How to Start a Home Care Agency in Delaware
Your complete 2026 guide to launching a home care business in Delaware, from DHCQ licensing and personal attendant agency registration to navigating the First State's business-friendly environment and high-density aging market.
Published April 4, 2026 · 25 min read
TLDR — Delaware at a Glance
Yes — DHSS/DHCQ registration or license mandatory (Personal Attendant for non-medical, Home Health Agency for skilled).
Division of Health Care Quality (DHCQ) under DHSS
$35,000 – $80,000 (non-medical)
$120,000 – $280,000+ (home health)
2 – 4 months (non-medical) | 6 – 12 months (home health)
$15.00/hr (2026)
Sandata — open model (free Sandata or own system feeding to Sandata)
Moderate overall; higher in New Castle County (Philadelphia proximity)
1Delaware Market Overview
A small, high-density state with proximity to the Philadelphia metro area
Delaware is a compact but strategically positioned home care market with approximately 990,000 residents spread across just three counties. Despite being the second-smallest state by area, Delaware's high population density, rapidly aging demographics, and proximity to the Philadelphia metropolitan area create meaningful demand for home care services. Starting a home care agency in Delaware means entering a market where personal relationships matter, regulatory navigation is straightforward, and the state's business-friendly reputation as THE incorporation state provides unique advantages for new business owners.
Delaware's home care demand is driven by its rapidly aging population and growing retiree influx, particularly to the southern beach communities. Approximately 19% of Delaware residents are 65 or older, above the national average, and this percentage continues to grow as retirees from the Philadelphia, Baltimore, and Washington D.C. metro areas relocate to Delaware for its favorable tax climate. The state has no sales tax and does not tax Social Security benefits, making it attractive to seniors on fixed incomes.
Regional Market Breakdown
New Castle County (Wilmington / Newark)
The most populated county with over 570,000 residents, containing Wilmington (the state's largest city), Newark, and suburban communities. New Castle County benefits from proximity to Philadelphia, creating a spillover market for home care services. Major hospitals, corporate employers, and a dense senior population make this the primary market for home care agencies. Higher cost of living than southern Delaware but also higher private pay rates and stronger referral networks.
Kent County (Dover)
The state capital region with approximately 185,000 residents. Dover is home to Bayhealth Medical Center, Dover Air Force Base (creating a military retiree population), and Delaware State University. Kent County offers a more affordable operating environment than New Castle County with moderate competition among home care agencies. The state government presence creates stable employment and healthcare infrastructure.
Sussex County (Rehoboth Beach / Georgetown)
Delaware's fastest-growing county with approximately 235,000 residents, driven by retiree migration to the beach communities of Rehoboth Beach, Lewes, Bethany Beach, and surrounding areas. Sussex County has the highest percentage of seniors in the state and a rapidly expanding need for home care services. Beebe Healthcare is the primary health system. Lower competition and growing demand make this an attractive market for new agencies.
Philadelphia Spillover Market
Delaware's northern border sits directly adjacent to the Philadelphia metro area. Many Delaware residents in New Castle County work in Philadelphia, and the healthcare networks overlap. This proximity creates referral opportunities from Philadelphia-area hospitals and physician offices. Agencies in northern Delaware can potentially serve clients who are transitioning from Philadelphia-area hospitals back to their Delaware homes, expanding the effective market beyond the state's small population.
Why Start a Home Care Agency in Delaware
2Home Care vs. Home Health in Delaware
Personal Attendant Agency (non-medical) vs. Home Health Agency (skilled) DHSS pathways
This is the most important decision you will make. In Delaware, the Department of Health and Social Services (DHSS) oversees both non-medical and skilled home care agencies through the Division of Health Care Quality (DHCQ). Personal attendant agencies and nurse registries provide non-medical personal care with lighter registration requirements, while Home Health Agencies provide skilled nursing and therapy services and require full DHCQ licensure with on-site survey and more extensive compliance.
Personal Attendant Agency
- Personal care (bathing, dressing, grooming)
- Homemaker services (cleaning, laundry, meal prep)
- Companion care and socialization
- Medication reminders (not administration)
- Transportation and errands
- Light housekeeping and nutrition support
DHSS personal attendant agency registration required
Lighter registration process for non-medical services.
