MIDDLEBURY — Larson and Amy Manifold started learning about home care while seeking care for his stepfather, Tom Tinkel, who had been diagnosed with Alzheimer's disease.
He still had enough cognitive ability to live at home, rather than a nursing home, but he needed daily care. Ultimately they found a home care provider they were satisfied with, but they also realized there were some things that could have been done better.
When they moved from Carmel to Amy's hometown of Middlebury to be closer to extended family as they began raising children, they had learned two things: Non-medical home care can greatly benefit the elderly and people with disabilities, and there are improvements they could bring to the service if they started one of their own.
Amy was a licensed nurse, while Larson still works full-time in sales and marketing for a health care company. Wanting "to do something that made a difference in people's lives," the couple in January 2013 launched Firefly Home Care, 100 S. Main St. They employ 20 caregivers and will continue hiring more as their clientele grows. For $20 an hour, a Firefly caregiver will come into the home and provide help with bathing, dressing, remembering to take medicines, preparing meals, cleaning the house and managing bills.
As baby boomers age and live longer, the Manifolds aren't the only ones drawn to non-medical home care, sometimes called "private duty." The number of businesses that have obtained Personal Services Agency licenses from the Indiana State Department of Health has grown from 291 in 2010 to 400 now, a 37 percent increase in three years, said Ken Severson, health department spokesman.
Health care reform is also playing a role, said Evan Reinhardt, executive director of the Indiana Association for Home and Hospice Care.
"The lay of the land in health care at the moment is you have to do more with less," Reinhardt said. "The Affordable Care Act and the general trend in health care is getting people out of facilities because that's where it's most expensive to take care of people. If you're in a situation where a family member can't prepare meals or needs help dressing themselves or bathing, this kind of agency is the easiest place to go."
Reinhardt has been lobbying the General Assembly this session for a bill that would let non-medical home care providers administer controlled substances in addition to the other medications they already can administer.
Staffing has proven the biggest challenge to launching the business, Larson said. It's not only difficult to know how many caregivers to hire — you want to be ready for new clients but you must have enough clients to keep caregivers busy — but you must rigorously screen their backgrounds.
"Trust is a huge thing," Larson said. "We're sending these people into other people's homes. My ultimate litmus test for hiring is would I send this person into my mom or dad's house for home care?"
Because it's such a service-oriented model, start-up capital costs are low, making it easier for people like the Manifolds who value autonomy to launch a privately owned agency. But Kelly Linhart chose the franchise route, recently starting a Visiting Angels franchise in Wakarusa.
Linhart, who holds a bachelor's degree in psychology, has worked with the Indiana Family and Social Services Administration's food stamps program, been a substitute teacher and special education assistant, an office manager for an electric company, and a longtime volunteer working with adolescents.
"This was something totally new for me but caring for people is what I do, so it wasn't that big of a jump for me working with seniors," Linhart said.
She had been impressed with Visiting Angels after seeing the Fort Wayne franchise run by her friends Dave Clendenen and Jim Burns, who are partners with her. She said she was drawn to the accountability that the franchise system requires.
"It gives me peace of mind knowing that if an issue comes up, I have other people I can call on for advice and guidance," Linhart said.
She took on her first clients in January and has hired 10 caregivers. She agreed that staffing can be difficult at first.
"You're looking for someone who has experience but also is caring," Linhart said. "It isn't just a job for them. You're looking for honesty, integrity and can they be available on an as-needed basis? Private duty caregivers understand that it kind of has to be an on-call situation due to the nature of the work."
Because most caregivers don't want to drive more than 15 miles to an appointment, she must also consider where the caregiver applicant lives so that she can cover the whole Elkhart metro area.
"It's kind of an interesting dance to make everybody happy," she said.