While buying a franchise can be rewarding and exciting, there is, of course, more to it than just picking up the key and turning on the lights. The US healthcare industry is carefully regulated–and rightly so. Each state has its own set of regulations to protect consumers.

In most states, a home health care business needs a license to operate non-medical services and/or skilled nursing services. It’d be nice to have the same process across the board, but you’ll find a very different application process from state to state.

Before you buy a franchise, you should get familiar with state and federal laws, the licensing process, length of time for approval, and how the franchisor (like Nurse Next Door) will guide and support you through the process.

What kind of license do home health care businesses need?

If you’re opening a home health care business in the US, most states (except Iowa, Michigan, Massachusetts and Ohio) need you to submit an application in order to get a state license for home care. You can decide to offer non-medical home health care services (personal care, housekeeping and companionship), or open a Home Health Agency and provide skilled care (the previous tasks mentioned, plus nursing services).

In most states, you can expect an on-site inspection before or after you are issued you a license. The other states may give you a provisional license and survey you later on in the process. You’ll have to follow specific policies, procedures and protocols during this time.

You don’t need a license to open home health care businesses in Canada. The only exception is in Newfoundland where, if you want to provide personal support (caregiving) services, you’ll need to provide information to the Regional Health Authority about how you plan to operate your business.

getting more information on home care license

How long will it take to get a Home health care license?

Licensing depends on your state, and the number of applications they’ve received. It can take less than three months, but it could take as long as 12-18 months. We suggest you contact the state directly to confirm processing wait times as they can vary.

Are license approvals guaranteed?

If your application is complete and includes all the documents your state has requested, it has a good chance of being approved. However, licenses aren’t guaranteed. If you forget to include something in the application, the State will notify you, and you’ll have some time to provide additional information. This may delay the processing of your application.

The most common reason for rejections is that the administrator or a Director of Nursing (if required) doesn’t have the right qualifications and experience.

Do I ever have to renew my license?

Most licenses are renewed on an annual basis, and you can do it by submitting a renewal with a fee. In some states, you only need to renew once every two years.


getting a home care license


How will the franchise team help me get licensed?

Nurse Next Door hosts weekly conference calls to help you through the process. We’ll also assign you a personal business coach who will support you by reviewing state regulations, going through your application and making sure you meet all the criteria.

Preparing to submit an application–depending on the amount of information your state needs from you–can take an average of 10-12 weeks. Because we’ve successfully done this hundreds of times, Nurse Next Door offers many templates for you to use and customize.


What are the steps to getting a home health care license?

Before you apply, you’ll need to get a few things in order. If you become a Franchise Partner with Nurse Next Door, your assigned business coach will walk you through all of it, including:

  • Understand state regulations. Your state will determine how experienced your managers and nursing supervisor must be. Our policy and procedure manuals are cross-referenced with state regulations to make things easier for you.
  • Get familiar with the fees. Each state is different, and you can find fee information on their respective websites.
  • Find out if you should have a Certificate of Need. If you’re going to offer Medicare and Medicaid–among other things–this might be mandatory. A separate department will process this application, so if it turns out you need a certificate, apply for one before you go for your license.
  • Make sure you have an office. Even if it’s in your home (which needs to adhere to local zoning laws), you’ll need a separate, locked room with locked cabinets to keep client and team records secure. Your state might require you to have staff and public access at your office during business hours. Make sure you include a copy of your lease in your license application.
  • Understand the policy and procedure manual. Nurse Next Door gives Franchise Partners a customized manual that meets your specific state’s regulations.
  • Have a clear business plan. You might have to submit a business plan when you apply for a license. To save you time, we’ll give you a template to customize.
  • Register your business. If you’re in the US, register with the Secretary of State and State Department of Revenue Services. If you’re in Canada, register with the CRA.
  • Hire your core people. You’ll need to hire an Administrator (if you won’t be managing your franchise), a Director of Nursing, and a backup Registered Nurse before applying.
  • Create a process for staff screening. Check your state regulations. Your managers, directors, and caregiving staff need a criminal background check, and may need fingerprints and random drug testing. Caregivers and nurses need to be cleared for tuberculosis. You’ll need to verify nursing licenses with the state board and regularly make sure Certified Nursing Assistants are on state registries as well.


getting license for home health care business


When you apply:

  • Make sure your team’s structure fits state requirements. You might need an administrator/agency manager and an alternate to act as their backup. If you’re offering skilled care, you may need a Director of Nursing or a Supervising Nurse and a backup, as well as at least one part-time Registered Nurse.
  • Create a process for staff training. Your state might need your manager (or you) to complete training before awarding you a license, and you need to allocate yearly time for training. Your caregivers and nurses may be required to attend staff development programs. Each of your new hires will participate in a Nurse Next Door orientation, called “Discovery Day”. It’s all part of putting together an incredible team and providing clients with the best home health services possible!
  • Make sure you have the right insurance. There are a number of coverage requirements, like liability insurance and workers’ compensation. Your state might have additional expectations on top of these, so our trusted insurance vendor will support you and make sure you’re ready to go.
  • Put together a staffing plan with specific job descriptions. Nurse Next Door provides our Franchise Partners with customizable templates.


Access Your Welcome Package which includes

  • Discovery Video – 15 min overview of this opportunity
  • Franchisee Testimonials
  • The Nurse Next Door opportunity
  • Access to our calendar to book a 1×1 call.
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