Your Parent Wants to Stay Home. Read the Agency's License First.

By Austin Senior Advisor Care Team · September 19, 2026

The word that decides everything is on the license, not the brochure

There is no such thing as a Texas home care license. Every company that sends a person into a private home for pay holds the same kind of license, a Home and Community Support Services Agency license, and everyone in the industry calls it an HCSSA. What varies between two Austin agencies with nearly identical websites is the category printed on that license.

Under 26 Texas Administrative Code Chapter 558, the categories are personal assistance services, licensed home health services, licensed and certified home health services, and hospice services. There are two add-on designations, home dialysis and a hospice inpatient unit. That is the whole menu.

An agency can hold more than one category. Plenty of Austin agencies hold exactly one. The brochure will say something like complete care at home, every stage, one phone call. The license says which of those words are legally true, and the two documents are not always describing the same company.

This matters more in home care than anywhere else in senior care, because there is no building to look at. In assisted living you can walk the halls and form an impression. Here, a stranger arrives at your parent's door and the only thing standing between your family and a bad outcome is what the state required of the company that sent her.

Personal assistance services: the category most Austin families are actually buying

When a family says they are hiring in-home care, they almost always mean personal assistance services, or PAS. Texas defines it in rule as routine ongoing care in a residence that lets someone perform the physical functions of independent living, and it explicitly includes respite.

The list of tasks is written out. Bathing, dressing, grooming, feeding, exercising, toileting, positioning, assisting with self-administered medications, routine hair and skin care, and transfer or ambulation. That is personal care as Texas defines it. If what your parent needs is on that list, PAS is the right category and you do not need to pay for anything more clinical.

Now the part almost nobody is told on the phone. A personal assistance services agency cannot administer medication, and it cannot prefill a weekly pill organizer. Texas HHSC states this directly in its own guidance for these agencies: filling a pill box counts as medication administration, and prefilling one is not a task a registered nurse is permitted to delegate to unlicensed staff. A PAS agency does not employ a nurse to do it either.

What an attendant may do is assist with self-administration, which the rule spells out just as precisely: remind your mother it is time, open and close the container, pour out a predetermined quantity of a liquid, put the bottle back where it belongs, and help reorder from the pharmacy. The medication has to already be sorted, and your parent has to be able to direct what happens next.

So the very common Austin scenario, an adult child hiring four hours a day of help because Mom is getting confused about her pills, is the one scenario PAS cannot solve. It solves the bathing and the meals. The pills need either a family member filling the organizer, a nurse, or a different category of agency. We walked through the parallel version of this line inside a facility in who is actually allowed to hand your parent their pills.

The clinical categories, and the one a discharge planner means

Licensed home health services is the next step up. This category allows skilled nursing and therapy in the home, which means a nurse who can actually administer a medication, manage a wound, or handle an infusion. It is licensed by the state but not necessarily tied to Medicare.

Licensed and certified home health services is the Medicare-certified version. These agencies also have to meet the federal conditions of participation at 42 CFR Part 484. When an Ascension Seton or St. David's case manager tells you they are setting up home health after a discharge, this is the category they mean, and it is worth understanding exactly what you are being handed.

Medicare home health is skilled, intermittent and time-limited. A nurse or a physical therapist comes a few times a week under a physician's order, works toward goals, and then the episode ends. It is not an attendant. It will not sit with your father for six hours while you go to work, and it was never designed to. Families who assume the hospital just solved the daily-help problem discover this in week three.

Hospice services is its own category, with its own federal rules at 42 CFR Part 418 for certified agencies. If your parent is on hospice at home, the hospice agency is the one coordinating. That is a different conversation, and one we covered separately in what changes when hospice starts.

The practical version: if your parent needs twenty hours a week of hands-on help for the indefinite future, that is PAS, no physician orders it, and nobody is paying for it except your family or Texas Medicaid.

Ten minutes on the HHSC search, before the first shift

The Texas HHSC Long-term Care Provider Search at apps.hhs.texas.gov/ltcsearch is free, public, and does not require an account. It is the same tool families use to check an assisted living community, and it covers home care agencies too.

Search the agency's licensed legal name, not the name painted on the car in your parent's driveway. The two are frequently different, and the difference is not by itself suspicious. Ask the agency for its license number and legal name and then go look. An agency that hesitates at that question has told you something.

Check three things. Is the agency there at all. Which categories does the license actually carry. And is the listed place of business a real address. Texas does not allow an HCSSA to operate from a virtual office; the rule requires a permanent physical location for each place from which services are directed.

While you are in there, read the survey history the same way you would read a facility's. Most agencies have citations and most citations are procedural. We wrote a longer guide to telling a paperwork finding from a real one in how to read a Texas HHSC inspection report, and the same instincts apply. If you cannot find the agency in the search at all, that is not a database problem. That is the answer.

There is a step-by-step version of this on our verify an Austin license page.

Who is exempt, and what a private hire really costs you

Not everyone who helps an older adult at home needs a license. The exemptions are listed in Texas Health and Safety Code Chapter 142.003, and two of them come up constantly in Austin.

