Keys to Success in Private Duty Home Care – A Partial Retrospective


Home Care Really Does Change Lives


Bruce W. McCollum, Publisher

Without private duty home care, imagine how many people would end up in nursing homes.  I have served over 300 people in home care and can attest to how important this service is.  I can also attest to how important it is to operate a well-managed company.  I can remember the first home care case I served.  His name for the purposes of this Blog Post was Mr. X.  We began services in Summer 1995.  We were under contract with the Detroit Area Agency on Aging for adult day care and one of their case managers – impressed with how we operated the adult day care – recommended I take on home care services, so we did.

I recall staying up a couple of entire nights just writing policy for this new area of our business.  Less than a month into servicing this case, my staff was accused of stealing from this client.  What saved us?  Policies!

I had rules against going into certain non-essential areas of the home and accessing private information relating to the client.  I dug in – including interviewing the client – and learned this client’s daughter was the thief but only because I was able to rely upon my staff adhering to published rules.

My point is that when I tell you these ten, (10) items will help you to succeed I know what I am speaking about.  I read tons of bragging on LinkedIn and other places from people who have never managed a home care operation but who swear they can teach you how to succeed.  That is their right.  All I can tell you is that I do not speak from theory, but no-nonsense experience.

I hope you will use these strategies to create and operate the kind of firm that can serve the public well and make its owners and clients proud.

Strategy I:  Define Specializations

This must be based upon where you operate.  However, far too many private duty firms take the “one size fits all” approach to defining service delivery and this is a mistake.  Some may decide to specialize in serving those with Alzheimer’s disease.  How do you measure up to that specialization?

You create the right training and preparedness apparatus to ensure your staff can meet the needs of this population.  This will include training in communicating with an Alzheimer’s sufferer as well as ensuring you arrange for nurse and physician led in-service sessions on some of the nuances of this disease.  If you specialize in an area, you must feed your company the ingredients required to remain polished and qualified to call this a specialty.


Strategy II:  Design and Maintain a Workable Budget


Because it takes time to grow, you need to be able to maintain a budget that fits the needs of the agency and the owner.  For example, in the beginning you need to be prepared to put on the roller skates and do it all.  You may be the clerk, receptionist, office manager, scheduler, bookkeeper and more.

You need to be sure and commit receivables to pay field staff and they pay yourself for your administrative work, unless you double as field staff.

Of course, if you are exceptionally well-capitalized in the beginning, maybe you can afford a small staff and with an accomplished investment into a marketing campaign perhaps you can do things differently, however, this is often not the case.

Example of a workable budget for your first 24-hour case.

Gross Revenue:        24 hrs x 7 days x 4.33 weeks @ $27.00     = $    19,640.88

Payroll:  24 hrs x 7 days x 4.33 weeks x $14.00      = $  10,184.16

Tax match: Payroll Tax Match averaging 12%              = $      1222.10

Miscellaneous:  Cost of insurances:                                          = $    300.00

Grand Total:   All expenses from the one case:                 = $   11,706.26

Profit:   Preliminary remaining monthly amount:          $     7,934.62

Then decide which skill level is the most extensive and place them in tiers.  Tier I may be a High-Tech Aide, so for this level of experience and ability you can charge more, Tier II will be aides with less experience and exposure, so they are billed out for less.  In this way, you demonstrate your company’s flexibility and ability to serve wide-ranging populations.  Then organize your staff into groups of qualifications, always trying to expand the ability of all staff. See Sample grid that follows:

Name Tier I Tier II Tier III Yrs.


Special Training
1 Simpson, Rachel XXX 11 Transfer and Ambulation

Wound Management (Duoderm, hygiene)

·         TBI

·         Behavioral Challenge

·        Incontinence

That $7,934.62 should be yours as the owner until you take on your second case.  This keeps you rolling in the early stages of development and can help prevent your having to take on additional employment, which can stifle your growth.  At this stage, there should not be a need for other support personnel who are not serving the client.  Keep those people expenses in-check!

Strategy III:  Tier Staffing and Services by Need and Qualification

Again, we are back to eliminating the “one size fit all” problem that plagues many private duty firms.  You may have aides who are trained and experienced in serving the chronically obese. Others may be trained and experienced in serving those with pulmonary issues and equipment while others may be trained and experienced in serving quadriplegics, perhaps in transfer and ambulation techniques.

How about medication reminder devices?  Many seniors and others are now using these in their homes.  Are new technologies being introduced with these devices?  Have you educated your staff on how they work?


Strategy IV:  Create and Maintain Consistent Staff Development Program


Like the best of silver, humans need to be polished.  We need reminders and updates on the latest in certain long-term care trends.  Is there a new type of lift available that can be used for the non-ambulatory?  Knowing your staff may encounter this equipment in a home care case, are you looking for ways to train your personnel in its usage?


