When you’re caring for a loved one and you need in-home help quickly, you might begin a search for a home care worker. But this umbrella term hides many beneath it: home health care worker, home health aide, certified nursing assistant, even home carer. Here, we’ll outline the primary home care worker roles, their expected qualifications, general duties, and more.
Home care worker vs. home health care worker: The primary distinction
You’ve decided you need help caring for your loved one at home. Now, you must decide what kind of care they need and what kind of support you want. In the world of home care employment, there are two primary types of home care workers: those who provide medical and medical-adjacent support, and those who do not. If your loved one wants to age in place, both home care and home health care workers can help achieve this goal, often up to and through hospice, or end-of-life care.
The two classes of care providers could be seen on a spectrum, with those in need of only light to moderate nonmedical help selecting a home care worker, and those needing medical assistance choosing home health care. And there are times where both medical and nonmedical assistance come together to ensure all of a care recipient’s needs are met.
Nonmedical home care workers: Qualifications and duties
Home care workers typically perform nonmedical tasks such as shopping, cleaning, meal preparation and cooking, transportation, and more. The roles below fall into this category.
Companion caregivers
Home care workers who provide companion care focus on emotional and social support. They ensure their clients are seen, heard, respected, and engaged. Duties could include the following:
- Activity planning (crafts, art projects, games)
- Excursions (religious events, volunteering, socializing)
- Reminiscing over photos or videos
- Physical activities (walking, gardening)
Qualifications for this role may include a high school diploma or equivalent, and perhaps the completion of a caregiving certificate. There is no broad standard for this role.
Personal care aides
A personal care aide’s first focus is on assisting with activities of daily living (ADLs). These include transferring, toileting, bathing, dressing, grooming, eating, and movement. Personal care aides can also be hired to help with other household duties:
- Food shopping, meal preparation, and cooking
- Light cleaning such as laundry, vacuuming, and dishes
- Personal calendar and medical appointment management
- Transportation to medical appointments or social engagements
As with companion caregivers, personal care aides usually must have a high school diploma or equivalent. They may have to complete a post-secondary certification program. According to the U.S. Bureau of Labor Statistics, personal care aides working in nursing homes or in a hospice setting must complete training and pass a test.
Home health aides
The U.S. Bureau of Labor Statistics places personal care aides and home health aides in a category together, but there are some differences between the roles. The home health aide blurs the line between the medical and nonmedical distinction made above — they may perform personal care tasks, for instance. However, they primarily focus on their patient’s health needs, and they work closely with nurses and/or therapists. Their duties usually include the following:
- Household tasks, including personal care assistance
- Assistance with walking, moving, transferring, and exercise
- Medication administration
- Health care tasks as directed by a supervisor, such as checking and recording vitals
Home health aides must have more training than the roles listed above. Federal guidelines mandate at least 75 hours of training and 16 hours of supervised practical or clinical training. They must also complete 12 hours of continuing education per year.
Medical home health care workers: Qualifications and duties
Home health care worker qualifications are more rigorous than home care workers’ and often include the completion of college- or university-level coursework. This kind of support is most often prescribed by a doctor. Home health care workers primarily provide medical care through tasks like injections, monitoring of vitals, performance of therapy activities (like physical or occupational therapy), and more. The following roles usually fall into this category.
Certified nursing assistants (CNAs)
Certified nursing assistants are frontline health care workers focused on helping with ADLs and vital monitoring. They typically work under the supervision of licensed practical nurses or registered nurses. Their tasks can include the following:
- Bathing, dressing, eating, etc.
- Dispensing medication (in some states)
- Recording vitals and reporting a patient’s health concerns to supervising nurses
- Transferring, turning, and repositioning patients
To become a CNA, a person usually completes “a state-approved education program that includes both instruction on the principles of nursing and supervised clinical work,” according to the U.S. Bureau of Labor Statistics. On-the-job training may be required. Requirements vary by state.
