Faced with death, W. C. Fields said he’d “rather be in Philadelphia.” Faced with old age, the postwar generation says they’d rather stay home.
“In 2008, the economy changed, and that helped change the attitude of a lot of the baby boomer generation,” says Denise Rabidoux, CEO of Evangelical Homes of Michigan. The 132-year-old Detroit-based nonprofit started serving orphans of German immigrants and later expanded into retirement communities in southeastern Michigan, including Saline’s Evangelical Home.
“When older adults tried to sell their homes, they found they weren’t worth what they thought,” Rabidoux explains. “And then they realized they didn’t want to sell their homes; they wanted to stay in their homes.”
The rapid drop in housing prices accelerated a generational shift in attitudes towards nursing homes, and it could have scared providers witless: what would happen to all those retirement and assisted-living communities, and worse, what would happen to the industry’s model for the future? But where some saw a crisis, Evangelical Homes and a few others saw an opportunity.
“We’re generally 99 to 100 percent full now,” Rabidoux says. But even if they wanted to, “we couldn’t build retirement communities fast enough to keep up with the increasing number of older adults. And the cost is enormous: $60 to $80 million per facility. But why build them if they weren’t going to come anyway? We asked ourselves, ‘Is there any reason why we can’t deliver the same environment at home?’ And the answer was, ‘There’s no reason why not. No service is impossible to deliver in the comfort of the individual’s own home.’
“So we aggressively acquired two local home-care service providers–a branch of Helping Hands Nursing Service and the Medicare-certified home health care division of Arbor Hospice.” Together, Rabidoux says, they cost nearly $2 million. Though Evangelical Homes changed the names, they kept the staffs, and three years later, most are still with them, expanding the nonprofit’s ranks from 680 to 1,000 employees.
Big employment growth has been accompanied by bigger client growth: from 660 in 1999 to nearly 2,000 in 2010 and an estimated 2,500 by the end of this year. Rabidoux says their biggest growth is in home-care services, and the nonprofit’s nursing homes have been largely converted from residential to rehabilitation facilities. About a quarter of their clients now receive care at home, and most of the rest remain for relatively short rehabilitation stays before returning home. “The traditional nursing home as we used to know it is now only a small portion of our business,” says Rabidoux.
Along with the new care model, Evangelical Homes has developed a new financial model: through their LifeChoices and LifeChoice Solutions programs, they promise to provide everything from shoveling the snow and modifying a bathroom to hospice care. “For a one-time membership fee [of] between $35,000 and $50,000, plus a monthly fee of $400, the older adult will be cared for for life,” says Rabidoux. “Our focus is on health and wellness and preventing life-altering diseases–because our goal is to keep them happy, healthy, and safe in their homes for life.”
She’s not kidding about “in their homes.” When a client must be hospitalized, they’re back home, on average, in seventeen to twenty-four days. “Having older adults return to home as soon as possible is so important to their recovery,” says Rabidoux. “There now exist technical devices which allow them to go home and still be in constant connection with qualified caregivers so they don’t bounce back.”
Will that still work in 2030, when the number of Americans over sixty-five will hit 71 million and the strain on the system will be gigantic? While Evangelical Homes won’t share their actuarial tables, Rabidoux says that “the program is financially sound, and member fees are set aside and utilized when the client needs services.” And, she says, seven other organizations around the country are already doing the same thing, many of them “very successful.”
It’s working for Evangelical Homes. Since 2008, their operating revenues have gone from $41 to $46 million. They haven’t kept it all: the religious-based nonprofit provides $2 million worth of charitable services and support annually, and 50 percent of those they serve are poor or receive state subsidies through the Medicaid program.
