Best Cities in Maryland to Start a Home Care Agency in 2026
Team Carepolicy.usMaryland’s healthcare landscape is shifting quickly.
Maryland’s healthcare landscape is shifting quickly. With one of the fastest-growing senior populations on the East Coast, the demand for home care services has never been stronger. By 2030, nearly 22% of Maryland’s residents will be 65 or older, and most will prefer aging in place over moving to facilities.
For providers, nurses, and investors, Maryland offers a powerful opportunity. But like any business, location matters: some counties are already crowded with home care agencies, while others are under served despite high senior density.
Book a licensing consultation to validate your county selection and map your Maryland application steps end-to-end. If you’re still shaping your concept, grab a ready-to-edit Home Care Business Plan template to accelerate lender- and investor-ready planning.
Why Maryland’s Home Care Market Is Expanding
- Aging Population: From Baltimore suburbs to rural Western Maryland, every region is seeing steady increases in seniors needing care.
- High Income Levels: Maryland households rank among the wealthiest in the nation, making private-pay home care services more accessible.
- Medicaid Waivers: Maryland’s Home and Community-Based Services (HCBS) programs cover personal care and in-home support, ensuring demand from low- and middle-income families as well. See Maryland Medicaid HCBS overview and Community First Choice for program details.
- Urban vs. Rural Divide: Metro areas like Montgomery County have high income and dense populations but strong competition, while rural counties like Garrett or Dorchester may have fewer agencies despite high elderly ratios.
Building out operations? Standardize intake, visit notes, and incident reporting with the Home Care Agency Operational Form Pack.
How We Evaluated the Best Counties
We used a Saturation Index = (Agencies ÷ Seniors 65+) × 10,000, alongside population growth and income insights. Lower index = more demand per agency (better opportunity).
Table: Seniors vs. Agencies by County in Maryland
| County / City | Estimated Agencies | % Seniors (65+) | Total Population | Seniors (65+) | Saturation Index | Market Insight |
|---|---|---|---|---|---|---|
| Frederick County | 45 | 16.7% | 293,000 | 48,931 | 9.2 | Strong senior growth, moderate competition – prime suburban opportunity. |
| Anne Arundel County | 82 | 16.0% | 598,000 | 95,680 | 8.6 | Large, affluent senior population with balanced competition. |
| Baltimore County | 190 | 18.0% | 855,000 | 153,900 | 12.3 | Big market, but high competition. Still viable with niche services. |
| Montgomery County | 220 | 15.5% | 1,050,000 | 162,750 | 13.5 | Wealthy, dense population, but very competitive. Differentiation is key. |
| Prince George’s County | 175 | 14.3% | 955,000 | 136,565 | 12.8 | Large senior population, significant demand, high competition. |
| Howard County | 40 | 15.7% | 339,000 | 53,223 | 7.5 | Affluent, high senior density – excellent for private-pay agencies. |
| Carroll County | 20 | 19.3% | 174,000 | 33,582 | 6.0 | Highest senior ratio, few agencies – strong rural/suburban opportunity. |
| Baltimore City | 210 | 15.6% | 569,000 | 88,764 | 23.6 | Oversaturated, difficult for new providers unless niche. |
| Wicomico County (Salisbury) | 18 | 17.8% | 105,000 | 18,690 | 9.6 | Regional hub on the Eastern Shore, underserved. |
| Garrett County (Western MD) | 5 | 24.5% | 29,000 | 7,105 | 7.0 | High senior percentage, very few providers – logistics challenge but untapped. |
Key Takeaways
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Best Opportunities (Low Index, High Demand)
- Carroll County – highest senior ratio in the state, low competition.
- Howard County – affluent seniors, balanced provider presence.
- Frederick & Anne Arundel Counties – strong growth corridors with manageable competition.
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Moderate Opportunities (Need Niche Services)
- Baltimore & Prince George’s Counties – huge populations, but crowded markets. Focus on specialization (Alzheimer’s care, bilingual caregivers, veteran support).
- Wicomico County (Salisbury) – underserved regional hub; good for waiver-driven agencies.
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Challenging / Highly Saturated Markets
- Baltimore City – already dense with providers. Only stand out if you offer unique care models.
- Montgomery County – wealthy market, but highly competitive. Differentiation is essential.
Planning to compete on quality and compliance? Download the Non-Medical Home Care Agency Policies & Procedures and the Home Care Employee Handbook to standardize operations from day one.
Insights for Providers and Investors
- Suburban wealth = private pay. Howard, Anne Arundel, and Montgomery counties are ideal for premium service agencies targeting wealthier families.
- Rural demand is real. Garrett, Carroll, and Wicomico have some of the highest elderly ratios but fewer providers. Logistics may be harder, but the market is less saturated.
- Urban density = niche strategy. Baltimore City and Montgomery County are crowded. Agencies succeed here by offering specialized dementia care, cultural/linguistic services, or post-hospital transitional care.
- Medicaid vs. private-pay mix. Rural and smaller cities lean on Medicaid waivers, while suburban hubs lean heavily on private-pay. Plan your revenue model accordingly. Explore Maryland’s HCBS programs and CFC personal assistance coverage to align services.
Need client-facing materials for Maryland intakes and service onboarding? Use the Home Care Agency Client Handbook and browse the List of All Forms.
Final Word
For those looking to start a home care agency in Maryland, the best counties in 2026 are Carroll, Howard, Frederick, and Anne Arundel. They combine high senior demand, manageable competition, and strong growth potential.
Urban centers like Baltimore City and Montgomery County remain major markets but require sharper positioning and niche care services to compete.
Whether you’re a nurse ready to open your own agency, a physician expanding into senior care, or an investor seeking stable healthcare growth, Maryland’s demographics make home care one of the strongest industries for the next decade.
Book a licensing consultation to map your Maryland licensure path, or order customized, state-aligned policies & procedures tailored to your model.
For broader demographic planning and projections, review Maryland’s official State Data Center projections.