Starting a home health care business in North Carolina could very well be the rewarding venture you’ve always dreamed of doing! If helping and supporting people through their health journey and business is your jam – starting a home health agency in your state of North Carolina may be just for you!

North Carolina Home Care


Starting a business in this field requires navigating the state’s licensing and regulatory requirements and considering the costs associated with launching a business of this calibre, including staffing, licensing, insurance, and marketing.

In this article, we’ll guide you through the process of starting a home health agency in North Carolina, including the licensing and regulatory requirements, the costs associated with starting a home health business, and the necessary steps it takes to establish your policies and procedures.

Is Owning a Home Health Care Business in North Carolina Profitable?

This is the number one question people ask when considering starting their own business. Profit and autonomy are huge drivers for potential business owners. Knowing whether you’re profitable will likely determine whether or not to venture off on your own.

You can breathe knowing that the home health care industry is growing at a rapid pace. According to the U.S. Bureau of Labor Statistics, “healthcare occupations and those associated with healthcare account for most of the 20 fastest growing occupations from 2019 to 2029.” [01] This is exciting for business newcomers. The home health care industry is even projected to reach a market value of $173 billion by 2026.

North Carolina is the 9th fastest aging population in the nation! It is also expected to double between 2015 and 2030. According to the ICA, in 2016, an estimated 688,970 North Carolina residents were categorized as “frail elderly,” “self-care disabled,” or “independent living disabled” and likely needing home care services [02]. Currently, the NCDHHS stated that “North Carolina leaders are projecting shortages in direct care workers and other caregiving positions in the coming decade. The demand for these services is rising. [03]”

Of course, the profitability of your home health agency in North Carolina will likely depend on several factors, including the size of your business, the types of health services you provide, and your pricing strategy. However, with the right plan in place and the proper approach, owning a home health care business in North Carolina may be even more profitable than you hoped!

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Steps to Starting a Home Health Care Agency in North Carolina:

There are many steps to the startup process (read our step-by-step guide on how to start a home care business in 2023).

We’ve given listed nine essential steps to help you start a home health care agency in North Carolina.

1) Create a Business Plan

The first step to starting any business is to develop a solid business plan. A business plan for a home health agency is a comprehensive document that outlines the business goals, strategies, and operational procedures of the business. It typically includes information about the services the agency will provide, the target market, a competitive analysis, financial projections, a marketing plan, and other important details that could influence your future health agency.

A well-crafted business plan is essential for any entrepreneur looking to start a home health agency. It truly serves as your roadmap to your business. One way a business plan can support you in your startup is by providing a clear vision of the business’s objectives, strategies, and how it plans to achieve them. This is a great tool to help identify potential challenges and opportunities and will enable you to make informed business decisions in the future.

Essentially, a business plan is a business bible for your future home health agency. It serves as the blueprint for the agency’s owners and investors, providing a clear vision of its goals, operations, and financial projections. A business plan is also extremely valuable for investors and lenders so that they understand the viability of your home health care business and its potential for success.

For more information on how to structure and create the perfect home health care business plan, visit our article: 8 Steps to a Success Home Care Business Plan.

2) Choose a Business Structure and Register Your Business

A home care agency is a private or public organization that provides home care services in a temporary or permanent residence used as an individual’s home. In order to do business in North Carolina as a home health care agency, you will need to register your business by choosing an appropriate legal structure and get a Tax ID Number and NPI Number.

Business legal structures are important to protect yourself legally. There are different types of legal business structures to choose from. Most companies use an LLC structure (limited liability corporation), corporation, or sole proprietorship. The simplest legal structure to set up is a sole proprietorship, as it is the most affordable. The downfall of a sole proprietorship is that it does not offer personal liability protection. When starting a home health agency, getting personal liability protection and seeking legal structures that reflect this is highly recommended.

With the right legal structure, you can protect your personal assets and minimize your tax liability while ensuring that your home health agency operates efficiently and effectively. We recommend consulting with a lawyer or accountant when selecting a legal structure for your home health agency in North Carolina. They can provide you with valuable advice and assist you with setting up the best structure for your agency.

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3) Obtain the Proper License

In North Carolina, they are very strict on obtaining proper licensing for a home health care business. You will definitely need a license to operate a home care business in North Carolina. Unlike other states, North Carolina has some rigorous licensing requirements that may be difficult to navigate independently. We’ve identified a few things to consider before applying. However, if you require additional support, consider phoning Nurse Next Door franchising support team at 1-855-737-6803, who can help you through the franchise process in North Carolina.

Different licenses depend on the type of home health care business you plan to operate. A great resource to explore is the NC Division of Health Service Regulation. They recommend following the Home Care Initial Survey Checklist prior to applying for a license.

The home health care license application process is quite extensive, and therefore, if you plan to go at it alone, we recommend contacting the NC Division of Health Service Regulation for more information. There are fees associated with obtaining a home health care license, especially if you plan to operate a home health care agency that offers medical services or nursing services. The license fee for an initial application is $560.00, with annual license renewal fees of $510.00. The license fee for a change of ownership is also $510.00. In order to successfully receive a license in the state of North Carolina, you must submit your policies and procedures with your application, along with other requirements. Refer to the application checklist for more details.

