Behind the Scenes of Running a Care Home: What It Really Takes
Oct 15, 2025
Running an assisted living business is rewarding, but it’s also a lot of work behind the scenes. Many people only see the warm, welcoming side of care homes, but as an owner or operator, you’ll quickly learn there are moving parts everywhere—from managing staff to handling compliance.
If you’ve ever wondered what it’s really like to run a care home, let’s break it down. ๐
Check out this video, too:
1. People Come First
When you own or operate a care home, you’re constantly dealing with people—residents, families, staff, and referral partners. You’ll also work with vendors, nurses, maintenance workers, fire inspectors, and even city officials.
๐ If you’re not a natural “people person,” that’s okay. You can hire an administrator or partner who is skilled at building and managing relationships. The key is making sure your team is comfortable communicating—whether by phone, email, or in person—because everything in this business relies on trust and clear communication.
2. Money Management is Huge
Finances can make or break your care home. The biggest financial responsibility you’ll face is payroll. Staff members rely on timely paychecks, and missing payroll can create serious problems. Many care home owners use systems like Gusto to make the process smooth, ensuring taxes and benefits are handled correctly.
Other big financial pieces include:
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Resident Rent & Medicaid Billing – You need clear systems for collecting payments and navigating Medicaid (which can feel overwhelming at first but gets easier with experience).
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Food & Supplies – Buying in bulk through Costco, Sam’s Club, or Walmart+ can save money since you’ll always need plenty of food on hand.
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Utilities & Insurance – Power, gas, internet, and insurance policies all add up. Negotiating contracts (like trash removal) can save thousands each year.
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Repairs & Maintenance – From broken appliances to heating systems, you’ll need reliable vendors and commercial-grade equipment, especially washers and dryers.
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Marketing & Admin Costs – Websites, ads, and networking are all essential to keeping your facility full.
And don’t forget: as the owner, you pay yourself last. It’s important to aim for a fair wage, but never lose sight of the impact you’re making in people’s lives.
3. Building a Positive Culture
Culture is the heart of your care home. As the leader, you set the tone for staff and residents. That means:
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Hiring Right: Take your time to choose good team members, especially key roles like administrators.
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Recognizing Efforts: Celebrate staff wins, whether it’s great survey results or creative activities for residents.
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Setting Clear Expectations: Consistency in rules and support builds trust.
Culture also extends to the look and feel of your home. Is it cozy? Bright and cheerful? Filled with art and activities? These details create an environment where residents and families feel welcome.
4. Staying Compliant
Healthcare and assisted living come with a long list of rules. You’ll need to keep up with:
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Licensing and annual surveys
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Fire safety drills and equipment maintenance
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Resident care plans and nursing oversight
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Employee training and HR compliance
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Medicaid regulations and billing
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Documentation through EMR/EHR systems
๐ก Pro tip: If it isn’t documented, it didn’t happen. Using tools like Access EMR or ECP makes compliance much easier and ensures you stay on top of state requirements.
5. You Don’t Have to Do It Alone
Running a care home can feel overwhelming, but remember—you don’t have to carry it all. Owners often hire administrators and operators to divide responsibilities. By building a strong team, you can focus on growth, culture, and creating a sustainable business.
Final Thoughts
Behind the scenes of a care home, you’ll find a mix of people management, financial responsibility, culture building, and compliance. It’s challenging, yes—but it’s also deeply rewarding. When you run your business with care and consistency, you’re not just providing a service—you’re changing lives.
Next Steps
๐ Want to launch your own assisted living business in the next 12 months?
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Step 1: Download the free Business Plan Checklist to build your foundation.
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Step 2: Need help figuring out where to start? Join the next Roadmap Challenge and build your launch plan with me.
You don’t have to figure this out alone. With the right tools and mentorship, you can build a thriving assisted living business that makes an impact.
