Opening a Nursing Service
The Biggest Hurdles to Fund Approval

The demographic change in Germany has reached an unstoppable dimension. The demand for outpatient and inpatient care services far exceeds the supply. For entrepreneurs and specialists in the healthcare sector, founding their own outpatient nursing service offers enormous economic potential. However, the market is strictly regulated. Those who set out without meticulous preparation not only risk their capital but will also fail at the strict requirements of the care insurance funds right at the start.

The Critical Threshold: Fund Approval (SGB V and SGB XI)

Without signing a care supply contract (Versorgungsvertrag) with the health and long-term care insurance funds, you cannot bill your services to the statutory funds. This would mean the end of your business model before it even begins. The approval process is primarily based on two social security codes: SGB V for medical home care (treatment care) and SGB XI for home care (basic care).

The funds examine your application mercilessly, down to the smallest detail. Motivation alone is not enough. You need a detailed care concept, a comprehensive hygiene plan, and a transparent organizational structure – all of which must be part of your professional business plan.

The Role of the Nursing Service Manager (PDL)

The most important personnel building block for approval is the Nursing Service Manager (PDL). Without a qualified PDL (and often a deputy PDL), it is impossible to obtain approval.

Many prospective founders ask the question: "Can I found a nursing service even if I am not a caregiver myself?" The answer is: Yes. You can act as the commercial manager. In this case, however, you must employ a full-time, permanently appointed PDL.

Expectations for this specialist staff are high: they must be a graduate in health and nursing care or geriatric care, have completed the legally prescribed PDL advanced training, and usually prove 4,600 hours of professional experience within the last five years.

Business Plan for Nursing Services: Numbers, Not Emotions

Banks and insurance funds know that the care sector is an economically secure market – if the commercial concept is right. A standard template from the internet will not suffice here. In your 3-year financial plan, the following factors must be meticulously processed:

• Personnel Cost Calculation: By far the largest cost item. Nursing specialists are rare and expensive. Your financial plan must realistically cover collective agreement developments (TVöD-oriented), employer social security contributions, sick days, and vacation losses.
• Vehicle Fleet and Route Planning: How efficiently can your employees reach patients in your service area? Leasing installments, rising fuel prices, insurances, and unproductive preparation times must be included in the plan.
• Pre-financing and Liquidity: Insurance funds often pay invoices with a delay of one to two months. However, in the starting phase, you have fixed costs (salaries, rents, fleet) that must be paid immediately. You absolutely need a sufficiently calculated liquidity buffer.
• Office and IT Infrastructure: The approval process requires suitable office spaces (e.g., a separate consultation room for sensitive patient data). Costs for specialized nursing software (billing systems) must also be planned.

Secure Financing with KfW Subsidies

To cover the high capital requirement for the start (office equipment, vehicle leasing, marketing, liquidity buffer), most founders turn to state subsidies. The KfW Founder Loan offers low-interest loans and risk exemptions for house banks. The prerequisite here is once again a commercially flawless business plan that convinces bank advisors.

How Konzept Consulting Supports You

At Konzept Consulting, we have specialized in the complex commercial requirements of the healthcare sector. We know exactly which data the risk auditors of the banks want to see and which liquidity structures are necessary to fulfill the strict legal requirements.

From choosing the right legal form (usually GmbH for liability limitation) to creating the investment plan and direct preparation for the bank meeting: as certified management consultants, we accompany you safely – and this service is usually 100% state-funded for the unemployed.