In Conversation with Holly Larson on Designing Care Systems That Scale with Families

Most families don't plan for a caregiving role. They inherit it one task at a time. In terms of a canceled appointment, a missed medication, or a phone call from a worried neighbor. By the time they notice the patterns, they are already dealing with something much bigger, something that they wrap their heads around easily.

Holly Larson, Founder of Your Chief Care Officer, points to this big picture and, through her insights, helps agency operators understand that families are not just at the receiving end of care. They are, in fact, the system integrators holding everything together. Coordinating with care providers, going to pharmacies, managing transportation, and paying heed to details that not everyone else can easily notice.

Perhaps hiring a home care agency solves the bigger purpose. But family too remains integral to it all.

She also points out that home care has a distinctive approach, and that distinction matters. If care is simply a set of tasks, the fix is more help. However, if care is a system, the fix is better coordination. These are two different problems, and most agencies still solve only the first.

To shed light on this, we interviewed a home care industry expert to share her perspective on the actual operational realities behind family caregiving.

Let’s dive into understanding her perspective on what it takes to build a strong caregiving system- one that can manage challenges at scale.

Question 1: Care is often treated as a collection of tasks: appointments, medications, transportation, personal care. You describe care as a system. What changes when families start thinking about care that way?

Families often come back into care slowly, taking over a responsibility at a time. That’s why they think about care as a series of tasks.

The challenge with this approach is that care stays tactical and siloed. Another approach is to recognize that families are actually executive managers who oversee and integrate care across domains, providers, participants, and processes. They are the CEO, CMO, COO, or another C-suite executive of their family’s care system. When they recognize that, they can step back to design and manage care more holistically.

I encourage families to look at how care changes across horizons, from independent living to end of life. While the passage of time and location of care are important, I believe that zeroing in on who holds the care – the individual, family, or paid system – is one of the most essential variables to consider. This helps families plan care in a way that meets their lived reality, not just their goals and preferences. They can also identify early signs of operational strain. For example, an independent living arrangement that really needs paid care support, so that they can redesign care and preserve family capacity.

Question 2: You've written that families can still end up managing schedules, call-outs, caregiver communication, and quality even after hiring professional help. Where do you think the boundary between “receiving care” and “managing care” has broken down?

Home care agencies provide valuable support that can help keep seniors in their homes longer and enable them to engage with their favorite activities and receive targeted care for their needs.

However, families that engage with a home care agency often maintain a coordinative load: initiating service, onboarding caregivers, sharing context and instructions, monitoring quality, and communicating changing needs or perspectives. These communications may happen reactively, when there’s a problem, and occur via phone, email, or text. As a result, families still maintain a significant management burden.

Now multiply these issues and others across domains. Families are acting as system designers and integrators of their care system with a team that includes physicians, pharmacies, PT and OT, transportation and other providers. Home care agencies, while important, are only one of these parties.

Technology helps agencies centralize schedules, care information, communications and other details families might otherwise manage across phone calls, emails and text threads. But technology alone doesn't eliminate the management burden. The real test is whether it reduces the number of things a family has to remember, initiate, monitor, or follow up on.

Over time, that kind of visibility and coordination will become part of what families expect when choosing and staying with a home care provider.

Question 3. You use the idea of “Stability Drift” to describe the gradual degradation of a care system before a crisis becomes visible. What are some of the earliest signals that a family's care arrangement is becoming unsustainable?

Recognizing stability drift

I encourage families to look at Stability Drift across a care system: what’s affecting seniors, what’s impacting families, and the systems of support that make care possible.

Senior risks can grow slowly, sometimes catching families unawares. For example, shifts in cognition aren’t always apparent until risks grow, such as when seniors pay bills late, leave a stove on, or get lost while driving. Detecting these warning signs earlier can help families consider how to evolve the care system proactively.

