Almost Family steps in when you're more than an arm's reach from family members with health needs. With its home health nursing services, Almost Family offers senior citizens in nearly a dozen states (including Florida) an alternative to institutional care. Its Visiting Nurse unit provides skilled nursing care at home under a variety of names, including Apex, Caretenders, Community Home Health, and Mederi-Caretenders. Its Personal Care Services segment, operating under the Almost Family banner, offers custodial care, such as housekeeping, meal preparation, and medication management. Almost Family operates about 105 Visiting Nurse agencies and more than 60 Personal Care Services locations.
As part of its business, Almost Family extends its reach to several US states, including Florida, Ohio, Kentucky, Connecticut, New Jersey, Massachusetts, Missouri, Alabama, Illinois, Pennsylvania, and Indiana.
The company's services are carried out by nurses, speech and occupational therapists, medical social workers, and home health aides. The services provided to a patient are determined by physician's prescribed plan of care -- generally issued upon the patient's discharge from a hospital. Payments from Medicare account for 92% of revenue in the Visiting Nurse segment, making Almost Family sensitive to any changes in Medicare reimbursement policies. The Personal Care segment receives 81% of its revenues from Medicare payments, with the balance coming from private insurance, private pay, and Medicaid. This diversification of reimbursement risk is intentional, but the company is also confident that its home-based services will always be lower in cost than institutional care.
Mergers and Acquisitions
While the Visiting Nurse segment brings in the largest portion of revenue, Almost Family's strategy has been to grow that part of the business through a steady stream of acquisitions. During 2008 the company acquired nearly a dozen visiting nurse branch locations, adding to its market presence in Florida, Connecticut, and Ohio, as well as marking its entry into the New Jersey and Pennsylvania skilled nursing markets. Acquisitions in 2009 and 2010 brought in the home health agencies affiliated with Florida-based Central Florida Health Alliance, and a small home health agency in Ohio. In 2011 it paid some $32.5 million to acquire Cambridge Home Health Care, greatly deepening its coverage in Ohio and Pennsylvania. To continue with its strategy of growing by buying (which it maintains it does), Almost Family intends to seek additional capital investments.
Albeit a modest increase, Almost Family logged a 1% rise in revenue in 2011 as compared to 2010. The company points to Medicare reimbursement rate cuts, which reduced both consolidated and Visiting Nurse segment revenue and pre-tax operating income by $15.7 million. Net income during the same reporting period dipped by 32% due to the decline in operating income before corporate expenses. It cites Medicare rate cuts and performance issues within its Florida Visiting Nurse operations for the results, despite offsets from operating income before corporate expenses from its purchase of Cambridge. – less