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

Plan of operation: organizational structure

Describe how the agency is organized (an organizational chart or narrative of key positions).

Plan of operation: job descriptions

Include personnel job descriptions that meet WAC 246-335-425(2).

Plan of operation: contractor and volunteer responsibilities

State what contractors and volunteers are responsible for (or that the agency uses none).

Plan of operation: services

List the services the agency provides.

Plan of operation: days and hours

State the agency’s days and hours of operation.

Management across service areas: intake and plan of care

Describe how intake and the plan of care are completed in every approved county.

Management across service areas: supervision

Describe how staff and volunteers are supervised and contractors monitored in every approved county.

Management across service areas: evaluations

Describe how performance evaluations and contractor evaluations are done in every approved county.

Management across service areas: quality improvement

Describe how the quality improvement program applies in every approved county.

Informing clients of alternatives

Have a process to tell clients about alternative services before closing, or when the agency cannot meet their needs.

Preserving records on closure

Plan how records are preserved, or disposed of, before the agency ceases operation.

Time frames for filing client documents

Set how soon visit notes and other documents are filed in client records.

Emergency preparedness

Plan service delivery when disasters, man-made incidents or public health emergencies stop normal operation: risk assessment and planning, a communication plan, coordination with emergency personnel for clients’ urgent needs, and staff training.

Administrator qualifications

Name an administrator who is a home care employee, and set in policy the education and experience the role needs.

Administrator: day-to-day operation

The administrator oversees daily operation and fiscal affairs, implements the plan of operation, arranges necessary services and is the liaison between the licensee, staff, contractors and volunteers.

Administrator: written alternate

Designate in writing who acts when the administrator is absent.

Administrator: management across service areas

The administrator manages and supervises services throughout all approved counties.

Administrator: contracts current

Keep contractor contracts current and consistent with the contracting policy.

Administrator: current Washington credentials

Make sure staff, contractors and volunteers hold current Washington credentials where their work needs one.

Administrator: policy compliance, quality and records

Make sure everyone follows the agency’s policies, implement quality improvement and manage recordkeeping.

Supplies and equipment

Make sure supplies and equipment needed for client care are available, maintained and working.

Accurate public information

Make sure brochures, websites and adverts are accurate (and use "home care" only as licensed).

Policies accessible to staff

Keep current written policies accessible to staff, contractors and volunteers during operating hours.

Keep the plan of operation current

Update the plan of operation as practice, services and laws change.

Admission, transfer, discharge and referral

Write and follow procedures for admitting, transferring, discharging and referring clients.

48-hour discharge notice

Give at least 48 hours’ written or verbal notice before discharge and document it in the client record.

When 48 hours’ notice is not needed

No 48-hour notice is required where worker safety, significant client noncompliance or non-payment is the reason.

Self-report on a concerning dischargeif the agency discharges a client whose ongoing care and safety concern itRecommended practice

When discharging a client whose ongoing care and safety concern the agency, it may self-report to the appropriate state agencies with the reasons and the steps taken.

DSHS or AAA contract time framesif the agency has a DSHS or AAA contract

Agencies with a DSHS or AAA contract may follow the contract’s discharge notice and start-of-service time frames.

Nonmedical services available

Describe the specific nonmedical services available to meet client or family needs in the plan of care.

Start services within seven days

Start services within seven calendar days of accepting a referral; a longer time is allowed only when requested or agreed (for example to hire the right caregiver) or the agency could not reach the client, and the reason is documented.

Medication self-administration with assistance

Describe what staff, contractors and volunteers may and may not do when helping clients take their own medications.

Medication assistance scope

Medication help is limited to reminding, handing, opening, enablers (no hand-over-hand), placing in the hand, setting up diabetic devices and handing injectables; transferring between containers and altering medication only on a practitioner’s direction; no IV or injectable administration.

Medication assistance restrictions

Help only clients cognitively aware they are taking medication, immediately before they take it; otherwise it must be administered by someone legally authorized.

