Irrational Labs / B2B Home Care Research
A Place for Mom connects families to home care every day. But the moment a referral is made, the context disappears. This research asks: where in the post-referral journey should APFM show up next?
Executive summary
The approach
We used three distinct research methods to understand the post-referral journey. Each answers a different question. Together, they triangulate where the real opportunities are.
90-minute conversations with agencies across 13 states. From 4-person startups to 500+ caregiver operations.
How agencies actually operate. Where systems break. 33 workarounds documented across 19 of 22 agencies.
Agencies across 38 states. Franchise (60%), independent (35%), corporate (4%). From 10-person shops to 500+ operations.
Which pains are widespread and which are niche. The magnitude at scale.
Competitive landscape scan across 15 operational areas. Tool density, market penetration, entrenchment, and adoption patterns.
Where the market has invested, where it hasn't, and what existing tools actually fail to do.
In-depth interviews (n=22)
Across three tracks, every area has distinct pain points, workarounds, and broken handoffs. But not all of them carry equal weight. Seven areas consistently surfaced with the strongest signal: the biggest operational drains, the deepest structural fragility, or both.
Survey findings (n=246)
246 agencies confirmed what the interviews surfaced: scheduling and hiring dominate at every size. But the pain ranking alone doesn't tell the full story. Several areas that agencies live with every day rank low, not because they're solved, but because agencies have normalised the fragility.
How agencies differ
APFM currently segments agencies by type: franchise, independent, corporate. When we cut the data by agency size instead, the patterns were consistently clearer. Three distinct profiles showed up.
Competitive landscape (80+ tools)
We evaluated 80+ tools across 15 operational areas, assessing how many vendors exist and how entrenched they are: platform integration, funding, and market penetration.
Each area contains specific unmet needs, and the entrenchment varies by need. Hiring has dozens of job boards, but the onboarding overhead and portable caregiver context gap is largely unaddressed. The categories above reflect how open the specific gap is, not the overall competitive density of the area.
The market built where penalties are immediate: miss a visit, lose revenue. Skip compliance, lose your license. But the areas with the highest relational stakes, the moments that determine whether care actually works for families, have the least supply-side competition. The tools that exist capture data into structured fields. The information that matters most stays in notes, texts, and people's heads.
The system underneath
The underlying dynamic is a supply-demand matching problem, complicated by low trust and fragmented information.
Demand volatility means agencies can't guarantee stable hours. Caregivers hedge by working for multiple agencies. Agencies respond by overhiring and under-investing because they expect people to leave. When demand doesn't match the bench they built, those caregivers sit idle and drift away. The hiring and onboarding overhead resets every time. The signals that could reduce this friction don't travel. On the demand side: where are families looking for care, what hours, what care types. On the supply side: who is reliable, who works well with which clients, who is actually available. None of it moves. It stays in one scheduler's head at one agency.
The convergence
We assessed 15 operational areas on three dimensions: agency pain (from survey and interviews), market openness (how well existing tools resolve the unmet need), and APFM advantage (where APFM can add unique value). The areas where all three converge are where APFM should play.
Where APFM should play
Each space has direct value for APFM, independent of the others. Together, they address the root system behind the biggest agency pains.
Deep dives
Each opportunity space is anchored in converging evidence: agency stories, survey data, competitive gaps, and behavioral mechanisms.
Holly has been coordinating clients at a franchise agency in rural Maryland for six years. She describes a recent caller: a woman who hadn't slept in over a week, whose voice was breaking on the phone. By the time that woman's information reaches Holly, it has already been sent to three other agencies. By the third call, the woman is frustrated. By the fourth, hostile. Holly starts from zero, asking questions the woman already answered, to someone who no longer wants to talk.
Holly is not unusual.
8 of 22 agencies described lead quality as eroding their trust in APFM. Families fill out one form and receive four or more calls within minutes. The agency that calls first wins, not the best-matched one. About half of agencies absorb unpaid family education: what home care is, what it costs, what Medicare covers. None of this is tracked.
