How to Start a Home Care Business. Gwendolyn A. Franklin, MSN, RN Healthy Living Home Care, LLC Owner

Transcription

1 How to Start a Home Care Business Gwendolyn A. Franklin, MSN, RN Healthy Living Home Care, LLC Owner

2 RN to CEO When we accept tough jobs as a challenge, and wade into them with joy and enthusiasm, miracles can happen. Arland Gilbert

3 Entrepreneurship in Nursing An Evidence-Based Approach According to the National Association of the Selfemployed. America s Young Entrepreneurs trend data, there are approximately 25 million small businesses and 10.5 million self-employed individuals in the United States. Of those self-employed Americans, women entrepreneurs represent the fastest growing economic trend in the United States. According to Spiegel, women-owned businesses contribute to $2.38 trillion in revenue to the US economy. National Association of the Self-employed. America s young entrepreneurs trend data at a glance. accessed June 9, Spiegel R. Small business women entrepreneurs. accessed June 9, 2007.

4 Entrepreneurship in Nursing An Evidence-Based Approach Given these staggering statistics, why is it that nursing, a predominately female profession, rarely is linked with the term entrepreneurship? According to Shirey & Associates, much of the answer rests with misconceptions about nurse entrepreneurship. This study provided insight into motivating factors, barriers, and reward outcomes from the perspective of a clinical nurse specialist aspiring to incorporate entrepreneurship as a dimension of practice. (Shirey, M. An Evidence-Based Understanding of Entrepreneurship in Nursing, Clinical Nurse Specialist Entrepreneurial Dimensions of CNS Practice, 21(5) September/October 2007)

5 Entrepreneurship in Nursing An Evidence-Based Approach According to Shirey and Associates, research in the area of nurse entrepreneurship is in it s infancy. Although, entrepreneurship in the business sector receives significant consideration, it is surprising how little attention is given to entrepreneurship in health care in general or nursing in particular. (Shirey, M. An Evidence-Based Understanding of Entrepreneurship in Nursing, Clinical Nurse Specialist Entrepreneurial Dimensions of CNS Practice, 21(5) September/October 2007)

6 Motivating Factors The drivers that motivated me to pursue Starting a Business include: 1) A love of nursing, 2) Self-efficacy as a professional nurse, 3) Influence of family, 4) Desire to make a difference, 5) Ability to see opportunities

7 Qualifications 1979 BSN Oakland University 1999 MSN Wayne State University, Community Health, Home Health Administrator 2005 Cohort Robert Wood Johnson Executive Nurse Fellowship 2008 DNP Student Oakland University

8 Qualifications 30 Years of clinical experience and expertise developed over time from different sectors of home care, community health, and public health. Self awareness about the business of nursing, mission driven, and envision unique potential for making a difference in the lives of clients. My strength is to see opportunities where others may see only problems. Seizing the opportunities has much to do with the Bureau of Health Professions, Health Resources and Services Administration (HRSA) projected supply, demand, and shortage of RN report. In that report the demand for RNs in home health will increase to 109% from the year 2000 to The demand for RNs in Home Health ranked highest compared to inpatient hospital care, nursing homes, nurse educators, physician offices, school health, and public health. (United States Bureau of Health Professions, Health Resources and Services Administration (HRSA) (2004). What is Behind HRSA s Projected Supply, Demand, and Shortage of Registered Nurses, Report of the Lewin Group).

9 Barriers to Getting Started Perceived lack of business skills in the area of finance. Legal issues Running the day to day operations of a business Billing and Collection knowledge Basic Office Management Skills Planning, management and networking Seeking help from outside experts Attorneys Accountants Business Start-UP Counselors Mentors

10 Starting a Non-Medical Home Care Business in Michigan Home Care Licensing Registering Your Business Federal Employer Identification Number (FEIN) IRS The Business and Specialty Tax line ( ). Three Registrations at One Stop in Michigan Business Entity Search (Choosing a name) Legal Structure Register for Taxes (withholding taxes, small business taxes, worker s compensation, unemployment compensation).

11 Starting a Non-Medical Home Care Business in Michigan Business and Economic Growth Start Your Business Guide to Starting a Business in Michigan. Click on Starting a Small Business in Michigan. The links include: Business Plan Ways to Legally structure a business and registering a business name Licenses Permits and other Regulations Business Taxes Being Self-Employed Buying/Financing a Business Hiring Employees Managing a Business Insurance Selling to Government Call for a printed version of the Guide, the website version is the most up-to-date

12 A Business Plan Framework Executive Summary General Description Products and Services Marketing Management Legal Finances Operations Goals/objectives to communicate to lenders and creditors for opportunities, resources and orientation.

13 Private Duty National Private Duty Association has guidelines to follow unless the state regulations for hiring, training, and supervision of caregivers are more stringent, or the agency may be limited by the insurance coverage or general business practice. Provided with Signed Referral from a Licensed Physician

14 Private Duty Level 1 Caregiver Companion Caregiver or Homemaker No hands on services Level 2 Caregiver Personal Care Assistant Certified Nurse Aide, Home Health Aide Hands on services Level 3 Caregiver Obtain vital signs Provide skin care under the direction of licensed nurse Staff evaluation in home every two weeks.

15 New Agency Development in Michigan Medicare Certification/CHAP Accreditation (Deemed Status) Phase I Thru to Completion of CHAP Self Study (3 months) Phase II Waiting for Survey (4-6 months) Phase III CHAP Survey and Medicare Approval (2-3 months).

16 Phase I Begins after the agency has established its organization s structure, Tax ID, approval to do business in Michigan, secured an office, phones, board of directors, and physician. Organizational functions include: policy and procedure, clinical procedure, safety, infection control, medication safety, Oasis Assessment, Medicare policy, and Medicare reimbursement manuals. Recruitment of supervising nurse and other key staff before submitting CMS 855A. Letter of Intent sent to the State Application for CLIA Waiver Apply online for National Provider Identification (NPI) number Documentation of required available funds. Completion of State Application. Human Resources overview (Personnel Policies, job description) Once letter indicating approval of the CMS 855A Agency applies to participate in CHAP accreditation process for a fee of $500. Completion of the Self Study.

17 Phase 2 Continuing training in preparation for survey and ensure legal compliance: Operations, marketing, human resource management, clinical management, Medicare documentation, OASIS and Basic Coding. Defining and ensure proper functioning of Board of Directors, Professional Advisory Committee and Operations Management team. Perform field visits with staff Perform ongoing review of clinical records Conduct Mock Survey

18 Phase 3 CHAP performs on-site survey Agency received Medicare approval Entire process takes approximately 12 months

19 Healthy Living Home Care, LLC Medicaid Provider, Bonded, and Insured Vision Statement: Premier home care services for optimum health and quality of life. Mission Statement Provide quality private duty and skilled nursing services in the home. The mission will be accomplished by: Creating a customer service driven work environment. Market services to medical providers for referrals. Complete a health history and assessment upon admission. Coordinate individualized plan of care with physician. Provide health teaching and measurable outcomes of care. Provide companionship, homemaker, and personal care. Compliance with local and state regulations. Become Medicare Certified