Texting is how a home care agency runs. Schedulers text caregivers about open shifts, families hear the caregiver is running late, and applicants expect a reply within the hour. Most agencies start from a coordinator’s personal phone and only later learn that three rulebooks apply.

The short answer: before your agency sends texts at any scale, you need consent that matches the type of message (TCPA), a registered sender number so carriers deliver your texts (A2P 10DLC), and rules for what health information is allowed in a text (HIPAA). If you plan to send anything promotional to Texans, Texas law adds its own layer. This post walks through each one in plain language and ends with the setup checklist I use.

The Telephone Consumer Protection Act is the federal law behind most texting lawsuits. The FCC treats a text message as a “call,” so the consent rules for automated calls also cover texts sent through an automated system. The regulation lives at 47 CFR 64.1200, and it splits messages into two groups that matter a lot for home care.

Informational texts vs marketing texts

  • Informational: visit reminders, “your caregiver is on the way,” schedule changes, shift offers to your own caregivers, interview confirmations for applicants. These need prior express consent, which in practice usually means the person gave you their number for that purpose.
  • Marketing: “We now offer respite care,” a holiday promotion, a referral bonus offer to families, a push to upgrade hours. Under 64.1200, telemarketing sent with an autodialer needs prior express written consent: a signed agreement (an e-signature counts) that names the number, clearly authorizes marketing messages, and states that agreeing is not a condition of receiving services.

The mistake I see is mixing the two. A reminder that ends with “Ask about our new companion care package!” is now a marketing text. Keep them in separate programs with separate consent.

The healthcare message exemption, and its fine print

Section 64.1200(a)(9)(iv) exempts certain healthcare texts to wireless numbers from the consent requirement. It applies to calls and texts by or on behalf of healthcare providers, and the list of allowed purposes explicitly includes appointment confirmations and reminders, post-discharge follow-up and home healthcare instructions. The conditions are strict. Each text must:

  • go only to the wireless number the patient provided;
  • state the provider’s name and contact information;
  • contain no telemarketing, advertising, billing, collections or other financial content, and comply with HIPAA;
  • be concise, generally 160 characters or less;
  • stay within one message per day and three per week per patient;
  • tell the recipient they can reply STOP, with opt-outs honored immediately;
  • be free to the recipient, not charged or counted against their plan.

I treat this exemption as a backstop, not a plan. A Medicare-certified home health agency fits the “healthcare provider” language more clearly than a non-medical personal care agency, it covers the patient’s number but not the daughter who coordinates care, and three texts a week runs out fast. Consent at intake covers more.

Opt-outs: where the rules changed

In 2024 the FCC adopted its consent revocation order (FCC 24-24), and its core rules took effect April 11, 2025. Under the current text of 64.1200(a)(10):

  • People can revoke consent by any reasonable method, not just the method you prefer.
  • A reply of “stop,” “quit,” “end,” “revoke,” “opt out,” “cancel” or “unsubscribe” counts automatically, and other wording counts if a reasonable person would read it as a request to stop.
  • Revocations must be honored within a reasonable time, no more than ten business days.
  • You may send one confirmation text, with no marketing in it, and sending it within five minutes is presumed fine.

The order’s “revoke all” provision, which would make one opt-out stop every automated message from that sender, was delayed in April 2025 and again to January 31, 2027. Then the FCC put a revised order on its September 30, 2026 meeting agenda (see the draft fact sheet), and it was reported as adopted. As drafted, it lets senders treat an opt-out as covering only the category of informational messages it responded to, and designate exclusive opt-out methods if clearly disclosed. A marketing opt-out still stops all marketing. The changes take effect 30 days after Federal Register publication, which had not happened when I wrote this, so check the final text and status first.

Either way, a family texting “please stop messaging me” has opted out, even without the word STOP.

Rulebook 2: A2P 10DLC registration

The second rulebook is not a law. It is the carriers. Business texts sent from ordinary 10-digit numbers travel over what the industry calls A2P 10DLC (application-to-person, 10-digit long code), and the major U.S. carriers require those senders to register through The Campaign Registry, usually via your texting provider. Unregistered traffic gets filtered or blocked. Twilio, for example, says it has fully blocked messages from unregistered 10DLC numbers since September 2023.

Registration has two parts:

  • Brand: your legal business name and EIN, exactly as they appear on your IRS records, plus your website and contact details. Mismatches get rejected.
  • Campaign: what you will send, sample messages, how people opt in, and your opt-out and HELP replies. Reviewers check that your website or intake form actually shows the opt-in language you describe.

Carrier expectations come from the CTIA Messaging Principles and Best Practices: clear consent, a confirmation message when someone enrolls in recurring texts, support for STOP and HELP, and an accurate description of what you will send.

The cleanest setup I know for a home care agency is separate campaigns for client and family notifications, caregiver scheduling and recruiting. Sending promotions through a campaign approved for reminders puts you outside what the carriers approved.

Rulebook 3: HIPAA and what goes in the text

The TCPA asks whether you may send the text. HIPAA asks what goes inside it. If your agency is a covered entity, a text tying a client’s identity to health information is protected health information (PHI), and so is the stored message history.

Standard SMS is not encrypted

Regular SMS is not end-to-end encrypted, and messages sit on phones that get lost or shared. HHS has said in its FAQ on email with patients that HIPAA does not ban unencrypted electronic communication with patients, but providers must apply reasonable safeguards, and a patient may choose to continue after being told the risks. I apply the same standard to text: the client or their representative chooses texting, after a plain warning, and the choice is recorded.

