Home-based care has been part of a pivotal shift in the U.S. health care system: the blurring of lines between traditional facility-based care and in-home services. Case in point, the rise of hospital-at-home models that bring acute care into the home.

In addition, non-medical home care providers have increasingly adapted to deliver care to more complex patients, branching into cancer care and chronic disease management, suggesting the erosion of boundaries between home health and personal home care.

The divides between home-based care and other segments of the health care system are also thinning. A shift that has slowly been unfolding over the past few years is now set to swing into a higher gear: the blurring of senior living and home-based care.

Lynne Katzmann, CEO of senior living provider Juniper Communities, is among those chipping away at the distance between in-home care and senior living.

Currently, Juniper Communities, which operates in Colorado, Delaware, New Jersey, Pennsylvania and Texas, is transforming to become what Katzmann describes as “place agnostic.”

“In other words, providing our services not only to our residents in our communities but elsewhere,” she said during a recent webinar hosted by Home Health Care News and other WTWH Media publications. “Another way of looking at it would be simply to say we’re separating the real estate from the services.”

The shift to being place-agnostic sets the stage for Juniper to operate on an Amazon-like model, Katzmann said, a mega-marketplace with everything its clients need in one easy-to-access location.

While Juniper is not the first organization to find promise in expanding its service lines, the company’s strategic shift, in my view, portends a hastening and expansion of this trend. Katzmann’s strategy is not just to become a provider of multiple service lines; it’s to totally redefine the traditional approach to sites of care. For Juniper and other companies that jump on this bandwagon, this represents an opportunity to care for a larger market, secure reimbursement for services already delivered and improve care coordination for patients.

In this week’s exclusive, members-only HHCN+ Update, I’ll give an overview of this ongoing trend, offering analysis and my key takeaways, including:

— The history of being “place agnostic”

– Why some providers are looking to create a health care’s answer to Amazon

— The future of this shift

Setting-agnostic organizations

One of my first interviews after I joined the Home Health Care News team was with senior care expert Dr. Bill Thomas.

During our conversation, he advised home care providers to invest in real estate. He even went into detail about the potential for what he called pocket neighborhoods.

“I think we’re going to see the rise of pocket neighborhoods, where home care providers are going to be able to support, say, half a dozen elders living in six smaller houses clustered around a little common area,” Thomas previously told me. “Home care agencies are going to be able to start getting into the real estate game. It almost sounds weird. ‘Whoa, we’re home care. We don’t touch real estate. We just ring the doorbell and people let us in.’”

Looking back on this discussion, I think that Thomas accurately identified the ways in which post-acute care organizations would adopt a more hybrid care delivery model in general.

In my view, Bloomfield, New Jersey-based Juniper Communities’ efforts to become place agnostic emerge from this trend.

Lafayette, Indiana-based Homecare By Design, for example, considers itself the best of both worlds in home-based care and senior living. In 2012, the company introduced its clubhouse model.

Through Homecare By Design’s clubhouse model, the company’s home care clients get access to the venue’s amenities, as well as social gatherings and support groups. Benefits include a seniors fitness studio, educational seminars, dining experiences, dementia support groups and religious studies.

“How can we start thinking outside of the box, be more creative and come up with solutions?” Traci Goudy, president of Homecare By Design, previously told me. “How can we tie all of those pieces together and be able to reach a broader market of people — and do it more affordably? How do we do that from an aspect of home care — with those similar amenities of senior living — and blending them together?”

Homecare By Design’s model gets to the heart of what’s often missing from the home-based care experience: social interaction and community building.

“When I worked in assisted living or retirement communities, so much of the time the social aspect was the reason for moving there,” Goudy said. “[Seniors] were lonely or had just lost their spouse or a lot of their friends. They needed that social aspect, as well as the activities [that senior housing offers] to keep their mind stimulated. When you have home care, you don’t have that. You have one-on-one care.”

Parker Health Group, which began as a residential service provider, made a concerted effort over the past decade to widen its offerings to include home- and community-based care. The company also formed Parker Advanced Care Institute at VNAHG, a home-based primary care joint venture, with Visiting Nurse Association Health Group in 2022.

Pathstones by Phoebe, LifeSpire of Virginia and Kendal at Home are other examples of this hybrid model. Kendal at Home, in particular, has cemented its reputation as one of the largest and longest-running continuing care retirement communities (CCRCs) without walls in the country.

It’s not just senior living providers looking to expand their horizons. On the home-based care side, companies like BrightStar Care and, more recently, a ComForCare location, have branched out into the senior living space.

Juniper Communities, meanwhile, is setting itself up to be a true integrated care and services delivery model.

“​​It means being able to integrate the services we provide, as well as curate, if you will, other services from other providers,” Katzmann said.

The model of the future

The blurring of the lines between care settings benefits providers of both senior living and home-based care.

For providers, these hybrid models can lead to greater continuity of care. For example, if an individual begins receiving care at home with a company that has expanded its services to include senior living, they could remain with the same organization if they decided to move into a continuing care retirement community down the line.

This shift also sets the stage for providers to be reimbursed for services they already deliver; that’s the case for Juniper, whose clients expect the company to play the role of coordinator.

“In senior living, when you take care of an older adult and their family and they have come to the conclusion that we are the best option for them, they expect us to conduct the orchestra, whether we want to or not,” Katzmann said. “So the reality of our situation is that we’ve been providing many of these services on an indirect basis over an extended period of time. So what we are trying to do is acknowledge what we already do and then find payment sources.”

Juniper was a founding member of the Perennial Consortium, which is a group of senior living providers that together own Medicare Advantage special needs plans. Perennial has been able to work with the Centers for Medicare & Medicaid Services (CMS) to redefine “what yields health” for older adults and offer corresponding benefits, Katzmann said.

As a result, not only can Perennial members get paid for care coordination but for “a whole host of services” ranging from medication management to transportation to a rent subsidy for senior living to home care and more.

“We’re able to tap a larger market, the home market, and we believe that that will enable us to expand the base of people from whom we can collect fees for providing packages of services, and that will be able to create a marketplace similar to what Amazon does,” Katzmann said. “To say, here we are. We’ve got all of these services. You can come and get them from us. We vetted them, we know how to provide them, we will coordinate them with you.”

Other financial benefits include reducing marketing and sales costs, Katzmann said. With a stronger client pipeline and a more centralized operating model, these costs will be reduced even as revenue grows.

Something that Homecare By Design has already figured out in its mission to capture the best of both home-based care and senior living is that hybrid models allow companies to embrace the strengths of each care setting while offsetting the weaknesses of both.

Of course, such efforts also come with significant challenges. Many senior living organizations have started home care business lines only to shut them down, often citing the difficulties in managing two distinct types of workers, with home care on a distributed model and senior living being facility-based. And with development at a near-standstill for senior living and slowing for residential projects – due to high construction costs, labor shortages, financing roadblocks and other issues – now could be a particularly difficult time for home-based care providers to take Thomas’ advice and get in the real estate game.

Still, at a time when access to home-based care is threatened, these hybrid models could also mean more options for individuals seeking these services, and a way for providers to tap into burgeoning demand.

The majority of the organizations I’ve seen embrace this hybrid model are senior living providers entering home-based care and vice versa – and this trend is set to only accelerate. We may soon see concepts like Thomas’ pocket neighborhoods become common as future-looking health care leaders take off industry-specific blinders and perhaps become the leading-edge innovators of the aging services industry.