Home Care Strategy Lab

#66 Adam Berry built As Close as Family over nearly a decade before realizing the business had outgrown what he could sustainably manage on his own. Rather than walking away, he sold the agency to Avenues Home Care and stayed on to focus on the work he enjoys most while gaining the back-office support he was missing. In this episode, Adam and Avenues CEO Doug Markham break down how they found the right acquisition fit, what due diligence actually looked like, and why culture mattered more than valuation. They also share how they divide responsibilities after the sale, which functions...

#65 Many home care agencies don't realize they've crossed the Affordable Care Act threshold until the IRS comes knocking. Brendan Mullins, CRO of Vitable Health, explains why agencies with as early as $1–2M in annual revenue can already qualify as Applicable Large Employers, how 30 hours per week (not 40) triggers eligibility, and why variable caregiver schedules make ACA compliance especially difficult. We break down how the 50 Full-Time Equivalent (FTE) threshold is calculated, the misconceptions that lead agencies into trouble, and why penalties can quickly climb into the six figures. Brendan also walks through how ACA audits typically unfold, why compliance issues of...

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Bonus episode recorded live @ Home Care Innovation Forum in Palm Springs, CA
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#64 Most home care agencies are still operating the old way: phone calls, spreadsheets, reactive scheduling, and constant firefighting. Nate West, owner of Heritage Home Care in Arizona, joins me to discuss how he's transformed a well-established agency from what he jokingly calls "the Stone Age" into a modern, tech-enabled operation in just two years. 

He talks about eliminating edge cases, transitioning from reactive scheduling to proactively filling shifts days and weeks in advance, and the role AI is playing in caregiver communication, shift confirmations, and open shift management. And maybe more importantly, we discuss what happens when t...

#63 Most home care agencies treat dementia care as a service line. Full Bloom built an entire company around it. Jim Kimzey, Co-Founder of Full Bloom Home Care, shares the systems, training, and care philosophy that allow his team to successfully serve some of the most challenging dementia clients while helping caregivers, families, and staff thrive.

Jim breaks down the three levers that drive better dementia outcomes, an eight-step process for overcoming care refusal, and the gold standard for supporting complex dementia clients at home. He also explains how a dementia-first approach can reduce caregiver burnout, ease operational...

#62 Most home care sales reps stay busy—but very few generate high-quality referrals consistently. Sean Reiley, CTO at 52 Weeks Marketing, breaks down the specific sales activities, scorecards, benchmarks, and accountability systems that separate top-performing reps from everyone else. Sean shares the five sales activities that actually drive referrals, how many referral sources a rep should manage, what productivity should look like week-to-week, and the biggest mistakes operators and sales leaders make when managing referral accounts.

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#61 90% of home care calls still happen in crisis mode—after the fall, hospitalization, or cognitive decline has already escalated. Paula Marks, VP of At Home Caregivers, explains why the industry must move from reactive “sick care” to preventative wellness models before the caregiver shortage reaches a breaking point. From the growing demand for in-home monitoring technology to the surprising resistance coming from referral sources themselves, Paula breaks down what’s actually preventing families from aging safely at home—and why quality, prevention, and trusted partnerships will dictate the future of home care.

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#60 Amy Pierce spent more than 20 years as a nurse and saw firsthand how fragmented healthcare makes it incredibly difficult—especially for older adults—to navigate. 

In 2018, she and her husband Scott set out to fix that. They started with nurse-led care management, quickly growing to ~10 clients before expanding the team—and within just six months realized they needed to bring caregiving in-house to control quality and outcomes. 

About 1–2 years later, they added clinical oversight so they could handle situations like a 4pm Friday change in condition without sending clients to the ER...

#59 Scott Pierce didn’t come from home care—he came from broadcasting and healthcare software. But after navigating his parents’ complex health needs, he and his wife Amy built something entirely different in Savannah, Georgia. Eight years later, Coastal Care Partners is doing nearly $13M in revenue and 7,000 hours of care per week—all from a single location.

