Home Care Workers Get Vaccine Prioritization in LA County, Setting Off Potential Domino Effect

Los Angeles County’s home care companies woke up to some welcomed news right before the new year.

Non-medical home care workers are now officially a part of the first tranche of individuals who can make an appointment for a vaccination, according to the Los Angeles County Department of Public Health.

Previously, home health care workers were clearly included in the county’s prioritization list. Home care providers, however, were unsure whether their employees made the cut.

Confusing and unclear guidance for non-medical home care operators has been a familiar problem across the country during the COVID-19 pandemic.

Los Angeles-based 24 Hour Home Care was among the organizations searching for answers to vaccine questions before Christmas. Its leadership was elated to learn that its caregivers could now begin scheduling vaccination appointments for themselves.

“This news was just fantastic for us, because we were kind of waiting to see what would happen when we saw that home health services were being considered,” Andy Matthews, vice president of business development at 24 Hour Home Care, told Home Health Care News. “But with the non-medical sector, there’s always confusion if we’re going to be included when [something] says ‘home health services.’ So to see that the non-medical side was included in that was such a breath of fresh air.”

Founded more than a decade ago, 24 Hour Home Care is an independent, non-medical home care provider with 20 locations across California, Arizona and Texas. It has over 10,000 caregivers in its network.

In LA County’s announcement, “home care organizations” are explicitly listed alongside “home health agencies.”

The clarity is especially helpful for agencies in the Los Angeles area, given that COVID-19 cases are currently spiking to unprecedented levels in the region. Nearly 820,000 cases have been reported out of the county, which accounts for more than a third of all of the cases in California.

The state reported its highest daily new case count — nearly 65,000 — the day after Christmas.

“This is impactful because it protects our caregivers and our field staff, which obviously indirectly affects our clients,” Ryan Iwamoto, the president and co-founder of 24 Hour Home Care, told HHCN. “At least from my team, too, there’s a fear that home care would be overlooked in this process, because we’re usually in the shadows of other post-acute care services. I think it was a great sign to see home care in the spotlight and elevated as an essential service in this pandemic.”

Los Angeles County is a large enough actor to sway other counties as well, which could go a long way to help home care advocacy efforts across California and the entire country. If home health employees are being prioritized in other regions, home care organizations should ask for clarification on whether that includes all home-based care workers, as 24 Hour Home Care did.

“You can use that as an example to say, ‘Hey, this [priority group] also should include home care as well,’” Iwamoto said. “Hopefully, we have set the precedent for other counties and states to include home care as a part of [that group].”

Los Angeles Mayor Eric Garcetti has complained about the amount of federal help the city has received for vaccine rollout. Far fewer doses have been administered at this point than what was expected, a trend playing out across the country.

“We have not been delivered what was promised at the national level,” Garcetti said on CBS’ “Face the Nation.” “We are at a pace right now to deliver vaccines in Los Angeles in over five years instead of over half a year.”

For home-based care organizations, available vaccinations are especially helpful because they are an invaluable resource to regions dealing with ongoing COVID-19 surges and in-patient capacity challenges.

As of Monday, nearly one-third of all in-patient beds in California were occupied by COVID-19 patients, according to the U.S. Department of Health & Human Services. Almost 90% of all ICU beds are occupied in the state.

Too much demand for home care

24 Hour Home Care is seeing 20% more inquiries than it did in November. Due to skyrocketing demand, it has been forced to turn down 26% of those inquiries after reaching operational capacity.

From a staffing perspective, more unemployment claims have hurt the agency as well during COVID-19. That’s likely to continue, with a new unemployment add-on provided by the recent government spending bill.

Before the public health emergency, the company usually experienced 250 to 300 unemployment claims per year. In 2020, at times, it saw that amount in just a week.

“I’ve never seen this type of supply and demand discrepancy in my 15 years of being in home care,” Iwamoto said. “We are being hit pretty hard.”

The company has established an affiliate network in the area to try to find care for the seniors that it has to turn away. That network has helped it turn inquiries over to other agencies when it cannot handle new cases, Iwamoto said.

It is also working with its assisted living partners to place patients there when they may fit better in that kind of setting.

In addition, 24 Hour Home Care is helping hospitals improve their home-based COVID-19 transition protocols and programs.

Hospitals, more than ever, are having to find ways to accommodate seniors who don’t want to stay inside their walls or go there in the first place.

“The good thing that has come from this is being able to work with our competitors and other home care companies,” Iwamoto said. “It’s actually been really, really cool to see our industry step up in this fashion.”

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Turnover, Tiny Homes and New Technology: 2021 Predictions from 14 Home Care Executives

The U.S. home care industry is at an inflection point.

Prior to the COVID-19 pandemic, an increasing number of payers and health care providers began to recognize the value of non-medical home care, particularly when it comes to chronic disease management and preventative care. That recognition has grown even stronger in 2020, with home care often playing a leading role in emerging care delivery models, including hospital-at-home and SNF-at-home programs.

That momentum will continue in 2021, most home care executives believe. To stay relevant, though, agencies will need to embrace new technologies, invest in staffing and boldly go where no home care operator has gone before.

For a clearer picture of home care’s future, Home Health Care News asked 14 executives to look into their crystal balls and describe what lies ahead. You can read their predictions below, edited for length and clarity.

HHCN previously shared our executive forecast for the home health industry on Dec. 14.

* * *

We all know that 2020 was unarguably one of the most difficult years in recent history. One aspect of the pandemic that influenced senior care is that aging in place as well as the demand for home care accelerated. And it will continue to accelerate in 2021. We predict that there will be a significant change in the mindset of seniors to favor aging at home instead of in congregate residences such as long-term care facilities, plus assisted living and independent living communities.

This influx of demand for home care will come with its own challenges, mainly the need for additional qualified staffing. As home care industry leaders, we need to ask ourselves, “How can we make caregiving a profession that will attract the ‘best’ talent in the coming years?” Regardless of the hardships that the pandemic caused, we need to view these challenges as potential opportunities in both business and in life.

