Florida licenses nurse registries separately from home health agencies. Here is what the difference means for Jacksonville families hiring in-home help.
By Jacksonville Senior Advisor Care Team · November 3, 2026
When a Jacksonville family starts calling around for in-home help, the companies on the other end of the phone can sound identical. Both send a caregiver to the house in Mandarin or Fleming Island. Both quote an hourly rate. Both say they are licensed by the state. But Florida does something most states do not: it issues two completely separate licenses for in-home care, and the difference between a nurse registry and a home health agency is not a marketing distinction — it changes who legally employs the person standing in your mother's kitchen, who is responsible for supervising that person's work, and who you turn to when something goes wrong. Section 400.462(15), Florida Statutes, defines a home health agency simply as "a person that provides one or more home health services." A nurse registry, by contrast, is defined in s. 400.462(25) as any person that "procures, offers, promises, or attempts to secure health-care-related contracts" for registered nurses, licensed practical nurses, certified nursing assistants, home health aides, companions, or homemakers "who are compensated by fees as independent contractors." The agency provides the care. The registry brokers the contract. Both are regulated by the Florida Agency for Health Care Administration (AHCA), Bureau of Health Facility Regulation, under Chapter 400, Part IV, F.S., but they answer to different rule chapters: home health agencies under Rule Chapter 59A-8, F.A.C. ("Minimum Standards for Home Health Agencies") and nurse registries under Rule Chapter 59A-18, F.A.C. ("Nurse Registries Standards and Licensing").
Section 400.506(1)(a), F.S., states the split plainly: a nurse registry "is exempt from the licensing requirements of a home health agency but must be licensed as a nurse registry." That single sentence is the whole legal architecture. A registry is not an unlicensed operator and it is not a lesser version of an agency — it is a different kind of business that the state regulates on different terms because it is doing a different thing. Families searching for home health care in Jacksonville, Florida often assume the only variables are price and availability. In practice the license type on the wall determines the supervision structure you are buying, and many families only discover which model they signed up for after a caregiver calls out sick at 6 a.m. or an aide does something outside her scope. Knowing the difference before you sign is the single most useful piece of Florida-specific homework a Northeast Florida family can do.
The defining feature of the registry model is spelled out in s. 400.506(6)(d), F.S.: a registered nurse, licensed practical nurse, certified nursing assistant, companion or homemaker, or home health aide referred by a nurse registry "is deemed an independent contractor and not an employee of the nurse registry under any chapter." Rule 59A-18.002(7), F.A.C., adds that the independent contractor "maintains control over the method and means of delivering the services provided." The consequence appears in s. 400.506(19), F.S., which prohibits a registry from monitoring, supervising, managing, or training the people it refers. That is not an oversight in the law — it is the point of the model. You are contracting with the caregiver; the registry matched you and takes a fee. Florida requires the registry to tell you so: under s. 400.506(6)(e), F.S., the registry must advise the patient, the patient's family, or anyone acting on the patient's behalf, at the time of contract, that the caregiver is an independent contractor and that the registry may not monitor, supervise, manage, or train that caregiver. If nobody said that to you out loud at signing, that is worth a question.
The statute does build in guardrails. When a registry refers a CNA or home health aide into a home, s. 400.506(6)(b), F.S., permits it "only if that patient is under a physician's care," limits the aide's work to "bathing, dressing, toileting, grooming, eating, physical transfer, and those normal daily routines the patient could perform for himself or herself were he or she physically capable," and bars medical or health care services requiring specialized training. The registry must obtain the attending physician's name and address and send that physician written notice within 48 hours after a contract is concluded. Under s. 400.506(6)(a), F.S., the registry must ensure each CNA and home health aide it refers has presented credentials showing adequate training for the home setting, and that each person referred provides current documentation of being free from communicable diseases. Section 400.506(9), F.S., requires compliance with the background screening in s. 400.512, F.S., which calls for level 2 background screening under s. 408.809(1)(e), F.S., pursuant to chapter 435 and s. 408.809. Where a physician directs care by a licensed nurse, s. 400.506(13)(a), F.S., requires a medical plan of treatment for each patient, reviewed in consultation with the licensed nurse at least every two months. And under s. 400.506(6)(c), F.S., when a CNA or aide is referred, the registry must advise at signing that registered nurses are available to make home visits "for an additional cost" — a line families frequently miss, because it means nurse oversight is an add-on, not included.