Scott breaks down some of the unconventional decisions behind their growth:

#58 His father founded the first home care company in Connecticut in 1985. After leaving to pursue a career in finance and private equity, Conant rejoined the family business in 2018. What he walked into? Whiteboards, minimal systems, and plenty of opportunity. In less than eight years, he’s helped 4x the business, driven by thoughtful change management, stronger office staff, and continuous process improvement. Conant breaks down how he hires and develops his office team, how they approach micro vs. macro SOP changes, and why regularly visiting other home care operators has been a game-changer for challenging his thinking and bringing fr...

#57 The federal government invested $500 million to understand why seniors are readmitted to the hospital within 30 days—and uncovered six key “preventable” gaps driving the problem. Ethan Guerrieri, VP of Operations at Preferred Care at Home, breaks down the research, explains each gap, and shares how his team turned these insights into their Smooth Transition Care Program. Designed for hospitals and SNFs, this evidence-based approach equips case managers and discharge planners with the tools and education they need to reduce readmissions—and shows why home care is the missing link in keeping clients safely at home.

#56 From 110,713 caregiver applicants, 76% of those hired live less than 20 miles from the center of an agency’s service area. Location, hours, and pay are a few of the most important things applicants care about according to Jen Waldron, Co-Founder of Augusta. Every quarter, Augusta publishes the Recruitment Benchmark Report that details top recruitment channels, interview preferences, time-to-hire stats, previous caregiving experience, and top benefits applicants are looking for. Jen shares data and insights she’s gleaned having seen nearly 1 million caregiver applications over the years—the results are simple, yet staggering.  

#55 Adding virtual assistants hasn’t just been a cost-strategy, it’s become a growth strategy for CareAdvantage. EVP Olivia Jones shares how initial skepticism gave way to a fully integrated model supporting both recruiting and on-call operations. Today, a team of 6 VAs drives the top of the recruiting funnel—each completing ~220 calls per week and collectively bringing in 40+ new caregivers weekly, while also placing dozens into their new caregiver training program. Olivia explains down how they hire, onboard, and train VAs like any other team member, and why that’s critical to success. She also unpacks how they’re unraveling...

#54 So you joined the GUIDE Program…but referrals aren’t coming in like you expected. Now what? That’s exactly where Debbie Miller—Owner of Senior Helpers Nashville and Founder of 52 Weeks Marketing—found herself. Instead of waiting, she got to work.

After running into gaps during implementation, Debbie didn’t just “figure it out”—she built a complete system around GUIDE:

She partnered with Harmonic Health to bring it...

#53 “Care managers turn chaos into clarity—bridging what families want with what their loved ones truly need.” Steve Barlam, a 40+ year geriatric care management leader, former ALCA president, and CEO of JFS Care, shares lessons from building one of the most integrated care management–led home care models in the country. He breaks down the critical differences between home care management and aging life care management, and why clarity in terminology and scope are essential for both families and providers. We unpack the business realities of adding care management—from recruiting the right talent to navigating pricing, market demand, and referr...

#52 What began as a personal mission to find young, hip caregivers for her aunt quickly turned into a business opportunity—and eventually the founding of Halcyon Home, now the 4th largest woman-owned business based in Austin, TX. CEO Amy Sweet shares how her clinical background as a physician assistant led her to quickly add geriatric care management, home health, and hospice to her home care company—and what she learned navigating the complex Texas licensing process. She discusses the leadership challenges of scaling multiple service lines, hiring the right people to grow each department, and communicating how home care, home...

#51 Jenny Johnson was an ICU nurse when a traumatic health crisis in her family changed the course of her career. After discovering private in-home nursing care, she decided to launch her own home care company, Heart of Gold Nursing. Jenny shares the leadership lessons she learned transitioning from hospital culture to running a home care business—building strong communication systems, prioritizing high-need clients, empowering her office team to make decisions, and creating growth opportunities for caregivers. She also explains how adding care management became a game-changing service line, helping her team address both the task-based needs of clients and th...

