As the population ages, an increasing number of Americans are looking at their options for aging in a healthy and comfortable environment. For many, the ideal solution is ‘aging in place’ —living at home and maintaining independence for as long as possible. To meet this need, home health care agencies provide skilled medical care and additional household help for the elderly. Here’s a look at three local companies and the people behind them who are doing just that.

Advanced Nursing Services of St. Louis

Maggie Holtman grew up in a big house in Nashville, Tenn. Her grandparents moved in when they were no longer able to live on their own, and Holtman remembers their private-duty nurses coming and going around the clock. “We never, as a family, thought it was intrusive,” she says. “At the time, there weren’t retirement centers, and they (the nurses) took really good care of my grandparents. We just loved them.”

Having seen the first-hand benefits of good in-home care for the elderly, Holtman became a nurse and, after relocating to St. Louis, began Advanced Nursing Services in 1984 when a family friend needed in-home nursing care for an elderly aunt. “She was my first client, and I modeled the business after the experience I had with the nurses in our house,” she says.

Although Holtman has been approached over the years about expanding her business beyond the St. Louis area, she chooses to remain local, focusing on providing quality care delivered by compassionate professionals. Many of the nurses she hires are experienced in other health care settings and are attracted to the continuity of care inherent to having a single patient.

Advanced Nursing Services also provides non-skilled care and one-time services, such as providing transportation to a doctor’s appointment. Long-term care insurance covers many of the company’s clients who require ongoing care.

Homewatch CareGivers/Mental Health Assistance and Solutions

Maria Gianino knows with it means to be part of the ‘sandwich generation.’ Twelve years ago, she was caring for her three children while realizing that her elderly mother needed ongoing help to remain in her own home. At the same time, Gianino and her husband, Mike, were exploring the idea of opening their own business.

“I thought, This is a great idea—a service to keep somebody in their home and at the same time provide care,” she says. “I totally was in that place where I was going to be caring for my mother and also caring for my family. At the time, people didn’t quite understand unless they were in that situation.”

Since opening a local Homewatch CareGivers franchise, the Gianinos have grown it into the Denver-based company’s largest and most profitable franchise. There are approximately 175 Homewatch franchises worldwide. The couple also recently opened Mental Health Assistance and Solutions, a company that provides non-medical, in-home care for adults who have depression, bipolar disorder or other psychiatric illnesses.

While in-home care for the elderly remains their core business, “I recognize that a lot of the issues our clients have aren’t just dementia, but that they were never properly diagnosed (with mental illness),” Gianino says. “This is a largely untapped need.”


Gretchen Curry, owner and president of StaffLink, started the company in 1987 after gaining experience as a regional manager for a national in-home care company. “Our goal is to help our clients stay in their home as long as possible while they age,” she says. “We do whatever we can in providing them with medical or non-medical assistance.”

Registered nurses and licensed practical nurses provide medical services, while certified nurse aides offer other hands-on services, such as bathing and moving patients from bed to wheelchair. Caregivers who provide non-medical services, such as meal preparation, transportation and basic household assistance, are often retired professionals who are “reliable, honest, bright and compassionate,” Curry says. “That’s what a senior is looking for in a companion.”

Curry takes a methodical approach to matching a caregiver to a client, arranging for families to interview potential caregivers and make a decision they feel completely comfortable with. “We really understand the family dynamics that go into the decision to bring a caregiver into the home,” she says. “We’re sensitive to how difficult that decision is for a family.”

Curry also counsels families to make sure any caregiver has been carefully screened and is given proper oversight. “I can’t tell you how many private caregivers come to us when work is slow for them, and they can’t pass our screening,” she says. “It’s very important to work with a reputable agency.”

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