FAIRHOPE, AL, September 2026. Home care, home health and hospice agencies are entering the weeks when next year's budgets and sales-rep compensation plans get set, and Melanie Stover, founder of the sales training practice Home Care Sales, says this is the decision most likely to be quietly wrong and least likely to be revisited.
Her argument is that agencies design compensation to control cost and then misread what it produces.
Why a Q4 Decision Shows Up as a Hiring Problem
Compensation plans in this sector are typically set once, in the fall, and then left alone. A representative working under a plan that does not fit rarely says so early. They stay, they underperform against a target that was never reachable, and eventually they go somewhere that offered a structurally different deal rather than a bigger one.
"Owners tell me they have a recruiting problem," Stover said. "Very often what they have is a design problem wearing a recruiting problem's clothes, and by the time it shows up the plan has had a year to do the damage."
What the plan pays for is the thing to get right
Stover argues the common failure is not the size of the number but what the number is attached to.
"If you pay on referrals received, you will get referrals received, including the ones that never admit and the ones nobody should have accepted," she said. "That representative is doing exactly what you asked them to do. Then we call them underperforming, which is neither fair nor accurate, and we go and hire another one and ask them to do the same thing."
Where the Practice Points Owners
Stover frames the design question around what the plan measures, how long a new representative has before the plan expects production, and whether the structure survives a quarter that went badly for reasons outside the representative's control.
The practice has offered guidance to owners on the sizing half of that question for years, including a 2022 post setting out its cost-justify-the-comp approach, which works the plan back from revenue, cost per admission and profit per client rather than from a market rate. That guidance also tells owners to re-check the numbers every 90 days, which Stover notes is the opposite of what most agencies actually do with a plan once it is signed.
Ramp is the part that gets underestimated
Referral relationships in home-based care do not produce on a quarterly rhythm. A new representative works an account for a long stretch before a start of care can be traced back to them, and the early period looks like nothing is happening because, measurably, nothing is.
"If your plan assumes a representative is producing before the referral cycle has even turned over once, you will lose good people before they get to the part where it compounds," Stover said. "Referral development is slow and then it is not, and a plan that cannot survive that shape means you never keep anyone long enough to see the second half."
Compensation and the Conversation Are One Problem
Stover, an occupational therapist who worked at a VNA before founding the practice, argues that no compensation structure can rescue a representative who has not been trained for the conversation the job actually requires.
"You cannot pay someone into a conversation they were never taught to have," she said. "We blend clinical knowledge with neuroscience selling because a representative who can talk about a referral source's real problem is worth paying properly. Someone delivering a capabilities pitch and a folder is not going to earn a plan like that, and no commission structure fixes it."
The argument tracks back to why she started the practice. "Every referral that does not happen is a family that did not get the help they deserved. Your mission is bigger than their no, and if your comp plan is quietly training your representative to chase easy referrals instead of right ones, it is working against the reason you opened the doors."
The practice carries a guarantee on its own homepage, offering to activate 6 new referral partners in 6 months, conditions apply.
About Home Care Sales
Home Care Sales is a sales training and coaching practice for home care, home health and hospice agencies, founded by Melanie Stover. It develops Care Continuum Specialists™ for agencies across the United States and globally, training owners, managers, representatives and liaisons in referral development built on clinical knowledge and neuroscience selling. More information is available at https://homecaresales.com.