#50 Indiana switched its Medicaid home care system to Managed Care in 2024—and two years later, many providers say the transition is still a “hot mess,” to put it mildly. Christian Sullivan, an office manager at one of Altra Home Care’s four Indiana locations, shares what it’s really been like on the ground: navigating new MCO relationships, managing operational complexity, supporting clients stuck on long waiting lists, and what this shift could mean long term. Relevant for any home care operator—but especially those serving Medicaid or operating in managed care states.

#49 Every home care business will go through a transition at some point in time via buy, sell, or exit. Cory Mertz, Managing Partner at Mertz Taggart shares why owners often overestimate “the multiple” and underestimate risk, and how factors like reimbursement exposure, transition planning, and management depth quietly drive value. We talk about common blind spots in profitable agencies, why highly unique businesses aren’t always the most attractive acquisition targets, and how buyers are thinking differently today than they were a few years ago. Cory also opens up about the emotional side of selling, the life events that change...

#48 You’ve probably heard about the Medicare GUIDE program—but you may still be wondering: Is my agency a fit? And how do we actually participate? PocketRN Co-Founder and CEO Jenna Morgenstern-Gaines delivers one of the clearest breakdowns I’ve heard on how GUIDE really works. We unpack the program model, the difference between participants and partner organizations, patient eligibility and enrollment, what services are actually included, and how home care agencies can use GUIDE to strengthen and differentiate their dementia care. If dementia is part of your caseload, this is an episode you can’t afford to miss. GUIDE is...

#47 If you’re building a strong culture, social media is easy. If you’re not, social media feels impossible—and most leaders opt out. Nick Bonitatibus breaks down how home care leaders should actually be using social platforms: not as a sales channel, but as a weekly business tool. We talk about what content really performs right now, why raw posts build more trust than polished ones, how to attract referrals and talent, and what real relationship-building looks (and it’s not cold DMs). We talk about how to translate visibility and credibility into real business outcomes—tune in. 

#46 There’s more to private pay rates than most people think. Jesse Walters, CEO of Hillendale Home Care, shares what it’s like to operate as both a low-cost provider and a premium provider—and the challenges that come with each. Jesse walks through acquiring Hillendale, scaling the business by 600% in just three years, and how pricing decisions impacted competition, staffing, and continuity of care along the way. He also discusses opening multiple de novo offices in his California market—by the way, de novo means starting from the beginning—and what that taught him about rates as a long-term...

#45 In the past 6-12 months, AI has gone from interesting and useful to reliable and effective. Dave Dworschak from Phoebe explains what that actually means for operators. It’s not a replacement for people, but a teammate that takes repetitive work off administrator’s plates. Dave breaks down three real scheduling workflows where AI is already being used today: last-minute call-out outreach, proactive shift confirmation, and missed clock-in and clock-out cleanup. Tasks that used to take schedulers 1.5 to 2 hours are now being handled in under 15 minutes. We focus on how agencies can integrate AI into their existing systems, workflows, and...

#44 Nick Provost started in home care as a teenager at his family’s business and has now spent his entire adult life working his way up in home care, eventually stepping into his current leadership role at Gratitude Homecare in New Jersey. The core of his care philosophy is: every family should look back and say working with us was “the best money we ever spent.” We dig into the reality of private-pay business development in home care and the two hats every great BD leader must wear: building referral relationships and converting those referrals into clients. Nick had no for...

#43 - He’s scaled Sunny Days In-Home Care to more than 37,000 hours of care each week across five offices through a mix of organic growth and acquisitions. In this episode, CEO John Bennett breaks down exactly how he’s centralized his back office, structured his org chart, and defined a clear set of North Star KPIs. He shares why hours—not revenue—drive alignment across the organization, how shift coverage acts as a real-time pulse check on culture, and how RACI thinking brings clarity as teams grow. John also walks through the challenge of getting buy-in during periods of change...

