Home health care is big business, very big business. Home health services reached $97 billion in 2017 with Medicare and Medicaid picking up 76 percent of that cost, according to US government statistics.

Grayson County, with a percentage of senior residents, has 34 companies offering home health services, but one company stands apart from the rest, not so much for what it offers but for whom it specializes in serving.

Angels of Care is a pediatric home health service for patients age 21 and younger. Started in Sherman in 1999 by Bonnie West, a pediatric home health nurse, the operation has grown into it is one of the largest children’s home health care businesses in Texas with 15 locations in the state and a new one that just opened in Colorado.

“While there is significant need for pediatric home health care, relative to the overall home health business, we are a niche industry,” registered nurse Ashlyn Estes said. “It’s very specialized. There are other agencies in the area who offer pediatric services, but none of them are based here as we are.”

Estes, who is also the vice president for home health operations for Angels of Care, said that about 180 people work out of the corporate office off US Highway 75 South near Howe to manage more that 2,000 employees — nurses, therapists, attendants, and non-skilled care givers, and other office employees — state wide.

“Pediatric home heath is a little different than other forms of home health,” Estes said. “Our nurses often stay with their patients, almost like in a hospital. It’s all based on their medical necessities, what the doctor orders, and what the insurance approves, but the nurse could actually be in the home for 12 hours straight providing one-on-one care for all of the patient’s needs. Some cases require a nurse 24 hours a day.”

The underlying idea behind home care is to keep the child out of the hospital and in his or her home environment, which is better for the child, better for the parents, less of a strain on limited hospital resources, and actually less expensive in the long run.

“It can be a lifelong medical need, or only a temporary need,” she said. “Either way, if possible, home care is preferred.”

The range of medical problems that can trigger extensive, full-time care is a broad one.

“It could be anything from nutritional needs such as the need for feeding pumps where gastric tubes prevent normal eating or swallowing, or being on a ventilator, where they can’t breath on their own, but they are stable, and they don’t need to be in the hospital,” Estes said.

Many patients have always had significant medical needs, and in many cases, those whose age eventually puts them outside the pediatric age guidelines are eligible for a special Medicaid program called Star 21 that can extend care beyond the age cutoff.

“We have patients with every diagnoses you could think of,” Estes said. “It’s a very special industry.”

While pediatric home health providers see many of the same problems day after day, in reality, each child is unique. And the plan for care, often developed with multiple physicians dealing with multiple disorders, must be unique as well.

“You could have two kids with exactly the same diagnosis, with different needs,” Estes said.

Nurses come with basic skills, but Angels of Care expands on that with special training in a general sense, and specific training to meet a particular patient’s needs.

“One thing that makes us a little different is that our whole company is family owned and operated,” Estes said. “The company was started by a nurse. The president of the company is a nurse. I’m a nurse. So, we try to do everything with the patient in mind. We wouldn’t want a nurse in the home we wouldn’t put with our own children. So the patient always comes first.”

Obviously, the first beneficiary of pediatric home health care is the child and then the parents and the family unit overall, but it doesn’t take long talking to nurses such as Ashlyn Estes, that the rewards for the caring angels are substantial as well. That is exemplified in the company’s motto, HALO.

“It stands for heart, advocacy, love, outreach,” Estes said. “The heart is for our clients; they are the heart of everything we do. We are advocates for the industry because there are so many people who don’t know how it works. Love is for our clients but also for our employees. We can’t take care of thousands of children if we don’t take care of our employees. And as for outreach, we are very involved in the community, particularly here in Sherman because it’s our home. We want to be a part of things and give back to the community.”

And that’s a good thing anyway you look at it.

Edward Southerland is a feature writer for Best of Texoma. For more information, visit BestofTexoma.com or www.facebook.com/BestOfTexoma.