Can You Run a Home Care Agency Alone?

Do you actually need a team to run a home care agency? Or can one person handle the clients, the caregivers, the billing, the compliance, and the marketing?

I get some version of this question every week. Not from people browsing business ideas. From people who are already doing it. They opened their agency six months ago, maybe a year. They're working 60-hour weeks. They haven't taken a real day off since launch. And they're calling a marketing agency because their phone stopped ringing and they don't know why.

I run the marketing agency those owners call. When I see what the solo phase looks like from the other side of the table, the missed calls, the website that's still "under construction," the Google Business Profile with two reviews from family members, I also know what happens when someone gets the timing right. So here's the honest answer, from someone who watches this pattern play out every month.

The Solo Operator Is More Common Than You Think

There are over 500,000 home care provider businesses in the United States. No single company controls more than 5% of the market. This is one of the most fragmented industries in the country.

A huge number of those businesses are one-person operations. IRS tax data shows 405,369 home health care sole proprietorships in the U.S. That's not agencies with one caregiver. That's businesses run entirely by one person: owner, caregiver, scheduler, biller, marketer, and receptionist all at once.

So if you're thinking about running an agency alone, you wouldn't be the first. You'd be joining the majority.

But those numbers hide something important: most of those sole proprietorships aren't thriving. They're surviving. The average annual revenue is $21,825, with expenses eating 73% of that. After taxes and insurance, what's left isn't a salary. It's a side hustle.

The Three Hats Problem

Every home care agency, no matter how small, needs three functions to survive. I call this the Three Hats Problem because every solo owner eventually discovers it the hard way.

Hat 1: The Caregiver. This is the direct client work. Showing up at the home, providing care, building trust with families. For most solo operators, this is where they started, and it's where they're most comfortable.

Hat 2: The Operator. Billing, payroll, compliance, scheduling, insurance, licensing. Over 70% of agencies rank compliance as their top priority, and for good reason: one missed regulation can shut you down. This hat is invisible to clients but takes enormous time.

Hat 3: The Growth Driver. Marketing, referral development, reputation management, website maintenance, Google reviews, community outreach. This is how new clients find you. Without it, you're relying entirely on word of mouth, which works until it doesn't.

You can wear two of these hats. You cannot wear all three. Not well. Not for long.

What a Solo Agency Actually Looks Like, Day by Day

Picture this. You're a solo agency owner. You have four clients. Monday through Friday, you're providing care from 8 AM to 4 PM. You drive between homes. You handle medication reminders, meal prep, light housekeeping, companionship.

At 4:30, you start on billing. At 5:15, you return the two calls you missed during the day, one from a potential new client, one from a family member with a complaint. At 6:00, you eat dinner while reviewing your schedule for tomorrow. At 7:30, you check your email and find a compliance update from the state that requires new documentation by next month.

At 8:00 PM, you remember you were going to update your Google Business Profile. You don't. You're too tired. You'll do it this weekend. You won't.

Over 60% of small business owners work more than 50 hours per week. Nearly a quarter work over 60. And 89% work weekends. That's not home care specific. That's all small business owners. Now add caregiving, which is physically and emotionally draining work on top of business management, and the math gets worse fast.

Myth: "I'll Save Money by Doing Everything Myself"

This is the one I hear most often. And the math seems obvious: if you don't hire anyone, you keep all the revenue. No payroll. No workers' comp. No management overhead.

Look at the math.

If you charge $28 per hour (a reasonable rate for non-medical home care) and you personally provide 30 hours of client care per week, you're billing $840 per week. That's roughly $43,680 per year in gross revenue.

Now subtract: liability insurance ($2,000-4,000/year), business insurance, vehicle costs, licensing fees, software ($100-300/month), phone and internet, supplies, and your self-employment tax (15.3%). You're looking at $25,000-30,000 in take-home pay. For 50+ hour weeks with no vacation, no sick days, and no backup if you get injured.

Meanwhile, an agency owner with even three caregivers can generate $150,000-250,000 in annual revenue while spending their time on growth instead of direct care. The gross margins on home care typically fall between 36% and 50%. That margin only materializes when you're not paying yourself caregiver wages. (If you want the full breakdown of home care margins and where the money actually goes, read our piece on revenue vs. profit in home care.)

The "savings" of doing it alone aren't savings. They're a revenue ceiling.

Myth: "I Just Need to Get Licensed and Clients Will Come"

Forty-six states require licensing for non-medical home care agencies, and the process varies dramatically. Some states can process you in weeks. Others take months and require facility inspections, background checks on all staff (including you), and proof of financial stability.