Coordination of care

Describe coordination with the agency’s own home health or hospice services (if licensed for them) and with other agencies when care affects the client’s health.

Communication needs

Describe how the agency meets client and family communication needs (language, hearing, vision, cognition).

Emergency care of the client

Describe what staff do in a client medical emergency.

Back-up care

Describe how substitute care is provided when scheduled care cannot be; ADL help only by credentialed or exempt workers, non-credentialed staff only for IADLs or emergencies.

Death of a client

Describe what staff do when a client dies or is found dead.

Advance directives

Describe what the agency does when a client has a signed advance directive.

POLST

Describe what staff do when a client has a signed POLST, including giving it to emergency personnel in a medical emergency; an incomplete section means full treatment.

Vital signs: informational helpif the agency offers help with taking vital signs

If offered, workers only assist clients to take their own vital signs, for information, with electronic digital devices, and pass readings to the client or representative.

Vital signs that guide medicationif the agency helps take vital signs that decide medication

If readings decide whether or how much medication to take, contract an RN to decide if nurse delegation is appropriate and to train workers.

Range of motion: therapist’s planif the agency offers passive range of motion

If offered, get a copy of the client’s passive range of motion plan from a PT, OT or qualified RN, dated within 12 months and stating maintenance only; otherwise direct the client to get a new plan. The client gives the agency an updated plan at least yearly.

Range of motion: skills checkif the agency offers passive range of motion

Verify and document assigned workers’ range of motion skills before they start.

Nurse delegationif the agency provides nurse delegation

If offered: only for stable and predictable clients, through a contracted RN delegator (or DSHS/AAA for Medicaid clients), with workers holding DSHS core delegation training. Agencies that do not offer it need no policy.

Nurse delegation trainingif the agency provides nurse delegation

Credentialed workers complete DSHS core delegation training before taking part in delegation.

Delegated tasks: consent and exclusionsif the agency provides nurse delegation

Delegated tasks are done only for that client, with consent, never injections other than insulin, sterile procedures, central lines or nursing judgment.

Non-discrimination in employment

Set employment criteria consistent with the Washington Law Against Discrimination (chapter 49.60 RCW).

Job descriptions

Write job descriptions with responsibilities that fit each credential’s scope of practice.

References

Check references for staff, contractors and volunteers.

Contractingif the agency uses contractors

If contractors are used: a contract describing their duties and stating the contractor withholds their own taxes; contractors meet the same rules as staff.

Credentials current

Verify health care professionals’ credentials are current and in good standing.

Background checks and disclosure statements

Run Washington State Patrol checks and get DOH-approved disclosure statements for everyone associated with the agency who has contact with children under 16, people with developmental disabilities or vulnerable persons; renew every two years.

WSP processing, DOH disclosure form, two-year renewal

Checks go through the Washington State Patrol, disclosure statements are on DOH’s approved form, and both are renewed within two years.

Initial checks through DSHS BCCU

DOH says home care agencies run initial hiring checks through DSHS BCCU (which satisfies -425(6)) and two-year rechecks through WSP.

Fingerprint checks for caregivers

Long-term care workers need a state and FBI fingerprint check at initial hire; a worker cleared on the name check may work up to 120 days while fingerprints are pending.

Fingerprint results within 120 days

If fingerprint results have not arrived within 120 days of hire the worker cannot keep working unsupervised.

Give workers a copy of results

Tell the applicant of the Washington State Patrol response within 10 days of receiving it and give them a copy (RCW 43.43.834(4), which covers the two-year WSP rechecks). DSHS’s instructions say the same for BCCU result notifications: keep a copy and give the applicant a copy within 10 days.

Conditional employment pending checksRecommended practice

Where the law requires a state or national check, a person may be engaged on a conditional basis pending completion.

Disqualifying history

People with unsupervised access may not have disqualifying convictions or findings, or be the respondent in an active vulnerable adult protection order; they disclose in writing under penalty of perjury.