In Chicagoland, Jeremy spent $4,200 on APFM leads when he was starting out. One converted. His trust in APFM is "fully broken."
Lead quality is a known problem with work underway. But the post-referral journey, what happens between the lead arriving and care actually starting, is what this research surfaced.
The home assessment juggles data capture, rapport-building, expectation setting, and scope-of-care education all at once. Agencies choose paper over screens deliberately. Paper signals active listening and presence. Agencies choose paper because it builds trust, not because they lack technology.
The cost: 10-60+ minutes of re-entry per assessment, done in parking lots and coffee shops. The care plan, supposed to be the source of truth, becomes a compliance document. Detailed understanding gets compressed into structured fields. Daily care runs off notes, not the plan.
The story APFM captures is the family's understanding of their situation, which is often partial. Many families call pre-decision, not yet knowing what they need. That incomplete picture then gets compressed across handoffs: what the intake coordinator heard, what the assessor observed on paper, reformatted and stripped of nuance at each step. The caregiver arrives with a task list. Not a story.
And the story doesn't stop evolving. Mom's condition changes. The daughter's work schedule shifts. The care plan that was right in week one isn't right in week six. Today, nobody maintains this thread. APFM goes blind after the referral. The agency captures snapshots but not the arc. The caregiver sees changes in real time but has no way to surface them.
Daryl runs an agency with about 50 caregivers in Clearwater, Florida. His operations coordinator's goal is to hire three people per week. "We invite a whole bunch of people into the office and we do a training session and mass paperwork," he says. "And then we call them in three days for work, and they're like, nah, I already got. So we waste a lot of our time."
Daryl's agency is not an outlier. 78% of agencies are continuously hiring. 74% lost caregivers just in the past three months. Each time a caregiver leaves, onboarding resets to zero: new background check, new paperwork, new probation period.
Agencies have adapted to this. A VP at a 300-caregiver operation across California and Nevada told us her workforce splits into two populations: those who self-select out within 90 days, and a long-term core. "A person who's new to caregiving is going to decide within the first 90 days if this is for them or it is not." The constant hiring engine exists to feed the first 90 days. Agencies don't invest because they expect most new hires to leave. And because agencies don't invest, new hires leave.
The top two reasons caregivers leave are hours instability and multi-agency work, not pay. 83% of agencies know caregivers work for multiple agencies. They estimate 38% of their workforce is shared. But nobody coordinates this. Every agency starts from scratch.
The lack of portable caregiver context doesn't just drive hiring overhead. It also means agencies rely on one or two people's memory to make the decisions that most determine care quality.
At an agency with 450 active caregivers in Los Angeles, one person holds the matching knowledge for the entire operation. "It's kind of in our head," Aisha says. Which caregiver has the patience for an anxious client, whose custody schedule affects their weekend availability, who actually shows up when they say they will. This is the caregiver's context. It exists, but it's not portable.
20 of 22 agencies rely on knowledge in one to three people's heads for matching. 81% rely at least partly on personal knowledge. Only 12% use software. Three matching tools exist, but 10 of 22 agencies bypass them because they solve credentials, not fit.
Holly coordinates clients at a franchise agency in rural Maryland, working alongside a counterpart who manages the caregivers. Six years of rotating through recruiting, scheduling, and coordination accumulated layers of knowledge about the 60-80 caregivers she places. "A lot of that information just kind of resided in my brain," she says. When colleagues cover for her, they ask questions she answers instantly but can't look up: "How am I supposed to know that this caregiver has custody of her children every other weekend?"
Caregivers state availability, then routinely refuse assignments within those parameters or accept ones outside them. This is systematic: caregivers maintain optionality. Stated availability is a soft signal, not a hard constraint.
We asked agencies: if a trusted third party had already verified a caregiver's background check and credentials, would you accept that instead of running your own?
Among those who said no, the top reasons were control ("my business is on the line"), compliance requirements, and accuracy concerns. Small agencies were most open (41% positive). Mid-size agencies were most resistant (23%).