Show full transcript ๐
Transcript
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Hey friend, it's Brandon Gustafson with Assisted Living Investing. I help beginners like you launch their assisted living business in the next 12 months. In today's video, I'm going to give you a little bit of a sneak peek and behind the scenes of running a care home. So, if you are interested in that, make sure you stick around for today's video. Hey, welcome back to Assisted Living Investing. Excited to have you here on the channel with me. Before we get into our topic of behind the scenes of
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running a care home, I want to remind you to go grab the free underwriting calculator at assistedlivinginvesting.net. It's going to be the big blue box in the top right corner. Make sure you go and grab that free resource to help you as you are trying to launch your assisted living business. Now, with that out of the way, let's get into the secrets behind running a care home and what that actually looks like. So, the first thing that I want you to be aware of when you are running a care home is the people.
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You're going to be dealing with a lot of people. You're going to be dealing with residents and their families and the staff and the referral partners that you have, which could be a hospital or rehab center or other assisted living facilities. It could be any number of people that you want to be networking with. You're going to be having to talk to vendors, nurses that are coming out, the fire department, the company that services the fire equipment that you have. There's going to be maintenance
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people. There's going to be a ton of people that you're going to have to interface with as you are trying to run your assisted living business. So, if you're not a people person, doesn't mean that you can't do this by any means. It just means you're going to need to hire somebody that can. And that could be your administrator, maybe it's a partner that you're working with as you're launching your assisted living business. Regardless of who it is, you're going to
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need somebody that is comfortable building and developing relationships and having a lot of interactions with people. Those interactions can come via phone. They can be via email. It could be any number of ways that you're going to be communicating to them, but you're going to have to communicate with them. So, you need to have somebody in your team that is good at that and comfortable having those conversations cuz it's key. It's absolutely necessary. and you're going to have to have a lot
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of conversations there. The next thing that I want you to be aware of as you are running your care home is you're gonna have a lot of money that you're going to have to manage. There's a lot that goes into the money management piece of this. The biggest money thing that you're going to have to deal with when it comes to assisted living is payroll. You're going to have to run that payroll. It happens whatever cadence you're doing this, but probably every other week you're going to be
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paying that. You need to make sure that the money is in the bank for it. You got to make sure that you have a really good system that's going to run that that's going to take care of all the taxes and if you're doing benefits that it handles all of that. There's a lot that goes into it. We use Gusto at our facilities. We're going to have a link down below for you that gets you I think it's a $100 Visa gift card. I get the same thing. A little bit of a kickback for me as well. But make sure you go and use
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that code for Gusto because it is an incredible software. Takes a lot of the headache out of running payroll. And payroll like I've mentioned is the biggest thing. people care a lot about it and so if you miss it or there's issues with it, it's late, people will ask questions, they will complain and you want to avoid that at all costs. And so I I strongly encourage you to use a system like Gusto that's just going to take the the headache away from it. Gusto is designed specifically for small
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businesses like what you're trying to operate and they do a great job. They have really good customer service. We've been using them since 2020 and have not had any issues with them. They're helpful when state comes out with a new regulation or adjusts minimum wage or a new program or whatever. They're on top of it that can answer all the questions and make sure that you're following the things that you need to follow so that you stay in compliance and you're paying your people the right way. So, make sure
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you go and check that out. Again, link below for gusto.com. Go test it out. After you run your first payroll, they will send you a $100 Visa gift card. I think it's via email. So, you know, why not? I'll give you 100 bucks. So, there you go. Another big piece of the financial puzzle that you're going to be having to deal with is rent. AC, resident rent, Medicaid. You're going to need to have processes in place so you can get money from your residence. That's how you're going to be able to
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make payroll and buy the food and all the other things that you're going to have expenses for. You need to have that money. And so setting up processes in place so that you can do this. And I think I've got a video, we'll link it up above, that talks about a and and why it's so important to set that up and the way that you can receive payments. So, we'll link that up up there. But doing that and having very strict and consistent policies on how you're going to get paid will save you a ton of
