Watchword For Booming Home Health Market? Quality

Emily Micucci

Published: 4/15/2013

People looking for a winning business venture are frequently choosing home health care agencies, and it's no wonder.

The merging of an aging population and a push toward moving more health care services into patients' homes to reduce health care costs are making the business seem like a great bet. 

In Worcester County, new agencies have been setting up shop since 2008, mirroring a national boom in the home health industry. Most are private-pay agencies, which provide daily living assistance to clients —a service not usually covered by insurance., a Chicago-based Internet service that connects elder care options to patients and their families, performed a national survey to plot the growth of home health agencies. The data found that 15 new agencies have opened within a 30-mile radius of Worcester since 2008. 

Adding to that data are projections by the U.S. Bureau of Labor Statistics (BLS) that peg personal care aides and home health aides as the two fastest-growing occupations between 2010 and 2020. According to the BLS, each occupation will grow about 70 percent within the decade, and by 2020, there will be 1.4 million personal care aides and 1.7 million home health aides in the United States.

'A Hard Business'

But while the market may be full of opportunity, it's also quite competitive. 

Opening an agency is one thing; making it successful for the long-term requires a lot of hard work, according to James Fuccione, director of legislative and public affairs at the Home Care Alliance of Massachusetts, which certifies home-care providers.

Fuccione said that often, entrepreneurs enter the home care business because they think there's money to be made, without realizing all that's involved, from licensing procedures to monitoring clients' care.

"What they don't understand is it's a hard business and you really have to learn the ropes," Fuccione said.

In this business, Fuccione said, it's important to become involved in industry associations. In addition, registering with the Massachusetts Department of Labor Standards is required by law.

Then there's the issue of quality ratings.

The limited number of agencies that accept Medicare and Medicaid payments are rated on quality of care by the Centers for Medicare and Medicaid (CMS). But they're the exception, not the rule. Fuccione noted that agencies often lose money when they accept Medicare and Medicaid, though some opt to do that out of a sense of community service to patients. 
Beyond those basic steps, how well one's home health business stacks up against the competition depends on service quality. Some agencies offer innovative services like remote monitoring of clients' vital signs, or a "falls prevention" program to ensure the safety of senior patients at home, Fuccione said.

The Caregiver As A Product

Area home health agency owners say old-fashioned customer service is crucial, too. 

"People think it's an easy business, and it's not, if you do this business well," said Laurie Bender, owner of the franchise Home Instead Senior Care in Northborough. 

After 17 years in business, Bender uses exit interviews and client surveys to monitor and measure quality of care. It's difficult to monitor employees off site, but it's very important, according to Bender.

"Your caregiver is your product," Bender said.

Bender is a veteran in the Central Massachusetts home care community, with a good perspective on the influx of new home care agencies in recent years. There are many reputable, new competitors, but Bender said there are agencies that forgo the basic steps to assure quality — like background checks for caregivers — and focus only on offering the cheapest service. 

"It's really the Wild West," Bender said.

Private-pay home care agencies that are not certified by CMS are subject to very little regulation. Fuccione, of the Home Care Alliance, said registration with the Department of Labor Standards is the only regulatory requirement, which means there's no agency that oversees quality.

Adhering To High Standards

Greg Lindstrom is a relative newcomer who realizes the importance of the quality of care. He opened his franchise, Visiting Angels Living Assistance Services, in Worcester in 2005, and prides himself on high standards for hiring and treatment of his staff. 

Clients pay out of pocket, so they have high standards, Lindstrom said, and meeting them has allowed him to prove his business as a reputable home health agency in the area.

"People want to see if you're going to do well, if you're going to survive," Lindstrom said.
Rick Stein is an even fresher face in the Central Massachusetts home care industry. He opened Worcester Home Care Companion Connections in January 2011 after leaving careers as a journalist and a mortgage broker. His grandmother's illness inspired him to pursue home care, and the work is rewarding, Stein said. 

Stein runs a small agency and intends to keep it that way. His agility allows him to meet clients and match them to caregivers himself — and that's what customers like about his company, he said. 

"It's very much hands-on," Stein said. "It's nothing against the bigger agency…but they just can't do it."