Home › Home care staff requirements › North Carolina

Home care staff requirements in North Carolina

North Carolina requires a DHHS license for home care agencies, including home health and in-home aide agencies, and a separate license for home assistance services providers that offer only companion, sitter or respite care. Workers who go into homes need a criminal history check, done by state fingerprint-based and FBI check if they have lived in the state under five years, and agencies cannot hire anyone with a substantiated finding on the Health Care Personnel Registry. The rules focus on documented competency rather than set training hours, and they require a baseline TB skin test, a Hepatitis B record, and nurse supervisory visits every 90 days for in-home aides.

Licenses

• No one may operate a home care agency or a home assistance services provider without a license from the Department of Health and Human Services (G.S. 131E-138).
• Home care services include nursing, therapy, in-home aide services, and companion, sitter, respite or homemaker services when given along with other home care services (G.S. 131E-136).
• Companion, sitter or respite care given alone, or with homemaker services, counts as home assistance services, not home care services (G.S. 131E-136).
• A home health agency is a home care agency that is certified for Medicare and Medicaid (G.S. 131E-136).
• Each agency location needs its own license unless exempt (10A NCAC 13J .0902).

Background checks

• A home care agency's job offer for a position that enters patients' homes is conditioned on the applicant's consent to a criminal history check (G.S. 131E-265).
• Applicants who have lived in North Carolina less than five years need a state and national check that includes fingerprints, and those who have lived there five years or more need a state check (G.S. 131E-265).
• The agency must send the check request to the State Bureau of Investigation or a private company within five business days of the conditional offer (G.S. 131E-265).
• An agency may employ an applicant conditionally before results arrive if it has the applicant's consent and submits the request within five business days after the person starts (G.S. 131E-265).
• A conviction is not an automatic bar; the agency must weigh factors such as how serious and how recent the crime was and how it relates to the job (G.S. 131E-265).
• An existing employee who moves into a job that requires entering patients' homes also needs a criminal history check (G.S. 131E-265).
• The agency may not hire anyone, directly or by contract, with a substantiated finding on the North Carolina Health Care Personnel Registry (10A NCAC 13J .1003).
• An in-home aide must be listed on the Nurse Aide Registry if the client's plan of care calls for extensive assistance with daily living activities (10A NCAC 13J .1107).

Training and competency

• The agency must document that each in-home caregiver has shown competence in every assigned task by demonstrating it to a health care practitioner (10A NCAC 13J .1110).
• For in-home aides hired after April 1, 2009 who are not on the nurse aide registry, a registered nurse must verify six core skills: mobility, bathing, toileting, dressing, eating and continence care (10A NCAC 13J .1003).
• Hands-on care employees need airborne and bloodborne pathogen training with yearly updates (10A NCAC 13J .1003).
• The agency must have written policies on orientation and in-service education and keep records of in-service attendance (10A NCAC 13J .1003).
• Companions and sitters must have documented competence for the tasks they are assigned (10A NCAC 13J .1504).

Health screening

• Hands-on care employees need a baseline TB skin test, and anyone who tests positive must show they are not infectious before going into a client's home (10A NCAC 13J .1003).
• Employees who tested positive in the past need a baseline and yearly verification that they are free of TB symptoms (10A NCAC 13J .1003).
• Employees found at risk by the agency's risk assessment must be retested at intervals set by OSHA standards (10A NCAC 13J .1003).
• Personnel records for hands-on care employees must show Hepatitis B immunization or a declination (10A NCAC 13J .1003).

Also in the personnel file

• Personnel records must include a verifiable application or resume, a signed job description, reference checks or verification of past jobs, TB records, at least yearly performance evaluations, credential verification and competency verification (10A NCAC 13J .1003).
• Personnel records must be kept for at least one year after the employee leaves (10A NCAC 13J .1003).
• For in-home caregivers who are not licensed, a health care practitioner must make a supervisory visit to each client's home every 90 days, and at least once a year while the caregiver is there (10A NCAC 13J .1110).
• For companions and sitters, the supervisor must contact the client every three months and visit the home at least every six months, and at least once a year while the companion or sitter is there (10A NCAC 13J .1504).

Common questions

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

Sources

• 10A NCAC 13J (Home Care Agency Licensure Rules), full subchapter PDF, NC Office of Administrative Hearings
• G.S. 131E-136 Definitions (Home Care Agency Licensure Act)
• G.S. 131E-138 Licensure requirements
• G.S. 131E-265 Criminal history record checks

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 North Carolina

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

Nearby states

Georgia home care staff requirements · South Carolina home care staff requirements · Tennessee home care staff requirements · Virginia home care staff requirements