The Key To Home Health Care Survival: Diversification

December 18, 2021

About thirty years ago, most home health agencies were non-profit Medicare agencies. Many had private pay home care as part of the organization's services. Back then, most of the Medicare agencies were VNAs or attached to a hospital system. We had our Medicare caseload and then there was the private pay which also included the DSHS Chore Services personal care program. There were few free standing private pay agencies. Approximately twenty years ago many of the Medicare agencies began to drop their private pay programs. It was about that time that that HCFA, now CMS began to allow for-profit organizations to participate in the Medicare Home Health benefit. The Medicare rules began to be enforced and those agencies which ran the private pay home care with the Medicare began to close the private pay sections because they were losing money. Most of that had to do with running the agencies under the Medicare license thus costing considerably more with less income to balance the P&L.

We are now coming full circle with Medicare Home Health and Private Pay services. We are beginning to see articles in the industry media about the need for diversification and alluding to the inclusion of home care private pay services as another revenue stream for the Medicare Certified agencies. For those Medicare Home Health agencies considering this move, there is one word of caution, run the new private pay company under a separate license. In looking back at why Medicare Home Health and Hospice agencies divested themselves of the private pay, it is clear that applying the Medicare rules to private pay made the private pay business a loser. In addition, the home care private pay business is a very different type of business and must be run differently. While Medicare is highly regulated, private pay is either moderately regulated or not regulated at all depending on the state. The managers of the home care private pay agency must be open minded and able to respond to the environment without regard to the constraints of Medicare. We have found that Medicare Home Health or Hospice staff has difficulty moving out of the regulated box they live in. It is for that reason we recommend that if you are considering this addition, you should run the home care private pay under a separate license with different home care staff.

Diversification to include a private pay program may still not be enough. As the competition becomes more intense for the private pay line of business, we are now seeing the need for home care private pay agencies to differentiate themselves from others as well. No longer will the tried and true personal care services only guarantee success. Private pay home health must add additional streams of revenue in order to survive and grow. There is no single set of services that will fit all agencies. Just as all politics are local, so are services.


Diversification takes two different forms in the private pay industry, additional lines of services (e.g. Cruise Companions, Day Surgery Support, Mom and Babe, pharmacy drug reviews with recommendations and counseling, home modifications and Holiday Helpers) and value added products that are part of service packages. Value added products include such things as Life Alerts, pharmacy discount and delivery, and financial management support. When addressing value added services, the services are included in the hourly or daily rate. The clients do not pay extra for these services or products, but receive them as part of agency package. As long as the client is a customer of the agency, they automatically receive the product or service. The cost of the value added is embedded in the hourly or daily rate by calculating the cost of the value added feature and dividing that cost by the hours of days of services currently provided by the agency. Sometimes the extra charge is as little as $.25/hour more.

Whatever services or value added elements you select, they must be services or products that your particular customers view as something they are willing to pay for or see as an added value. With this in mind it is critical that you survey your customers to make sure they see what you have to offer is something they want.

If you need help with determining what other services or value added elements would be appropriate for your agency, call Kenyon Homecare Consultin g at 206-721-5091 or contact us online today!

Results Based Consulting

Did you find value in this blog post? Imagine what we can do for your home care or hospice agency. Fill out the form below to see how we're leading the industry with innovation, affordability, and experience.

