Starting a Personal Care Home for Seniors

T he following is intended to provide an understanding of potential license, permit or registration requirements when considering the establishment of a personal care home for seniors in Canada.  It also contains a series of possible steps and issues to consider in carrying out your project. The extent to which the information will apply to you will depend on the circumstances related to your situation. This document was prepared by Canada Business.

For further information on individual topics identified herein, contact your local Canada Business service centre . Because this document is only meant as a guide, Canada Business service centres will not accept responsibility for business decisions made based on the information provided.

BASICS TO GETTING STARTED

Before proceeding, reference should be made to the Business Start-up Info-Guide for your region which offers information on the steps involved in establishing a new business.

• Alberta - Business Start-up (Alberta) Info-Guide
• British Columbia - Starting a Small Business in British Columbia
• Manitoba -  Business Startup Checklist and Pathfinder
• New Brunswick - Business Start-up in New Brunswick
• Newfoundland and Labrador - Business Start-Up Info-Guide
• Northwest Territories - Business Assistance Programs Info-Guide
• Nova Scotia - Business Start-Up Info-Guide
• Nunavut - Business Start-Up Info-Guide
• Ontario - Business Start-Up Info-Guide
• Prince Edward Island - Business Start-up in PEI
• Quebec - Info-Guide – Business Start-Up
• Saskatchewan -  Business Start-up Info-Guide
• Yukon - Business Start-Up Info-Guide

Starting a business can be a rewarding undertaking, but it comes with its challenges. Before starting a business in Canada, it is wise to do your own research. You should also make sure that you are suited for entrepreneurship, and that you understand the significant effort required. As such, you should thoroughly enjoy the field you are getting into, and you must believe in your product or service as it may consume much of your time, especially during the start-up phase. There are many issues to consider such as:

• regulations;
• financing;
• taxation;
• managing your business;
• advertising; and
• and much more.

For more information, see the Checklists for Going Into Business

Since eldercare is a very demanding multi-disciplinary activity, there are many questions you should asked yourself and others before making your decision to enter into this business. Such questions might include:

• What type of services do I want to provide?
• Can my house be adapted for this business or do I need a new dwelling?
• Are there any competitors in my area, if so, can my services be distinct?
• How many older people live in my area? How many live alone?
• Do I understand the needs of elderly people?
• Do I know the related services offered in my region?
• How many clients do I want at one time?
• I am realistic?
• Do I have the time, money and abilities for such a business?
• Is the location of my home appropriate for such a business?
• Should I consult with professionals? Which ones?
• What type of professional help will I need?
• Is there a need to have a market study done?
• What is covered by the health care system?
• How do I deal with nearest relatives?
• What are the regulations involved?
• What happens when a person living under my care dies?
• Is there a bus system in my area? If not, do I want to provide this service?

The following is additional information to consider.

INDUSTRY OVERVIEW

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With regards to housing, seniors have to face numerous challenges. More and more seniors share a vast range of interests and needs. They also have variable physical limitations and health conditions. Partnerships between the public, non-profit and private sectors are being organized to offer housing services adapted to seniors' specific needs. Some concerned citizens are looking for means to offer a service in their own community that would allow long-time residents to continue living in their community. Private houses are a convenient way for the autonomous persons or those in light loss of autonomy to stay in their community.

Personal care homes for seniors provide a supportive and nurturing environment for their residents. Services in those homes may include the following:

• meal preparation;
• administration of medication;
• surveillance;
• environment that is secure;
• assistance with activities of daily living (ambulatory care, bathing, grooming, feeding);
• laundry; and
• entertainment.

Seniors are one of the fastest growing population groups in Canada. The senior population has grown about twice as fast as the overall population since the early 1980s. The growth is also expected to continue early in the second decade of the new century when baby boomers turn 65. Seniors aged 85 is the fastest growing segment of the overall senior population. Consequently, the demand for eldercare services is also growing.

Eldercare services are:

• demanding physically - expect long working days, including some part of the nights;
• demanding emotionally - you have to deal with lonely and sick people most of the time;
• challenging - you must excel in many areas such as food preparation, services, management, marketing, meeting people, purchasing, inventory control and personnel administration;
• including numerous disciplines, such as finance, accounting, social work, medicine, psychology, law, fitness, healthy eating, recreational, restoration and nursing; and
• rewarding, but it can be a negative experience if you are not comfortable working with the elderly - especially as their mental and physical health deteriorate.

Classification of the Levels of Care
There is no uniform designation for the levels of care for seniors. Most of the time, the levels are divided in the following three categories:

• independent;
• semi-independent; and
• dependent.

