Survival Instincts, Inevitable Tailwinds Will Guide Home-Based Care Providers Through Current Tough Times

This article is a part of your HHCN+ Membership

There’s a confusing outlook right now for both providers of home care and home health care. More value, worth and attention is being placed on those respective industries than ever. But, all the while, providers are facing some of their toughest challenges as 2024 nears.

The attention being placed on home-based care is not leading to a windfall for them. Increased awareness and attention on an industry generally means its operators stand to benefit. That has not been the case for most thus far.

In 2020, that’s what many of us expected, even with an acute pandemic and staffing shortage to get through.


Instead, longtime providers with the sense to see home care’s value years before it was widely popularized are handcuffed by inflation, rate cuts and internal operational challenges.

But their leaders, front-line workers and back-office staff would be wise to keep their heads up.

Demand will continue increasing for the foreseeable future. And, though there’s always been ebbs and flows in the home-based care business, providers are now dealing with those ebbs and flows from a much more advantageous position than they were in years past.


When Bo Schembeckler took over Michigan’s football program – during a period of turmoil in the late 1960s – he coined a phrase as players were deciding whether to stay and put in the work under a new regime or, alternatively, to quit or leave.

“Those who stay will be champions.”

It’s not easy right now for new providers, nor for old providers. But those who power through, with the sense that brought them to home-based care in the first place, will ultimately reap the benefits.

That’s the topic of this year’s final, members-only HHCN+ Update.

Turnaround time

While some of the largest home health providers in the country get gobbled up by insurers, the smaller ones are struggling to survive.

“It’s about finding people,” Accurate Home Care CEO Bill English told me earlier this month at Aging Media Network’s Continuum conference. “If I had 200 nurses show up in my parking lot, I would hire them all without interviewing them. [That shortage], that’s probably the biggest pain point.”

Accurate Home Care is a Minnesota-based provider that offers home health care, private-duty nursing and non-medical home care. It covers 43 of the 87 Minnesota counties.

English did not mean that literally, but he got his point across.

He came to the company, in part, to turn it around. In one month in 2018, the company lost $536,000 on $2 million in revenue.

“We had the sub-debt lender put more money in over time in 2018 so we could survive,” English said. “And we had it turned in 2020, in January and February and in the first half of March. And then COVID hit, and boom, we’re back into it again.”

Now, English and Accurate Home Care are on the path to a second turnaround. It hasn’t been easy.

As a provider with limited resources, English and the rest of his staff have had to work day and night to keep things afloat. Culture hasn’t been one of many crucial components. Instead, at times, it has been the only component to keep people around.

“Today, we were voted as one of the top 200 workplaces in Minnesota by the Star Tribune,” English said, with visible emotion on his face. “I got a great staff. I love my staff. And our retention rate of care providers is 72%. And for the office, it’s over 80%. And it’s not because we pay the most, or we have the most interesting jobs. It’s because of the culture that we have built.”

If English and Accurate Home Care made the justifiable choice to forgo a second turnaround, hundreds of people would have lost their jobs. Hundreds more would have lost their access to necessary care services.

Like many providers of its size, Accurate Home Care has been through the ringer over the last five years. Giving up now, however, would keep it from realizing the fully grown fruit from its labor.

As interest rates come down in 2024 – hopefully – there will be more money to be put behind providers. More nurses will be coming to home-based care in the near-term future, so long as institutions continue to invest in those pipelines.

More care will be coming to the home.

When it does, the country will begin to fully recognize the value of these providers and these workers.

The New York-based HCR Home Care – like Accurate Home Care – is another provider I’ve talked to with a similar plight.

HCR Home Care has been around for half a century. It built a statewide home-based care business, allowing employees to have a stake in the business along the way.

That used to be one of its primary draws, until COVID-19 hit.

“We experienced extremely high turnover during COVID, much like many other agencies did,” HCR Home Care President Suzanne Suzanne Turchetti told me earlier this month. “Our profits were significantly decreased during COVID. So, we haven’t been able to contribute as much as we used to, to the [employee ownership] plan.”

But I caught Turchetti at the right time. Unbeknownst to me, another turnaround there is ongoing.

She started as an assistant to the former president of HCR Home Care. Since then, she’s worked in every department of the business. Now, she’s running the whole shop.

Turchetti’s story is one that’s unique to home care. She plans to leverage that experience to get HCR Home Care where it needs to be in 2024 and beyond.

“COVID took a lot from all of us,” she said. “But we keep rebuilding.”

To ease some of the margin pressure that’s hit its home health and home care segments, HCR Home Care is banking on technology – as well as its part-owner employees – to drive revenues back up.

“Our job as agencies is to be prepared,” Turchetti said. “With staffing, education and technology, in order to meet that demand. Home care has historically been one of the last thought of parts of the continuum of care. But with COVID, it’s really come to the forefront, and I think there’s going to be an increased amount of attention on home care as consolidation in the industry happens, as payers look to find the most inexpensive way to care for their members.”

The home-based care space is not for the faint of heart. But America’s seniors depend on these providers. Without them, we’d all be much worse off.

Leaders and workers know that. But they should also know that better times are ahead. In my opinion, they’ll be happy they stuck things out when they did.

“It’s a good time to be in home care, in my opinion,” Turchetti said.

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