By Thomas A. Parmalee
When Jeff Pitts, 42, was a federal attorney in Washington, D.C., he managed risk on government acquisitions worth more than $60 billion annually. He advised senior leaders, worked in the White House, and built what many would consider a dream career.
On paper, everything looked perfect.
In reality, Pitts was beginning to ask himself a difficult question: Do I want to spend the rest of my life doing this?
The answer would ultimately lead him thousands of miles from the nation’s capital to Colorado’s Western Slope, where he now owns and operates one of the largest home care territories in the Comfort Keepers system. Today, Pitts oversees a team of more than 200 caregivers serving seniors across approximately 12,000 square miles of rural Colorado.
The path from attorney to home care entrepreneur was anything but conventional. Yet his journey offers valuable lessons for anyone considering home care ownership — particularly operators serving rural communities where workforce challenges, geography and economics create obstacles that many urban agencies never face.
The Shift
Like many successful professionals, Pitts followed a safe and predictable path.
Both of his parents were entrepreneurs, but he chose law school and government service instead. The career offered stability, prestige and financial security. It also came with significant student debt, making it difficult to walk away.
But as he approached his 40s, Pitts found himself confronting questions that many professionals avoid until much later in life.
“I realized I’d been a lawyer for a long time, but I never really loved it,” he said.
His soul-searching forced Pitts to think seriously about what he wanted the next chapter of his life to look like.
At the same time, he became fascinated with entrepreneurship through acquisition — the concept of buying and operating an existing business rather than starting one from scratch.
He wasn’t looking to invent the next Uber.
Instead, he wanted a business with staying power, recurring demand and the opportunity to make a meaningful difference.
With these thoughts running through his head, life intervened again.
Becoming the Caregiver
As Pitts explored acquisition opportunities, both of his parents experienced serious health challenges.
His mother was struggling with Alzheimer’s disease. His father began to struggle and could no longer manage her care on his own.
Pitts and his sister suddenly found themselves juggling demanding careers while rotating back to their childhood home in Kansas to care for their parents.
“We were literally moving back into our childhood bedrooms,” he said.
For six months, Pitts became deeply involved in caregiving. He helped his parents navigate daily life while wrestling with a question that millions of adult children face every year: How do you help aging parents remain safe without sacrificing your independence?
His mother was adamant about one thing.
She did not want to move into a facility.
Like many older adults, she wanted to remain in the home she had worked hard to build and maintain.
Eventually, Pitts and his family hired caregivers to provide support in the home. The impact was immediate.
“Having caregivers gave my sister and me our lives back,” he said.
Assisting his parents through some of the most intimate and challenging aspects of aging left Pitts with a tremendous respect for those who perform that work every day.
It also introduced him to the home care industry from the client’s perspective — a viewpoint that continues to shape how he runs his business today.
What Changed Everything
The final piece of the puzzle arrived when Pitts connected with a former business professional who had made a dramatic career change and purchased a Comfort Keepers franchise.
The conversation wasn’t supposed to be about home care – Pitts was simply trying to figure out if he should leave a lucrative career to start something new.
Yet by the end of lunch, Pitts had become convinced that home care was exactly the type of business he had been searching for.
“It was steady. It had a future. And it was something I could feel passionate about,” he said.
Then fate intervened once more.
Just six days later, a Comfort Keepers territory in Grand Junction, Colorado, came up for sale. It had originally opened in 2003, peaking at 250 caregivers.
Pitts received the listing through an acquisition newsletter.
His reaction was immediate.
“I just had a gut feeling. I said, ‘That’s the one.'”
At the time, he lived less than four hours away in Denver and the agency was billing about 3,600 hours per week. He saw the opportunity as one that could replace his salary as well as his wife’s in time.
Within 48 hours, he was under a letter of intent. Six months later, after completing due diligence, he closed on the acquisition.
The Scariest Decision of His Life
Despite his legal background and extensive risk management experience, Pitts admits the transition was terrifying.
He walked away from a stable 15-year federal career to purchase a business operating in an industry heavily influenced by reimbursement rates, workforce shortages and economic uncertainty.
At the time of acquisition, approximately half of the agency’s business came from Medicaid-funded services.
That represented both opportunity and risk.
While Colorado historically offered relatively favorable reimbursement rates, Pitts quickly learned one of the most important lessons in home care ownership: Assumptions can change.
Since he acquired the business in September 2024, Medicaid reimbursement rates have been reduced multiple times.
The agency responded by intentionally shifting away from certain Medicaid services and increasing its focus on private-pay clients and veterans. Billable weekly hours have gone down to about 3,100, but it’s a better mix, he said.
“These were some of the hardest decisions I’ve had to make as an owner,” he said. “As the rate cuts added up, it became difficult to staff certain cases adequately and safely, and we weren’t willing to take on care we couldn’t reliably stand behind. Stepping back from those services was painful, but it let us keep our focus on delivering dependable, high-quality care to the families we serve.”
Pitts entered home care to help people. Telling families that his agency could no longer serve certain cases ran counter to that mission.
“It was one of the saddest parts of ownership,” he said.
Yet he also recognized the financial realities facing providers.
“You can’t run a business based on hope,” he explained. “You have to understand what you can control and what you can’t.”
