Hiring in Senior Care and Home Care: The Employer and Owner Guide

This hub is written for the people who do the hiring in senior and home care.

That means owners and operators of non-medical home care agencies and franchises, and administrators of Medicare-certified home health agencies and hospices.

It means the executive directors and administrators who run assisted living, memory care and nursing home communities, too.

It is also for the schedulers, recruiters, HR leads and directors of nursing who hire day to day.

And it is for anyone starting, buying or growing a care business, because owner decisions about licensing, payer enrollment and software land on the same desk that posts the jobs.

It is not for job seekers.

The career guides on this site cover what each role does, what it pays and how to get into it.

It is not for families shopping for care, either.

Your provider type decides your rulebook.

A non-medical home care agency answers to its state's home care licensing rules and to federal wage-hour law.

A Medicare-certified home health agency or hospice answers to CMS's federal rules on top of state law — the federal home health aide training standard (42 CFR 484.80) carries into hospice aide qualifications as well.

Assisted living and residential care settings are governed almost exclusively by state law rather than federal rules, and nursing homes add federal nursing facility requirements on top of their state's.

Every hiring decision below starts from which rulebook you are holding.

Match the credential check to the title, and set pay expectations from the right benchmark.

Here is the quick map.

• Caregivers and personal care aides (non-medical). What you must verify is set by your state: its caregiver or aide training rules, its background-check system, and any registry or listing it keeps. Confirm the current requirements with your state licensing agency before you write the posting.
• Certified nursing assistants. Federal rules require state-approved nurse aide training of at least 75 clock hours, including at least 16 hours of supervised practical training, and many states require more. Require an active listing on your state's nurse aide registry, and verify it before the first shift. If you operate a nursing facility, federal rules require receiving registry verification before letting someone serve as a nurse aide, and they bar employing anyone with a registry finding involving abuse, neglect, exploitation, mistreatment of residents or misappropriation of their property. Benchmark: nursing assistants (SOC 31-1131) earned a national median of $20.32 an hour in BLS OEWS May 2025.
• Home health aides. At Medicare-certified agencies, federal rules require at least 75 hours of training, with at least 16 hours of classroom training preceding at least 16 hours of supervised practical training, plus at least 12 hours of in-service training in each 12-month period. States can add requirements of their own, so confirm your state's rule with the state agency. A CNA certificate and an HHA credential are not interchangeable everywhere: California separately certifies home health aides, and a California CNA cannot work as a certified HHA without completing a CDPH-approved HHA training program. Check your state's rule before you assume one covers the other.
• Home health and hospice nurses. Verify an active RN or LPN license with your state board of nursing. The broad BLS benchmark for registered nurses (SOC 29-1141) is a national median of $46.90 an hour; in the home health care services industry row it was $40.83. Licensed practical nurses (SOC 29-2061) earned a national median of $30.96 an hour.
• Schedulers and care coordinators. BLS's OEWS wage survey has neither a scheduler, a staffing coordinator nor a care coordinator occupation, so both benchmarks here are the weak proxies we use, not pay tables. For schedulers it is medical secretaries and administrative assistants (SOC 43-6013), a national median of $22.08 an hour in May 2025. For care coordinators it is social and human service assistants (SOC 21-1093), also a $22.08 national median.
• Directors of nursing and administrators. The broad BLS category covering these leadership roles, medical and health services managers (SOC 11-9111), earned a national median of $123,860 a year. Verify the credential your state requires. Every state requires nursing home administrators to be licensed, with requirements varying by state — confirm the license with your state board. Assisted living administrator credentials vary by state: some states license or certify the administrator, while others set administrator qualifications in the facility rules instead. NAB does not set licensing requirements or issue licenses.

The worker-side home health aide career guide and personal care aide career guide are useful reading while you write a posting, because they show the questions candidates arrive with.

The pool you are recruiting from is large and still growing.

BLS Employment Projections expect home health and personal care aides to grow 18.1 percent from 2025 to 2035, with about 760,500 openings a year.

Nursing assistants are projected to grow 2.6 percent over the same span, with about 196,200 openings a year.

PHI's Key Facts 2025 report projects an estimated 9.7 million total job openings in direct care from 2024 to 2034, counting occupational transfers and labor-force exits.

Post where caregivers actually look: your own careers page, the job boards your candidates use, training programs — CNA schools and aide courses graduate your next cohort — employee referrals, and community organizations.

A board that lists only senior and home care work, as CaregiverHires does, puts your opening next to role guides instead of next to unrelated listings.

Look at the caregiver jobs and CNA jobs pages to see what candidates see before you write yours.

