Your Blueprint for Starting 2026 Strong
By the time autumn arrives, the pressure is on. The fourth quarter (Q4) is more than just a countdown to the holidays; it’s your final chance to get organized, tie up loose ends, and set the stage for a smoother, more profitable new year.
This comprehensive Home Care Agency Year-End Checklist will guide you through the necessary steps.
For all businesses, Q4 housekeeping means fewer surprises come January — steadier cash flow, stronger team morale, and clearer direction. For home care businesses, it’s even more important to focus on year-end planning sooner rather than later. This is an ideal time to assess your agency’s business goals, refine processes, and prepare for the new year so that January doesn’t catch you off guard. 
The key is balancing your ongoing commitment to client care with the behind-the-scenes business wrap-up that sets you up for success. Think of Q4 as your opportunity to review your data, meet with your team to identify glaring holes or problems, and have broader conversations about what’s possible in the coming year.
Q4 Housekeeping: A Quick Guide for Home Care Agencies
The Home Care Agency Year-End Checklist focuses on balancing client care with business wrap-up to ensure a profitable new year. Key steps include:
- Review Performance: Track length of client stay, caregiver retention rates, and referral source performance.
- Financial Clean-Up: Reconcile accounts, review outstanding invoices, and ensure EVV (Electronic Visit Verification) data is complete for state compliance.
- Compliance Audit: Confirm caregiver credentials, update training requirements, and review care plans against state regulatory standards.
- Strategic Planning: Define 2026 priorities, set SMART goals, and draft your Q1 action plan to ensure execution in January.
Let’s dive into each step.
Review Your Year-to-Date Performance: A Key Step in Your Home Care Agency Year-End Checklist
For All Businesses
Start by treating your agency like the business it is. Compare actual performance against annual goals and budget forecasts, reconcile accounts, and close out bookkeeping for the year. Even if you didn’t set specific goals at the beginning of 2025, reviewing your annual year-end KPIs is a great way to prepare for setting realistic goals for 2026.
Focus on identifying gaps and opportunities through KPIs, revenue trends and targets, expenses, and outstanding invoices. This comprehensive retrospective of how the year went gives you the data you need to inform next year’s plans and shape realistic goals.
Without this thorough review, it’s difficult to identify and address problems in the new year. Use this data to inform your Home Care Agency Year-End Checklist for 2026.
For Home Care Agencies
Track client growth, client length of stay, caregiver retention rates, and referral source performance. Client retention can be misleading, as you have limited control over it. Clients often leave due to external factors, such as passing away, requiring more intensive care, or relocating to be closer to family.
Focus instead on length of stay metrics, as longer client stays generally translate to more profitable relationships.
Referral source performance is one of the most underappreciated and undervalued KPIs an agency can track. It’s easy to mark how you got clients and track revenue generated by each referral source. Year-over-year comparisons show whether you’re seeing growth, especially important if you’re paying for marketing.
Evaluate service types and billing rates for profitability. Some agencies knowingly operate certain services as loss leaders, making up revenue elsewhere for a healthier service blend. For example, Medicaid agencies often supplement lower Medicaid rates with higher-revenue private pay services. Understanding your profit margins by service helps you make educated decisions about continuing various types of care.
Spot underperforming territories or shifts in client needs in the community. Can you expand your service area? Many areas see constant development—new subdivisions and senior living communities that represent untapped business potential. Consider looking 10 miles further than your current service area to identify growth opportunities from the past year.
Financial and Administrative Clean-Up for Your Home Care Agency Year-End Checklist
For All Businesses
Reconcile accounts and close out bookkeeping for the year. Review outstanding invoices and follow up on overdue payments. This is about business operations and cash flow, not just tax purposes. Confirm vendor contracts and negotiate renewals where needed.
Meet with your accountant or bookkeeper for more than just tax prep. If you’ve identified possible loss leaders when reviewing service margins, talk strategically about ways to mitigate losses and prepare for more success. These professionals’ job is to understand this stuff — seek assistance and don’t hesitate to ask for help.
For Home Care Agencies
Make sure EVV data is complete and accurate for state compliance. While EVV should be monitored daily, quarterly reviews help identify patterns that might need attention. Look for caregivers consistently clocking in slightly off-location—this might indicate client location data that needs cleaning in your software, reducing future administrative work.
Verify Medicaid and insurance claims are processed before year-end deadlines. Start this as a November project since Medicaid typically has a six-month window for claims. Prepare for December to be essentially a dead zone—some report that Medicaid and VA systems grind to a halt the week before Christmas and don’t resume until after New Year’s.
Audit payroll to ensure proper overtime, bonuses, and benefits are accounted for. If you had payroll problems during the year, use this as an opportunity to discuss with your team what went wrong and implement necessary guardrails to prevent future issues.
Compliance and Documentation Audit
For All Businesses
Update business licenses, certifications, and insurance policies as needed. Review employee files for required documents. Have you moved, changed emails, or gotten a new phone number? Update your vendor partners with current information so they can reach you. Ensure ACH withdrawals are set up properly and no credit cards are expiring.
