How to Choose a Home Care Agency in Tennessee

The 5 things that matter most

Most decision frameworks bury the short list and walk through everything sequentially. Here it is up front. If an agency falls short on any of these five, the rest of the evaluation rarely saves them.

• License — Tennessee PSSA license for non-medical home care; CON license for skilled home health; DIDD provider agreement for ID/DD waiver work. Verify the license number on the TN Department of Health public registry.
• Screening — minimum 7-year criminal background check (10-year multi-state is the high standard), TN abuse and sex offender registry, drug screen, and TB test on every caregiver before placement. Ask for the standard in writing.
• Insurance — bonding (theft), general liability (property and injury to your loved one), and workers' compensation (caregiver injury in your home). All three should be verifiable on request.
• Supervision — clear answer about who supervises the caregiver, how often, and how concerns get reported and resolved. Look for nurse-supervised intake and at minimum monthly supervision visits.
• Continuity — community-based caregivers (working in their own neighborhood) cut turnover materially. Ask how many caregivers a typical long-running client has seen and how the agency handles call-outs.

State licensing in Tennessee — PSSA, CON, DIDD provider

Tennessee separates home care and home health into different regulatory categories. Most families don't know this until they get on the phone with an agency and find out the service they thought they wanted isn't what the agency delivers. The three licenses that matter:

• PSSA (Personal Support Services Agency) — Tennessee's license for non-medical home care: bathing, dressing, meals, supervision, light housekeeping, transportation, companionship. PSSA-licensed agencies do not provide skilled nursing or therapy. PSSA licensure is administered by the TN Department of Health and is publicly verifiable.
• CON (Certificate of Need) for home health — required to provide skilled, Medicare-billed home health: skilled nursing visits, physical therapy, occupational therapy, speech therapy under physician orders. CON-holding agencies are different from PSSAs and serve a different need (medical recovery, not ongoing personal care).
• DIDD provider agreement — required to serve adults with intellectual or developmental disabilities under TennCare ECF CHOICES, the 1915(c) Statewide HCBS waiver, or other DIDD funding. Most home care agencies do not hold this; agencies that do can serve a wider client population.

If you're hiring for non-medical care (the most common situation) you want a PSSA-licensed agency. If you're hiring after a hospital stay and Medicare is paying, you want a CON-licensed home health agency for the medical part — and possibly a PSSA-licensed home care agency for the ongoing support that home health doesn't cover. Many families end up needing both.

Background checks and screening — what to verify

The screening standard varies more than you'd expect across home care agencies. Some run only a one-state, 7-year background check; others run a 10-year multi-state, federal, and registry-screening package. The cost difference to the agency is meaningful — which means cheaper agencies sometimes cut here. Ask for the standard in writing before placement.

• Criminal background check — minimum 7 years, 10-year multi-state is the high standard. Should include the national criminal database, not just Tennessee.
• Tennessee abuse registry screening — TN's elder and vulnerable adult abuse registry plus the federal OIG List of Excluded Individuals and Entities for any Medicaid-funded care.
• Sex offender registry — TBI Tennessee Sex Offender Registry plus NSOPW (National Sex Offender Public Website).
• Drug screen — pre-placement plus random or for-cause testing during employment.
• TB screening — required for Tennessee home care employees, typically annual.
• Reference checks — at least two professional references, ideally from prior caregiving employers.

Insurance, bonding, and workers' comp — what protects you

The three insurance protections every reputable home care agency carries are bonding, general liability insurance, and workers' compensation. Together, they cover the three things that go wrong most often in home care: theft, accidental property damage or injury to your loved one, and injuries to the caregiver in your home. Without all three, you may be personally liable when something happens.

• Bonding (commonly $5,000 to $50,000 in coverage) — covers theft of personal property by the caregiver. If a watch or piece of jewelry goes missing, bonding is what reimburses the family. Ask for the bonding company name and the limit.
• General liability insurance (typically $1 million or more per occurrence) — covers accidental injury to your loved one or property damage. If the caregiver drops a Hoyer lift improperly and the client breaks a hip, this is what pays.
• Workers' compensation — required by Tennessee law for any employer of three or more workers. Covers injuries to the caregiver in your home (which can otherwise become a homeowner's insurance issue or a personal liability claim against your family). Watch out for 1099 caregiver arrangements that skip this.

Caregiver supervision, training, and continuity

The single biggest predictor of whether a home care assignment works long-term is caregiver continuity. The same caregiver, week after week, builds trust with your loved one and notices changes the family doesn't see. Agencies vary widely on this. Big national chains often rotate caregivers across the metro to fill open shifts; smaller, community-based agencies match caregivers to clients near where the caregiver lives, which materially reduces turnover.

