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Home care staff requirements in Tennessee

Tennessee licenses home health agencies through the Health Facilities Commission, and licenses non-medical personal support services agencies through either the Department of Mental Health and Substance Abuse Services or the Department of Intellectual and Developmental Disabilities. Personal support services workers need a criminal background check, abuse registry and sex offender registry checks before client contact and on a repeating schedule, plus basic competency training before starting. Home health agencies must run an annual flu vaccination program and keep proof of communicable disease screening for each employee.

Licenses

• Home health agencies are licensed as home care organizations under the Health Facilities Commission's standards for home care organizations providing home health services (Tenn. Comp. R. & Regs. 0720-27-.01(28)).
• Agencies providing personal support services (help with bathing, dressing, toileting, housekeeping, meals, shopping, and community activities) need a license from either the Department of Mental Health and Substance Abuse Services or the Department of Intellectual and Developmental Disabilities (Tenn. Comp. R. & Regs. 0465-02-17-.02(1); 0940-05-38-.01(1)).
• An agency where 50% or more of clients are aged or have a mental illness or substance use diagnosis should get its license from the Department of Mental Health and Substance Abuse Services; one where 50% or more have an intellectual or developmental disability should get it from the Department of Intellectual and Developmental Disabilities (Tenn. Comp. R. & Regs. 0465-02-17-.02(3)).

Background checks

• Personal support services workers must have a criminal background check under T.C.A. Section 33-2-1202 within 10 days of employment, within 10 days of a change to duties with direct client contact, and every two years (Tenn. Comp. R. & Regs. 0940-05-38-.07(2)(c)).
• Each personal support services worker must be checked against the Tennessee Abuse Registry before direct contact with clients and every year, and no one on the registry may be hired (Tenn. Comp. R. & Regs. 0940-05-38-.07(2)(d)).
• Each personal support services worker must be checked against the Tennessee Sexual Offender Registry before direct contact with clients and every year, and no one on the registry may be hired (Tenn. Comp. R. & Regs. 0940-05-38-.07(1)(e), (2)(e)).
• For agencies licensed by the Department of Intellectual and Developmental Disabilities, each personnel file must show a criminal background check, Abuse Registry status, Sex Offender Registry status, and status on the Tennessee Felony Offender Information Lookup (Tenn. Comp. R. & Regs. 0465-02-06-.04(6)).
• Home health agency personnel files must contain accurate information about each employee's education, training, experience, and background (Tenn. Comp. R. & Regs. 0720-27-.04(11)).

Training and competency

• A home health aide is defined as someone who has completed 75 hours of training, including 16 hours of clinical training, before or during the first three months of employment (Tenn. Comp. R. & Regs. 0720-27-.01(29)).
• Home health aide training must cover self-reliance, nutrition and meals, aging and illness, a clean environment, reporting changes, the health team, ethics, confidentiality, dignity, and record keeping, and must follow the federal aide training and competency rules (Tenn. Comp. R. & Regs. 0720-27-.06(7)(a)).
• Home health agencies must hold regular in-service programs for aides, with on-the-job training during supervisor visits (Tenn. Comp. R. & Regs. 0720-27-.06(7)(d)).
• Every home health employee must receive orientation to the agency, its policies, and their job, and the agency must keep records of staff training topics and attendance (Tenn. Comp. R. & Regs. 0720-27-.04(13)).
• Before working with clients, personal support services workers must show basic competency in reporting changes, abuse and neglect prevention and reporting, client rights, universal precautions and infection control, personal hygiene help, client safety, and emergency procedures (Tenn. Comp. R. & Regs. 0940-05-38-.08(1)(a)).
• Personal support services workers must get job-related training at least once a year, and workers who assist with medication must have documented training by or under a registered nurse (Tenn. Comp. R. & Regs. 0940-05-38-.08(1)(b)-(c)).
• At agencies licensed by the Department of Intellectual and Developmental Disabilities, support staff must be trained in First Aid and CPR and get basic seizure management orientation before being assigned to work (Tenn. Comp. R. & Regs. 0465-02-17-.04(3)-(4)).

Health screening

• Home health agencies must keep proof in each employee's file of medical screening adequate to rule out communicable disease (Tenn. Comp. R. & Regs. 0720-27-.04(11)).
• Home health agencies must run an annual flu vaccination program that offers free vaccine to all staff, keeps a signed declination from anyone who refuses for non-medical reasons, and educates employees about flu (Tenn. Comp. R. & Regs. 0720-27-.06(10)(d)).
• At agencies licensed by the Department of Intellectual and Developmental Disabilities, employees must be screened or tested for TB under Tennessee Department of Health procedures, with documentation in the personnel file (Tenn. Comp. R. & Regs. 0465-02-17-.04(2)).
• Personal support services workers must follow infection control procedures and standard precautions (Tenn. Comp. R. & Regs. 0940-05-38-.07(2)(b)).

Also in the personnel file

• Home health personnel records must include job descriptions, verification of references and credentials, and performance evaluations (Tenn. Comp. R. & Regs. 0720-27-.04(12)).
• A registered nurse or other appropriate professional must make a supervisory visit to each home health aide patient's home at least monthly, alternating visits with and without the aide present when possible (Tenn. Comp. R. & Regs. 0720-27-.06(7)(c)).
• Each personal support services worker file must include a signed job description, date of birth, annual performance evaluations, a five-year work history, and three personal references, one from someone who has known the worker at least five years (Tenn. Comp. R. & Regs. 0940-05-38-.07(1)).
• Personal support services workers must be at least 18, and the agency must carry liability insurance covering the agency and its workers (Tenn. Comp. R. & Regs. 0940-05-38-.07(2)(a), (3)).

Common questions

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

Sources

• Tenn. Comp. R. & Regs. ch. 0720-27, Standards for Home Care Organizations Providing Home Health Services (TN Secretary of State)
• Tenn. Comp. R. & Regs. ch. 0940-05-38, Minimum Program Requirements for Personal Support Services Agencies (TN Secretary of State)
• Tenn. Comp. R. & Regs. ch. 0465-02-17, Personal Support Services Agencies, DIDD (TN Secretary of State)
• Tenn. Comp. R. & Regs. ch. 0465-02-06, Minimum Program Requirements for All Facilities/Services, DIDD (TN Secretary of State)

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.

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