When Care is Hard to Come By: How Two Nurses Are Bringing In-Home Care to Rural Tennessee

In rural East Tennessee, getting help for an aging loved one isn’t as easy as making a phone call.

The towns are small, and the terrain is mountainous.

The distance between a client and the nearest available caregiver can be an hour's drive, and qualified caregivers are stretched thin across the community.

Most families looking for help hear the same answer: There’s no one available.

Nurses Donna and Cassandra Butts experienced that answer firsthand, and the struggle that followed led them to create Private Duty Home Services.

When Care Becomes Personal

Like many mission-centered businesses, Private Duty Home Services was born out of a crisis.

Cassandra's grandfather was hospitalized, and the facility wanted to discharge him while his care needs were still high.

Both Cassandra and Donna were working full time as nurses and couldn’t provide the care he needed, and Cassandra’s grandmother was already coping with Alzheimer's disease.

When looking for in-home help, they hit a wall.

"We got a ton of pushback," Cassandra says. "He's not going to go anywhere because he's angry and lashing out. So it left us calling around to different rehab facilities and nursing facilities, saying, how can we make this better? How do we get him somewhere where he can get the rehab he needs and then get home?"

When they finally secured in-home help through an agency, it didn't hold.

"Every single day we were hearing, 'I'm sorry, we don't have anybody to place over there,'" Cassandra says. "And so again, we were right back in that situation of, what do we do?"

She pauses.

"We felt that anxiety, we felt that stress and all of the disruptions that it caused."

As nurses, they knew the type of specialized care their family needed, but the resources just weren’t available in their community.

So they decided to step up and fill the gaps themselves.

The Reality of Rural Care

Private Duty Home Services now serves families across the Tri-Cities area, including Kingsport, Johnson City, Bristol, and the surrounding East Tennessee communities.

The work is meaningful, but the logistics can be brutal.

“We live in a very mountainous region of Tennessee. So a lot of times people might have to commute an hour to get to someone and that might be the closest caregiver that they have in that area,” Donna explains.

“The spaces in between, the caregivers getting to their homes, their drives, the safety, especially when we had the snow and the bad weather. We really had to make sure that they had that extra coverage and support. Because it's more difficult for not only the family to get to the clients, but also the caregivers to get to the clients."

And the need keeps growing.

"The aging population is growing rapidly," Donna says. "And there is a challenge of trying to fill that need with qualified caregivers who can assist them safely."

Where Herewith Comes In

About six months ago, Donna came across Herewith while searching for caregiver support in the area.

She researched the platform, brought it to Cassandra, and reached out to Alfredo, a Sales Manager on the Herewith team.

They've been working together ever since.

"They sent very qualified Helpers to assist us," Donna says.

"They have the knowledge, the skills, and the experience already to jump in and get started. So it really helps us out when we're in a bind and need that coverage asap."

A flexible pool of Helpers, available for the specific hours a client needs, is something small rural agencies rarely have access to.

"Being able to go to Herewith and say, this person's available and this is what they're available for, they're a great fit for this client, let's bring them in," Cassandra says.

"Having that flexibility is going to be a game changer for us."

What Makes a Great Caregiver

When finding good caregivers, Donna and Cassandra look beyond resumes.

"Someone who just has a heart," Donna says. "Someone who naturally cares for other people and individuals. From there, I can teach and train anyone. But they really have to have that drive and motivation to care about the next individual, to care about their neighbor, no matter what their need might be."

Donna says the Helpers they have found through Herewith have “Naturally gone above and beyond for our clients.”

For example, one client was living about an hour away in a rural area. The Helper went right in, and as they got to talking, she learned that the client had spent years preserving and canning her own food, but hadn’t had the ability to do so in years.

As it turned out, the Helper was learning to can herself.

They spent the whole day canning food together, pulling out supplies and working through the process side by side.

The client called Donna and Cassandra to tell them the story.

"She thought it was the best thing," Cassandra says.

Working Toward a Better Future for Rural Care

The process hasn’t been easy, but Cassandra and Donna remain rooted in their mission to find care for rural families in Tennessee.

"As our caregiving business continues to grow, we just want to grow and mature with it," Donna says. "We want to be able to be flexible and move with the challenges that our caregivers and our clients face on a daily basis."

They both believe older adults deserve to spend their final years at home.

“Being able to provide peace and comfort for somebody that has already given so much of their life, it just means everything,” Cassandra says.

Donna gives the final word on why their work matters:

"Culturally in our society, we tend to forget our older population. We don't give them the reverence and the attention that they deserve. They have lived their lives. They have created lives for their families to continue. And that means something."

Private Duty Home Services serves the Tri-Cities area and surrounding East Tennessee communities. Herewith is proud to partner with agencies like Private Duty Home Services to expand access to in-home care. Learn more about in-home care services on Herewith.