Right at Home Sets Sights on ‘Boomer Consumers’ with Custom Aging-in-Place Approach

For reasons beyond the coronavirus alone, 2020 was an unprecedented, action-packed year for home care operators. This year is guaranteed to bring more disruption as well, particularly as U.S. demographics continue to skew older and as the overall health care system looks to decentralize traditional models.

Omaha, Nebraska-based Right at Home — an international home care franchise system with roughly 500 domestic locations — is working to stay ahead of the curve.

In part, that means launching new service offerings to better target “boomer consumers,” a population that prefers to take charge of their aging-in-place strategy. It also means accelerating market development with a mix of de novos locations, new franchise openings and acquisitions.

To learn more about Right at Home’s 2020 and plans for 2021, Home Health Care News recently caught up with CEO and President Brian Petranick. Highlights from that conversation are below, edited for length and clarity.

HHCN: Can you start by briefly recapping Right at Home’s 2020, if that’s even possible after all the challenges you had to face?

Petranick: It was an interesting year. And this is a good time for this conversation, because I’ve been doing a bunch of reflection on 2020 over the last few weeks. I always get very reflective this time of year.

Let me start off by saying that I am incredibly proud of our team, including both our franchise system and our corporate-owned locations. I’m so proud of everybody, top to bottom in our network, in addition to our international partners. With COVID-19, we saw the real concern surface toward the end of February. Then all sudden, by March, it was like, “Oh my god! Here we are. We’ve got a potential pandemic on our hands.”

I’m sure every organization out there did some level of projecting, thinking about worst-case scenarios. We certainly did. And you know what? We never came close to that. We had about a six-week period of time where our business faced pretty significant losses. That was from March 1 to the middle of April. From that point on, we’ve been building back up and growing very steadily. We actually had a record level of volume across our system during the last week in February, right before the pandemic became “official.” We had our highest amount of volume in the domestic U.S. system — ever.

Well, we got back to that volume. We even exceeded those record numbers by September. We’ve been hanging around that all-time high, breaking records week after week. We’re on a pretty good trajectory here. But with that being said, we know infection rates shot up right after Thanksgiving and may rise again due to the winter holidays.

Again, I would say, in summation, that I’m incredibly proud of our year and our people. I’m proud of the way people responded. I know they’re tired. They’re fatigued. But they’re resilient. We’ve learned a lot about our team here at Right at Home, in terms of how we can respond to a crisis and how quickly we can make decisions. There are so many positives that have come out of this really awful year, at least from that standpoint.

How did Right at Home grow in terms of number of new territories or new locations?

We probably had a little bit lesser growth in that area than we’ve had in the past. Some of that is obviously due to the pandemic. But looking back on 2020, we are finishing up with a handful of — maybe about 10 — new operating territories. Some of those are corporate-owned, while some are new franchises that have opened.

What were the biggest challenges you had to navigate in 2020? I know you already mentioned fatigue, for example. There’s, of course, personal protective equipment (PPE) procurement.

I think it was broadly managing the volume and the speed of change in an efficient and effective manner. Early on, there was so much information flowing from different sources — PPE policies, infection protocols and more. We had to figure out, at the corporate level, how to get all of that information and filter it in a meaningful way to the people who are operating the local offices.

Our goal was to take that information and give our team the tools to act on it without having to think a whole lot. Instead of operators having to do their own extensive research, we wanted to say, “Hey, we’re here. This is what we know. This is what we’re learning. Here’s how you need to apply this in your business.”

There was a lot to decipher. But out of everything, I think we got the most questions about dealing with the Paycheck Protection Program (PPP) loan and PPE protocols. Understandably, there was also confusion about cities being shut down, with caregivers sometimes being in this murky area of “essential” or “non-essential.”

So much changed on a daily, even hourly basis. Ultimately, I think our biggest success was our ability to take all of that information and rapidly distribute it in a meaningful way, allowing our partners to focus on their caregivers and clients.

The debate around home care staff being “essential” from a regulation standpoint surprised me. Was that somewhat revealing to you? Seems like there’s a ton of advocacy left to do.

