Starting a Home Health Agency

hoolahan, ASN, RN · Jul 25, 2001

Wow! I am in awe of you. I would love to do this, for cardiac pt's. But I wasn't sure where to begin either, and how to go about getting HHA's, PT OT RD MSW ST all involved if needed as well, then I'd have to have all the ancillary staff to manages all the billing involved for the multi disciplines, etc.... So, that was where the dream stopped. I couldn't even stand having to be the weekend super at my former job at a HH agency, and now am much happier back as staff doing visits.

Please keep us posted on your progress. I'd love to know how you did it. Maybe when my kids are grown....

E-mail me anytime [email protected] I'm in Jersey.

PS, try posting this on the Home Health Forum too. NRSKaren may be able to help you, she's been a DON of an agency before, and has mucho experience in many many HH roles.

Good Luck!

mustangsheba · Jul 26, 2001

Make sure you have all your ducks in a row about documentation and other federal requirements. I have seen independent HH businesses get nailed big time.

LoisJean · Jul 26, 2001

Way to go, DJH! Not only is it do-able but it might just turn out to be the best decision you have EVER made for yourself.

There could be as many ways for a nurse to set out solo as there are nurses...my home care business is small but successful and continues to grow.

You will want to think in terms of services which you will provide and the fee for service. If you are an RN providing any skilled service, it may be covered by your client's health insurance. Get out and introduce yourself to area physicians and present them with a plan, (in writing), of what you intend to do. (Almost half of all our referrals come from docs now). Introduce yourself to State agencies like medicaid waiver programs--they might be interested in contracting your skills.

I am certain you are aware of the liability factor and are keeping your insurance premiums paid up to date; you can create your own documentation forms--many of us who are self-employed have created care plans and nursing notes more in line with sanity. You might check with your board of nursing and/or public health department as to what they might suggest. Ours said basically, "go for it".

You understand that self-employed nurses are a rarity and you will have few if any to bounce things off of. Depending on whether you plan on employees, partners, encorporating or working as a sole owner, the basic business aspect is the same for you as it is for an auto mechanic. May I suggest you contact your area Small Business Association as they can give you some wonderful advise and support.

There is a great deal that goes into this decision of yours. It is not for the faint of heart or for those who are shy. You have GOT to believe that your services are needed and necessary in your community and you need to get that word out to the people of your community....and it is always good if you can come up with a patient care service that is not normally done on an in-home basis -(one that health care insurance no longer pays for--like visits made only for venipunctures, for instance.)

There is so much more that goes into this; the best I can say is that if you step out into this you will learn as you go along...makes my life infinately more exciting! Like I say--it's not for the wimpy and I say that with all respect to all nurses. It's just that for some of us, this is not the way to go.

Good luck and like Hoolahan says--keep us posted.

Lois Jean

hoolahan, ASN, RN · Jul 27, 2001

lois jean, shippy shame on me for not also suggesting your name. you are business woman and nurse extraordinairre!

eventsnyc · Jul 27, 2001

DJH, I am very happy for your decision. You have the right spirit. It would work! I would pray for you.

Christina

PammieRN · Jul 28, 2001

I would love to contract for my services....I just don't seem satisfied somehow working for other companies. I wouldn't know where to start...can anyone point me in the right direction? Oregon just settled a law suit that requires that they provide services for the developmentally disabled that were formerly on waiting lists. I know there must be skills I possess that would fit into that somehow.

PammieRN

Home Health Columnist / Guide · Jul 28, 2001

Hoolahan: Thanks for the promotion! Seriously, never served as DON, only acting administrator during vacation refief over two years for a home care agency. Did serve as Clinical coordinator/QA in my previous home care agency. Currently work in intake/UR in non-profit homecare agency.

My first home care experience in 1985 was working for a 6 month old, privately RN owned company that is still in existence. Working as independent contractor, We did private pay shift nursing, facility staffing, Medicare + insurance cases and served as subcontractor for various IV agencies, so I've seen a lot as I grew with them over 10 years.

DJH: See that you only want to do private pay. Will it be RN only staffing, or have HHA/homemaker's? Different rules for each.

With RN's you can be broker and hire staff as independent contractors. With the HHA's, you will be employer, workman's comp, background checks, overtime, etc., will be big costs, along with no shows, as I have seen about 10% HHA no call, no show for work over the past 15 years.