This is an even three-way split, not a clear rejection. The resistance may itself be a trust issue: agencies say they wouldn't accept third-party verification, but that could change if the system proved reliable. There may also be a say-do gap. We need more research to understand what agencies would actually adopt and what "caregiver context" means to them in practice. The broader opportunity (a system that helps agencies trust caregivers faster) is supported by the rest of the data, but the specific shape of that system is an open question.
Competitive note: Kare is the closest existing tool to a cross-agency caregiver layer model. Both sides rate each other after each shift, reliability scores accumulate, and agencies can see a caregiver's track record across placements. It's early-stage but validates that the market is moving in this direction.
Hiring overhead and matching fragility are both consequences of the same gap: no caregiver context follows them across agencies. The trust cycle drives the hiring loop. The knowledge gap drives matching failure. A shared caregiver pool addresses both.
The entry point is onboarding: solve the overhead and agencies have a reason to participate. As caregivers move between agencies, their context builds across the network. That context helps agencies trust faster, which reduces churn and improves matching. What exactly that caregiver layer looks like needs more research.
Agencies described a pattern we heard across interviews: families split care across multiple providers. One agency covers Medicaid hours during the week. A second, private-pay agency fills evenings or weekends. Home health or hospice overlaps with home care as the client's condition changes. Each agency does its own full intake. Each gathers the same information independently.
Agencies view each other as competition, so information doesn't flow between them. One operator described getting clients' records through MyChart because the other agency "won't give us anything." The family ends up as the only thread connecting their providers, managing the complexity manually.
At a small Acticare franchise in Georgia, Myrna has a rule: no caregiver walks into a client's home alone on their first day. She arrives first. The caregiver waits outside. They walk in together. She's already sent the client a photo and bio of the caregiver. She stays 30-40 minutes, walks through the care plan, and lets the conversation settle before leaving. She built this protocol herself. It's not in the franchise playbook. No technology supports it.
Myrna is one of the few operators who has formalized what most do by instinct.
11 of 22 agencies described structured first-shift introductions. No dedicated tool supports this. Agencies do it with phone calls, printed photos, and personal presence. Brightwheel validates the category: 8M users in childcare with exactly this kind of handoff.
Agencies that mentioned family portals described low engagement. Families want a person on the other end, not a portal to check.
Part of the gap is generational. Many seniors receiving care are uncomfortable with technology. Agencies describe clients who resist digital forms, are uneasy about location tracking, and prefer paper because it feels less formal. Any family-facing product has to meet people where they are, not where the technology is.
At a 280-caregiver franchise in Indiana, caregivers call clients directly to cancel shifts. Clients cancel their own care based on the caregiver's message, bypassing the agency. The concern is caregiver protection, not convenience: preventing unpaid work requests, boundary violations, and hostile after-hours messages.
Agencies do have structured closure processes: billing close-out, system updates, portal deactivation, family notification. Some offer bereavement support and feedback surveys. But what they capture is administrative: that care ended, not what was learned or what comes next. APFM uniquely benefits from knowing when care ends: families often transition to senior living. Agencies have no incentive to flag this. APFM has every incentive.
What agencies track in their systems is operational: scheduled visits, hours, tasks completed. What actually matters to families is softer: is the caregiver a good fit? Is my parent comfortable? Is the situation changing? These signals live in phone calls, texts, and the coordinator's intuition. They don't make it into the ERP.
Family and caregiver communication is largely handled manually via phone, text, and email, with the ERP used primarily as a documentation repository. The 30-day goal framework during assessment serves a dual purpose: anchoring family expectations and providing a diagnostic tool if complaints emerge. But once care is underway, these signals fragment across channels that the agency can't search, aggregate, or act on.
From where to how
The research doesn't just point to where APFM should invest. It reveals how agencies work, what they protect, and what they won't adopt. These three principles should guide every product decision that follows.
What comes next
APFM currently connects families to agencies. The research points to a bigger role: the trusted layer in a three-sided marketplace that makes the entire care ecosystem work better.