1 What Is Home Health Care?

Introduction

Many health care and support services may be provided outside of the traditional health care environment such as a hospital, skilled nursing facility, rehabilitation center, or long-term care environment. Receiving care within the home allows individuals to remain in the comfort of their residence, surrounded by loved ones, while their health care and daily living needs are managed. Patients who receive home health care services have a team of health care workers together help patients and their families manage their needs.

As part of this team, the Home Health Aide (HHA)/Personal Care Aide (PCA) play a vital role. Home health aides and personal care aides often spend more time with patients than any other team member. Being a home health aide/personal care aide is a very rewarding career as you have an opportunity to play a very important role in the home care team. You will meet many different people and work in a variety of settings. You will often have the chance to work with the same patients and families for a long period of time. You will have the chance to get to know your patients and families in a very personal and special way as you work with them to meet their health care and daily living needs.

Home health aide and personal care aide are two of the fastest growing occupations. There is high demand for home health aide and personal care aide workers, with many opportunities for employment. This course will provide you with the background necessary to begin working toward a career as a home health aide/personal care aide. There are many similarities between home health aides and personal care aides. They both provide assistance to patients with eating, bathing, managing a budget, cleaning, and provide personal care. However, one important difference is that personal care aides may not perform any medical related service or task as a home health aide may. For example, personal care aides may not take blood pressures or assist patients with taking their medications.

What Is Home Health Care?

Home care or home health care is supportive care that is provided in the home. Home care allows a person to remain in the comfort of their home while they are receiving services to recover from illness, injury, or disability. Home care services are also provided for people who have chronic conditions such as diabetes, HIV/AIDS, hypertension, heart failure, cancer, and chronic obstructive pulmonary disease (COPD). Home care may be provided for people who have cognitive or physical disabilities to help them complete activities of daily living. Home care may also be provided for patients who are on hospice. Hospice home care is for patients who have been diagnosed with a terminal illness (an illness that cannot be cured) and who have a prognosis of six months or less. Hospice home care allows people with a terminal illness to remain in the comfort of their homes, surrounded by familiar people and things.

People who receive home care have a variety of needs depending on their physical condition and specific disease or injury. Patients may need reminders or help to take their medications. Patients often need assistance with ambulation (walking) and transferring (moving) from a bed to a chair or wheelchair, or getting in and out of the shower. Many patients have adaptive equipment such as walkers, wheelchairs, canes, and prosthetic devices that assist them in moving about their home. Often, patients require help with activities of daily living (ADLs) such as toileting, bathing, dressing, and eating. Some patients need help with managing their budget, and with purchasing and cooking food. Patients may need assistance with changing simple dressings on wounds, making and changing their bed linens, doing laundry, and maintaining a safe and clean home.

Who Receives Home Care Services?

Home health services help people of all ages who are recovering from an illness, operation, or injury to remain in their home and avoid an unnecessary hospitalization or skilled nursing facility placement. Home health care provides support for people with physical or mental disabilities so that they may remain at home out of an institution or long-term care placement. Home health services are provided to people who are living with chronic conditions such as diabetes, obesity, HIV/AIDS, congestive heart failure, and asthma. Many chronic conditions are complex to manage and require the use of various technological devices and equipment such as a glucose meter, blood pressure monitor, and adaptive equipment such as wheelchairs. Many people have conditions that require special diets to be prepared and followed. Assisting patients who have chronic diseases to manage their conditions within the home allows them independence within the comfort of their own home.

Patients who have recently had surgery may continue to recover within the comfort of their home while receiving supportive services to manage dressings, complete a course of antibiotics, and regain their strength. Adolescents and children may also receive home care services to recover from illness or injury or to receive assistance with activities of daily living. At-risk newborns, children, and teenagers may receive home care services to avoid foster care or institutional placement. When people receive supportive services within their home, they are able to remain connected with their family, neighborhood, community, and places of worship. Remaining in the home allows a person to be as independent as possible. Patients benefit by being surrounded by the people and things they most care about. This promotes their comfort and dignity and helps to maintain the family unit.

An increasing number of people are receiving home care services. One of the reasons for this is that the cost of medical care in hospitals is rising, and patients are being discharged from hospitals sooner than they have had a chance to fully recover (National Research Council, Committee on the Role of Human Factors in Home Health Care, 2011). These patients often have complex needs and require support as they recuperate. Medically-necessary skilled home care services are often covered in full or in part by reimbursement through private or government-sponsored programs like Medicaid and Medicare. Continuing to receive skilled medical support within the home is a less expensive alternative than care received within a hospital.

