By Thomas A. Parmalee
When Neelima Gaikwad launched A Place At Home in Schaumburg, Illinois, about four years ago, she wasn’t simply opening a business. She was redefining how post-acute care could work at home.
But her path to ownership began in burnout — and during the COVID-19 pandemic.
The Moment That Changed Everything
Neelima spent about a decade working as an occupational therapist in skilled nursing facilities. Over time, she watched reimbursement structures and care models shift.
“The therapy had been changing — insurance, Medicaid, etc. It has always been changing every year. But during COVID, there were even more changes.”
She worked through the pandemic inside a skilled nursing facility.
“None of us were prepared for COVID,” she said. “It was very hard to see how COVID was taking out health care. The way the care was given … I saw so much fragmentation in health care and I thought, ‘This is not what I want to do.’”
Her frustrations with a “one size fits all” approach in terms of delivering health care weighed on her so much that she hit her breaking point, she said. “The longer a patient stayed in skilled nursing, they actually received less reimbursement from Medicare, so the push was to let them go home in less than two weeks, even if they were not ready,” she said.
That experience forced a professional reckoning.
“So, it kind of opened my eyes that we need to do this better. And how can we do it better?”
She left her job in September 2021.
“I just wanted to leave health care at that point,” she said. “I didn’t even want to be associated with it.”
That lasted about a month.
“What am I doing with all my knowledge and medical experience?” she thought.
She began exploring home care — and realized she could still serve seniors while building something different.
Turning Discharge Training into a Business Model
Neelima didn’t abandon her clinical roots. She built her agency around them.
“The business model is based on what I used to do in skilled nursing facilities,” she said. “When we used to discharge a patient, we would have an hour of caregiver training on how to take care of a patient after.”
That hour of discharge education became the foundation of her agency’s differentiator.
“How to take from someone from the bed to a wheelchair. How to maneuver them in the house safely, so that falls don’t occur – so they can heal and recover at home,” she explained.
She continued, “So that one hour of training is actually the business model of mine. We train the caregivers in the house with the client. Hands-on training is so important.”
She isn’t the only one who brings a clinical background to the agency: Her director of client care services is a physical therapist. Together, they ensure caregivers receive hands-on training inside the client’s home — not just classroom instruction.
That approach – coupled with providing each client with a consistent caregiver – has paid off, she said.
“That is because consistent caregivers are able to identify when something is wrong,” she said. “It could be a change in condition. They are able to tell.”
Consistency, combined with clinical oversight, directly impacts outcomes, she said.
Why She Chose a Franchise Model
A Place At Home is a franchise system that began offering franchise opportunities in 2017 after launching its first location in Omaha, Nebraska.
For Neelima, the support system was critical.
“It is one of the best,” she said. “That may sound very biased —we have the support system where you can just put one question as an owner and there will be different owners who will try to help you with that question.”
She added, “I would always say we believe the problems we are facing today are the same ones that others faced yesterday.”
She also points to strong corporate backing:
“We get lots of support from HQ and corporate,” she said.
For clinicians considering ownership, she offers both encouragement and caution.
“If someone is from a clinician background, they should consider this and make this move if they can,” she advised.
But she is candid about the mindset shift required:
“As a clinician, you often do not have the sense of business… so that awareness and understanding that you need to reach out to others who know how to run a business is critical,” she said. “You need those business coaches and must learn from different avenues.”
The bottom line is that those with a clinical background typically have a different mindset, she said. “We do think of how we are taking care of overhead, what the rate should be,” she said. “For me, it took time to look at what it means to be profitable.”
So far, she has focused strictly on private pay clients, she said.
“We are not striving for Medicaid credentialing at this time — our entire focus is private pay,” she said. “We are credentialed to serve veterans, as well.”
Neelima Gaikwad and her team.
Hiring for Interest, Not Just Credentials
One of Neelima’s most distinctive strategies is her hiring philosophy.
“What we look for is very interesting,” she said. “We just look for an interest.”
It’s not unusual for her to hire young caregivers — even 18- and 19-year-olds — if they are serious about health care.
“We have had nursing students, a surgeon going to school — he still goes to school and is a part-time caregiver with us,” she said. “He is 20 years old and was 18 when he joined.”
The key is training and evaluation.
