Home care providers are fighting many enduring challenges, from caregivers and staff sales to Medicaid fees that vary widely from state to state. Still, CEOs of some top home care companies are not only navigating these hurdles, but also evolving strategies to drive organic growth.
Leaders at Houseworks, Griswold Home Care and TheKey have set KPIs each week for each department, expanding the personal pay segment and implementing a diverse strategy that involves new client demographics.
At Houseworks, organic growth is our number one priority. One way a company can drive organic growth is through its “payer hub” platform.
“We drive a 52-week model within the company through the hub,” said Mike Trigilio, CEO of HouseWorks. “We drive a 52-week model within the company through the hub,” in a recent Home Health News webinar. “() Everywhere in our state, we monitor client counts, times, or caregivers as well as organic growth, but every department has KPIs driving weekly.
Supported by Intandem Capital, Houseworks is a Boston-based home care company that also offers meal delivery, adult day and laundry services. We serve in Massachusetts, Connecticut, Maine, New Hampshire, New York, Pennsylvania and Tennessee. The company serves 30,000 clients and 20,000 caregivers.
Another growth driver for HouseWorks is the movement to expand into private pay, where Medicaid was previously present. Trigilio noted that these efforts aim to recalibrate their business. This has focused primarily on Medicaid's growth over the past few years.
“We have continued to build some new de novos around our private pay model, just like what Griswold and Key do in other parts of the country,” Trigirio said.
Historically, HouseWorks has been a very acquisition company. In the past, the company had one trading goal per quarter. According to Trigilio, this was late, but the Houseworks plan again set its sights on the acquisition in the second half of 2025.
Finally, key private nursing business has become a source of growth for the company.
“We feel that complementing the personal care (non-medical) we provide to our clients is an increasingly demand not only in the care management department, but also in increasing demand.” “Having that perfect complement has been a bit of a differentiator for us in the marketplace where we provide those services.”
Based in Delray, Florida, TheKey offers home care, care management, memory care and specialized care services in 60 markets spanning 100 locations in the US, Canada and Australia. The company serves 13,000 clients a year and employs 10,000 caregivers.
Key has turned to connecting with elderly adult children looking for care services for their parents and other families.
“It's going to drive real organic growth for the business,” Gerald said.
As a home care franchise network, geographical expansion is Griswold's major growth source. According to CEO Michael Slupecki, the company will add dozens of new markets this year and continue at this rate.
Based in Bluebell, Pennsylvania, Griswold offers home care services in about 30 states. The company has over 150 locations.
The company also focuses on improving outcomes as a means of driving growth. To achieve this, Griswold is partnering with a clinical remote patient monitoring company. The arrangement is currently in the pilot phase.
“It can draw another eye on our care plans, and if something happens at home, we can interact with our clients 24/7,” Slupecki said. “This resonates very well with our community and referral partners, and we have an extra layer of surveillance with clients that are typically beyond what we offer in non-health home care agencies.”
Overcoming challenges
In addition to being leaning towards growth opportunities, home care leaders are navigating operational and economic challenges.
Like most of our peers in the industry, The Key focuses on recruiting and retaining caregivers. The company has increased employment by 18%. Key has also seen a significant decrease in voluntary turnover.
“Most of that is through some of the tools available to promote recruitment,” Gerald said. “We believe (specifically) that the application to the initial shift process, better practical training, will also improve organizational performance.”
At Griswold, it's also great to deal with office staff turnover. This is an issue that we consider Slupecki to be underestimated compared to caregivers' turnover.
“We talk about caregiver turnover and retention, but staff turnover in the office is highly correlated with poor performance in all aspects of our business,” he said. “I think it really starts with the office team because if they are stable, the client has better experience. The caregivers have better experience.”
Griswold has taken a multifaceted approach to solving this problem.
“We've relied on professional development opportunities like tuition reimbursement,” Slupecki says. “We make sure people are paid properly. We don't want to buy people. We want them here for the mission, but we don't want to miss out on opportunities with great employees as we are pound hoolish on the penny front.”
As a business with 90% Medicaid and 10% private wages, HouseWorks navigates multiple different Medicaid programs based on specific state rules.
“The Medicaid model is a surprisingly different model from state to state,” Trigirio said. “We literally have a house lined up from one property or zip code at another property, and the refund could change $4 or $5 per hour.”
Trigilio explained that developing repeatable processes and maintaining nymble is key to expanding Medicaid-centric home care companies. This helped the company when New York stopped having multiple financial intermediaries for its Medicaid Personal Assistance Program (CDPAP).
“To be honest, our biggest challenge was New York and the CDPAP program,” Trigirio said. “We had a program one day and were one of the next providers, and we were the next providers, and we sat and didn't talk for a year. In fact, we pivoted our business about 7-9 months before the April 1 deadline. We literally stopped the CDPAP service on April 2nd.
