Nurse Next Door

The standard franchise fee is $72,000 for a single U.S. territory — above average for home care. Several discount programs exist: $5,000 off per additional territory if purchased concurrently, 10% off for military service members ($64,800), $10,000 off for frontline healthcare workers ($62,000), and $10,000 off for new markets without an existing NND franchise ($62,000). A $2,500 deposit is required to attend the Virtual Final Interview Day, credited toward the franchise fee.

Additional upfront costs include an $8,000 Technology Start-up Fee (non-refundable, covers initial software licenses) and $7,000 in pre-opening branding and promotion.

Total investment ranges $119K to $217K. The wide range reflects the variability in setup costs: legal and accounting ($5K–$10K), worker's compensation insurance ($2K–$15K — a major variable in home care where caregiver injury risk is real), optional consultant or Director of Nursing fees ($0–$15K), and licensing and permits ($200–$5K depending on state). Working capital of $20K–$50K covers three to six months of operations before billings ramp up.

Ongoing fees: 5% royalty on gross sales monthly, plus a Care Services Center fee of 7% of gross sales (or $300/month minimum) — this is the scheduling and coordination center that dispatches caregivers. That Care Services Center fee is essentially a second royalty, bringing the total to approximately 12% of gross sales before advertising. The 1% General Brand Fund Fee and $1,000–$2,000/month local marketing requirement add further. Technology fee is $600/month, with additional per-license costs as you add caregivers.

The renewal fee is just $7,200 (10% of the franchise fee) — one of the lowest in the category.

Nurse Next Door provides tiered Item 19 data for 35 territories opened between October 2020 and September 2025, broken into annual cohorts. The data is informative but comes with an important caveat: 31 territories ceased operations during this same period, including 14 in their first 12 months. Those failed territories are excluded from the revenue averages.

Years 1–12 (35 territories reporting): - Average gross revenue: $221,375 - Median gross revenue: $139,239 - Range: $0 to $771,306

Years 13–24 (32 territories): - Average gross revenue: $525,653 - Median gross revenue: $373,360 - Range: $0 to $2,134,807

Years 25–36 (15 territories): - Average gross revenue: $922,781 - Median gross revenue: $620,532 - Range: $0 to $2,312,857

The average per-client annual spend at month 12 is $3,348 ($2,812 median). Building revenue requires building a client book, which takes time and consistent caregiver quality.

At a median Year 2 of $373K and a 5% royalty (plus the 7% Care Services Center fee and 1% brand fund), roughly 13% leaves the business immediately. Home care gross margins are typically 25–35% after caregiver pay, meaning net operating income on $373K revenue is limited in early years. The business is cash-flow positive for most operators by year 2–3, not year 1.

The system has been essentially flat to slightly declining: 74 U.S. territories at end of 2023, 73 in 2024, 71 as of the most recent filing. The net change is -2 over two years — a small number, but concerning in context. In 2024, 4 territories opened and 5 closed; in 2025 (partial year), 4 opened and 6 closed.

The more alarming figure is the five-year cohort attrition: of territories opened between October 2020 and September 2025, 31 territories ceased operations — nearly a 44% attrition rate for that cohort. Of those 31, 14 failed within the first 12 months. That is an exceptionally high early-stage failure rate for any franchise category.

Possible explanations include the difficulty of standing up a caregiving workforce, state licensing complexity, and the competitive pressure from established incumbents like Home Instead and Right at Home in many markets. However, the data is what it is: roughly 1 in 3 NND territories opened in this period did not survive to the end of their third year.

The brand is Canadian-headquartered (Vancouver, BC), which introduces some strategic distance from the U.S. market. There are no company-owned U.S. locations to validate the model domestically.

The Care Services Center fee is the most unusual structural cost: at 7% of gross sales (or $300/month minimum), you are essentially paying a second royalty for the scheduling and caregiving dispatch service that NND operates on your behalf. This is bundled into the business model — NND handles caregiver matching and scheduling centrally — but it means your combined royalty burden is closer to 12–13% of gross sales before advertising costs. Carefully model whether this centralized dispatch model is an advantage or an additional cost layer that eats into margin.

Worker's compensation insurance is listed at $2,000–$15,000 for initial estimates, but this is a highly variable cost in home care. Caregiver injury claims can spike premiums significantly in your second and third year. Some states require state-fund workers' comp with no private market options, limiting your ability to shop rates.

State licensing for home care agencies varies dramatically. Some states require a Director of Nursing on staff, which adds $0–$15,000 in upfront costs and ongoing salary. Accreditation fees (CHAP or similar) add another $0–$8,500 upfront. Factor in your specific state's licensing requirements before modeling the investment.

The franchise term is not stated in this data, but renewal at $7,200 is low — that's the good news. The system's attrition pattern suggests the bigger risk is not making it to renewal at all.