What You Don’t Know About Scaling Your Home Care Agency
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Erin Cahill: Welcome to CareSmartz360 On Air, a Home Care Podcast. I’m Erin Cahill, a Senior Sales Consultant at Caresmartz. Joining us is Ralph Laughton, the mastermind behind Heart, Body & Mind Home Care—a national award-winning, tech-driven, person-centered powerhouse. Ralph isn’t just leading a home care agency; he’s redefining what excellence looks like in private duty care.
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Erin Cahill: Under his leadership, his agency has landed in the Top 100 for service quality two years running and became the first private duty agency to earn the Memory Care Seal of Excellence from the NCCDP.
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Erin Cahill: He’s a strategist, an innovator, and a published thought leader—his insights recently graced the pages of HCAF’s Florida at Home journal. But today, he’s here to reveal what you don’t know about scaling your agency—the blind spots, the breakthroughs, and the battle-tested strategies.
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Erin Cahill: So, grab your notepad because Ralph is about to drop some serious home care wisdom. Let’s dive in! Welcome to the podcast, Ralph.
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Ralph Laughton: Well, Erin, thank you so much for having me on the podcast 1st of all, and for those very kind words. I truly appreciate your comments and introduction.
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Erin Cahill: Of course.
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Erin Cahill: So, we’ll jump right into it. 1st question for you. What are some hidden pitfalls or unexpected challenges? Home care agency owners face when trying to scale effectively.
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Ralph Laughton: Yeah, there, there are several. I think that 1st of all, you need to have a strategy. That may sound obvious.
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Ralph Laughton: But it is about looking internally at what your capabilities are, what your staff makeup is, what their individual abilities are. Are they capable of their job responsibilities to get you where you need to be? So, it’s really analyzing your organization and then putting together.
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Ralph Laughton: creating a big vision of where you want to be and then putting together a plan to get you there. So, one of the
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Ralph Laughton: pitfalls, I would say, is attempting to grow rapidly, without adequate resources that could be in the structure of your staff. That could be financial. For example.
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Ralph Laughton: one year, 3 years ago we grew it by over 39%. The year after that we grew to something like 45, 47%. This year, we’re up 53%.
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Ralph Laughton: What that will do can cause is that your payroll costs can outrun your receivables. In other words, every week or every few weeks, you can be paying more in payroll, or almost as much in payroll as what you have coming in from billing the prior few weeks ago, because you’re growing so rapidly, so cash management.
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Ralph Laughton: Maybe, after looking at your staff cash management may be the biggest pitfall in outrunning your cash flow.
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Erin Cahill: Absolutely. And how do AI and technology play a role in scaling a home care agency while maintaining the quality of care.
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Ralph Laughton: So, I think that AI can play several important
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Ralph Laughton: key factors in developing your growth strategy. But maybe not the way people think so one way that AI that we’ve used AI is in
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Ralph Laughton: Oh, our social determinants of health in tracking our falls.
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Ralph Laughton: And by doing that, we can. When we go to our referral sources or talk about heart, body, and mind, home care, we can speak authoritatively about the quality of our service, how we can prevent readmissions or minimize readmissions compared to the industry standard. So it’s about having software, perhaps, like with care smart that can track
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Ralph Laughton: that that information for your social determinants of health. For example, we use that information. We’re a Va provider. We can determine which of our clients may be at risk of hospitalization.
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Ralph Laughton: And so, we can take that data, print it out on a Pdf. And with our local veteran’s administration, we can go to them and say, Hey, for these veterans we are recommending additional hours. Here’s why.
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Ralph Laughton: and that is a use of AI that folks might not immediately think of. It’s not as sexy, but it’s practical in helping us build the hours.
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Erin Cahill: Yeah, absolutely. And what strategies can agency owners implement to ensure that rapid growth doesn’t dilute their care standards or company culture?
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Ralph Laughton: We’ll go back to looking at what your staff is, and hire in advance of your growth.
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Ralph Laughton: That, I think, is a key. Well, let’s call that one of the potential pitfalls is running real fast, growing rapidly.
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Ralph Laughton: I root for everyone’s success. Who does that?
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Ralph Laughton: But
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Ralph Laughton: Be sure that you think through what staff you need in order to manage that growth and still have quality care. So, one thing that was has been important for us, Erin is and a differentiator that has been intentional was having excellent service.
