How to Hire Home Health Aides: An Employer's Guide

Home health aides carry the hands-on work of a home-based plan of care. The federal rule that governs aides at Medicare-certified home health agencies describes the job as 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.

The role plugs into your clinical operation rather than sitting beside it. An RN or other skilled professional assigns the aide to a patient with written care instructions, and the aide may furnish only services that are ordered, in the plan of care, permitted under state law, and consistent with their training. Aides are interdisciplinary team members too: they report changes in a patient's condition to the RN or other skilled professional and complete records per your agency policy.

Where the hire fits depends on your provider type. Medicare-certified home health agencies hire under the federal home health aide conditions. State-licensed non-medical home care agencies hire under their state's rules. Hospices hire hospice aides — a distinct role whose federal qualifications under 42 CFR 418.76 reference the home health aide training and competency standards. Decide which role your open visits need before you write the posting — companion and homemaker work is a different hire with different requirements.

One narrower role is worth naming for agencies that furnish Medicaid personal care: the federal rule allows individuals to furnish personal-care-aide-only services if they meet the state's qualification standards and demonstrate competency only in the services they will furnish. The qualification standards on that route are the state's, and the competency demonstration covers only the services the individual will furnish — so decide which route your open visits need rather than drifting into one.

The occupation is large. In the Occupational Employment and Wage Statistics for May 2025, BLS counted 4,305,810 home health and personal care aides (SOC 31-1120) in payroll employment — the two occupations published together as one combined group.

The worker-side view of the job — what a visit looks like, how candidates train and choose the field — lives in the home health aide career guide. This page stays on your side of the hire. To see what candidates see, browse the home health aide jobs board.

At a Medicare-certified home health agency, federal Conditions of Participation control who can work as an aide. The agency may use only qualified home health aides, and the rule recognizes four qualification routes (42 CFR 484.80(a)(1)). A candidate qualifies by completing an HHA training and competency evaluation program, or by completing an HHA competency evaluation program alone. A state licensure program that meets the federal standards also qualifies. So does a state-approved nurse aide program, while the person is listed in good standing on the state nurse aide registry.

The training route has a floor: classroom and supervised practical training totaling at least 75 hours, with at least 16 hours of classroom training before at least 16 hours of supervised practical training (42 CFR 484.80). The federal curriculum spans 14 required subject areas, from communication and observation through vital signs, infection prevention, personal hygiene, safe transfers and range of motion.

Nobody furnishes aide services before competency, either. An individual may furnish home health services for a Medicare-certified agency only after successfully completing a competency evaluation program (42 CFR 484.80(c)). The evaluation must be performed by a registered nurse, with communication, vital signs, personal hygiene, transfers and range-of-motion skills observed on a patient or pseudo-patient.

The training route also sets the instructor bar (42 CFR 484.80(e)). Classroom and supervised practical training must be performed by an RN with at least 2 years of nursing experience, including at least 1 year in home health care, or by others under that RN's general supervision.

Two screening implications fall out of the rule. First, qualification can lapse: an aide who goes 24 consecutive months without furnishing paid services must complete another qualifying program before working as a Medicare home health aide again (42 CFR 484.80(a)(2)), so an old certificate alone does not settle a hire. Second, a registry-listed nurse aide is one of the federal routes — but the federal floor is not the whole picture. The routes run through state-approved programs and your state's nurse aide registry (42 CFR 484.80(a)(1)), and the rule confines aide services to what state law permits (42 CFR 484.80(g)(2)).

What you verify, then, is the qualification route and its current status: the registry listing for nurse aide routes, and the training and competency documentation for aides your agency qualifies. Confirm the requirement that applies to your agency and setting with your state health agency before you write the qualification line into a posting.

Rules change. Confirm the current training, competency and state qualification requirements with your state health agency, and the Medicare conditions with CMS, before you hire.

Two projections frame the competition for candidates. BLS Employment Projections expect home health and personal care aide employment to grow 18.1% from 2025 to 2035, from 4,677,100 to 5,524,400 jobs, with 760,500 openings a year. PHI separately projects an estimated 9.7 million total job openings in direct care from 2024 to 2034, counting occupational transfers and labor-force exits.