This last point might seem basic, but you’d be surprised how many agencies fail to communicate changes. Don’t be the agency that misses important notices because a former employee’s email is still on file four years after they left.
For Home Care Agencies
Confirm that caregiver credentials, background checks, and training requirements are up to date. If you have Rosemark, you should have this automatically set up using Actions to track expiration dates.
Schedule in-service trainings for the year. Think broadly about when you want to plan group trainings and continuing education for caregivers. Consider not just where you’re at, but where you’re going in terms of training needs.
Review care plans and ensure all documentation meets state regulatory standards. Remember that Medicaid authorizations are now required every six months instead of annually, so this has become a year-round rather than annual task.
Technology and Process Optimization
For All Businesses
Review your tech stack. Are tools being used effectively? Clean up digital files, folders, and shared drives. Audit your hardware infrastructure: are computers outdated and need updates? Consider updating your modem for more stable internet access. Review your digital presence and website for marketing effectiveness.
The question isn’t just whether you have the right tools, but whether you’re getting the most out of them. What can you do to be more efficient and effective?
For Home Care Agencies
Evaluate scheduling, billing, and caregiver communication tools for efficiency. Are you using your software’s integrations like CareCrown, Activated Insights, or QuickBooks? Review the Rosemark Knowledge Base if you have questions, check out tutorials on the Support page for process reviews, and schedule training with your team.
This is the time to think about whether you’re leveraging available tools to do things you’ve been putting off. Q4 is perfect for broader conversations about what might be possible so you can begin implementing improvements in the new year.
Employee Engagement and Planning for 2026
For All Businesses
Conduct year-end performance reviews and feedback sessions where possible. While high caregiver volumes might make individual reviews challenging, taking time to speak with your caregiving core about their performance builds increased engagement in their work and team connection.
Recognize contributions and celebrate wins to boost morale. Consider hosting a company holiday lunch where you share broad year-to-date stats: number of clients helped, hours of care provided, and successful post-operative rehabilitation cases. Celebrate how the team collectively achieved these outcomes — they are the KPIs.
For Home Care Agencies
Gather caregiver feedback about what’s working and what’s challenging. Consider adding a reward program like CareCrown to help improve morale and compliance. Use your KPI data to include caregivers in the success story—they generated the results you’re reviewing.
Schedule annual in-service trainings and plan recruitment efforts for Q1. Look at your KPIs to determine where you had trouble scheduling. If you had a high number of office-canceled shifts due to caregiver unavailability, identify patterns like pre-holiday staffing challenges and plan accordingly.
Are your current employees in the right seats? You might have hardworking employees who show up on time and are willing to learn, but struggle in their current role. Don’t lose good employees—find their strengths and put them where they can succeed. Many agencies successfully hire from their caregiving core into office positions, but don’t be afraid to look externally if you need different skills for specific roles.
Strategic Planning and Goal Setting
Define your 2026 priorities based on this year’s data and emerging market trends. Set SMART goals (Specific, Measurable, Achievable, Relevant, Time-bound) for your business or agency. Draft your Q1 action plan now so January can be about execution, not catch-up mode.
For Home Care Agencies
Factor in industry changes, payer opportunities, and potential partnerships to position your agency for growth. Should you add new services? Is it time to expand your footprint? Will caregiver rewards help with compliance and retention?
The reality of home care is that most growth opportunities depend on caregiver availability. Whether you’re expanding services, growing your territory, or adding new client types, you need caregivers to deliver the care. Consider offering travel subsidies or hourly bonuses for caregivers willing to work in new areas. Higher caregiver costs can be worthwhile if they open access to larger client pools.
Leverage state and local resources like networking groups and state associations to stay on top of industry trends and upcoming legislation. These networks provide invaluable support—there will never be enough home care agencies to serve everyone who needs care, so collaboration benefits everyone. Rising tides raise all ships.
Use the Activated Insights data available in Rosemark and compare it with the benchmarking study. This comparison shows where you fall relative to national averages and can indicate opportunities for growth in areas where demand clearly exists.
Get Your Home Care Agency Year-End Checklist
The right Q4 housekeeping sets the tone for a more profitable and less stressful new year. By following the steps in this Home Care Agency Year-End Checklist, you ensure that January becomes about execution rather than catch-up.
Download our “End-of-Year Checklist” to make sure you’re ready for a successful 2026.
Want help mapping out your Q4 priorities? Schedule your quarterly coaching call with your Rosemark account manager today.
FAQs
- When should home care agencies start year-end planning?
Begin your year-end planning in Q4 (October-December) to avoid January catch-up mode. - What are the most important KPIs for home care agencies?
Focus on client length of stay, caregiver retention rates, referral source performance, and service profitability margins. - How often should EVV data be reviewed?
While EVV should be monitored daily. Conduct quarterly reviews to identify patterns and ensure state compliance.