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
By Guest Author Yohannes Zewudie with Yohannes Tax & Accounting
The Oregon Department of Human Services identifies adult foster care home licensees as independent business owners. Owners, who are responsible for Adult Foster Home (AFH) businesses are usually expected to wear so many hats to discharge their responsibilities and achieve their company’s vision. Trust and relationships created with owner(s), customers, employees, government (federal & state) agencies and the society determine the success of businesses.
Small businesses, including adult foster homes, deserve the opportunity to be successful in their line of business. Regardless of the business size, accounting as a profession plays a significant role in creating a conducive environment for success. It is with this in mind that I argue small businesses should consider having an accountant if not a certified public accountant (CPA) to achieve their ultimate goal.
Here are seven ways an accountant will benefit your adult care home business:
1. Effective and Efficient Business Management
Businesses need historical, current and projected financial information to make the right decision in their business. Without complete and accurate financial recordkeeping and reporting, a small business owner cannot say for sure the true profitability of his/her business. Small businesses that tend to measure their profitability and success based on available cash flow or bank balance are only looking at one criterion. Business owners who rely on incomplete or wrong information usually make decisions that impact their business negatively.
Accounting, as a support function to owners, is tasked with recording business financial data, analyzing them and generating timely and reliable financial reports to show the true picture of business status and profitability. It is for this reason that small businesses need accountant who can assist them in running and evaluating their business.
2. Peace of Mind
In the ever increasing federal and state regulatory environment, small businesses are required to comply with various tax laws and regulations. Among other, businesses including AFHs have to report:
Many AFHs are not well-equipped to meet these and other regulatory and compliance requirements. Having an accountant who properly handles these mandatory compliance requirements gives AFH owners peace of mind for them to focus on other important business matters.
Having an accountant who properly handles these mandatory compliance requirements gives AFH owners peace of mind for them to focus on other important business matters.
3. Ease of Annual Business and Personal Income Tax Reporting
The United State Internal Revenue Service (IRS) and the State of Oregon expect taxpayers to:
Small businesses and their owners face challenges in compiling the necessary business records during tax season. Without a good recordkeeping and tracking method, it is daunting for small businesses to fully meet the tax reporting requirement.
Lack of proper accounting system could result in understated business income and/or deductions that may result in higher taxes, interest and penalties. If the owner or business deliberately attempt to evade taxes or willfully fails to file or pay taxes, they could be subjected to criminal tax fraud cases.
AFH owners can ease the stress associated to tax return filing by hiring an accountant who:
4. Utilize Available Business and Financing Opportunities
More than large and medium businesses, small businesses tend to miss out on available business and financing opportunities due to lack of information or poor financial recordkeeping. The missed opportunity to utilize the Small Business Administration Paycheck Protection Program (PPP) is a very good example. Significant number of small businesses failed to utilize federally available PPP. An accountant comes handy to assist small businesses to have the necessary records and enable them seize these available business and financing opportunities.
5. Quality of Life
AFH owners assume so many duties and responsibilities (manager, receptionist, purchaser, accountant, janitor and many others) in a single day to be successful. Since AFH owners are not expected to be knowledgeable or proficient in every task, they might have to work more than 12 hours a day to accomplish all these tasks. These business burdens make the owners unhappy and inefficient. The opportunity cost of spending too much time at work may also negatively impact their health, family dynamics and other social life.
An accountant can shoulder one burden and perform the accounting-related duties in the right way. Delegating the accounting tasks to the right professional would result in the following:
6. Financial Consultation
Based on available company financial data and their business environment, a certified public accountant can provide knowledge-based financial consultation to AFH businesses. These consultations could have a significant impact on tax savings and business growth.
7. Representation in Federal and State Audits
In case of federal or state audits, a CPA can represent an AFH to handle their audit. Unlike an accountant, which is limited to the return prepared by him/her, a CPA can represent any business in federal or state audits.
"While all CPAs are accountants, not all accountants are CPAs”. A CPA is an accountant that passed the rigorous testing and strict licensing requirement to practice in the state. CPAs are expected to abide by the code of ethics and must update themselves by taking the required continuing educations every year.
A CPA is an accountant that passed the rigorous testing and strict licensing requirement to practice in the state. CPAs are expected to abide by the code of ethics and must update themselves by taking the required continuing educations every year.
The benefits listed above are not an exhaustive list as to why adult foster care homes need an accountant, if not a CPA. It is always advisable for small businesses to reach out to professionals and seek advice on how they can achieve their ultimate business goals.
Article by Alyssa Elting McGuire, MA, MPA
Most hospitals and skilled nursing facilities adopted electronic medical records years ago. Now, larger community-based facilities, such as assisted living and residential care, are slowly adopting electronic health records; however, the adult care home industry has yet to jump on the electronic records bandwagon.
This lag in adoption is likely due to several factors. Adopting electronic records can be more challenging for adult care home providers without electronic record experience who may initially believe they lack the money, staffing, and infrastructure to implement this change. Fortunately, these potential barriers are not insurmountable.
