How To Take The First Step Toward Building Your Senior Care Business!

Portrait Of Happy People Running


With the dramatic increase in the 65+ population, you can practically hear the stampede of entrepreneurs running towards elder care and senior care businesses. I’m often asked for advice on how to get started!

My expertise is in the private pay service areas of elder or senior care; geriatric care management, life coach, counselor,  senior care advisor, non-medical home health agency, bookeeping services, senior moving, cleaning services …

The piece of the elder care or senior service pie that’s paid for privately and harks back to the days when patients paid their doctors with a dozen eggs or bartered services.

My best advice for those of you considering jumping in to the senior care business world is not about business plans or market research (YET)  but it’s about the equation involved in a helping business that often times trips people up!

Purpose + Ambition = Profit

Get clear on your purpose …

For people considering building a senior or elder care business, I recommend you dig deep in to your intentions to understand why you even remotely think you can succeed in the senior “pay for service” market.

If you think you’re going to make a quick million by tapping into the silver tsunami, you may want to re-think that mindset. The hours are long, the stress is high and the issues are complex!

If you think you’re going to save all the elderly people in the world, you may want to re-think that mindset. You really don’t have that kind of superman(woman) power!

tweet-graphic-3Tweet this On the other hand if you feel you have a unique talent, a head for business and a passion for wrinkly old hands, senior care  may be the business for you.

Consider these questions …

Are you clear on why you want to work with older adults? Most people considering a business in this field have already had experience working with older adults and their families. If you haven’t done this, I suggest you find a way to get this experience. Working with older adults is very rewarding but it’s not for the faint at heart. You need to be very clear on why you want to work with elderly people and their families.

Are you clear on why you want to be a business owner? This is a trickier question because I think most of us “helping” type professionals really have no idea about what it takes to run a business. How hard can it be; right? A book that really helped me get clear on my intentions for My Elder Care Consultant is Danielle  Laporte’s Fire Starter Sessions. She mences no words in helping you get clear on what you desire in business and your personal life!

{Danielle’s blog is here———–CLICK}

One of the most important aspects of intentions and exploring if you want to build a senior care business is being honest with yourself. When you dream about your future do you dream of holding people’s hands as they die? Running to the store to pick up something for a client? Dealing with angry family members? Not being able to pay bills on time? Struggling to get a steady flow of referrals? If not, run the other way as fast as you can because owning a senior care business may not be for you!

On the other hand if you have a strong desire to help others and feel you can bring a unique value to someone’s life, you can succeed in this market and be fulfilled in ways you never thought possible.

Become comfortable with ambition…

Ambition is the drive that powers your purpose and this can be tricky for those of us in the helping professions. Ambitions is the external manifestation of your internal purpose. Too often, we think ambition is a dirty word.

Ambition is not a dirty work and it is the key to fulfilling your purpose in your business; get comfortable with it!

Are you uncomfortable with your ambition?

Identify and visualize the intersection where your passion and ambition cross; this is your business purpose. Your ambition will be the reason you push through some of the challenges mentioned above and move forward with creating your business.

Without passion and ambition aligned, your purpose for creating a senior care business will be unclear, unfocused and you could end up broke. It’s impossible to help others if you are broke so let your ambition be a BIG part of our business plan!

True Story Time…

I participated in a creative workshop recently and was paired with another woman to explore our intention for the new year. I’m seriously passionate about what I do and don’t hold back in expressing that passion. Personally, I’m driven by the knowledge that regardless of age, physical limitations or cognitive impairment there is always a way to bring meaning to the late life experience.

I know I can help aging families make the late life experience the best it can be and I want to do it in a way that’s financially and emotionally rewarding to me; I make no apologies!

When I finished expressing all this to my intention partner, she says to me “you’re very driven and ambitious”. To be honest, I wasn’t 100% sure she meant it as a compliment but I went and took it as one {instead of crying}. What I’ve learned is that without drive and ambition I cannot fulfil my business purpose to make the late life experience the best it can be for my families.

When it all comes together, my purpose is fulfilled, my client’s are happy and I make a living fulfilling my purpose! 

Explore your relationship with money…

You will come up against a lot of negative people that somehow think that helping people should be done for free and profit should not be part of the equation. Maybe deep inside you struggle with this concept. I admit that I’ve struggled with this as well.

I’m here to tell you that the relationship between a client paying me privately and me working directly for them versus government regulators and corporate big wigs is the purest form of a professional helping  relationship there is. It works for me; it works for my clients.

