The American home care industry is teetering on the edge of a systemic collapse, caught between the financial strain of rising labor costs and the growing desperation of families unable to afford the essential services their loved ones need. Traditional models, built on selling time in rigid, multi-hour blocks, are proving increasingly unworkable, creating a gap between the care that is available and the care that is actually accessible. As agencies struggle to find and retain qualified caregivers and clients face insurmountable bills, a fundamental question arises: is there a better way to structure and deliver home care? An innovative task-based billing system, pioneered by Honolulu-based Vivia Cares, offers a compelling alternative, shifting the entire paradigm from selling hours to selling outcomes and potentially offering a lifeline to a sector in crisis. This new approach aims to rebalance the delicate ecosystem of home care by making services more affordable for clients while simultaneously creating more stable, financially rewarding jobs for caregivers.
The Cracks in the Conventional Model
The long-standing home care model, which often obligates clients to purchase care in minimum four, six, or even eight-hour shifts, is buckling under modern economic pressures. A confluence of rising minimum wages and intense competition for labor from other sectors, such as retail and hospitality, has forced home care agencies to substantially increase caregiver compensation simply to remain competitive. In high-cost areas, this competition is particularly fierce. To cover these escalating labor costs and maintain profitability, agencies have had little choice but to pass the financial burden onto their clients, driving service rates to a point of unaffordability for a vast segment of the population. This has created an unsustainable cycle where the cost of necessary care outpaces the financial capacity of the average family, leaving many to either forego professional help or deplete their life savings, all while the agencies themselves struggle with razor-thin margins and the constant threat of being priced out of the market.
This pricing dilemma has given rise to a dual crisis that threatens the very foundation of the industry. On one hand, there is a severe and worsening shortage of available caregivers. Faced with physically and emotionally demanding work, many potential caregivers are lured away by less strenuous jobs in other industries that offer comparable or better pay, more stable hours, and greater benefits. This talent drain leaves agencies perpetually understaffed and unable to meet the growing demand for services. On the other hand, the pool of clients who can afford the high costs associated with minimum-hour service blocks is steadily shrinking. Families who may only need help for an hour in the morning and an hour in the evening find themselves forced to pay for an entire eight-hour shift, an expense that is simply not feasible long-term. This market failure means that even when a caregiver is available, the care itself remains financially out of reach, trapping both providers and recipients in an untenable situation.
Designing a Solution from the Ground Up
Recognizing the unsustainability of the status quo, Vivia Cares embarked on a complete redesign of its service model, a process rooted in direct, actionable feedback from the two most critical stakeholders: caregivers and clients. The company, a unique merger of a traditional home care agency and a technology firm, was well-positioned to innovate. Management began by consulting its top-performing caregivers to understand the core components of a desirable job in their field. The feedback was clear and consistent: they needed stability of hours, increased pay, and reliable transportation to navigate their workday efficiently. In direct response to these needs, the agency crafted a revolutionary employment package that featured guaranteed 40-hour workweeks, a substantial 30% raise in pay, and the provision of a company car. This comprehensive strategy directly addressed the caregivers’ primary pain points, transforming a typically precarious gig-based role into a stable, attractive, and well-compensated career path.
Simultaneously, the company gathered extensive feedback from its customers, who voiced significant dissatisfaction with the rigidities of the traditional model. The primary complaints centered on mandatory minimum service hours that forced them to pay for unused time and the frustrating inconsistency of having different caregivers assigned for each visit. This valuable input became the blueprint for the company’s new service structure and its proprietary pricing model. By eliminating mandatory minimums, Vivia Cares allowed clients to purchase only the specific assistance they needed, when they needed it. The new system was built around selling “tasks and outcomes” rather than blocks of time, providing clients with cost certainty and a clear understanding of the services they would receive. This client-centric approach, developed in tandem with the caregiver-focused employment package, created a synergistic model designed to solve the industry’s most pressing problems from both sides of the care equation.
