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

The statute says "To operate a personal services agency, a person must obtain a license from the state health commissioner." (IC 16-27-4-6(a)). A personal services agency is ""personal services agency" means a person that provides or offers to provide a personal service for compensation, whether through the agency's own employees or by arrangement with another person" (IC 16-27-4-5(a)), so offering the services counts, not only providing them.

Personal services are attendant care, homemaker services (housekeeping, shopping, laundry, meal planning and preparation, cleaning) and "companion services that provide fellowship, care, and protection for a client, including transportation, letter writing, mail reading, and escort services", provided at the client’s residence (IC 16-27-4-4(a)). Knowingly or intentionally operating or advertising an unlicensed PSA is a Class A misdemeanor (IC 16-27-4-23).

Indiana’s definition of attendant care includes hands-on care and help with medications. It covers help a person could do for themselves if they were not impaired, so they can live at home (IC 16-18-2-28.5):

The limits

• Services that need a health care professional’s order to be lawfully performed are not personal services (IC 16-27-4-4(b)(4)).
• If a client’s condition becomes unstable or unpredictable, the agency tells the client, a representative, a relative or another person the client named that a medical referral is needed, and records it. It may keep providing personal services but "may not manage or represent itself as able to manage the client's medical or health condition" (IC 16-27-4-8).
• IDOH’s 2022 instruction letter says: "A personal services agency is a not medical agency and may not provide medical care. Do not include medical language in policies and procedures." It also says a PSA may not advertise as a home health agency or use "health" or "nursing" in its name (IDOH instruction letter, 08.2022).

If you plan Medicaid work later, note that FSSA’s Attendant Care service definition says waiver attendant care cannot cover skilled needs such as a Hoyer lift, even though the PSA license allows lift services (FSSA, Attendant Care service definition).

IDOH’s program page says "The IDOH Gateway is used to complete initial registrations, renewals, upload required documents, and complete payments for PSAs." Its page as archived in May 2026 described mailing a paper form or emailing PSA@health.in.gov, and said "This process is applicable until May 1, 2026." (IDOH program page, archived May 18, 2026). The current page still links the 2018 paper forms; with IDOH’s 2022 instruction letter, they are where IDOH lists the documents it wants.

1. Get access. Register with Access Indiana and request access to the Personal Service Agency License Registration application. "Once an administrator approves the registration, users will receive an email notification of approval." The approval email includes the registration ID you sign in with (IDOH program page).
2. Register the agency. Enter its basic details; all fields are mandatory, including agency hours. Then ownership, manager and location details.
3. Upload, attest and pay. "Upload required documents in Documents section, then click Next." Then complete the attestation and pay the $250 fee online (IDOH program page, steps 3 to 10).

The documents IDOH asks for

From the paper application form (State Form 53391) and IDOH’s 2022 instruction letter:

• Secretary of State documents for your entity, plus a Certificate of Assumed Business Name if you trade under another name, and an IRS document showing the legal name and EIN. "The legal name on the IRS and SOS must match." (Form 53391, Sections II and VIIII)
• Criminal history reports for the manager, alternate managers, officers and owners: lifetime expanded or lifetime national, dated within the past three months (Form 53391, Section VIIII).
• Owners of 5% or more, and all owners, directors, officers, partners, managing agents and managing employees, listed on the form (Form 53391, Section IV).
• A physical location and phone. "The applicant must have a physical location and operational telephone for a personal services agency for licensure." IDOH’s letter says it must be in Indiana and may be a home address (IDOH letter).
• The nine policies and seven forms listed below, and for any branch office its address and a map showing it is within 120 miles of the parent (IDOH-HCBC/PSA-1; IC 16-27-4-6(b)).

The paper form is signed under penalty of perjury by an owner, CEO or president and by the manager, and certifies that "the operational policies of the agency will not discriminate based upon race, color, creed or national origin" (Form 53391, Section VI).

What we could not see: the Gateway’s document upload step needs an Access Indiana login, so we do not know exactly which uploads it asks for. If in doubt, email PSA@health.IN.gov (IDOH program page, Contact).

The application in full: what to have ready, each Gateway step, renewal, changes and selling →

How IDOH reviews it

IDOH’s form says "All documentation must be received and approved prior to issuance of a license to operate a personal services agency." Its 2022 letter adds that applications are reviewed in the order received and that IDOH will not accept requests for immediate review because of a provider’s timeline (IDOH letter, page 2). We found no published processing time.

