Family Home Care Corp., a Spokane home health-care provider, says its transition to a for-profit company from a unit of a nonprofit hospital operator has gone well, and the venture now is adding new services and expects to hire additional employees.


The company employs about 140 people and serves about 200 clients a month, says owner and President Michael Nowling. He declines to disclose companys annual revenue, but says its in the range of $5 million to $8 million.


Nowling bought Family Home Care in 2001 from Empire Health Services, the big Spokane nonprofit that operates Deaconess Medical Center and Valley Hospital & Medical Center. He had come to Spokane in 1990 to serve as the first president of the Heart Institute of Spokane, a nonprofit cardiovascular services and research organization here. He left the Heart Institute to buy Family Home Care, a 30-year old organization that at various times had been a unit of Deaconess and the former St. Lukes Memorial Hospital.


Were very excited by the progress we have made, says Nowling. Were up about 15 percent from last year.


Family Home Care is a physician-referred health-care provider that offers in-home care and rehabilitation to patients who are physically unable to use outpatient services, but are able to recuperate at home. The business has two divisions that are mostly defined by whether or not a certain service is covered by Medicaid, Medicare and private insurers.


Among the services the company provides are nursing; physical, occupational, and speech therapy; and diabetic education and management. It also offers a package of assisted-living services in the private-duty division, such as helping patients take a bath, cook, and ensure that they get their medications.


Recently, the company launched a new service called Baby Steps that provides additional assistance and counseling to expectant and post-partum mothers, Nowling says.


We will cook meals, or do the laundry, so the mom can relax and discover all of the joys of having a child, he says.


Medicaid, Medi-care and private insurers dont cover Baby Steps. The service typically costs $85 for three hours of assistance.


Family Home Care doesnt have any customers for its new program yet, but it believes the service will be popular.


We have seen programs like this implemented elsewhere, Nowling says. Its a unique product in our marketplace.


In the skilled-care division, the company recently started a lymphedema management program. Lymphedema is a condition commonly seen following breast cancer surgery, lymphatic infections, or other trauma. The condition is characterized by swelling of an extremity that can be painful and disfiguring, says Donna Goodwin, Family Home Cares vice president of operations. She says the companys program provides a physical therapist who gives massage treatments, compression, and instruction in the patients home. So far, the company has a handful of clients in the program.


Family Home Care also says it has streamlined and improved its physical therapy for total knee and total hip surgery recovery, says Goodwin.


As for its hiring plans, the company declines to be specific about how many people it ultimately will employ or when, but its hiring now. The company is looking for several nurses, physical therapists, and other caregivers.


Acting as a for-profit


Nowling believes the company is growing because it has taken steps to improve its processes and services.


Our private duty (assisted-living) care is up 80 percent in the last six months, Nowling says. I think its because we raised our expectations and accountability, and we are seeing it pay off.


Those changes were part of a transition to for-profit from nonprofit that has occurred faster than originally predicted, Nowling says.


Were about a year ahead of schedule, he says. We thought it was going to take about four or five years to make the switch.


The switch to for-profit was challenging on several levels, Nowling says. Even determining how many employees worked for the company and how many clients it was servicing was hard, he says.


It was difficult to get a handle on things because of the way everything was structured, Nowling says. We changed the philosophy of management and made sure everything was very accurate.


The company is now more in tune with its revenues and expenditures than it was before, he says.


Being a for-profit business is just different than being a nonprofit, Nowling says. I think there is clarity of focus and youre more aware of all the costs. I used to bang that nonprofit drum proudly for years, saying, We run things just like a for-profit business. But its not the same.


Nowling says that at the time he bought Family Home Care, there was some concern from employees that patient care would suffer as a result of the operation becoming a for-profit concern.


Its the opposite of whats happened, he says. The federal government has quality indicators for home-care providers, and ours have improved every quarter.


Medicare tracks quality measures of home-care providers that receive Medicare reimbursements, and Family Home Care ranks higher than the national and state averages in those measures, says Rod Haynes, a spokesman for the Center for Medicare and Medicaid Services.


The company believes its high scores are proof that its doing things the right way.


We work very hard to get them there, says Goodwin. Its very important to patients and the physicians and other referral services. You couldnt be in business without them.


Family Home Care now tracks its patients more closely than before, says Nowling. Each employee carries a notebook computer and updates case files immediately after visiting a client.


Its a system that builds on an established one, he says. Its more sophisticated, and people back in the office can find out immediately how a patient is doing in real time. It goes back to our emphasis on accountability.


Medicare, Medicaid


Family Home Care is located at 9922 E. Montgomery, in Spokane Valley. About half of its 140 employees work full time, another 25 percent work part time but have regular hours, and the remainder are on call and work when needed, Goodwin says.


The employees range from nurses and physical therapists to nursing assistants and people who help with assisted-living tasks. The companys employees typically have set schedules and go directly to clients homes.


Family Home Care is certified to offer services in both Washington and Idaho, though most of its clients are in Spokane County, says Goodwin.


About half of the care it provides to clients is paid through Medicare, Medicaid and private insurers, though in a small number of cases, usually for assisted-living tasks, patients or patients families pay for the services directly, she says.


The companys clients often have been discharged from a hospital, but require additional nursing or health-care support for an interim period following their release. How long a patient receives care through Family Home Care depends greatly on what care is required, Nowling says. For instance, some patients need only a month of care or therapy following a surgery or ailment, while others require indefinite assistance and increasing levels of therapy as their health deteriorates.


Client age varies as much as the companys range of services, but many clients are senior citizens in their 70s, Goodwin says.


The skilled-care division accounts for about half of the companys revenues and patients. Of that, about 50 percent receive Medicaid or Medicare.


The level of reimbursement from Medicare and Medicare is a constant source of concern for the company, says Nowling.


Its adequate, he says, but its something you have to monitor closely. You get nervous. As long as we manage our business carefully, we will be ok.