An industry at home here

Stacey Bock, a certified nursing assistant with in-home care agency Right at Home, talks with client Donald "Skip" Thomas at his Omaha home.


The days of the doctor's house call belong mostly to a bygone era, but Donald "Skip" Thomas might have the next best thing.

Twice weekly, Stacey Bock drops in to check on Thomas, who is 79 and has early-stage Alzheimer's. Bock wears many hats: When needed, she cleans, cooks and shops for Thomas.

Bock is a certified nursing assistant with Omaha-based in-home care agency Right at Home, which this year expects to enter its 500th territory.

Instead of a hospital or nursing home, Right at Home lets people who need some extra care stay — as the name says — right at home.

It joins long-established Omaha firm Home Instead, which also offers in-home care to people who need some extra help.

You might say Omaha is an epicenter of the home-care business. The two firms together have more than 1,500 franchisees around the world that last year took in almost $1.75 billion in revenue.

Thomas' daughter, Kirsten McGargill, said choosing an in-home aide over a nursing home was equal parts reluctance on her part and stubbornness on her dad's behalf.

"We got to the point where there is some forgetfulness going on, and things like laundry were starting to pile up," McGargill said. "We visited a facility in Omaha, and he said he just wasn't ready for it."

As baby boomers age and insurance companies and others try to keep people out of hospitals, in-home care services are growing steadily. According to franchising market research firm FRAN data, there were 13 home health franchises in operation in 2000, compared with 59 such brands today.

Right at Home's revenues last year were roughly $410 million and should approach $1 billion in five to seven years, its founder says. Home Instead had $1.33 billion in revenue last year.

Individual market areas are run by franchisees, who hire the nursing assistants and match them with prospective clients who need the extra care.

Franchisees pay Right at Home corporate an initial franchise fee of $45,000 to $47,500, depending on the market. Add in other business costs like real estate, insurance, hardware and furnishings, training and operating cash, and startup costs can range from about $78,000 to more than $130,000, the company said.

The franchise fee for Home Instead is slightly more than that of Right at Home at $48,000, but total estimated startup costs for that franchise are between $110,000 and $120,000, according to the company.

Clients pay an average of $21 an hour for such care; the aides themselves earn around $10.30 an hour, on average, according to federal statistics.

In Omaha, Right at Home aide Bock was paired with Thomas 18 months ago. As the 21-year-old franchise network continues to expand, officials expect that 2016 will be a year of milestones.

With about 440 locations globally, Right at Home will approach 500 by year end.

Revenues are projected to approach $500 million.

"Our volume keeps going up, but our growth rate is slowing down because of our large scale," said the company's founder and executive chairman, Allen Hager.

Hager is OK with that. He says the company expects to hit the $1 billion revenue mark in the next five to seven years, which means Right at Home caregivers will have provided thousands more patients like Thomas with the ability to live out their twilight years in the comfort of their own homes.

"Years ago, we really began seeing more demand for increased care offerings in the home," Hager said. He contends that it costs less to care for people in their own homes — and outcomes are better, he says.

In a three-year research partnership with a North Carolina hospital system, Right at Home patients proved far less likely to return to the hospital in the ensuing 30 days after their release. The Centers for Medicare and Medicaid Services now assess hospitals financial penalties for such readmissions.

A newer and ongoing study with Harvard Medical School's Department of Health Care Policy and home health software provider ClearCare seeks to demonstrate how in-home health care affects health outcomes for patients; it also aims to identify how to best manage or eliminate potential complications.

"Hospital case managers and discharge offices have always seen the value of what we do," said Right at Home President Brian Petranick. "Now others are seeing us as a viable solution, too."

The proving ground is an aging U.S. society that, as Hager is quick to cite, sees 28 percent, or nearly 12 million, of its senior citizens living on their own.

Over the next 10 years, anywhere from 11,000 to 14,000 Americans will turn 65 each day. That means Right at Home and its local competitor Home Instead could very well have their best years ahead of them.

Market researcher IBISWorld in a November 2015 report cited other industry drivers including physicians' growing acceptance of such care, more chronic disease and incentives for more cost-effective means of care — and it's not just a trend in the U.S.

"The demand for home care services around the world is strong," said Jeff Huber, chief executive of Home Instead.

Huber's organization has 611 franchises in the U.S. and about 450 in foreign countries.

Foreign markets are expected to grow at nearly three times the rate of the company's domestic operation, and Huber said he is "very optimistic" for Home Instead's future in China.

In Omaha, McGargill remains optimistic that the periodic visits by Bock will keep her dad in a familiar, comfortable and healthy environment.

"The beauty of it is we can always increase the amount of time that somebody does come in," she said. "It's peace of mind for myself and for my brother knowing that he's being cared for in his own home."

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