Throwback to her corecubed Days 

About Amy Selle

Amy Selle is the Founding Growth Architect for The Home Care CPAs, an accounting and financial strategy consulting firm exclusively focused on home care agencies. She brings more than 20 years of home care industry experience to her role, with a background spanning hospital marketing, senior living, and over a decade as Managing Director and then Vice President at corecubed — a marketing and advertising firm dedicated to the home care space. At The Home Care CPAs, Amy leads growth, partnerships, and business development, connecting agency owners with the financial clarity and strategic support they need to run more profitable, sustainable businesses.

What first drew you into the home care industry, and what has kept you committed to it for more than 20 years?

After working in hospital marketing for a while, I was ready for something different. Two offers came in at once: a communications director role for a school district, and a sales and marketing position in home care. The decision came down to one thing. I wanted to work with people who had rich, lived experiences. The chance to engage with older adults, learn from their wisdom, and build real relationships pulled me in. More than 20 years later, relationships are what keep me here. This industry is full of people who genuinely care about how others live and age, and I’ve never taken that for granted.

You have worked on both the provider side and now at a strategic level. What is the biggest misconception agency owners have about growth?

That it comes from a single effort. Owners often pour energy into one tactic and wonder why progress stalls. Sustainable growth is never one thing. It comes from marketing and community outreach working together, each reinforcing the other. Marketing alone won’t fill your census. Relationships alone won’t either. But when they work in tandem, you start to see real momentum.

You talk about how sales, hiring, and revenue are all connected. Where do most agencies break down in that cycle?

Usually with the financials. Revenue supports marketing and hiring, but if your bookkeeping is behind or reports are not clear to you, you’re flying blind. You end up making decisions without knowing how they’ll affect your agency, or you don’t make decisions at all. Growth requires velocity, and velocity requires accurate, timely financial data. Having a financial partner who keeps you current and helps you interpret your reports isn’t a luxury. It’s a growth tool.

“Growth requires velocity, and velocity requires accurate, timely financial data. Having a financial partner who keeps you current isn’t a luxury. It’s a growth tool.”

Amy Selle — The Home Care CPAs

Many agency owners struggle with caregiver shortages. What are the practical steps they should take today to improve hiring and retention?

Too many agencies treat hiring like a cattle call when it should be a courtship. Caregivers have options and pay attention to how you show up before they fill out an application. Share your culture. Show what it feels like to work for you. And the courtship doesn’t end at the offer. If the experience doesn’t match what you sold them, you lose trust. Retention starts with honesty in hiring and follows through in how you lead your team every day. Agencies that get this right don’t just fill shifts. They build a workforce that stays.

From your experience, how does poor financial visibility impact decision-making inside a home care agency?

It creates confusion or paralysis. When your reporting can’t tell you which payer sources, service lines, or referral partners are profitable, you’re operating without a roadmap. You don’t know what to do more of, what to pull back on, or what you have available to build with. The agencies that grow intentionally can look at their numbers and make confident decisions. Everyone else is guessing. In an industry with thin margins and real workforce pressure, guessing is a luxury you can’t afford.

What are the most common pricing mistakes you see agencies make, and how do those mistakes affect long-term stability?

Failing to revisit rates regularly is a big one. Agencies bring on a client at a set rate and hesitate to renegotiate, even as caregiver pay increases. If you’re not adjusting at least annually, cost inflation quietly eats your margin.

The other mistake is failing to account for the true cost of filling a shift. Admin time, recruitment costs, and hard-to-fill bonuses should be baked into your pricing. A good rule of thumb: charge roughly 2x what you’re paying caregivers per hour. That gets you to about a 50% gross margin on paper, though payroll taxes and workers’ comp will bring it closer to 45%. That margin has to cover fixed costs and still leave you with a net operating margin in the 10–25% range, depending on payer mix.

“Too many agencies treat hiring like a cattle call when it should be a courtship. Retention starts with honesty in hiring and follows through in how you lead your team every day.”

Amy Selle — The Home Care CPAs

Compliance pressure continues to grow in home care. How should agencies balance compliance with maintaining strong operations and growth?

Know what you’re signing up for before you commit. A fair amount of compliance pressure comes from Medicaid, which brings growing requirements, friction with electronic visit verification, and slower payment cycles. State licensing adds another layer, sometimes taking one to two years, and agencies that don’t plan for that timeline can find themselves carrying overhead long before they serve a single client.

You work at the intersection of marketing, operations, and financial performance. What is one change an agency can make that would immediately improve all three?

Track your data, and that means all of it. Most agencies rely on revenue as their primary metric, but revenue alone doesn’t tell you if you’re making money or where your best growth comes from. Start tracking gross margin by payer source, caregiver cost per shift, and overhead as a percentage of revenue. Then apply the same thinking to your marketing. Which referral sources are converting? What does it cost to acquire a new client? When you know those numbers, you stop spreading effort evenly and start investing in what’s working.

For agency owners who feel stuck or overwhelmed, what is the first metric or number they should focus on to regain control of their business?

Gross margin is the best place to start regaining clarity. Revenue is the number most owners watch, but it’s also the most misleading. You can be growing revenue and losing ground if costs are creeping up faster than you realize. Gross margin is what you keep after caregiver pay and direct care costs are deducted. If it’s healthy — typically in the 45–50% range — you have a foundation to build from.

At EnhDme, we focus on giving caregivers and agencies the tools they need to support clients safely at home. From your perspective, what equipment or resources make the biggest difference in both quality of care and operational efficiency?

The ones that reduce caregiver burden and prevent avoidable crises. When clients have the right tools at home — whether mobility aids, fall prevention equipment, or remote monitoring — agencies see fewer client hospitalizations and more stable long-term relationships. That stability matters operationally because crisis-driven scheduling is expensive and hard to plan around. Caregivers who feel equipped to do their job safely stay longer, and retention is one of the biggest drivers of efficiency and profitability in this industry. Agencies that treat equipment as part of their care model, not an afterthought, tend to run better and deliver better outcomes. It’s good care and good business at the same time.

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Amy Selle — Founding Growth Architect, The Home Care CPAs

The Home Care CPAs founded Margin Matters — a free online community built specifically for home care agency owners and leaders. Access financial tools and resources, join live expert-led sessions, and connect with peers navigating the same challenges around profitability, cash flow, and growth. If you are ready to stop guessing and start leading your business with confidence, you are welcome.

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About the Author

Kevin Lambing, CDME is the CEO and owner of EnhDme (enhdme.com), a retail DME and home-care hardware distributor operating as a brand of Kevin’s Caregiver Network LLC, based in Columbus, Mississippi. A Certified DME Specialist, National Marketing Director veteran in care education, and author of Swipe Right On Care, Kevin is a two-time presenter of the National Caregiver of the Year Award at the Home Care Association of America’s annual event.