This was originally a call to action, published in 2014 while I was running a home care business in North Carolina. The legislative situation it describes has long since moved on. I’ve kept it because the experience underneath it is one most business owners never write about.
Here was the situation.
We had done the work and obtained our companion care licence. But we remained unable to provide hands-on care to our clients, because of a ban on new hands-on home caregiver licences in North Carolina.
That meant we could not help someone to the bathroom. We could not offer a steadying hand when a client walked across a room.
We had a waiting list of clients we weren’t allowed to help. People needing just a few hours of care a week are frequently overlooked by home care agencies anyway, because small bookings aren’t lucrative. We wanted those clients. We were forced to refer them to agencies that often had neither the capacity nor the inclination to take them.
And the downstream effect was the part that made no sense to anyone. People who couldn’t get a few hours of help at home ended up in assisted living or skilled nursing far sooner than they needed to. Many couldn’t afford it for long, at which point the state picked up the bill. A rule intended to control the market was reliably producing the most expensive possible outcome.
The budget before the State Senate contained an extension of the ban, and it looked likely to pass without discussion.
What I learned from that
Three things, and I’d never have predicted any of them.
Regulation can be the binding constraint on your business, and you may not notice for years. I spent a long time thinking about marketing, hiring and service quality — the things business books discuss. None of them was what capped the company. A licensing rule written by people who had never met us was, and no amount of working harder touched it.
Almost nobody is representing small operators. The large chains had government affairs people. Trade associations existed, but their priorities followed their largest members. The perspective of a small agency wanting to serve clients needing four hours a week was simply not in the room, because nobody whose job it was to be there had any reason to carry it.
And the door is more open than you’d think. I assumed the legislature was a closed world requiring connections I didn’t have. It mostly isn’t. Legislators and their staff take meetings. Many of them know very little about any specific industry and are quietly grateful when someone who actually operates in it explains how a rule plays out in practice.
What actually works
If you find yourself in this position — and more owners are than realise it — a few things I’d pass on.
- Lead with the constituent, not the business. “This rule is costing me revenue” is a complaint. “There are people in your district who can’t get four hours of help a week and are ending up in facilities the state then pays for” is an argument. Both were true; only one got attention.
- Bring the arithmetic. The cost comparison between a few hours of home care and residential care did more work than anything I said about fairness.
- Talk to staff, not just members. Legislative aides write the briefings and remember the detail. They are also far easier to get time with.
- Expect it to be slow, and show up anyway. Budget provisions get extended quietly, year after year, precisely because nobody objects. Being the person who objects annually is unglamorous and it is how these things eventually change.
- Find the others. One small agency is an anecdote. Six of them saying the same thing is a pattern, and patterns get noticed.
The part worth generalising
Most business advice assumes the rules are fixed and your job is to compete within them. For a great many businesses — care, childcare, food, trades, transport, professional services — that assumption is wrong. The rules are a variable, written by people who can be spoken to.
I’m not suggesting every owner should become a lobbyist. It takes time you don’t have, and most regulatory fights aren’t worth picking.
But it’s worth knowing that the option exists, and worth noticing when a constraint you’ve been treating as weather is actually a decision somebody made. Those are very different problems, and only one of them responds to working harder.
It also changed my sense of what leadership includes. I had thought of it as something that happens inside a company — decisions, delegation, the people who report to you. Some of the most consequential things a business owner does happen entirely outside the building, in rooms where your industry is being discussed by people who have never worked in it.
That turned out to be a much bigger lesson than the licence.
