How to start a home care agency in Delaware (the PASA license, 2026)

The statute: "The services are limited to individual assistance with, or supervision of, activities of daily living, homemaker services, companion services, and those other services as set out in § 1921(a)(15) of Title 24." (16 Del. C. § 122(3)x.2). The rule adds transportation, reporting changes in the consumer’s condition, medication reminders and completing reports (3345-1.0), and says "These services do not require physician’s orders."

• Companion work is licensed. "“Companion” means a person who provides social interaction for an individual primarily in the individual’s place of residence. A companion may provide such services as cooking, housekeeping, errands, etc." (3345-1.0)
• So is homemaker work. "“Homemaker” means a person who performs household chores for an individual primarily in the individual’s place of residence." (3345-1.0)
• Private pay is covered. By our reading, yes: the definition covers any business that refers workers to people at home, "whether public or private, proprietary or not-for-profit", and says nothing about who pays (§ 122(3)x.1).

Who is outside it

• A worker hired directly by the consumer. "Those individuals who contract directly with a consumer to provide services for that consumer, where the consumer pays the individual for services rendered and neither the consumer nor the individual pays an agency on a periodic basis." (3345-2.9.1.1)
• Staffing-only agencies. The statute excludes "an agency which provides staffing exclusively to other agencies (including but not limited to, nursing facilities, home health agencies, and hospitals)", along with agencies providing skilled professional health-care services and agencies under Chapter 94 of Title 16 (§ 122(3)x.3). "Temporary employment/staffing agencies may not provide services under direct agreements with consumers." (3345-2.9.1.3.1)
• Home health agencies that only provide home health services (3345-2.9.1.6).

The medical licenses

DHCQ’s FAQ says of the PASA: "This is a non-medical model." (DHCQ FAQ). The aide-only home health agency license (rule 3351) is the medical alternative: "All assessments of the patient must be performed by a registered nurse." (3351-6.2.1). DHCQ’s January 2026 list shows 12 of those licenses (DHCQ list, our count). DHCQ’s FAQ is not consistent about that license: one answer ends "This is a medical model." (DHCQ FAQ), while its Medicare answer says "PASA and home health agency aide-only HHAAO are non-medical and may not apply to receive Medicare payments." (DHCQ FAQ)

The rule makes your policy manual and your competency test part of the application: "A copy of the applicant's policies and procedures manual as outlined in subsection 4.3" and "A copy of the test to be given to each direct care worker, as required by subsection 4.5" (3345-2.2.2.2 and 2.2.2.7). DHCQ collects them in a binder and reviews it against its Part 1 Document Compliance Checklist, with columns for the regulation number, the requirement, your page numbers, met, not met and comments.

• Page numbers. "Number all pages of the submission (i.e. 1, 2, 3, 4, etc.) and organize the submission in numerical order." "In the column of this document entitled "Page Number", write the page number of your submission that contains the language that demonstrates compliance with that specific regulation." (DHCQ checklist, directions)
• By email too. "The Document Compliance Checklist (excel spreadsheet) must be submitted electronically as an excel file type to the email listed on the cover page." (DHCQ FAQ) The emergency management plan is emailed as well (DHCQ checklist).
• DHCQ’s policy layout. Its sample template says: "Tag this policy with the regulation number for easy reference at the time of the Document Compliance Meeting and the initial licensure survey." (DHCQ slides, slide 19)
• Consultant binders. DHCQ warns that "Delaware’s regulations differ from our surrounding states including New Jersey, Maryland, and Pennsylvania." (DHCQ slides, slide 14) It will not pre-read drafts: "No, that would be unfair to all the other agencies." (DHCQ FAQ)

The checklist has 57 numbered rows. We grouped them below; the row numbers are DHCQ’s (DHCQ checklist, Internet Archive copy).

Not on the checklist, but still in the rule. DHCQ’s slides call completing the checklist "a starting point for licensure" and say surveyors check compliance with all applicable laws and regulations (DHCQ slides, slide 21). So the surveyor can check every other part of rule 3345, including the full list of consumer rights, the Notice of Direct Care Worker Status, home visits and service plans, activity logs, major adverse incident reports, personnel records, insurance, the infection prevention program and the COVID-19 items in 9.4 and 9.5 (rule 3345). DHCQ’s 46-page review guide explains what its reviewers look for, row by row (PASA Binder Review Guide).

