Part 1
At least one year in direct health care
Training and experience in direct health care service delivery, at least one year of it, with evidence you can show.
Virginia · Administrator and RN · 12VAC5-381-160, -170, -290, -360
Virginia home care administrator and RN requirements
A Virginia home care organization is run by a governing body, an administrator who manages it day to day, and, for personal care, a registered nurse who plans and supervises the care. Here is who can fill each role, what the regulation asks of them, and how the home attendants they lead qualify.
- Rule-verified October 1, 2026
- Quoted from 12VAC5-381-10, -160, -170, -200, -250, -290, -300 and -360
- And Va. Code § 32.1-162.12
Quick answer
Every Virginia home care organization (HCO) has a governing body that is legally responsible for it and appoints an administrator. The administrator needs at least one year of training and experience in direct health care service delivery, with at least one year within the last five years of supervisory or administrative management experience in home health care or a related health program. The administrator must be an employee, and the regulation does not require them to be a nurse.
An organization giving personal care also designates a registered nurse who writes each client’s plan of services and supervises the care at least every 90 days, face to face under the current rules. An RN or LPN must be available during all hours personal care is being given, and the home attendants who give it meet one of six qualifications and get 12 hours of in-service training a year.
The governing body
"The organization shall have a governing body that is legally responsible for the management, operation and fiscal affairs of the organization." 12VAC5-381-160 A It is "the individual, group or governmental agency" with legal responsibility and authority over the organization, 12VAC5-381-10 so in a small organization it can be the owner, or the members or board of the company that holds the license.
Its four duties
- 1Decide which services the organization provides.
- 2Make sure the organization is staffed and adequately equipped for the services it offers, whether given directly or through contract.
- 3Comply with federal and state laws, regulations and local ordinances that govern the organization.
- 4Establish a quality improvement committee.
Every year it also reviews and approves the organization’s written policies and procedures, and reviews and approves the quality improvement committee’s recommendations when appropriate. 12VAC5-381-160 C-D The committee’s results are reported to the governing body and the administrator every year, and the governing body acts on the report. 12VAC5-381-250 E
A hospital that runs a home care organization shows it as an identified unit of home care services in its internal structure. 12VAC5-381-160 A
Who can be the administrator
The qualification is one sentence. Here it is in full:
"The governing body shall appoint as administrator an individual who has evidence of at least one year of training and experience in direct health care service delivery with at least one year within the last five years of supervisory or administrative management experience in home health care or a related health program."
12VAC5-381-170 A
Part 2
One recent year managing or supervising
At least one year, within the last five years, of supervisory or administrative management experience in home health care or a related health program.
The rule does not define "related health program" or say whether the two years may overlap. If your experience is in a neighboring field, the OLC’s prelicensure consultation, which explains the regulation once a complete application is on file, is a good place to ask. 12VAC5-381-40 A
Two more points come from the definitions. The administrator is "designated in writing by the governing body", and "The administrator must be an employee of the organization." 12VAC5-381-10 An employee is someone with employee status as the U.S. Internal Revenue Service defines it. 12VAC5-381-10
The administrator must also be easy to reach: "The administrator or his designee shall be available at all times during operating hours and for emergency situations." 12VAC5-381-170 D Available here means "readily available on the premises or by telecommunications", so a phone counts. 12VAC5-381-10
The administrator’s eight duties
"The administrator shall be responsible for the day-to-day management of the organization, including but not limited to:" 12VAC5-381-170 B
- 1Organizing and supervising the administrative function of the organization
- 2Keeping an ongoing liaison with the governing body, the professional personnel and staff
- 3Employing qualified personnel and ensuring adequate staff orientation, training, education and evaluation
- 4Ensuring the accuracy of public information materials and activities
- 5Implementing an effective budgeting and accounting system
- 6Keeping the organization compliant with laws and regulations, and implementing corrective action in response to reports of organization committees and regulatory agencies
- 7Arranging and negotiating services provided through contractual agreement
- 8Implementing the policies and procedures approved by the governing body
"Including but not limited to" means the list is a floor. Elsewhere, the regulation gives the administrator a named part in a few routines:
- Inspections. At the end of an on-site inspection the inspector discusses the findings with the administrator or the administrator’s designee, 12VAC5-381-80 C and the administrator submits an acceptable plan of correction within 15 working days of receiving the report. 12VAC5-381-80 D What the OLC checks at an inspection →
- Criminal record reports. They are confidential and kept in locked files that only the administrator or a designee can open. 12VAC5-381-110 I-K Background checks, step by step →
- Quality improvement. The committee’s results are reported every year to the governing body and the administrator. 12VAC5-381-250 E
When the administrator is away
The regulation does not use the title "alternate administrator", but it expects one in substance: "The individual designated to perform the duties of the administrator when the administrator is absent from the organization shall be able to perform the duties of the administrator as identified in subsection B of this section." 12VAC5-381-170 C
So the person who covers needs to be able to do all eight duties above, not just answer the phone. Between the administrator and that designee, someone must be available at all times during operating hours and for emergencies. 12VAC5-381-170 C-D
Anyone who takes on the responsibilities of a staff position must meet the minimum qualifications for it, 12VAC5-381-200 E so check your stand-in against the job description you wrote for the administrator.
