Start-Up & Operations Manual for Non-Medical Home Care


Table of Contents


Module  1  –  Overview

What Is Home Care?        

Is There A Need for Home Care?            

What Are The Goals of Home Care?            

What Are The Advantages & Disadvantages Of Home Care?              

Who Needs Home Care Services?              

What Types of Organizations Provide Home Care Services?                  

Home Health Agencies                      

Non-Medical Home Care Agencies                    

Registry & Staffing Agencies            

Private Hire or Independent Providers      

Client Responsibilities as an Employer     

Social Service Agencies        

Pharmaceutical and Infusion Therapy Companies        

Medical Equipment & Supply Companies        

Public Authorities        


What Job Positions Perform Home Care Services?              

Medical Personnel Duties                

Non-Medical Personnel Duties                  

Who Pays for Home Care Services                    

Public Third Party-Payors                      

Older Americans Act (OAA)                     

Veterans Administration                      

Social Services Block Grant Program                       

Community Organizations                      

Religious Associations                      

Private Third-Party Payors              

Commercial Health Insurance Companies              


Long-term Care Insurance              

Health Insurance and Managed Care Organizations              

Civilian Health & Medical Program of the Uniformed Services (CHAMPUS)       

Health Maintenance Organization (HMO)       

Automobile Insurance Companies        

Workers’ Compensation        

Disease/Condition Focused Organizations        

Limited Government Payors          



Medicaid Waiver               

Medicaid: Consumer Directed Services Program                   

Where Can Inquiries About Home Care Be Directed?                    


Module  2 –  Preliminary Considerations

Mission, Vision and Value Statements      

Mission Statement     

Examples:  Mission Statements        

Vision Statement       

Examples:  Vision Statements        

Values and Beliefs        

Example:  Value and Belief Statement           

Goals and Objectives            

Business Objectives            

Criteria for Effective Business Objectives              

Example:   Objectives Your Business Might Choose              

Advantages and Disadvantages to Owning a Business                

Keys and Obstacles to Successful Business Operations                

Keys to Success:               

Obstacles to Success                

Home-Based Businesses                  

Advantages and Disadvantages of Having a Home-Based Business                  

Sources of Additional Information on Home-Based Businesses                      

Community-Based Businesses                    

Home Care Franchises                    

The Franchisor           

The Franchise System       

The Franchise Agreement     

Services Delivered by the Franchise System         

Obtaining Input from Experienced Franchisees        

Advantages and Disadvantages of Buying Into a Franchise          

Membership Organizations              


Module 3 – Feasibility Study

Meaning & Objective of Feasibility Study    

The Feasibility Process      

Market Research    

Conducting Test Market Research      

Primary Research      

Secondary Research      

Value and Format of a Test Market Survey        

Things to Consider When Designing a Test Market Questionnaire        

Things to Research When Evaluating the Market           

Market Area (Geographical)           

Market Profile (Potential Clients)             


