Guides
Building a home care agency service menu for 2027
Building a home care agency service menu for 2027 means pricing every line by payer mix, visit length, and the caregiver shortage reshaping who can staff it.
What to take away
- Seventeen service lines is a capacity plan, not a price list. Each line consumes caregiver hours you may not have on a Friday night.
- Price every line on full on-cost, not on the caregiver's hourly wage.
- Morning, evening, weekend and holiday work carries a shift premium. If the rate does not, the line loses money quietly.
- Recurring weekly packages fill a schedule in advance. One-off visits leave holes a coordinator has to sell again every week.
- Track fill rate and gross margin per visit by service line. A menu line that never fills is a marketing cost, not revenue.
The 17 lines and what each requires
Build the menu from the schedule outward. A service line exists when you can staff it, price it, and bill it without a supervisor improvising.
Service line readiness tests
- Can you staff it this month?
- Can you price it without improvising?
- Can you bill it cleanly?
- Does it need a supervisor to improvise?
- Companion visits.Conversation, light errands, a walk. Lowest skill requirement, easiest to fill, thinnest margin.
- Personal care.Bathing, dressing, toileting. Needs a certified caregiver and often a delegated-care plan.
- Morning support.Wake-up, breakfast, medication reminders, dressing. Concentrated in a two-hour window, so it strains capacity.
- Evening support.Supper, settling, bedtime routine. Same window problem, later in the day.
- Respite blocks.Relief for a family caregiver, booked in four-hour minimums.
- Overnight care.Awake or sleeping shift. Sleeping shifts still attract wage-and-hour scrutiny.
- Weekend coverage.Saturday and Sunday visits, usually at premium rates.
- Holiday coverage.Statutory holiday work. Check your state or provincial holiday pay rule before quoting.
- Live-in arrangements.Room, board and a lower hourly rate. Classification questions belong with an employment lawyer.
- Post-discharge support.The first two weeks home from hospital. Short, intense, high referral value.
- Dementia support.Routine, redirection, caregiver coaching. Requires dementia-trained staff.
- Transportation.Appointments, shopping, dialysis runs. Mileage and wait time both billable.
- Meal support.Planning, cooking, feeding assistance where in scope.
- Household support.Laundry, light cleaning, dishes. Often the add-on that keeps a client.
- Family caregiver relief.Scheduled relief so a spouse can work or rest.
- Facility companion.One-to-one visits inside a retirement home or long-term care home.
- Recurring weekly packages.A fixed block, same days, same caregiver. The line that stabilizes payroll.
One line, costed. A certified caregiver at $19.50 an hour costs $23.40 per paid hour after a 1.2 burden multiplier. A 90-minute visit is 1.5 billable hours plus one hour of travel, so it uses 2.5 paid hours and costs about $58.50.
Companionship at $16.50 an hour costs $19.80 per paid hour. Those wages and multipliers are planning assumptions, not market rates.
Price the line, not the hour
Start with the caregiver's hourly wage. Add the statutory burden. In the United States that is FICA, unemployment tax and state workers' compensation.
In Canada it is CPP, EI, and the WSIB or WCB premium for your rate group. Add vacation pay and any health spending. Add mileage at the IRS business rate in the U.S. or the CRA per-kilometre rate in Canada, plus the unpaid travel between two clients.
Build the hourly floor rate
- Start with caregiver hourly wage
- Add CPP and EI contributions
- Add WSIB or WCB premium
- Add vacation pay and health spending
- Add mileage at CRA per-km rate
- Add unpaid travel between clients
- Divide weekly cost by billable hours
If a caregiver is paid for six hours but only four are billable, the two dead hours belong in the rate. Divide total weekly cost by billable hours and you have your floor. Anything quoted below it is a subsidy.
Rates vary by state or province, payer and client type, so the current figures come from your own payroll register and your state workers' compensation filing or provincial premium rate notice.
What changes for 2027
Caregiver supply stays tight, because aides leave for hospital and warehouse jobs with steadier hours.
Payer mix shifts. State Medicaid waiver programs and long-term care insurance set a rate ceiling.
Wage floors rise. State minimum wage schedules and Medicaid rate-setting push payroll up before private rates move.
