The intake process is the first real impression your agency makes. And in home care, the family making the call is usually stressed, often in crisis, and comparing you to at least two other agencies they called the same day. A structured intake process does three things: it gives the family confidence, it captures the information you need to deliver good care, and it protects you legally before a service agreement is ever signed. Here is how to build one: STEP 1: STANDARDIZE YOUR INITIAL CALL Create a script — not a rigid word-for-word read, but a guide that every person answering the phone follows. It should cover: how you greet the caller, what questions you ask to understand their needs, what you share about your agency and your process, and how you close the call (either scheduling an assessment or sending information). Document it. Train anyone who answers that phone on it. STEP 2: BUILD YOUR ASSESSMENT PROCESS Before any service starts, you need a documented in-home assessment. Who conducts it, what it covers, and what form is used should be consistent every single time. Your assessment should capture: the client's care needs, home safety factors, emergency contacts, physician information, any advance directives, and the client's and family's goals for care. STEP 3: DOCUMENT YOUR SERVICE AGREEMENT WORKFLOW Who sends the service agreement? How? When does it need to be signed before the first visit can be scheduled? What happens if it is not signed? This should be a written checklist, not a mental note. STEP 4: CREATE A CLIENT ONBOARDING PACKET Before the first visit, the client and family should receive: a copy of the signed service agreement, your agency's rights and responsibilities document, your grievance process, emergency contact information for your agency, and a schedule confirmation. This packet communicates professionalism and protects you if there is ever a dispute about what was communicated at the start of service. STEP 5: DOCUMENT THE CAREGIVER INTRODUCTION

A system is not a binder on a shelf. It is a documented process that someone other than you can follow and produce a consistent result. That distinction matters because most agency owners have processes — they just live in their heads. And a process that lives in your head cannot scale. Here are the five operational systems every home care agency needs to build before they can grow: SYSTEM 1: INTAKE AND ONBOARDING From first inquiry to signed service agreement to first visit — who does what, in what order, within what timeframe? If this is not written down, every new client is a custom project. That is not sustainable. SYSTEM 2: SCHEDULING AND COVERAGE What happens when a caregiver calls out at 6am? Who gets called? In what order? What is the backup plan if no one is available? If the answer to any of these questions is "I handle it" — that is not a system, that is a dependency. SYSTEM 3: CAREGIVER ONBOARDING AND ORIENTATION From offer letter to first shift, what does a new hire go through? If every new caregiver's first week is a little different depending on who is available to train them, you do not have an onboarding system. You have an onboarding guess. SYSTEM 4: QUALITY ASSURANCE AND SUPERVISORY VISITS How often are you or your staff checking in on active clients? Who documents it? Where does it go? What happens when a concern is identified? This system is both a regulatory requirement and a client retention tool. SYSTEM 5: BILLING AND DOCUMENTATION REVIEW Before claims go out, who reviews them? Who checks that the documented hours match what was scheduled? Who follows up on denials? If billing happens after the fact with no review process, you are either leaving money on the table or creating audit exposure. This week, I am walking through each one of these in detail. Today: take honest stock. Which of these five do you actually have documented and functional? Drop the numbers in the comments — which systems do you have (1-5) and which are still living in your head?

There is a specific kind of stuck that nobody talks about. It is not the stuck of not knowing what to do. It is the stuck of knowing exactly what you are supposed to do — and still not being able to make it run smoothly. You have your license. You have your policies. You probably have some staff. Maybe even a few clients. But every week feels like you are managing a fire instead of running a business. Someone calls out and the whole schedule falls apart. A client complaint comes in and you handle it personally because there is no system for anyone else to follow. You are the scheduler, the intake coordinator, the HR department, and the CEO all at once. That is not a staffing problem. That is a systems problem. And it is the most common place licensed home care agencies get stuck — right after they get their license and before they build the operational infrastructure that lets the business run without them in every chair. This month, we are fixing that. Over the next 30 days I am going to walk you through exactly how to build the three things that will unlock your agency's growth: operating systems that run without you, a client acquisition strategy that does not depend on word of mouth, and a staffing model that keeps good caregivers from walking out the door. But first — I want to know where you are right now. Of these three areas, which one is your biggest problem today? A) Systems — nothing is written down, everything depends on me B) Clients — I am not getting enough referrals or signed clients C) Staff — I cannot find good caregivers, or I find them and then lose them

I want to walk you through a real engagement — anonymized, but real. The organization was a group home serving adults with intellectual and developmental disabilities under the Maryland DDA. They had been operating for two years. They genuinely cared about their residents. And they received a monitoring visit that resulted in a 14-item deficiency report. Fourteen items. In a single visit. When they came to me, the owner was overwhelmed and honestly scared. She did not know how to respond to the deficiencies, which ones were most serious, or how to prevent this from happening again. Here is what we found when we dug in: The most critical deficiencies were documentation related. Person-centered plans were not being updated on schedule. Incident reports were being filed internally but not escalated to DDA within the required timeframe. Medication administration records had gaps. None of these were intentional. They were the result of a staff team that had never been formally trained on compliance documentation requirements, and a supervisor who was managing by instinct rather than written procedures. Here is what we did: First, we prioritized the deficiencies by severity and wrote a Corrective Action Plan with specific responsible parties and dates for each item. Second, we revised the policies and procedures to reflect the correct processes — not what the template said, but what the staff would actually be trained to do. Third, we conducted a half-day training with the full staff team on documentation standards, incident reporting timelines, and person-centered plan requirements. Fourth, we built a compliance calendar with scheduled internal audits every 30 days for the first quarter. At the 90-day follow-up visit, all 14 deficiencies had been addressed. The organization received a clean monitoring report. The problems were fixable. They always are. But you have to know what you are fixing and why. If your organization has received a deficiency report or is worried about an upcoming survey, drop a comment or DM me. This is exactly what I do.

We are going live THURSDAY at 3pm Eastern. Here in the community. We will discuss startup, operations, and growth strategies. Join using the link on calendar. See you on Thursday.