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Home Care + Day Services = The Perfect Pair

Today's episode of Home Care Heroes is exciting because we've expanded to include day services (like Adult Day Care and Day Habilitation for individuals with Intellectual or developmental disabilities).  From now on we'll be calling the podcast Home Care Heroes and Day Service Stars.

Christina Vlosich is the perfect guest and today's topic explores why home care and day services go together so well.  As a short preview, here are some of the reasons why so many home care agencies are adding day services:

  • Client benefits: Day Service Participants benefit from the social aspect of having friends who they can meet with at day care plus the activities and nutrition. 
  • Benefits to your agency: In a Day Services setting, you generally only need one team member for each 4 to 5 participants so it's easier to staff and even though the reimbursement is lower, the staff cost is much lower too.
  • Secret Benefits to your agency: Two of the biggest problems in home care are 1) Being able to visit with and staff new prospective clients fast enough, and 2) training caregivers who immediately drop out when they get placed in a senior's home. With a day center, you can give your home care trainees hands on experience to better prepare them for their jobs. Plus, you can slightly overstaff your day center such that when a new prospect calls on the phone you can send a team member to meet them right away.

We also talk a lot about the critical topics of branding and differentiating your day center.

Christina Vlosich is the principal of Adult Day Service Consulting (adsconsult.biz). You can reach Christina on 1-330-719-8044​ or via email at cvlosich@adsconsult.biz.


Home Care Heroes and Day Service Stars is produced and sponsored by Ankota - If you provide services that enable older or disabled people to continue living at home that Ankota can provide you the software to successfully run your agency.. Visit us at https://www.ankota.com.



This is an episode you don't want to miss. So many of the home care agencies we're working with are now adding adult day services, and today we have one of the greatest national consultants in adult day services. Her name is Christina Vlosich, and you're gonna love her. Enjoy.



Welcome to the Home Care Heroes and Day Service Stars podcast. If you provide services to keep older or disabled people living at home, then this podcast is for you. Now, here's your host, Ken Accardi



Well, hello and welcome to this new episode of the Home Care Heroes podcast. I'm going to start with a big announcement. We're actually going to rebrand the Home Care Heroes podcast. We're going to call it Home Care Heroes and Adult Service Stars. Interestingly, then today's podcast guests are going to meet in a minute is really going to be the inaugural guest. Who's really going to take us into that. But the, the reason for it is because at Ancoda, we've really focused on anybody who



cares for individuals and wants them to continue living in their home and having high quality of life. And that might be because you're helping them live in their home by providing home care services, or it might be that you are helping them to live in their home by giving them the day services, which gives them some companionship and camaraderie and all those kinds of wonderful things. We actually do see more and more home care agencies that are also offering adult day services. So that is the part of the rebrand, but without further ado,



Let me jump over to introducing our very special guest for today. Her name is Christina Vlosich and Christina, her organization is called ADS consults, so ADS is adult day services consult. And she is really the preeminent person. If you are looking to start or improve your adult day services offering, Christina is one of the, the best consultants that's out there. And she's a premier partner of the.



group that's called NADSA, which is the National Adult Day Services Association. So she's a premier partner there and really everybody in the industry knows her and she's helped so many organizations get things off the ground. And with that, let me welcome you. Welcome Christina to the Home Care Heroes and Adult Service Stars podcast. Well, thank you. I'm excited to be a part of this, especially the new kickoff, including the adult day. You are right at the forefront and in the right place.

Why do Home Care and Day Services go so well together


Okay, so the first thing I wanted to talk to you about was, why is it that, let's say a home care agency who's providing services in the home and adult day services are such a perfect match together? And I will say as a side note that at Ancoda, we started as a home care software business and then in the state of Kentucky, when you do home care services for Medicaid, you have to provide adult day services as well. So we really said, okay, great, we'll...



adult safe services for you in our software. And that's kind of why we got there. And that was the first time it occurred to me, wow, these go together so well. But yeah, why don't you tell the listeners, what are some things that make it that they go together so well? Well, first I'd like to say, I have a background that enabled me to do home healthcare. So I was a home healthcare physical therapist assistant for many, many years.



before starting in the adult day industry. So I have a great understanding of how those services work. And then also with the adult day being an owner of a startup adult day. I love adult day. And I think that adult day and homes care services really go hand in hand. You're giving your...



participants is what we call them in the adult day or clients, an added service. So when you're sending somebody into the home, that particular client only really gets to interact with that caregiver that's coming into the home, where if they go out into the adult day arena, then they get a lot more socialization, their schedule programming. So you get activities, exercise. And it's a great



marketing piece because you may have somebody that's going to adult day three days a week, and then you're providing caregivers for them the other two days a week. Yeah, fantastic. So that's great. And I love that you started with the benefits for the participant. And I would say, you know, nine out of 10 home care agencies call their folks clients. So it sounds like those are the common terminology, the participant or client. So that works perfectly.