You need to be honest with yourself.  If you have any doubts at all about the senior care business model of accepting private pay clients versus tapping in to the Medicare/Medicaid/Insurance market, you need to step back and do some soul searching…

If you struggle with the concept of charging for helping services and making a profit, listen to the words of Kate Northrup from her book Money; A love Story…

“Just remember, you don’t have to give up your wealth or health to give others wealth or health. There’s plenty of wealth and health for everyone. It’s like oxygen in our atmosphere. Imagine how insane it would be to believe that we have to hold our breath because we’re afraid that if we breathe deeply the person next to us won’t have enough air. Similarly, sacrificing our own financial needs so that we can help someone else is misguided. It comes from a good place, but it doesn’t work”

{Kate’s blog is here——————–CLICK}

This applies to our ability to create successful senior businesses and help older adults and their families. We can’t care for aging families for free and help the next family that will so desperately need our help and, trust me when I tell you, there is a long line of aging families that need our help.

If your relationship with money is messed up, you will forever be undercharging, under billing or heaven forbid giving your product or service away for free. This is not a business model you can sustain and without a financially solid business you can’t help older adults and their families.  So get your relationship with money ironed out before you open your senior care business.

Questions To Ask Yourself

1) What is my purpose and what is motivating me to explore the senior care business world? Do I want to help? Financial freedom? Am I truly driven and ambitious enough to push through the hard times?

2) When I get that little twinge of guilt about charging for my senior care service, what is that really about? Is it about wanting to be liked? Is it a deep seeded desire to please (a BIG reason many of us gravitate towards helping businesses)?

So if you’re exploring the possibility of creating a private pay senior care business does this resonate with you? What hurdles do you face? Have you thought about how to overcome these hurdles?

If you found this article helpful, please share or leave a comment!


Strategies for Dealing with Difficult Aging Families

Stressed Nurse

As a geriatric care manager, I’m often called when a difficult family has created disruption and chaos with service providers and their staff.  A geriatric care manager can help elder care and senior care providers cope and care for difficult families in an attempt to ensure that the older adult continues to receive the care they need. My role is to collaborate, strategize, problem solve and communicate in a way that bridges the gap between the difficult aging family and the organizations that care for them. All this naturally translates in to improved quality of life and care for the older adult.

Let’s not kid ourselves…

When you work with aging families, you have a long list of stories about families that pushed you to the limit and required more patience than the average family. Difficult aging families can create chaos in an organization and can even impact the care other clients, residents and patients receive. If left unchecked, they can bring an organization to its breaking point and create burn out with staff. Dealing with difficult aging families is especially challenging when there is a vulnerable older adult in the eye of the storm and we, as professionals, have to stay engaged with the process (i.e. the difficult family) in order to protect, provide care and advocate for our aging client, resident or patient.

Difficult aging families come in many forms and sizes…

Contentious: the family that right off the bat starts arguing over doctor’s orders, cold food and lack of response. They see an argument at every corner and everyone is the enemy. They may want to complain about old family grievances and family arguments break out in front of us. Arguments so intense we are sure the grievance occurred yesterday only to find out it was 30 years ago. They continue to complain about issues that have been resolved; over and over again. You find yourself always defending yourself and your care team’s actions. You hear that voice inside your head: “there is no pleasing this family”!

Time Consumers: the family that seems to think their mom or dad is the only person you have to care for. You give advice, educate, rearrange the covers, close the blind, straighten up the home, answer more questions but it’s never enough. They call you at all hours of the night and refuse to accept time constraints when you attempt to set a boundary. This family can be self-centered and unable to see that others around them also need help. They start taking valuable time away from other clients/residents/patients and you find yourself hustling to get your work done by the end of the day. We all know that charting and documentation doesn’t write itself.

Denial: the family that despite all the evidence that mom may be actively passing they want the doctor to order an MRI to uncover some disease that can be cured. You provide education and communicate but it falls on deaf ears; you start to doubt and question yourself. You find yourself feeling like you’re talking to a brick wall. The denial is making it impossible for your client/resident/patient to receive the care they so desperately need. It’s at this point that the denial has become problematic and needs to be addressed.

