This annual list of the best in-home senior care franchises was revised and updated on January 26, 2022.
The in-home senior care industry has grown hugely in recent decades, and franchises have taken a significant place in that market. The top franchises in this sector are all relatively new businesses, founded in the 1990s or later, in response to growing customer demand, and long-term social changes mean that this sector is set for further growth.
As lifespans increase and family sizes fall, the American population is aging. According to the Population Reference Bureau, “The number of Americans ages 65 and older is projected to nearly double from 52 million in 2018 to 95 million by 2060, and the 65-and-older age group’s share of the total population will rise from 16 percent to 23 percent.” While the proportion of over-65s who remain working has increased since the late 1980s, over 60% are retired, and many of them need some form of care. The aging out of the baby boomer generation has driven the rocketing expansion of an industry.
While the number of older people going into care homes has increased, so has the number needing care in their own homes. Many prefer to stay at home as long as possible, for both personal and financial reasons. The average monthly cost of a private room in a nursing home was $8,821 in 2020, compared with $4,481 for home services. Technological, medical, and social changes are all supporting those who want to stay at home better than ever before. In-home care allows people to live independently for longer and at less expense.
Older people living outside nursing homes are often very reliant on others for support. Nearly a third of them live alone, and this increases to almost half among over 75s. Because we are more likely to survive chronic illnesses, more adults are living with them. In 1984, 80% of older adults had a chronic condition. By 2005, it was 91%. This leads to a far greater need for outside support. While this can sometimes come from family and friends, professionals are vital to keeping older people happy and healthy in their own homes.
The result has been great growth for franchises in this sector, with average growth of 8% per year from 2014 to 2019. The franchised part of the industry is currently worth $16 billion and employs over 460,000 people across 12,600 businesses.
The COVID-19 pandemic accelerated the growth of the in-home care industry, with some companies seeing revenues grow by hundreds of percent. With so much else of society shut down, and with older people being particularly vulnerable to the disease, many clients needed more in-home help than ever before. As a vital service, in-home carers were not hit with the sorts of restrictions that devastated some other businesses. They became a lifeline during a difficult time and saw their business soar.
That said, the industry also saw challenges. Restrictions on interactions made it difficult in some cases to provide in-home care, and the additional costs for personal protective equipment cut into revenues. As with many industries heavily reliant on labor, the industry is likely to face growing wage pressure as the economy shifts into a post-COVID era in which lower paid workers are making higher demands. The health risk factors involved in personal care may also make it harder to recruit.
The end result of these factors pushing in different directions is that there are conflicting reports on the current state of the industry. Is it suffering from the same drop in revenues that so many industries have suffered thanks to COVID, or flourishing like never before? Different sources offer different stories, and only time will reveal the truth.
In the longer term, it is likely that there will be growth over the coming years. The population is still aging, with the target demographic of over-65s reaching 56.9 million people in 2021, and the experience of COVID has demonstrated the value of in-home care. Living at home has helped to protect some older people, as they are less likely to be exposed to someone with an illness than if they lived in a retirement home. It’s also a more comfortable alternative for many, as they give up less of the life they’re used to.
Technology is changing the way that in-home care is provided. Areas such as communication with patients and the scheduling of care can be improved with the right technology, and companies are looking for ways to profit from this. Tech-savvy franchises may be able to profit both from the efficiencies and from the branding benefit this provides. Tools taken from telemedicine could become part of the home care package, adding a distanced element to the service while keeping customers in their own homes. Other changes include new services such as in-home COVID testing, which allow companies to provide more value for their customers.
The services provided by franchises vary. Some people need medical care, while others only need non-medical assistance, and this affects the skills employees need to demonstrate. Some franchises work with other groups as well as seniors, such as those with disabilities or recovering from medical conditions. In all cases, the aim of the work is to make people feel comfortable and cared for, to support them in living as independently as possible.
Demographic change guarantees growth for this sector, and these top franchises are well placed to benefit from that growth.
