🎯 The business: caregivers who help older people stay in their own homes: bathing, dressing, meals, medication reminders, companionship, rides. It is the demographic certainty of the century, and it is a staffing business in a care uniform: the agency that keeps good caregivers wins.
Families, mostly adult daughters and sons, paying privately at $28 to $40 an hour, plus long-term care insurance and in some states Medicaid waiver programs at lower rates. A typical client takes 15 to 40 hours a week for months or years. Hospital discharge planners, elder law attorneys and senior living communities are the referral sources.
| State home care agency license (application, policies, inspection) | $1,000 to $5,000 plus months of lead time |
| Liability, professional, bonding and workers’ comp insurance | $5,000 to $10,000 a year |
| Scheduling and electronic visit verification software | $200 to $500 a month |
| Caregiver recruiting, background checks, training | $3,000 |
| Payroll float for the first clients (you pay caregivers before families pay you) | $15,000 to $30,000 |
| All-in | ≈ $30,000 to $60,000 |
Start the license application now; it is the long pole. Write the care policies the state requires, or buy a template set. Recruit five caregivers before the first client, with background checks and a real orientation. Visit the discharge planners at your two nearest hospitals and the elder law attorneys in town. Take the first client yourself for a shift so you know the work.
Billing $32 an hour and paying caregivers $17 plus about 20 percent in payroll costs leaves roughly $11 an hour. Twenty clients at twenty hours a week is 400 hours, or about $4,400 a week of gross margin, from which the office, software, insurance and recruiting are paid. Agencies commonly net 10 to 15 percent of revenue; the good ones are above that because their caregivers stay.
Most states license non-medical home care agencies, with background checks, training hours, care plans and supervision rules. Caregivers are employees, not contractors, in nearly every state. Electronic visit verification is required for Medicaid-funded care. Wage and hour rules for live-in and overnight shifts are a frequent source of lawsuits; get them right.
A caregiver who does not show up for a client who cannot be alone; you are the backup. Turnover of 60 percent a year, which is the industry norm. A theft accusation. A fall. Families who pay late. The agencies that last pay above market, schedule humanely, answer the phone at night, and keep a float for payroll.