Home Care Growth Best Practices

Picture a person shopping for home care in your area. I bet the first picture that came to mind was a woman around 45 to 55 years old who is searching for care for her mom.

A family chooses your agency because something in the first two minutes felt different from the last three agencies they looked at. That is a lower bar than it sounds and most agencies still miss it. The differentiator does not have to be elaborate. It has to be specific, true, and memorable enough that she repeats it to her brother that evening.

• If she sees the same stock photos that she saw on the last three sites and all you say is "Home Care for Elderly People" will she call you?
• If she calls your agency and gets voice mail, how will that make her feel?
• What if instead, your Scheduler answers, tired from a long day dealing with caregiver issue, and the Scheduler says "What do you want?" Will she answer or hang up?

Click here for a full lesson on making your agency different.

Here are a few examples of ways to set your agency apart from others in your market:

Click on Deb’s picture to learn more about CircleTalk and consider whether this could help your agency stand out. If CircleTalk isn’t the right fit, what other innovative programs could set you apart?

You can also listen to our  Podcast Episode with Deb Skovron here.

Caregivers quit most often over hours, not over pay. The top reason caregivers move to a different agency is that the other agency can give them the number of hours they want to work. The second pattern worth knowing is how early the losses happen: a meaningful share of turnover occurs in the first days on assignment, which is an onboarding and support problem rather than a compensation problem.

• Do you provide consistent, thoughtful, individualized, and supportive direction to your team about their job duties? Learn more about Caregiver Quality Assurance - A Process-Based Approach
• Do you make tangible efforts to show appreciation for your team, both individually and as a group? Consider implementing Caregiver Rewards That Make an Impact to boost retention and morale.
• Do you put in the time and thought to create a strong company culture, provide skill building opportunities for employees, and offer incentives such rewarding employees if they generate referrals? 5 Ways to Build a Positive Culture at Your Home Care Agency offers insights into how a thriving culture leads to better retention and
• For more in-depth strategies on caregiver recruitment and retention, check out the Caregiver Recruiting and Retention Bible.

Click here for a full lesson on attracting, recruiting, and retaining a strong team for your agency

Here are a few examples of ways to set your agency apart from others in your market:

Offering stellar service and compassionate care from a trained caregiving team may feel like enough to stand out from your competition. With so many caring and professional folks in the home care market these days, providing excellent care is just the start of growing a successful home care agency.

You get more clients by being findable when a family starts looking, credible when they land on you, and fast when they reach out. Most agencies invest heavily in the first, neglect the second, and lose the sale on the third. Median customer acquisition cost was $845 per client in the 2025 Activated Insights Benchmarking Report, so a lead you fail to call back is not a missed opportunity, it is money you already spent and threw away.

• Posting creative, consistent, and engaging content on social media (while interacting with other creators, community organizations, and businesses) Click here for: 4 Ideas for Promoting Your Home Care Agency in Your Community
• Email campaigns and newsletters
• "Snail Mail" outreach to your market
• Participating in or organizing events to present your services and ideas
• Community involvement such as sponsorship, word-of-mouth, and client referrals
• Remarketing or following up with leads via online ads
• Creating "Thought Leadership" posts such as blogs, social media posts, and video content

Click here for a full lesson on Marketing

Here are a few examples of ways to set your agency apart from others in your market:

We can all agree that finding and "closing" new client leads is integral to a successful home care business. Without a strong pipeline of new clients, a business is unlikely to generate revenue to cover (and hopefully exceed) the cost of doing business. And if you don't have a strong sales process that yields the required revenue to run your business, it's impossible to continue to provide the care and to do the important work that is the reason why we all got into home care.

That all said, for many folks, though we understand and appreciate the need for a strong sales process, even the thought of the word "Salesperson" may make us cringe. I'd guess that many of us have had a negative experience or two of a salesperson being "high pressure", use questionable sales tactics, or just give us a feeling that they are not operating in our best interest.