A New Paradigm in Care Delivery
In practice, the task-based system fundamentally alters the nature of a caregiver’s workday and the way families purchase services. Instead of a caregiver remaining with a single client for a prolonged shift, often with significant downtime, they operate with remarkable efficiency within a specific geographic neighborhood. Each day, a caregiver may visit between eight and ten different clients, with each visit focused on completing a pre-arranged and specific task, such as assisting a client with dementia with a shower or preparing a meal. The billing is tied directly to the completion of that task, not the duration. This means that whether the task is completed in twenty minutes or, due to an unforeseen delay, takes an hour, the client pays the same fixed price. This model provides crucial cost predictability for families and focuses the caregiver’s work on achieving a clear, defined objective. The immediate result of launching this innovative service was a “skyrocketed” demand, as it opened the door to professional care for a new segment of the market that had previously been excluded by prohibitive costs.
However, the operational backend required to support this fast-paced, dynamic model is immensely complex and should not be underestimated. Transitioning from a time-based to a task-based system is not a simple logistical switch; it requires a highly sophisticated level of communication and expectation management. Because clients are effectively “sharing a caregiver” within a geographic zone, the daily schedule is fluid and can be easily disrupted by emergencies. For instance, if a caregiver arrives at a client’s home and finds them in medical distress, the protocol is to call for help and remain with the client until an ambulance arrives. This necessary but unforeseen delay has a domino effect on the entire schedule for the rest of the day. To manage this volatility, the central office must maintain constant, real-time communication with all subsequent clients on the route, informing them of the delay and offering to reschedule if necessary. This logistical intricacy is a critical and challenging component of the model’s success, demanding a robust technological platform and a highly skilled coordination team.
Redefining the Caregiver Role and Client Base
The shift to a task-based model also prompted a significant change in the type of caregiver best suited for the job. The faster-paced nature of the work, involving constant movement between clients and a focus on task efficiency, proved to be a challenging adjustment for some of the company’s best traditional caregivers. Many of these experienced professionals thrived on the one-on-one, long-duration engagement with a single client, where building a deep, personal relationship was a central part of the role. The new model, with its emphasis on completing discrete tasks for multiple clients each day, required a different skill set and temperament. Consequently, Vivia Cares had to develop a new training program and actively recruit a different caregiver demographic. This new cohort was described as generally younger individuals who “enjoyed the pace and didn’t mind the driving,” highlighting a necessary evolution in the company’s human resources strategy to align its workforce with its innovative operational structure.
It is crucial to understand that the task-based model is not intended as a universal replacement for all forms of home care but rather as a powerful, targeted solution for a specific and largely underserved segment of the market. Company leadership readily acknowledges that there will always be a critical need for traditional, hourly care, especially for clients with severe cognitive or physical impairments who require constant, 24/7 supervision and companionship. The task-based approach is specifically designed to meet the “in-between” needs of clients who are largely independent but require reliable assistance with specific Activities of Daily Living at different points throughout the day. For example, instead of being forced to book an eight-hour shift to get help with three meals, a client can now schedule three separate, short, and affordable visits for breakfast, lunch, and dinner preparation. This flexibility makes professional care accessible and practical for a much broader range of needs and budgets.
The Path to a More Efficient Future
The demonstrable efficiency gains realized through the task-based system have presented a compelling case for its broader adoption. The statistical evidence from Vivia Cares is striking: the agency’s task-based service branch successfully serves 350 patients with a lean team of just 30 caregivers. In stark contrast, its traditional hourly service requires 74 caregivers to serve the same number of patients. This represents a more than twofold increase in workforce efficiency, a monumental advantage in an industry crippled by a chronic and persistent labor shortage. By optimizing each caregiver’s time and focusing their efforts on direct service delivery, the model allows a smaller team to have a significantly larger impact. This not only makes the business more resilient and scalable but also directly addresses one of the most significant barriers to accessing care, which is the sheer lack of available professional caregivers to meet the growing demand from an aging population.
With its model proven successful in a dense urban environment, the company has now set its sights on future expansion and replication. A pilot program in Washington was launched to test the model’s adaptability to a less densely populated area, a key step in determining its viability across different demographic and geographic landscapes. The ultimate goal extended beyond internal growth; the company aimed to refine and package its entire system—encompassing the proprietary technology, detailed operational scripts, and specialized training programs—so that it could be replicated by other home care providers. This vision for a scalable, franchise-like solution suggested that task-based billing was not just a localized fix but a potential blueprint for transforming the home care industry on a national scale, offering a sustainable path forward that better served clients, caregivers, and agencies alike.