Yeah, and I love that. So in my mom's case, so I've talked about my mom on the podcast before, she's now 86 years old. She does have pretty severe Alzheimer's, so her memory is dropping, but she actually started by going to an adult day services program that is focused on folks with memory issues and that kind of thing. And prior to that, she was at home with a caregiver exclusively,



you know, having some issues like falls and some issues, you know, I think that, you know, are maybe a result of, you know, being a little bit sedentary and just being cared for in your home. And then when she started going to the adult day services center and participating in, you know, these fun activities and games and like the exercises that they do and kind of making friends there that it actually did.



uh, you know, give her a positive jolt in a lot of different ways. So it kind of made her more, uh, I would say, you know, engaged, but it also, like after that, her, her falls reduced because she was getting out of the house and she's doing these physical activities and things like that. And actually, I mean, just putting a timeframe on this, when she was having a lot of falls, this was, you know, kind of in the

How this helps with recruiting, retention and client acquisition


you know, late 2019, early 2020 arena where she I think had three falls in one month. And now here we are three years later, you know, she's gone from 83 to 86 and she actually has fewer falls as an older person. So that's incredible. But you know, I was actually thinking a little bit from the perspective of the provider side. And one thing I've seen that is, you know, pretty profound is that a lot of, I'd say, you know, the biggest issue that our home care owners talk about is



recruiting and retention of caregivers. And one thing that happens, unfortunately, is you recruit a caregiver and you put them through your training program and all goes well and good. And then you send them out to the home of this, you know, 82 year old person for the very first time. And then they're just kind of like in shock. It's like, oh my gosh, I didn't think it was gonna be like this at all. And then all of a sudden you've trained this person for a while and they just kind of quit right away. And so...



One of the other things that I, why I think they're a perfect pairing is a couple of things. So if you actually are training your person and then they could spend time, even if they're not part of the official staff of the Adult Aid Services Center, then they're interacting with different individuals that have needs and they're kind of getting used to that. And they could maybe put the things that they've learned in the training into practice. And then another one.



which is kind of interesting is that we've seen that the home care agencies that grow the fastest are the ones who can provide care the fastest, right? So like think of the scenario, it's like, hey, my mom fell and broke her hip. She's being discharged tomorrow. I'm flying to Florida to see her. I need a caregiver, right? And if they call the first agency that they find in a Google search and they say, okay, well, we think we could get your mom a caregiver in two weeks.



you know, that's going to be one data point. Then they call the next agency and the next agency says, you know, hey, I'm going to send you one of our supervisors and they'll meet you. What time are you getting there tomorrow? Or can we meet you this afternoon? And if you think about it, one of the things in adult day services is that you need, you have certain ratios, right? So if you have, let's say, you know, 50 participants in the center, then you might need to have, you know, depending on your state and there's different rules and things like that.



you know, just kind of making this up, you might need 10 staff. And let's say that you have some trainees who are going in and doing home care training. And so now you have two or three extra folks. So there's now 13 people in the center. And when you need to have that supervisor go meet the person who needs care right away, you know, you have the ratios that you can send the person out right away. So, I see like such incredible synergies between the businesses. I will say that I...



You know, we kind of one of the themes of the Home Care Heroes podcast is that, you know, this caregiver shortage issue that we're experiencing today, it's only gonna get worse, right? Because we have, you know, this huge population of the baby boom and we're actually, you know, looking at the age range of people who need these kinds of care services, that population demographic is gonna more than double and we're already facing a caregiver crisis. So,



You know, anything that you can do to, you know, start thinking about, all right, you know, how do I, you know, think of a future where maybe it's not gonna be one caregiver in one home. And like I said a minute ago, you know, now I have a day center with 50 participants and I have a staff of 10 or 11, right? That's a much better ratio for you. You're caring for more people with fewer people.

Concerns expressed by Home Care about adding Day Services


and that type of thing. But I do know that my home care folks, they're reluctant and they're like, oh my gosh, that's like, I would need real estate. I have no idea anything about real estate. So anyway, that's that. But I guess, you know, Christina, I've kind of rambled on for a minute here. I mean, do you have any other thoughts here just on those synergistic opportunities? Yeah Ken, you didn't even need me. You like, you are like the perfect spokesperson for Adult Day because you have a true testimonial experience with your mom, right?



So you see all those benefits, but you know, Adult Day, like your mom was in a memory care Adult Day, correct? But you know, there's those specialized programs that are like memory care. You could also do a social model or you could do a medical model. Some particular states do require a medical model, just it depends on what your state regulations are. Same thing with the participant to staff ratio. They say the national average is one to six.