Market Status                      

Market Analysis                      

Market Share                    

Example:  Estimating Your Share of the Market                   

Determine Price Structure for Home Care Services            

Things to Consider When Pricing Home Care Services            

Direct Labor (Variable) Costs      

Overhead (Fixed) Costs      

Formula:   Determining Total Costs        

Pricing to Actual Costs        

Formula:  Determining the Cost per Hour to Deliver Service        

Formula:  Calculating the Amount to Charge for Service per Hour         

Example:  Determining How Much to Charge for Service per Hour         

Pricing to the Market         

Pricing by Position              

Determine Start-Up Expenses/Costs              

Main Start-Up Expenses                

Main Advertising Expenses                  

Newspaper, Yellow Pages, Business Directories                  

Brochures, Stationery and Business Cards                  

Introductory Letters                  

Equipment and Supplies                  

Office Equipment/Supplies                    

Housekeeping Equipment/Supplies                    

Window Washing Equipment/Supplies                        

Yard & Garden Maintenance Equipment/Supplies                        

Personal Care Equipment/Supplies                      


Example:  Setting-up a Spreadsheet for Projecting Start-Up Costs              


Determine Operating Expenses/Costs        

Main Operating Expenses          

Example:  Setting-up a Spreadsheet for Projecting Labor Expenses            

Example:  Setting-up a Spreadsheet for Projecting Operating Expenses                


Project Service Revenue                      

Formula:   Forecasting/Projecting Service Revenues                      

Calculate the Break-Even Point                         

Determining Service Hours Required to Meet Expenses                          

Formula:    Estimating the Break Even Point in Service Hours                          

Example:   Estimating the Break Even Point in Service Hours for One Month                        

Determining Service Hours Required to Provide a Salary                        

Formula:  Determining Service Hours Required to Provide a Salary                        

Determining Revenue Dollars Required to Meet Expenses                

Formula:   Determining Break-Even Point in Revenue Dollars                

Example:  Estimating Break-Even Point in Revenue Dollars for One Month                

Project Profit and Loss          

Project Cash Flow           

Analyze Cash Flow Projections            

Example:  Cash Flow Projection Chart           

Analyze Other Factors            

Analyze Feasibility Study and Make Decisions              


Module 4  –  The Business Plan

What is a Business Plan?    

Purpose of Business Plan      

How a Business Plan Benefits You      

Information Required in a Generic Business Plan        

Table of Contents        

Executive Summary        

Business Concept           

Description of the Home Care Industry            

Description of Business Venture            

Business Goals            

Marketing Plan            

Revenue Forecast             

Corporate Structure              

Risk Assessment             

Action Plan              

Financial Plan              

Financial Statements                

Financial Forecasts                

Financing and Capitalization                

Operating Loan                




Module 5  –  Financing Your Business

Need for Financing    

Criteria for Borrowing      

Start-Up Capital and Operating Capital       

Start-Up Capital       

Operating Capital       

Debt Financing            

Alternatives to Debt Financing            

Investor Financing            

Equity Financing              

Royalty Financing              

Mezzanine Financing                

Hybrid Financing                  

Funding Sources for Setting up Your Business                  

Personal Investment                 

Family and Friends                      

Financial Institution Loans                      

Line of Credit                   

Collateral or Security                    

Government Grants and Loans                    

Small Business Administration Loan            


American Corporate Giving Programs      

Dealing with Loans        

Shopping Around          


Module 6  –  Business Start-Up Requirements

Determine Professional Consultations Needed      

Legal Issues      




Decide Which Business Structure/Form to Use        

Common Business Structures            

Sole Proprietorship              



Limited and Limited Liability Partnership (LLP)               

Limited Liability Company (LLC)                 


Choose, Search & File Your Business Name                    

Fictitious Business Name (FBN)           

Choose Your Fictitious Business Name & Logo            

Search Your Fictitious Business Name for Previous Registrations            

Register Your Fictitious Business Name (FBN)     

Sole Proprietorship      


Limited Partnership, LLC, Corporation      

Register Your Business with the State        

Apply for An Employer Identification Number (EIN)         

Open a Business Checking Account             

Obtain a State Seller’s Permit             

Obtain a State Home Care Agency License              

State Licensing Authority Links                

Determine Insurances Needed                        

Business Liability Insurance                        

Professional Liability Insurance/Errors and Omissions Insurance                        

Fidelity Bonds                        

Disability Insurance                        

Vehicle Insurance                      

Fire Insurance                      

Site Insurance                      

Check Zoning By-Laws                      

Determine Hiring as Employee or Independent Contractor             

When Individuals are Hired as Employees              

Individuals Hired as Independent Contractors (ICs)       

Strengthening Your Case for Independent Contractor Status        

Complete Required Forms (obtain from government)           

The  W- 4                   

The  I- 9                               

The  W-2                  

IRS Form 941                                              

IRS Form 940                                                

Set-Up Your Record Keeping System                     

Purpose of Accounts and Records                    

Components of an Effective Accounting System                     

Tips for Maintaining Good Records                      

Record Storage                          

Comply with Required Regulations                          

Federal Labor Law                           

State Labor and Employment Laws                        

Occupational Health and Safety Administration (OSHA) Requirements                

US Equal Employment Opportunity Laws          



Determine Required Payroll Deductions            

Federal Income Tax Withholding            

Social Security and Medicare Taxes (FICA)           

