People in Germany are getting older and older and the demand for outpatient care services is growing. If you are looking for a meaningful job and like to be there for others, starting a nursing service may be the right thing for you.
In this article, you will find out which legal regulations you have to observe (some!) And what are the biggest challenges in the nursing foundation. At the end we tell you what Christoph Kahl, who has become self-employed with a care service for seniors and families, advises others who want to follow his example.
You should bring with you: Professional and personal requirements
More than in other areas, the professional and personal requirements of the founders count in the care sector. A sound education, empathy and organizational skills are good prerequisites to be able to cope with the manifold tasks.
But it’s not just about nursing know-how, you should also be able to handle money. Because in order to be responsible for your patients, you must also make sure that your care service is economical and reliable.
Since care is about people who depend on outside help, this area is heavily regulated. The Social Code (SGB) stipulates which requirements you have to fulfill. In order to start a nursing service you need a geriatric nursing education (or a training as a nurse in nursing or nursing) and at least two years of experience in this profession, which may not have been more than eight years old (§ 71 SGB XI). In addition, as part of a training course, you must have undergone further training in the nursing management (PDL) or have a nursing management degree program at a university or college.
You have no training in nursing management, but are an organizational talent and love the handling of numbers and bookkeeping? Then you can still start a nursing service, as a holder or owner – provided you hire someone with the statutory qualification as nursing service.
This is how you calculate your benefits
The costs of the services you provide with your care service are largely covered by the care funds. In order to settle with the funds, you need a formal admission. It is linked to various conditions: The management of the nursing service by a qualified specialist is one of them. In addition, you must be able to guarantee that your patients are well looked after at all times – even on weekends and when an employee suddenly falls ill or is on vacation. This means that you need enough nurses who can represent each other. Also for the management, you have to hire a substitute who takes a break in the event of illness or vacation.
In addition, a hygiene plan and internal quality management are prescribed by law, which are reviewed by the Medical Service (MDK) prior to approval and later during ongoing operation. In particular, the MDK pays attention to the size, qualification and further education of the workforce, to the constant accessibility of the nursing service, to the care concept, the documentation of care and to the counseling and participation of patients and their relatives.
The admission procedure by the nursing and health insurance is very extensive and can take some time. Take care of it in good time, so that you do not create unnecessary idling phases before the foundation. Important: The Social Code distinguishes between home nursing, which is prescribed for a doctor and has a fixed duration (for example, after surgery), and outpatient care. For each form of care you have to apply for a separate admission.
In addition to the cash register, you need an institution code, also called the IK number. You can apply for it at the collection and distribution office (SVI) of the Arbeitsgemeinschaft Institutionskennzeichen.
When the test procedure is completed and the official approval is obtained, you have to conclude a supply contract with the care funds. It is agreed in which catchment area you take over which care services.
Billing with the nursing care funds is nowadays only done electronically via data medium exchange (DTA), which makes things easier for you. Since sensitive data is involved and the nursing care funds have to bill with countless care facilities, the billing procedure is meticulously regulated.
So you write a business plan for your nursing service
As with any business startup, a business plan is indispensable if you do not want to start self-employment in blind flight. When writing you will inevitably be confronted with all the questions about your business idea, which should be clarified before the foundation: from the legal provisions and approvals to the appropriate positioning to the question of where you can find suitable professionals and how you bind them to you permanently want. In your business plan you deal intensively with the market and the competition, the opportunities and risks, and explain the measures you want to take to ensure that your care service works reliably and economically.
Your business plan will show you if you can meet the high quality standards and at the same time work cost-effectively. He is also the prerequisite to get a public start-up promotion or a bank loan.
The population in Germany is getting older and older and the need for care services is growing. However, this does not apply to all regions to the same extent. And even the competition does not sleep, as the saying goes. That’s why you should choose your location wisely. In your business plan, show how much supply and demand is in your catchment area and how it’s likely to develop.
However, location is not only interesting for your readership on a geographical level. It is also about the premises in which your care service is to be housed. Although the people in need of care are looked after in their home, you still need an office and a contact point for customers and staff. Your nursing service should be centrally located, easily accessible and barrier-free and provide enough space for training and meetings.
Animate to exercise, train the motor skills: quite a nursing task.
