Aging in Place
UNO grads are changing the way we care for our parents and grandparents
By Greg Kozol
Jerod Evanich cherishes the memories of summers spent fishing, camping and golfing with his grandparents.
“We spent so much time with them every summer,” he says. “We went clear across the Midwest on different adventures. They were instrumental in my success as a human being and as a professional.”
Evanich grew up, went to UNO and graduated with a triple major in business administration, small business management and real estate/land use economics. He went into real estate and found success selling houses, even in the midst of a financial crash that led to one of the worst housing markets in U.S. history.
Everything was going as planned. Yet something nagged at him.
Evanich had always helped with mowing, putting up Christmas decorations and doing other chores for his grandparents. He discovered that the demands of a burgeoning career made it harder to be a devoted grandchild.
“It took me away from being the grandkid I once was,” he says. “I wasn’t OK with that.”
Evanich discussed his concerns with a friend, UNL graduate Dustin Distefano. Together, they hatched a plan to launch A Place At Home, an agency that provides housekeeping, meal preparation and other non-medical services to help seniors remain independent for as long as possible.
“It didn’t take long to realize it is an extremely valuable service,” says Evanich, who also has an executive MBA from UNO.
It’s no secret that the population in the United States — and Nebraska — is continuing to age. By 2030, an estimated 80 million Americans will be 65 and older. But nursing home usage remains flat because today’s aging baby boomers insist on remaining independent and at home for as long as possible.
Christopher Kelly, an associate professor of gerontology at UNO, calls it “aging in place.”
“We are seeing a demand for greater consumer choice,” Kelly says. “That has created an opening for services that seniors can get in the home.”
UNO graduates like Evanich are finding that home care doesn’t just make a difference in the lives of senior citizens. It’s good business.
Since starting A Place At Home in 2012, Evanich and Distefano have expanded into 11 locations serving around 350 clients. In addition to Omaha, franchise locations are in Iowa, Colorado, California, Oregon, Arizona, Texas, Michigan, Arkansas, Florida and Arizona.
“The industry is only going to grow,” Evanich says.
Preparing for ‘The Gray Tsunami’
More than two decades ago, UNO graduate Lori Hogan found herself at the forefront of this trend of helping seniors age at home. After receiving a psychology degree, she and her husband, Paul, started Home Instead Senior Care in 1994.
The couple looked into various business ventures and decided on senior care after anticipating a “gray tsunami.” At the time, it was a risky move for Hogan to start a new business in a new industry. She had three young children and a fourth on the way.
“Talk about a motivator to get the business going,” she says.
It paid off. From its global headquarters at 132nd and Dodge Streets, Home Instead Senior Care grew to include 1,200 franchises worldwide, with operations in 14 countries. The company employs more than 80,000 caregivers and provides 80 million hours of care annually to its elderly clients.
The Hogans seek to be more than caregivers and successful business leaders. They are advocates for seniors in the United States and other countries, through involvement with Alzheimer’s associations, the World Economic Forum and other groups that drive policy.
“We want to help seniors age successfully and change the face of aging,” Lori Hogan says. “I see Home Instead Senior Care being a go-to resource in the future.”
The idea for Home Instead Senior Care sprang from personal experience when Paul’s grandmother needed care as she began to age. It became an all-hands-on-deck effort for an extended family to help Grandma Manhart with housekeeping, groceries, beauty appointments and other needs so she could live independently, instead of in a nursing home.
Grandma Manhart lived to celebrate her 100th birthday.
Hogan began to wonder how families without such a large support network were able to do it. “How are they managing?” she says. “We wanted to do for others what we were able to do for Grandma Manhart. We know you don’t have to be a nurse to open a can of soup or push
a vacuum.”
The Business of Trust
To provide services like meal preparation, medication reminders, trips to doctor’s office, light housekeeping and personal care, these caregivers don’t necessarily need a nursing degree. They do need compassion and patience, in addition to extensive training.
“A lot of agencies will go in and have 15 minutes to get the tasks done,” Hogan says. “It takes so much longer than 15 minutes to get them bathed and dressed and have their breakfast. You have to build their trust.”
For Evanich, getting started in the business wasn’t a simple task. He and Distefano knew little about the health care industry and found themselves trying to build connections with clients who were decades older than them.