Does the administrator have to be a nurse?
No. 12VAC5-381-170 A asks for experience in direct health care delivery and in supervision or management. It does not ask for a nursing or any other professional license. 12VAC5-381-170 A
A nurse can still hold the role, and can hold it alongside a clinical one: "The administrator, the director of nursing, or other clinical director may be the same individual if that individual is dually qualified." 12VAC5-381-10 In a small organization, an RN who also meets the administrator qualifications may be able to hold both posts, as long as they meet the minimum qualifications for each position they take on. 12VAC5-381-200 E Both jobs still have to be done, and an RN or LPN must be available whenever personal care is being given, so plan cover for both before you combine them, and raise it at your prelicensure consultation if you are unsure.
What every personal care organization does need is a registered nurse in the supervising role, which is the next section.
The registered nurse who supervises personal care
"The organization shall designate a registered nurse responsible for the supervision of personal care services." 12VAC5-381-360 A A registered nurse means someone with a current license from the Virginia Board of Nursing or a current multistate licensure privilege to practice in Virginia as an RN. 12VAC5-381-10 Verify the license when you hire and keep the result in the personnel record. 12VAC5-381-200 C-D, O
1. The plan of services
"Such services shall be delivered based on a written plan of services developed by a registered nurse, in collaboration with the client and client's family." 12VAC5-381-360 C It covers at least six things:
- 1An assessment of the client’s needs
- 2The client’s functional limitations
- 3Activities permitted
- 4Special dietary needs
- 5The specific personal care services to be performed
- 6How often services are given
The plan stays in the client’s record, a copy goes to the client, and it is reviewed with the assigned home attendant before they start. 12VAC5-381-360 D
2. Supervision, never more than 90 days apart
"Supervision of services shall be provided as often as necessary as determined by the client's needs, the assessment of the registered nurse, and the organization's written policies not to exceed 90 days." 12VAC5-381-360 E Ninety days is the ceiling, not the target: a client whose needs change, or an RN assessment that calls for it, means more often. Your written policy sets the normal interval.
Under the current rules, supervision is in person: ""Supervision" means the ongoing process of monitoring the skills, competencies and performance of the individual supervised and providing regular, documented, face-to-face guidance and instruction." 12VAC5-381-10
3. An RN or LPN available whenever care is given
"A registered nurse or licensed practical nurse shall be available during all hours that personal care services are being provided." 12VAC5-381-360 F This can be the designated RN or a licensed practical nurse, meaning someone with a current Virginia Board of Nursing license or multistate privilege as an LPN. 12VAC5-381-10 If your aides work evenings, nights or weekends, your nurse cover has to as well. It sits alongside the organization’s 24-hour on-call duty to clients. 12VAC5-381-150 I
4. A seat on the quality improvement committee
The governing body sets up the committee, and the RN is on it. 12VAC5-381-250 C 1 The committee has four kinds of member: 12VAC5-381-250 C
The nurse
The director of skilled services or the organization’s registered nurse, as appropriate for the services provided.
Administration
A member of the administrative staff.
Each service
Representatives from each service the organization provides, including contracted services.
A client voice
Someone with a demonstrated ability to represent clients’ rights and concerns: a staff member, a client or a client’s family member.
One of the things the committee evaluates is supervision appropriate to the level of service, so the RN’s own supervision records feed straight into it. 12VAC5-381-250 B
Pending · not in force
Remote supervision of aides
The Code of Virginia already points toward video supervision: "Regulations governing the delivery of personal care services shall provide for supervision of home care attendants providing personal care services by a licensed nurse through use of interactive audio or video technology." Va. Code § 32.1-162.12
The regulation has not caught up. A standard regulatory action on remote supervision of personal care aides. The Board approved proposed amendments on March 23, 2023; they are under Executive Branch Review (at Secretary review in July 2026, per Town Hall), with the comment period still to be set. VDH, Current Regulatory Projects No proposed text has been published for comment. The text VDH proposed in 2023, which could still change, would let an RN or LPN supervise by audio or video between in-person visits at least every 60 days, with the client’s consent. What the remote supervision proposal would change →
For now: plan supervision as face to face, at least every 90 days. Leave your email below if you would like an alert when the amendment is published.