— Mario D’Aquila, COO at Assisted Living Services Inc.

* * *

Demand is running high for caregivers and senior homes. We believe we’ll see a wave of ingenuity and innovation in senior living solutions. We’ve seen the tiny home movement model on TV that’s popular with millennials; we think we might also see that with seniors as well to help combat the loneliness epidemic. The idea is that older adults have their own bedroom, bathroom and living space, but they’ll walk down a short path to join others for meals and engagement.

The tiny home park allows caregivers to operate more easily because the seniors are aggregated more so than they are in a traditional neighborhood home. This model allows seniors to maintain their independence but also offers much higher engagement with others.

Companies will try to bust that loneliness and isolation bubble we’re seeing so much of, which has only been escalated in 2020.

— J.J. Sorrenti, CEO of Best Life Brands

* * *

Heading into 2021, the need for home care will drastically increase as a result of the COVID-19 crisis. Over the past year, it has become evident that in-home care is a much more attractive option for families looking to care for their aging relatives, without needing to place them in a restrictive or possibly unsafe nursing home or long-term care facility. They’ve learned that there is a huge difference between aging at home while being in your own community and aging in a facility where you have little to no control.

Individuals don’t want to put themselves or family members into a situation where they are restricted from their family. This lesson has been burned into the minds and psyches of people who are aging — and their search for non-medical home care and assistance with daily living activities is going to strengthen the home care industry in the coming years.

— David Savitsky, CEO of CareBuilders at Home

* * *

Personal Care benefited from amazing positive awareness in 2020. I predict that there will be a divergence in 2021 — of agencies who stay the course, and those who capitalize on this awareness and press the advantage for greater utilization within the health care continuum and attention from payers.

I foresee this divergence also spreading to include agencies that innovate on how they recruit, retain, train and incentivize their caregivers, and those that continue to struggle with enough staff. I feel we will look back on this time as a watershed moment in home care, where we truly saw advancement in the industry. 2021 is the year to truly make that a reality.

— Jeff Wiberg, CEO of Family Resource Home Care

* * *

While we can’t wait for 2020 to end, 2021 probably won’t be much different for the first half of the year. We are looking at 2021 being a bifurcated year. More of the same for at least the first quarter and probably most of the second quarter, but we should start to see some significant relief from the virus by late spring of next year as the vaccine hits our communities broadly. Nonetheless, we have to prepare ourselves for potential glitches in the role-out of the vaccine and that helping hospitals discharge COVID-positive patients may consume more of the year than we hope. We are continuing to stock up on PPE and hire and train aides for COVID cases, but it would be great to get to a point where we are throwing away PPE in 2021!

— John Bradshaw, CEO of Georgetown Home Care

* * *

After a year like this one, where every business and employee has had to adapt, I expect 2021 to continue to drive innovations that bring care to the consumer, leverage new technology and increase our talent pools.

From hospital-at-home programs to home care agencies innovating their offerings, each will bring solutions that increase independence and the ability to live at home longer. Integrated solutions bringing care and support to the home will enable consumers to be more compliant with care plans and will enhance revenues.

I predict this innovation will come from two approaches. One, strategic partnerships will help optimize the consumer experience and reduce redundancies. Second, technological solutions that help manage a consumer’s ongoing care and anticipate changes in health proactively.

My final prediction: We will experience new candidate pools for positions across the health care continuum. Those companies with strong training programs will be able to differentiate themselves and will see faster growth. By retooling workers from other service industries into meaningful, needed roles in health care, home care especially may see dramatic improvements in staffing and quality.

— Emma Dickison, CEO of Home Helpers

* * *

In 2021, providing home care is going to be harder but the quality of care will be much better. It’ll be harder since COVID-19 isn’t going away, but it’ll also drive improvement in care quality through better infection control, faster restaffing when a caregiver reports flu-like symptoms and other innovations that pay dividends into the future. This means the bar to operate becomes higher. Home care companies will have to invest more in technology and tools to deliver the new level of expectation — likely leading towards further consolidation in the industry

— Seth Sternberg, co-founder and CEO of Honor

* * *

2021 will be all about people and technology. Every industry webinar talks about the need to create an engaged and empowered workforce. It’s no longer a talking point — industry survival depends on it. Every company without a specialized caregiver engagement focus will lose. Business models that address caregiver wages will win.

This year has demonstrated more than ever the need for “touchless” strategies to serve the customer and the employees. Virtual onboarding and virtual visits will become the baseline. Stakeholders will expect real-time interventions.

— Andrea Cohen, co-founder and CEO of HouseWorkers

* * *

COVID has been a catalyst for a major shift in how we serve seniors. 2021’s opportunity lies in more data, analytics and partnerships. Isolation is fatal! Providers need to start moving their models away from high-touch-only, to high-touch and high-tech. There is tremendous opportunity to connect to value-based opportunities, which require more analytics to provide better care across integrated delivery systems and prove efficacy. High-tech augments high-touch and intelligently and thoughtfully supports our ability to address workforce demands, cost, and meet the growing need for effective whole-person community-based options.

— Joel Theisen, CEO of Lifesprk

* * *

In 2021, as we transition out of the COVID-19 pandemic into a normal way of life, we will begin to see the marriage between the “old way” of how traditional home care was done with the “new way,” including technology-process integration. As home care agencies are looking to stay ahead, we will see a major shift toward telehealth services over traditional aide services while we look to continue placing an emphasis on keeping patients both healthy and happy in the comfort of their own homes. 2020 has taught home care clients the necessity of including a tech component within their homes. As patients have become more comfortable with this change, we will continue to see an increasing number of seniors seek out home care technology alongside an aide as part of their home care solution.

