Provider Profile: Nexus Homecare, Salem, VA

For Tammy, the road to building a thriving home care agency began with another road – many of them, in fact.

“I had been a tractor trailer driver for 11 years,” said Tammy, owner and founder of Nexus Home Care of Salem, Virginia. “When the company I worked for announced they would be shutting down our department in 2009, I was told I would be losing my job.”

Where some might be discouraged, Tammy, a self-starter, saw opportunity. “At the time, I'd always wanted to do something else, but I wasn't really sure what I wanted to do,” she said.

What she did know was that it was time to be at home more with her teenage daughters. So Tammy started a business running personal errands called Roanoke Valley Concierge. “I like to tell people we were DoorDash before there was a DoorDash,” she said.

Tammy quickly noticed something about the customers she was getting. “Out of the clients that I had initially, only one was not a senior citizen. It was nearly all senior citizens that needed my help.”

These older adults also had needs beyond getting errands done. “They would ask for help with incontinent care or other personal care needs,” Tammy said.

So Tammy obtained licensing from the Virginia Department of Health and changed the name of her business to Nexus Home Care. She hired personal care assistants and caregivers, nine employees initially.

Growth occurred at a steady pace. “I was able to be very competitive with my rates versus a franchise,” said Tammy. “And I found that a lot of people were happy to have someone that was small and locally owned and operated.”

That was 14 years ago. Today, Nexus employs nearly 70 people and serves about 50 clients at any one time. Services have expanded to include transportation, companionship, personal care, end of life care, and dementia care. Tammy attributes her agency’s growth partly to marketing but notes that historically, Nexus has grown organically through referrals. “Word of mouth is how we get most of our business,” she said.

What has prompted families to recommend Nexus Home Care to others? The agency’s model for providing quality care has all the hallmarks of a person-centered approach: focusing on the client as a unique individual, partnering with client and family, and continued training for staff, including caregiver training for Alzheimer’s disease and other forms of dementia. If the numbers are any indication, that approach appears to have earned Nexus a loyal following.

One key to providing quality home care is making sure caregivers can appreciate how a client’s life story and health condition may affect their behavior, Tammy said. She calls this person-centered approach “finding their why.” It’s a critical strategy for Nexus, especially since clients with dementia account for more than half of the agency’s business.

“Finding the why for these clients is a big deal,” said Tammy. “Because a lot of times if you have a patient who is having an emotional issue, if you can find out why they’re having it, then you can offset that. This keeps them calm and in a much better state as well. So far, that's worked very well for us."

Finding a client’s why can involve something simple, like getting to know their family members and how everyone relates, said Tammy. Or it can be as complex as understanding what in a client’s past may be driving their behaviors. 

She recalls a story she heard years ago from an administrator in a facility. “There was a patient in that facility who, every day at three o'clock on the dot, would go to an open picture window in the front office and have an outburst,” said Tammy. “She seemed to want to go outside very badly.”

The facility staff couldn’t determine how to stop the woman’s distress and ended up medicating her while they tried to learn why it was happening.

The administrator decided to call the woman's daughter. “Does three o'clock have any significance to you in being outside?” she asked the daughter. “Because your mother is having these behaviors every day at three o'clock."

Yes, the daughter replied. She said her mother used to get her grandchildren off the bus at three o'clock every day on a busy road, and that she would panic if she was running late, because she was always worried the children were going to get hit by a car.

So instead of medicating the woman or making her more upset by trying to pull her away from the window, the administrator instructed her staff to close the window and pull the curtains every day from 2:30 to 4 pm.

“It worked,” said Tammy. The woman stopped having those episodes. “Sometimes there isn't a clear and present why,” she said. “But a lot of times, if you just take a moment and try and get some background information, you can learn how to address the issue.”

Another important tenet of person-centered care is involving the client and their care circle in creating a custom care plan, which is standard procedure for Nexus. However, Nexus will often go further to help the family anticipate the financial impact of care, Tammy said, noting that for most clients, home care is a long-term prospect that will incur higher costs over time.

“We always say, let's sit down and come up with a care plan that can help you keep your costs down and save your money until you really, really need it more on a long-term basis,” she said.

She recalled recently meeting with a man’s family to create his care plan. Based on Nexus’s initial assessment, he needed only four hours of care a week. Other companies had told the family he would need 20 hours.

“Eventually, he will need 24/7 care,” Tammy said. “But right now he doesn't.”

Helping families plan for the long term in this way is the right thing to do, Tammy said, for families and for her agency. “I tell them, save your money, so that you can utilize it for care later on when you absolutely need more of our services.” 

It’s one way Nexus is responding to one of the major challenges it faces today: clients’ ability to pay for home care. “I think a lot of the challenges we face today are financial,” Tammy said. “Our rates have almost doubled over 14 years. We're seeing more and more clients having to move into facilities where they're not getting that one-on-one care that they wanted because they can't afford to stay home.” Partnering with families to personalize care plans that provide just the right level of care is one way to try to mitigate that, she said.

Nexus also partners with its caregivers to ensure they have the skills and support they need to provide quality care for even the most complex situations. All Nexus caregivers undergo monthly training using self-paced training modules, said Tammy, but that’s just the beginning.

“We also offer our caregivers Alzheimer's and dementia training because knowing how to handle a combative person or a person who is having an emotional outburst or moments of anxiety is critical,” said Tammy. “Knowing what to do and what time of day to watch for those behaviors really makes things easier for the client and the caregiver.”

Helping caregivers be successful is an ongoing process, Tammy said. She cited a recent example in which a caregiver received additional dementia care training because her client, who had been easygoing, was growing more argumentative, and the caregiver was correcting her, which in dementia can aggravate the situation.

Subsequent training helped the caregiver understand how going along with the client – staying in their reality – can help alleviate tense situations.

“I learned years ago that I needed to be able to help my employees understand how to navigate those situations and keep the patient calm,” Tammy said. 

Also significant in that example is how the Nexus team gave both the family and the caregiver a voice in how to proceed.

“We had a care plan meeting with the family and collaborated on what we could do,” Tammy said. “They love the caregiver. But they realized she had started as more of a companion for their mother and it was now morphing into more personal care.”

So the Nexus team asked the family which they would prefer: provide personal care training for the caregiver, or start sending a certified nursing assistant in her place? The family chose the first option because their mother was comfortable with the caregiver. The Nexus team then asked the caregiver if she would like to go through personal care training, which she did.

The outcome? The family got to keep the caregiver they loved, and a successful resolution was reached in a very person-centered way.

Another important factor in the success of Nexus Home Care is what Tammy said was the best piece of business advice she ever received: Treat people as if they were your family.

Not only does this attitude help clients and caregivers have a better aging care experience, said Tammy, it helps the business, too. “The financial side will come because you're giving good quality care,” she said. “More clients are going to come and your business is going to grow. And that's been our philosophy.”

Today, Tammy passes that advice on to others. “When I hire caregivers, I always ask them if they can possibly look at their client and see their mom, their grandmother, their family member.

“If you take care of someone with that kind of heart, the rest will follow.”