That brief career in real estate proved helpful.
“You have to be able to talk to people, in their homes, face-to-face, and create a relationship quickly and gain people’s trust,” Evanich says. “When I was selling real estate. I was selling people’s homes who were two or three times older than me. I was this young 20s guy coming into their house and telling them the best way to make money or get out of a foreclosure situation.”
In a competitive industry that’s seeing new startups and mergers, Evanich tries to find a niche with services like medication management and assistance in navigating the complexities of the health care system.
Hogan says the industry has changed somewhat, with a higher level of acuity for some patients. She says Home Instead Senior Care always focused on non-medical services but has expanded into areas like Alzheimer’s care support and the administration of some medications.
Full Buckets
It’s all part of the same goal of keeping seniors in the home for as long as possible. In addition to improving quality of life, the home-care model often proves to be more affordable than a nursing home or assisted-living facility, while enhancing quality of life.
“It does help all of us in the long run,” Kelly says. “They are less likely to suffer social isolation. They are better connected to families. They have more autonomy and life satisfaction.”
Caregivers also ease the burden on family members who are dealing with end-of-life issues. That’s exactly what happened for Colleen Naughton when A Place At Home caregivers were brought in as Naughton’s mother suffered from Alzheimer’s disease.
“Mom loved them like they were one of us,” says Naughton, who has an executive MBA from UNO. “However, the gift they gave us was peace of mind that mom was cared for as she deserved. We wanted our time with mom to not be focused on daily hygiene but on conversations about her memories she still shared.”
It’s that kind of impact, more than the international growth and number of franchises, that provides a sense of meaning for those who enter this burgeoning industry.
“I can’t imagine doing anything else,” Hogan says. “Our buckets are so full. I love watching the relationship with the caregiver and the family. They become almost like family.”
For Evanich, the benefits of his career choice will hit home after a long winter, when the weather warms and his grandfather calls. Business has taken off, but he can find time for grandparents now.
“He told me you better have your clubs ready,” he says. “We’ll be golfing this spring. I guarantee we’ll be out hitting the sticks. He’s still teaching me to this day.”
Under One Roof
For some families, taking care of an older parent means having them move in
For numerous Americans, the best option for taking care of older parents is joining them under one roof.
In 2018, a Pew Research analysis of U.S. Census data found that 64 million people — or 20% of the population — lived in a multi-generational home, defined as being composed of two adult generations plus children younger than 25.
Christopher Kelly, associate professor of gerontology at UNO, says the trend appears to be strongest among immigrant communities.
“That is a dynamic that still exists, multi-generational families in the same household,” he says.
Most likely to do so, the Pew Research study suggests, are Latino and Asian communities. Driving that are economic pressures and cultures that hold the elderly in high status.
That said, even those families are seeing change. Kelly says immigrant communities have a tendency to transition to a two-generation household over time, especially as young people disperse throughout the country in search of employment or educational opportunities.
“We find as families immigrate to the U.S. and are two or three or more generations removed, the trends tend to mirror the rest of the population,” he says.
In Nebraska, according to 2010 Census data, there were more than 13,000 multi-generational households. At 3% of total households, that’s lower than the number reported in a Pew Research national study that came a few years later.
Whatever the actual number, Kelly says, it’s important to note that taking care of grandparents can be an overwhelming task, even for well-meaning caregivers. That’s especially the case as people live longer and health needs increase.
“I think when you factor that the younger generations have multiple responsibilities, education and employment of their own, when care for an elder becomes a 24/7 situation, I think there is that greater potential for caregiver burnout and that risk for mistreatment and neglect,” he says.
Kelly says it’s important for adult caregivers to know they’re not on an island when taking care of parents or another elderly person.
As the population ages, more and more resources will become available for both skilled nursing in the home and for assistance with tasks like light housework. This can ease the burden, Kelly says.
“The trend is in moving from informal to formal services,” he says. “The care is provided by somebody outside the home.”
With such changes, Kelly stresses the importance of UNO’s department of Gerontology as one of those resources.
“We’re hoping to help train the decision-makers in the field of aging,” Kelly says, “the people who will be managers, administrators and leaders in the for-profit and nonprofit sectors. I would like to put us out there as a resource for individuals who have questions about this and other issues.”