The first 90 days of a new home care agency set the pattern for everything that follows. Here is what to have in place as you add caregivers, clients, and miles on the road.
The first ninety days after a home care agency opens are when everything gets decided, whether you decide it or not. The first caregivers start driving. The first clients open their doors. The first aides walk into homes you have never seen, working for people you have met once.
It is also the window where a new agency's insurance program takes its shape. Get the structure right early and the growth that follows is mostly paperwork. Get it wrong and the problems tend to surface at the worst possible moment, usually after something has already happened. Here is how I would think through the first ninety days.
The road is your workplace: caregivers driving their own cars
Most new home care agencies start without company vehicles. Your caregivers drive their own cars from client to client, and that changes the insurance picture in a way that surprises a lot of first-time agency owners.
When an employee drives their personal car on your business errands, the claim generally starts with their personal auto policy. Whether the rest of it reaches your agency depends on hired and non-owned auto coverage, and on how that coverage is written. Every new hire in those first weeks adds another driver to that exposure, which is why the non-owned auto decision belongs in week one, not month six. I covered this in detail in our article on home health agency auto insurance when no one drives a company vehicle.
Workers comp for work that happens inside someone's home
In almost every state, workers compensation is required from the first employee's first shift. With home care, there is a wrinkle on top of the requirement: the workplace is someone's living room, and you will rarely see it.
Falls, lifts gone wrong, dogs, icy steps between the car and the door. In-home work produces injury patterns that an office-based business never sees, and the premium basis is usually payroll, which means your workers comp premium moves with every caregiver you hire. That is worth budgeting for as you scale in those first months rather than treating it as a fixed cost. Our home healthcare workers compensation guide walks through what in-home coverage needs to account for.
Professional and general liability: two policies, two jobs
New agencies sometimes buy one liability policy and assume it does both jobs. It almost never does.
Professional liability responds to claims about the care itself, something an aide did or failed to do, a medication issue, a client harmed through the services your agency provides. General liability responds to the rest, a slip on a wet floor, damage to a client's property, the ordinary bodily injury claims that come with sending people into homes. Home care sits in a spot where both exposures are real from day one, and the claims data backs that up. Industry claims research reported by American Nurse found that home health poses unique liability risks for nurses, with the NSO and CNA home health claim analysis showing professional liability claims arising across care settings that a single policy rarely addresses completely.
Abuse and molestation coverage, and what it actually excludes
Because home care sends your employees into private homes with vulnerable clients, abuse and molestation coverage is one of the most important parts of the program, and one of the most commonly misunderstood.
This is a coverage where the exclusions and conditions matter as much as the limit. Some policies include it automatically at a modest limit. Some carve it out entirely. Some require specific procedures to have been followed, background checks on file, supervision protocols documented, before the coverage responds at all. Ask specifically how your policy handles it, and make sure your hiring practices match whatever the policy expects.
A crime or fidelity bond for staff inside clients' homes
Sooner or later, a client will report something missing, and whether or not the caregiver took it, the question that arrives next is whether you have coverage for it. A crime policy or fidelity bond responds to theft by your employees, and for a home care agency it is inexpensive relative to the alternative.
It also does double duty. Some clients and referral sources ask about bonding before they will sign with an agency, so having it in place in the first ninety days is both protection and marketing.
Adding a second office later, and what that changes
If the first ninety days go well, a second office is often the next step, and it brings its own checklist: the new location needs to be added to your property and general liability policies, and depending on your structure, it may raise the same named-insured questions that a new entity would.
The licensing side gets overlooked too. A second location can trigger its own licensing requirements depending on the state, and Massachusetts, which we wrote about in detail in our article on home care licensing and insurance requirements, is a good example of how state-specific the rules can be. Wherever you operate, confirm with your state before the second office opens rather than after.
Ninety days, one structure
Caregivers in their own cars, workers comp for work inside homes, professional and general liability doing their separate jobs, abuse coverage with exclusions you have actually read, a bond for staff in clients' homes, and a plan for the second office. That is the structure. Build it in the first ninety days and everything that comes after gets easier.
If you are in those first months and want to talk through your program, I am happy to help. You can reach me at jeremyajones.com/contact.
Enjoying this article? Get Jeremy's latest posts delivered to your inbox.
