River Edge Advisors provides outsourced accounting and fractional CFO services for home care agencies: monthly bookkeeping and close, caregiver payroll coordination and analysis, receivables tracking by payer, gross margin per care hour, 13-week cash forecasting, multi-location consolidation and lender-ready reporting, led by a CPA with a team of 75+.
Agencies that are growing faster than their books
Home care is a business of thin margins and big payrolls. Caregiver wages, overtime and payroll taxes are most of your cost, collections arrive on different timelines depending on the payer, and every new client adds hours to the schedule before they add cash to the bank. When the books can't keep up, owners feel it as a tight Friday, even in a month with record hours.
We work with non-medical home care and home health agencies that have outgrown a part-time bookkeeper or an overstretched office manager. Typical clients include:
- Single-location agencies that are adding clients and caregivers quickly and want to know which growth is actually profitable.
- Multi-location and multi-entity agencies that need every office or territory closed the same way and rolled up into one consolidated picture.
- Owners planning an expansion, acquisition or sale who need numbers a lender, partner or buyer will trust.
- Agencies with a mix of payers such as private pay, long-term care insurance and managed-care or agency contracts, each with its own rates, terms and payment timing.
A note on scope: we focus on accounting, reporting and financial management. Your billing team or vendor keeps handling claims and invoicing; we work alongside them and make sure what they produce lands correctly in the books.
Where home care books drift
Most agencies don't have a revenue problem. They have a visibility problem. The same issues come up again and again when we first look at a home care agency's books.
Payroll is one big line
Caregiver wages, overtime, office salaries and payroll taxes all land in a single payroll account. That makes it impossible to see gross margin on care, which is the single most important number in the business.
Hours billed and hours paid are never compared
Missed visits, shifts that were worked but never invoiced, travel time and overtime quietly erode margin. If nobody ties the hours you paid caregivers for to the hours you billed, the gap only shows up as a weaker bank balance.
All revenue sits in one account
Private-pay clients, insurance-funded clients and contract work have different rates, different margins and very different collection timing. Booked together, they hide which part of the business funds the rest.
Receivables aren't aged by payer
When receivables are reviewed as one total, slow payers stay invisible until they're a cash problem. Your payroll runs every week or two regardless, so every slow-paying account is effectively financed by you.
Locations close at different speeds
Agencies with several offices often close each one on its own timeline with its own chart of accounts. By the time the numbers are combined, they're too old to act on.
A finance function built around the care hour
We set up your books around how a home care agency actually runs, then close them on a fixed calendar every month.
Monthly bookkeeping and close
Every bank, card and payroll account reconciled, revenue and receivables recorded by payer, and a close delivered on a set date. We work in QuickBooks Online and other common accounting platforms, and alongside your scheduling and payroll systems.
Caregiver payroll visibility
Payroll split into caregiver wages, overtime, office staff and payroll taxes, so gross margin on care is a real number. We coordinate with your payroll provider so each pay run is booked correctly, and we track overtime as its own line so you can see what it costs.
Margin per care hour
Gross margin per care hour by payer type, by location and, where the data allows, by client. This is the number that tells you which contracts to grow, which rates to renegotiate and whether a new territory is pulling its weight.
Hours billed versus hours paid
A monthly reconciliation between scheduled, worked, paid and billed hours, with the differences explained. This is often where the quickest wins are.
Receivables by payer
Accounts receivable aged by payer, with a short list of the accounts that need attention first, so collections effort goes where it matters.
13-week cash forecast
A rolling forecast that lines up payroll dates with expected collections, so you can see a tight week coming a month in advance instead of the day before.
Multi-location consolidation
One chart of accounts and one close calendar across every location and entity, with each office's P&L on its own and a consolidated group view that ties out.
Fractional CFO
When you need more than the books, a fractional CFO helps with rate negotiations, expansion decisions, hiring plans, lender conversations and preparing for a sale.
A healthcare close that went from six weeks to ten days
Speed matters as much as accuracy. A close that arrives six weeks after month-end describes a business that no longer exists, and in home care, staffing and payer decisions can't wait that long.