Another thing new home health agencies must consider is whether or not they want Medicaid certifications. Many home care agencies want to be able to accommodate Medicaid clients. Therefore we recommend researching what it takes to provide services that fall under Medicaid and how to obtain certification.

Link to application for home health care license in North Carolina.

5) Get Insurance

Insurance is a major factor to consider when you’re a business owner. Liability insurance coverage can prevent you from being liable for accidents or injuries on the job with clients or your own staff. Insurance in the health care field is essential when offering medical services to individuals. You want to ensure all your bases are covered and protect your business.

6) Develop Policies and Procedures and Other Requirements

Before applying for your home health care license in North Carolina, one thing to consider is developing appropriate policies and procedures manuals. These manuals are essential for your staff, the state’s office (North Carolina policies), and your business.

Defined by the NCDHHS, “a policy is a principle or a predetermined course of action to guide decision making. A procedure describes a method to carry out a policy and often includes a series of steps. The policies and procedures submitted by the agency represent a sampling of the policies and procedures necessary to direct all administrative, personnel, and client care operations of the agency as required by 10A NCAC 13J. The policies and procedures reflect an assurance of compliance.”

For more information, visit the FAQ page on the NCDHHS website.


7) Hire Staff

As a home health care agency business startup, you may wonder when it’s the right time to start hiring staff. You won’t be able to do all the work alone. Many clients require 24/7 care services, and one person cannot do the job independently. That is why it’s essential to hire reliable staff to support you when you need a break or are too busy to handle the workload (now that’s a good problem to have).

Generally, it would help to consider hiring staff when getting more clients than you can handle. This will ensure you provide all of your clients with the best quality of care while you keep up with the demand for your services. Additionally, you may want to consider hiring staff if you plan to expand your service offerings or take on larger contracts.

Before hiring staff, ensure you have the necessary resources to support their employment, including a solid financial plan, appropriate insurance coverage, and a comprehensive training plan. By hiring the right people at the right time, you can truly develop your home health care agency while providing high-quality care to your clients.

For more information on hiring and retaining the right staff and caregivers, visit our recent blog post.

8) Market Your Home Health Care Agency

Marketing is a crucial component of the success of all home health care agencies. We encourage a business owner to always develop a clear marketing plan prior to startup. Though we want to offer up several strategies you can use to market your agency in North Carolina in this day and age. Here are a few you could try:

  1. Develop a strong online presence: It is important to create a professional website and social media presence for your home health care agency in today’s market. Utilizing social media platforms like Facebook, Twitter, and Instagram will help you engage with potential clients and promote your health services in your region. Some things to include in your online strategy are an easy-to-navigate website, customer testimonials, and showcasing your home care services online and on social.
  2. Network with local healthcare providers: Building relationships is essential in this business. Network with physicians, hospitals, and other healthcare providers in your community. Attend local healthcare events and conferences to introduce your agency and services to other practitioners and stakeholders.
  3. Attend community events: we recommend participating in local community events to raise awareness about your agency and home health services. Also, consider sponsoring a community event or health fair to connect with potential clients and other healthcare providers. These events never hurt to get the word out!
  4. Leverage referral marketing: Encourage satisfied clients to refer their friends, family, and acquaintances to your agency. Consider offering incentives for these types of referrals.Another way to leverage referrals is to establish referral relationships with healthcare providers. One way to do so is by reaching out to hospitals, clinics, and physician offices and introducing your agency and services. Usually, when health care providers witness your high-quality care, they are more likely to refer their patients to your home health agency. By building strong relationships with healthcare providers and providing excellent service to your clients, you can establish your home health care agency as a trusted and reliable go-to home health care provider in North Carolina.
  5. Offer exceptional customer service: consistently providing high-quality care and excellent customer service is always the best marketing strategy!

For a complete guide on home care marketing, visit our recent article.

To Franchise or Not to Franchise, That Is the Question

It requires years of hard work and effort to grow home health agencies. Starting from scratch may not always be the best option for potential business owners. It takes a lot of time and money to invest in strategy, marketing, brand development, policies, procedures, etc. That’s where franchising comes in.

Franchising is a great alternative for those business owners who want an established and well-recognized brand to lean on. There are many perks to owning a franchise, especially owning a Nurse Next Door franchise.

There are several advantages to joining Nurse Next Door’s franchise, one of which is the continuous support throughout your journey with the company. You’ll receive thorough training, ongoing support and assistance, and access to various tools and resources that can help you operate your business effectively. With a well-established brand reputation, Nurse Next Door can also help you attract new clients that much easier, further contributing to the success of your business.

Of course, there are always risks involved with starting any business, including franchising. For information on the pros and cons of starting a franchise with Nurse Next Door, visit our recent blog post here.

Whether or not you choose to franchise, a career in the home health industry is rewarding and meaningful. If your values are the same as Nurse Next Door’s core values, including Admiring PeopleWOW Customer ExperiencesFinding Better Waysand being Passionate About Making A Difference, then perhaps franchising with Nurse Next Door is for you!

Founded in 2001 with a mission to make lives better, Nurse Next Door provides compassionate and personalized in-home health care services to seniors. Learn more about franchising opportunities in North Carolina today!

Contact us today: 1-855-737-6803