How to start a home care agency in Illinois (2026)

Governing body

A governing body with legal authority and responsibility for the agency.

Bylaws reviewed yearly

Bylaws or the equivalent stating the agency's objectives, available to every governing body member and reviewed every year.

Policies adopted by the governing body

The governing body adopts the agency's operating and administrative policies and revises them as needed.

Governing body meetings and minutes

The governing body meets to review the agency's operation and keeps minutes of every meeting.

Written administrative policies

Written administrative policies and procedures that ensure clients receive safe and adequate care.

Liability insurance

Liability coverage of at least $1 million per occurrence and $3 million aggregate, with evidence available.

Agency manager

Designate an agency manager with overall responsibility for day-to-day operation and supervision of services.

Agency manager responsibilities

The manager ensures legal compliance, keeps the rules on hand, completes required reports and records, liaises with the governing body and community, manages business affairs, keeps personnel and administrative records and all policies, hires to job descriptions and provides orientation and in-service education.

Staff and contractors know the rules

Keep the IDPH rules in the agency and familiarize every employee and contractor with the Act and rules, with copies available.

Organization chart

A current organization chart showing lines of authority down to the client level.

Written alternate manager

Designate in writing the qualified staff member who acts when the manager is absent; the alternate is named in the license application.

Staffed office

An office with a working phone staffed during business hours, adequately equipped, keeping client records confidential and meeting local fire safety rules.

Operating hours and after-hours access

A written policy stating operating hours and how clients get care from the agency or another provider outside those hours.

Change notices within 10 days

Tell IDPH within 10 days of a change to name, manager, physical or mailing address, operating hours, phone, fax or email, including at branches.

Service area changes approved first

Get IDPH approval before expanding or reducing the geographic service area.

Change of ownership

Written notice to IDPH at least 30 days before a change of ownership or sale; the new owner applies at least 30 days before the sale; return the old license by certified mail.

Closing the agency or a branch

Written notice 30 days before closing with reasons and the records custodian; transfer active clients' records to receiving agencies and tell IDPH which; surrender the license when services stop.

Annual renewal

File the renewal 60 to 90 days before expiry with client load data, and be able to show client activity before the second renewal.

Policies filed with the application

Copies of the complaint, employee health and safety, infection control, background check and mandated reporting, supervisory visit, client records and training policies go to IDPH with the initial application.

Contract, acceptance criteria and service plan form

The initial application also includes the client service contract, the criteria for accepting clients and a sample service plan form.

Inspections and access

Help IDPH visit clients at home during inspections and make all books, records, policies and procedures available.

Plans of correction

File a plan of correction within 10 days of a notice of violation, stating how and by when each violation will be corrected; a modified plan within 10 days of any rejection.

Branch office operationif the agency has an approved branch office

Branches within 100 miles, same services, lines of authority traceable to the parent, parent manager supervising during all branch hours, parent-held personnel records, training and contracts, and branches included in quality reviews.

Monthly branch supervisory visitsif the agency has an approved branch office

At least monthly on-site visits to each branch, documented with the date, content, attendees and recommendations.

Drop-site limitsif the agency has an approved drop site

A drop site has no designated staff, takes no referrals or orders, does no payroll or billing, stores no files and is not advertised.

Contracted services agreementsif the agency provides any services through a contract with a third party

A written agreement for third-party services covering services, adherence to agency policies and background checks, agency control, notes, charges, liability, insurance and taxes, term, signatures and termination.

Qualified contract personnelif the agency uses contracted workers or services

Contracted services are provided by qualified, properly licensed or certified personnel under the agency's supervision.

Student training agreementsif the agency takes students from an educational institution

A written agreement with each educational institution covering client care responsibility, education, expectations, supervision, ratios, confidentiality, insurance and joint evaluation.

List of services and scope of work

Keep a list of services offered and the scope of work for each, and give it to clients before contracting, with the signed contract and whenever it changes.

Written client agreement

A written agreement with every client covering compliance with the Act and background checks, who pays employment taxes and workers' compensation, who supervises and hires and fires workers, charges and payment, term and termination, and contact details for concerns.

Client contract contents

Contracts in at least 12-point type include consent, agency contacts, the manager to contact, license status, compliance with the Act, duration, rate and services, how to modify or end it, the complaint process, billing and the emergency notification policy; copies to the client and the client file.

Who is the employer notice

A notice naming the party responsible for employing, insuring, paying, taxing, supervising, assigning, hiring and firing the worker, and supplying equipment.

Emergency notification policy

A policy on notifying a relative or other person in an emergency, stated in the client contract.

Acceptance and discharge policies

Written policies on accepting and discharging clients, followed in practice.

Who can be accepted

Accept clients for household or personal support or companionship; never provide medical services that need a home health or home nursing license.

Documented acceptance information

Base acceptance on documented information, gathered with the client and family or representative, about functional limitations and circumstances such as medications, treatments, activity, diet and mental status.

No discrimination

No one is refused service based on race, color, religion, national origin, ancestry, age, sex, marital status, order of protection status, disability, military status, sexual orientation, pregnancy or unfavorable military discharge.

Clients needing full repositioningif the agency accepts clients who need complete repositioning

Accept a client who needs complete repositioning and cannot signal it only if the worker is trained and checked for competency and the client's representative can help or give feedback.

Seven working days' termination notice

At least seven working days' notice with a reason before the agency ends services, recorded in the client record; when a worker's safety is at risk, notice may be shorter but the risk is documented.

Service plan contents

A plan for each client, made with the client or representative (and family at their request), covering ADL and support tasks, medication reminder times, treatments, activity, diet, functional limitations and safety procedures, mental health status, visit frequency, equipment and limitations.

Plan stays within scope

The service plan never includes tasks outside the home services worker's permitted scope.

Yearly plan review

Review and revise the plan as needed and at least once a year.

Complaint resolution

Written complaint resolution policies for clients and their advocates, described in the client contract.

Workers stay within home services

Workers provide only the home services Part 245 allows: observation and reporting, chores, errands, companionship, records of each visit and ADL and personal care help.

Prohibited worker roles

Workers never give skilled personal care, act as a power of attorney, handle client money outside contracted services, set up medications or do anything else agency policy or law forbids.

Receipts for client purchases

An agency policy on getting receipts for items bought for clients, signed by the client and the worker.

Skin care and first aid

Preventive skin care on unbroken skin with non-prescription products; simple first-aid bandages only after lay first aid training and a competency check. Wound care is skilled.

Ambulation and adaptive equipmentif workers help clients who use adaptive equipment to walk

Help with walkers, canes and wheelchairs only once training on the equipment is finished by a licensed provider and the worker is trained and checked for competency.

Bathingif workers help clients bathe

Bathing help only after training in the client-specific bath and a competency check, with bathing training and competency repeated every year. Clients with skilled skin or dressing needs go to a home health or home nursing agency.

Prescription compression devicesif workers apply prescription compression devices

Applying prescription elastic bandages or compression devices needs a health care professional's order, worker training and a competency check.

Feeding and thickenersif workers help clients eat

Feeding help only when the client swallows independently and sits upright; high choking risk goes to a home health or home nursing agency. Pre-measured thickeners need training and a competency check.

Prescription shampooif workers apply prescription shampoo

Prescription shampoo only with an order, training, a competency check and annual retraining; open skin lesions are documented and reported.

Nail care

No nail trimming. For clients with circulatory problems or loss of sensation, filing only with an order, training and a competency check.

Positioningif workers help clients change position

Positioning help after training in cues and repositioning procedures and a competency check, following the service plan.

Transfers and liftsif workers help clients transfer

Transfers, including with gait belts or mechanical lifts, only when the client can stand and pivot or give feedback, after training on the client's equipment and a competency check.

Toileting, catheters, ostomies and shaving limits

Workers may empty catheter and ostomy bags but never insert or remove catheters, give enemas or suppositories or do digital stimulation; shaving only with an electric or safety razor.

Medication remindingif workers remind clients to take medications

Reminding only from pre-filled, day-and-time-marked containers filled by someone else; report irregularities to the supervisor immediately.

Oxygen system changesif workers serve clients on continuous oxygen

Switching oxygen from stationary to portable only after training and a competency check, with a trained staff member able to train and evaluate workers. Other respiratory care is skilled.

Vital sign remindersif workers help with blood pressure, pulse oximeter or similar devices

Workers may remind clients to take readings and help record them, but the agency never interprets the data or acts clinically on it.

Supervisor available at all times

A designated supervisor available to workers for questions at all times.

Supervisory visits every 90 days

On-site supervision at least every 90 days, or more often if the plan requires, with the worker present or absent.

Observation visits

Observe a worker giving care by the next supervisory visit when there is a concern, and observe every worker on site at least once a year, checking safe care, the plan, competency, infection control, reporting, rights and communication.

Supervision is not billed

Supervision time is never billed to the client.

Observation, reporting and visit records

Workers observe and report changes in the client to their supervisor and complete records of the services given at each visit.

Personnel policies

Personnel policies available to all staff covering wages, benefits, hours and leave; orientation and continuing education; Civil Rights Act compliance; and confidential personnel records.

Initial health evaluation

An initial health evaluation for each new employee with client contact, as the governing body specifies.

Job descriptions

Job descriptions for every position, and staff hired to them; copies go with the initial application.

Annual performance evaluation

An annual performance evaluation for every employee.

Employee health and communicable disease

Employees report symptoms and exposure to communicable disease; the policy says when they are removed from client contact and when they may return.

Worker safety in clients' homes

Procedures to identify dangers to staff working in homes and to protect them.

Professional license checksif any position needs a state professional license

Before hiring anyone into a position needing a state professional license, verify it is active with IDFPR and keep the verification in the file.

Personnel records

Name and address, Social Security number, date of birth, next of kin, evidence of qualifications, dates of employment and separation and the reason.

Worker eligibility documents

Each worker's file shows no disqualifying background check without a waiver, a copy of their Social Security card, and a visa or proof of citizenship.

Ten hours of initial training

At least 10 hours for each worker: five before the first assignment and five in the first 30 days; prior training at another licensed agency in the past year may be accepted.

Competency evaluations

No assignment until the worker passes a competency evaluation on the first five hours (including workers with prior training and CNAs); test again after the second five.

Initial training topics

Fourteen subjects: job limits, communication, observing and reporting, personal care tasks, adaptive equipment, hygiene and infection control, a safe home, safety precautions, emergencies and first aid, confidentiality, dementia, challenging behavior, abuse and neglect, and other assigned tasks.

Ten hours of annual training

At least 10 hours a year, by calendar year or anniversary, covering client dignity and rights, disaster procedures, hygiene and infection control, abuse and neglect, and the listed personal care skills.

Qualified supervisors and trainers

Supervisors or trainers with the required experience give initial training and ongoing supervision on the task list and are available for continuing education.

Training records and certificates

Document the date, time per topic, instructors and qualifications, content and the worker's signature or time-stamped e-certificate; give workers their certificate on request.

Orientation and in-service education

Orient new staff and run regularly scheduled in-service education with chances for continuing education.

Background check compliance

Comply with the Health Care Worker Background Check Act and Part 955.

Policy defining direct care positions

A policy defining which unlicensed employees provide direct care, based on job duties, time alone with clients and physical contact.

Registry check and six searches before hire

Check the Health Care Worker Registry before hiring, run the six web searches, and start a fingerprint check if the person has none or is inactive.

Fingerprint check timelines

Start a check after a conditional offer; submit data within 2 working days; fingerprints within 10 working days or suspend; terminate if none within 30 days; send fees within 10 working days.

Supervision while results are pending

Conditional employment up to three months with supervision enough to prevent abuse, neglect or theft.

Who cannot be employed

No direct care work for anyone with a disqualifying conviction without a waiver, or with a registry or APS finding; no work from a disqualifying notice until a waiver is granted.

Notice to applicants

Tell applicants and employees about the fingerprint check, their right to see and challenge the report and seek a waiver, and the consequences of disqualifying convictions.

Policy on employing waiver holders

A policy on employing people who have been granted waivers.

Annual registry employment verification

Verify every employee and contracted worker in the registry at least yearly and enter hire and separation dates within 30 days.

Background check files

Keep criminal records requests 5 years and the forms and notices for the length of employment, plus screen prints of the registry result and the six searches.

Checks for contracted workersif the agency uses contracted or subcontracted workers

Unlicensed contracted or subcontracted workers also undergo the fingerprint-based check.

Registry portal access

Register for the IDPH web portal so the agency can start checks and verify staff; the manager must be able to show access at survey.

Reporting to Adult Protective Services

On reasonable suspicion of abuse, neglect or financial exploitation of a client 60 or over or an eligible adult, notify the designated elder abuse provider agency and keep documentation 12 months.

Reporting child abuseif the agency serves anyone under 18

For an alleged victim under 18, call the DCFS Child Abuse Hotline and keep documentation 12 months.

Removing an accused employee

Immediately remove an accused employee from client contact and investigate.

Investigation report to IDPH

A written investigation report within 14 days with the six listed contents, sent to IDPH within 24 hours of completion and kept 12 months.

Staff and volunteers report

Employees and volunteers report abuse, neglect or exploitation to agency management and to the elder abuse provider agency or Department on Aging; mandated reporters still make their own reports.

Immediate police notification

Call local law enforcement immediately for physical injury or sexual abuse by staff, a crime in the home by someone other than the client, or a death not from disease or natural causes.

Law enforcement notification policy

A policy on keeping clients safe when police are called, calling police for abuse by others, calling police, fire, ambulance and rescue, and preserving a possible crime scene.

Infection control policies

Policies and procedures for investigating, controlling and preventing infections.

CDC guidelines

Follow the CDC guidelines Part 245 incorporates (immunization best practice, hand hygiene, infection control in health care personnel) as appropriate.

Quality improvement program

A quality improvement program with written policies that evaluates the whole program at least yearly, including a client record review; results go to those running the agency, are acted on and kept as administrative records.

Quarterly record review

Review a sample of active and closed client records at least quarterly, including whether visit frequency matched the plan and workers followed the service plan.

Client record contents

Client and representative contact details, an emergency contact, the agreed plan of services, the client agreement and the worker's documentation of services at each visit.

Documentation of each visit

Workers document every service provided at every visit.

Records policy and two-year retention

Written records procedures and maintenance policies; keep records at least two years after the last service, on paper or electronically.

Record confidentiality and release

A written policy on protecting record confidentiality covering use, removal and release of records; the office protects paper and electronic records.

Dementia services rulesif the agency serves clients with Alzheimer's disease or a related dementia

An agency offering any Alzheimer's or dementia services follows the Alzheimer's Disease and Related Dementias Services Act and Part 973.

Alzheimer's services supervisorif the agency serves clients with Alzheimer's disease or a related dementia

Designate an Alzheimer's services supervisor with a recognized dementia certification or two years' dementia experience, who completes 8 hours of dementia training a year.

Dementia care plansif the agency serves clients with Alzheimer's disease or a related dementia

A care plan for every client with a dementia diagnosis, following nationally recognized dementia care standards.

Dementia services disclosureif the agency serves clients with Alzheimer's disease or a related dementia

At enrollment, give materials on the philosophy of services, services offered and behavior management and drug therapies, with a disclaimer that the services are not certified under the Special Care Disclosure Act; never advertise non-compliant dementia services.

Dementia trainingif the agency serves clients with Alzheimer's disease or a related dementia

Six hours of initial dementia training in the first 60 days for staff with direct access to clients with dementia, on the seven listed topics; 3 hours of advanced training each year; documented like other training.

Emergencies and disaster proceduresRecommended practice

Part 245 has no stand-alone agency emergency plan rule for home services, but workers must be trained to implement each client's emergency preparedness plan and on disaster procedures every year, so the manual includes an emergency and disaster procedure.