— Josh Klein, CEO of Royal Care and Emerest

* * *

After an unprecedented year in 2020, home care needs to stay the course on its momentum prior to the pandemic and the tailwinds after. The desire for seniors to age in their home has increased even more since the pandemic, and the best news is that the health care system is supporting that as well. Home care agencies must look to data-driven outcome strategies to help families understand their loved one’s ability to age safely in their home. Agencies who embrace partnerships and technology solutions will enable this to happen. 2021 offers a bright future for those agencies that adapt to a value-based care environment.

— Peter Ross, CEO and co-founder of Senior Helpers

* * *

In 2020, we asked, “Who or what is essential?” Our caregivers were heroes before 2020, but the year brought their heroics into the spotlight. The goal in 2021 and beyond is to never forget this fact. As more and more baby boomers become senior citizens, they will require companionship and assistance at home or at a facility, not just clinical care. We must focus on recruiting and retaining by attracting new caregivers and welcoming back the heroes sidelined due to the pandemic. We will also need all in the non-medical care industry to embrace existing and emerging technological services, such as those designed to connect receivers with loved ones or doctors. We saw tremendous success among our own receivers and expect the efficiency and quality of these systems to improve and grow in popularity in 2021.

— Howard Algeo, director of business development and training at Seniors Helping Seniors

* * *

In 2021, I think the home care industry will see proof that the private equity groups that are consolidating the industry are creating huge competitive advantages over smaller independently-owned businesses and franchisees. Any home care agency that operates in a top-20 market and is under $15 million in revenue in their local market will continue to struggle in caregiver recruiting, online marketing and operational efficiency. Our industry is just starting to see what can happen when you scale a business nationally, with geographic concentration of caregivers, clients and referral sources in local markets.

— Jim Kimzey, CEO and founder of Tender Rose Dementia Care Specialists

* * *

Home care has long been an underappreciated element of health care. The vital role it has played during COVID-19 reminded the industry — and society — of the value of providing quality in-home care to keep vulnerable populations safe. In 2021, I predict that home care will ride this momentum by supporting managed care organizations to reduce overcrowding in hospitals and extend their ambulatory care management bandwidth while lowering costs. I predict an increase in Medicare Advantage plans that offer home care as a supplemental benefit. Because of the compelling data and positive outcomes that demonstrate the holistic benefits that home care provides to its members and the plans, it’s a no-brainer to meet this demand similar to what we witnessed in the past with outpatient physical therapy (PT) and hospice care.

— Ryan Iwamoto, president of 24 Hour Home Care

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Senior Helpers, Reliant at Home, Others Crack 2020’s Best Workplaces in Aging Services List

On Thursday, Fortune unveiled its annual Best Workplaces in Aging Services list. The list features several home-based care providers that made a mark when it comes to company culture.

Last year, Senior Helpers and 24 Hour Home Care cracked the list’s top five. These companies make a return appearance on 2020’s top workplaces list, compiled by analytics firm Great Place to Work. Other companies that earned a spot on the list include Reliant at Home, Assistance Home Care and Constellation Health Services.

To compile this year’s list, Great Place to Work analyzed survey results from 189,159 employees working in the U.S. senior care and aging services sector. Those surveyed were asked about their experiences working at their current company.

The questions stem from the Great Place to Work’s Trust Index, which measures a number of factors, including respect of management, fairness, credibility, camaraderie amongst colleagues and pride in the work.

The companies that make up the list meet the Great Place to Work-Certified standard, Activated Insights CEO Jacquelyn Kung told Home Health Care News.

Oakland, California-based Activated Insights is a Great Place to Work subsidiary focused on senior care.

Companies that have earned a spot on the list have a competitive edge over other home care agencies when it comes to recruiting caregivers. Even companies that didn’t make the list, but are Great Place to Work-certified have found success when it comes to these efforts, according to Kung.

“In our research, we found that just getting certified, which is the baseline, increases the number of applicants to your organization by an average of 19.7%,” she said. “That’s huge for our industry, especially this year when turnover has gone up for a variety of reasons. Recruiting has always been important. There’s always been a talent shortage coming into the sector.”

One noteworthy takeaway Great Place to Work identified was that in-home care employee engagement is higher in comparison to providers on the congregate settings side.

The COVID-19 emergency had a significant impact on companies this year. The way companies responded to the public health emergency influenced their performance on the list. During this time, many providers embraced “servant leadership,” according to Kung.

“They, No. 1, put their employees and their safety first,” she said. “They did everything they could to make sure their employees were protected. This meant sending packs of PPE out to homes, making grocery deliveries to their employee’s homes, if a grocery delivery service wasn’t available. Executives would actually drive groceries around and drop them off with employees.”

Kung also noted that quick response from leadership teams and transparency were greatly valued by employees.

One company that made the list, Reliant at Home, partnered with the North Texas Food Bank and Shiftsmart as part of its COVID-19 response. The company also implemented health care screenings for workers.

“Local community and employee-centered benevolence is a culture priority for Reliant at Home,”

Jana Lightfoot, the company’s CEO, said in a statement. “We made hundreds of meal kits for our employees who are front-line health care workers and for patients [and] families that had trouble getting food on their table due to long days caring for others and mitigated access to groceries.”

Allen, Texas-based Reliant at Home provides a number of services, including personal care, home health and hospice.

Another company on the list, Senior Helpers, leaned on training and education when it came to keeping workers safe.

“We continue to offer updated protocols in weekly communications to our system on COVID-19 so that all feel comfortable and prepared,” Peter Ross, CEO and co-founder of Senior Helpers, said in a statement. “Additionally, we offer extensive staff training with courses that include topics such as hand hygiene, infection control, influenza prevention and transmission-based precaution — all aimed so that our clients can age safely and gracefully in the comfort of their own home.”

Senior Helpers is an international home care franchise with more than 320 locations worldwide.

