In the ever-expanding health and fitness market, there are opportunities to do good work and to expand business models. Wellness programs for the home health care market are a tremendous opportunity for wellness providers to do both.

According to the National Association for Home Care (NAHC), there are almost eight million people in the US who require some form of home health service. This would entail basic activities for daily living (ADLs), nutrition assistance, shopping and general home assistance. Almost two-thirds of home care patients are women, and a high percentage are over the age of 65. Most of the medical conditions that they suffer from (which may have an impact from active wellness instruction) include diabetes, skin ulcers, arthritis and hypertension. To date, the NAHC estimates that there are over 20,000 home health care provider agencies, and this number is growing rapidly each year. How big is this market? Over five years ago, approximately $41 billion was spent on home health care. That number will certainly double by the end of this decade.

With this in mind, the home health industry is looking into working with wellness companies to provide wellness services for their clients and continuing education for home care providers. This is a tremendous opportunity for wellness trainers and educators who may already be working with clients at home to expend their market to seniors who may need a basic exercise and wellness plan to improve their fitness and health.


The Beneficiaries of Home Wellness

Traditionally not college-educated, most home care providers earn at the low end of the health care pay scale. An average wage in most areas of the nation is around $10 per hour. By having an �advanced� certification in wellness, they may be able to earn more per hour through their employers or, if working as an independent contractor, from their client base.

Home wellness programs are also important for personal trainers who are interested in working with one of the fastest-growing markets in health care � for two reasons:


1.       The number of clients who will need some level of home care wellness will increase by over 10% each year for the next 40 years. This means that a personal trainer at 25 years of age will be able to work exclusively with home care clients throughout their entire career, if they choose to do so.

2.       Home care wellness programs, although a part of health care, represents a special niche, in that they don�t follow many of the regulations of hospital or rehab center programs. There is more freedom in working with home care clients � keeping in mind that they still may need a particular feeding, dressing and medication regime that the trainer must be aware of. For this, they can work with nurses, counselors and therapists to design the proper exercise/wellness routine around any specific medical needs.


The Home Care Regimen

Home care wellness programs concentrate on the basics of exercise, such as balance, skill training and foundational strength (legs, hips, arms, core exercises). Regimens such as standing on one leg, half-lunges, quarter-squats and light bicep curls make up the bulk of this program. Safety exercises such as getting out of the car, a chair or a tub are also important. Nutritional advice involving types of foods, glycemic index and supplements are also a part of the overall package. Lastly, improving one or more element of their quality of life is paramount to establish a fitness program as part of the standard of care for this group. Many gerontologists are reluctant to refer a fitness/wellness program for home care; most are concerned with the basics (medications, ADLs, general caloric intake). If wellness programs are prescribed properly, there should be little concern for safety. Trainers will also learn the many other aspects of caring for persons outside of the health club environment. To recap, a regimen may look something like this:


Fitness Routine            Balance Routine          Ergonomic Routine      Nutrition Routine

Foundation strength       One-leg stands              Getting out of car           Picking supplements

Fitness ball squats         Step-ups                       Getting out of chair         Smoothie drinks

Dumb-bell exercises       Medicine ball                 Standing posture            Glycemic Index

Breathing exercises       Abdominal tightening      Getting up off toilet         Protein needs


Developing a Home Care Relationship           

            Getting to know one or more home care agencies in your community is paramount to obtaining referrals. Developing a regular �Fitness at Home� presentation for agencies, senior centers and hospitals is a good way to brand your company. Sending brochures and referral pads to gerontology doctors is another way to get your name to the groups that will ultimately refer patients to you. You may speak to nursing and therapy groups � be active on health care boards, and write articles on fitness (a senior wellness series would do well) for your local newspaper and magazine.


Keeping Your Business Moving Forward

            Once you have relationships with agencies, doctors and nurses, you need to let them know that your clients like your work, and that it is improving their health. Developing a health outcomes assessment twice a year is important to see progress in any aspect of their wellness routine � whether it is improved strength, change in diet, better sleep patterns or ability to walk two blocks each day. A one-page report per client is an easy way to report on the outcomes of your clients, and physicians and home care agencies will understand that you mean business when working with home care clients.


Avoiding the Health Care Pitfalls

            If you�re a personal trainer, you�re not a licensed professional. Neither are home care providers, but you may get this question from doctors and other therapists. Your reply is simply that you are trained in providing wellness and fitness services, and anything else that needs attention would be referred to (meaning physician visits or PT therapy). Being a part of the health care community means knowing when to refer as well as obtaining referrals. A working relationship with home care nurses and gerontologists would serve you well in terms of increasing your client base from home care agencies.


Wellness can have a major impact on health care in the coming years, not just in the areas we can see at present (hospital wellness, post-rehab, nutrition education) but in areas that have business growth potential and have a need for this type of education (home health, assisted living, boutique medicine, etc.).

The number of health care areas that wellness can impact is as large as health care itself. It is this �out-of-the-club� thinking that will allow fitness professionals to make an ever-greater impact on our nation�s health care market while working within their scope of practice, provide much-needed education and allow a new niche of health care clients to enjoy the benefits of fitness in a fun and safe format.

Eric Durak is the President of Medical Health and Fitness and Director of the Wellness @ Home and Cancer Wellness CEU Programs. He is also the author of The Reimbursement Book for Health and Fitness Instructors. Contact him at or 805.451.8072 for more information.