A home health aide (HHA) is a trained direct-care worker who gives hands-on personal care to clients in their homes: bathing, dressing, toileting, safe transfers, mobility, and the everyday tasks a client can no longer do alone.
Home care agencies, Medicare-certified home health agencies and other care providers hire HHAs.
At Medicare-certified agencies, an RN or other skilled professional supervises the aide services, and federal rules set a 75-hour training floor.
This guide covers the work, employers, scope limits, training and pay.
What is a home health aide (HHA)?
A home health aide helps people who need daily hands-on care but live at home instead of in a facility.
The work is home-based: care happens in a client's own bedroom, bathroom and kitchen.
The title is used broadly.
O*NET lists Certified Home Health Aide (CHHA), Caregiver, Direct Care Professional, Home Care Aide, Hospice Aide and In Home Caregiver among the job titles reported for home health aides.
This guide uses home health aide (HHA) throughout.
Federal law gives the title one precise meaning at Medicare-certified home health agencies.
Under 42 CFR 484.80(a)(1), a qualified home health aide has completed one of four routes.
- An HHA training and competency evaluation program.
- A competency evaluation program on its own.
- A state-approved nurse aide program, with current good standing on the state nurse aide registry.
- A qualifying state licensure program.
Outside certified agencies the rules differ.
BLS notes that private care agencies that do not receive federal funds may have other employment requirements, and those requirements vary by state.
Some aides work with only one client, sometimes on a long-term basis or for a specific purpose such as hospice care, according to BLS.
What does a home health aide do?
Federal rules describe the HHA's work in four buckets: hands-on personal care, simple procedures as an extension of therapy or nursing, help with ambulation or exercises, and assistance with medications that are ordinarily self-administered (42 CFR 484.80(g)(3)).
The day-to-day skill set matches the federal training curriculum for aides (42 CFR 484.80(b)(3)).
The curriculum covers these skill areas.
- Communication, plus observation, reporting and documentation of the client's condition.
- Reading and recording temperature, pulse and respiration.
- Infection control and recognizing emergencies.
- Bed, sponge, tub and shower baths, shampooing, and nail and skin care.
- Oral hygiene and toileting.
- Safe transfers, ambulation, range of motion and positioning.
- Nutrition and fluid intake, and recognizing changes in skin condition.
BLS adds that home health aides may check pulse, temperature and respiration depending on the state, may help with simple prescribed exercises, keep records on the client, and report changes to a supervisor or case manager.
Two structural rules shape the job at Medicare-certified agencies.
An RN or other skilled professional assigns the aide to each client with written care instructions.
From there, the aide may provide only what the physician or allowed practitioner ordered, what the plan of care includes, what state law permits, and what the aide's training covered (42 CFR 484.80(g)(1)-(2)).
Aides are members of the interdisciplinary team: they report changes in the patient's condition to the RN and complete records under agency policy (42 CFR 484.80(g)(4)).
Supervision is built into the Medicare rules.
For patients receiving skilled services, an RN or other skilled professional assesses the aide's services at least every 14 days; for patients not receiving skilled services, the RN makes an on-site visit every 60 days.
Who employs home health aides?
Among the employers that hire under the home health aide title, two types run on different rulebooks.
Medicare-certified home health agencies furnish care under Medicare's conditions of participation.
By rule, such an agency must make skilled nursing plus at least one other therapeutic service — physical therapy, speech-language pathology, occupational therapy, medical social services, or home health aide services — available on a visiting basis in the patient's residence (42 CFR 484.105(f)).
Those aide visits sit inside an episode of care that Medicare defines narrowly: the beneficiary must be confined to the home and need intermittent skilled nursing or qualifying therapy, among other conditions (42 CFR 409.42).
Aide services are one part of that skilled, intermittent plan of care.
Private-duty and non-medical home care companies are the second employer type: aides support clients with long-term daily help at home rather than inside a Medicare skilled episode.
For those jobs, state requirements — not the federal aide rules for certified agencies — set the bar.
BLS's 2025 employer breakdown for home health and personal care aides covers one combined group.
Individual and family services employed 51% of the group, and home healthcare services 23%.
Residential intellectual and developmental disability facilities employed 6%, and continuing care retirement communities and assisted living another 6%.
Because BLS counts the group together, those industry rows mix home health aide and personal care aide jobs across settings, from agency visits to assisted living residences.
What can a home health aide not do?
Federal rules and the national nursing delegation guidelines put three limits around the job.
- Only ordered services. An aide may provide only what the physician or allowed practitioner ordered, what the plan of care includes, what state law permits, and what the aide's training covered (42 CFR 484.80(g)(1)-(2)).
- No nursing judgment. Under the NCSBN-ANA National Guidelines for Nursing Delegation, a licensed nurse cannot delegate nursing judgment or any activity involving it.
- Medication help, not medication management. The federal duty list ends at assistance with medications that are ordinarily self-administered (42 CFR 484.80(g)(3)). Whether an aide may do more in a given state is state law.
The delegation guidelines add a working rule for the aide's side of that line: a delegatee must not make decisions or modifications while carrying out a delegated activity without first consulting the licensed nurse, and must report patient information back to the nurse.
