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Home care staff requirements in Missouri

Missouri licenses home health agencies through the Department of Health and Senior Services and holds them to Medicare home health rules plus annual dementia training. Home health agencies and in-home services providers must run a criminal background check and an Employee Disqualification List check before a new hire has any client contact, and in-home workers must register with the Family Care Safety Registry. In-home service providers that contract with the state must give 12 hours of orientation (6 before first client contact) and 5 hours of in-service each year after the first year.

Licenses

• A home health agency that provides two or more home health services, or calls itself a home health agency, must be licensed by the state (RSMo 197.405).
• Missouri-licensed home health agencies must meet the federal Medicare home health Conditions of Participation in 42 CFR 484, and state surveys follow Medicare standards (19 CSR 30-26.010(1)(A)).
• In-home service providers (non-medical personal care, homemaker and respite) that contract with the state must meet the in-home service standards (19 CSR 15-7.021(2)).

Background checks

• Before a new hire has any contact with a client, home health agencies and state-contracted in-home services providers must request a criminal background check through the Missouri State Highway Patrol (RSMo 192.2495, subsections 1 and 3(1)).
• If the applicant has not lived in Missouri for five straight years, the provider must request a nationwide fingerprint check (RSMo 192.2495, subsection 3(1)).
• Before client contact, the provider must also check whether the person is on the DHSS Employee Disqualification List (RSMo 192.2495, subsection 3(2)).
• Applicants must sign a consent form and disclose their criminal history, any Employee Disqualification List listing, and any Family Care Safety Registry listing (RSMo 192.2495, subsection 5).
• Home health and in-home services agencies may not employ a person who refuses to register with the Family Care Safety Registry or who has listed disqualifying offenses, a DMH registry listing, or a child abuse and neglect registry finding (RSMo 192.2495, subsection 7).
• In-home service providers must make sure all employees are registered with the Family Care Safety Registry (19 CSR 15-7.021(19)(F)).
• In-home service providers must keep a record of each EDL and criminal background screening showing who was screened, request and completion dates, and the result (19 CSR 15-7.021(24)(C)).

Training and competency

• Licensed home health agencies must give dementia training to staff who provide direct care to clients with Alzheimer's disease or related dementias, covering five set topics (19 CSR 30-26.010(1)(B)1.).
• Home health dementia training must be part of new-employee orientation and be given every year (19 CSR 30-26.010(1)(B)3.).
• In-home service providers must give new aides, respite workers and homemakers 12 hours of orientation within 30 days of hire, including 2 hours on the agency and its emergency procedures (19 CSR 15-7.021(22)(A)).
• At least 6 of those orientation hours must be given before the first day of client contact (19 CSR 15-7.021(22)(A)1.).
• Orientation for in-home workers must include an overview of Alzheimer's disease and how to communicate with people with dementia (19 CSR 15-7.021(22)(A)2.).
• In-home workers need 5 hours of in-service training each year after the first 12 months, which may drop to 2 hours of refresher after 3 years of employment and 15 in-service hours (19 CSR 15-7.021(22)(B)).
• Advanced personal care aides must be an LPN, a CNA, a competency-evaluated home health aide under 42 CFR 484.80, or have completed personal care aide training (19 CSR 15-7.021(19)(D)).

Health screening

• In-home service providers must have a policy that keeps staff with a communicable condition, including colds or flu, away from clients (19 CSR 15-7.021(20)(E)).

Also in the personnel file

• In-home service workers must be at least 18, able to read, write and follow directions, and not an immediate family member of the client (19 CSR 15-7.021(19)(C)).
• An in-home supervisor must evaluate each aide in writing at least once a year, based in part on at least one on-site visit (19 CSR 15-7.021(21)(B)).
• Training records must list dates, trainer, topics, hours, location, the date of first client contact and the aide's signature (19 CSR 15-7.021(23)(A)).
• In-home service providers must keep personnel records for five years, including the application, training, annual evaluations, signed acknowledgments of client rights and ethics, and license or CNA verification (19 CSR 15-7.021(24)(B)).

Common questions

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

Sources

• RSMo 192.2495, Criminal background checks of employees (revisor.mo.gov)
• RSMo 197.405, Home health agencies, license required (revisor.mo.gov)
• 19 CSR 30-26.010, Home Health Licensure Rule (sos.mo.gov)
• 19 CSR 15-7.021, In-Home Service Standards (sos.mo.gov)

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 Missouri

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

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