Direct Service Worker in Louisiana: Training, Checks, Registry

To work as a direct service worker in Louisiana, you must complete at least 16 hours of initial training before providing care, pass a fingerprint-based criminal background check, show you are free of communicable tuberculosis, and appear in good standing on the state’s Direct Service Worker Registry. Ongoing certifications, Electronic Visit Verification, and periodic registry checks keep you eligible once you start.

Who the Requirements Apply To

Louisiana law defines a direct service worker as an unlicensed person who provides personal care or other support to people with disabilities or older adults in face-to-face settings.¹ The duties run from help with bathing, grooming, eating, transferring, and toileting to job coaching and community integration support.² To be paid, you must work either for a licensed home and community-based service provider or under one of the state’s self-direction programs, where the care recipient is your employer of record.

Family members can be paid DSWs, but with limits. A parent, stepparent, grandparent, sibling, aunt, or uncle of the recipient must meet criteria set by rule before serving as a paid worker, unless the Secretary of the Louisiana Department of Health grants a waiver.¹

Initial Training Before You Start

Every DSW must complete a minimum of 16 hours of training upon hire, before providing any direct care. Your employer is responsible for verifying that you finished it. The required topics are:

Personal care skills: bathing, dressing, grooming, eating, and toileting
Transfer techniques for safely moving or repositioning a person
Recognizing and reporting abuse and neglect through LDH’s approved curriculum
Infection control and standard precautions
Meeting the routine health needs and problems of the client

Training combines classroom instruction, hands-on practice, and competency assessments, and must be delivered by a licensed home and community-based service agency or a state-recognized training provider following LDH guidelines. Some content is tailored to the population you will serve, particularly for people with complex behavioral or medical conditions.²

Extra Training If You Will Administer Medication

DSWs are generally prohibited from performing medical tasks. Medication administration and noncomplex health tasks are the significant exception, allowed under registered nurse delegation for a recipient in stable condition where the procedure is routine and results are predictable.³

Authorized tasks include giving oral and topical medications, applying ointments and suppositories, administering pre-measured inhaler doses, and providing routine hydration, nutrition, or medication through an established gastro-tube. To qualify, you must complete a separate 16-hour medication administration training coordinated and approved by an RN, covering legal responsibilities, drug classification, measuring and documenting medications, recognizing side effects and interactions, and skill proficiency in areas like taking vital signs and infection control.⁴ Without that training and a documented competency check, you cannot perform any medication-related tasks. The delegation is only valid if the recipient is enrolled in home and community-based services, has an approved plan of care, and receives an RN assessment at least annually.³

Ongoing Training and Certifications

Beyond the initial 16 hours, you must complete periodic refresher training to keep your qualifications current. That includes keeping first aid and CPR certifications active, plus updates on de-escalation and any changes in care protocols. Employers must document every completed training and keep records available for LDH audits. Some agencies require more than the state minimum.

If you work in an Alzheimer’s special care unit inside a nursing facility, Louisiana adds dementia-specific training. Direct nursing and nursing assistant staff must complete at least eight hours within 90 days of employment and five hours annually thereafter. Staff who have regular contact with residents but do not provide direct nursing care must complete four hours within 90 days and one hour annually.⁵

Criminal Background Check

Before you have any direct contact with a client, your employer must request a criminal history check through the Louisiana State Police or an authorized private agency with access to the state’s computerized criminal history database.⁶ No prospective worker can begin providing services until results come back.

The check is fingerprint-based. The Louisiana State Police submit fingerprints to the FBI to catch out-of-state convictions that would not show up in the state database alone. The state background check fee is $31 (including a $5 technology fee), with an additional $12 for FBI processing when required, for a typical total of $43.⁷

Convictions That Disqualify You

If a check turns up certain convictions, the employer must refuse to hire you or terminate your employment. The disqualifying list under Louisiana law covers:⁸

Violent crimes: murder, manslaughter, aggravated assault, aggravated battery, armed robbery, aggravated burglary, aggravated arson, and kidnapping
Sexual offenses: rape, sexual battery and its aggravated forms, crimes against nature, and video voyeurism
Exploitation and cruelty: human trafficking, cruelty to persons with infirmities, and identity theft
Drug offenses: distribution of or possession with intent to distribute any controlled substance in Schedules I through V
Theft: felony theft over $500, theft targeting an elderly person or person with a disability, or any theft by someone with a prior theft conviction regardless of amount

