First 90 Days After Buying a Senior Care Business

Establish readiness before taking control

Prepare the handoff during diligence. Identify the legal operator, required approvals, qualified management, premises, insurance and staff cover. Confirm payroll funding, bank access, scheduling, records and billing responsibilities. A public announcement does not supply any of these. Keep a material gap visible in the closing decision.

The closing-evidence guide checks the event that comes before this operating plan. Its fictional funds statement balances, but a required permission remains pending. Use separate evidence for money, authority and essential tasks; do not move an unmet prerequisite into the first ninety days merely to mark closing complete.

The acquisition-insurance exercise lays out a fictional service event before closing and a claim report afterward. The buyer’s proposed policy has its own start and retroactive dates. Use the timeline to assign questions to the insurance adviser. Keep the handoff coverage question open until the review supplies an answer.

For providers covered by 42 CFR 489.18, Medicare agreement assignment has defined conditions, including an existing plan of correction. It does not establish that the buyer may use every seller arrangement indefinitely. Counsel should assess the actual structure and any other state, payer or contract steps. (Source: 42 CFR 489.18.)

Decide who can pause the commercial handoff if a required condition is unmet. Staff need to know who remains accountable for the business while that decision is resolved. Do not let a planned ceremony, press release or seller departure drive an unsupported operating change.

The closing-contingency register checks the entity, scope and effective date of each required document. It shows why a planned handoff can remain unfunded after an approval date moves, even when the loan was previously discussed.

Use stages that follow evidence and actual duties

The stages below are an optional way to organize the work. They are not legal deadlines or permission to delay a required correction. The care model, size, contracts and actual service needs determine what happens and when. Some tasks begin long before closing; others remain ongoing management duties.

An acquired agency already serving clients needs staff and working systems from the start. It cannot follow a startup plan that waits to recruit until later months. A campus with several care models may need separate operating leads and records for each. The shared schedule should not hide those differences.

Give staff clear and accurate information

Coordinate the communication plan with the seller, counsel and operating lead. Meet required notices and protect personal information. Explain the confirmed employer and reporting lines, how schedules and payroll questions are handled, and who is available for support. Avoid promises about pay, benefits or jobs that have not been approved.

Give people a way to raise concerns and get an answer. Record unresolved questions with an owner and a next step. A complaint may reveal a genuine gap in coverage or a payroll setup error. Do not dismiss it as resistance to change before checking the facts.

If a key employee will not remain, update the plan and budget promptly. An unsigned retention proposal is not a confirmed staffing solution. The seller's willingness to answer questions is also different from an agreement to cover a required management or clinical role.

Check scheduling and the first payroll carefully

Have the qualified team check service coverage and backup arrangements. A home-care agency should know which assignments remain open and who responds when a caregiver is absent. A residential operation needs its own assessment against resident needs and applicable duties. Revenue targets cannot substitute for that review.

The employees-after-sale FAQ checks a fictional handoff plan against three staff records: one person has no agreed next role, and another starts after the planned handoff. A third has stated availability but still needs a role check. Use the exercise to review coverage before relying on the roster.

Confirm the legal employer, payroll provider, staff setup, time records and funding dates. Reconcile work that spans the ownership change so hours are not omitted or counted twice. Assign who resolves errors and handles any required corrections. Use the approved process for employee data, rather than sharing personal-account logins or unrestricted files.

Review proposed pay or work-practice changes with the relevant advisers. The buyer needs to understand actual duties and legal requirements before labeling a payroll cost unnecessary. Preserve the records that support hours, payments and any agreed allocation between buyer and seller.

Keep billing ownership and exceptions visible

Define who handles old and new service activity, invoices, claims, collections, credits and refunds. The treatment should agree with the purchase documents and the lawful payer arrangements. The buyer does not automatically acquire a right to use a seller's portal login or billing number.

Track different types of exceptions separately. Unsubmitted activity, a rejected file, a denied claim and cash awaiting allocation require different actions. Assign an owner to each. More invoices in a system do not prove that services were documented correctly or that payment will arrive.

For covered Medicaid personal-care and home-health services involving in-home visits, review the applicable electronic visit verification workflow. Confirm state or payer requirements and the system roles after the ownership change. The federal EVV scope is not a claim that all private-pay care follows one national vendor process. (Source: Medicaid.gov EVV.)

Keep AR aging by payer in the operating review. Follow each correction back to the relevant service period and account. If a pre-closing receipt belongs to the seller, record it under the agreed arrangement rather than treating all money in a bank account as buyer revenue.

Reconcile cash forecasts with actual results

Use a short-interval forecast based on payroll, rent, debt, supplies and transition work. Include the timing of receipts, not just expected monthly revenue. Keep restricted funds and resident or client obligations apart from unrestricted operating money. A total bank balance may not be available for general expenses.

Use the working-capital FAQ to check the assumptions in a fictional seller forecast. It removes collections kept by the seller and adds omitted buyer transition costs. The handoff team can use that exercise before comparing the buyer’s expected cash movements with actual results.

