An image of a bathroom grab bar.
Why the sector is at a turning point
by Hannah Wolfson

With demand as great as ever for aging in place—and housing costs high—the market is ripe for a surge in the home modification business. HomeCare sat down with Jim Greatorex, vice president of VGM Live at Home, to catch up on what’s new and what’s coming in the world of home access.

HomeCare: Let’s start with a little flashback: In 2016, we ran a story that called home access a new emerging market. Has it emerged? Where is it now?

Greatorex: What has happened is that we’re seeing the medical community now realizing that this is a bigger need than they had been aware of. But they also are looking for our industry to professionalize itself and learn how to work with (them). So that’s what our focus has turned to.

Public awareness has definitely grown; we’re still not a household name that everybody knows about, but there is a lot more known than there was in the past. Companies like Lowe’s coming in and doing a lot of direct marketing has really helped. As we continue to evolve, what we really want to do now—and where we see the future for the most growth—is building a solutions-based home access industry. That’s where we believe there will be a really good opportunity for growth. There’s going to be more investment … in this industry because people are going to see the value in it. And we’re also seeing payers that are a little bit more open to a real benefit for this. They’re not going pay for a whole home access project, but they may offer more robust benefits than they have before.

Right now, 90% of the business that we do is reactive—something has happened, a traumatic health incident of some kind or disease progression or injury. What we’re trying to do is to teach contractors what their role is in this service. They have to be able to work with mostly occupational therapists, who are the ones who are in the home assessing. And what we really need to do with the occupational therapists is to take their training up a notch so that they understand how to do a home accessibility assessment, because most of them are doing just what we call a home safety assessment.

Right now most of the business that folks are getting is through state waiver programs. Veterans Affairs also does a lot, and there’s some workmen’s comp business out there, but the private pay market is growing. It’s digital marketing that gets you in the door—but even then, you’re probably one of three people coming in to give a quote on one particular pain point, while there are probably four others in the home that go unaddressed and that could actually be a higher priority if we had clinical intervention or oversight.

HomeCare: So when you say a solutions-based home access industry, you mean coming in and looking at all the obstacles to aging in place, not just the one primary issue the client is focused on?

Greatorex: Right. It’s doing a full assessment of the home and giving them a comprehensive recommendation of what they’re probably going to need to do to their home in order for them to live there as long as they probably want to. Of course, there are going to be other mitigating factors: Mental health is obviously one, and dementia can make it so people’s home is not the safest place for them. But in a lot of cases, modifying the home so it’s good for the long run is the goal. That’s where we see the industry going.

HomeCare: If you’re not in home access yet, is now a good time to jump into this business?

Greatorex: Yes, it’s still a good time to get in it. Interestingly, for the people we work with who are most successful, it’s their primary business. Seven years ago when I came into this job, our membership list was about 70% home medical equipment (HME) companies who had a revenue stream from home accessibility. It’s completely flipped now: 70% are standalone home access companies, and 30% are businesses who have more than one service that they’re doing—it may be HME or it could actually be a commercial contractor. The other thing is that the people who are really doing well are the ones who are able to handle all the product categories and can show folks different solutions and have them choose the ones that are going to work for them. We need more good people in this industry. It is growing; we are having people come in. It’s common for good businesspeople to be profitable in six months, and some can do it quicker than that. And the investment is not tremendous compared to a lot of businesses. There are a couple of product categories in which you need to have product on hand in order to be competitive—if you’re not stocking stair lifts and ramps, you’re not going to get that business, because that’s stuff that everybody else stocks and the time factor will definitely work against you. But most of the other product you can order on an as-needed basis. We have people who are working out of garages who are very successful, and we have people who have showrooms who are very successful. Most of the transactions happen in a person’s home; showrooms help some people, but others see pictures, they see videos, and they understand the concept.

HomeCare: Is there a primary piece of advice that you have for someone who’s already in the business and looking to grow?

Greatorex: For most of the people that are in this now, the biggest problem they have is keeping field techs. One of the things that we’re working on is building an apprenticeship program for the industry. The thing about our industry is that it isn’t a high-tech construction field—it requires some construction skills, but for the most part you’re not building a modern house. Most apprenticeship programs are four years and lots of classroom work. Ours is two years and it does have classroom work, but it’s very doable. And it will bring the skill set that we need to the industry, and it will help us invest in our employees so that they want to work for us and they’ll have a career path. The other thing that we’re working on that is really needed is that everybody’s certified education courses aren’t really prepping people appropriately for the industry; we have an extensive plan to build that out.

HomeCare: What else are you working on these days?

Greatorex: We’ll be speaking at Medtrade on value-based care. We’d like to influence a new best practice for folks at discharge that are seniors that have certain disease states, traumatic health incidents or injuries. We believe 80% of them will need some type of home modification, and we would like to create a system where they (receive a) home accessibility assessment and a home access company is brought in to bring the recommendations to the client and let them understand the need.

In many cases, when a recommendation comes from the clinical setting, it’s a lot different than when a son and daughter say, “Mom, if you go down those stairs one more time, you’re going to fall.” I hear it all the time: Seniors will do what the doctor says or what their therapist says; when their son or daughter tells them, it is a way different conversation and is accepted much less. So, for senior acceptance and to get our guys in as an invited guest into the home instead of one of three (contractors brought in to provide estimates) to do a stair lift—I think that’s where we need to go. And I think there will be some pilot programs where we could really make a difference.

Hannah Wolfson is editor of HomeCare Media.