Konstantin Yepifantsev, CEO, Home Caregivers

Konstantin Yepifantsev, CEO of Home Caregivers, spoke with Invest: about using new technology to increase the quality of care. “Technology is the only solution we have to be able to meet the growing demand. The more human elements we can responsibly replace with technology, the more access and affordability we can provide,” said Yepifantsev.

In the past year, are there any specific changes that have impacted your organization, and in what ways?

The most significant change has been navigating a shifting workforce. Every year, people’s expectations of wages and benefits continue to increase. Healthcare largely operates on fixed costs, and unless the state of Tennessee, federal government, or private insurance decides to increase their rates, we have to navigate a labor market to hire qualified individuals that can serve our clients and take care of themselves in the process. Compared to last year, we have had to pivot and go into areas that require specialized services that come with higher levels of reimbursements, enabling us to pay significantly higher wages than our competition. 

What major trends are you seeing in the healthcare space?

We are an aging society. Tennessee is projected to have more residents over 65 than under 18 in the next five to seven years. There is a 75% chance of needing long-term care after the age of 78, typically one to two years. Long-term care demand is often inevitable, but the system is fragmented. It’s a huge need that isn’t being filled by any one, big company. Many companies are working under Medicaid, the only national public payer for long-term care. Medicaid is even more fragmented and relies on hundreds of small providers. There is no universal standard of practice. Consolidation of smaller companies is key to creating standardized practices and affordable services.

What are some of the biggest barriers families face while trying to access quality care for aging or disabled loved ones?

Sixty-five percent of Americans live paycheck to paycheck, and households only save, on average, about $200,000 for retirement. For example, let’s say you charge $30 an hour, $20 of which is paid to the caregiver. If you provide three hours of care a day, three days a week, it costs $270 per week. This comes to almost $1,200 per month. This can force families to pool resources or make difficult trade-offs. Medicaid attempts to help, but with federal deficits and strained state budgets, coverage remains limited. It is a high barrier of entry for many families.

What changes are being made to better support and prepare employees and caregivers for their responsibilities of caregiving?

Training and onboarding are critical first steps. Caregivers are certified in CPR and first aid, and many are even taught basic life skills like cooking. Most people, especially in an entry-level position, usually quit because of a frontline supervisor. The most impactful thing we’ve implemented is focused resources on employee experience. Our human resources department and program directors are constantly speaking to new hires between days 15 and 90 to talk about their experience and flag issues early. Supervisor quality is treated as a gatekeeper to long-term retention.

How is Home Caregivers adapting to the rising demand of assistive technology, home modifications, and other aspects of technology?

We did an enabling technology pilot with UnitedHealthcare. We learned a lot about how an elderly population can integrate with enabling technology. We worked with a company called Simply Home out of North Carolina and started the pilot with six individuals in two homes. Our typical staffing model provides 24-hour care, seven days a week. The pilot replaced overnight staff with passive monitoring technology. We created a proof of concept that you don’t need a human there 24 hours a day. Many clients who believed they needed 24-hour care discovered they could live more independently. Several moved into their own apartments within 70 to 80 days, saving costs and improving outcomes. Because caregiver demand is much higher than the supply, technology is the only solution we have to be able to meet the growing demand. The more human elements we can responsibly replace with technology, the more access and affordability we can provide.

What partnerships are in place to continue improving patient outcomes and finding new solutions?

Partnerships in healthcare are essential. Healthcare is compartmentalized by services, requiring strong partnerships to ensure quality outcomes. We meet regularly with Putnam County EMS and speak to case management at Cookeville Regional Medical Center. We have contracts with two providers that offer physical, occupational, and speech therapies as well as behavioral health services for conditions like dementia. We partner with local planning and zoning officials to integrate new care homes into neighborhoods. In the healthcare field, it takes a village. Building community trust is as critical as building medical partnerships. 

What are your top priorities over the next two to three years?

My primary goal is a focus on technological implications as we continue to grow our services. In 2024, we were making service pivots from serving one population to another. We currently specialize primarily in behavioral services for individuals with intellectual and developmental disabilities. We still serve some elderly individuals, but in different programs. Our goal for the future is to bring as much enabling tech to the care process to remove the human elements and touch points, reserving human caregivers for the most impactful moments. We want to create an affordable private-pay market for home care, reducing sole reliance on Medicaid. We want to raise wages beyond the living wage, an uncommon approach in our industry, to sustain our business in the long term. My grandfather was in a nursing home after having a stroke. In hindsight, if we had the capacity to afford a home caregiver, he would have survived longer than he did in the nursing home. We have to do better, and we have to think outside of the box.