Building Client Trust in A La Carte Home Care: 3 Tips

Home care agencies are hearing concerns that the charging on a per-service basis seems like an attempt to “nickel and dime” their patients — but if the program is done right, providers can build the trust of their client base while increasing their bottom line.

In fact, a fee-for-service system can give patients and their families greater flexibility and can even decrease their costs, as they won’t be paying for care and services that they don’t receive, as is the case with some bundled service packages.

“Needs will change over time and you need a system to capture that,” said Wade Elliott, executive director and founding CEO of Orland, California-based WestHaven Senior Living, during a recent webinar hosted by the Institute for Professional Care Education (IPCed). “Fee-for-service programs [offer] personalized care, concierge services, technology programs — they give families choices. You’re allowing them to get what they want, rather than saying this is what we offer.”


Examples of some add-on services that families may choose are: transportation, housekeeping, bill paying, personal shopping, meal preparation, dressing, hygiene and grooming, appointments, occupational therapy, companion care, sitter service and concierge services.

And depending on where home care providers are located nationwide, they may be able to charge beyond the average price tag for these services. 

“You can charge whatever your clients are willing to pay; there is no top end,” Elliott said. “If I’m in Palo Alto, Calif., I can probably charge more than I would in Chico, Calif., because the clients that I serve are able and willing to pay it.”


Perhaps it’s because of this flexibility that some home care agencies say their clients think the fee-for-service structure is taking a “nickel and dime” approach. One provider brought up this concern during the webinar, to which Elliott said clients may feel that way because the fee increases may not be reflected by an increase in service. 

So how exactly can home care providers prevent their clients from having this mentality? It starts with building trust, Elliott said, offering three strategies for doing so. 

1. Communicate Early and Often

Being upfront and honest with your clients — both verbally and in written documentation — will provide a solid foundation for the fee-for-service model moving forward.

This means helping them understand exactly what fees are associated with what services, and how much you will be charging that particular patient. 

“You’ve got to educate them [and] undo that ‘nickel and dime’ interpretation of what you’re doing through careful, methodical, consistent communication of what’s going on,” Elliott said. “Put it in writing; tell them the truth.”

One of Elliott’s fee-for-service principles is: “If it’s not written, it’s not real.” 

Make sure that you’re providing written notice of any care plan changes — and also when a patient’s care hasn’t changed. 

“One of the mistakes we [as an industry] may have made was not disclosing up front what our services and fee structures are,” Elliott said. “If you don’t do a good job of explaining fee-for-service, … you’re going to have difficulty [with clients].”

2. Have a Purpose, Promise and Price

A fee-for-service program needs to be explicitly defined for clients. It could be as simple as giving each service a name. 

For example, at WestHaven Senior Living, “Level 2 Activities of Daily Living,” or L2AA, is the package for clients who need this level of care. 

Its purpose: “The goal of our Level 2 ADL program is to assist the resident with physical limitations in the maintenance and/or recovery of independent living skills,” according to an actual form WestHaven uses in determining a resident’s care plan. 

Its promise: “This level of care supports individuals who need personal assistance with up to five ADLs as described on page four. Level 2 residents (as distinguished from Level 3) are stable or improving physically and are participating in the maintenance and/or recovery of their independent living skills,” the form states. 

And finally, its price: Listed on the form, L2AA costs residents $525 per month.

“The key in building trust is you have to link all of this language to your appraisal,” Elliott said. 

3. Make Good On Your Word

If you’re increasing the care plan and the fees for a client, be sure the client begins receiving those additional services immediately. 

One complaint from fee-for-service clients is that they were provided written notice of the change in care plan, but they hadn’t yet received additional care. 

Providing inaccurate or inconsistent care could be a major obstacle in building clients’ trust. Be sure to avoid poor follow-up, and build in time for implementation of the additional service. 

Above all else, be patient. 

“When it comes to getting paid, just think about this: Would you rather get paid fast with pushback or would you rather get paid even if it takes a while with no pushback?” Elliott said. “It’s better to get it right than to get it fast. Part of the trust-building process frankly just takes time. Your families and clients or residents aren’t living and breathing this language the way we are. It takes time for them to get on board. I am committed in our organization to take the long approach and build this trust through very deliberate, careful, ongoing communication.”

Written by Emily Study

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