Home care relies on one fundamental principle — care provided in the home. However, in a car-centric country such as the United States, caregivers face delays with public transportation, car break downs or issues maintaining or financing a personal vehicle.

Transportation barriers can cause patients to miss care, frustrate families, fuel caregiver turnover and lead to falls for older adults, experts told Home Health Care News. Home care providers must address caregiver transportation issues by strategically staffing employees based on locations and considering initiatives such as company cars.

“All of the ails that bother us as owners with our caregivers — Why do they call off at the last minute? Why are they late? Why do they no-show? — So much of it had to do with transportation,” Dew-Anne Langcaon, CEO of Vivia Cares, told HHHCN.

Honolulu, Hawaii-based Vivia Cares provides home care services in Hawaii and Washington state.

Even if a client is usually within proximity to a caregiver, transportation issues can still occur. Cars break down, trains get delayed. And traffic remains a consistent nuisance. The national average for congested travel time was 3 hours and 39 minutes in 2025, according to a 2025 Urban Congestion Report from the U.S. Department of Transportation, an increase of 24 minutes year-over-year.

“Given that we deliver care in the home, our model inherently presents transportation and logistical considerations as clinicians travel between patients throughout the day,” Rupen Amin, regional chief medical officer at HarmonyCares, told HHCN in an email. “Factors such as traffic, construction, weather, travel distances and changing patient needs can affect travel times and add complexity to scheduling. These dynamics require thoughtful route and schedule planning to support reliable, timely patient care.”

Founded in 1993, Troy, Michigan-based HarmonyCares provides in-home healthcare across 12 states.

Caregiver transportation issues can cause clients to lose meals such as breakfast, miss medication doses, external medical appointments and even increase the likelihood of falls, Leslee Deanes-Bryant, CEO of UltraCare Home Care Services, told HHCN.

Transportation issues can also cause scheduling disruptions, Deanes-Bryant added. Scheduling disruptions were among the most-reported reasons why families discontinued working with a caregiver, according to a 2026 survey commissioned by care connection platform A Place for Mom.

These transportation-related effect could cascade into the family feeling frustrated and discontinuing services with the home care agency.

“It’s not just the caregiver affected — it’s the client affected, it’s the family affected. … The agency can lose a client or may have to try to find another caregiver,” Deanes-Bryant said. “You don’t want to necessarily terminate the caregiver. You now want to try to figure out how you can help the caregiver.”

Los Angeles-based UltraCare Home Care Services provides home care from 10 locations in Los Angeles County.

Los Angeles, City of Traffic

UltraCare faces a unique challenge of serving the worst metropolitan area for traffic congestion. People in Los Angeles get stuck in traffic for about 7.3 hours cumulatively within a year, a 2024 report from the Bureau of Transportation found.

Public transportation does not fare much better. A 2025 analysis from Streets for All, a Los Angeles-based advocacy organization, found that Los Angeles bus rides lose a collective 5.58 million minutes from delays each day.

“Transportation is a huge, huge problem, and it’s a headache,” Deanes-Bryant said.

To mitigate the effects of transportation issues on both caregivers and clients, UltraCare pairs caregivers with clients based on geography.

“To be a caregiver, honestly, in the California area, you really need a car,” Deanes-Bryant said. “Unless, if you’re like us, we usually don’t staff anyone that’s more than 10 miles away from that client’s home.”

UltraCare also over-staffs its offices and maintains a system to check bus routes, train schedules and different freeways. In addition, the company is looking into offering company vans for its caregivers, as well as a stipend or a car allowance for its caregivers, Deanes-Bryant added.

HarmonyCares has taken steps to reduce transportation issues as well, particularly with vehible reliability and routing, Amin said. The company’s scheduling and routing tools factor in travel time and traffic patterns for clinicians so they can spend more time with clients. In addition, HarmonyCares offers clinicians company cars as well as fleet support should car issues arise.

“If we’re serious about aging in place, then I feel like we have to make sure caregivers can actually get to a place where aging is happening — which is in the home,” Deanes-Bryant said.

Company cars and the task-based service model

While Hawaii has a much lower state-level population of 1.43 million, it is still very car dependent, Langcaon said. After conducting a focus group, the CEO learned that caregivers’ greatest concern — even over pay and benefits — was transportation.

In the focus group, caregivers reported issues with public transportation delays that could result in transit times longer than their shift times. Other transportation issues occurred among caregivers who share a car with their family members, which could mean calling off if the spouse needs the car.

In 2019, Vivia Cares began offering caregivers company cars to address these issues and compete with hotels, hospitals and other service sectors that provide better pay and compensation for the same workers.

“Even though they were CNAs, they could make so much more money working in the hotels as housekeepers,” Langcaon said. “Home care was at the bottom of the rung in terms of jobs, and so we could not hire caregivers if our life depended on it. We had to do something.”

The company car offering required a shift in job description and benefits.

“If I’m going to provide a company car, I need full-time guaranteed work as well. So that’s what we did,” Langcaon said. “We designed a job that has full-time guaranteed 40 hours a week and a company car, paid 30% more, full benefits, PTO, healthcare, all full-time benefits of a full- time employee equal to what the hospitals were paying, retirement, all of those things.”

Vivia Cares also shifted to assigning each caregiver to 15 to 20 clients based on geographic neighborhood and created a task-based billing model.

“What started out as that solved the transportation problem ended up in creating an entirely different operating model for home care,” Langcaon said.

The shift came with certain obstacles, the CEO noted. Some existing caregivers did not like the change because they preferred staying in one place for an entire shift. The new model required caregivers to visit between four and six homes a day, necessitating driving.

However, the majority of Vivia Cares’ traditional caregivers did not drive. Vivia Cares therefore sent caregivers to driving school because, even if everyone had a license, driving skills varied among employees. Eliminating transportation barriers started out as a retention model but ended up transforming Vivia Cares’ business model.

“The whole culture of the way we operate the business is different because of this one change,” Langcaon said. “It cascades into better client satisfaction, better reputation in the community. We never set out [for] the strategy to be a revenue-generating strategy. This was a staffing strategy, but it really has transformed into a completely different strategy altogether.”