Exactly. I think, to some degree, it was eye-opening. But we’ve always known that some people, policymakers and insurance companies don’t truly understand what it is that we do. When policies are rushed out the door during a pandemic and you see that you’re not included in something important, it crystalizes that idea.

It’s good and bad. The bad is that it highlights how others view our industry at the moment. And the good is that we can more clearly see where there are opportunities to start open discussions about home care.

Listen, policymakers have been trying to figure it all out. They also need help. Right at Home — independently, as well as a part of the bigger coalition of the Home Care Association of America (HCAOA) and other advocacy groups — continues to get in front of policymakers to have those key conversations. That will benefit us, long term.

It’s going to be interesting to watch as policymakers and others start writing new policies and reimbursement schedules around shifting more care into the home. Do they really understand the dynamics of the home environment and all the different types of care delivery models?

How about two or three predictions for the new year. What do you expect for home care in 2021, maybe even looking beyond COVID-19?

None of this is probably going to be a surprise for you. But I would start by saying that we’re clearly on a path where there is just more change, more disruption coming. I’m talking about changes in the health care system, changes in U.S. demographics, changes to reimbursement models — all of those things. As we think about home care in 2021, we need to expect more change.

This acceleration to the pace of disruption is partly due to the pandemic. That isn’t doing anything to slow the changes down. But we’re also coming off of a presidential election. There could be some big philosophical changes coming into the White House. For as much as people want 2021 to be calm and a year where we get back to normal, there will be a lot to navigate. I think it’s going to be a lot like 2020, just in different ways.

With all that disruption will likewise come an increase to the level of sophistication within home care. Operators — independent home care providers and individuals who are part of a franchise system — will have to become more sophisticated in their approach to business. Wage pressures are increasing. Service costs are increasing costs. The traditional structures of health care are evolving, with more Medicare Advantage opportunities and new initiatives, including hospital-at-home programs. Operators will need to be overall more sophisticated to succeed.

What else? I would say — again, not shocking — there will be more collaboration between home health, home care and the broader health care sector. There’s just so much focus right now on bringing down the cost of care. The best way to do that is with stronger collaboration across the board.

A final prediction for 2021 is that the “boomer consumer” will take centerstage. We’re starting to deal a lot more with baby boomers — and they just have very, very different demands in regard to the care they want. They want to control that care and how they interact with their care providers. We should see a lot more focus on the boomer consumer outside of health care, too.

What’s an example of that? How is your “boomer consumer” different than the traditional home care consumer from a generation before?

It’s a great question. Some of this will probably be overly broad, but I think the generation before — the post-depression era, let’s say — was a generation that didn’t question their doctors. If a doctor said, “Here, this is what you need,” then they just did it. They were raised to listen to their doctors. That’s not the boomer generation or any other generation. They’re the WebMD generation, the Google generation. They’re used to going in and searching for answers on their own. And they’re used to getting what they want.

Boomers have had a lot of resources. They’re typically wealthy, as a group. They’re used to BMWs, Starbucks and those types of things. I think they’re going to expect more from their home care providers, more from all of their health care providers.

We’ve already seen some of that, right? If you look at the way hospitals were in the 80s and, to some degree, the 90s, you had to pay all kinds of money for a private room. Now, some of these hospitals are like hotels. You get a single room. You’re ordering off of menus. We’ve all got different expectations now.

We’ve already operationalized some of those changes, but there’s definitely more coming because we’re still on the leading edge of the baby boom generation. At the end of the day, they want more communication, more choice and a better experience.

How about two or three predictions for Right at Home? What specific goals or strategies did you have in mind for 2021?

You’ll definitely see from us more accelerated market development. I don’t think that’s a secret. At this point, everybody knows we’re opening up more corporate-owned locations, where we’re doing de novos. That means going into markets where we don’t have offices now and opening from scratch. We’re also growing through acquisition of independents in some of the markets where we’re interested in going. We’re still franchising. We’re just kind of agnostic to how we grow. But we want more market development. That’s No. 1.