Registry and findings bar

Do not employ in care with unsupervised access anyone on the vulnerable adult abuse registry or with a qualifying founded finding.

Character, competence and suitability

Make and document a determination for anyone whose check shows non-disqualifying convictions, pending charges or negative actions, weighing ability to meet care needs, client vulnerability, behavior since, patterns, time elapsed, self-disclosure and other safety concerns.

Reporting noncompliance to DOH

Staff report failures to comply with the rules or statute to DOH on DOH’s forms within 14 calendar days.

Reporting abuse, neglect and exploitation

Staff report suspected abandonment, abuse, financial exploitation or neglect immediately to DSHS and to law enforcement.

Sexual and physical assault reports

Suspected sexual assault goes immediately to law enforcement and DSHS; physical assault or acts causing fear of imminent harm go immediately to DSHS and law enforcement.

Suspicious death

If abuse, neglect or abandonment is suspected in a death, report to the medical examiner or coroner, DSHS and local law enforcement.

What a report contains

Reports give as much as possible of: reporter, the vulnerable adult and the agency, guardian, what happened, history, alleged perpetrator and other helpful information.

No policy may block reporting

Agency policies may not interfere with staff’s direct duty to report (for example, by requiring permission first).

No retaliationRecommended practice

Whistleblowers who report in good faith have remedies against reprisal, and retaliation against clients who complain is presumed within a year.

In-person orientation and skills verification

Give in-person orientation to current policies and verify skills or training (written test, observation, prior training) before anyone gives care independently.

Ongoing training

Provide ongoing training relevant to clients’ care needs.

Food safety

Safe food storage, preparation and handling following the FDA’s "food safety at home" guidance, and no homemade food for clients.

Standard precautions

Hand hygiene, respiratory hygiene and cough etiquette, and personal protective equipment.

PPE available

Make PPE and other equipment needed for each plan of care available.

TB risk assessment at hire

Assess every new employee with DOH’s TB risk assessment form and test as the form recommends.

Annual TB risk assessment

Reassess all employees for new TB risk factors every year on DOH’s form; retest only those who tested negative and have new risks.

TB training

Train workers on TB at hire or orientation using DOH’s TB program materials.

Use DOH’s Adult TB Risk Assessment

DOH says to use its Adult TB Risk Assessment form and test if any of the three boxes is checked.

Communicable disease

Say what to do when staff or clients show or report symptoms of a communicable disease in an infectious stage, following chapters 246-100 and 246-101 WAC.

Bloodborne pathogens risk assessment

Assess occupational exposure risk in staff’s working environments (per L&I chapter 296-823 WAC), let it shape policy and training, and check yearly whether a new assessment is needed.

Hepatitis B vaccine offer

If exposure is reasonably anticipated, offer the Hepatitis B series at the agency’s expense; workers may decline.

Annual infection control review

Document a yearly review of state and federal health authority guidance on infection control, testing and vaccination, and update training and policies.

Annual performance evaluations

Evaluate every staff member and volunteer who gives direct care each year, including on-site observation of care and skills.

Annual contractor evaluationsif the agency uses direct care contractors

Evaluate direct care contractors’ services each year.

Records: credential or exemption

Keep each worker’s current credential, or documentation that a non-credentialed long-term care worker meets a chapter 246-980 WAC exemption.

Records: references, orientation, contracts, skills

Keep reference checks, evidence of orientation, contracts and skills or training verification.

Records: background checks

Keep evidence of initial and later background checks and disclosure statements.

Records: policy training

Keep records of training on current and revised policies, including client care issues.

Records: food handlingif staff prepare food for clients independently

For staff who prepare food for clients independently: food worker card, equivalent FDA training, or home care aide certification.

Records: testing and vaccination

Keep communicable disease testing and vaccination records as current health authority guidance recommends.

Records: evaluations

Keep documentation of performance and contractor evaluations.

Entry-level training within 120 days

Non-exempt long-term care workers complete 75 hours of DSHS-approved training within 120 days of hire, 5 hours (orientation and safety) before giving any care.