LICENSES, PERMITS AND REGULATIONS

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One area of rules and regulations that all new businesses must comply with is that of licenses, permits and regulations. When creating a business, the entrepreneur must contact the municipality involved, along with the provincial/territorial and federal governments.

Each municipal government has the authority to issue its own business licenses within its jurisdiction. Since there is no uniformity throughout the country regarding municipal licenses for businesses, you should consult with the appropriate local officials to determine whether your business will be affected by local regulations and licensing requirements. Businesses (including home-based businesses) must also meet the zoning by-laws that control property uses in their municipalities.

Eldercare services are governed by federal, provincial and municipal laws. Six provinces have legislation related to home care: British Columbia, Alberta, Saskatchewan, Ontario, New Brunswick and Nova Scotia. The Canadian Legislation Web site might help you in finding the regulations related to your province.

The  Canada Health Act sets out two major categories of service: Insured Health Services which include hospital care and services provided by physicians, and Extended Health Care Services which are not insured and include nursing homes or long-term residential care, home care, adult residential care and ambulatory health care services, and are not insured services. Health is a provincial responsibility, but the federal government is also involved in the delivery of home care services as part of its obligations under the Canadian constitution, i.e. Veterans Affairs Canada, First Nations, and the Department of National Defence.

Examples of licenses, permits and regulations that could apply to you when starting your eldercare service may include, but are not limited to:

Licenses

• municipal business license; and
• food service establishment license.

Permits

• building or renovation permit; and
• health department permit.

Regulations

• health regulations and requirements;
• fire safety standards and regulations;
• retail sales tax;
• zoning by-laws;
• Food and Drugs Act ;
• Controlled Substances and Precursors ;
• smoking regulations;
• hazardous waste/air quality regulations;
• security regulations/emergency plan;
• Protection of Personal Information - Your Responsibilities  
• infection control regulations; and
• room and board regulations.

You can get permit, license and regulation information by contacting your province or territory, local city hall, town or village office or rural municipal office. Contacts for local, provincial, territorial and federal governments can be found in the government listings of your telephone directory or on the  Provincial/Territorial  Web site.

BizPaL

BizPaL - Business Permits & Licences provides Canadian businesses with one-stop access to permit and licence information from all levels of government. This online service is offered by Industry Canada in partnership with provincial, territorial, and municipal governments.

FINANCING

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Canada Mortgage and Housing Corporation
Home Adaptations for Seniors' Independence : By the intervention of the Canada Mortgage and Housing Corporation (CMHC), the Government of Canada finances certain number of programs on housing which may be of benefit to the elderly. Every province has its own programs. 

Residential Rehabilitation Assistance Program (RRAP): RRAP programs help low-income Canadians, people with disabilities and Aboriginals live in decent, affordable homes. These programs also support renovations to rooming houses and rental units to increase the availability of housing for those in need. 

The Canadian  Seniors Policies and Programs Database  can be a good site to start looking for which programs and services are offered in your province.

MANAGING YOUR OPERATION

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Insurance
Insurance needs for businesses vary greatly. It is best to choose an insurance agent or broker familiar with your size of business and, in particular, an agent familiar with your type of operation. If you don't have an insurance agent, it could be a wise decision to ask other business owners in your area to recommend one. Your local seniors' associations or clubs may also have information about insurance packages specifically tailored for eldercare services.

The following list is included to remind you not to overlook the complex areas of business insurance. It is best, however, to discuss your specific requirements with your insurance agent.

Basic insurance:

• fire insurance (extended coverage on buildings and contents);
• liability insurance (depending on the type of business);
• burglary protection (theft coverage); and
• dishonesty insurance (covers thefts by employees).

Marketing/Advertising
Word-of-mouth advertising and good public relations are often the best ways of promoting an eldercare service. Networking, including an open-house day for intervenors in the health field of your region such as employees from hospitals, clinics, pharmacies and community services, is a good way to promote your establishment. These employees will afterwards be able to answer questions from seniors looking for a home. Also, bear in mind that a happy customer or family is also a very good method of advertising.  

You should also:

• spend about one percent of gross revenues on advertising into your target market;
• install a brightly-lit sign to attract drive-by traffic; and
• talk to people in your neighbourhood.

For more information regarding advertising and marketing, see the following documents:

• Signs and Your Business
• Plan Your Advertising Budget
• Advertising Do's and Don'ts
• Ways to Promote Your Product or Service
• Marketing Plan Outline

The Marketing Basics section of the Online Small Business Workshop covers the basics from developing your customer profile to promoting your business.

The Competition Act governs misleading advertising and deceptive marketing practices for all businesses in Canada. The Act defines which marketing practices are illegal and the process of complaint investigation, and is administered by Industry Canada.

For more information, consult the document Competition Act - Misleading Advertising and Deceptive Marketing Practices or visit the Competition Bureau Web site.

