How do you know the visit actually happened?

Three systems, and the question none of them answers

The one person with an independent account of the visit is the client, and in most agencies nobody asks her. Not out of neglect — there is no one whose job it is to telephone ninety people a day to ask how it went.

• The scheduleKnows a visit was planned. Says nothing about what happened.
• Electronic visit verificationKnows a device was at an address between two times. A good attendance record and not a care record.
• The care notesWritten by the person whose visit they describe. Useful, and not independent.

The failure that actually costs you the contract

It is rarely the missed visit. A missed visit is visible, someone rings, it gets covered.

It is the visit that happened and was not good enough. Cut short because the round was running late. Rushed. The worker was fine and the client was left feeling like a task. Nobody reports it, because the client does not want to make trouble for a person she likes, and the agency's systems all record a completed visit.

Four to six weeks of those and the family cancels. The exit conversation is usually the first time anyone at the agency hears about it, and by then the account is closed.

If you start asking, three rules keep it honest

• “I don't think so” is not “nobody came”A large share of home care clients have memory problems — that is the population. Treating an unreliable recollection as a missed-visit finding puts somebody's job at risk on evidence that would not survive an afternoon. Unsure has to be its own answer and must never be rounded up.
• A finding is about a visit, never about a workerThe moment the workforce experiences this as surveillance it gets quietly sabotaged, and in a sector running at this level of vacancy an agency will drop the tool rather than fight its own staff. Group by client. If you need to know who was rostered, the schedule already tells you, alongside the ninety visits that went fine.
• When two records disagree, do not pick a winnerIf the door log says attended and the client says nobody came, that is a question for a person. Ringing her to say the records show somebody came is telling an eighty-year-old she has misremembered — and if she is right, you have taught her that reporting things is pointless. Check the roster first. That is usually where the fault is.

What to do on Monday, without buying anything

A coordinator can run a version of this by hand and find out within a fortnight whether it is worth automating.

• Pick ten clientsThe ones whose families ask the most questions, since they are the accounts most likely to churn.
• Ring each one once a weekOne question: “did someone come to see you yesterday, and how did it go?” Two minutes.
• Write down the answer, not your interpretationCame, came but rushed, not happy, nobody came, not sure. Five words.
• Count the “rushed” and “not happy” onesThat number is your churn pipeline, and it is the one number no system in your office currently holds.

If ten clients over a fortnight produce nothing, you have learned something genuinely reassuring for the cost of forty minutes.