A new report from the International Association of Homes and Services for the Ageing (IAHSA) explores how 9 providers of aging services in the U.S., Canada, Europe, and Australia expanded their business lines to include the provision of home and community-based services (HCBS).

Residential Provider Expansion into Home and Community-Based Services is based on a qualitative study conducted by the LeadingAge Center for Applied Research (CFAR) and funded by Sodexo Quality of Life Services.

The providers featured in the report include nursing homes, continuing care retirement communities (CCRC), and a CCRC at Home (CCAH) program.

“We set out to examine how a diverse group of providers carried out successful expansions into HCBS,” says Natasha Bryant, senior research associate at CFAR. “Our study provides practical information that could help other providers plan and implement similar expansions.”

Different Programs, Common Themes

The CFAR research team completed case studies of 5 U.S. providers, 1 Canadian provider, 2 Australian providers, and 1 European provider.

The participating organizations differed in a number of ways, including the design of their current HCBS lines, the size of their workforces, the number of clients they served, and their primary payer sources.

“Despite these differences, organizations shared many of the same aspirations, faced common challenges, enjoyed similar benefits, and learned a variety of lessons during the expansion process,” says the report.

After conducting telephone interviews with all of the participating providers and site visits with 2 of the organizations, CFAR researchers wrote case studies describing:

• How each HCBS program was developed and what it entails.

• National or regional policies affecting the expansion into HCBS.

• Financial implications of the expansion.

• How providers addressed workforce issues in their HCBS programs.

• How each HCBS program fit into or changed the organizational culture.

• Program outcomes.

• Perceived challenges.

• Lessons learned during the expansion process.

The IAHSA report also explores a number of common themes that characterized the organizations’ experiences with the expansion process. For example, many providers in the study expanded into HCBS to serve more individuals and seek new revenue streams.

Participating providers also took common approaches to staffing and funding their programs, and faced common challenges regarding marketing, competition, workforce development, funding, and government policies.

Despite these challenges, however, providers cited many benefits associated with the diversification of their service lines, including:

• Development of relationships between the provider and consumers early in the aging process.

• An enhanced ability to fulfill their missions by reaching a greater percentage of the target population.A stronger financial picture for the organization.

• The IAHSA report also highlights lessons learned that could help guide other providers planning a similar type of expansion.

Studying 9 Organizations

A total of 9 organizations participated in the Sodexo-funded study. Four organizations began as nursing homes:

• Alterszentrum Viktoria in Bern, Switzerland, started providing home health care and limited non-medical home care to members of its external community in 2011. The organization’s small program currently serves 23 clients.

• Feros Care in Queensland, Australia, expanded into HCBS in 2002-2003 and now delivers home health care, home care, telehealth, companionship, and other services to approximately 5,000 clients per year.

• Isabella Geriatric Center in New York, NY, started its HCBS expansion in The organization now provides more than a million service hours per year of home health care, home care, adult day, and other services.

• Tabitha Health Care in Lincoln, NE, began providing home health care in 1966 and home care in 1974. Each month, the organization delivers more than 10,000 service hours of home care, and serves an average of 254 home health clients.

Four organizations in the CFAR study began as continuing care retirement communities (CCRCs) or CCRC-like entities, and later developed traditional HCBS service programs:

• BallyCara Village of Friends in Queensland, Australia, expanded into HCBS in 2013 and now provides an average of 458 service hours to 200 external clients per month.

• First Choice in Harrisonburg, VA, is a partnership of 3 CCRCs: Virginia Mennonite Retirement Community, Bridgewater Retirement Community, and Sunnyside Retirement Communities. The agency provides more than 4,000 service hours of home care per month and serves 65-70 home health clients per day.

• Shepherd’s Care Foundation in Alberta, Canada, has been providing companionship, transportation services, and other home care services since September 2014. It now delivers more than 1,500 service hours per month to approximately 40 clients.

• Well-Spring in Greensboro, NC, delivers 9,000 hours of home care per month to older people living in its CCRC and 1,000 hours of home care per month to older adults in the external community. Well-Spring’s adult day program serves approximately 200 clients each month.

One organization began as a CCRC and provides home and community-based services through a CCAH program:

• Cadbury at Home in Cherry Hill, NJ, and Lewes, DE, established its CCAH program in 1998 that now provides a full range of services to its
200 members.