Guide to Market Research and Analysis
Successful businesses have extensive knowledge about their customers and their competitors. Acquiring accurate and specific information about your potential clients and competitors is a critical first step in market investigation and development of a marketing plan.

In developing a marketing plan, your primary functions are to understand the needs and desires of your clients, select or develop a service that will meet their needs, develop promotional material that will make them aware and ensure service delivery.

Basic Bookkeeping
A good record keeping system should be simple to use, easy to understand, reliable, accurate, consistent and designed to provide information on a timely basis.

Note: All staff working with cash should be trained to recognize counterfeit currency.

The legal requirement concerning financial records specify only that they be a permanent, accurate and complete record of your daily income and expenses. There are many types of record books available. For example:

• double entry bookkeeping;
• commercial bookkeeping systems;
• one-write systems;
• computerized systems; and
• single entry bookkeeping.

Choosing Your Location (see the document Store Location - "Little Things" Mean a Lot)
Choosing the right location for your business is important. Considerations include the needs of your services, the location of your potential clients and competitors, and such things as:

• taxes;
• zoning restrictions;
• accessibility to hospital, transit system, recreational activities and church services;
• noise; and
• secure environment.

Layout and Design
It is very important to choose a layout and a design that is appropriate for your clients as well as for yourself and your employees. Convenience and security are two main issues to consider. To be adapted for seniors, your home might need some of the following:

• bath and toilet grab bars;
• handrails where needed;
• doorways which are accessible;
• air conditioning;
• dwelling with no stairs, preferably ;
• shower without steps;
• good lighting;
• lever handle on doors; and
• nonslip, heavy doormats and runners.

Selecting Your Equipment
Your house might need to be equipped with bathing equipment, toilet seats, walkers, and wheelchairs. These may be purchased, or may be loaned from the Canadian Red Cross . A good first aid kit is also a must; please ask your doctor or a nurse about the most practicable accessories for this kit or verify with St. John Ambulance  in your area.

Leasing Equipment - Another alternative is to lease equipment to help keep start-up costs down. 

For more information on parts and materials, overhead, stock control and pricing, see the document Business Plan for Small Service Firms .

Selecting Your Menus
It might be wise to have a dietitian prepare a list of meals for your clientele according to their specific needs or as recommended by their doctor. The Web site of Dietitians of Canada .

Selecting Professional Services
The use of professional services is essential to the success of a small business. Since eldercare service comprises many disciplines, professionals can provide knowledge and expertise in the areas where you may have little. They can round out your management team to ensure your business is operating efficiently. Under no circumstances should you attempt to render professional services that you are not qualified for, such as nursing, social work and legal advice.

As an entrepreneur, there are professionals which you might want to consult or might need to consult on a regular basis, so have a personal contacts list ready in case of emergency. These may include:

• lawyer (contact a lawyer about legal issues such as proxy, tutor);
• social worker;
• dietitian;
• doctor;
• nurse;
• physiotherapist;
• occupational therapist;
• pharmacist;
• ambulance driver:
• insurance broker;
• accountant; and
• banker (for tips and pointers on dealing with your bank, see the document Dealing With Your Banker & Other Lenders )

Staff Training
Provide ongoing training and maintain a library of resource materials. You might want to consider having all staff, including non-professional, trained for:

• First Aid;
• CPR;
• injury prevention;
• nurturing care;
• security; and
• dieting and meal preparation.

The Canadian Red Cross and St. John Ambulance offer courses which might be very useful for you and your personnel.

Clients' Record
It would be wise to keep a good record on each client; some even use a binder for this information. The type of information could be anything pertaining, but not limited, to:

• medication intakes;
• name of physician;
• hospital preference;
• infection control information;
• oxygen therapy information;
• incidence reporting;
• smoking and alcohol consumption;
• resuscitation;
• family contacts;
• allergies;
• weaknesses;
• strengths;
• preferences;
• injuries; and
• diseases.

Another useful type of reporting is a book to record comments of staff on each client at the end of each shift.

Incidence reporting/Emergency situations
You will need to find out to whom in your area you have to report to in case of an accident. You will also need to create your own emergency plan and will have to ensure that all your employees know all the procedures in case of emergency. Information is available at Public Safety Canada  on the Public Safety and Emergency Preparedness Canada Web Site.
 

Setting Up a Pay System
Pay administration is a management tool that enables you to control personnel cost, increase employee morale, and reduce workforce turnover.

Checklist for Profit Watching
Making a profit is important. Profit can be defined simply: revenues - expenses = profit. So, to increase profits, you must raise revenues, lower expenses, or both. To make improvements, you must know what's really going on financially at all times.

You can find additional information on managing your operations, by viewing our index of Popular Business Topics .

