The Revenue Problem Most Home Care Agencies Misdiagnose

Revenue down while your rates go up should make your stomach drop, because it almost never “fixes itself.” We walk through a real home care agency scenario where the owner assumed the website or Google Ads were the problem, but the data told a more uncomfortable truth: client census was shrinking, client hours were slipping, and the business was losing clients faster than it could replace them.

We break down the exact numbers that clarify what’s really happening in a home care business, from website traffic and call volume to the operational metrics that actually determine revenue: referral leads by month, assessments scheduled, starts of care, ends of care, active caregivers, and the conversion rates between each step. Once you can see the full lead-to-client flow, you can stop guessing and pinpoint whether the gap is marketing activity, booking, closing, or retention.

Then we get practical about fixes. We talk about why marketing location matters, how skilled nursing facilities and rehab referrals often produce higher-hour cases, and why you should track 12-hour and 24-hour starts as a weekly KPI. We also dig into the assessment itself: families need an expert recommendation, not a vague menu of options, and the wrong approach quietly reduces hours and revenue. Finally, we zoom in on basics that still get missed like answering calls live, plus simple weekly KPI tables and quarterly reviews that keep small leaks from turning into a lost year.

If you found this useful, subscribe for more home care growth tactics, share this with an owner or marketer who needs it, and leave a review with the KPI you want to improve first.

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Transcript

A Revenue Warning Sign

SPEAKER_00 0:10

We want to talk about a conversation that probably every home care agency needs to have at some point. And Don did a great job with one of our clients recently about helping him identify why his revenue was stalled or maybe declining a little bit. And this home care agency is has been in business for years. They're in a pretty good place. But the challenge in the last few years is that they're not seeing, and you can tell me, Don, their challenge was that they were not seeing an increase in revenue. They were stalled, right?

Web Traffic Is Not The Whole Story

SPEAKER_01 0:45

Correct. Correct. Yes, stalled even though their rate had gone up and some of their hours have gone up, but the revenue was down. And so that's definitely a warning sign. It definitely stands out when your rates are going up and your revenue is dropping. It doesn't add up. So you need to start digging and figuring out what's really going on here. The client surf has definitely been decreasing over time. So, you know, when that happens, you have to think okay, are rates too expensive? Or am I, are my marketers out in the field doing the right thing? Are they seeing the right people? Did I have some clients that were with us for years leave? Is that you have to figure out why the clients are dropping? And there's several reasons that could be happening. It could be the way that you're booking your service inquiries. It could be the that you're not signing when you do get in front of them. So there's a lot of reasons that client served could be going down. And if I remember right, his client hours were also going down. So each client that he did have, not only were the client served dropping, but the clients that he currently had on staff or on his schedule, their hours were also less than what they'd been before. Yes. So digging into that's going to be important.

Build The Full Data Picture

SPEAKER_00 2:06

Okay, just a look at client served from like December of 23 through January of 26. And that's the only number we had. But what he asked for was our website traffic and ad word spend and calls generated and anything else that we could think of. So what he was leaning on was is my web presence not as good as it used to be? So that was his first assumption out of the gate is why is this happening because of my web presence? And the important thing to that I learned and to kind of learn is that web presence probably maybe it's it could be part of the cause, but to don't jump to web presence as the real challenge you're having with revenue. So what we did was we took a methodical approach to this. This is what he requested, and we asked him for more information. So this is a long email, but we took a look at everything he wanted to look at Google business, referral leads. And so to rewind, what the client originally sent us was but Google My Business, our Google Business Profile information, we looked at his website traffic, we looked at how many leads are being generated, how many forms have been filled out, how many, what his budget for Google Ads was, how many calls and clicks he was getting from that. We looked at all of that. Um, but what we realized is that we needed more information from him. So to complete the picture, there are some operational numbers that we needed, like referral leads by month. How many referrals is he getting from non-internet activity? How many assessments were scheduled? How many clients started care? How many ended care? How many active caregivers? Was he having trouble staffing at any point in all of this? And I don't think that was his issue really. But for some people it is. If you don't have enough caregivers or you are declining cases because you can't serve a certain area anymore, or whatever that is, those are some of the things to also consider. So we gave him that information, and here's what some of that looked like over the course of time. But this just isn't the entire picture. So we asked him to fill in all these blanks. How many, how many clients started, how many ended, the lead to assessment conversion? So, how many leads did he have that turned into an assessment? How many assessments turned into a conversion? I don't know if he gave us all that. He may, he I have more numbers coming up, but how many assessments actually started business? So, in in overall, how many leads did he get that actually started? And then active caregivers and cases declining because of staffing. So we asked for a whole lot more. And interestingly, he gave us this, which I'm going to blank out so nobody can see. But he gave us everything. If you look at the top cases declined, we're not, he never declined any cases. So he had news starting care, clients ending care, their hours, daily hours. So this is what you looked at, Don. This was the actual information that helped you say, hey, let's get on a call and talk about this, right? Yes. Yeah.

