Home Access -- The Big Leagues -- HME Business

Business Solutions

Home Access -- The Big Leagues

Home access experts discuss what it takes to go from simple solutions to major remodels and installations.

By Joseph Duffy
May 01, 2013

As a result of competitive bidding, audits and the need to diversify revenue streams, home access has grown into a critical business strategy to find safer sources of income.

How much of an increase, however, depends on many factors, including provider education, experience and partnership development. If you are currently selling grab bars, ramps and miscellaneous safety items, and want to expand your home access operation to include room remodeling and elevator installation, read on. Our experts share their experiences and what you need to make it into the home access big leagues.

A growing market

Many factors are inviting HME providers to expand their home access business. Jerry Keiderling, President, Accessible Home Improvement of America (AHIA), says one way to look at home access’ trending growth is through the sales of accessibility products by quality manufacturers.

“All indicators show that these product lines are showing some very good double digit percentage increases in both product sales and new accounts being set up,” he says. “We’re also seeing a tremendous amount of interest in accessibility throughout the HME industry. All of it is fueled by the continuation of competitive bidding, audits, and the strong desire to diversify revenue streams.

“The trend to move their revenue streams away from traditionally high percentages of Medicare and Medicaid to more diversity with private pay insurance, workers’ compensation, and of course cash, is very strong,” he continues. “Accessibility, home modifications and a strong retail presence are well suited to meet the need for a more stable level of cash flow and growth.”

Along with providers seeking new revenue streams, the aging population, the obesity epidemic — which includes seniors and an alarming number of younger people — and the growing number of bariatric patients all point to a growing home access market with a variety of needs.

“Remember, we are living longer but not necessarily healthier,” Keiderling says. “Projections in the new home construction and remodeling industry for aging in place and independent living for the physically challenged are very strong. This bodes very well for the provider wishing to expand into accessibility. Contractors love to build, but few are willing to offer equipment solutions for those who need it. That’s the advantage of networking with trade people in your area.”

Keiderling calls accessibility a natural progression for any HME provider because much of the clientele already exists within their own patient files, referral sources are often the same, and their current expertise in disease state management, understanding of diagnosis, prognosis, and range of motion give them the upper hand in this market.

Taking the home access business to the next level demands commitment, but If providers are willing to educate and credential their associates, formulate and execute an aggressive marketing plan, and develop their team of professionals, then, Keiderling says, “the sky is the limit.”

Understanding the big leagues

Playing in the home access big leagues boils down to the amount of training and expertise or licensing involved in being able to offer, sell and install home access products. For example, threshold ramps, adaptable door handles, and reachers require only sales training, where as full bath remodels, ceiling lift and powered cabinetry require a much higher level of factory training and certification to offer and install.

Blair Ferguson is president of Beyond Barriers Minneapolis, LLC, founded 22 years ago as a licensed accessibility contractor.

“AHIA’s Certified Environmental Access Consultant (CEAC) certification has designated multiple levels of accessible certifications,” he says. “Levels 1 through 5 have been established to help consumers identify the provider’s skill and knowledge level in home access and establish minimum standards for providers of this service. Most HME/DME companies are a basic level 1 home access provider carrying such items as portable suitcase ramps, bath safety items, and ADLs.”

Ferguson helps to explain what the credentialing levels include:

Level 1 — Threshold and suitcase ramps, basic assistive transfer devices, bath safety, and multiple aids to daily living products.
Level 2 — Designated to a provider who has obtained a CEAC designation and provides products requiring simple installation, such as simple portable ramps with handrails, standing poles, bedrails, portable patient lifts, trapezes, and bath and tub lifts. Included are all products that require operational training and simple technical instructions.
Level 3 — Includes light remodeling requiring CEAC designation and the knowledge and capability to align with applicable local building codes and license requirements. Level 3 providers provide an assessment of need and provision of products and equipment. They are manufacturer trained for more complicated modular ramps, grab bars, and bridge lifts. Also included are modular ramps with platforms and turns, grab bars, and handrails.
Level 4 — Designates CEAC and CAPS certifications to comply with all applicable local building codes and license requirements. Providers will give the client an assessment and have obtained manufacturer training. Level 4 providers offer sales and installation of stair lifts, vertical platform lifts, and ceiling lifts. Also included are roll-in showers, walk-in tubs, vertical/incline platform lifts, and wall- and ceiling-mounted track lifts.
Level 5 — Designates CEAC, CAPS, certified/licensed healthcare professional, licensed contractor or remodeler. Projects at this level are considered quite involved and a team approach is recommended. Level 5 providers comply with any applicable building codes and license requirements along with involving the licensed trades, such as plumbers and electricians. Typical projects would be complete bathroom modifications or renovations, such as roll-in showers, walk-in tubs, widening doors, kitchen modifications, additions and elevators, along with the more advanced previous levels. Also included are wooden ramps and decks, complex bathroom, kitchen and bedroom remodels, power door openers, non-slip flooring, room additions, and indoor elevators.