The statute frames it more narrowly. It says "The application may not require any information except as required under this chapter." and that "After receiving a completed application that demonstrates prima facie compliance with the requirements of this chapter and the payment of the fee required by subsection (d), the state department shall issue a license" (IC 16-27-4-6(d)-(e)). The forms, tests, job description, alternate managers, IRS and Secretary of State documents (apart from an out-of-state agency’s authorization) and owners’ criminal history reports that IDOH asks for are not named in IC 16-27-4. Our reading: the form, the 2022 letter and the 2024 document are what IDOH has published about what it reviews, so the straightforward route is to send what it asks for, written to the statute. If IDOH asks for something you think the chapter does not require, you can ask which section it rests on. An applicant or licensee aggrieved by an IDOH action under the chapter may request a review under IC 4-21.5 (IC 16-27-4-21).

IDOH "may conduct an onsite inspection in conjunction with the issuance of an initial license or the renewal of a license" (IC 16-27-4-6(e)), but the client rights statement must tell clients that IDOH does not inspect PSAs as part of licensing and does investigate complaints (IC 16-27-4-12(12)).

Two IDOH documents, two lists

The application form (revised September 2018) asks for all nine, with their forms. IDOH’s 2024 requirements document (IDOH-HCBC/PSA-1, effective March 26, 2024) names four and says "Certain policies and procedures are not evaluated at the time of initial licensure however the agency is required to have those policies and procedures in place." (IDOH-HCBC/PSA-1, FAQs). By our reading, the difference is in what IDOH reviews before licensing. All nine rest on duties in the statute, and the 2024 document itself says the agency must have the others in place. We could not see which of them the Gateway asks you to upload. Our suggestion: have all nine and the seven forms ready, in the form’s order. Each item, what its forms must hold, and every requirement mapped to a policy →

How IDOH wants them written

• Your own policies, not the statute or a handbook. The form says "Do not send a handbook as policies and procedures and/or cut and paste IC 16-27-4 as policies and procedures." (Form 53391, Section VIII). The 2022 letter: "The agency must develop policies and procedures and include the elements of the state statute."
• Specific to Indiana. "General policies not specific to the State code will be rejected." Name each policy by its statute heading, one policy per sheet, under your Secretary of State name, not abbreviated (IDOH letter).
• Nothing extra. The letter says "Do not submit additional information not required when writing your policies." Keep Medicaid waiver (FSSA) policies separate (Form 53391), and keep medical language out.
• Packaging. The letter dates from the paper process and says no binders, folders, sleeves, staples or paper clips (IDOH letter). It does not say how this applies to Gateway uploads.

What IDOH’s letter says the forms must hold

• Satisfaction review form: questions on the client’s satisfaction, the question "does the client require a change to his/her service plan?", and the reviewer’s signature and date (IDOH letter).
• Complaint investigation form: client name and date; signature and date of the person receiving the complaint; the narrative; the investigation, resolution and follow-up or corrective action (IDOH letter).
• Training policy, written test and skills test: the form asks the policy to say how the agency decides competency (its example is 80% on the written and skills tests; the letter’s is 85%), who trains, and how training is signed and dated by trainer and employee. The letter says training records go in the employee’s file. Copies of both tests go with the policy (Form 53391, item 7; IDOH letter).
• Service plan form: client name and date, start date, signatures of the client or representative and the manager or designee, detailed services such as bathing, dressing and transfers, the client’s right to suspend, end or add services, and no medical language (IDOH letter).
• Visit record: client name, dates of service, services provided, and the client’s and employee’s signatures (IDOH letter).
• Client rights statement: the rights listed in IC 16-27-4-12, signed and dated by the client and the manager (IDOH letter).

The letter also asks the unstable conditions policy to cover a medical emergency, and the compliance documentation policy to give the time frame, where and how records are stored (IDOH letter; IDOH letter).

The office. IDOH’s form asks for a physical location and an operational agency phone, and its 2022 letter says "The provider may utilize a home or residential address for the personal services agency." (IDOH letter). The statute does not say what kind of premises the office must be, though it expects an office in Indiana: records must be kept, or be electronically accessible, at the agency’s Indiana office for at least 7 years (IC 16-27-4-18). Zoning is a question for your city or county. Running an Indiana PSA from home covers the office, records, branches and moving in detail.

The manager, designees, the alternate and the 24-hour phone in detail →

IC 16-27-4 sets no training hours or curriculum. Instead, each worker who will give attendant care is evaluated for each task the agency has them do, and "The agency has the sole discretion to determine if an employee or agent is competent to perform an attendant care services task." (IC 16-27-4-16(a)).

• Train and re-evaluate. After an evaluation, train the worker on tasks that need improvement, and re-evaluate after any training (IC 16-27-4-16(b)).
• Before working alone. The evaluation and competency decision "must occur before the employee or agent performs that task for a client without direct agency supervision" (IC 16-27-4-16(b)).
• Lift services. Train each worker on general lift standards and, at the client’s home, on that client’s lift following the manufacturer’s instructions; lift use is evaluated like any attendant care task (IC 16-27-4-16(c)).
• Records for every worker. The content, date and signature of the person evaluating and training are documented for each worker who performs personal services, including lift services, not only attendant care staff (IC 16-27-4-16(d)).

• Service plan before services. "The personal services agency's manager or the manager's designee shall prepare a service plan for a client before providing personal services for the client." It is written, dated and signed by the person who prepared it, lists the types and schedule of services, and states the client’s right to suspend, end or add any service (IC 16-27-4-10).
• Client signature. "The service plan must be signed and dated by the client not later than fourteen (14) days after services begin for the client and not later than fourteen (14) days after any permanent change to the service plan." Every permanent change needs a written change to the plan (IC 16-27-4-10).
• Satisfaction review. The manager or a designee "shall conduct a client satisfaction review with the client every seventy-six (76) to one hundred four (104) days to discuss the services being provided and to determine if any change in the plan of services should occur", in person or by phone. Each review is written, signed and dated by the reviewer (IC 16-27-4-11).
• Visit records. The agency documents the services it provides (IC 16-27-4-18), and IDOH asks for a visit record form signed by the client and the employee.

Supervision. We read all of IC 16-27-4: it mentions supervision only in the competency rule above ("without direct agency supervision") and sets no supervisory visit schedule or supervisor qualifications. The satisfaction review is the only recurring client contact it schedules. How you supervise caregivers beyond that is your policy to set.

Give the client or their representative your "written statement of client rights not more than seven (7) days after providing services to the client" (IC 16-27-4-12). It must include 13 things:

1. Property treated with respect.
2. The right to temporarily suspend, permanently end, temporarily add or permanently add services.
3. The right to file grievances about services or lack of respect for property, without discrimination or reprisal.
4. Freedom from verbal, physical and psychological abuse, and treatment with dignity.
5. That managing unstable or unpredictable medical conditions is outside the license.
6. Your charges.
7. Your policy for telling clients about price increases.
8. Your office hours.
9. That a list of owners of 5% or more is available on request.
10. How to reach the manager or designee when the office is open or closed.
11. Your complaint procedure and phone number.
12. That IDOH does not inspect PSAs as part of licensing but does investigate complaints.
13. IDOH’s complaint procedure, phone number and business hours.

(IC 16-27-4-12(1)-(13).) IDOH’s 2022 letter asks for the statement to be signed and dated by the client and the manager.

IDOH’s complaint details for item 13. IDOH’s 2024 document gives a toll-free complaint line, 1-800-246-8909, during state business hours (8:15 am to 4:45 pm, Monday to Friday), with voicemail at 317-233-7241 outside them (IDOH-HCBC/PSA-1). IDOH’s complaint page now says its online form is the best way to complain, and that callers to 1 (800) 246-8909 leave a voicemail complaint (IDOH, Report a Complaint). Check that page before you print your statement.

Complaints to you. Investigate complaints from a client, their family or representative about services given or not given, or lack of respect for the client’s property. "The personal services agency shall document the complaint and the resolution of the complaint." (IC 16-27-4-13)

Records. Document evidence that you comply with IC 16-27-4 and the services you provide, and keep it, or electronic access to it, at your Indiana office for at least 7 years (IC 16-27-4-18). IDOH’s 2024 document says that during an investigation a PSA has 24 hours to produce the documents it requests (IDOH-HCBC/PSA-1); the statute’s own wording is "not less than twenty-four (24) hours" (IC 16-27-4-6(g)). IDOH’s complaint page, which describes its complaint program in general, says facilities do not receive advance warning of complaint investigations (IDOH, Report a Complaint).

The rules below are IC 16-27-2 as it reads today: amended by House Enrolled Act 1457 (P.L.171-2025) from July 1, 2025, which widened the offense lists, and by P.L.85-2026 from July 1, 2026, which only changed the cross-reference for "crime of violence" (HEA 1457 (2025); HEA 1258 (2026)). IDOH’s criminal history letter, last updated in August 2022, still shows the older list (IDOH criminal history letter; IC 16-27-2 (2024 edition)), so follow the statute. Caregiver background checks in detail →

• Owners and operators. No one may operate a PSA after a conviction for a sex crime, exploitation of an endangered adult, failure to report battery, neglect or exploitation of an endangered adult, murder or voluntary manslaughter; theft, conversion or receiving stolen property, identity deception or fraud (a felony within 10 years, a misdemeanor within 5); a crime of violence within 10 years; or felony battery or a felony drug offense within 5 years (IC 16-27-2-3(a)). Someone already operating before July 1, 2025 whose only bar is a recent misdemeanor theft or identity deception conviction may continue (IC 16-27-2-3(c)).
• Apply within 3 business days. Apply for each caregiver’s national or expanded criminal history check no more than 3 business days after they start providing services in a client’s home (IC 16-27-2-4).
• Result within 21 days. A caregiver may not keep working in clients’ homes for more than 21 calendar days without the agency receiving the result, unless the State Police, the FBI or the check vendor caused the delay (IC 16-27-2-5(c)).
• Who you cannot employ in clients’ homes. Anyone whose check shows the same offenses as for owners, or who has a finding on the state nurse aide registry for abuse, neglect, mistreatment or misappropriation (IC 16-27-2-5(a)). A caregiver employed before July 1, 2025 whose only bar is a recent misdemeanor theft or identity deception conviction may be kept on (IC 16-27-2-5(d)).
• Which checks count. A national check is a fingerprint check, for which the State Police tells you whether the person has a disqualifying conviction (IC 10-13-3-39(i)). An expanded check follows IC 20-26-2-1.5: either a consumer reporting agency search covering identity, all names, every county lived in, federal district courts, sex offender registries and a multistate database, or an FBI fingerprint check plus a sex offender registry check (IC 20-26-2-1.5).
• Report convictions. Since July 1, 2025, if you know of an employee’s conviction that would indicate unfitness, report it to the state nurse aide registry or the right licensing authority (IC 16-27-2-5.5).
• Fees. The agency is responsible for check fees but may require applicants to pay them or reimburse the agency (IC 16-27-2-6).

Breaking the 3-day or 21-day rules or the hiring bar is a Class A infraction; knowingly or intentionally operating while disqualified is a Class A misdemeanor (IC 16-27-2-7; -3(b)).

IC 16-27-4 has no reporting rule of its own, and IDOH’s incident reporting system is for comprehensive and residential care facilities (IDOH, Facility-Reported Incidents). Indiana’s general reporting laws apply to everyone at your agency.

Endangered adults

• "An individual who believes or has reason to believe that another individual is an endangered adult shall make a report under this chapter." (IC 12-10-3-9(a)). An endangered adult is 18 or over, cannot manage their property or self-care because of mental illness, intellectual disability, dementia or another incapacity, and is harmed or threatened with harm by neglect, battery or exploitation (IC 12-10-3-2).
• A staff member immediately tells the person in charge or their designated agent, who also becomes responsible for reporting. The staff member still reports unless they believe a report has already been made (IC 12-10-3-9(b)-(c)).
• Report to Adult Protective Services (hotline 800-992-6978, or online) or a law enforcement agency; call 911 if someone is in immediate danger (FSSA, Adult Protective Services). Knowingly failing to report is a Class B misdemeanor (IC 35-46-1-13).
• You may not discharge, demote or otherwise retaliate against an employee who reports in good faith (IC 12-10-3-11(c)).

Children

Anyone with reason to believe a child is abused or neglected must report. A staff member reports immediately to the Department of Child Services (hotline 1-800-800-5556, 24 hours a day) or the police, then tells the person in charge (IC 31-33-5; DCS hotline). An agency "may not establish any policy that restricts or delays the duty of an employee or individual to report under this chapter" (IC 31-33-5-5(b)), so, by our reading, a child abuse policy cannot make staff go through a manager first.

IDOH’s forms call the fee non-refundable (State Form 53591). The statute sets no other state fee. Other costs depend on your choices: liability insurance covering lift services if you offer them (IC 16-27-4-6(l)), and criminal history checks, which applicants may be asked to pay for (IC 16-27-2-6).

• Term. "A license expires one (1) year after the date of issuance of the license under subsection (e). However, the state department may issue an initial license for a period of less than one (1) year to stagger the expiration dates." (IC 16-27-4-6(h))
• Renewal. "The option for renewal becomes available at the 60-day mark for the current expiration of each agency." (IDOH program page). The renewal form warns that an agency whose renewal is not received and approved by the expiry date may face a civil penalty (State Form 53591). Changes such as a new name, new branch or ownership transfer are reported as they happen, not with the renewal (State Form 53591). IDOH’s 2022 letter and 2018 renewal form give different timings; we compare all three.
• Selling or closing. A PSA license may not be transferred or assigned; a new owner gets its own license before operating, and the licensee tells IDOH in writing at least 30 days before closing or selling (IC 16-27-4-6(h)-(i)).
• Enforcement. IDOH may issue a probationary license, resurvey, deny renewal, revoke the license or impose a civil penalty of up to $1,000 (IC 16-27-4-19).

Timeline. No statute, form or IDOH page we read gives a processing time, and IDOH reviews applications in the order received. We cannot give you a date. Our suggestion: have every document ready before you apply. Every cost and step, from Gateway access to renewal →