As larger facilities migrate to electronic record-keeping, it is simply a matter of time before more and more providers in Oregon start implementing electronic record-keeping systems in their adult care homes.
One trailblazer in the area of electronic record use in adult care homes is Shannon Carskadon. Shannon owns and operates Silver Cloud Adult Family Homes in Forest Grove and has been in the business for 25 years. I recently had the opportunity to sit down with Shannon to talk about her experience transitioning to an electronic records system earlier this year.
The system Shannon uses is supported through Beaverton-based company Care Facility Management Systems that works with individual adult care home providers to “cost-effectively transition their business operations from paper to electronic records.” Owners Gueipin Xi and Elaine Hartman bring over twenty years of experience providing technical support and security to health care clients.
Interview with provider Shannon Carskadon (Interview has been edited for brevity and clarity)
Have you used electronic records for your homes before?
I used Excel files, which I printed out for licensing, but I had no system set up.
What made you decide to transition to electronic records?
There were current issues [with the hard copy records]. At licensing inspections, the books would be torn apart and nothing got put back correctly. There was too much repetition and similar mistakes. There was a huge potential for medication errors.
Elaine [with Care Facility Management Systems, LLC] called me and asked if I’d be interested in helping build this program for use in other adult foster homes. The company takes care of online security with a private network, and provides training and support to use the system. I was all for it.
Tell me about the process of transitioning your paper records to the electronic records? How long did it take?
Gueipin and Elaine provided me with the hardware and software, set up, and training. They also provide the system security, and ongoing technical support for the electronic records system. The support is amazing. Often, providers are isolated. For me, it feels like a professional system with support and cohesion.
The support is amazing.
-on working with Care Facility Management Systems, LLC
At first, it was about 10-15 hours of work at the first of the month. I first started with medications only [eMAR], and it took as long as it takes to enter medication orders. The eMAR is a no fail system. For example, with a PRN, caregivers have to write the result in the record, or they cannot close the entry. Also, I can easily track narcotics using the system.
There was a learning curve, but my caregivers picked it up quickly. We worked on it piece-by-piece until they were comfortable with each section.
Elaine then came to my home with a large scanner. I scanned all resident records into the system and they’re saved in a secure folder. All the [paper] records I have left are in two binders.
What are some other benefits of the system?
I can send and receive [electronic] faxes to the doctor, and I can have legal representatives electronically sign documents.
We also use the system to document resident activities and facility records, such as smoke detector testing. I can add reminders and tasks for staff. Caregivers log in with an individual login and see the reminders and tasks. I can run reports and look at tasks that were done. I can also see when caregivers read an email I sent.
My data is secure and consistently updated, and I can access the information securely and remotely. If we have a fire or earthquake, I can get into the system remotely and I don’t have to worry about losing records.
Tell me about your renewal inspection after you started using an electronic records system.
It saved a lot of time. The inspection at my first home was in January (2019), and the renewal inspection of my second home was in March. I learned from the first inspection, and had everything ready to go for my second inspection. The licensor was in-and-out in two hours and got everything [the licensor] needed. I had no medication violations.
The licensor was in-and-out in two hours….I had no medication violations.
What advice do you have for other providers who are considering the transition to electronic records, but are concerned about either cost, the challenge of transitioning, licensing, or other issues?
Take the time to learn the program. It’s especially beneficial for multiple homes. I can run compliance reports, and I can check on caregivers remotely and run audits to see who logged in, when, and what actions they took. The program is customized so it meets licensing requirements. If you do your due diligence, the system helps you be compliant.
Finally, the cost is worth it. It’s less than ink and paper, and that doesn’t include the time saved. We’ve been thrilled with this. I can’t say enough positive about it.
About the Author
Alyssa is founder, principal consultant and training specialist with Oregon Care Home Consulting. She has spent the majority of her career providing program service delivery, regulatory leadership, training development, and program coordination and management in government and not-for-profit organizations. She is passionate about helping current and future adult care home providers in Oregon successfully navigate the licensing process and provide quality care to seniors.
Article by Alyssa Elting McGuire, MA, MPA
I was recently sitting in a class on the topic of website marketing offered through the Small Business Development Center, and I started thinking to myself, “why do so many adult care home businesses not have websites?” I’ll be the first to admit I’m no marketing expert, but I can say I recognize the value of a small business having an online presence.
Why, as an adult care home provider, should you invest the time and money into having a website or an alternative web presence for your adult care home business? I’d like to give you seven reasons why you need an online presence that showcases you and your adult care home.
You don’t have to be a web designer or developer to create your web presence. If you have some understanding of website development and design, you can create your own site, but your time is money, so I would encourage you to consider hiring out this service, or using a service that will do the work for you to market your home. Let the professionals handle it. It will be worth your time and money, and you’ll be on the right path to creating a professional, online presence for your adult care home business.