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Senior housing providers branch into at-home care models

October 15, 2012
by Sarah Spellman, LNHA
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Sarah Spellman, LNHA

Market research has shown that fewer Americans plan to move to continuing care retirement communities (CCRCs), assisted living centers, and nursing homes. Factors contributing to this shift include increasing costs and moderating income for seniors, technology that enables people to receive care and maintain social relationships at home and public policy efforts to support older adults at home.

To address changing consumer demands and industry trends, senior living providers are refining their business models to offer more services and stay competitive. Many senior living providers are extending services off-campus to reach those people who plan to stay in their homes for as long as possible as they age.

The 2012 LeadingAge Ziegler 100 Fact Sheet, a study of the largest 100 nonprofit senior living organizations in the United States, notes the number of at-home programs offered by the listed organizations increased by 32 percent between 2010 and 2011. Franchise Business Review has identified private-duty home care franchises as among the fastest-growing businesses with solid financial returns.

The Patient Protection and Affordable Care Act included demonstration projects for providing home- and community-based services as alternatives to higher levels of care, and also reduced the financial qualifications for consumers to receive these services.


While some organizations are offering traditional home care models that include home health, hospice and private-duty care, others are developing innovative programs that duplicate the breadth of services typically provided on a continuing care campus. Along with serving more older adults, senior living providers are diversifying off-campus in order to:

  • develop new and diverse revenue streams,
  • prepare for bundled payments under healthcare reform,
  • spread administrative expenses over additional product lines,
  • drive referrals to other service lines in private homes and facilities,
  • increase brand awareness and
  • retain senior managers by offering programmatic challenges. 

While innovative at-home programs across the country include a variety of fee structures, staffing models and service packages, most share a common model: a continuum of services that allows seniors to easily access the services they need as they age. Home-based services ranging from personal care to home maintenance and transportation are provided by employees of the sponsor or through partnerships with local vendors. Assisted living and home nursing care is provided by the sponsor or through a network. Any service a client needs can be obtained by making one phone call.

Care coordination is an integral component of this new approach. Care coordinators assess and monitor the medical status of their clients, coordinate necessary services, solve problems, facilitate communication among family and friends, and advocate for clients with healthcare and service providers. Care coordinators are the heart of at-home programs and are essential to consumer satisfaction and successful aging.

Most innovative home-based programs—which target a private pay market ranging from people with incomes just above the poverty line to the very wealthy—also offer educational opportunities, wellness programs, social and spiritual experiences. The goal is to provide comprehensive services that enhance quality of life, not just physical health.

Following are examples of several different innovative home-based program models.


These at-home membership programs are similar to Type A CCRC services. In return for payment of an entrance fee and a monthly fee, the member or participant can access a comprehensive package of LTC services that supports independence even as care needs increase. An initial screening of applicants is required, and only those who are not in need of services and have no degenerative diagnoses, such as Alzheimer’s or Parkinson’s, are accepted. A deficit in at least one of five Activities of Daily Living (ADL) is required to access services.

The pricing structure for continuing care at home is a life-care model that offers a member a lifetime guarantee of care for a one-time entry or membership fee paid when he or she joins the program, and monthly fees that begin the first month of membership. Entry fees vary depending upon the age of the member; fees are higher with age.

Monthly fees increase annually to reflect the overall operating expense and cost of living, but typically do not increase as a member needs care, thus protecting the member’s assets. Pricing is actuarially based and entry fees can be used by the provider to support the initial start-up, keeping the investment capital needed to a minimum. Excess cash goes into a reserve account that funds future services.

Life-care-at-home programs appeal to healthy older adults who are planners and want the security of knowing where to turn for future care and services.


These programs offer a continuum of services on a fee-for-service or as-needed basis. The provider must employ many of the service workers and charge prevailing rates, so the margins from the sale of services can be used to support the administrative infrastructure. Typically, services sold by the provider fall into the general category of home care or private-duty services, and also may include simple home maintenance, housekeeping and transportation. Referrals to outside vendors are provided for service requests not offered by the provider.