Volatile: the family that at one moment appears to be engaged, complimentary of care and part of the care plan process and the next minute they are accusing you of abuse and incompetency; Dr. Jekyll and Mr. Hide. You never know what to expect or how far their outburst will go. They can be confusing and rope you in with a false sense that everything is fine and then the light switch goes on (or off).  Their anger is so scary that you take a step back and wonder if you should call in reinforcements. It’s difficult to know what to expect and you find yourself shying away from them when you go for a home visit or see them walking down the hall. I’ve been known to dodge in to an office to hide from this family!

Triangulates: the family that has a tendency to pick sides, pit people against one another and create chaos in relationships. They get along with people who see their side of things and if you don’t look out.  They will do their best to create chaos within your team to take the attention away from their issues or problems.  They are vindicated when you take their side and they thrive on tension between family members and staff members. They may even “stretch the truth” a little to pit people against one another. As a team, you start to disagree about the best course of action and tempers flare.

I’m sure as you read down this list various families and scenarios come to your mind…

I don’t have the time or expertise to go in to the underlying psychology involved with difficult and dysfunctional families.  What I want is for you, as a professional, to be able to identify that you are indeed working with a difficult aging family, identify their pattern and create strategies that work for you and your team ultimately leading to better care for the older adult you care for.

Strategies for Working with Difficult Families

Compassion: as difficult, inappropriate and volatile as dysfunctional families can be and as much as you’d like to run away from them, they need your help. Have compassion for the fact that they are scared. Their aging parent may be the glue that has held their family together and without mom or dad they don’t know how to function. The family in denial may not be able to face the fact that they’re mother or father may be dying. Understand the sadness this difficult family is experiencing and express compassion towards them. Your compassion may be able to break through the denial and disarm the dysfunction. Compassion may be the bridge to better understanding.

Boundaries: you don’t have to “by in” to the dysfunction nor should you tolerate abuse from difficult families. Set a boundary and be very clear that you expect respect and cooperation from the aging families you work with. This does not mean that you should discourage a family from complaining or voicing about care or treatment but they must do it in an appropriate way. Also, learn to set a boundary with yourself and not “take on” the burden of providing perfect care or making all your difficult families happy. You may want to consider transferring someone off your case load to get a break and re-group.

Pro-active: be proactive in the way you communicate and care for their aging family member. If you notice something “not quite right” address it right away don’t wait for the difficult family to discover the problem and bring it to you.  Educate in advance and provide service beyond what they expect. For me, this is the strategy I prefer as it’s simple and inexpensive. By being proactive, you take away some of the fuel for their dysfunction and you disarm them from the ability to triangulate or become argumentative.

Teamwork: if you give the difficult aging family mixed messages, you might as well throw gasoline on the fire. Your entire professional team needs to be aware of the difficult or dysfunctional family and work together to help them. If the family that triangulates is unable to pit you against one another, they will be forced to deal with the issue at hand or if you all communicate the same prognosis a family may be able to come out of their denial and start dealing with the issue at hand. I guarantee you that if you send mixed messages and confusing information, the difficult family will escalate. The key is for the entire clinical team to be communicating the same message and when the family attempts to triangulate or head back in to denial, go back to the message. Don’t underestimate the power of a high functioning team!

Expectations: don’t expect too much from a difficult family; they may never want to hear what you have to say and they will certainly not become emotionally healthy while you’re working with them. Also, be realistic in the expectations you communicate with them in regard to care and services. Don’t promise something you can’t deliver. This goes back to the concept of boundaries but realistic expectations can set the stage for the difficult family. When we communicate clear expectations and set the stage for a difficult family, this can be a huge relief for a struggling family in chaos.

If you or your elder care organization is coping with a difficult aging family before you start talking discharge, utilize community resources that can assist in helping your difficult family and care team cope. Consider working with a geriatric care manager, counselor, ombudsman or mediator to help you with difficult families. It can really pay off in the long run….






Physical Therapist, Occupational Therapist and the Geriatric Care Manager


A physical and occupational therapist can assist with mobility or activities of daily living but often they find their clients need assistance with life care planning and the “big picture” of their lives. It’s not uncommon for therapist (by default) to take on the role of geriatric care manager. This can become uncomfortable when you’re acting outside the scope of physical or occupational therapy. A referral to a geriatric care manager and ongoing collaboration can take the stress and worry out of therapy sessions and put the focus back on the clinical  experience.