SPEAKER_01 5:08

Yeah, this information was really telling. And even more when you see a gap somewhere, you do need to have a conversation about it because we can assume all sorts of things. So we did need to get on a call and discuss it to think to find out like, is what I'm thinking what's happening, or is it another area? Because there could be several places to nip and tuck.

The Real Leak Is Client Churn

SPEAKER_00 5:29

So here's what dummy me came up with without having this conversation. And Dawn's really the person to have this conversation with. Your census is not declining because lack of online activity, it's declining because clients are leaving at a rate that isn't being replaced fast enough. And I think Dawn came to that conclusion. In several months, there are higher numbers of clients ending care. And when that happens, the total census drops right after. And then we asked for a phone call. And AI helped us a lot in this or helped me a lot in this. Don already knows these answers, but it helped me a lot. And what we told him, we gave him this information to get a clear answer. We need a few more pieces of information. How many why did people leave? Did they pass away? Were they hospitalized? Did they move to a facility? Was it dissatisfaction? And I don't know that he has every piece of this information. And but the more you have, the better. Lead to client flow. How many leads were you getting? How many turned into assessments? How many started care? And then the referral activity, which I don't think we have, but how many referrals are you getting each month? And any key referral sources change over time. How many did somebody quit their job and now you're not getting any referrals from that place? I think the reason we're doing this, and I'm going to be quiet and let you talk, is that there's so much more to this story. It's not just your online, it's not just your in-person sales. There are so many variables here that you need to consider. And only when you know all of these things can you actually come up with a real plan to improve your revenue.

Fix Hours By Fixing Marketing

Assessments Need An Expert Close

SPEAKER_01 7:09

Yeah, that's true. So when we met, I had some ideas of what was I noticed that his client hours had dropped, his revenue had dropped, even though his rates had gone up. He even increased clients that had been with him for years, not by the same amount, but he even increased their rate. So revenue shouldn't be down. So after talking to him, I found out that he had two marketers, one had left. Um, so that was definitely a piece of it. But as we dug in a little bit deeper, client hours are down. Why are client hours, the average client hours, down? And it's because they're not signing up, obviously, for as many hours a week as they used to. Why is that? There could be a lot of reasons for that. One, where are you marketing? His people or his marketer, the most recent one, is spending more time with assisted living and independent living and not still nursing facilities. I'm telling you, still nursing facilities, rehabs are the best place to go to get bigger client hours. It's just a numbers game. If you if the people there are in need, they should not go home alone. Something major in their life has happened and they shouldn't go home alone. And they shouldn't go home alone with three hours every other day, right? And so your odds increase by a lot. And so marketing to the wrong places is a problem. And if you don't know how to get in a skilled nursing facility or who to see or what to say, we have sales training. That's why we do this, is because it's important and it is more intimidating. When you walk into independent living or assisted living, they're excited to see you. You're they're happy you're there. Everybody waves to you. When you go into skill nursing facility rehab, sometimes you get a side eye. They don't want you there. They don't, it's harder, it's much harder. So I understand why people avoid it, but the reward is so much bigger. And Zap's going to change. He's going to be doing that now. He doesn't have as a KPI how many 12s and 24s are something each week. This should be something on your mind all the time. You should always be going after 12s and 24s because you need to be replacing them. Years ago, they would stay for months on end, even years, they would stay. They don't stay that long now, most of them. And so you should always be on the lookout for 12s and 24. So adding that KPI to the weekly, the weekly goals is super important. The other reason that client hours could be down is the way we're signing. When we walk into an assessment, we're the expert. If we don't walk in with that role, it's not going to sign. If you're allowing them to decide what they need, and I'm not saying you go in and say, oh, you need 24 hours for the rest of your life, it's nothing like that. It's really, though, you are the expert. They're depending on you. You're coming in to do an assessment. There should be a suggestion at the end of that. Based on what I'm seeing, we should you should have services four hours a day, four days a week. And this is why. This is the expectation when you're in there. And so if your marketer is not doing that, then of course, if we're leaving it up to the senior and the family, the hours aren't going to be what they should be. And that's not doing them a service either, because they need more care than that most of the time. And I'm not saying you're going to get them to sign up for exactly what you think they need, but at least starting somewhere and being the expert in the room is a big deal. And so that could be another reason hours are down. So there's just so many reasons that you'll see gaps. Maybe you're not making enough marketing stops each week. We have benchmarks, benchmark goals, KPIs that we teach in our sales training class for that reason. If you don't know what they are, and your competitors do, and they're doing all the right things and you're not, that's going to be a problem. So taking a look at the revenue and finding the revenue leak gap, whatever you want to call it, is really important. And I would say looking at this quarterly at least is really important. Even just looking at your numbers weekly is important. If you're looking at it, shining a light on it, and figuring out where's the stop gap, like I know that I'm supposed to make as a marketer 40 to 50 stops a week. 15 to 20 of those should be face to face. And I know how many referrals I'm going to get from that. But I also have to have a booking ratio that's good and a signing ratio. And we have those, we have those benchmarks as well. And so if you're not getting the referrals you should be getting, what is it? Are you not marketing enough? Are you not seeing the right people? Is your booking ratio not good? Is your signing ratio not good? What's causing the problem? So you should be able to look at each step and see where the gap is. And so this was really telling for him. And I loved helping with this as well. Uh, it's just fun for me. I don't know, maybe there's something wrong with me, but I love to look at the numbers and try to figure out where is the problem. He knew there was a problem. And he he had an idea that client hours were down, but not exactly why. Why was that happening? So it was really fascinating actually to see what came out of it.

