This year’s edition of Inc. magazine’s 5,000 fastest-growing, privately held U.S. companies featured several in-home care providers, many of which have continued growing amid the COVID-19 pandemic.

Of those businesses are 24 Hour Home Care, Senior Solutions Home Care and Assisted Living Services — organizations that all share similar themes in their ascents. Their founding stories are similar, their innovative strategies stand out, and the unavoidable challenges they face are often identical.

Some have seen steady growth throughout their respective histories, while some have experienced ebbs and flows. Regardless of the journey, all have landed at the same place — a part of this year’s Inc. rankings — and have big things planned moving forward.

24 Hour Home Care emphasizes hospital relationships

Clocking in at the No. 4,601 on the list with a 68% three-year growth trajectory, according to Inc., is El Segundo, California-based 24 Hour Home Care.

24 Hour Home Care is no stranger to the Inc. 5000 list. Ryan Iwamoto, its president and co-founder, founded the company for two reasons: the opportunity baked into the industry due to the country’s aging population, but also his grandmother’s struggle finding quality care as she grew older.

The latter was ultimately the impetus behind starting the self-funded 24 Hour Home Care in 2008. An initial $160,000 investment got the company up and running. Today, it has 20 locations in Arizona, California and Texas, employing over 10,000 caregivers.

The majority of 24 Hour Home Care’s revenue comes from private-pay — about 80% to 90% of it — but the company has also invested heavily in capitalizing off of the rapidly evolving Medicare Advantage space.

“All of the growth has been organic, but it’s continued to focus on the relationships in the community,” Iwamoto told Home Health Care News. “We have a team that goes out and builds relationships with hospitals, senior organizations, home health companies, hospice companies, and I think really creating those types of relationships have brought in the majority of our private-pay business.”

That ability to drive home care referrals from hospitals and create meaningful, productive relationships with them has been a major contributor.

“I think if you look at our stats compared to some others in the industry, I think a lot of them don’t really get too much business from hospitals,” Iwamoto said. “And I think a higher majority of our referrals have come from hospital case managers and discharge planners. I think a lot of that has come from some of the partnerships that we’ve created to really build value for not only the patient, but also for the health systems and hospitals.”

An example of this strategy is 24 Hour Home Care’s partnership with Los Angeles-based Cedars-Sinai’s Medical Center.

Senior Solutions changing the playbook

Senior Solutions Home Care has an impressive three-year growth rate of 182%, which puts it all the way up at no. 2,311 among the fastest-growing private companies in the U.S. The organization is run by founder and CEO Kunu Kaushal.

Kaushal has a background in home health care and hospice, but he transferred over to non-medical home care when he started Senior Solutions as a means to take care of his grandparents. Now about 10 years later, the Brentwood, Tennessee-based company’s footprint spans across every county in Tennessee. It has plans to soon enter the Atlanta market as well.

It’s payer sources are diversified; the company works with long-term care insurance, private pay, Medicare Advantage and Medicaid. It has over 1,400 clients on service and currently conducts more than 18,000 hours worth of care per week.

The growth has been steady over 10 years, but it hasn’t happened free of ups and downs, nor has it all been a product of the same game plan.

“The need and the demand is not getting any smaller,” Kaushal told HHCN. “But what we’re noticing is the consumer is getting to be much more educated over the last 10 years, and the needs of the caregivers are much more than they’ve ever been. So put those two things together and having a home care company that’s still using the same playbook from five or 10 years ago just doesn’t work today.”

That adaption, Kaushal believes, has helped Senior Solutions Home Care grow its census to an all-time high of 1,400 during the COVID-19 crisis.

And while there’s undeniable tailwinds for any at-home care company right now due concerns over institutional-based settings, that alone is not enough to grow during the pandemic.

Each company has to have a plan, and caregivers need to be more trained than they’ve ever been, Kaushal said.

“The business has to be more efficient than it’s ever been,” Kaushal said. “Because we’ve been able to keep up with that demand, that’s why we’ve been seeing our growth. The opportunity to grow is available to everyone. It’s just that not all companies can keep up with that or respond to that [room for growth] appropriately.”

Assisted Living Services sets aspirational goals

At no. 4,022 on Inc.’s list is Cheshire, Connecticut-based Assisted Living Services, which is a home care company based in Cherise, Connecticut. It’s three-year growth rate is 87%, according to Inc. 

Mario D’Aquila, the COO, has taken over for his parents. They became first-time entrepreneurs in 1996 after they had to personally care for their own parents — D’Aquila’s grandparents — in the latter stages of their lives.

Assisted Living Services is primarily private-pay, but also takes long-term care insurance and — like 24 Hour Home Care and Senior Solutions — is benefitting from CMS’s evolving mindset when it comes to paying for non-medical services.

“We always start with private pay,” D’Aquila told HHCN. “But then we’ve gone into the more governmental payer side, so Medicaid waivers through the home- and community-based waiver system … and also here are some Medicare Advantage plans that do pay for some home care, which is becoming more common.”

The agency serves roughly 500 to 600 patients daily and has its eyes set much higher for the future.

“We set aspirational goals every year,” D’Aquila said. “And a few years ago, for example, our goal was to become the best home care agency in Connecticut.”

Recruiting and retention challenges

Despite their successes, all three still struggle to recruit and retain workers.

“Recruiting and retaining has been a challenge,” Iwamoto said. “It has been challenging for us to find caregivers, but also find the right ones to [do the job].”

Home care has been an industry challenged with high turnover rates throughout the years. In 2018, it reached an all-time high of 82%, according to Home Care Pulse. In 2019, it was 64%.

The labor market has left more workers looking for jobs in home-based care, but there are other factors at hand that make it hard to find workers who are a good fit, according to Kaushal.

“We just always have had a hard time attracting people to this line of work,” he said.

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