Caregiver capacity is part of the equation

I also believe that caregiver risks are as important as care recipient risks, since they plan and manage care for their loved ones. That’s one reason I created my Care Stacks visual model series to show the pressures they face: across the care system, planning and decision-making, and the care load.

A common sign of Stability Drift is a family’s growing lack of caregiving capacity. In a recent LinkedIn post, I modeled what a 168-hour week can look like for someone balancing work, commuting, children, and aging parents. In that scenario, just 9.6 hours remained. Solo caregivers likely have even less margin, given that they have no one to help share the care load. Care can start to feel unsustainable very quickly.

Redesign care before crisis

If we recognize that care is always changing, we can determine what warning signs should prompt conversations about how to redesign it proactively. For example, if a senior is increasingly confused or falling at home, that might indicate it is no longer a safe place to be. Or if a family is tapped out, it might mean they need more professional support, such as hiring a home care aide for both weekday and weekend support.

A common theme I hear when I talk to caregivers is that they waited too long to engage paid care and didn’t realize how much they needed that support until they received it.

By having these conversations, families can move ahead of a crisis, while preserving love, time, and energy for the responsibilities that matter most.

Question 4: Aging in place is often presented as simply staying at home. But you've argued that the care system around a person can change dramatically even when the home doesn't. What are families and care providers missing when they focus too heavily on the location of care?

We often talk about aging in place as if it’s just a housing and safety decision: Does the house support safe living with zero-entry entrances and showers, grab bars, or other assistive devices?

But I think a more useful question is: Who is holding the care? Is it the individual, the family, or the paid care system?

If aging in place requires an entire system of care supporting the senior, families need to consider under which conditions it is realistic to continue.

Families may be stepping in to provide wraparound support, such as cleaning, meal support, and home maintenance; personal and skilled nursing care; transportation to and from appointments; medication management; and help with finances and administrative tasks.

Sometimes finances are the driving factor, and families have to leverage social services while filling in significant gaps. But in other cases, seniors or families have finances to pay for additional support.

Home care aides play a vital role supporting seniors’ goal to age in place, freeing up family capacity or supporting seniors when they don’t live close to family. They can also serve as the eyes and ears of the family, identifying and communicating changes that indicate when aging in place is unsustainable. By doing so they help protect family trust.

Question 5. What would a genuinely sustainable partnership between families and home care providers look like?

Onboarding is a two-way process

I think onboarding should work in two directions. The agency needs to onboard the family into how its care model works, and the family needs a structured way to onboard caregivers who are delivering care to a loved one in the home.

Agencies should be clear about roles and responsibilities, standards for interacting with caregivers and staff, how to communicate concerns and changes, who has decision-making authority and for what, and how cancellations or no-shows are handled.

Care plans need human context

A care plan tells a caregiver what care needs to be delivered. Families also hold a tremendous amount of human context: routines, preferences, expectations, history, and the small details that help someone provide care well.

For example, a senior with hearing loss may need caregivers to approach or touch them only when facing them so they are not startled and frightened. Or a loved one may have strong preferences when it comes to the types of food they eat, the rituals they participate in at home, or how they engage with community life.

A digital guide that’s stored and shared helps agencies when they need to send a new home care aide to a family. Families benefit by not having to continually repeat instructions to different people, reducing their cognitive load, while improving continuity of care.

Building continuity across care

In the future, I think a richer human data layer will travel with seniors across providers and locations, simplifying how this information is shared and providing better continuity of care.

A strong partnership is one in which agencies work proactively to reduce redundant processes, minimize the family workload, and improve communication.

Question 6. Where do you see the biggest coordination gaps today and what could the industry do differently?

The biggest coordination gap today is with clinical transitions, both small and large.

A physician changes a medication, but someone has to make sure the prescription is filled and that the senior is taking it. Or a senior may have a side effect to this new medication. The home-care aide can add value by noticing these changes and escalating them to the family and agency for action.

Larger clinical transitions can also create significant risks if not well managed. The transition from hospital to medical rehab to home is often difficult, and seniors may have safety issues at home.

