How to start a home care agency in Pennsylvania (the DOH license, 2026)

Chapter 611 defines the two kinds of license holder:

• A home care agency is "An organization that supplies, arranges or schedules employees to provide home care services, as directed by the consumer or the consumer’s representative, in the consumer’s place of residence or other independent living environment for which the organization receives a fee, consideration or compensation of any kind" (611.5).
• A home care registry "supplies, arranges or refers independent contractors to provide home care services" in the consumer’s home, for a fee (611.5).
• Both. The license says whether you are licensed as an agency, a registry or both (611.2(b)).

The services

• Personal care: "The term includes, but is not limited to, assistance with self-administered medications, feeding, oral, skin and mouth care, shaving, assistance with ambulation, bathing, hair care and grooming, dressing, toileting and transfer activities" (611.5).
• Companionship services are "Socialization, support and assistance with instrumental activities of daily living" (611.5). Instrumental activities of daily living include "meal preparation, shopping and errands, telephone use, light housework, laundry and transportation" (HCFA 802.1).
• Respite care and specialized care. Specialized care means "Nonskilled services unique to the consumer’s care needs that facilitate the consumer’s health, safety and welfare, and ability to live independently" (611.5).

DOH sums it up: "Home care agencies (HCAs) and home care registries (HCRs) provide non-skilled services to individuals in their homes or other independent living environments." (DOH home care page)

Who Chapter 611 does not cover

• Home health care agencies, durable medical equipment providers, volunteer providers, and fiscal agents designated under section 3504 of the Internal Revenue Code that provide financial management or supports coordination services in Medicaid waiver or other publicly funded programs (611.3(a)).
• Private arrangements. The Act does not apply to "A private contract or arrangement entered into by a consumer and caregiver, provided that the caregiver was not supplied, arranged, scheduled or referred to the consumer by a home care agency or a home care registry" (HCFA 903.1(1)).

One license per location

"Each physical location of the home care agency or home care registry must be separately licensed." Each needs its own application and fee (611.2(a), (e)). DOH’s FAQ puts it plainly: "Branch offices do not exist in home care." (DOH FAQ)

Operating without a license

DOH may go to court for an injunction to stop an unlicensed health care facility (HCFA 816(a)), and a person who violates the chapter or its rules may be assessed a civil penalty of up to $500 for each deficiency for each day it continues (HCFA 817(b)). That is a penalty, not a fee.

What the application asks for

DOH says its updated application "now includes references to the relevant regulations for each section", and that the online process is meant to speed up initial applications, renewals and change of ownership applications (DOH home care page). The online form needs a login, so we could not see it. The paper form it replaced, revised in January 2024, had four parts (DOH application, 2024):

• Identifying information, including the days and hours someone is physically present in the office: "An on-site inspection by surveyors will occur during the business hours submitted." (2024 form).
• A Civil Rights Survey, with "A copy of your agency’s non-discrimination policy" (2024 checklist).
• Ten questions for health care providers: business structure, everyone with 5% or greater direct or indirect ownership or control, formation documents, managers, previous facilities and any adverse actions or fraud matters (2024 form).
• The Licensure Survey, with the owner’s criminal background check and your policies as labelled exhibits A to L (2024 form). DOH’s current direct care worker status form still says it goes in Exhibit L of the initial application (DOH form).

DOH’s FAQ also says not to send what the application does not ask for, "such as an entire policy and procedure manual, a business plan"; it will be discarded (DOH FAQ).

After you are licensed

• Ownership and management. Tell DOH in writing at least 30 days before a change in ownership or a transfer of 5% or more, and within 30 days after a change of management (51.4). DOH’s FAQ says an ownership change of 5% or more cannot happen until DOH approves it (DOH FAQ), and a license cannot be transferred without DOH’s prior written approval (HCFA 809(a)(3)).
• A new administrator. DOH’s FAQ asks for a letter, a signed Password Agreement, the new administrator’s resume and criminal background check results from no more than a year before (DOH FAQ).
• Other changes. "All agency updates must be reported to the Division by emailing a letter attachment to ra-dhhliceonlychange@pa.gov" (DOH home care page) Serving counties that do not adjoin your own needs a plan for staffing, staff supervision and training there, according to DOH’s FAQ (DOH FAQ).

