Caring for the elderly and other adults who need special care can be challenging, rewarding and meaningful work. While starting a large nursing home facility can be quite expensive and involve a lot of red tape, starting a smaller board and care home is more achievable. Small board and care homes typically house six or fewer residents and provide high-quality care in a homelike setting and environment.

Nursing Homes Vs. Board and Care Homes

One of the ways to ensure your board and care home is successful is to understand the difference between the services you will offer and the services larger nursing homes offer. This empowers you to capitalize on your strengths in meeting the needs of families who seek comfortable residential environments for their loved ones.

Nursing homes typically include the following attributes to their care:

  • Hands-on medical care
  • Nursing staff and physicians available on-site
  • Large residential facility
  • Scheduled care and activities of daily living

While board and care homes are also concerned with the health of their residents, medical and nursing care are not available on-site for residents. Board and care homes typically include the following attributes to their care:

  • Help with activities of daily living
  • Housekeeping
  • Nutrition and meals
  • Recreation
  • Transportation to medical appointments
  • Flexible scheduling
  • Small homelike environment or residential home

Assisted Living Vs. Board and Care Homes

Like assisted living facilities that offer independent living options for residents, board and care homes give residents the flexibility to retain the power of choice about many of their activities of daily living. Assisted living facilities are typically much larger than small board and care homes and offer on-site medical care, but not to the level of a nursing home. Many assisted living facilities do not afford residents the same flexibility in choosing outside medical providers as board and care homes.

Create a Vision 

Starting and maintaining a board and care home for adults is a large undertaking, one that will likely energize you at times and challenge you at other times. Intentionally set your vision and be clear about why you are doing this so that you have something concrete to help you create clear business plans, prioritize expenses and endure the wait during the licensing process. Your vision can also help you with marketing and finding residents who will be a good fit for your program.

Some things to consider in crafting your vision include:

  • Why you want to start a board and care home
  • Personal meaning and purpose in starting a board and care home
  • Ways your home is different from the competition
  • Ways your home is different from nursing homes or assisted living facilities
  • Values that undergird what you do
  • Mission statements
  • Programs you want to include
  • Experiences you want to share with the residents

Continuity of Care

Offering continuity of care is one of the things you can do for residents that will help you stand out from the crowd and offer peace of mind to them and their families. This can look different depending on the stage of care each resident needs. For new residents, perhaps they get to keep their existing doctors or home health nurses. As residents require increasing levels of care, it might mean working within regulations in your state to provide home health hospice services or transfer to a skilled nursing facility with a few familiar faces.

Anything you can do to give residents something familiar to hold on to during times of great change will let them know that you truly care and give them a sense of security. This level of care and concern can bring comfort to families who want to know their loved ones are receiving the best care possible.

Funding Plans and Your Success

Just like in any other business, to operate a successful board and care home, you will need a fully fleshed-out business and funding plan. Make sure to include a marketing plan and cash flow plan, as well. If you are a sole proprietor with a good amount of money to invest, you might not need outside capital. On the other hand, if you apply for and receive federal nonprofit status, you might be able to get some funding help through private or government grants.

Funding plans for board and care homes also include considering when and how you will be paid for services. Many homes are private payer only, but you might also consider looking into Medicare, Medicaid and working with managed care organizations.

Staffing Considerations and Plans  

Staffing is vital to operating a successful board and care home, maintaining your facility license and providing exceptional care. Your home will be required to provide staffing around the clock. This means that you cannot have a gap between employee shifts and residents cannot be left home alone.

Ensure that you have a plan for including on-call personnel in your schedule rotation so that you always have backup staffing available. You might also plan to always have two staff members on duty, even if your state only requires one. This way, if someone has a sick kid or needs to leave early, the residents still have the care they are worthy of.

Consider how you will recruit high-quality staff to care for your residents with heart and joy. Contact your local colleges and universities to see if students from medical or psychology programs are interested in full-time, part-time or internship based work at your home. Couple this with some long-term staff with broad experience in the area of elder care in small environments.

