Updated and reposted from March 2019.
You’re thinking of opening your own adult care home for seniors and individuals with disabilities. Congratulations! This is an exciting decision. Maybe you’ve worked as a caregiver for several years in an adult care home, assisted living facility, nursing facility, or as an in-home caregiver. Perhaps you've worked as a nurse and would like to take it to the next level and be your own boss.
You’ve now decided you’d like to take the next step and become an adult care home provider with your name listed on the license. You most likely feel passionate about caring for seniors and individuals living with disabilities. This is great, though this is not a decision to be made lightly. Owning your own adult care home business and being a caregiver for someone else are two very different experiences with their own unique challenges and benefits.
When I started my own business in 2018, I had a vague idea of the level of commitment it would take, but in retrospect, I really had no idea. I consistently work more than I've ever worked before in my life. I haven't taken a true vacation in four years, and I regularly work 12-14 hours per day and work at least six days per week. Like most small business owners, I work a lot, but I also recognize I have the luxury of having some down time because I'm not caring for others. I've heard this same feedback from new providers, as well. They didn't realize how much time owning their own business would take, especially a business where you're providing 24/7 care to other people.
Frankly, running a small business is not for everyone. Sometimes the best advice I can give someone is to consider a different path. Often, providers mention they spend a lot of time on business management, rather than solely direct caregiving. If you simply love being a caregiver, you might want to consider remaining a caregiver and working for someone else, but working in a capacity with more responsibility, rather than owning your own business. If you have management and leadership skills, you're highly organized, have strong ethics, and you're business-minded while also passionate about high-quality care, then owing a care home business might be the right move for you. It's an added benefit to have prior experience running a small business.
If you're considering this next step in your career path, now is a critical time to reflect on your motivation...while also taking inventory of both your skillset and your understanding of the level of commitment this role entails.
If you're considering this next step in your career path, now is a critical time to reflect on your motivation for becoming an adult care home provider, while also taking inventory of both your skillset and your understanding of the level of commitment this role entails. Now is the time for a frank discussion: I’d like to talk about seven reasons to open your own adult care home, and four reasons to not open a care home.
Let’s start with four reasons not to open your own adult care home.
1. You're just going to see what happens.
Starting any business requires a lot of foundational work. You want to lay a solid foundation on which to build your care home business. Do you have a business plan? Do you have a realistic idea of the money you can make your first year? I've heard a lot of misinformation out there. It's vital to get the correct information and guidance and have a plan before taking the next step.
2. All you see are dollar signs.
Sure, you need to make money, as this is a business; however, people who go into this field mainly for the money quickly burn out, or realize the money isn’t worth it. When starting out, you might go months without income while you’re working through the licensing process and finding your first residents. Residents paying privately can pay well, but the Medicaid rate is fairly low with the highest standard Medicaid rate plus room and board at around $3,500/mo. You also have to factor in the cost of your lease or mortgage, insurance, food for a large household, and utilities.
You also have the cost to hire and keep good caregivers, as payroll is one of your largest expenses and will run into the thousands of dollars per month. If you've planned well and have made good business decisions along the way, you’ll make a good living, but it's going to be a lot of work.
3. This will be your side business.
The State of Oregon and Multnomah County require you, as the licensee, to be involved in the business. Frankly speaking, everything falls on your shoulders. You shouldn’t expect to simply hire a resident manager and take a hands-off approach to your adult foster home business. This work requires direct and ongoing involvement, especially when you're just starting your business.
4. You take issue with government regulation.
This adult foster care home industry in Oregon is highly regulated. Let me say that again. This field is highly regulated. Did I mention this is a highly-regulated field? To put this into perspective, not only do you have state or county regulations, but there are both federal and local regulations you must follow as a small business and an adult care home. To top things off, state licensors will show up to your home unannounced, and you might have periodic visits from Adult Protective Services (APS), case managers, and a long-term care ombudsman. If you take issue with government regulation, this might not be the right fit for you.
The purpose of mentioning this is not to scare you away from this business, but to make sure you’re going into this business for the right reasons and with a solid plan.
I will admit, the reasons not to open a care home are a bit intense, but over the past decade working in adult care homes in several capacities, I’ve seen a lot. The purpose of mentioning this is not to scare you away from this business, but to make sure you’re going into this business for the right reasons and with a solid plan.
What are seven reasons you should open your own adult care home?
