Caregiver talks to patient on couch at home

“Thinking small” is the biggest mistake senior living communities can make when expanding into home-and-and-community-based services (HCBS). That’s according to Senior Options President Nancy King, who advises operators expanding into HCBS.

“It’s really hard to be small because if one person goes on vacation or quits, you have no backup,” King said.

King made those comments Wednesday during a session on the financial metrics of HCBS at at the 2021 Ziegler LeadingAge National Virtual Senior Living CFO Workshop.

The COVID-19 pandemic has made HCBS a hot sector in long-term care. It’s become even more attractive since President Joseph Biden announced last month that HCBS would become a cornerstone of his $400 billion plan to improve America’s caregiving economy. HCBS provides opportunities for Medicaid-eligible older adults and the disabled to receive services in their homes and communities, rather than in institutional settings. 

Senior Options has partnerships with 15 agencies in six states. King said some senior living firms make the mistake of expanding into HCBS without building a staff for it first.

“If you don’t have the staff, you are going to get the reputation of not being able to serve. That is part of your investment in growth. It’s like asking people to move in somewhere without a building,” King said. 

Offer meals and wheels

Although some assisted living communities already provide HCBS through Medicaid waivers, there are a variety of ways providers in the senior living and care continuum can offer home-and-community-based services. Home-delivered meals and transportation are two examples.

Hamilton, OH-based Community First Solutions, which operates assisted living and independent living communities, also offers Meals on Wheels and transportation through a local office on aging. Chief Financial Officer Brian Krause said his firm’s Meals on Wheels program became a surprisingly strong revenue stream during the pandemic.

“While we were struggling with other service lines, our demand (for meals) went through the roof. You don’t think of Meals on Wheels as a great revenue generator, but it’s great for our community and it’s great from a mission standpoint,” Krause said. 

Get a goal

King advised agencies interested in offering HCBS to have a stated goal before expanding into HCBS. “Is your goal to serve more people? Is your goal social accountability or is it to diversify revenue?”

King also said having a chief executive officer who supports HCBS and understands how to integrate those services into an existing business is mission critical.