Insurance for Board and Care Homes

Board and care homes provide around the clock adult care, which means there is a certain amount of risk assumed in operating the home. Because of this, insurance is key to your success. At the very least, look into obtaining the following forms of insurance:

  • Workers' comp
  • Liability insurance
  • Fidelity bonds
  • Surety bonds

If you retain full-time employees, you might also look into the cost of providing medical and dental insurance to your staff.

Meet Local Licensing Authorities

In order to become licensed as a board and care home, you will need to contact your state's department of health or social services. In many states, like North Carolina, your state will require you to meet with a county representative about your application. During this meeting, rules, regulations, zoning requirements and the application process are explained in great detail. This gives you the opportunity to make an informed choice about moving forward with your home, as well as the opportunity to ask questions of those responsible for issuing your home their license to operate.

Receive Zoning Approval

Receiving zoning approval for a board and care home is typically less complicated than for larger skilled nursing or assisted living facilities. You will need to contact your local zoning board for information on how to proceed. Forms and paperwork will likely require you to state your home's name, the activities you plan to conduct in the home, as well as the number of residents you expect to serve at any given time. You may need to submit a fee with your paperwork and attend a zoning hearing for official approval.

Submit an Application 

With zoning approval in hand, contact your local licensing representative, as well as some basic financial and insurance plans in place, you should be ready to begin the official application process. When you submit your application, you will need to pay a fee to apply, plus a certain fee per bed you will offer in your facility.

Be prepared to provide your name, address, the home's name and to answer whether the home is nonprofit or for-profit. You might also need to provide a certified administrator number or proof that you have applied as an administrator of a small family home. If you are not the owner of the home you will be using, be prepared to provide contact information for the owner, as well as a copy of your lease allowing for the board and care home.

Be prepared to answer to the type of services you will be providing to residents. For instance, you will need to share whether all residents will be above the age of 60 or if you plan to provide care to ambulatory or non-ambulatory residents. Some board and care homes provide services to those with dementia or mental health concerns, while others do not.

Hoops in the Application Process

Once your application has been submitted, be prepared to play the waiting game and jump through hoops before you are issued approval. For instance, in the state of Minnesota, you could wait up to 90 days to hear back after your initial application. As part of the approval process, expect the following:

  • Meet with construction authorities
  • Pass inspections
  • Provide detailed floor plans
  • Medication management training
  • FBI background checks
  • Meetings with social services

Even once your board and care home is licensed and approved, be prepared to have additional inspections every several months or once a year. Your license will also need to be renewed at regular periods, so ensure you have solid policies and procedures in place to help make keeping your license and providing high-quality care a breeze.

Comprehensive Residential Care

One of the ways you can stand out from the crowd of other care homes and facilities is by providing a caring environment or opportunities that are not available elsewhere. Some basics to start with include:

  • Resident housekeeping services
  • Nontoxic cleaning options
  • Resident activities and recreation opportunities
  • Transportation to services or recreation
  • Medication management
  • Delicious on-site meals
  • Nutrition management

When possible, include residents in things like choosing meals, grocery shopping, decorating their own rooms, holiday preparations and activities in the community. Art classes, concerts, plays and unique dining outings are other things you could offer that might help you stand out from the crowd. Perhaps include a reading room, a special garden with a gazebo or quiet places for meditation to appeal to different types of residents.

Special Situations

Many residents and their families seek out board and care homes in order to avoid an institutionalized feeling of eldercare. They may wish to extend an experience of personalized care when their loved one is non-ambulatory or when they require hospice. Depending on the rules and regulations in your state and county, your home might or might not be allowed to contract with outside providers to come in and provide specialized care. When possible, this would allow your residents to stay in a comfortable and familiar environment.

When non-ambulatory, hospice or memory care extends beyond the scope of your home or rules and regulations do not allow outside care providers to come in, special planning is important. During a resident's enrollment process, consider planning with families for these eventualities. Many areas offer quaint hospice homes, memory care programs set up like residential neighborhoods or temporary housing for non-ambulatory care.