The emergency plan. The rule asks for "Each personal assistance services agency shall prepare and maintain a comprehensive emergency management plan that is consistent with the national standards (i.e. FEMA, ASPR, TRACIE) and consistent with the local and state plans" (3345-8.1). DHCQ’s guide says of it: "This is by far the most complicated section." (review guide, p. 43)

Rights wording. For the nine consumer rights in 6.3, the guide says: "Feel free to cut and paste." (review guide, p. 2)

This part of Delaware’s binder goes beyond policies. "All direct care workers are required to complete an orientation program given by the Agency before providing services to a consumer." (3345-4.5.1) The rule lists 24 topics (3345-4.5.2), and every staff member must also be oriented to the disaster preparedness plan (3345-8.3). DHCQ’s guide counts "currently a total of 25 orientation topics" (review guide, p. 13).

• Teaching material, not just a list. DHCQ’s guide says: "EACH SECTION OF THE ORIENTATION PROGRAM MUST INCLUDE THE TEACHING MATERIAL THAT IS BEING USED TO INSTRUCT NEW EMPLOYEES ON THAT TOPIC." (review guide, p. 16)
• No video links. DHCQ will not review links to training videos; send a detailed summary, preferably a transcript, instead (review guide, p. 16)
• The competency test. "All direct care workers must pass a competency test prior to providing care to consumers and annually thereafter." "The competency test must include questions addressing the competencies listed in subsection 4.5.2." (3345-4.5.3)
• The answer key. The guide says the test row is unmet "if the answer sheet is not provided, or the one provided is not organized in the same order as the test, then it is unmet." (review guide, p. 35)
• The pass mark. "The general guideline for passing grade is 80%" (review guide, p. 14)
• No set hours. The rule sets no minimum training hours for PASA workers; DHCQ’s licensure matrix lists orientation and a competency test at hire and yearly (DHCQ matrix).
• Every year. Agencies serving people with dementia "shall provide annual dementia-specific training to all direct care workers" (3345-4.5.4), and "all agency staff shall receive orientation at the time of employment and annual in-service education regarding the infection prevention and control program." (3345-9.3)

A PASA needs no nurse. DHCQ’s slides describe the license as one that "does not require the judgment and skills of a licensed nurse" (DHCQ slides, slide 6). DHCQ’s FAQ, reading rule 3.13 (no healthcare language in the agency’s title or advertising, 3345-3.13), says a PASA’s policies should not describe RN assessments: "The RN implies healthcare so it cannot be used." (DHCQ FAQ) Home visits are made by the director or a designee, and service plans are developed under the director’s supervision (3345-5.2.1; 3345-5.3).

• If you employ a nurse anyway. DHCQ’s FAQ lets a PASA nurse meet consumers to make sure the agency can meet their needs, "complete intake documents, develop care plans, and conduct initial and follow up visits to ensure the consumer’s needs are being met", and supervise workers, but not perform nursing interventions (DHCQ FAQ). A PASA that employs a nurse signs DHCQ’s attestation that its nurses perform no nursing interventions other than assessing consumers to make sure the agency can meet their needs (DHCQ RN/LPN attestation) "Yes, a PASA may hire a CNA; however, the CNA must work as a direct care worker." (DHCQ FAQ)
• Transfers. "Assistance with transfers is not permitted if the consumer is unable to physically assist with the transfer (i.e. use of transfer boards, mechanical lifts are not permitted)." (3345-1.0)
• Personal care limits. "Toenail care may not be provided." "Shaving may be performed only with the consumer's personal electric razor." "Tube and syringe feeding are not permitted." No catheter or ostomy care (3345-5.4.2).
• Consumer delegation. A competent consumer who does not live in a medical facility or a facility regulated under 16 Del. C. Ch. 11 may delegate personal care tasks they could do themselves but for functional limits, if the task is not excluded by law or other state or federal regulation. "The delegation decision is entirely voluntary." (3345-5.4.1)

Medication: reminders, or administration with conditions

"A medication reminder does not include the administration of or any physical contact with the medication." (3345-1.0) Administration is possible only for an adult consumer, only if a responsible caregiver with appropriate capacity authorizes it, and only if every condition in 5.4.3.1 is met: an agreement in which the caregiver confirms the medication and the process are safe and appropriate (DHCQ’s checklist asks for a signed form), doses prepackaged and labeled with written instructions, no excluded routes (such as injections, IV therapy or feeding tubes) and no Schedule II or IV drugs (3345-5.4.3.1). The worker must have completed a Department-approved training program (3345-4.6).