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headaches. We use a payments through our bank who we bank with. It's a local credit union that we use to do things with and they have a process in there that allows us to do CAC. So, you can do that there. There are a bunch of other places that will allow you to do this online banks or uh you can do invoicing using tools like Wave or there's a bunch of other tools that are out there that can help you do this, but you want to make sure you have a way to collect that money. And if you're working with
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Medicaid, it can feel overwhelming, especially in the beginning. But my dad, who has no experience with healthcare before we started our facilities, didn't understand Medicaid at all, he runs our Medicaid process now. He's very familiar with it. He knows how to talk to the state. He knows all the acronyms that he sees, he knows how to go in and bill. And so these are things that while they can feel confusing and feel overwhelming, they're very easy to learn and be able to work through them. So,
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highly encourage you if you're going to go the Medicaid route that you spend a little bit of time figuring out what that's going to be for you so that you can get the the money there. If you're interested in learning more about Medicaid, type in Medicaid down below and we'll make sure we get you some other resources that help you understand exactly how that works. And I've got a ton of videos here on the channel that can help you understand how to go find fee schedules, understand how Medicaid
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works. And we'll try to link one of those up above here as well, so you can go and watch one of those videos. Another thing that you're going to need to be aware of when it comes to finances is food. You're going to need to buy the food, all the supplies that are around the food, the storing of the food, the the prepping of the food, the cooking of the food, all of those things. They they kind of fall on you to manage and make sure those things are working and that you are getting the food that you need.
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A lot of states are going to have specific guidance on how much food you need to have on hand and what you have in the pantry and is food labeled and is it cooked to certain temperatures and you need to manage a lot of these things. We're talking specifically here about finances. And what we found is using a service like Walmart Plus for example, you can get pretty good pricing or joining a membership club like Sam's Club or Costco can really save you a lot because you have to remember you're
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going to be buying in bulk. you're going to buy a lot of food. Um, and while residents don't eat a ton, it's still better for you to buy this food in bulk because then you're going to have it cuz you while they don't eat a lot, you are still preparing food for a lot of people. And so, you want to make sure you have a lot on hand. So, that's a quick tip for you and how you can kind of really just use things to your advantage to help you get the food that you need for your residents to make sure
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they're happy and healthy. Utilities and insurance is another huge expense that you need to be aware of. So, you're going to need to pay insurance, and that's going to be property insurance and liability insurance and workers comp insurance. Uh, depending on your situation. Ours is about $2,2500 per month, but that's based off of our facilities and how long we've been been in business and the locations we are. So, that could very much be different for you. But, I suggest that you work
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with an insurance broker to help you get the insurance that you need as you're trying to launch your assisted living business. I would also suggest not just any insurance broker, make sure that they are familiar with commercial properties and commercial insurance because that's what you're going to need to make sure that you are getting the right plans in place for your assisted living business. You're also going to need to be worrying about utilities. So, that's going to be your power, your gas,
00:08:02 - 00:08:58
your water, your internet, TV, any of the things that you use that are utilities. You're going to need to manage those. There's contracts there. You're going to have to potentially negotiate that. that uh we've been able to negotiate trash contracts in our Colorado facility and reduced our payment by close to I I want to say it was about $4,000 per year just in waste management. And so that's a huge savings, especially for a small business like ours. There's a lot of opportunities out there where you can
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find some cost savings, but it's going to take a lot of effort for you to figure all of that out. Repairs and maintenance. You're going to have a lot of repairs and maintenance at your facility that you're going to have to take care of as well. Things are going to happen. furnace or an air conditioning unit's going to go out. You're going to need to replace a toilet. There's going to be plumbing issues. Have one of your appliances will go out. You're going to have to make
00:08:51 - 00:09:45
sure that you are repairing and and maintaining those things. Quick pro tip that I'm going to give you is when it comes to washers and dryers, make sure you're getting industrial level um uh versions of these or commercial levels of these because you are constantly doing laundry in there. Large loads of laundry. And the more that you spend on that upfront, the better off you're going to be. Don't just go get the thing that's at the Home Depot on sale on Memorial Day or something like that.
