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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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