There is a steady increase in the aging population within the United States, many of whom have numerous health issues and needs (National Research Council, Committee on the Role of Human Factors in Home Health Care, 2011). Family members may not always be able to provide the care these patients need. Some families may live far away, have work responsibilities, or need to care for small children. This makes providing care for a loved one difficult. Sometimes, families may be able to provide some of the care, but may benefit from respite (relief) that a home health agency can provide from the emotional and physical stress of caregiving. The United States also has a growing number of veterans returning home with disabilities (National Research Council, Committee on the Role of Human Factors in Home Health Care, 2011). Veterans with disabilities may require help with the care of injuries, completion of activities of daily living, or with the emotional support home care workers provide.

Advances in technology, medicine, and disease prevention have extended the lives of people living with chronic diseases. People living with chronic conditions require monitoring and health care interventions. Chronic illnesses are often progressive (become worse) and patients living with these types of conditions require advanced care as their disease progresses. For example, patients with heart failure or HIV/AIDS require disease-specific care to manage their numerous medications, treatments, appointments, diet, and completion of activities of daily living (ADLs). Many people want to be as independent as possible and are more comfortable at home. Providing supportive home health care services allows them to do this.

Self-Check Activity m1-1


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Self-Check Activity M1-1

Patients with______________ may benefit from home health care. Select all that apply.

  • Terminal illness
  • Chronic illnesses
  • Cerebral palsy
  • HIV/AIDS
  • Birth defects
  • Kidney failure
  • Multiple sclerosis
  • Stroke
  • Swallowing difficulties
  • Physical disabilities
  • Cognitive disabilities
  • Dementia
  • Hearing impairments
  • Heart failure
  • Chronic obstructive pulmonary disease
  • Wounds
  • Asthma
  • Arthritis
  • Diabetes
  • Hypertension
  • Vision impairments
  • Cancer

Check your answers!

History of Home Care

In 1813, the Ladies Benevolent Society, (LBS), a group of women volunteers in Charleston, South Carolina, began the first efforts at providing home care services (Buhler-Wilkerson, 2001). These untrained women were the first to provide direct care services within people’s homes. The LBS visited the sick poor in their homes, helped them to obtain medicines, food, and supplies such as soap, bed linens, and blankets. They also helped to supply them with nurses, although these nurses were untrained.

According to Buhler-Wilkerson (2001), in the North, women from wealthy families volunteered with the sick poor to establish “friendships” in which to help the sick overcome disease and poverty. These women quickly realized that trained nurses were needed to help the sick poor, as establishing friendships alone could not help prevent or cure disease (Buhler-Wilkerson). They began to hire trained nurses, who they called “visiting nurses.” This idea came about based on the “district nurse” model which was established in England (Buhler-Wilkerson).

The National Nursing Association for Providing Trained Nurses for the Sick Poor was created in England in 1875 (Buhler-Wilkerson, 2001). This organization trained, organized, and created standardized practices for district nurses who worked within people’s homes. In addition to attending to the physical needs of their patients, these visiting nurses worked to teach the sick poor about how disease is spread and how to maintain a clean home in order to prevent the spread of infection.

Based on this model, Visiting Nurse Societies were established in major cities throughout the Northern United States (Buhler-Wilkerson, 2001). By 1890, there were 21 home care visiting nursing associations (Buhler-Wilkerson). The need for nursing care within the home continued to grow. This need grew to not only caring for the sick poor, but also to provide preventative services to babies, children, mothers, and to care for patients with infectious diseases such as tuberculosis. Although the death rate for infectious diseases had declined, there was a growing concern for prevention and good hygiene. By 1909, the Metropolitan Life Insurance Company began to send nurses into their policyholders’ homes to provide nursing services (Buhler-Wilkerson). Their hope was that providing home nursing care would reduce the amount of death benefits claimed. They were the first organization to provide reimbursement for home care nursing services.

Lillian Wald, a nurse, is credited for establishing the Henry Street Settlement and with defining the term “public health nursing”. The nurses who worked at the Henry Street Settlement visited the sick in their homes, and also provided social services for people throughout the city. In addition to the Henry Street Settlement house, the organization grew to include numerous nursing houses throughout the city to meet the growing need for nurses within communities. These nurses also held classes for their neighbors to teach carpentry, sewing, cooking, English, and home nursing (Buhler-Wilkerson, 2001). They established kindergartens and various social clubs to meet the needs of their neighborhoods. By the time of Lillian Wald’s retirement, her nurses were making 550,000 home visits to 100,000 patients (Buhler-Wilkerson).

