Biniam (Ben) Solomon Sheds Light on Why Execution Defines Home Care Growth

Demand for home-based care has never been higher, but demand alone does not guarantee sustainable growth. Many agencies enter growing markets with strong opportunities, yet only a small number can scale without running into operational strain.

One simple reason is that positive growth tends to expose what is already weak. Errors in documentation, supervision, scheduling, or billing may seem manageable at a smaller scale. However, as case volume increases, those same issues become harder to manage and costlier to fix. And this is especially true of the home care industry.

One of the biggest reasons agencies that grow successfully tend to focus equally on expansion and on operations that run behind the scenes and drive success at scale. Strong clinical processes, reliable scheduling, caregiver readiness, and clean operational systems create the foundation that allows agencies to scale without compromising care quality.

Execution is integral to home care because scaling comes wrapped in complexities. The biggest example is workforce shortages, compliance errors, and payers’ increased demand for proof of quality. Alongside this, the expectations for the measurable outcome are growing rapidly. This also indicates that agencies are no longer measured solely by billable hours. Instead, they are judged on how reliably they can deliver care while sustaining peak performance.

Only those home care agencies that treat execution as an integral function of the system will succeed. And by that, it means building systems that minimize friction, support caregivers through and through, and create greater visibility across operations. Growth, in this sense, becomes more about growing with purpose and less about scaling to reach only a number.

To shed light on this, we interviewed a home care industry expert who shared his expert views on why execution has become one of the most important drivers of long-term success.

Let us now delve into what he has to say about why execution defines growth in home care.

Question 1: Why is scaling the business side of a home care agency before strengthening care delivery so risky?

In this business, growth is just exposure if the clinical foundation isn’t there to absorb it. Every new client, every authorized hour, every new market is a multiplier — and a multiplier works on your weaknesses as much as your strengths. If your documentation is sloppy at 40 cases, it’s a liability at 400. If your supervision is thin, scaling doesn’t dilute that risk; it concentrates it.

I think about it as load-bearing. Sales and intake are the easy part — demand for home-based care is enormous and only accelerating. The hard part is whether the underlying structure can actually support the weight you’ve sold. When we opened our DC location after Virginia, my mandate to the team was that we had to be compliant from the get-go — Joint Commission-accredited before we scaled volume, not after. People sometimes read that as cautious. I read it as the opposite.

Accreditation and clean clinical processes are what let you scale, because payers, referral partners, and families will trust you with higher-acuity, higher-stakes cases. Grow the business ahead of the care, and the first serious incident — an audit finding, an adverse event, a recoupment — doesn’t just cost you that case. It costs you your reputation in a region where everyone talks.

Question 2: How does investing in hands-on caregiver training improve both retention and recruitment?

The numbers in our industry are brutal, and most owners look away from them. Caregiver turnover runs around 79% industry-wide, and roughly 80% of that churn happens in the first 90 days. When you’re spending several thousand dollars per hire, losing people before they’ve even stabilized in a case is a wound you keep reopening.

Hands-on training is the single highest-leverage fix I’ve found. A caregiver who feels competent stays; a caregiver who feels thrown into a complex pediatric trach-and-vent case with no real onboarding leaves — and tells everyone why. At Thrive, we built a real clinical education function rather than treating orientation as a checkbox, because the first two weeks determine whether someone makes it to year two. Confidence is a retention strategy.

And it compounds into recruitment, because this is a word-of-mouth labor market. Nurses and aides talk to each other constantly. When your people feel supported and developed, they become your best recruiters — they bring their friends. The agencies winning the talent war aren’t necessarily the ones paying the most. They’re the ones that make the job doable and make people feel they’re getting better at their craft.

Question 3: What key scheduling pillars allow for successful scaling and managing demanding, round-the-clock cases?

Three pillars. First, continuity over coverage. Especially in 24/7 pediatric private-duty nursing, the goal isn’t just to fill the shift — it’s to protect the patient–nurse relationship. A medically fragile child does far better with a small, consistent team than with a rotating cast, even if the rotating cast is technically covered. We schedule around continuity first and treat it as a clinical outcome rather than an HR convenience.