Licensed practical/vocational nurses
Licensed practical nurses (LPNs), or licensed vocational nurses (LVNs), provide the nursing care many associate with nurses in general:
- Monitoring and recording of vitals
- Performing essential medical duties like wound and catheter care
- Ensuring patient comfort and hygiene through help with bathing, grooming
- Discussing patients’ health concerns and reporting information to supervisors
Additionally, these nurses support registered nurses and care teams in general by ensuring nurse and doctor guidance is understood and adhered to as much as possible. Their training is much more involved than that of a CNA. Licensed practical or vocational nurses usually complete a yearlong program at technical schools or community colleges, though duration may vary. They typically take courses in basic nursing, biology (including anatomy and physiology), pharmacology, and others. Supervised clinical instruction is required, as is passing a national exam.
Registered nurses (RNs)
Registered nurses are health care team leaders who work closely with doctors and other medical professionals to ensure patients’ complex needs are fully addressed. In addition to care coordination, they may also have public-facing duties, such as educational roles. They advise, coach, and manage care teams and are an essential connection between patients and doctors. Their duties typically include the following:
- Patient needs assessment
- Patient observation, recording, and tracking
- Medication and procedure administration (injections, wound care, etc.)
- Patient care plan coordination with doctors and other professionals
- Operation of medical equipment, such as respirators, electrocardiograms, etc.
- Performance of diagnostic tests and, in some cases, interpretation of test results
- Patient instruction and discharge preparation
Registered nurses typically complete two to three years of post-secondary coursework and attain an associate’s degree in nursing (ADN) or an associate of science in nursing (ASN) degree. Coursework includes what is required of licensed practical or vocational nurses plus, in some cases, social and behavioral science courses (such as sociology and anthropology), microbiology, psychology, etc. Supervised clinical training is required. Nurses must complete a national certification exam after their degree program.
Those pursuing nursing degrees may also seek a four-year bachelor of science in nursing (BSN) degree. BSNs may perform duties similar to RNs, above, but they also may serve as nurse educators, recruiters, researchers, forensic experts, and other roles.
Therapists, including physical, occupational, speech-language, respiratory, and more
Aside from the caregivers listed above, the umbrella term of home care worker includes therapists, of which there are many kinds. A therapist should be considered a home health care worker even if their expertise isn’t centered on prescribing medications or the treatment of disease. Therapists are making more home visits given that a large percentage of seniors wish to age in place. However, many still require patients to visit them in an office setting. Your loved one’s doctor can determine the kind of therapist(s) needed as part of establishing a care plan.
Hiring a home care worker
It’s challenging to know what kinds of home care workers to hire. Maybe your loved one just needs a caregiver for companionship, or maybe they need help with household chores. Seniors may also need assistance with their personal or medical care. Home care employment is complex, and navigating the rules, duties, salaries, taxes, and more is a lot to take on by yourself. If you’re ready to begin your search or want some initial guidance, our Care Advisors can help you find home care that meets your loved one’s needs.
Reviewed by Amanda Lundberg, RN.
Sources:
FYI: Different Types of Home Care Workers (https://www.als.org/navigating-als/resources/fyi-different-types-home-care-workers)
Types of Careers in Home Care (https://www.thinkhomecare.org/page/careersinhomecare)
Home Health and Personal Care Aides (https://www.bls.gov/ooh/healthcare/home-health-aides-and-personal-care-aides.htm)
Home Health Aide Training Requirements, December 2016 (https://www.phinational.org/wp-content/uploads/2017/07/hha-training-reqs.pdf)
Home Health Aide Training Requirements by State (http://www.phinational.org/advocacy/home-health-aide-training-requirements-state-2016/)
Nursing Assistants and Orderlies (https://www.bls.gov/ooh/healthcare/nursing-assistants.htm)
Licensed Practical and Licensed Vocational Nurses (https://www.bls.gov/ooh/healthcare/licensed-practical-and-licensed-vocational-nurses.htm)
Registered Nurses (https://www.bls.gov/ooh/healthcare/registered-nurses.htm#tab-2)
What Can You Do With a BSN? 7 Careers Beyond Bedside Nursing (https://www.stkate.edu/academics/healthcaredegrees/what-can-you-do-with-a-bsn)