A licensed home health agency sits on the other side of the relationship. Section 400.464(1), F.S., requires a license or registration from AHCA to operate a home health agency in Florida, and provides that licenses or registrations issued on or after July 1, 2018 must specify which services are authorized and whether those services are skilled care. Section 400.462(19), F.S., defines home health services to include nursing care, therapy, home health aide services, dietetics, and medical supplies restricted to physician-prescribed drugs and biologicals. Agency personnel, under s. 400.462(16), F.S., are persons "employed by or under contract with a home health agency" — note that an agency may use either arrangement, so "agency" does not automatically guarantee a W-2 employee. What it does guarantee is a supervisory structure the registry model is forbidden from providing: Chapter 59A-8, F.A.C., carries rules on Personnel (59A-8.0095), Plan of Care (59A-8.0215), RN Delegation of Tasks (59A-8.0216), Medication Administration (59A-8.0219), and Clinical Records (59A-8.022). Skilled care itself is defined in s. 400.462(32), F.S., as nursing or therapeutic services required by law to be delivered by a professional licensed under part I of chapter 464, parts I, III or V of chapter 468, or chapter 486, and who is either employed by or under contract with a licensed home health agency or referred by a licensed nurse registry — so both models can route skilled care, but through different paperwork.
There is a third category Jacksonville families run into constantly without knowing it has its own legal status. Under s. 400.509(1), F.S., a provider of companion services or homemaker services that does not provide a home health service is exempt from licensure under Part IV — but must register with AHCA. Section 400.509(2), F.S., is blunt: "Registration or a license issued by the agency is required for a person to provide companion services or homemaker services." The registration fee is $50 per biennium under s. 400.509(3), F.S., compared with a nurse registry license fee that may not exceed $2,000 per biennium under s. 400.506(3), F.S. Registrants must obtain employment or contract history for anyone who will have contact with clients in their homes (s. 400.509(4), F.S.), and advertising must include the AHCA registration number (s. 400.509(5)). The scope limits matter enormously: a homemaker under s. 400.462(22), F.S., performs housekeeping, meal planning and preparation, shopping assistance, and routine household activities, and "may not provide hands-on personal care to a client." A companion or sitter under s. 400.462(8), F.S., spends time with or cares for the individual, accompanies them on trips and outings, and may prepare and serve meals — and likewise "may not provide hands-on personal care." Personal care, defined at s. 400.462(27), F.S., covers dressing, bathing, eating, personal hygiene, physical transfer, and ambulation. So if your father in San Marco needs help getting out of the tub, a registered homemaker or companion provider is legally the wrong category of help, no matter how willing the individual is.
The practical differences line up cleanly once you see them together. The table below summarizes what the Florida statutes and rules cited above establish for each category. Use it as a checklist when you call providers serving Duval, Clay, St. Johns, Nassau and Baker counties — and ask each one directly which of these three it holds, because the answer is a matter of public record and a reputable provider will state it without hesitation.
| Feature | Nurse Registry | Home Health Agency | Homemaker / Companion |
|---|---|---|---|
| Florida authority | s. 400.506, F.S.; Ch. 59A-18, F.A.C. | s. 400.464, F.S.; Ch. 59A-8, F.A.C. | s. 400.509, F.S.; Rule 59A-8.025, F.A.C. |
| State credential | Nurse registry license | Home health agency license or registration | AHCA registration |
| Caregiver status | Independent contractor by statute (s. 400.506(6)(d)) | Employed by or under contract with the agency (s. 400.462(16)) | Varies by provider |
| May supervise the caregiver? | No — prohibited (s. 400.506(19)) | Yes — plan of care and RN delegation rules apply | Not applicable to hands-on care |
| Hands-on personal care allowed? | Yes, within aide scope (s. 400.506(6)(b)) | Yes, per authorized services | No (ss. 400.462(8), 400.462(22)) |
| State fee cycle | Up to $2,000 per biennium | Set under Part II, Ch. 408, F.S. | $50 per biennium |
| Level 2 screening | Required (ss. 400.506(9), 400.512) | Required (s. 400.512) | Required (s. 400.512) |
Every one of these credentials is verifiable for free before you hand over a deposit. Florida Health Finder (floridahealthfinder.gov, with facility detail at quality.healthfinder.fl.gov) is the state's public lookup for AHCA-licensed providers; search the exact legal business name, not the brand on the van, and confirm the license type reads nurse registry or home health agency as expected. Florida also gives you a shortcut that works from your couch: under s. 400.506(4), F.S., a licensed nurse registry that advertises a service requiring licensure must include its license number in that advertisement, with a fine of not less than $100 for a violation and $500 for a second or subsequent offense. Section 400.509(5), F.S., imposes the same advertising duty on registered homemaker and companion providers, and s. 400.464(4)(a), F.S., on home health agencies. If a flyer stuffed in a Riverside mailbox or a Nassau County Facebook ad promises hands-on care and shows no license or registration number, that absence is itself informative. Operating without a license is not a technicality either: under s. 400.506(5)(a), F.S., a person who runs an unlicensed nurse registry and fails to cease operation and apply for a license after notice from AHCA commits a second-degree misdemeanor, with each day of continued operation a separate offense.
