The main software needed for a home care agency is needs to track caregivers, clients, schedules, visit completion (for which the industry requires Electronic Visit Verification [EVV] , billing, and payroll. Those are the basics. Additional software is available (often in a single application) for expanded functionality like a client/family app, tracking sales (often referred to as CRM [Customer Relationship Management]), Human Resources (applicant tracking, skills, certification, training, and background checks). We will break it all down below:

First off, most home care agencies call their customer clients as opposed to patients. In some specialty areas of home care like home infusion nursing care after a hospitalization, the term patient is used, but for the kind of home care that keeps the elderly and disabled living at home (as opposed to institutional care like nursing homes), the most common term is client. Here are the key features needed in client management:

• Demographics: Name, address, phone numbers and related items like client identification numbers
• Contacts: There are often family members, case managers, referral sources, physicians and other related contacts associated with clients
• Clinical Records: As explained, the focus of this page is on the ongoing care that keeps elderly and disabled individuals living at home, but there is also “medical home care” that will require tracking of some health records like diagnoses and medications. Note that home care software is generally not expected to be an electronic medical records (EMR) system like they have at hospitals and doctor’s offices.
• Authorizations: In most cases home care recipients are wealthy or poor. Wealthy individuals are able to afford to pay for the care out of pocket, whereas the poor receive home care benefits through Medicaid. The Medicaid world pays for home care because sending a caregiver for a few hours a day is much lower than the cost of round-the-clock nursing home care (averaging from $60K - $90K per year). Plus the quality of life is much better too! Medicaid and other government programs that pay for home care authorize a specific amount of care that they will reimburse and for agencies serving these patient communities, authorization management is a critical function
• Care Plans: The term “Care Plan” has many different meanings depending on the discipline of care that is being provided. For ongoing home care, the care plan is generally the list of tasks that the caregiver performs on behalf of the individual. A typical care plan will include help with Activities or Daily Living (ADLs) <see if we have an article to link to about ADLs> like dressing and grooming, meal preparation, light cleaning, assistance with bathing and toileting and similar tasks.
• Schedules: Most home care agencies schedule their caregiving activities for a specific number of hours per week on specific days, and scheduling is a very important part of home care software. There is a family of home care programs called Consumer Directed Services (CDS) <see if we have an article on this that we can link to> where the scheduling is done by the person receiving the care. In some agencies CDS care is not scheduled but instead the visits are “created” when the care is delivered.
• Special Requirements and Preferences: It’s best to match a caregiver who is compatible with each client, so home care software tracks items like when the client needs a Hoyer lift, spoken language and preferences or habits like pets, smoking, or even “likes to watch sports” that are used for caregiver matching.
• Methods of payment: The system should track how the bills will be paid such as via credit card, bank draft, through Medicaid or other methods.

Similar in some ways to client management, home care software needs to track caregiver information, as follows:

• Demographics: Like name address and caregiver IDs (required so that they can use apps for clocking in and out of their visits)
• Pay Rates: Often a single hourly rate is set, but some agencies pay different rates for different services
• Skills and Preferences: Home Care software must track the work that a caregiver is qualified for. In many homecare agencies skills are only assigned to staff who can perform special function like supervisory visits or nursing functions. However, others keep track of spoken languages, preferences such as whether the caregiver is ok serving a client with pets or who is a smoker and other attributes used for matching caregivers to clients.
• Certifications: Some states require that home care providers be trained and certified to perform CPR or to have had a TB Test each year.
• Schedules: The software also tracks schedules and caregiver visit history

Beyond the tracking the caregiver basics, some home care software has more extensive Human Resources (HR) tracking. Some features to look for here are as follows:

• Applicant Tracking: for prospective caregivers. This tracks where the caregiver was found (or who referred them), education, interview notes, and more.
• Background checks: Some states and agencies require background checks such as making sure that the caregiver is not listed in the Family Care Safety Registry, the Office of the Inspector General (OIG) List of individuals precluded from providing care or others.
• Online application form: Ankota’s software provides a way for caregivers to apply online (that can be embedded into your company website)
• Documentation: This tracks forms filled out or provided by caregivers such as I9, W4, and certificates for things like CPR training.
• Workflow: Sometimes attaining and keeping up with caregiver information is a process. For example, when it’s time to renew CPR training, you need to inform the caregiver to sign-up for a class, make sure that they attended, make sure that they passed their test and more. A sophisticated system can automate these steps.

