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If you're considering entering the home healthcare industry at an entry-level, you'll discover an array of job titles and accompanying qualifications.
Some of the most common entry-level positions are those of personal care assistant (PCA), home health aide (HHA), and certified nurse assistant (CNA).
While the duties of these positions greatly overlap, there are some subtle distinctions depending on the state in which you work as well as the company or facility that hires you.
How Do CNAs, HHAs, and PCAs Differ in Duties and Training Requirements?
Below, we'll explain the different duties and requirements of certified home health aides.
Personal Care Assistant (PCA)
Personal Care Assistants primarily work in clients' homes. They provide the most basic level of care to a client and focus on routine, non-medical tasks such as personal hygiene, laundry, meal preparation, and household chores.
Usually, no specialized training is required to become a PCA.
Home Health Aide (HHA)
Home Health Aides also usually work in clients' homes.
They provide a mid-level caregiving role, incorporating the tasks of the PCA but also adding minor medical tasks such as the following:
- checking vital signs like temperature or pulse rate
- changing bandages
- administering medications when supervised by a nurse
HHAs do require some formal training, either from a vocational school or community college or through an on-the-job training program through their home health agency. Requirements vary by state.
Certified Nurse Assistant (CNA)
Certified Nursing Assistants often work in nursing homes, hospitals, rehab centers, and other similar facilities as well as in clients' homes.
CNAs often perform the same routine non-medical tasks as the PCA or HHA but also have training in basic medical care. They report to a supervising nurse or doctor.
They also receive training and authorization to perform more skilled medical tasks such as controlling infections, cleaning catheters, and administering some treatments.
They must pass state licensing exams after their classroom training and supervised clinical experience.
What is the Average Salary of In-Home Caregivers?
The pay rate varies for these three somewhat similar career roles.
According to Indeed.com, as of mid-2023, the average pay per hour in the United States for each role is:
- CNA salary: $19.66 per hour
- HHA: $15.69 per hour
- PCA salary: $14.10 per hour
Please note that HHAs earn more than 25% higher pay than average in many western and northwestern states as well as Vermont and Wisconsin.
In May 2023, the U.S. government's Centers for Medicare and Medicaid Services (CMS) proposed new rules to increase pay for home and personal care aides working with patients on Medicaid.
The new rules require Medicaid home care agencies to pay at least 80% of their received care rate to care workers, resulting in a lower percentage going to administrative overhead and profit.
The new law will affect only Medicaid-paid home and community-based (HCBS) long-term care services but not Medicare-paid home health.
What Does a Home Health Aide Do on a Daily Basis?
The role of a home health aide will vary from state to state as well as with the agency you work for.
The role also varies greatly from client to client, based on the client's specific needs and abilities. Some clients mostly need companionship and light assistance, while others need more hands-on care.
As a home health aide, you may be asked to:
- assist with activities of daily living such as dressing, using the bathroom, and bathing
- prepare meals, snacks, and beverages
- engage your client in stimulating activities
- provide companionship and conversation
- provide medication reminders
- perform light housekeeping duties
- purchase groceries
- transport your client to doctor's appointments or other places
- handle emergencies that arise
As an HHA, you will always be expected to monitor and document your client's health and well-being.
However, HHAs usually cannot provide advanced medical assistance or advice, such as administering medications, unless under the supervision of a registered nurse or nurse practitioner. This may vary by state, however.
How Much Training Do You Need to Become a Home Health Aide?
The most important criteria to become certified as a home healthcare provider are those issued by CMS.gov, the federal agency regulating Medicare and Medicaid.
The following guidelines for home health aide qualifications are in the Code of Federal Regulations (Section 484.80):
- must have completed 75 hours of training, including at least 16 hours of clinical training
- must complete 12 hours of continuing education each year
Since the majority of recipients of home healthcare receive one of these sources of federal health funding, in order to qualify for payment, you as the provider must satisfy their criteria.
In addition, insurance companies providing long-term care insurance to individuals needing care usually require their clients' caregivers to be certified in order for their policies to pay.
Always check on your state's requirements. For example, New Jersey's state caregiver certification requirements require certified home health aides to have more than 60 hours of training and 12 hours of annual caregiver certification training.
It's not always necessary to possess a high school diploma for this career role. However, most states require you to complete a course of training at a college or vocational school.
Caregiver training should include such content as:
- job descriptions and responsibilities
- documenting activities in care plan notes
- communicating well with clients and their families
- activities of daily living (ADLs) and personal care
- nutrition
- basic hygiene and infection control
- assisting with ambulation, exercise, transfers, and fall prevention
- working with adaptive equipment
- maintaining a clean, healthy, and safe environment
- emergency preparedness and first aid
- HIPAA laws
- detecting, reporting, and preventing abuse and neglect of clients
What Agencies Certify or License Home Health Aides?
HHAs can receive national certification from the National Association of Home Care and Hospice (NAHC).
The American Caregiver Association is also a national accrediting body for caregivers, but the training requirements vary by state.
The Professional Association of Caregivers also provides caregiver certification training and a code of ethics.
These include such behavioral guidelines as:
- treating clients with kindness and respect
- never leaving clients unattended
- honoring a client's right to privacy and confidentiality
- not engaging in financial transactions or intimate relationships with a client or a family member
- never drinking alcohol or using illegal drugs as a professional caregiver
Some states require licensing in the categories of personal care, companion/homemaker, home services, or possession of a special business license.
After initial certification or licensing, most states require a minimum of eight hours of continued training per year, although California requires 10, and Louisiana, New Jersey, and Washington require 12 hours. Caregivers must receive renewal training each year.
Some states also provide certification guidelines for Alzheimer's and dementia care as well as training for HIV/AIDS and medication monitoring.
Learn More about Certified Home Health Aide Training Programs
When you need information on how to prepare for any career role, be sure to consult with our team at Best Accredited Colleges to get the most comprehensive information and assistance possible.