These are different series — the BLS figures cover this combined occupation, while PHI's estimate covers all direct care roles — and both point at the same hiring reality. Your candidates have options, and the agencies that hire fastest tend to be the ones whose pipeline already exists before the opening does.

The channels you can operate yourself include: cohorts finishing state-approved home health aide and nurse aide training programs, employee referrals, rehires and prior applicants, postings on the boards aides actually search, staffing agencies, and community and workforce organizations.

Training partnerships deserve one compliance check before you sign. The federal rule requires supervised practical training to take place in a practicum laboratory or another setting where the trainee provides services under the direct supervision of an RN — or an LPN who is under an RN's supervision. A fully online route cannot meet the Medicare home health aide requirement. Ask any pipeline partner exactly how its supervised hours are delivered.

Ad wording is regulated. EEOC-enforced laws make it illegal to publish a job ad that shows a preference for, or discourages, applicants because of race, color, religion, sex, national origin, age (40 and older), disability or genetic information. The EEOC's own examples include ads seeking "females" or "recent college graduates." A client's request for an aide of a particular sex or background does not make the preference lawful to act on: the EEOC treats job assignment decisions based on protected characteristics as illegal as well.

The funnel detail — which boards deserve budget, how the ad is worded, how referral rewards are structured — belongs to the recruitment strategy guide, which walks the process from posting to hire.

Verify the credential itself before you read the resume. For registry-listed candidates, check the listing directly with your state nurse aide registry and hold it against the qualification routes in the last section. Then screen for the things a certificate cannot show.

If your agency bills Medicare or Medicaid, exclusion screening belongs next to the registry check. No federal health care program payment covers items or services furnished by an excluded individual or entity (42 CFR 1001.1901). A provider that employs a person it knows or should know is excluded may face civil money penalties, an assessment of up to three times the amount claimed, and exclusion itself. Federal law does not require providers to check the OIG's list — OIG says so itself — but it recommends screening before hiring and periodically thereafter, and it updates the list monthly.

Background reports run through the Fair Credit Reporting Act: before you order a consumer report on an applicant — criminal history, motor vehicle record — you must give a clear written disclosure in a stand-alone document and get written authorization (15 U.S.C. 1681b(b)(2)).

Sequence the health steps lawfully. Under the ADA, a covered employer may require a medical examination only after a job offer and before duties begin, and only if every entering employee in the job category gets one. A test for the illegal use of drugs is not a medical examination under the ADA. The CDC recommends TB screening of health care personnel upon hire, and does not recommend routine annual testing absent known exposure or ongoing transmission. What your aides need beyond that — TB testing schedules, physicals, vaccinations — is set by your state's licensing rules, so confirm with the agency that licenses you.

Fingerprint checks are state law. CMS's National Background Check Program has awarded more than $65 million to 28 states to build fingerprint-based background check programs for direct patient access employees of long-term care providers. Whether your state requires fingerprints, and whether you may hire pending results, is your state's call.

The step-by-step — what to order, in which sequence, with which disclosures — is the background checks guide's territory.

Anchor the offer to the figures BLS publishes, and label the basis when you use them. In the Occupational Employment and Wage Statistics for May 2025, home health and personal care aides earned a national median of $17.21 an hour, or $35,800 a year. The percentile spread runs from $13.00 to $21.65 hourly, 10th to 90th. BLS publishes home health aides and personal care aides as one combined group, SOC 31-1120 — the median covers the two occupations together, not home health aides alone.

Industry moves the median. Aides in home health care services (NAICS 621600) had a median of $17.42 an hour in the May 2025 release. In services for the elderly and persons with disabilities (NAICS 624120), where most non-medical home care agencies are classified, the median was $16.73 an hour. These are benchmarks to set your range against, not offers to copy — what you need to offer is set by the postings your local candidates are comparing yours against, and the home health aide salary data page carries the national percentiles and pay by setting.

