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Any money in Non Medical Senior Care?

Anonymous

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My wife who is an RN and myself are thinking of starting a non medical senior care business. We found this, company 21st century consultants, that will put everything together for about 10K. After reading through many of the posts on this website it seems like home health is a miserable business and very cut throat, especially on the medical side with Medicare referrals and whatnot.

Please, give me the bad, ugly, worst information you have about owning, operating, and managing a NON MEDICAL home health biz. There is so mush shit on the net that can lead one to believe you can easily build your non medical home care biz to 100 patients within the first year and average $150-$200 per week for each patient...I can live with that but I wasn't born yesterday.

I am very excited about this new opportunity but want to make sure I know as much as possible before preceding. Lay in on me,,,,foul language and all! I think this website is great.
 




My wife who is an RN and myself are thinking of starting a non medical senior care business. We found this, company 21st century consultants, that will put everything together for about 10K. After reading through many of the posts on this website it seems like home health is a miserable business and very cut throat, especially on the medical side with Medicare referrals and whatnot.

Please, give me the bad, ugly, worst information you have about owning, operating, and managing a NON MEDICAL home health biz. There is so mush shit on the net that can lead one to believe you can easily build your non medical home care biz to 100 patients within the first year and average $150-$200 per week for each patient...I can live with that but I wasn't born yesterday.

I am very excited about this new opportunity but want to make sure I know as much as possible before preceding. Lay in on me,,,,foul language and all! I think this website is great.

Be careful and do your due diligence. I have been in home care since 2001 working in medicare certified agencies, pediatric home care, private duty and hospice. I have seen a fair amount of private duty companies come and go. Unless you are in a high income demographic area you may have challenges. It is very much driven my price with a very low percentage of the population having long term care insurance. Their are some govt waivers available but they will not generate a lot of revenue. I have also found that hha aides are very difficult to recruit and more importantly retain. Low pay and they will leave for a small increase to another company. Contact your state home health care association and ask them the tough question. Every state has one. I participated in a state association meeting last year and was absolutely floored on the large percentage of home care companies fail in the first two years.
 




Also, look at the thread name care Minders home care. They are a franchised private duty company. I can tell you that in my state they started with 6 locations 2 years ago and now they are down to 2. Save your money. Trust me.
 




My wife who is an RN and myself are thinking of starting a non medical senior care business. We found this, company 21st century consultants, that will put everything together for about 10K. After reading through many of the posts on this website it seems like home health is a miserable business and very cut throat, especially on the medical side with Medicare referrals and whatnot.

Please, give me the bad, ugly, worst information you have about owning, operating, and managing a NON MEDICAL home health biz. There is so mush shit on the net that can lead one to believe you can easily build your non medical home care biz to 100 patients within the first year and average $150-$200 per week for each patient...I can live with that but I wasn't born yesterday.

I am very excited about this new opportunity but want to make sure I know as much as possible before preceding. Lay in on me,,,,foul language and all! I think this website is great.

For the LOVE O'God (!) do NOT go into this business!!! You've been warned. I'm telling you that those people will be more than HAPPY ALL THE WAY TO THE BANK to take your $10K and run. With all the cuts and the new healthcare rules...RUN AWAY!!!

BLESS YOU AND GOOD LUCK...I mean it! :)
 
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I don't know if you'll see this or not but I just came across this thread. I'm about to hit 5 years of owing a non medical senior care business. I bought a franchise so I had training provided, materials and now we have support and a national advertising program. The goods of the business.

1) It is a growing market as nobody is getting younger and the baby boomers just started retiring to the tune of 10k a day so the market is huge.
2) The relationships you will gain with your referral sources and clients is great.
3) The money is pretty good. The difference being that with owning a franchise, of course I give away 8% right off the top every month. If you are going independent with set up assistance and no ongoing royalties, you can make money. I give up $5-6000 a month in royalties and ad fund. Even with royalties though, I still make about 8-12000 a month. The franchise is a blessing in the beginning to help get set up and avoid pitfalls. It sucks later as you get established and successful and you are giving up 8% a year in revenues. Part of that 8% does go a national ad fund so we do have national advertising programs but it is in it's infancy so I don't have any results to speak of.
4) This can be true of owning any business but being my own boss is the only way to go. I could never go back to working for someone else. I have freedom to do what I need to do to make the business successful. I don't waste time doing busy work for someone else. I only work to drive my business. I came from pharma so I know the time wasted there, call plans set for us even with customers who are giving us business, etc.