Owner of first agency had equity line of credit tied to home in order to meet payroll till established cash flow, be careful of this. Consider having 6 months expenses in savings, to protect against losses. In the Phila. area, homecare staffing has almost dried up---how easy to recruit in your area? Thinking you have experience in home care re your post, I offer the following.

Where to start:

1. Contact state board of health re rules/regulations.

2. Contact small business administration re startup, funding and business plan.

3. Look at Medicare and JCAHO web sites re laws and standards, also fraud and abuse rulings. You will be held to their standards, even if not servicing their members as they are national standards

HCFA: http://www.hcfa.gov.

Medicare and Medicaid manuals, bulletins online, and link to healthwatch update re MC laws

here @ http://www.hcfa.gov/pubforms/pubpti.htm.

JCAHO site with links to some standards: http://www.jcaho.org.

4. Visit a college with nursing program major: nursing administration. I'm sure they'd have textbooks/resouces available on home care agency's and maybe they can put you in contact with more resources.

5. Consider joining homecare organization. One group I'm aware of is American Home Care Association,Inc.

Web site http://www.americanhca.org.

They have a large convention, October 22 - 25, 2001 New Orleans, Louisiana.

Convention website including listing of presentations:

http://www.americanhca.org/Medtradeconf/.

Newsletter links from this site-http://www.americanhca.org/execs/nlengine.exe

Most familiar with these publications, all excellent. Eli's is one of the bible's of the industry, expensive subscription but with it. ?? available at college library's with MBA Healthcare programs.

T.M. Marrelli's Home Care Nurse News

Eli's Home Care Week

Home Care Compliance Alert

Other group that my Homecare agency is a member of is National Association of Homecare Agencies:

http://www.nahc.org/NAHC/FAQ/faq.html

The have a magazine CARING with other links here:

http://www.nahc.org/NAHC/CaringComm/caringcomm.html

Check out thie Homecare University that I just found on 7/30/01:

http://www.homecareuniversity.org/edu.html

6. Do you have a healthcare council in your area? Here is a link: http://www.pohly.com/assoc4.html.

7. Check out website I found this week from another healthcare consultant, Pam Pohly's "Toolbox for Health Managers & Administrators" @ http://www.pohly.com/admin.html.

Major topics listed here with may further links:

Executive & Health Administration - Wealth of health management resources here

Publications, Journals & News - Industry news, research, who's who

Medical Legal, Governmental & Regulatory Links - Resources for compliance

MIS & Software Links - Systems, software, telemedicine, what's hot

Other Health Administration SuperSites - Other health management websites

Medical & Clinical SuperSites - Clinical links with mostly medical information

Human Resource Tools - HR and personnel resources for health care

Road Warrior & Traveling Tools - Make reservations, check weather, maps & more

Professional Associations - Guide to organizations for health professionals on the net

Hospital Associations - Links to hospital associations, by state

Health Care Compensation & Salary Surveys - Check out what everybody makes

Internet Guide for Mental Health Professionals - Links for behavioral health

Hospitals, Managed Care & Healthcare Companies on the Net - A wealth of links to employers

8. Consider consultant. Know of Tina Marrelli from her Homecare documentation handbook and newsletter, does consultations.

Her website is http://www.marrelli.com

Marrelli and Associates, Inc.

P.O. Box 629

Boca Grande, FL 33921

Phone: (800) 993-6397 (NEWS) or (941) 697-2900

Fax: (941) 697-2901

Email: [email protected]

9. Willing to ask RN colleagues that own homecare agency, if they would be willing to speak to you (know two different agencies) if you desire.

Ten years ago, considered having my own agency. Knowing it would tie up 80% of my time, beeper and cell phone forever tied to me, I decided against it. Email me if desired: [email protected].

Best wishes,

Karen

hoolahan, ASN, RN · Jul 29, 2001

Karen, acting DON = DON, at least it would on my resume!!

That was a lot of info girfriend! Ya scared the he!! outta me!

BTW, THat 10% HHA call-out, so true. When I was weekend super, I had to take all the sick calls. WE had a first and second on-call HHA to act as subs, but if I was lucky they would answer my pages! Occassionally, this can be a major headache, esp if you serve pt's who have PCA's, or are totally dependent to be fed, get in and out of bed etc. Try to screen your cases very well before accepting them, depending on what you will be able to provide.

Good luck, keep us posted.