In Conversation with John Kublank on The Cost of Getting It “Almost Right” in Home Care Operations

In home care, operations rarely collapse overnight – they slowly drift into risk.

It starts small. A missed documentation detail here. A new hire who isn’t fully trained. A workflow that “mostly works,” until it doesn’t. These gaps often go unnoticed because day-to-day operations continue to move. Clients are served, shifts are filled, and revenue still comes in. On the surface, everything looks stable.

But beneath that stability, a different reality builds. Small inconsistencies turn into compliance gaps. Delayed documentation impacts reimbursement. Undertrained teams struggle during audits. What feels like “almost right” operations begins to create very real financial and regulatory exposure.

In today’s environment – where EVV, audits, and payer scrutiny are tighter than ever – there’s far less room for approximation. Agencies are no longer judged on intent, but on execution.

This is where many agencies fall short. Not because they lack effort, but because they underestimate the cost of getting it almost right.

To shed some light on the same, we interviewed a home care industry expert to bring his perspective on getting it “almost right” in home care operations.

Let us now delve into what he has to say about getting it “almost right” in home care operations:

Question 1. From your experience leading statewide operations, what are the biggest operational blind spots hospice and home care agencies overlook until they start impacting revenue or compliance?

The most significant blind spot I see is an under-investment in employee knowledge. Many agencies have scaled back on continuous training and robust orientation to save short-term costs. 

This creates a “competency debt” that leads to compliance failures. I’ve seen agencies with inadequate office expertise effectively forced into closure because they lacked the clinical and administrative backbone to navigate a survey or an audit.

Question 2. You’ve restructured organizations at scale—what are the first 2–3 operational fixes you prioritize when stepping into a struggling agency?

When stepping into a struggling agency, I focus on three levers in this order:

• Labor Optimization: Agencies are often overstaffed with underperformers. I prioritize lean, high-performing teams rather than “working around” weak links.
• G&A Overhead: Trimming non-essential administrative spend to protect margins.
• Contract Renegotiation: Addressing vendor and payer contracts for loss savings. This is a “long game” that I initiate immediately due to legal and lead-time requirements.

Question 3. Staffing continues to be a major pressure point – what systems or processes have you seen actually improve caregiver retention in real-world operations?

We must move away from the myth of “forever” staff and focus on operational readiness. If we accept that field staff turnover is a reality, our systems must focus on a “Plug and Play” model: world-class orientation that ensures any new hire can be successful immediately.

Additionally, staying lean in the office allows us to reallocate funds toward competitive pay and tangible appreciation for the field.

Question 4. As agencies grow across locations, how should they think about balancing centralized control with local operational flexibility?

My philosophy is simple: High-touch stays local; back-office goes central. If a patient or family member needs a face-to-face conversation or an immediate response, that position must remain in the community.

Conversely, functions like billing, HR, and high-level admin can be centralized for efficiency. I feel like Centralized intake has to be evaluated on a case by case basis. Mainly, does the top 3 referral sources you have depend on speed? If so, centralized intake will ruin your relationships.

Question 5. Looking ahead to 2026, what operational shifts or industry changes do you believe agencies must prepare for now to stay competitive and compliant?

Regulatory bodies are already using AI to flag non-compliance. To stay competitive, agencies must return to the ‘Clinical Triple Threat’: Excellent Care, Proactive Communication, and Timely Documentation.

We must also be vigilant about legal compliance with third-party tech; for example, in Texas, I advise clients to send certification letters regarding the new 2026 Texas Law SB 1188 to ensure they aren’t inadvertently violating state-specific privacy laws. This law specifically looks at AI, and how we need to handle data.

Question 6. AI is becoming a bigger conversation in post-acute care – where do you see it actually making a meaningful operational impact versus just being hype?

AI won’t replace clinicians, but it will “supercharge” them. I believe the traditional “point-and-click” EMR will be obsolete by 2030, replaced by sensory EMRs that use audio, video, and wearables to automate documentation in real-time.

In the short term, the biggest “win” is in QA and QAPI—using algorithms to catch documentation errors before they become revenue or compliance liabilities.

In conclusion

What this conversation makes clear is simple: in home care, success isn’t defined by effort; it’s defined by precision. The difference between “almost right” and truly operationally sound is where compliance is protected, revenue is secured, and teams can scale with confidence.

As agencies move into 2026, with tighter audits, evolving regulations, and AI-driven oversight, the margin for error continues to shrink. Those that invest in training, tighten execution, and build systems designed for consistency – not just activity – will be the ones that stay ahead. Because in today’s landscape, getting it right isn’t optional, it’s what keeps agencies in business.