The bads of the business
1) Depending on your area, there is lots of competition. There are big name players like Home Instead, Visting Angels, Always Best Care, Synergy, Right at Home, etc. These are all franchises and typically have national advertising behind them. There are also several mom and pop shops but I see them getting squeezed out by the franchises over time. You could have an advantage having a wife as your RN. Some states require an RN, some don't so you will need to check on the state regs where you live. You could also have a price advantage since you don't have to charge to cover 8% royalties.
2) Staffing can be a nightmare. This business is full of good, hard working people who care. It is also full of trash and scum that want to say they have a job, but they don't really want to work. You will have last minute call offs, no call no shows, people who show up but aren't very good at the job. You will hear every excuse in the book from they don't have gas to go to work, sick child, have to go to grandmother's funeral even though they've already buried a grandma 4 or 5 times this year. The one I got Friday night was that they couldn't go to work because their cousin got shot and killed. There is a lot of drama in alot of these people's lives. You just have to weed through them. You can get a good staff which I do have now but in the beginning, it was a challenge. I basically threaten my new hires with prosecution for elder neglect and abuse if they even think of doing a no call no show.
3) If in a licensing state, you will be under govt scrutiny at that point. I'm in Texas so we are required to have a license. I am subject to surprise surveys by the state at any time. It's a typical govt operation in that the left hand usually has no clue what the right hand is doing. I've had one survey in 4 years and it wasn't that bad however I only had about 8 or 9 clients at the time so the sample size they were looking at was pretty small and survey was quick. Now, the survey will probably last 3 or 4 days. I do dread that.

Here is the low down. My first six months in business, I did $45,000. That's from June to December. The next year was a full year and I did $425,000. The next was $640,000. The next was $650,000 and this year I will do a little over $800,000. It takes time to grow it and it requires the willingness and ability to really market the business. You can't just open an office and wait for the phone to ring. Nobody will know about you. Face to face marketing works the best for me. I've tried local ads and got nothing from them. Getting out and beating the bushes has been the key for me. I would be leery if someone is telling you that you will have 100 clients in your first year. I guess anything is possible but I don't think that is accurate. I don't even look at number of clients. The key is the number of billable hours. You could have only 10 clients but they are 24/7 clients and that is all you need to be successful. Or you could have 30 clients at 6 hours a day. You can still be successful like that too but think more in terms of billable hours versus number of clients because each client's needs will be so different.

In our franchise system, we have about 175 offices. The biggest office does about $2 million a month. Yes, that is a month. A big agency is $2 million a year. The office is not the norm. They tapped into some type of govt assistance program so this is not the norm. We have probably 10 to 15 offices over $1 million a year and the rest are less than a million but more and more will reach the million dollar mark. I should get there next year so it's not impossible.

You can make money in this business. It does take alot of work especially when you are getting started. Once established, the demands do diminish and I am working typically 40 hours a week. Some weeks, I don't work that much, others more. It's not for everyone but if you can hold it together for the first year and get it going, it is a goo business. In my area, it is somewhat seasonal. Summer time is typically very slow with fall and spring being the busiest.

If you decide to do this, get in an area with high income and affluence because they have to be able to pay for this service. Some people will have long term insurance however that typically only covers a portion depending on how much the policy will cover. Good luck to you on whatever you decide to do.
 








I get great pleasure from helping doctors realize their digital goals. It’s rewarding to see their faces light up when they take their first digital image. I know they are improving their practice and the care they provide to their patients.
 




Thanks for taking the time to type this, it was very insightful as I'm also looking at the possibility of opening a home care business soon. What part of Texas are you in?

I don't know if you'll see this or not but I just came across this thread. I'm about to hit 5 years of owing a non medical senior care business. I bought a franchise so I had training provided, materials and now we have support and a national advertising program. The goods of the business.

