In-Home Care Aides Find Demand For Services Is Booming

In-home care aides find demand for services is booming
11:24 AM CDT on Tuesday, September 2, 2008

By BOB MOOS / The Dallas Morning News bmoos@dallasnews.com
When Gertrude Hurd returned home from the hospital after a fall, she relied on in-home caregivers to fix her breakfast, remind her about her medications, tidy up her place and help with other household chores.
"I've graduated from a wheelchair to a walker in just a month," boasted Ms. Hurd, an 84-year-old Lewisville resident, who added that her Home Instead aides share the credit for her recovery.
Mildred Krueger has had the same aide from Right at Home for seven hours a day, four days a week since 2006. The two women have become good friends and enjoy baking and cooking together.
The 87-year-old Dallas resident likes having someone around her house who knows her well enough to anticipate her needs. "I'd be in a nursing home otherwise," she said.
As more seniors decide to "age in place" and remain out of nursing facilities, they're increasingly turning to professional in-home aides to help with everyday living.
Some 11,000 licensed home-care businesses served 7.6 million people last year, according to the American Association of Homes and Services for the Aging. And in-home aides are projected to be the second fastest-growing job over the next decade – the government forecasts a 50 percent increase, from 767,000 to 1.2 million jobs.
Though "mom and pop" businesses have dominated home care, entrepreneurs have propelled the recent growth by opening franchises to capitalize on the expected doubling of the older population by 2030.
The industry includes established brands such as Home Instead Senior Care and Comfort Keepers as well as up-and-comers like Always Best Care Senior Services and Right at Home.
"Nothing is recession-proof, but home-care franchises are faring well in the slow economy because the elderly need help in both good times and bad," said Alisa Harrison, a spokeswoman for the International Franchising Association.
The nonmedical in-home caregivers don't do physical therapy, as home health aides do. Rather, they concentrate on personal care, such as bathing, dressing or just keeping someone company.
Ms. Hurd's aides work for the Home Instead franchise, which Gianna Loftis opened in Denton early this year.
Ms. Loftis got into the field partly because of her experience in caring for her father after his cancer diagnosis. She had been a financial consultant and launched her business after visiting for months with Home Instead's executives and other franchisees and after training at the company offices in Omaha.
"I'm now putting in 70-hour workweeks," she said, "but I don't know of another business where your clients tell you that you're a gift from God."
Franchises
Franchises appeal to people who want to start their own businesses but also prefer to reduce their risk. Franchisees follow a proven business plan and can call on company staff for advice when problems pop up, Ms. Harrison said.
Home-care and other service-based franchises are particularly attractive to entrepreneurs because they don't require as much capital to open as brick-and-mortar franchises, such as restaurants.
Still, home-care franchise owners say initial franchise fees and other start-up expenses can amount to between $50,000 and $100,000.
Harley Cohen, a financial planner before buying a Right at Home franchise in Dallas in 2006, also recommends setting aside enough money to cover one to two years of personal expenses.
"Your first goal is to break even and meet your business expenses and employees' salaries," he said. "Only then do you think about paying yourself a salary. For me, it took 16 months to get a paycheck."
Marcus Gardner, who launched an Always Best Care franchise in June, keeps his overhead down by operating a "virtual office" with a Grapevine mailbox. He and his two employees work out of their homes – or on the road – and communicate by computer.
"My time is better spent visiting hospitals and senior-living communities and introducing the business," he said.
Michael Newman, president of Always Best Care, said the Web-based tool is popular with new franchisees because it lets them manage their business until they can lease office space,
The company charges franchisees a royalty fee of 5 percent of their gross revenue.
Mr. Gardner considers it a fair exchange for the training and support he receives from the home office in Sacramento, Calif.
"Shortly after I opened, a company trainer rode with me for a week and coached me on sales calls to hospitals, nursing homes and doctors' offices. It was quite an education," said Mr. Gardner, who has a civil engineering degree.
Growing industry
The two biggest challenges for any home-care franchisee are cultivating referral sources, such as case managers and social workers, and hiring and supervising caregivers, Mr. Cohen said. On any day, his agency has 40 to 60 aides on duty.
Licensed agencies routinely screen their job applicants, said Anita Bradberry, director of the Texas Association for Home Care, an industry group. Besides checking references, the agencies perform criminal background investigations.
"We also do a gut check," Mr. Cohen said. "If we can't see someone caring for one of our own family members, we don't hire. It's not worth the risk. A couple of bad apples can destroy your business."
Experts say competition among home-care agencies has become fierce in Dallas and other metropolitan areas. Dallas County has 322 licensed agencies, the second-highest concentration among Texas' most populous counties.
"The competition can be difficult for the franchisees, but it should be good for consumers because it will drive up quality and hold down prices," Ms. Bradberry said.
Most seniors pay out of pocket or use long-term care insurance to pay for in-home care, though some on lower incomes qualify for help from Medicaid. Private home care costs an average of $18 per hour nationwide and $17 in Dallas, according to a Genworth Financial survey of long-term care prices.
Ms. Bradberry sees no letup in the industry's steady growth.
"If everyone had three daughters who lived around the corner and checked in every day, I might think otherwise," she said, "But most of us aren't that fortunate."
WHAT TO ASK
The 10 questions to ask before hiring a home care agency:
1. How long have you been in business?
2. Is your agency licensed?
3. Are your caregivers employees, and are you withholding taxes for them?
4. Is your agency insured?
5. How do you screen your caregivers?
6. What are your fees?
7. How do you match a caregiver with a client?
8. If I'm unhappy with a caregiver, how will you find a replacement?
9. How do you monitor your caregivers?
10. Will you provide references I can call?
SOURCE: Dallas geriatric care manager Molly Shomer