Reinventing After a Family Crisis

When her grandmother could no longer manage by herself, former marketing executive Denise Thomas found her passion: helping the elderly live at home for as long as possible.

by Michelle Stacey
Reinventing after Family Crisis
Photograph: Misty Keasler

On a sultry day in April 2011, Denise Thomas, the owner of Home Instead, a franchise business in Austin, Texas, drives to the home of an elderly client. Ninety-one-year-old Emily Lake moved into her comfortable single-story house five years ago and plans to stay there, thanks to Home Instead's caregivers, who help her bathe, pay bills, shop, track medications and generally maintain her independence. For Thomas, visits to satisfied clients are the best part of her job.

“This is what it's all about,” she says. “The fact that Emily can live here, with her things around her, playing her piano, being able to visit the supper club she's gone to for decades, seeing the friends who live nearby: That's why I got into this business in the first place.”On this visit, Thomas, a gregarious woman with a wide smile, chats easily with the elegant older woman. Their conversation eddies around subjects like cats, classical composers and Lake's memories of hobnobbing with Austin politicos in the 1950s. “You were friends with Dick Cheney, weren't you?” asks Thomas. Well,” drawls Lake, “I wouldn't say friends. I'm friends with George W. and Laura. I love the Bushes, father and son.&rdquoAn hour later, Thomas says good-bye, confident that the caregivers she's selected to look after Lake have been doing a good job. For Thomas, the rewards of running an at-home senior-care business are personal as well as professional. “What I love about working with the elderly is that it forces you to slow down,” she says. “They're going to talk slow, so you're going to talk slow. It's not a bad thing to be forced to do.” She savors her conversations with clients and their families, getting to know each person's biography and then figuring out the right person to fill his or her needs: someone who can prepare meals and help create a family scrapbook? Attend concerts? Discuss the Bible? Clean the cat's litter box? “Our relationship with clients is very intimate,” says Thomas. “We are matchmakers in a way, putting together people with similar interests, personalities, backgrounds. Nothing is more satisfying than when it clicks.”


All of her Home Instead staffers are specially trained to help clients struggling with memory loss and dementia. “People with memory loss have a better chance of staying engaged if they're in familiar surroundings,” says Thomas. “In general, most seniors—about 90 percent—want to stay in their own homes as they age.” She's not against assisted-living communities. “If a house is falling apart, then it's not suitable for an aging person,” she says. “My mission is to respect the senior's wishes. For some, a move can be good. But if they don't want to move, that's where I see a problem.”


Since launching her business in 2003, Thomas has expanded from 30 caregivers and zero office staff to her current team of 150 caregivers and eight administrators, with annual gross earnings of $2 million. Her success has proved recession-proof; those who care for the elderly and ill constitute the fastest-growing segment of the workforce, according to PHI, a health care advocacy group, and by 2018 home-based workers are expected to outnumber nursing home workers two to one. The Home Instead parent company, which launched with one office in 1994, has expanded to 900 locations worldwide. The franchises now employ more than 65,000 caregivers and serve nearly one million clients.


Thomas got into the business after rising up through the corporate ranks at IBM and then becoming a marketing executive for the Discovery Channel's international development arm. “I wanted to see the world,” she says. In the 1990s, her globe-trotting work took her to cities in Europe, South America and Asia. She met and married a Japanese man, and the couple lived in Japan while Thomas learned the language and taught at a business school for Japanese nationals preparing for careers with American companies. The couple were also trying to have a baby. Then, in 2001, her husband, a venture capitalist, was transferred to Austin, where neither of them had lived before.


Thomas felt ready to come back to the U.S. Unsuccessful fertility treatments had left her emotionally fragile, and she wanted a fresh career challenge. At the same time, her grandmother, who lived halfway across the country in New York State, was afflicted with Alzheimer's and in decline. What unfolded next, says Thomas, echoes the story she now hears over and over from families that seek her help. “My mom decided to move Grandma into her house and take care of her,” she says. But the stress on all concerned was too much, and the family had to transfer Thomas's grandmother to a senior living community. “It was a beautiful place, but she hated it,” says Thomas. She suffered from leaving the home she'd lived in for 50 years, the church she'd attended, the lifelong friends she'd spent time with. “My grandmother had been an outgoing person, but when she got to the facility, she kind of shut down,” says Thomas. Her decline accelerated; she had a stroke and passed away soon afterward.


Back home in Austin after her grandmother's funeral, Thomas hit bottom, mourning the loss, despairing about her infertility and fretting about finding a next step for her career. One day, while listening to a tape by the motivational speaker Marianne Williamson, Thomas burst into tears. “Williamson was talking about focusing on what you can give to others rather than on what you want to get back for yourself,” says Thomas. Right after the tape ended, as she idly flipped through a business magazine, she came upon an article about the Home Instead Senior Care franchise.