Home care aide certification

Non-exempt direct care employees apply for certification within 14 days of hire and must stop giving care if training is not done in 120 days or certification in 365 days (425 provisional), the 2025 to 2027 timelines.

Documenting exemptions

Know which workers are exempt (nurses, CNAs, limited-hour, family-only, pre-2012 workers, CNA trainees) and document the basis.

Continuing education

Track 12 hours of continuing education a year for long-term care workers; home care aides need it to renew.

Verify training and certification before hiringRecommended practice

DSHS’s rule says the employer reviews and verifies a worker’s highest training or certification (and continuing education for the hiring year) before hiring. It cites a "home care agency" definition no longer in RCW 74.39A.009, so whether it binds private-pay agencies is unclear; treat as good practice.

Keep training certificatesRecommended practice

DSHS’s rule says a home care agency keeps a copy of each worker’s training certificate or transcript on file.

Rehiring workers who never finished trainingRecommended practice

Do not employ a former long-term care worker who never completed required training or certification unless their date of hire is reset under DSHS’s rule.

Caregiver standards of practiceRecommended practice

Long-term care workers may not borrow from or solicit clients, accept gifts above twice the hourly minimum wage, take client drugs or alcohol, work impaired, hold power over client finances or decisions, be the client’s landlord, or photograph clients without written permission. These bind each worker; the manual should say so.

No power of attorney for clients

No owner, contractor or employee may hold a durable power of attorney for a client.

Written bill of rights at admission

Give each client (or family member or legal representative) a written bill of rights at admission.

Rights: quality care and planning

Quality services under the plan of care, appropriately trained or credentialed staff, and ongoing participation in developing the plan of care.

Rights: choice of agency

Access to DOH’s list of licensed home care agencies and the right to choose any licensee, subject to payment arrangements.

Rights: services, refusal, supervisor

A list of all services offered and those provided, the right to refuse specific services, and the name and contact details of the person supervising the client’s care.

Rights: respect, safety, property, privacy

Courtesy, respect and privacy; freedom from abuse, neglect, exploitation and discrimination; respect for property; confidentiality of personal and health information.

Rights: charges and billing

What the agency charges, what insurance or public programs may pay, what the client pays, and an itemized bill on request (not required for managed care plans).

Rights: advance directives and POLST

Information about advance directives and POLST and the agency’s scope of responsibility.

Rights: discharge and back-up care policies

The agency’s policies on when it may discharge a client and on back-up care.

Rights: complaint process

How clients and family complain to the agency and have complaints addressed without retaliation.

Rights: DOH and End Harm hotlines

DOH’s complaint hotline number and DSHS’s End Harm hotline number.

Rights implemented and updated

Make sure the rights are carried out and the document kept up to date.

Written plan of care

Develop and follow a written plan of care for each client, with the client’s (or family’s or representative’s) input and written approval.

Plan from an on-site visit

Plans are developed by trained or credentialed staff, list requested or recommended services, and are based on an on-site visit, following agency policy.

Plan of care contents

Functional limitations; nutrition needs and food allergies; relevant equipment and supplies; whether there is a signed advance directive or POLST; nurse delegation tasks if any; the specific nonmedical services and how often.

Plan of care: equipment, directives, delegation, services

The plan also lists equipment, directive or POLST status, delegated tasks and the services with their frequency.

Review every 12 months

Review the plan on-site, update it and get it signed by staff and the client every 12 months and whenever care needs change significantly.

Reporting condition changes

Have a system so the supervisor learns of changes in a client’s condition that need a plan update.

One-time visitsif the agency provides one-time visits

For a one-time visit, record name, age, address and phone, confirmation the bill of rights was given, consent, and services provided, instead of a full plan.

DSHS CARE assessment as the planif the agency has an AAA contract for Medicaid clients

AAA-contracted agencies may use the DSHS CARE assessment details and service summary as the plan of care if it covers every required item.

