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Starting a private nonmedical home care business is a tough but rewarding venture. Here are 39 things that are better learned now than later.

Starting a private non-medical home care business is a tough but rewarding venture. The growth outlook for home care agencies is strong, but the work is demanding.

Our team has the privilege of working with thousands of home care owners, and it’s clear that the job requires compassion, resilience, and business smarts in equal measure. Here’s a list of things we’ve learned that anyone managing a home care agency would benefit from.

Where did we get this list?

A few sources:

1) our team members’ experiences managing or working with home care agencies

2) conversations with thousands of home care agency owners over 12 years

3) long discussions with successful agency owners who founded their own agency and grew it successfully

4) advice from major leaders in home care and the business world

While we’ve directed this list to first-time home care entrepreneurs in the early stages of figuring out how to start a home care agency, most of this tips apply to agencies at all stages of growth.

We encourage you to forward this on to any home care professionals who would benefit from it.

Tips Related to Office/Admin Staff – The Backbone of Your Home Care Business

1. Recognize that your office staff are one of the single biggest factors in the success or failure of your new home care agency. Hire accordingly, and be particularly careful about hiring friends or family members; it can be difficult to know who will be a good fit for your agency long-term, and you don’t want to set yourself up to have to choose between business success and personal relationships.

2. Don’t delay establishing accountability systems for your staff. Identify 1-2 metrics that measure the most important output of each role, work with each team member to set a realistic weekly goal for their metric, and hold them accountable to hitting that goal. We list some suggested metrics in the third section of this article.

3. Hire a scheduler who likes solving tough puzzles. Caregivers with full-time hours that fit their schedule rarely quit—so a scheduler who can solve the Rubik’s cube of good scheduling is someone to find and hang on to.

4. Hire for new staff positions before the need becomes urgent. If you wait to hire until you’re desperate, you’re much more likely to make a subpar hire. Additionally, they might be starting in circumstances where they have less time to train as well as more problems to deal with from day 1.

5. Understand that every single interaction with your agency shapes people’s perception of your brand, not just caregiver visits. Every conversation, every visit, and every phone call help to make or break your brand.

6. Recognize that as your business grows, it will grow its own culture whether you intend it or not. Your choice is simply whether or not to be deliberate about what kind of culture grows.

7. Give your employees the benefit of the doubt, but don’t make excuses to keep someone you know is a poor fit. It makes your life harder and does them a disservice.

8. Wherever possible, learn to measure your staff’s performance on output, not input. The results they drive matter more than the time they put in. This is especially true if they’re working remotely.

9. From your very first hires, your eventual goal should be to build a team that can operate without you. While that goal is years away, the more you keep it focus at the beginning, the more you’ll gravitate toward hiring the people who will make your life easier long-term.

Tips Related to Recruiting, Retaining, and Managing Caregivers

10. Learn your caregivers’ birthdays and text them on their birthdays. It’s a small gesture that goes a long way, and they’ll love you for it.

11. As you’re implementing training, use a blended solution for caregiver training (a mix of both online and in-person trainings). We survey thousands of caregivers every month about their experiences, and demand for blended learning formats is a topic that comes up constantly.

12. Treat your caregivers the way you want them to treat your clients. In the course of starting a private home care business it’s easy to get so caught up in business operations that you don’t take an interest in your individual caregivers. Your treatment of them will determine their treatment of your clients to a large extent.

13. When a caregiver applies to your agency, get them in for an interview as soon as possible—same-day or next-day if possible. If they seem like a good fit, get them to their orientation and first shift as quickly as possible. Time to first shift is usually the biggest determinant of getting caregivers to work for you (once they’re in your hiring process) vs. losing them to another opportunity.

14. Get in the mindset that you are always recruiting. Possibly excluding the initial phase of getting your first 6-8 clients, there will be always be a need for new caregivers and it’s almost impossible to get too many caregivers.

15. Text each new caregiver before their first shift to check in and see if they have any more questions. This will help them get started on a good note and also help you avoid caregiver no-shows.

16. In your job postings, don’t require qualifications that you could easily help them achieve in a night of training. Your agency will miss out on good applicants otherwise.

17. Use texting as one of your channels to communicate with caregivers. You can set up business SMS accounts for relatively cheap, and the advantage of quick, reliable communication with caregivers in their preferred channel is invaluable.

18. Resist the temptation to view caregivers as replaceable commodities. They are priceless assets.

Tips Related to Providing Good Client Care

19. You or a member of your staff (not the regular caregiver) should call every client regularly just to check up on them. Multiple channels of communication are important, and it sends a good message about your agency cares when someone in a management position calls to see how everything is going.

