Home Health Aid and Personal and Home Care Aid Careers

Significant Points

  • Job opportunities are expected to be excellent because of rapid growth in home healthcare and high replacement needs.
  • Training requirements vary from State to State, the type of home services agency, and funding source covering the costs of services.
  • Many of these workers work part time and weekends or evenings to suit the needs of their clients.

Nature of the Work

Home health aides and personal and home care aides help people who are disabled, chronically ill, or cognitively impaired and older adults, who may need assistance, live in their own homes or in residential facilities instead of in health facilities or institutions. They also assist people in hospices and day programs and help individuals with disabilities go to work and remain engaged in their communities. Most aides work with elderly or physically or mentally disabled clients who need more care than family or friends can provide. Others help discharge hospital patients who have relatively short-term needs.

Aides provide light housekeeping and homemaking tasks such as laundry, change bed linens, shop for food, plan and prepare meals. Aides also may help clients get out of bed, bathe, dress, and groom. Some accompany clients to doctors' appointments or on other errands.

Home health aides and personal and home care aides provide instruction and psychological support to their clients. They may advise families and patients on nutrition, cleanliness, and household tasks.

Aides' daily routine may vary. They may go to the same home every day or week for months or even years and often visit four or five clients on the same day. However, some aides may work solely with one client who is in need of more care and attention. In some situations, this may involve working with other aides in shifts so that the client has an aide throughout the day and night. Aides also work with clients, particularly younger adults at schools or at the client's work site.

In general, home health aides and personal and home care aides have similar job duties. However, there are some small differences.

Home health aides typically work for certified home health or hospice agencies that receive government funding and therefore must comply with regulations from to receive funding. This means that they must work under the direct supervision of a medical professional, usually a nurse. These aides keep records of services performed and of clients' condition and progress. They report changes in the client's condition to the supervisor or case manager. Aides also work with therapists and other medical staff.

Home health aides may provide some basic health-related services, such as checking patients' pulse rate, temperature, and respiration rate. They also may help with simple prescribed exercises and assist with medications administration. Occasionally, they change simple dressings, give massages, provide skin care, or assist with braces and artificial limbs. With special training, experienced home health aides also may assist with medical equipment such as ventilators, which help patients breathe.

Personal and home care aides-also called homemakers, caregivers, companions, and personal attendants-work for various public and private agencies that provide home care services. In these agencies, caregivers are likely supervised by a licensed nurse, social worker, or other non-medical managers. Aides receive detailed instructions explaining when to visit clients and what services to perform for them. However, personal and home care aides work independently, with only periodic visits by their supervisors. These caregivers may work with only one client each day or five or six clients once a day every week or every 2 weeks.

Some aides are hired directly by the patient or the patient's family. In these situations, personal and home care aides are supervised and assigned tasks directly by the patient or the patient's family.

Aides may also work with individuals who are developmentally or intellectually disabled. These workers are often called direct support professionals and they may assist in implementing a behavior plan, teaching self-care skills and providing employment support, as well as providing a range of other personal assistance services.

Work environment. Work as an aide can be physically demanding. Aides must guard against back injury because they may have to move patients into and out of bed or help them to stand or walk. Aides also may face hazards from minor infections and exposure to communicable diseases, such as hepatitis, but can avoid infections by following proper procedures. Because mechanical lifting devices available in institutional settings are not as frequently available in patients' homes, home health aides must take extra care to avoid injuries resulting from overexertion when they assist patients. These workers experienced a larger than average number of work-related injuries or illnesses.

Aides also perform tasks that some may consider unpleasant, such as emptying bedpans and changing soiled bed linens. The patients they care for may be disoriented, irritable, or uncooperative. Although their work can be emotionally demanding, many aides gain satisfaction from assisting those in need.

Most aides work with a number of different patients, each job lasting a few hours, days, or weeks. They often visit multiple patients on the same day. Surroundings differ by case. Some homes are neat and pleasant, whereas others are untidy and depressing. Some clients are pleasant and cooperative; others are angry, abusive, depressed, or otherwise difficult.

Home health aides and personal and home care aides generally work alone, with periodic visits from their supervisor. They receive detailed instructions explaining when to visit patients and what services to perform. Aides are responsible for getting to patients' homes, and they may spend a good portion of the work day traveling from one patient to another.

