Papa, a company that offers companion care, has learned valuable lessons in the past seven years as it has expanded its services to more older seniors.
The company is now sharing its trust and safety best practices with the industry as the demand for home healthcare services is expected to steadily grow.
Over the past two years, Papa has made operational changes and rolled out product enhancements to enhance safety protocols for members and caregivers, called Papa Pals. The company's goal is to make it the safest in-home care delivery platform on the market, according to Andrew Parker, founder and CEO of Papa. As it stands, 99.8% of Papa Pal visits occur without a reported safety incident, the company reported.
"We’ve known since the early days that building this company and scaling a new kind of person-centric care would be challenging—and we’ve always been up to the task. While people are imperfect, the care they provide is also irreplaceable," Parker said in a statement.
Papa issued a transparency report today that serves as an honest assessment of the challenges providers face when serving vulnerable populations in one-on-one, in-home settings. The report offers a guide for others in the space looking to advance it, the company said.
"We've implemented dozens of new initiatives, and we have learned so much along the way. This effort actually started with letting our trust and safety advisors have a peek under the hood of all of our operations, our policies and our features," Jane Yu, Papa’s head of trust and safety, told Fierce Healthcare in an exclusive interview. "We wanted to share what we've learned across the industry, because we see a real responsibility to make sure that in home, in-person interactions happen safely. I really feel like there's a lot that we can learn from each other if organizations share their best practices and what they've learned along the way. We wanted to make it public and and be transparent with how we thought about things."
More companies are jumping in to offer in-home care services, and the demand for these services will only increase with an aging population.
By 2040, forecasts predict that the U.S. aging population will have grown to 80 million people. At the same time, it's projected there will be a national shortage of both 11 million family caregivers and 355,000 paid caregivers to care for them.
Papa partners with health plans and employers to tackle loneliness among seniors through companionship and support. The company matches seniors with younger caregivers, called Papa Pals, who socialize and help out with in-home tasks as well as shopping, transportation to doctors' appointments and medication pickups. Papa works with Medicare Advantage and Medicaid health plans, and a number of large employer-sponsored programs also offer it as an eldercare benefit.
Since its founding in 2017, Papa has provided more than 2.6 million visits across 7,300 cities. Papa caregivers conducted more than 1 million visits in 2023.
The company was a pioneer in offering a care network addressing social drivers of health. But, it also has been among the first to experience the challenges of doing so at scale.
Last year, a media report claimed that a lack of training and oversight as part of Papa's gig economy solution was putting a vulnerable population at risk. In an article published May 30, Bloomberg Businessweek reported that a review of more than 1,200 confidential complaint reports uncovered a range of incidents.
Amid growing safety concerns, the company immediately stepped up security protocols and its vetting process for in-home companions. In August 2023, Papa brought on Yu to manage implementation of Papa's Trust and Safety Roadmap strategy. As part of those efforts, the company implemented mandatory training for Papa Pals, enhanced screenings and identity verification checks and created more secure communication channels.
Papa took those lessons and outlined them in a road map for other organizations striving to facilitate safe in-person, at-home interactions at scale, according to the company.
The report was developed in collaboration with multidisciplinary trust and safety experts including members of global consultancy Shared Advisory.
Ally Coll, an attorney and expert on workplace sexual harassment who co-founded the Purple Method, helped craft the report. In the new gig economy, companies are faced with new workplace challenges as people invite strangers into their cars and enter other people's homes.
"There's not been as much law or norms or shared best practices around how to create safe interactions in these new gig economy workspaces," Coll, a member of Papa's Trust and Safety Advisory Board, said. "One of the things in the roadmap that was highlighted as a priority was doing better learning and education for Papa Pals before they went on a visit. That's something we had been doing a lot of work on with Airbnb and Uber around training and how to really create learning modules that make sense and are effective for people who are often finding themselves in such different situations."
"Papa is a great example of why that's so important because home health care and sending people into each other's homes is not the same kind of environment as people often find themselves in other kinds of earnings situations or contexts," she said.
In the report, Papa's activities are organized under three pillars—Prevent, Support and Act. The company focuses on preventing issues upstream, supports safe interactions as they happen and takes action against violations of policies and standards, as outlined in the report.
Under the "prevention" initiatives in the report, Papa outlines how it enhanced its background and motor vehicle checks, strengthened its identity verification processes and stepped up its Papa Pal assessments. The company offers expanded training programs for Papa Pals outlining safety expectations, cultural sensitivity and how to respond to and report difficult situations. A Papa Pal hub offers access to ongoing education, videos and best practices to effectively support members.
The report details Papa's member enrollment process in which members are educated on Papa’s service scope and what to expect on a visit with a Papa Pal, particularly the type of tasks that Papa Pals can and cannot perform.
The report also details mechanisms to better support members and caregivers. Papa offers Papa Pals a digital “badge” in the app that displays essential information so members can easily and quickly confirm their Papa Pal’s identity before inviting them inside heir home. Papa Pals have access to an emergency assistance feature directly to request immediate help from trained emergency operators during a visit.
The company also uses GPS technology in the Papa Pal app to actively monitor each visit as it takes place.
And, the report details investigation policies, procedures and enforcement actions to take if an issue occurs.
“Human connection is essential to physical, mental, and social health, but facilitating thousands of in-person interactions across the country every week comes with inherent challenges,” Yu said. “We’ve invested significant time and resources to develop high-quality trust and safety practices that prioritize and protect both Papa Pals and the communities they serve."
A key lesson learned in the past few years is that members develop connections and establish trust with certain Papa Pals and often request the same person. In response, the company expanded its Preferred Pals program to improve the member and Papa Pal experience.
"We also noticed that there was a lot of organic kind of pairing that was happening on the platform. We noticed that a lot of female members were organically pairing with female Preferred Pals. We implemented a new protocol where, when female members are enrolled through Papa, we can actually ask them that question on the front end and let them know that they have a choice on who they want to see," Yu said.
Coll said there needs to be more transparency around trust and safety with home healthcare, and Papa is setting a new standard with this report.
"I see too many companies that are afraid to acknowledge that there are risks affiliated with sending people into vulnerable populations' homes. Common sense just tells you that that's a real dynamic in the world that we live in. And, I would much prefer to see a company like Papa talk about it, address it, acknowledge both issues that exist in the world and specific issues that they've dealt with, and do their best to learn from them and help others learn from them," she said.
"I'm hopeful that more companies do that and it becomes regularized and normalized that we can have a safer environment for everybody, because we can all learn from each other. There's no doubt that these other companies, in my mind, entering this space are having the same challenges and issues. The question is, are they learning from others about it, or are they just solving problems and trying to keep it all as internal as possible? And I think that's risky, because it just slows down the ability for the industry to evolve and grow and improve in their safety practices," Coll said.