Attempt and conspiracy to commit any of these offenses are equally disqualifying. If the employer serves anyone under 21, second-degree kidnapping, felony carnal knowledge of a juvenile, and second-degree cruelty to juveniles are also on the prohibited list.⁸ One exception: the hiring prohibition does not apply if you received a pardon for the conviction.⁶

Health Screening and Records

Before you start work at any LDH-licensed healthcare facility, if your duties include direct patient care, you must be free of communicable tuberculosis. You need one of the following: a negative TB skin test (Mantoux method) or an FDA-approved blood assay; a normal chest X-ray if the skin test or blood assay is positive; or a physician’s statement certifying you are non-infectious if the X-ray is abnormal.⁹

A worker with a history of untreated latent TB must complete an annual symptom screening asking about prolonged productive cough, coughing up blood, unexplained weight loss, and fever or night sweats lasting three or more days. A positive answer triggers a medical referral. You cannot be denied employment solely because of a TB infection, as long as it is not communicable.⁹

Your employer must keep a personnel file with proof of identity, work authorization, background check results, and training records. Federal law requires each employee to complete Form I-9 for identity and work eligibility, and employers must retain each Form I-9 for three years after the date of hire or one year after termination, whichever is later.¹⁰ Training documentation matters as much as anything else in the file. The employer must keep records of the initial 16 hours, any medication administration training, CPR and first aid certifications, and every competency assessment, all available for LDH inspections.

The Direct Service Worker Registry

Louisiana maintains a Direct Service Worker Registry inside the Department of Health to track qualifications and any findings of misconduct. The registry was established by statute, and LDH sets the minimum qualifications and requirements through administrative rules.¹¹

Licensed and certified healthcare providers must check the registry before hiring any DSW and at least every six months for current employees. The purpose is to identify workers with a finding of abuse, neglect, exploitation, extortion, or misappropriation of a recipient’s property or funds. If such a finding exists, the provider cannot hire or continue to employ that person as a DSW.¹²

To stay active on the registry, you must keep your credentials current. If CPR, first aid, or other required certifications lapse, you are suspended from the registry and cannot be employed until you catch up. Workers inactive for an extended period may need to retrain before reinstatement. For status and renewal questions, the Louisiana Nurse Aide/Direct Service Worker Registry can be reached at 225-342-3240 or HSS-CNA-DSW-Referrals@la.gov.¹³

Coming From Another State

If you are certified as a DSW or CNA in another state, you can request reciprocity to join the Louisiana registry, but the state must verify your current home-state certification. During an emergency declaration, a CNA from another state may work in the affected area for up to 30 days after home-state verification. After that, formal reciprocity through the Louisiana Nurse Aide Registry is required.¹³

Electronic Visit Verification on Every Shift

The 21st Century Cures Act requires every state to run an Electronic Visit Verification system for Medicaid-funded personal care services. States that fail to comply face incremental reductions in their Federal Medical Assistance Percentage of up to one full percentage point.¹⁴ Louisiana’s system is in place, and you must use it.

Each visit must be electronically verified with six data points: the type of service, the identity of the person receiving care, the identity of the worker, the date, the start and end time, and the geographic location. You can check in and out using a smartphone, a landline from the participant’s home, or a fixed verification device installed in the home. Any other method requires LDH approval. In self-direction, the participant validates your EVV entries, and the Fiscal Employer Agent must provide a backup method if the system goes down.¹⁵

Pay, Overtime, and Taxes

Louisiana has no state minimum wage law, so the federal minimum of $7.25 per hour applies to covered workers.¹⁶ Under the Fair Labor Standards Act, most DSWs are entitled to overtime at one and a half times the regular rate for hours over 40 in a workweek. A narrow companionship services exemption exists, but it rarely applies: it only covers workers employed directly by a family or household (not a third-party employer) whose duties are limited to fellowship and protection, with care tasks like bathing and dressing making up no more than 20 percent of weekly hours. If care exceeds that share, or if you work for a staffing agency or home care company, both minimum wage and overtime apply.¹⁷

