Given that the vast majority of people say they want to age at home, some senior housing companies are on a mission to sway popular opinion more toward community living. But that doesn’t mean they see home health strictly as competition—many are looking to add in-home care to their own service lines.
This may sometimes be framed as a “build it or buy it” proposition, but acquiring an existing home care company or building one from scratch are only two of many potential options. Creative senior living companies are finding other ways of increasing their presence in this part of the continuum.
It appears that some major senior housing operators are opting to work with relative newcomers to the home care space; specifically, companies that are leveraging technology to connect caregivers and clients in new ways. One of these companies is CareLinx, which is working with assisted living and independent living operators through an arrangement that the company’s CEO and founder, Sherwin Sheik, describes as “private label” home care.
Started about five years ago, San Francisco-based CareLinx has grown into a nationwide caregiver marketplace with more than 150,000 caregivers on its platform in 3,000 metros, according to Sheik. This scale enables CareLinx to be a partner to some major post-acute and senior living companies, as well as more regional providers such as Brookfield, Illinois-based Cantata Life Services. Non-disclosure agreements bar him from naming other senior living companies that CareLinx is working with, Sheik says, but he described the basic structure of these partnerships, as well as how he sees the caregiving marketplace shaking out in the coming years, in a recent discussion with Senior Housing News.
Large senior living providers see the writing on the wall when it comes to the importance of home care, both as a low-cost option favored by health care reform and as the setting of choice for consumers. So, these companies are moving downstream in the care continuum, looking to be more “agnostic” about where they provide services—whether in one of their communities or in people’s own homes, Sheik says.
Recognizing that their own residents desire to age in place by maintaining the greatest independence for as long as possible, senior living companies also understand that home care can be a valuable service even to those already living in one of their communities.
However, there are some common problems that senior housing companies run up against in their home care efforts, he says. The major one is that the recruitment and retention of in-home caregivers is enormously difficult, severely compromising margins.
“They’re operating [home care] near break-even or as a loss leader, but justifying it as a feeder into the community,” Sheik says.
And if a senior housing company does not have a strong home care offering, residents may find caregivers on Craigslist or from similar sources, and personal aides soon begin coming onto the campus who may not be properly licensed, bonded, or insured.
Recognizing these pain points, CareLinx has begun essentially offering its platform to assisted living and independent living providers as a “white label” product, Sheik says.
That is, after working out a revenue-sharing agreement, the senior housing provider can tap into the CareLinx network of caregivers and take advantage of CareLinx’s infrastructure, but essentially place its own brand on the offering.
As the exclusive provider of private duty home care to these senior housing communities, CareLinx benefits, Sheik says.
“From our standpoint, instead of having to pay Google and search for customers, we’re partnering with providers who already have relationships in the community,” he explains.
The senior living company benefits as well. Say, a prospective resident tours the campus but is not ready to move in. The provider can offer the home care services as an alternative and establish an early touchpoint with the customer. This maintains home care as a feeder for the community. Current residents also can be steered to the CareLinx offering.
As for why a provider may choose CareLinx in particular as a home care partner in this “private label” arrangement, Sheik points to a few factors.
One is that CareLinx has a huge footprint across the country, covering the service areas even of large, multi-state senior living providers. Also, typical agencies tend to staff based on availability of caregivers rather than their compatibility with clients, and that caregiver supply is finite. On the CareLinx marketplace, there may be 10,000 caregivers in major metros, and the technology can match those with seniors based on characteristics such as language, personality type, cultural background, and interests, Sheik says.
Another factor is pricing. CareLinx caregivers are full employees with W-2 tax status, benefits, and liability insurance, but CareLinx does not set their rates. Rather, CareLinx shares information about what the fair market wages are for a particular locale, and then caregivers set their own rates. CareLinx receives a transaction fee, but clients still typically pay less than they would with a traditional agency while caregivers earn more, Sheik says.
This means that senior living companies can work with CareLinx without too much danger that their residents will spend down their assets to pay for home care, and then not be able to afford the community rates, Sheik says.
An Enterprising Future
It’s been about 18 months since CareLinx first began this private label home care model with senior housing providers, according to Sheik. He’s interested in growing this side of the business by partnering with other large senior living companies.
“Going to one facility, it takes me about the same amount of time with training and building out the custom white-labeled website [as with a multi-site],” Sheik says. “I definitely get a lot larger yield off investment working with larger operators and some mid-sized. A single-site location, it’s harder for me justify. It’s more the mid-size, at least three or four properties or larger.”
He’s also targeting other ways of building the enterprise-side of the business, such as by working with accountable care organizations (ACOs) and skilled nursing companies.
In these arrangements, CareLinx offers private duty home care services but also, of equal importance, keeps tabs on how well a client is adhering to a plan of care, and monitors clients’ health status. If it appears a senior is in danger of needing to be readmitted to the hospital or SNF, CareLinx alerts the proper medical professionals to do an intervention. This helps keeps rehospitalization rates down—a key concern for hospitals and, soon, SNFs facing Medicare penalties for high readmissions.
CareLinx started as a consumer-facing product and that still is the “core side of the business,” Sheik says. But the enterprise-facing side could eventually grow to be about half the company, he estimates. While the “private label” senior housing approach suggests it may not be easy to track the expansion of the company, its founder and CEO does not hesitate to articulate the possibilities for growth.
“We’re seeing health systems evolving, and a lot of ways to help the health system to become more efficient and hopefully improve the cost of care and outcomes,” he says.
Written by Tim Mullaney