Ultimately, a business can't survive without sales. The way I view it is that the stronger and more focused an agency's sales process is, the more much needed care they can provide to more clients. Another way to put it is: A better sales process equals more sales which equals more folks getting great care, which equals a win for us all.

A sales process that closes is fast, written down, and owned by a specific person. Speed to first response is the biggest predictable difference between agencies that convert inquiries and agencies that do not, because a family in crisis calls three agencies and often goes with whoever calls back first and sounds like they have done this before.

• Do you have a sales process and is your team well trained on the process? Here's a Home Care Growth Kit: Sales Tips to Blow Away the Competition
• Do you have a Sales Director or a team of folks dedicated to generating, fielding, and following up on sales?
• Do you earn, ask for, and promote glowing clent reviews (via your website or online sources such as Google?) Here's 10 Top Complaints of Clients According to Home Care Pulse.

Click here for a full lesson on creating a sales process, and general sales best practices.

One thing we love is to hear the personal stories of how home care entrepreneurs and agency leaders entered the business and became successful.  Karl Pierre is a very interesting and charismatic agency owner with a fun story to share.  Check out Karl's story here:

There are many diverse funding sources for home care. Here are just a few:

• Private Pay
• Long Term Care Insurance
• Medicaid - State Funded
• Disability Services - State Funded
• Veterans
• Medicare Advantage Programs
• and more

Most agencies only focus on one (or perhaps one plus a near neighbor like Private Pay and Long Term Care Insurance).  The two biggest "camps" are the Private Pay camp and the Medicaid camp.  This makes sense because agencies are usually started to serve the owner's local community and it's rare to have a single community that serves wealthy folks who can afford to pay for home care and economically disadvantages folks who qualify for Medicaid.  There are also differences in regulation such as the need for Electronic Visit Verification (EVV) for serving government payers like Medicaid. If you're exploring Medicaid as a funding source, understanding EVV Requirements and its impact on home care operations is crucial.

Add a new payer when your growth is capped by the size of your current payer's population rather than by your staffing. Adding a payer is often faster than adding a marketing channel, because the clients already exist and are already looking for a provider. Before you commit, check the rate in your state rather than the rate in general. The same service can be twice as profitable one state over.

• Do you have a long-term plan to expand your service offerings?
• Have you explored ways to increase your service area (geography)?
• Are you taking steps to diversify your team's skills and areas of expertise?

Click here for a full lesson on making your agency different.

Below are three stories of ways to set your agency apart from others in your market. The first is a way of partnering with an agency who can bring Veterans to your agency. The second is a large home care agency that has partnered with Home Health to support medically complex patients, and the third is an owner who focuses on clients with disabilities:

What good is it to read about all of these ways to grow your agency if you're not measuring your growth?

Growth itself is not a specific term.  While most businesses want to grow, the specific goals for growth can vary.  Some agencies want to grow overall revenue, others want to grow profitability or average hours per client or average time that a caregiver stays on board. You should think about what success means to you and your agency and put the business metrics, sometimes called Key Performance Indicators or KPIs, into place to measure progress.

If you're not sure what to measure, the  home care industry has a great resource for you to learn more about. It's called the Home Care Pulse Benchmark Report.  You can buy last year's report to see what KPIs are being measured in home care and to help you determine the best KPIs for your agency to focus on.  

Track the numbers that tell you whether you can accept the next case and whether the last one made money. At minimum: total inquiries, inquiry-to-client conversion, customer acquisition cost, revenue, gross margin, hours delivered against hours authorized, caregiver turnover, first-30-day turnover, and client satisfaction. In the 2026 Activated Insights Benchmarking Report, agencies that track every single client inquiry reported median revenue of $3.15 million against $1.40 million for agencies that do not.

• Do you track sales data such as total leads, closed leads, and customer churn?
• Do you measure revenue and your gross margins?
• How about client and employee satisfaction? By what method?

Click here for a full lesson on tracking measurements that drive growth.

