Forty Visits, One City, One Morning: Routing Home Care Without Losing Continuity

At ten past six a caregiver calls in sick and four coordinators start rebuilding a day. Forty visits have to move across a city. Some clients need a nurse rather than a personal support worker. Some have not met most of the roster and should not be meeting somebody new today. All of that lives in the coordinators’ heads, and none of it is in the scheduling software, which offers a calendar and no opinion.

This is the transformation we would run for that agency. It is presented as a concept, built on the same method we use in client engagements, so the before, the after, and the path between them are all visible.

Why is scheduling the whole business here?

Because in home care the schedule is the service. There is no waiting room absorbing variance and no building where staff and clients happen to be co-located. A visit that lands late or lands with the wrong person is not an inconvenience, it is the product failing.

The stakes sit with the family. The Canadian Institute for Health Information reports that more than 1 in 3 unpaid caregivers of long-stay home care clients experience distress within a year, and that distressed caregivers provide an average of 38 hours of care a week, twice what non-distressed caregivers provide. For caregivers of seniors with dementia the distress figure is 45%, against 26% for those caring for seniors without dementia.

Read that as an operational constraint rather than a sad statistic. When a scheduled visit does not arrive, or arrives with someone the client does not recognise and will not cooperate with, the hours do not disappear. They transfer to a family member who is already at 38 a week.

Before and after: the morning

Drag the handle. The before is the whiteboard reshuffle; the after is the drafted day designed in its place.

The coordinator still owns the day. What changes is that they start from a draft that already respects skill, continuity and travel, instead of from a blank grid at 6am.

What we built

The concept above is the output of the same engagement steps we run in client work, and several are decisions a competent peer could argue with.

• We weighted continuity above travel efficiency by default, and this is the decision most likely to be argued with by anyone who has optimised logistics before. A router tuned for kilometres produces a better map and a worse service, and in dementia care in particular an unfamiliar face can cost more time than the drive it saved.
• We got client preferences and caregiver constraints out of coordinators’ heads and into structured fields, which is unglamorous, takes weeks, and is the precondition for everything else. An agency unwilling to do that work should not buy this.
• We made the draft explain every change against yesterday, because a schedule a coordinator cannot interrogate is one they will quietly rebuild by hand.
• We built pinning as a first-class action. A coordinator pins a visit and the draft treats it as immovable, which is how the system absorbs the context it will never have.
• We wire evals from day one against the agency’s own historical schedules, scored on continuity preserved and travel time, and every coordinator override becomes a test case.

How it works

The scheduling system stays the source of truth. Care plans, caregiver skills, availability and continuity history feed a drafted day. Travel is calculated rather than estimated. Each visit shows why it landed where it did, and any change from the previous day is annotated. A coordinator pins anything that must not move, adjusts, and releases. Only a released schedule reaches a caregiver’s phone. On a same-morning call-off the affected visits re-draft inside the same constraints and go back to a coordinator, never straight to a client.

Because care plans and schedules stay in Canadian infrastructure and processing runs with zero data retention, the design lines up with what PHIPA expects: a privacy impact assessment before deployment, an agreement naming the processor as an agent under section 17, and an audit log on every access.

Why this pays back

The measurable return is travel time, which in home care is real money and is currently invisible because much of it is absorbed unpaid by caregivers between visits. Break-even for the first slice is about thirty-five travel hours removed per week at the agency’s own loaded cost.

The limit worth saying before anyone signs: this cannot create caregivers. An agency short-staffed relative to its client list will get a better-ordered version of an impossible day, and the drafted schedule will make the shortfall more visible rather than smaller. Several coordinators have told us a version of that visibility is itself worth having. An operations director who wants a scheduling tool to solve a recruitment problem should not buy this, and should be told so before the engagement rather than during it.