Introduction

Many home care operations are stuck at 65–70% care time. This often leads to a false conclusion: that the solution is more detailed time management. But Sweden's National Board of Health and Welfare (Socialstyrelsen) shows that strict time management can reduce flexibility and negatively impact both quality and working conditions.

The path to around 80% care time is instead about planning the whole – visits, shifts, continuity, working time rules, and real-time deviations – as a coherent system. Here you get an evidence-based model, concrete actions, and KPIs to follow.

What Does 80% Care Time Mean in Practice?

Care time (sometimes called customer time) is a common municipal efficiency measure: the time staff spend with the care recipient as a share of working time. SKL/SKR have long described time with the care recipient as a process measure for tracking resource utilization. IFN describes the same definition: care time = share of working time spent at the care recipient's home.

But 80% is not a "magic number". Too high care time without buffer can squeeze out recovery, documentation, and learning – creating a work environment that the Swedish Work Environment Authority (Arbetsmiljöverket) links to unhealthy workload. Therefore, the target must always be measured together with work environment and quality metrics.

Important about buffer

80% care time without buffer can increase time pressure. Requires active work environment management and OSA framework.

Continuity: Why It Is a Quality and Safety Issue

Staff continuity is often measured as "the number of unique staff members that a care recipient with at least two visits per day meets during 14 days". This indicator is used in several Swedish monitoring frameworks precisely because many different people in the home risk lowering quality and experience.

Socialstyrelsen's open comparisons have shown that elderly with home care can meet many different people: in 2021 the average was 16 different people during 14 days with large variation between municipalities. Socialstyrelsen emphasizes that continuity is important for safety and for providing support based on the individual's needs and wishes.

16 different people

Average over 14 days (Socialstyrelsen 2021)

<11 unique

Kolada recommendation (N00941)

International research in home-based long-term care strengthens this picture: higher continuity in which home care worker provides services is associated with better client outcomes – such as fewer falls and better functional status (Reckrey et al., 2024). This supports continuity as a direct health-related quality factor, not just a "service value".

Why "Strict Time Management" Is Not the Path to 80%

It may seem logical to plan every minute in detail to "increase efficiency". But Socialstyrelsen's national report on home care management shows that detailed management of time and content can leave little room to adapt care to the individual's current needs – which affects both the work environment and the quality of care.

Arbetsmiljöverket describes that home care staff often experience a stressful work environment with minute-scheduled shifts and that this can contribute to unhealthy workloads and sick leave.

The evidence-based conclusion: you cannot optimize care time by reducing flexibility. You need a model that raises care time through better structure (teams, zones, routes, shifts) and better ability to handle variation – not by locking execution into detail.

The Practical Model: Four Steps to 80% Without Continuity Collapse

Step 1: Define KPIs and Ground Rules (2 weeks)

Set common definitions for care time, staff continuity (14 days), travel time, miscellaneous time, and execution rate. IFN shows that digital time measurement can generate these KPIs, but use must be improvement-oriented – not controlling.

Step 2: Build Stability with Teams and Micro-zones (4–6 weeks)

Create primary teams per care recipient and geographic clusters that minimize travel time. This is the most effective way to raise both care time and continuity simultaneously, because the same staff naturally returns without having to "force" continuity.

Step 3: Integrate Shifts + Visits + Rules (pilot 4–8 weeks)

Home care planning is an integrated routing and scheduling problem where time windows, working time rules, and continuity must be handled simultaneously. If you only optimize routes but leave the shift logic unchanged, you often get stuck below 75%.

Step 4: Real-time Management with Buffer and Human Control (ongoing)

Because home care is dynamic, the plan must be able to adapt to illness and cancellations without breaking continuity unnecessarily. Transparency and human control in decisions is required in line with data protection principles around automated decision-making.

Calculation Example: What Does +10 Percentage Points Mean?

If an operation goes from 70% to 80% care time, the direct care time per working hour increases by approximately 14%. With Swedish wage levels and employer/pension costs, this can be translated into a "capacity value" in FTE.

Assumptions (SCB + SKR)

Average wage, home care assistant: ~SEK 33,000/month (SCB 2024)
Employer cost surcharge, municipalities: ~40.5% (SKR 2026)
Cost per FTE/year (wage + surcharge): ~SEK 556,000
Realization rate: 50–70% of theoretical gain

+14%

More direct care time per hour (70→80%)

1–2 FTE

Practical capacity gain per 20 FTE

Be careful: home care's variation means you rarely can "capture" 100% of the theoretical gain as reduced staffing. A more realistic interpretation is that 50–70% is realized – through less overtime, fewer substitutes, and increased ability to meet increased demand.

Checklist: Data, Roles, and Risk Control

To succeed you need good data about visits and staff, clear roles, and risk control for work environment, working time, and data protection.

Data: visits and staff

Address/geo, time windows, care types, double staffing, staff competencies and working time rules.

KPI definitions and follow-up

Care time (%), staff continuity (median/14 days), travel time (%), execution rate (%), daily rest violations.

Legal and work environment

Daily rest (minimum 11 hours per 24-hour period), OSA framework (AFS 2015:4), union dialogue from the start.

Data protection and transparency

GDPR/DPIA for automated decision-making, human-in-the-loop approval for major changes (IMY guidance).

Sources and Evidence Base

Conclusion

80% care time is achievable – but it requires a planning model that integrates visits, shifts, continuity, and working time rules in the same system, combined with real-time management and human control. Socialstyrelsen, research, and legal frameworks all point in the same direction: quality, continuity, and efficiency go together when the management model provides flexibility instead of minute discipline.

Want to know how large the potential is in your home care operation? Start with a 2-week baseline measurement of care time, staff continuity, and travel time – and build a pilot in 2–4 micro-zones with integrated planning and continuity rules.

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How Home Care Can Reach 80% Care Time – Without Losing Continuity