Write the ad the way a busy candidate reads it.

Lead with the pay range, the shift and schedule, the setting and client type, your mileage and travel-time policy for in-home roles, and the training you provide.

Then state your credential requirement in your state's own words — "active [state] nurse aide registry listing," for example, where the role requires one.

Two legal checks before you publish.

EEOC-enforced laws make it illegal to publish an ad that shows a preference for, or discourages, applicants based on race, color, religion, sex, national origin, age (40 and over), disability or genetic information — wording like "females" or "recent college graduates" can cross that line.

Whether you must publish a pay range is set state by state: Washington, for example, requires employers with 15 or more employees to disclose the wage scale or salary range and a general description of benefits in each job posting.

Other states have their own rules, so check yours.

A workable order: phone screen, interview, reference checks, then the formal checks, then the offer and paperwork.

The formal checks carry the legal deadlines.

Background checks.

If you order a consumer report — a criminal background check or motor vehicle record through a consumer reporting agency — the Fair Credit Reporting Act requires a clear written disclosure in a stand-alone document and the applicant's written authorization before you order it.

Nurse aide registry checks.

If you operate a nursing facility, federal rules require you to receive registry verification before letting someone serve as a nurse aide, and to seek information from every state registry you believe has information on the individual.

They also bar employing anyone with a registry finding involving abuse, neglect, exploitation, mistreatment or misappropriation of resident property.

What other provider types must check is set by your state and your payers, so confirm with your state agency.

OIG exclusion checks.

Federal law does not require providers to check the HHS Office of Inspector General's List of Excluded Individuals, but OIG recommends screening before hiring and periodically afterward, and it updates the list monthly.

The reason to bother: no federal health care program pays for items or services furnished by an excluded individual, and a provider that employs someone it knows or should know is excluded can face civil monetary penalties, assessments and exclusion itself.

Form I-9.

Complete it for every hire.

The employer's review and verification section is due within three business days of the hire date, and jobs lasting less than three business days must be verified at hire.

Keep each form for three years after the date of hire or one year after employment ends, whichever is later.

E-Verify is a separate online confirmation service; whether it is required of you depends on federal-contractor status and state law.

Health screens.

Under the ADA, a required medical exam comes only after a real job offer, and only if everyone entering that job category gets one.

A test for illegal drug use is not a medical exam under the ADA, and federal law neither requires nor bans drug testing for private employers — state law varies.

CDC guidance recommends TB screening at hire rather than routine annual testing unless there is known exposure or ongoing transmission; whether your aides need TB tests at all is a state licensing question.

The baseline rule for agencies: since January 1, 2015, third-party employers such as home care agencies cannot claim the FLSA companionship-services exemption.

Your caregivers are owed at least the minimum wage for all hours worked and overtime at time-and-a-half over 40 hours in a workweek.

The same restriction covers the live-in overtime exemption — a third-party employer may not use it even when the household jointly employs the worker, though the household itself can still claim it.

The Department of Labor proposed on July 2, 2025 to rescind that Home Care Rule and return to its 1975 regulations, which would let third-party employers claim the exemptions again.

That is a proposal, not a final rule — the current obligations stand.

Budget for minimum wage and overtime now, and confirm the state of play with the DOL's Wage and Hour Division before you change anything.

Three more wage-hour lines trip agencies up.

Travel between clients during the workday is compensable hours worked, and as the third-party employer your agency owes it; ordinary home-to-work commuting is not.

Hiring and retention bonuses are not discretionary — under the FLSA they belong in the regular rate you use to compute overtime.

And classification is a test, not a choice: the IRS looks at behavioral control, financial control and the type of relationship, and a worker whose work you can direct in both what is done and how is an employee.

Take classification questions to the IRS or a CPA.

For budgeting, BLS OEWS May 2025 gives the national context.

Home health and personal care aides (SOC 31-1120 — the combined home health and personal care aide group, and the closest BLS series for caregiver pay) earned a median of $17.21 an hour, with a 10th-to-90th-percentile hourly range of $13.00 to $21.65.

The industry rows differ: $16.73 in services for the elderly and persons with disabilities — the industry row that generally captures non-medical home care agencies — $17.42 in home health care services, and $17.82 in continuing care retirement communities and assisted living.

Set offers from your own market and your state's wage floor, not from a national table.

If you bill Medicaid, one coming rule belongs in your pay model now.

Under the 2024 Access Rule, states must ensure providers spend at least 80 percent of Medicaid payments for 1915(c) homemaker, home health aide and personal care services on direct care worker compensation, with an optional state-set percentage for small providers.

