Rewards of and Critiques for Private Duty Home Care

PIC - PRIVATE DUTY HOME CARE CLIENT SHOTBecause we work with over 300 home care companies, we listen to a variety of operational concerns associated with rendering home care across America and those affecting many of our foreign clients as well. For this reason every now and then I provide what we believe are some helpful critiques that can help you avoid some of the landmines others have faced while enjoying the rewards this wonderful business model can provide.

I.   Agreements:

a. One civil attorney we asked to contribute to this dialogue told us to remember to ensure there is an arbitration clause in each agreement. You do not want people dragging you into courts for every little thing that could be easily resolved in conversation. There are clients, client family members and plenty of underhanded lawyers who clog the court system with frivolous complaints and who will invest the $100.00 or so filing fee to make your life miserable in an unethical money grab.

At least forcing them into arbitration (which can be a $900.00+ filing fee) ensures they think twice before trying to make you the victim of a shakedown.

b. Additionally you need to have language that makes it clear that if the client hires your employee away from you in an effort to save money, your workers compensation and general liability coverages no longer apply and they are required to pay you a one-time fee of $10,000.00 and whatever you would have likely earned from that person’s services for the next one, (1) year.

Remember employees sometimes offer their services by reminding the client that money can be saved. At other times the offer comes from the client or client’s family so be sure and word such a clause in a manner that makes it clear it does not matter who made the offer, the client or their representative.

II. Introductory Information Kits Left in Home

When you open a new case it is customary to leave an information kit in the home. I have long advocated this for private duty companies just as skilled companies do. I just wanted to make sure we leave the right things in such a kit.

First be sure there are rules governing care. Leave these rules in the folder even though you verbally covered them then the case was opened. This includes to what extent your employees can receive gifts. It is often good policy to place limits on this which eliminates the likelihood that employees will solicit favors from wealthy clients.

Be sure and leave an actual copy of the Home Health Aide Activity Form (preferably as a sample already completed) so the client and their families know what has to be signed by them in order for your employee to be paid. This also alerts them that staff must document what services are being performed which puts them on notice that they are there to serve the client, not the entire family.

III. Introducing New Staff

I always lived by the rule that a stranger never approached a client’s home. Whenever I opened a new case a supervisor, normally the one who had opened the case, had to go along and officially introduce new staff to the home and spend some time covering the routine.

This eliminates the possibility that a stranger is approaching the client’s front door from your agency and allows a supervisor to observe them in action on the case.

IV. Cameras

PIC - CAMERA COLLAGEI remain an advocate of cameras when the client lives alone. They can be placed in the living room, hallways and other common areas and allow you to monitor your staff’s activity while on duty. Of course they are never installed in bathrooms or bedrooms.

These protect your client, personnel and your agency. Just be sure you have permission before these are installed and that you can monitor them on-line. A good source is

Be sure you have a signed release from the client or their authorized representative before the installation that acknowledges that the equipment belongs to you and is removed in the event services discontinue.

V. The Day Overlap

Save yourself from payroll confusion. Sometimes a shift may start on one day and end on a different day, for example when someone works 7:00 p.m. on one day until 7:00 a.m. the next. So design your documentation to record that. See example below:

Shift Start Date/Time Shift End Date/Time Your Name Location

VI. 24 Hour Services

Of course the most profitable cases are those that operate around-the-clock. I serviced tons of these. On average I charged $21.00 per hour for a gross monthly income of: $15,276.24. With staffing costs including the allocation of my insurances my monthly case expenses averaged $10,184.16 leaving me with $5,092.08 monthly per case.

PIC - 24 7You build wealth by serving multiple 24-hour cases. You build an outstanding reputation by providing high quality services via well-trained and well-supervised staff. Remember ideally for every five, (5) around-the-clock cases you add one, (1) field supervisor and that person keeps an eye on these cases, inspects personnel, conducts care conferences with the client and their representatives, etc. In some cases companies have a field supervisor for every seven, (7) cases.

You will have to decide what works for you but do not allow your field personnel to go unsupervised. I kept a close eye on my cases and numerous referrals came from their families.

VII. Billing

Normally I recommend you bill monthly. You will have no choice with Medicaid waiver cases as you normally bill each month for services rendered the previous month. Most states now insist on electronic Medicaid billing and payments are electronically deposited.

With those cases paying you privately I recommend you bill biweekly so you are not leaving so much money in the street. Bill for the first two, (2) weeks in advance of case commencement so your payroll is in the bank before the first payroll for that case is due.

Some have asked me about marketing to Michigan no-fault cases and caring for them in Florida, Georgia, Texas and other warmer states which many of the catastrophically injured prefer. I will speak to this in a July webinar which will be posted two, (2) weeks in advance on-line at

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