Home Health Agency
- Skilled nursing care
- Physical, occupational, and speech therapy
- Wound care and injections
- Medical social services
- Home health aide services
- Medication administration
Full DHCQ Home Health Agency license required
Plus Medicare certification for Medicare billing.
3Business Formation in Delaware
Incorporate in THE incorporation state
Choose Your Business Structure
Most Delaware home care agencies register as an LLC for liability protection and tax flexibility. Delaware is widely regarded as THE best state for incorporation in the United States, with over 60% of Fortune 500 companies incorporated here. LLC formation costs just $90 through the Division of Corporations. LLCs pay a flat $300 annual franchise tax. The Delaware Court of Chancery provides a specialized business court with predictable case law.
Register with the Division of Corporations
File your Certificate of Formation (LLC) or Certificate of Incorporation with the Delaware Division of Corporations at corp.delaware.gov. Filing can be done online with same-day or 24-hour expedited processing available. Delaware's Division of Corporations is one of the most efficient in the nation, handling over 1 million business entities. You will also need a registered agent with a physical Delaware address.
DE Division of CorporationsObtain Your EIN
Apply for a free Employer Identification Number (EIN) from the IRS at irs.gov. You need this for bank accounts, payroll, and tax filings. It takes minutes to obtain online.
Register with Delaware Division of Revenue
Register your business with the Delaware Division of Revenue for the gross receipts tax and employer withholding. Delaware has no sales tax, but it does impose a gross receipts tax on business revenue. Home care services fall under the "services" category with applicable rates. Register online through the Division of Revenue One Stop portal for streamlined business registration.
DE Division of RevenueRegister for Unemployment Insurance
Register with the Delaware Department of Labor for unemployment insurance. All Delaware employers must carry unemployment insurance. The Department of Labor also administers Delaware JobLink, the state's online job matching system, which can help you find and recruit caregivers throughout the state.
DE Dept. of LaborWilmington Business License (If Applicable)
If your agency will operate within the City of Wilmington, you must obtain a Wilmington business license and register for the Wilmington Wage Tax (1.25% on employee wages). Other municipalities in Delaware generally do not impose local business taxes or licenses, making Wilmington the primary exception. Check with your local jurisdiction for any specific requirements.
Open a Business Bank Account
Open a dedicated business checking account to separate personal and business finances. You will need your EIN, Certificate of Formation, and any applicable business permits. Delaware has many community banks and credit unions, and the state's strong banking industry (Wilmington is a major banking center) provides numerous options for small business accounts.
Delaware business formation advantage: Delaware's $90 LLC filing fee is among the lowest in the nation, and the flat $300 annual franchise tax for LLCs is straightforward. Delaware has no sales tax, but does impose a gross receipts tax on business revenue (rates vary by business category). The state also has no state income tax on out-of-state revenue, which is why so many companies incorporate here. For a home care agency operating locally, the primary tax obligations are the gross receipts tax, state income tax withholding for employees, and the Wilmington Wage Tax (1.25%) if operating in Wilmington.
4Licensing Requirements
DHCQ under DHSS requires registration or licensure for home care agencies
Personal Attendant Agency — DHSS Registration
Delaware requires non-medical home care agencies to register as a personal attendant agency or nurse registry through the Delaware Department of Health and Social Services (DHSS). This registration pathway has lighter requirements than full Home Health Agency licensure but ensures consumer protection and quality standards. The registration process includes:
- Submit personal attendant agency registration application to DHSS
- Complete SBI background checks for all owners and operators
- Develop and submit required policies and procedures
- Provide proof of workers' compensation insurance
- Designate a qualified administrator for the agency
- Maintain ongoing compliance with DHSS regulations and reporting
Home Health Agency — Full DHCQ License
If you plan to provide skilled nursing, physical therapy, or other medical services, you must obtain a full Home Health Agency license from DHCQ under DHSS. This licensure pathway is significantly more rigorous than personal attendant agency registration and involves:
- Submit Home Health Agency license application to DHCQ
- Pass an on-site survey/inspection by DHCQ surveyors
- Designate a qualified clinical director (RN or qualified healthcare professional)
- Employ or contract with licensed nursing and therapy staff
- Maintain comprehensive quality assurance programs
- Comply with all DHCQ regulations and Delaware public health code
Medicare Certification
Medicare certification is a separate process from state licensure. To bill Medicare, you must apply through the Centers for Medicare & Medicaid Services (CMS), pass a federal survey, and meet all Medicare Conditions of Participation. In Delaware, the survey process runs through DHCQ, which serves as the state survey agency for CMS. Delaware's senior population, with approximately 19% of residents aged 65 or older, makes Medicare certification particularly valuable for agencies serving the state's aging demographic.