Budget the wage-hour floor into the offer too. Since January 1, 2015, third-party employers such as home care and home health agencies cannot claim the FLSA companionship exemption and owe minimum wage for all hours worked plus overtime at time-and-a-half over 40 hours in a workweek. Travel between clients during the workday is compensable hours worked your agency pays for; ordinary home-to-work commuting is not. Wages must also be paid free and clear — unreimbursed job costs cannot push pay below the minimum — so settle your mileage and uniform policies before the first visit, not after a complaint.

Two more rules touch common offers. A bonus promised at hiring, or announced to keep employees working steadily or to remain with the firm — including most attendance bonuses — is not discretionary: it goes into the regular rate used to compute overtime. And posting disclosure is state law — Washington requires employers with 15 or more employees to disclose the wage scale or salary range and a general description of benefits in each posting. Other states run their own pay-transparency laws, so confirm what yours requires with your state labor agency.

Interview for the visit, not the certificate. Build scenario questions around what actually happens in a client's home. What does the aide do when a patient's condition changes mid-visit? How do they handle a refusal of care, and when do they call the RN instead of waiting for the next supervisory visit? Ask how they document and clock a visit, too. Whatever skills check you run should mirror the competency areas the federal evaluation itself observes — communication, vital signs, personal hygiene, safe transfers and range of motion — not a generic quiz.

Keep the questions lawful. EEOC guidance limits pre-employment inquiries to what is essential for judging whether a person is qualified, and says to avoid questions that would reveal race, sex, national origin, disability status, age, religion, color or ancestry. If you require a test, it must be necessary and related to the job.

Sequence after the yes. The ADA point at which a required medical examination becomes allowable — after an offer, before duties begin — is the same point where background reports and exclusion screening should be wrapping up ahead of a start date. If the offer includes a hiring bonus, write the terms the way the FLSA reads them: a bonus promised at hiring counts toward the regular rate used to compute overtime.

Then the paperwork has deadlines. Form I-9 Section 2 — your review and verification of the employee's documents — is due within three business days of the hire (8 CFR 274a.2). E-Verify, where you use it, is a free online service that confirms an employee's information against government records; whether it is mandatory for you depends on federal-contractor status and state law, so confirm with USCIS.

Close with the qualification line in your state's own terms — the exact credential and registry status your posting requires, worded so a candidate can self-match before they apply.

Onboarding starts with the floors your setting sits under — federal minimums for Medicare-certified agencies, with your state's rules on top. For a Medicare-certified home health agency, the aide conditions set the calendar. Each aide must receive at least 12 hours of in-service training in each 12-month period (42 CFR 484.80(d)).

Supervision runs on the rule's cadence. When a patient receives skilled services, an RN or other appropriate skilled professional must complete a supervisory assessment of aide services at least every 14 days. When only aide services are furnished, the RN makes an onsite, in-person supervisory visit every 60 days. And if an onsite visit verifies a deficiency in aide services, the agency must conduct — and the aide must complete — retraining and a competency evaluation for the deficient and all related skills.

Safety onboarding is its own track. OSHA identifies home healthcare hazards from bloodborne pathogens to ergonomic risks, with workers having little control over the home environment. Where your aides have occupational exposure, the bloodborne pathogens standard requires a written Exposure Control Plan reviewed at least annually, an offer of hepatitis B vaccination within 10 working days of initial assignment, and annual training.

Retention is where the hiring math pays out, and the honest benchmark is your own data. PHI points to the economics of the field: median annual earnings for direct care workers were just under $26,000, which it attributes to low wages and part-time hours. Against that backdrop, the levers you control are concrete. Schedule the hours you promised, and pay travel time the way the FLSA counts it. Give every aide a supervision contact they can name. Build a training calendar that keeps the in-service requirement from becoming a year-end scramble. Judge your retention from your own records — separations, exit reasons, weeks to first quit — rather than from any industry figure.

The playbooks for the weeks after the hire sit in the caregiver onboarding guide and the caregiver retention guide, and the other cross-role employer guides are indexed in the employer hiring guide.

Employer information, not licensing, legal, medical, benefits or tax advice. Training, competency, screening, pay and supervision rules come from the state agencies and federal bodies named above — confirm the current requirements with your state health agency, CMS, the DOL, the EEOC, or your own attorney or CPA before you hire.