1. You've done your research and homework.
You've gathered the correct information you need to make an informed decision about starting your own care home. You know that you qualify and you know the requirements of the classification for which you'll be applying. You understand the differences between licensing types and State and County requirements. You know the training requirements and have started your training. You know how to market your business and find residents and you have a plan to recruit and train staff. You understand the importance of the home you choose and the role it plays in your business success. You understand the steps in the process and haven't skipped important steps.
2. You have a plan.
You're willing to take a risk, but you take calculated risks that are well-planned. You've started a business plan and have a realistic idea of your possible income and have done a cost-benefit analysis of your option(s). You have enough funds saved to weather months where a resident moves out or passes away. You also have a plan, in advance, to find and retain quality care staff.
3. You have a solid idea of the commitment this decision involves.
You understand going into this business often requires a complete lifestyle change. You've communicated with other providers to get an idea of their day-to-day experience and understand this is not like a typical job where you can go home and leave work at work. You’re okay with living where you work, and working where you live. Frankly, you’re excited about living in a multi-generational household. You enjoy talking with older individuals and hearing about their amazing life stories.
4. You've taken inventory of your own skills and abilities.
You've taken some time to really reflect on your own KSAs (knowledge, skills, and attitude). Are you highly organized? Do you have leadership and management experience? Have you ever recruited or hired staff? Do you have experience supervising staff or have the skills to do so effectively? Have you been responsible for communicating with doctors and overseeing all recordkeeping? Are you a go-getter and a self-starter? Are you good at prioritizing, delegating, and effective time management? Do you have the skills, or willingness to learn, about how to run a small business?
5. You’re an organizational wizard.
Following along the lines of number four, the providers who we find are most successful are highly-organized. The Oregon Adult Foster Home Administrative Rules (OARs) and Multnomah County Administrative Rules (MCARs) require you to document practically everything. Are you organized enough to keep resident records, facility records, personnel records, and business/financial records straight, in addition to meeting the care needs of residents?
6. This is your passion and your calling.
You know this is what you’re meant to do, whether it's a personal or spiritual calling. Working with older adults and/or individuals living with disabilities brings you immense joy and fulfillment. You feel called to do this work, and you’re committed to helping seniors live in a safe, home-like environment where you help them remain as independent and engaged as possible. You want to provide top-notch care and are willing to go above and beyond to meet the holistic care needs of residents and provide an enriching environment and experience for residents.
7. You’re ready to commit yourself 110% to the business, and everything that entails.
You've reflected on, and have completed the previous six steps and are ready to fully commit yourself to the success of your adult care home business. You recognize you don't need to do this alone and can get support along the way.
Now is the perfect opportunity to really reflect on your skills, passions, interests, personality, and lifestyle before you make the leap into becoming an adult foster care home owner and licensee. It can be a challenging, yet highly rewarding career, especially if you go into the business for the right reasons and with a solid plan. As the old adage goes, find a job you enjoy doing, and you'll never have to work a day in your life.
Your work is going to fill a large part of your life, and the only way to be truly satisfied is to do what you believe is great work, and the only way to do great work is to love what you do. If you haven't found it yet, keep looking and don't settle. As with all matters of the heart, you'll know when you find it." - Steve Jobs
We recently interviewed Valli Brunken, MBA, BSN, RN with Nightingale Consulting to discuss her background and the benefit of having an RN consultant on your care team.
Please tell us a bit about yourself.
I have lived in the Portland metropolitan area my whole life. I know the city and its surrounding areas very well. When I was a child and living with my parents, we lived near a very busy street. There were traffic accidents near our home several times every week. Many drivers and passengers suffered severe injuries. My mom was an RN and she would run with a large first aid travel box to help until an ambulance could arrive. I would often run after her and help her. I saw and helped with things no 6 to 10-year-old should be exposed to, but rather than scare me, it inspired me to help those in extreme need. The question I was left with as I was growing up was, “How shall I do this – in what capacity, what profession?”
Why did you decide to become a nurse?
I decided to become a nurse after my freshman year in college. I went to the University of Oregon and started in Biology because I knew I wanted to do something in the healthcare field and that is a good starting place. After a year, I knew I had to select a profession and one that would allow me time to be married, have a family, and have some modicum of balance in my life. When I studied what I’d have to do to become a nurse, and thought back on my childhood when I was helping my mom at the scenes of all of these accidents, it seemed like a natural fit. I will say, after 41 years now as a nurse, it is the very best decision I could have ever made. I absolutely love being a nurse and have mentored many young people in the profession as well.