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Ralph Laughton: And
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Ralph Laughton: and we did that before we engaged home care pulse now activated insights. So that was, you know, 3 years ago, we said, we want to make sure that we live.
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Ralph Laughton: You know, by our
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Ralph Laughton: or let’s say, by our word, our reputation, you know, services, our passion excellence is our promise, and we engaged activated insights to measure our quality. Well, we won the top 100 the year. After that
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Ralph Laughton: we won the top 100, but to do that we had to have the resources so caregivers, training in field or field supervision to make sure that we were providing very good care at that level, you know, in to our clients.
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Erin Cahill: Right, and what compliance or legal consideration should agencies be aware of when scaling in Florida’s home care market.
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Ralph Laughton: Well.
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Ralph Laughton: compliance. Legal considerations are probably just about the capability into so Florida is a highly regulated State for private duty, home care. Unlike many others, we’re highly regulated. And in the 9 plus 9 and a half years we’ve been
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Ralph Laughton: in operation here in Florida. We’ve never had a single deficiency.
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Ralph Laughton: through surveys by the State Regulator.
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Ralph Laughton: And they are strict. We’ve never had a single deficiency. So, with respect to compliance rapid growth can cause strain in an organization.
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Ralph Laughton: you know, for all of the reasons we might suspect. You have caregivers who don’t meet expectations. You may have clients or family dynamics that cause issues, and
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Ralph Laughton: you know, and service failures, etc.
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Ralph Laughton: if you are hiring a lot of new care providers to service the new growth. Well, then, processes can fail. If you have new staff that you’re hiring that affects culture and processes. So, as you grow, you have to think through
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Ralph Laughton: again, going to your capability and higher in advance of your growth, or at least be very cognizant as you’re growing of the stresses and strains in your office
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Ralph Laughton: So that you do what’s necessary to still maintain the regulatory standards. So, we just had, you know, a
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Ralph Laughton: an agency for healthcare survey back in November.
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Ralph Laughton: Sometimes they can be 2 days. They are certainly always all day. 2 2 surveyors came in. They come in unannounced, and they’re looking for problems. And I have to say that.
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Ralph Laughton: again. We had no deficiencies. We were fairly confident that we would be pretty good, but you don’t know if something’s going to be found, but we make the investment internally.
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Ralph Laughton: To remain compliant, and we audit our files, but we make sure we have that resource inside to do that.
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Erin Cahill: Yeah, that makes sense. And the last question for you, Ralph, with the industry evolving rapidly what key trends or challenges do you foresee shaping home care in 2025. And how should agency owners prepare for that?
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Ralph Laughton: Well, of course, we’re all aware that the population is growing rapidly among seniors. In fact, I know that.
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Ralph Laughton: there’s a stat out there that’s interesting. Maybe it’s around 2034, 2035. The population of seniors, age 65, and older, will, for the 1st time in our country, be greater than the population of children.
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Ralph Laughton: So, we’re aging rapidly, and that also would mean that the workforce is going to be pretty small.
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Ralph Laughton: I would say opportunities to take advantage of that would be looking at.
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Ralph Laughton: expanding your range of services. So maybe diversifying your services, maybe adding additional conditions. We specialize in Alzheimer’s and Parkinson’s as well as complex conditions. Well, Alzheimer’s and Parkinson’s, of course, fairly prevalent right now, but also the clients who have that condition typically.
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Ralph Laughton: have had that condition for many years, and around the say with Alzheimer’s about 7 years, say, is, when home care is likely going to be needed. And so that’s about the length of service of clients who have certain conditions. You can look at that we do.
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Ralph Laughton: You can also take a look at adding additional payer sources. So, we’re a big Va provider in our area. It’s private pay equivalent.
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Ralph Laughton: Others may
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Ralph Laughton: consider medicaid waiver. We’re not a waiver provider, but in some States the waiver pays pretty well. You can consider in some jurisdictions, adding people with disabilities
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Ralph Laughton: that would. That’s similar to Medicaid Waiver, and that could be a specialization. So, take a look at payer sources. Different payer sources like that to diversify your payer sources, increase your revenue, increase your profit so that you can make the investments you need to make in order to continue growing.
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Erin Cahill: That’s really helpful. Thank you so much for sharing your expertise with our lovely audience. Thank you so much for tuning in until next time. I’m Erin Cahill. Signing off.
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Ralph Laughton: Thank you. Erin.
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