SBI background checks: Delaware uses the State Bureau of Identification (SBI) under the Delaware State Police for fingerprint-based criminal history background checks. Background checks are required for home care agency owners, operators, and caregivers. Checks can be submitted through approved livescan vendors located throughout the state, with processing typically taking 5 to 10 business days. Both state (SBI) and federal (FBI) checks may be required depending on the position and the type of agency license.
5Insurance Requirements
Workers' comp required for all employers, plus Healthy Delaware Families Act
General Liability
$2,200 - $5,500/yrCovers bodily injury and property damage claims. Recommended minimum: $1M per occurrence / $2M aggregate. Delaware premiums are moderate compared to neighboring states like Pennsylvania and New Jersey.
Professional Liability (E&O)
$1,800 - $4,500/yrCovers errors, omissions, and negligence claims related to care services. Essential for any home care business. Delaware's court system is generally business-friendly, but professional liability coverage remains critical for protecting your agency.
Workers' Compensation
$3,000 - $9,000/yrDelaware requires workers' compensation for ALL employers. The Delaware Office of Workers' Compensation administers the program. This is also a DHSS registration/licensing requirement for home care agencies. Rates are moderate compared to neighboring northeastern states.
Healthy Delaware Families Act
Employer/employee shared contributionThe Healthy Delaware Families Act provides paid family and medical leave benefits beginning January 2026. Employers with 10 or more employees must participate, with contributions shared between employers and employees. The program provides up to 12 weeks of paid parental leave and 6 weeks of other family/medical leave. Plan for this new compliance requirement in your operations.
Workers' comp is mandatory for all employers. Delaware requires workers' compensation insurance for every employer. The Delaware Office of Workers' Compensation enforces this requirement. DHSS also requires proof of workers' comp coverage as part of the home care agency registration and licensing process. Non-compliance can result in significant penalties and fines. Additionally, the Healthy Delaware Families Act beginning in January 2026 adds a new paid leave mandate that agencies must plan for in their benefits and payroll administration.
6Staffing and Hiring in Delaware
$15.00/hr minimum wage, SBI background checks, Delaware JobLink, workforce development
Delaware's labor market for home care workers is competitive, particularly in New Castle County where agencies compete with Philadelphia-area employers for caregivers. The state's minimum wage of $15.00/hour (2026) is a meaningful factor since labor is the largest ongoing cost for home care agencies. Combined with mandatory overtime after 40 hours per week and the new Healthy Delaware Families Act paid leave program, Delaware home care agencies must plan carefully for total labor costs. However, the state's community colleges and workforce development programs through Delaware JobLink provide a solid pipeline for caregiver recruitment.
SBI Background Checks
Delaware requires State Bureau of Identification (SBI) background checks through the Delaware State Police for home care workers. Fingerprint-based criminal history checks are processed through approved livescan vendors. Both state and federal (FBI) checks may be required. Processing typically takes 5 to 10 business days. The SBI also maintains the Delaware Adult Abuse Registry, which must be checked for all prospective home care employees.
Delaware State Police (SBI)Training Requirements
For home health aides working under a Home Health Agency, federal requirements mandate 75 hours of training including 16 hours of supervised clinical practice. Non-medical personal care aides under personal attendant agencies should receive thorough initial training covering ADLs, safety protocols, infection control, emergency procedures, and Delaware-specific labor law requirements including the Healthy Delaware Families Act and Wilmington Wage Tax withholding (if applicable).
Where to Find Caregivers in Delaware
State workforce development system connecting employers and job seekers
CNA and healthcare training programs at campuses statewide
Industry association with workforce resources and networking
Indeed, Delaware JobLink, social media, local community groups
Wages and Labor Laws in Delaware
Delaware's minimum wage is $15.00/hour (2026). To attract quality caregivers in Delaware's competitive labor market, most agencies pay between $15.50 and $20 per hour for personal care aides and $18 to $26 per hour for home health aides and CNAs. New Castle County rates skew higher due to competition from Philadelphia-area employers, while Sussex County rates are more moderate.
