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8/30/2019
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HOW TO BUILD A GUARDIANSHIP PRACTICE
Erin Droll, BA, NCGDirector, Corridor Care Management, Local Office of the Iowa Public Guardian
HISTORY OF CCM, LOCAL OPG• Passion for the elderly• Wide variety of experience• Decision 2013• Adios business partner 2014• Hello baby! 2015• Welcome Jodie and April • What just happened? State contract 2017• Here we are today-Erin, April, Jodie, Sonya, Jackie, and Kevin
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SUIT UP-YOU’RE NOW A BUSINESS OWNER
• Autonomy
• Financial Freedom• Professional Freedom• Power
• It’s all on you• No sick days
• Vacation is more work• Taking care of employees• It’s a whole different hat for a
lot of us
This Photo by Unknown Author is licensed under CC BY-SA
DECIDE ON A LEGAL STRUCTURE
For-Profit• Sole Proprietorship or single member• Partnership
• Controlling interest?• Corporation• LLC• LLP• Consult an attorney and tax
planner!
Non-profit 501 (c) 3 or 4
• 501 (c) 3 • Can accept charitable donations• Student Loan Forgiveness• Usually a must have for grants• Harder to get and maintain
• 501 (c) 4• Easier to get• Less oversight/More Privacy• Less economically advantageous
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SCOPE OF YOUR PRACTICE
Boutique Go Big or Go Home
This Photo by Unknown Author is licensed under CC BY
SCOPE OF YOUR PRACTICE
Boutique• Smaller-more hands on
• Easier to manage
• Easier to transition out of
• Minimal overhead
• Can be choosier about clients
• More vulnerable to challenges
• Consequences of turning down cases
Middle Ground• A few services
• 1 or 2 employees
• Leader/Owner can remain hands on
Go Big• Several divisions and programs
• Serves the most people
• More people dependent on you
• Eventually leaders/owners are less hands on
• More likely to face challenges
• But less vulnerable to them
• Can’t be as selective with clients
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DEFINE YOUR TERRITORY
This Photo by Unknown Author is licensed under CC BY-SA
HOME OR AWAY• Work Style
• Pets? Kids? Husband? Neighbors?• Style of Practice• Scary Clients
• Scarier Families• Neighborhood/condo/city rules and regulations• Price of commercial real estate
• Tax consequences
This Photo by Unknown Author is licensed under CC BY-SA-NC
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COMMERCIAL REAL ESTATE
What is NNNNNN stands for net, net, net. These pass through expenses of leasing are portions tenants or lessees pay in addition to the lease fee, or rent to the landlord or lessor. The NNN fees are property taxes, property insurance and common area maintenance. ... That means the rent is $15 per foot per year plus the NNN
You have to build itIf you don’t like the way it’s laid out, or it doesn’t suit your purposes, you can modify it but most likely at your expense.
Appearances MatterDecorating is fun! But most likely you’ll have to buy the desks, phones, chairs, computers and all the other office paraphernalia.
You are responsible for setting your cyber security.
Will the office grow with you?
What does the outside look like?
What are your neighbors like?
LET’S TALK ABOUT TECH
2 cells or 1?• I use one cell
• I just find this easier• Less expensive• But I’m the owner
• Sonya uses 2• She can “shut off” easier• Her personal stays personal• She’s an employee
Fax• Landline
• Perhaps it’s more secure• Paper based• Ribbons, toners, machines
• Online• Helps us be all electronic• Saves trees• Easy to disseminate information• Uses tech you have to have
anyway
Portability• Laptops and Tablet
• Jet Packs
• CCM uses web based document storage and software-access from anywhere
• Ensures prompt documentation
• Phone apps-MileIQ
• Eric Mayfield will be talking about this later! Come see him
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INVEST IN A BEAUTIFUL WEBSITE
BUILD YOUR NETWORK
Normal Attorney Let’s fight a little bit It’s throw down time
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FIND YOUR TEAM
Insurance Guru Bond Lady Wise Advisor
This Photo by Unknown Author is licensed under CC BY-SA
INSURANCEMY BIGGEST EXPENSE
Liability• Fiduciary Specific
• Errors and Omissions• Dominion or Cincinnati• Cyber Crimes
• General Liability• Dominion• Secura
• License Specific
Everything Else• Auto• Premises• Umbrella• Workers Comp• Medical
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LITIGIOUS SOCIETYReview your state laws• Who can sue you
• Under what circumstances
• Google for news stories
• What can you do to avoid it?