Contact Us

Interim Management
By Ginny Kenyon January 20, 2026
An experienced interim manager can provide stability, expertise, and momentum- if the right individual is selected during your time of need and transition.
OASIS success
By Ginny Kenyon January 17, 2026
OASIS plays a critical role in care planning, quality, reimbursement, and regulatory compliance and is also key to success and integrity of Medicare Home Health.
policy and procedure manuals
By Ginny Kenyon January 15, 2026
Policies and procedures serve as the foundation for consistent, fair, and effective operations. Your manual should be a living breathing guide for your agency.
chronic disease education
By Ginny Kenyon January 7, 2026
For aides, education in chronic diseases is not just helpful, it is essential for ensuring safety, dignity, and quality of life for the people they serve.
nurse key to HHCAHPS
December 23, 2025
Educate your staff to the HHCAHPS questions so they remember that performance is measured by the patients and will be reflected in the survey findings and payment
success in home health surveys
December 19, 2025
Surveys are heavily focused on data to serve as evidence of your agency's practices. Create a "Survey Book" containing all required documents for immediate access.
December 18, 2025
For home health agencies, a regulatory survey is not just an inspection—it's a high-stakes assessment of your commitment to patient safety, quality care, and operational compliance. Since repeat surveys are unannounced, the goal is to cultivate a culture of "survey readiness every day." Preparing your agency for a successful survey requires proactive planning, meticulous documentation, and full staff engagement. Below are the steps to build for continuous compliance. 1. Develop a Survey team: Preparation starts with designating a core team responsible for the survey response. Clear roles ensure a calm, organized, and efficient process when a surveyor walks through the door. Each person needs to know exactly what they are responsible for and what metrics they need to track to be sure the agency is always ready for a survey. The Administrator/Survey Lead: Must be present for the entrance conference. This person is the main point of contact, handles high-level questions, and maintains a professional atmosphere for the organization with the agency staff and with any surveyors. Director of Clinical services/ Supervisor: This team member is responsible for assuring all documentation is reviewed and appropriate. This includes OASIS accuracy, that the plan of care matches the OASIS findings, and visit documentation follows the plan of care. ICD-10 Coders: This team member reviews the OASIS and matches it with the discharge summary to assure accuracy of OASIS (along with DCS or Supervisor). The coders also verify the ICD-10 code accurately reflects findings of the OASIS. Clerical Support: Staff is responsible to all personnel records monthly review for required documents and all new employees for same while reporting any missing documents (e.g. updated license, auto insurance, driver’s license etc.). Create plans and have operations in place to communicate at least a month in advance to employees when items need updated. This person is also responsible for managing the logistical needs when the surveyors are on site (e.g., Wi-Fi password, workspace, etc.) to create a buffer for management. They also discreetly communicate critical questions to the Survey Lead. The team member acting as Survey Lead is considered the survey readiness team leader. Promoting survey readiness should include regular monthly meetings with all of the survey readiness team members. Each team member should be ready to report on the status of their responsibilities and any data to support their findings. These findings include: a. Status of OASIS accuracy and any staff who need training. b. Planned OASIS training that provides regular updates on areas where staff continue to struggle. c. Plan of care with matching visit notes d. Personnel files and any updates when employees are not responding to the request for documents e. Status of continuing education per state or federal requirements f. Yearly evaluations with supervisory visits to support evaluation. Supervision needs to pay particular attention to hand washing according to policy and standard infection control procedure when getting in an out of bag, with client contact, or coming in and out of the home. This remains one of the primary findings by surveyors. g. Evidence of yearly required continuing education such as: • Infection control • Patient Rights and Advocacy to uphold dignity and autonomy • Emergency Preparedness with response protocols; evidence of bi-yearly practice drills for a potential emergency • Medication Management and safety to prevent errors • Updated relevant health care regulations and policies • Cultural competency to enhance communication and care for diverse populations. All data collected by the team members may need to be sent to the compliance manager and may become part of a plan of correction for the Quality Assurance program.  Should you need assistance with survey readiness, please continue to part 2 of this series and call Kenyon Homecare Consulting at 206-721-5091 to help you get there!
ICD 10 coding and Oasis
November 25, 2025
In the regulated world of home health, OASIS and ICD-10-CM Coding integrity non-negotiable for quality, compliance, and critically, and agency's financial health!
sales strategy
November 19, 2025
"Boots on the ground," emphasizes direct, in-person engagement to build the crucial referral network between your agency and referral sources and it is a necessity.
Recruitment and retention
November 8, 2025
A positive corporate culture isn't just a feel good initiative, it's a critical business strategy that directly impacts ability to recruit and retain top talent.