In the late 1920s, many of the home care agencies closed due to the poor economy and the nursing shortage during World War II (Buhler-Wilkerson, 2001). The establishment of hospitals resulted in a model where patients moved from receiving care in the homes to into hospitals. Despite experiments by The Health Insurance Plan of Greater New York and Blue Cross to include home care services, coverage for visiting home care was not universally provided at that time (Buhler-Wilkerson). By the late 1950s and early 1960s, however, it became clear that there was again a growing need for home care services. People with chronic illnesses did not necessarily need to be hospitalized. The cost of hospitalizations began to be apparent, and the long-term effects on lengthy institutionalizations began to be studied (Buhler-Wilkerson).

In the U.S., it was not until 1965, when Medicare was established for people over 65 years of age, that home care services were once again covered by insurance (Buhler-Wilkerson, 2001). Medicare is a federal health insurance program. Medicare now also pays for patients with kidney failure and certain disabilities. According to the U.S. Department of Health & Human Services, Centers for Medicare & Medicaid Services (2010), patients who receive home services through Medicare must be under the care of a physician who certifies the need for skilled nursing care, physical therapy, speech-language pathology services, or occupational therapy. Patients must also be certified to be home-bound by their doctors. This means that it is either unsafe for the patients to leave their home or they have a condition that makes leaving the home difficult. Medicare provides “intermittent” home care, meaning home care is not needed on a full-time basis. While Medicare will often pay the full cost of most covered home health services, they do not pay for 24 hour a day care. Medicare may also cover up to 80% of special equipment the patient needs, such as a wheelchair or walker (U.S. Department of Health & Human Services, Centers for Medicare & Medicaid Services).

Medicaid is a joint state and federal health insurance program. Coverage for patients will vary from state to state, and states may call it different names, such as “Medi-Cal” or “Medical Assistance” (U.S. Department of Health & Human Services, Centers for Medicare & Medicaid Services, 2010). Medicaid provides coverage for low-income patients and families. Eligibility for this program depends on income, number of people in a household, and other circumstances. It is important to remember that not everyone is eligible to receive Medicare or Medicaid, and home care services may not be covered in full. Agencies who receive reimbursement through Medicare or Medicaid must meet certain guidelines, including the requirement that HHAs receive formal training and pass certification exams. Due to the growing need for home care services, and in an effort to reduce costs to insurance programs such as Medicare, the need for home health aides (HHAs) and personal care aides (PCAs) continues to increase.

Who Is Part of the Home Health Care Team?

Home health care may be provided by licensed medical personnel such as physicians, registered nurses (RNs), licensed practical nurses (LPNs), physical therapists (PTs), occupational therapists (OTs), speech language pathologists (SLPs), registered dieticians (RDs), medical social workers (MSWs), respiratory therapists (RTs), wound care specialists, and unlicensed, but certified workers such as home health aides, nursing assistants, and personal care aides. Unlicensed personnel such as home health aides and personal care aides are vital members of the home health care team. Every member of the home health care team has a role to play. When all members work together, they can achieve the goal of caring for the patient.

Roles of Health Care Professionals on the Home Health Care Team

This information is based on the Occupational Outlook Handbook from the U.S. Department of Labor, Bureau of Labor Statistics (2014). The information within this section is based on typical professional requirements within the United States. For requirements concerning governing laws within specific countries or states, information should be obtained from those particular countries and states.

Physician (MD or DO)

While physicians may not often provide direct health care within the home setting, they oversee patient care, diagnose and monitor conditions, and prescribe medications and treatments. Doctors have graduated from a bachelor’s degree program and medical school. They have passed a licensing exam within their state. All physicians must be licensed within the state they practice. Many doctors also have specialty certifications.

Registered Nurse (RN)

Registered nurses in a home health agency coordinate and manage the patient’s care. RNs perform assessments, monitor test and laboratory results, administer treatments and medications, monitor the patient’s condition, and provide education to the patient and family. Registered nurses supervise LPNs, Home Health Aides, and Personal Care Aides. Registered nurses have degrees from two- or four-year nursing programs, or have graduated from a diploma program, and have passed a licensing examination in order to practice within their state. RNs may have advanced academic degrees and education/certification in specialty areas.