Your home care software should be able to provide you with the metrics you need to support your KPIs.  This dashboard from the Ankota Home Care Software shows how an agency is performing relative to the number of hours they're authorized for.

At the top of this page, we start with the wonderful news of the growth in the population of folks who need home care and how our industry needs to more than double to meet this demand. The corresponding unfortunate news is that the population of likely candidates for caregiver jobs is declining (and has been for around 15 years).

Part of the solution will require us to rethink the our industry and to find ways that we can provide more care with less staff. One way to do that is to add a day services program where folks come to a care center to receive services. The benefits of combining home care and day services are huge:

Adult day services are one of the few structural answers to the caregiver shortage. In home care you need one caregiver per client. In a day services setting one staff member supports several participants at once, so adding a day program changes the arithmetic of your capacity rather than just improving your odds in the same hiring pool. Ratios are set state by state, so confirm yours before modeling anything.

Here are a few of the key benefits

• One care provider can generally care for up to 5 care recipients (ratios are set state-by-state)
• Your new caregivers can get on the job training in your day center, making them better prepared for when they are the sole provider in a client's home
• Since the combination of scheduled staff plus trainees will push your staffing levels above the required ratios, you're in the position of sending experienced staff to meet with prospects on short notice
• Participants in a day program will be able to make friends and participate in group activities, increasing their experience of care

One of home care's most memorable consultants is Steve "the Hurricane" Weiss who runs Home Care Evolution by Hurricane Marketing Enterprises. Steve's organization used to be focused solely on Marketing but now they've branched into many areas including recruiting and retention, operational efficiency and sales.  If you want to experience Steve the Hurricane, just Google the name and you'll have a chance to see many educational videos that he offers. But the best way is to meet Steve and his team is to go to one of their home care boot camps.

I attended a recent "Millionaire's Bootcamp" with Steve where over 100 agencies were represented, and learned a ton. One session that stuck out was a session on Care Coordinators, which is a way that some agencies have created career paths, improved care, and grown their profit margins.

Steve joined us on home care heroes to speak specifically about how Care Coordinators have led to this success.

Care coordinators add margin by putting a higher-billing, higher-skill role between your caregivers and your office, which raises the value of the visit and gives your best caregivers somewhere to be promoted to. It solves a retention problem and a profitability problem with the same hire. In most agencies a caregiver's only path up is out of caregiving entirely and into the office, and there are very few office seats.

Grow without burning out by building an agency that runs on process rather than on you. An owner who is the single point of failure for scheduling, sales and staffing has already found the ceiling, and no amount of additional effort raises it.

Use AI where it removes repetitive work from your office staff and where it gives you an early warning you did not have before. Start with back-office, low-risk tasks, keep a human on every decision, and never ship raw output to a client or a caregiver. Home care is a relationship business, and done wrong, AI makes you sound robotic.

Yes, and most agencies leave this money on the table. Assisted living communities, continuing care retirement communities and memory care facilities generally pay a commission for referrals that convert into new residents, with reported fees ranging from $1,500 to over $8,000 for a single placement. You are almost certainly generating these referrals for free already.

• Do clients sometimes need to leave your care and move to a facility?
• Do you receive inquiries from clients who aren't appropriate for home care and would be better off in residential care?
• Do you expect that the residential facilities in your area sometimes refer their clients for home care?

The following episode of the Ankota podcast takes a deeper dive into the concepts explained above

Here are some curated articles to help with home care agency growth:

• How Home Care Scheduling Software Increases Retention and Reduces Caregiver Burnout
• How AI is Transforming Home Care
• Innovation, Workforce and the Future of Care at HCAOA

Short answers to the questions home care owners and managers ask us most.

How do I grow a home care agency?

Grow a home care agency by expanding your staffing capacity first, then your client acquisition and payer mix. Demand for home care already exceeds industry capacity, so the binding constraint for most agencies is the ability to staff cases rather than the ability to find them. Recruit continuously, reduce first-30-day turnover, and add a second payer source before adding a second marketing channel.

