There’s no shortage of potential clients. Connie Freeman owns and manages two home health-care companies, Universal Pediatric Services Inc. and Ultimate Nursing Services of Iowa Inc., and figures her nearly 900 employees are reaching just a small fraction of the people who could use their help.

But finding enough qualified caregivers, that’s another matter.

“When I started, all I thought about was marketing,” said Freeman. “Now all I think about is recruiting.”

Twenty years ago, Freeman started Universal Pediatric Services, which provides home health care for infants, children, young adults and adults in Iowa, Minnesota, Wisconsin, North Dakota and South Dakota. Ultimate Nursing Services of Iowa sprang to life in 1996 and provides home nursing services to children, young adults and adults throughout the Midwest.

Along with a constant search for qualified caregivers, Freeman said she struggles to find adequate funding to pay them. “In the past 10 years, our payer source has switched from insurance companies to Medicaid,” she said. “That’s not the highest-paying source, and it has restricted our ability to do things.”

Still, the companies are thriving, Freeman plans to expand them and recently bought a building in Waukee to use as the headquarters for Universal. She has brought her business a long way since starting it from scratch, and it all came as a surprise to her.

“We had a big party after three years with Universal,” she said, “because I didn’t know if we’d make it to five. For the first 10 years, I read the want ads every week.

“Never in my wildest dreams did I imagine I’d still be in business today.”

Freeman, who grew up in Southwest Iowa, was a critical-care registered nurse for 20 years, taught for a year at a community college and then went to work for a large health-care company. After that company pulled out of Iowa, Freeman decided the time was right to start her own home health-care business.

It wasn’t a dollars-and-cents decision as much as a compassionate one, she said. Her concern for the disabled can be traced to her sister, who was born with Down’s syndrome, was paralyzed by an accident at the age of 8 and died at 17. “There were no home health-care services for her except a wheelchair from Easter Seals,” Freeman said.

So Freeman — who once scored in the 99 percentile on persuasive skills and in the 98 percentile on dominance in a personality test – started Universal on a small scale. “We were invited into Nebraska, then into Kansas, and so on,” she said.

The invitations most often have come from clients in rural areas. “I’ve been invited to various states because most home-care agencies are hospital-based and want to stay in their city,” she said. “When we’re invited, I always make the first visit.”

And when the company has opened a sizable office in a new state, Freeman has gone there to live for a year or more. She did that in Utah and Florida.

In 1992, Inc. magazine placed her on its list of Entrepreneurs of the Year along with such local names as Jim Cownie and Bill Krause, and nationally known business giants such as Jenny Craig, Lillian Vernon and Don Tyson.

Universal has since pulled back from ventures into the South and West. “We wanted to be a Midwest company,” Freeman said, “and that’s because of the quality of people we want to hire. People in the Midwest are more committed to their work, and the only asset we have are our nurses.”

Those nurses are getting harder and harder to find, though. Freeman often drives off alone in her Jaguar to rustle up new candidates. She worked the North Dakota State Fair last year. This past summer, she spent lots of time in Wisconsin.

“I’ll get in my car and go to every community within 50 miles of a patient,” she said. “I go from business to business and tell them we’re recruiting nurses. I put up posters and distribute fliers; an ad in the paper doesn’t do it.”

In that part of her territory, Freeman competes with the Mayo Clinic of Rochester, Minn. “All of the nurses are driving to Mayo and getting the big bucks,” she said.

In Central Iowa, “we’re competing with two hospitals with their own home care,” she said.

As if two businesses weren’t enough to occupy her time, in 2000 she restored a 1902 hotel in her hometown of Essex, turning it into a bed-and-breakfast inn. And she’s working on her bachelor’s degree, having come this far with an associate’s degree.

Freeman and her husband separated a year into her first business venture, and have since divorced. She said the demands of starting Universal Pediatric Services created some of the strain on her marriage. “I used to work from 6 a.m. to 10 p.m., seven days a week, and I had no true vacation for five years,” she said. “It was hard on the kids, too.”

She has three children, one of whom, Tucker Anderson, moved back from Florida and is now president of Universal. “I’m going to pass the business down to Tucker; it will be a family-owned business forever,” Freeman said.

However, she has no plans to hand it over anytime soon. At 57, she says, “I can’t retire. I couldn’t sit still for 5 minutes.”