Many of these workers work part time and weekends or evenings to suit the needs of their clients.

Training, Other Qualifications, and Advancement

Home health aides must receive formal training and pass a competency test to work for certified home health or hospice agencies that receive reimbursement from Medicare or Medicaid. Personal and home care aides, however, face a wide range of requirements, which vary from State to State.

Education and training. Home health aides and personal and home care aides are generally not required to have a high school diploma. They usually are trained on the job by registered nurses, licensed practical nurses, experienced aides, or their supervisor. Aides are instructed on how to cook for a client, including on special diets. Furthermore, they may be trained in basic housekeeping tasks, such as making a bed and keeping the home sanitary and safe for the client. Generally, they are taught how to respond to an emergency, learning basic safety techniques. Employers also may train aides to conduct themselves in a professional and courteous manner while in a client's home. Some clients prefer that tasks are done a certain way and will teach the aide. A competency evaluation may be required to ensure that the aide can perform the required tasks.

Licensure. Home health aides who work for agencies that receive reimbursement from Medicare or Medicaid must receive a minimum level of training. They must complete both a training program consisting of a minimum of 75 hours and a competency evaluation or state certification program. Training includes information regarding personal hygiene, safe transfer techniques, reading and recording vital signs, infection control, and basic nutrition. Aides may take a competency exam to become certified without taking any of the training. At a minimum, 16 hours of supervised practical training are required before an aide has direct contact with a resident. These certification requirements represent the minimum, as outlined by the Federal Government. Some States may require additional hours of training to become certified.

Personal and home care aides are not required to be certified.

Other qualifications. Aides should have a desire to help people. They should be responsible, compassionate, patient, emotionally stable, and cheerful. In addition, aides should be tactful, honest, and discreet, because they work in private homes. Aides also must be in good health. A physical examination, including State-mandated tests for tuberculosis and other diseases, may be required. A criminal background check and a good driving record also may be required for employment.

Certification and advancement. The National Association for Home Care and Hospice (NAHC) offers national certification for aides. Certification is a voluntary demonstration that the individual has met industry standards. Certification requires the completion of 75 hours of training; observation and documentation of 17 skills for competency, assessed by a registered nurse; and the passing of a written exam developed by NAHC.

Advancement for home health aides and personal and home care aides is limited. In some agencies, workers start out performing homemaker duties, such as cleaning. With experience and training, they may take on more personal care duties. Some aides choose to receive additional training to become nursing aides, licensed practical nurses, or registered nurses. Some may start their own home care agency or work as a self-employed aide. Self-employed aides have no agency affiliation or supervision and accept clients, set fees, and arrange work schedules on their own.

Job Outlook

Excellent job opportunities are expected for this occupation because rapid employment growth and high replacement needs are projected to produce a large number of job openings.

Employment change. Employment of home health aides is projected to grow by 50 percent between 2008 and 2018, which is much faster than the average for all occupations. Employment of personal and home care aides is expected to grow by 46 percent from 2008 to 2018, which is much faster than the average for all occupations. For both occupations, the expected growth is due, in large part, to the projected rise in the number of elderly people, an age group that often has mounting health problems and that needs some assistance with daily activities. The elderly and other clients, such as the mentally disabled, increasingly rely on home care.

This trend reflects several developments. Inpatient care in hospitals and nursing homes can be extremely expensive, so more patients return to their homes from these facilities as quickly as possible in order to contain costs. Patients, who need assistance with everyday tasks and household chores rather than medical care, can reduce medical expenses by returning to their homes. Furthermore, most patients-particularly the elderly-prefer care in their homes rather than in nursing homes or other in-patient facilities. This development is aided by the realization that treatment can be more effective in familiar surroundings.

Job prospects. In addition to job openings created by the increased demand for these workers, replacement needs are expected to lead to many openings. The relatively low skill requirements, low pay, and high emotional demands of the work result in high replacement needs. For these same reasons, many people are reluctant to seek jobs in the occupation. Therefore, persons who are interested in and suited for this work-particularly those with experience or training as personal care, home health, or nursing aides-should have excellent job prospects.