A New Jersey home-care agency

The audit · document 03 of 07

Where the value is lost

What the 24 office hours are made of, why a finished week spends eight more days becoming official — and the dollars, at the agency’s own rates.

The hands-on time — what the 24 h 15 m actually is

Per weekly cycle, median. Classified from the step trace in document 02.

24 h 15 mper week
re-keying the same data — 7 h 00 m chasing — 5 h 30 m correction round-trips — 4 h 15 m rebuilding the official form & filing — 3 h 45 m review & intake — 3 h 45 m

Every category except review is mechanical: the same fact moved between places, the same form rebuilt, the same person called again. The care judgment in the cycle — reading each packet against the participant’s plan — is about 2 h 30 m of the 24 h 15 m.

The waiting — why 24 office hours take 8 days

Hands-on work is a fraction of the elapsed time. The rest is the week sitting still, waiting on:

Correction phone tag
~2 days
The chase — late packets trickle in
~2 days
The weekend in the middle
~2 days
The filing batch, queued to Monday
~1½ days

Two of the four waits are self-inflicted: the chase exists because the deadline has no reminder, and the filing batch exists because the official form is rebuilt by hand in one sitting. The proposed state (document 04) removes both and shrinks the other two to hours.

The dollars

At the loaded hourly rates the agency gave us — office coordinator $28/h · office manager $34/h — plus the software bill as invoiced.

Office labor, one weekly cycleTodayProposed
Office-coordinator time17 h 15 m · $4834 h 15 m · $119
Office-manager time7 h 00 m · $23845 m · $26
Per week, office labor≈ $721≈ $145
spend today$8,100 a month≈ $721/week office labor + the $5,000/month forms platform
spend after the build$1,980 a month≈ $145/week office labor + a $1,350/month run cost — hosting and support, itemized below
saved$73,000 per year$8,100 − $1,980 ≈ $6,100 back every month — the platform bill gone and ≈ 83 office hours a month returned to the work itself

The run cost is real and stays on the table, not in a footnote: ≈ $350/month of Azure hosting in the agency’s own tenancy, plus a $1,000/month support agreement — four hours at the builder’s $250/hour rate, for changes and support. Rates are the agency’s own figures; the time is measured, not estimated. Recompute with different rates in one line — the time split is the finding.

Not counted in the money — deliberately

Three real costs the headline leaves at zero, so the number that decides stays conservative.

  • U1
    ≈ 34 caregiver-hours a week, spent on Sunday nights — 45 workers × ~45 minutes; after the build, ~25 minutes during the visits.measured in the deep dive · workforce capacity, not office labor
  • U2
    State-review prep: ~3 office days, twice a year — mostly dissolves once filing is organized and current; sized in document 06.agency estimate · out of the approved scope
  • U3
    Billing corrections and unbillable overruns — episodic, not weekly — real dollars in the failure stories below, left out of the monthly arithmetic.office manager’s records · risk, not run-rate

Three things that went wrong — and what each one cost

From the agency’s own records — each one a category, not a one-off.

The sixteen-day December — pay ran with six packets unverified

A holiday weekend, a doubled pile, and one sick day stacked into sixteen days from the week’s end to the last packet filed. The pay run was trued up a cycle later; state billing shifted; the first office week of January was spent untangling December. No single dollar figure fits — the cost is rework and trust.

The overrun nobody could bill — 19 hours of care, unbillable

One worker delivered 19 more hours across a quarter than three participants’ plans authorized. The side spreadsheet caught each overrun after the care was delivered — care given in good faith, never billable. The ceiling existed all along; nothing enforced it at the moment the hours were entered.

The 2024 form — silently re-pasted, every week for months

One worker’s template predated two revisions of the official form. The office re-pasted that worker’s weeks into the current layout — the re-pasting had simply become part of the job. Found during fieldwork, not by the office.

Prepared by /analog · part of the home-care case study.
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