When the Department added the medication training rule (4.6) in 2020, it wrote: "As of the final publication of these regulations, there are no approved programs for administration of medication training." and "Personal assistance services agencies can create a program and submit the program to the Department for review." (23 DE Reg. 1033). We found no published list of approved programs; ask DHCQ before you offer administration. Either way, the binder needs an attestation: "Provide an attestation that your agency plans to have DCW's participate in medication administration or an attestation that you are not participating in Medication administration and only doing medication reminders." (DHCQ checklist, row 5.4.3)

• In Delaware. "The office shall be located in the State of Delaware." (3345-1.0)
• A home office can work. DHCQ’s FAQ says owners "can work out of their homes as long as the home has a room that can be designated as an office with a door and a lock and key for the purpose of securing consumer/patient and personnel information." (DHCQ FAQ)
• The service area. "“Service Area” means the county in the state of Delaware in which the agency office is located and the county or counties in the state of Delaware which are immediately adjacent." (3345-1.0) By our reading of Delaware’s map, an office in New Castle County serves New Castle and Kent, one in Kent serves all three counties, and one in Sussex serves Sussex and Kent. "The agency may provide personal assistance services to a consumer during time-limited travel outside the service area." (3345-2.1.7.1)
• One license per office. "A separate license shall be required for each office maintained by a personal assistance services agency." (3345-2.1.2) DHCQ adds: "You can only open one agency at a time. You can open the second agency once you receive a full (annual) license with the first agency." (DHCQ FAQ)
• The name. "The personal assistance services agency must not use the word "healthcare", or any other language which implies or indicates the provision of healthcare services, in its title or in its advertising." (3345-3.13) DHCQ’s guide extends this to the binder: "the use of "health", "patients" or any medical-related terms, icons, logos, or symbols are not permitted for use by PASAs and must be removed." (review guide, p. 45)

• Paying. "Certified bank check or money order should be made payable to State of Delaware", handed in with the Part 1 application and binder (Part 1 application).
• Liability insurance. General liability of $1 million per occurrence and a $500,000 single limit, in force at all times (3345-7.2). "PURCHASE of an actual policy is not necessary until the binder has been approved and the step 2 application process has started." (review guide, p. 2)
• Bonding. The application list asks for "Proof of insurance and bonding as required in Section 7.0." (3345-2.2.2.8). Section 7.0 is headed "Insurance and Bonding" but sets only liability insurance. Our reading: no bond amount is required; ask DHCQ to confirm.
• Penalties. Civil or administrative penalty up to $5,000 per violation; each day is a separate violation (3345-2.4.2.7). Hiring without a criminal history: $1,000 to $5,000 for each hire without a criminal history (16 Del. C. § 1145(g)).
• Costs we cannot price. Our sources do not publish the Background Check Center, fingerprinting or drug test costs, and DHCQ sends the Part 2 paperwork only after the binder passes.

Who. DHCQ’s acknowledgement form says screening applies to all staff, including office and support staff and administrative positions (DHCQ receipt form), and contract workers "must meet the same requirements as the direct care workers employed by the agency." (3345-3.8).

