By Thomas A. Parmalee
Isaac Miller had built the kind of career many attorneys spend decades pursuing.
He graduated from Vanderbilt University before earning his law degree from Pepperdine, built a successful practice in complex class-action litigation, and eventually found himself leading large teams in the death care technology sector before returning to private practice.
Along the way, he managed operations for a rapidly growing marketing company, helped oversee the sale of that business and directed multinational software implementation teams numbering more than 60 employees.
Today, however, Miller’s focus has shifted dramatically.
Instead of preparing legal arguments or overseeing software implementations, he is preparing to open FirstLight Home Care of West Des Moines, Iowa, where he’ll help older adults remain safely in their homes while supporting families.
His official open date is Oct. 1.
For professionals contemplating a second career in home care, Miller’s journey offers a blueprint for the due diligence that goes into starting an agency.
An Unexpected Career
Ironically, Miller’s legal career almost never happened.
“I actually went to law school thinking I was going to become a sports agent,” he recalled.
On his very first day, he met with one of the school’s sports law professors.
“She asked me if I was bringing any clients with me or whether I already had athletes on a roster who were about to graduate. I didn’t have either,” he said.
The conversation forced an immediate reassessment.
“I basically pivoted on day one of law school,” he said.
That pivot led him into class-action litigation, where he spent roughly a decade developing courtroom skills that, unbeknownst to him, would prove valuable elsewhere.
“I don’t think there are a lot of skills as an attorney that naturally transfer over into business,” he said. “But one of them is being comfortable having difficult conversations.”
That ability would become increasingly important after another unexpected career turn.
Discovering Entrepreneurship
In 2018, Miller joined MKJ Marketing, a small family-owned company started by his father-in-law and mother-in-law, which serves funeral homes and cemeteries across the country. Initially brought in as chief operating officer, he quickly discovered he enjoyed the unpredictability of entrepreneurial life.
“It was my first real experience working inside an entrepreneurial business,” he said. “I absolutely loved it.”
Unlike practicing law, where responsibilities are often narrowly defined, life inside a growing company required flexibility.
One moment he’d be addressing legal issues. The next he’d be solving operational challenges or helping clients navigate marketing decisions.
Then an unexpected resignation reshaped his role entirely.
“Our head of website development left unexpectedly,” Miller said. “That represented a significant portion of our revenue, so somebody had to jump in.”
Although he had no formal background in web development, he soon found himself overseeing design teams and presenting website concepts directly to funeral home owners.
“What I realized was that my legal background actually helped. I was used to presenting an idea, listening to objections, responding thoughtfully, and helping people arrive at a solution,” he said.
Eventually that responsibility became his specialty.
When MKJ was acquired by Tribute Technology in late 2021, Miller moved into progressively larger leadership positions, ultimately overseeing website development and software implementation teams spanning multiple continents.
The experience exposed him to nearly every type of business environment imaginable.
“I’ve now experienced the traditional legal career, entrepreneurship inside a family-owned business, and leadership inside a much larger private-equity-backed organization,” he said. “Those are three very different worlds.”
One Last Return to the Law
Despite finding success outside traditional legal practice, Miller wasn’t quite ready to close that chapter.
He accepted an opportunity to return to litigation for about a year and a half, wanting to answer one lingering question.
“I really wanted to know if law was where I wanted to spend the rest of my career,” he said.
The answer became clear fairly quickly.
“I had spoken with a number of attorneys who had left law for business, and they all told me the same thing — it was very difficult to go back … they were right,” he said.
Rather than reaffirming his commitment to practicing law, the experience confirmed something else.
“I realized entrepreneurship was probably where I belonged,” he said.
The Experience That Changed Everything
While Miller had spent years helping funeral homes communicate compassionately with grieving families, it wasn’t until his own family needed care that home care became personal.
His mother underwent several major surgeries, including multiple cancer-related procedures, within a relatively short period.
“We suddenly found ourselves needing much more help than we expected,” he said.
Like countless adult children across America, Miller found himself attempting to balance competing responsibilities.
“I was trying to be a husband, a dad, a full-time employee, and also care for my mom … I realized pretty quickly that I couldn’t do it by myself,” he said.
The family’s initial exposure to what they thought was “home care” left them confused.
“When my mom’s doctor said they had already arranged for home care, I thought, ‘Great. Everything’s taken care of,'” he said.
It wasn’t.
“What they had actually arranged was home health,” he said. “What we really needed was to layer home care on top of home health.”
His mother, who is now doing much better, required help with grocery shopping, companionship, housekeeping, transportation, and personal assistance — services that fell outside traditional home health. “But we had no framework for understanding any of that,” he said.
