In a crowded home care market where numerous organizations are vying to be seniors’ provider of choice, standing out has become increasingly critical.

At Pansy Homecare, differentiation has meant leaning further into its specialty of providing dementia care in the home. While the company has always emphasized these services, Pansy Homecare has recently moved to transform itself into an exclusive dementia care agency.

Hartford, Connecticut-based Pansy Homecare was founded in 2013 by former caregiver Pansy P. Francis. Pansy’s son, Jonah Francis, has since taken the helm of the company.

When Francis recently caught up with Home Health Care News, he identified differentiation as the top challenge in home care.

“When we started 13 years ago, there were about 300 agencies in Connecticut,” he said during the most recent episode of Home Health Care News’ Disrupt Podcast. “Fast forward to today, and that number has increased dramatically to about 1,100 agencies in Connecticut. Differentiation is going to be key.”

During the conversation, Francis also discussed the strategy behind Pansy Homecare’s current payer mix, why Medicaid funding cuts could keep patients from receiving care and much more.

Below is that conversation, edited for length and clarity.

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HHCN: Delivering non-medical home care support for seniors living with memory damage has been Pansy Homecare’s main focus for several years. Can you describe the process of transitioning to this type of care?

Francis: We’ve been on this journey now for the last three and a half years, just in terms of shifting our focus to an exclusive dementia care agency. We thought that as we go along this process, it’ll be a tweak to something here and something there. It’s been an entire overhaul of our company, from our follow-up process to how we recruit our right-fit caregiver, as well as our right-fit clients. All of those things have changed along the way.

What does recruitment look like at a company that specializes in dementia care?

It starts with the experience level of our caregivers. But regardless of where they’re coming in from, we’re making sure that they hit on the heart aspect required to be in the industry, but also required for dementia. We always like to say there’s a difference between a good caregiver and a good employee. We like to have both. However, we also know that good employees can fail in situations if they’re not trained and given the right delegations to be successful on their shifts.

We partnered with Second Wind [Dreams] as a part of our recruiting process to put all of our caregivers through the Second Wind Dementia experience. [We] then talk to them in a group setting to see if they again have the heart for dementia care, not just being a normal care pro, but dementia care overall.

A few years ago, I profiled Pansy Homecare for HHCN. When we spoke, I learned that Pansy Homecare is a mostly private-pay agency, but the company also has a contract with Veterans Affairs and the Medicaid waivers program. Is this still the current payer mix? Will that payer mix be the priority moving forward, or are there plans to diversify? Why or why not?

Yes, we do still have this payer mix. We have been ramping up our relationship with the VA so that we can continue to build on the relationship we already have here. However, over those years, our census for the Medicaid waivers has continued to dwindle down purposely here in Connecticut. Here in Connecticut, we’re not receiving the funding that is required, the same reimbursement rates that even our neighboring states, Boston and New York, are seeing. Their PCA waivers are up to $40 an hour, versus $24 here in Connecticut. We’ve made an effort to continue to dwindle down our Medicaid waivers program. However, we will never completely move away from it, because our guarantee to all of our private clients is [that] if they start with us privately, we will not let them go when they shift on to the program. That’s still a guarantee. We just don’t take any direct referrals from the waivers program. Right now, they stand at about 12% of our census. The waivers program and private pay make up the balance of our census overall.

What would need to happen for there to be any kind of shift in this current payer mix?

It’s our community engagement that we’re trying to really hang our hats on getting more VA [opportunities]. We do have long-term care clients on board with us, so that is also a part of our payer mix. We’re really hopeful that Connecticut improves its reimbursement for the Medicaid waivers program. What we’ve been asking for as a home care association, here in Connecticut, is a 13% increase effective immediately, and then 10% year-over-year, as minimum wage continues to go up.

Our thoughts are: if we can get this to go through and we can get this passed for those rates, then Pansy Homecare will step back into the forefront when it comes to supporting clients on the Medicaid waiver side as well.

I brought up Medicaid, so I have to ask. As a home care provider working in the space, what impact could the potential cuts, being discussed by the current administration, have when it comes to access to care?

In terms of access, one of the things that I like to hang my hat on is that our clients do great when our caregivers do great, and our caregivers do great when the agency does great. Unfortunately, if we are not able to, as agencies, take care of our caregivers, who then, in turn, take care of our clients, we’re going to see caregivers exiting the home care industry overall. As they continue to exit, we’re going to start to see clients not being able to get the support that they need at home. Clients are going to suffer immensely because there just won’t be a workforce able to support them.

What are some of the biggest operational and financial challenges for home care providers now? How is Pansy Homecare navigating these challenges?

I still think recruiting is amongst the top, but I think differentiation is probably going to be the number one challenge. When we started 13 years ago, there were about 300 agencies in Connecticut. Fast forward to today, that number has increased dramatically to about 1,100 agencies in Connecticut. Differentiation is going to be key. Those agencies that can hang their hats on something, for instance, we do with dementia — that niche is going to be what sets you apart and drives quality of care. How you measure and communicate your quality of care is what’s going to help you to stand out as well.

Last time I interviewed you, we touched on how the company has expanded the business. At the time, you had recently acquired A Better Way, a mental health organization for seniors, with your sister. How does A Better Way add value for Pansy Homecare?

Clients who need support where Pansy Homecare cannot help, we’re able to refer them. A Better Way has licensed mental health clinicians who are able to meet with clients. Our offer to clients, unlike many others, is that we’ll meet them in their homes.

Oftentimes, our clinicians are going into homes to do therapy sessions. We don’t see a lot of utilization from our clients at Pansy Homecare, so we don’t tend to share clients much. However, it is a tool that we’re able to offer out to all families, not just families under our umbrella.

Are there other services that Pansy Homecare is interested in rolling out in the future?

We are actually in the process of rolling out and being part of the 1,000 agencies that are currently [with] Sensi.AI. Technology is definitely the wave of the future — being able to not only measure care, but communicate care. Sensi.AI would help us to do that as well.

Looking ahead, what are your overall goals for the company moving forward?

Short-term goals, within the next six months, we will be launching our second branch servicing an additional county here in Connecticut. By 2029, our goal is to be the best. We feel as if we are. The numbers say we are the best [non-medical] dementia care agency in Connecticut.