We were lucky to catch up with Kara Welke recently and have shared our conversation below.

Kara , thanks for taking the time to share your stories with us today We’d love to hear about how you went about setting up your own practice and if you have any advice for professionals who might be considering starting their own?

I was actually teaching in an OTA program when a student came to me looking for a fieldwork site. The site she mentioned was a non-medical home care company, and I told her that I did not think they had OT services. However, I reached out to the company just in case.

When I reached out, they mentioned they were planning to start providing home health services under Medicare Part A. During the conversation, I mentioned that I had always thought there was a huge opportunity for Medicare Part B therapy services in the home, especially for people who couldn’t easily get to an outpatient clinic.

One of the coowners actually suggested I started my own business and I could contract with them for the Medicare Part A services and I could do the Part B myself.

I had no idea what I was doing, but I started Home Therapy Solutions in July of 2018.

I honestly had no idea how to run a business, and I wanted everything to be perfect and follow all of the rules and regulations. I found it was extremely hard to figure out what those rules and regulations were. I made plenty of mistakes. Some of them were expensive. There were times I spent hours trying to figure things out on my own because there really were not many resources available for therapists who wanted to start a private practice.

Social media existed, but there was a lot of misinformation and people sharing opinions as facts. It was difficult to know who to trust and what was actually correct. I made several costly mistakes by trusting some of that information.

About a year later, in May of 2019, I attended a physical therapy business conference. I called Smart Success PT. That conference completely changed my perspective. It was the first time I was around people openly talking about business, systems, marketing, operations, finances, and growth.

I remember sitting there thinking, “Occupational therapists need something like this.”

While I was at that conference, I started a facebook group called Next Level Occupational Therapy. I also joined a mastermind program, and that experience taught me not only how to run my own business better but also how much I still had to learn about entrepreneurship, leadership, and business ownership.

Then PDPM and PDGM happened, and a lot of therapy professionals were losing jobs or seeing major changes in their careers. It became obvious that many therapists needed another option.

That is really where Therapy Business Builder came from.

The whole premise was simple: create the resource I wish I would have had when I started. Give therapists access to the education, support, systems, mentorship, and resources that I spent years trying to figure out on my own. Although when we started the Therapy Business Builder program it was really just helping people get started, completely different from what it is now.

If I could go back and do anything differently, I would have found mentors sooner and invested in learning the business side of healthcare much earlier. It would have saved me a lot of time, money, and frustration.

My advice to anyone considering starting a practice is don’t try to figure everything out alone. Being a great clinician is important, but running a successful practice requires a completely different skill set. Find people who have done it before, ask questions, and learn from their mistakes instead of making all of your own. Invest in yourself, your education, and the right support systems early. While it may feel expensive at the time, it will pay off significantly in the long run and save you countless hours, mistakes, and frustration.

Kara , before we move on to more of these sorts of questions, can you take some time to bring our readers up to speed on you and what you do?

I grew up on a farm in South Dakota outside of a town of about 80 people. Looking back, I was probably entrepreneurial from the beginning, even though I didn’t know it at the time.

I was always trying to sell something. I’d ride my bike to neighboring farmhouses, which could be miles away, to sell greeting cards and wrapping paper. I set up lemonade stands and apple stands even though there really wasn’t much traffic driving by our farm. Over the years, I sold everything from Mary Kay and Pampered Chef to Tupperware, jewelry, and just about anything else you could think of.

When I first went to college, I was planning to go into Family and Consumer Sciences or Dietetics. It wasn’t until my freshman year that my mom called and suggested I shadow an occupational therapist. I had never even heard of occupational therapy before. I went and shadowed, and after that experience I knew it was exactly what I wanted to do.

I transferred schools, earned my Bachelor’s degree in Social Work, and then went on to get my Master’s degree in Occupational Therapy. My first job was at a hospital where I had completed one of my fieldwork rotations. I ended up getting a great opportunity to start a brand new Early Head Start program from the ground up in the town I lived in, so I switched to that position but kept my hospital position as a PRN therapist to maintain my occupational therapy skills.

When my husband and I moved to North Dakota, I planned to stay home with our children. I ended up taking a part time position that allowed me to work while still being home with my kids. Family has always been my top priority, and I have always tried to build my career around what mattered most to me.

Over the years, I worked in a variety of settings and had the opportunity to start new programs and services. In 2012, I began teaching in an Occupational Therapy Assistant program. I loved teaching, but I also found myself constantly looking at ways things could be improved and opportunities that weren’t being addressed.

In 2018, I started Home Therapy Solutions, a mobile outpatient therapy practice. I never really set out to become a business owner. I just kept seeing problems that needed to be solved and opportunities to do things differently. I saw too many people who couldn’t easily access therapy services because of transportation challenges, mobility limitations, or because traditional healthcare models simply weren’t meeting their needs.

In December 2019, I left teaching and went all in on both Home Therapy Solutions and Next Level Occupational Therapy. What started as one therapist with a vision has grown into businesses that now impact patients, families, and therapy professionals across the country.

Today, I spend my time helping people in two ways. Through Home Therapy Solutions, we provide occupational and physical therapy services that help individuals remain active, independent, and engaged in their homes and communities. We have a special focus on older adults, aging in place, dementia care, home modifications, neurological conditions, and helping people live life to the fullest regardless of age or diagnosis. Home Therapy Solutions was recognized as the first therapy practice in the world to achieve Age Friendly Health System recognition, something I am incredibly proud of. We also provide women’s health, men’s health, and pediatric pelvic health services.

