The home care business is looking at significant growth in the coming years. The U.S. Bureau of Labor Statistics estimates that, even with a global pandemic, over 1 million home care jobs were created during 2020.

As a business owner, this presents a huge opportunity to provide health care to aging patients in the comfort of their own homes, all while building a profitable home healthcare business in a growing industry.

Thinking about starting a home health care business? By partnering with a home care franchise, you’ll get access to seasoned advice for creating a business plan, company description, marketing plan, and operational plan so your business can hit the ground running.

All you have to do is decide which state is the best choice for starting a home health care business.

Article Executive summary:

Why senior home health care is a growing industry

Before starting a home care business franchise, it’s important to understand why home health care agencies are in growing demand in most states.

There has been a big shift from traditional care to home care in the U.S. as older adults are forgoing long term care facilities in favor of in home care provided by medical professionals and personal care aides. Affordability plays a big part, as does the general shift in the public perception of the home health care industry.

The population of the United States is aging at a faster rate than it is being replaced. Some estimates suggest that over the next 20 years the number of older adults will increase exponentially, and, because fewer children are being born each year, there will be one senior for every 2.5 people of working age. This means that hospitals, live in facilities and rehab outpatient centers will run out of space very quickly.

Fortunately, the home care business is prepared to pick up the slack. Given the nature of home care, and elders playing a larger part in choosing their own healthcare options, the industry is projected to continue to grow well into the future. In other words, starting a home care agency in a U.S. state is a strategic business move.

Choosing to start your care business alongside an established franchise partner can be a quicker way to get your business plan up and running, so you can start seeing profits.

Home health care services are affordable

From doctors appointments to nursing home care, the costs of medical care for elders can reach upwards of $60,000 per year. Medicare doesn’t cover any of that medical cost, and only a few third-party insurance providers provide coverage for long-term care facilities.

This can negatively affect a client’s family’s financial plan, especially when you take into consideration that a senior’s savings and income for medical care often don’t stretch that far. Starting a home care business can provide a more affordable health care option for these families. With home care costing less than half this amount, aging in place makes much more financial sense for aging and chronically ill seniors and their families.

If the lower cost is taken into account, starting a home care becomes easier to plan for, especially because both Medicare and third party providers do cover some, if not all of the costs.

Home health care is safe

Once considered an afterthought, home care is increasingly top of mind when elders and their families are looking at safer care options. The coronavirus pandemic has made starting a home care business the obvious choice when it comes to keeping elders safe at home.

Approximately 40 percent of deaths due to Covid-19 in the U.S. happened in nursing homes or other types of long term facilities. Added to that, the inability of residents to be with their families after the doors to these places were closed as a result of the emergency, placed a heavy burden on the future of this type of care. This has opened a doorway for the home care agency to thrive.

Given what we’ve learned about the need for families to be active participants in the health care of their family members during the pandemic, it is almost certain that they will continue to choose a home healthcare agency over residential facilities in the future.

As the coronavirus pandemic quickly approaches its first anniversary, we are already starting to see these changes take place. The home care business continues to give seniors the choice to stay safe at home while strictly following CDC guidelines. With the addition of telehealth options, patients and their families are already seeing an increase in the quality of healthcare their seniors are receiving, which bodes for a brighter future for the home care industry as a whole.

As families start to move away from the nursing home and assisted living facility models of senior care, the home health care business has moved to the forefront of the possible options for the elderly, especially during and after the pandemic.

With the right business plan, starting a home care agency is a viable business investment with excellent returns in the short to mid-term.

(We have a separate blog that speaks to the state of home care business post Covid-19. Take a peek!)

Home health care keeps seniors in their community

One of the best parts about starting a home care agency or business is the wide selection of services your professional caregivers can provide to clients in care—especially to elderly patients who require help with their day to day activities.

Unlike nursing homes, a healthcare agency can provide transportation to local physicians appointments, senior centers, local yoga classes, or coffee dates with friends. This helps seniors stay engaged in their community and prevents isolation which can lead to poor mental health.

A professional caregiver can help seniors with everyday tasks such as:

  • Personal care including bathing, grooming, and getting dressed
  • Support senior citizens with grocery shopping and other errands
  • Help seniors prepare meals in the comfort of their own home.

Not to mention assisting senior citizens with light medical care and nursing care including physical therapy, blood pressure checks, mental state checks, wound care, medication monitoring and other health services. This can be especially helpful for seniors who don’t need around-the-clock care, but could use some personal care assistance a few times a week.

Home care post covid-19

Do home health care businesses provide better care?

Starting a home care agency is a rewarding business endeavor. Maintaining a senior’s highest level of care is also more practical with a one on one approach to home care services. Each home health care provider will only have to care for one patient at a time, increasing the quality of care at the same time the patient’s quality of life is improved.

