Senior care & aging services
Books and taxes for non-medical home care agencies.
Private-pay hours, Medicaid waiver reimbursements, VA authorizations, and caregiver overtime across split shifts. Your own bookkeeper keeps it straight, an accountant checks every transaction, and you get one clear number each month.
- From $197 a month
- An accountant on every transaction
- Cancel whenever
March cleared $11,000. Payroll ran high because two caregivers hit overtime covering the same client's night shifts, so I kept that separate from base wages.
- AxisCare private-pay payoutPrivate-pay billing
- State Medicaid waiver depositMedicaid waiver
- Payroll direct depositCaregiver wages
- State Fund workers compWorkers comp
- Costco bulk suppliesCaregiver supplies
Why your books are different
A home care agency's books go wrong in the same four places.
A generalist sees payroll and deposits. Your business is caregivers split across several clients, three or four different payers, and reimbursement that lands weeks after the visit. When the books do not know that, overtime gets missed and slow months look like bad ones.
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1
Caregivers who float between three payers
The same caregiver works private-pay hours, Medicaid waiver hours, and VA hours in one week, and if it all lands in one payroll number, you cannot tell that the waiver pays $19 an hour on a client billed at $28.
What we doSplits caregiver hours by payer so you can see what each contract actually nets, not just what payroll cost that week. -
2
Overtime hides across four households
A caregiver working Monday through Sunday split between four client homes still owes overtime on the whole week, and agencies that check hours per client instead of per employee routinely miss it until a wage claim shows up.
What we doBooks hours by caregiver across every client she worked, so overtime is calculated on the full week and flagged before payroll runs. -
3
The Medicaid waiver check lags the visit
A February visit gets billed to the waiver program, and the reimbursement lands in April. If the books only track cash in the bank, February looks thin and April looks great for no real reason.
What we doTracks what has been billed and what is still pending by payer, so a slow month caused by timing does not read as a bad one. -
4
1099 caregivers who look like employees
Paying a caregiver on a 1099 because it is simpler, while the agency sets her schedule, assigns her clients, and supplies her gear, is usually misclassification, and it gets expensive to unwind later.
What we doFlags any caregiver paid outside payroll whose work looks like employment, and gets the accountant's read before it becomes a pattern.
Your categories
The categories Gus keeps for a home care agency.
Set up once for how you get paid and what you spend. You never pick a category. He does, and an accountant checks it.
Money in
- Private-pay hourly billingFamilies paying weekly or biweekly through AxisCare, Smartcare, or a plain invoice.
- Medicaid waiver reimbursementThe state's home and community-based waiver program, paid after the visit is billed.
- VA Community Care NetworkHours authorized for a veteran client, paid through Optum or TriWest.
- Long-term care insuranceFamilies with a policy that reimburses hours after the fact.
Money out
- Caregiver wages and overtimeBase pay plus anything owed for hours over forty in a week.
- Payroll taxes and workers compThe cost of employing caregivers, not just paying them.
- Scheduling softwareAxisCare, Smartcare, or WellSky, billed monthly per caregiver or client.
- Background checks and bondingRequired before a caregiver is placed in a client's home.
- Mileage reimbursementWhat caregivers are paid for driving between client homes.
- Caregiver suppliesGloves, gait belts, and hygiene items bought in bulk.
- Recruiting and lead feesJob board postings and referral bonuses to keep the roster staffed.
What we watch for you
- Caregiver cost per hour
Wages, tax, and workers comp against what each hour bills. Tells you if a rate increase is overdue.
- Payer mix
The share of hours billed to private pay against Medicaid or VA, since they pay at different speeds.
- Overtime hours
Hours over forty per caregiver each week, tracked before payroll runs, not after.
- AR aging
What private-pay families owe and how long it has been outstanding.
Ask Gus
Things home care agency owners ask Gus.
Text him like you would text anybody. He answers in plain English, and when a question is above his pay grade, an accountant looks and gets back to you.
The Medicaid waiver payment for those hours has not landed yet. I am tracking it as billed, not paid, so you can see it is coming.
Likely yes, on the total hours across all four, not per client. I flagged it so payroll gets it right this run.
That call is above my pay grade. If you set her schedule and supply her gear, it usually reads as employment, and the accountant should weigh in before it becomes how you do things.
The tax side
The tax side of a home care agency.
Most of what goes wrong here is who counts as an employee and when a payment actually landed. Get those two right and the rest is straightforward.
What your return has to get right
Your accountant signs it, so it gets done right the first time.
- Employee or 1099 caregiverA caregiver whose schedule, clients, and supplies come from you is usually an employee under federal rules, even if the arrangement is called a contract. Getting this wrong is expensive to unwind.
- Mileage between client homesMiles a caregiver drives between visits in her own car can be deducted at 72.5 cents a mile through June 2026 and 76 cents after, when the agency has not already reimbursed the full rate.
