SOULcial Salute June 2026
Josh Cesaro-Moxley, LALD & Founder, Heart to Home, Mendota Heights MN
From The Start It Was From The Heart
In 2005 Josh graduated from the University of Minnesota Duluth with his degree in Business Administration. He was thinking of a career in medical technologies. He learned quickly though that was not his future. Josh knew he was more about people than products.
Josh’s career was just beginning but the roots of his passion began far earlier. His mom was an R.N. and his dad started college pre-med but found his calling being a paramedic back in New York. That shared ethos of serving others combined with both grandmothers’ end of life experiences being very different from one another left a lasting impression.
One grandmother had Parkinson’s and lived her final months in the old stereotypic nursing home. The other in New York spent her final years in a well-run residential setting experiencing dignified care. That experience helped set the stage for Josh’s outlook.
Care Begins and Ends With Dignity
Having worked part time in nursing homes during school Josh continued using his Certified Nursing Assistant designation and worked in skilled care in Duluth.
Caring for elders was what Josh wanted. But the way care was being delivered was not how he liked it. The conditions for both staff and residents left a lot to be desired. Josh recalled, “In college I had 10-12 residents to care for myself. It was clearly untenable if dignified and quality care was to be given.”
This experience combined with his passion helped him discover examples of better approaches such as Rakhma Homes in the Twin Cities and the Green House Project in St Louis. Both are successful examples of 10-12 resident homes focused on dignity and empowerment of both residents and staff.
Small Business Savvy Succeeds
With all this in mind, it wasn’t long after graduation that Josh had an idea. He asked his dad, then a home building general contractor, to team up and create a more dignified home-like senior living. One offering more dignity for both physical and cognitive care. Josh’s dad had the financial and construction resources. Josh had caregiving and business management skills.
They pooled their research and resources along with the counsel of some progressive healthcare executives – Angie Swetland of Rakhma and Presbyterian Homes and Dr. Todd Stivland of Blue Stone Physicians. With that and years of sweat equity they got off on the right foot and opened Mendota Manor in 2007.
Then came Mendakota Manor in 2008 – along with a new baby at home. Josh was emphatic about how instrumental his wife Rachel’s influence and support was in the success of what they’ve built.
Josh operates in line with their core value of dignity for both residents and staff. It is counter-intuitive to run higher than average staffing. However, this has proven to maintain better resident care and family satisfaction. Staff as well are more satisfied and dedicated. Their staff longevity is definitely above average. Less staff turnover produces less expense in the long run.
Quality Care And Business Are Mutually Beneficial
In 2014, after several years of caring for staff, families and residents, often through end of life, Josh was approached by the City of Mendota Heights. They wanted Josh’s help to redevelop two challenging properties. From that came the opening of Hilltop Manor and Lake Manor in 2015 and 2017.
The “Manor” naming is a nod to the study abroad year that Josh and then girlfriend Rachel spent traveling in England. They stayed in many English manors. The great hall element is the architectural center that brings all the occupants together. This was the inspiration for the design of all 4 of their 10-bedroom homes. Plus, the modern element of private bathrooms in every bedroom.
Quality Care And Compliance Are Not Mutually Exclusive
Josh’s mild manner, business acumen and strong relationships have been the perfect skill set to navigate the regulatory cross winds in this evolving and expanding corner of healthcare.
The number of classifications and licenses Josh has had to earn, hold and transition through, let alone the innumerable regulations to meet in 20 years providing this care is mind numbing. The Zen Josh exudes when describing the governmental gauntlets he has run over the years is awe inspiring.
Most recently it was the overarching “Assisted Living” licensure overseen by the Minnesota Department of Health that was enacted in August of 2021. This sweeping regulation unintentionally, yet foreseeably, boxed out operators of residential assisted living and dementia care homes between 6-10 bedrooms. This is the category Josh exclusively operates in.
Josh however helped work to achieve a number of 6–10-bedroom homes like his being granted a “grandfathering in” under the new law. Since this law’s enactment not one new “10 room or less” home has been licensed.
Fathers Form Lasting Foundations
Josh was vivid in his descriptions of how much he learned from his dad. He described how dedicated his dad was not only to his work but his clients’ best interests. Josh brightened when recounting “I clearly recall dad sitting at their dining room table at night, after working all day, penciling out a client’s estimate until everything was just right.”
Likewise I can imagine Josh laying the same foundation for all 5 of his and Rachel’s kids. Today Josh’s dad is retired but still visits the homes with the dog occasionally. Josh and his dad’s friendship now lives in gardening, grandkids and those special summer vacations back east crabbing and fishing on the pontoon.