I’m a retired police officer and a former elder abuse investigator. After I retired, I started a private-pay, non-medical home care business. Later I built Nodal Care to run it. This guide is the checklist I wish I’d had at the start, in the order I’d do it again.
It’s written for people who want to start lean: often doing the visits themselves at first, then either staying solo or hiring a small team. Each step below is a short version. The series that follows goes deeper, with my real numbers and mistakes.
This is general information for the United States, not legal, tax, or insurance advice. Rules differ from state to state, so check each step with your state and with an attorney and accountant who know home care.
1. Make sure you like the work itself
Before licensing or spreadsheets, be honest with yourself. This business is built on time with older people: their stories, their routines, and sometimes the same story twice in one visit. Loneliness sits underneath a lot of what clients ask for. If you enjoy that kind of company, the rest is learnable. If you don’t, no system will fix it. Part 1 tells how I came to this work.
2. Decide what you’ll offer, and who will pay
Non-medical home care is help with daily life at home: companionship, meals, light housekeeping, errands, transportation, technology help, and reminders. In many states it can also include hands-on personal care such as bathing, dressing, and toileting. It does not include skilled nursing tasks such as wound care, injections, or managing medications.
Write down what you will and won’t do. That list decides which license you may need, what insurance you buy, and who you hire.
Then decide who pays. A private-pay agency bills clients and families directly, sometimes with help from long-term care insurance. Billing Medicaid or other government programs brings extra enrollment, billing, and documentation rules. Starting with private pay keeps the first steps simpler.
3. Check your state’s licensing rules first
Do this before you spend money on anything else. Some states license non-medical home care agencies, some require only registration, and some draw the line between non-medical and medical care in different places. A service that needs no license in one state may need one in the next. Start with your state’s department of health, or whichever agency oversees home care, and keep a written record of what they tell you. Part 2 has the full list of what to ask.
4. Set up the business
Choose a legal structure, such as an LLC, and register it with your state. Get a federal Employer Identification Number (EIN), and register for state payroll taxes when you hire. Open a business bank account from day one. Pick an accounting tool early, and give your business its own email address on its own domain. Families and referral partners notice.
5. Buy real insurance
Talk to an insurance agent who works with home care agencies, and tell them every service you plan to offer. Ask about general liability, professional liability, bonding or crime coverage, auto coverage for driving clients, and workers’ compensation once you have employees. My own rule is to buy high limits, not the minimum. Part 2 explains why.
6. Put your agreements and intake in writing
Before your first client, have a client service agreement that covers services, rates, minimum visit length, billing, and how either side can change or cancel. Add an intake conversation, a care plan caregivers can follow, and written policies for emergencies, incidents, complaints, and privacy. Have an attorney review the agreement; your state may require specific language.
7. Organize your schedule and records from the first client
A forgotten shift is one of the hardest things to recover from in this business. From the start, you need to see every shift, record when visits start and end, keep a short note of each visit, and turn worked hours into invoices and payroll without retyping. That can begin as a shared calendar. It gets hard to keep straight once someone else is working shifts. Part 3 covers the systems I use.
8. Price from your real costs
Your hourly rate has to cover much more than the caregiver’s wage: payroll taxes, workers’ compensation, insurance, software, and the unpaid hours you’ll spend on scheduling, family calls, invoicing, and payroll. Decide your minimum visit length, your holiday rates, and the hours you’re willing to work yourself. Part 3 walks through my actual numbers.
9. Find clients through people who already have their trust
Families rarely hire a stranger from an ad. They hire someone a trusted person recommends. Build relationships with senior living staff, discharge planners, social workers, geriatric care managers, elder law attorneys, and local senior services, and track every lead and where it came from. Part 4 covers what worked for me and what didn’t.
10. Decide whether to stay solo or hire
You don’t have to grow into an agency with employees. Staying solo is a fine business; you’ll just reach a point where you turn work away. If you do hire, plan for backup coverage from the start, decide carefully whether caregivers are employees or contractors, and train everyone on what to do when something goes wrong. Part 5 covers how I hire, and Part 6 puts every step on one checklist.
How Nodal fits in
Nodal is software built for non-medical, private-pay home care agencies. It covers steps 7 and 9 and much of what comes after: scheduling with open shifts that qualified caregivers claim from their phones, GPS-verified clock-ins, shift reports that supervisors approve for the family portal, lead and referral-partner tracking, and payroll and billing exports built from worked hours. $99 a month covers up to 10 active clients, with every feature at every size. If you’d like to see whether it suits your agency, here’s how Nodal works for private-pay agencies.
Next in the series · Part 1Starting a home care business solo: why small jobs win →