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Find the Right Home Health Aide for Your Loved One

What they do, what to look for and how to hire help for your loved one at home


spinner image Home health aide giving her female care recipient her pills and a plate of lunch
Blend Images/Rolf Bruderer/Getty Images

If you have a parent or spouse nearing retirement age, chances are good that at some point you’ll be in the market for home health care.

Most Americans can expect to need some help as they age, and more than half of people (56 percent) turning 65 today are predicted to need significant long-term health services, according to a 2022 U.S. Department of Health and Human Services brief.

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When to begin searching for home care help

As your loved one ages, watch for these signs. The behavior may be obvious or subtle, but they signal that it's time to talk to him or her about their living situation:

  • Changes in the condition of the home.
  • Forgetting appointments.
  • Driving unsafely.
  • Looking disheveled.
  • Forgetting things such as turning the stove off.
  • Wandering away from home.
  • Not eating regularly or nutritiously.
  • Not being able to prepare simple meals.
  • Not bathing regularly.
  • Falling frequently or having difficulty walking without help.

You may get some pushback from your loved ones who say they don’t want or need assistance. While every situation is unique and everyone’s needs are different, if you feel your loved one is not safe without help you should discuss the options and allow the care recipient to determine what he or she is most comfortable doing.

Types of home health workers

People who provide paid care for older, ill or disabled people at home are often referred to generally as home health aides, but there are actually several classes of home health workers with varying duties and with levels of professional training requirements differing by state. They include:

Companion

  • Provides companionship, meal preparation, light housekeeping.
  • Does shopping and errands, escorts care recipient for doctor and other appointments.
  • No certification or license required.

Personal Care Aide (PCA)

  • Performs tasks of companion plus assistance with more involved personal care such as bathing, grooming and using the toilet.
  • State requirements for training range from zero to 100 hours. Requirements for additional clinical hours vary. You can find the requirements for a PCA in your state here.

Home Health Aide (HHA)

  • Checks vital signs (blood pressure, respiration rates, pulse).
  • Observes recipient’s physical and mental health and reports on conditions to health care professionals such as a registered nurse.
  • Some states require as little as little as 75 hours of training, 16 hours of supervised practical or clinical training and 12 hours of continuing education each year — others require as much as 180 hours of training and 70 hours of clinical work. You can check the requirements for a HHA in your state here.

Certified Nursing Assistant (CNA)

  • Can perform certain medical procedures such as basic wound care, emptying catheter bags and measuring urine input and output.
  • Some states require as little as 75 hours of training and 16 hours of clinical training and others require up to 180 hours of training and 100 hours of clinical training. You can search for the requirements for a CNA in your state here. ​

What is a home care aide?

If you are not able to meet your loved one's caregiving needs due to distance, job or family demands, or if you are experiencing symptoms of caregiver burnout, you may be considering hiring caregiving help, such as an aide.

Home health aides are considered health care paraprofessionals and must meet set training requirements, which vary widely from state to state. (Other types of home health workers are sometimes lumped together under the title of home health aides; see the box.)

Under federal law, home health aides must get at least 75 hours of training through a state-approved program, including at least 16 hours of hands on practical and clinical training and 12 hours of continuing education per each 12-month period.

Most states follow that standard, but some set a higher bar. Thirteen states require at least 100 hours of training and 11 states and the District of Columbia exceed the federal minimum and mandate at least 30 hours of clinical training.

According to PHI, a New York City-based nonprofit organization that works to improve direct-care services for older and disabled people, only six states and the District of Columbia meet or exceed the standard suggested by the National Academy of Medicine of 120 hours of training. 

Helpers without special training such as certification or licensing are technically not home health aides. They are companions who can carry out routine tasks your loved one can no longer manage such as laundry, cooking, shopping, running errands and light housekeeping. They can also take your family member to the doctor and other appointments.

What do home health aides do?

Skilled home health aides should be able to do the following:

  • Assist with activities of daily living including bathing, dressing, eating, grooming, moving from one place to another, going to the toilet and cleaning up afterward.
  • Check vital signs such as blood pressure, respiration and pulse.
  • Monitor a client including his or her physical and mental condition, level of exercise, as well as how much the client is eating, drinking and going to the bathroom.
  • Handle emergencies such as an accident, heart attack or stroke.