A twelve-entity close, cut from six weeks to ten days
A healthcare group with twelve entities needed six weeks to close the books after each month-end. We took on the accounting and reporting across all twelve entities. The close went from six weeks to ten days.
See all case studies →For a home care agency, a faster close means you see last month's margin per hour while you can still do something about it: adjust a schedule, chase a slow payer, or rethink a rate before the next contract renewal.
What you should see every month
Whether you work with us or not, these are the numbers a home care owner should have on one page within a couple of weeks of month-end:
- Revenue by payer type and by location, with hours billed.
- Gross margin per care hour, by payer and location.
- Caregiver wages, overtime and payroll taxes as a share of revenue.
- Hours billed versus hours paid, with the gap explained.
- Receivables aged by payer, with the accounts that need attention flagged.
- Cash on hand and a 13-week forecast lined up against upcoming payrolls.
- The three things to fix next.
If your current package doesn't include most of these, that's the place to start. Our free monthly close checklist lists every step of a clean close, and our article on margin per care hour goes deeper on the numbers above. For more on the wider healthcare side, see the monthly numbers a home health owner should see.
Growth only helps if the hour is profitable
Home care growth has a trap built into it. Every new client adds caregiver hours, and caregiver hours are paid weekly or biweekly. Collections arrive later, sometimes much later depending on the payer. An agency adding clients quickly can be profitable on paper and still short on cash, simply because payroll goes out before the money comes in.
That's why the questions lenders, partners and buyers ask are so consistent: what does an hour of care earn, how fast do you collect, how much overtime are you carrying, and how quickly do your books close? Owners who can answer clearly negotiate better rates, borrow on better terms and expand with far less stress. Owners who can't end up making decisions on instinct and a bank balance.
Getting there doesn't take new software or a bigger office team. It takes a chart of accounts built around payers, locations and payroll categories, reconciliations that happen every month, and someone whose job is to turn the books into a short list of decisions.
No cleanup required before we begin
Many agencies come to us with books that are behind or partly right. That's normal, and it's not a reason to wait.
- Free review of last month's books. We look at last month for one location or the whole agency and walk you through what stands out: where margin is leaking, what doesn't tie and what we'd fix first.
- Catch-up and setup. We bring the books current, restructure the chart of accounts around payers, locations and payroll categories, and set the close calendar.
- Monthly rhythm. A closed set of books and a short owner's package on a fixed date every month, with fractional CFO time when decisions come up.
Questions owners ask
Do you replace our billing team or vendor?
No. Your billing team or vendor keeps handling claims and invoicing. We work alongside them and make sure billed revenue, collections and receivables are recorded and reconciled correctly in your books, and that the gaps between hours worked, paid and billed are explained.
What is margin per care hour and why does it matter?
It is what the agency keeps from an hour of care after caregiver wages, overtime, payroll taxes and other direct costs. Because caregiver payroll is most of a home care agency's cost, this number tells you which payers, contracts and locations are actually profitable.
Can you handle agencies with several locations or entities?
Yes. We close every location and entity on the same calendar with the same chart of accounts, then produce a consolidated view for the group alongside each location's own P&L.
Do you work with our payroll provider and scheduling system?
Yes. We coordinate with your existing payroll provider and use reports from your scheduling system to reconcile hours worked, paid and billed. You don't need to change systems to work with us.
Can you help us prepare for a loan, an acquisition or a sale?
Yes. Lenders and buyers ask predictable questions about margin, payroll, receivables and close timing. We prepare clean financials and supporting schedules, and a fractional CFO can walk them through the numbers.
How do we get started?
Request a free review of last month's books using the form on this page. There's no obligation.
See your agency's numbers clearly
Send us last month's books for one location or the whole agency. We'll walk you through where margin is leaking, what doesn't tie and what we'd fix first.
- → Tell us about your business and the questions you want to answer.
- → We discuss what we see: where cash is going, what doesn't tie, what we'd fix first.
- → A follow-up conversation to walk through it. No obligation either way.