Editor’s note: Peer-to-Peer is a feature from McKnight’s Home Care Daily in which we talk to the leaders in home care, your peers, about their operational initiatives, efforts and ideas. If you think someone in home care would make a good subject for Peer-to-Peer, please email Diane Eastabrook at [email protected]

Twenty-four years ago, Stephen Rymal, attorney, became Stephen Rymal, franchisee. Rymal operates Griswold Home Care in Burlington County, New Jersey.

Rymal’s business provides nonmedical home care services, including 24/7 live-in care. During the pandemic he consolidated three offices into one and has weathered a reduction in clients. 

As a veteran franchise owner and a leader in the American Association of Franchisees and Dealers (AAFD), Rymal has a ground-level view of the home care industry and a more expansive view one at a national level.

Home care has been one of the hottest sectors, according to the International Franchise Professionals Group, a consulting firm for prospective franchise owners. Rymal isn’t surprised by that assessment, but he told McKnight’s Home Care Daily that becoming a home care franchisee now is more complicated than it was two decades ago when he entered the business.

McKnight’s Home Care Daily: How are you seeing momentum building for home care and how is that affecting franchisees like you?

Stephen Rymal

Stephen Rymal: If you’re looking at it from a private equity standpoint or a venture capital standpoint, healthcare is a big area to pursue. At the ground level here, I think the growth potential is still there. I think being in this market is the right place to be; it’s just dealing with the bumps in the road. You’re dealing with the COVID issue, you’re dealing with vaccination programs and it just becomes harder. People are aging, so there is demand. But you have to have the income, the funds available to pay for it.

McKnight’s Home Care Daily: Do you have to be better capitalized today to get into this business versus 20 years ago?

Stephen Rymal: I think so. You really have to be better prepared financially. The more regulations there are and the more policies affect regulation, the more complex the business becomes. I know there can be bad players. But for the good players, having to devote more and more resources to regulatory compliance becomes taxing. When you get into licensing and maintaining accreditation, there is a cost associated with regulations.

McKnight’s Home Care Daily: What are the other cost pressures today?

Stephen Rymal: The minimum wage is increasing across the country. President Biden is looking at a $15 minimum wage nationwide. New Jersey adopted a progressive minimum wage, which has been going up a dollar every year for five years up to $15 an hour. That is putting a strain on costs because in a 24/7 live-in model, like we have, people get paid overtime. So if you increase the minimum wage to $15 an hour, the time-and-half is actually $45 an hour. Price gets to be a big problem going forward with that. I don’t disagree that the caregivers deserve more money. I’d love to give them more money, it’s just how you balance the ability to pay.

McKnight’s Home Care Daily: There’s been talk from a policy perspective about having Medicare cover long-term care or expanding Medicare coverage for home care. Are you in favor of that?

Stephen Rymal:  With Medicare, the reimbursement rates are not great. It might work for the big companies. For small companies that are doing home care now, there might not be that much of an opportunity. It would be hard to make a profit and stay in business with it. The larger players can use it as a loss leader and get into other services, but just for personal care alone, it’s not going to pay the rent.

McKnight’s Home Care Daily: You mentioned large companies. Humana will soon own all of Kindred At Home and the other large public home care companies are expanding through acquisition. Will that make it harder for franchisees like you to compete?

Stephen Rymal: It might. From my perspective, it’s really having a presence in the community, having hospital referral sources. There are some bigger players who have been around, but I don’t know if they have the same connections that you can make with the closer community relationships. What I bring to the table when I deal with a referral source or a family is we’re local. The caregivers are local. My office manager has lived in this area her whole life. You have that kind of connection with the community. That may be the secret sauce going forward. I don’t know. It’s going to be a lot of things: the affordability of the care, the quality of the caregiver, the connection to the community itself.

McKnight’s Home Care Daily: You’ve been very active in the AAFD and your own Griswold’s director’s group. What do you get out of these groups?

Stephen Rymal: We have franchises in different states and we’re able to talk amongst ourselves to know what Florida is doing, what Texas is doing. We also have best practices where we can get together and talk about what works and doesn’t work: “This is how I solved something. This is how we changed our methods to make sure we were in compliance.” There are benefits to the franchisee association you don’t get from the franchisor down to the franchisee, but you get that horizontal support. You have someone with a business background or someone from a homecare background. I listen a lot on these calls because I hear other people chime in with their expertise. You have this library of assistance because everyone brings a different background to the meeting.