ASSOCIATIONS

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There are associations that may be of use to home care business owners. Although it is not necessary to join an association, there can be advantages in becoming a member because they:

• promote and exchange marketing and promotional ideas among members;
• establish and encourage high standards of quality and professionalism;
• represent and advocate on behalf of members.

Example of an association includes, but is not limited to:
Canadian Home Care Association : The Canadian Home Care Association is a national not-for-profit membership organization representing over 600 home care stakeholders across Canada.

Other associations which might be useful, but are not limited to:
Canadian Lung Association : The Canadian Lung Association is the umbrella group for the ten provincial Lung Associations.
Canadian Association of Gerontology : The Canadian Association on Gerontology is a national, multi-disciplinary scientific and educational association established to provide leadership in matters related to the aging population.

RESOURCES

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Additional resources which may help eldercare business owners include, but are not limited to:
Division of Aging and Seniors , Public Health Agency of Canada: Provides federal leadership in areas pertaining to aging and seniors and serves as a focal point for information and centre of expertise.
Alzheimer Society of Canada : A not-for-profit health organization dedicated to helping people affected by Alzheimer Disease.
Canada Safety Council : A national charitable organization dedicated to safety. It mission is to lead in the national effort to reduce preventable deaths, injuries and economic loss in public and private places throughout Canada.
Canadian Continence Foundation : A non-for-profit organization dedicated to helping people with incontinence.
Canadian Hearing Society : Provides a wide range of services to meet the needs of deaf, deafened and hard of hearing people.
Canadian Institute for Health Information : An independent, pan-Canadian, not-for-profit organization working to improve the health of Canadians and the health care system by providing quality, reliable and timely health information.
Canadian National Institute for the Blind : A national voluntary agency providing services to individuals across Canada to whom loss of vision is a central problem in personal and social adjustments.
Caregiver Network Inc. : A national single information source to make the life of a caregiver easier.
Dietitians of Canada : A site providing all kind of information on eating and living well.
Osteoporosis Society of Canada : Aims at educating, empowering and supporting individuals and communities in the prevention and treatment of osteoporosis.
Victorian Order of Nurses : A not-for-profit national health organization and registered charity offering a wide range of community health care solutions that meet the needs of Canadians from coast to coast.

Publications
You may find books, magazines and other relevant print material at the Canada Business service centre and/or business service organizations in your community that provide Canada Business information. Contact your Canada Business  Regional Office for the location nearest you.

Statistics
Statistics Canada : Provides a wide range of statistics on seniors.
Canadian Mortgage Housing Corporation : Information on needs of seniors living in rural areas (in PDF* format).
Public Health Agency of Canada :  Canada's caregivers.  Statistics and general information.

Related Web Sites
Active Living Coalition Older Adults : The Coalition strives to promote a society where all older Canadians are leading active lifestyles that contribute to their overall well-being.
Information for Seniors —Canada Revenue Agency: Seniors quick reference on a variety of subjects.
Seniors Canada Online —Veterans Affairs Canada: Provides quick and easy access to hundreds of federal, provincial, and territorial government Web sites and well-known non-government sites for seniors, their families, caregivers and supporting service organizations.  
Canadian Senior Years : A site specifically designed for Canadians over 50 that provides information, articles, news. It is also possible to advertise a service or product that would be of interest to Canadian seniors.

ADDITIONAL INFORMATION

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When seeking business information, feel free to visit the Web sites for the Business Start-Up Assistant  and the Online Small Business Workshop . You may also want to check with the local library, the major chartered banks, the local Chamber of Commerce, and educational institutions and business development organizations -- some of which offer courses, seminars and workshops.

For general business information, you may contact your local Canada Business service centre  by:

• Telephone : Call our toll-free telecentres and speak to a business information officer who will direct you to the best sources of information or refer you to programs and services relevant to your business situation. Some Centres have optional recorded answers to frequently asked questions to speed up service.

• E-mail : You can also send your questions via e-mail from the Web site.

• In-Person : The Canada  Business service centres offer an extensive collection of business-related publications, directories, leading-edge business products (e.g., videos, CD-ROMs) and access to external databases. Business clients can use these materials on their own or with the help of a business information officer. The Canada  Business service centres have arrangements with existing business service organizations in communities across Canada to provide Canada Business information. Contact the service centre in your region for the location nearest you.

*To download publications in PDF format, Adobe Reader is required (available free of charge).

DISCLAIMER
Information contained in this document is of a general nature only and is not intended to constitute advice for any specific fact situation. Users concerned about the reliability of the information should consult directly with the source, or seek legal counsel.

Links Policy
Some of the hypertext links lead to non-federal government sites which are not subject to the Official Languages Act and the material is available in one language only.