Starting a care business in South Carolina

South Carolina has no license called assisted living. Room, board and personal care for more than 24 hours to two or more adults not related to you within the third degree requires a community residential care facility (CRCF) license under Regulation 60-84. The same license covers a two-bed house and a large building, so there is no separate small-home or adult foster care license. Even the smallest CRCF must be run by an administrator licensed by the LLR Board of Long Term Health Care Administrators. Daytime group programs for two or more unrelated adults, open 4 to 14 hours a day, need a day care facility for adults license under Regulation 60-75. The license fee is $3 per participant, but the building must meet commercial-grade rules: a monitored fire alarm, a call system and 50 square feet of activity space per participant.

Home care is split by skill level. Non-medical help with bathing, dressing, walking, eating or toileting, including referral models where you take a cut of the caregiver's fees, needs an in-home care provider license under Regulation 60-122, amended effective May 22, 2026. The license costs $1,000 to start and $800 a year to renew. Each person who signs the application must pass a drug screen and a SLED background check. Skilled nursing plus at least one other service is a home health agency. The 2023 certificate-of-need rollback left home health alone, so you need a certificate of need for each county before you can be licensed, and then you must serve every part of each county on the license. On top of that, a nationwide moratorium has barred new home health agencies from enrolling in Medicare since May 13, 2026, and SC Medicaid requires Medicare certification.

For children, the line is drawn by headcount. Caring for up to six children in your own home, counting your own and related children, means you register with DSS before the second unrelated child arrives. A license is optional at that size. At 7 to 12 children the home becomes a group child care home, which must be licensed under Regs. 114-510 to 114-519. Group homes have no separate guide; the family child care home guide explains where that line falls. From 13 children you need a child care center license. DSS issues a provisional license first and returns after you have operated with 13 or more children for 45 days. A church-run center that takes no state or federal child care money registers instead of being licensed.

Watch for a few loose ends. Health facility licensing moved from DHEC to DPH, and some statutes still use the old name. The 2024 child care law says a regular license lasts three years, while the DSS rules still say two, so ask your regional office which term your license will carry. A rewrite of the 2018 center rules was still in a Senate committee in October 2026. No DSS registration or license fee appears in the child care statute or rules. Apart from home health, the general certificate of need law now covers only nursing homes, plus hospitals until January 1, 2027, so CRCFs and adult day programs need none. DPH's 2015 guidance says it does not regulate private duty nursing.