Federal Unemployment Taxes (FUTA)           

State Income Tax Withholding and Registration                  

State Unemployment Insurance                  

Workers’ Compensation Insurance                  

Consider Accreditation & Certification Options                    

JCAHO Accreditation                      

CHAP Accreditation                      

ACHC Accreditation                        

Medicare Certification                        


Module 7  –  Marketing

Marketing Synopsis    

Marketing Stategy      

Marketing Plan        

Difference between Marketing Plan and Business Plan        

Guidelines for Marketing Plans            

Marketing Process              

Developing a Competitive Advantage              

Conducting a SWOT Analysis              

Example:  SWOT Analysis                  

Creating a Unique Selling Position (USP)                     

Creating a Good Mission Statement                   

Example:  Mission Statement for a Home Care Business                    

Creating Your Image                    

Choosing a Business Name                    

Designing a Custom Logo            

Points to Consider When Web Building              

Differences In Marketing Methods                

Difference Between Marketing and Promotion                

Difference Between Promotion and Advertising                  

Difference Between Advertising & Direct Marketing                  

The Marketing Mix                  





The Promotional Mix                        


Advertising Strategies                      

Targeting Your Audience                      

Creating an Effective Ad              

Using Your Resources Prudently              

Branding Effectively              

Determining the Best Time to Advertise        

Advertising in the Appropriate Places        

Measuring Results          

Personal Selling                

Establishing a Relationship                


Promotion Suggestions                  

Public Relations                      


Developing a Referral Network                          

Direct Marketing                        

Developing a Direct Marketing Strategy                

The Senior Market               

Offline & Online Marketing            

Offline Marketing            

Online Marketing            



Social Media                  

Listing Services                  



Press Releases/Media Outlets                        

Community Forums                            

Budgeting For Marketing Costs                            

Marketing Samples                          

Introductory Letter                   

Example:  Introductory Letter               

Business Cards                  

Example:   Business Card                  


Example:  Brochure                      

Fee Schedules                            

Example:  Fee Schedule                                


Module  8 –  Relationship Selling to Clients

Relationship Selling to Clients      

How to Build and Maintain Relationships with Clients        

Build Trust       

Focus on Filling Your Clients’ Needs            

Listen More Than You Talk              

Use Body Language              

Apply Other Useful Techniques              

Understand & Apply the Commitment/Sales Process                

Network Effectively                    


Module 9  –  Home Care Service Menu

Overview of Non-Medical Home Care Services    

Service Delivery Workers      

Typical Non-Medical Home Care Services            

Companionship/Sitter Services              

Homemaker/Home Management Services                

Personal Care Services                

Caregiver Respite                  

Friendly Reassurance                  

Live-In Care and               -Hour Care                  

Intermittent Chore/Home Maintenance Services                    


Module 10 – Role of the Home Care Assistant


Home Care Assistant Roles      


Work Duties/Tasks and Responsibilities      

Duties/Tasks Companionship Does Not Include        

How to be a Good Companion/Sitter       


Work Duties/Tasks and Responsibilities            

Duties/Tasks Homemaking Do Not Include              

Personal Care              

Work Duties/Tasks and Responsibilities              

Duties/Tasks Personal Care Does Not Include                      

Respite Care                      

Live-In Care                    

Live-In Duties/Tasks Do Not Include            

Friendly Reassurance            

