Aging in Place Opportunities Abound for HME Providers

What do General Motors, Ford, Chrysler, RCA, Texas Instruments, McDonalds, KFC, MasterCard and Visa have in common? Throughout the past 50 years, they have had tremendous success by courting baby boomers and selling products and services directed specifically toward them. Many companies, products and services have been established and developed solely to meet the needs and desires of this population. HME/DME providers can take advantage of the fact that baby boomers are aging and beginning to face other health care issues. They want to continue to live in their homes for as long as possible, if not for the rest of their lives. Why? Because there is no place like home. The need for the products and services that will allow them to stay in their homes is underserved in this marketplace. Taking an interest in meeting the needs of boomers will allow you to diversify your business and become less involved in the downward spiral of reimbursements from Medicare, Medicaid and traditional health insurance. Primarily a cash business, the choice to serve boomers will lead to an increase in profits. And because it is a rapidly growing market, there are many interesting facts to consider. Size of the boomer and senior markets:

• 77 million people were born between 1946 and 1964, which is defined as the baby boom era (U.S. Census).
• The first baby boomer turned 65 years old on January 1, 2011.
• One American turns 60 years old every 7 seconds—that’s more than 12,500 people every day (U.S. Census).
• By 2030, the 65-year and older population will double to about 71.5 million, and by 2050, will grow to 86.7 million people (U.S. Census).
• In 1960, 3,000 people were between 90 and 100 years old. In 1997, this same statistic grew to more than 54,000, and in 2010, more than 1.2 million.
• In 2010 there were 27.3 million people older than 70

Wealth of baby boomers and seniors:

• People ages 50 and older hold $2.4 trillion in annual income, which accounts for 42 percent of all after-tax income (U.S. Consumer Expenditure Survey).
• Adults ages 50 and older own 65 percent of the aggregate net worth of all U.S. households (U.S. Consumer Expenditure Survey).

More than 22 million Americans are currently caring for an older person in their home. As these people continue to look for ways to meet in-home medical and aging needs, they often find the answer in home modification products. Savvy HME/DME companies have begun offering these products and services in a systematic way. You can enter into this market by offering new items on your HME shelves, separated into the following five product levels.

Level One

Level one products require basic to no instruction for assembly, installation and proper use and can be provided easily by customer service or delivery staff at the time of purchase or delivery. A few examples of these products are reachers, shower benches, elevated toilet seats, basic assistive transfer devices, threshold ramps, portable ramps and door handles. These products can vary in price from $10 or less, to several hundred dollars.

Level Two

Products in the second level require the ability to follow relatively simple technical instructions for assembly, installation and proper use. These instructions come with the products, and customer service or delivery staff can also review these with the customer at the time of purchase or delivery. A few examples of these products are stand poles, bed rails, bath lifts, over-bed trapeze, portable ramps with handrails and portable patient lifts. These products can vary in price from $50 to $3,000 or more.

Level Three

Slightly more complicated, level three products require specific training with respect to assembly, installation and proper use. This training is usually provided to staff at your location by the product manufacturer’s representative. A prime example of a level three product would be grab bars. While grab bars are a relatively simple product, proper installation is extremely important. The personnel installing the grab bar must have a strong understanding of the proper procedure and optimal location to install the grab bar. A few other examples of level three products are: hand rails, bridge lifts, and modular ramps and platforms. Installation charges included with these products can vary in price from $100 to several thousand dollars.

Level Four

Level four products require specific and detailed training, usually off-site and quite frequently at the product manufacturer’s training facility. In most cases, a proficiency exam or manufacturer certification is required. In some instances, a state, county (parish) or community permit or license may be required, and the provider may have to be bonded or show proof of extensive liability insurance coverage. A few examples of level four products are stair lifts (stair glides), vertical or incline platform lifts, ceiling or wall-mounted lifts, walk-in tubs and roll-in showers. Installation charges included with these products can range from $3,000 to more than $15,000.

Passport Vertical Platform Lift with gate. 
Photo courtesy of EZ-ACCESS.

Level Five

Level five includes products as well as projects, many of which frequently require a license as a contractor, builder, remodeler, electrician, plumber or other specialized service. At this level, many companies use the term project or job instead of product. At level five, it is often necessary to meet building code specifications, and in many cases, a building permit is required. This varies tremendously by state, county (parish) and individual community. A few examples of level five products or projects are: wooden ramps/deck, complex bathroom renovations, most kitchen renovations and modifications, indoor elevators, widening doorways and hallways, and accessible room additions. These products or services can vary greatly in price from less than $500 to $50,000 or more. Generally, the price increases as the level of products and services increases. The complexity of the products and services in levels four and five demand a high level of expertise in evaluating individual circumstances and making the appropriate recommendations. Installations or modifications can be complex as well. Environmental access (home modification) contractors are overwhelmingly faced with issues pertaining to the Americans with Disabilities Act—more often than any other legislation. Many contractors refer to the process of meeting the ADA laws as “Universal Design.” This is because the ADA is the broadest and most encompassing legislation that directly affects public construction at the local, regional, state and federal levels. It is important to remember that the ADA only governs public accommodations and places of employment and has no merit in residential housing, except that more likely than not, the environmental access specialist will be asked by the payer and even the building inspector if his or her design recommendations meet the ADA requirements. Thus, it is vital to understand the ADA in order to argue its legal requirements and its lack of application in the residential market. I believe that beginning with ADA laws (Universal Design) is a strong starting point with respect to private residences, and more specifically, the “Four A’s of Appropriate Design.” They were brought into existence for the overall benefit it would provide in public places. They allow a much larger portion of the population to freely use and enjoy public places and a proposed guideline to be used in private residences. Accessible Design is the attempt to use and modify Universal Design to meet a specific person’s needs. Accessible Design looks in depth at an individual’s specific issues and needs. It is a very good starting point when you are looking at home accessibility remodeling, but you may find it to be difficult or even impossible to utilize because of the existing home’s construction, the cost limitations of the remodeling project or the appearance of the home after the modifications are made. Adaptable Design is where Accessible Design and the limitations of the existing home intersect. You do not want to hurt or destroy the structural integrity of the existing home while meeting Accessible Design guidelines. You have to come up with adaptable solutions that may sacrifice a little in one aspect (generally you vary away from the Accessible Design guidelines) but still accomplish most of the benefit for your client. You are now matching up the needs of your client with the limitations of the existing home. The next challenge is the cost. Affordable Design is where the rubber meets the road. After you have developed your Adaptable Design, no parties involved can proceed with the project if there are not enough funds to pay for it. You need to have a good understanding of the financial situation of your client with respect to what is affordable and/or what they may be willing to pay to finish the project to completion. There may be circumstances in which the client is unwilling to pay even though it may appear to be quite affordable. One of the reasons for a client’s hesitancy may be a fear of what the home will look like after the project is completed. The appearance of a person’s home usually says a lot about them. They may not want the redesign to appear that it has been altered for the handicapped, or they may want to make sure the modifications match well with the rest of the home, so Aesthetic Design (the attractiveness of the finished project) becomes a very important aspect of the client’s decision making process. The combination of the 4 A’s comprises appropriate design. And while the four A’s may not come into play in all potential projects—and some may be more important than others on occasion—it is vital that you address each to be sure that none of them becomes a point of frustration in the client’s decision-making process. When all of the laws of Universal Design are taken into consideration, it is much easier to find the appropriate design for your customer. Opportunities in the home modification marketplace are abundant. You just have to develop a plan to move forward. Some companies choose to gradually progress through all five levels, while others choose to specialize in only one or two levels. It is important for you to design and implement an individual plan of success for your business.