Three more verification steps are worth the twenty minutes. First, ask the provider to confirm in writing which services its license authorizes and whether they include skilled care — s. 400.464(1), F.S., requires newer home health licenses to say so on their face, so the provider can answer precisely. Second, ask about emergency planning. Section 400.506(12), F.S., requires a nurse registry to prepare and maintain a comprehensive emergency management plan, updated annually, with a $5,000-per-occurrence fine under s. 400.506(12)(e) for failing to submit it; s. 400.506(11), F.S., also directs registries to help disabled persons register with local emergency management. In a metro where hurricane evacuation is a yearly reality from Jacksonville Beach to Fernandina Beach, ask to see that plan and ask what happens to your contracted caregiver when an evacuation order hits your zone. Third, ask how billing works and whether the provider participates in your specific Florida Statewide Medicaid Managed Care Long-Term Care plan network — Sunshine Health, Humana, Simply Healthcare, UnitedHealthcare Community Plan, Aetna Better Health, Florida Community Care or Molina — or in any Veterans Affairs or long-term care insurance arrangement you hold. Get the answer from the plan as well as from the provider. For free, unbiased help sorting the options, ElderSource, the Area Agency on Aging for Northeast Florida, runs the Elder Helpline at 1-888-242-4464 or (904) 391-6699 for Duval, Clay, St. Johns, Nassau and Baker counties.
There is no universally better license — there is a better fit for a given family, and the deciding variable is usually how much management capacity the family has. The registry model tends to suit families who want continuity with one specific caregiver, are comfortable acting as the responsible party, and have someone local who can handle a call-out. Because the registry cannot supervise or train the contractor, the oversight job lands on you: you are checking that the aide stays inside the scope set by s. 400.506(6)(b), F.S., you are arranging coverage when she is unavailable, and you are the one who notices if something drifts. Section 400.506(19), F.S., does give you a backstop — when a credential deficiency comes to the registry's attention it must advise the patient to terminate the contract, stop referring that person, and notify the licensing board if practice violations are involved — but that is a reactive duty, not day-to-day oversight. Families who live out of state, or adult children in Nocatee juggling work and their own kids, often underestimate how much of the coordination load the registry model leaves with them.
The home health agency model generally fits better after a hospital stay, when clinical needs are changing, or when no family member can function as the manager. Discharge planners at Baptist Medical Center Jacksonville, Mayo Clinic, UF Health Jacksonville, Ascension St. Vincent's Riverside, Memorial Hospital Jacksonville, Orange Park Medical Center and Flagler Health+/UF Health St. Johns are routinely coordinating with agencies precisely because a plan of care, RN delegation and clinical records exist on the agency side under Chapter 59A-8, F.A.C. If the need is purely housekeeping, errands and company — a widow in Ortega who is safe on her feet but isolated — a registered homemaker and companion provider at the $50-per-biennium registration tier may be exactly right and cost less, provided everyone understands that hands-on personal care is off the table under ss. 400.462(8) and 400.462(22), F.S. Many Northeast Florida families end up blending: a companion three mornings a week, an agency for the skilled nursing visits after a procedure, and a conversation revisited every few months as needs change. In-home care in the Jacksonville metro generally runs about $26 to $34 per hour in 2026, with the Beaches and St. Johns County skewing higher and Baker and Nassau counties lower, but the license type behind that rate tells you what you are actually buying for it. Ask which license. Ask who supervises. Write the answers down.
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