SPEAKER_00 12:07

And the client was really happy when you guys got done talking. He was enlightened. He it's sometimes it takes like a somebody that's not deep in the business every day to take a look at things and say, look at this. And you noticed that he was thrilled at the end and he knew he needed to take some steps and he had a better direction.

SPEAKER_01 12:27

And this comes back to, I think, did he say he was going to sign up for sales training or have yeah, he's sending three people through very soon because they're not they're they didn't know about the benchmarks, they're spending time in places that aren't going to yield the results they need or want. So yeah, he wants for them to go through the training.

SPEAKER_00 12:46

Yeah, I think so. The the lesson for me was that when I've always been more of the digital marketing side of the business. And the lesson for me was that when somebody comes to us and says, I want to take a look at my internet numbers, I think my website's not performing the way it should, and I'm not, then that could be part of the problem. It could be until you look at the numbers, you really don't know. But on the other hand, there's so much more to this story, and the real changes that probably need to be made, have something to do with your in-person marketing in the field and your internal operations, how things are being handled from the time the phone rings or the minute you get a referral from a skilled nursing facility to the time that client signs, how things are rolling, and what your people, you as an owner or your marketing people know how to do efficiently. So anyway, it was very enlightening for me to hear all of this and to Don it. This is you're right in there with all this is like Kevin looking at these numbers.

Weekly KPIs That Scream The Truth

SPEAKER_01 13:54

It really is. I really do. It's just being in the industry for so long. I think that when you've done this for so long and you have a goal that's here and you're sitting here, what can I tweak? What can I do? And it may not even be that you have a revenue leak, it might just be that you want to get from here to here. How do I do that? How do I make that jump? And it's normal in home care when you hit the jump, you drop immediately, just for a while. It always happens that way. I think the team isn't ready enough, like maybe something fell through in staffing or we didn't have enough caregivers, but you hit the number and then you drop a little bit, but you'll get it back. I've just seen enough patterns and things through my years that I don't panic when that happens. So revenue leaks are important, but also how do I get to the next level? What's it gonna take? Because I would sit, I worked at a franchise and we were in friendly competition with all of the other franchises because every year there was a banquet and awards given, and we were the number one office every single year. We never wanted to lose that. And the other office, we were just neck and neck all the time. And so we wanted to hit that next level. What can I do? And so I've pulled out all the magic trips out of my bag through the years to do that, to get to that next level. So I think you have to know your numbers. You have to know the numbers weekly. You can't wait till the quarter's over and go, oh good God, I'm not gonna hit my hole unless we triple time it the rest of the year. Don't do that to yourself or your team. Watch a weekly. And if you start seeing a downward trend, you've got to jump in and do something right now to turn it around.

