When I started in home care in the nineties, I worked for a company that strongly believed in promoting from within. The philosophy was simple. If someone could grow a caseload, they understood the business. If they understood the business, they could eventually open and run their own office. I learned the ropes in Winston-Salem, NC, then pitched and opened the Charlotte office in the late nineties.
So, I followed suit from Charlotte, investing in, supporting, and growing people just as others had done for me. When a client service manager (CSM) proved they could recruit nurses and aides, retain them, and staff their cases consistently, we would give them the opportunity to open a new location. Sometimes it meant splitting an existing office like Charlotte. Sometimes it meant starting from scratch.
After splitting Charlotte numerous times, we decided to expand further out. One of our strongest CSMs opened the new branch. She was excellent. Families loved her. Nurses and aides trusted her. She built strong relationships and kept her cases staffed. The new office started almost from zero with only one case transferring over. It was a true de novo start and I was super proud of her.
And she did exactly what we expected. She recruited the field staff and began growing the caseload. Then, unexpectedly, the growth stopped. I was left scratching my head. This went on for months. It wasn’t because referrals slowed down. Demand was still there. The office simply plateaued around 2,000 hours per week. And unfortunately, this took us to break even, which wasn’t sustainable long term. We needed operating income to fuel more growth to help more people.
At first, it was confusing. She was doing everything right. It kept me up at night…What was I missing?
Eventually the issue became clear. She could run a caseload incredibly well. But when it came time to hire the next CSM and transition cases to them, growth slowed. Training the next CSM to operate at her level was harder than doing the work herself. Turnover happened because she didn’t quite have the right capabilities to invest in, train, and develop the next leader. At least, not yet.
She had the director title, but the office was still operating at the CSM level. Leadership books often describe this as the player-coach trap. A strong operator gets promoted, but the system still depends on their personal execution instead of their ability to build other leaders. When that happens, growth hits a ceiling. In home health care, that ceiling often shows up as hours capacity. For this office, that number was about 2,000 hours per week. That was the amount of complexity one great operator could personally manage. To grow beyond that required something different.
She didn’t need more referrals. She didn’t even need more nurses or home health aides. It required more operational capacity beyond herself.
Over time, I realized something interesting. That 2,000-hour range shows up in a lot of home health care offices. It’s often the point where one very strong operator, whether it’s a CSM or director can still personally manage the complexity. Scheduling. Hiring. Family communication. Call-outs. Compliance. But once the office grows beyond that level, the work can no longer live inside one person’s head.
For many years, the only way to break that ceiling was time. We needed time to train leaders. Time to mentor CSMs. Time to build the next layer of management. And it never felt like we had enough time.
But the good news is something new is emerging. Something to complement the leadership capacity framework and give us back that critical time to invest in value-added activities, like development.
AI systems are beginning to take on many of the administrative tasks that fill the day of a CSM or branch leader. Some of these systems, like Arya Health, can fill a last-minute call-out, update renewable requirements, handle credentialing processes, streamline onboarding, handle strategic staffing making better matches for long-term success, and reduce time to hire dramatically.
When those routine tasks move off the plate of the people running the office, something interesting happens. Their role shifts from operational triage (what I call "firefighting") to capacity building. AI doesn’t replace them; it expands their capacity. It allows them to function at a higher level. They move from reactive to strategic. It can allow for the extra time needed to mentor and develop the next generation of management or develop new strategies to solve everyday problems.
But there’s an important nuance that I must highlight. AI still needs strong operators to show it how great operations actually work. The best leaders in home health care already know how to run a 2,000-hour office, and many of them know how to hire and expand their leadership capacity to handle 5,000+ hours per office, or even multiple offices.
What AI can make possible is helping them efficiently run a 10,000-hour+ office without burning out the people responsible for making it work.
So, when someone asks why the AI conversation in home health care isn’t really about technology, the answer is simple.
It’s about capacity.