“It was magical,” Thomas recalls. “It hit me: This is what I'm supposed to be doing. I had wanted to be a doctor when I was young, and I volunteered as a candy striper at a hospital in my teens. I wanted to help care for other people—especially seniors.” She started researching the franchise and talking to her close friend Ariel Miller about it, and that's when the second piece fell into place. Miller, a neighbor with two young children, offered to partner with Thomas, sharing the work and the $50,000 start-up cost.


In April 2003, Thomas and Miller flew to Omaha for a week of intensive training at the company's headquarters. It was on the plane that Thomas turned to Miller and asked, offhandedly, “Do you ever think of having more children?” The two women had discussed Thomas's struggle with infertility, so Miller knew the details: that the problem was not Thomas's eggs, which were viable, but some unknown factor that prevented her from carrying a pregnancy to term. Miller, a petite, birdlike woman who describes herself as intuitive and spiritual, suddenly felt called to help. “I'm going to have your child!” Miller blurted out. “This is how it will happen: You've got great eggs, and I've got a great uterus, so I'll carry it. This baby wants to be born.” Three months later, fertilized embryos from Thomas and her husband were implanted into Miller's uterus, and on May 11, 2004, Maya came into the world.


For Thomas, it was a miracle—but the business was having a harder time being born. Miller, who'd developed debilitating morning sickness, had pulled out of the franchise, and by the time Maya arrived, Thomas was overwhelmed by work. She called Pamela Mitchell, a friend from her days at the Discovery Channel who is also a career coach. “I told Pamela I was ready to quit,” Thomas says. “I felt guilty about having to leave Maya, and I had to do everything—scheduling, even filling in for caregivers if they couldn't make it.” Mitchell advised her to read The E Myth, a book about entrepreneurship subtitled Why Most Small Businesses Don't Work and What to Do About It. Thomas already owned a copy: The Home Instead founders had given one to each new franchisee, but she hadn't found the time to read it. Now she did. “It summarized all my mistakes,” she says. The biggest one: trying to do everything herself. She stepped back and started trusting her staff to make decisions.


Being part of a franchise meant that Thomas had a ready-made “kit” that included website templates, computer programs and hiring guidelines. “Franchisees don't have to reinvent the wheel,” says Carol Roth, a business strategist and the author of The Entrepreneur Equation. They generally don't have to figure out procedures or marketing strategies on their own. In exchange for giving the parent company a percentage of the gross revenue, they get to operate under the aegis of a known brand and to benefit from the experience of other franchisees. Although it's tough to get figures on whether franchises have a higher success rate than independent start-ups, Roth adds, most experts think they do.


The downsides of a franchise: the fees you continue to pay to the parent company and a lack of creative control (the founders decide how you will present the brand, in marketing, logos and so on). If the parent company gets bad publicity, you may be affected as well. For instance, when an outbreak of E. coli was linked to several Taco Bell outlets in 2006, other franchisees experienced a temporary downturn; the same thing happened at Domino's Pizza in 2009 when a video on YouTube showed one franchise's employees fouling pizza with unsanitary “ingredients.”


A few years ago, two Home Instead franchise offices in Maryland were accused of race discrimination, with the U.S. Equal Employment Opportunity Commission alleging that they'd let clients specify the race of the caregivers assigned to them. Home Instead settled the lawsuit in December 2010. Complaints about some Home Instead offices have also popped up on consumer websites.


Thomas says her business was unaffected by these dustups. To maintain excellent client relations at her own franchise, she relies on careful quality control: finding caregivers who have a genuine sympathy for the elderly (many of Thomas's hires got into the business because they'd cared for their own relatives and found the work rewarding) and doing rigorous background checks. In the end, she takes on only about 20 of the 300 people who apply for jobs each month. The next step is training her workers to handle sensitive situations; for example, how to respond if a client doesn't want help getting out of a chair but may hurt herself if she tries to do it on her own. And Thomas monitors caregivers by making surprise visits to her clients' homes.


For a first-class experience, however, matching a client with a caregiver who has a similar background is key. “We set up one elderly gentleman, a retired executive, with a male caretaker who was a retired IBM executive, and that worked out very well,” she says. “I love my clients dearly, and I have a real affinity for them. It feels good to know that I'm helping to make their last years comfortable. That's why I'm in this business.” ❦


Running the numbers


103Age of oldest client (and her caregiver was 74—the family requested an older attendant so the two would have more in common)


120 to 140Number of clients Thomas has at any given time


$70,000Total start-up costs for Thomas's first year in business ($50,000 for the franchise kit plus $20,000 for cash flow)


$18Average hourly rate paid by clients, depending on their requirements


$9 to $14Hourly wage that Thomas pays her home-care workers (nationwide, the average hourly wage is about $9.50, and nursing aides earn about $11.50 an hour)


This story first appeared in More magazine's December 2011/January 2012 issue.

Michelle Stacey is the author of The Fasting Girl. She blogs at

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First Published Tue, 2011-11-08 12:43

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