Updated August 2018, originally posted on Quora during November 2017
There is no simple answer to this question. What type of client? What are their clinical, administrative and hourly support needs? How many hours per week do they require and what is the potential and likely frequency of change in care relative to their circumstances. It’s necessary to consider a number of scheduling factors as well. The relative geography between clients, visit frequency, visit duration and volume of total hours the agency handles.
Client Condition & Support
Clients faced with a progressive neurological condition like ALS or dementia will continue to see changing care requirements. The continuity requirements for these clients are higher than most. ALS clients who become non-verbal rely on intuitive caregivers who can understand their minute non-verbal queues. Dementia clients rely on intuitive caregivers who can live in their world and understand how their altered perspective needs to be handled. The clients with the greatest complexity of care also see some of the quickest change. Is your caregiving team able to manage this type of client? Do you have nursing support available to address other clinical concerns such as choking, transfers or medications?
Admin & Communication
Administrative costs for a client in home care is primarily communication time. This will be be updates on client conditions with family, discussions about scheduling and staffing, care plan updates and a lot of emotion all of the time. A client who may not have a lot of hours per month may be one of your top “costs”. Clients who are dealing with short term memory loss or a mental health issue may not have a lot of care hours but may take up a lot of administrative time. What client mix is your administration able to support? What generates your communication workload? How can you improve your communication practices to reduce the workload?
Since the care hours someone may normally require ranges between 1 to 168 hours per week it actually becomes easier to provide a more effective service with better continuity as an agency becomes larger. Hours for the agency will go up and down each month which means your staffing and capacity must accommodate. Most agencies struggle to cope with the seesaw nature of capacity management while providing effective client continuity. For small agencies, a new client with a lot of hours each week can create a lot of disruption which has to be balanced through your other clients. Once the agency is running around 1500+ hours per month (roughly 10-12 full-time employees) it becomes easier to provide stable employment and corresponding client continuity.