Licensed Practical Nurse (LPN)

Working under the supervision of an RN, a LPN may administer medications, check vital signs, provide wound care, collect samples for testing such as urine and blood, and assist with patient self-care activities. LPNs must complete a state-approved educational program and apply for a license within their state after passing an examination.

Physical Therapist (PT)

Physical therapists help patients to strengthen and restore their ability to be mobile and to prevent further injury. PTs may teach patients to use special equipment such as walkers and canes, assist patients with specific exercises to help regain mobility and strength, and administer treatments such as massage, heat, or cold to help improve patient circulation, reduce pain, prevent disability, and improve muscle and joint function. PTs must obtain a Doctor of Physical Therapy (DPT) degree and pass national and state licensure exams to practice. PTs must be licensed within their state.

Occupational Therapist (OT)

Occupational therapists work with patients to help them learn to adapt to a disability so they may function as independently as possible. OTs help patients perform activities of daily living such as dressing, eating, and bathing. An OT teaches patients how to use assistive and adaptive devices such as special forks, plates, long-handled shoe horns and sponges, and raised toilet seats. OTs usually have a master’s degree in occupational therapy and have passed a national certification exam. OTs must be licensed and/or registered within their state.

Speech-Language Pathologist (SLP)

Speech-Language Pathologists or speech therapists work with patients who have communication or swallowing disorders, who have experienced strokes or accidents, or have a neurological health problem. The SLPs teach patients exercises to improve speech, to effectively communicate, and to safely swallow. They may suggest special diets to aid in swallowing, such as mechanical diets and thickened liquids. Most SLPs have a master’s degree and depending on the state in which they work, must be licensed.

Registered Dietician (RD)

A registered dietician evaluates a patient’s nutritional intake and orders special diets for the patient to follow. They provide education to patients and families about special diets to manage their illness and to improve their nutrition. RDs must have completed a bachelor’s degree and often have a master’s degree. Most states require certification or license to practice.

Medical Social Worker (MSW)

A medical social worker works with the patient and family to help them get support services such as counseling, financial assistance, and community services. An MSW provides emotional support to the family and works as an advocate to help meet the patient’s needs. Social workers typically have at least a bachelor’s degree. Clinical social workers must have a master’s degree and two years post-masters supervised clinical experience. MSWs must be licensed within the state they practice.

Home Health Aide (HHA)

Under the supervision of a nurse, a HHA provides supportive care to patients within their homes. They work to increase or maintain independence, health, and well-being of the patient. HHAs provide or assist with self-care activities such as bathing, dressing, grooming, toileting, feeding, skin care, use of medical supplies and equipment such as walkers and wheelchairs, and assisting with light housework, laundry, and home safety. Depending on the state in which they live and if they work in a certified home health agency, home health aides (HHAs) must be certified and complete training programs.

Personal Care Aide (PCA)

Under the supervision of a nurse, a PCA provides self-care and companionship to a patient. They assist with self-care activities such as bathing, dressing, grooming, toileting, feeding, skin care, and use of assistive devices such as walkers and wheelchairs. They also assist with housekeeping tasks such as laundry, changing bed linens, washing dishes, and preparing meals. Personal care aides may not perform any type of medical service or task, as a Home Health Aide may. A PCA may not take vital signs or glucose meter readings. Personal Care Aides are usually trained on the job. There are no educational requirements to become a PCA, but most PCAs have a high school diploma.

Patient/Family

The patient and their family are the most important parts of the health care team. Patients have the right to make decisions about their health care. They have a right to be informed about treatments and the care they receive. They have a right to refuse treatments, medications, and services. All patients and their families are unique and have various needs, desires, cultures, and traditions. It is important that the health care team respect these individual differences and work to meet each patient’s needs. Without the patient, there can be no health care team.

Self-Check Activity M1-2


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Self-Check Activity M1-2

Match the team member with the role they play:

Team Member Role
1. Home Health Aide a. Oversees care, makes diagnoses, and prescribes medications
2. Registered Nurse b. Most important team member, has the right to be involved in care and refuse treatments
3. Occupational Therapist c. Assesses a patient’s nutritional status and suggests special diets
4. Medical Social Worker d. Teaches a patient to use assistive or adaptive devices so they may perform activities of daily living
5. Registered Dietician e. Under supervision of an RN, administers medications, performs dressing changes, and monitors vital signs
6. Physician f. Helps restore mobility and prevent injury by working with patients to perform exercises and use special equipment such as wheelchairs
7. Patient g. Under supervision, provides and assists patients with self-care such as bathing, dressing, and feeding, and performs household tasks. They may not perform medically related tasks
8. Speech-Language Pathologist h. Under supervision, provides and assists patients with self-care such as bathing, dressing, and feeding, performs household tasks, and may assist with medically related tasks
9. Physical Therapist i. Connects the patient to community services and provides counseling
10. Licensed Practical Nurse j. Helps the patient to improve speech and swallowing problems
11. Personal Care Aide k. Coordinates patient care, supervises LPNS, HHAs, and PCAs, assesses patients, and administers medications

Check your answers!