Self-direction participants who employ a DSW are household employers for tax purposes. In 2026, if the participant pays a household employee $3,000 or more in cash wages during the year, Social Security and Medicare taxes apply to all cash wages paid to that employee, with the Social Security wage base capped at $184,500.¹⁸ The Fiscal Employer Agent normally handles withholding and deposits, but the participant remains the legal employer. Classification also matters: the IRS looks at behavioral control, financial control, and the nature of the relationship, and DSWs working under a care plan with set schedules and defined duties almost always qualify as employees rather than independent contractors.¹⁹

Discipline, Reporting Duties, and Appeals

Employers must have written disciplinary policies that comply with state labor laws. Neglecting assigned duties, falsifying records, failing to follow a care plan, or breaching client confidentiality can trigger progressive discipline from written warnings up through suspension. Abuse, exploitation, extortion, or misappropriation of a recipient’s property leads to immediate termination and a finding on the DSW registry, which effectively bars future employment in the field. Criminal prosecution may follow.

You are a mandatory reporter of suspected adult abuse and neglect. Failing to report is a misdemeanor punishable by a fine of up to $500, imprisonment for up to six months, or both. The same penalty applies to anyone who obstructs an abuse investigation or makes a knowingly false report. Louisiana law also prohibits retaliation against workers who report abuse in good faith, so an employer cannot discharge, demote, suspend, threaten, or harass a reporter.²⁰

If you receive a notice of violation for a substantiated allegation of abuse, neglect, exploitation, or misappropriation, you can challenge the finding before it becomes permanent on the registry. Two levels of review are available. First, you can request Informal Dispute Resolution by writing to the Health Standards Section within 15 calendar days of the notice. If that does not resolve it, or if you want to skip it, you can request an administrative hearing through the Division of Administrative Law within 30 calendar days after receiving either the original notice or the IDR results.¹²

Miss the deadlines and the department’s findings become a final and binding administrative determination, permanently recorded on the registry. If your only registry finding is neglect (not abuse, exploitation, or extortion), you can petition LDH in writing after at least one year to be removed. You must show the neglect was a one-time event and that your employment and personal history shows no pattern of harmful behavior. Only one removal petition is allowed.¹²

1
Louisiana State Legislature. Louisiana Revised Statutes 40:2179.1 – Definition of Direct Service Worker
2
Louisiana Administrative Code. Chapter 50 – Home and Community-Based Services Providers Licensing Standards
3
Louisiana Department of Health. Chapter 92 – Direct Service Worker Registry, Subchapter D
4
Cornell Law Institute. Louisiana Administrative Code tit. 48, I-9245 – Training Requirements for Medication Administration
5
Justia. Louisiana Revised Statutes 40:2200.2 – Dementia Training; Nursing Facilities and Alzheimer’s Special Care Units
6
Louisiana Department of Health. Criminal Background and Screening FAQs for Nursing Home Providers
7
Louisiana State Police. General Authorization Form – Background Check Fee Schedule
8
Louisiana State Legislature. Louisiana Revised Statutes 40:1203.3 – Refusal to Hire or Contract
9
Cornell Law Institute. Louisiana Administrative Code tit. 51, II-503 – Mandatory Tuberculosis Testing
10
eCFR. 8 CFR 274a.2 – Verification of Identity and Employment Authorization
11
Justia. Louisiana Revised Statutes 40:2179 – Establishment of Direct Service Worker Registry
12
Louisiana Department of Health. Chapter 92 – Direct Service Worker Registry
13
Louisiana Department of Health. CNA/DSW Registry
14
Medicaid.gov. EVV Requirements Workshop
15
Cornell Law Institute. Louisiana Administrative Code tit. 50, XXI-1141 – Electronic Visit Verification Requirements
16
U.S. Department of Labor. State Minimum Wage Laws
17
U.S. Department of Labor. Fact Sheet 79A – Companionship Services Under the FLSA
18
Internal Revenue Service. Publication 926 – Household Employer’s Tax Guide
19
Internal Revenue Service. Independent Contractor (Self-Employed) or Employee?
20
Louisiana State Legislature. Louisiana Revised Statutes 14:403.2 – Abuse and Neglect of Adults