How to Survive the Industry's Most Brutal Reset

Let’s not sugarcoat it—the non-medical home care industry has been out here acting like the Wild West for years. Light regulations, big checks, and more "gray area" than a bad lacefront in July. But I’m here to break the news to you, my money-making friends: the feds just showed up like the IRS at a pop-up shop with no receipts, and they’re ready to raid, report, and reset the whole system. And for some of you, that means it might be time to sell—before you lose all your clients and end up with nothing left to sell but a stack of expired gloves and an old fax machine.

In 2024, the Department of Justice dropped the hammer: $2.7 billion in healthcare fraud charges across nearly 200 people. But before you get your panties in a bunch, let’s be real—it wasn’t just shady agency owners running game. It was everybody: caregivers finessing time sheets, clients claiming their loved ones were "at the store" during scheduled visits, office staff recycling documentation like it was aluminum. If you know, you know.

Now the government is pressing reset. MCOs (Managed Care Organizations, aka the insurance gods) are shrinking their networks. Medicaid said, "no more raises 'til y’all clean this mess up." Translation? The party is over. The lights are on. The DJ packed up.

Welcome to the New Reality: Adapt or Die

Here’s the tea: Medicaid is not raising your rates anytime soon. You’re getting paid the same amount you were getting pre-pandemic, back when gas was cheaper and eggs didn’t cost $8. You want to survive? You’ve got to pivot—and not like Blockbuster refusing to go digital while Netflix took over the world. I’m talking real transformation, not wishful thinking.

It’s time to get into private pay.

I know what you're thinking: "Jon’na, this is a recession. Who’s got money to pay out of pocket for a bath and a sandwich?"

Let me put you on game: Millennials and Gen Z aren’t broke—they’re busy. They’re running businesses, flipping Airbnbs, and investing in crypto yoga (whatever that is). What they don’t have is time. What they do have is money. They’ll pay for convenience, peace of mind, and quality care for their loved ones. Need receipts? Here you go:

• The private duty home care market is projected to hit $79.2 billion by 2030.


• 66% of adult children say they’d rather pay for care than rearrange their lives.


• Agencies with private pay revenue grew 3x faster than Medicaid-only ones in 2023 (shout out to Home Care Pulse).


Already Doing Private Pay? Good. Now Diversify or Disappear.

If you're still only offering "non-medical care" in 2025, you’re basically a flip phone in an iPhone world. Here’s what your agency needs to be doing:

• Companion Care — aka "Please make sure Mom doesn’t set the microwave on fire and Dad has on pants when he walks outside."


• Hospice Coordination — be the agency that stays when it gets hard.


• Medical Services — partner with RNs or NPs.


• Personal Care — ADLs done right.


• Memory & Behavioral Support — for dementia and Alzheimer’s clients.


And let’s stop fighting each other. Collaboration is the new competition. You’re not losing business because they’re better—you’re losing it because you’re distracted fighting for crumbs while big box agencies buy the whole bakery.

Trust Is the New Currency

Post-pandemic + post-fraud = nobody trusts anybody.

So your agency better show up polished, professional, and ready with receipts.

Here’s how to earn trust:

• Get accredited. Your cousin’s CNA from 2003 just isn’t going to cut it.


• Train your team. Not just binders. Real education.


• Show your receipts. Collect testimonials. Share wins. Be transparent.


And please—stop using blurry logos and old flyers. Clients Google you. MCOs Google you. I Google you. Don’t show up looking expired.

The Way Forward: Partnerships, Tech & Hustle

If you want to thrive (not just survive), here's your move:

• Partner Up. Adult day centers, hospice, hospitals, rehabs, geriatric doctor offices. Build a care ecosystem for your clients.


• Use Tech. EVV, CRM, automation—get into it.


• Follow the Money. Grants. Concierge packages. Innovation funds. It’s all out there.


The industry is consolidating fast. Only the real ones will be left standing. And here’s a truth you won’t hear often—if you’ve already pivoted, added private pay, diversified your services, built your partnerships, and you’re still feeling maxed out… then selling your agency might be your next power move. Don’t wait until the margins dry up and the stress eats you alive. Sometimes the smartest play is knowing when to exit at your peak.

Final Word from Jon’na

This isn’t just a shift—it’s a reckoning.

The government is cracking down. MCOs are ghosting. Clients are over it.

You’ve got two choices:

• Step up. Get strategic. Build the agency people whisper about in meetings.


• Stay stuck. Pray for Medicaid raises. Complain on Facebook until your license expires.


This is your wake-up call.

The future of home care? It’s private. It’s premium. And it’s powered by people who are actually paying attention to the current needs, not just of the client, but of the industry.

If you’re not evolving, you’re dying, my friends. So call me—you know where to find me.

Until next time.

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