Home health aides do not provide services such as physical and occupational therapy or skilled nursing care, but they are often tasked with observing your loved one’s health, and reporting on conditions to a registered nurse or other health care professional.

What to look for in a home health aide

Traits to look for in a home health aide include compassion, good communication skills and attention to detail, says Christian Steiner, owner and operator of the Manhattan office of Home Instead Senior Care, a national provider of home health services.

Flexibility, honesty, patience, physical stamina and some medical knowledge also are required to do the job well.

“The most important traits of a good home health aide are skills and experience,” says Nancy Avitabile, who owns and runs Home Care Match, an employment agency that works with caregivers.

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There are at least three ways to find and hire caregivers:

Hiring a home health care aide through an agency

An agency should handle hiring and human-resource matters such as background checks, payroll, taxes and insurance. They should also handle any mishaps or complaints and are responsible for monitoring and supervising the home health aides.

If a particular health aide isn’t working out or there is change in the care recipient’s condition requiring a more skilled aide, an agency will find a replacement. It also can provide substitute aides when your regular aide is ill or needs time off.

Look for an agency that has been licensed by the state where it operates. Your local Area Agency on Aging may be able to guide you to resources. Medicare rates private home-care services and has a searchable directory at its website. AARP has links to each state's caregiving resources as well as a checklist of questions that can help you evaluate in-home care agencies.

Using a direct-hire group to hire a home health aide

Direct-hire agencies, also known private care agencies, maintain networks of independent caregivers and facilitate their introduction to clients looking for help, taking into consideration clients' personal needs. These caregivers are paid directly by the family and the families set the terms of the arrangement.

"Direct hire agencies give families the opportunity to pick the candidate for their loved one and specifically match [caregiver] responsibilities to their loved one’s needs," says Avitabile.

After all, “Home health aides are not interchangeable. Each has his or her own skill set, experiences with different patient conditions, personality and cultural background,” says Betsy Gold, cofounder of the caregiver network Lean On We, which advises families about their options and matches them with caregivers. “Be sure to specify your specific needs so you can hire somebody who is a good fit.”

Some direct-hire firms charge a one-time finder’s fee, normally a percentage of the aide’s gross pay, says Avitabile. They may be able to refer you to third party providers for payroll and benefit services, as well as provide a substitute aide to cover an emergency or the regular aide's scheduled vacation, she adds. Families should also inquire about background checks.

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Employing a home health aide on your own

When you directly employ an aide you may spend less while the aide makes more as you are not paying a middleman. However, you need to do your own background and reference checks as well as ensure you are in compliance with any federal and state employment law and handle payroll, paperwork and taxes. Monitoring your home health aide and resolving any problems will also be your responsibility.

To find a home health care aide on your own ask friends, neighbors and doctors for recommendations. Communities at senior centers and houses of worship may also be able to refer you to candidates.

Paying for a home health aide

Nearly eight in 10 caregivers report having routine out-of-pocket expenses related to looking after their loved ones, according to AARP’s “Caregiving Out-of-Pocket Costs Study” in 2021. On average, family caregivers spend 26 percent of their income on caregiving activities.

If your loved one has long-term care insurance, it may cover paid home care; contact the insurer for information. If the care recipient is a veteran or on Medicaid some care costs may be covered. While Medicare does not cover full-time care, it will help with some costs of caregiving at home.

To estimate caregiving costs, AARP has a long-term care cost calculator that measures the price for different types of caregiving services in your area.

Managing a home health aide

Gold offers tips for working with home health aides and keeping a good one on board.

  • Treat the aides as valued employees. Keep in mind their workload, their need for daily breaks, scheduled time off and the tasks they are trained to do. Work with them to adapt to changes in working conditions and your loved one’s needs.
  • Become familiar with local, state and federal laws regarding aides’ scheduling and wages. This will decrease the likelihood of conflicts between health aides and loved ones as well as families.
  • Be mindful when assigning duties. Home health aides are usually hired to care for one person or a senior couple — not an entire family. If your elderly father lives with you and needs home care, don’t expect his caretaker to do everyone’s laundry or drive your children to school. Your home aide may be willing to do these things, but if so, you should negotiate additional compensation.

This article was originally published October 21, 2021 and has been updated by the author with new information.

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