1) It is a growing market as nobody is getting younger and the baby boomers just started retiring to the tune of 10k a day so the market is huge.
2) The relationships you will gain with your referral sources and clients is great.
3) The money is pretty good. The difference being that with owning a franchise, of course I give away 8% right off the top every month. If you are going independent with set up assistance and no ongoing royalties, you can make money. I give up $5-6000 a month in royalties and ad fund. Even with royalties though, I still make about 8-12000 a month. The franchise is a blessing in the beginning to help get set up and avoid pitfalls. It sucks later as you get established and successful and you are giving up 8% a year in revenues. Part of that 8% does go a national ad fund so we do have national advertising programs but it is in it's infancy so I don't have any results to speak of.
4) This can be true of owning any business but being my own boss is the only way to go. I could never go back to working for someone else. I have freedom to do what I need to do to make the business successful. I don't waste time doing busy work for someone else. I only work to drive my business. I came from pharma so I know the time wasted there, call plans set for us even with customers who are giving us business, etc.

The bads of the business
1) Depending on your area, there is lots of competition. There are big name players like Home Instead, Visting Angels, Always Best Care, Synergy, Right at Home, etc. These are all franchises and typically have national advertising behind them. There are also several mom and pop shops but I see them getting squeezed out by the franchises over time. You could have an advantage having a wife as your RN. Some states require an RN, some don't so you will need to check on the state regs where you live. You could also have a price advantage since you don't have to charge to cover 8% royalties.
2) Staffing can be a nightmare. This business is full of good, hard working people who care. It is also full of trash and scum that want to say they have a job, but they don't really want to work. You will have last minute call offs, no call no shows, people who show up but aren't very good at the job. You will hear every excuse in the book from they don't have gas to go to work, sick child, have to go to grandmother's funeral even though they've already buried a grandma 4 or 5 times this year. The one I got Friday night was that they couldn't go to work because their cousin got shot and killed. There is a lot of drama in alot of these people's lives. You just have to weed through them. You can get a good staff which I do have now but in the beginning, it was a challenge. I basically threaten my new hires with prosecution for elder neglect and abuse if they even think of doing a no call no show.
3) If in a licensing state, you will be under govt scrutiny at that point. I'm in Texas so we are required to have a license. I am subject to surprise surveys by the state at any time. It's a typical govt operation in that the left hand usually has no clue what the right hand is doing. I've had one survey in 4 years and it wasn't that bad however I only had about 8 or 9 clients at the time so the sample size they were looking at was pretty small and survey was quick. Now, the survey will probably last 3 or 4 days. I do dread that.

Here is the low down. My first six months in business, I did $45,000. That's from June to December. The next year was a full year and I did $425,000. The next was $640,000. The next was $650,000 and this year I will do a little over $800,000. It takes time to grow it and it requires the willingness and ability to really market the business. You can't just open an office and wait for the phone to ring. Nobody will know about you. Face to face marketing works the best for me. I've tried local ads and got nothing from them. Getting out and beating the bushes has been the key for me. I would be leery if someone is telling you that you will have 100 clients in your first year. I guess anything is possible but I don't think that is accurate. I don't even look at number of clients. The key is the number of billable hours. You could have only 10 clients but they are 24/7 clients and that is all you need to be successful. Or you could have 30 clients at 6 hours a day. You can still be successful like that too but think more in terms of billable hours versus number of clients because each client's needs will be so different.

In our franchise system, we have about 175 offices. The biggest office does about $2 million a month. Yes, that is a month. A big agency is $2 million a year. The office is not the norm. They tapped into some type of govt assistance program so this is not the norm. We have probably 10 to 15 offices over $1 million a year and the rest are less than a million but more and more will reach the million dollar mark. I should get there next year so it's not impossible.

You can make money in this business. It does take alot of work especially when you are getting started. Once established, the demands do diminish and I am working typically 40 hours a week. Some weeks, I don't work that much, others more. It's not for everyone but if you can hold it together for the first year and get it going, it is a goo business. In my area, it is somewhat seasonal. Summer time is typically very slow with fall and spring being the busiest.

If you decide to do this, get in an area with high income and affluence because they have to be able to pay for this service. Some people will have long term insurance however that typically only covers a portion depending on how much the policy will cover. Good luck to you on whatever you decide to do.
 
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I live the Houston suburbs but as a follow up, I sold my home care business at the end of 2016. I'm still happy to answer any questions about it though. I am the one who wrote the long good/bad and ugly paragraph so feel free to ask whatever you like.
 




For the LOVE O'God (!) do NOT go into this business!!! You've been warned. I'm telling you that those people will be more than HAPPY ALL THE WAY TO THE BANK to take your $10K and run. With all the cuts and the new healthcare rules...RUN AWAY!!!

