Starting Accord two months before a global pandemic hit was either the best time or the worst time to launch a personal care company with a unique subset in complex clinical care. But the Marietta, GA-based company is navigating through the pandemic, made its first acquisition and is eyeing an expansion beyond the East Coast.
Nightingale began as a combination of three companies: NY-based Allegiant Home Care and GA-based A Hand to Hold provide in-home personal care services. GA-based Accord Services provides specialized in-home care for people suffering from strokes, spinal cord and traumatic brain injuries.
Leading the company is Brandon Ballew, a former executive at Kindred at Home and a 20-year veteran of the home care industry. McKnight’s Home Care Daily talked to Ballew about the challenges of starting a new company during a pandemic and guiding it through an evolving industry.
McKnight’s Home Care Daily: What was it like launching a new company, and two months later a global pandemic hits?
Brandon Ballew: On the positive side, it emphasized the value that home care can bring. We obviously saw COVID having a massive impact on skilled nursing facilities and hospitals. It allowed people to get back into their homes, stay in their homes with qualified care. It continues to push a lot of the market dynamics and the healthcare system towards the home. I’m a big believer that we can keep people in their homes — where they want to be — and still have great clinical outcomes. But the negative of COVID is it really stressed the healthcare system, including PPE [personal protective equipment], finding the right equipment to get to our caregivers out there. We had to do a lot of training and education for our caregivers. We had to stay very close to the CDC on guidelines. Then, the caregiver shortage has just been accelerated which has been extremely difficult.
McKnight’s Home Care Daily: You have a specialty in treating people at home with very serious injuries. How important is this in your ability to differentiate yourself from other providers?
Brandon Ballew: Accord Services was started by a nurse who worked at the Shepherd Center, which is a large rehab hospital in Atlanta that does great work. We found that you get these folks up to a certain level of their potential and they leave the facility and go back home, but they are still going to need care. She really developed a lot of great training protocols where you could get a nonclinical person to be in a quadraplegic or paraplegic’s home taking care of them the rest of their lives. You can take that and there is some application into the traditional home care model. The care may be less clinical in nature, but those folks are tending to have clinical needs.
McKnight’s Home Care Daily: You straddle two different segments of the industry. Can agencies survive today simply focusing on one thing, such as home care or home healthcare?
Brandon Ballew: I think you can survive, but I think it’s going to become more and more difficult. You really do have to partner. There are uniquenesses to each business and they do operate differently. You have to be careful not to become an expert in everything, but you know how your piece fits into the overall care in the home. That is where I think we’ll do a great job understanding that. We are having more and more conversations with other groups and around physicians. Telemedicine is also finally getting its due. We have to know how each one of our groups can work together and I think that will take a more sophisticated operator who is used to working and speaking those languages in order to get the outcomes for the client or patients that they need.
McKnight’s Home Care Daily: You spent much of your career at Kindred at Home, which was recently acquired by Humana. How do you think Humana might change the game for Kindred and the industry?
Brandon Ballew: I don’t know that I would speak specifically on Humana’s goals. What I do believe is the trend in our industry will be Medicare Advantage plans now evaluating in-home care. They obviously are taking care of a very vulnerable population of the elderly and need to be able to find out what services can help them with their benefits without them going back to a facility. That is the goal of our healthcare system, including the consumer. If a consumer can be at home and doesn’t have to go to a facility, Medicare Advantage has some flexibility in the rules and what kinds of services they can offer.
McKnight’s Home Care Daily: Earlier, you touched on staffing. How big of a challenge is recruiting and retaining staff today?
Brandon Ballew: I have been in home care for over 20 years and this is about as tight as I’ve seen the labor market. We are committed to a couple of things. We are committed to growing our employees and giving them a great home. I think caregivers have been marginalized in the past by other companies. We want to increase benefits, we want to increase paid time off (PTO) and help these people earn a living. We at Nightingale are investing in those employees who want to be with a company and value what they do. We’re focusing on wages, continuing education, benefits, PTO, health insurance, long-term disability — whatever it is we can do to grow their careers. I’m a big believer in helping those folks get continuing education. We are looking at partnerships with schools. If a CNA wants to be an LPN or an RN or even an M.D., I’d love to have that person work for us for all of their career or at least parts of their career.
McKnight’s Home Care Daily: You made your first acquisition a couple of months ago — Just For You Personal Support Services. You’re now in six Eastern states. What are your expansion plans?
Brandon Ballew: I do believe size and scale make a difference in our healthcare services. When I started 20 years ago in home care and hospice, it was highly fragmented and very difficult for individual practitioners to keep up with the regulation changes, as well as the market dynamics of the baby boomer growing older. We will continue to be acquisitive, we will probably continue to fill out the East Coast and then start moving West.