Patient rights you have to support

  • Confidential communications: under 45 CFR 164.522(b), clients can ask you to contact them by a different method or at a different number, and providers must accommodate reasonable requests. “Call me, never text” has to be a field in your system, not a sticky note.
  • Family members: HIPAA generally lets you share relevant information with family involved in care when the client agrees or does not object. Record who is on the approved contact list before anyone texts them.
  • Minimum necessary: 45 CFR 164.502(b) requires limiting PHI to the minimum needed for the purpose. The rule has exceptions, including disclosures to the patient themselves, but I use it as a design rule for every template anyway.

What I put in a text, and what I leave out

A good reminder looks like this: “[Agency name]: your visit is confirmed for Tue 9 AM. Reply C to confirm, call 555-0100 with questions. Reply STOP to opt out.” No diagnosis, no service type, no medication, no address. Caregiver shift offers should say the shift time and general area, then send the details inside the scheduling app the caregiver logs into. Never text care plans, wound photos, Medicaid numbers or anything a coworker or teenager glancing at the lock screen should not see.

Your texting platform stores those messages, so it is a business associate and needs a signed BAA, the same as the form tools I covered in what a HIPAA-compliant website means for a home health agency.

Visit reminders, caregiver shifts and recruiting texts

Each audience needs its own consent path:

  • Clients and families: consent language in the service agreement or intake packet, with a separate, optional checkbox for marketing. Each family contact gives their own consent for their own number.
  • Caregivers: a texting consent in onboarding paperwork covering shift offers, schedule changes and EVV reminders. Even for employees, I keep consent on file and honor opt-outs, with a phone or app fallback for anyone who declines. If EVV is part of your day, my Texas EVV guide covers where those reminders fit.
  • Applicants: a consent line on the application form, right next to the phone field. An applicant expects texts about their application. Texting purchased or scraped numbers is the risky version, and I don’t build that. The broader hiring funnel is in how I’d automate caregiver hiring.

FCC rules bar telephone solicitations before 8 a.m. or after 9 p.m. local time. That targets marketing, but I use the same quiet hours for routine family texts and leave real emergencies to a phone call.

Texas: when texts became telephone solicitations

Texas passed Senate Bill 140, effective September 1, 2025. It amended Chapter 302 of the Business and Commerce Code so that a “telephone solicitation” explicitly includes text and image messages sent to induce someone to buy or receive something. Chapter 302 requires telephone solicitors to register with the Texas Secretary of State unless an exemption applies. SB 140 also made violations of Chapter 304 (the Texas no-call rules) and Chapter 305 enforceable as deceptive trade practices, which opens the door to private lawsuits.

In November 2025, the state settled a lawsuit over the law, and as reported by the National Law Review, the Attorney General’s office took the position that marketing texts sent only to people who opted in do not trigger Chapter 302 registration. Chapters 304 and 305 still apply.

For a typical Texas agency, visit reminders and shift texts are not solicitations. The risk starts when you text families or past clients to promote services: collect written marketing consent and have your attorney confirm your registration position.

My setup checklist

  1. Inventory every message you send today and sort it by audience and purpose.
  2. Move texting onto one business platform that signs a BAA, logs consent and opt-outs, and supports two-way replies.
  3. Register your brand and separate campaigns in A2P 10DLC, with sample messages that match what you will actually send.
  4. Add consent language to intake packets, onboarding paperwork and the job application, with marketing as a separate opt-in.
  5. Write templates that identify the agency, avoid health details and include opt-out instructions.
  6. Handle opt-outs automatically: STOP keywords, plain-language requests and staff-entered opt-outs, all synced to every system that sends texts.
  7. Record contact preferences such as “call only” and approved family contacts, and make them block texting in the software, not just in training.
  8. Set quiet hours and frequency limits per message type.
  9. Revisit opt-out methods once the FCC’s new order takes effect, and audit every six months.

I am building this into Nuraflow, my home care, home health and hospice software: consent stored per contact and message type, so the system refuses texts it is not allowed to send.

Frequently asked questions

Do home care agencies need consent to text clients?

In most cases, yes. Automated informational texts such as visit reminders need prior express consent, and marketing texts need prior express written consent. A narrow FCC exemption covers some healthcare texts to a patient’s own wireless number, with strict limits on content and frequency. Collecting consent at intake is simpler and covers family contacts the exemption does not.

Is it HIPAA compliant to text patients appointment reminders?

It can be. Keep reminders free of health details, use a texting platform that signs a BAA, honor requests to be contacted another way, and let clients choose texting after a plain warning that SMS is not encrypted. Clinical details belong in a secure portal or app.

What is A2P 10DLC and does my agency need it?

A2P 10DLC is the carrier registration system for business texts from ordinary 10-digit numbers. If you text through software, you register your business as a brand and each message type as a campaign through your provider. Carriers filter or block unregistered traffic.

Does Texas SB 140 apply to home care agencies?

It targets texts meant to sell or promote something, so routine visit and shift texts are generally outside it. For promotional texts, the state’s settlement position is that opted-in recipients do not trigger registration, but the no-call and lawsuit provisions still apply.

Want help setting this up?

Most agencies need consent captured in the right places, one registered texting platform and templates that say less. If you want a second pair of eyes, tell me how your agency texts today and I’ll give you an honest read on what to fix first.