BLESS YOU AND GOOD LUCK...I mean it! :)

AGREE RUN FROM THIS SCAM !!!!!!!!
 




I live the Houston suburbs but as a follow up, I sold my home care business at the end of 2016. I'm still happy to answer any questions about it though. I am the one who wrote the long good/bad and ugly paragraph so feel free to ask whatever you like.

Hi there,

I am interested in possibly starting a home care company . I was curious as to why you decided to sale your company ? Did it prove to not be as profitable as you thought it would be in the long run ?
 




Good morning. I sold the business for a couple of reasons. Some of which were fixable, some not. Home care can be very profitable so money wasn't the issue. Lifestyle was number 1. The government oversight and changes to the overtime laws was number 2. I'll address lifestyle first. I ran the business from my home and was essentially a one man show. I handled marketing, operations, staffing to include hiring, firing and scheduling all client shifts. As we grew, it just became a nightmare. Could I have hired someone to do some of this? Yes but I chose not to so that one can be solved by hiring someone to handle these aspects. The second part of lifestyle is that this business is 24/7. There is never a true day off including weekends, nights, holidays, etc. You never know when someone will have a need for care. It could be late at night. Early on a Sunday. Christmas day, etc and to be successful, you or someone will need to be available to answer the call. Just when things were running smoothly, I would get that call of a caregiver can't make it or someone is leaving the nursing home Friday afternoon at 4 pm and needs 24/7 care starting that night. Families don't typically plan well. Once that call comes in, the fire drills begin trying to line up care, getting client information, obtaining a deposit of some sort, etc. If you have help, all of this can be managed so don't let it necessarily discourage you. Just be prepared to hire some help and be willing and able to pay them for it. When you first start out, you won't need it but as you grow, to avoid some of what I just mentioned, you will want it.
Government oversight. In Texas, you are required to obtain a license from the state. TXDADS regulates the industry and they are a typical, poorly run, unorganized govt operation. They will issue the license and then at that point, you are subject to surprise surveys at your office at any time. Depending on your surveyor, these can last from 2 days to a full week. Some are understanding, some aren't. They will come in and review client files, employee files, client records, policy manuals, quality control and the list goes on. You will live with this burden from the time you get your license until the day you get rid of it. You can have outstanding client satisfaction rates, no reported incidents and good reputation but fail to dot an "i" on job application, and they can fine you and ask for extensive plans of correction. They miss the big picture sometimes. On the good side though, these only occur about every 2 years but you have to always be ready. The second govt problem is that since the 70's, caregivers had been exempt from overtime meaning they could work as many hours as they wanted and you didn't have to pay overtime. Our former president (and I'll leave it at that) passed an overtime law in 2015 requiring caregivers to receive overtime. This made scheduling 10 times harder. Remember those Friday afternoon calls for 24/7 care? When you get that call, all of your staff is typically out of hours for the week so what do you do? Do you pass on the case? Heck no if you want to be successful. Do you just staff it and pay overtime? Yes. Do you charge the new client? That's your call. It's not fair to that client in my opinion to have them pay overtime. They just need care. I used to negotiate some of that but 9 times out of 10, i ended up eating the overtime. Is that fair to the business? No. So I got tired of eating the overtime. This law also had many unintended consequences. Caregivers were working 50 to 60 hours a week and were happy as some of the work is not that hard and they needed the money. When we were forced to cut their hours, it hurt them financially. It also caused us to have to hire more people which is good to create jobs, but it also got us closer to the requirement to start having to provide Obamacare. That is another catastrophe but for another discussion. So in a nutshell, these are the reasons I sold. I am in a better business for lifestyle now. Set hours. Low stress. Less money but I found out that my lifestyle was more important than money. I'll still make a good living but not as good. How did I do financially? in 2015, I made $224,000. 2014, $188,000. 2013, $157,000. I hope this helps.
 
