Home care providers and senior living operators don’t always see eye to eye.

When the two do come together, however, there are plenty of benefits for both parties. Massachusetts-based HouseWorks is the perfect example of that.

Led by founder and CEO Andrea Cohen, home-based care provider HouseWorks currently works with roughly 50 senior living communities in the Boston area. The PE-backed HouseWorks now gets about half of its clients from those communities.

Senior living partnerships are just one of the reasons HouseWorks stands out as an innovative provider. In addition to its core home care services, HouseWorks also runs a growing home-modification businesses, where its team of handymen help clients install grab bars, relocate bedrooms, widen doorways and more.

Home Health Care News recently connected with Cohen, a former home health aide, to learn more about the HouseWorks model. During the conversation, the CEO also touched on her company’s plans for 2020, which will likely include two or three acquisitions.

Subscribe to Disrupt via Apple Podcasts, Google Play Music, SoundCloud or your favorite podcast app.

Highlights of HHCN’s conversation with Cohen are below, edited for length and clarity.

HHCN: HouseWorks has been around for about 20 years. How did you get into the senior care space in the first place? And why focus on the home?

Cohen: Growing up, I had parents who were older. And they constantly reminded me they were older. I think that’s what helped me gravitate toward taking care of older people. When I went to college, I knew I wanted to help people. When I graduated, instead of going to graduate school, I became a home health aide.

That helped me understand that I wanted to do more direct work, instead of policy or macro-level work. I eventually did go to graduate school at Boston College. My first job out of graduate school was at a not-for-profit organization that helps seniors stay at home. I loved it. Around that time, my parents became sick. They lived in New Jersey, and I lived in Boston, so it was a difficult time. Nothing really went right. I felt like, “This is my background. I’m doing this. I know every resource that’s out there.” And it was possible that I was still unprepared. My parents died when I was 33, within six months of each other. I think that was my pivotal moment when I became determined to help get [senior care] right.

I saw how there were just so many gaps in care. I hired home health aides who didn’t show up. I called the doctor, then I’d get off in tears. There was no one to guide me, to help me order the chaos. I knew that this could be done better. Ultimately, it’s that experience that drove me to build my business.

I didn’t know you worked as a home health aide. That must give you valuable insight as a CEO.

Yeah. Honestly, I have a picture of me with my first client. I remember what it was like, as if it were yesterday. It’s really helpful. I teach and mentor as much as I can. I feel strongly that people can’t effectively run a business unless they get inside the heads of their customers and their clients. That’s where you’ll learn so much. I remember how much that first client of mine looked forward to me coming over, and how that client’s daughter just wanted to sit with me and have a cup of coffee because she felt isolated and alone.

For our listeners who aren’t familiar with HouseWorks, can you give us a quick overview of your company?

Building it has been fun. My original partner and I co-founded the company in 1999. His background was in nursing homes, assisted living, transitional care units, skilled nursing facilities (SNFs) and that kind of thing. Back then, we instinctively knew that the home was where people wanted to be. We’ve been in Greater Boston for that entire time. In the past two years, we expanded into Philadelphia, then we just acquired a company that covers New Hampshire and southern Maine for approximately $20 million in revenue.

We’re growing. We have about 600 caregivers in all three of our markets. Operating in Boston helped us grow into one of the largest single-site private home care companies in the country. That means we do have a lot of revenue out of one location. In 2019 alone, we delivered about a half-a-million hours of care into the home, out of Boston. We have about 200 clients per week. And we provide care to pretty complex clients.

About 50% of our clients receive around-the-clock care, whether that’s with a live-in [aide] or on an hourly basis. Those clients stay with us for a long time. The average length of stay with us is about 26 months. Our core services include personal care, companionship, home safety and fall prevention. We have a dementia care specialty. We do home transition services. And we’re 100% self-pay. We do accept long-term care insurance. We have no Medicaid. We don’t do any Medicaid work at all.

Finally, just in terms of the overview, we have an expertise in providing care in senior housing. In Boston, over 50% of our clients actually live in senior housing. We build strong referral relationships and establish formal agreements. We’re in about 50 senior housing residences in and around Boston.

Any tips for reaching out to senior housing operators or getting inside those communities to deliver care?

At first, the question was always, “Do we try to approach the corporate office that might have 10 or 15 communities? Or do we locally try to meet with the resident care directors and executive directors?” I would tell other providers to do both. Try to find the owners and operators if you have someone in your organization who can get that, but you have to convince these resident character actors, these executive directors that you can actually provide the kind of care they need. You need to help them understand why using a company like a HouseWorks or your home care company is beneficial.

We basically came up with a pitch deck of all the reasons why they would want to use us. And then we just keep at it. We ask them to attend transition meetings. We show them we respond quickly. And then when we get enough cases and residents using us in one place, we have people on site all the time. That means the caregivers providing the care can take short shifts, can fully integrate into the community. When our caregivers walk around, they all have the right shirts and the right name badges. They know everybody. The residents always see us and feel way more comfortable using us.

When I first started the business so many years ago, a lot of senior housing operators were trying to do it themselves. That was our biggest competition. And what has happened over the years is most of them have closed because it’s not their core focus. It’s not their core business. Running senior housing is not the same as running a home care company, and you can’t just hire 10 or 15 home health aides and expect to succeed.

You said that you expanded into Philadelphia in January after acquiring Caring Friends Home Care. Then most recently you had that expansion into New Hampshire and Maine through Extended Family. What are some of the things you look for in an acquisition?

Our strategy is to acquire companies with similar values. We try to find companies that value quality care the same way we do. We also look for companies that are locally managed by talented and experienced staff. It’s not easy to find a deal. When you can, the key to a successful expansion is integration.

Geographic expansion remains a key priority in 2020, we’ll probably make at least two or three more acquisitions this year.

Are there dangers in growing too fast?

Yeah. I mean, we have been building up our infrastructure in order to be able to intentionally bring acquisitions on, to make sure each acquisition is taken care of fully. I think the art to an acquisition is making sure it’s the right one by doing your due diligence, making sure that your own team is ready to take it on, making sure that everybody in your company understands the vision and bigger picture. You need to get your ship in order before you can make acquisitions.

I want to read something that you told us last year: “In order for people to be able to stay at home, you need good service. But you need to look at your environment, because as good as the services are, if the environment for the client isn’t right, it’s not going to work. People are going to really look to home modification as increasingly important.” Can you expand on that?

We’ve been doing home safety and falls prevention for the last 20 years. If you think about it, an unsafe home is a significant barrier to aging in place. And it’s one of the primary reasons that people move. When people can’t do little things like get downstairs to sit with their family for dinner or get out of the house to do errands, their day just isn’t as good. And, you know, you can’t just think about care in a silo. You have to think about care, environment and everything else that goes along with it.

The home modification business — or the home safety and false prevention business, as we call it now — is about 5% of our overall revenue. The margins in home mod are a little bit higher, but it’s a smaller business. We have about 20 full-time handymen on staff. We have an experienced manager who can sort of problem-solve. I would say the most common jobs that we do are installing grab bars and handheld showers, bringing over shower chairs and raised toilet seats. We often help move bedrooms to the first floor to accommodate a discharge until a person gets better. We install a lot of wheelchair ramps. We widen doorways to accommodate wheelchairs. We also do a lot of decluttering. Lighting is a huge issue. We’ve also done things like install elevators.

I would say our vision moving forward for home mod is to integrate it more deeply into our home care offerings. And right now, this year, we trained up our case managers to do a solid home safety inspection.