A son in Laredo calls your office about his mother. He is comfortable in English, but she isn’t, and she is the one who has to agree to care, understand the plan and open the door to a caregiver. An English-only website makes that family’s job harder, and it quietly loses caregiver applicants too.

The short answer: a Spanish version of your home care agency website matters in Texas because a large share of the state speaks Spanish at home, including hundreds of thousands of older adults who are more comfortable in Spanish. If your agency takes Medicare or Medicaid, Section 1557 language access rules also apply to your website. Doing it properly means human translation, separate Spanish URLs with hreflang, Spanish intake forms and phone routing, and translating the whole path a family or applicant takes, not just the home page.

What the Census numbers say about Texas

The Census Bureau’s American Community Survey (ACS) asks about language at home and English ability. The 2024 ACS 1-year estimates for Texas, in table S1601, show:

  • About 29.3 million Texans are age 5 or older, and 35.7% of them speak a language other than English at home.
  • 28.2% speak Spanish at home, roughly 8.3 million people.
  • Of those Spanish speakers, 38.8% (about 3.2 million people) speak English less than “very well,” the Census category commonly used to estimate limited English proficiency.

The age breakdown matters more for home care. In table B16004 for the same year, about 942,000 Texans age 65 and older speak Spanish at home, and about 480,000 of them, roughly half, speak English less than “very well.”

The same table shows the recruiting side. About 5.8 million Texans age 18 to 64 speak Spanish at home, and about 3.5 million of them also speak English “very well.” Bilingual caregivers are exactly who you want for Spanish-speaking clients. A careers page that only speaks English is a quiet filter on that pool.

Section 1557: what applies to your website

Section 1557 of the Affordable Care Act prohibits discrimination, including national origin discrimination, in health programs that receive federal financial assistance. HHS published the current rule on May 6, 2024 (89 FR 37522), codified at 45 CFR Part 92.

Is your agency a covered entity?

The rule defines a covered entity to include any recipient of federal financial assistance. For a home health agency billing Medicare or a personal care agency billing Texas Medicaid, that is usually the case. A purely private-pay, non-medical agency may sit outside the rule, but I would still build the Spanish site, for the business reasons above.

The notice of availability (the old “taglines”)

Under 45 CFR 92.11, a covered entity must provide a notice saying it offers language assistance services and auxiliary aids and services free of charge. The key website points:

  • The notice must be in English and at least the 15 languages most commonly spoken by people with limited English proficiency in the state or states where you operate. For Texas, that is more than English and Spanish.
  • It must appear at a conspicuous location on your website, if you have one.
  • It must also go on certain communications, including application and intake forms, complaint forms, notices of privacy practices and the notice of nondiscrimination.
  • The compliance date for this section was one year after July 5, 2024, so it is already in effect.

Separately, 45 CFR 92.10 requires a notice of nondiscrimination, also at a conspicuous location on your website. It has to explain that you provide language assistance free of charge and how to get it. HHS’s resources for covered entities page has sample notices and translations you can start from.

In practice, I put a “Language assistance” link in the footer of every page, English and Spanish, leading to a page with both notices in all required languages.

Machine translation and qualified translators

The language access section, 45 CFR 92.201, requires a qualified translator when translation is required. It also says that if you use machine translation for text that is critical to someone’s rights, benefits or meaningful access, or where accuracy is essential, a qualified human translator must review it. An intake form, a privacy notice or a description of what services Medicaid covers falls in that category.

The same section says you can’t rely on staff who aren’t qualified interpreters, translators or qualified bilingual staff, or on a minor child except in narrow emergencies. That shapes your Spanish phone line.

Is this still in force?

Executive Order 14224 designated English as the official language and revoked an earlier language access executive order. A federal court also vacated certain gender-identity provisions of the 2024 Section 1557 rule, and HHS’s June 2026 notice of that vacatur says the other provisions of the rule remain in force. As I read it, the language access sections above still stand. Confirm with counsel.

Doing it properly

Use human translation, not a translate widget

A “translate this page” widget is cheap, and I don’t use one for agency sites. The translation happens in the visitor’s browser, so there are no real Spanish pages for Google to index, and healthcare terms often come out wrong.

My process: a professional translator who works in healthcare translates the copy, a bilingual person on your staff reads it for tone and local terms, and the translator signs off on changes.

Give Spanish its own URLs

Google’s guidance on managing multilingual sites recommends different URLs for each language version, rather than cookies or browser settings that swap content on one URL. It also says to avoid automatically redirecting people to another language version, and to add links so users can choose. For most agencies I use a subfolder:

  • /services/personal-care in English
  • /es/servicios/cuidado-personal in Spanish

A visible “Español” link in the header lets anyone switch, and it should go to the matching Spanish page, not the Spanish home page.

Add hreflang correctly

Google’s localized versions documentation explains hreflang. The rules that trip people up:

  • Each language version must list itself and all other versions. If the English page points to the Spanish one and the Spanish page doesn’t point back, Google may ignore the annotations.
  • Use ISO 639-1 language codes, such as en and es, optionally with a region such as es-US. A country code by itself isn’t valid.
  • Add an x-default for visitors whose language doesn’t match. For a Texas agency, that is usually the English page.