20. Start a system to keep a pulse on how visits are going. On a similar note, you should establish channels where clients (and employees) can give feedback if they’re the kind of people who are normally reluctant to do so. Caregivers will make mistakes, and that’s fine as long as you know about them and can take steps to address them. Early on, it’ll be easy to know exactly how every client is doing, but as your business scales you’ll need to come up with deliberate processes to get regular feedback from your clients or mistakes will start to slip through the cracks.

21. In a service business, nothing is more important than perfecting the experience you provide to your clients. Keep a laser focus on client experience.

22. Hire caregivers who are good communicators and have warm personalities. It makes a huge difference to the clients in their care.

Tips Related to Your Own Leadership, Time Management, and Self-Care

24. Find mentors who can help you. Even Tiger Woods has a coach.

25. Study servant leadership. Servant leadership is a particularly important leadership style for someone starting a home care agency; it will shape the entire culture of your business to care about people.

26. Get enough sleep. Starting and running a home care agency takes energy.

27. Schedule regular ‘clarity breaks’ to work on the business instead of in the business. If you don’t think big picture regularly, you’ll struggle to run your business because your business will be running you.

28. Your home care scheduling software is your best friend—as is technology in general. Agencies that use their software properly typically operate far more efficiently. Long-term and all else held equal, and agency that embraces the right technology will leave an agency that avoids technology in its dust.

29. Find a community where you can talk to other agency owners, whether it’s a Facebook group, membership network, franchise group, or accountability group. You’ll need the support.

30. Read Leadership and Self-Deception by the Arbinger Institute. It will change how you view leadership and personal relationships.

Tips to Grow Your Home Care Business

31. Make sure you understand the costs and are prepared to cover them. The average amount that owners spent to start a non-medical, private duty home care agency through its first six months in 2019 was $60,000, though some reported spending as little as $9,000 and as much as $260,000. (Home Care Benchmarking Study data)

32. Remember that there are three ways to bring in more revenue: 1) getting more clients, 2) increasing per-client revenue, and 3) retaining clients longer. While the first is a necessity when you’re starting out, your ability to manage the second and third will play a huge role in your profitability and growth as you scale the business. Don’t neglect any of these pillars.

33. Invest in getting good online reviews from the start. 90% of consumers read online reviews before making a purchase, and this number is probably even higher for a major decision like in-home care.

34. Unless you come from a background in digital marketing, consider hiring a marketing agency to manage your website, SEO, and Google Ads. It’ll take a lot of strain off you and your online presence is worth the cost of doing right.

35. Develop something that differentiates your agency, both to potential clients and to referral sources. Saying how great your caregivers are or are much you care isn’t enough; anybody can say that. You need something specific, easily communicated, and concrete. For instance, you might train your caregivers to focus on helping clients get enough socialization and make that a key talking point in your marketing. Quality of caregivers can be a great differentiator, but you would need to go truly above and beyond with multiple other sources (client reviews, third-party awards, testimonials) to validate your claim.

36. Understand that establishing relationships with referral partners takes time. According to marketing consultant Steve “The Hurricane” Weiss, it takes 8-12 visits with the average referral source before you receive a single referral from them. (The article linked above also has some suggestions on what to do in those visits.)

37. Use client referral programs and employee referral programs. When executed properly, they typically yield the most loyal clients and the longest-tenured caregivers. Volume of referrals will be tiny as you’re starting, but the more quickly you can put these programs in place the more rapidly you can scale.

38. In general, plan on hiring a sales rep at around 1,000 weekly billable hours. Until then, you’ll need to be thinking about how to make your referral partnerships dependent on a process, not on you as a person, so that you’ll be able to successfully hand them off when the time comes.

39. It’s almost always better to have a few solid referral relationships than many weak ones. As you start to get online reviews, respond to every review regardless of whether it’s positive or negative. If it’s positive, thank them. If it’s negative, give them your number and invite them to reach out to you directly. Whether or not they take you up on it, this sends a great message to other people looking at your reviews.

Starting a Private Home Care Business? Start Watering the Bamboo

We’ll close with an analogy.

There’s a species of bamboo called giant timber bamboo that takes three years of watering before it even breaks the surface of the ground. Once it breaks the surface in the fourth year, however, it grows up to 90 feet in just 60 days.

That exponential growth, however, doesn’t happen unless you diligently water the plants for three years before it starts producing results that are visible to you.

This doesn’t mean that after three years of operation without any results, you should keep doing the same things. But it does that mean that building the foundation of a business takes time and commitment.

Starting or managing a home care agency takes patience and hard work, but it’s rewarding. Are you watering the bamboo?

