Three Things I Wish Someone Had Told Me Before I Applied for My Home Care Licence

There is a particular kind of person who starts a home care business.

Usually they have worked in this field for years. They have watched care done badly and thought I could do this better. They are competent, organised, and used to solving problems for other people. And then they sit down to actually start one, and discover that nothing about the licensing process resembles the work they are good at.

I know, because that was me. I hold a PA Department of Health Chapter 611 licence as both a home care agency and a home care registry, issued in July. Getting there took months, and I made mistakes that cost me time I did not have to spare.

The three things

• Decide whether you are an agency or a registry before you write a single policy
• Your application will come back for something small — and it will not be what you worried about
• Recruit caregivers before you have clients, not after

1. Decide what you are before you write a single policy

This sounds procedural. It is actually the decision that determines everything downstream, and most people rush past it.

A home care agency employs its caregivers. You recruit them, hire them, schedule them, supervise them, and pay them. You carry payroll taxes, unemployment, workers' compensation, and liability. You bill the client one rate and the caregiver never becomes the family's problem. Higher overhead, more control, more risk.

A home care registry refers independent contractors to families. The family selects the caregiver and pays that caregiver directly. You do not set the caregiver's rate, you do not collect it, and you are not their employer. Lower overhead, fewer employment liabilities — and a completely different compliance posture under Chapter 611.

Here is why this matters more than people expect: your policies, your service agreements, your job descriptions, and every word of your marketing have to match the model you chose.

⚠ The most expensive mistake in this industry

A registry that advertises "our caregivers" or "we match you with a caregiver" has just handed a regulator — or a plaintiff's attorney — the argument that those contractors were really employees all along. It usually starts with sloppy language, not bad intent.

You can hold both licences, as I do. But even then, every document has to be clear about which model it governs. There is no such thing as a policy that covers both.

Decide first. Write second. Reversing that order means rewriting everything, and you will not catch every instance.

2. Your application will be returned for something small

Everyone starting out worries about the big questions. Will they approve me? Do I have enough experience? Is my business plan good enough?

In my experience, and in the experience of everyone I have talked to since, that is not what happens. What happens is that your application comes back because a policy was missing a required element, a form did not reference the correct regulation, or a document contradicted another document you had submitted alongside it.

Applications rarely fail. They get returned. And every return costs weeks.

Two things reduce that risk more than anything else.

Reference the regulation inside each policy. Not in a cover letter — in the policy itself. When your background check policy says which section of Chapter 611 it satisfies, the reviewer can verify it in seconds instead of searching. Make their job easy and your application moves.

Read your own documents as a stranger. Your service agreement, your intake form, your job descriptions and your policies all have to agree with each other. I have seen applications where the service agreement described one model and the job description described the other. The reviewer notices that. They notice everything.

And a related warning that has nothing to do with the application and everything to do with what comes after: check that your entity paperwork is right before you build on top of it. I discovered — after licensure — that my EIN had been registered with the wrong filing classification, and that a Medicaid enrollment I had submitted was recorded under the wrong enrollment type. Both were fixable. Both cost weeks I had not planned for. Get your legal name, your EIN, your NPI, and every enrollment matching each other from day one, character for character.

3. Recruit caregivers before you have clients

This is the one nobody says, and it is the one that determines whether your business survives its first year.

Here is the mistake almost every new owner makes: they build the business, market for clients, and plan to hire caregivers once the work comes in. It feels responsible. Why pay for clearances on someone you cannot yet assign?

Then the phone rings. A daughter whose father was discharged Tuesday needs someone starting Monday. And you say let me see who I can find — and she calls the next agency on her list, who says yes, Monday works.

In home care, demand is not the constraint. Workforce is. Turnover in this industry runs somewhere between 65 and 80 percent a year. Every agency in my county receives more inquiries than it can staff. The ones that grow are not better at marketing. They are better at recruiting.

Clearances take weeks. Training takes time. If you start that process when the case arrives, you have already lost the case.

Start recruiting before you are ready. Post the position. Run the clearances. Build a small bench of cleared, trained people who are waiting for hours. It feels premature and expensive. It is the difference between an agency that grows and one that spends two years explaining to families why it cannot help them.

You do not have to figure this out alone

I want to say something honestly, because I think it matters more than the three points above.

I did most of this by myself, and I do not entirely recommend it.

I built a 29-document compliance package, a full competency training programme, and my own application — and I learned an enormous amount doing it. I also lost weeks to mistakes that someone who had done it before could have caught in a single conversation. That trade is worth it for some people. For others, it is the reason they give up in month four.

Most people selling home care startup advice have never held a licence. That is not a small thing. There is a difference between knowing the regulation and having had your own application come back with corrections — and knowing exactly what the reviewer wanted.

If you want to talk it through

Consulting sessions, whether you are at "I am thinking about starting" or "the Department sent me a letter and I do not understand it." You leave with a written summary and a specific next-step list.

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If you would rather not build the documents yourself

Every policy exhibit, intake form, service agreement, and staff document — customised to your agency's name, address, and operations, and referenced to the specific regulation each one satisfies. Consultants charge $3,000 and up for the same scope.

$597

See the Chapter 611 Policy & Forms Package →

If you want to start smaller

The complete Chapter 611 roadmap — licensing, required policies, application steps, and what the Department actually looks for.

$57

See How to Start a Home Care Business in PA →

Whatever you choose, choose it deliberately. The people who succeed in this industry are not the ones who worked hardest alone. They are the ones who knew which parts to stop doing by themselves.

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Gabrielle Dibonge, MBA, is the founder and Administrator of Gilgal Home Care & Registry in King of Prussia, licensed under 28 Pa. Code Chapter 611 as both a home care agency and a home care registry.