With $5M Infusion, Home Health Staffing Startup Sees Skilled Nursing Opportunity Amid PDPM Upheaval

A health care staffing startup that had initially focused on the home setting sees significant opportunity to expand into a skilled nursing space still grappling with the implications of a new Medicare payment model — and it recently pulled down a $5 million funding round to help fuel that growth.

The Los Angeles-based Gento, formerly known as Nursing Without Walls, raised all $5 million in Series A funding from private equity investor Palisades Growth Capital in a deal announced this week, bringing the startup’s total haul to $7 million since its founding in 2016.

“In a vastly changing regulatory landscape, Gento is providing highly cost-effective solutions to the growing in-home health care market,” Jeff Anderson, partner at the Los Angeles-based Palisades, said in a statement announcing the deal.


But while the company staked its early development on the home health space, Gento has already begun to organically grow into the brick-and-mortar post-acute industry — with the new Patient-Driven Payment Model (PDPM) serving as a potential supercharger for demand in novel staffing platforms.

“The traditional ways of staffing, I believe, are over,” CEO and co-founder Victor Gajendran told SNN. “Now it’s the modern era.”

Gajendran calls the Gento model “micro-staffing,” and in practice it works sort of like a rideshare app: Health care providers post openings for available shifts at a specified payment rate. Available clinicians then pick up the shifts that work best, with the nursing home or home health provider charged a flat service fee for the connection.


Over time, the nurses and therapists who use the service build up quality metrics that operators can use when deciding to place certain workers, and providers can block specific job-seekers from seeing open positions at a given facility. The system also uses GPS tracking to monitor the progress of each visit and ensure that the care objectives were actually completed.

“We make sure that the visit really happened,” Gajendran said. “It’s not just finding a body for whoever needs it. It’s actually making sure the care is delivered.”

Gento isn’t the only company on the market with an “Uber for nurses”-style platform — the Waltham, Mass.-based connectRN, for example, has raised $11 million since its 2014 founding, and recently landed a new CEO with a resume that includes stints at tech giant athenahealth and travel service Priceline.

On the clinician side, Gento targets nurses and therapists who may have full-time jobs in other care settings, such as a hospital, but want to pick up the occasional set of extra hours. For instance, an acute-care nurse may work three long shifts as part of his or her primary job, leaving four additional days available for extra work if desired.

“We are reaping all that excess bandwidth that was stagnant in the community,” Gajendran said.

The model is particularly suited to the home health space, which has long struggled with nurse and therapist turnover — especially during an extended stretch of low unemployment and increasing competition from companies outside of the sector, including Amazon and other large retailers.

But the skilled nursing space is also mired in an extended employment crunch, and Gento’s entrance into the institutional market came from a home health agency owner who was looking for staffing help with some skilled nursing assets. Though the company hadn’t targeted nursing home operators from the start, Gajendran figured that tailoring the product to institutional users would be almost easier than its core business model; after all, unlike the home health setting, the skilled nursing residents are always at the same address.

Gento has since grown its skilled nursing footprint to cover more than 300 facilities, and Gajendran sees massive opportunity ahead amid the shift to PDPM.

The new payment model, which took effect October 1, eliminated operators’ incentive to provide the greatest number of therapy minutes as possible, a factor that led to both confirmed and anecdotal stories of therapist layoffs throughout the country. In addition to straight job reductions, operators have converted therapy staff to PRN status, a term for as-needed shifts; an SNN poll last December found that 43% of operators had laid off some staff, while 53% moved some therapists to PRN.

“Because of this, the demand for our services on the skilled nursing side has really increased,” Gajendran said.

While the PRN conversions may have made expense-savings sense in the short term, operators still must provide uninterrupted care for their residents, and Gajendran said many providers may have difficulty fitting the sudden influx of as-needed workers into a given building’s normal workflow.

“They have to do more with their existing staff, or only use staff on a PRN basis,” he said. “They’ve been doing it manually — in fact many SNFs are used to working with full-time employees, and now they’re struggling to figure out, using manual ways, how to make this PRN thing work.”

And though staffing agencies that specialize in long-term and post-acute care are nothing new, Gajendran touted the efficiency of the tech-forward model; with comparatively less overhead and human interaction, he argued, app-based staffing companies can compete with the entrenched players.

“In an ideal world, we don’t even want to exist in the middle — we want to be away and let the technology take care of it,” he said.

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