Ferguson’s company is a level 5.

Staff and Education

According to Keiderling, the need for specialized staff comes with options. Regardless of where providers are in their home access business, staffing levels come down to the choice of W-2 employees, networking with trade people, or sub-contracting with the trades. With that said, he points out that the constant within all staffing needs is to have those with specialized sales and product training and credentials in home assessment and evaluation. These are the individuals, Keiderling says, who can make the right thing happen and boost your sales and image in your market area.

John O’Callaghan is the vice president of home accessibility and caregiver services with Premier HomeCare in Kentucky, a provider of home medical equipment. They also offer high-level home accessibility services.

His company is associated with AHIA, CEAC, CAPS, NAHB and their local homebuilder’s organizations. They also work with workman’s compensation management companies and high-end or complex rehabilitation facilities.

“I believe having relationships with these organizations is important and as with any of these types of organizations, you get out of them what you put in,” says O’Callaghan. “Attend meetings and educational seminars, and reach out to other members. Really understand and be educated on the latest greatest products available.”

O’Callaghan says advanced home access HME providers have specialized employees on staff. Premier HomeCare has a home accessibility manager, who grew up in the homebuilding industry, worked for the family business and then owned his own homebuilding company. Premier HomeCare also hires technicians who have a construction background or specialty trade expertise. They do not employ a licensed plumber or electrician on staff because as O’Callaghan points out, “Those are special trades where we want the best of the best to come into a very prepared work area, do specifically what their expertise calls for, and be as efficient and focused as possible.”

O’Callaghan says that advanced home access providers form partnerships with licensed plumbers; electricians; and tile, drywall and finish carpenters.

“But it is really important that these specialty trade subcontractors understand the business we are in,” he says. “It is not typical contracting. We may have to clear out of the bathroom we are remodeling five times a day because it is the only bathroom the homeowners can access. We do not leave jobs lingering. Most are completed in three days or less. We do not have specialty trade subcontractors show up to the home without us being there, ever. Our goal is to make homeowners and families more comfortable knowing they have a trusted, clean, neat and friendly professional looking out for them.”

“Having traditional trades people, such as plumbers, electricians, carpenters and even masons, available and ready to assist is a must,” adds Keiderling. “All of these trades can be found within your local homebuilders association. A membership within their organization is a great way to meet and discuss business opportunities. Networking and subcontracting are considered the norm in their business model.”

Ferguson says he doesn’t believe anybody should just “dabble” in higherlevel home access and that upper-level home access providers should have the following: CEAC, CAPS, contractor license, EPA lead certification, and a manufacturers certification. They should also be licensed healthcare professionals.

“If HME/DME companies want to get heavily involved with home access at a higher level they should license and insure themselves as a contractor or partner with a knowledgeable and credentialed contractor in their area,” Ferguson says. “ Home access is a true mix of clinical and construction of which very few specialize in. Just hiring a plumber or an electrician to install a product you want to sell may leave you exposed and you may be construed as providing the function of a general contractor.”

Ferguson also points out that construction can be quite involved and complicated and that you are held responsible for the project. “For example,” he says. “If you disturb more than six square feet of a wall with lead base paint on it you are required to follow the EPA (federal) guidelines or face steep fines, not to mention local building codes that need to be known about and followed. What I have also found is this is a difficult field to be proficient and profitable in unless you are doing it full time and have dedicated significant resources to it.”

Regardless of the level you are trying to achieve, Jim Quinly, General Manager of Home Elevators& Accessibility Products, at Harmar, located in Florida, offers, perhaps, what all home access providers should consider as they begin to ramp up their services: “Every state and even municipality can be different in what they require when dealing with home access equipment. Local codes and regulations must be considered and adhered to when selling and installing this equipment. Harmar has a full-time codes administrator on staff that assists dealers on understanding and complying with these requirements.”