How fast do I need to interview a caregiver applicant?

Within four days. Agencies that interview caregiver applicants in under four days are 100% more likely to hire them, according to Jen Waldron of Augusta Software. Because one-click job applications let a caregiver apply to fifteen or twenty positions at once, agencies compete primarily on who responds first rather than on the job posting itself.

Why do caregivers quit?

Caregivers most often leave because another agency can give them the number of hours they want to work, not because of pay alone. A significant portion of turnover happens within the first days of an assignment, which points to onboarding and support rather than compensation. Median caregiver turnover was 75% in the most recently published Activated Insights Benchmarking Report covering 2024 data.

How can I improve caregiver retention without raising pay?

Hire against named values rather than credentials, and make recognition structural. Consultant Ginny Kenyon screened for compassion, loyalty, dependability, respect, and commitment to lifelong learning, and found values fit more predictive of retention than credentials. She paired it with a tenure ladder of star pins at six months and personalized lab coats at one year.

How much does it cost to acquire a home care client?

Median customer acquisition cost was $845 per client in the 2025 Activated Insights Benchmarking Report, covering 2024 data, which was a six-year high. That figure makes response time on inbound inquiries a financial issue, not just a service issue, since an unreturned call wastes acquisition spend that has already been incurred.

What KPIs should a home care agency track?

Track total inquiries, inquiry-to-client conversion rate, customer acquisition cost, revenue, gross margin, hours delivered against hours authorized, overall and first-30-day caregiver turnover, applicant-to-interview time, and client and caregiver satisfaction. Agencies that track every client inquiry reported median revenue of $3.15 million versus $1.40 million for those that do not.

Is EVV required for Medicaid home care?

Yes. Electronic Visit Verification is required under Section 12006(a) of the 21st Century Cures Act. Compliance was required for Medicaid personal care services as of January 1, 2020 and for home health services as of January 1, 2023. States face incremental reductions in federal matching funds if they are not compliant, so they enforce EVV requirements on providers.

Is self-direction a threat to home care agencies?

Self-direction undercuts traditional agency rates but creates a new service opportunity. Self-directed families typically pay caregivers roughly $18 to $22 per hour against a program rate near $24, compared with agency billing that can approach $60 per hour. The growth position for an agency is on the administrative side, since participants consistently report the employer paperwork burden as the program's main weakness.

How much do home care agencies charge per hour?

The national median rate for a non-medical caregiver was $35.00 per hour in the CareScout Cost of Care Survey covering 2025, released in March 2026, up 3% year over year. CareScout now reports homemaker services and home health aide services as a single non-medical caregiver category rather than two separate rates.

Can a home care agency make money on facility placements?

Yes. Assisted living communities, continuing care retirement communities, and memory care facilities commonly pay a referral commission for a placement that becomes a resident, often around one month of the facility fee. Reported fees range from roughly $1,500 to over $8,000 per placement.

Should a home care agency add adult day services?

Adult day services let one staff member support several participants at once rather than the one-to-one ratio required in home care, which raises capacity without requiring proportionally more hiring. Staffing ratios are set state by state and efficiency improves with scale, so confirm your state's requirements before modeling.

Is the home care industry still growing?

Yes. The US population aged 80 and older grows from 15.0 million in 2025 to 26.8 million in 2040 and 30.1 million in 2050, based on US Census Bureau population estimates and the 2023 National Population Projections. The Bureau of Labor Statistics projects 17% employment growth for home health and personal care aides from 2024 to 2034.

Ankota's mission is to enable the Heroes who keep older and disabled people living at home to focus on care because we take care of the tech. If you need software for home care, EVV, I/DD Services, Self-Direction FMS, Adult Day Care centers, or Caregiver Recruiting, please Contact Ankota. And if you're ready to see how the most innovative agencies are using AI to empower their caregivers and automate the rest, meet your new companion at www.kota.care.