No. 2, we’re thinking about all these changes that are happening in health care. We want to make sure we’re moving in the right direction. We want to make sure that we’re buttoned up on our data and thinking strategically about how we’re leveraging our data. We’re going to continue to put a lot of focus on our, like I talked about earlier, sophistication level. We know that we need to position ourselves best for working with the broader health care system and home health partners.

Lastly, we’re looking at all kinds of different ways to broaden our value proposition to our clients. That partly means hitting on what the boomer consumer wants. We’re not thinking about ourselves as just a home care company. How do we think broader? Where are there other opportunities to add to our own value proposition? There are some really interesting models out there that we’re looking at.

What do you mean by that?

Care coordination is an example. To use one analogy: Most people, when they build a custom home, they don’t do it themselves. You could hire a plumber. You could hire an electrician. You could hire a framer. You can hire all of those people individually. You can have somebody come in and put your foundation in and do your grading and all of that stuff. You don’t need the contractor.

But what the contractor does is make it easy. The contractor becomes the middleman and coordinates all of those other things. All you have to do, as the homeowner, is decide on design, your choice of your tile, your carpet, your paint. I think there’s going to be more of a demand for that type of service in home care.

If you think about it, there’s probably 5,000 different pieces of technology that somebody can bring into the home to help with the aging process. Well, who in their right mind has time to research 5,000 pieces of technology, from a consumer perspective? Or 50 home care companies? Or 20 transportation companies? I think there is an opportunity for somebody that can come in and help people manage the broader aging process, not just one aspect of it.

What else is important to touch on?

One of the things we have to be very, very cognizant of is the impact of COVID fatigue. I can’t stress that enough. We’ve had a strong year at Right at Home. I’m incredibly proud of our team. But we’re tired. People are just tired after operating at really, really high levels for nine or 10 months. COVID fatigue is real. It’s a challenge, but people are going to have to fight that off as best as they possibly can in 2021.

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Right at Home Partners with Home Modification Company TruBlue to Expand Aging-in-Place Services

Home-based care companies are trying to become one-stop shops for seniors wishing to age in place.

That’s why, when Omaha, Nebraska-based Right at Home’s executives saw a Home Health Care News article highlighting home modification franchise TruBlue Total House Care, they dialed up its president and began working on a partnership.

Cincinnati, Ohio-based TruBlue and Right at Home now have a preferred provider agreement, meaning that TruBlue will recommend its clients in need of home care to Right at Home. Right at Home will, in turn, recommend TruBlue for clients who need house work to age in place comfortably.

Right at Home — a franchise with over 500 U.S. locations — and Right at Home International are wholly owned subsidiaries of RiseMark Brands.

The new partnership will likely increase each company’s client base, executives from both told HHCN. For Right at Home, it will also advance its quest to become a home care organization that does far more than basic home care.

“In that aging journey, we want to be alongside that senior, helping them to navigate all the hurdles and the challenges that they face,” Kerin Zuger, the chief of strategic growth at Right at Home, told HHCN. “For us, that means providing them home care and doing everything that we can from a personal companion and skilled level, but also recognizing what community resources, tools, services and other providers need to come to the table to ensure they stay in the home as long as possible.”

TruBlue specializes in house care, home maintenance and safety modifications for seniors aging in place.

The partnership is launching at every franchise in TruBlue’s network that is within range of a Right at Home agency, so just under 50 locations as of mid-October. In June, TruBlue President Sean Fitzgerald expressed his desire to grow by 400% in the coming year.

The only roadblock to that was awareness. Now, after going into business with Right at Home, that shouldn’t be a problem.

“We feel that this is a key component that’s been missing in aging in place to provide complete peace of mind for families,” Fitzgerald told HHCN. “Combining home care with the maintenance of the home to make sure it is safe and comfortable, that can alleviate a lot of anxieties that families have over their loved ones aging in place.”

Many of TruBlue’s services are designed to cut down fall risk. Falls are the leading cause of both fatal and nonfatal injuries to older Americans, according to AARP.

The company also offers Age Safe America-certified home safety assessments, and its services span from general handyman work within the home to necessary yard work just outside of it.

