Company notes emphasis on long-term care insurance policy reimbursements
by Kristin Easterling
September 1, 2017

Sandy Kursban founded Family & Nursing Care in 1968, when the idea of in-home care was relatively new. She had a close relationship with her grandparents growing up, which inspired her to dedicate her life to promoting the well-being of aging adults. This vision led to the creation of a company that today gives seniors the option to age in place with the support of experienced caregivers, including certified nursing assistants, certified medication technicians, registered nurses and licensed practical nurses. In 2018, the company will celebrate its 50th anniversary.

Since the founding of Family & Nursing Care (FNC), Sandy Kursban's children, Neal and Mindy, have joined the executive team as president and corporate counsel, respectively. The growing aging population, coupled with the company’s initial vision and mission, have combined to produce unprecedented and strategic growth. Today, the private duty homecare company serves the greater Washington, D.C., area and helps older adults age on their own terms.

What is the biggest challenge of transitioning the business to your children?
"My first and most important goal is making sure there is harmony and love in the family. The second is that my children have the experience and training to take over so that the business thrives and is managed successfully. Prior to transitioning the business, I engaged the services of a family business consultant to work with us proactively to address as many potential challenges as possible. We certainly couldn’t anticipate everything that would come up, but, when something we had previously discussed did, we were able to refer back to our partnership charter and memorandum of understanding to remind us of our agreement. This was very helpful in achieving both of my goals." 
—Sandy Kursban, Founder of Family & Nursing Care

“The homecare industry has evolved since Sandy founded the company nearly 50 years ago,” says president Neal Kursban. “Back then, people either moved in with family members, or they went into a ‘convalescent home,’ the term used many years ago. Women then began working outside the home in greater numbers, leaving fewer family members to fill the traditional caregiver role.”

Finding the Right Match

These days, myriad newcomers are entering the homecare market every day. After nearly 50 years, what does FNC do to stand out?

Kursban shares that the company built an infrastructure around having a point person for family members to get in touch with about their loved one’s care—a client services manager, who acts as a liaison between the caregiver, client, family and any professionals involved in the client’s care. Kursban also notes that because of the company’s longevity, caregivers have accumulated thousands of hours of care and experience with clients.

“We regularly receive unsolicited letters and phone calls from our clients sharing glowing feedback about their homecare experiences, showing us that we are meeting one of our guiding principles to exceed our clients’ expectations,” Kursban says.

Homecare companies try to match their caregivers and clients appropriately. Placing a caregiver into a home only to find that there is a bad fit, based on need or personality, can be a disaster. FNC strives for that “right match.”

“The right caregiver with the right client at the right time,” Kursban says. “Clients need caregivers with different personalities. Some clients need a caregiver who is assertive, others need a caregiver who can converse about current events, and some want a caregiver who knows all about sports.” It’s also important that the company match a caregiver who has the skills the client needs. For example, if a client needs a Hoyer lift in order to get out of bed, the caregiver should have experience using this device.

Designing Two Models of Care

Family & Nursing Care offers two models of care. The options allow families to choose from an independent contractor model of care, which offers a lower price point, or an agency-directed model where the caregivers are employees of the company. Under both models, clients receive high-quality care from screened and certified caregivers.

Under the Family & Nursing Care Classic model, caregivers are independent contractors. They have extensive training in a variety of care specialties, including Alzheimer’s, Parkinson’s, dementia care, hospice and palliative care, heart disease and diabetes, among others. Caregivers provide support with tasks including personal care; daily activities such as bathing, dressing, toileting, continence, transferring and feeding; medication reminders; meal preparation; light housekeeping and laundry and companionship.

Under the Family & Nursing Care Select model, caregivers are available to provide the same types of care as with the Classic; however, they are FNC employees with access to benefits such as health insurance and 401(k) plans. Select clients also begin care with an assessment by a registered nurse (RN), who creates a plan of care for the caregivers to follow and who supports the family throughout the care process. The RN also provides ongoing caregiver training and supervision. FNC Select also employs certified medication technicians (CMTs), licensed practical nurses (LPNs) and RNs.

Referring or providing caregivers who are prepared to tackle the challenges of homecare is important to FNC and the families the company serves. “We have strict requirements for caregivers. Last year, only the top 10 percent of applicants made the cut,” says Kursban.

Hiring and Training

Each applicant must, among other requirements, be licensed as a certified nursing assistant (CNA), pass a computer competency exam, criminal background check, be CPR-certified and have a minimum of two years of hands-on experience within the last three years.

Under current laws, FNC is unable to train the independent contractors under the Classic model, though the caregivers can and most often do pursue training on their own. Kursban says that caregivers on the Classic registry not only come onto the registry with a minimum of two years’ experience (and usually more), but also get real-world, on-the-job training while working with clients referred by FNC.

For its Select employee caregivers, FNC has partnered with Relias Learning for the company’s online training and testing in areas such as customer service, HIPAA, bloodborne pathogens, lift and transfer devices, dementia and Alzheimer’s care, Parkinson’s disease and more. Select also offers in-house trainings to re-certify CMTs and to increase CNAs’ credentials to include CMT certification.

Recognizing the trend in the increased use of long-term care insurance policies (LTCI) to pay for homecare services, FNC specializes in getting LTCI reimbursements, Kursban says. One of their biggest differentiators is having a full-time long-term care insurance manager, who is an in-house expert on everything LTCI and a staunch client advocate who fights with determination for proper coverage and reimbursement.

“We strategically assess each client’s LTCI policy to ensure that each and every client is reaping their policy benefits to the fullest extent, allowing family members to concentrate on their loved ones,” Kursban says. FNC also bills and receives reimbursement directly from the LTCI companies for Select clients.

Adopting Technology

Many homecare companies are building technology platforms to replace the interaction between the company and family members, but FNC is quite intentionally “old school,” Kursban says, and keeps the personal interaction between its office staff, clients and their family members a priority.

FNC is not technology-averse, Kursban says. The company moved from a paper-based record keeping system to an electronic system, which Kursban says has significantly improved operational efficiency. In weekly emails, family members have access to view schedules and tasks completed. These tech tools provide convenience for clients and their families where it is needed, but they don’t replace the personal touch of the human point of contact (the client services manager).

Giving Back

Throughout its 50-year history, Family & Nursing Care has concentrated on giving back to the community that helped build the business. This giving spirit was formalized in 2008, when founder Sandy Kursban established the Family & Nursing Care Foundation after passing the presidency of the company to her son, Neal.

The Family & Nursing Care Foundation supports three local nonprofit organizations: Home Care Partners, the Community Ministries of Rockville’s Elderly Ministries program, and the Jewish Social Service Agency’s (JSSA) program that provides care to at-risk, aging Holocaust survivors. All three provide homecare and coordinate resources for aging adults. Support of these organizations has provided more than 6,200 hours of care to aging adults in need. The Foundation is a fund of the Community Foundation in Montgomery County, Maryland.

A portion of FNC’s profits go to the Family & Nursing Care Foundation, which also receives individual donations. Sandy herself matches every donation dollar-for-dollar. The Foundation also provides scholarship funds to Montgomery College, a local community college, for candidates in Certified Nursing Assistant programs. The goal is to help increase the number of homecare workers to bridge the gap between the need for care and the availability of qualified people to provide that care.

For an organization approaching its 50th year, Family & Nursing Care is not slowing down anytime soon, Kursban says. Plans for next year’s anniversary are still under wraps, but word is they are big. Even with the constantly increasing competition in the homecare market, the customer-first model that has served FNC for the past half-century will carry the company into the next.

Read HomeCare's Q&A with Neal Kursban, here.