In Conversation with Kristen Duell on The Hidden Reason Home Care Growth Stalls Before It Scales

Most home care agencies don’t stall because they lack demand, effort, or ambition. In fact, many are doing everything right; running marketing campaigns, closing deals, onboarding clients, and pushing teams to move faster. And yet, growth plateaus. Margins tighten. Teams feel stretched.

Leaders step in to patch gaps that shouldn’t exist. What looks like a sales problem, an operations issue, or a technology shortfall is often something deeper and harder to spot: misalignment at the seams. Growth breaks not in one function, but in the handoffs between them – where marketing promises meet sales expectations, where sales commitments meet operational reality, and where operations absorb the pressure without clear ownership.

Without a single view of the full client journey – from first inquiry to long-term retention – momentum turns into friction. Systems get blamed. People burn out. Scale feels risky instead of repeatable. The agencies that break through don’t grow faster by chance; they grow cleaner by design.

Understanding where growth truly stalls is the first step toward building a home care agency that can scale with confidence, clarity, and control.

To shed some light on the same, we interviewed a home care industry expert to bring her perspective on the hidden reason home care growth stalls before it scales.

Let us now delve into what she has to say about the hidden reason home care growth stalls before it scales.

Question 1: From what you’ve seen, where do home care agencies most often break their growth engine, marketing, sales, or operations?

Most agencies do not break in one place. They break at the intersection.

Marketing creates demand that sales cannot convert consistently. Sales closes business that operations is not set up to deliver at scale. Operations then absorbs the pressure. The issue is not capability. It is alignment.

Growth in home care requires ownership of the full client journey, from first touch to long-term retention. When no one owns that end-to-end experience, the engine stalls.

Question 2: What separates go-to-market strategies that look good on slides from those that actually drive adoption in care at home?

Adoption-focused strategies are built for real life, not boardrooms.

The difference is whether the strategy answers one critical question. Who has to change their behavior for this to work?

If that answer is not specific and supported with training, clarity, and accountability, adoption will fail. The strongest go-to-market strategies are simple, practical, and grounded in how care is actually delivered.

Question 3: How should agencies evaluate tech investments to ensure ROI, not just implementation?

Agencies should evaluate technology based on outcomes, not features.

Before purchasing, leaders should be clear on what problem the technology is solving, what manual process it replaces or improves, and who is accountable for adoption after go-live.

Technology only delivers ROI when behavior changes. Without ownership, training, and follow-through, even the best platforms become underutilized tools.

Question 4: What’s the biggest disconnect you see between vendors’ promises and agencies’ day-to-day realities?

Time and capacity. Vendors often assume agencies can absorb change quickly. In reality, most teams are stretched thin, balancing staffing challenges, compliance, and growth pressures at the same time.

When vendors design solutions without acknowledging operational constraints, trust erodes. The strongest partnerships come from shared accountability and realistic expectations on both sides.

Question 5: For agencies scaling fast, where does CRM or EMR optimization matter most, and where is it overcomplicated?

CRM and EMR optimization matters most at intake, referral management, and communication workflows. That is where growth either accelerates or quietly leaks.

It becomes overcomplicated when agencies customize before they standardize. Clean data, clear ownership, and a few critical workflows executed well drive far more value than excessive customization.

Question 6: How can agencies grow with intention without burning out leaders or teams in the process?

Intentional growth requires boundaries. Agencies burn out when leaders compensate for broken systems with personal effort. Sustainable growth means being disciplined about what the organization can support, whether that is client mix, service offerings, or internal change velocity.

Growth should reduce chaos, not amplify it.

Question 7: Looking ahead, what mindset shift do care at home organizations need to make to build sustainable growth, not just short-term wins?

The shift is from chasing momentum to directing it. Short-term wins come from speed. Sustainable growth comes from alignment. Organizations that succeed long term prioritize clarity, accountability, and operational health over rapid expansion.

In care at home, growth is inevitable. Stability is intentional.

In conclusion

Home care growth doesn’t stall because leaders lack vision or teams lack effort. It stalls when alignment, ownership, and operational clarity fall behind ambition. Kristen Duell’s insights remind us that sustainable scale is not about moving faster; it’s about moving deliberately.

Agencies that succeed long term take control of the full client journey, design for real-world adoption, and set boundaries that protect both people and performance. Growth done right reduces chaos instead of creating it. For care-at-home agencies navigating their next phase, the takeaway is clear: stability is not accidental. It’s built: intentionally, thoughtfully, and together.