Chores/Home Maintenance            

Work Duties/Tasks and Responsibilities            

Home Care Assistant Responsibilities      


Occupational Health and Safety        

Accountability, Judgment and Decision Making        


Module 11 –  Preparation Activities


Preparation Activities Flow Chart     

Develop Your Service Standards        

Develop Your Policies and Procedures            

Purpose of Policies & Procedures            

Essential Policies & Procedures                

Choose those Services You Will Provide                    

Determine Your Staffing & Human Resources Needs            

Organizational Chart for a Typical Home Care Business      

Manager Administrator       

Office Coordinator/Manager       


Home Care Assistants        

Develop Job Descriptions          

Develop an Employment/Job Application Form               

Recruit Candidates              

Effective Recruitment               

Steps in the Recruitment & Hiring Process                  

Define the Person and their Role in Your Agency                    

Home Care Assistant Competency Model                     

Attract Candidates to Your Agency              

Advertising for Candidates              

Example:  Advertisement for Home Care Assistants          

Assess Candidate’s Suitability for Role          

Screening and Short-Listing            


Do’s and Do Not’s of Interviewing                

Behavioral Interviewing                  

Other Key Factors for Assessing Candidates                    

Select Candidates for Your Agency                      

Guidelines for Selecting Employees                      

Post Selection Contact               

Conducting Pre-Employment Screening          

Conducting Reference Checks          

Conducting Background Checks            

Orientation/Training New-Hire Employees                        

Conducting Effective Staff Orientations                            

Identifying & Documenting Orientation/Training                            

Determine Wage Payable                          

Criteria for Establishing Pay Rates                    

Types of Services Being Performed                    

Employee Qualifications and Experience                    

Work Difficulty                    

Overnight Shifts              

The Going Rate              

Negotiating Wages              

Create Employer/Employee Contracts/Agreements                

Respect Privacy of Information                  

Follow Payroll Obligations                  

Obtain Forms for Client Records                      

Personnel Records                        

Understand Basic Legal Terms                          


Module 12 –  Service Delivery Process

Service Delivery Model     

Initial Contact/Inquiry to Agency        


Action # 1 :  Request for Information        

Action #  2  :  Referral to Outside              

Action # 3     :  Request for Service              

Steps for Implementing and Delivering Service              

Step  1:  Receive Request for Service              

Step  2:  Conduct In-Home Interview                 

Identify/Assess Needs                

Develop Care Plan/Service Plan                      

Confirmation of Service Delivery                    

Develop and Sign a Service Agreement           

Obtain Consent to Release Information      

Step  3:   Schedule Staff        

Step  4:  Deliver/Provide Services          

Step   5  Maintain Client Records              

Things to Know About Documentation              

Responsibilities for Record Maintenance                    

Client Rights Regarding Their Records                      

Step  6:  Follow-Up and Monitor                     

Step  7:  Make Changes as Required              

Case Studies              

Case Study #1  :  Applying the Service Delivery Process        

Receive a Request for Service (Step 1)       

Conduct In-Home Interview (Step 2 )       

Develop a Care Plan/Service Plan          

Example:  Care Plan/Service Plan            

Example:  Service Agreement               

Example:  Consent to Release Information                  

Schedule Staff (Step 3  )                   

Deliver Service (Step 4 )                     

Example:  Confirmation of Service Delivery                        

Maintain Client Records (Step 5 )                           

Follow-Up and Monitor (Step 6 )                         

Make Changes as Required (Step 7 )                   