The requirement begins July 9, 2030, or with the first managed care rating period starting on or after that date.

It is not in force yet — plan for it.

Training obligations depend on what you are certified as.

Medicare-certified home health agencies owe aides the federal training floor — at least 75 hours, with at least 16 hours of classroom training before at least 16 hours of supervised practical training — plus at least 12 hours of in-service training in each 12-month period.

Nursing facilities owe nurse aides at least 12 hours of in-service a year, including dementia management and resident abuse prevention training.

For non-medical caregivers, your state's training rules apply; get the current requirement from your state agency rather than from a training vendor's marketing page.

Onboarding is where retention is won.

Start with orientation before solo visits, shadow shifts with an experienced caregiver, and a walkthrough of your EVV clock-in and documentation systems.

Add a care plan review for each client, plus a named supervisor with scheduled check-ins in the first weeks.

Each step costs little.

Retention deserves the same discipline.

PHI reports median turnover in home care was nearly 75 percent in 2024 and says no comprehensive turnover measure exists for the whole direct care workforce — so benchmark against your own records, not a headline number.

With BLS projecting about 760,500 openings a year for home health and personal care aides, your best caregivers have options.

The levers are operational.

Post schedules far enough in advance to plan a life around, keep the pay progression transparent, and make recognition specific.

Offer training that leads somewhere — into a medication aide role where your state certifies them, for example — and hold exit interviews you actually act on.

Licensing a non-medical home care agency is state law, and the answers differ more than new owners expect.

Illinois has required an IDPH license to operate or advertise a non-medical home services agency since September 1, 2008.

Massachusetts created its first license for non-medical home care agencies in 2026, under Chapter 180 of the Acts of 2026, approved August 6, 2026.

The license under that law is issued by the Executive Office of Health and Human Services, and the law bars using the words "home care" to describe services without one.

South Dakota's Department of Health, by contrast, states that it does not regulate non-medical in-home providers, so there is no state license for non-medical home care agencies there as of October 2026.

Some states register agencies rather than license them.

Florida requires companion and homemaker-only agencies to register with the Agency for Health Care Administration, and Connecticut registers homemaker-companion agencies with the Department of Consumer Protection.

Start with your state licensing agency, whatever its model.

Starting a Medicare-certified home health agency or hospice runs into a hard stop.

On May 13, 2026, CMS imposed six-month nationwide moratoria on new Medicare enrollment of home health agencies and of hospices, denying initial applications and non-exempt changes in majority ownership, and CMS's moratorium page still listed both as active in its August 27, 2026 update.

The moratoria can be extended in six-month increments — recheck the status with CMS before you build any timeline.

Enrollment itself runs through Form CMS-855A, and your state's licensing requirements still apply on top.

Assisted living and residential care settings are governed almost exclusively by state law, so the facility licensing conversation starts with your state.

Adding Medicaid-funded services brings waiver and home-and-community-based settings requirements with it.

However you grow — payer enrollment with your state Medicaid agency, electronic visit verification, software, billing, a franchise — each line has its own rulebook and its own regulator.

On EVV: states must require it for Medicaid personal care services (since January 1, 2020) and home health services (since January 1, 2023, with a one-year good-faith exemption available), and each state chooses its own EVV model and system.

Two resources worth knowing early.

Trade associations in the industry include the Home Care Association of America and the National Alliance for Care at Home — the Alliance formed when NAHC and NHPCO combined.

And if you buy into a franchise instead of building independent, the FTC's Franchise Rule entitles you to the Franchise Disclosure Document at least 14 calendar days before you sign or pay.

Item 5 covers initial fees, Item 6 ongoing fees such as royalties, Item 7 the estimated initial investment, and Item 19 any earnings claims, which is optional — some franchisors publish no earnings figures at all.

Read the items yourself; never take a directory's summary as the number.

CaregiverHires is a job board for this industry only.

The roles on it span caregivers, personal care aides, CNAs, home health and hospice aides, medication aides, home health and hospice nurses, schedulers, care coordinators, directors of nursing and administrators.

It is built for home care agencies, home health and hospice providers, assisted living and memory care communities, nursing homes and staffing agencies.

Your posting sits alongside the career guides candidates read while they decide, not beside unrelated listings.

Create your first posting, check pricing, and get listing edits made through support as your census and schedule change.

Employer information, not licensing, legal, medical, benefits or tax advice. Rules change and vary by state — confirm current requirements with your state licensing agency, the state Medicaid agency, CMS, the DOL, the IRS, or a CPA or health care counsel before you act.