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Each state's laws are different. In Texas, it is legal to start from home. I'm not 100% sure about Maryland and if it is a state that requires a license. In Texas, we are required to have a license to operate and we can list our home address as the office location. Assuming Maryland is a licensing state and that you can operate from home, you would want to contact the state's department of aging and disability services. In Texas, it's called DADS for short. I'm sure Maryland has something similar. Ask them what the licensing process is in that state and if an RN is required to be on staff. If so, you would then first need to hire an RN but you could do that on a contract basis where you aren't paying them a salary right off the bat. If no RN is required, once you know the licensing procedures, fill out the application, pay the fee (I'm assuming there will be a licensing fee). In Texas, the fee is $1750. You will also want to look into getting some type of scheduling/billing software (Soneto, ClearCare) are two that come to mind. This helps you keep track of all client/caregiver schedules, billing, payroll, payments, etc. Once licensed, start marketing your business to nursing homes, hospitals, assisted living/memory care facilities, home health, hospice, etc. Hire your first 5 caregivers because you don't want to be caught unprepared when you get your first referral. Even though you hire 5, within 2 weeks you will more than likely have 2 left to choose from due to high turnover. If you don't have hours to keep them busy, they will go somewhere else. Once you start getting referrals, you will then implement your billing/scheduling software to keep track of everything. They offer a system called Telephony to have caregivers clock in and out from client's homes and that is what builds your billing and payroll. I cannot stress enough how important it is to market the business. These businesses fail because of a lack of marketing. You can't simply hang a shingle and expect anyone to find you. You will also want to check into the state's Medicaid program as it will sometimes pay for these services. Also, look into workman's comp insurance companies, long term care insurance companies as they will feed you referrals as well. Network with senior care business groups, BNI, financial planners, estate attorneys. This is a basic framework for how to get up and running. Please feel free to respond with any questions. I hope it works out good for you.
 




  • Each state's laws are different. In Texas, it is legal to start from home. I'm not 100% sure about Maryland and if it is a state that requires a license. In Texas, we are required to have a license to operate and we can list our home address as the office location. Assuming Maryland is a licensing state and that you can operate from home, you would want to contact the state's department of aging and disability services. In Texas, it's called DADS for short. I'm sure Maryland has something similar. Ask them what the licensing process is in that state and if an RN is required to be on staff. If so, you would then first need to hire an RN but you could do that on a contract basis where you aren't paying them a salary right off the bat. If no RN is required, once you know the licensing procedures, fill out the application, pay the fee (I'm assuming there will be a licensing fee). In Texas, the fee is $1750. You will also want to look into getting some type of scheduling/billing software (Soneto, ClearCare) are two that come to mind. This helps you keep track of all client/caregiver schedules, billing, payroll, payments, etc. Once licensed, start marketing your business to nursing homes, hospitals, assisted living/memory care facilities, home health, hospice, etc. Hire your first 5 caregivers because you don't want to be caught unprepared when you get your first referral. Even though you hire 5, within 2 weeks you will more than likely have 2 left to choose from due to high turnover. If you don't have hours to keep them busy, they will go somewhere else. Once you start getting referrals, you will then implement your billing/scheduling software to keep track of everything. They offer a system called Telephony to have caregivers clock in and out from client's homes and that is what builds your billing and payroll. I cannot stress enough how important it is to market the business. These businesses fail because of a lack of marketing. You can't simply hang a shingle and expect anyone to find you. You will also want to check into the state's Medicaid program as it will sometimes pay for these services. Also, look into workman's comp insurance companies, long term care insurance companies as they will feed you referrals as well. Network with senior care business groups, BNI, financial planners, estate attorneys. This is a basic framework for how to get up and running. Please feel free to respond with any questions. I hope it works out good for you.
 




Thank you for taking the time out of your busy schedule to reply....And what a wealth of info you've shared. You have the experience and the knowledge, have you thought about putting all that in a book form and marketing it?? I am sure people out there will appreciate and buy it from someone like you who gives real info with no fluff and genuinely cares. Thanks again
 




Non medical care in a private sector setting is a horrible business investment and prone to litigation.
Under paid caregivers neglect the the residents and the Family retains legal representation for damages and or death. RUN FROM THIS SEEDY BUSINESS.
 








You're welcome. Glad to help out. I have thought about a book but I'm pretty busy with my other business now. A friend of mine from the industry actually started consulting home care agencies on this stuff but I'm not sure how he is doing with it. Again, feel free to ask anything else that comes to mind. And to answer some of the other posts, yes there is the possibility of litigation in this industry but that is possible in any industry. I never felt threatened by litigation. I carried adequate insurance and I also invested in quality hiring and training. That will make a huge difference in the quality of care that the clients receive and reduce the risk of litigation.