#42 He grew the business impressively for five years, exited daily operations, and then things didn’t go as planned. Justin Currie, CEO of Thema Home Care opens up about what happened after he stepped away, the people and process issues he discovered, and how he ultimately tuned the business around. He gets detailed and prescriptive on people in the wrong seats, processes not being followed, hard decisions and conversations he had to have, and the results of re-engaging in daily operations. He also shares an exciting update about partnering with the American Health at Home fund to expand his bu...

#41 Lawyers. Home Care. California. Need we say more… I sat down with Angelo Spinola, ‘the lawyer of home care’, shareholder at Poslinelli, and one of his clients, Yazmin Hamilton, VP of Compliance at industry giant, 24 Hour Home Care. Angelo talks about audit pitfalls, misunderstood regulations, when to bring in outside counsel, and how to be proactive before it’s too late. Yazmin breaks down her 20-person compliance team, what they’re focused on, how they operate, and lessons learned scaling across states, services, and payor sources. These two keep what could be a dry legal episode, fresh with stories and framew...

#40 A $5M home care company can have upwards of 300-500 communication touch points in a single day. It’s not uncommon for an agency to be using 8-12 tech tools and for caregivers to interphase with 3-5 every week. Technology often feels like the root of many issues, even turnover, but often times it’s actually the integration and implementation of these tools. Denise DiSano, the Founder and CEO of enCappture breaks down her 3 C’s framework to analyze and improve your tech selection, adoption, and consolidation. 

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#39 Melissa Morante didn’t come from home care—she came from New York PR—but since joining her family’s agency in 2016, she’s become one of South Florida’s go-to experts on Parkinson’s and chronic illness care. In this episode, she shares how that deep dive into Parkinson’s led to her building a network of support groups that now serve hundreds of families looking for education, community, and relief from caregiver burnout. We talk about what it really takes to run effective support groups, why consistency matters more than structure, where she hosts these groups, and how these gather...

Live @ HCAOA—20-minute conversation with Clayton Foutch, CEO of Home Matters Caregiving

Live @ HCAOA—20-minute conversation with Michelle Cone, SVP of Industry Engagement at HomeWell Franchising, Inc.

Live at HCAOA—30-minute conversation with Stephen Tweed, Founder/CEO of Leading Home Care

Highlights

#38 Most home care agencies talk about “differentiation,” but the Supported Living Group in Connecticut is actually doing it. In this episode, Executive Director Jamie Arber breaks down how his team built a high-acuity, high-retention brain-injury program anchored by Medicaid waivers (ABI), brick-and-mortar program sites, creative arts and vocational services, and an in-house clinical team. He explains the financial model (including $60K–$350K waiver budgets), how programs extend client lifetime value, and why specialization protects margins. Jamie also shares what Medicaid waiver work really requires—operational sophistication, rapid responsiveness, the ability to bolt on profitable private-pay and workers’ comp layers and more. ...

Live at HCAOA—15 minute conversation with Jenny Cambra, CEO of Senior Helpers Honolulu

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Live at HCAOA—45 minute conversation with Carmen Perry, the VP of Provider Engagement @ Paradigm

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#37 42% of Direct Care Workers rely on public health coverage and on average only 32% of agencies doing $1.6-4.9M in annual revenue are offering major medical. Joseph Kitonga, CEO of Vitable, breaks down what small, medium, and large agencies need to know about ACA compliance, nuances for part-time and FTEs, major medical plan options, and other advice and warnings when it comes to offer major medical. (See the chapter highlights below to skip to the content relevant to your size.) 

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Live at HCAOA—20 minute conversation with Chaim Gewirtzman, CEO @ NCE Home Care

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