- 1099s for per-diem helpA caregiver who truly sets her own hours and works for more than one agency, paid $2,000 or more in 2026, gets a 1099-NEC by January 31.
- The pass-through deductionOwners can often deduct up to 20 percent of business profit, though personal-care businesses can see it limited once taxable income passes $201,750 single or $403,500 joint.
Deductions non-medical home care agencies miss
Your bookkeeper knows what to look for in your statements. You never have to.
- Caregiver liability insurance
- Background checks per hire
- Bonding for in-home staff
- Mileage between client visits
- Scheduling software subscription
- Uniforms and name badges
- Gloves and hygiene supplies
- Workers comp premiums
- Recruiting and job board fees
- Phone plan for caregiver check-ins
General information about 2026 federal rules, not advice for your business. Your accountant looks at your actual numbers before anything gets filed.
All year, not just April
A home care agency's year, kept every month.
Client calls come any week of the year. Your taxes and your waiver renewals come on a schedule. Your team keeps you ahead of both. Every month in between, your bookkeeper closes the books and speaks up the moment something looks off.
- January
Waiver renewals confirmed
Medicaid waiver and VA authorizations often reset for the new year, so the team confirms yours are active before billing continues, while this year's set-aside gets planned.
- April
Filed, care goes on
Your return is filed and signed while caregivers keep working their routes. The set-aside built since January already covers it, no scramble needed.
- July
Halfway on caregiver cost
A look at what caregiver pay and overtime are costing against what each contract bills, and whether this year's growth is paying for itself.
- October
Before flu season staffing
Hospital discharges to home care climb as flu season nears. Before the rush, the team looks at hiring plans and anything worth buying before December.
What you get
What you pay depends on what your business needs, and it does not move after that, busy season or slow. No hourly bills, no surprise invoices, no setup fee.
Book a call- Monthly bookkeeping
Every transaction sorted into categories set up for non-medical home care agencies. You never categorize a thing.
- An accountant checks every transaction
Real review, every month, before your books close. Not a spot check.
- Your business tax return, filed
Prepared, reviewed, and signed by that same accountant every year.
- The monthly number
What you made, what you spent, what to set aside for taxes.
- Your own bookkeeper
A real person assigned to your business, in the app whenever you need them. No hold music.
- On your books all year
Every month, not just in April. Your team speaks up whenever something is worth your attention.
- Cancel any time
No contract. No cancellation call. Your books are yours.
Straight answers
Questions home care agency owners ask first.
Can Gus tell me which payer is actually worth keeping?
Yes. He splits money in by private pay, Medicaid waiver, VA, and insurance, so you can see which one pays fastest and which one is worth a second look.
My caregivers work split shifts across several clients. Does that complicate payroll?
No, it just needs tracking by caregiver instead of by client. Gus keeps total weekly hours per employee so overtime comes out right.
Do I have to switch off AxisCare or Smartcare to use Goatkeeper?
No. Keep scheduling the way you do. Gus works from your bank statement, and asks once if a deposit is unclear, then remembers the answer.
The Medicaid waiver pays slower than my private-pay families. Is that a problem for my books?
It is normal in this business. Gus tracks it as billed versus paid by payer, so a slow month from timing does not look like a bad one.
What happens if I have been paying a caregiver on a 1099 and she really works like an employee?
Gus flags it and the accountant walks you through fixing it going forward. That call needs a real look at your situation, not a guess.
My books are a mess from switching scheduling software last year. Can you still help?
Yes. Send the bank statements you have, however far back they go. Gus sorts caregiver payroll and payer deposits from scratch, and most owners see where they stand within a week.
Is a real accountant checking my books?
Yes. You get your own bookkeeper, Gus does the first pass on every transaction, and an accountant checks every one before your month closes. That same accountant prepares, signs, and files your business return. Goatkeeper is not a CPA firm, and we never pretend a person looked when they did not.
What does it cost, and can I cancel?
It starts at $197 a month, depending on what your business needs. No setup fee, no hourly bills, no contract. Cancel any time from the app, and your books go with you.
More in senior care & aging services
We keep books for the business next door too.
- Adult day care centers
- Geriatric care managers
- Medical alert system dealers
- Residential care homes (board & care)
- Respite care providers
- Senior dental & mobile care
- Senior home safety assessments
- Senior living placement advisors
- Senior move managers & downsizing specialists
- Companion care services
- Memory care communities
- Small assisted living facilities
- Home health agencies (skilled)
- Hospice providers
What makes a bookkeeper worth paying for Every business we keep books for
Book a call
Pick a time. That's the whole signup.
Fifteen minutes with a real person on our team. They look at where your books are, tell you straight what it takes to get caught up, and get you set up on the spot if it fits.
- $197 a month to start
- An accountant on every transaction
- Cancel whenever