Best Cities & Counties in Florida to Start a Home Care Agency in 2026
Team Carepolicy.usFlorida is the nation’s retiree capital: more than 1 in 5 Floridians are 65+, and migration from other states keeps that number climbing. That means rising demand for personal care, companion care, Alzheimer’s/dementia support, respite, and post-hospital transitional care—but competition and payer mix vary sharply by county.
Below is a practical, investor-ready overview: where demand is hot, where competition is heavy, and where a new agency can carve out market share.
Book a licensing consultation to validate your chosen Florida market and accelerate approvals and payer contracting.
How to read the table
- Senior % (band): Directional share of residents 65+.
- Competition: Field signal from directories, franchise footprints, and hospital discharge networks (Low / Medium / High).
- Opportunity Tier: Overall attractiveness for a new agency (Top / Good / Niche).
- Model Fit Tips: Quick pointers (Private-Pay, Medicaid LTC/waiver mix, specialty focus).
Use this to shortlist markets, then validate with local hospitals, skilled nursing facilities, senior centers, and Florida’s Statewide Medicaid Managed Care – Long-Term Care (SMMC-LTC) plans for contracting.
For scope clarity in Florida: Homemaker & Companion Services (HCS) are registration-based and may not provide hands-on personal care; personal care requires licensure (e.g., Home Health Agency or Nurse Registry) under AHCA rules. See AHCA’s Homemaker & Companion Services overview and SMMC-LTC program overview.
Get Florida-ready policies & procedures tailored to your payer mix and service scope.
Florida County Opportunity Snapshot (2026)
| County / Primary City | Senior % (band) | Competition | Opportunity Tier | Model Fit Tips |
|---|---|---|---|---|
| Sumter (The Villages) | 45–60% | Medium | Top | Dense retiree hub; private-pay, live-in care, mobility/fall-prevention programs. |
| Sarasota (Sarasota/Venice) | 30–36% | Medium–High | Good/Top | Affluent retirees; memory care, post-surgical ortho bundles, care concierge. |
| Charlotte (Punta Gorda) | 30–36% | Medium | Top | Long visit blocks; dementia & caregiver-relief bundles. |
| Collier (Naples/Marco) | 27–33% | High | Niche | Luxury private-pay; RN-led complex care; premium live-in teams. |
| Lee (Fort Myers/Cape Coral) | 25–31% | Medium | Top | Rapid growth; hospital discharge partnerships; COPD/cardiac tracks. |
| Pinellas (St. Petersburg/Clearwater) | 24–30% | High | Niche | Competitive; differentiate with Parkinson’s, stroke, VA programs. |
| Pasco (Wesley Chapel/New Port Richey) | 23–29% | Medium | Good | Value-priced hourly care; SMMC-LTC + private-pay mix. |
| Hernando (Spring Hill) | 25–31% | Low–Medium | Top | Underserved retiree clusters; longer shifts; travel-efficient routing. |
| Citrus (Crystal River/Inverness) | 28–34% | Low | Top | High senior ratio; recruit local CNAs; church/faith partnerships. |
| Marion (Ocala) | 23–29% | Medium | Top | Equestrian/retiree mix; dementia day coverage; transportation add-ons. |
| Volusia (Daytona/Deltona) | 23–29% | Medium | Good | Snowbird swings; orthopedic & fall-reduction pathways. |
| Brevard (Melbourne/Titusville) | 22–28% | Medium | Good | Space Coast retirees; veteran programs; remote-monitoring checks. |
| Indian River (Vero Beach) | 27–33% | Medium | Top | Affluent retirees; post-hospital rapid-start within 48–72h. |
| St. Lucie (Port St. Lucie) | 22–28% | Medium | Good/Top | Fast growth; bilingual teams; SMMC-LTC contracting. |
| Martin (Stuart) | 27–33% | Medium | Top | Private-pay dementia & respite; care-manager referral ties. |
| Palm Beach (Boca/West Palm) | 24–30% | High | Niche | Crowded; win with luxury concierge, RN oversight, 24/7 live-in. |
| Broward (Fort Lauderdale) | 18–24% | High | Niche | Differentiate via bilingual caregivers, hospitalist & SNF pipelines. |
| Miami-Dade (Miami) | 16–22% | High | Niche | Cultural/linguistic specialties; post-acute transitional care; tech-enabled check-ins. |
