Does Mom Need a Nurse or a Health Aide?

I often hear people use the term ‘nurse’ to describe the person who comes to the house to help mom or dad bathe and get dressed three or four times a week. There’s apparently a lot of confusion out there between what home health aides and nurses do.

The person who helps your loved one bathe and dress is typically a Home Health Aide (HHA) or Certified Nursing Assistant (CNA). There are other titles and designations for this type of help, but HHA and CNA are two of the most common.

While many HHAs have a high school diploma or a GED, formal education generally is not required to be an HHA. Home care agencies typically provide their own training programs. Some states do offer a training and certification process to become a certified home health aide, or CHHA.

CNAs must pass a state licensing exam to be certified. This requires a formal training program offered by community colleges and vocational and technical schools. Candidates must learn basic principles of nursing care and complete several hours of supervised clinical training.

HHAs and CNAs working in the home setting may assist with bathing, dressing and other self-care and hygiene needs. As needed, they may also grocery shop, prepare meals, help clients eat, perform light housekeeping and provide occasional transportation.

In healthcare language, both CNAs and HHAs are considered “Unskilled” help. By definition, "Skilled" services are functions that must be performed by a licensed practical nurse (LPN) or a registered nurse (RN).

All states require RNs to earn at least an associate degree, but some employers prefer candidates with bachelor's degrees. RNs must also be licensed to practice, a process that requires that they complete an accredited nursing program, lasting from two to four years, and pass the National Council Licensure Exam for Registered Nurses, or NCLEX-RN.

LPNs must complete a state-approved training program, often in the form of a diploma, certificate or associate degree. The majority of programs can be completed in one year, although some offering an extensive nursing curriculum may take longer. Individuals must then pass the National Council Licensure Examination for Practical Nurses, or NCLEX-PN. 

While the differences between RNs and LPNs are beyond the scope of this article, both are qualified to provide more advanced care than HHAs and CNAs. In general, nurses may administer medication, perform wound care, create and implement detailed care plans, and collaborate with doctors and other members of your loved one’s healthcare team. 

Hiring an HHA or CNA is usually one of the first steps in planning to keep your loved one safe at home. They are typically employed at a home care agency in your area and are private pay (meaning not covered by insurance). 

Nursing care may or may not become necessary as certain health conditions progress and are often ordered by your family doctor. When ordered by a doctor for a specific illness or condition, nursing services are generally covered by health insurance. There are also private duty nurses that can be hired by an individual patient, their family, or an agency. They are not necessarily under the direction of a physician and their salary is paid by the individual. 

It’s important to make an accurate assessment of your loved one’s needs and obtain the proper level of  help to keep them safe and healthy at home. Many times family members are overwhelmed by the prospect of figuring things out, or have differing opinions about what’s best for mom and dad. This often results in family strife, leading to inertia and nothing gets done until there’s an emergency. If this is the case in your family, it may be wise to hire a professional health advocate to perform a comprehensive and objective assessment for the family.