Home Health Aide/Personal Care Aide Tasks

Home health aides typically provide assistance to people with every-day tasks so that they can be as independent as possible while remaining in their own homes. Typical tasks include bathing, dressing, and assisting a patient with using a bedpan, urinal, commode, or toilet. HHAs may also be involved with purchasing and preparing food and assisting a patient with eating during meals. Depending on the state in which they live, HHAs may also participate in health care activities such as taking vital signs (such as checking blood pressure, pulse, respiration rate, and temperature) and assisting with prescribed medications under supervision, by providing reminders to patients. Personal care aides, however, may not perform the above health care activities.

Other tasks, such as light housekeeping duties such as vacuuming, laundry, and washing dishes, help to maintain the home of the person to whom care is being provided. It is important that home health aides and personal care aides keep accurate records of the services they provide and the tasks they complete. They must document all services provided and those that were unable to be provided due to time constraints or patient refusal. Home health aides and personal care aides also keep records of their patient’s progress and must report any changes in their patient’s condition to their supervisor. Developing a trusting relationship and providing companionship for the person for whom they are caring for is an important aspect of being a home health aide and personal care aide. This can also be one of the most rewarding aspects of the job. Since HHAs and PCAs are providing intimate and important care to their patient, they have an opportunity to get to know him or her as a person very well.

Examples of Tasks Performed by HHAs and PCAs:

  • Bathing
  • Dressing
  • Toileting
  • Purchasing and preparing food
  • Eating
  • Monitoring vital signs (for HHAs only)
  • Housekeeping duties (vacuuming, laundry, dishes)
  • Companionship
  • Record keeping

Scope of Practice for HHAs

Scope of practice defines the tasks that health care workers are legally allowed to perform. For example, there are some procedures that HHAs may not perform because they are considered to be outside of the scope of practice. In the U.S., there are variations that exist from state to state about what a HHA can do. It is important to be aware of the rules and regulations that pertain to the state in which the HHA works. According to the New York State Department of Health (2009), the following includes a list of tasks that HHAs may not perform:

Tasks that HHAs may not perform include:
HHAs may not administer medications unless trained and allowed to do so by their state and agency. In certain situations and with special training a HHA may assist patients with self-administration of medications.
HHAs may not insert or remove tubes from a patient’s body. Examples may include, but are not limited to insertion of catheters, fecal containment devices, nasogastric tubes, feeding tubes, and intravenous catheters. Insertion of a tube or object is considered an invasive procedure and may only be performed by licensed professionals.
HHAs may not perform sterile procedures. This includes changing dressings on deep, open wounds which require sterile technique. HHAs may assist a licensed professional with completion of these tasks by gathering supplies, distracting a patient, or assisting with cleanup after the procedure once the sterile area has been covered.
HHAs may not perform a task or duty that is outside of their scope of practice or that has not been assigned to them. When working as an HHA, there may be situations in which a patient or family asks the HHA to do something they are not trained or allowed to do. In these situations, the HHA should explain that they are not allowed to perform that particular task. They should then seek the assistance of their direct supervisor. It is always the right of the HHA to refuse to complete a task that is outside of their scope of practice.
Scope of Practice for PCAs
In general, PCAs may not perform any medically-related task. They may not administer or assist patients with medications under any circumstance. They may not provide assistance with dressing changes, apply medicated lotions to a patient’s skin, or take vital signs.

Self-Check Activity M1-3
Scope of Practice for HHAs
Which of the following tasks may a HHA perform? Select all that apply.

  1. Provide assistance with feeding
  2. Perform a sterile dressing change
  3. Assist a patient to the toilet or commode
  4. Insert a urinary catheter
  5. Complete records of tasks you complete
  6. Perform injections
  7. Vacuum
  8. Help a patient bathe and dress
  9. Laundry
  10. Administer medications without special training
  11. Apply medicated lotion to a patient’s skin
  12. Remind patients about taking medications
  13. Brushing a patient’s teeth
  14. Assisting the family with budgeting and paying bills
  15. Assist a nurse with a clean dressing change
  16. Take and record

vital signs

Check your answers!