Delaware labor law essentials: Weekly overtime at 1.5x after 40 hours per week. Healthy Delaware Families Act provides paid family and medical leave benefits beginning January 2026 for employers with 10+ employees. Wilmington Wage Tax of 1.25% applies to wages earned in Wilmington. Home care agencies must carefully track weekly hours across all client shifts to ensure overtime compliance. The $15.00/hr minimum wage, while lower than some neighboring states, still represents a significant cost factor when combined with benefits and payroll taxes.
7Medicaid and Medicare in Delaware
DMMA Medicaid, Diamond State Health Plan, Sandata EVV (open model), HCBS waivers
Delaware Medicaid (DMMA)
Delaware's Medicaid program is administered by the Division of Medicaid and Medical Assistance (DMMA) under DHSS and operates under the Diamond State Health Plan managed care umbrella. DMMA manages home and community-based services for elderly and disabled populations through multiple programs. The Division of Services for Aging and Adults with Physical Disabilities (DSAAPD) coordinates aging services and can refer clients to home care agencies. Multiple Home and Community-Based Services (HCBS) waivers fund home care for eligible populations as an alternative to institutional care. To bill Medicaid for home care services, you must enroll as a Medicaid provider through DMMA.
Division of Medicaid and Medical Assistance (DMMA)Sandata EVV — Open Model
Delaware uses Sandata as the state-selected Electronic Visit Verification (EVV) system under an open model. This is a key advantage for Delaware agencies compared to closed-model states. Under the open model, agencies can either use the free Sandata system provided by the state or use their own EVV system that feeds data to Sandata. This gives agencies flexibility to choose EVV technology that integrates with their existing care management software while still meeting 21st Century Cures Act requirements for all Medicaid-funded personal care and home health services.
Open EVV model = vendor flexibility. Unlike closed-model states where agencies must use a specific EVV vendor, Delaware's open model lets you choose your own EVV solution as long as it feeds data to Sandata. This allows integration with your preferred care management software for a seamless workflow.
AveeCare note: AveeCare currently supports Medicaid billing and EVV compliance for Arizona (AHCCCS). If you are a Delaware home care agency seeking Medicaid reimbursement, please contact us to discuss your needs before signing up.
DE Medicaid Programs for Home Care
- Diamond State Health Plan (managed care)
- HCBS waivers for elderly and disabled populations
- DSAAPD aging services and referrals
- Delaware Choices (HCBS waiver for elderly/disabled)
Medicare Certification
To bill Medicare, your Home Health Agency must be certified by CMS. Delaware's senior population, with approximately 19% of residents aged 65 or older, makes Medicare certification valuable. Expect 3 to 6 months for the certification process after obtaining your DHCQ Home Health Agency state license. DHCQ serves as the state survey agency for CMS in Delaware.
8Startup Cost Estimator
Delaware-specific startup cost breakdown (moderate cost of living state)
Delaware costs vary by county. New Castle County (Wilmington/Newark) is the most expensive region due to proximity to Philadelphia, with higher office rents and wages. Kent County (Dover) offers moderate costs, while Sussex County has the most affordable office space but growing demand and rising prices in beach communities. Delaware's $90 LLC filing fee and no sales tax help keep formation costs low. The $15.00/hr minimum wage and mandatory workers' comp make payroll the largest ongoing cost driver.
Business Formation
$1,965 – $4,715Filing with Division of Corporations (Certificate of Formation)
Flat $300 annual franchise tax for LLCs
State business license through Division of Revenue
Required if operating within City of Wilmington
Attorney review, CPA setup, operating agreement
Licensing
$9,710 – $24,050Non-medical home care agency registration fee
Per person; fingerprint-based through Delaware State Bureau of Identification
If offering skilled nursing/therapy services
Survey prep, policies, consulting (if pursuing Medicare)
Insurance (Annual)
$7,400 – $20,200$1M per occurrence / $2M aggregate
Errors and omissions coverage
Required for ALL employers in Delaware
Recommended for client trust and protection
Office & Equipment
$3,900 – $13,700Varies by county; New Castle County highest, Sussex County more affordable
Laptops, smartphones, scheduling software
Desk, chairs, printer, supplies
Marketing & Initial Growth
$2,850 – $10,500Professional site with local SEO for Delaware market
Google Ads, social media, community outreach
Brochures, flyers, referral materials
Working Capital (3-6 Months)
$13,000 – $39,000DE wages ($15.50-$20/hr avg), OT after 40 hrs
Rent, utilities, software, fuel, insurance premiums
Estimated Total Startup Cost (All Categories)
$38,825 – $112,165
Costs are estimates based on typical Delaware home care agency startups and vary by county. New Castle County is at the high end; Sussex County is more affordable outside beach areas. Workers' comp, payroll ($15.00/hr minimum), and office space are the biggest ongoing cost drivers. Delaware's $90 LLC fee and no sales tax help keep initial formation costs low.