State law is the swing variable in all three limits.
The NCSBN-ANA guidelines themselves say what a CNA or aide may do depends on state law and employer policy.
In practice, the aide's lane is the written plan of care, and anything that looks like a clinical decision goes back to the supervising nurse.
Scope rules are state rules
How is an HHA different from a CNA or PCA?
All three titles sit in the direct-care cluster, but they answer to different rulebooks and different settings.
Versus a CNA.
The federal nurse aide rules are written around nursing homes.
Federal law defines a nurse aide as an individual providing nursing or nursing-related services to nursing home residents who is not a licensed health professional, registered dietitian or unpaid volunteer (42 CFR 483.5).
The nurse aide rules set a 75-clock-hour training floor with at least 16 hours of supervised practical training (42 CFR 483.152(a)), and BLS notes nurse aides must be on the state registry to work in a nursing home.
The HHA rules mirror that structure for home health agencies under 42 CFR 484.80, and one of the four HHA qualification routes is a state-approved nurse aide program with current good standing on the state nurse aide registry (42 CFR 484.80(a)(1)).
The credentials connect, but the jobs differ: one is built around facility residents, the other around home visits.
Versus a PCA.
BLS says personal care aides are generally limited to nonmedical services such as companionship, cleaning, cooking and driving.
BLS publishes HHAs and personal care aides as one combined occupation group, so there is no separate national wage or employment count for HHAs alone.
Federal home health rules also recognize a narrower aide role for Medicaid personal care services: a personal care aide-only worker meets state qualification standards and demonstrates competency only in the services they furnish, a smaller scope than full HHA qualification (42 CFR 484.80(i)).
Settings and outlook differ too.
BLS placed 36% of nursing assistants in nursing care facilities in 2025, while the largest employer group for home health and personal care aides was individual and family services at 51%.
The trajectory is not the same either.
BLS's Employment Projections for 2025-35 expect 18.1% growth for home health and personal care aides, with 760,500 openings a year, versus 2.6% growth and 196,200 openings a year for nursing assistants.
How do you become an HHA?
At a Medicare-certified agency, the four qualification routes from the definition above are the whole federal gate (42 CFR 484.80(a)(1)).
The training route carries a federal floor: classroom and supervised practical training must total at least 75 hours, with at least 16 classroom hours coming before at least 16 hours of supervised practical training (42 CFR 484.80(b)).
An RN with at least two years of nursing experience, including at least one year in home health, performs or generally supervises that training (42 CFR 484.80(e)).
The competency evaluation is hands-on.
Communication, vital signs, personal hygiene, transfers and ambulation, and range of motion must be observed on a patient or pseudo-patient, and an aide rated unsatisfactory in more than one required area has not passed (42 CFR 484.80(c)).
Two federal rules keep the qualification current.
Aides need at least 12 hours of in-service training in each 12-month period, supervised by an RN (42 CFR 484.80(d)).
An aide who goes 24 consecutive months without furnishing paid services must complete another qualifying program before providing services again (42 CFR 484.80(a)(2)).
For jobs outside Medicare-certified agencies, BLS notes private agencies that do not receive federal funds may have other employment requirements that vary by state.
Check the state's home health or home care licensing agency before enrolling in any program.
Confirm training rules before you enroll
How much do home health aides make?
BLS does not publish a wage for home health aides alone.
Federal statistics combine home health and personal care aides into one occupation group, so every figure here covers that combined group, not HHAs by themselves.
BLS's Occupational Outlook Handbook reports a 2025 median pay of $35,800 per year ($17.21 per hour) for the combined group, with projected employment growth of 18% from 2025 to 2035 — much faster than the average for all occupations.
BLS OEWS May 2025 counted 4,305,810 wage-and-salary jobs in the combined group nationally, with a median of $17.21 an hour ($35,800 a year).
The 10th percentile wage was $13.00 an hour and the 90th percentile was $21.65.
OEWS counts wage-and-salary jobs and excludes self-employed workers, per the BLS file these figures come from.
By industry, the same OEWS release reports a median of $17.42 an hour in home health care services, with 1,079,060 employed there.
Other industry rows: $17.82 an hour in continuing care retirement communities and assisted living, $17.72 in skilled nursing facilities, $19.38 in hospitals, and $16.73 in services for the elderly and persons with disabilities.
For percentiles, outlook and pay by setting, see home health aide pay data — labelled as the combined group, the way BLS publishes it.
Find home health aide jobs
Home health aide employers include Medicare-certified home health agencies and private-duty and non-medical home care companies.
Which credential an employer checks depends on its rulebook — certified agencies follow the federal routes, while private agencies follow their state's requirements.
On CaregiverHires, home health aide jobs list openings from home care agencies, home health and hospice providers, assisted living communities and nursing homes, with filters for pay, benefits and schedule.
Employers on the other side of the market: if you are hiring HHAs, post a job where caregivers, CNAs and aides look for senior care work.
Career information, not licensing, legal, medical, benefits or tax advice. Training, competency, scope and pay rules come from federal regulation and state law — confirm current requirements with CMS, your state's home health licensing agency, or the agencies named above.