• Criminal history. "An employer may not employ an applicant for work in a private residence before obtaining a criminal history." (16 Del. C. § 1145(c)) The criminal history covers the applicant’s FBI record and Delaware State Bureau of Identification record (§ 1145(b)(4)), through the Background Check Center (BCC). On request, it goes to the consumer when the worker starts (§ 1145(c)).
• Conditional hire. Up to 60 days from hire, but only after the employer has verification that the applicant was fingerprinted by the SBI (§ 1145(e)). DHCQ says fingerprinting happens only after you pass the binder review (DHCQ FAQ).
• Disqualifying convictions. "No agency shall employ a person who has, within the past 15 years, been convicted of abusing, neglecting or mistreating a resident of a facility, or an adult who is impaired, or of a theft-related misdemeanor within the past 2 years, or of a theft-related felony within the past 10 years." (3110-8.2)
• Drug screen. "An employer may not employ any applicant without first obtaining the results of that applicant’s mandatory drug screening." The screen covers marijuana, cocaine, opiates, PCP and amphetamines (16 Del. C. § 1146).
• The BCC Master List. "All persons working for agencies are required to be on the Master List of the BCC." (3110-4.1) Keep signed consent forms in a separate file (3110-10.3). The BCC runs a Rap-back on everyone on the Master List for new Delaware arrests and convictions; the rule has the Department’s licensing division (DLTCRP in the rule’s wording) decide whether to tell the employer of an arrest, and tell the employer the outcome (3110-5.2).
• How long a check lasts. The statute says a BCC criminal history is valid for a new employer for 1 year from the applicant’s last fingerprinting (16 Del. C. § 1145(c)). Rule 3110-5.3 adds that an applicant whose last check is 3 years old or older is checked again, because Rap-back does not cover FBI records (3110-5.3). Our reading: plan on new fingerprints for anyone last fingerprinted more than a year ago.
• Adult Abuse Registry. Check the online registry before hiring anyone or retaining a contractor, and "the provider shall maintain a copy of the results of the check to demonstrate compliance with this requirement." (3101-2.1)
• Child abuse registry. DHCQ’s FAQ: "Are we required to do a child abuse check if we only work with adults? Yes" (DHCQ FAQ)
• Service letters. From the current or most recent employer, and "if a person seeking employment was employed in a health-care facility or by a child-serving entity within the past 5 years, the employer must obtain a service letter from all such employers." (19 Del. C. § 708(b)(1)a). For someone never employed, DHCQ’s slides ask for two letters of reference from non-relatives (DHCQ slides, slide 36).
• TB and a physical. Pre-employment and annual TB testing per current CDC recommendations (3345-4.4.2.6.1). A physical examination is needed before providing care; the rule and DHCQ’s FAQ disagree on how recent it must be (see below).
• COVID-19. The rule still says: "Before their start date, all new staff, vendors and volunteers must be tested for COVID-19 in accordance with Division of Public Health guidance." (3345-9.4.1) We have not saved the Division of Public Health’s current guidance; ask DHCQ how it applies this today.

At the survey, DHCQ’s slides list what each personnel file must include: application, service letters, criminal check, adult and child abuse checks, physical, drug test, orientation, competency, signed job description, TB (DHCQ slides, slide 29).

• Adults. "A person, including a health-care professional as defined under § 701 of Title 16, having reasonable cause to believe that an adult who is impaired or an adult who is incapacitated and is in need of protective services shall report the information supporting reasonable cause to the Department in the manner and format that the Department requires." (31 Del. C. § 3910(a)(1)) For people living at home, "The APS can be reached at 1-888-277-4302 (1-888-APS-4302)." (DSAAPD, Internet Archive copy)
• Children. "Any person, agency, organization or entity who knows or in good faith suspects child abuse, neglect, or human trafficking shall make a report to the Department in accordance with § 904 of this title." (16 Del. C. § 903(a)) The report line is 1-800-292-9582 (DSCYF, Internet Archive copy).
• To DHCQ, within 48 hours. "The personal assistance services agency must report all major adverse incidents occurring in the presence of a direct care worker involving a consumer to the Department within 48 hours in addition to other reporting requirements required by law." (3345-5.5.12.1) Major adverse incidents include "Suspected abuse, neglect, mistreatment, financial exploitation, solicitation or harassment", an accident that causes serious injury, the unexpected death of a consumer, medication diversion, and medication error or omission (3345-5.5.12.2). A complete report follows within 30 calendar days (3345-5.5.12).
• Complaints about an agency. OHFLC: 302-292-3930; toll free 1-800-942-7373, 24 hours a day; off-hours messages are picked up the next business day (OHFLC page, Internet Archive copy). Your procedure must tell consumers and families they can report concerns to the Department without fear of reprisal (3345-3.6).

Our reading: Delaware’s facility abuse law (16 Del. C. §§ 1131 to 1140) covers facilities licensed under chapter 11 of Title 16, state-operated long-term care residential facilities, hospitals and adult day care facilities. A PASA is licensed under chapter 1 (§ 122(3)x), so we cite the Adult Protective Services Act, the child abuse law and the rule’s 48-hour report as the duties that reach a PASA (16 Del. C. § 1131(4)). Ask DHCQ if you are unsure which line to call.

