Private Duty

Agency reduces liability, productivity drain by eliminating petty cash

After years of using cash to handle client needs such as grocery shopping, one California agency made the decision to reduce risk while saving time and money by introducing a new card solution.

Burlingame, Calif.-based Sage Eldercare Solutions started having its caregivers use True Link cards as part of its home care business.

True Link functions like a reloadable Visa card. Unlike a debit card, it doesn’t automatically pull money directly from a bank account.

While agencies that use True Link face a $10 monthly service charge per card, they see financial benefits because they don’t have to spend time transporting petty cash to the home, says Jack Herndon, managing partner at Sage Eldercare.

For Sage Eldercare, True Link saves the agency at least five to 10 hours a month on average as well as costs associated with staffing and travel, Herndon estimates.

True Link cards also could be marketed to potential clients and their families as an added benefit of service, adds Marcie Rogo, head of marketing with True Link Financial in San Francisco, Calif.

At Sage Eldercare, the cards have relieved headaches. Eliminating the use of petty cash reduced the risk for theft — money isn’t left in clients’ homes — and removed many of the administrative burdens associated with operating on a cash system, Herndon says.

“We had a pretty rudimentary process,” Herndon says.

Until 2014, Sage Eldercare had a lot of cash changing hands. Under its model, agency care managers would drive to clients’ homes with cash in $100 or $200 increments. Caregivers would use that money to purchase groceries or needed items.

Expenses were noted in a binder in the home. Receipts and any change were kept in a pouch in the binder.

“That process worked, but it was not efficient in terms of time,” Herndon says.

The old process required drives to the bank to ensure cash was on hand in the office, time for care managers to pick up and drop off money at clients’ homes and time to reconcile the petty cash ledger.

It also was difficult to track money. While the agency never had an issue with theft, the risk of it always made Herndon uneasy.

How does the True Link card work?

Sage Eldercare loads money onto True Link cards in $100 and $200 increments as outlined by the client’s family. That amount is then included in the client’s bill.

An online dashboard that contains no HIPAA-related information shows each purchase and where it was made. The dashboard is available for the agency and clients to view; this provides transparency.

While agencies also could encourage their client’s families to sign up for their own True Link cards and fund and track them on their own, Sage Eldercare prefers handling that task on clients’ behalf.

“We’re really high touch, and mom and dad are in good hands with us,” Herndon says. “Our clients don’t want to be bothered with that effort.”

How to handle the cost of the cards

Sage Eldercare charges clients for the monthly cost, so the fee is built into the service they provide.

“Instead of paying staff for their time, that fee for the card is paid for by clients,” Herndon says.

This isn’t the approach for all agencies that use the cards, however. Oregon Home Care Services in Portland, Ore., absorbs that monthly cost, according to agency accounting manager Carolyn Waldrup.

Because the ability to load the appropriate amount of money allows the agency to avoid interest payments on credit cards, Waldrum says the True Link cards have provided a big cost savings.

“That $10 is minimal compared to what we are making back with the client for services,” Waldrup says.

Take steps for effective implementation

Develop a system to keep track of the card.

  • Train employees to make sure they put the card back where it belongs — in the client’s folder — and don’t carry it around in their wallets after hours, Herndon recommends.
  • Set a policy that details care giving staff only should take possession of the card when they will use it for client needs. After it’s used, it should go right back where it belongs, Herndon says.
  • Sage Eldercare requires employees put the card in a designated client binder that includes hand off notes between shifts.

Set up purchase restrictions. 

  • True Link allows cardholders to set restrictions on where the card can be used. Waldrum recommends using this feature, but encourages some flexibility and a little trial and error at the start.
  • “When we first rolled them out, it was a matter of figuring out what to block and what not to block,” Waldrum says.
    For instance, Oregon Home Care Services initially set up a block on all online purchases. But on several occasions, a charge at a local business was declined because of the way the business coded the purchase, Waldrum says.
  • With this in mind, broad designations may need to be adjusted in order to accommodate some necessary purchases.

Take advantage of the alert system. 

  • Cardholders can set up notifications and receive alerts when money is spent and where. Waldrum recommends monitoring these notifications and reviewing card balances regularly to ensure smooth operations. — Kirsten Dize (kdize@decisionhealth.com)