• Can you avoid it?
• Who are you accountable to?
• Don’t forget the difference between federal and state
Review your practice• Policies and Procedures
• Redundancies
• Checks and balances
• Notifications system
• Documentation system
• Accounting Practices
System Limitations• Case of the drunkest man in the
world
• Case of Captain Inappropriate
• Case of the Court Mandated Gamble
CLIENT AUTONOMY AND LIABILITY
• This is probably its own presentation• In Iowa, I am not liable for acts of the Protected Person
• Doesn’t mean they can’t try and sue me• Bad publicity• General public lacks empathy
• NGA Ethics and Standards of Practice• Do what the client wants if it is at all reasonable• If you’re in the boat alone, maybe it’s not so reasonable• You’re the guardian for a reason
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KNOW YOUR SYSTEMS
MedicareA, B, C, D, Supplements, LIS In Iowa-nursing home,
elderly waiver, BI waiver, ID waiver, MCO’s, etc
MedicaidLong term S&SNursing homes, assisted livings, RCF, ICF, group homes, host homes, in home
ACQUIRE MEDICAL KNOWLEDGETake a Medical Terminology Course• Hypertension
• Neurocognitive
• Bursitis
• Dysplasia
• Mulomedic
• Degenerative
• Autoimmune
• Myalgia
• Hydroplosion
Basic Pharmacology• Lasix
• Seroquel
• Trazodone
• Eloquis
• Invega
• Namenda
• Hydrocodone
• Apomorphine
• Rimadyl
Independent Research• Brain Injury
• Alzheimer’s
• Diabetes
• UTI
• Xenopolycythemia
• Geriatric
• Autism
• Frontal Lobe Dementia
• Bipolar
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Income sources
Social Security
SSDI
SSI
Pension
Annuity
Wages
Financial Products
Annuity IRA
Mutual Funds
CD Brokerage Account
Stocks Bonds
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FINANCIAL SIDE OF A HUMANITARIAN BUSINESS
YOU MAY VERY WELL OPERATE IN THE RED THE
FIRST 1-2 YEARS• This is part of any new business• We have to do a lot before we
get paid• You can minimize the impact by:
• Having a 2nd job while you build
• Start up fees are always the biggest-get it done
• File for fees on a schedule-always• But not monthly, it makes
your business look unstable This Photo by Unknown Author is licensed under CC BY-NC-ND
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HOW TO SET YOUR RATES
What are others charging?
What are you bringing to the
table?
Education matters but it’s not everything
How big is your business?
How big is your area?
How are your fees structured?
What is your overhead? What
is passed on?
Postage? Mileage?
Copying? Court fees?
ACQUIRING CLIENTS
Relationships Are Key• Attorneys
• Trust Departments
• Hospitals
• Judges
Take Pro Bono Cases• Hospital Campers
• One good round of payment• SNT if young enough• Usually nursing home bound
• Kiddos• Stable in services• Committed service provider
• Volatile Cases
Caution!• Beware the age of the client
• Consider the distance
• Don’t take everything
• Consider the diagnosis
• Consider the person• PBK-Iowa City, Dubuque, Baxter,
Pomeroy, Keokuk. 5 Cities in 2.5 years
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MARKETING
• New System• Annual Round may be sufficient• Get your pick of colors, names, etc• First in line for public funding• Pro bono still important• Less Money• Less time reputation building
• But don’t forget it’s still important
• Established System• Research your competitors
• Avoid duplicating logos, names, color scheme
• Where are they entrenched?• Will have to spend more money• More time reputation buildings• More pro bono cases• Good marketing is sustained
marketing
IT’S TIME TO CLONE YOURSELF
• You’re the boss, what do you want to do?
• Hire a clerical person• Inexpensive• Easy to find on a part time basis• Low workers comp costs
• Hire a case manager• What level of education does your state require?• What are your weaknesses?• Need at least 20 hours• Higher workers comp
This Photo by Unknown Author is licensed under CC BY-SA-NC
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BUSINESS OF HIRING
Taxes and Benefits• Payroll system of some sort
• CCM uses Gusto
• Health insurance?
• Dental?
• Retirement
• Workers comp
• Company car?
Interviewing• Personality fit
• Experience
• Moral dilemma questions
• Loyalty
CYS• Background check
• Credit check
• DHS check
• Reference check
• Employment verification
• Non-compete
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