Starting a care business in Delaware

Child care licensing starts at one child. If you are paid to care for an unrelated child in your home and hold yourself out as a provider, you need an OCCL license; care only for listed relatives, unpaid care and nannies in the child's own home are exempt. A family child care home opens as Level I (5 or 6 children, counting your own who are not yet in kindergarten) and can move to Level II (9) only with added experience and training and OCCL's written approval. A large family child care home takes up to 12, and 13 or more children, relatives included, makes you an early care and education and school-age center. Both start on a six-month provisional license, and the fire marshal, lead-paint and radon work is paid to third parties.

On the adult residential side, size decides the license. A family care home serves 2 or 3 residents, the license holder must live there full-time, and the statutory fee is $50. Anything that calls itself assisted living needs an assisted living facility license issued for a set number of beds, and the bed count sets the leadership you must hire: a qualified director and a CNA house manager at 4 beds or fewer, a part-time licensed nursing home administrator at 5 to 24 beds, and a full-time one at 25 or more. Rest (residential) homes for adults who can mostly manage daily living have their own rule, 16 DE Admin. Code 3230, and need a licensed nursing home administrator.

Home care is split three ways, by the most medical service you offer. Companionship, homemaking and help with daily living from referred direct care workers is a personal assistance services agency license ($250 application, $100 a year). Nursing or therapy needs a skilled home health agency license ($500 application, $300 a year), and DHCQ's licensing office says its binder review takes 6 to 9 months or longer. An agency sending only aides holds a separate aide-only home health license under rule 3351 at the same fees. Both the personal assistance and skilled licenses start with a 90-day initial license, are surveyed while you are already serving clients, and limit you to the county of your Delaware office and the counties next to it.

An adult day care facility license applies once you serve 4 or more functionally impaired adults for under 12 hours a day outside anyone's home; the statute sets a $100 application fee and $50 a year, and every application needs a fire marshal compliance letter. Delaware Medicaid pays for adult day and assisted living through DSHP Plus, a mandatory managed care program.

Delaware's certificate-of-need program, the Certificate of Public Review, does not name home health agencies or assisted living facilities, though it does cover continual care communities and any long-term care facility that DHSS or the Delaware Health Care Commission identifies, so ask the Health Resources Board in writing before building an assisted living project. Two recent changes matter: a law signed July 23, 2026 added owner disclosure and change-of-ownership notice duties for long-term care facilities, and from February 27, 2027 every assisted living facility must carry $1 million per claim and $3 million aggregate in both general and professional liability coverage. Separately, CMS has frozen new Medicare home health enrollment nationwide since May 13, 2026, and a Delaware license does not get you around it.