The Top In-Home Senior Care Franchises of 2022
1. Home Instead Senior Care
Home Instead Senior Care can provide seniors with part-time or full-time live-in care, but it has to be nonmedical kinds of assistance and companionship, although hospice care is a service offered for those needing end-of-life care. This will be a theme that runs throughout this list in terms of franchised in-home senior care that does not rise to the level of skilled nursing care.
The ideal senior for this franchise is one who mostly does whatever physical tasks they need to do, but just requires some assistance and supervision. Caregivers will also perform light housework and general companionship. The goal is “aging in place” to allow seniors to remain living in their home longer than might otherwise be possible without assistance.
Founded in 1994 by Paul and Lori Hogan in Omaha, Nebraska and franchising since 1995, the number of locations has expanded in recent years from 973 in 2012 to the current total of 1,144 (up from the previously reported total of 1,094), of which three are company-owned and 530 are located outside the US.
2. Right at Home
Right at Home serves families when they start to notice their aging parents need help with daily life activities. Nonmedical in-home care services include companionship care and homemaking, physical assistance, hygiene, wellness, nonmedical home care, home health aide, respite care, Alzheimer’s/dementia/cognitive change services, health reminders, and transportation assistance.
Skilled nursing services include visiting nurses, medication set-up, medication administration, insulin injections, wound care, dressing changes, catheter care, ostomy/colostomy care, and skilled hospice support.
Founded by Allen Hager in Omaha, Nebraska in 1995 and franchising since 2000, the number of locations has grown rapidly in recent years from 250 in 2012 to the current total of 663 (up from the previously reported total of 614), of which 20 are company-owned and 161 are located outside the US.
3. Interim HealthCare
Interim HealthCare is the longest-lived company on this list, and over its 50-year history has created a signature standard of care called HomeLife Enrichment. It is designed to ensure care for “…the whole individual – mind, body and spirit, in addition to care for the family.”
Care options include both the full range of standard in-home care as well as hospice care. In addition to medication reminders, help with laundry, light housekeeping, meal preparation, transportation, toileting/incontinence, transferring/positioning, bathing/hygiene, mobility assistance, and eating/feeding, caregivers focus on enrichment activities to give seniors more vitality and happiness as they age.
Founded in 1966 and franchising since then, the number of locations has risen in recent years from 325 in 2013 (all domestic) to the current total of 623 (up from the previously reported total of 597), of which two are company-owned and 275 are located outside the US.
4. Visiting Angels
Visiting Angels offers hourly care, overnight care, or 24-hour care as needed to help seniors with all kinds of activities of daily living. Care services include respite care, companionship, personal care, hygiene assistance, meal planning and preparation, light housekeeping, laundry assistance, medication reminders, and assistance running errands. The company’s philosophy is that every senior deserves quality, affordable in-home care and assistance.
The company also offers a Constant Companion device that works in conjunction with Amazon’s Alexa smart speaker. It comes fully programmed and ready to use. Seniors can make calls hands-free by just saying, “Alexa, call my daughter (or son).” It is also programmed for urgent voice-activated medical alerts.
Founded by Jeffrey Johnson in 1992 and franchising since 1998, the number of locations has marched steadily upward in recent years from 445 in 2012 to the current total of 578 (down from the previously reported total of 594), of which none are company-owned and 12 are located outside the US.
5. Synergy HomeCare
Synergy HomeCare sends caregivers into the homes of seniors to help them with life’s daily activities. This can include personal assistance (standby assistance with morning and evening routines, transfer assistance, bathing and showering assistance, personal hygiene assistance, help with restroom use, assistance with dressing, personal appearance care, and incontinence care), errands and transportation (incidental transportation, escort to and from appointments, schedule planning and assistance, errand services), meals (assistance with meal planning, mealtime feeding assistance, assist with and motivate meal preparation, complete meal preparation), light housekeeping, companionship, live-in care, and 24-hour care.
Founded by Peter Tourian in Gilbert, Arizona in 2001 and franchising since 2005, the number of locations has risen substantially in recent years from 248 in 2012 to the current total of 347 (up from the previously reported total of 325), of which none are company-owned and all are located in the US.