That perspective reflects a critical lesson for agency owners evaluating acquisitions or expansion opportunities.
While many operators focus heavily on current revenue and profit-and-loss statements, Pitts advises digging deeper.
Study reimbursement trends. Understand local demographics. Analyze household income levels. Evaluate competitors. Learn which payer sources dominate the market and how vulnerable they are to regulatory changes.
“The things you can know are important,” he says. “But you also need to understand the things you can’t know.”
Expect to do a lot of work if you buy an agency, he warned.
“I work full time doing this … and I may work 100 hours per week, but it’s good stress,” he said.
The Complexity Nobody Talks About
Pitts entered home care with “eyes wide open.”
Even so, the first year surprised him.
Not because of the caregiving itself — it was simply the complexity of so many moving parts, including caregivers, clients, family members, nurses, schedulers, referral sources and community partners.
When an organization employs hundreds of caregivers across thousands of square miles, something unexpected is almost guaranteed to happen daily, he said.
One day, a nurse may encounter a bear while visiting a client.
Another day, a caregiver might call out unexpectedly, leaving a vulnerable senior without support.
As Pitts puts it, statistics alone ensure that something will go wrong every day.
The key is learning how to respond.
“You just roll with it,” he said.
Building a Rural Home Care Operation
Perhaps the most challenging aspect of Pitts’ business is geography.
Many home care operators think of a service area in terms of neighborhoods or ZIP codes, but Pitts thinks in terms of counties.
His territory spans approximately 12,000 square miles and includes communities separated by mountains, rural highways and long stretches of open land.
Some clients live more than an hour from the nearest caregiver; others live 45 miles from the agency’s satellite office. That creates big challenges revolving around recruitment, scheduling and growth.
Yet Pitts believes rural markets also offer significant advantages.
Competition is often less intense, community relationships run deeper, and reputation matters more.
“In a small community, everybody knows everybody,” he said.
Strong character and consistent service become competitive advantages, he observed. At the same time, if you make a mistake, word travels fast.
Why Community Involvement Matters
Many agencies focus heavily on hospitals, discharge planners and elder law attorneys when building referral relationships.
Pitts certainly values those partnerships.
But he believes community engagement extends much further.
His team actively participates with organizations such as the Alzheimer’s Association, local charities, firefighters and law enforcement agencies.
The goal is simple: become part of the fabric of the community.
One lesson emerged directly from his family’s experience.
His parents ultimately trusted their primary care physician more than anyone else involved in their health care journey, which has led Pitts to place renewed emphasis on physician relationships.
His agency communicates directly with physicians when clients begin receiving services, helping doctors understand the role home care plays in keeping seniors safe and independent.
“The future is being part of the care team,” Pitts said.
Home care providers who effectively communicate their value can help reduce hospitalizations, delay nursing home placement and improve quality of life, he said.
The Workforce Challenge
Like virtually every home care operator, Pitts spends significant time thinking about workforce recruitment and retention.
He knows firsthand how difficult the math can be.
Caregivers perform emotionally demanding work, yet agencies often compete against employers in retail and food service for talent.
Retention remains a constant challenge.
An agency may hire 20 or 30 caregivers in a month and consider it a success if 10 remain six months later.
For Pitts, culture is the differentiator.
Creating an environment where caregivers feel supported, appreciated and connected matters as much as compensation.
That philosophy is influenced heavily by his experience as a family caregiver and home care client, he said noting that the first agency that served his parents failed miserably.
He quickly enlisted help from another agency, which did a much better job, allowing him to see the importance of employing compassionate people with layers of accountability throughout the organization.
The Outsider’s Advantage
Despite entering home care without an industry background, Pitts believes being an outsider created advantages.
His legal training taught him how to analyze complex problems, question assumptions and adapt to changing circumstances.
Those skills have translated well into business ownership.
He has also embraced technology aggressively, integrating artificial intelligence and other tools into agency operations.
Not every employee has welcomed the changes.
Like many operators, Pitts has discovered that introducing innovation often requires as much attention to change management as the technology itself.
Still, he remains convinced that agencies willing to adapt will have a significant advantage in the years ahead.
“The providers who adapt to technological, demographic and economic changes will be the ones that survive and thrive,” he said.
The Next Mountain to Climb
Most entrepreneurs eventually begin looking for the next challenge.
For Pitts, that challenge may be geographic.
Large portions of central Colorado remain underserved by home care providers due to sparse populations and difficult terrain.
“The central part of Colorado, which consists of the center third of the state and encompasses about 22,000 square miles, has been up for grabs for 27 years as a Comfort Keepers franchise,” he said. “There is a reason for that … it’s a very dispersed population.”
While many operators see those markets as impractical, Pitts sees opportunity and describes it as “the Mount Everest I want to climb.”
Expanding into those communities will require creativity, persistence and what he jokingly calls “guerrilla warfare” — finding innovative ways to deliver care where traditional models struggle.
Technology may help make that vision possible.
But regardless of how the industry evolves, Pitts remains grounded by the experience that first brought him into home care.
Every major decision still comes back to one question: What would he want for his own parents?
For an owner who entered the industry as a family caregiver, that perspective may be his greatest competitive advantage of all.
Learn more about Comfort Keepers in Grand Junction and Colorado’s Western Slope.