• No refunds. "There will be no rebate, refund, or prorating of the application fee." (611.2(e)) The Act sets the same $100 for a home care agency or registry license or renewal (HCFA 807(b)).
• Every year. A license lasts one year (HCFA 809(a)(1)), and DOH’s summary says it collects "an annual licensing fee" (DOH regulations page). A second location means a second license and a second fee (611.2(e)).
• Background checks. The Department of Aging says the FBI background check fee is $26.20 from June 15, 2024; that is a federal check fee, not DOH’s (Department of Aging). Our sources do not give the State Police’s current fee.
• Insurance and bonds. We found no insurance or bond requirement in Chapter 611 or Chapter 51 (our reading). DOH’s consumer notice asks you to tell clients whether you maintain general and professional liability insurance covering the worker (DOH consumer notice).
• Penalties are not fees. Violations can bring a civil penalty of up to $500 for each deficiency for each day it continues (HCFA 817(b)).

"The Department will conduct an inspection prior to issuing an initial license or a license renewal." (611.2(a)) Chapter 611 defines an inspection as "A scheduled or unscheduled examination or assessment of a home care agency or home care registry during regular business hours, to determine compliance with requirements for licensure using one or more of the following means: inspection of records, interviews with office staff, consumers and direct care workers, and observation of the provision of services to consumers who have consented in advance to observation" (611.5).

• Checks on file first. Before licensing, DOH must determine that the workers, office staff and owners have criminal history records on file (HCFA 806(d.1)(4)).
• Consent to entry. Applying for or holding a license is consent for DOH to enter for inspection during regular business hours (HCFA 806.4(a)).
• What DOH looks at. DOH’s summary says it checks compliance through on-site surveys, interviews with office staff, workers and consumers, and "review of all relevant files, documents, policies and procedures" (DOH regulations page).
• Unannounced visits later. DOH’s FAQ refers to its "unannounced, on-site inspections" after licensing (DOH FAQ), and DOH inspects before each renewal (611.2(a)).
• Plans of correction. If violations are found, you get a report and send "a written plan of correction" with actions and a time frame (HCFA 806.4(b)), within 30 days of the notice or sooner if DOH directs (HCFA 814(a)). DOH’s Password Agreement makes the signer (administrator, director or CEO) responsible for plans of correction to deficiencies cited on CMS Form 2567 (Password Agreement).
• Provisional licenses. With numerous deficiencies or a serious one, DOH may issue a provisional license for up to six months, renewable three times, while the agency corrects them on an agreed timetable and there is no cyclical pattern of deficiencies over two or more years (HCFA 812).

Before a worker’s first assignment or referral, the agency or registry makes sure they have one of these (611.55(a)):

• a valid Pennsylvania nurse’s license;
• a passed competency exam developed by the agency or registry; or
• a completed training program: one developed by an agency, registry or other entity, a home health aide program meeting 42 CFR 484.36, the Department of Education’s nurse aide program, a program meeting a Medicaid waiver or other public program’s training standards, or another program DOH names.

• No set hours. The rule sets subjects and routes, not hours: an agency’s exam or program "must address, at a minimum, the following subject areas" (611.55(b)). Our reading is that we found no minimum number of training hours.
• Proof travels. Proof of competency goes in the worker’s file and transfers to another agency or registry if the break in work is no more than 12 months (611.55(d)).
• Ongoing supervision. "Ongoing supervision of an employee by a home care agency or ongoing documentation of the referral of an independent contractor by a home care registry shall be maintained to ensure that the employee has the skills necessary to provide the care required by the consumer." (HCFA 806(d.1)(6))
• TB screening. Workers, and office staff or contractors with direct consumer contact, show before contact that they have been screened for and are free from active tuberculosis, following CDC guidelines, with a screening no more than a year before they start (611.56(a)). They update it at least every 12 months from the last evaluation (611.56(b)). The Act itself asks for documentation from a physician or other appropriate health care professional that the person is free from communicable disease, including at a minimum a TB screening (HCFA 806(d.1)(5)); Chapter 611 spells out the TB part.
• No nurse required. We found no rule in Chapter 611 requiring a nurse on staff. A nurse’s license is one competency route, not a staffing rule (611.55(a); our reading).