Google says it detects a page’s language from the visible content, not from hreflang or the HTML lang attribute. I still set lang="es" on Spanish pages, because screen readers use it to pronounce the text correctly.

Don’t translate only the home page

The most common half-done version I see is a Spanish home page that links straight back into English. Google’s multilingual guidance also warns that translating only boilerplate while the main content stays in one language makes a bad user experience. A family who starts in Spanish should be able to finish in Spanish. At minimum, translate:

  • The home page and every service page
  • The service area page and the payers and insurance you accept
  • The contact and intake page, including confirmation messages and error text
  • The careers page and the job application
  • The privacy notice, the nondiscrimination notice and the language assistance page
  • FAQs about cost, scheduling and what happens at the first visit

Google’s spam policies also list pages mass-produced through automated transformations, including translating, where little value is provided, as scaled content abuse.

Spanish intake forms that feed the same system

The Spanish inquiry form should go to the same place as the English one, with a hidden field that records the language. Your intake team can then call back with a Spanish speaker. The form labels, help text, validation errors and the thank-you message all need translating, and the notice of availability belongs on intake forms under 92.11.

Keep the Spanish form as short and low-risk as the English one. My guide to a HIPAA compliant website for a home health agency covers why I avoid asking for medical details on public forms, and that applies in every language.

A Spanish phone path that reaches a qualified person

Most families still call. If your site says “Hablamos español,” the Spanish visitor should reach someone who does. Options that work: a phone tree option for Spanish that rings your qualified bilingual staff, a separate Spanish number shown only on Spanish pages, or a telephone interpreter service your staff can conference in. Write it down in your language access procedures, which 45 CFR 92.8 requires covered entities to have, including the names of qualified bilingual staff.

After-hours calls are where this usually breaks, which I cover in after-hours calls for home care agencies. When I built an AI receptionist for a home healthcare agency, anything clinical or sensitive went to a person, and that matters even more across languages.

Google Business Profile considerations

You don’t get a separate Spanish profile. Google’s guidelines for representing your business say not to create more than one profile per location, and they specifically disallow repeating the business name in multiple languages, even if your sign shows it that way. Adding “Se habla español” to the name would also break the rule against extra keywords and taglines in the name.

What you can do: make sure the website on your profile has a clear Spanish switch, reply to Spanish reviews in Spanish, and keep the reply as careful as any other (never confirm the reviewer is a client). My post on local SEO for home health agencies in Texas covers the rest of the profile setup.

Recruiting in Spanish

Put job descriptions, pay information you already publish, and the application in Spanish too. If you require English for certain roles, say so plainly on both versions. If you are automating parts of hiring, make sure the texts and emails go out in the language the applicant chose. I go through those workflows in automating caregiver hiring.

Checklist

  1. Confirm with counsel whether your agency is a Section 1557 covered entity.
  2. Add a footer link on every page to a language assistance page with the notice of availability in English and the top 15 languages for Texas, plus your nondiscrimination notice.
  3. Hire a qualified human translator, and have bilingual staff review tone and local terms.
  4. Publish Spanish pages on their own URLs, such as an /es/ subfolder, with a visible language switch and no auto-redirect.
  5. Add reciprocal hreflang for en, es and x-default, and set lang="es" on Spanish pages.
  6. Translate the full journey, including form errors and confirmations, and record the language on each submission.
  7. Set up a Spanish phone path that reaches qualified bilingual staff or an interpreter, including after hours.
  8. Keep one Google Business Profile per location, with no bilingual name, and reply to Spanish reviews in Spanish.
  9. Write your language access procedures and keep a list of translated materials and dates.
  10. Review the Spanish pages whenever the English pages change.

For everything else a good agency site needs, my home care agency website checklist is the companion to this one.

Frequently asked questions

Does a Texas home care agency need a Spanish website?

Not every agency is legally required to have a full Spanish site, but agencies that are Section 1557 covered entities must post a notice of language assistance on their website in English and the 15 most common languages for people with limited English proficiency in Texas. Beyond that, ACS data shows about 480,000 Texans 65 and older speak Spanish and speak English less than “very well,” so a Spanish site is good business.

Can I use Google Translate or a translation plugin for my agency website?

I don’t recommend it. Under 45 CFR 92.201, machine translation of critical content must be reviewed by a qualified human translator. Browser-side widgets also don’t create indexable Spanish pages, so they don’t help families find you in Spanish search.

Can I add “Se habla español” to my Google Business Profile name?

No. Google’s guidelines prohibit extra keywords and taglines in the business name and disallow repeating the name in multiple languages. Put that message on your website instead.

Want help building a Spanish version of your agency site?

I’m a Solutions Architect at Lonestar Home Healthcare, I built the Epic Home Healthcare and Lonestar websites, I built an AI receptionist for a home healthcare agency, and I’m building Nuraflow, software for home care, home health and hospice agencies. If you want a Spanish site that is translated properly, indexed correctly and connected to your intake and phones, get in touch.