Self-Check Activity M1-4
Scope of Practice for PCAs

Which of the following tasks may a PCA perform? Select all that apply.

  1. Provide assistance with feeding
  2. Perform a sterile dressing change
  3. Assist a patient to the toilet or commode
  4. Insert a urinary catheter
  5. Complete records of tasks you complete
  6. Perform injections
  7. Vacuum
  8. Help a patient bathe and dress
  9. Laundry
  10. Administer medications
  11. Assist patients with taking medications
  12. Apply medicated lotion to a patient’s skin
  13. Remind patients about taking medications
  14. Brushing a patient’s teeth
  15. Assisting the family with budgeting and paying bills
  16. Assist a nurse with a clean dressing change
  17. Take and record

vital signs

Check your answers!
Chain of Command
Care plans, which are the prescribed treatments and services a patient will receive are developed from input from all members of the team. There may be many care plans for a patient who has many needs. For example, a physical therapist will develop a care plan for mobility needs after assessing the patient. The registered dietician will develop a care plan for nutritional guidelines for the patient to follow. The supervisor, who is often a registered nurse, will coordinate the care the patient will receive.

Home health aides and personal care aides work under the supervision of a Registered Nurse (RN). The supervisor will provide the HHA/PCA with a care plan to follow. It is important that the instructions written on the care plan are followed. This ensures that the patient receives the proper and safe health care they deserve. It also protects the HHA/PCA and the agency for which they work from liability. Liability means that the employee (the HHA/PCA) or the agency for which they work can be held legally responsible for harming a patient. For example, if the HHA/PCA did not follow what was instructed in the care plan and performed a task outside of their scope of practice, such as inserting a urinary catheter, and harm comes to the patient, the HHA/PCA and the employer (the agency) are legally liable.

Care plans are updated regularly to ensure the patient’s needs are being met. They are also updated when there are changes in a patient’s condition. As the person on the healthcare team who spends the most time directly with the patient, the HHA/PCA will have first-hand knowledge of the patient’s condition. It is important that they immediately report any change in patient condition to their supervisor, and that these changes are documented. For example, an HHA/PCA may observe that the patient is weaker than a previous visit, which puts the patient at a greater risk for a fall. It is important that these observations are documented and reported to a supervisor. Other examples of changes that may be noticed include: a change in the patient’s behavior, unexplained bruises, skin breakdown, or an unsafe situation in the home, such as cluttered hallways, which may be a trip hazard. These would be important observations to document and inform a supervisor about.

While patients always have the right to refuse treatments or assistance, it is important that the HHA/PCA document these refusals and inform their supervisor. Under an HHA/PCA’s employment conditions and certification requirements, they may be legally liable to report changes in patient conditions and within patient environments. If an HHA/PCA is ever unsure of a situation or an observation, they should talk to their supervisor. It is important to follow the care plan and instructions from supervisors to protect oneself, the agency, and most importantly, the patient.

Self-Check Activity M1-5
Which of these situations should a HHA/PCA report to their supervisor? Check all that apply.

  1. A patient falls
  2. The HHA/PCA notices a bruise on a patient that was not there before
  3. The patient refuses to allow the HHA/PCA to perform a task on the care plan
  4. The patient tells the HHA/PCA a family member has been abusive
  5. The HHA/PCA notices there does not appear to be enough food in the home
  6. The HHA/PCA is unable to make it to work or will be late

Check your answers!
Qualities of Home Health Aides and Personal Care Aides
Taking care of someone requires that you have good physical health. Assisting a person to walk, transfer into a wheelchair or shower, and completing household tasks such as cleaning and cooking can be physically demanding. According to the U.S. Department of Labor, Bureau of Labor Statistics (2014), Home Health Aides and Personal Care Aides have a higher rate of injury and illness as compared to other jobs. It is important that a HHA/PCA take good care of their physical health and protect themselves against injury. Using proper body mechanics will help protect a person from back, muscle, joint, and other injuries. Proper body mechanics will be discussed throughout this course.