Before hiring or rostering a worker, the agency or registry holds a face-to-face interview, gets "at least two satisfactory references", and requires the criminal history report and any ChildLine verification (611.51(a)). A satisfactory reference is "a positive, verifiable reference, either verbal or written, from a former employer or other person not related to the individual" (611.51(a)(2)). Since Act 96 of 2024, approved and effective on October 16, 2024, "The face-to-face requirement of this paragraph may be fulfilled through the use of two-way video remote technology." (Act 96 of 2024)

The criminal history report

• Who. Each applicant for work or referral as a direct care worker, applicants for office staff, and the owners, with a report from the time of application or the year before (611.52(a)).
• Which check. Someone who has lived in Pennsylvania for the 2 years before gets a State Police criminal history record (611.52(b)); DOH says it must be requested "for "employment" purposes" (DOH regulations page). Anyone else gets an FBI record and a Department of Aging letter of determination (611.52(c)).
• The rule’s prohibition. The rule says not to hire, roster or retain someone whose State Police record shows a prohibited conviction listed in 6 Pa. Code 15.143, or whom the Department of Aging finds not eligible (611.52(e)). That list includes felony drug convictions, homicide, aggravated assault, kidnapping, sexual offenses, arson, burglary, robbery, and felony theft or two or more theft misdemeanors (6 Pa. Code 15.143).
• After Peake. The Department of Aging says the Commonwealth Court held on December 30, 2015 that the lifetime employment ban in the Older Adults Protective Services Act "violates due process guarantees under the Pennsylvania Constitution and is therefore not enforceable". It adds: "Please note that criminal history background checks are still required for all applicants." (Department of Aging) It recommends an individualized risk assessment, case by case, and talking to an attorney before deciding. It says the Court’s guidance looks at factors such as the nature of the crime, its facts, the time since conviction, evidence of rehabilitation and the job, and that the Commonwealth decided not to appeal (Department of Aging). DOH’s rule still prints the prohibition, so see our readings.
• Records. Keep the State Police records or Aging letters for workers and office staff, and the owners’ reports, for DOH to inspect. Keep them confidential, use them only to decide eligibility, and tell anyone you turn down because of them how to appeal to the record source (611.52(f)-(h)).
• Transfers. A worker who moves to another agency or registry of the same owner, or whose employer changes ownership, needs no new report (611.52(i)). We found no periodic re-check in Chapter 611 (611.52(a); our reading).

ChildLine

If you serve anyone under 18, worker and office staff applicants request a ChildLine verification, and you may not employ, roster or retain anyone ChildLine verifies as the perpetrator of a founded or indicated report of child abuse (611.53).

Provisional hiring

• The conditions. A worker may start provisionally while the check is pending if they have applied and given you copies of the completed request forms, you know nothing about them that would disqualify them under 18 Pa.C.S. 4911 (tampering with public records), they swear or affirm in writing that they are not disqualified, and they have met the competency rule. The period is up to 30 days for someone who has lived in Pennsylvania for 2 years or more, and up to 90 days otherwise (611.54(a)).
• Monitoring. Monitor provisional hires "through random, direct observation and consumer feedback", documented in their file; for clients under 18, directly supervise them or send another worker with them while the child abuse clearance is pending (611.54(a)(5)-(6)).
• If the check fails or never arrives, terminate or remove the worker immediately (611.54(b)).

The Older Adults Protective Services Act has a chapter on reporting by employees of a “facility”. Its definition of a home health care agency includes any agency that "provides care to a care-dependent individual in the individual's place of residence", and “care” includes homemaker, companion-care and home-care aide services (OAPSA section 103). Our reading is that this reaches home care agencies.

• Report to the local agency. "An employee or an administrator who has reasonable cause to suspect that a recipient is a victim of abuse shall immediately make an oral report to the agency." A written report follows within 48 hours, and an employee tells the administrator straight after reporting (OAPSA 701(a)). The “agency” is the local area agency on aging or the protective services provider it designates (OAPSA 103), and a recipient is anyone who receives care from the facility (OAPSA 103).
• Serious cases. For suspected sexual abuse, serious physical or bodily injury, or a suspicious death, also report orally to law enforcement immediately, and in writing within 48 hours (OAPSA 701(b)). The Act also has you contact the Department of Aging, and its rule sets the timing: an oral report during the current business day, or at the opening of the next if it happens after hours (6 Pa. Code 15.152).
• When a worker is accused. The facility immediately puts in place a plan of supervision or, where appropriate, suspension, subject to approval (OAPSA 704(a)).
• Failing to report. A person required to report who willfully fails to do so commits a summary offense the first time and a third degree misdemeanor after that (OAPSA 706(c)).
• The helpline. "The Elder Abuse Helpline is staffed 24 hours a day, seven days a week. Call 1-800-490-8505 to report suspected abuse or neglect." Reports can be anonymous (Department of Aging).
• Telling DOH. Chapter 51 has a licensed facility tell DOH in writing immediately about an event that could seriously compromise patient safety, which includes "Complaints of patient abuse, whether or not confirmed by the facility." (51.3(f)-(g); see our readings).
• Adults 18 to 59. The Adult Protective Services Act has its own employee reporting duty for adults 18 to 59 with a disability. Its facility list, which "includes, but is not limited to" the types it names, names home health care agencies and publicly funded care organizations, not home care agencies by name, and its “employee” covers anyone paid to provide care in the adult’s home (APS Act 103, 501). If you serve these adults, ask DOH or the Department of Human Services which law applies to you.