Strategy V:  Pursue Accreditation


Accreditation has value.  JHACO and other organizations will assign accreditation to the right firm.  Your corporate governance, personnel policy usage, enforcement and development must be in place along with corporate management, activity tracking and responsible, professional billing apparatus.  You must also define clinical ability and limitations.

Some governmental agencies will not contract with a staffing firm that does not have accreditation.  Pursuing this can be worth the effort as it demonstrates the required competence and sophistication many funders seek from home care companies.

If you serve catastrophically inured parties or those injured in work-related accidents, those insurance companies paying for services and state mandated claims management associations may also require accreditation.

Strategy VI:  Develop Well-Rounded Marketing Strategy


Marketing cannot be single-focused.  Let’s say you are qualified and willing to serve those injured in catastrophic auto collisions.  Then you need relationships with:

  • Specifically, for PIP states: No-Fault Focused Law Firms
  • Specifically, for PIP states: Independent PIP Focused Case Managers
  • Care Managers and Direct Purchase of Service Personnel within Medicaid Waiver Agents, often Area Agencies on Aging
  • Outpatient Rehabilitation Program Social Workers

1.5% to 5% of your operational budget at any given time should be devoted to local radio as a start, especially in markets where television exposure may be cost prohibitive.  Pay for professionally developed spots that push your phone number and website into your community’s consciousness.

Not a week should go buy without dedicated outreach.  This includes paying for even lower tiered search engine optimization such as that available through which has packages for as little as $99.00 per month.  You get to select your key words and they ensure you rank effectively in Google, Bing, Yahoo, and other search engines.  Remember Google purges data monthly so a campaign that actively updates information is important.

Be sure you have credentialed your company to serve those enrolled in Medicare Advantage Plans.  No stone is left un-turned when it comes to earnings.

Medicare Advantage Word Circle Concept with great terms such as enroll benefits and more.

Pursue Credentialing…

Strategy VII:  Be Technology Friendly and Astute


To ignore technology is a fatal mistake.  Technology must guide billing, marketing, training and every other key aspect of your operation.  Guess what, it offers even more.  There are APPS you can use to guide scheduling in your client’s homes.  Each staff member can access and use the APP from their smartphones and tablets to learn the week’s schedule and the APP will notify them whenever adjustments are made, i.e. client goes into hospital, client requests a holiday scheduling adjustment, client dies, etc.

Technology can also be used to document in-home activity and then this form is electronically stored.  Do whatever it takes to promote efficiency and add sophistication to your operation in the digital age.

Strategy VIII:  Join Meaningful Associations


You need to embrace the reality that you cannot be an island all onto yourself.  You need an active networking regimen with the right organizations.  These include:

  • Paralyzed Veterans of America Chapter in your state
  • Brain Injury Association in your state
  • Area Agency on Aging Association in your state *Some offer auxiliary memberships such as Michigan, which supplies you with quality updates affecting long-term care and meaningful contacts.

Strategy IX:  Keep Tight Field Governance Standards

You need to have enforceable policies that govern:

  • Employee Attendance
  • Private company in a Client’s Home
  • Use of Client’s Belongings
  • Sanitation Procedures
  • How Medications are Handled in a Private Home
  • More…

Have forms designed for supervisors to complete when inspecting a case.  As the administrator, read every one of them when completed by staff.  This includes the Activity Forms used by in-home staff and Incident Reports.  As the firm grows this can be delegated, but nothing should be filed away – electronically or on paper – until someone in management reviews it.

Strategy X:  Never Take Anything for Granted

As a business owner, your alertness to certain realities is paramount.  The public does not owe you a case you do not fight for.  A referral source does not owe you a case you do not fight for.  And the rest of the world only owes you a swift kick, and even then, it’s not all that timely.

We must avoid the disease of entitlement and understand we must remain at the top of our game to prove we have both the sophistication and know how to manage complex cases.

In conclusion:

If you truly love home care, jump in with both feet.  Be energetic and focused and make it your life’s work – from an income-producing, career perspective.

PIC - HODGE ANNE BEFORE HAIRCUT 10-12-05I have taken care of so many people in my career, with a few of the more memorable cases pictured below.  Mrs. Hodge, at the left, was my home care client for 8.5 years.

Be an organized networker, read applicable blogs at least twice weekly, feed your curiosity, look for ways to add operational sophistication and commit to helping those you employ to be their very best.

When you combine them all, you can not only find success but tons of enjoyment in private duty home care.


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A Blog Post by Health Industry Marketing, LLC and Direct Care Training & Resource Center, Inc.  Images used are for the sole purpose of adding quality to the written word.  They do not imply an an endorsement by nor affiliation with any individual or organization and may belong to their respective licensees.

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