How to Start a Home Care Business: Franchise vs. Going Independent

Demand for in-home care keeps climbing. Families want their aging parents to stay safe at home, older adults overwhelmingly prefer to age in place, and hospitals want patients discharged to a supported environment. For an entrepreneur who wants a business with real purpose, a home care agency is one of the most rewarding paths available.

This guide walks through what it takes to start a home care business. It also covers one of the biggest early decisions: buy a home care franchise, or build an independent agency from scratch?

Step 1: Decide what kind of care you will provide

“Home care” and “home health” are often used interchangeably, but they are different businesses:

• Non-medical home care (also called private duty or personal care) covers help with daily living: bathing, dressing, mobility, meal preparation, companionship, transportation, and medication reminders. Clients usually pay privately, through long-term care insurance, or through certain VA and state Medicaid waiver programs.
• Home health provides skilled, physician-ordered medical care such as nursing and therapy. It is typically billed to Medicare and requires certification, clinical leadership, and a much heavier compliance burden.

Most new agencies start with non-medical home care, which has a lower barrier to entry and a simpler payer mix. Some franchise brands also set professional requirements for owners. At All Hours Home Healthcare, franchises are awarded only to licensed healthcare providers, and each location offers both medical and non-medical home care. For a deeper comparison, see Home Health vs. Home Care: Which Business Should You Start?

Step 2: Research your market

Before you invest, understand the demand where you live:

• Senior population. How many adults aged 65+ and 85+ live within your intended service area, and how fast is that number growing?
• Household income. Private-pay home care depends on families who can afford it.
• Referral sources. Count hospitals, rehab centers, physician practices, assisted living communities, and elder-law attorneys. These relationships will drive much of your growth.
• Competition. Note who already operates locally, what they emphasize, and where the gaps are (for example, reliable overnight and 24-hour care).
• Caregiver labor pool. Your growth is limited by your ability to recruit. Look at local wage levels and competing employers.

Step 3: Understand your state’s licensing rules

Home care licensing is set state by state. Some states require a formal license with an application, an office inspection, policies and procedures, and an administrator with specific qualifications. Others have registration-only requirements, and a few have minimal oversight. Licensing timelines can range from a few weeks to many months, and they often drive your overall launch date.

Contact your state’s department of health (or the equivalent agency) early, or work with a franchisor that has already navigated licensing in your state.

Step 4: Build your business foundation

Every home care agency needs:

1. A legal entity and insurance: general and professional liability, workers’ compensation, non-owned auto, and a fidelity or crime bond.
2. An office: often a modest professional space, since care happens in clients’ homes.
3. Technology: home care scheduling, electronic visit verification (EVV) where required, payroll, and billing.
4. Policies and procedures covering client intake, care plans, caregiver supervision, incident reporting, and privacy.
5. Working capital to cover payroll before client payments arrive. This is one of the most underestimated costs.

Step 5: Recruit and retain great caregivers

Caregivers are your product. Agencies that win treat recruiting as an ongoing marketing function, not an occasional task. They also invest in onboarding, training, recognition, and flexible scheduling. High retention means more consistent care, happier clients, and lower costs.

Step 6: Market to families and referral partners

Families typically find home care in a moment of crisis, often after a fall or hospital stay. To be the agency they call, you need:

• A professional website that ranks in local search
• A complete, well-reviewed Google Business Profile
• Consistent relationship-building with discharge planners, case managers, and senior living staff
• A fast, compassionate response when the phone rings, including after hours

Franchise vs. independent: an honest comparison

	Home care franchise	Independent agency
Brand recognition	Established brand from day one	Built from scratch
Systems & training	Proven playbook, manuals, and initial training	You create everything yourself
Licensing help	Guidance from people who have done it	Self-directed research
Upfront cost	Franchise fee plus startup costs	Startup costs only
Ongoing fees	Royalty and brand fund contributions	None, but you fund your own marketing and tools
Flexibility	Operate within brand standards	Complete freedom
Support network	Franchisor team and fellow owners	Consultants you hire, if any

A franchise tends to make sense if you are new to owning a business, want to shorten the learning curve, value a proven system, and want a team behind you. For licensed healthcare providers, a franchise like All Hours pairs your clinical expertise with the business training you may not have had.

Going independent may suit you if you have deep home care operations experience, already have referral relationships, and are comfortable building every system yourself.

Either way, success comes down to leadership, caregiver culture, and relentless focus on quality care.

Next steps

If you are a licensed healthcare provider and a franchise sounds like the right fit, read why All Hours franchises are awarded only to licensed healthcare providers, then learn what an All Hours Home Healthcare franchise investment looks like and how our six-step ownership process works. When you’re ready, request franchise information and we’ll set up a no-pressure introductory call.