Overall, Care to Stay Home (No.1), Assistance Home Care (No. 2), Senior Helpers (No. 3), Sunland Home Care (No. 4), 24 Hour Home Care (No. 5), Constellation Health Services (No. 6), Compass Care (No. 7), Elite Home Health Care (No. 8), Sunshine Homecare (No. 9) and Reliant at Home (No. 10) rounded out the top 10 home-based care providers.

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24 Hour Home Care’s Ryan Iwamoto: ‘We Wanted to Be the Trader Joe’s of Home Care’

Ryan Iwamoto co-founded 24 Hour Home Care 12 years ago, right in the middle of the country’s last major recession. Now, Iwamoto and his company find themselves operating through another economic downturn, with this one caused by the COVID-19 crisis.

Los Angeles-based 24 Hour Home Care is an independent, non-medical home care provider with 20 locations spanning California, Arizona and Texas. It employs over 10,000 caregivers and has been one of the fastest-growing companies in the U.S. for the past several years, according to Inc. Magazine.

Despite a lengthy list of challenges over the years, the home care company has managed to thrive. It has mostly grown organically since launching, though these days, it’s becoming more of an M&A player as well.

Iwamoto, who serves as the president of the company, credits 24 Hour Home Care’s success to its people — which he calls its “secret sauce.”

To learn more about that secret sauce and how 24 Hour Home Care has thrived in forming partnerships with Medicare Advantage (MA) plans, hospitals and other health care providers, Home Health Care News sat down with Iwamoto for a recent episode of Disrupt.

Highlights from HHCN’s conversation with Iwamoto are below, edited for length and clarity. Subscribe to Disrupt via Apple Podcasts, Google Play Music, SoundCloud or your favorite podcast app.

HHCN: 24 Hour Home Care has been recognized as one of the fastest-growing home care companies for eight years in a row. How have you managed to do that, year over year?

Iwamoto: When we started 24 Hour Home Care, we wanted to combine the professionalism of a large company with the personalization of a mom-and-pop business. And when we were thinking about what company did this well, in any industry, there weren’t really many that came to mind. But there was one: Trader Joe’s.

Everyone loves Trader Joe’s. They did an amazing job of being your grocery store, even though there aren’t many Trader Joe’s across the country. The store in your neighborhood, you probably identify that one as “your Trader Joe’s.” And their motto was brilliant, too, right? They’re not the cheapest. They’re not your 99-cent grocery store. They’re also not your Whole Foods. But they did a really good job of offering quality products at competitive prices.

Most importantly, the people that you deal with are their secret sauce. The people are super engaged, helpful, motivated and seem to be happy to work at Trader Joe’s. That was something we really wanted to emulate at 24 Hour Home Care. We wanted to be the Trader Joe’s of home care.

Is that the magic bullet that you think made 24 Hour Home Care successful — its people?

Absolutely, just like Trader Joe’s. It’s our people.

We actually have a motto here at 24 Hour Home Care, which is “Care and Compete.” Every employee has to have a little bit of both to work here, a dedication to caring and a sense of competition.

On the care side, you have to care for what we call the four C’s: your clients, your caregivers, your colleagues and, of course, the community. On the competition side, to be frank, we are a mission-driven company, but we are for-profit. So, you have to be able to compete.

This is not just competing in the traditional sense of competing with your industry competitors, but also competing with yourself to be a better version of yourself every day. I like to say those two values are the two threads that are interwoven to make the fabric of our culture.

Do you think you’d be able to launch in the same way you did 12 years ago?

To be honest, probably not. As everyone knows, home care is not easy. When I started the company with David [Allerby], I was 26. It was during the heart of the recession.

The one thing we didn’t have on our side is experience. But the one thing that we did have on our side is just this blind ambition. We really didn’t know any better. But we kept pushing forward. We would fail a few times, but “fail forward” and keep adapting to our circumstances.

And I think that’s what’s helped create the mentality that we have today, that with any challenge comes an opportunity. With COVID-19, I think we’ve seen the same thing. You just have to find that opportunity to rise above it. Once you get more established and more experience, I think you get a little bit more set in your ways, maybe more resistant to change.

It would be a lot harder going into home care with a little bit more experience now.

Most of your business comes from private pay, but you’ve also invested heavily in Medicare Advantage (MA). Why did you see that as an opportunity for growth, and how is that effort going?

We’re extremely bullish on MA. And one of the things that I love to see is the needle starting to move for our health systems — people seeing the benefit and value of home care. Medicare Advantage adding home care as a supplemental benefit a couple years ago, I think, was a huge leap forward.

As a company, we were truly honored to be able to work with some of the plans like Anthem Inc. (NYSE: ANTM) to help create a home care benefit.

Right now, MA is not a significant portion of our revenue. But being a part of this mission to show the value of home care is why we do it. Five to 10 years down the line, to see this as your standard insurance and Medicare benefit — that’s what keeps me going every day.

If you think about it, Medicare was established in the 1960s. For a while, outpatient physical therapy (PT) wasn’t a Medicare benefit at all. Then programs were put together, pilots were made to show the benefit of outpatient PT. Then in the late 60s, it was added. Hospice didn’t become a Medicare benefit until the 1980s. It was several years down the line before people really saw the value in it.

But people put programs and pilots together to show the value of hospice. Now today, people think differently. It’s just assumed as a benefit. I’m very confident home care will follow suit. We’re already seeing it start to happen with MA. I’m excited to be able to help pioneer this for the industry.

In terms of the presidential election, how are you looking at it from a home care perspective?

We’ve gone through three presidents — George W. Bush, Barack Obama and Donald Trump.

I think that with every election, there’s going to be some change, of course. And there’s also going to be change that you’re just not going to have any control over.

For me, I try not to get so bogged down thinking of what may or may not [happen]. Where my mind goes with any of this, whether it’s the election, crisis or change, is ‘with change comes opportunity.” You just have to find it.

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24 Hour Home Care Acquires Grace Care Management, ‘Actively’ Searching for More M&A Opportunities

In an effort to bolster its at-home care offerings in the San Diego market, 24 Hour Home Care has acquired Grace Care Management, another home care agency located in the area.