Second, a single source of truth. You cannot run round-the-clock cases on spreadsheets and text messages. Our scheduling, documentation, EVV, and billing live in one connected system, so a missed visit, an open shift, or a documentation gap surfaces immediately instead of becoming a billing problem or a compliance finding three weeks later. EVV in particular has become a revenue-integrity issue, not just a mandate.

Third, depth on the bench and clear escalation. Demanding cases break when there’s a single point of failure. You need backup-qualified staff for high-acuity assignments and a defined chain — coordinator to clinical lead to Director of Nursing — so that a 2 a.m. call-out has a real answer, not a scramble. Scaling is just doing all three reliably as the case count grows.

Question 4: What’s the key to securing and managing contracts with major insurance payers?

Earning the right to be at the table, then proving you can be trusted at it. Payers — Medicaid, managed care organizations, and others — are not really buying hours of care. They’re buying predictability: clean claims, verifiable services, documentation that survives an audit, and outcomes that lower their total cost of care. Everything I do on the operational side is ultimately about being a payer’s lowest-risk option.

Concretely, the things that open doors are credentials and infrastructure. Joint Commission accreditation in both Virginia and DC matters here — it’s third-party proof that our clinical and quality systems meet a national standard, which shortens many conversations. Rock-solid EVV and billing accuracy matter because payers have long memories about agencies that generate denials and recoupments.

Managing the relationship is its own discipline. You have to know each payer’s authorization rules cold, bill clean and on time, and treat your quality data as a relationship asset. When you can walk in with evidence of low readmissions and high satisfaction, you’re negotiating from strength. The industry is moving steadily from volume-based payment toward value-based reimbursement, where you get paid for outcomes, not just visit counts. The agencies that already track and can prove quality will be the ones writing favorable contracts.

Question 5: Looking ahead, what major shifts will define the future of home care scaling?

A few, and they’re converging at once. The demand side isn’t in question — roughly 10,000 Americans turn 65 every day, and the overwhelming majority want to age at home, while institutional capacity simply can’t absorb that curve. So demand is no longer the differentiator. Execution is. The next phase belongs to the agencies that can actually staff and bill cleanly for every hour they’ve sold — scaling by execution, not by volume.

The binding constraint will keep being the workforce. Labor projections show home and personal care aide jobs among the fastest-growing in the economy this decade, with a real risk of a serious shortfall by 2030. That means the agencies that win are the ones that solve retention, because in a market this tight, your ability to grow is strictly capped by your ability to keep people.

The third shift is consolidation around capability. Reimbursement pressure and tightening compliance — stricter EVV, more aggressive audits, the move to value-based care — will squeeze out under-built operators. Scaling will increasingly mean deepening in your existing market and service lines rather than planting flags everywhere. Operate best, not just biggest. That’s the era we’re entering.

Question 6: How do you see AI changing operations, care delivery, or decision-making in home care?

I see it moving from pilots to plumbing — quietly running underneath everything rather than being a flashy add-on. The honest picture right now is a belief-action gap: the vast majority of leaders believe AI will transform their operations, but far fewer have actually deployed it. I’m less interested in AI as a headline and more in where it removes friction that’s currently driving good caregivers out the door.

The highest-value uses I see are unglamorous, and that’s the point. Documentation: taking the charting burden off clinicians so they spend their energy on the patient, not the keyboard. Scheduling and matching: pairing caregivers to cases by skill, location, and continuity to reduce burnout and protect those round-the-clock assignments. Back-office and revenue integrity: catching the EVV and billing gaps before they become denials. AI’s biggest clinical payoff may actually be a workforce payoff.

In decision-making, predictive tools that flag a patient’s rising fall risk or early decline allow us to act before a crisis and an avoidable hospitalization, which is exactly what value-based payers reward. But I’ll say this plainly: home care is a human business. AI should give my nurses back time and attention for the bedside. The day it starts replacing the relationship instead of protecting it, we’ve used it wrong.

In conclusion

Sustainable growth in home care is no longer defined by expansion alone. It’s rather determined by the ability to execute at scale. As Biniam Solomon highlights, strengthened operational capabilities outweigh the benefits of rapid expansion, especially for agencies seeking to grow consistently. Agencies that invest in caregiver support, strong infrastructure, and execution will be better positioned to manage the ever-changing landscape of the home care industry.