For someone who had spent years helping families navigate emotionally difficult decisions in another profession, the experience was eye-opening.
“It completely changed how I viewed this industry,” he said.
Lessons From the Other Side of the Phone
The family’s challenges didn’t end after hiring caregivers.
“My mom didn’t really connect with several of the caregivers who came into the house,” he shared.
One talked constantly, another hardly talked at all, and another mistakenly filled the dishwasher with regular dish soap, creating a kitchen full of bubbles.
More frustrating than any single incident was the lack of communication.
“I would wake up every morning wondering if someone was actually coming, who it would be, and what they were planning to do,” he said.
As the family member responsible for arranging and paying for care, Miller expected updates that often never arrived.
“I wasn’t getting text messages. I wasn’t getting communication if someone was running late. Sometimes, I wouldn’t know my mom had sent a caregiver home early,” he said.
Looking back, he believes those experiences fundamentally shaped the agency he is now building.
“I think communication starts within the first three minutes of the very first phone call,” he said. “You have to present yourself as someone who’s there to listen first.”
Building the Business the Right Way
Once Isaac Miller concluded that entrepreneurship — not law — was his long-term future, he faced another decision.
What kind of business should he build?
By then, his experience working alongside funeral professionals had already taught him the value of serving families during life’s most difficult moments. But his mother’s experience with home care had revealed another profession built almost entirely on trust.
“When I was introduced to the FirstLight Home Care brand, I realized this was the opportunity to build the kind of agency that I wish we’d had when my mom needed care,” he said.
Like many aspiring entrepreneurs, Miller considered whether to build an agency from scratch.
Ultimately, he decided the economics —and perhaps more importantly, the speed to market — favored joining an established franchise.
“What the franchise really did was dramatically shorten my learning curve,” he said. “The value isn’t simply having a recognizable name. It’s having people who are constantly looking around corners for you.”
Rather than reacting to changes in regulations, technology or consumer expectations, he now has an organization continuously evaluating what franchisees will need six months or two years down the road.
“I felt like that gave me the best opportunity to be successful and, more importantly, to scale my impact,” he said.
Why FirstLight Stood Out
Miller evaluated multiple opportunities before selecting FirstLight Home Care.
Some alternatives involved significantly more complex licensing requirements because they offered skilled medical care. Others simply didn’t offer the support structure he wanted.
“There were a couple of businesses I looked at that required intensive state licensing, and even after going through the process there was no guarantee you’d receive approval,” he said.
FirstLight’s focus on nonmedical home care aligned with his vision.
Ironically, however, he almost became a Tennessee franchise owner.
About a year ago, he had progressed far enough through the purchasing process that he was preparing to acquire a territory outside Nashville, where he lived up until last year.
At almost the same time, however, his wife began discussions with a company in Iowa about a new position.
“As those conversations developed, it became clear pretty quickly that we were going to be moving to Des Moines,” he said.
Rather than proceed with the Tennessee territory, Miller contacted FirstLight.
“I told them, ‘I’d really like to change to Des Moines, Iowa,'” he said.
Looking back, he believes the change may have been one of the luckiest breaks in the process, as if he had opened a franchise in Tennessee, he would have been living about 35 minutes outside his coverage area.
“I really think living in the community you serve gives you a tremendous advantage,” he said, which is something he did not fully appreciate at the time.
His territory currently covers communities including West Des Moines, Urbandale and Waukee, while neighboring territories remain available for future franchisees.
“I’m actually the first FirstLight franchisee in the state of Iowa,” he said.
The Importance of Capital
One lesson Miller heard repeatedly while conducting due diligence involved money — not the franchise fee itself, but the working capital required after opening.
“It isn’t an especially capital-intensive business to start,” he said, but this can create false confidence.
Unlike businesses with predictable monthly revenue, home care agencies experience constant fluctuations in client hours, which is why he’s setting aside working capital.
“I want to know that even if client hours fluctuate, the lights stay on,” he said.
That financial flexibility will allow him to make better long-term decisions instead of reacting out of desperation, he believes.
“If you’re constantly worried about cash flow, you’re much more likely to make short-term decisions that aren’t best for your business,” he said.
Choosing the Right Payor Mix
Among experienced agency owners, few subjects generate more discussion than payor mix between private pay, Veterans Affairs and Medicaid.
Each comes with different reimbursement structures, operational demands and financial realities. “I think payor mix is critically important,” he said.
Initially, he intends to focus on two markets: Working with veterans and private-pay clients.
Medicaid, however, is another matter.
“In many ways, Medicaid feels like an entirely different business,” he said, noting lower reimbursement rates often require significantly higher client volume.
“It becomes much more of a volume business,” he said.
So. before considering Medicaid, Miller wants to master the fundamentals.