Since its founding in 2008, Los Angeles-based 24 Hour Home Care has grown quickly and steadily. But that growth has been mostly organic — until now.

Grace Care Management will become a part of the 24 Hour Home Care brand later this month. The deal will mark 24 Hour Home Care’s fifth acquisition overall.

“[Grace Care Management] has been in the San Diego area for nearly 20 years, so they’re really a staple of the community,” Andy Matthews, the VP of business development for 24 Hour Home Care, told Home Health Care News. “It made a lot of sense for us from that standpoint.”

24 Hour Home Care is an independent, non-medical home care provider with 20 locations spanning California, Arizona and Texas. It employs over 10,000 caregivers and has been one of the fastest growing companies in the U.S. for the past eight years, according to Inc. Magazine.

The acquisition of Grace Care Management was seamless considering that the two agencies have been working together since 2018, when Grace Care Management needed help with staffing capacity. Since then, 24 Hour Home Care has helped with any overflow the agency has had.

“But what we saw while helping was that they really have a patient-centered focus, and they also have a geriatric case manager — and we love that aspect,” Matthews said. “That’s something that really adds a lot of value to our clients, that we can now provide. It really seemed like this was the obvious next step.”

Grace Care Management is based in Ramona — a part of San Diego county — and expands 24 Hour Home Care’s footprint nicely in that area, Matthews noted. In addition to home care services, the organization also offers 24/7, on-call care management capabilities, as its name implies.

Ryan Iwamoto, the president and co-founder of 24 Hour Home Care, explained how the first decade of the company’s expansion was mostly driven by internal, organic growth on the most recent HHCN Disrupt podcast.

Now, the company’s success has positioned it to become more aggressive in M&A, Matthews said.

“We were very fortunate that Grace Care Management fell right into our lap,” Matthews said. “But we are actively looking for acquisitions as well. This is an active part of our strategy that we’re looking for new partners, whether it be in new markets or in our current market share.”

24 Hour Home Care’s strategy now will combine that trust in organic growth and growth through M&A. Matthews sees M&A as a way to add value to its existing markets and also expand to new markets in California, Texas and Arizona, and perhaps across the U.S. moving forward.

Cindy Hasz — the founder and CEO of Grace Care Management, and the geriatric expert that 24 Hour Home Care was so eager to add to its network — believes that the move will be mutually beneficial. 

“We’ve been looking for a partner that could provide the tech infrastructure that will create greater efficiencies,” Hasz said in a press release. “This is a win-win for seniors and those with special needs throughout San Diego because they will get the best of both worlds – the same great caregivers they know and love along with access to a staff of experts that can provide counsel any time they need it.”

Broadly, an increasing number of home health and home care companies have been active in seeking care management assets.

In August, for example, Caring People completed a handful of deals driven by a focus on care management. Meanwhile, in January, Arosa+LivHome acquired Lifecare Innovations to expand its care management footprint.

The focus on care management is likely to continue heading into 2021, especially as providers build out their service lines and care for more clients or patients on a longitudinal basis.

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Disrupt Podcast #37: Ryan Iwamoto of 24 Hour Home Care

The 37th episode of our podcast, Disrupt, is now available!

In 2008 — amid the last recession — Ryan Iwamoto and his co-founders started Los Angeles-based 24 Hour Home Care with $160,000 total of investment cash from family and friends. The company is now one of the largest privately owned home care companies in the U.S. with 19 locations spanning three states and over $115 million in projected revenue in 2020.

The growth that 24 Hour Home Care has seen over the last 12 years has been completely organic. Iwamoto, who serves as the president, has seen his company make the Inc. 5000 list recognizing the fastest growing companies in the country for eight years straight.

That success is due to the company’s ability to make innovative partnerships, its team and its ability to adapt on the fly — like it did when COVID-19 arrived in California. The biggest, however, is its “secret sauce,” Iwamoto said.

For this episode of Disrupt, HHCN caught up with Iwamoto to discuss that secret sauce, as well as non-medical home care, Medicare Advantage and the company’s 12-year journey to the top of the industry.

Listen to this episode of Disrupt to learn:

— What company 24 Hour Home Care modeled itself after

— How it adjusted when COVID-19 hit and how it plans to keep growing

— How it wins partnerships with hospitals and MA plans

— And more!

Subscribe to Disrupt to be notified when new episodes are released. Listen today!

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Future Leader: Andy Matthews, Vice President of Business Development, 24 Hour Home Care

The Future Leaders Awards program is brought to you in partnership with PointClickCare. The program is designed to recognize up-and-coming industry members who are shaping the next decade of senior housing, skilled nursing, home health and hospice care. To see this year’s future leaders, visit Future Leaders online.

Andy Matthews, vice president of business development for Los Angeles-based 24 Hour Home Care, has been named a 2020 Future Leader by Home Health Care News parent company Aging Media Network.

Future Leaders are high-performing, passionate employees nominated by their peers. Candidates must be 40 or younger and put vision into action while also advocating for seniors and their caregivers.

Matthews recently sat down with HHCN to talk about his career trajectory and how market forces, regulatory changes and the COVID-19 pandemic are changing the home care game.

You can find the conversation below, edited for length and clarity.

HHCN: What drew you to this industry?

Matthews: I was going to the University of Southern California, and I was in the middle of switching from a health care practitioner route to the business side of health care. 24 Hour Home Care had a health care management internship, which I applied to and was selected for.

When I joined, it was just the three owners. They were in startup mode, with one office in the South Bay of Los Angeles. I saw a really great vision initially.

I love health care because it’s a chance to help people. I really liked home care specifically because there’s a little bit of entrepreneurial spirit to it.

They brought me on as the first employee shortly thereafter, and I’ve helped them grow the company from one office to now 20 locations across Arizona, California and Texas.

What’s the biggest lesson you’ve learned in home care?