All cities, towns, municipalities, counties and states have formalized building codes of their own design, says Keiderling. Although they all follow the national/international set of building and remodeling codes to an extent, most have adopted their own individual versions of what they feel to be proper guidelines that best suit their communities.

“As with any profession, it’s always best to practice only within your level or field of expertise,” says Keiderling. “For much of equipment installation, a general knowledge of local codes will suffice. A visit to your local and county inspectors offices is worth its weight in gold, especially to build that much-needed relationship for the future. But as you enter into any project that will involve remodeling of any kind, then rely on trades people for their knowledge and understanding.”

Funding high-level projects

Home access providers offering high-end, expensive projects will need to deal with customers seeking financing opportunities.

“It is important to know what resources are available and be able to suggest or guide clients to them,” says O’Callaghan. “Many are local organizations managing federal, state and local funds. Some are long-term care insurance, workers compensation and the Veterans Administration. We have found that it is not practical to be an expert in all of these but it is very important to know who the experts are and how and when to point clients in those directions. Other funding comes from typical loans like home equity, credit cards and financing.”

Keiderling says the need for financing can develop with many customers. He suggests that sometimes the home assessment of need can be tailored and the completed plan stretched out over a period of time, meeting the customers’ current needs, with additional products and services added as required in the future. This lets families spread the cost out over time, rather than doing it all at once. Of course, this scenario totally depends on client condition and their immediate and longterm needs.

You know you’ve made it to the big leagues when…

Keiderling provides a final checklist that helps to differentiate between beginning home access providers and those who are advanced in their practice.

Showroom — The serious home access provider will have or develop a showroom of popular accessibility products and room scenarios depicting solutions for bathrooms, bedrooms, kitchen, entries and exits. Along with products, a catalog of before-and-after examples with testimonials is always a good sales tool. Accessibility sales are more a touchy-feely business than traditional HME. The customers like to see what they are buying and try it out to see how it can really be beneficial to them in their daily lives.
Marketing — The key to success. The message and the method of delivering that message are different than traditional HME marketing. With home access being a relatively new market, the audience is largely unaware of what products or services are available to them. The marketing strategy for referral sources is to educate them as to what products and services you can now offer to their clients. They have many cases in need of assistance and many times have had nowhere or no one to turn to for help. As far as the consumer side, the strategy is much more detailed and personalized. Colorful, informative and descriptive literature is widely welcomed and useful. Often in meeting with consumers in your store or in their homes, there will be family members present, so handout information is a must. The other valuable marketing tool for those advancing their business model is local cable TV advertising. Proven to be effective and cost manageable, advertising aimed at the proper age group and aired on the channels for these age groups has been quite successful for many.
Credentialing and education — The advanced accessibility provider has found the value in credentialing their associates in the field of home and environmental access. As with any business that deals directly with the consumer, displaying and promoting a high level of professionalism is valueadded and helps greatly in building that trust level between your company and the consumer.

Basic vs. Advanced Approaches to Home Access	John O’Callaghan, Vice President of Home Accessibility and Caregiver Services, Premier HomeCare, categorizes different home access projects to help providers gauge their level of home access expertise. Here is a breakdown:
Beginner	Advanced
Providing grab bars.	Knowing and having five other options if a simple grab bar will not suffice.
Installing a banister in the hall or down the steps.	Installing angled rails at garage entrances that fold up. Installing custom iron handrails on front steps. Having and showing a variety of hand grips or grab bars for all areas and styles of homes.
Offering portable two-to eight-foot ramps and threshold ramps.	Modular ramp systems 10 feet and larger. Having a modular ramp rental inventory and ability to install. Having and knowing when it might be more practical and economical to suggest a vertical platform lift over a modular ramp.
Providing a handheld shower, grab bar(s) and transfer bench.	Complete and turnkey tub tear out and install of an accessible shower system in three days or less. Includes all options, such as grab bars that clients want, colors to match bathroom, nice trim finish, proper shower curtain and collapsible water retainer, fold down bench, handheld shower on glide bar with pause control and extra long hose and an extra hand held shower holder near the bench seat.
Offering a Hoyer lift.	Offering a variety of different types of lifts, patient turners and transfer devices, slings, overhead lifts, (portable and fixed), and having a rental program.