Starting a privately-owned adult day-care business

There is a lot involved in being self-employed. For example, you will have to keep records and comply with special laws and regulations. By following this step-by-step guide, you will be on the right track and know which rules apply to you.

Step-by-step guide to starting an adult day-care business

Make a business plan so that you can make your plans concrete. Answer at least the following questions: who are you, why do you want to become an entrepreneur, and what qualities do you have? Also describe your offer and target group. What kind of care do you want to provide and for whom? 

1. Make a financial plan

Make a financial plan to determine whether you can earn enough to live on. Determine your hourly rate. Also check under which law the care you provide is paid for. Check with your (future) client or their contact person. You can be paid for providing care under the following Acts:

•    Wet langdurige zorg (Wlz, Long-term Care Act), which is paid for by healthcare insurance.
•    Wet maatschappelijke zorg (wmo, Social Support Act), which is paid for by the municipality.
•    Jeugdwet (Jw, Youth Act), which is paid for by the municipality.
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Next, choose how the care is paid for. Who pays you and where you claim care costs varies depending on the situation. This depends on your clients, your own preferences, and future clients you want to attract:

•    Zorg in Natura (ZIN, Care in Kind, in Dutch). As a care provider, you enter into a contract with the municipality (Wmo and Jw) or the healthcare insurer (Wlz). You submit claims directly to them.
•     Persoonsgebonden budget (PGB, Personal Budget). You enter into a care agreement with your clients and bill your clients yourself.
•    As a subcontractor. You enter into an agreement with a main contractor (a healthcare organisation, in Dutch). They do the administration and are responsible for the quality of care. You invoice the main contractor.
•    Clients pay for the care themselves and do not use government reimbursement. You invoice them directly.

In doubt? Ask for advice in your network or call the KVK Advice Team.

2. Find a suitable location

Find a location for your day care. Check the municipality’s environment plan for information on practical matters such as parking and noise. What is allowed and what do you need a permit for? Also check whether you need to apply for an environment and planning permit. And check the location's lease or purchase contract to see if you can start an adult day-care centre there. This is only possible if the location is designated for societal or care purposes.

3. Check the safety requirements of your location

You are responsible for the safety of the people who visit you. The fire brigade will help newly registered care institutions to check how safe the location is. Ask your municipality or care office what other requirements apply to your location. Think about the permitted number of guests and precautions for emergencies or extreme weather conditions, such as a heat protocol. The requirements vary per municipality or healthcare insurer. 

Keep in mind that the municipality or the Inspectie Gezondheidszorg en Jeugd (IGJ, Healthcare and Youth Inspectorate) may inspect your venue. 

4. Check the requirements for your staff

There should be enough well-trained staff at your day-care facility. They should have the right knowledge and skills to help the clients. If necessary, there should also be specialists for clients who need a lot of care and/or help with behaviour. Ask your municipality or healthcare insurer what additional rules there are.

These requirements are mandatory:

• For youth care, there is the Standard for responsible work allocation (in Dutch). This means ensuring that your staff have the right knowledge and skills do the work. In practice, you often need someone who is registered with the Kwaliteitsregister Jeugd (SKJ, in Dutch). This is the professional register for youth care workers in the Netherlands.
• To carry out certain medical actions, such as giving injections, a care provider must be BIG-registered.
• Do you provide involuntary care under the Wet zorg en dwang (Wzd, the Care and Coercion Act, in Dutch)? You must follow the Wzd step-by-step plan (in Dutch). You must also register with the location register (in Dutch).

Requirements also apply to your staff. It is your responsibility to make sure they continue to learn and improve their skills. This is stated in the following quality frameworks and competence profiles:

• For care of people with disabilities, there is a quality compass and competence profiles (in Dutch). 
• For youth care, there is the youth quality framework and competence profile (both in Dutch).
• For outdoor care centres, there is the quality framework (in Dutch).

5. Register with KVK

Register at KVK as an entrepreneur. You will be given an SBI code corresponding to the work you do. For day care for clients with a mental disability, non-congenital brain injury, and GGZ clients (Gemeentelijke Gezondheidsdienst, Municipal Health Service), the SBI code is 8720. For day-care services for clients with non-mental disabilities, it is 87301. For youth care, the SBI code is 87901. And for welfare work for the elderly, the SBI code is 88102. 