If this list was useful to you, share it with another agency owner who could benefit from it.

Experienced agency owners, what would you add to this list?

HCP’s Care Intelligence Platform offers RN-developed training, satisfaction surveys, and reputation management tools to help you become the best employer and provider in your area—and make sure everyone knows about it.

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  1. Alexis June 30, 2020 at 9:08 pm - Reply

    Very good article. It is a very useful and throughout guide for starting this business.

    • Solomon medeludo December 29, 2021 at 4:15 pm - Reply

      Thanks for adding me and the information provided

  2. Amita July 19, 2020 at 2:32 am - Reply

    Very nice article. We have been in business for a while but, we will try some of the suggestions here

    • Linda Mhute October 5, 2020 at 7:20 am - Reply

      Am thinking of opening a business along this line and this is for sure very helpful need to look at more information and see how I go about it.

  3. Julius andrew October 5, 2020 at 3:48 am - Reply

    Wow. Thank you for this article. We have recently started a home care agency and there are a lot of tips here that we should be thinking about!

    I had no idea that a big portion of this game is about hiring people! Always look to hire. Got it!
    There are others that are so useful also (they are by no means less important), it is just the one that got my attention the most because it makes sense!

    Thank you again for this article. I will probably read this a couple more times so it sinks in.

  4. Janet Jennewein December 8, 2020 at 10:45 am - Reply

    Fantastic, succinct yet all encompassing article! Well written and well done.

  5. Nathaniel G Koah December 29, 2020 at 1:04 am - Reply

    My Nathaniel G. Koah. I enjoyed reading your information, and I want to know what does it cause me to get your help at the initial stage of my endeavor for establishing non-medical home care business?

    My phone number: 215-921-0005.

  6. Minnie Cotten-Beal March 15, 2021 at 7:09 pm - Reply

    I enjoyed your information very good tips I was wondering to do help getting started

  7. Rosalind Ruffin March 22, 2021 at 1:28 pm - Reply

    I need help to recruit Pca’s and Cna’s I started my home health business in 2019. It was good and the clients and caregivers were good, but now a lot of girls don’t want the job because of unemployment and of course the covid, and plus a lot of people are getting unemployment which is sometimes more than what the agency Is giving. Can you help me to get back on track

  8. Rochelle Anderson March 28, 2021 at 1:02 pm - Reply

    Very helpful and clear verbiage!! Thank you! I’m driving into business mode 😀

  9. Anita June 3, 2021 at 12:22 am - Reply

    It’s not that people are getting more on unemployment. The real issue is you wanna pay very minimal. I see it all over home care agency’s.
    People are smarting up and you need to also.
    You get what you pay for. Cheap labor needs to end immediately.

    • Jennifer Lagemann June 23, 2021 at 5:59 pm - Reply

      Hi Anita, thank you for your reply! Home care is a low-margin business, which often makes it difficult to pay more. However, there are proven benefits to paying more, and more agencies are seeing this every day.

  10. Sena Price December 29, 2021 at 6:30 pm - Reply

    I appreciate the information that was giving. I’m a brand new first time business owner and looking for guidance. This really helped me.

  11. CJ February 18, 2022 at 2:55 pm - Reply

    Very helpful article and I will certainly incorporate these tips into my agency.

  12. EJIMOLE Fidelia Onwuekwe March 18, 2022 at 5:12 pm - Reply

    Thanks for the great information. I would like to have the training kits for the trainees.

  13. EJIMOLE Fidelia Onwuekwe March 18, 2022 at 5:14 pm - Reply

    I need a training starter kit for new employees.

    • Julie Redd March 21, 2022 at 12:27 pm - Reply

      Excellent idea, thank you for sharing!

  14. Ekokobe May 2, 2022 at 11:25 am - Reply

    this is an interesting article. it is very rich in explanation and experience in handling home care issues . thanks so much for the write up.

    • Julie Redd May 16, 2022 at 3:54 pm - Reply

      We are so glad to hear this, Ekokobe! Thank you for reading.

  15. Charlotte Fleet August 19, 2022 at 5:33 pm - Reply

    It makes sense that you suggest finding mentors to help guide you when starting a home care business. I think it would also be helpful to hire a professional service that can help you through the licensing process. Doing so could mean you’ll get licensed much quicker and you’ll feel more confident in your agency.

  16. Karen P October 11, 2022 at 1:20 am - Reply

    Thanks for putting together these informative tips. Will there be more?

  17. Marie January 8, 2023 at 4:43 pm - Reply

    I am in the process of starting up a new business.Thank you for all this very informative information.
    Were could i get a training starter kit for new employees.

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