By Thomas A. Parmalee
Before launching CareCrown, Elizabeth Moss wasn’t an outsider trying to “fix” home care from a distance. She was running a large home care agency that she started in 1997 to serve the greater Nashville area in Tennessee.
After the 2015 exemption law change, she found herself navigating last-minute callouts, missed shifts and an increasingly unstable caregiver workforce that seemed unmotivated by incremental wage increases.
Today, through CareCrown, she is helping home care agencies rethink caregiver performance by reinforcing the behaviors that drive revenue, retention, and growth. By turning everyday operational activity into a measurable, incentivized system of engagement, CareCrown gives agencies a clearer way to improve reliability, recognize strong performance and retain more caregivers.
It’s all done through the CareCrown app, which is compatible with many of the leading home care scheduling software solutions and can cost as little as $100 per month for a smaller agency.
Moss’s perspective is shaped by an unusually long arc in health care that spans nursing and assisted living roles, to private duty care to running her own agency.
That experience is central to CareCrown’s ability to provide agency owners an operational system that identifies the leaks in the budget and allows reallocation of those lost dollars toward the caregivers for recognition and incentives they deserve while helping agencies not only recover lost revenue, but grow their business and improve culture and staffing relationships.
“Caregivers have been hugely underserved, underappreciated, underrecognized and undervalued,” she said.
The CareCrown system is built at the intersection of culture and cash flow — where retention is not treated as sentiment, but as measurable infrastructure.
From Regulatory Shock to Operational Breakdown
Moss traces the origins of CareCrown back to a pivotal disruption in 2016, when regulatory changes around overtime and wage structures upended how home care agencies in Tennessee staffed their operations.
For agencies that had long depended on caregivers working 60–65 hour weeks, the new constraints created immediate labor shortages. Families couldn’t always absorb overtime costs. Agencies couldn’t absorb the staffing elasticity they had relied on. Caregivers, meanwhile, began working across multiple agencies just to reconstruct full-time income.
The result was operational fragmentation: overlapping schedules, rising callouts and chronic instability in coverage.
Even for Moss — who notes she was already paying above minimum wage — the deeper issue wasn’t compensation alone. It was predictability. Agencies were losing control of scheduling capacity and, with it, revenue.
At one point, she estimates her agency was losing roughly $250,000 annually in revenue leakage tied to late clock-ins, unfilled shifts and an inability to accept new clients due to staffing constraints.
Asking a New Set of Questions
Rather than doubling down on broad wage increases, Moss began reframing the problem as one of performance design rather than compensation alone.
She started asking a different set of questions:
- What behaviors drive revenue loss?
- Which caregiver actions are measurable in real time?
- What would happen if compensation included performance-based incentives, not just tenure?
That thinking led to a compensation model inspired, in her words, by a “Starbucks game” that allowed her to earn points every time she bought something: structured rewards tied to observable behaviors, not abstract evaluations.
Inside her agency, she began tracking operational “leaks” such as:
- Late clock-ins.
- Last-minute callouts.
- Open shifts.
- Lost new-client capacity due to staffing gaps.
She realized that her agency, as well as others, were not just dealing with turnover. They were losing revenue through micro-failures in daily execution.
Working with a fractional chief financial officer and benchmarking tools, Moss connected workforce behavior directly to financial outcomes. What emerged was a clearer picture of how small operational breakdowns compound into large revenue losses.
Her example is stark: If a scheduler books 1,500 hours per week but only 1,000 are billable due to staffing inefficiencies, that 500-hour gap at roughly $30 per hour translates to about $15,000 per week in lost revenue. Annualized, that approaches $780,000, not including secondary losses from client churn, hiring costs and onboarding delays.
That realization reframed caregiver engagement not as a “soft HR issue,” but as a direct margin driver.
The Formation of CareCrown
The concept that would become CareCrown took shape inside her own agency around 2018. A year later, she launched a pilot program within her own agency, Caregivers by WholeCare.
Initially embedded within her operations, the platform was later spun out as a standalone company after external interest grew and Moss was approached about selling her agency in 2020. She ultimately separated the technology from the legacy business, recognizing it as a scalable product category on its own.
By late 2022, CareCrown had begun expanding beyond its original environment, building integrations and partnerships with major home care scheduling systems including Rosemark, AxisCare and WellSky, embedding directly into caregiver workflows.
“We connect and integrate with the scheduling platforms to get the shifts and the things we need to know, including the time that caregivers are clocking in and clocking out and so forth,” Moss said.
How the Platform Works
At its core, CareCrown functions as a performance management, rewards and recognition layer that sits alongside agency scheduling systems.
Caregivers interact with their scheduling system daily — often multiple times per shift. Activities encompass the following:
- Clock in, on time → earn points.
- Complete shifts → accumulate rewards.
- Receive “kudos” from supervisors.
- View leaderboards and badges.
- Redeem points for cash or cash-equivalent rewards.
- Track referral bonuses and hiring outcomes.
Points are typically calibrated to a simple structure (often pegged around a penny per point), but agencies can customize reward economics based on budget and strategy.
“We guide agency owners in the conversation, and they customize the point value,” Moss said. “Agency owners determine what is right for them.”
Moss emphasizes that most agencies start small — often $10–$20 per caregiver per month and scale up to the $50 per caregiver per month range as they see a significant return on investment.
Importantly, caregivers are not just passive recipients. The system introduces:
- Gamified recognition loops (leaderboards, badges).
- Peer visibility, which promotes friendly competition.
- Referral incentives tied to actual hiring and hours worked.
- Immediate feedback on punctuality and performance behaviors.
- Training, Google Reviews, etc.
The result is a daily engagement cycle rather than a quarterly HR intervention.
For caregivers, the payoff can be significant.
“We have one agency where their caregivers are now earning an average of an extra $1.50 per hour,” Moss said. “So, this is not only meaningful for the caregivers but as a differentiator to the agency in attracting caregivers and new clients. Clients appreciate it when their caregivers earn more money, which helps ensure their continuity of care.”
What Changed in Performance
Across deployments, Moss reports measurable operational shifts within agencies:
- 34% improvement in on-time clock-ins within first 60 days.
- 50% reduction in caregiver turnover within first 9 months.
- 23% decrease in callouts.
- 21% reduction in lost hours tied to callouts.
- 100% increase in positive Google reviews.
- Significant improvements in overall billable hour capture.
One of the most consequential benefits is recovered capacity. Agencies can take on more clients without increasing headcount simply by stabilizing attendance and punctuality.
Changing Behavior
Moss is explicit that the underlying shift is not simply financial.
Early iterations of agency incentive programs, she notes, often focused on wages and benefits. Those remain necessary, but insufficient. Caregivers also want recognition, belonging and community.
Where traditional systems emphasize compliance and supervision, CareCrown is designed around reinforcement loops that make caregivers feel seen in real time.
That includes structured “kudos” flows, birthday and anniversary recognition, and client feedback loops that can trigger public Google reviews and appreciation moments.
The effect is less about surveillance and more about embedding positive reinforcement into the operational fabric of care delivery.
Moss frames CareCrown not as an HR add-on, but as a revenue protection system.
For agencies operating on thin margins, the difference between stable and unstable staffing is often the difference between growth and stagnation. A single missed client opportunity or inability to staff new hours can represent tens of thousands in annual lost revenue.
In that context, CareCrown’s pricing starts from roughly $100/month for small agencies to significantly lower than the cost of replacing even one caregiver per month in a high-turnover environment.
A Category Being Created in Real Time
What makes CareCrown notable in Moss’s view is not just the product itself, but the emergence of a new category: caregiver performance management and operational engagement infrastructure for frontline care workers.
Where scheduling systems manage logistics, CareCrown sits on top of them to manage the day-to-day activities, recognition and retention signals in real time.
Through partnerships and integrations with major home care software providers, CareCrown has access to an ecosystem representing approximately 3,000 home care agencies, creating a significant opportunity for future growth. Moss is confident that over time, more agencies will recognize the wisdom of using CareCrown.
“Agencies don’t know their numbers, so they can’t see the leaks in their budget,” she said. “If I can help them identify how much they are losing in callouts, and how they are losing new clients, they will see this is a no-brainer.”
Connect with Elizabeth to learn how CareCrown can help you stop any leaks you may have.
