Download the printable PDF above, or use the inline form below to help build out your policies and procedures.

Looking for other forms? Check out our full set of home care form templates here.

Home Care Policies and Procedures Manual Template

Non-medical home care. This template is a structural starting point for a policies and procedures manual. It does not satisfy licensure requirements in any state on its own.

1. Agency Overview

Establishes who you are: your mission, the services you provide, your service area, and your hours of operation.

• Agency name, mission statement, and year founded: ________________

• Services offered (list only what you actually provide): ________________

• Geographic service area, by county or zip code: ________________

• Business hours and after-hours contact procedure: ________________

• Ownership and state license number: ________________

2. Client Rights and Responsibilities

Documents the rights clients have when receiving care, and what is expected of them in return.

• Client rights: respect, participation in care planning, confidentiality, right to voice complaints without retaliation, right to refuse care

• Client responsibilities: accurate information, a safe home environment for caregivers, timely payment

• [YOUR STATE REQUIREMENT: any state-mandated client rights language or disclosure form]

3. Intake and Admission

Describes how a new client comes into your agency, from first inquiry through signed service agreement.

• Eligibility criteria for accepting a new client: ________________

• Initial inquiry and screening process: ________________

• In-home assessment process and who conducts it: ________________

• Care plan development based on the assessment: ________________

• Service agreement signed by client or representative: ________________

• [YOUR STATE REQUIREMENT: mandated assessment timeline or intake documentation]

4. Care Delivery

Covers how care is supervised once it begins, including care plan review frequency and missed visit handling.

• Caregiver supervision structure and check-in frequency: ________________

• Care plan review and update schedule: ________________

• Documentation expectations for each visit: ________________

• Missed visit or late arrival procedure and client notification: ________________

• [YOUR STATE REQUIREMENT: mandated supervisory visit frequency]

5. Caregiver Hiring

Documents your hiring process, one of the most closely reviewed sections during a licensing survey.

• Application and interview process: ________________

• Reference check process: ________________

• [YOUR STATE REQUIREMENT: background check requirements, including which registries must be checked]

• Onboarding checklist and required documentation before first shift: ________________

6. Caregiver Training

Explains how new caregivers are trained before working unsupervised and how ongoing training is tracked.

• Orientation content and length: ________________

• [YOUR STATE REQUIREMENT: minimum required initial and annual training hours]

• Ongoing training topics: infection control, body mechanics, emergency response

• Competency evaluation process: ________________

7. Scheduling and Attendance

Covers how caregivers are assigned to clients and what happens when someone cannot work a scheduled shift.

• Shift assignment process: ________________

• Call-out and no-show procedure: ________________

• Backup caregiver or coverage plan for last-minute gaps: ________________

8. Timekeeping, Pay Practices, and Overtime

Documents how hours are tracked and paid. Confirm every figure below rather than assuming it.

• Timekeeping method: manual, app-based, or EVV if state-required: ________________

• Pay schedule and pay period: ________________

• [YOUR STATE REQUIREMENT: overtime threshold and rate under your state's wage and hour law]

• [YOUR STATE REQUIREMENT: holiday pay policy, if any, and how it is calculated]

• Worker classification: confirm with a professional whether caregivers are employees or contractors under your state's rules

9. Incident Reporting and Emergency Procedures

Describes what happens when something goes wrong during a shift, from a minor incident to a medical emergency.

• Definition of a reportable incident: falls, injuries, medication errors, property damage

• Immediate steps a caregiver takes during an emergency: ________________

• Incident report form and completion timeline: ________________

• [YOUR STATE REQUIREMENT: mandatory reporting timeline to the state licensing agency, if applicable]

10. Infection Control and Universal Precautions

Covers basic hygiene and infection prevention standards expected of every caregiver.

• Handwashing and universal precautions expectations: ________________

• Personal protective equipment use, when required: ________________

• Procedure for an ill caregiver or a client with a suspected infection: ________________

11. Client Complaints and Grievance Procedure

Gives clients and families a clear, documented path to raise concerns.

• How a client or family member files a complaint: ________________

• Timeline for acknowledging and resolving complaints: ________________

• Escalation process if not resolved at the first level: ________________

• [YOUR STATE REQUIREMENT: any state ombudsman or complaint hotline you must disclose to clients]

12. Confidentiality, HIPAA, and Records Retention

Covers how client information is protected and how long records must be kept.

• Confidentiality policy for client and employee information: ________________

• HIPAA compliance basics, if your agency is a covered entity: ________________

• [YOUR STATE REQUIREMENT: minimum records retention period for client and employee files]

• Secure storage and disposal procedure for physical and digital records: ________________

13. Discharge and Termination of Services

Explains how and why services end, whether initiated by the client or the agency.

• Reasons for voluntary discharge: client moves, no longer needs services, chooses another provider

• Reasons for involuntary discharge: non-payment, safety concerns, non-compliance

• Required notice period before discharge: ________________

• Transition or referral assistance offered at discharge: ________________

14. Non-Discrimination and Equal Opportunity

States your agency's commitment to serving clients and employing staff without discrimination.

• Non-discrimination statement covering protected classes under federal and state law

• Reasonable accommodation process for clients or employees with disabilities: ________________

15. Quality Assurance and Supervisory Visits

Describes how your agency monitors the quality of care it provides on an ongoing basis.

• Frequency and format of quality assurance reviews: ________________

• Client satisfaction check-ins and how feedback is used: ________________

• [YOUR STATE REQUIREMENT: mandated supervisory visit or quality review frequency, if different from Section 4]

How to Use This Manual

Work through each section and replace the blanks with your agency's actual practices. For anything marked as a state requirement, do not guess. Go to your state's home care or personal care licensing agency website, or call them directly, to confirm the number or rule that applies to you.

Pay close attention to Section 8. Wage and hour law is where new agency owners most often run into trouble, usually without realizing it until much later. If you are unsure how to classify your caregivers or what your state's overtime rules require, a short call with an employment attorney or a payroll professional who works with home care agencies is worth the cost.

Before you submit anything for licensure, this is also a good point to make sure your intake and client record process can actually support the policies you just wrote. If your agency is still tracking inquiries on spreadsheets or in a notebook, moving to a proper CRM before you scale past your first few clients is worth doing early rather than after things get messy.

Once every blank is filled in, have someone with home care licensing experience in your state review the full document before you submit it. Many state associations or local Small Business Development Centers can point you to someone qualified to do this at low or no cost.

Revisit this manual at least once a year, and any time your state updates its home care licensing regulations.

This template is a starting structure. It does not satisfy licensure requirements in any state on its own, and nothing in it is legal or employment-law advice. State requirements for training, background checks, overtime, and records retention vary and change over time. Have your completed manual reviewed by someone familiar with your state's home care licensing requirements before relying on it.