Pennsylvania Caregiver Laws: Wages, Training, and Penalties

Pennsylvania caregiver laws set requirements in six main areas: background checks, training, wages and overtime, tax treatment when a family hires directly, privacy, and mandatory reporting of abuse. The rules reach professional caregivers at licensed agencies, certified nurse aides in nursing homes, and family members paid through state programs. Violations can cost you a license, a lawsuit, or in serious cases a criminal conviction.

Background Checks Before Anyone Starts Work

Every caregiver in Pennsylvania has to clear a background check before beginning direct care. The Older Adults Protective Services Act (OAPSA) governs screening for anyone working with older adults, and the Child Protective Services Law (CPSL) sets parallel rules for those working with minors. At a minimum, an applicant must pass a Pennsylvania State Police criminal record check. Anyone who has lived outside Pennsylvania at any point in the previous ten years also has to complete an FBI fingerprint-based check through the Department of Human Services.

Home care agencies licensed by the Pennsylvania Department of Health add two more steps: child abuse clearances where applicable, and verified tuberculosis screening before a worker has any direct contact with clients.¹ Caregivers hired into Medicaid-funded programs also get checked against the Pennsylvania Nurse Aide Registry and the federal Office of Inspector General’s List of Excluded Individuals and Entities. A name on either registry bars the person from direct patient care.

Offenses That Permanently Disqualify a Caregiver

OAPSA names specific convictions that permanently disqualify someone from caregiving work in facilities serving older adults. The list covers criminal homicide, aggravated assault, kidnapping, rape, statutory sexual assault, involuntary deviate sexual intercourse, arson, burglary, robbery, forgery, incest, endangering the welfare of children, and felony drug offenses. A single felony theft conviction, or two misdemeanor theft convictions, also triggers permanent disqualification. Federal or out-of-state convictions for similar offenses count the same.² Employers who hire someone with any of these convictions bear the liability, not the applicant.

Training Requirements by Setting

What training you need depends on where you’ll work. Direct care workers at licensed home care agencies must demonstrate competency before providing unsupervised care, and Pennsylvania recognizes several pathways: a valid nursing license, a nurse aide certification, a home health aide program meeting federal standards under 42 CFR 484.36, or an agency-developed competency exam. Agencies must review each worker’s competency at least once a year.¹

Certified Nurse Aides in federally funded nursing homes are governed by CMS rules. Federal regulations require at least 75 clock hours of training, including 16 hours of supervised practical training.³ Pennsylvania-approved programs typically go beyond that floor. After training, the CNA must pass a competency evaluation to be listed on the Nurse Aide Registry; without registry listing, the person cannot work in a federally regulated nursing home.

Training content across settings covers infection control, emergency response, patient rights, and recognizing signs of abuse.

Wages, Overtime, and the Exemptions That Trip Up Employers

Caregivers in Pennsylvania are covered by both the state Minimum Wage Act and the federal Fair Labor Standards Act. As of 2026, Pennsylvania’s minimum wage is $7.25 per hour, matching the federal floor.⁴ Non-exempt caregivers who work more than 40 hours in a week must be paid overtime at one and a half times their regular rate.⁵

Two federal exemptions complicate that picture, and both are commonly misapplied.

Live-In Caregivers

A domestic service worker who lives in the employer’s home may be exempt from FLSA overtime. To qualify, the worker must reside on the premises either permanently (seven days a week with no other home) or for extended periods, meaning at least five days or 120 hours per week. Even then, the worker is still owed at least the federal minimum wage for all hours worked.⁶

Here is the part agencies miss: only the individual or family directly employing the caregiver can claim this exemption. Home care agencies and other third-party employers cannot use it, even if the worker sleeps in the client’s home. Agency-employed live-in caregivers are entitled to full overtime for hours over 40.⁶

Companionship Services

A narrower exemption covers “companionship services,” meaning fellowship and basic supervision for elderly individuals or people with disabilities. A qualifying companion is exempt from both minimum wage and overtime. The exemption disappears entirely for any workweek in which the worker spends more than 20 percent of the time on hands-on care, or performs medically related tasks that normally require training. And again, only the family or individual employing the worker can claim it, not an agency.⁷

Recovering Unpaid Wages

A caregiver who isn’t paid can file a claim under Pennsylvania’s Wage Payment and Collection Law. If wages stay unpaid more than 30 days past the regular payday, the worker can pursue liquidated damages of 25 percent of the unpaid amount or $500, whichever is greater. Courts may add attorney’s fees to the judgment.⁸ Overtime owed must be paid with the wages for the next regular pay period, and caregivers in Medicaid-funded programs may also be entitled to reimbursement for travel time between clients.