6. Apply for eHerkenning

You need eHerkenning for your registration with the Zorgaanbiedersportaal (Healthcare Provider Portal). Keep in mind that this costs money. The costs differ per type of login and per reliability level. You will receive the eHerkenning within one to a few days. If you only provide care under the Social Support Act Wmo, you can skip this step.

7 Register as a new healthcare provider

As a new healthcare provider in the Netherlands, you must register with the CIBG (in Dutch). This government organisation is part of the Dutch Ministry of Health, Welfare and Sports. Registration is mandatory under the Care Providers Entry Act (Wtza) and ensures that you are known to the Helathcare and Youth Inspectorate. Log in to the Healthcare Provider Portal and complete the questionnaire (in Dutch). After submitting your questionnaire, your registration is ready. If you only provide care under the Wmo, skip this step.

8. Comply with the Wkkgz

Make sure you comply with the requirements of the Wet kwaliteit, klachten en geschillen zorg (Wkkgz, the Care Sector Quality, Complaints, and Disputes Act). This means, among other things, that you must have an independent complaints officer and join a recognised disputes body. If you only provide care under the Wmo or Youth Act, you do not have to comply with the Wkkgz. But you do have to meet the requirements of the municipality where you provide care. Check with that municipality what these requirements are.

9. Apply for an AGB code

Apply for a personal AGB code so you can declare the care you provide to the municipality or the healthcare insurer. You can apply for the AGB code (in Dutch) from Vektis, the organisation managing the AGB register. You can find all the relevant information on registering for AGB on starterindezorg.nl (in Dutch). Does something change in your situation or your activities? This may affect the validity of your AGB code. This is because the KVK and Vektis registers are linked. So, check regularly whether both are still in line with your actual situation.

10. Check if you need a VECOZO certificate

You need a VECOZO certificate to declare electronically to healthcare insurers that work with VECOZO software. You also need this certificate for declarations to the personal budget portal (in Dutch). A VECOZO certificate (in Dutch) is free of charge. After applying, you will receive the certificate within a maximum of 5 working days. 

11. Check if you need an NZa code

The NZa is the Dutch Healthcare Authority. If you provide Wlz care in kind and have budget agreements with a healthcare insurer you need an NZa code (in Dutch). Do you not have an agreement with a healthcare insurer, but with the municipality, for example? Then you do not need an NZa number. The code is also not needed if your client pays you from a personal budget. Applying for an NZa number is free of charge. You usually receive the code within a few working days.

12. Comply with food and safety requirements

Do you work with food? Then you are responsible for food safety and complying with the hygiene code. Read more about the hygiene code in healthcare (HACCP).

13. Are you playing music?

Do you play music? Then you will have to deal with music rights. Find out at Buma/Stemra what the costs are.

14. Make a Risk Assessment and Evaluation (RI&E)

As an employer, you are responsible for the health and safety of your employees. This is set out in the Arbowet (the Working Conditions Act). The law requires you to have an in-house emergency response worker (BHV).

With an RI&E you identify the risks, set priorities, and draw up an action plan. The assessment is compulsory for every employer with at least one employee.

15. Think about your client records

Think about how you want to keep client records. You must keep records of each client's health and counselling. The exact data you need to record depends on the treatment and medical profession. Clients should be able to view and manage their data securely and free of charge (in Dutch). 

16. Check whether you are liable for VAT

Check whether you have to declare VAT. Most care services are exempt from VAT (in Dutch). Do you also have other activities, such as selling goods or services? If so, you are probably liable for VAT. Two weeks after your registration at KVK, you will receive a letter from the Netherlands Tax Administration. This will state whether you have to file a quarterly tax return or are exempt from VAT. It is your responsibility to check whether this is correct. Call the Tax Administration if you are in doubt.  

17. Do some marketing

Making a marketing plan can help you find clients. Use your own network and online platforms where supply and demand meet. For example, ZorgkaartNederland (in Dutch) is an online platform offering independent information to patients and healthcare providers. Or get in touch with case managers and social workers in your municipality. For example, a Dementia Case Manager visits people with dementia at home and may know clients.

18. Arrange general matters for starting businesses

As an entrepreneur, you need to arrange general terms and conditions and insurance. This will help prevent problems and reduce entrepreneurial risks. It is also a legal requirement to keep business records. Read more about administration and bookkeeping.