Home care aides can identify changes or safety concerns that may warrant additional clinical evaluation and escalate them quickly to the family, agency, or appropriate healthcare provider.

The opportunity is to build better systems around those observations so that an important change doesn't remain buried in an individual visit note.

Families need support managing these clinical transitions and reducing coordination gaps. And home care aides are well positioned to do this.

Question 7: Looking ahead, what do you think the home care industry will need to redesign, not just digitize, as families take on more responsibility for coordinating care?

Home care agencies will increasingly compete with a much wider range of providers, services, and technologies. But I don't think the answer is simply to digitize the traditional home care model.

The bigger question is what a home care agency becomes:

• Is it primarily a provider of caregivers in predefined blocks of time?
• Or does it become a broader aging-in-place partner that brings together people, technology, monitoring, coordination, and other services around what an individual actually needs?

Given that so many people want to age in place, the long-term opportunity may be for home care agencies to become the hub of a broader, tech-enabled care ecosystem.

We're already seeing marketplaces and providers bring more services together, along with emerging models built around care orchestration, personalization and more holistic support. That creates new competition. But it also creates opportunities for home care agencies to expand their role.

I think leading agencies will increasingly build partnerships and flexible service models around the client rather than expecting the client to fit into a rigid, predefined model.

Imagine a turnkey service that improves a senior’s safety and quality of life while giving families greater visibility into care when they are at work or on the go. Personalized care, risk identification and escalation, and access to a broader range of services could make aging in place more sustainable while giving families capacity back in their own lives.

Question 8: Where do you see AI genuinely reducing the burden on families and care organizations and where should the industry be careful not to automate something that still requires human judgment?

I think the best use of AI in care is to remove administrative and cognitive work without removing human judgment.

For care organizations, that can mean using AI to reduce repetitive administrative work, synthesize large amounts of information, and surface patterns that deserve a person’s attention. Home care agencies that serve large populations can use analytics to continuously identify new patterns or gaps and design services to meet families’ changing needs.

Families can benefit from AI as well, provided tools are introduced when they are able to understand and adopt them. A common challenge is that families may delay technology exploration and adoption until a moment of peak crisis, when they lack the emotional and cognitive bandwidth to adopt it.

Solving for the real source of strain

AI tools are most valuable when they solve a real, identifiable source of family strain. Consider an AI tool that clones a caregiver’s voice and answers repetitive calls from a loved one who has dementia. It eases the strain on the caregiver who may receive dozens of calls a day and provides the loved one with comfort, as they receive a calming automated message that helps soothe their anxiety.

Making complex care easier to manage

While AI documentation tools are everywhere, they are probably most valuable to families who struggle with complex care. This may mean families taking care of a loved one with multiple medical conditions, navigating long-term disability, or caring for multiple people at once. There has to be a compelling advantage for families to give up Google Docs and text threads to adopt new technology. If it takes more effort to enter and manage data than their current processes, they probably won’t do it.

Balancing personalization with privacy

The challenge with AI, of course, is the more data you give it, the more it knows about you. There’s a balance between privacy and personalization. Families will have to weigh the privacy concerns of feeding AI tools with intimate data about a loved one’s personal background, medical conditions, and care plans with the benefits of streamlining processes. These choices will probably vary across families.

Human judgment still comes first

There are also decisions I wouldn't hand over to AI: creating or materially changing a care plan, interpreting meaningful changes in behavior or symptoms, or making decisions where the consequences of being wrong are significant. Consider a family deciding whether to pursue a medical intervention near the end of life or preserve quality of life. This is inherently a human-guided decision.

While AI can organize information and surface patterns quickly. Human judgment and accountability still remain the top two priorities.

In Conclusion

The agencies that establish long-term trust won't be the ones optimizing for more caregiver hours. Rather, they will be the ones that make the coordination task feel lighter in every sense. So that families have more time to be present and they spend less time tracking systems. That's the shift worth building towards.