St. Joseph Hoag Health, Irvine, Calif., has adopted a unique approach to shore up its home care services: becoming a franchise owner.

St. Joseph launched 16 Nurse Next Door home care franchises and plans to unveil more in the next few months. “We are trying to build a comprehensive network of care,” says John Bennett, chief administrative officer. “To do that, we sometimes need to partner with other organizations that are a good fit with us.”

St. Joseph Hoag is not new to home care; it also operates a home care agency. But the integrated delivery system is trying to fill a growing need among its aging population for non-skilled — or private-duty — home care services, such as help with bathing, shopping and other activities of daily living, care not typically done within a health system.

"Private-duty home care is a totally different animal than skilled home care,” says Erin Denholm, R.N., president and CEO, Trinity Home Health Services, Livonia, Mich. Skilled home care is provided for short periods, and is typically paid for by Medicare and private insurers. In contrast, nonmedical, private-duty care is often a long-term arrangement to help people with functional limitations — such as difficulty moving around — and is typically paid for out-of-pocket.

More health systems are starting to recognize private-duty home care as critical to meeting goals of value-based population health, says Denholm, who sits on the board for the Visiting Nurse Associations of America. “When you look at a cross section of a senior population, for instance, those who go to the ER and are admitted to the hospital are those with one or more functional limitations. Private-duty agencies support people with functional limitations and help them prevent exacerbations of their conditions.”

The nonprofit Catholic system aims to provide a critically needed service in the community. “If you have parents you can’t take care of on a consistent basis, it can be a huge relief to have someone to help drive them to doctor appointments or come into their home and make sure they are eating well,” Bennett says.

The Nurse Next Door services also may help to reduce lengths of stay. “Sometimes there is a hurdle in getting patients home because they don’t have transportation or a family member who can get their medications,” Bennett says. “These services will enable patients to go home sooner than they otherwise might be able to.”

St. Joseph Hoag wanted a partner that understood the ins and outs of the private-duty business, such as staffing and client billing. “We can adopt the infrastructure and processes that Nurse Next Door has built and tested over time,” Bennett says.

Vancouver, B.C.-based Nurse Next Door is one of a growing number of home care franchises — an industry that experienced a 47 percent net growth rate between 2010 and 2013, according to the Home Care Franchise Industry Update 2015

St. Joseph Hoag has a number of value-based partnerships with accountable care organizations and health plans, including Medicare Advantage contracts. “There are definitely some opportunities to assist these patients more effectively through the Nurse Next Door services,” Bennett says.