When you are looking for your loved one to receive care at home, you may be looking for someone that can help with either specific or general tasks, such as provide companionship or help with some medical tasks. The differences between these two can be staggering, and yet, somewhere in the middle lies your state’s requirements for a home health aide.
For the most part, a home health aide is someone who can provide help with day-to-day living tasks and can monitor your loved one’s health.
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Each state determines the requirements for these categories of caregivers. Federal law requires home health aides to have a minimum of 75 hours of training, but some states will require more than that.
All that said, we can identify some similarities across the home health aide profession that will help guide you in making a choice.
Steps for Getting a Home Health Aide
When looking to get a home health aide, you will want to figure out what kinds of tasks they can do in your state before making a decision. You will want to make sure that your loved one can receive the care they need from the person you choose.
You will also want to identify the two areas where you will most likely find home health aides. The first way you can find one is through insurance-covered home health. This time-limited benefit provides nursing, physical and occupational therapy, and home health aides. In most cases, these aides come into your home or assisted living to help with daily living activities. However, you will have very little say in who is assigned to you — and requesting a different aide could be very difficult.
The second way you can find one is through in-home care agencies, which is what we will be focusing on. These companies provide privately paid caregivers to assist with daily activities and other tasks as permitted by your state. In-home care can be a good alternative to assisted living if aging in place is a priority. In addition, you have more of a say in terms of who will be working with you and your loved one. Below are the steps you want to keep in mind when looking for the right home health aide.
1. Assess your loved one’s needs
Assessing your loved one’s needs is a step that many people neglect to make. Putting together a safe and comprehensive plan of care is part of the long-term care planning process. As a family caregiver, it is not unusual to take on tasks that lead to caregiver burnout.
Identify and write down every bit of help your loved one requires. Don’t forget to consider emotional needs as well. By going through this exercise, you can make an informed decision (taking into account state requirements) about the person you need to hire.
2. Find out what the aide can do
The importance of this cannot be overstated. Before expending energy and time finding the right person, you will want to know what they can do. Most states do not permit home health aides to provide any medical care, but other states might allow medication administration of medications. If a certified nursing assistant would be a better fit than a home health aide, ask the agency if they have any certified nursing assistants on staff. They may not.
At a minimum, most home care aides can offer these valuable tasks.
- Help with bathing, dressing, and hygiene
- Assistance with toileting
- Medication reminders (and in some states dispensing)
- Shopping and cooking meals
- Light housekeeping and laundry
- Check vital signs (in some states and if supervised by a nurse.)
3. Decide whether to go through an agency or hire privately
Families across the country make both choices and for different reasons. If you decide to hire privately, be aware that the liability, payroll, background checks, and staffing are your responsibility. The cost per hour for you will be lower, but the management responsibilities could be arduous and time-consuming.
Hiring through an agency puts all responsibility for background checks, liability, and management on the agency. The cost per hour will be higher, but for many families, this provides peace of mind. If a caregiver does not show for their shift, the agency has the responsibility of finding a replacement.
Getting a Home Health Aide: Frequently Asked Questions
Most people would prefer to have their home health aide covered by insurance. In some instances, this is possible, but many families will end up paying privately for the care they need. In situations where you pay personally, we will identify some helpful questions to ask before hiring.
Does Medicare or Medicaid pay for a home health aide?
Medicare and Medicaid both pay for home health aides under certain circumstances. Under Medicare, if you qualify for home health (which requires a doctor’s order), a home health aide is typically available about three days a week for one hour each visit. Home health through Medicare is almost always time-limited, so if you need a home health aide after discharge from home health, you will have to pay for it.
Medicare also pays for a home health aide if you are in skilled nursing rehab. Rehab is an intensive short-term program for people who have had an accident or illness and have stayed three nights in the hospital. Home health aides are a valuable part of the team since they can assume some medical duties and assist nurses. Aides in a rehab setting are available 24 hours a day.
Medicaid is more complicated. Medicaid also pays for home health care, which includes aides, but other state programs might pay for a home health aide outside of home health care. Specific state programs pay for aides for very vulnerable adults who meet the criteria. If someone is in a nursing home under Medicaid, Medicaid pays for all expenses, including home health aides.
What are some questions you should ask a home health aide before you hire them?
Are you certified, and what other training do you have?
This is where things get tricky. The terms for home health aides, personal care aides, and home care aides are often used interchangeably. You will want to make sure you are getting adequately trained personnel for your loved one. Otherwise, they may be restricted in the kind of care they can provide. If hiring through an agency, the agency will be able to tell you what tasks are allowed under state rules.
What is your experience?
If your loved one has dementia or another mental health issue, it is good to have someone who has experience working in this area. People with dementia have special needs that require patience, flexibility, compassion, and the ability to cope with challenging behaviors. Also, you may want to ask how long they have worked in the home care field.
What emergency protocols do you follow?
If hiring from an agency, these protocols will already be in place, and you can ask the agency for a copy of those. If you are hiring privately, you will want to know about CPR training, COVID safety procedures, and any other emergency training.
How do you document your time?
Specifically, how is the family informed about what happens during the day? Agencies will have their own methods-either online or in a book kept in the client’s home. When hiring privately, you may want to have a process in mind, whether it is through regular email, phone calls, or written documentation.
What strengths do you bring to the job?
The most important part of a caregiver’s job is connecting with your loved one. You won’t be able to predict this until they start to work together. But during the interview, you can get a feel for what the aide is like and how they evaluate their strengths.
Is there a difference between a certified and uncertified home health aide?
In reality, an uncertified home health aide is called a personal care aide or companion. States do not require licensing or certification of personal care aides and companions unless they receive payments from Medicare or Medicaid.
Training requirements for personal care aides are a patchwork across the country. Some states require no training, and others have consistent training. Just because personal care aides may not have a home health aide certification, it does not mean they are not valued caregivers. Non-medical tasks are often a needed and vital part of care. It is possible to have both personal care aides and home health aides assisting your loved one.
Home Health Aides
Everyone wants to provide the safest, most compassionate care available for their loved one. When it comes to home health, if you plan and prepare by keeping your state requirements in mind, you can make the best choice. Preparation can help you with any unexpected changes or adjustments along the way.
If you're looking for more on getting care at home, read our guides on hiring a caregiver for in-home help, home hospice, and home care vs. nursing homes.
- “Home Health Aide Training Requirements by State.” PHI, phinational.org/advocacy/home-health-aide-training-requirements-state-2016.
- “Home Health Aides: When Your Loved One Needs Help With Personal Care.” AARP, www.aarp.org/caregiving/home-care/info-2019/home-health-aides.html#:~:text=Under%20federal%20law%2C%20home%20health,some%20set%20a%20higher%20bar.
- “Certified Nursing Assistant (CNA).” Nursing.org, www.nursing.org/careers/certified-nursing-assistant.