• Service planning. Consumers have the right "to be involved in the service planning process and to receive services with reasonable accommodation of individual needs and preferences, except where the health and safety of the direct care worker is at risk" (611.57(a)(1)).
• Ending services. At least 10 calendar days’ written notice before you end services. Less notice is allowed if the consumer has not paid despite notice and is more than 14 days in arrears, or if the worker’s health and welfare is at risk (611.57(a)(2)).
• Money and authority. Nobody affiliated with the agency or registry may become a consumer’s power of attorney or guardian, and you may not require a consumer to endorse checks over to you (611.57(b)).
• The information packet. Before services start, give the consumer or their representative an easy-to-read packet with the services and the worker who will provide them, the hours, fees and total costs, who to contact at DOH, DOH’s complaint hotline (1-866-826-3644) and the local ombudsman’s number, the hiring and competency requirements for workers, and the employee or contractor disclosure (611.57(c); 611.57(c)(5)). The statute’s list also includes documentation of each worker’s interview and at least two satisfactory reference checks (HCFA 806.3(b)(7)).
• DOH’s consumer notice. "This form is to be completed by every consumer utilizing the services of a Home Care Agency or Home Care Registry" (DOH form). It covers whether the worker is your employee, who handles taxes and workers’ compensation, and whether liability insurance covers the worker.
• Proof on file. Keep documentation that you meet these protections, available for DOH inspection (611.57(d)).

We read Chapter 611, Chapter 51, Chapter 53, Chapter 8 of the Health Care Facilities Act and DOH’s forms for written duties that apply to a home care agency or registry. Here is what we found.

Written policies the rules name

• A nondiscriminatory policy. Chapter 51 applies to home care (611.4(b)), and "A health care facility shall have a nondiscriminatory policy which applies to all patients or residents and staff." (51.12(a)) You sign a civil rights compliance statement before your initial license (51.12(b)), keep a dated admission policy, a signed notice to employees and evidence of publicizing the policy at least every 3 years, and post it where staff and the public can see it (51.13(a)-(b)). Send DOH a signed and dated copy within 30 days of any change (51.13(c)).
• Photo ID exceptions. Chapter 53 has employees who give direct care in clients’ homes wear a photo ID badge, and asks for policies and procedures for two exceptions: a religious objection to a photograph, and leaving off the last name with a client who shows signs of irrationality or violence (53.2-53.3; 53.5). Chapter 53 is printed as interim regulations, so its status is unclear (see our readings).

Policies DOH asked for with the application

DOH’s January 2024 Licensure Survey asked you to describe or attach your policy or process, as labelled exhibits: hiring (A), background checks (B), ChildLine clearances (C), provisional hiring (D), your training program or competency exam and competency review (E), how you verify outside training (F), TB screening (G), service planning (H), ending services (I), power of attorney (J) and check endorsement (K), and to attach your consumer information packet (L). Its checklist says: "Required policies included (Be sure to label the exhibits accordingly)." (2024 form; checklist) Each exhibit points to a section of Chapter 611. We could not see whether the 2026 online form asks the same questions.

Records the rules require

• Worker files with the interview date and references, background check records, ChildLine verifications where needed, provisional hiring monitoring, competency proof and TB screening (611.51(b)).
• A yearly competency review for each worker, documented in the file (611.55(e)).
• Consumer protection records, including the information packet (611.57(d)).
• A current copy of Chapter 611 at the agency or registry (611.4(a)).

Left to you (our reading)

Chapter 611 sets minimum standards for hiring, checks, competency, TB screening and consumer protections (611.1(c)). We found no section in it that requires a general set of written policies and procedures, and no rule on care plans, client records, infection control plans, emergency plans or a schedule for reviewing policies. That does not mean those things do not matter: clients, families, payers and DOH’s surveyors may ask how you handle them, and DOH’s summary says its surveys review "policies and procedures" (DOH regulations page). It means Pennsylvania’s home care rules leave the method to you.