SPEAKER_00 15:26

Yeah, weekly. When you say weekly, I mean that it sounds micro, but you got to start with the micro until you're but you're only watching the benchmarks as eight things for marketing anyway, and you're watching your your weekly run rate weekly.

SPEAKER_01 15:40

So there's eight things for marketing, maybe six, seven things for scheduling, eight things for recruiting. They're in a table, a KPI table. It's not, they have their goals, they list what actually happened and you're just comparing. And and we teach that and give that list in sales training? Yes, yes, we do. We give you all of that and how to manage that piece of it. If they're going, you're meeting with them weekly as well. They're going in, they see their goal, and on the left-hand side, they complete what happened this week. You can clearly see where the numbers are off. Um, and then because each one is the next step, each number is the next step. So it's how many stops did I make? How many were face to face? How many referrals did I get? You could, but you know what they're supposed to be. You can see if you're supposed to get five to seven referrals, but maybe you only got three. Well, did I make four to 40 to 50? How many were face to face? So you can see very quickly the way that it's listed in the KPI sheet where the gap is. You can see, and it has to stand out, it has to scream at you. And that's that's why KPI sheet is so important, so that it does scream out at you and you can very quickly see where the issues are. But then from there, you have to go, okay, are we marketing to the right places? There's usually a little bit more side work to do. And that's why the training's good because we point out those benchmarks. And I think there's many companies out there that I meet with that don't know what the benchmarks are. It's to hold people accountable. But if you don't know what others are doing, really becomes impossible. Really.

SPEAKER_00 17:09

And we're talking about a client here who's been in business almost as long as we've been in business. I mean, they're easily way more than 10 years, probably 15, almost 20 years.

Answer The Phone And Review Quarterly

SPEAKER_01 17:18

We didn't even get into and I because I know better. He's answering his calls live. Nothing's there's a lot of that going on in the industry, too, where phones just aren't answered live. And that's crazy because that adult child is in crisis. I know for us it's oh yeah, his mom needs home care. But for him or for her, the adult child, they're in crisis. They have no idea what to do with mom or dad. No idea. And you think they're gonna fill out a form on a website? They might, perhaps. Maybe at night, maybe on the weekends. Yeah, that they think they're not gonna get a hold of someone, they might, but I'm not gonna do that. I don't want to sit and wait for somebody to call me. I want to talk to somebody right now. That's right. I'm gonna call somebody right now. And whoever answers that phone call and I connect with, that's who's gonna get my business. And so I didn't worry about that with this slide. He's been around long enough. I'm not worried about his phones being answering live. I know he knows all of that, but there are several out there that don't realize the whole reason we're doing all of these things is for the phone to ring and then we don't answer them live. Come on, we gotta do it. We gotta be better than that.

SPEAKER_00 18:25

Absolutely. And so I think we've, as we think about our services and our offerings to our clients, you and I and George have talked about a quarterly, maybe a quarterly meeting to look at all these numbers with clients that are current with us and that have a great internet presence and that have been working with us for a while, maybe doing a quarterly numbers roundup and see if there's anything we can offer as far as advice or consultation.

SPEAKER_01 18:55

I think that's a great idea. And if anything, it'll force them to look at their numbers quarterly. They should be doing it more often. I've been in home care. I get it. You're busy. The last thing you think you're gonna have this whole day planned out, and this is what I'm gonna do. And then there's five call-offs and four durations signed, and nobody knows it's just fires all day, not all the time, but several days of the week, or Mondays and Fridays especially. There are fires to put out. Who has time to look at their numbers? But that's why the KPI speech sheet is so crucial because it's so easy. And you put it in a Google Drive where everyone has access and they're just throwing their info in there before you meet with them every week. It's not too tough. But yes, quarterly meeting with our current clients. I would love to do that because it will force them to take a look and we can talk about how it's going and where the gaps might be.

SPEAKER_00 19:46

And I think that reinforces the fact that your internet presence is really important, super important, but your in-person presence is more important. And the way and the way you handle clients either on the phone or in person is very important. It is, it's very important.

SPEAKER_01 20:04

But without the website and without your Google reviews, they're not going to call you anyway. So they are important. Absolutely. The online stuff is really important. For that reason, if you don't have a good online presence, you don't have Google reviews, and that adult child's been referred to you, they may call somebody else because of your website or because of your Google reviews not being good or just not enough of them. But yes, it starts here. It definitely starts with the feet on the ground. That piece has to be happening and it needs to be consistent and it needs to be the right places, the right times, the right things to say, bringing the right things with you. There's just a lot more to it than just popping around the city all day.