6. BrightStar Care
BrightStar Care provides both medical and nonmedical in-home care services to all individuals who need them, although senior care is a primary focus. The basic philosophy is one that makes sense: “Home is always associated with comfort, security and positive feeling. For seniors and for all of us, when we are not feeling well, we all want to be at home.”
The senior care services menu includes personal care (ambulation, bath visits, dressing and grooming, expertise with memory loss/confusion/forgetfulness, feeding, personal safety home evaluation, outpatient pre and post-op assistance, oral and personal hygiene, reporting conditions and changes to supervisory RN and/or physician, toileting), companion care, home care (light housekeeping, laundry, meal preparation), and outside support services (getting out and about).
Founded by Shelly Sun in 2002 and franchising since 2005, the number of locations has grown quickly in recent years from 238 in 2012 to the current total of 342 (up from the previously reported total of 325), of which 5 are company-owned and all are located in the US.
7. Senior Helpers
Senior Helpers offers a wide range of professional in-home senior care services, including Alzheimer’s and dementia care, Parkinson’s care, companion care, personal care (hygiene, light housekeeping, appointment transportation, hobbies), transitional care, chronic disease care, VA Aid & Attendance Benefit assistance for senior veterans, respite care, in-hospital surgery assistance, and end-of-life support care.
The company has developed a LIFE (Life, Independence, Function, Evaluation) Profile tool it uses to help families assess care needs and plan how to meet them.
Founded by Tony Bonacuse and Peter Ross in Baltimore, Maryland in 2001 and franchising since 2005, the number of locations has grown in recent years from 256 in 2014 to the current total of 331 (up from the previously reported total of 317), of which four are company-owned and 21 are located outside the US.
8. ComForCare Home Care
ComForCare Home Care assists older adults, those with disabilities, and those who are recovering from surgery or hospitalization with a wide range of nonmedical services such as bathing and grooming, meal planning and preparation, medication reminders, transportation, light housekeeping, safety supervision, and companionship. There is also a specialized program it calls DementiaWise to care for those with Alzheimer’s disease and other forms of dementia, and private-duty nursing in some locations.
The company also pays particular attention to “transition care” when a person is returning home after time away in a hospital, rehab center, or nursing home because those transitions often don’t go well without the proper support in making the transition.
Founded in Bloomfield Hills, Michigan in 1996 and franchising since 2001, the number of locations has expanded in recent years from 168 in 2012 to the current total of 216 (up from the previously reported total of 206), of which none are company-owned and 10 are located outside the US.
9. FirstLight Home Care
FirstLight Home Care provides in-home care services to anyone who needs assistance, but has a primary focus on nonmedical senior care. Services include companion care, personal care (bathing/hygiene, walking/mobility, transfer/posture, continence/toileting, meal preparation, eating assistance, oral hygiene, etc.), dementia care, respite care, brain health services, and a travel companion program.
The company aims at fostering a “culture of care” based on learning as much as possible from care recipient’s loved ones. The ultimate goal is to help seniors “…enjoy the best quality of life and enjoy independence for as long as possible.”
Founded by Jeff and Devin Bevis in Cincinnati, Ohio in 2009 and franchising since 2010, the number of locations has steadily climbed to the current total of 202 (up from the previously reported total of 190), of which none are company-owned and two are located outside the US.
10. Griswold Home Care
Griswold Home Care helps seniors remain independent in their homes, as well as anyone who is disabled, bedridden or wheelchair-bound, living alone, recovering from hospitalization or nursing home stays, or who have special needs. Respite care to give family member caregivers a break is another focus.
The services offered include personal care, cooking and preparing meals, doing light housekeeping and laundry, shopping and running errands, and assisting with medication and transfers. Additional options include companion care, hospice care, and live-in/overnight care.
Founded by Jean Griswold in Philadelphia, Pennsylvania in 1982 and franchising since 1984, the number of locations has been declining in recent years from a high of 261 in 2014 to the current total of 180 (down from the previously reported total of 181), of which 14 are company-owned and all are located in the US.