“We do extensive training, including state mandated training,” she said. “We see if they are still interested to move forward and then move on to the hands-on training. We want to be sure they are interested in being a caregiver.”
Her retention reflects the strategy’s effectiveness, with most of her caregivers having stayed on since she started the business more than three years ago and as she’s grown her client base.
Keeping them, however, has not been easy.
“If they don’t feel supported, valued or respected, they are not going to stay,” she said.
In terms of hiring new employees as her business has matured, her best source has been her current staff members, she said.
They appreciate the fact that they earn a referral bonus when they recommend a hire that works out, she said.
Operational Discipline: Consistency as a Strategy
Neelima prioritizes continuity of care.
“We strive for consistency a lot,” she said. “We try to give one client one caregiver. A lot of them don’t promise consistency but we do.”
The impact shows up in metrics:
- 61 clients served last year.
- Average length of service: 20 months.
- 0% readmission rate within 30 days.
- Close to 1,200 billable hours per week.
She monitors performance rigorously.
“We look at our home care surveys a lot, including data from Activated Insights,” she said. “We definitely look at those caregiver satisfaction scores. Every month, we make sure we understand how we performed, and if we receive a score of less than 10, we want to know why. And we work based on that.”
She also tracks key performance indicators through WellSky CRM and annually reviews readmission data and quality indicators with her team.
Referral Strategy: Leaning Into Clinical Credibility
Her largest referral source?
“Rehab facilities are our biggest source,” she said.
Coming in at a close second are senior care advisers.
“They help people find the next place called home,” she said. “Those struggling with dementia and others. If the patients are not ready to move home, then we become their best option … we still are able to maintain that safety at home with the support of our caregivers.”
Her rehab background strengthens those partnerships.
“They understand I come from a rehab background,” she said. “We are able to train the caregivers to maintain that quality at home.”
Learning to Collaborate, Not Compete
When asked about early mistakes, Neelima doesn’t claim mastery.
“I am still making mistakes and still learning,” she said. “I don’t think we are there yet.”
Early on, she tried to take on everything herself — marketing, sales, scheduling and recruiting.
“I did all of it … and now I have a team after three years,” she said.
She learned the importance of knowing her limits.
“The one thing I would say is to collaborate more and work together more as a home care community than competing,” she said. We have enough seniors to take care of.”
“If we are not able to support a client, we have other home care owners who can take care of them.”
But knowing your limitations can be hard to determine at first, she said, sharing her inclination to help clients who needed 24/7 care even when she was starting out, before she had scaled and had the appropriate number of staff.
Now, she can take on those clients, but there was a time when she would have been better off referring them to someone else, she said.
The Reality of Ownership
Neelima is transparent about the emotional load of home care.
“It is not easy … this is not for the faint of heart,” she said. “There are so many moving pieces. You are always working with people — this is a people business; there are many emotions involved.”
As an owner and leader, you must be sure to stay grounded, she said.
Also, unless you’ve already attained significant wealth, breaking into the home care business is risky.
She invested everything to make it work, she said.
“All my savings and all I have,” she said.
But today, she’s happy she took the chance and would do it all over again.
“The business changed my life … now this is my passion,” she said, noting that she’s single, without any children.
“Definitely home care is at first very hard and overwhelming … but once you know how it can be done … and how to delegate… and to who, you can definitely move forward and get that work life balance.”
For her, that means traveling to see the world.
“For five weeks I was in India and just came back last week,” she said. “Before that, I was in Iceland. But this is after years of working very hard.”
The Takeaway for Home Care Owners
Neelima Gaikwad’s journey underscores several high-level lessons for operators:
- Clinical experience can be a competitive advantage — if paired with business discipline.
- Hands-on caregiver training inside the client’s home can materially impact outcomes.
- Consistency of staffing directly influences readmission rates.
- Hiring for interest and training for skill can build loyalty.
- Collaboration beats competition in some cases.
- Franchise support systems can accelerate learning curves.
- Emotional grounding is a leadership requirement in a people-centered business.
Neelima’s evolution from occupational therapist to franchise owner was not a rejection of health care — it was a reinvention of it.
“I saw so much fragmentation in health care … so, it kind of opened my eyes that we need to do this better.”
In Schaumburg, she is delivering a solution to the problem she identified — one trained caregiver, one consistent match, and one client at a time.
