Texas’s Home Care Business Is Booming: County-by-County Growth And Where New Entrants Can Win

Texas’s non-medical home care market has expanded sharply over the past six years, and the numbers show a sustained, compounding trend. New agency formation climbed from 191 in 2019–2020 to 311 in 2020–2021, 348 in 2021–2022, 517 in 2022–2023, 644 in 2023–2024, and reached 679 in 2024–2025. In other words, Texas added more new agencies every single year, with a near 3.6x increase from 2019–2020 to 2024–2025. But the growth is not evenly distributed: it is concentrated in a handful of counties—led by Harris, Dallas, Fort Bend, Tarrant, and Collin—whose shares collectively shape where competition and opportunity are highest.

Harris County Anchors Expansion

Across four consecutive years, Harris consistently accounts for roughly one-fifth of new agencies: 20.40% in 2021–2022, 22.24% in 2022–2023, 21.74% in 2023–2024, and 19.35% in 2024–2025. Put differently, in 2024–2025 nearly one in five of the state’s 679 new agencies are in greater Houston.

By comparison, Dallas County holds a steady second position, contributing 10.06% in 2021–2022, 11.22% in 2022–2023, about 11% in 2023–2024, and 11.73% in 2024–2025. Fort Bend has surged as an affluent suburban hub: 11.21% in 2021–2022, 10.83% in 2022–2023, then a leap to 13.20% in 2023–2024 and 12.17% in 2024–2025.

Together, these three counties—Harris, Dallas, and Fort Bend—represent well over 40% of the most recent year’s new entrants, indicating both deep demand and heightening competition.

Suburban Diffusion

DFW’s spillover appears clearly in Tarrant and Collin. Tarrant accounts for 5.75% in 2021–2022, 9.09% in 2022–2023, 8.85% in 2023–2024, and 9.38% in 2024–2025, while Collin posts 5.17% in 2021–2022, 7.16% in 2022–2023, 4.66% in 2023–2024, and 8.36% in 2024–2025. These swings reflect suburban diffusion and private-pay growth just outside the urban core, where families expect premium service, rapid callbacks, and caregiver fit.

South Texas and coastal hubs contribute meaningful shares as well, led by Hidalgo County—7.47% in 2021–2022, 5.61% in 2022–2023, 2.95% in 2023–2024, and 3.23% in 2024–2025—alongside Cameron, Nueces, and border markets like Webb. In these counties, bilingual intake and payer fluency often determine whether inquiries become starts of care.

Even outside the headline metros, smaller suburban and exurban rings show steady traction. Williamson posts 1.44% in 2021–2022, 1.16% in 2022–2023, 1.40% in 2023–2024, and 2.05% in 2024–2025, signaling North Austin’s private-pay expansion. Montgomery reaches 1.35% in 2021–2022, 2.02% in 2023–2024, and 1.91% in 2024–2025, mirroring growth around The Woodlands. These counties may represent fewer agencies in absolute terms, but their higher-income demographics and predictable scheduling opportunities create compelling economics for well-run operators.

What Does This Mean for Operators?

What this data means for operators is straightforward: demand is rising and clustering. In 2024–2025, Harris (~19%), Dallas (~12%), and Fort Bend (~12%) are the most concentrated hot spots, followed by Tarrant (~9%) and Collin (~8%), with meaningful activity across Bexar, Hidalgo, and suburban rings like Williamson and Montgomery. New entrants can absolutely win—but they must align their playbooks to county-level realities.

Data-Driven Strategies To Win

• Harris and Dallas (dense, high-volume metros): Speed-to-assessment and referrer-grade documentation are table stakes. Aim for sub-15-minute callback SLAs and same-day or next-day assessments; close the loop with concise outcome notes that make case managers look good.

• Fort Bend and Collin (affluent suburban rings): Premium experience over price. Systematize caregiver matching, care plan clarity, and proactive family updates; use reviews and medically literate content to capture high-intent private-pay search.

• Tarrant (DFW spillover): Win cost-effectively with local SEO—neighborhood-specific service pages, tuned Google Business Profiles, and fresh reviews that highlight responsiveness and fit.

• South Texas hubs like Hidalgo, plus coastal/border markets (Cameron, Nueces, Webb): Bilingual intake, discharge planner relationships, and payer fluency (MA, Medicaid waivers) are decisive differentiators.

Operator Playbook: Turn County-Level Demand Into Throughput

• Easy Intake: Use structured forms to capture diagnosis, schedule, budget window, and language preferences so assessments start with complete context. Ensure that this information is readily accessible to you and your team: nothing breaks client trust early like asking them the same question three times during intake. (Sound familiar? Check out Sage).

• Referral Ops: Map discharging hospitals and senior living communities in your top counties; establish weekly outreach, monthly in-services, and quarterly outcome briefs that quantify response times, assessment throughput, caregiver reliability, and client satisfaction. See here for more on building a referral strategy.

• Private-Pay Growth: Build county-specific pages—“Post-Surgery Home Care — Fort Bend,” “Dementia Care — Collin,” “Bilingual Home Care — Hidalgo”—and maintain review velocity that mentions speed, clarity, and caregiver fit.

Why Workflow Automation Matters In Concentrated Markets

As more agencies crowd into Harris, Dallas, Fort Bend, Tarrant, and Collin, the constraint shifts from lead availability to operational throughput. The silent killers of conversion—missed callbacks, incomplete notes, delayed scheduling, inconsistent family follow-ups—compound quickly in busy counties, giving your competitors a foot in the door. Automating call summaries, intake routing, pre-compiled assessment notes, and 24-hour visit recaps reduces leakage and raises inquiry-to-start conversion. In short, moving faster with fewer errors becomes your moat.

The Bottom line

Texas has added more home care agencies every year for six straight years, culminating in a huge 679 new agencies in 2024–2025. The growth is concentrated—Harris near 19–22% over recent years, Dallas around 10–12%, Fort Bend 11–13%, Tarrant 6–9%, and Collin 5–8%—with notable momentum in South Texas and suburban rings. New entrants that tune their operations to county-level expectations and invest in workflow automation will convert clustered demand into durable, profitable growth.

Are you a new home care business trying to grow your client census? Sage is built for home care operators, by home care operators to help you grow your business. Schedule a demo to learn more.