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DALLAS - Cathy Smith started thinking about nursing homes after her 76-year-old mother, Dolly, suffered a heart attack.
"No matter how much I wanted, I couldn't take care of her and my father," Smith explained. "I live in Lubbock (Texas), and they're in Dallas."
Then she heard about Home Instead Senior Care, a business that sends caregivers to older people's homes to help with nonmedical tasks or just to provide company.
The Smiths became clients of a growing senior-care industry that promises to become even more lucrative as the older population increases.
Experts say the potential market is almost limitless. Propelling the growth are 36 million Americans over 65 and an additional 76 million baby boomers who will turn 65 by 2030.
Surveys show that eight of 10 seniors would prefer to "age in place," remaining in their homes as long as possible and relying on aides when necessary.
"My parents' caregiver has become part of our family," Smith said.
The woman visits the Smiths twice each week, doing whatever has to be done. That may mean driving Smith's mother to the mall or reminding her to take her medicine.
Philip Fritz, the Home Instead franchise owner in Dallas who placed the caregiver in the Smiths' home, said most of his calls come from adult children such as Smith.
"Many are juggling the demands of two households and can't take care of their elders by themselves anymore," he said.
Fritz and his wife, Libbie, started their business with a couple of clients four years ago. Today they have 75 caregivers who serve 80 families throughout the Dallas area.
National franchising companies have emerged as the largest providers in a business once populated only by individuals. Home Instead is the biggest, with 600 franchises that employ 29,000 caregivers and serve 50,000 clients annually in 47 states and five foreign countries.
The Omaha, Neb.-based business adds 50 franchises a year.
Founder and president Paul Hogan said the inspiration for his company came when his grandmother moved in with his mother because she was too weak to live alone.
"Our vision was to provide many of the same services my family had provided for Grandma Eleanor," he said.
Allen Riggs, president of another major franchiser, Comfort Keepers of Dayton, Ohio, said his company also grew out of a desire not just to do well but to do good.
One of the founders had been a home health-care nurse who often fielded patients' requests for everything from a loaf of bread to a few hours of conversation.
"As a nurse, she could only tend to their medical needs, so she and her husband created Comfort Keepers to answer older people's other wants," Riggs said.
A social worker's zeal is common among owners of senior-care businesses.
Many get into the industry in their 40s and 50s, after tiring of their jobs at large corporations and deciding to do something more personally satisfying.
Lori Nesler, who quit her retail supervisory job to open a Comfort Keepers franchise in Dallas, sees her new work almost as a ministry. Like all Comfort Keepers franchise owners, she runs extensive background checks on prospective caregivers.
The company's typical employee is a middle-aged woman, though its "caregiver of the year" in 2004 was a 74-year-old retired Lutheran minister.
Many of Nesler's calls come from out-of-town children who visit an elderly parent and are horrified to find the house in disarray.
"They realize their mother isn't doing as well as she said on the phone," Nesler said. "We step in and set things right."
The Comfort Keepers who look after Sherri Nelson's 85-year-old mother and mentally challenged brother often prepare favorite meals in their own kitchens and bring them to the two.
"That's not part of their job, but they really care," Nelson said.
Susan Kendall of Dallas, who's recovering from an illness, said her caregiver helps with cooking, housekeeping and laundry and seems almost like a roommate.
"I'm not going to tell her name because I'm afraid someone will steal her from me," she joked.
But not all older adults get along as well with their companions.
Bill Archinal, president of Abundant Life Home Care in Amarillo, Texas, said some fiercely independent seniors are slow to admit they can't live by themselves anymore.
"They fire their caregivers, only to see their children hire them back," he said. "Eventually, they're persuaded to give up a little of their independence to preserve the rest of it."
Caregiver visits last anywhere from a couple of hours each week for people who just need a ride to the doctor to round-the-clock companionship for older adults with dementia.
Fees generally run from $13 to $17 an hour in the Dallas area.
"Our care may cost $1,000 to $1,200 a month, but it's less than half the price of assisted living or nursing care," Hogan said.
"Plus, Mom's happier to be in her own home."
As the industry grows, so have the caregivers' duties. Besides fixing meals and running errands, some help with bathing, dressing and grooming.
Others provide a brief respite for wives and husbands caring for spouses with Alzheimer's disease.
Because neither Medicare nor Texas' Medicaid program typically covers nonmedical home care, almost all clients pay for it out of pocket or with long-term care insurance.
Haunted by stories of abuse and neglect, the industry is trying to protect itself from unscrupulous caregivers who befriend clients only to steal from them.
It has created an association to educate consumers and, eventually, to accredit businesses.
"This is a young industry that's still like a Wild West town," said Sheila McMackin, president of the National Private Duty Association. "We're trying to promote professionalism."
McMackin said it's important to know the difference between a senior-care company that hires its own caregivers and a referral agency that merely acts as a matchmaker.
Seniors who use home-care businesses don't have to worry about payroll taxes or injury claims, she said.
Those who rely on referral agencies must assume that responsibility and liability.
Government regulators aren't waiting for the industry to police itself.
Twenty-three states, including Texas, already require nonmedical senior-care businesses to be licensed if they provide personal services such as bathing and grooming.
Industry executives say they understand the need for government scrutiny to keep out "bad actors," but some fear too many regulations will make home care unaffordable.
"That would be unfortunate, for we've begun to realize that older people can lead fulfilling lives into their 70s, 80s and even 90s if they just get a little help," Hogan said.
He knows so from his own family. Grandma Eleanor lived to be 100.
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(c) 2005, The Dallas Morning News. Distributed by Knight Ridder/Tribune News Service.
