Not every in-home care provider is the same kind of business. Here is how Texas licensing works, how to check an agency, and what to ask before you sign.
Calling the first in-home care agency you find on a search page is how many Houston families end up with a caregiver who cannot do what the parent actually needs, or with a bill that looks nothing like the quote. "In-home care" covers very different businesses under one name, and in Texas the differences are partly set by state licensing rules. This guide gives you a way to compare agencies on the things that matter, without relying on anyone's marketing.
Step one: name the kind of help you need
Agencies sell hours, but families need outcomes. Before you call anyone, write down what a typical day looks like and where it breaks down. Most needs fall into one of three groups:
- Companionship and household help. Light housekeeping, meal preparation, errands, reminders, and someone present for safety. Texas law says services that do not involve personal care, health or health-related services, such as sitter-companion and chore services, are among those that do not require a home and community support services agency license.
- Personal care. Hands-on help with bathing, dressing, toileting, eating, and moving safely. This is where licensing and caregiver training start to matter a great deal.
- Skilled care. Nursing, therapy or wound care ordered by a physician. This is a separate category of home health, usually involving a licensed nurse or therapist, and it is a different conversation from a caregiver who helps with daily living.
Many agencies offer more than one tier, but a caregiver who is fine for companionship may not be the right person for transfers from bed to chair. Matching the tier to the need is the single most useful thing you can do before comparing prices.
What a Texas license does and does not tell you
In Texas, a person who engages in the business of providing home health, hospice, habilitation or personal assistance services generally needs a home and community support services agency license from the Texas Health and Human Services Commission (HHSC) for each place of business. The statute is Chapter 142 of the Texas Health and Safety Code, and the standards for agencies licensed to provide personal assistance services appear in the Texas Administrative Code, Title 26.
That framework gives you some concrete things to verify. Under the personal assistance standards, an agency must have a written policy on supervising its personnel, and it must develop an individualized service plan that you or your parent and the agency agree to and sign. The plan must spell out the types of services, supplies and equipment, where services will happen, how often and for how long, the planned start date, and the charges if the client is paying. The agency's client file is also supposed to show that supervision visits happened and that services were delivered according to the plan. If an agency cannot show you a written plan and a written supervision approach, treat that as a signal.
Licensed agency, registry, or a caregiver you hire directly
Not every route to a caregiver goes through a licensed agency, and the exemptions in the statute explain why prices and protections vary so much:
- A licensed agency employs the caregiver and is the party the state licenses and can inspect.
- A registry can be exempt from licensing if it only connects consumers with providers, does not keep official client records, does not directly provide services, and does not pay the provider. In that arrangement the caregiver is not the registry's employee.
- A caregiver you hire and pay directly, or one hired directly by the client's family or guardian, is also outside the licensing requirement. That can cost less per hour, but you may become the employer, with responsibility for payroll, back-up coverage and supervision.
None of these is automatically wrong. A family that is comfortable managing an employee may do well with a direct hire. The point is to know which arrangement you are buying, because the answer to "who is responsible when something goes wrong" differs in each.
How to check an agency before you sign
Start with the agency's own claim, then verify it independently. Ask for the exact legal name, the license number and the license type. Then look the agency up on HHSC's Long-term Care Provider Search, the state's public lookup, and compare what you find with what the agency told you. If the names, addresses or license types do not match, ask why before going further. HHSC's search pages are an imperfect tool and do not capture everything about quality, so use them as one input rather than a verdict.
If you ever need to report suspected abuse, neglect or exploitation of an older adult, the Texas Abuse and Neglect Hotline is 1-800-458-9858. Keep that number with the care plan, whichever agency you choose.
Questions to put to every agency
Ask the same questions of at least three agencies and write down the answers. The consistency is what makes the comparison useful.
- What license do you hold, and can I see it? Then verify it yourself as described above.
- Are your caregivers your employees? Employees are typically covered by the agency's payroll and insurance arrangements; ask what those are and ask for proof of coverage rather than a verbal assurance.
- How do you screen and train caregivers? Ask what checks are done before a caregiver enters a home, what training is required, and how competency is demonstrated for tasks such as safe transfers.
- Who supervises the caregiver, and how often? The state standards expect a written supervision policy with input from the client or family on frequency. Ask who the supervisor is, whether that person is a nurse, and how you reach them after hours.
- What happens when a caregiver calls out? A missed shift is the most common failure. Ask how quickly a replacement is arranged and whether you will be told in advance.
- Will my parent see the same caregivers? Consistency matters enormously for someone with memory loss. Ask how the agency handles continuity and what you can do if a match is not working.
- What are all the charges? Ask for the full rate sheet in writing: hourly rates, minimum shift length, overnight and live-in rates, holiday and weekend differentials, mileage, and cancellation terms.
- How do you handle emergencies and hurricanes? Ask for the agency's plan for a power outage or evacuation, which matters in the Houston area. Our guide on hurricane and power-outage planning for Houston seniors covers what families should prepare on their side.
Understanding the cost without being misled
Home care is billed by the hour, and totals climb quickly with the number of hours. CareScout's Cost of Care Survey, which covers July through November 2025, reports a Texas state median of $30 an hour for a non-medical caregiver. That is a statewide figure, not a Houston figure, and prices in Greater Houston can sit above or below it depending on the agency, the care tier, shift length and the time of day. Treat it as a rough reference point and rely on written quotes from the agencies you are actually considering.
Hours drive the real cost. A few hours a day for meals and bathing is a different budget from round-the-clock supervision, and at higher hours many families compare home care against assisted living, which in the Houston area is commonly quoted in a wide range of roughly $3,200 to $7,800 a month depending on the community and level of care. Our in-home care cost guide and assisted living cost guide lay out how those comparisons work. Ask each agency whether it bills by the scheduled shift or the minute, what the minimum is, and how it charges when a shift runs long.
Who might help pay
Original Medicare generally does not cover long-term custodial help with daily living, so many families pay privately. Others use long-term care insurance, which has its own elimination periods and paperwork, or veterans benefits such as Aid and Attendance, covered in our post on Aid and Attendance for Houston-area veterans. Texas Medicaid programs for in-home help carry waiting-list realities, which we describe in the STAR+PLUS interest-list post. If you are relying on any of these, ask each agency in advance whether it accepts that payer, and get the answer in writing.
Red flags worth walking away from
- No written service plan, or a reluctance to put rates and terms in writing.
- Pressure to sign a long contract or prepay a large block of hours before you have met the caregiver.
- A license number that cannot be found, or that does not match the business name.
- Vague answers about who employs the caregiver or who is responsible for supervision.
- No plan for a missed shift and no way to reach a human after hours.
Start small, then review
Whatever you choose, begin with a trial period if the agency allows one, and set a review date. After the first two weeks, sit down with your parent and ask plainly: do you feel safe, do you like these people, and is the help matching what we agreed? Compare what happened against the written plan. If the plan no longer fits, change it. If the agency does not respond, change agencies. A good agency expects to be evaluated.
If you would like a second set of eyes while you compare options, the Houston Senior Advisor team can talk through your parent's situation at no cost to your family. Call (346) 385-3815 and ask for help sorting through in-home care and the alternatives.
Last updated October 20, 2026. This guide is general information for Greater Houston families, not medical, legal, or financial advice.
