How to start a home care agency in Pennsylvania

Updated October 21, 2026 · CensusDesk research

Pennsylvania at a glance

Fees and forms change. Check the Department of Health’s “Home Care” page before you pay anything.

Step 1. Decide what kind of agency you are

Most new agencies in Pennsylvania start non-medical: help with bathing, dressing, meals, light housekeeping, errands, and companionship. Pennsylvania calls that home care, and it doesn’t include nursing or skilled care. If you plan to offer skilled nursing or therapy, you’re a home health care agency instead, licensed under a different chapter (28 Pa. Code Chapter 601) with more requirements. This guide covers the non-medical path.

Pennsylvania splits non-medical care two ways. A home care agency employs its caregivers. A home care registry refers independent contractors to families. Each one needs its own license, so decide which you are before you apply. Most owners start as an agency.

Decide one more thing early: private pay, Medicaid, or both. Private-pay families pay you directly. Billing Medicaid is a separate enrollment with the state after you’re licensed. Many owners start private pay because the money comes in faster and the paperwork is lighter.

Step 2. Form your business and pick your location

Most owners form an LLC, get a federal EIN from the IRS, and open a business bank account before they apply. You also need a physical office. The address of that location goes on your license, and each physical location needs its own license and its own fee. Talk to an insurance agent about liability and workers’ compensation coverage now, too. You will want it in place before your first caregiver starts.

Step 3. Get your caregiver rules in place

Pennsylvania doesn’t require an owner training course before you apply, but Chapter 611 sets rules for every direct care worker you send to a client. Build these into your hiring from day one:

• Competency. Before a worker’s first assignment, they must hold a Pennsylvania nursing license, pass a competency exam, or finish an approved training program. The exam or training covers set topics, like infection control, emergencies, and reporting abuse, plus personal care skills for workers who give personal care. Review each worker’s competency at least once a year.
• Background checks. Owners and staff need criminal history checks. Agencies that serve children also need child abuse clearances.
• TB screening. Workers are screened for tuberculosis before they meet a client, no more than a year before they start, and again at least every 12 months.

Step 4. Apply online

The Division of Home Health takes initial Home Care Agency and Home Care Registry applications through its online application. As of March 31, 2026, it no longer accepts mailed or emailed applications.

1. Complete the online application, every form, for each physical location.
2. Include all the supporting documents it asks for. An incomplete application comes back to you.
3. Pay the $100 fee. It isn’t refundable.
4. Wait for the Department’s review.

The Department doesn’t publish a processing time. Ask the Division of Home Health how long reviews are taking, and how to pay the fee under the online process. Complete is the fastest path.

Step 5. Get licensed, then open

The Department inspects licensed agencies on site, and inspections are unannounced. Ask the Division of Home Health when your first one happens. Have your policies, personnel files, and worker records ready. Once your license is issued, you can start serving clients. Send your renewal form at least 60 days before the expiration date on your license.

What it costs to get licensed

Getting your first clients

A license doesn’t bring families to you. Here’s what the research says about where clients come from, and what that means for a new Pennsylvania agency.

• Referrals lead. Current and past clients are the top referral source for private duty home care, followed by discharge planners, home health, hospice, and rehab. A new agency has no past clients yet, so the referral engine starts slow.
• Families search first. Most families looking for senior care start with a generic search like “home care near me,” and few search an agency by name. If your agency has no website, those families find someone else.
• Directories charge per lead. Lead directories and paid search often run $50 to $150 per lead, and the family may be shopping three agencies at once.
• Speed wins. On average about a third of home care inquiries become clients. A family coming home from the hospital may have only a day or two to decide.

What one client is worth in Pennsylvania

That’s why the first thing a new agency needs after its license is a front door that works when you can’t pick up the phone: a real website, a way for families to get answers at night, and every inquiry in your inbox the minute it happens.

Sources

• Pennsylvania Department of Health, “Home Care” (online application, March 31, 2026 cutoff for mail and email, Division of Home Health contact), pa.gov, read October 22, 2026
• Pennsylvania Department of Health, “Home Care Agency/Registry License FAQ” (fee payment, incomplete applications, separate license per location), found October 21, 2026
• 28 Pa. Code Chapter 611, Home Care Agencies and Home Care Registries (§ 611.2 license and fee, § 611.5 definitions, §§ 611.52 to 611.56 worker requirements), pacodeandbulletin.gov, read October 22, 2026 (the Department’s copy on pa.gov)
• Health Care Facilities Act, Act 69 of 2006, licensure of home care agencies (fee schedule, criminal history checks), found October 21, 2026
• CareScout Cost of Care Survey 2025, median hourly cost of non-medical in-home care by state
• HCAOA Private Duty Benchmarking, via Activated Insights (referral sources)
• Caring.com search behavior figures, via CoreCubed (generic search)
• Home Care Pulse, via Home Health Care News (inquiry conversion benchmarks)
• Sagapixel (directory and paid search cost per lead estimates)