By Rachel Newman

Ross Kimbarovsky’s elderly grandfather was living independently in his Chicago home when he developed a rare form of cancer. Kimbarovsky and his mother were his grandfather’s primary caretakers, but as his condition worsened, it was clear that they couldn’t do it alone.

Their hope quickly turned to frustration when they turned to local home care agencies and were met with inconsistent pricing, unreliable scheduling and under-qualified staff.

Shortly before his grandfather’s passing in 2015, Kimbarovsky reached out to his friend, Bruce Masterson, who had a similar experience caring for his mother-in-law. Together, they founded Respect, a home care agency for the 21st century.

Users can manage their loved one’s care through Respect’s mobile app. The app sends clients a notification when the caregiver arrives and departs at their loved one’s home. It allows them to communicate with caregivers via messages and photos and schedule activities in advance.

Users can even use the app to split payments among family members, who may be dispersed across the country.

[vimeo 208567103 w=640 h=360]

Headquartered in Chicago’s West Loop, Respect began providing home care services in the Milwaukee area in summer 2016. The company expanded to the Chicago area in January. Between the two locations, Respect serves about 20 clients.

Kimbarovsky describes the company’s revenue as “modest” but “improving month-over-month” as increased name recognition brings in more clients.

Aging by the numbers

As the population ages, Kimbarovsky foresees no shortage of people seeking home care.

Respect offers what are known as “homemaker” services: things like personal care, companionship, medication reminders, and light housekeeping.

More than 90 percent of Respect’s caregivers have nursing assistant or home health certifications, but the company isn’t focused on providing home health care. Home health care involves clinical medical care and is often administered by a registered nurse or an occupational therapist.

“That’s a growth industry as we say,” said Daniel Brauner, a geriatrician at the University of Chicago. “There’s a tremendous need, obviously. Lots of people as they get older, and lots of people who are younger, need help at home.”

The population of adults over the age of 65 is expected to double to 83.7 million by 2050, according to the U.S. Census Bureau. About 22 percent of Illinois’ population will be 60 or older by 2030, a 28 percent increase from 2012, according to the Department of Health and Human Services.

In Illinois, adults over the age of 65 reported an average of 4.6 days in the past month in which their ability to complete activities independently was limited, according to the Centers for Disease Control.

Money matters

Though the demand for home care is growing, wages for personal care aides remain low.

The 1.4 million personal care aides working in the U.S. make an average of $10.48 an hour, according to data from the Bureau of Labor Statistics. Aides in the Chicago area fare slightly better, with an average hourly wage of $10.70, while Milwaukee-based aides fare worse at $10.13 an hour.

“The problem in the traditional industry is that pay is so low that opportunities are limited, and that’s one of the problems we’re trying to solve,” Kimbarovsky said.

Respect employs 20 to 25 caregivers, and they pay them 20 to 30 percent above the market average, Kimbarovsky said.

Nadiesha McAdory, a Respect caregiver based in the Milwaukee area, said that she appreciates the company’s focus on compensating its employees fairly.

“It’s way more than what I ever really made at any other home,” McAdory said. “So home help, I usually make like, $10. With Respect, I’m almost at $13.”

Leveraging technology to streamline logistics has allowed the company to cut costs and pay caregivers more, Kimbarovsky said.

“We are able to pay them 20 to 30 percent above market because in rethinking home health care, we were able to create efficiencies in many of these processes,” Kimbarovsky said. “So we built mobile apps that shortcut some of the problems that existing agencies have, and that allowed us to reduce the cost of healthcare and return some of that to caregivers.”

The high cost of home care

Though services like Respect are essential for families with ailing loved ones, the cost can prohibit some from hiring the help they need.

The median monthly cost for home care services amounts to $4,385 in the Chicago area, compared with a national median of $3,813, according to a report by Genworth. The average hourly rate for homemaker services, in Chicagoland is $21, compared with $20 for the Milwaukee area and $19 nationally, according to a survey by MetLife.

Respect’s services start at $24 an hour, $3 above Chicago’s average.

“We’re looking at ways we can help people pay,” Kimbarovsky said. “So, for example, some people have long-term care insurance. And long-term care insurance will often pay for home care, for non-medical home care. Many people don’t know that.”

So-called “aging in place” is generally beneficial for patients, but it’s challenging for those who don’t have a supportive social network, said Geraldine Luna, a geriatrician at the University of Illinois at Chicago.

U.I.C.’s geriatric medicine unit serves a majority low-income population that often can’t access the home care services they need without financial assistance from the state of Illinois, Luna said.

“You want to keep the patients at home and independent as long as you can,” Luna said. “When they’re at home, but they can’t complete all the tasks, there’s money out there for patients that do qualify, and they do pay for a homemaker that comes to the home a couple hours a day.”

Avoiding burnout

It’s common for family members to experience “caregiver burnout” from the stress that comes from balancing caretaking activities with daily life, Luna said.

That’s exactly what Christine Bartholow of Elm Grove, Wisc. experienced while caring for her husband, Les, who has dementia.

“I really needed some time for me,” Bartholow said. “I was really feeling burnt out, and January was a very difficult time. And his doctor had said, ‘Get somebody to help.’”

After interviewing several home care agencies, Bartholow settled on Respect because she felt the caregivers were more qualified and could be helpful as her husband’s disease progressed. She liked that so many of Respect’s caregivers have professional training.

Though the Bartholows’ caregiver, Ebony, does not have a certification, they’re happy with the care she’s provided.

“Just having the one-on-one for him is so great because, not that I wouldn’t love to just do that, but I can’t,” Bartholow said. “I’m running the household for both of us and taking care of the maintenance on the home and making sure he has nutritious meals.”

Not just about the cost

As health services at every level experience budget and time constraints, some experts worry that patient care will suffer.

Brauner, the University of Chicago geriatrician, worries that relationships between patients and care providers will become transactional, like the sort of relationship a customer has with a salesman.

“With any caregiver, knowing the person you’re working with is essential, and really the way to know somebody is to know them longitudinally, over time,” Brauner said.

Respect has prioritized offering families a more personalized experience. Clients are shown video interviews of prospective caregivers when they sign up for the service.

Some home care agencies send caregivers to clients’ homes with minimal training and little background information, leading to an awkward first meeting, McAdory said. With Respect, that wasn’t the case.

When she got her first client, McAdory and her manager visited the client’s home together to make sure that everyone was comfortable with each other.

For the Bartholows, these personal touches have paid off.

“We’re glad to have someone like [Ebony],” Christine Bartholow said. “Anybody can do the technical stuff, but she’s a very kind and concerned young lady.”