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(DE) 302-358-2114


Delaware License Model

Delaware's Department of Health recently introduced a new home care license model: The Home Health Agency, Aide Only (HHA-AO). The aim is to get both medical expertise and oversight into non-medical homecare and to create more professional and business-like providers.

See the table below to understand the benefits of using a HHA-AO.


Like Four Seasons Healthcare

Like Most Franchises



Home Health Agency, Aide Only (HHA-AO)

Personal Assistant Services Agency (PASA)



Must have medical experience & oversight


Home Care is Healthcare so medical oversight is key


Full time RN, geriatric expertise

Not required

HHA-AO's expected to be medically-minded and to use trained caregivers supervised by an experienced healthcare professional


Bachelor's degree in a health-related field

No qualifications required

Would you trust a doctor who isn't qualified? Then why trust a Franchise Director?


Nursing Assessment: Physical, Social, Mental. Review of drug regimen

No Nursing Assessment. Physical, Social, Mental

Drug review is important to understanding side- effects

How is a non-healthcare person evaluating Physical & Mental status?


Established by an RN. Nursing Assessment, Needs Assessment, Care Plan

Established by Director who is not required to have medical expertise

TheHHA-AO's care plan is expected to be medically sound


Performed by an RN every 60 days

Supervision for PASA is only every 90 days and no RN is required

HHA-AO's medical review is of the entire dynamic. Caregiver can add input about the patient's condition that might add more insight & lead to a better care plan

New hire caregiver

75 hours of training to include instruction and practicum. Over 2 yr break training course must be repeated.

No 75-hr HHA training program requirement

Better providers use CNA's (150 hrs. of training) who have Nursing Facility experience.


Training supervised by an RN. 12 Hrs. annually. The better companies have State- approved CEU's (Continuing Education Units).

None required

CNA's are trained to spot potential problems so they can be dealt with in early stages

HHA-AO caregivers are learning up-to-date information and techniques and broadening their professional expertise.


Substantial section Inregulations with extensive requirements

None mentioned

HHA-AO's required to think-through and plan for the safety and wellbeing of their patients (& caregivers) in a broad range of emergency situations. Must ensure uninterrupted provision of care even in extreme circumstances


Ongoing program required. Includes performance measures, patient satisfaction, and process reviews

No Quality Improvement Program required. Review & evaluation of P&Ps required.

HHA-AO's expected to be a more professional and well managed

Source: Delaware Division of Public Health, Office of Facilities, Licensing and Certification

Four Seasons Healthcare is licensed as a Home Health Agency-Aide Only (Unskilled, Medical Model) in Delaware {HHAA0-021) and as a non-medical provider of in-home care in Pennsylvania (19323601). We are an Agency and not a Registry. We are not a franchise. We are RN Run and RN Supervised. We are also a Medicaid Waiver provider. You can see the Delaware Home Care Regulations at our website. Be safe - understand the regulations. They are there for your protection.

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