The difference between non-medical home care and home health, state licensing, hiring and screening caregivers, wage and hour rules for home care workers, visit verification, scheduling and the records that keep an agency compliant.
| Non-medical home care | Home health | |
|---|---|---|
| Services | Help with bathing, dressing, meals, housekeeping, companionship, reminders and errands | Skilled nursing, therapy and other medical services ordered by a clinician |
| Staff | Caregivers, personal care aides, home health aides (depending on state) | Registered nurses, therapists, home health aides under clinical supervision |
| Licensing | Many states license home care agencies; requirements vary | State licensing plus, to bill Medicare, Medicare certification |
| Payment | Mostly private pay, long-term care insurance and some Medicaid programs | Medicare, Medicaid and private insurance |
| Complexity to start | Lower | Much higher |
Most new owners start with non-medical home care. This guide focuses on that model, with notes where home health differs.
Many states require a license to operate a home care agency, and requirements vary widely: some require detailed applications, policies, background checks, minimum training for caregivers, a qualified administrator and inspections; others have lighter requirements. If you plan to accept Medicaid, you will also need to enroll as a provider and meet the program’s rules. Home health agencies that want to bill Medicare must meet federal conditions of participation and pass a survey by the state or an approved accrediting organization. Contact your state health department early; licensing can take months.
Your caregivers are your service. Clients and families trust them in their homes, often with vulnerable people. Build a careful hiring process: structured interviews, reference checks, background checks as required by your state (and as permitted under fair chance hiring laws), verification of any certifications and a drug screening policy if you use one. Train caregivers on your policies, client rights, safe transfers and lifting, infection control, recognizing changes in a client’s condition and how to report concerns. Many states set minimum training hours for home care aides. See employee training programs.
Home care agencies must be careful here. Since federal rule changes in 2015, third-party employers such as home care agencies generally cannot use the companionship services or live-in domestic worker exemptions from minimum wage and overtime. That means agency-employed caregivers are generally entitled to:
Agency launch checklist complete.
Pay attention to 24-hour and live-in arrangements, which have special rules for sleep and meal time that vary by state. See how to calculate overtime pay.
The companionship exemption confuses many new agency owners. The DOL is clear:
Travel between clients during the workday also generally counts as hours worked. Build travel time and overtime into your rates and schedules from the start, because these are the costs that surprise new agencies most.
Under the federal 21st Century Cures Act, states must use electronic visit verification (EVV) for Medicaid-funded personal care services and home health services. EVV systems typically record the type of service, the person receiving and providing it, the date, location and start and end times. If you serve Medicaid clients, you must use your state’s EVV system or an approved alternative. Even for private-pay clients, verified visit records protect you in billing disputes and show families that care was delivered.
Scheduling is the daily heartbeat of a home care agency. You must match caregivers to clients by skills, availability, location and preferences, keep continuity so clients see familiar faces, cover call-outs quickly and avoid unplanned overtime as hours add up across clients. Build a pool of trained caregivers who can fill gaps and use open shifts so available caregivers can claim visits. See how to handle employee call-outs.
If you provide services that involve protected health information as a covered entity, HIPAA applies. See what is HIPAA compliance.
Caregiver turnover is one of the biggest challenges in home care. Caregivers stay with agencies that pay accurately and on time, including travel time, give them consistent clients and predictable hours, respond when they raise concerns and recognize the hard work they do. See healthcare worker burnout and how to reduce employee turnover.
EZTime lets caregivers clock in and out at the client’s home with a GPS stamp, tracks hours across clients so overtime is visible, schedules visits with open shifts and swaps, assigns care tasks with completion records and stores caregiver certifications with expiry reminders. Check whether your state requires a specific EVV system for Medicaid visits. See EZTime for home care agencies.
Many states require a license for home care agencies, with varying requirements for policies, staff screening, training and inspections. Home health agencies that bill Medicare need certification as well. Check with your state health department.
Non-medical home care provides personal care, companionship and household help. Home health provides skilled medical services such as nursing and therapy ordered by a clinician, with heavier regulation and Medicare certification for Medicare billing.
Generally yes when employed by an agency. Since 2015, third-party employers generally cannot use the companionship or live-in exemptions, so agency caregivers are typically entitled to minimum wage and overtime, including paid travel time between clients.
EVV is a system that electronically records visit details such as service type, who provided and received care, date, location and start and end times. Federal law requires states to use EVV for Medicaid personal care and home health services.
Through job boards, referrals from current caregivers, community colleges and training programs, and community organizations. Competitive pay, consistent hours and good scheduling help both recruiting and retention.
Yes, in many states, usually through Medicaid home and community-based services waiver programs. Enrollment rules, rates and electronic visit verification requirements vary by state, so contact your state Medicaid agency early.
A franchise gives you a brand, systems and training for an upfront fee and ongoing royalties. Starting independently costs less but takes longer to build processes and reputation. Read the franchise disclosure document carefully if you consider a franchise.
As soon as you have hourly staff, two jobs take more time than most owners expect: recording hours accurately and building a schedule everyone can see. Under the federal Fair Labor Standards Act (FLSA), employers must keep accurate records of hours worked and pay non-exempt employees overtime for hours over 40 in a workweek, and some states add daily overtime or meal-break rules. This is general information, not legal advice.
EZTime covers all three with a time clock app, employee scheduling and payroll-ready exports, from $2 per employee per month. See pricing and start a 14-day trial.
EZTime records caregiver clock-ins by GPS at each visit, with schedules on their phones and shift reminders before each visit.