“I want to understand what great home care looks like first,” he said. “I’m not in a position to do that today.”
Understanding the Regulatory Landscape
Launching in Iowa offers one unusual advantage.
Unlike many states, Iowa currently does not require licensure for nonmedical home care agencies.
“If you’re providing nonmedical home care, there isn’t a licensing process,” Miller said.
That streamlined environment has allowed Miller to focus on building his business rather than navigating lengthy regulatory approvals.
At the same time, he views the lack of licensing as something of a double-edged sword.
“It means virtually anyone can open an agency,” he said.
For consumers, that places even greater importance on asking thoughtful questions before choosing a provider, he said. That includes asking about staffing, whether they have backup caregivers and the type of training they provide.
Although Iowa imposes relatively few requirements, Miller has intentionally studied training standards from more heavily regulated states.
Rather than simply meeting Iowa’s minimum expectations, he plans to exceed them.
“My goal is to build those higher standards into our agency from day one,” he said.
Building a Culture That Lasts
If there’s one lesson Miller thinks aspiring home care owners should understand, it is this: The business is fundamentally about people, which includes caregivers.
“We want to be very caregiver-centric,” he said.
He observed that many caregivers work simultaneously for multiple agencies, which some view in a negative light.
Miller, however, accepts that it all boils down to economics.
“Most caregivers have a monthly amount they need to earn in order to support themselves or their families,” he said.
Because agencies closely monitor overtime, assembling a full-time income frequently requires working for more than one employer.
“I understand why caregivers do that,” he said.
Rather than pretending otherwise, he plans to address the issue openly, holding honest conversations about how many hours caregivers need each month.
He also observed that two processes must always be running: Caregiver recruiting and marketing the business — neither of which can exist independently.
“If your business development team is bringing in new clients but your operations team isn’t prepared with the right caregivers, you’ve got a problem,” he said. “But the opposite is true, too. If you’ve recruited wonderful caregivers and don’t have enough clients, they’re going to leave.”
Finding equilibrium between those two competing priorities may be one of the industry’s greatest operational challenges, he said.
Training as a Competitive Advantage
Miller believes ongoing education represents another opportunity to distinguish his agency.
“I want to build a real culture of training,” he said.
New employees will complete required onboarding, but the learning won’t stop there.
“My goal is to continually create opportunities for specialization,” he said.
Whether developing dementia expertise, strengthening communication skills or preparing caregivers for leadership roles, Miller wants education to become part of the agency’s identity.
He also plans to discuss career advancement almost immediately.
“I think it’s important to present a career path during the recruiting process,” he said.
Not every caregiver wants additional responsibility, but others may want to become a lead caregiver or move into scheduling, recruiting or operations. “Maybe someday someone wants to become a director of operations,” he said.
Becoming a Problem Solver
While caregivers form one half of the business equation, referral partners represent the other.
Like many first-time owners, Miller admits he is still learning exactly how those relationships develop.
One lesson, however, has already become clear.
“I need to become a problem solver,” he said.
Many newcomers approach hospitals, rehabilitation centers and senior living communities with lengthy presentations describing everything their agency can do, but Miller intends to begin somewhere entirely different.
“I’m going to ask questions,” he said.
Simple questions, such as:
- What are your biggest challenges?
- If I could solve one problem for your organization, what would it be?
He believes those conversations establish credibility far more effectively than promotional brochures ever could.
“If you don’t understand someone else’s problems, how can you possibly solve them?” he said.
A Growing Need
Miller has little doubt that demand for home care will continue increasing.
“Between 10,000 and 11,000 people are turning 65 every single day,” he observed.
Just as important, Americans increasingly want to remain in their own homes, which is a belief that has been reinforced since he moved to Iowa.
“So many people here grew up on farms, inherited family homes and have lived there virtually their entire lives,” he said.
Leaving those homes can be emotionally devastating.
“People want to age in place,” he said.
He also points to dementia as one of the defining health care challenges of the coming decades.
“We simply aren’t going to build enough facilities to meet the demand,” he said.
As that population grows, he believes high-quality home care will become increasingly essential.
“Home care is going to play a critical role in helping some of our most vulnerable populations,” he said.
Looking back, Miller believes nearly every entrepreneur entering home care shares one thing in common.
“Almost every owner I’ve spoken with got into this business because someone in their family needed care,” he said.
Many also describe disappointing experiences that convinced them they could build something better.
Whie he’s looking forward to opening his agency, his legal career isn’t entirely behind him: He plans to activate his Iowa law license, primarily so he can perform pro bono legal work and continue serving his community.
“I hope I never have to practice law again professionally,” he said with a smile. “But I’d love to use those skills to give back.”
