Buying a home care agency in Southwest 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 Lee, Collier, Charlotte, Sarasota and Manatee counties on the Gulf coast and Hendry, Glades and DeSoto inland: Fort Myers, Cape Coral, Naples, Bonita Springs, Punta Gorda, Port Charlotte, Sarasota, Venice, Bradenton, LaBelle, Clewiston, Moore Haven and Arcadia. The coastal economy runs on people who choose to live or spend the winter here: retirees, seasonal residents, and the construction, real estate, health care, financial and home services that follow them. Tourism, golf and boating add to it.

Inland, the economy is agricultural: sugarcane around Clewiston, citrus, cattle and vegetables, with Immokalee in Collier County a center for farm work. The building trades, pool, landscaping and pest control companies, property managers, medical and dental practices, and marine businesses tend to do well along the coast.

This is one of Florida's most seasonal markets. From roughly January through April, restaurants, shops and service companies run at full speed. Summers are slower, so look at monthly revenue, not only the yearly total. The coast has taken two major hurricanes in recent years: Ian came ashore at Cayo Costa in Lee County in September 2022, and Milton at Siesta Key in Sarasota County in October 2024. Rebuilding brought a wave of work for contractors that won't last forever, so ask how much recent revenue came from storm repairs. Insurance costs and flood zones weigh on every property.

Housing costs near the coast make hiring hard, especially around Naples. New communities east of Interstate 75 in Lee, Collier, Charlotte and Manatee keep service companies busy.