Market and competition
Closely related to the location issue is the business plan chapter on the market and the competition. The numerical base for your market analysis provides you with official population statistics, broken down to the catchment area in question. In addition, many communities have old-age benefit plans that include forecasts of future care needs on the ground. Using this data, you can see how big the market is that you are entering and what the development is likely to be.
Then you research what the supply side looks like: how many care services and health facilities are there on the ground? How many patients are cared for by them? Which care services do they offer and with which strategies do they try to gain patients? Most of the answers to these questions can be found on the Internet, for example in business directories and on the websites of the individual providers. It may also be worthwhile to make a small impression of the existing offer during a short trip on site. But do not overdo it: your competitive analysis does not have to include every single nursing service. It is better to pick out five to ten of your main competitors and describe how they each hold their own in the market.
This is how you find your unique selling point
In order to lead your care service into a secure future, you should position yourself clearly in the market. Think about how you can differentiate yourself from the existing offer. You can concentrate on a nursing specialty, such as the care of intensive care patients after outpatient surgery or on the care of incurable sufferers (palliative care). Or you rely on culture-sensitive care or another special understanding of values that sets you apart from other providers.
You can not develop a business idea that thrills your patients at the desk. It is important that you talk to your target audience about their needs and desires. Use your personal network and nursing experience, talk to prospective clients and loved ones about their expectations of good care, and check with healthcare professionals about local demand.
In the intensive engagement with your target group, with the care offer and the care needs in your region you will get an ever clearer picture of how you could differentiate yourself from your competitors and which niches are not yet occupied. Now you must not forget to summarize your thoughts comprehensible in your business plan – because even your readers would like to know how you have found your positioning and why you believe that you will succeed with it.
Rattling is part of the craft
Demographic change or not: the foundation of a nursing service is not a matter of course. You have to make sure that people hear about your offer and its uniqueness. How you want to achieve that is an important point in your business plan.
For a nursing service there are three addressee groups with different interests in marketing:
- of care
- Mediators (hospitals, nursing homes etc)
Set up a marketing strategy that will do justice to these three groups. While you may reach your real target group, the elderly, with flyers that you can lay out at the barber’s, you can address your loved ones quickly and inexpensively through social media. The Internet is today the most important source of information – a compelling corporate website is therefore mandatory. Recommendation portals also play an important role. Think about how you can encourage your satisfied customers to rate you online.
Health care institutions, especially nursing homes and hospitals, are worth a personal visit to introduce you to nursing.
Specialists – urgently needed
The shortage of skilled workers is particularly noticeable in the nursing sector. The question of how to attract and retain qualified personnel for your nursing service has become as important as the question of customer acquisition.
Think in advance of how you want to recruit your team. Maybe you still have contacts to colleagues from your job or training who would like to work for you? Then you should definitely mention that in your business plan. Also, describe what you want to offer your people so they can hire and stay with your young business for as long as possible: fair pay, family-friendly working hours, regular training, and decent working conditions are not enough. The most important thing is probably a good working atmosphere, which should be more than an empty promise.
Which legal form is the right one?
One of the many questions that you need to clarify is the question of the right legal form for your nursing service. It affects, among other things, liability, tax and accounting.
With little effort is the creation of a sole proprietorship: You need no seed capital and no complicated contracts. However, you are liable for all of your personal wealth should your care go broke. To hedge your assets, it may be advisable to establish a limited liability company (GmbH) or an entrepreneurial company (UG). Then you only stick with your deposit. These legal forms are associated with certain accounting obligations. However, since nursing services have to demonstrate their profitability with an annual balance sheet anyway, this argument hardly matters.
All in all, it is not possible to say which legal form best suits your company. You can read online and decide for yourself – or discuss the subject with professionals. These may be corporate lawyers, but also a tax consultancy that is knowledgeable in the industry. Incidentally, it is possible to change the legal form. So you can start as a sole proprietorship and later convert this into a UG or GmbH.
Costs, capital requirements and financing
In a company not only money is earned, money is also spent. A nursing service is no exception. In order to assess whether and when your nursing service pays off, you must know the costs that arise.
These are the most important costs of a nursing service:
- Salaries and other personnel costs (training, health care, etc.)