11. Nurse Next Door Home Care Services
Nurse Next Door Home Care Services aims to help seniors achieve happier aging by offering a range of in-home senior care options, including companionship, meal preparation, homemaking, home nursing care (medication management, dementia care, etc.), respite care, personal care (hygiene assistance), end-of-life care, transportation (errands), and so on.
In the company’s happier aging philosophy, caregivers help seniors rediscover the interests and hobbies seniors used to do but that have fallen by the wayside for whatever reason.
Founded by John DeHart and Ken Sim in 2001 and franchising since 2007, the number of locations has expanded rapidly in recent years from 49 in 2012 to the last known reported total of 172 in 2019, of which nine were company-owned and 63 were located outside the US.
12. Assisting Hands Home Care
Assisting Hands Home Care provides individualized in-home care services to people of all ages, in many situations, with a main focus on senior care.
Its certified, bonded, and insured caregivers offer compassionate, skilled assistance with bathing, grooming, meal preparation, housekeeping, home safety evaluations, recommendation for and placement of assistive devices in the home, fall risk assessments and individualized fall prevention plans, care coordination with all members of the client’s healthcare team, transportation and accompaniment to vital healthcare appointments, specialized care for the Alzheimer’s or other dementia client, one-on-one end of life care for clients on hospice, automated medication reminders, medical alert system, and video monitoring services. Additional care options include skilled nursing and therapy.
Founded by Dr. Gail Silverstein and Cline Waddell in 2006 and franchising since then, the number of locations has risen rapidly in recent years from 52 in 2012 to the current total of 159 (up from the previously reported total of 134), of which four are company-owned and all are located in the US.
13. Acti-Kare
Acti-Kare offers in-home care for all ages, but has a primary focus on nonmedical senior care that lets seniors live independent, active lives without having to give up their home. The company has developed a proprietary approach call Acti-Vate that aims to keep seniors active by promoting memory stimulation, along with activities to stimulate physical, mental, social, and emotional well-being.
Care options include companionship care, respite care (to give family caregivers a break), personal care, hospice care, memory care, Alzheimer’s care, and dementia care. Caregiver activities can include assistance with meal preparation, conversations, medication reminders, light housekeeping, and running errands.
Founded in 2007 and franchising since then, the number of locations has been growing rapidly in recent years from 35 in 2012 to the current total of 137 (up from the previously reported total of 134), of which none are company-owned and all are located in the US.
14. Amada Senior Care
Amada Senior Care has a unique mix of services to help aging seniors. In-home care services include bathing, dressing, meal preparation/feeding, medication reminders, walking/exercise assistance, light housekeeping, errands/shopping, toileting, and all manner of other non-medical help. When it’s time for a senior to leave their home, the company’s housing options service helps families narrow down housing choices based on individual care needs, budget, location, and personal preferences.
The company also offers Amada Connect, a technology tool that provides information on daily activities and reports behavioral patterns to a web-based dashboard or directly via email or mobile device. Amada also provides financial coordination services to help families understand long-term care (LTC) insurance and veterans assistance programs.
Founded in 2007 and franchising since 2012, the number of locations has grown rapidly from just three in 2012 to the current total of 111 (up from the previously reported total of 99), of which one is company-owned and all are located in the US.
15. Touching Hearts at Home
Touching Hearts at Home provides in-home care services for older adults, seniors, and people with medical conditions and/or disabilities. Care services include companionship, Alzheimer’s and dementia care, transportation, light housekeeping, and meal preparation.
Founded by Renae Peterson in St. Paul/Minneapolis, Minnesota in 1996 and franchising since 2007, the number of locations has grown in recent years from 28 in 2012 to the current total of 72 (no change from the previously reported total), of which none are company-owned and all are located in the US.
An Important Note About Our Methodology
The franchises on this list were ranked according to the number of units in the franchise system. If you are a prospective franchisee searching for franchise opportunities that meet or exceed certain performance benchmarks for sales, profits, and return on investment, please check out this list of America’s Most Lucrative Franchises.
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