Grooming on a regular basis is important to maintain good physical health and appearance. It helps a person to feel good about oneself and shows others that they care about them. Showering or bathing daily, brushing teeth, using deodorant, and keeping hair and/or facial hair well-groomed are important tasks to help a HHA/PCA care for themselves and others. Uniforms should be freshly laundered and appear neat, without rips, tears, or stains. Long hair should be tied or held back. Jewelry should be kept to a minimum. Makeup should be kept to a minimum, and strong cologne or perfume should be avoided, as it could be irritating to patients. Fingernails should be kept trimmed and clean. Artificial nails harbor bacteria and should be avoided. Hand hygiene is extremely important, as it is the best way to prevent the transmission of infectious diseases. A health care worker should always wash their hands prior to and after performing a task where patient contact is involved, and any time hands appear dirty. Gloves should be worn when providing patient care where there is possible contact with body fluids.

Working as a Home Health Aide/Personal Care Aide is very rewarding, but can also be emotionally challenging. A HHA/PCA may work with a person with a cognitive or emotional disability who may display difficult behaviors. Patients who are in pain or who do not feel well may have mood swings or display behaviors that may be challenging to work with. Throughout this course, we will discuss ways to work with people who may have difficult behaviors. The skills for developing good communication with patients will be discussed throughout this course.

Providing supportive care also requires that the HHA/PCA is dependable, organized, responsible, trustworthy, patient, caring, and compassionate. As they work with people on a daily basis, it is important to be people-oriented and enjoy working with others. Patients and families allow home care workers to come into the privacy of their homes and take care of them in very personal ways. It is important that an HHA/PCA is trustworthy, honest, and respectful. This means that the HHA/PCA must respect a patient’s right to refuse a treatment or care, right to privacy, and right to practice any customs or traditions important to them.

Both the agency the HHA/PCA works for and the patient the HHA/PCA cares for relies on the HHA/PCA. An HHA/PCA should report to work on time. Home health aides/personal care aides work as part of a team, but are also required to work independently. This means that they are asked to complete tasks that have been assigned to them by their supervisor and the agency for which they work. They are also expected to document completion of these tasks. The entire health care team and especially the patient depend on home health aides/personal care aides to complete assigned tasks and to document their completion honestly. If a problem with completing a task occurs, the HHA/PCA should seek direction and assistance from their supervisor. Part of this documentation will include the time spent performing patient tasks and any travel time or mileage. Many agencies may reimburse for mileage and will have policies in place for the time spent traveling to the work site.

Self-Check Activity M1-6
Which of the following behaviors could lead a HHA/PCA to get dismissed from their position? Check all that apply.

  1. Being on time
  2. Completing a task outside the scope of practice
  3. Stealing from a patient or their home
  4. Falsely documenting that a task was completed
  5. Providing privacy during bathing of a patient
  6. Respecting a patient’s right to refuse a service or medication
  7. Not following agency policies and procedures
  8. Repeatedly showing up late for work
  9. Showing compassion for patients
  10. Lying about the hours you spent working with the patient
  11. Being culturally sensitive and respecting differences of others

Check your answers!
Educational and Training Requirements

Home Health Aides

According to the US Bureau of Labor Statistics Bureau of Labor Statistics (2014), in the U.S. there are no universal formal educational requirements to become a home health aide (HHA), but states and employers may require specific training, including a minimum number of hours of classroom, lab, or clinical practice. Most home health aides have a high school diploma before entering the field, but this may not be a requirement in all locations. Formal educational programs may be available at community colleges and vocational schools. According to the bureau, the job growth outlook is projected to grow 48% from 2012 to 2022 for Home Health Aide workers, making it one of the fastest growing occupations!

Home health aides who work in certified home or hospice agencies, such as those who receive reimbursement from Medicaid and Medicare, must receive a minimum level of training and pass a competency exam or become certified by the state where they live. In some cases, they may be able to take a competency exam without having formal training. Requirements will vary state to state. Some states may only require that they receive on-the-job training from their employer. States may often conduct background checks and in some cases, a physical exam. It is important to check the regulations and requirements in your state or country to make sure that you meet all qualifications before practicing as a HHA.

Personal Care Aides

According to the US Bureau of Labor Statistics, Bureau of Labor Statistics (2014), there are no universal formal educational requirements to become a personal care aide (PCA), and most PCAs receive on-the-job training. Most PCAs have a high school diploma, but this may or may not be a requirement, depending on the employer. Some states require completion of a formalized training program. Employers may require completion of a first aid and cardiopulmonary resuscitation (CPR) course, and passing of a competency evaluation. The job outlook is projected to grow 49% from 2012 to 2022 for Personal Care Aide workers, making it one of the fastest growing occupations! It is important to check the regulations and requirements in your state or country to make sure that you meet all qualifications before practicing as a PCA.