The more adaptable you are to change, the more likely you are to succeed.

There have been a lot of industry changes, whether they’re regulatory or minimum wage or COVID-19.

At 24 Hour Home Care, we’ve really risen to all of those different challenges, most recently with COVID-19.

We started providing temperature screening services and using our caregivers to screen essential workers and help them get back to work. We also started providing COVID-19 testing to nursing homes in our communities, setting them up with a partner of ours so they could test their residents and workers.

If you could change one for the future of home care, what would it be?

Over the past several years, it’s been encouraging to see organizations and payers funding home care.

Medicare Advantage is brand new, but it’s very exciting to see those plans starting to cover home care services. We also work with the VA in a similar program, where veterans that could be considered for nursing home placement can receive home care instead. These organizations are seeing cost savings involved with keeping people at home and preventing more severe health outcomes.

I would love to see more organizations continue to fund home care. More insurances would be very welcome.

I’m starting to see the tide turn now with some of these programs. I hope we continue to see that, and one day everybody has access to home care.

What do you foresee as being different about the home care industry in 2021?

Cost considerations have always been front of mind, but now infection control and safety are the number one issue.

We’ve been fortunate: We were able to secure a good amount of PPE, and after consulting with an infectious disease doctor and getting protocols set up, we felt comfortable caring for COVID-positive patients.

Since March, we’ve provided over 10,000 hours of care to COVID-positive clients referred to us by over 200 hospitals and skilled nursing facilities. In providing that care, less than 1% of our clients and caregivers reported any COVID-19 exposure in the home setting.

That’s the biggest change every company is adapting to right now, and I think it’s going to be present through 2021.

In a word, how would you describe the future of home care?

This word is said so often now, and before 2020 I don’t think I used it very often: Essential.

Our workers are essential. They’re providing a service needed to keep people safe and comfortable in their homes. I also believe that home care is going to be essential in the future in that it is a cost-effective and safe way to provide care.

Including home care in the continuum of care is going to be the way of the future.

To learn more about the Future Leaders program, visit the Future Leaders homepage.

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Home Care Companies Create New Revenue Streams by Helping Businesses Safely Reopen

After weeks — in some cases, months — of closures due to the coronavirus, businesses across the U.S. began reopening in early June. But by July, many of those same businesses were forced to go in the opposite direction, thanks to a national resurgence of COVID-19 cases.

As shops, manufacturing plants and warehouses again attempt reopening, many are turning to traditionally consumer-facing home care providers for backup. To help prevent the spread of the coronavirus, Senior Helpers, BrightStar Care, 24 Hour Home Care and several other organizations have expanded their service lines to offer screening services for unexpected business partners.

It’s a revenue-diversification opportunity that wasn’t on the home care industry’s radar, but it’s one likely to stick around for a while, according to Senior Helpers CEO Peter Ross.

“It’s a service that you and I would never have dreamed of months ago, but it’s come to fruition,” Ross told Home Health Care News. “I wouldn’t say our numbers are better than last year because of that, but certainly it has shown our flexibility and our ability to help the community.”

With a corporate headquarters in Maryland, Senior Helpers has more than 320 home care offices in its global franchise network, which covers parts of Canada and Australia in addition to the United States.

Many of Senior Helpers’ franchise owners have struck contracts to do temperature checks and related COVID-19 screenings for local businesses, Ross said. To support them in that mission, the franchiser sent forehead thermometers to owners and created an electronic brochure to help with marketing.

“We’ve noticed a bunch of opportunities across our system,” he said. “We’ve been finding a lot of manufacturing plants, warehouses, different types of factories … weren’t taking the proper precautions to do what they needed to do.”

Illinois-based BrightStar Care — another home care franchise giant with more than 340 locations in the U.S. — has taken similar steps to help businesses safely reopen. On top of doing temperature checks, the franchiser has also connected different businesses to its personal protective equipment (PPE) distribution center.

“Outside of securing PPE inventory for BrightStar Care franchisees to ensure the safety of their caregivers and clients, we’ve also shared access to our PPE distribution center with fellow business owners,” CEO Shelly Sun told HHCN. “We want to do our part in helping communities re-open safely, so that’s why we felt it was important to share access to our PPE supplies.”

Moving into B2B

In 2019, home care agencies typically sourced the bulk of their revenue from hourly in-home care, followed by live-in care, geriatric care and alert monitoring, according to the 2020 Home Care Benchmarking Study from market research and education firm Home Care Pulse.

But many of the home care professionals who participated in the benchmarking study said they expect to generate revenue from new avenues brought on by health screenings tied to the public health emergency in 2020.

Another Home Care Pulse report highlighting the impact of the COVID-19 virus on home care had similar findings.

“In our impact report that we [previously] released, a little over 50% of businesses said that their service lines were going to adapt and change based on learnings in the middle of the pandemic versus post pandemic,” Home Care Pulse COO Todd Austin told HHCN. “This is definitely one example — screening.”

Besides helping warehouses and manufacturing plants safely reopen, Austin said he’s also heard agencies are doing screenings at airports and various retail locations.

“Home care has had a little bit of B2B exposure through providing staffing and shipping to some facilities, but it’s never been a true B2B [industry],” he noted. ‘And that’s what 2021 will likely bring. home care agencies won’t just focus on B2C, but also more B2B service lines to where they can go out and network with other businesses.”

Per its screening contracts with non-health care businesses, Senior Helpers sends in rotating teams of certified nursing assistants (CNAs) or home health aides to cover different shifts of employees going into work. It typically does temperature checks, charging by the hour for those services.

“The last thing you want to do in a factory is let an employee who’s got COVID in with another couple hundred other people, with all of them working a few feet apart,” Ross said. “Look at what happened with all the different meatpacking plants in the country because of that issue.”

A July report from the U.S. Centers for Disease Control and Prevention reported that 23 states had COVID-19 outbreaks in meat and poultry processing facilities, with 16,233 cases in 239 facilities. Those outbreaks included 86 COVID-19-related deaths.