Collaboration between physical therapists, occupational therapists and geriatric care managers can be critical when an elderly client is struggling to reach their goals and maintain their independence: depression, anxiety, poor family support, unmet critical needs, long-distance families, poor problem solving skills are just a few indicators that a referral to a geriatric care manager may be in order. As a therapist this conversation can be uncomfortable so therefore the referral doesn’t get made and everyone continues to struggle.

Overcoming Barriers to the Referral

While the therapist sees the value in working with a geriatric care manger (no doubt it makes their life a little easier) but how do you get the aging client and family to take a leap of faith and say yes to the referral?

Without a doubt the number one barrier for physical and occupational therapist in referring to a geriatric care manager is the perception that it is “too expensive”. Since a fee for service geriatric care manager is not paid for by insurance or Medicare the perception for a lot of people is that they can’t afford the service and expertise of a geriatric care manager.

I contend that the average person can’t afford not to hire a geriatric care manager. With the average cost of a consult being under $200 and a clarity session being as little as $65, the benefits gained such as improved communication and quality of life far outweigh the money you stand to lose because of poor planning, miscommunication and lack of knowledge about available resources.

Ways a Geriatric Care Manager Can Help a Therapist Help Their Client Reach Their Goals

Service Coordination - often times physical and occupational therapist are able to identify unmet needs but are unable to assist in locating and coordinating the appropriate services. A geriatric care manager is able to collaborate with the therapy team by providing service coordination and reporting back any additional concerns and updates.

Transitions – a physical or occupational therapist may be the professional that indicates a need for additional care or a move to assisted living. The geriatric care manager can provide the client with resources and education to assure that the best individual solution is identified. They can also assist with the actual move and transition to a new home.

Additional Screens – while physical and occupational therapist focus on the physical it’s not uncommon for the emotional to get in the way of reaching therapy goals. A geriatric care manager is able to provide additional mental health screens such as a geriatric depression screen or quality of life assessment and additional mental health screens such as a geriatric depression screen or quality of life assessment and report the results to the physician and the rest of the clinical team.

Medical Management – facilitate communication between doctor, client, family and other health care providers to assure that everyone is on the same page and working towards compatible goals.  A GCM can also monitor adherence to medical orders and instruction: strategize interventions if necessary and recommend appropriate resources.

Family Meetings – let’s face it, it’s becoming more and more common for family dynamics and friction to interfere with the goals of therapies. A family that is not engaged with the process can easily side track your client and create challenges in reaching goals. A family meeting with a geriatric care manager can clarify the issues and create consensus in moving forward.

Ongoing Monitoring – physical and occupational therapist have insurance and Medicare guidelines they must meet in order to receive reimbursement. For therapist, this means they sometimes have to discharge a person from their case load even though they have concerns about their care and well-being.  A fee-for-service geriatric care manager can be that safety net that provides ongoing monitoring and the ability to refer back to the therapist as needed.

When the therapist and geriatric care manager work together for their clients, they offer a holistic and comprehensive approach that is unique in the world of health care.  A comprehensive approach ensures that the goal of maximizing an older adult’s independence and quality of life are met and clients are satisfied with the care they are receiving and the life they are leading. The leadership and client focus that the GCM brings can empower the entire team, including the client, to work towards care plan goals and maximizing potential.

If you are a physical or occupational therapist exploring ways to refer your clients to a geriatric care manager or integrate geriatric care management into your therapy company, I’d love to hear from you.

LuAnn Smith, email: or phone: (970) 223-5656

Your feedback is always appreciated!

Aging Parents: Let’s Talk Home Health Care Agencies!


There are two different types of home health care agencies that I want you to be familiar with: Medical and Non-Medical. Depending on your location, you may or may not have a lot of options but basically the following information will educate you about what to expect and help you with your elder care planning…

Non-Medical Home Health Care; these agencies can provide assistance with chores, errands, light house cleaning, cooking, transportation, bathing, hygiene, dressing, ambulation and companionship. Their employees are probably not going to be certified nursing assistants but are most likely to be personal care assistants that have been trained by the agency.

My experience has been that the majority of agencies take their training seriously and they monitor their employees to ensure that quality service is being provided. You will not find physical therapist, occupational therapist, registered nurses or social workers in the non-medical home health agency.

Cost: The cost of non-medical services in Northern Colorado varies depending on need but a good ball park figure is approximately $20 an hour. If you purchase service 24 hours a day that cost can be as low as $14 – $15 an hour. This service is paid for privately unless you qualify for some type of home based community service through your county aging programs. Contact your local area council on aging for guidance on this. Don’t assume that you don’t qualify; ASK!