The first is the sole practitioner. A registered nurse, licensed vocational nurse, physical therapist, occupational therapist, speech therapist or medical social worker practicing on their own, not as an agency, does not need an HCSSA license. Neither does a physician making occasional home visits in place of an office appointment.

The second is a person employed by the consumer, or by an entity acting as the consumer's fiscal agent. That is the Medicaid self-direction route, and it is described further down.

Then there is the arrangement that is not an exemption at all, because no license was ever in play: you find a caregiver through a neighborhood group or a church list and pay her directly. She is not an unlicensed agency. She is your household employee. That is legal, a great many Austin families do it, and for some of them it is the better arrangement, because it is cheaper and the relationship is real.

Just be clear about what you traded away. There is no supervising nurse or administrator above her. There is no substitute at 6 a.m. when she has the flu. There is no agency liability coverage. Nobody ran the registry checks described in the next section. And payroll taxes, workers' compensation exposure and the consequences of an injury in your parent's house are now yours. If you go this route, go into it with your eyes open rather than discovering the structure on the worst possible morning.

The background check your parent will never see

This is the part of agency care families are actually paying for, and it is invisible, so it never gets credit.

Before a licensed agency hires unlicensed personnel, and before that person has any face-to-face contact with a client, the agency must search the Nurse Aide Registry and the Employee Misconduct Registry and run a criminal history check under Chapter 250 of the Health and Safety Code. A conviction listed in Section 250.006(a) bars employment outright. So does an unfinished deferred adjudication for one of those offenses, until the court has actually discharged it.

The checks are not one-and-done. For unlicensed employees with face-to-face client contact, the agency has to re-run the registry searches at least every twelve months. The Employee Misconduct Registry exists under Chapter 253 of the Health and Safety Code specifically so that unlicensed staff with substantiated findings of abuse, neglect, exploitation or misappropriation cannot be hired anywhere else in the regulated system.

Ask the agency three plain questions: who ran the check, when, and do you re-run it every year. A licensed agency answers in one sentence because it is a routine part of their file. Note also that the screening applies to whoever actually shows up. If an agency subcontracts or sends a last-minute fill-in, ask whether that person went through the same process.

If something does go wrong, there are two numbers and they are not interchangeable. Adult Protective Services at 1-800-252-5400 handles abuse and neglect in community settings, including a private home. HHSC Complaint and Incident Intake at 1-800-458-9858 handles licensed providers, which the agency is. When the allegation involves an agency employee in your parent's home, both apply, and the agency itself is required by rule to report it to both within 24 hours. Our reporting abuse in Texas page has the rest.

What it costs, and what Medicaid changes

The 2025 CareScout Cost of Care Survey puts the Texas statewide median for a non-medical in-home caregiver at $30 an hour, which CareScout converts to roughly $5,720 a month at its standard full-time assumption. The national median is $35.

That is a Texas figure, not an Austin figure, and the distinction is not pedantic. CareScout publishes state medians and does not publish an Austin metro table. Austin's labor market runs hot and local quotes generally land above the state median. Anyone who tells you the Austin hourly rate with a decimal point is estimating, not citing. Ask three agencies for their actual current rate and you will know more than any published number can tell you. The full set of Texas medians is on our what senior care costs page.

Medicaid changes the arithmetic entirely. STAR+PLUS covers personal attendant services in the home, which is the point of the program, but the waiver side runs on an interest list rather than an application queue. We explained the difference in why there is still a wait, and the program itself is laid out on our STAR+PLUS page. Call 2-1-1 to get a name on the list; there is no cost and no reason to wait until it is urgent.

For families already in STAR+PLUS, the Consumer Directed Services option is the one most people have never heard of. Under Section 8200 of the HHSC STAR+PLUS handbook, the member or their legally authorized representative becomes the employer of record and hires their own attendants, including certain relatives. They select a financial management services agency, which runs payroll, pays the employer taxes, and screens the people being hired for employment eligibility. That is the Chapter 142.003 fiscal-agent exemption working as designed.

We are not going to publish a CDS hourly rate. It is set through the managed care organization and the approved service plan, it varies by plan and region, and there is no single published Texas figure we can point you to. Your service coordinator can tell you what your parent's plan allows, and that is the only number that applies to you.

Three questions before the first shift

Which categories are on your HCSSA license, and what is the licensed legal name? Then spend ten minutes confirming it yourself. This one question filters out more bad outcomes than anything else on the list.

Who supervises this attendant, and what happens at 6 a.m. when she calls in sick? The answer reveals whether you are buying an organization or a single person with a dispatcher. Both can work. Only one of them should be priced like an agency.

Show me in writing what your attendants are not allowed to do. A well-run PAS agency has that document, because their staff needs it more than you do. Handing it over without flinching is the single best sign you have called the right place.

If you are reading this because the current arrangement has stopped working and you are the one holding it together, start with this instead. And if you want help sorting through which Austin agencies hold which categories, that is what we do, at no cost to your family. Our overview of in-home care in the Austin area is the place to start.

Talk to an Austin advisor about your situation →