Six months after telling Home Health Care News that balancing quality care with Medicaid’s limited reimbursement rates was among her top challenges, Comfort Keepers CEO Natalie Black is closely watching potential updates to Medicaid policy.

The executive is monitoring the Medicaid situation while pursuing two major aims: completing the company’s transition to a fully franchised business model while simultaneously expanding into new markets in the U.S.

With only four company-owned locations remaining in the conversion pipeline, the Irvine, California-based company expects to reach its goal of becoming 100% franchised within the next few months while working to ensure a smooth transition for its clients.

As Comfort Keepers nears the finish line on its franchise transition, Black is seeking to eliminate what she calls one of the company’s biggest “time sucks” – managing company operations – by redirecting all headquarters resources toward supporting franchisees with the necessary tools and training.

HHCN recently caught up with Black to discuss the company’s growth since January, how the company attracts and retains both clients and caregivers and the need for technology in the personal care industry.

The interview has been edited for length and clarity.

HHCN: When you last spoke with HHCN in January, you said the process of re-franchising Comfort Keepers’ company-owned locations was a “success,” but not yet 100% complete. What’s the status now?

Black: It’s still a successful one, and still not 100% done. We have some employees who are now our franchisees, which is wonderful. We have a bunch of franchisees who have additional territories, which is also wonderful. We’ve seen a lot of those transition over, we have a few left, not many, but a few. They are all in some form of progress at the moment, but not completed just yet.

We have four left [to transition]. That number will change in a few weeks. It’ll be down to three, and hopefully, within the next few months, that will go to zero. But we’ll see how things go. As with everything, regulation plays a role in all of this. So some things are just a bit out of our control. Different states have different transfer types of regulations. It just depends on state specifics.

But we are functioning pretty much like a 100% franchise at this point, and that’s been a very big shift for us in terms of how we operate and what our focus is. The biggest shift was internally for our HQ team. Unfortunately, company ops is a big time suck, and it was a big time suck for us. What we found is that we were split in terms of where we were giving our attention. About half our attention was going to franchisees, and half to company operations. We’re now able to have all of our attention to our franchisees, and that has meant a lot more support for them, which is why it’s been very popular.

What are the benefits of moving to a 100% franchise model?

It’s a really good thing for our clients. Home care is a local business, and people want to work with people that they feel comfortable with, and that’s local to them, and it resonates very well with franchising for that reason. We are fortunate enough to have incredible franchisees who take wonderful care of our clients in all their local areas, and shifting it back to them has enabled that.

My hope is that our clients of our existing company operations have not felt a huge shift. That they feel the presence is one of the benefits of having a large national brand, that they feel that Comfort Keepers is quality, then it’s quality now, and they are not feeling a huge shift there.

To follow up on Comfort Keepers’ plans for growth, how has franchisee growth gone in the last six months?

Growth has been going well, we are continuing to grow. We’re very much focusing on our franchisee support. That’s first and foremost, and it’s a continuing conversation of, ‘What are the additional tools that they need to be able to do what they do?’ Because we don’t want them focusing on things that we can help them with, in terms of tools.

We’re also continuing to focus on growing in areas where we don’t have a Comfort Keepers presence. Because we do have a national footprint, but there are still spots in the US [where] we don’t, and we’re focused on that and making sure we have full coverage nationally.

In January, you highlighted the challenge of balancing quality care with Medicaid reimbursement limitations. HHCN has been closely covering potential changes to the future of Medicaid since then. What’s your take on what needs to happen at a state or national level regarding Medicaid to help people get access to home care?

It’s a very tough question, because I am very supportive of making sure that the quality is there and the standards are there. Regulation is still an important thing for home care. Ultimately, we are taking care of clients, and regulation needs to be there to ensure the best for all the clients. That’s an important piece. At the same time, I’m also obviously a very big proponent of people who need care getting the care they need and trying to find the right balance there. There’s no right answer. It’s why I think that it’s such a hot-button conversation, and I don’t have the right answer. But as much as we can get resources to support people being able to stay home, which is what people want. I will always be supportive of that.

What can providers do in terms of advocacy?

We have the Home Care Association of America (HCAOA), and our chief operating officer, Ramzi Abdine, is on the board of the HCAOA. I think that it is a great body of people that are very focused on this piece of, ‘How do we help people stay home?’ We’ll continue to support from that direction.

What regulation or policy news is the most impactful for the personal care industry right now, in your opinion?

The Medicaid one continues to be [the most impactful]. We’re watching that one from a policy perspective, and that probably continues to be. I’d also say making sure that the Veterans Affairs (VA) funding stays strong, to continue to support our veterans, and being able to stay home as well, is an important one.

You told HHCN in January that franchisees need to focus on both client recruitment and retention, and caregiver recruitment and retention. Can you share any specific strategies or tools that you’re using right now to manage that dual challenge?

We’re looking at a lot of different things from a technology perspective, and I think technology will continue to evolve to assist that. There’s only so much technology to replace, though. We are a people business. Both when you talk about clients and when you talk about caregivers, the best of the best of the people who take care of their clients, and they take care of their caregivers. We are focused on training and resources to enable our franchisees to do that.

What, if anything, has changed in the caregiver workforce landscape since January?

This is probably a good time to mention the documentary that we’re sponsoring, which is a caregiving documentary. It’s premiering online today through the PBS app and then through actual PBS next month. This brings focus to caregiving in general, and before, I feel like it was a little bit more silent. It wasn’t really a conversation. Caregiving is becoming more and more prominent in our society, as we have an aging population. More and more people are involved in a form of caregiving, one way or another, and that has enabled us to bring the conversation more and more to the public. 

What I am seeing is that people are more interested in how we support our caregivers so that it’s not so silent, and that’s really important for us, because they’re taking care of our clients, or for those that are not working for Comfort Keepers, that are doing it for family members. They’re taking care of their family. We need to be able to support all of these different caregivers. That’s what I’m seeing a little bit in the landscape right now, I don’t see that changing.

Demographics are continuing to shift, where we have more and more people aging, and we need to continue providing more and more support for our caregivers.