Types of Home Care and the Regulatory Enviroment

Types of Home Care

There are many different types of care provided by franchisors:

• Residential/Nursing home care – This type of facility provides care to residents requiring full time or short term care.  A residential care home supplies help with ADLs (activities of daily living) and also nursing and medical care.
• Assisted living community - This is an assisted living arrangement where people with special needs, especially seniors, live in a facility that provides help with ADLS. This form of facility bridges the gap between home care and residential/nursing homes.
• Home care - non medical –This form of care allows an individual to remain in their own home while a caregiver comes to their house. The caregiver provides companionship and help with ADLs and household tasks.
• Home care - medical - A franchise may employ a trained nurse to offer medical care at home.
• Many franchises also offer products that are aimed at aiding seniors such as personal and emergency response systems. ComForCare Senior Services has partnered with ADT, the worldwide leader of in-home electronic monitoring and communications systems, in an effort to provide their customers with around-the-clock access to help as needed. Home Helpers has also partnered with Direct link, a personal emergency response system (PERS), which enables the client to stay safely at home for longer.

Table 2: Specific assistance provided by franchises represented in this report:

Graph 1: Depicts the unit growth of selected home care franchises in the U.S.A.

Regulatory environment

The home care industry is highly regulated and approximately one-half of all U.S. states require licenses or otherwise regulate some aspect of home care businesses. A franchisee will need to be aware of the laws and codes applicable to home care businesses. These include federal, state and in most instances, city, county, parish, borough, municipality or other local laws.

1. General Laws Regulating the Home Care Industry: Many jurisdictions have senior home care laws which will affect a franchisee. These may encompass licensing, bonding and insurance, building code compliance, safety, fingerprinting, criminal background checks and other similar requirements when starting a home care franchise.
2. Federal: Federal laws cover similar items to general laws, such as occupational health and safety, equal employment opportunity and taxes. Under the current requirements of the Federal Fair Labor Standards Act and regulations issued by the United States Department of Labor, individuals providing companionship services to the aged or the infirm, and who are employed by a franchisee, are exempt from minimum wage and overtime requirements. If the state law, where the franchise is operated, varies from the minimum wage and overtime requirements of the Federal Fair Labor Standards Act, then state law will take precedence over federal law.

A home care franchisee will need to be aware that Federal Health Insurance Portability and the Accountability Act apply to personal and home care providers. 

3. State: State laws may cover the same areas as federal laws. Examples of other state laws affecting small businesses include environmental, occupational and health and safety laws and taxes. 
4. Local: Local laws may cover the same areas as federal and state laws. Examples of other local laws affecting many small businesses include health and sanitation regulations, building codes, permits and waste disposal.
5. A franchisee may also need to obtain Medicare certification from the federal government.

A franchisor may or may not provide assistance in determining the federal, state and local laws that affect the franchise. As there are often variations in licensure requirements and regulations from state to state, investigating, understanding and application of licensure regulations is the franchisee’s sole responsibly. 

For more information contact the National Association for Home Care and Hospice’s (NAHC) regulatory affairs division which is responsible for keeping abreast of current federal regulations and government policies that affect an agency's day-to-day operations as well as its long term business planning.

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