But getting licensed is the easy part. The hard part is what comes after.

If an agency owner called me tomorrow and said they spent six months and $50,000 getting their license, building their office, buying their software, printing their business cards, then sat in that office waiting for the phone to ring... that story wouldn't surprise me. It's one of the most common patterns in home care.

Clients don't come to you because you have a license. They come because they can find you. That means a website that shows up in local search, Google reviews that prove you're trustworthy, and some form of marketing that puts you in front of families at the moment they need care.

The startup costs for a non-medical home care agency run $40,000 to $80,000. I've watched owners spend all of that on licensing, office space, and equipment, with zero dollars left for the one thing that actually generates clients: marketing. They treat marketing as something they'll "figure out later." Later never comes.

Myth: "Word of Mouth Is Enough"

In the early days, word of mouth is everything. Your first two or three clients come from personal connections: a neighbor whose mother needs help, a friend from church, a referral from a doctor you know. This creates a dangerous illusion that growth will just keep happening organically.

It won't.

Word of mouth has a ceiling. It's unpredictable. It's unscalable. And it dies the moment your personal network is exhausted. I've seen agencies plateau at 3-5 clients for years because the owner keeps waiting for the next referral instead of building a system that generates them.

The home care market is projected to grow from $100 billion to $176 billion by 2032. That growth is real. But it doesn't automatically flow to you. It flows to the agencies that families can find online, the ones with updated websites, real Google reviews, and a visible presence in their community.

So When Does "Alone" Stop Working?

The honest answer: sooner than most people expect.

Running alone works when you're in startup mode. You're learning the business. You're building relationships with your first few clients. You're figuring out what kind of agency you want to be. That phase is valuable, and there's nothing wrong with starting solo.

But there are clear signals that the solo phase needs to end:

You're turning away clients. Nearly 40% of home care providers turn down cases because they don't have enough staff. If you're a solo operator and someone calls asking for care on Tuesday afternoon while you're already with a client, you can't help them. That's not a staffing problem. That's a business model problem.

Your revenue has flatlined. If your income hasn't grown in six months, you've hit the solo ceiling. You can't bill more hours because there aren't more hours in the day. You can't raise rates much beyond what the market will bear. Growth requires more hands.

You haven't updated your website in months. Or your Google Business Profile. Or your social media. When marketing is the first thing you cut, it's because you don't have time. And if you don't have time for the thing that brings in new clients, you've outgrown solo.

You're exhausted. Burnout among entrepreneurs jumped to 51% in 2024, up from 36% the year before. And that's across all industries. In home care, where the work is physically demanding and emotionally heavy, burnout hits faster and harder. If you're dreading Monday morning, that's not a motivation problem. That's a structure problem.

Clients are noticing. Missed calls. Late billing. Forgetting a schedule change. When you're wearing all three hats, mistakes creep in. And in home care, mistakes erode trust. Trust is the only thing families are buying.

What Smart Solo Operators Do Instead

The owners who break through the solo ceiling don't try to hire their way out all at once. They outsource strategically, starting with the hat that makes the least sense for them to wear.

Almost always, that's Hat 3: marketing.

There's a reason for this. Marketing is skilled work that compounds over time. A website built right keeps generating leads for years. A Google Business Profile with 30 reviews keeps converting browsers into callers. A local SEO strategy keeps you visible when families search "home care near me" at 10 PM.

You can't do that kind of work in 15-minute bursts between client visits. It requires focus, tools, and expertise that most caregivers don't have, and shouldn't need to have. 90% of small businesses now outsource at least one function, with efficiency and expert access being the top reasons.

After marketing, the next thing to outsource is usually bookkeeping and billing. Then scheduling. Then, when revenue supports it, your first caregiver hire.

The sequence matters. You don't hire a caregiver before you have enough clients to keep them busy. And you don't get enough clients without marketing. So marketing comes first.

The Real Answer

Can you run a home care agency alone? Yes. People do it every day.

Can you grow a home care agency alone? No. Not past a very low ceiling.

The industry is massive and growing fast. There is real demand for quality home care in almost every market. But the solo operators who capture that demand aren't the ones working 70-hour weeks doing everything themselves. They're the ones who recognized early that some things are worth paying someone else to do.

If you're in the solo phase right now, that's fine. Learn the business. Serve your clients well. Build relationships.

But start thinking about what you'll hand off first. Because the difference between an agency that stays at $22,000 a year and one that breaks $200,000 isn't harder work. It's smarter structure.