Post-test

  1. True or False: People of all ages, cultures, and with different types of disabilities, injuries, or conditions may receive home health care at various points in their lives.
  2. Which of these tasks should a HHA/PCA not perform?
    1. Help a patient wash their hair.
    2. Fold a patient’s laundry.
    3. Insert a urinary catheter for an incontinent patient.
    4. Change a patient’s bed linens.
  3. Who coordinates and supervises care of the patient?
    1. Registered Nurse
    2. Occupational Therapist
    3. Medical Social Worker
    4. Home Health Aide
  4. In which of these situations should a HHA/PCA contact a supervisor? Select all that apply.
    1. The patient falls getting out of the tub.
    2. Their car breaks down and they can’t get to work on time.
    3. They are re-positioning a patient in bed and notice a bed sore.
    4. A patient refuses to let them in the house.
  5. True or False: If a HHA work for an agency that accepts Medicare or Medicaid they must complete a minimum level of training and pass a competency exam or be certified in the state they live.
  6. True or False: Hand washing is the number one way to prevent the spread of infectious diseases.
  7. Which of the following are qualities a HHA/PCA should possess? Select all that apply.
    1. Tardiness
    2. Compassion
    3. Can work independently
    4. Is not people-oriented
    5. Is well-groomed
    6. Respectful of patient rights and cultural differences
    7. Honest
    8. Impatient
  8. True or False: Scope of practice are the tasks that a HHA/PCA are legally allowed to perform.
  9. Which of these behaviors could lead to a HHA/PCA getting dismissed (fired)? Select all that apply.
    1. Showing up late to work repeatedly
    2. Not properly documenting
    3. Performing a task outside their scope of practice
    4. Stealing items from the patient’s home
  10. Which of the following are benefits of receiving home care for patients? Select all that apply.
    1. Patient is in a familiar environment
    2. It is less expensive than a hospital or skilled nursing facility
    3. Patients may remain with their family and within their community
    4. Patients feel that they retain more of their independence than if they lived in an institutional facility.

Check your answers!

Self-Check Activity M1-1 Answers

If you selected all of the answer choices, you are correct. Anyone has the potential to need home care services. Home health care workers and personal care aides serve people of all ages, culture, ethnicity, gender, and type of disability or illness. Return

Self-Check Activity M1-2 Answers

  1. H
  2. K
  3. D
  4. I
  5. C
  6. A
  7. B
  8. J
  9. F
  10. E
  11. G

Return

Self-Check Activity M1-3 Answers

These are tasks that MAY be performed: 1, 3, 5, 7, 8, 9, 11, 12, 13, 14, 15, 16

Return

Self-Check Activity M1-4 Answers

These are tasks that MAY be performed by a PCA: 1, 3, 5, 7, 8, 9, 13, 14

Return

Self-Check Activity M1-5 Answers

If you checked all of these situations, you are correct. All of these examples should be reported to a supervisor.

Return

Self-Check Activity M1-6 Answers

The following could get you DISMISSED: 2, 3, 4, 7, 8, 10

Return

Post-test Answers

1. True

2. C

3. A

4. A, B, C, D

5. True

6. True

7. B, C, E, F, G

8. True

9. A, B, C, D

10. A, B, C, D

Return

References

Buhler-Wilkerson, K. (2001). No place like home: A history of nursing and home care in the United States. Baltimore, MD: Johns Hopkins University Press.

National Research Council, Committee on the Role of Human Factors in Home Health Care. (2011). Health care comes home: The human factors. Retrieved from http://www.nap.edu/catalog/13149/health-care-comes-home-the-human-factors

New York State Department of Health. (2009). Home Health Aide scope of tasks: Guide to Home Health Aide training and competency evaluation and MATRIX permissible and non-permissible activities. Retrieved from http://www.nyscal.org/files/2013/11/hha_scope_of_tasks-updated-3-09.pdf

U.S. Department of Health and Human Services, Centers for Medicare &Medicaid Services. (2010, May). Medicare and home health care (CMS Product No. 10969). Retrieved from http://www.medicare.gov/Pubs/pdf/10969.pdf

U.S. Department of Labor, Bureau of Labor Statistics. (2014, January 8). Dieticians and Nutritionists. In Occupational Outlook Handbook, 2014-15 Edition. Retrieved from http://www.bls.gov/ooh/healthcare/dietitians-and-nutritionists.htm

U.S. Department of Labor, