The escalating crisis in home care, defined by critical staffing shortages and costs that place essential services beyond the reach of many families, has demanded a fundamental rethinking of how care is delivered and valued. In response to this industry-wide challenge, an innovative, task-based billing model is gaining traction, shifting the economic foundation of care from hours logged by a caregiver to specific, pre-defined outcomes achieved for a client. This paradigm shift, pioneered by Honolulu-based Vivia Cares, addresses the dual pressures of client affordability and provider labor costs by deconstructing the traditional, time-based shift into a series of targeted, efficient service deliveries. The result has been a significant surge in demand, signaling a market eager for a more flexible and sustainable approach to aging in place. This new formula not only offers a lifeline to providers struggling in competitive labor markets but also promises clients greater control, predictability, and access to the precise support they need.
The Catalyst for Change
Breaking the Traditional Mold
The traditional home care system, built on selling blocks of time, has demonstrated its unsustainability, particularly within high-cost labor markets where competition for workers is fierce. Vivia Cares, established in 2020 through a strategic merger, reached a critical inflection point in Hawaii, a state characterized by a severe caregiver shortage, an aging demographic, and a shrinking general population. The company found itself in an intense battle for talent against the robust retail, restaurant, and hotel industries, which forced a significant increase in caregiver wages to remain competitive. This necessary wage hike translated directly into higher service rates for clients, creating a vicious cycle where essential home care services were becoming a luxury few could afford. This untenable economic pressure threatened the very viability of the business model and acted as the primary catalyst for a profound philosophical reevaluation. It led CEO Dew-Anne Langcaon to declare a new direction, stating, “We don’t sell time. We sell tasks and outcomes,” a principle that would redefine the company’s entire operational framework.
The inherent weaknesses of the time-based model extend beyond pricing pressures, revealing systemic inefficiencies that affect both clients and providers. In the conventional approach, families are often required to book a caregiver for a minimum block of hours, typically four or more, regardless of whether the client needs continuous attention. This structure frequently results in clients paying for significant periods of caregiver downtime, while the caregiver may feel underutilized during a long and static shift. This rigidity fails to meet the growing demand for more agile care solutions, as many older adults require assistance with only a few specific activities of daily living, such as meal preparation or bathing, at distinct times of the day. The one-size-fits-all, hourly model imposes a financial burden for unneeded supervision and creates a mismatch between the services required and the services rendered. This systemic flaw, which prioritizes the sale of time over the completion of necessary tasks, highlighted an industry ripe for disruption and innovation.
A New Operational Blueprint
The task-based model represents a meticulous re-engineering of the entire service delivery process, beginning with the initial point of contact. A specialized call center team works closely with families to conduct a comprehensive needs assessment, a critical step that provides immediate clarity and control over costs. During this consultation, staff help families delineate which specific duties genuinely require the skills of a licensed professional and which can be managed by family members or friends, empowering them to make informed financial decisions from the outset. Instead of committing to a lengthy and often costly block of time, clients arrange for the completion of specific, itemized duties. This approach fundamentally alters the transaction, moving it from a vague purchase of time to a clear purchase of a completed task. The example of assisting a client with dementia with a shower perfectly illustrates this principle: whether the task takes a straightforward 20 minutes or is delayed to an hour due to unforeseen challenges, the client pays a single, fixed price. This predictability shields families from fluctuating costs and ensures their payments are directly tied to the value they receive.
From an operational perspective, the model is built on a foundation of logistical precision and efficiency that transforms the caregiver’s role. A task-based caregiver’s daily route is a dynamic circuit involving visits to between eight and ten different clients, with each visit lasting only as long as it takes to complete the prearranged task. This high-tempo workflow necessitates a sophisticated scheduling and routing system, likely powered by technology, to optimize travel times and ensure punctual arrivals across a neighborhood. This stands in stark contrast to the traditional caregiver’s day, which is typically spent with a single client and often involves significant periods of companionship rather than active task completion. This new blueprint maximizes the productivity of each caregiver, allowing a smaller workforce to serve a larger number of clients effectively. The focus shifts from passive presence to active, targeted intervention, retooling the very definition of a caregiver’s workday to address the core challenges of labor shortages and operational efficiency head-on.
Building a Sustainable Ecosystem
Centering the Caregiver and Client Experience
A truly sustainable home care model must be built around the intertwined needs of both its clients and its workforce. Recognizing this, Vivia Cares proactively engaged its most effective caregivers to understand what constitutes a “good job” in a highly competitive labor market. This feedback revealed a crucial insight: while higher pay was appreciated, it was not the sole or even primary motivating factor. Instead, caregivers prioritized the stability of their hours and practical assistance with daily work-related challenges like transportation. Armed with this knowledge, the company implemented a revolutionary benefits package for its task-based caregivers that directly addressed these core needs. This package included guaranteed 40-hour workweeks, providing financial predictability; a substantial 30% raise, acknowledging their high-demand skills; and the provision of a company car, removing a significant barrier to employment. This was not merely a gesture of goodwill but a strategic investment in workforce stability, designed to reduce turnover, attract top talent, and build a reliable team capable of delivering consistent, high-quality care.
Simultaneously, the company gathered extensive feedback from its customers, which pinpointed deep-seated dissatisfaction with the inflexibility of the traditional home care model. Clients consistently expressed frustration with the rigid minimum-hour requirements that forced them to pay for more care than they needed, as well as the lack of consistency when different caregivers were assigned to their loved ones. By synthesizing this client feedback with the insights gained from its caregivers, Vivia Cares was able to develop a proprietary pricing and service model that created a powerful alignment of interests. The new system offered clients the flexibility they craved, allowing them to purchase specific tasks without long-term commitments, while providing caregivers with the stability and support they needed to thrive professionally. This dual-feedback approach was instrumental in building a holistic ecosystem where the solutions for client problems also served as the foundation for a more sustainable and rewarding career path for caregivers, fostering a cycle of mutual benefit.
Managing New Expectations
The shift to a task-based model necessitates not only a new operational structure but also a different caregiver profile and a proactive approach to managing expectations. The dynamic nature of the work, which involves a much faster pace and daily driving between multiple client homes, proved to be a significant departure from the traditional role of sitting with a single client for an entire day. This distinction was so pronounced that some of the company’s top-performing traditional caregivers declined to switch to the new system, preferring the established rhythm of their work. Consequently, Vivia Cares had to develop a new, specialized training program and actively recruit a demographic—often younger individuals—that was more comfortable with the dynamic, technology-driven demands of the role. This required a fundamental shift in human resources strategy, focusing on identifying candidates who possessed not only compassion and skill but also adaptability, efficiency, and comfort with a mobile work environment.
Central to the model’s success is a robust and transparent communication strategy designed to manage the complexities of a “shared caregiver” system. This operational principle, where a single caregiver serves multiple clients within a neighborhood on a tight schedule, carries inherent logistical risks. If a caregiver is unexpectedly delayed at one home due to an emergency, such as needing to wait for an ambulance to arrive, it creates a domino effect for all subsequent appointments on their route. To mitigate this, the model relies on a protocol of immediate and proactive communication. The central office must instantly contact every client further down the schedule to inform them of the delay and offer to reschedule if necessary. This constant flow of information is not merely a component of good customer service; it is a fundamental pillar of the model’s viability. It builds trust, manages expectations, and prevents the logistical challenges from eroding client satisfaction, ensuring the system remains reliable and responsive even when faced with unforeseen events.
Measuring Success and Looking Ahead
Quantifiable Impact and Market Validation
The efficacy of the task-based system was quickly validated by the market, with demand “skyrocketing” shortly after its launch, indicating a profound resonance with consumer needs. Beyond anecdotal success, the model’s impact is underscored by striking gains in labor efficiency. Vivia Cares found it could serve the same number of clients—approximately 350—with a significantly smaller workforce: just 30 caregivers on the task-based side compared to the 74 required to support its traditional, time-based services. This extraordinary increase in productivity directly addresses the industry’s pervasive caregiver shortage by optimizing the impact of the existing labor pool rather than solely focusing on recruitment. It demonstrates that a key to overcoming staffing crises lies in re-engineering the work itself to be more efficient. By enabling one caregiver to effectively meet the specific needs of multiple clients in a single day, the model multiplies the reach of each skilled professional, representing a powerful strategy for expanding access to care.
While this innovative model demonstrates profound efficiency, it is not positioned as a total replacement for all forms of home care but rather as a vital solution for a specific, underserved segment of the market. Company leadership confirms that traditional, 24/7 care will always be necessary for clients with complex medical needs or advanced dementia who require constant supervision for their safety and well-being. However, the task-based and other short-hour models are effectively replacing the intermediate “four, six, eight-hour shifts” that have long been the industry standard. For instance, a client who primarily needs assistance with meals at breakfast, lunch, and dinner can now schedule three targeted 20-minute visits. This is a far more focused, logical, and affordable solution than booking a full eight-hour shift, much of which would be underutilized. Vivia Cares itself has evolved to a 50/50 split between its traditional and task-based services, proving that these two models can coexist to create a more comprehensive and flexible continuum of care offerings.
The Path to Scalability
The task-based billing model, while still uncommon in the broader home care landscape, was proven to have significant potential for scalability. Vivia Cares actively worked to expand its application, and its initial efforts focused on a pilot program in Washington. This expansion was a critical test of the model’s adaptability, as it required tailoring the system to different environments, such as the less dense suburban and rural populations found outside the concentrated urban core of Honolulu. The challenges of greater travel distances and varied client distribution demanded operational adjustments. In response, the company focused on developing a comprehensive virtual training program. This initiative was designed to standardize the delivery of the model and overcome geographical barriers, ensuring that the core principles, operational protocols, and quality of care could be replicated consistently as the company ventured into new markets. This deliberate and methodical approach underscored the complexities of scaling such a nuanced operational shift.
The ultimate vision for the model extended far beyond the growth of a single company; it aimed to forge a replicable package that could transform the entire industry. The goal was to refine the system into a turnkey solution encompassing the essential technology for scheduling and communication, detailed operational scripts for call centers and administrative staff, and robust training protocols for a new generation of task-oriented caregivers. The ambition was to create a framework so well-defined that other home care providers could adopt and implement it within a few years, fundamentally altering the industry standard for efficiency and accessibility. This forward-looking strategy framed the initiative not merely as a competitive business expansion, but as the creation of a new blueprint. It was intended to provide a viable path for the industry to make essential home care more sustainable, affordable, and available to a wider population on a national scale.
