Starting a care business in Tennessee

The Department of Human Services (TDHS) handles both child care and adult day care, and both start with its Pre-Licensure Unit. Child care needs a license once you care for five or more unrelated children for three or more hours a day. Five to seven is a family child care home, eight to 12 is a group child care home, and 13 or more is a child care center. Either route starts on a 120-day provisional license, and the continuous license follows four satisfactory monitoring visits. An adult day services center needs a license once it serves five or more unrelated adults for more than three and less than 24 hours a day; amended rules took effect on September 22, 2026.

Residential care for older adults is split by size. A home for the aged with five or fewer nonrelated residents is a Tier 1 home licensed by the Department of Disability and Aging (DDA); six or more is a Tier 2 home licensed by the Health Facilities Commission (HFC). Public Chapter 973 of 2026 moved that line from three residents, and DDA's own Tier 1 rule still says three, so a four- or five-resident operator should get DDA's position in writing. A Tier 2 home may not keep residents who need continual or daily nursing care. Those residents belong in an assisted-care living facility, which the HFC licenses after plans review and surveys, with fees from $1,040 a year.

Home care has two licenses. Hands-on or household help in clients' homes, without nursing, needs a personal support services agency (PSSA) license at any size. The Department of Mental Health and Substance Abuse Services (TDMHSAS) issues it when 50% or more of clients are older adults or people with mental illness or substance use disorders, and DDA issues it when 50% or more have an intellectual or developmental disability. Sending nurses, therapists or aides under physician orders is a home care organization providing home health services, licensed by the HFC at $1,404 a year.

Home health is the one business on this page that needs a certificate of need first, and the license covers only the counties named in it. Agencies limited to patients under 18 or to EEOICPA patients are exempt but must be accredited within two years. Assisted-care living facilities, homes for the aged and PSSAs need no certificate. Since May 13, 2026, a CMS moratorium has also blocked new home health agencies from enrolling in Medicare nationwide.

TDHS does not publish its child care license fee in the rule or on the pages we reviewed; it asks for the fee during the application. Family homes pay a $100 application fee after their fire, environmental and zoning clearances. PSSA fees are invoiced from a per-site schedule that starts at $810, so confirm the amount on your invoice.