Home attendants
Home attendant is the regulation’s word for the aide: "Home attendants are also known as certified nurse aides or CNAs, home care aides, home health aides, or personal care aides." They are nonlicensed and work under the supervision of the appropriate health professional. 12VAC5-381-10
"Home attendants shall be able to speak, read and write English and shall meet one of the following qualifications:" 12VAC5-381-290
Route 1
Nursing education
Satisfactorily completed a nursing education program preparing for RN or LPN licensure.
Route 2
Approved nurse aide program
Satisfactorily completed a nurse aide education program approved by the Virginia Board of Nursing.
Route 3
Nurse aide certification
Certified as a nurse aide by the Virginia Board of Nursing.
Route 4
Nursing student
Enrolled in an RN or LPN program and has completed at least one nursing course with clinical experience in direct client care.
Route 5
Competency evaluation
Passed a competency evaluation program meeting 42 CFR 484.36(b). For personal care, only the tasks related to the personal care services to be given need to be evaluated.
Route 6
DMAS curriculum
Completed training using the Department of Medical Assistance Services “Personal Care Aide Training Curriculum,” 2003 edition. This route is for personal care home attendants only.
12VAC5-381-290 1-6 · 12VAC5-381-290 6
12 hours of in-service a year
"Home attendants providing personal care services shall receive at least 12 hours annually of inservice training and education." 12VAC5-381-360 G The rule adds: "Inservice training may be in conjunction with on-site supervision." So an RN supervisory visit that includes teaching can count toward the hours, as long as you record it. The organization records participation in staff development, 12VAC5-381-200 L and that record goes in the personnel file. 12VAC5-381-200 O
Every home attendant also needs a criminal record check and sworn disclosure statement. Virginia caregiver background checks →
Staffing plan and job descriptions
A staffing plan
Reflecting the services you offer, with qualified staff in sufficient numbers to meet the assessed needs of all clients.
12VAC5-381-200 BLicensed where required
Employees and contractors are licensed or certified as the Department of Health Professions requires, and you have a way to verify professional credentials.
12VAC5-381-200 C-DQualified for every role they cover
Anyone who takes on the responsibilities of one or more staff positions meets the minimum qualifications for each.
12VAC5-381-200 EA written job description per position
Job title, duties and responsibilities, the immediate supervisor’s job title, and the minimum knowledge, skills and abilities or professional qualifications for entry level.
12VAC5-381-200 GThe staffing plan is where the people on this page meet: the administrator and the person who covers, the RN, the nurse cover for every hour of care, and enough qualified home attendants for the clients you accept.
If you add skilled services
An organization giving skilled services such as nursing or therapy adds another role: "There shall be a director of skilled services, who shall be a physician licensed by the Virginia Board of Medicine or a registered nurse", responsible for the overall direction and management of skilled services, including their availability, quality and appropriate staffing. "The individual shall have the appropriate experience for the scope of services provided by the organization." 12VAC5-381-300 F
The director of skilled services then takes the nurse’s seat on the quality improvement committee, 12VAC5-381-250 C 1 and, if dually qualified, can be the same person as the administrator. 12VAC5-381-10 Skilled services fall under the same HCO license but bring a medical plan of care approved and signed by the client’s primary care physician. 12VAC5-381-300 B Virginia home health vs home care →
What to keep on file
Our practical suggestions, not rule text. Each card links the rule it helps you show you meet, which matters most when an OLC inspector asks.
The administrator’s written designation
The definition says the administrator is designated in writing by the governing body. A dated, signed appointment is the simplest record of that.
12VAC5-381-10Evidence of the administrator’s experience
The rule asks for an administrator who “has evidence” of the training and experience. Keep it: a résumé, references and dates showing direct health care delivery and the supervisory or management year within the last five.
12VAC5-381-170 AWho acts when the administrator is away
Name the person, and keep evidence that they can perform the eight duties. Make sure staff know how to reach the administrator or this person during operating hours.
12VAC5-381-170 C-DThe RN’s designation and license check
A written designation of the RN responsible for supervising personal care, and the result of verifying their current license, which belongs in the personnel record.
12VAC5-381-360 A; -200 D, OAn on-call rota for nurses
Who the RN or LPN is for every hour personal care is being given, including evenings and weekends if you serve clients then.
12VAC5-381-360 FJob descriptions for every position
Title, duties, the supervisor’s title and the entry qualifications, for the administrator, the RN, home attendants and office roles.
12VAC5-381-200 GWant every step for your organization, from appointing the administrator to the first inspection? Use the free Virginia license checklist →
CareRulebook
Every role, in policies written for you
CareRulebook’s Virginia manual includes Policy 1.1, governing body, administrator and license; Policy 1.2, organizational structure and lines of authority; Policy 3.1, personnel qualifications and job descriptions; Policy 5.5, supervision of personnel. Each policy quotes the rule it meets and uses the names and answers you give.