Here is a rundown of how home care scheduling works. The modes of scheduling required by an individual home care or home health care business will depend on the types of services that it performs

• Weekly Recurring Care: For example: Mary goes to see Mrs. Johnson Monday through Friday from 8:00 until noon.
• Self-scheduled care recurring care: In some “consumer directed care” models, the person receiving the care tells the caregiver when to come and the visits are created when the caregiver arrives.
• Episodes of Care: On the home health nursing side, including physical therapy, occupational therapy and speech therapy in the home, there is a model called “episodes of care” and there’s a special notation that is used where, for example, they can say 3w2;2w4 to mean that the care is delivered 3 times a week for 2 weeks then twice a week for 4 weeks.
• Periodic Care: Sometimes nursing and supervisory care is delivered one a month or it may be more complicated such as “the next assessment must be completed within 90 days of the previous assessment”
• Route optimization: One form of home care is deliveries such as for Meals on Wheels or Home Medical Equipment (HME). In this case the software should optimize the driver’s route to minimize driving time

While we have tried to avoid acronyms and jargon on this page, it is important to learn about EVV, which is the acronym for Electronic Visit Verification. If you are learning about home care software for the first time, read on. But if you are already familiar with EVV and want to dive deep, please visit our Ultimate Guide to EVV <link>. Here is the high-level overview:

• EVV has been mandated by the 21^st Century Cures Act. In summary, when a caregiver clocks in or out of a visit, the home care agency needs to provide electronic proof of the client, the type of service, the caregiver, and the location. Although the law and mandate is for government reimbursed home care (mostly Medicaid and Veterans care), EVV has been adopted as the standard for private pay home care as well.
• There are 3 primary ways of gathering EVV data as follows:
  • Mobile GPS App: Caregivers location of arrival and departure is verified by GPS
  • Voice Telephony: Caregivers dial in from the client’s home phone and caller ID is used for location verification
  • FOB Token: A FOB is affixed in the home and generates a code at the arrival and departure time
• Visits are reviewed electronically for errors: If there is an error in the EVV data or other visit parameters like the duration, the office reviews it, verifies the facts with the client and caregiver, indicates how the issue was resolved with exception codes, and in most cases backs up the facts with a paper timesheet.

The Home Care Billing module calculates the pricing of the visits based on the service types and the duration of service and applied rounding rules <link to a rounding rules article>. There are a variety of billing approaches that are required based on the home care agency’s “payers.” Here are the key billing approaches:

• Private Pay: The agency creates invoices and sends them to the client or their designated payer (such as their daughter). Many private pay clients agree to have their fees charged to credit cards or drawn from their bank account via and ACH payment.
• Long Term Care Insurance (LTCI): Most LTCI agencies want a detailed description of the care received by the client. There is generally a requirement in LTCI policies for the client to need help with at least two and sometimes three Activities of Daily Living (ADLs)
• Medicaid: Medicaid services are generally billed as 15 minute units of care. Historically small agencies have entered their claims on a Medicaid portal via Direct Data Entry (DDE) or have submitted 837 claims. Medicaid is administered on a state-by-state basis and as states move over to EVV, the payment methods are changing. In some states, additional information is added to the claim, whereas in other cases visit records are sent to an EVV aggregator that turns it into a claim.
• Managed Care Organizations (MCOs): Some states have outsourced their Medicaid billing administration and EVV programs to MCOs (most of which are insurance companies). In this case the MCO specifies how claims are to be submitted.
• Other forms of billing: Most other payers accept some type of paper invoice, paper claim (like a CMS1500 or UB04) or an electronic claim

The calculation of payroll is like the calculation of billing. Most home care agencies use a service for processing their payroll and filing their taxes. Ankota provides this service, but most home care software providers do not. Some special considerations for home care payroll are as follows:

• Overtime: In most cases overtime is payable after 40 hours
• Travel: Travel pay rules vary greatly by agency. The most typical approach is not to pay to the first visit of the day or to pay for the travel home from the last visit, but payment is generally made for travel from the home of one client to another and for mileage in the caregiver’s personal vehicle for running errands on behalf of their client.

The more sophisticated home care software tracks remittance from the home care payers. The system will show Accounts Receivable (outstanding balances) by payer category and by care recipient. It will be depicted as current or overdue balances (usually 30 days. 60 days, 90 days and 120 or more days). There are 3 primary remittance methods:

• Automatic payments: When bank drafts are taken or credit cards are charged, the charges can be automatically marked as paid
• Checks: Checks can be entered to pay one or more invoices fully or partially. It’s not uncommon for a client to overpay their balance. In this case the software should track the overpayment and apply it as a credit towards the client’s next bill.
• Electronic Remittance: Most government payers (Medicaid, VA and MCOs) will deposit your payments into your bank account and they will send a Remittance Advice file (EDI 835). The home care software will apply the payments and based on the 835 will document any rejected claims or partial payments.