Case Study #2    :  Completing Client Care Records                    

Example:  Client Status Notations                

Example:  Client Medication Record                        

Example:  Client Flow Chart                               

Example:  Client  Progress Report               


Module  13 –  Client Services

Principles of Client Services    

Guidelines for Effective Client Service      

Traits Clients Want Home Care Personnel to Have        

Interpersonal Relationships in Client Services            

Client Character Traits            

Home Care Assistant Character Traits                

Cultural Considerations                

Personal Boundaries in Client Service                  

Client Bill of Rights                  


Home Care Agency Responsibilities                      

Client Responsibilities                    

Personal Information and Privacy            

Guidelines for Personal Information and Privacy Management     


Guidelines for Disclosing Confidential Information        

Confidentiality Statements          

Rules of Conduct         

Ethical Guidelines for Home Care Assistants          

Standards for Developing a Code of Ethics              

Work Ethics for Home Care Assistants              

Characteristics and Qualities of Good Work Ethics                

Ethical Behavioral Patterns and Attitudes                

Discouraged Practices                    

Telephone Usage                    

Gift Acceptance                    

Financial/Property Pursuits                    

Image and Self Care Responsibilities                        


Personal Hygiene                      

Mental and Physical Health                      

Team Work              

Elder Abuse              

Types of Elder Abuse        

Signs and Symptoms of Elder Abuse        

Where to Report Suspected Elder Abuse          


Module  14 –  Day-to-Day Operations

Command Post   

Telephone Calls      

Telephone Log      

After-Hour Calls               

Staff Roster           

Example  –   Home Care Assistant Work Schedule                

Service Start-Up                  

Client Files                  

Guidelines for Recording Client Information                  

Service Agreements                      

Service Cancellations                    


Credit Reports      

Pre-Service Deposits      

Price Changes        

Independent Contractor Agreements        



Employee Time Cards/Sheets          

Example:  Employee Time Sheet             

Employee Mileage Records                

Example:  Employee Mileage Record                        

Client Cash Transactions                      

Example:  Client Cash Transaction              

Rates/Fees and Minimum Service Hours:       

Accounting Systems            

Computerized Accounting System             

Manual Accounting System             

Client Accounting Documents                  

Client Invoice:  Individual                 

Example:  Client Invoice:  Individual                   

Client Invoices:  Master Log                      

Example:  Client Invoices:  Master Log                          

Late Payment Notice – First Letter                       

Example:  Late Payment Notice – First Letter               

Late Payment Notice – Second Letter         

Example:  Late Payment Notice – Second Letter           

Client Service Schedule              

Example:  Client Service Schedule                  


Continuous Quality Improvement                   

Continuous Risk Management                     

Quality Improvement Evaluations                        

Confidential Information in Electronic Devices                        


Appendix “A” – Sample Business Plan


Appendix “B” – Forms

Care Plan/Service Plan (includes a Needs Assessment)

Client Cash Transactions

Client Flow Chart

Client Invoice:  Individual    –  (MS Word)

Client Invoices: Master Log –  (MS Word)

Client Medication Record

Client Progress Notes

Client Service Satisfaction Survey

Client Service Schedule

Client’s Consent:  Referral & Release of Information

Confirmation of Service Delivery

Employee Confidentiality & Non-Disclosure Agreement

Employee Mileage Record

Employee Orientation Checklist

Employee Reference Check

Employee Time Sheet

Employer & Employee Agreement

Employment Interview

Field Supervision Review

Financial:  Profit & Loss Statement – Excel Worksheet

Financial Projection Model – An All-in-One Excel Worksheet for projecting:

  • Start-Up Funds
  • Salaries & Wages
  • Fixed Operating Expenses
  • Projected Sales Forecast
  • Projected Sales (Year 2)
  • Cash Receipts Disbursements
  • Income Statement
  • Cash Flow Statement
  • Balance Sheet
  • Year End Summary
  • Income Projection Statement (Year 2)
  • Cash Flow Statement (Year 2)
  • Balance Sheet (Year 2)
  • Income Statement (Year 3)
  • Cash Flow Statement (Year 3)
  • Balance Sheet (Year 3)
  • Financial Ratios (Years 1,2, & 3)
  • Breakdown Analysis
  • Amortization Schedules
  • Financial Diagnostics

Home Safety Check List

Independent Contractor & Agency Agreement

Job Description – Home Care Assistant Model

Job Description –  Home Care Companion

Job Description –  Home Care Manager or Administrator

Job Description –  Home Care Supervisor

Job Description –  Homemaker

Job Description –  Personal Care Attendant

Job Description  – Live-In home Care Aide

Job Description  – Registered Nurse

Job-Employment Application

Market Analysis for Home Care Business

Nursing Assessment

Personal Suitability Questionnaire

Personal Care Supplies Check List

Phone Numbers – Emergency

Pre-Employment Background Check Authorization

Rights & Responsibilities of Client & Agency

Service Agreement (Client & Agency)

Special Equipment Check List

Start-Up Work Plan Check List


Optional Forms

Assessment: General Needs

Assessment: Nursing

Assessment: Personal Care

Client Invoice:  Individual MS   –  MS Word Manual Completion Version

Client Invoices:  Master Log      –  MS Word Manual Completion Version