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Overview of home health assistance


Hiring in-home help can give caregivers a much-needed break from their duties. This article offers basic tips on choosing a home health attendant and then describes the different kinds of in-home assistance available.

Choosing a home health attendant

Hiring in-home help can give caregivers a much-needed break from their duties. Before looking for in-home help, the caregiver and person receiving care should make a list of what they most want help with. If the main goal is to free up time for the caregiver, they can choose from the less credentialed end of the spectrum, such as a companion caregiver. If the person needs more specialized care, then an attendant with more training, such as a nurse, may be more appropriate.

Available home health services include companion care, personal care aides, home health aides, nursing assistants, skilled nursing providers, and registered nurses. Caregivers can find them through word of mouth or agencies. Many home care agencies (which are not the same thing as homemaker or home-care aide agencies) are Medicare certified, meaning that they meet federal standards. Medicare’s Home Health Compare offers information on all home health agencies in the caregiver’s area.

Companion caregivers

A companioHiring In-Home Help. Family Caregiver Alliance.n caregiver’s main role is to keep the person receiving care company. To get a good match between the person and the companion, a list should be made of the kinds of activities the person enjoys (for example, watching TV, doing puzzles, playing board games). Some companion caregivers also do light housework and other non-medical tasks, such as driving people to appointments.

Personal care aides (PCAs)

Also known as personal attendants, personal care aides (PCAs) are unlicensed aides who can provide custodial care, such as helping a person bathe, dress, and brush their teeth. They usually also provide companionship, do light housework, pick up prescriptions, and drive the person to appointments. Different states have different training requirements for PCAs, and some states have none.1

Home health aides (HHAs)

Home health aides (HHAs) have at least 75 hours of training and are certified by the state. Along with offering companionship and doing light housekeeping, they can help the person receiving care with activities of daily living such as eating and bathing. Part of their training is to identify adverse symptoms (for instance, stroke or heart failure), so a person can get help quickly if needed. In some states, HHAs with extra training are allowed to administer medications, including giving insulin injections.2

Nursing assistants (LNAs and CNAs)

There are two kinds of nursing assistants: Licensed nursing assistants (LNAs) and certified nursing assistants (CNAs). The main difference between them has to do with the certification process rather than their training. Like home health aides, nursing assistants are certified by the state and must have at least 75 hours of training. Along with helping with routine activities, they perform some clinical-care tasks under the supervision of a doctor, nurse, or nurse practitioner. These include monitoring a person’s vital signs and physical condition, giving them medication, and setting up medical equipment.

Licensed practical nurses (LPNs)

Skilled nursing providers, often referred to as licensed practical nurses (LPNs), have completed a two-year nursing program, usually at a community college. They can perform medical tasks, such as giving intravenous drugs and changing wound dressings. Some have specialized training in occupational, physical, or speech therapy, making them a good choice for older adults who need these services. 

Registered nurses (RNs)

Registered nurses (RNs) who provide home care have the same training and qualifications as nurses in a hospital: at least an associate degree in nursing, and often a four-year nursing degree. They are legally allowed to provide a range of medical care, including administering medications, operating equipment, and guiding rehabilitation. RNs are recommended if the person receiving care has just undergone a procedure or been discharged from a hospital and needs follow-up medical care.

Costs and sources of funding

The cost for in-home health care varies depending on the assistant’s level of qualifications, the care tasks required, and state regulations and wages. As an example, in 2021, the median hourly wage for a home health aide was $13, while the wage for a skilled nursing provider was $25.3 Those hiring a care worker independently can look at their state’s Department of Labor for information such as the minimum wage and minimum shift length for care workers. For those using a home care agency, the agency will set the rates. Rates and reviews for local agencies are available on Medicare’s Home Health Compare site.

Medicare, Medicaid, or the Veterans Administration (VA) sometimes cover much of the cost of in-home services, as do many long-term care insurance policies. The cost for hiring in-home help also may be tax-deductible, so checking with a tax accountant is a good idea. The local Area Agency on Aging (AAA) will be able to tell you whether your community is one that has specialized funding for low-cost home care. For caregivers with financial power of attorney, hiring in-home health care assistance is considered an appropriate use of the funds of the person receiving care.4

Related information

Anticipate impacts on your personal life

Avoid feeling alone, isolated, or incapable 

Balance care responsibilities

Create a care plan

Deal with caregiver burnout

Deal with caregiver depression

Join a caregiver community

Take care of yourself emotionally

Take care of yourself physically

End notes

1How to Hire a Caregiver. AARP.
2Advanced Home Health Aides Frequently Asked Questions. New York State Department of Health.
3How to Hire a Caregiver. AARP.
4Hiring In-Home Help. Family Caregiver Alliance.

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