Although home care caregivers mostly work with care plans in the form of check lists, there are documents required as part of the client onboarding process and for initial and ongoing assessments and supervisory purposes. Since many agencies and states have made their own forms, a rich home care software solution will have a form builder.

Additionally, the home care software will have the ability to associate forms with clients and with visits. Another important feature is the ability to fill forms at the point of care in a mobile app, and for that app to work both online and offline. 

Another important home care software feature is the ability to provide intelligent notifications to caregivers, office staff and even to clients. There are many notifications available in home care software. Here are a sampling of those notifications:

• Caregiver Notifications:
  • Upcoming visit reminders
  • Late arrivals
  • Time to clock-out
  • Late clock-out warnings
  • Newly assigned visits
  • Available shifts
  • Upcoming expirations of certifications or other items
• Home Care office staff notifications
  • Late arrivals and departures
  • Visits needing review
  • Expiration of HR Requirements
  • Upcoming birthdays
• Client Notifications:
  • Reminders of upcoming appointments
  • Notifications of customer satisfaction surveys

A study by Home Care Pulse <link to home care pulse> showed that agencies who track their prospective clients, where the leads came from, and reasons for losses make on average $600K more than those who do not. Home Care CRM software tracks the following:

• Client demographics
• Client contacts, most importantly the person contracting for care
• How the lead was generated (website, post card, referral partner, etc.)
• Who the referral was from
• Which marketer or salesperson is in charge of the lead
• Meetings (such as a home visit) associated with the lead
• If the client is not won, why not?

All home care agencies should have a website and social media presence. The website should answer the following questions:

• Agency name
• Geographic coverage
• Personal story – why did you start the business
• What services do you offer
• What makes you special or different
• How can you be contacted (there should be a phone number and web form)

In addition to having a static website, you should consider having the following things:

• A plan to update the site on a regular basis
• Ability to send an email newsletter
• Note that a good approach for achieving these items is to tell stories on your website in the form of blog articles and to have those blog articles pushed to social media such as Facebook, Instagram and Twitter

Note that your website, email marketing and social media are not generally part of your home care agency management software.

Outside of the home care agency management, home care businesses should have accounting software. Most of the agencies we work with use QuickBooks. The key features of your accounting system are as follows:

• Track revenue
• Track expenses
• Organize the revenue and expenses into a general ledger
• Track your assets and liabilities (presented on a Balance Sheet)
• View profit and loss in a statement of cash flows

Home Healthcare and Home Care are similar but different. In general, Home Healthcare agencies provide medical services (Nursing, Physical, Occupational and Speech Therapy) for up to 60 days to help them recover after a hospitalization. By contrast, home care is an ongoing service that enables elderly and disabled individuals to stay in their homes. Key features of home care software are as follows:

• Creates an OASIS E (Outcome and Assessment Information Set) for assessing care and determining the reimbursement rate
• Medical Record tracking (such as diagnoses)
• Adheres to the PDGM standard (Patient Driven Groupings Model)
• Allows nurses and therapists to document their patient visits

The software required for home health therapy is encompassed inside the home healthcare software described above, however there are also “standalone” therapy companies who provide physical occupational and speech therapy services as subcontractors to home health agencies. This requires a special form of billing and also the requirement to maintain different document sets for the different home healthcare agencies that they subcontract to.

Providing dialysis and other IV drug infusions in the home results in lower costs and less patient exposure to other diseases when compared to having the patients receive treatment in dialysis centers. Home infusion software needs to optimize driving routes for the therapists who administer the treatments. It must also coordinate with the specialty pharma to make sure that the compounded drugs and infusion pumps necessary for treatment are supplied.

Durable Medical Equipment (DME) and Home Medical Equipment (HME) are similar terms. DME refers to specific pieces of equipment and HME is the family of services needed to deliver and train the equipment for home use. Most DME/HME businesses have a software package that tracks the equipment that they offer, the quantities on hand, reorder points for inventory management, plus the ability to take orders and bill for those orders.

Often DME/HME software needs to be supplemented by software that can track and optimize deliveries.

In normal times, supervisory personnel and/or on-staff nurses visit with their caregivers and clients on a regular basis for the purposes of supervision and periodic assessment. In order to keep those practices alive during the COVID crisis, telehealth is a great solution.

Additionally, there is a growing shortage of available and qualified caregivers that will only grow. As a result, the need to administer care remotely will grow correspondingly. Today’s seniors are growing in their ability to use technologies like apps, Facetime and Zoom. These factors lead logically to the use of remote patient monitoring and remote chronic care management.

Lastly and importantly, there are a growing number of reimbursable telehealth and remote care services that can be delivered by home care agencies.