Supervisor and alternate

Employ a supervisor of direct care services, who names a similarly qualified alternate in writing.

Supervisor: 10 hours training a year

The supervisor and alternate each complete and document at least ten hours of relevant training a year (in-services, classes, conferences, emergency duties).

Supervisor available during care hours

The supervisor or designee is available whenever clients are receiving care.

Supervisor duties

Supervise all care by staff and volunteers, evaluate contractors, coordinate and revise written client care policies, coordinate with other providers, and ensure care follows the plan.

Workers report changes

All direct care workers observe and report changes in a client’s condition and needs to the supervisor or designee.

Workers start emergency procedures

All direct care workers initiate emergency procedures under agency policy.

Workers read the plan first

Each worker reviews the plan of care and any written instructions before giving care and whenever the plan changes.

Medication help follows policy

Each worker assists with medications only as agency policy and the rules allow.

Six-monthly client contact

The supervisor contacts each client by phone or visit every six months to check the plan is followed and the client is satisfied, and documents it.

A current record for each client

Keep a current record for each client consistent with the health care information law (chapter 70.02 RCW).

How records are kept

Accessible at the office to staff and DOH, legible in permanent ink or electronic, on standard forms, legally acceptable, confidential, chronological, and fastened together if on paper.

Records kept current per policy

File documents within the time frames the agency’s policy sets.

Record contents

Name, age, address and phone; consent; payment source and client responsibility; plan of care; signed, dated visit notes for every contact; supervision records; anything else the chapter requires.

Client access to records

Records belong to the agency, but clients may access their own.

Information on transfer

On request and under agency policy, give client information or a care summary when a client transfers or is discharged to another provider.

Retention periods

Adults: three years after services end; minors: three years after age 18 or five years after discharge, whichever is longer; deceased clients: three years.

Security, release and closure

Store records securely against loss and unauthorized use, release them only under chapter 70.02 RCW, and after closing keep or dispose of them confidentially for the retention period.

Quality improvement program

Run a quality improvement program across all approved counties.

Complaint procedure

A procedure for receiving, investigating and resolving complaints about services.

Finding and fixing problems

A method to identify, monitor, evaluate and correct problems raised by clients, families, staff, contractors or volunteers.

Client satisfaction

A system to assess client satisfaction with the agency’s overall services.

Policies demonstrate compliance

Policies cover the chapter for the home care category and clearly show compliance; no Medicare references.

Policies in the agency’s own words

DOH says policies may not be the WAC or RCW copied word for word.

Review templates before submission

Applicants who used AI or templates review the documents thoroughly for legal accuracy, WAC applicability and fit with their actual workflows before submitting.

In-state office and license display

Keep at least one Washington office holding the records, and display the license there.

Cooperate with surveys

Cooperate with DOH surveys, including record review and home visits with client consent.

Notify DOH within 30 days

Tell DOH in writing within 30 days of a new administrator or supervisor, opening or closing an office, ceasing home care, or reducing service areas.

Approval before serving new counties

File an amended application and get approval before serving a new county.

Renewal package

At least 30 days before expiry: renewal application, insurance evidence, FTE worksheet, current checks and disclosure statements for the administrator and supervisor (renewed within two years), organizational structure and fee.

Insurance kept in force

Keep commercial general liability cover of $1 million per occurrence or $2 million combined, with evidence at renewal.

Change of ownership noticeif ownership changes

At least 30 days before the change, the current licensee files DOH’s change of ownership form, and the prospective new owner files a change of ownership application with DOH’s change of ownership fee ($500 per licensed service category, a state fee set in WAC 246-335-990).

Plan of correctionif DOH issues a statement of deficiencies

Submit a signed plan of correction within ten working days of a statement of deficiencies and finish corrections within 60 days.

Keep approved exemptionsif DOH has granted an exemption

Keep a copy of any DOH-approved exemption available at all times.

Use of "home care" in names and adverts

Use "home care" or "in-home services" in the name or advertising only for licensed services; do not advertise home health or hospice without those categories.