9Compliance Checklist
Track your progress across all Delaware requirements
Business Formation
0/7Licensing
0/6Insurance
0/5Staffing
0/5Medicaid & Medicare
0/3Operations
0/5Marketing
0/510Building Your Referral Network
Key referral sources in Delaware for your home care agency
In Delaware, building strong relationships with the state's health systems, DSAAPD, the Delaware Association for Home and Community Care, and Area Agencies on Aging is essential for growing your client base. Delaware's small size means personal relationships with discharge planners, social workers, and community organizations carry tremendous weight. You can realistically build face-to-face relationships with every major referral source in the state within your first few months of operation.
ChristianaCare
ChristianaCare is Delaware's largest health system, operating Christiana Hospital and Wilmington Hospital in New Castle County. Their extensive network of physician practices, outpatient facilities, and post-acute care services makes them the most significant referral source for home care agencies in northern Delaware. Discharge planners and case managers coordinate patient transitions to home care services. Building relationships at ChristianaCare is essential for any agency serving New Castle County.
Bayhealth Medical Center
Bayhealth is the major health system in Kent County, operating hospitals in Dover and Milford. As the primary healthcare provider for central Delaware, Bayhealth's discharge planning and social work teams are key referral sources for agencies serving the Dover area. Their growing network of outpatient services and physician practices creates additional referral opportunities throughout Kent County.
Beebe Healthcare
Beebe Healthcare is the primary health system for Sussex County, operating a medical center in Lewes and outpatient facilities throughout southern Delaware. With Sussex County's rapidly growing senior population driven by retiree migration to the beach communities, Beebe is becoming an increasingly important referral source. Their geriatric services and community health programs connect directly with seniors needing home care.
DSAAPD
The Division of Services for Aging and Adults with Physical Disabilities (DSAAPD) is Delaware's state agency coordinating services for seniors and adults with disabilities. DSAAPD manages aging services, administers Older Americans Act programs, and connects individuals with home and community-based services. Building a relationship with DSAAPD is essential for agencies seeking state-funded and Medicaid referrals.
Delaware Area Agencies on Aging (AAAs)
Delaware has multiple Area Agency on Aging regions covering the state. AAAs serve as local hubs connecting seniors with home care resources, administer Older Americans Act programs, provide information and referral services, and manage aging programs. Each AAA can direct seniors and families to registered home care agencies in their region, making them a valuable grassroots referral source.
Delaware Association for Home and Community Care
The Delaware Association for Home and Community Care is the leading industry trade association for home care providers in the state. Membership provides networking opportunities, advocacy, education, regulatory updates, and referral connections. In a small state like Delaware, association membership is particularly valuable because it puts you in direct contact with every major player in the home care ecosystem.
Manage patient inquiries and referrals across Delaware with AveeCare
Small state advantage: Delaware's compact size means you can build personal relationships with every major health system, DSAAPD office, and AAA in the state within your first few months. In a state of 990,000 people with only 3 counties, word-of-mouth and personal reputation are powerful differentiators. Attend Delaware Association for Home and Community Care events to quickly establish your presence in the industry.
11Marketing and Client Acquisition
How to advertise your home care business and acquire clients in Delaware
Marketing a home care agency in Delaware requires a blend of digital marketing, community outreach, and healthcare referral relationship building. Delaware's small size is a significant marketing advantage: you can realistically become a known name in the entire state's home care market within your first year. Personal relationships matter more here than in larger states, and word-of-mouth referrals carry outsized weight in a community where everyone is connected.
