1. Belcher, David

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Kristina Clum, RN, of Springfield, Ohio, never imagined that an idea that she and her business-savvy husband had in 1998 would turn into the national franchise business Comfort Keepers, a provider of in-home services that fills the gap often left by Medicare, Medicaid, and private insurance. Her desire to care for local residents who needed help with simple daily tasks has grown into a 427-office concern.

FIGURE. Kristina Clu... - Click to enlarge in new windowFIGURE. Kristina Clum, right, and office manager Tracy Dunsdon at the Springfield, Ohio, office of Comfort Keepers.

It all started when Clum graduated from the Mercy School of Nursing in Toledo, Ohio, in 1993 and took her first job on the continuing care unit at Mercy Medical Center in Springfield. While providing care to home-bound patients-typically older adults who are isolated and in poor health-she ran errands, such as grocery shopping, and clocked the time as hours on the job. When her boss noticed that Clum's workdays were considerably longer than her coworkers', she accompanied Clum on a typical day and told her that she was spending several hours on tasks that weren't part of the job and not covered by the hospital, Medicare, Medicaid, or private insurance.


But Clum couldn't let her patients down, she says, and she continued to help, volunteering her time. "I would go back and cook meals and help out in other ways," she explains. "But I had small children and a husband, and it put a strain on my family." Clum realized that her years of training as a nurse and the demands put on her as a nurse were moving her in a new direction. She realized that there was a huge need for basic assistance and companionship and that there were few ways-and even fewer people-to provide that assistance. Many elderly people were simply isolated and in need.


"The medical part of my job took eight to 10 hours a day, but the other things they needed took three or four hours a day," she says, pointing out that her boss insisted that those needs were best addressed by a social worker, not a nurse. "It set me back a bit when a supervisor told me that I wasn't allowed to provide certain services such as cooking meals or running errands," says Clum. "I'd go home at night and tell my husband that I had to tell someone 'no' today, and I just didn't feel comfortable with that."


Her husband, Jerry, a salesman with a master's degree in business administration, realized that the solution could lie in a simple business equation. "We decided that we could be a dynamic team-his MBA and sales background and my nursing," she says. "But it took a lot of arm-twisting from him to convince me."


A company grows in Ohio, and beyond.

What began as a plan to provide companionship and other nonmedical assistance to mostly older adults in the Clums' home county became a thriving business that branched out across the state. "The franchising of Comfort Keepers came about by people in neighboring counties calling for services, and I had to tell them 'no,'" Clum says. "That word, again, made me uncomfortable, so we opened an office in Dayton. Then Jerry realized that people in other states might need this as well. When we started Comfort Keepers it was to serve people in Clark County. Once we got everything together, we sold our first franchise in August 1999 and now there are 80 to 100 offices sold every year."


All 427 franchises, in 47 states, provide services in the homes of older adults, pregnant women, and people recovering from illnesses, Clum says. (Starting a Comfort Keepers franchise costs $18,750 initially, with $65,000 for working capital, which is money to live on until the business turns a profit, Clum says.)


All caregivers are screened, insured, and bonded. They cook, clean house, and transport clients, as well as make daily phone calls to clients who would otherwise be isolated.


"We've just launched a personal care aspect to the business," Clum says. "But there are certain criteria employees must meet for performing light transfers, feeding, and providing incontinence care and hands-on care."


Depending on state laws, providers often must be trained for four to eight weeks and licensed to provide this type of care, Clum says.


Seventy percent to 80% of the services are paid privately, although Medicaid and private insurance will pay if the client is eligible. Medicare doesn't pay, and isn't expected to.


"We don't set prices for the franchises, but we really try to keep our prices competitive," Clum says. "The cost depends on the area of the country. For instance, hourly services cost $22 to $23 per hour in California, but as little as $11 per hour in the Midwest."


Clum says that, for example, in the Dayton area costs range from $14 to $18 per hour.


"And the more hours you buy, the cheaper it is-in all franchises," she says.


For Clum, it has been nothing short of astonishing to watch Comfort Keepers grow into a nationwide franchise business cited last year by Entrepreneur magazine as the number-two new franchise company nationwide. It's not, however, a huge surprise to her, given the well-documented statistics about the aging baby boomers.


Although the Clums sold 80% of Comfort Keepers in 2003, Kris still owns the Springfield office and Jerry serves as chairman of the company's board of directors. "I don't do hands-on care any-more. I have a staff that does that. It's to the point now that I can step back," Clum says. "My Springfield office has about 125 clients and 52 employees."


The path of many Comfort Keepers employees, Clum says, reflects her own as a health care provider. "Several of our offices are owned by nurses," Clum says, including three in nearby Dayton, Kettering, and Centerville. "Also, we have physicians, social workers, discharge planners, and geriatric case managers." Allen Riggs, chief operating officer of Comfort Keepers, says that 10% to 15% of the franchise owners are nurses or have backgrounds in nursing or social work. And two workers in the Springfield office are in nursing school.


Inspiring and helping people in all capacities is exactly what the Clums set out to do with their work. "I'm so glad we started this company," Clum says. "It's quite rewarding to know that we started something that helps people from ages 40 to 101." For more information, visit