Why Washington Needs More Home Care Agencies
Washington State has one of the most comprehensive developmental disabilities care systems in the country. The demand for quality home care providers continues to grow as more families choose community-based services over institutional care.
If you're considering starting a home care agency, you're entering a field where the work matters—and where the right systems can help you succeed.
Step 1: Understand DDCS Requirements
Washington's Developmental Disabilities Community Services (DDCS) program provides funding for individuals with intellectual and developmental disabilities. To become a provider, you'll need to understand:
- Service types: Community Engagement (CE), Specialized Habilitation (SH), Staff-Family Consultation
- Billing structure: Services are billed in 15-minute units
- Authorization process: Clients receive authorized units through their case managers
Before anything else, familiarize yourself with the DSHS Provider Handbook and attend a provider orientation session.
Step 2: Form Your Business Entity
Most agencies operate as an LLC (Limited Liability Company) for liability protection and tax flexibility.
Required steps:
- Choose a business name and verify availability
- File Articles of Organization with the Secretary of State
- Obtain an EIN (Employer Identification Number) from the IRS
- Register for Washington State business taxes
- Open a business bank account
Cost: Approximately $200-500 for initial filings
Step 3: Get Your Provider Number
To bill Medicaid for DDCS services, you need a provider number through ProviderOne, Washington's Medicaid payment system.
Application process:
- Complete the provider enrollment application
- Submit required documentation (business license, insurance, etc.)
- Pass background checks for all owners
- Attend mandatory provider training
- Sign the provider agreement
Timeline: 4-8 weeks for approval
Step 4: Set Up Your Operations
Before your first client, you need systems in place for:
Scheduling and Time Tracking
You'll need a way to schedule appointments, track caregiver hours, and verify visits. GPS verification and electronic visit verification (EVV) are increasingly required for compliance.
Billing and Payroll
DDCS billing is complex—15-minute units, multiple service types, authorization limits. Manual tracking leads to errors and lost revenue.
Documentation
Every visit requires documentation. Case managers and families expect transparency about what happened during each appointment.
Tip: Many new agencies start with spreadsheets but quickly outgrow them. Consider purpose-built home care software from the start.
Step 5: Ensure Compliance
Washington has specific compliance requirements for DDCS providers:
HIPAA Compliance
As a healthcare provider, you must protect client health information. This includes:
- Secure data storage (encrypted, access-controlled)
- Staff training on privacy requirements
- Business associate agreements with vendors
- Incident response procedures
EVV Requirements
Electronic Visit Verification captures the date, time, location, and caregiver for each visit. Washington is implementing EVV requirements aligned with the 21st Century Cures Act.
Background Checks
All staff providing direct care must pass:
- Washington State Patrol background check
- DSHS background check
- National Sex Offender Registry check
Step 6: Hire and Train Caregivers
Your caregivers are your agency's most important asset. Quality care starts with quality hiring.
Hiring Best Practices
- Screen for compassion and reliability, not just experience
- Conduct thorough interviews with scenario-based questions
- Check references—actually call them
- Start with a probationary period
Training Requirements
Washington requires specific training for DDCS caregivers:
- 75 hours of basic training (can be completed on the job)
- CPR and First Aid certification
- Specialized training for specific client needs
- Annual continuing education
Retention Strategies
Caregiver turnover is one of the biggest challenges in home care. Reduce turnover by:
- Paying competitive wages
- Offering consistent schedules
- Providing recognition and appreciation
- Creating clear paths for advancement
- Using tools that reduce administrative burden
Step 7: Find Your First Clients
New agencies often struggle to find their first clients. Here's how to build your caseload:
Build Relationships with Case Managers
Case managers are the gatekeepers. They refer clients to agencies and monitor service quality. Build trust by:
- Attending provider meetings and training events
- Being responsive and transparent
- Following through on commitments
- Making their job easier, not harder
Leverage Your Network
Many agencies start with clients they already know—family members, community connections, referrals from existing relationships.
Differentiate on Quality
In a competitive market, quality stands out. Agencies that provide:
- Real-time family updates
- Transparent documentation
- Reliable, consistent caregivers
- Modern technology
...attract more referrals from case managers and families.
Step 8: Grow With Systems
The agencies that scale successfully are the ones that build systems early.
What to Systematize
- Onboarding: Standardized process for new clients and staff
- Scheduling: Automated matching of caregivers to clients
- Billing: Automatic calculation of billable units
- Compliance: Built-in checks for authorization limits and documentation
- Reporting: One-click reports for DSHS and case managers
When to Invest in Software
Many agencies wait too long to adopt proper software. Signs you've outgrown spreadsheets:
- Billing errors and missed revenue
- Scheduling conflicts and double-bookings
- Compliance gaps discovered in audits
- Caregivers frustrated with paperwork
- Families asking for more visibility
Common Mistakes to Avoid
Underpricing services: Medicaid rates are set, but don't underestimate your operational costs. Build a sustainable business model.
Hiring too fast: One bad caregiver can damage your reputation. Hire carefully, even when demand is high.
Neglecting compliance: A compliance violation can shut you down. Build it into your operations from day one.
Ignoring technology: Manual processes don't scale. The time you save with good software pays for itself.
Forgetting families: Case managers refer clients, but families choose agencies. Make family communication a priority.
Ready to Start?
Starting a home care agency is challenging, but the work matters. Every day, you'll help individuals with disabilities live fuller lives in their communities. You'll give families peace of mind. You'll create jobs for caregivers who want to make a difference.
If you're ready to take the next step, here's what we recommend:
- Download our free startup kit with checklists and templates
- Talk to existing providers about their experience
- Explore software options that can support your growth
CareCade was built by someone who understands both sides of home care—as a father and as a provider. We'd love to help you be there for the families who need you.