Employee or Independent Contractor

Classification matters because it decides whether the wage rules above even apply. The IRS looks at behavioral control, financial control, and the nature of the relationship, weighing the full picture rather than any single factor.⁹ The Department of Labor applies an “economic reality” test under the FLSA, and a proposed rule announced in February 2026 centers on two core factors: the degree of control the employer has, and whether the worker has a genuine chance of profit or loss based on their own initiative.¹⁰ Most caregivers working regular schedules under an agency’s or family’s direction are employees under both tests, and treating them as contractors invites back wages, penalties, and tax liability.

If You Hire a Caregiver Directly

A family that hires a caregiver without going through an agency is almost always a household employer with federal tax obligations. The IRS defines a household employee as someone you hire for work in or around your home when you control what work is done and how it’s done, which covers most in-home caregivers.¹¹

Social Security and Medicare

Pay a household caregiver $3,000 or more in cash wages during 2026 and you owe Social Security and Medicare taxes on those wages. Each side pays 6.2 percent Social Security (on wages up to $184,500) and 1.45 percent Medicare (no cap). You can withhold the employee’s share or pay it yourself, but your employer share is not optional.¹¹ Under $3,000 in wages for the year, neither side owes.

Filing and Deadlines

Household employers report these taxes on Schedule H attached to Form 1040. You need an Employer Identification Number, and you must issue a W-2 to the caregiver by February 1, 2027, for 2026 wages. Schedule H is due with your income tax return by April 15, 2027.¹²

What Missing These Costs

The IRS charges a failure-to-file penalty of 5 percent of unpaid tax per month up to 25 percent. Returns more than 60 days late carry a minimum penalty of the lesser of $525 or 100 percent of the tax owed. A failure-to-pay penalty of 0.5 percent per month runs on top of that, also capped at 25 percent. Interest compounds daily at the federal short-term rate plus 3 percentage points.¹³ Most families discover the obligation when a notice arrives, and the sooner it’s addressed, the less it costs.

Paying a Family Member Through Community HealthChoices

Pennsylvania’s Community HealthChoices program is a Medicaid managed care program that covers long-term services and supports for eligible adults. Under participant-directed service models, the person receiving care (or their representative) can choose who provides that care, and in some cases that includes a family member.

Some CHC managed care organizations separately offer caregiver support programs for unpaid live-in family caregivers, which may include individualized coaching and a daily stipend based on the participant’s level of need. Eligibility, rates, and program details vary by plan, so a family interested in payment should contact the specific CHC plan directly. A family member paid through one of these programs is generally subject to the same background check and training requirements as any other caregiver in the system.

Duty of Care on the Job

Every Pennsylvania caregiver owes a legal duty of care to the people served. The standard is the level of attention and competence a reasonable person in the same role would provide under similar circumstances. In practice, that means concrete precautions against foreseeable harm. A caregiver helping someone with mobility issues must clear walkways and use proper transfer techniques to prevent falls. A caregiver administering medication must follow dosage instructions and watch for adverse reactions. When harm results from a failure to take those basic precautions, the failure can support a negligence claim, and in serious cases it can trigger both mandatory reporting obligations and criminal exposure.

Privacy and Confidentiality

Caregivers routinely handle sensitive personal and medical information, and both federal and state law restrict what you can do with it. HIPAA applies to caregivers working for covered entities like home health agencies and nursing facilities. Pennsylvania’s Confidentiality of HIV-Related Information Act adds specific protections for HIV-related data.¹⁴

Practically, you cannot share a client’s medical conditions, treatment details, or personal identification with anyone who does not have a legitimate need to know. Casual disclosures count. Mentioning a diagnosis to an unauthorized family member, leaving records visible to visitors, or sending unencrypted health information by email can each violate these rules. Agencies and facilities have to limit record access on a need-to-know basis, and caregivers in state-funded programs also follow Department of Human Services data security policies. Unauthorized disclosures can lead to civil penalties, termination, and disqualification from future Medicaid-funded work.