Now that the program is in place, TruBlue’s expansion plans will be based largely on meeting Right at Home where they are around the country, Fitzgerald said.

Right at Home is excited about the partnership, particularly because it had been looking for one in the home modification arena before they found TruBlue.

“We were definitely seeking something like this out,” Zuger said. “This checks a box for us aswe continue to look forward into the future and think about our brand and how we really want to position ourselves relative to all things aging.”

TruBlue will also help Right at Home as it continues to explore Medicare Advantage (MA) and its franchisees pursue plan partnerships. For the franchisees that will benefit, their value proposition will grow due to the TruBlue partnership.

In 2020, at least 44 MA plans offered supplemental benefits focused on “structural home modifications,” according to an analysis from research and consulting firm ATI Advisory. Those plans covered more than 450,000 Medicare beneficiaries.

“It’s just an excellent extension of what Right at Home and our franchisees have been looking to accomplish in terms of that value proposition to our clients and to our families,” Zuger said. “It’s a great marriage of resources and service.”

The vast majority of Americans prefer to age in their own homes, a preference that existed prior to the COVID-19 crisis.

The mental hurdle for family members in the past, however, has been allowing their loved ones to stay at home without constant supervision, which is offered in more facility-based settings.

“One of the reasons why people put somebody into assisted living facilities or nursing homes is because they feel like they’re doing the right thing,” Fitzgerald said. “They’re getting the medical care, and they’re in an environment that is being monitored and is perceived to be safe. But aging in place, it’s healthier. It’s what seniors want, and it’s what they deserve. But I think the missing ingredient has been the home environment itself.”

One of the reasons Fitzgerald got into the home modification business in the first place was due to a family member falling and eventually dying from complications tied to that fall.

That fall risk, with TruBlue’s services and Right at Home’s coinciding care, would have been preventable, he said.

Bringing in new business

Right at Home is confident that it can access seniors earlier in their aging process due to the partnership.

Frequently, TruBlue will enter a client’s home and realize that they could also use home care services based on their condition.

“Let’s say our average senior is 80, but because of the partnership with TruBlue in shared markets, we were able to back that up to 79. That’s a big deal,” Zuger said. “Because we were able to get to that senior a year or two earlier because of this partnership, what does that do long term for that client, in terms of quality of life… as well as from a cost and outcomes standpoint?”

TruBlue, Zuger hopes, will help seniors get home care when they need it, as opposed to after a fall or similar tragedy, which is often the impetus for a home care inquiry. It’s all about getting into the home sooner.

On TruBlue’s end, interest in its services have “exploded” during COVID-19. With its new partnership, more tailwinds are likely ahead.

Helping seniors with their homes is a way to help them and their families while they’re being cared for there, but also after as well, Fitzgerald said.

“When a home is in such bad condition, as it often is, it becomes a big problem for families and the home can lose tremendous value because it wasn’t properly maintained,” Fitzgerald said. “So by doing this, we can create an environment where it’s cheaper for them to age in place, obviously, and then also just help maintain the property. Then when families do have to sell the home, it retains its value versus the opposite, which is what typically happens.”

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Only 25% of Home Care Agencies Track Hospital Readmission Rates

Hospital readmission rates are one of the most important markers of success in the post-acute and long-term care spaces. But a large number of home care agencies still don’t keep track of those metrics.

Overall, 75% of home care agencies did not track readmission rates at all in 2019, according to recently released data from Idaho-based market research and education firm Home Care Pulse.

Historically, home care has largely been focused on activities of daily living (ADLs) and social determinants of health — things that sometimes fall slightly outside of the medical lens. With that in mind, it’s not entirely surprising that one-quarter of home care agencies haven’t been tracking their clients’ readmission rates.

Increasingly, though, home care agencies are taking care of clinically complex, chronically ill individuals, people who are constantly in and out of hospital settings. Additionally, agencies are starting to develop relationships with Medicare Advantage (MA) plans and accountable care organizations (ACOs), both of which seek to curb health care spending and keep their members in the lowest-cost settings possible.

Today, if a home care agency wants to be competitive in the MA landscape or win partnerships with ACOs, it likely needs to have advanced data capabilities, Home Care Pulse CEO Erik Madsen told Home Health Care News.