- Cost of remodeling and furnishing the business premises
- Rent (including utilities)
- Costs for vehicles (including fuel, taxes, maintenance and insurance)
This list is not complete. There are many more issues added, such as the purchase and cleaning of clothing or disinfectants and disposable gloves. Write down everything you can think of for your business plan. Then calculate the amount and research the price. Sometimes a look at current price lists is sufficient, sometimes it is necessary to request a quote.
For funding and later billing, it’s important to split your costs into three categories:
- Start-up costs (roughly: everything you spend before the actual start-up)
- Investments (for things that you can touch and usually use over a long period of time)
- ongoing operating expenses
Be sure to spend enough money in your financial plan to help you get started. In the first few months after founding, your nursing service may not be fully utilized. In addition, you can only bill your services with the care funds and patients after you have provided them. Your landlord or your staff expects you to transfer their money on time. With solid cash planning, make sure you are always liquid to settle outstanding bills.
Most founders rely on mixed financing, which is made up of their savings, loans, and public funding. No matter whether you borrow money from the bank or apply for a loan from the regional investment bank or the nationwide KfW: Without a solid business plan, which proves the feasibility of your project, it does not work!
Accounting obligations for outpatient care services
As the owner of a nursing service, you must be able to guarantee the care of your patients. Imagine, you are slipping into bankruptcy. Then that’s not just annoying for the patients – maybe their health or even their lives are in danger if suddenly they are no longer being cared for! In order to rule out this case as well as possible, the legislator has laid down certain rules with regard to operational management. Thus, according to the Nursing Implementation Regulation (PBV), every nursing service must submit once a year a balance sheet, a profit and loss account and other evidence that he is working in business administration.
This makes the bookkeeping for care services a bit complicated. With a tax accountancy office that has PBV experience and industry-standard accounting programs, you can make your life easier.
Excluded from PBV are small care services with less than seven full-time employees and an annual turnover of less than € 250,000. These establishments only have to submit an income surplus calculation (EÜR) at the end of the year. It may be a good idea to start small to familiarize yourself with the regulatory requirements in the nursing sector, and then gradually grow when your nursing job is well underway.
Founding tips from experienced experts
Who would know better what it takes to start a nursing service, as one who has already taken this step successfully? We asked Christoph Kahl, who founded a nursing and care service a few years ago.
Here are his most important tips!
… about finance:
“Keep an eye on your liquidity” is Christoph’s first and most important tip to all those who want to found a nursing service. Careful liquidity planning in the business plan is the best preparation for the foundation.
In addition, factoring is an appropriate way to secure solvency. When factoring, you transfer your unpaid bills to a bank for a fee, which in turn demands the money from the care funds. “That’s not as expensive as you think,” says Christoph. However, it would be important to find a reputable financial services provider that offers fair conditions and does not jeopardize their own reputation. He himself has had good experiences with the Bank for Social Policy, which pays the outstanding bills for a fee of 0.7%.
… about growth:
“Start small and do not grow too fast,” is the advice of Christopher on this topic. Many care services are taking on growth, thereby putting their liquidity at risk. Because the bigger the team is, the higher will be the sum, which must be advanced for salaries. “Growth is only possible if you have enough reserves to afford it.”
… about marketing
“We cleaned many latches at the beginning,” recalls Christoph. “We introduced ourselves to all the important points of contact in the region, such as hospitals, doctors and nursing homes.” The response was very good “Basically, they were glad to know who they could put their patients through.” the foundation distributed quite classic handouts.
… about values
Christoph is convinced: A care service should not be opened out of purely economic interest. “The special thing about such a company is that you work with people for people.” That was an enormous responsibility, which one must be aware of. “I myself was looking for a meaningful activity. When I learned of the opportunity to start a nursing and care service in the franchise, I was immediately convinced. “
The establishment of a nursing service is a demanding task, but offers excellent opportunities due to the steadily growing demand. A good idea is to start small and then gradually grow – also because of the shortage of skilled workers in the nursing sector. So you can build yourself a safe and fulfilling existence.
About the author Founding expert dr. Jan Evers is the owner of the consulting firm evers & jung in Hamburg. For ministries, banks and business development organizations, evers & jung GmbH has been developing concepts and solutions for entrepreneurs for more than 15 years that make entrepreneurship easier and more self-reliant.