Reporting Suspected Abuse

Pennsylvania caregivers are mandated reporters, and the reporting path depends on who is being harmed.

Older Adults

Under OAPSA, a caregiver who suspects an older adult is being abused must report it. The primary channel is the statewide Elder Abuse Helpline at 1-800-490-8505, staffed 24 hours a day. Reports can cover older adults in any setting, not just institutional care.¹⁵ Willful failure to report is a criminal offense under OAPSA.²

Children

Caregivers working with minors are mandated reporters under the CPSL. If you have reasonable cause to suspect abuse, you must immediately contact ChildLine at 1-800-932-0313 and file a written report within 48 hours.¹⁶ Penalties for willful failure to report range from a second-degree misdemeanor to a second-degree felony depending on the circumstances.¹⁷

Crimes in Federally Funded Long-Term Care Facilities

Caregivers in long-term care facilities that receive at least $10,000 in federal funding have an added obligation under the Elder Justice Act. Reasonable suspicion of a crime against a resident that resulted in serious bodily injury must be reported to both the state survey agency and local law enforcement within two hours. If the suspected crime did not cause serious bodily injury, the deadline is 24 hours.¹⁸

Federal penalties for failing to report are steep: a civil money penalty of up to $200,000, rising to $300,000 if the failure worsens the victim’s harm or causes harm to another person. The Secretary of Health and Human Services can also exclude the individual from all federal health care programs.¹⁸

Under both state and federal law, caregivers who report in good faith are protected from retaliation and shielded from civil and criminal liability for the report itself. Reports can generally be made anonymously.

What Noncompliance Costs

Consequences for violating Pennsylvania’s caregiver laws fall into three categories.

Administrative penalties come from the Department of Human Services or the Department of Health. Employers who skip required background checks, fail to maintain training documentation, or violate licensing rules can lose their licenses; facilities serving older adults can be shut down. Medicaid-funded programs face especially strict oversight, and violations can result in exclusion from future reimbursement.

Civil liability follows when a caregiver’s negligence causes harm to a client or when an employer fails to pay proper wages. Under the WPCL, workers can recover unpaid wages plus liquidated damages of 25 percent or $500, whichever is greater, and attorney’s fees.⁸

Criminal charges come into play for willful failure to report suspected abuse, and for financial exploitation or intentional abuse of a care recipient. A conviction for any of the disqualifying offenses listed in OAPSA permanently bars the person from working as a caregiver in Pennsylvania.² For an agency, a pattern of noncompliance can also trigger loss of Medicaid provider status, which for many home care operations ends the business.

1
Commonwealth of Pennsylvania. Home Care Regulations
2
Pennsylvania General Assembly. Older Adults Protective Services Act
3
eCFR. 42 CFR 483.152 – Requirements for Approval of a Nurse Aide Training and Competency Evaluation Program
4
National Conference of State Legislatures. State Minimum Wages
5
U.S. Department of Labor. State Minimum Wage Laws
6
U.S. Department of Labor. Fact Sheet 79B – Live-in Domestic Service Workers Under the FLSA
7
U.S. Department of Labor. Fact Sheet 79A – Companionship Services Under the FLSA
8
Commonwealth of Pennsylvania Department of Labor and Industry. Summary of the Wage Payment and Collection Law
9
Internal Revenue Service. Independent Contractor (Self-Employed) or Employee?
10
U.S. Department of Labor. Notice of Proposed Rule – Employee or Independent Contractor Status Under the FLSA
11
Internal Revenue Service. Publication 926 (2026), Household Employer’s Tax Guide
12
Internal Revenue Service. About Schedule H (Form 1040), Household Employment Taxes
13
Internal Revenue Service. IRS Notices and Bills, Penalties and Interest Charges
14
Pennsylvania General Assembly. Confidentiality of HIV-Related Information Act
15
Commonwealth of Pennsylvania. Report Abuse of an Older Adult
16
Legal Information Institute. 49 Pa Code 13.302 – Suspected Child Abuse – Mandated Reporting Requirements
17
Commonwealth of Pennsylvania. Report Child Abuse or Neglect as a Mandated Reporter
18
Office of the Law Revision Counsel. 42 USC 1320b-25 – Reporting to Law Enforcement of Crimes in Federally Funded Long-Term Care Facilities