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Home care staff requirements in Texas

Texas licenses home and community support services agencies (HCSSAs) through the Health and Human Services Commission, with separate standards for licensed home health, licensed and certified home health, and personal assistance services. Unlicensed staff with face-to-face client contact need a criminal history check and a search of the nurse aide registry and employee misconduct registry before hire or first client contact, then registry searches at least every 12 months. Home health aides need a 75-hour training and competency program or another listed qualification, and personal assistance workers must show competency for assigned tasks.

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Licenses

A home and community support services agency (HCSSA) is anyone who provides home health, hospice, or personal assistance services for pay in a client's residence or similar setting, and it needs a license from the Health and Human Services Commission before admitting clients (26 TAC 558.2(48); 558.11(a)).
The rules set separate added standards for the license categories of licensed home health services, licensed and certified home health services, and personal assistance services (26 TAC ch. 558, subch. D).
Personal assistance services means routine ongoing help with activities of daily living or the physical tasks of independent living, including respite services (26 TAC 558.2(87)).

Background checks

For unlicensed applicants and employees who will have face-to-face client contact, the agency must run a criminal history check under Texas Health and Safety Code Chapter 250, may not hire anyone with a barring conviction under Section 250.006, and must document its review of any other conviction (26 TAC 558.247(a)(1)-(2)).
Before hiring an unlicensed applicant, or before an unlicensed employee's first face-to-face client contact, the agency must search the nurse aide registry and the employee misconduct registry and may not employ anyone listed as unemployable (26 TAC 558.247(a)(3)).
The agency must search both registries again at least every 12 months for each unlicensed employee (26 TAC 558.247(a)(5)).
The agency must give unlicensed employees written information about the employee misconduct registry (26 TAC 558.247(a)(4)).
The agency must immediately discharge an unlicensed employee with client contact once it learns the person is listed as unemployable or has a barring conviction (26 TAC 558.247(a)(6)).
The personnel file must hold printed copies of the initial and annual registry search results and proof the employee received the misconduct registry information (26 TAC 558.246(a)(6)).

Training and competency

Agency staffing policies must require orientation, job-specific training, a demonstration of competency when education, license, or experience does not show it, and a continuing training program for all staff (26 TAC 558.245(b)(1)-(2)).
Personal assistance services may be done by an unlicensed person who is at least 18 (or younger if a high school graduate or in a vocational program) and has shown competency for the tasks assigned (26 TAC 558.404(c)).
A home health aide in a licensed home health agency must qualify through one of these: one year of direct care experience in a hospital or nursing facility, one year of agency experience in the last five years, a training and competency evaluation program, a competency evaluation program, nursing student status, or a nurse aide registry listing with no findings (26 TAC 558.701(a)).
A home health aide training program must total at least 75 hours, including at least 16 hours of clinical experience, with at least 16 classroom hours before clinical work, under an RN (26 TAC 558.701(d)).
The aide competency evaluation must be done by an RN, with skills such as vital signs, hygiene, transfers, and range of motion observed in person (26 TAC 558.701(f)).
Unlicensed staff in personal assistance services may do gastrostomy tube feedings only after completing the required training and competency program, and trainer competency must be re-evaluated every year (26 TAC 558.404(h)).
Staff serving pediatric clients must be instructed in and show competency in pediatric care (26 TAC 558.245(b)(9)).

Health screening

The agency's infection control policies must ensure staff comply with state communicable disease law, the OSHA bloodborne pathogens standard, and state rules on preventing HIV and hepatitis B transmission (26 TAC 558.285).

Also in the personnel file

Personnel records must include a signed job description, the application, verification of licenses, permits, references, experience, and education, and performance evaluations and discipline (26 TAC 558.246(a)).
Agencies must evaluate employee performance every year (26 TAC 558.245(b)(6)).
Direct care staff must sign a statement that they have read, understand, and will follow agency policies (26 TAC 558.245(b)(10)).
Personal assistance agencies must have a written supervision policy that considers client or family input on how often supervision happens, and supervisors must be licensed nurses or have two years of college or substituted supervisory experience (26 TAC 558.404(g)).

Common questions

What background checks do home care aides need in Texas?

For unlicensed applicants and employees who will have face-to-face client contact, the agency must run a criminal history check under Texas Health and Safety Code Chapter 250, may not hire anyone with a barring conviction under Section 250.006, and must document its review of any other conviction (26 TAC 558.247(a)(1)-(2)).

How much training do home care aides need in Texas?

Agency staffing policies must require orientation, job-specific training, a demonstration of competency when education, license, or experience does not show it, and a continuing training program for all staff (26 TAC 558.245(b)(1)-(2)).

What health screening do home care workers in Texas need?

The agency's infection control policies must ensure staff comply with state communicable disease law, the OSHA bloodborne pathogens standard, and state rules on preventing HIV and hepatitis B transmission (26 TAC 558.285).

Which license does a home care agency need in Texas?

A home and community support services agency (HCSSA) is anyone who provides home health, hospice, or personal assistance services for pay in a client's residence or similar setting, and it needs a license from the Health and Human Services Commission before admitting clients (26 TAC 558.2(48); 558.11(a)).

Some rules for Texas 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.

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