The Invisible Homecare Market

Paths to Empowering Caregivers

At the end of the day, the importance of empowering family caregivers who are out there is paramount. There are 70 million people in the US who are providing care to a loved one in partnership with or in lieu of skilled care. According to the Pew Research Center, over one half of those are adult children caring for an elderly parent, and almost one quarter (24%) are those assisting aging spouses. Chances are, the family would be paying out of pocket for a home health aide, which the Genworth Cost of Care Survey reports would cost an average of $3,861 per month. Multiply that by 12 months by 70M Americans, and that's a $3.2 Trillion invisible market. As baby boomers age, the number of Americans caring for their parents will continue to increase.

Today, Homecare Agencies partner with skilled nursing facilities or hospitals, and there are kickbacks for placements. When caregivers are outsourced, complexity starts to increase and become more expensive. We need to figure out how to standardize and reimburse the 70 Million Americans who are invisible and underserved.

Options for Families Today

Today, there are four primary ways family caregivers can recoup revenues: through state-specific Medicaid programs, Veterans Programs, Long Term Care Insurance, or getting paid by family members. The eligibility requirements are many, and the paperwork and timeframes are tedious.

Here are a few stories of millions.

My husband and I have been paying a friend to help with our care. My husband cannot walk on some days and needs help to get around. This person does all of the yard work and heavy housekeeping. He also cooks for us. We are running out of money to pay him. Is there some way we can get help paying him? We don’t want anyone else but he may have to leave to get a job soon. — Sharon Patterson

First Step for Sharon: If her husband has Medicaid, he may qualify to choose the caregiver to get paid and have it covered by his insurance. You are eligible for Medicaid if you make less than 100% to 200% of the federal poverty level ($12,490 annually) and are pregnant, elderly, disabled, a parent/caretaker or a child, there’s likely a program for you. If he does have medicaid, Sharon can call a Medicaid Program with his medicaid number to get started in the application process for getting the neighbor approved. Otherwise, she’s out of luck!

My fiancé has congestive heart failure, COPD, diabetes and renal kidney failure stage 3. He needs home care and he is on Medicaid. How can I qualify as his care giver?

Answer: Spouses don’t count as caregivers (!). The lawmakers in Albany have decided to not allow spouses to be paid as caregivers.

Hi: A friend I’ve lived with for 20 years is diabetic with feet and lower leg problems. He has medicare, not medicaid. Could he still qualify and could I be his caregiver? We live near Rochester, New York. Thank you

Answer: Medicare does not offer coverage for long term care or anything similar to a program that would let a family caregiver be reimbursed. Your friend would have to qualify for Medicaid as well and once he is approved, he will need to go through the enrollment process for Managed Long Term Care.

Creating a new way for people to be reimbursed for homecare.

Better Long Term Life Insurance

One way is by building a long term life insurance company and that actually structures the policies so that owners are truly protected and prepared for aging. You would make the experience feel like Lemonade, and then in the backend, instead of being the policy provider yourself, you are helping them buy a (better) policy from Penn Mutual or Mass Mutual, without the shitty fees that insurance agents are incentivized to optimize in your platform. This would and should shift buying patterns as encouraging Millenials to think about long term care for themselves. You could potentially target boomers but I’m not sure if the policies will actually be a good deal for them — would need to look into this more.

Employer Benefits Program

Another way of creating a new way for people to be reimbursed for homecare is through employer benefit programs. As more families require at least one member to serve as a caregiver for aging parents, companies are realizing that they need to assist employees with paid leave. Companies like Deloitte and Nike are allowing up to 8–16 weeks of paid leave for caregiving employees, and nearly 20% of companies today offer some form of paid family leave with a provision for caring for an elderly parent.

Maybe I could create a home care agency that solely sold B2B to employer benefit programs. Here, I would tailor the needs to employees who are likely losing productivity because they are taking time off to care for their parents, stressed out because caregivers cancel, or considering leaving work to care for a parent. Unlike today’s agencies who tailor to the client, I would build an agency that also cared about their families and made sure that they knew their family was being taken care of. Employers can get a write off for providing child care benefits to their families. Federal Tax Credits reduce the cost of every dollar spent on childcare for employees by over 50%. I wonder if you could extend that to family caregiving? You could think about building a company like Vivvi, a childcare company selling to employers, for elderly care.

Make it easier to receive Medicaid benefits

Marketplace.

The Medicaid programs that help caregivers get reimbursed for care are for-profit companies. I need to better understand their business models. One high-level opportunity is helping people take advantage of Medicaid programs by creating a faster onboarding and matching platform and charging a referral fee somewhere in there to the medicaid programs that are going to be helping them get set up to receive benefits.

New Medicaid Programs

Another is building a tech-enabled Medicaid program that helps people get access to these benefits quickly. These programs are not actually hiring people — they are helping people become eligible to get paid as home care aides. I need to understand this business better as well.

These are a few ideas I’ve been thinking about this week. Huge thank you to Greg Moore for his feedback. If you’re interested in talking about any of these, or thinking about alternatives, I’m game!