ROAD MAP
The Change Management Playbook for Smart Scaling
What homecare agencies need to know before reaching $5M in revenue
By Jack Turgeon
For many homecare agencies, early growth feels manageable. At $1 million–$2 million in annual revenue, owners can stay close to operations, decisions move quickly and informal processes often work well enough. But as agencies grow toward $3 million–$7 million in revenue, that approach starts to break down. What once felt efficient becomes reactive, and growth begins to strain staffing, scheduling, billing and supervision.
This is where many agencies hit the “complexity wall.” It is not caused by a lack of demand or quality care, but by systems that have not evolved with the business. At this stage, change management becomes essential. Organizations that address it proactively continue to scale. Those that don’t often stall, burn out their leadership or lose control of margins.
Growth Gets Harder With Scale
As companies grow, owners can no longer be involved in every decision. Informal communication fades, and “tribal knowledge” becomes a risk. Scheduling mistakes increase, caregiver turnover rises, billing slows and quality oversight becomes inconsistent. These challenges are normal—but ignoring them is costly.
Successful organizations recognize that growth requires a shift from hands-on problem solving to building repeatable systems.
This shift does not happen by accident. It requires clear leadership and intentional change.
5 Systems That Must Evolve
While every agency is different, we consistently see five operational areas that must mature to support sustainable growth:
1
SCHEDULING
Manual workarounds and last-minute fixes no longer scale. Agencies need defined workflows, coverage plans and technology that reduce reliance on individual schedulers and prevent constant firefighting.
2
RECRUITING & RETENTION
Hiring must become proactive rather than reactive. Standardized onboarding, clear expectations and consistent communication improve retention and reduce staffing gaps as caregiver counts grow.
3
TRAINING & SUPERVISION
As staff expands, consistency matters more than customization. Agencies need documented training programs, regular supervision and clear quality standards to maintain care outcomes.
4
BILLING & REVENUE CYCLE
Small delays compound quickly at scale. Clean processes, defined ownership and visibility into billing performance are essential for cash flow and informed decision-making.
5
MANAGEMENT STRUCTURE
Growth requires delegation. Introducing lead roles or middle management reduces owner dependence and improves accountability across the entire organization.
A Simple Framework for Managing Change
Change does not have to disrupt operations, but it does require structure. The most successful homecare organizations treat change as a process rather than an event, using a repeatable framework that reduces resistance and improves adoption.
- Communicate the reason for the change clearly and early. Before rolling out any new system or process, the leadership team must explain why the change is happening and what problem it is intended to solve. Team members and managers are more likely to engage when they understand how the change improves schedules, reduces stress or supports better care. Silence or vague messaging often leads to pushback.
- Pilot new processes in a controlled setting. Rather than changing everything at once, effective agencies test new workflows with a small team, branch or client group. Pilots allow leadership to identify gaps, gather feedback and refine the process before scaling. Just as importantly, they create internal champions who can support broader adoption.
- Train teams thoroughly and consistently. Training should go beyond a single meeting or email. Agencies that succeed invest in hands-on training, clear documentation and role-specific guidance. Managers should be equipped to answer questions and reinforce expectations, ensuring consistency across shifts and locations.
- Reinforce expectations through follow-up and accountability. Change sticks when it is measured and reinforced. Regular check-ins, performance tracking and feedback loops help teams understand what success looks like and where adjustments are needed. Without reinforcement, even well-designed changes tend to fade over time.
Skipping steps—especially communication and reinforcement—is where most change initiatives fail. Agencies that approach change methodically are better positioned to scale without sacrificing quality, culture or operational control.
What Change Looks Like in Practice
In day-to-day operations, change management often shows up in practical ways: implementing new scheduling software, formalizing quality assurance reviews, standardizing onboarding or strengthening compliance oversight. These changes may seem incremental, but together they create stability, reduce errors and improve consistency across teams.
Just as importantly, they reduce owner burnout. When systems work, leaders can focus on growth, strategy and culture rather than constant crisis management.
When systems work, leaders can focus on growth, strategy & culture rather than constant crisis management.
Why These Changes Matter Long-Term
Agencies that invest in scalable systems operate more efficiently and adapt more easily to market shifts. They are also more attractive to strategic partners and buyers, who consistently value businesses that are not dependent on the owner’s daily involvement. While most operators implement change to improve performance—rather than to sell—the same discipline that supports growth also creates flexibility for the future.
Building a Business That Can Grow Without You
Scaling a homecare agency is ultimately a leadership transition. Owners who succeed are willing to step back from daily operations and invest in structure, people and systems. Change management is how that transition happens smoothly, without sacrificing quality or culture.
Early investment in operational discipline leads to stronger performance and greater flexibility over time. In today’s environment, scaling smart is not about growing faster—it is about building a business that can grow without depending on one person to hold it together.
Jack Turgeon, CM&AA, MBA, is a managing director at VERTESS, a health care-focused mergers & acquisitions advisory firm. He leads deal strategy and execution across the full transaction life cycle, working closely with companies on both sell-side and buy-side engagements. Turgeon has extensive experience advising founders through full equity sales, private equity recapitalizations and strategic growth initiatives. He earned his MBA from Babson College and brings a background in sales, consulting and operations. Turgeon focuses on helping owners navigate growth, leadership transitions and complex transactions while preserving quality of care. Visit vertess.com.
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