Medical Home Health Care; You’ll find registered nurses, physical therapist, occupational therapist, social workers and certified nursing assistants at the medical home health agency.  The medical home health agency is driven by the Medicare dollar. The care provided under the Medicare A benefit is limited and a person must meet the requirement of being “home bound” in order to receive this service through your Medicare A benefit. This is a short term benefit and is typically a short term solution to a long term problem…

Cost: This service is covered under your Medicare A benefit on a limited basis. There will probably be a co-insurance that you will be responsible for. If you have Medicare supplemental insurance, they should pay the co-insurance and the agency should bill them.

Keep these points in mind

  • Medical Home Health is driven by Medicare dollars and regulated by the Federal Government. Therefore, they are limited in scope and what they can do for you. They can only provide services related to the skilled need.
  • In some areas such as Northern Colorado, some agencies provide both medical and non-medical home care which can be confusing as they have the businesses structured independently to meet government requirements (back to above point).
  • Worried about your aging parent at home but they haven’t had a hospitalization, don’t appear to need therapy or a nurse to manage medical treatment? Call a non-medical home health agency.
  • Is your aging parent in the hospital waiting for discharge? Start asking the discharge planner about getting a referral to a medical home health agency and ask about the specifics in terms of coverage and what the clinical team is recommending in terms of follow-up care.
  • You may need both non-medical and medical home health care at some point. The non-medical to assist with day to day living needs and the medical to assist with medical needs as well as physical and occupational therapy.
  • In Larimer County, Colorado there are over 30 home health agencies and more coming in to the market every day. In Blackford County, Indiana, I found 3 home health agencies. Not all regions have the same resources and practices. Always start your search locally.

I hope in some small way you find this information helpful and you feel a little better  equipped to make decisions about home health care agencies.

If you continue to find yourself confused about home health agencies and you’re not sure which fork in the road to take, a clarity session may be helpful so you can ask questions and receive advice about your individual situation …

Aging Parents: Hospital Discharges

Hospital discharge planning is the process of developing a plan post hospitalization for an individual to receive appropriate services {think home health, rehab or nursing home}. The hospital by law must identify, at an early stage of hospitalization, all patients who are likely to suffer adverse health consequences upon discharge. For our purpose, this identification begins at the time of admission when your parent presents their Medicare card. The nuts and bolts list of what is required of the discharge plan process is very lengthy {dare I say boring} but what you need to know is this:

  •  The doctor following your parent in the hospital is the one driving the discharge time frame. If your primary care physician is not following in the hospital they cannot write orders regarding your treatment or hospital discharge.
  • That physician is very aware of the Medicare A guidelines in terms of billing and believe it or not their hands may be tied. This all relates to diagnostic related groups which you can read more about here…
  • If your hospital says to you: “I’m sorry but we’ve assessed your mother and believe she does not need a discharge plan” you can have your physician request one.
  • A discharge planner is responsible for arranging the services your parent will need at the time of discharge. Your discharge planner may be referred to as a care manager, social worker or registered nurse.
  • You have the right to appeal your discharge and there are very specific steps in place to do this. Speak with your physician, discharge planner or patient advocate for specifics.
  • The hospital indication that it’s time for discharge does not mean mom is ready to live at home independently but that the condition she was admitted for is stabilized and her time under Medicare A has come to an end.
  • Your hospital discharge planner will provide you with a list of available services i.e. home health agencies, skilled nursing facilities and can provide you with education but cannot give an opinion or recommend a specific organization.
  • Be open and honest with your discharge planner. If your dad was struggling at home before this hospital admission, he will probably need additional help {either at home, rehab or nursing home, companion care} at the time of discharge.
  • In order to receive skilled Medicare A services following the hospital admission, your mom or dad needs to be in the acute care setting for a minimum of 3 DAYS! This means that if discharge to skilled rehab happens on the 2nd day your parent will not receive inpatient Medicare A coverage for their rehab. Be aware, ask questions and advocate!

A discharge planner’s job is a pressure cooker type job with high expectations and huge case loads. I recommend that within 48 -72 hours of your parent being admitted to the hospital {depending on the situation: if it looks like a short term stay move quicker} YOU ask to speak with your discharge planner. The RN on the floor or someone at the nurses’ station should be able to provide you with the name of your discharge planner and how to get in contact with that person.

I’m happy to answer any questions you may have! Leave a comment…