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.
Home health and personal care aides held about 3.5 million jobs in 2020. The largest employers of home health and personal care aides were as follows:
- Individual and family services - 44%
- Home healthcare services - 25%
- Continuing care retirement communities and assisted living facilities for the elderly - 7%
- Residential intellectual and developmental disability facilities - 7%
Many home health and personal care aides work in clients’ homes; others work in group homes or care communities. Some aides work with only one client, while others work with groups of clients. They sometimes stay with one client on a long-term basis or for a specific purpose, such as hospice care. They may work with other aides in shifts so that the client always has an aide.
Aides may travel as they help people with disabilities go to work and stay engaged in their communities.
Injuries and Illnesses
Work as a home health or personal care aide can be physically and emotionally demanding. Because they often move clients into and out of bed or help with standing or walking, aides must use proper lifting techniques to guard against back injury.
In addition, aides may work with clients who have cognitive impairments or mental health issues and who may display difficult or violent behaviors. Aides also face hazards from minor infections and exposure to communicable diseases but can lessen their chance of infection by following proper procedures.
Most aides work full time, although part-time work is common. They may work evening and weekend hours, depending on their clients’ needs. Work schedules may vary.
Education & Training Required
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.
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.
Other Skills Required
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.
How to Advance
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.
Employment of home health and personal care aides is projected to grow 33 percent from 2020 to 2030, much faster than the average for all occupations.
About 599,800 openings for home health and personal care aides are projected each year, on average, over the decade. Many of those openings are expected to result from the need to replace workers who transfer to different occupations or exit the labor force, such as to retire.
As the baby-boom generation ages and the elderly population grows, the demand for the services of home health and personal care aides will continue to increase.
Elderly clients and people with disabilities are increasingly relying on home care as an alternative to nursing homes or hospitals. Families may prefer to keep aging family members in their homes rather than in nursing homes or hospitals. Clients who need help with everyday tasks and household chores, rather than medical care, may be able to reduce their medical expenses by staying in or returning to their homes.
The median annual wage for home health and personal care aides was $29,430 in May 2021. The median wage is the wage at which half the workers in an occupation earned more than that amount and half earned less. The lowest 10 percent earned less than $22,290, and the highest 10 percent earned more than $37,010.
In May 2021, the median annual wages for home health and personal care aides in the top industries in which they worked were as follows:
- Individual and family services - $29,670
- Residential intellectual and developmental disability facilities - $29,230
- Continuing care retirement communities and assisted living facilities for the elderly - $29,140
- Home healthcare services - $28,630
Most aides work full-time, although part-time work is common. They may work evening and weekend hours, depending on their clients’ needs. Work schedules may vary.