Start a Home Care Agency in Tennessee
Starting a non-medical home care agency in Tennessee requires understanding the state’s licensing requirements, regulatory structure, and administrative expectations before providing services.
Tennessee is considered a regulated state, meaning agencies that provide hands-on personal care services must obtain approval before operating.
This guide outlines the key steps and expectations so you can better understand what is involved in opening a home care agency in Tennessee.
1️⃣ Understand Tennessee Home Care Licensing Requirements
In Tennessee, non-medical home care agencies are typically licensed as:
Personal Support Services Agencies (PSSA)
These agencies are regulated by the:
Tennessee Department of Health
If your agency provides:
• personal care (bathing, dressing, grooming)
• assistance with activities of daily living (ADLs)
• hands-on support or supervision
you are required to obtain a license before operating.
Agencies offering companion-only services (without hands-on care) may not require full licensure, depending on how services are structured.
2️⃣ Define Your Services
Most home care agencies in Tennessee provide:
• personal care assistance
• companionship services
• meal preparation
• light housekeeping
• mobility support
Once your agency provides hands-on personal care, it falls under full regulatory oversight, including licensing and inspection requirements.
3️⃣ Complete Business Setup Requirements
Before applying for a license, you must:
• register your business (LLC or Corporation)
• obtain a Federal EIN
• secure general liability insurance
• obtain workers’ compensation insurance (if hiring employees)
• establish a business location
• designate an administrator
Tennessee expects your agency structure to be clearly defined before application.
4️⃣ Prepare Your Administrative Documentation
A critical part of the licensing process in Tennessee is preparing your agency’s documentation.
This typically includes:
• policy and procedure documentation
• client intake and service forms
• caregiver hiring and training records
• operational and compliance documentation
In regulated states like Tennessee, documentation must be organized, consistent, and reflective of how your agency will operate in real-world conditions.
5️⃣ Submit Your Application to the Department of Health
Once your documentation is prepared, you will:
• submit your PSSA license application
• pay the required licensing fees
• provide all required supporting documentation
Incomplete or unclear applications are one of the most common causes of delays.
6️⃣ Prepare for the State Survey
Tennessee requires a pre-licensure survey (inspection) before approval.
During this process, your agency will be evaluated using a structured review approach that focuses on:
• administrative organization and oversight
• caregiver hiring, training, and documentation
• client intake, care planning, and records
• policies, procedures, and operational workflows
• safety, infection control, and emergency preparedness
• overall compliance readiness
Surveyors are not only verifying documents — they are assessing whether your agency is fully prepared to operate safely and in compliance with state requirements.
7️⃣ Receive Approval and Begin Operations
You may begin providing services only after:
• your license has been issued
• your agency successfully completes the survey
• all regulatory requirements have been met
Medicaid Pathway in Tennessee
Tennessee allows home care agencies to participate in Medicaid programs. Enrollment typically occurs after licensure and may require additional approvals and provider enrollment steps.
Tennessee Home Care Startup Checklist
✔ Register your business entity
✔ Obtain EIN and insurance
✔ Designate an administrator
✔ Prepare administrative documentation
✔ Submit application to the Department of Health
✔ Prepare for state survey
✔ Receive approval and begin services
What New Agency Owners Often Miss in Tennessee
Tennessee is a state where many applications are delayed due to documentation gaps and lack of survey readiness.
Some of the most common challenges include:
• underestimating how detailed documentation needs to be
• inconsistencies between policies, forms, and procedures
• unclear administrative roles and responsibilities
• lack of preparation for how the agency will be evaluated during inspection
Many new agency owners focus on creating documents individually, but overlook how those documents must work together as a complete system.
Why Documentation Preparation Matters
In Tennessee, your documentation should clearly demonstrate:
• how your agency will operate day-to-day
• how caregivers are trained and supervised
• how client care is planned and documented
• how compliance and safety are maintained
Well-prepared documentation helps show that your agency is organized, structured, and ready for approval.
Prepare Your Home Care Agency Documentation
Wise Caregiving® provides professional home care startup template bundles designed to help entrepreneurs organize the documentation commonly required to start and operate a home care agency.
These templates provide a structured administrative foundation that can be customized to reflect your agency and your state’s requirements.
For regulated states like Tennessee, many entrepreneurs choose a more comprehensive solution to help ensure their documentation is organized and ready for review.