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Make sure that you are getting something that can handle the volume that you're going to be putting into it. So, there's a quick tip for you. You're also going to have to handle marketing and admin costs. And that can be your administrator. It could be just other like administrative type of work that you may be handling yourself or you may want to hire somebody to take care of it for you. marketing, you know, Facebook marketing, Google ads. There's a lot of the building your website, maybe it's
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travel to go out and do some network marketing. There's a lot that goes into the marketing piece that you want to be aware of and that's more financials. So, you can see like we've gone through a ton of these things here. I've just listed off a bunch of different expenses you need to be handling and managing. That's a big part of what you do as a care home owner, as an assisted living facility owner. And on top of that, if you can, you want to pay yourself. So, you got to figure out how much am I
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going to pay myself? What's that going to look like? Am I able to do it? And remember, you're going to pay yourself last. Like that. That's what's going to happen. You're you're the business owner. You get paid last. And so, just want to be realistic with you on there. So, hopefully you're able to pay yourself and and that's going to work for you. What you have to remember those you can't lose sight of the incredible work and incredible impact that you're
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making on people's lives. As much as you might want to pay yourself a a living wage, and I hope you can, and and I it's very realistic to do that, I just want you to be careful and and not get too caught up in in this because you are making a huge impact on people's lives. So, that also needs to be really important. The third piece of running a care home that you're going to be doing is creating a culture. You are going to set and create the culture. So, you're going to need to hire the right people.
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And this can be hard because there's a lot of turnover already. But the more time you can take in hiring the right people, especially key positions like your administrator, the better off you're going to be. You want to recognize and appreciate your staff as well. When they do something good or you have a really good survey and and there's no issues, you want to celebrate those things. When you have a staff member that takes the initiative to create some incredible activities for the residents, you want to celebrate
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that person. You want to give them thanks. You want to just like really like go over the top a little bit celebrating that because that's the type of culture that you want to be building. When you're dealing with staff, you're also going to need to set some really clear expectations. You need to have consistent rules when somebody goes out of line. You need to be consistent with how you are disciplining or having conversations. You want to make sure that you are there to support people
00:11:48 - 00:12:36
when they have issues or they're struggling with something and trying to figure out exactly how they're going to handle certain situations. And you want to do those things because how you and I' I've been focusing a lot on staff here, but the reason why that you want to focus on staff is they are the ones that are in there on a daily basis. They're talking to the residents. They're interacting with the residents and they are the ones that are going to carry out that tone and that culture
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that you want to implement. And so the better you are at doing that with them, the better they're going to be at implementing that with your residents and their families and make it a much better experience for those individuals as they are interacting with you and interacting with your home. So it's really important for you to be doing that and building out that culture. On top of that, you're going to be kind of setting the look and the feel of the house. What does it feel like when you
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come in? Is it warm and cozy or is it like cool and relaxed? What What do you want that to look like? Do you have a bunch of artwork? Do you have TV going all the time? Do you have game area? What's your dining room going to look like? You want to look at those things cuz they are very, very important for you to have as you're trying to build this culture. And the more that time that you put into creating a home that's just inviting and exciting to be in, the happier people are going to be. And the
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fourth thing that I want you to be aware of when you are running a care home is staying in compliance. Regulations and healthcare. It's hard. There's a lot that goes into I've worked in the healthcare industry now since I think it was 2013 is when I started. I have a lot of experience working in the industry and understanding how it works. I have a masters in healthcare administration. I've been doing assisted living since 2020. Have a lot of experience in the healthcare industry. That doesn't mean I
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know everything. It doesn't mean that I'm not immune to just kind of learning how to handle all those rules and regulations because it happens. There's going to be state licensing rules when you get the license, when you renew the license, when you have annual surveys, fire and life safety codes you need to be aware of and doing the drills that are associated with it. Staying up on the maintenance of your fire suppression system and recharging your fire extinguishers that you're going to have