• Supervision — ask how often a registered nurse or supervisor visits the home (monthly is standard), how supervision is documented, and how concerns get reported and resolved.
• Training — pre-placement training plus ongoing competencies (dementia care, safe transfers, medication observation, infection control). Ask for the training catalog.
• Caregiver continuity — ask how many caregivers a typical long-running client has seen, how call-outs are handled, and what their backup model is.
• Care planning — every assignment should start with a written care plan that names the tasks, schedule, and goals. Ask for a sample.
• Communication — how does the agency keep the family updated? Is there a care log, a family portal, or scheduled check-ins?

Community-based caregiver staffing — caregivers working in their own neighborhood — is one of the few structural differences that actually shows up in turnover data. It costs the agency more to recruit locally but reduces caregiver fatigue, no-show rates, and time-to-replacement. Ask whether the agency staffs by ZIP code or by metro area; the answer tells you a lot.

Funding pathways and pricing transparency

The cost of home care depends on the funding pathway, the hours, the level of care, and the geographic market — which is why most reputable Tennessee agencies don't publish hourly rates publicly. Pricing transparency is more about how the agency talks about cost than whether they post a number on a website.

• TennCare CHOICES — Tennessee's Medicaid HCBS program for adults 65+ or with disabilities; covers in-home personal care for eligible members. Agency must be MCO-credentialed (BlueCare TN, UHC Community Plan, or Wellpoint).
• DIDD ECF CHOICES — Tennessee Medicaid HCBS for adults with intellectual or developmental disabilities. Requires a DIDD provider agreement.
• VA Community Care — home care for eligible veterans through TriWest. Agency must be in the VA network.
• OPTIONS for Community Living — Tennessee's state-funded program for older adults who don't qualify for Medicaid. Administered through the Area Agencies on Aging.
• Long-term care insurance — most policies cover in-home care; the agency files reimbursement directly in many cases.
• Private pay — direct billing, fastest start, no eligibility constraints. Ask the agency how they handle billing, payment cadence, and rate adjustments.

Questions to ask during the consultation

Most home care agencies offer a free in-home assessment before contracting. Use it. The questions below are the ones families wish they'd asked before signing.

• What's your TN PSSA (or CON or DIDD) license number, and where can I verify it?
• What's your background check standard? Can you put it in writing?
• Are your caregivers W-2 employees or 1099 contractors?
• Do you carry bonding, general liability, and workers' comp? What are the limits?
• How often does a registered nurse or supervisor visit the home?
• How do you handle call-outs and caregiver no-shows?
• How many caregivers does a typical long-running client see in a year?
• Will I have a written care plan? How often is it updated?
• How do you handle communication with the family?
• What happens if my loved one's needs change mid-assignment?
• How do you handle disputes or complaints?
• Are you contracted with my MCO, insurance plan, or VA program?

Red flags — when to walk away

A few patterns show up reliably in agencies that families later regret hiring. None are guarantees of bad service, but each is a meaningful signal worth weighing.

• Refuses to put credentials, screening standard, or rate structure in writing.
• Pressures you to sign before you've met a nurse, completed an in-home assessment, or seen a written care plan.
• Leads with a low introductory rate that changes at intake.
• Can't tell you whether caregivers are W-2 or 1099, or admits they're contractors.
• Vague or evasive on insurance — bonding limits, general liability carrier, workers' comp coverage.
• Bad reviews citing missed visits, caregiver no-shows, or the office not returning calls.
• High Better Business Bureau complaint volume relative to agency size.
• Caregiver turnover not addressed when you ask — answers like everyone has turnover without specifics.

Tennessee resources for verifying a home care agency

A short directory of TN-specific resources for verifying credentials and filing complaints if something goes wrong after you've started care.

• TN Department of Health Health Care Information Quality System (hciqs.health.tn.gov) — Public PSSA license verification, including complaint history and inspection results.
• TN Long-Term Care Ombudsman (tn.gov/aging/ombudsman, 877-236-0013) — Handles complaints about home care quality; can mediate disputes with agencies.
• TN Attorney General Consumer Affairs Division (tn.gov/attorneygeneral, 615-741-4737) — Handles billing disputes, contract issues, and deceptive-practices complaints.
• Better Business Bureau of the Mid-South (bbb.org) — Complaint history and accreditation status for Memphis and Jackson agencies.
• TennCare CHOICES Member Services — verifies whether an agency is contracted with your MCO; resolves authorization disputes.
• Aging Commission of the Mid-South (Memphis) and Southwest Tennessee Development District (Jackson) — Area Agencies on Aging that can recommend agencies and provide care coordinator support.