But it’s not always that simple, he noted.

“It’s one of the challenges,” Madsen said. “The industry is very much relationship-based. And that also brings some downside in my opinion, because companies are slow to embrace technology, they’re slow to embrace data, they’re slow to embrace some of these other areas that other [adjacent] industries have taken more seriously.”

Moving forward with data

Without a doubt, direct relationships between home care agencies and their clients will continue to be important. But without embracing data, even agencies with the most quality relationships could fall behind.

Improved operational procedures could bring agencies to the next level, but they’re not always on the top of their priority lists.

“[Home care agencies] are slower to adopt those operational processes and procedures that they’re going to have to if they want to compete in the next decade,” Madsen said. “It’s just a fact.”

Part of the problem is that a vast majority of home care agencies operate on a smaller scale, with razor-thin margins and relatively small administrative teams.

In these situations, many agencies looking to invest in their data capabilities don’t know where to start. But that way of thinking needs to change, Family Resource Home Care CEO Jeff Wiberg said during HHCN’s Medicare Advantage Summit in June.

Family Resource Home Care is a large, independent home care operator out of the Pacific Northwest. The agency recently invested in new software to collect all sorts of data, partly to prepare itself for more MA business in the future.

“I think we’d really be putting our head in the sand if we don’t start gathering details and information that will help position us as an industry to really demonstrate our value,” Wiberg said. “[That 25% number] — that’s a big wake up call to say, as an industry, we need to be collecting more of this data.”

As one of the home care agencies to embrace data, Family Resource Home Care tracks a whole lot more than just readmission rates, too. It’s other focus areas include tracking emergency room utilization and fall rates for its clients.

Family Resource Home Care additionally keeps tabs on its census and how many clients are living with multiple co-morbidities, among other information. It also separates hospital readmission rates into different categories, including hospitalization rate prior to home care admission.

“Getting away from that pen and paper [system] is going to be key,” Wiberg said.

‘Winning a seat at the table’

Even for the agencies that are collecting hospital readmission data, nearly 40% are using Excel spreadsheets or another less-than-scientific way to track numbers, according to Home Care Pulse.

“The average agency, they’ve just got a couple of people working, between answering the phone and trying to recruit, retain, train and do check-ins,” Madsen said. “Margins are small enough that they don’t have an overabundance of staff. So they’ve got to identify what are those two or three key [data] points that they want to track are and then really dial in on those.”

In 2019, the typical home care agency collected anywhere from $800,000 to $2.8 million, on average. The majority of them have been in operation for over seven years, usually relying on just one location for business.

Omaha, Nebraska-based Right at Home is another home care organization that has invested in data capabilities and tracking client readmission rates. As a franchise system, Right at Home has nearly 500 U.S. locations.

Right at Home had been working to develop its data strategy even before new MA opportunities started to appear. The steps the U.S. Centers for Medicare & Medicaid Services (CMS) has taken to open up MA to home care only accelerated those efforts.

“Let’s make sure that we’re on a path to cleaning up our data and trying to get better access to our data as a system,” Right at Home CEO Brian Petranick said at the HHCN MA Summit. “[The MA tailwinds] gave us some fuel for our message. Now we have [even more reason] … to collect data.”

Among its efforts, Right At Home tracks patients’ changes in condition and takes a special interest in a wide array of social determinants of health.

Cincinnati-based FirstLight Home Care has likewise invested heavily in its data capabilities, according to CEO and founder Jeff Bevis.

“We went ahead and pursued an actual [electronic medical record] and have that component in our software platform now.” Bevis said during the MA Summit. “If home care companies are able to really track that data and go away from pen and paper … that’s going to make all the difference too.”

The top home care providers in the country are becoming more and more intricate with their data collection.

The smaller agencies, with a few simple steps, can kickstart a better system for themselves and paint a brighter picture for home care overall along the way.

“The next decade in home care is going to be just phenomenal as we start to become more mature as an industry [through these processes] and get more opportunity to have a seat at the table,” Madsen said.

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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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