So, you know, you're right around that ballpark. Some states have a one to 10 ratio. So if you think about those ratios, you're bringing all of your people to one location. And as a provider, it's more cost effective when you have more people attending your center. And so, you know, you could even have your home caregivers go in and get somebody ready in the morning to go to their adult day program.



you know, and that's still beneficial for both aspects of your business. And then, you know, to think about like specialized programs as far as fall prevention, that's a wonderful component of Adult Day. So, you know, as you mentioned, I'm part of the National Adult Day Association and I do do some webinars for them. And what I'm doing with the co-presenter is in August on how to initiate an Adult Day, or excuse me.



an initiator falls program within your adult day center. And so, you know, those are things that people don't think about is funding sources and getting grants to do those. So it also can drive revenue into your adult day program. Some other things to think about with adult day is like payer sources. So you can do private pay, you can have VA, there's Medicaid contracts, you're

Reimbursement comparison - Home Care and Day Services


waiver programs, long-term care insurance. So there's a lot of different avenues for money to be paid in adult day that people sometimes just think it's a private pay industry. And you can do a private pay model or you can do a combination of private pay and then those other payer sources. Yeah, incredible. I do know that in my mom's case that she does have long-term care insurance and that I think the...



reimbursement kind of total per day is something just north of a hundred dollars that we get through her policy. And I think that that probably covers most programs. I guess he made me think of one thing here. I guess that when we look at Medicaid home care, there's a big range. I think Georgia is probably around $19 an hour reimbursement from the state and like the Missouri consumer directed services program is around that kind of a rate.



Whereas in Kentucky at the moment, they actually are doing an incentive and paying more. They're paying close to 30. But at the end of the day, I mean, usually Medicaid adult daycare is being reimbursed in the low 20s per hour. And in adult day services, like if we say the national ratio is more like a one to six kind of thing. I mean, do you have any idea for a full day in...



adult day services with like Medicaid or VA, like what you've seen for the reimbursement ranges? So I can tell you there's a Genworth study and it says that the national average for adult day reimbursement is $78, but it doesn't break it out into Medicaid or private pay. I worked with a client that's in Maryland and their adult day daily reimbursement rate was 120.



And so they had to be a medical model. And when you look at medical models, that could just be having a nurse on staff. So, you know, it's not a huge undertaking as far as like what the medical services are, mostly just having that licensed nurse there and to oversee the plan. Ohio, our rate, that's where I'm from is Ohio.



is we have like around 60, it's right around $65 for what we call would be our social model. And then we have an intensive program, which would be our medical model. And that's right in that $85 range. And then our transportation is billed separately. So we get like $25 round trip for that. So it does add up private pays. You can set them at whatever you want.



There's a franchise called Home Talent, I think it is. I think that's what it is. And their daily rate for private pay in Maryland is $148 per day. So it just varies state to state what their reimbursements are, as well as what you're gonna charge for private pay.



Adult Day is growing. It really is. You know, there's a lot of studies out there that indicate that there's growth in Adult Day because especially with COVID and seeing how isolation has really affected our aging population. And so in Ohio, we have $8 million from our Department of Medicaid that's going directly to Adult Day. And so, you know, you can, if you're looking to start in our, an Adult Day in Ohio.



They are doing RFPs for startups. And so there is money out there for Adult Day. I've had clients who their city gave them a grant to do renovations and a building to get it, you know, up to what we need for Adult Day. So, and you know, Adult Day doesn't have to be aging population only, you know, some centers do the IDG population and both. So it just depends.

Terminology for home care and day services


Yeah, that's great. Yeah. And so in Ankota in our business, but also in, in home care, there is, we, we always, you know, either thinking whatever kind of home care we do. So a lot of times it's, you know, focused on the elderly and other times it is focused on intellectual developmental or even physical disabilities. And in those spaces, I guess on the home care side, there's a terminology difference. So it's usually, you know, we call it, we call them caregivers and we call it.



We use the word care and then in intellectual and disability services we call, instead of adult daycare, we call it like day habilitation or day supports and things like that. And then instead of home care, they usually call it long-term supports and services and things like that. But yeah, there is a big market, both for the elderly, but also for individuals with disability. And that's a really, really good point.



So this is great. I just thought a very small minor point, Christina. So you and also like NADSA, the organization, you use adult day services as opposed to like adult day care. And I guess one reason might be because we're using terminology like day habilitation or something like that for intellectual and disability, others, but like, is there kind of a reason why folks say adult day services instead of adult day care?