The following invented weekly example begins after closing with unrestricted cash. It includes all receipts and payments assumed for the illustration, including modeled payroll, rent and debt payments. Closing costs are already funded separately and are not deducted again. No restricted client funds are included.

Forecast closing cash is $90,000 + $120,000 − $130,000 = $80,000. Actual closing cash is $90,000 + $100,000 − $138,000 = $52,000. The shortfall against forecast is $28,000: $20,000 less in receipts plus $8,000 more in payments.

In this scenario, the missing receipt is delayed, still collectible and not yet received. The extra payment is for unplanned repair work. Neither fact can be assumed in a real case without evidence. The accountant must assess the repair's accounting treatment; the cash has left whether it is expensed now or recorded as an asset.

The delay and new spending need different responses, although both reduce current cash. Update the forecast and arrange permitted funding when needed. The week-end balance is not proof of the lowest balance during the week or a recommended reserve. Check the dates of large payments and expected receipts.

IRS recordkeeping guidance supports records behind income and expenses. The forecast and variance review here are original operating tools. They do not replace reconciled accounts, a lender's definitions or professional advice about a specific cash problem. (Source: IRS recordkeeping.)

Prove records and system access before a cutover

Inventory critical software, devices, domains, phone accounts, vendor contracts, backups and records. Identify the business owner and authorized users of each. Confirm any consent, new contract or account setup needed for the buyer. A tool tied to the seller's personal identity can become a serious dependency.

Before moving records, test more than whether the new system opens. Check complete histories, attachments, permissions and a sample of the tasks staff must perform. Record which discrepancies remain. Set a cutover decision and a lawful fallback that can preserve service if the new process fails.

HHS's Security Rule summary concerns covered entities and business associates and their electronic protected health information. The responsible privacy and technical professionals should assess the applicable safeguards. One software product or a successful login does not establish compliance. (Source: HHS Security Rule summary.)

Keep record-retention duties separate. The HIPAA Privacy Rule does not set a universal medical-record retention term. State and other applicable rules still need review, with safeguards while records are held and disposed of. Do not confuse medical records with documentation required to show HIPAA compliance. (Source: HHS retention FAQ.)

Make seller training a demonstrated handoff

Describe training as tasks with a successor and a completion test. For example, the buyer's authorized billing lead should be able to identify an exception, find its records and route it correctly. Watching the seller handle a problem once is weaker evidence than performing the task with the right access and supervision.

List unusual but important routines, such as a payroll exception, landlord report or vendor renewal. Keep suitable written instructions and current contacts. Arrange any relationship introductions through the agreed legal and privacy process. A list of names is not a guarantee of future referrals.

Before the seller's agreed support ends, review the tasks that still depend on that person. Fund qualified cover or negotiate further support if appropriate. State the duties, time and compensation. Do not quietly convert a finite training arrangement into indefinite responsibility for operating the business.

The seller-training task guide adds a paid-support schedule and a successor demonstration. Its fictional billing task stays open because the required routing role is missing, even though the successor correctly identifies the exception.

Address issues through the right people

Carry permissible ongoing tasks from diligence into the operating issue log. Keep the facts, responsible person, required action, deadline and proof of completion. A change of ownership or a reserve does not erase a finding. Required pre-closing conditions should not be moved into this log as a substitute for resolving them.

OIG's General Compliance Program Guidance is voluntary and nonbinding. It can help organize questions, but the actual legal duties and evidence of implementation remain separate. Give staff a clear route to report problems and assign qualified people to assess them. (Source: HHS OIG GCPG.)

Urgent safety, service, privacy or legal concerns need the applicable response when they arise. Do not wait for the end of the month or the ninety-day review. Keep commercial negotiation over responsibility separate from the work needed to protect people and meet current duties.

The individual-buyer handoff guide shows the seller's side of that support review. Its task schedule separates buyer hours, paid help and the need for qualified relief. Use it to identify duties still dependent on the seller before treating the agreed training period as a complete operating handoff.

Test improvements and finish the support review

Establish a baseline before making an optional process change. Select measures that fit the service, such as delivered hours, coverage exceptions, billing corrections and collections. Qualified staff should select and interpret clinical measures. More billing or fewer paid hours alone does not demonstrate better care or a healthier business.

Try a defined change with a responsible lead and a way to assess its effects. A revised invoice check should be tested for accuracy, staff time and whether it delays legitimate bills. Necessary risk responses may require rapid action; optional changes should have evidence and a workable fallback.

At the end of the agreed support period, confirm that records remain accessible, accounts reconcile and the buyer's team owns the remaining duties. Update the cash plan with actual results. Jason Taken, business broker with HedgeStone Business Advisors, can help organize agreed commercial tasks; the buyer's qualified team remains responsible for operating the business.

Use the interim-management responsibility map when planning duties before a completed handoff. Name who can prepare a schedule or payment, who can approve it and who takes control if the expected sale stops.

Before assigning the handoff tasks, use the home-care buyer-fit question to test your intended role. The example reveals gaps in named responsibility and available cash that a broad promise to retain the team would leave unresolved.