Starting a home care business in Nebraska in 2025 is a timely and strategic decision. With an aging population, increasing demand for in-home care services, and favorable regulatory conditions for non-medical home care providers, Nebraska offers fertile ground for building a sustainable and impactful business. Whether you’re an entrepreneur, caregiver, or healthcare professional, this guide will walk you through every essential step to start a home care business in Nebraska.

Table of Contents

  • Why Nebraska is a Growing Market for Home Care
  • Understanding the Types of Home Care (Non-Medical vs. Medical)
  • Business Structure Options in Nebraska
  • Nebraska DHHS Licensing Process
  • Medicaid Waiver Programs and HCBS
  • Background Checks, CNA Certification, and Hiring
  • Required Insurance, Contracts, and Documentation
  • Home-Based vs. Commercial Space
  • Launching With Confidence
  • Final Checklist and Resources

Why Nebraska is a Growing Market for Home Care

Nebraska’s senior population is rapidly increasing. By 2030, nearly 25% of the state’s population will be aged 65 or older. This trend is especially evident in rural counties where access to nursing homes and hospitals is limited. Seniors overwhelmingly prefer aging in place, creating a massive opportunity for home care agencies.

In addition to aging trends, Nebraska is experiencing a shortage of skilled nursing staff, pushing families to seek alternative care models such as in-home support for daily living, companionship, and safety. Urban centers like Omaha and Lincoln are growing, but rural communities have the greatest service gaps—ideal for home care startups willing to serve these areas.

Understanding the Types of Home Care (Non-Medical vs. Medical)

Before registering your business or hiring staff, you must decide which type of home care services your agency will provide. Each category has different regulatory, staffing, and billing requirements.

Non-Medical Home Care Includes:

  • Companionship and conversation
  • Assistance with bathing, grooming, and dressing
  • Meal preparation and grocery shopping
  • Light housekeeping
  • Medication reminders (not administration)

Medical Home Health Care Includes:

  • Wound care
  • IV therapy and injections
  • Rehabilitation therapy
  • Vital sign monitoring and physician-directed care

Medical services require licensing through the Nebraska DHHS and clinical oversight from an RN or physician. Most new agencies start with non-medical services, which still allow you to serve a large population without dealing with medical regulations.

Business Structure Options in Nebraska

Selecting the right legal structure for your agency ensures you’re protected from liability and set up properly for taxes and payroll.

Common Structures:

  • LLC (Limited Liability Company): Flexible, protects personal assets, and allows pass-through taxation.
  • Corporation (C-Corp or S-Corp): Offers stronger liability protection and scalability but comes with added administrative work.
  • Sole Proprietorship: Easy to start but offers no personal liability protection—generally not advised for healthcare services.

You can register your business online through the Nebraska Secretary of State website. After filing, apply for a free EIN via the IRS website to handle payroll and taxes.

Nebraska Department of Health & Human Services (DHHS) Licensing Process

All home care agencies offering personal care or medical services must be licensed by the DHHS. The process varies depending on whether your services are medical or non-medical.

Licensing Steps:

  • Download the appropriate license application from the DHHS website.
  • Submit your business structure documents, EIN, and service descriptions.
  • Prepare your operations manual, policy procedures, staff qualifications, and emergency protocols.
  • Schedule and pass a site inspection conducted by a DHHS inspector.
  • Pay the application fee (fees vary by license type).

This process may take 60–90 days, so start early. Once approved, you’ll receive your operating license and can legally begin services in the state.

Medicaid Waiver Programs and Home and Community-Based Services (HCBS)

Nebraska’s Medicaid system allows private agencies to be reimbursed for services provided to qualifying seniors and individuals with disabilities.

Popular Medicaid Programs:

  • Aged and Disabled Waiver (ADW): Supports personal care and homemaker services for qualifying individuals.
  • Home and Community-Based Services (HCBS): Offers structured support to prevent nursing home placement.

To participate, your agency must complete Medicaid provider enrollment and maintain compliance with reporting, staffing, and billing regulations. Visit dhhs.ne.gov for program-specific criteria.

Background Checks, CNA Certification, and Caregiver Hiring

Your caregivers are the face of your agency. Hiring qualified, compassionate, and vetted staff is essential to maintaining your reputation and complying with state requirements.

Minimum Requirements:

  • Pass a state and federal background check
  • Drug screening (recommended)
  • Basic life support (BLS) or CPR certification
  • CNA license for any hands-on personal care or ADL services

Where to Recruit:

  • Community colleges with CNA programs
  • Facebook groups and local job boards
  • Referral networks and caregiver agencies

Train your staff in documentation, infection control, and elder rights. Retain your best team members by offering incentives, respect, and consistent hours.

Required Insurance, Contracts, and Operational Documents

Home care businesses in Nebraska must maintain specific insurance coverage to operate legally and protect all parties.

Must-Have Policies:

  • General liability insurance – Covers property damage and third-party injury
  • Professional liability insurance – Protects against service errors
  • Workers’ compensation – Required for businesses with employees
  • Auto insurance – If caregivers transport clients

Important Documents to Prepare:

  • Client service agreements
  • Employee handbooks
  • Care plans and intake forms
  • Incident reporting templates

Work with a healthcare attorney to customize these documents and ensure state and federal compliance.

In-Home Business vs. Commercial Space in Nebraska Cities

Most home care agencies do not require a traditional storefront, but you’ll still need a designated office for licensing and client file storage. Choosing between a home office and leased space depends on your budget, growth plans, and location.

Home Office:

  • Lower startup costs
  • Ideal for single-county operations or solo providers
  • May be subject to zoning restrictions

Commercial Office:

  • Professional appearance for staff and interviews
  • Allows for expansion and team collaboration
  • More overhead and regulatory scrutiny

Agencies in Lincoln, Omaha, and Bellevue may prefer a physical office due to client expectations and higher staff volumes. For rural areas, a home base may be more practical.

Launching With Confidence: First Client, First Month, First Year Goals

Start slow and smart. Rushing into operations without a support system will lead to burnout and client dissatisfaction. Set measurable goals from the beginning to track progress.

First Client Goals:

  • Deliver perfect service
  • Collect detailed feedback and a testimonial
  • Refine intake and scheduling process

First Month Goals:

  • Onboard 2–5 new clients
  • Complete all caregiver onboarding
  • Test internal systems (billing, care notes, call tracking)

First Year Goals:

  • Serve 15–30 regular clients
  • Secure 1–2 Medicaid contracts or private partnerships
  • Break even or become profitable by month 10–12

Review goals monthly and make adjustments. Success lies in consistency, compassion, and strategic scaling.

Final Checklist + Resources

Starting a home care business in Nebraska is a rewarding venture. With the right preparation, licensing, staffing, and community connections, your agency can thrive while supporting the growing population of seniors who wish to age safely and happily in their homes.