Buying a home care agency in Orlando and Central Florida

• Referrals from many hospitals, doctors' offices, senior communities and case managers, not one or two relationships the owner holds personally.
• A core group of caregivers who have stayed for years, and steady hiring that keeps shifts filled without constant overtime.
• A director of nursing and an office team who run intake, scheduling and billing without the owner.
• For Medicare-certified agencies, clean recent surveys (inspections) and solid ratings on Medicare's Care Compare website.
• For private-pay agencies, long client relationships and a mix of payers, so no single Medicaid plan or insurer controls the business.
• Files that would survive an audit: background screening, training records, visit notes and physician orders, all current.
• Scheduling and visit verification that run smoothly. Florida's Medicaid plans require electronic verification of home health and personal care visits.

• Payers. Medicare rates change yearly, Medicare Advantage plans often pay less and require approvals, and Medicaid plan contracts can end. Florida is part of Medicare's Review Choice Demonstration, which reviews traditional Medicare home health claims before or after payment. Ask for the agency's results.
• Audit history. Records requests, denied claims and repayment demands. The seller stays liable for AHCA penalties from before the sale (section 408.807), but Florida Medicaid can also hold the buyer liable for overpayments identified by closing (section 409.907(6)). Ask AHCA, and cover the rest in the contract.
• How caregivers are paid. Treating aides as contractors outside a licensed nurse registry, or skipping overtime, can leave the business owing back wages. Federal overtime rules for agency caregivers are being revisited, so have an employment attorney look.
• The service area. A home health agency license lists the counties it may serve, all in one state health planning district. Adding counties takes an AHCA filing, and going beyond the district takes a separate license (rule 59A-8.003).
• People. Caregiver turnover, pay compared with local competitors, and any liability claims involving falls or missing property.

• Where do most new patients or clients come from, and which referral sources know you personally?
• Who pays for most of your clients' care, and has any payer changed rates or terms lately?
• How long do your caregivers usually stay, and how do you find new ones?
• When were your last AHCA survey and accreditation visit, and what came up?
• How have your claims fared under Medicare's Review Choice Demonstration? Any audits or repayment requests?
• Who handles intake, scheduling and nursing oversight day to day, and do you think they'll stay?
• Do you turn away any areas or kinds of clients because you can't staff them?

This region covers Orange, Seminole, Osceola, Lake, Sumter and Marion counties: Orlando, Winter Park, Kissimmee, St. Cloud, Sanford, Clermont, Leesburg, Ocala and the large retirement communities of Sumter and Lake counties. Tourism is what the area is best known for, built on the theme parks, the hotels, the vacation rental homes around Kissimmee and the Orange County Convention Center. It's far from the only business. The University of Central Florida and the military simulation and training offices near it support a technology base, and health care is a major employer.

Marion County is horse country, with thoroughbred farms around Ocala, and it has added warehouses and distribution centers along Interstate 75. Retirees in Sumter and Lake create steady demand for medical practices, home care, home maintenance and auto services. The building trades, restaurants, and companies that serve hotels and rental homes do well across the region.

Central Florida is inland, so storm surge isn't the worry it is on the coasts. Hurricanes still bring wind damage and flooding, though: Hurricane Ian flooded neighborhoods in Orange, Seminole and Osceola counties in 2022. Ask whether the business or its customers were affected.

Tourism keeps demand steadier through the year than in markets that depend on winter residents, with busy stretches around school holidays. Hotels, parks and restaurants compete hard for workers, which pushes up wages for any company that hires hourly staff. New homes have spread fast in Osceola, south Lake and southeast Orange counties and around Ocala, so check whether a company's customers are in growing areas or older ones. Traffic on Interstate 4 limits how much ground a service company can cover in a day.