Assume a caregiver wage floor 4 percent above your 2026 average, and check the IRS mileage rate each December and the CRA per-kilometre rate each January. Build both into the 2027 price list and reprice from January 2027 rather than absorbing the increase.
Where the menu meets real rules
The U.S. Department of Labor's fact sheet on hours worked for domestic service employment sets out which on-duty, waiting, travel and job-to-job time is compensable. Overnight and live-in lines turn on those rules, so read them before quoting a sleeping shift.
The Federal Trade Commission's advertising guide for small business governs how you describe a service. "Dementia-trained caregivers" is a claim you have to support with training records.
The IRS recordkeeping guidance covers what backs up the payroll and mileage numbers in your rate build.
Employment classification, holiday pay and licensing sit with your state labor department or provincial employment ministry, and your state or provincial licensing body. Confirm the current rule before you publish a rate.
Which lines to launch first
Rank candidate lines on three tests: can you staff it this month, does it cover full on-cost, and does it feed another line.
| Launch order | Line | Why it ranks here |
|---|---|---|
| 1 | Recurring weekly packages | Fills the schedule before you hire. |
| 2 | Personal care | Steady demand, feeds morning and evening work. |
| 3 | Morning and evening support | One caregiver, two visits, one travel leg. |
| 4 | Respite blocks | Sells hours families already budget for. |
| 5 | Post-discharge support | Feeds recurring packages from hospital referrals. |
Morning support feeds personal care. Post-discharge support feeds recurring packages. Transportation feeds companionship. A line that stands alone and fills a hard-to-staff window is a cost centre.
Pilot one line for a quarter. Set a fill-rate target and a gross margin per visit target before the first shift, then compare. The monthly numbers that matter are in the KPIs an owner should track.
Worked example: a weekend line
Suppose a Saturday four-hour visit. The caregiver is paid for four hours plus one hour of travel, at $19.50 an hour. Mileage is 30 miles, at the IRS business rate of 70 cents per mile for 2025.
Use a burden multiplier of 1.4 for Saturdays, because it carries the statutory burden and the shift premium. The wage and the multiplier are planning assumptions.
Weekend line worked example
- 4billable hours
- 5paid hours including travel
- 30 kmmileage
- 1.2burden multiplier
Cost is $136.50 in wages and burden, from five paid hours at $19.50 times 1.4, plus $21.00 in mileage, from 30 miles at $0.70.
Total cost is $157.50, which is $39.38 per billable hour. A 15 percent margin takes the rate to about $45.30 an hour, or about $181.00 for the four-hour visit.
If your quote sits above the going rate in your area, the line does not launch yet.
Packaging the menu for families
Families do not buy seventeen lines. They buy a solution to one problem, usually after a hospital discharge or a fall. Group the lines into three or four named packages with a clear entry point, then let the coordinator add lines later.
How you present those packages, and what each tier includes, is covered in how to package home care agency services for families.
The full line-by-line reference sits in the services and packages guide.
Before you finalize the tiers, decide which profitable home care agency services worth offering deserve a guaranteed place in every package and which belong only in the add-on list.
Common questions
How many service lines should a small agency offer?
Fewer than you can staff reliably. A ten-line menu that fills every week beats a seventeen-line menu with four lines that never book. Add a line when you have caregivers asking for hours in that window.
Should weekend and holiday visits cost more?
Yes, and the premium has to appear in the quoted rate, not in a footnote. Typical weekend premiums run 1.25 to 1.5 times the weekday rate, and statutory holidays 1.5 to 2 times. Those are common ranges, not a rule.
Your state or provincial holiday pay law sets the floor, so put the multiplier in the price list and use it on every quote.
Can I sell recurring weekly packages below the hourly rate?
Only if the guaranteed hours cut your recruiting and scheduling cost by more than the discount. Run the arithmetic on your own fill rate and travel time. A discount that is not covered by saved coordination hours is a margin cut.
Who decides whether a caregiver can take a personal care assignment?
Your clinical lead or a regulated health professional, against the client's care plan. Scope of practice, delegation and training requirements vary by state and province, so check the rule where you operate.
This article covers business operations only. It is not clinical, legal, tax or licensing advice. Confirm current requirements with the agencies that regulate you and a qualified adviser before you change your menu or your rates.