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to handle. Resident care policies and care plans. You're going to have to keep those up to date and that can be really hard. You have to work directly with your nursing staff. This doesn't need to be a full-time nursing staff that are at your facility, but you're going to need to have an RN presence at your facility to handle things like care plans and diagnosis and those types of things. So, you're going to be handling a lot of that inside of your assisted living facility. And it can be overwhelming. It
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can be hard and difficult to learn how to navigate those things. But, it's a key part of operating and running your own assisted living business. You're going to have to do all the employee training and the HR policies and rules and paperwork and everything that goes into that, documenting all of the resident care. We have a video on the channel here with access EMR. I'm going to link that up above so you can go check that out. But using a system like that, an EMR or an EHR system is going
00:14:43 - 00:15:28
to help you out a ton. If you're interested in learning more about those, type in EHR and tell me which one you're most interested in learning about. um put that in the comments as well so I can try to build out some relationships and get an understanding. There's ones that I use. I use Alice and have used ECP in the past and those ones I think are great, but there's a lot of different ones out there and something I would love to do is build relationships with people and understand how those
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systems work. So, make sure you go check out Access EMR and tell me which one is most important to you because it's so so key to what you're doing in your assisted living business to document everything. if it didn't get documented, it didn't happen. So, you have to make sure that that's something you are doing consistently. And there's going to be Medicaid billing. There's going to be some a component of billing, making sure if you are Medicaid that you're staying in
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compliance with Medicaid, that you're doing all the trainings, that you're staying up to date on exactly what that's going to look like and how that's going to impact you and impact your facility. So, that's a lot, right? But that's exactly what it's like running a care home, running an assisted living business. Those are all the things you need to do. Now, does that mean that you, the person watching this, have to do all of those things? No. You can hire people to do this. If you're somebody
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like me that's an owner operator, you hire an administrator. That administrator can take care of a lot of the things that we've talked about today. Um, or if I want to just be an owner and I want to hire an operator, they can take care of even more. So, you can delegate these things. In my mind, there are three key positions. There's the owner, the operator, and the administrator. And amongst those three people, you can divvy out the things that we've been talking about here in this video. So, if there's something
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there that you're confused about or need a little bit of help on, type that in the question. But probably easier than that is to join our ALI basics community. If you go to assistedlivinginvesting.net/basics, you can learn more about that program. It's a a membership that is designed to help you get the answers that you need. We have member onlyly Q&As. We do weekly tips and tricks and I'm in there answering your questions as you have them as you're trying to navigate your assisted living business and launch and
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and get to where you want to be so you are getting that time and financial freedom that you're looking for. It's the easiest way to work with me. So, we went through a lot today in today's video. We talked about what it's like behind the scenes running a care home. You're going to be dealing with a lot of people. Cannot stress how many people you're going to be dealing with is a lot. A lot of personalities. You're going to be managing the money. Key for you to do that so you can be profitable
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and make money and actually progress so that you can make a living wage out of this. You're going to be creating a strong culture. Super important for you to be doing that. And you're going to be handling all of the compliance things that come with the world of healthcare and assisted living and care homes that you're going to have to navigate. If you found this video to be helpful, make sure you like the video, subscribe, and ring the bell as well so we you get notified when we put out content like
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this. We go live on Tuesdays. We put out content like this on Thursdays. I'm here to help you and guide you to launch your assisted living business. Does residential assisted living sound interesting to you, but you don't know how to get started? At assisted living investing, I'm here to help beginners like you launch their assisted living business in the next 12 months. I love helping and coaching people, and I would love to help you on along your journey. Go check us out at assistedlivinginvesting.net.
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And remember, it doesn't take a lot, just a little bit. Just keep going step by step by step. And I promise you if you do and you're consistent and persistent, you're going to be successful. Thanks for watching and have a great day. [Music]
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