Senior Helpers has also used its screening contracts as an organic way of touting its caregiving services, Ross said.

“People say, ‘Oh, well, tell me more about Senior Helpers.’ They might need help in the home for their mother, their uncle, their grandfather,” he said. “From our perspective, it’s just a great investment in the community to keep people safe. And it certainly helps to drive the brand.”

That organic information campaign may also inspire some people to branch out into home care, perhaps even opening their own Senior Helpers franchise location one day, Ross said. It’s something that could factor into the strong growth the franchiser has seen lately.

“We’ve been growing really well, to the tune of 25 to 30 new owners a year,” Ross said. “We’ve been bringing more people on at a higher pace during COVID.”

On its end, BrightStar Care’s locally owned-and-operated agencies have provided screening services to 270 customers, including multiple Fortune 500 companies, as of mid-July, according to Sun.

BrightStar Care screening services are typically conducted by either a registered nurse (RN) or licensed practical nurse (LPN). Services range from taking vitals and conducting screenings, to interviewing employees and documenting answers for HR files.

Rates are based on the number of hours that the RNs and LPNs serve the needs of the customer.

“We’ll continue offering screening services as long as they are needed. We are proud to be able to support our communities and businesses to ensure safe reopenings,” Sun said. “We see staffing services as a long-term opportunity since each of our agencies have RNs, LPNs and CNAs on staff and have a 20-year history of providing staffing services in addition to home care. We are able to deliver on the skilled and non-skilled services, and [we’re] ready to provide future staffing services from screening to administering vaccines.”

Outside interest

California-based 24 Hour Home Care officially launched “SAFER at work by 24 Hour Home Care” to help with reopenings. The independent and fast-growing home care company has a team of 3,000 on-staff screeners to not only assist businesses, but also government buildings, schools and more, its website says.

But home care providers aren’t the only ones helping businesses reopen safely. Some of the technology companies that partner with home care agencies or post-acute care providers have gotten into the screening game as well.

Dina — an AI-powered care coordination platform that works with some of the largest home health providers and health systems around — is one example.

As of mid-July, Dina has two non-health care company screening customers: one municipality and one food manufacturer, President and CEO Ashish Shah told HHCN in an email. Those customers represent roughly 1,200 users, he noted.

Dina is helping home care agencies with screenings, too. Overall, Dina has helped facilitate more than 1 million employee screenings.

“We’re seeing more non-medical home-based care agencies start to step up and ask for help,” Shah said. ‘They’re finding very creative ways to use technology to check in on their patients and staff. And we’re seeing more non-healthcare businesses adopt our screening products to do exactly what hospitals and health care providers are doing to take care of their caregivers and patients.”

Home care agencies interested in launching new safe reopening business lines should keep two key things in mind, Home Care Pulse’s Austin said.

Caregivers screening dozens or even hundreds of workers need to have necessary PPE. Additionally, agencies should consider assigning one employee to one site to limit their exposure and possible virus spread.

“The first thing agencies need to do is make sure that the individual doing the screening is isolated to that [one location], whether it’s consumer screening or employment screening,” Austin said. “That’s step No. 1.”

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24 Hour Home Care Gets Candid About Logistical, Day-to-Day Aspects of MA Partnerships

While the Medicare Advantage (MA) home care opportunity continues to expand, cynics have been quick to criticize it.

Some say the opportunity is too small to be worthwhile — and that it’s more of a trendy talking point than a viable business option for most home care providers.

In 2020, only 619 of more than 3,000 MA plans nationwide decided to offer some sort of in-home support services, according to data shared by ATI Advisory. Of course, that was before the COVID-19 emergency, which experts have predicted will add fuel to MA’s home care fire.

On top of that, MA plan reimbursement for home-based care providers is notoriously low. Amedisys Inc. (Nasdaq: AMED) President and CEO Paul Kusserow painted a picture of MA home health rates — different from home care rates — during a recent presentation.

“I still think that Medicare Advantage is the place to be for us, but not under the current reimbursement,” Kusserow said. “Average reimbursement on a visit for Medicare Advantage is $125 a visit, versus $165 for fee-for-service Medicare.”

While such figures and statistics have been well-publicized, the actual day-to-day of what it’s like to provide home care to MA beneficiaries is not. In fact, that’s another common criticism of MA partnerships — few people really know what they’re like.

As such, Home Health Care News set out to learn more.

To discuss the more granular details of working with MA plans, HHCN recently connected with Gavin Ward, a regional director of strategy for 24 Hour Home Care. The Los Angeles-based home care provider is one of the few agencies nationwide to have secured those highly sought after MA partnerships.

Ward dove into what services his agency provides to MA beneficiaries, how often it provides them and more — including how much of 24 Hour Home Care’s revenue was funded by MA plans in 2019.

You can read HHCN’s conversation with Ward below, edited for length and clarity.

HHCN: First of all, how many hours on average do you spend caring for MA beneficiaries per month?

Ward: Our partners are grateful for the flexibility we have in caring for their members, as MA plans are not currently designed to fund full-time caregiving long-term.

Authorizations vary per plan, and most are short-term, averaging less than a month of care and during a transition. An average length authorization would be for 20 total hours of care.

What’s the most common type of home care service you provide for MA members?

Most of the members receiving care from us require some form of personal care and transfer assistance.

Our caregivers receive additional training upon hire to ensure they are safely and properly caring for members’ needs, especially during the pandemic — which is why we’ve developed safety protocols with our team, which includes an infectious disease physician.

I’m interested in hearing more about what the process looks like when you get a request for service from an MA plan. Can you provide more details on that and how it differs from the intake process for other clients?

Each health plan varies, but we continuously work to understand our partners’ ecosystems and to serve as an extension of their teams.