Well, they'd like to get away from using daycare because you think of that as more of a child daycare setting. And so kind of more of a dignity thing. And people, you know, when people say I'm going to a daycare, it's like, it's almost like they're, you know they need care that either, I don't want to say incompetent but it just kind of makes them sound like they need more than services than what they do. Where adult day services



is kind of out there with that like senior center type of terminology where, you know, it makes people feel like, you know, hey, I'm going to a day center where instead of I'm going to a daycare in some places are not even using day center, they might be using adult day health, you know, that as well. That terminology being used. And I mean, you know, we used to, you know, call people and, you know,



at the nursing homes, we always called them residents and now they wanna be called individuals in a lot of places. So it's just a matter of they're to keep changing things. Yeah, for sure. Well, I think that, yeah, I mean, the change is coming because I do think that there's been a lot of looking at the way that elderly and disabled folks are referred to in a way that just is, does kind of



doesn't positively impact their dignity, I guess we'll put it that way, right? So I think that's an important thing. And that's, you know, and actually as the last kind of topic that we cover, and I think it's a biggie is that, you know, just like in any business, you know, if you're like, okay, well, we do, you know, we have this adult day center, we have this adult day health center. It's like, well, what makes you different and what makes you special? And I know that in your practice at, you know, ADS consult,

Differentiating your Day Center


that that's where you spend a lot of time. And, you know, I see you've talked about social versus medical model, but, you know, what are some ways that if somebody's gonna offer a center and offer these services that, you know, what are some of the unique ways and things that they should think about about, you know, how do they wanna make their service different and special? So, you know, it's all gonna come down to your activity programs. Those are the biggest selling points for your center. You know, I mean,



Some people say, I'll do bingo, but you know, like the center I had, if we didn't do bingo once a week, there would have been like mutiny. So you have to go with what the interests are of your center. You know, there's a lot of centers that are very ethnic. So, you know, it might be a Russian based center or a Chinese based center. So they do those activities based on our cultural needs. But if you're a multicultural center, then you're gonna wanna make sure that you include different activities for every...



person that's attending there that's relevant to them. As far as like different programs like fall prevention, again, I can't say enough about it. You could bring Tai Chi programs in, you can bring chair yoga programs in, you can offer those type of programs to the people attending your center, but also to the general public, so that you're getting people into your center.



that may not really know what you're doing. And then they come in for this cheer yoga class. They're like, Oh, wow, this is really nice. I wish I would have known about this when, you know, my mom was here, I wouldn't have put her in assisted living. So it's a great way to market your center. But those people, when they attend your center, they're going to talk to their family, they're going to talk to their case managers, and they're going to say how much they love your center. If they're just going there and sitting around in front of a TV all day,



that is not engaging for them. They can do that at home. So you need to look at those things that you can bring to them that's outside of the services that they can get at home. So hiring a great activities director is very, very important. And that's really what's going to make your center stand out the most. Yeah, fantastic. So your activities are your brand. I love how you just put it in such a nutshell, because that's what it really comes down to, and that's what you need to.



focus on and market. And again, if you are a home care agency that's thinking about adding adult day services of some kind, I mean, you already have a population and also think about those folks that you might have told they're not ready for home care yet, right? So if somebody calls and says, well, my mom, I'm starting to worry about her a little bit, can you send a home care person over to stay with her like twice a week for...



you know, three or four hours. That's not really home care. I mean, that's kind of more like babysitting, you know, or maybe you need a housekeeper or, you know, a little bit of, you know, that kind of thing. But now you can say, well, you know, hey, we have this day center. Mom can come and, you know, she could come two days a week and that sort of thing. And she could, you know, make some friends and then we could observe her in a group. And that might be, you know, sort of a, just another one of those wonderful synergies. All right, so listen, I mean, time flies when we're having fun. We're already,

Wrap-Up and How to Contact Christina


I think we have really the makings of a great episode here and I certainly learned a lot of things. So let me wrap it up by just saying, first of all, a big thanks to Christina Vlosich and I'll give you her contact information. So the business is called ADS Consult, ADS being Adult Day Services Consult. The website is adsconsult.biz and actually Christina can be reached also by email.



But if you go to the website, you'll get it. But it's C. Vlosich. So it's C-V-L-O-S-I-C-H at adsconsult.biz. And I’ll give you the phone number as well. It's 330-719-8044. And so that's how you could learn more from Christina. I have a feeling that we're gonna have Christina back on the podcast. So you'll be learning more too. And we'll definitely try to get some information out about this webinar about


23:48 fall prevention in the day center and these wonderful things. But with that and me being such a rambler, sorry for babbling on, but thank you so much, Christina for a fantastic episode. Thank you for being on your home care heroes and day service stars podcast. Thank you so much. I appreciate it. And if you have any Ohio clients that want to learn about these RFPs, they need to reach out to me because this is going to be happening very quickly. Fantastic.



Thank you, Christina. Bye-bye. Thank you. We'll see you. Bye-bye. Thanks everyone.

Thanks for joining us today on the Home Care Heroes and Day Service Stars podcast, produced by Ankota. You can listen to back episodes by visiting forhomecareheroes.com. That's the number four, then the words homecareheroes.com.

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