Starting a care business in Oregon

For adults who need a place to live, the dividing line is six residents. Five or fewer adults who are 65 or older or have a physical disability, living in a family home and unrelated to you, is an adult foster home. You or a resident manager must live in the house, and your license class (1, 2 or 3) depends on your hands-on care experience and decides how much help your residents may need. The state fee is $20 per non-relative bed. Local ODHS offices and Area Agencies on Aging do the licensing work, while Multnomah County runs its own Adult Care Home Program with an English test and a one-year experience requirement.

Six or more residents needs an assisted living or residential care facility license, two license types under the same rule (OAR 411-054): assisted living means private, self-contained apartments, and residential care allows shared rooms. ODHS reviews the project before you build. You file a letter of intent with a third-party market analysis before applying for a building permit, and ODHS answers in writing within 60 days. If you have never run one of these facilities in Oregon, you must hire an ODHS-approved consultant, starting a month before licensure and keeping it for six months after. Application fees run from $2,000 to $6,000 by bed count. No certificate of need applies, because ORS 442.315 covers only hospitals and skilled nursing or intermediate care facilities.

Care in the client's own home goes through OHA. Personal care with no curative or rehabilitative services is an in-home care agency license in one of four classifications, from Limited ($2,000) to Comprehensive ($3,000). Only a Comprehensive agency can enroll with ODHS to serve Medicaid clients. Skilled nursing plus at least one other service, such as therapy or home health aide visits, is a home health agency license, with a $4,000 fee, a 60-mile limit on your service area and an obligation to meet the federal Medicare rules in 42 CFR Part 484 even if you never bill Medicare. A nationwide CMS moratorium has blocked Medicare enrollment of new home health agencies since May 13, 2026.

Child care in a home needs a DELC license once you care for more than three children from more than one family, not counting your own. A Registered Family or Certified Family home can take up to 10 or 16 children, under rule books that took effect July 1, 2025, and state law (ORS 197.671) treats both as a residential use that cities and counties cannot zone out. A certified child care center operates under OAR 414-305, amended effective September 1, 2026 to require a suspension and expulsion prevention policy. DELC asks for proof that the building is zoned for child care before its pre-certification visit.

Adult day programs need no state license in Oregon. ORS 410.495 sets up an ODHS registry with voluntary standards, and ODHS certification under OAR 411-066 is required only if you want to enroll as a Medicaid adult day services provider. Several adult foster home and assisted living rules are temporary rules in force only into early 2027 (through January 27 and February 5, 2027), so check the current text with ODHS before you apply.