Like most contracted partners outside of the MA world, we serve alongside a case manager or social worker, care coordinator, and/or authorization assistant for each client. Our plan partners appreciate that we have dedicated care coordinators for each client as well as a dedicated intake team seven days per week to accept new cases.

The main difference with MA clients and our general client base is that we are not accepting payment information, nor discussing the cost of care.

How does payment work? Generally, do you get paid more during months when you care for more MA beneficiaries or is it more of a flat monthly rate?

While I can’t go into the fine details of the payment process, what I can share is that we file via a third-party claims system, which could present a challenging onboarding process if an in-home care organization is not equipped with the right personnel and systems. 

Smaller firms may struggle learning and adapting to these systems, but we have a strong, knowledgeable accounting team that has learned these systems and can invoice properly.

Some MA plans are also not used to working with non-medical agencies and may go through their own challenges ensuring their systems are designed to properly accept non-medical home care claims.

Do you have any statistics you can share regarding how much of your revenue is attributable to MA plans?

MA plans are still in their infancy stages, and we are appreciative of the opportunity to be selected and partner with them to provide care to members that are in need. As a result, it is still too early to disclose impact, which the plans themselves will also likely state.

Less than 1% of our revenue was funded by MA plans in 2019.

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‘A Decrease in Need’: Home Care Agencies Face Less Profitable Transportation Lines Amid COVID-19

Over the past several years, many home care agencies have invested heavily in transportation business lines to help their clients stay connected and active within their communities. The industry’s turn to transportation has been so popular, that ride services are often seen as core offerings for many agencies.

But while transportation services remain important, the ongoing coronavirus emergency made those business lines less profitable in the near term.

Prior to the COVID-19 crisis, there was a clear effort to “Uberize home care,” especially in regard to on-demand transportation services. Now, that’s not so much the case, Kerin Zuger, chief of strategic growth at Right at Home, told Home Health Care News.

Omaha, Nebraska-based Right at Home is a home care franchise system with nearly 500 locations in the U.S. The company is a subsidiary of RiseMark Brands.

Often built on partnerships with Uber (NYSE: UBER) and Lyft (Nasdaq: LYFT), transportation services garnered a lot of attention in the home care world in 2019 and early 2020. In addition to keeping clients connected, agencies also saw transportation services as a way to keep clients safe after leaving the hospital while maintaining visibility.

Internally, transportation programs also helped keep workers happy, as many home care agencies used them to coordinate rides for caregivers going from client to client. Furthermore, transportation offerings additionally allowed for some agencies to begin dipping their toes into government money by making headway in the Medicare Advantage (MA) world.

In MA, transportation is covered for non-medical purposes under the new Special Supplemental Benefits for the Chronically Ill (SSBCIs) initiative.

But currently, the Centers for Disease Control and Prevention (CDC) is urging those who are 65 and older to stay home whenever possible. The CDC is doing the same for those who have an underlying health condition,too.

“I would speculate, as an industry, that there is going to be a huge decrease [in transportation line volume],” Zuger said. “CDC actually recommends not using services like Uber and Lyft, particularly for those over the age of 65. So with everybody right now referring to the CDC and their recommendations, that’s just kind of scary.”

Los Angeles-based 24 Hour Home Care, which has its own transportation platform — RideWith24 — was one of the first home care companies to get into the transportation business and to partner with a ride-sharing giant like Lyft. The agency provides professional caregiving services to older adults and individuals with developmental disabilities in California, Texas and Arizona.

24 Hour HomeCare has experienced the COVID-19 transportation fallout first hand.

“We’ve faced quite a few challenges,” Irene Perez, 24 Hour Home Care’s community partnerships coordinator, told HHCN. “We have seen a decrease in clients calling in for transportation, and we’ve seen a decrease in contracts and ride requests. And a lot of that was about clients feeling uncomfortable.”

24 Hour Home Care used to experience a volume of about 2,500 rides per month. That total decreased almost 50% to 1,300 in April, though it has since rebounded slightly to over 1,500 per month.

In order to curb some of its woes, 24 Hour Home Care has relied on its partnership with Heal, which is an on-demand doctor service. Heal does house calls for patients who can’t or aren’t willing to leave their homes for doctor visits, which is one of rides home care agencies used to facilitate.

Right at Home, like 24 Hour Home Care, has partnerships with Uber and Lyft. For its clients, Right at Home has tried coordinating rides ahead of time so they know who the driver will be.

Both companies also try to reduce risks in other ways, like ordering larger vehicles instead of more compact cars.

Otherwise, putting a caregiver or patient in a rideshare could be considered risky, given the inherent closeness between the driver and rider in most car situations — and the amount of potential exposure.

“I think one thing we want to emphasize with all of our clients is that we cannot eliminate risk — period,” Gavin Ward, a regional director of strategy for 24 Hour Home Care, told HHCN. “What we can try to do is mitigate risk.”

Relying on Lyft and Uber has presented other challenges as well.

If there are fewer Uber and Lyft drivers available — which there have been — that means longer wait times and less efficient transportation overall, which was one of the perks of transitioning to ridesharing in the first place.

More headwinds

Another headwind for transportation lines has been the uptick in telehealth.

Telehealth claim lines increased 8,336% in the U.S. from April 2019 to April 2020. It used to represent 0.15% of medical claim lines; it represented 13% of claim lines in April, according to new data from FAIR Health’s Monthly Telehealth Regional Tracker.

A claim line is an individual service listed on an insurance claim.

If patients can experience visits virtually more often, the transportation line is immediately devalued.

“Before the pandemic, we were seeing this really big shift to Uber in home care, right?” Zuger said. “It’s [going to] be interesting to see what happens to those organizations [who invested so heavily in that]. … I have to think that those types of organizations have seen a pretty significant decrease in need.”

Still, in the end, transporting caregivers, patients and resources will continue to be a need.

Companies will just need to increase their creativity for their transportation lines for the foreseeable future — especially if they view them as a crucial revenue stream.

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