How to start a home care agency in North Carolina

Updated October 20, 2026 · CensusDesk research

North Carolina at a glance

Fees and forms change. Check DHSR’s Home Care Licensure Information page and its current fee schedule before you pay anything.

Step 1. Decide what kind of agency you are

Most new agencies in North Carolina start non-medical: help with bathing, dressing, meals, light housekeeping, errands, and companionship. When your aides give hands-on personal care, that’s In-Home Aide Services, and you need a home care agency license. If you plan to offer skilled nursing or therapy, you’re a home health agency instead, with more requirements. This guide covers the non-medical path.

North Carolina draws one more line. Under state law, companion, sitter, and respite care on their own aren’t treated the same as hands-on home care. They count as home care when you provide them along with other home care services. If you plan to offer only companion or sitter care, with no hands-on help, check with DHSR on what you need before you open.

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

Register your business with the North Carolina Secretary of State. Most owners form an LLC, get a federal EIN from the IRS, and open a business bank account before they apply. Plan your office, too: each site that provides home care needs its own license. Talk to an insurance agent about liability and workers’ compensation coverage now. You will want it in place before your first caregiver starts.

Step 3. Finish the DHSR-approved training

If you can’t show that you’ve owned or run a home care agency before, DHSR won’t issue your license until you complete training it approves. The course covers the licensure rules, the licensure process, and how to run an agency under those rules. Keep your proof of completion. You send it in with your application.

Step 4. Apply to DHSR

What DHSR asks for:

1. Fill out the home care licensure application, with In-Home Aide Services checked.
2. Pay the $510 initial license fee. It’s nonrefundable.
3. Send proof that you’ve owned or run a home care agency, or proof you finished the approved training (Step 3).
4. Write your agency’s policies and procedures to match the state rules in 10A NCAC 13J.
5. Get your personnel records ready, including proof you have staff to provide the services you’ll offer.

You have 12 months from the date DHSR receives your application and fee to finish every requirement. DHSR doesn’t publish a set processing time, so check with DHSR.

Step 5. Pass your office survey, then serve clients

Before a new license is issued, DHSR does a survey of your agency. Surveyors review your policies, procedures, and personnel records. DHSR’s Home Care and Hospice Licensure Survey Checklist is the guide to use. DHSR says the main reason applicants are denied is not following that checklist or the rules. Once you pass and your license is issued, you can start serving clients.

One rule to plan your hiring around: a registered nurse has to check each in-home aide’s skills by watching them do the work.

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 North Carolina 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 North Carolina

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

• NC DHSR, Home Care Section “Frequently Asked Questions” (revised 5/30/25: initial fee, renewal fee, training, contact email), read October 22, 2026
• NC DHSR, Acute and Home Care “Fee Schedules” (initial licensure application fee, section phone), read October 22, 2026
• NC DHSR, “Requirements for Establishing a Home Care Agency” (application steps, one license per site), found October 20, 2026
• NC DHSR, “Requirements and Instructions for Initial Home Care Licensing” (survey before licensure, denial reasons), found October 20, 2026
• NC DHSR, home care, nursing pool, and hospice licensure application (In-Home Aide Services, the 12-month rule), found October 20, 2026
• NC DHSR, Home Care and Hospice Licensure Survey Checklist, found October 20, 2026
• 10A NCAC 13J, Home Care Agencies (.0903 training before licensure, personnel records, in-home aide rules), found October 20, 2026
• N.C. G.S. 131E-136, definitions (home care services, in-home aide services, companion, sitter, and respite), read October 22, 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)