• How recent the physical must be. The rule: "The physical examination must have been completed within 12 months prior to employment/referral." (3345-4.4.2.6.5.1). The July 2023 amendment changed three months to 12 (27 DE Reg. 43). But DHCQ’s FAQ, revised October 22, 2025, still answers: "No, the physical examination must have been completed within three (3) months prior to employment/referral; and a copy of the physical examination shall be maintained in the individual's file." (DHCQ FAQ). Our reading: the rule governs, but a physical within three months before hire satisfies both. Ask DHCQ which its surveyors apply.
• Director experience. The rule: "The director shall have at least an associates degree plus 2 years healthcare or home care supervisory experience." (3345-1.0), and DHCQ says the experience cannot be waived (DHCQ FAQ). Its FAQ answers the question "I have many years’ experience at a non-skilled home care. Do I qualify as Director?" with: "A non-medical home care facility does not qualify as healthcare supervisory experience." (DHCQ FAQ) The rule also accepts "home care supervisory experience", so our reading is that DHCQ may not count PASA-only supervision. Confirm with DHCQ before you name your director.
• RN wording. Rule 3.13 covers healthcare language in the agency’s title or advertising (3345-3.13). DHCQ’s FAQ applies it to policies that describe RN assessments (DHCQ FAQ), yet the same FAQ and DHCQ’s attestation let a PASA nurse assess consumers, write care plans and supervise workers (DHCQ FAQ; attestation). Our reading: describe the director or a designee doing home visits and service plans, and if you employ a nurse, keep their role within DHCQ’s attestation.
• How long the first annual license lasts. The rule: "An annual license shall be granted, for a period of 1 year (12 months) to all personal assistance services agencies which are and remain in substantial compliance with these regulations." (3345-2.3.3.1). DHCQ’s slides: "If you are found in compliance, you will be granted a license for the remaining nine additional months." (DHCQ slides, slide 28) Our reading: expect the first renewal about a year after the initial license was issued; check the expiry date printed on your license.
• Bonding. 2.2.2.8 asks for proof of insurance and bonding, and Section 7.0 is headed "Insurance and Bonding" but sets only liability insurance (3345-2.2.2.8; 7.0). Our reading: no bond amount is required; ask DHCQ to confirm.
• Abuse reporting law. Covered above: our reading is that the facility abuse law in 16 Del. C. §§ 1131 to 1140 does not reach a PASA directly.
• COVID-19 items. Rule 3345 still has COVID-19 testing and policy items in 9.4 and 9.5, though DHCQ’s checklist has no row for them (3345-9.5). DHCQ’s review guide, under row 3.5, says: "The latest Departmental requirements for COVID-19 should be included in the policy" (review guide, p. 6). Our reading: include them, because the survey can check any part of the rule.

• Renewal. "Existing personal assistance services agencies must apply for licensure at least 30 calendar days prior to the expiration date of the license." (3345-2.3.3.3) The renewal application includes your disaster preparedness plan as Exhibit J, and the director attests that all staff had background checks, drug tests, child and adult abuse checks and service letters (renewal application, p. 2; p. 3).
• Policies. "Policies shall be reviewed and dated annually and revised as necessary." (3345-4.3.3)
• Consumers. Follow-up home visits at least every 90 calendar days, every other one in person and the rest by telehealth (3345-5.2.4), and "the service plan shall be reviewed no less often than every 90 calendar days and revised as necessary." (3345-5.3.4)
• Changes. Tell the Department in writing within 15 calendar days of a change of director or management (3345-3.7) and at least 30 calendar days before moving office (3345-2.1.3). "Any agency that undergoes a change of ownership is required to re-apply as a new agency." (3345-2.1.4)
• Inspections. "Inspections by authorized representatives of the Department may occur at any time and may be scheduled or unannounced." (3345-2.7.1)
• Rule changes. The last change to rule 3345 took effect on July 11, 2023 (27 DE Reg. 43). We found no Division of Health Care Quality proposal open in the Delaware Register on October 4, 2026 (our Register listing).

DHCQ’s PASA list dated January 31, 2026 has 70 licensed offices, one license per office; its lists from October 1, 2025 and June 11, 2025 have 69 and 70 (DHCQ lists, our count). License IDs run up to PASA-123 on the January list (DHCQ list). It is a small market, and DHCQ’s list is the place to check an agency’s license before you talk to a seller.