When I retired from policing, I didn’t know what I wanted to do next. Then I read Oliver Burkeman’s Four Thousand Weeks: Time Management for Mortals. Instead of telling me to follow my passion, advice that I find to be useless, it asked plain questions about what I wanted out of my life and my work. My answer was more friendships and deeper personal connections.
Looking back at my years as an elder abuse investigator, I realized my favorite part of that job had been talking with older people. Even as a teenager I used to visit older relatives just to talk. My great, great aunt was a particular favorite. That’s how I ended up starting a non-medical home care business.
First, a gut check
My first rule: don’t go into this business unless you genuinely like talking with older people and hearing their stories. Clients often repeat themselves, and it takes a certain patience to meet that with warmth every time.
It also helps to understand what’s going on under the surface. Loneliness and isolation are part of almost every visit. Clients are often delighted just to have someone to talk to, or at least someone new. I’ve spent 20 minutes connecting a printer to Wi-Fi and the next 40 minutes talking with a couple at their kitchen table. Hooking up a printer is fine as far as work goes, but the 40 minutes at the table is why I love this job.
Leave heavy personal care to agencies built for it
Hands-on personal care assistance (often called PCA work) is mostly a volume business with thin margins. It’s important work, and agencies built for volume, with schedulers and large caregiver teams, do it well. On your own, it’s very hard to make a living at it.
So I don’t compete there. I offer companionship, transportation, errands, technology help, and light help around the house. That narrower list also shapes everything after it: licensing, insurance, and who you hire. (Part 2 covers those.)
Within that list, I say yes to a lot. I like to use my wife’s description of what I do: “I’m the son you either don’t have or can’t call.” If I can do something for a client, I do it. If I can’t, I help them find someone who can.
Take the small and one-off jobs
An agency built around full shifts usually needs longer minimum visits to make its schedule work. They have employees who expect regular, full-time hours. That leaves a gap. When an 82-year-old needs a 90-minute ride to the eye doctor, an iPad that stopped getting email, or help with groceries, a lot of providers can’t take the job.
Starting solo, you can. I have a one-hour minimum, and I’m glad to take a single ride or a single tech fix. When you show up for a small job, do it well, and stay to talk, you build real rapport. Clients who trust you start calling you for more and more.
Offer the appointment, not just the ride
Rides to the doctor are one of the most common requests, and they’re where I add the most value. If someone just needs a ride, I tell them to use Uber or a medical transport service. If they want someone who will go inside and attend the appointment with them, I’m who they’re looking for.
In the exam room I’m a second set of eyes and ears. I ask the doctor questions, look out for my client’s interests, and report back to the family when that’s needed. Older adults aren’t always the most accurate reporters of what the doctor said, and families value hearing it from someone who was there.
I also offer to do the scheduling. Often I book the next appointment at the front desk before we leave, so it goes on my calendar right away at a time I know I’m free. That’s much better than a back-and-forth of texts and emails with the client relaying messages between me and the clinic.
Know what your ideal client looks like
Because I don’t do heavy personal care, my ideal client can feed, bathe, and dress themselves.
Transportation sets another line. I drive clients in a regular car, not a wheelchair van, so they need to be able to walk on their own or move themselves in and out of the car. I’ve had plenty of clients who use wheelchairs, and that’s never a problem as long as they can make that transfer themselves. I keep a folding wheelchair in my garage in case a client needs one at an appointment.
Start with private pay
A private-pay business bills clients and families directly, sometimes with help from long-term care insurance. Billing Medicaid or other government programs means enrollment, billing rules, and documentation requirements, usually for lower rates. Medical and insurance billing are their own career fields. Starting with private pay keeps the business simpler while you learn.
Know your boundaries
When you’re starting out, it’s hard to say no to any work. Before saying yes to a task, ask two questions: can I do this safely, and am I allowed to do it? Then weigh the answers against what happens if something goes wrong.
Medication is a good example. In many states, setting up a client’s pill organizer can count as handling medications, which non-medical caregivers may not be allowed to do. I never set one up. I’ll sometimes keep a client company while they fill their own, and even that is a gray area worth checking with your state.
When a client outgrows you
Eventually a client you’re fond of may need more than you offer: help bathing, lifting, or nursing care. New owners often worry that saying “I don’t do that” means losing the client.
In my experience it doesn’t. When a client’s needs grow past what I do, I help the family find a provider for that care. Another provider comes in for those tasks, and because the client already trusts me, they usually keep me for what I do: rides, technology help, errands, and company.
Get organized on day one
Even as a solo owner taking one-off jobs, run it like a real business from the first client: keep every shift on a calendar, keep notes on each visit, and track every lead. In Part 3 I explain why I wish I had started more organized, and the systems I use now.