Bro I have been trying to think of a short way to respond without making this a long drawn out reply. When I think over all of the important lessons I have learned through trial and error it’s hard to decide which ones I should highlight. Let me start by just saying that there are some good resources that are essential to you running a compliant agency, like your states Department of Health and Human Service website which is where your going to go to get the licensure application and requirements. Usually this is found under the section for Home Health services on that site.

Payer sources for Home Care services include but are not limited to Medicaid, the VA, some long term disability policies and of course out of pocket. There are pros and cons with each but I will just touch on the largest which is Medicaid. After you get your company licensed there is usually a separate application and enrollment (some states even require you to take a class as well) to become an approved medicaid provider which simply means you can be reimbursed by medicaid for serving clients with medicaid.

Although the medicaid market is easy to tap into please don’t make the mistake, as so many do, of allowing your entire business to become dependent solely on medicaid clients. One major reason is that the second your state has a budget deficit guess whose rates get decreased? And if your company has a 100% medicaid based clientele guess what a 2% rate cut does to your profit margin of 30%? Also as a medicaid provider you will be audited eventually by privately contracted companies whose sole mission is to find a way to recoup money from something you have documented incorrectly…And everyone makes a mistake eventually so you will need to keep a rainy day fund on hand because they usually want it in 30 days.

Hospital and rehabilitation discharge coordinators and case managers are worth their weight in gold if you can build a trusted relationship with one that will send you refferrels. I am fostering a relationship with one now that discharges an average of 15-20 per month. If you can get in good with a field coordinator from a Home Health Agency like Gentiva, Advance Home Health, Amedysis etc. that provide home therapies for many patients discharged from facilities your business will grow very fast.

Some challenges in this industry you will face that may be discouraging if you are not fully committed and tenacious as hell are 1. Discovering that the behind the scenes business of healthcare (when dealing with large institutions) is really not about what’s best for the patient all the time. But your service can be the one that makes a difference in someone’s life once you convince the facility to refer them to you upon discharge. 2. I don’t care how educated they are many people that work 9 to 5 are creatures of habit that want to keep doing things the way they have done them and convincing them to add another step in is like pulling teeth. That goes for doctors, nurses, social workers, case-managers, hell even EDs and administrators. That will be the biggest part of your job, educating them on how utilizing your service adds to the independence and quality of life that you help enhance.

Private pay is the holy grail. We generally receive about $20 per hour per client with a minimum weekly requirement of 20 hours per week before we accept a case. CNA’s and PCA are usually paid anywhere from $7.50 up to $10 per hour. Medicaid pays nowhere near that much which limits what you can pay the aides. Private pay is highly competitive and you will be competing with the franchises for that business. Right at Home and Home Instead are 2 national chains that spend kazzillions of dollars on google, caring.com, local newspapers, carrier pigeon or whatever source they can utilize to get those dollars. So you will have to get creative going after that market.

I could go on for days but a good resource to go and get some good info is the site Consulting Services | Bookstore. He sends out a great newsletter and has some good resources to help your biz grow. Hope this helped