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Home care providers look for care models that meet flexibility and budget requirements. However, putting these models into practice can be complicated.
Home Health Care News spoke with Cypress HomeCare Solutions Managing Partner Bob Roth to discuss new care models for home health, meeting consumer and caregiver needs and more.
Scottsdale, Arizona-based Cypress HomeCare Solutions is a home health company that provides a range of services, including in-home personal care, overnight care, respite services, concierge care and memory care.
The conversation below has been edited for length and clarity.
HHCN: Can you explain the main reasons your organization has shifted to care models with shorter visits?
Roth: First and foremost, I want to stress that, for me, the biggest factor is the economy. The cost of home care services has increased nearly 50% over the past five to six years, which has affected how we deliver care. Consumers don’t have more money; they are trying to figure out how to do more with less.
Building on the economy, the cost of traditional care—across the board, not just home care—continues to rise. According to the Genworth Cost of Care Report, prices for assisted living and nursing homes have increased by more than 10% year over year in recent years. I am used to seeing increases of 1% to 3%, but lately, they have been in the double digits, which has had a significant impact.
We’re aging rapidly, and one-third of our population aged 65 and older lives alone. This is common in senior living. When I speak with executive directors of residential care communities, over 70% of residents are solo agers. Each of these directors will tell you that people are entering their communities at a much higher acuity level today. Twenty years ago, people moved into independent living around age 55 and were healthier. Now, the only way they are admitted to independent living is if they need extra care.
Some believe that moving into assisted living means being around “old” people. People fight to stay in their homes, and when we try to enforce a four-hour minimum for care, it becomes difficult.
If you do the math now, we’re charging over $40 an hour for private care. Let’s just use the $40 an hour figure. That’s $160 they have to pay for just one hour of care [because of a four-hour minimum requirement]. But with our care package, one hour costs $1 a minute, which totals $60. So, it’s $60 versus $160. Which one would you choose? That’s the point from an economic perspective.
One of the main reasons we are doing this is that the population aged 65 and older will double in the next 25 years. We also know that the population aged 85 and older will likely almost quadruple. It’s the 85-year-olds who will put the most pressure on the entire health care system because they will have multiple health issues, and their impact on health care resources will be enormous. Therefore, the need will only increase. Even though we’re implementing this in community settings, we must figure out how to care for this aging adult population in large communities like Maricopa County [in Arizona].
Key factors driving caregiver shortages include shorter visits, which maximize limited labor by allowing caregivers to serve multiple clients within the same community. Additionally, marketing and advertising efforts help us promote our services to support activities of daily living.
Many of our older adults prefer brief visits, typically lasting 15 to 30 minutes. In community settings, we’ve observed that 70% of these seniors live alone, and most—around 65% to 75%—are women. Women tend to outlive men and often find themselves widowed. A major concern in these communities is personal hygiene; many are afraid to shower or bathe alone. One of my caregivers can spend 15 minutes providing standby assistance or sitting outside the bathroom while they shower to ensure their safety and prevent slips or falls.
How do you create these care models to meet both consumer needs and caregiver requirements?
You need a partnership, a leader and buy-in. If I don’t see leadership within the community setting supporting this concept, we will fail. This is crucial because many of these communities have independent living contractors, as residents often bring their caregivers with them, and I’ve heard executive directors say they lose sleep over this.
They’ve contracted with us because they have no idea who’s in their building. They carry the liability if something happens to one of the residents. So, we need to ensure we have that buy-in. If we don’t, then, frankly, it’s not going to work.
What are the biggest challenges you’ve faced when implementing these innovative care models, and how did you overcome them?
With both the team in a care setting and the family and clients, we often face skepticism. People doubt how our model works. The key to our success is holding town hall meetings and webinars. We also set up tables in the dining hall with brochures, where we answer questions and discuss the economic and clinical benefits of shorter visits.
Stories are everything, and we need to be telling stories. When we’re just entering a community, we’ll offer trial packages to show that we can deliver on our promises.
One of the biggest challenges we’ve learned is that you can’t start with fractionalized care in a community. It’s too difficult to build that up initially, and we realized this. When we begin working with a new community, we start with more extended visits.
Providing care in a community setting differs from delivering care in someone’s home. The main requirements are flexibility and a thorough understanding. There is also some operational complexity involved. Scheduling multiple short visits demands strong logistics. A reliable enterprise software solution is essential to keep track of your activities.
We’ve faced challenges with electronic visit verification (EVV) because it relies on geofences. Clocking in and out can be difficult since the apartments are so close together, making it hard to get an accurate location.
Another challenge is the financial risk of doing short-hour visits. We might break even or lose a little money, but the goal is to move toward longer visits.
It’s about trust. It’s about the leadership managing the community, trusting us and our caregivers. They’re endorsing [our service] because they know we have all the necessary insurances and that these caregivers are our employees.
What financial metrics do you track to assess the success of these models, and what results have you seen so far?
The key financial metrics are the number of hours, revenue and the number of long-term clients in the community who are receiving 20 hours or more. Those are the metrics we’re focusing on.
How do you ensure quality and consistency of care with shorter visit times?
First and foremost, it’s about selective hiring and staffing. We’re very particular about hiring caregivers who live within 20 to 30 minutes of the clients. Additionally, I noticed that caregivers who are extroverted are advantageous.
Training and supervision are crucial for maintaining quality during short visits. The first caregiver assigned to a community is usually our lead caregiver. This person oversees and manages the schedule to ensure each resident receives the necessary care and supervises to ensure the care aligns with the resident’s preferences.
Regular feedback is essential—we strive to find the best match between client and caregiver. An extroverted caregiver may not suit Mrs. Abramson, who prefers quieter interactions.
Quality checks, whether done by our field care coordinators or the lead caregiver in the community, are crucial to ensure we deliver care that meets everyone’s expectations.
What upcoming trends do you expect in home care service delivery regarding innovations in care models?
We need to rethink how we deliver care and do it differently from before. Consumers have limited discretionary income for care, so I believe we will see more innovation in future trends.
We need to figure out how to deliver care in smaller, more manageable parts.
The hospital-at-home model is part of our future. We can’t keep building more hospitals; instead, we can bring care into people’s homes. We can perform diagnostic testing at home, bring nurses into the residence, offer therapy, X-rays, dental cleanings and much more. Much of this emerged during the pandemic, which greatly accelerated our adoption of telehealth.
We need to find ways to help Americans stay at home because, to this day, we disappoint 50% of our callers who believe Medicare covers in-home supportive care services. There must be more education out there. I don’t want to be hyperbolic, but college grads today should be saving for long-term, supportive care because many can’t afford it anymore. We need to rethink care, starting with fractional care in communities. I believe sharing care is a way to provide care in a different way.
I’ll finish with this: the previous generation, like my mom, who grew up in Baltimore, was surrounded by family caring for each other—her mother taking care of her father, her siblings and extended family all living nearby. I believe we’re returning to that way of life. I think we’re at a turning point. This might be one of the biggest challenges to face—not just for our generation but for humanity.
I’m excited about the future because problem-solving drives innovation, technology and new ideas. We are on the verge of something big, and fractional, on-demand care is already here. It may look different tomorrow, but we need to reimagine health care.
The post ‘We Must Reimagine Health Care’: How Short-Hour Models And Shared Care Are Paving The Way For Future Growth appeared first on Home Health Care News.
