The direct care workforce offers care in a variety of settings such as hospitals, assisted living facilities and homes. Home care workers are a segment of the direct care workforce comprising over four million workers, as estimated by the Bureau of Labor Statistics and PHI, a leading authority on the direct care workforce.  They perform home care jobs that can include – regardless of occupational title – assistance with daily living activities and some clinical tasks under the supervision of a licensed medical professional.
Home care workers can be home health aides, personal care aides or nursing assistants. This article focuses on the definition, profile, responsibilities and limitations of home health aides (HHAs).
What is home health aide?
The 2018 Standard Occupational Classification (SOC), the federal standard that federal agencies use to classify workers into occupational categories, defines Home health aides (SOC 31-1121) as following:
Monitor the health status of an individual with disabilities or illness, and address their health-related needs, such as changing bandages, dressing wounds, or administering medication. Work is performed under the direction of offsite or intermittent onsite licensed nursing staff. Provide assistance with routine healthcare tasks or activities of daily living, such as feeding, bathing, toileting, or ambulation. May also help with tasks such as preparing meals, doing light housekeeping, and doing laundry depending on the patient’s abilities.
Alternative titles for a home health aide are home health attendant and home hospice aide.
Home health aides are different from personal care aides, personal assistants and direct support professionals who, in addition to assisting with activities of daily living also help clients with household work, getting ready for work outside the home, and remaining engaged in their communities. In this sense, personal care aides perform their work in a variety of settings: home, workplace, local community or at a daytime non-residential facility. Direct support professionals serve people with intellectual and developmental disabilities. An elderly companion, blind escort or geriatric personal care aide belong to the occupational category of personal care aides.
HHA duties and responsibilities
A home health aide’s duties towards his/her client can be broadly categorized into the following:
1. Assisting client in personal care and hygiene
Home health aides assist individuals with mobility issues related to age or disability with regular grooming to maintain good hygiene. This includes bathing, eating, getting dressed, toileting, transferring and continence.
Hygiene has a significant impact on physical and mental health. Regular bathing and nail trimming prevent bacterial and fungal infection. If the patient is diabetic, scratches from long, unkempt nails or itchy skin from irregular showering can progress into a serious infection. A home health aide plays a role in the client’s diabetes self-management.
Good hygiene also builds confidence and prevents discrimination. Whether clients are completely or moderately immobile, they must be encouraged to live as happy and optimistic a life as possible. Being well-groomed is a key aspect of feeling good about themselves, which in turn affects their attitudes towards other family members.
2. Supporting family members
As a caregiver and companion, HHAs allow patients’ family members to carry on with their professional work and routine activities in a stress-free manner. It is unviable for most to work close to their home to be able to spend a few hours each day assisting parents with basic ADLs, drive them to their afternoon appointments at the doctor, and perform the role of a home health aide.
Juggling a full-time job and parent care may be challenging for individuals in today’s fast-paced world. Those who attempt to meet all obligations will have less time to care for themselves and likely burn out quickly.
With HHAs attending to their parents every day, other family members can enjoy peace of mind and don’t have to put their aspirations on hold. If the patient stays with them, then they can always spend a few minutes everyday with him/her, balancing their professional and personal commitments to a large extent.
3. Ensuring client’s comfortability and rest:
Seniors or disabled individuals need ongoing assistance to lead a comfortable, worry-free life. Even if family members take turns caring for their senior, recuperating or disabled parent/relative, there will always be times when there is no one to care for the patient. For consistent and regular service, HHAs are the best option.
HHAs understand their clients’ requirements thoroughly to make them feel physically comfortable, whether that means helping them get into bed for an afternoon nap, leading them to the garden or driving them to a nearby park in the early evenings, ensuring that they take their medication on time and generally assisting them with comfortability. This service is especially useful for patients with limited or no mobility who need more or less constant care.
4. Liaising with nurses regarding patient condition:
HHAs will also find themselves interacting with the client’s physician or nurse to learn about the do’s and don’ts of caring for the client. For instance, if the client has recently undergone a cataract surgery, then the HHA may be asked to ensure that the client sleeps with an eye shield on, doesn’t bend over, avoids dusty places and doesn’t use a hot tub the first week after surgery.
Limits of a home health aide’s responsibilities
HHAs provide a vital service to the elderly, sick and disabled who prefer to age, recuperate and lead as independent a life as possible from the comfort of their home. It is important to know what HHAs are expected to do as part of their work duties and what they cannot be expected to perform.
A home health aide is not a replacement for a nurse. Registered nurses have either a Bachelor’s of Science in Nursing, an Associate’s Degree in Nursing or must have graduated from an accredited nursing program. Home health aides have a high school diploma or an equivalent; some may have completed a formal education program at a vocational school or community college. Given the vast difference in nurse and HHA educational requirements, their roles are not interchangeable.
HHAs are not employed to perform household duties. Although some may assist with light housekeeping – and only if it pertains to the family member they are caring for – they are not a replacement for a house helper. Patient’s family members should be clear about an HHA’s duties prior to hiring so there is no misunderstanding or dissatisfaction later.
Is there a certification that HHAs can obtain?
Although HHAs don’t always require certification, they can receive one from the National Association for Home Care & Hospice (NAHC). Students must complete 75 hours of training, document 17 skills demonstrating competency, and pass a written exam. 
HHAs who work for in-home care agencies that receive Medicare or Medicaid reimbursement need a minimum level of training and must either pass a competency evaluation or receive a state certification. Besides these minimum requirements, states may have additional requirements.
Anyone contemplating a career in the direct care industry should reflect on whether they have the mindset and characteristics to deliver quality care. Do they have strong interpersonal skills that allow them to be good companions and relieve clients’ mental stress? Are they emotionally strong to help patients navigate their physical hardships without it taking a toll on them personally?
Home health aides can expect to be on their feet a lot, so high levels of physical stamina are mandatory. They also need to be detail oriented to follow instructions from clients’ family members, nurse or physician, as well as be good time managers to adhere to clients’ schedules in a responsible manner.
Protections and risks of a home health aide
HHAs have to contend with certain on-the-job risks. One of them pertains to alleged acts of negligence that causes the client harm in some way. If the client brings a suit against the aide or the agency employing the aide, then professional liability insurance will pay the legal costs and settlements or judgments.
Another type of insurance for home health aides is general liability insurance that covers slip and fall accidents. If the HHA knocks over an expensive showpiece in the client’s living room, then a general liability cover pays the costs of replacing the showpiece.
Adequate insurance coverage is essential for HHAs to be able to defend themselves in the court of law without paying for legal expenses from their own pocket. High attorney costs apart, there is also the risk of the judge ruling in favor of the client and awarding them substantial damages. In this situation too, an insurance policy with appropriate limits will prevent financial devastation for the aide or agency.
Costs of home health aide liability/malpractice insurance
The costs of home health aide liability/malpractice insurance depends on a number of factors, including the state from where the aide or agency provides services, the minimum limits required by the state, and the competitiveness of the city’s insurance marketplace. Malpractice insurance premiums have dropped in the past decade. Coupled with an increasingly competitive insurance market, HHAs can hope to pay a reasonable premium that sufficiently covers them without being too large a burden on their working capital.