Digital Marketing Strategies
Google Ads
Run targeted Google Ads campaigns for keywords like "home care agency Wilmington", "in-home care Delaware", and "senior care services Dover". Delaware's small market means lower cost-per-click than larger metro areas. Target each county separately with tailored ad copy. Consider geo-targeting the Philadelphia spillover market for New Castle County campaigns.
SEO and Content Marketing
Build a professional website optimized for local search terms in Wilmington, Dover, Newark, and Sussex County beach communities. Create content about home care topics relevant to Delaware seniors, such as aging in place in Delaware, Delaware senior resources, and navigating DSAAPD services. Local SEO is especially powerful in a small state with less competition.
Google Business Profile
Set up and optimize a Google Business Profile for your Delaware home care agency. This is critical for appearing in local search results and Google Maps. Encourage satisfied clients and families to leave reviews. In Delaware's small market, even a handful of positive reviews can significantly differentiate your agency from competitors.
Online Reputation Management
Actively manage your online reviews on Google, Yelp, and home care directories. Respond professionally to all reviews, both positive and negative. In a state as small as Delaware, your online reputation will be checked by virtually every potential client and family member before they reach out. Maintain a minimum 4.5-star rating through excellent service delivery.
Community Outreach
Visit senior centers in Wilmington, Dover, Newark, Georgetown, and the beach communities. Offer free educational presentations on aging in place, fall prevention, and caregiver resources. Delaware's tight-knit communities make in-person outreach highly effective.
Delaware has active faith communities, especially in Kent and Sussex Counties. Many churches have senior ministries and health fairs where you can connect with families seeking home care for loved ones. Sponsor church events and provide brochures for pastoral care teams.
Attend local health fairs, county events, and community gatherings throughout all three counties. Set up informational booths, offer free blood pressure screenings or health resources, and network with other healthcare providers. Delaware's small population means repeat visibility at events builds rapid name recognition.
Build relationships with DSAAPD offices and Area Agencies on Aging in each county. These organizations directly connect seniors with home care agencies and can become a steady source of referrals, particularly for Medicaid-funded services and Older Americans Act programs.
Healthcare Referral Relationships
Healthcare referrals are the highest-quality lead source for home care agencies. In Delaware, building relationships with the three major health systems is manageable and highly impactful:
ChristianaCare
Meet discharge planners and social workers at Christiana Hospital and Wilmington Hospital. Establish yourself as a reliable, responsive agency for post-acute transitions.
Bayhealth
Connect with case management teams in Dover and Milford. Dover's central location makes it ideal for agencies targeting Kent County and statewide coverage.
Beebe Healthcare
Build relationships in the Lewes/Rehoboth area where the growing retiree population creates steady demand for home care services year-round, not just seasonally.
Delaware-Specific Marketing Advantages
Acquiring Non-Medical Clients
- Target private pay families through Google Ads and local SEO
- Partner with elder law attorneys and financial planners
- Connect with DSAAPD for state-funded service referrals
- Network at senior centers and community events statewide
- Target Sussex County retiree communities for premium services
Acquiring Medical/Skilled Clients
- Build discharge planning relationships at all 3 major health systems
- Obtain Medicare certification for Medicare-funded referrals
- Enroll with DMMA as a Medicaid provider for state-funded clients
- Network with primary care physicians and specialist offices
- Connect with skilled nursing facilities for transitional care referrals
12Frequently Asked Questions
Common questions about starting a home care agency in Delaware
13Sources and Resources
Official Delaware state agency links and resources
Ready to manage your Delaware home care agency?
You do not need software on day one. But when you are ready, AveeCare starts at $6/client/month with no contracts, no mandatory demos, and a free trial. Scheduling, care plans, billing, caregiver management, real-time tracking, and alerts in one platform built for simplicity, designed to help Delaware agencies manage operations across all three counties efficiently.
Disclaimer
This guide is for informational purposes only and does not constitute legal, financial, or professional advice. While we strive to keep this information accurate and up to date, Delaware laws, regulations, fees, and requirements may change. Always verify current requirements directly with the relevant Delaware state agencies before making business decisions. Consult with a qualified attorney and accountant in Delaware before starting your home care business. AveeCare is not affiliated with the Delaware Department of Health and Social Services, the Division of Health Care Quality, the Division of Medicaid and Medical Assistance, or any Delaware state agency. Published April 4, 2026.