- 35 policies, 85 rule requirements mapped
- The administrator, the person who covers, the RN and home attendants
- Editable Word and PDF, delivered instantly
Preview your manual
$199CareRulebook founding price for the first 50 Virginia organizations, then $249. Not an OLC fee.
Myths about Virginia roles
Can a Virginia personal care agency run without a registered nurse?
No. You must designate an RN responsible for supervising personal care. An RN writes each client’s plan of services, supervision happens at least every 90 days, and an RN or LPN must be available whenever personal care is being provided.
"The organization shall designate a registered nurse responsible for the supervision of personal care services."
Can a nurse supervise Virginia personal care aides by video?
It depends. Not yet under the regulation. The statute says the rules must provide for supervision by interactive audio or video, but the amendment to do this is still under Executive Branch Review. The current regulation defines supervision as regular, documented, face-to-face guidance.
"Regulations governing the delivery of personal care services shall provide for supervision of home care attendants providing personal care services by a licensed nurse through use of interactive audio or video technology."
Must Virginia personal care aides be certified nurse aides?
No. Nurse aide certification is one of six routes. For personal care, completing the Department of Medical Assistance Services Personal Care Aide Training Curriculum also qualifies, as does a competency evaluation on the personal care tasks. Aides must also speak, read and write English.
"However, this training is permissible for home attendants of personal care services only."
Frequently asked questions
What are the administrator qualifications for a Virginia home care organization?
The governing body appoints an administrator with evidence of at least one year of training and experience in direct health care service delivery, with at least one year within the last five years of supervisory or administrative management experience in home health care or a related health program (12VAC5-381-170 A). The administrator must be an employee of the organization.
Does a Virginia home care administrator have to be a nurse?
12VAC5-381 does not require it. The qualification is experience in direct health care delivery plus supervisory or management experience, not a license. The definition allows the administrator, the director of nursing or another clinical director to be the same person if that person is qualified for both roles. A personal care organization still needs a designated registered nurse to supervise personal care.
Can the owner be the administrator?
The regulation does not bar an owner from the role. It does require the administrator to meet the qualifications in 12VAC5-381-170 A and to be an employee of the organization, which 12VAC5-381-10 defines by employee status under the U.S. Internal Revenue Service. If you are an owner planning to take the role, check how your position is set up against that definition.
Who runs the organization when the administrator is away?
The person the organization designates to perform the administrator’s duties during an absence. They must be able to perform all eight duties listed in 12VAC5-381-170 B. The administrator or the designee must be available at all times during operating hours and for emergencies, on the premises or by telecommunications.
Does a Virginia personal care agency need a registered nurse?
Yes. The organization designates a registered nurse responsible for supervising personal care services. The RN writes each client’s plan of services with the client and family, supervision happens as often as needed and never more than 90 days apart, and a registered nurse or licensed practical nurse must be available during all hours personal care is being provided.
Can the RN supervise aides by video in Virginia?
Not under the current regulation, which defines supervision as regular, documented, face-to-face guidance and instruction. The Code of Virginia says the personal care rules must provide for supervision by a licensed nurse using interactive audio or video, and the State Board of Health approved proposed amendments on March 23, 2023, but they are still under Executive Branch Review and not in force.
What training do Virginia home attendants need?
Before working, a home attendant must speak, read and write English and meet one of six qualifications, such as nurse aide certification, an approved nurse aide program or, for personal care only, the DMAS Personal Care Aide Training Curriculum. After that, home attendants providing personal care receive at least 12 hours of in-service training and education a year, which may be given alongside on-site supervision.
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Keep reading
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The remote supervision proposal and the rewrite of 12VAC5-381.
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Texas home care administrator requirements
How Texas does it: an alternate administrator and 24 hours of training.
North Carolina
North Carolina agency director and RN
Director qualifications, the RN for aides and 90-day visits.
Georgia
Georgia administrator and RN
The administrator, the RN on every application and supervisors.
Sources
- 12VAC5-381, Regulations for the Licensure of Home Care Organizations · Virginia State Board of Health (Virginia Administrative Code, law.lis.virginia.gov) · retrieved October 1, 2026
- Code of Virginia §§ 32.1-162.7 to 32.1-162.15, Home care organizations (incl. § 32.1-162.9:1, barrier crimes, criminal records checks and drug testing) · Virginia General Assembly (Code of Virginia, law.lis.virginia.gov) · retrieved October 1, 2026
- Current Regulatory Projects · Virginia Department of Health, Office of Licensure and Certification · retrieved October 1, 2026