Tell us about your background in nursing.
When I was attending nursing school full-time at Oregon Health & Science University (OHSU), I also worked full-time as a nursing student on a surgical ward for adult cancer patients. That is where I learned most of the fundamentals of good nursing. The manager and staff there were excellent and they taught me well.
When I graduated, I took my first position as an RN in the ICU at St. Vincent Medical Center where I worked for over eight years. Most of what I did there was care of post-surgical and trauma patients. I later moved to OHSU and managed the Trauma Level 1 ICU and was later given additional responsibility for the open heart ICU for both adults and pediatrics. I was there for nearly nine years.
After that, I went to Portland State University to study for my Masters in Business Administration (MBA). I did this to broaden my perspective and create a path for advancement or for starting my own business…whichever suited me. My final MBA capstone project was on starting a consulting firm for nursing consultation for those with serious illnesses or injuries. This project and the feedback I received encouraged me to want to start my own consulting business one day in the future. I continued my career in other areas of hospital care, most recently managing a cardiac cath and electrophysiology lab at Salem Health.
...I felt a well-qualified and well-run adult foster care home was the best option for the elderly who needed a good place to live where they could get the assistance they needed and still enjoy their autonomy.
How did you decide to get into the business of adult care home consulting?
I have been exposed to all kinds of people in need – from cancer surgery, to critical illnesses, to traumatic injuries, to people in need of an emergent heart catheterization to save their life. In all of these instances, what I really enjoyed was caring for and helping elderly clients. They were always so strong, resilient, kind, grateful, and had so many wonderful stories to tell. They also were always chock full of great advice when asked!
I retired from hospital work in the fall of 2019, but I really wanted to stay in nursing. I had a brief opportunity to work for in-home care and discovered community health nursing. I had never been exposed to that world before and it is amazing! Exploring various areas to enter community health nursing led me to care for the elderly, which was a natural fit for me and what I love.
After exploration and comparing some of my own personal experiences with elderly family members, I felt a well-qualified and well-run adult foster care home was the best option for the elderly who needed a good place to live where they can get the assistance they need and still enjoy their autonomy. I was able to participate in care in one very well-run home in NE Portland, and I was so impressed that I told my husband, “If I ever become too much to care for – take me to them!”
Looking at how I could use my nursing degree and experience, and my business education and desire to start my own business, RN consulting for adult foster care homes seemed like the perfect fit. I started my consulting firm in August 2020 and haven’t looked back. I love community health and I really enjoy working in the adult foster care home industry.
A good RN consultant is worth their weight in gold and can be an enormous asset to helping you care for the residents the right way the first time, every time.
How can an RN consultant add to the overall success of care homes?
In your May 31, 2022 blog you had a provider spotlight article where you interviewed Margaret Gikaru, BSN RN. She really said it best, and so I will echo what she said. Because of my training and experience, I can move into any situation with a resident or an owner/operator to assist them in the care of their residents.
There is a misconception that RNs are just to be utilized for delegations. That would be a gross misunderstanding of what a good RN consultant can do for you. For example, some homes have asked me to help them assess hospital patients to determine if they would be an appropriate resident and others have asked me what is the best way to handle a resident who needs wound care. Still others ask for training for themselves or for their staff.
In some cases, I notify a resident’s physician that new orders are needed, sometimes owners or managers send me orders and I transcribe the MARs for them and give them education on the medications they are giving, give them a schedule for the medications, and help them understand what can be taken with food, without food, and when is the best time to take the medications. Owners or managers also ask me to come and do assessments on residents in whom they’ve noticed changes, or residents who have fallen to determine the best course of action to ensure the resident’s optimal care and safety. A good RN consultant is worth their weight in gold and can be an enormous asset to helping you care for the residents the right way the first time, every time.
I enjoy helping new business owners be successful. I commit myself to being a sort of “business partner” with them – helping to ensure their success by giving them the best advice and service possible."
What do you love the most about the work you do?
I love helping others. I enjoy helping new business owners be successful. I commit myself to being a sort of “business partner” with them – helping to ensure their success by giving them the best advice and service possible. In exchange, I like to see them providing the residents with the very best care possible, which I believe every resident deserves!