Through Next Level Occupational Therapy, I help therapy professionals start, build, grow, and scale their own private practices. This work is especially meaningful to me because I know firsthand how difficult it can be to navigate business ownership as a healthcare professional. Most of us are taught how to be clinicians, but very few of us are taught how to run a business. There is nothing more rewarding than seeing a therapist go from having an idea to building a successful practice that serves their community, creates jobs, and gives them more control over their future.

Outside of work, my family is my greatest accomplishment. My oldest daughter is an occupational therapist, my middle daughter recently graduated as a registered nurse, and my son is in college studying to become an electrician while playing baseball. My husband is a psychologist, and together we have always valued relationships and experiences over things. We love to travel and take multiple family trips every year because those shared experiences and memories are what matter most. We also love sports. I enjoy walking, listening to audiobooks, and painting.

If there is one thing I would want people to know about me, it is that I genuinely love helping people succeed, whether that is an older adult trying to remain independent in their home, a caregiver navigating a difficult situation, or a therapy professional building a business. At the end of the day, I have always been drawn to solving problems, creating opportunities, and helping people achieve things they didn’t think were possible.

Do you think you’d choose a different profession or specialty if you were starting now?

100% yes!

I think we have one of the best degrees there is. Occupational therapy gives us so many opportunities, far beyond what many people would consider “traditional occupational therapy.”

We can work with infants to older adults, prenatal care to caregivers of older adults, physical health to mental health, and everything in between. The options are limitless. There are so many great opportunities outside of nursing homes, hospitals, and school settings. Many therapists don’t realize just how many opportunities are available to them.

In fact, I think in some places what is being done as occupational therapy has truly gotten away from what occupational therapy should be. At its core, OT is about making sure people can do the things they need and want to do in their daily lives, from getting out of bed in the morning, getting dressed, making a meal, driving to work, playing with friends, raising a family, caring for a loved one, sleeping, and yes, all of the everyday activities that make life meaningful.

What I love about occupational therapy is that we help people in ways that are functional and purposeful. There are countless ways we can apply those skills and make a difference.

That is one of the reasons I am such a strong advocate for private practice. When you own your own practice, you have the freedom to build services around what you know is best for your clients and your community. You are not always constrained by the way things have always been done or stuck in a rut like many professionals find themselves over time when working in traditional healthcare settings. Of course, there are still rules and regulations that need to be followed.

Can you share a story from your journey that illustrates your resilience?

One of the things I always tell the business owners I work with is that you have to be persistent and relentless.

There are always going to be challenges. Staffing issues, regulatory changes, reimbursement cuts, insurance company headaches, unexpected expenses, technology problems, difficult conversations, and things you never saw coming.

My husband jokes with me because every so often I will come home and announce that I am going to shut everything down. He’ll look at me and say, “What is this, number 465?” And honestly, there have been days when I have felt completely overwhelmed and questioned whether it was worth it.

Some of my biggest lessons have come from the hardest situations, whether it was dealing with staffing challenges, navigating major healthcare changes, figuring out how to respond to new regulations, or managing the constant ups and downs that come with running a business.

In fact, this is one of the things that has helped me become a better business coach. I am able to help therapists avoid many costly mistakes because I have already made them myself. While I certainly don’t know everything, I have learned a lot over the years, and I can often help people avoid the frustration, expense, and headaches that come from learning every lesson the hard way.

Resilience doesn’t mean you don’t get frustrated. It doesn’t mean you don’t have days where you want to throw in the towel. It means you keep going anyway.

One of the biggest lessons I have learned is the importance of getting the right people on the bus and being willing to help the wrong people find another bus. The team and network you surround yourself with are critical. The right people help you solve problems, navigate challenges, and continue moving forward when things get tough. The wrong people can drain your time, energy, and focus.

Business ownership is not easy, but every challenge is an opportunity to learn, grow, and improve. The key is not letting those challenges break you down. Learn from them, adapt, and keep moving forward.

Persistence and relentlessness are key.

I see far too many people give up or quit before they have really given themselves a chance to succeed. I’m not sure if it is social media or the constant stories about overnight success, but many people expect to start and build a successful business in a very short amount of time. The reality is that building a business takes time. It takes hard work, consistency, and a willingness to keep going even when things are not happening as quickly as you would like.

Most small businesses do not become profitable overnight. In fact, many do not make a profit for the first few years. Yet I see people ready to quit after six months or a year because things are harder than they expected.

Business ownership is a marathon, not a sprint. They are the ones who are willing to keep showing up, keep learning, keep adjusting, and keep moving forward when others would have quit.

That is why I always come back to the same advice: be persistent, be relentless, and don’t let temporary obstacles stop you from achieving your long term goals.

Contact Info:

• Website: hometherapysolutionsnd.com & homept.ot
• Instagram: nextlevelot.pt.slp hometherapy
• Facebook: https://www.facebook.com/groups/nextLeveloccupationaltherapy https://www.facebook.com/search/top?q=next%20level%20occupational%20therapy https://www.facebook.com/profile.php?id=100086000135878
• Linkedin: https://www.linkedin.com/in/kara-welke-5b0b9a99/
• Youtube: next level occupational therapy