] looking at how we can leverage our reputation and our skill set, and start to manage families in the community, and then layer in the ability for people to sign up for a subscription and pay for services that would be in the bank,” Salmon said. “For example, we might guarantee that you would have 21 days of home health aides in the next year anytime you need it.”

On its end, Alivia Care is looking at primary care acquisition targets, too.

“CMS believes that primary care is going to be the answer to this fragmented care problem, and it can be depending on how you structure it,” Ponder-Stansel said.

Ultimately, for providers hoping to build out continuums of their own, Ponder-Stansel, Salmon and Kunysz all emphasized the importance of staying the course.

“It’s water grinding away the stone rather than trying to figure out where to get the capital and the staff for a significant expansion,” Salmon said.

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