• The application form. DOH moved to an online application, and mailed or emailed submissions are not accepted from March 31, 2026 (DOH home care page). The online form needs a login, so the exhibits and checklist on this page come from the paper form revised January 25, 2024, saved by the Internet Archive on July 9, 2024 (2024 form). DOH’s current consumer notice still refers to Exhibit L, which suggests the exhibits continue (DOH form). Our reading: follow the online form where it differs.
• The lifetime ban. Chapter 611 still prints the prohibition on hiring anyone with a conviction on the 15.143 list (611.52(e)), and DOH’s 2024 application asked for your policy for "prohibiting individuals with a prohibited conviction" from being hired (2024 application). The Department of Aging says the OAPSA lifetime employment ban is not enforceable after Peake (Department of Aging). We found nothing from DOH on how it applies 611.52(e) since Peake. Our reading: keep running every check, ask DOH how it surveys these decisions, document how you decided, and take legal advice.
• Video interviews. Act 96 of 2024 lets two-way video satisfy the face-to-face interview and abrogates 611.51(a)(1) to the extent of any inconsistency (Act 96 of 2024). DOH’s undated exception form still offers an exception for virtual interviews (DOH form). Our reading: the form predates the Act; confirm with DOH whether you still need an exception.
• Two lists of training routes. The Act lists a nurse’s license, DOH-approved nurse aide or home health aide programs, a DOH-approved personal care worker credentialing program, or "a competency examination for persons performing only activities of daily living services" (HCFA 806(d.1)(1)). The regulation lists its own routes, including an agency’s exam or training program meeting 611.55(b) and (c) (611.55(a)). Our reading: DOH’s summary is close to the regulation’s list (it does not mention an agency’s own training program), so we follow the regulation (DOH regulations page).
• Which abuse law applies. OAPSA’s definitions are broad enough, on our reading, to reach home care agencies (OAPSA 103), and its Department of Aging rule adds an orientation on policies, procedures and laws on proper care and abuse reporting for provisional hires (6 Pa. Code 15.146(a)(4)). For adults 18 to 59 with a disability, the Adult Protective Services Act’s list of facilities does not name home care agencies (APS Act 103). Ask DOH or the Department of Human Services.
• Chapter 51 in a client’s home. Chapter 51’s duty to tell DOH about serious events is written for events "at the facility" (51.3(f)). Our reading is that for home care it covers events during your services, including complaints of abuse; confirm with DOH.
• Chapter 53 is interim. The Code prints Chapter 53 as interim regulations adopted in 2011 that "expire 18 months following the effective date" unless otherwise noted (Chapter 53 source note). The statute behind it still applies to employees who give direct care outside a facility, with no badge needed during care if not clinically feasible (HCFA 809.2). Our reading: issue photo badges and ask DOH whether Chapter 53 is still enforced.
• Posting the license. DOH’s FAQ says "It is a requirement, per regulation, that the license be posted in the agency." (DOH FAQ) We did not find that rule in Chapter 611 or Chapter 51 (our reading). Post it anyway.
• The rule is current. The Pennsylvania Code site reflects changes through August 8, 2026, and the last change it shows to Chapter 611 is Act 96’s partial abrogation of 611.51(a)(1) (Chapter 611). We found no proposed change to the chapter as of 8 October 2026; that is the result of our searches, not a statement that none exists.

DOH’s Division of Home Health publishes a monthly license list. On its October 2026 list, by our count:

• Home care agencies: 3,455 licenses (our count).
• Agency and registry: 1,177 licenses for both (our count).
• Home care registries: 49 licenses (our count).

That is 4,681 home care licenses in all, every one shown as a regular license; 41 show an expiration date before 1 October 2026, and 1,298 are in Philadelphia County (our counts). Each physical location has its own license, so this counts locations, not companies.

Medicaid, for context only

Community HealthChoices is Pennsylvania’s Medicaid program, run through managed care organizations, that people 21 or older may be eligible for if they have both Medicare and Medicaid or get long-term supports through Medicaid, with some exceptions (DHS). DHS says each of its five zones is covered by all three CHC managed care organizations (DHS). DOH’s FAQ says a licensed agency may then apply to the Office of Long-Term Living for a waiver, and that Medicaid enrollment does not guarantee a place in each managed care network (DOH FAQ). These are program rules, not part of the home care license, and this guide does not cover Medicaid enrollment.