| Hillsborough (Tampa) | 16–22% | High | Niche/Good | Competitive; focus on specialty clinics & readmission reduction. |
| Manatee (Bradenton) | 24–30% | Medium | Top | Retiree influx; memory care at home; ALF/IL partnerships. |
| Sarasota-adjacent inland (DeSoto/Hardee) | 18–24% | Low | Top | Rural underserved; SMMC-LTC heavy; 3–4h minimums to protect margins. |
| Orange (Orlando) | 13–19% | High | Niche | Younger market; hospital discharge & neuro rehab niches. |
| Seminole (Sanford) | 16–22% | Medium | Good | Suburban seniors; cardiac/COPD bundles; employer elder-care benefits. |
| Osceola (Kissimmee) | 14–20% | Medium | Good | Bilingual/private-pay mix; tourism workers caring for parents. |
| Duval (Jacksonville) | 14–20% | Medium–High | Good | VA & Mayo/UF Health ties; specialty pathways win. |
| St. Johns (St. Augustine) | 18–24% | Medium | Good/Top | Affluent growth; premium companionship + transportation. |
| Escambia (Pensacola) | 17–23% | Medium | Good | Panhandle hub; VA contracts; wound-care coordination. |
| Okaloosa/Santa Rosa (Destin/Navarre) | 16–22% | Low–Medium | Top | Military retirees; coastal second-home seniors; seasonal staffing. |
| Alachua (Gainesville) | 14–20% | Medium | Good | UF Health discharges; neuro & oncology caregiver coaching. |
Top counties to prioritize
Sumter, Charlotte, Lee, Hernando, Citrus, Marion, Manatee, Indian River, Martin, Okaloosa/Santa Rosa, St. Johns.
Enter with a niche in high-competition metros (Miami-Dade, Broward, Palm Beach, Hillsborough, Pinellas, Orange).
What this means for different readers
For new providers
- Start where competition is manageable and seniors cluster (e.g., Hernando, Citrus, Charlotte, Marion, Manatee, Indian River, Martin).
- In rural/semirural counties, set 3–4 hour visit minimums and cluster routes to protect caregiver utilization.
For nurses & clinicians
- Lead with clinical-lite specialty tracks: dementia pathways, Parkinson’s programs, cardiac/COPD recovery, and fall-prevention.
- Turn hospital/rehab relationships into post-discharge bundles (48–72-hour rapid-start plans + RN follow-up).
For investors
- Private-pay plays: Collier, Sarasota, Indian River, Martin, St. Johns, parts of Palm Beach.
- Medicaid-anchored plays (SMMC-LTC): Citrus, Hernando, Marion, Pasco, rural inland (DeSoto/Hardee).
- Look for 55+ master-planned communities (Sumter/The Villages; Pasco; Manatee) to pre-sell care plans.
Talk to a Florida licensing specialist about whether to register HCS only, license a Home Health Agency or Nurse Registry, and how to align with SMMC-LTC.
Positioning ideas that win in Florida
- Memory care at home: Alzheimer’s/dementia training, wandering-prevention, caregiver coaching, safety tech.
- Orthopedic & cardiac bundles: 2–6 week protocols aligned to local hospital discharge checklists.
- Veterans & military families: Panhandle and Jacksonville corridors—opt in to VA programs and transport.
- Seasonal coverage: Gulf/Atlantic coasts—scale for snowbird peaks with float caregivers.
- Multilingual teams: Miami-Dade/Broward/Palm Beach/Orlando—Spanish, Haitian Creole, Portuguese, Russian, etc.
Quick launch checklist (Florida)
- Choose your payer mix (private-pay vs. SMMC-LTC) based on county.
- Line up 4–6 referral anchors: hospital case managers, SNFs, PCP groups, care managers, ALF/IL directors.
- Recruit for reliability first: schedule density beats headcount; enforce 3–4h minimums and tight routing.
- Package services: dementia pathway, fall-prevention, post-surgical care, respite bundles.
- Differentiate in metros: bilingual teams, RN oversight, 24/7 live-in, 48-hour rapid-start, remote check-ins.
Customize your Florida-ready policy set for HCS, Home Health Agency, or Nurse Registry models.
Bottom line
If you’re opening in 2026, Florida’s best bets balance high senior density with manageable competition—notably Sumter, Charlotte, Lee, Hernando, Citrus, Marion, Manatee, Indian River, Martin, and Okaloosa/Santa Rosa. Enter Miami-Dade, Broward, Palm Beach, Tampa Bay, and Orlando only with a clear niche and stronger referral partnerships.