‘No Two States Are Alike’: The Home Care Industry’s Road To Standardization

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For years, many industry advocates have pushed for more standardization across home care. Home care licensure is largely seen as one of the main avenues to industry standardization.

Though the majority of states in the country require home care businesses to have some form of licensure, the stipulations are different depending on the state.

“It is all over the board,” Caring Senior Service COO Jeff Bevis told Home Health Care News. “No two states are alike.”


For instance, some states stipulate that a nurse perform a client assessment or quality assurance, even when the company operates as an entirely non-medical agency. Some states – New York, for example – have an extensive licensure application process that can sometimes take up to three years to clear, according to Bevis.

A state’s political climate can also play a role when it comes to licensure requirements, according to Eric Reinarman, vice president of government relations at the Home Care Association of America (HCAOA).

“Generally speaking, if it’s a blue state, there’s going to be more requirements, as opposed to a red state, which may have fewer requirements,” he told HHCN.


Reinarman also noted that some states even call for home care businesses to have a specific type of training. For instance, Florida recently implemented licensure stipulations regarding Alzheimer’s training.

Bevis is a home care industry veteran with decades of experience under his belt. He noted that when he first got his start in the business in early 2003, only six states had licensure requirements.

Currently, 34 of 50 states have licensure requirements in place for home care businesses.

As for why more states have implemented licensure requirements for home care agencies, Bevis pointed to a few reasons why.

“You’ve got such an exploding senior population, states are paying more attention to protecting seniors,” he said. “They also see this as a revenue source, as far as application or licensure fees. States also see it as a growth area of business, creating jobs in their states.”

Despite the variations that can be seen across different states, there are some common stipulations that many state licenses have in place for home care businesses.

“You have basic information you have to submit, such as your articles of incorporation, your corporate documents, a franchise agreement if you’re part of a franchise system, typically your org chart, oftentimes resume or resumes of the ownership or key staff in that given office,” Bevis said. “You usually have to at least make some reference, in most states, to caregiver education or training.”

Ultimately, while some state licensure stipulations are improving the home care landscape and making care safer, others are restrictive and can lead to administrative burden for agencies.

“Something that’s been a good component is to require basic caregiver training, and that is present in many of the states,” Bevis said. “On the flip side, I’ll cite New Jersey. In terms of overreach, New Jersey has a process where every caregiver has to be registered with the state. You can only be credentialed to a state approved accreditation body. That ends up being a bottleneck, and takes away, I think, almost kind of the free market component to it.”

Bevis believes New Jersey’s licensure stipulation blurs the line between skilled and non-medical, and makes it more difficult for the latter to operate.

“It almost makes non-medical a branch of skilled in an unjustified way,” he said.

Additionally, some states have become notable for making it tougher for new home care businesses to become licensed.

“One example of ones that are really slow is the state of Delaware,” Bevis said. “I have a current franchisee who went over a year and still didn’t get their license. The state of Colorado right now is running six to seven months, and we’re still waiting for a license. Florida, historically, was one of the toughest ones. California, earlier this year, was taking five to six months.”

This is, sometimes, the result of inadequate staffing in the state departments that are in charge of the licensure process for home care.

Overall, many see home care state licensure, and regulation in this space, as important for the future of the industry.

“There’s a big gray market out there for home care, and we’re concerned about that,” Reinarman said. “There are agencies that, even in states where licenses are required, still engage in providing home care without a license. What does that mean? It means you don’t know who the caregivers are. You don’t know how trained they are. That’s not good for the industry as a whole.”

HCAOA has long been a proponent of home care standardization, including more uniform, licensure requirements across states.

“We’re in favor of regulation because it protects patients, and it protects home care providers as well,” Reinarman said.

Similarly, Bevis thinks that state licensure is a positive for home care.

“Licensure is really a good thing for the industry,” he said. “I think it raises the quality level, as much as we would complain about the process taking too long, it really is a good thing to give us uniformity and standards.”

Out of the 34 states that have implemented licensure requirements for home care, that leaves 16 states that haven’t.

“Those 16 states either haven’t discovered or don’t understand that there’s a need for a growing senior population in their respective states,” Bevis said. “There are providers out there now with an extremely low barrier to entry that could — not saying this is the case everywhere — lead to substandard care.”

Bevis also noted that some of these 16 states could have plans to implement licensure requirements in the future, pending their state’s legislative approval process.

States that have licensure requirements for home care agencies

  1. California
  2. Colorado
  3. Connecticut
  4. D.C.
  5. Delaware
  6. Florida
  7. Georgia
  8. Hawaii
  9. Illinois
  10. Indiana
  11. Kansas
  12. Kentucky
  13. Louisiana
  14. Maine
  15. Maryland
  16. Minnesota
  17. Nevada
  18. New Hampshire
  19. New Jersey
  20. New Mexico
  21. New York
  22. North Carolina
  23. Ohio
  24. Oklahoma
  25. Oregon
  26. Pennsylvania
  27. Rhode Island
  28. South Carolina
  29. Tennessee
  30. Texas
  31. Utah
  32. Virginia
  33. Washington
  34. Wisconsin *Only applies to Wisconsin providers working under Medicaid, not private-pay.

This list was made available through Polsinelli.

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