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Home care staff requirements in Maryland

Maryland licenses residential service agencies for in-home care such as help with daily living activities, and licenses home health agencies separately; agencies that only help with household tasks or child care need no license. Before a new worker starts, the agency must get a state criminal history check or a private background check and ask the last employer about any history of physical abuse. Residential service agencies must also screen health and TB, check references, interview and test skills before referral, and have a nurse supervise on site every 45 days to 4 months depending on medication tasks.

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Licenses

A residential service agency, meaning a business that employs or contracts with people to provide home health care services in a client's residence, may not operate without a license from the Secretary of Health (COMAR 10.07.05.03; COMAR 10.07.05.02).
Licensed home health agencies are licensed under a separate law and are not residential service agencies (COMAR 10.07.05.02).
An agency that provides only household or family support services, meaning child care without medical needs or help with housekeeping, meals, shopping and errands, does not need a license (COMAR 10.07.05.03; COMAR 10.07.05.02).
Home health agencies follow their own licensing chapter (COMAR 10.07.10.10).

Background checks

Home health agencies, residential service agencies and hospices are adult dependent care programs under the state background check law (Md. Code, Health-Gen. § 19-1901).
Before a covered employee may begin work, the program must apply for a state criminal history records check or ask a private agency to run a background check (Md. Code, Health-Gen. § 19-1902).
The program must also request a reference from the applicant's most recent employer that asks about any history of physical abuse (Md. Code, Health-Gen. § 19-1902).
A private agency check must cover every state where the program knows or should know the employee worked or lived in the past 7 years (Md. Code, Health-Gen. § 19-1902).
Residential service agencies must screen each worker with a criminal or private background check, license or certification verification, health and TB screening, reference checks, employment history checks, an I-9 and identity check, an in-person interview before referral, and a skills assessment and demonstration before referral (COMAR 10.07.05.10).

Training and competency

Residential service agency caregivers must be trained in personal care, when to refer to a registered nurse, record keeping, ethics and confidentiality, CPR, standard infection control precautions, and abuse and neglect prevention (COMAR 10.07.05.11).
A residential service agency must send a certified caregiver to clients who need help with daily living activities or medication administration, with limited exceptions such as a signed waiver (COMAR 10.07.05.10).
Home health agency aides must receive a structured program of training and orientation covering at least 13 listed topics, such as personal care, nutrition, safe environment, changes to report to the nurse, and confidentiality (COMAR 10.07.10.11).
Home health agency staff, including aides, must have in-service education every quarter, with subject, content and attendance documented (COMAR 10.07.10.11).

Health screening

Residential service agencies must do a basic health screening, including TB screening, before referring a worker to clients (COMAR 10.07.05.10).
Home health agencies must keep a certification that certain staff are free of communicable TB, such as staff who will care for TB patients, as set out in the rule (COMAR 10.07.10.10).
Under the home health agency TB rule, certification must happen within 10 days after the person starts, using a Mantoux skin test or chest X-ray method described in the rule (COMAR 10.07.10.15).
Home health agencies must teach each employee the signs and symptoms of active TB (COMAR 10.07.10.15).

Also in the personnel file

For residential service agency clients who need skilled services or help with daily living activities, a registered nurse must supervise on site at least every 45 days if staff give medications, every 3 months if staff help with self-administration, and every 4 months otherwise (COMAR 10.07.05.12).
Residential service agencies must keep training records in the personnel file and keep screening records at the business office (COMAR 10.07.05.10).
A residential service agency must report to the Board of Nursing and the Office of Health Care Quality any act by a referred worker that may be grounds for nursing board discipline (COMAR 10.07.05.10).
Home health agency personnel records must include current license or certification, proof of qualifications, and periodic performance evaluations, and the agency must have job descriptions for each type of staff (COMAR 10.07.10.10).
Home health agencies must provide periodic on-site supervision of aides and document it (COMAR 10.07.10.11).

Common questions

What background checks do home care aides need in Maryland?

Home health agencies, residential service agencies and hospices are adult dependent care programs under the state background check law (Md. Code, Health-Gen. § 19-1901).

How much training do home care aides need in Maryland?

Residential service agency caregivers must be trained in personal care, when to refer to a registered nurse, record keeping, ethics and confidentiality, CPR, standard infection control precautions, and abuse and neglect prevention (COMAR 10.07.05.11).

Do home care workers in Maryland need a TB test?

Residential service agencies must do a basic health screening, including TB screening, before referring a worker to clients (COMAR 10.07.05.10).

Which license does a home care agency need in Maryland?

A residential service agency, meaning a business that employs or contracts with people to provide home health care services in a client's residence, may not operate without a license from the Secretary of Health (COMAR 10.07.05.03; COMAR 10.07.05.02).

Some rules for Maryland weren't confirmed from an official source. Check with the state before relying on this page.

Sources

This page summarizes state licensing rules in plain words, with links to the rules themselves. It is not legal advice, rules change, and your license type decides what applies: check the linked source and your licensing agency. Medicare-certified home health agencies also follow 42 CFR 484.80. Checked October 2026.

More for Maryland

Maryland background check laws · Maryland drug testing laws · Medicare home health aide rules · All states

Nearby states

District of Columbia home care staff requirements · Delaware home care staff requirements · Pennsylvania home care staff requirements · Virginia home care staff requirements · West Virginia home care staff requirements