KOGSYWhat it costsEight costs

The costs nobody itemises

Last updated 28 July 2026. If there is a cost you carry that is not on this list, tell me and I will work it out and add it: henrik@gokogsy.com

Most of what an agency spends money on shows up somewhere. Payroll, insurance, rent, software. It is on a report and somebody looks at it.

Then there is the other kind. Work that happens inside hours you already pay for, so it never appears as its own line. Money that leaks between two records that nobody compares. Time absorbed by salaried people whose job description is "everything else."

None of it is hidden, exactly. It is just never counted, so nobody knows whether it is trivial or whether it is the difference between a good year and a bad one.

Below is every one of them we have found so far, with the arithmetic to work it out for your own agency. No figure on any of these pages is a benchmark, because we could not find a credible one to give you. You will have to do it with your own numbers, which is the only version that would have been any use anyway.

01 · Documentation

Documentation

• How much time do caregivers spend on shift notes?
  Nobody bills for writing up a shift, so it never appears on a report. It is still paid for.
• What share of shifts get billed differently to how they were scheduled?
  The schedule lives in one place and the invoice is produced in another. Almost nothing compares them.

02 · Coverage

Coverage

• What does one caregiver call-out cost?
  The scramble is handled by salaried people, so on paper it is free.
• What is a normal gross margin on a short shift?
  Margin per hour is easy. Margin per visit is the one that decides whether short shifts make money.

03 · Workforce

Workforce

• What does caregiver turnover actually measure?
  Everyone quotes a rate. Almost nobody states the denominator.
• What does it cost when a new caregiver leaves in the first month?
  You paid to recruit, screen, onboard and train. Then it stopped.

04 · The office

The office

• How much office time goes to work nobody bills for?
  Office pay is one line. What that line buys is not broken down anywhere.
• Is Medicaid personal care work profitable for a private-pay agency?
  Short units plus unpaid travel changes the arithmetic more than the rate does.