It also allows for clients to take an active role in their care while maintaining their independence. With the future looming on the horizon, home care is no longer an issue to be decided on the fly, and because of its essential nature, it has become a part of a person’s life plan.

Hot locations to start a home care business in the united states

How profitable is the home health care business model?

Starting a home health care can be very profitable if you’re willing to work hard and put in the hours. One survey revealed that top home care franchises can gross $1 million or more, with gross margins at 30 percent to 40 percent. Since the target audience of a home health care franchise is elderly people and people who need healthcare support, there is no shortage of clients in this recession-proof industry.

On top of that, senior health care has one of the highest satisfaction ratings of owner satisfaction. According to Franchise Business Review, almost 90% of home care franchise owners say they enjoy their business operations.

With established training frameworks, ownership structure, and a proven business model, franchise owners are set up for success right away. Owners can also keep costs low by operating from their home in the beginning.

The national average cost of home care runs at $22,000 per year, but at a state level these figures can vary significantly.

The best states to start a home health care business

How does starting a home care agency in North Dakota compare to South Dakota? Will a senior medical care business in Rhode Island do better than one in West Virginia? We’ve broken down the data of franchising, and here are our top state picks.

Let’s take a look:


  • Demographics: Once considered to be one of the youngest states, California’s senior population is projected to grow to an estimated 8.4 million people over the next decade, faster than the national rate, a number which will have doubled by 2040.
  • Cost of Care: The average cost of home care in California is approximately $4,600 per month ($55,000 per year). In comparison, the average cost for a nursing home in the state runs about $125,000 per year, which can end up costing families millions of dollars during the patient’s lifetime.
  • Licensing: In California, the Home Care Services Consumer Protection Act requires a home care franchise to be licensed in order to protect patients who allow home care aides into their homes.

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  • Discovery Video – 15 min overview of this opportunity
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  • Demographics: There are approximately 800,000 seniors living in the state of Oklahoma, a number that represents 20% of the state’s total population, with this figure being projected to grow 37% over the next decade. Of these, about 200,000 live alone, with the number increasing as more and more people reach the age threshold and continue to work.
  • Cost of Care: Home care for seniors in Oklahoma costs an average of $4,200 per month, which places it lower than the national average and totals $50,400 per year. On the other hand, the average cost for a nursing home runs an average of $60,000 per year.
  • Licensing: The Oklahoma State Department of Health requires licensing for all senior communities and home care franchises throughout the state.


  • Demographics: There are more than 3.8 million people in Texas over the age of 60, representing approximately 15% of the state’s population. As per the most recent projections, this number is expected to grow to 12 million over the next 3 decades, which makes this demographic the fastest growing in the state.
  • Cost of Care: The cost of home care in Texas can vary according to the exact location, but runs an average of $48,000 per year, whereas the average cost for a semi-private room in a nursing home is around $57,000.
  • Licensing: The Department of Health and Human Services of the state of Texas is in charge of licensing and certifying all senior home care franchises, as well as all live-in facilities throughout the state.


  • Demographics: There are almost a million and a half seniors currently living in Missouri, a number that is projected to grow by and additional half a million over the course of the next five years.
  • Cost of Care: The state average for home care costs in Missouri is $4,200 per month, or $50,400 per year, which is about $100 less per month than the national average. Contrary to that, a semi-private room in a nursing home will cost $60,000, an amount that is expected to increase in the near future.
  • Licensing: The Missouri Department of Health & Senior Services is the office in charge of licensing and certifying all home care franchises in the state.


  • Demographics: It has been estimated that there are currently half a million seniors living in the state of Kansas, with this number expected to grow by 100,000 over the next decade.
  • Cost of Care: In the state of Kansas, a family can expect to pay an average of $48,000 every year for senior home care, whereas the cost of a nursing home would set them back an average of $67,000 per year for a semi-private room.
  • Licensing: The responsibility for licensing, certifying and inspecting senior care facilities and franchises in the state of Kansas is the Kansas Department of Health & Environment Bureau of Health Facility Regulation.


  • Demographics: The state of Virginia has a total population of 7.7 million residents, of which approximately 12 percent are seniors over the age of 65. This translates to a little less than a million senior citizens living in the state, with this number expected to grow significantly over the next decade.
  • Cost of Care: Home care costs in Virginia are significantly lower than the national average, with an annual total of approximately $48,000, or $2,000 per month. In opposition, the cost of a semi-private room at a nursing home averages $82,500 per year.
  • Licensing: The Virginia Department of Health – Office of Licensure and Certification is the entity in charge of granting licenses and certifications of home care organizations, as well as conducting periodic inspections to ensure compliance with state laws.

Access Your Welcome Package which includes

  • Discovery Video – 15 min overview of this opportunity
  • Franchisee Testimonials
  • The Nurse Next Door opportunity
  • Access to our calendar to book a 1×1 call.
Watch Now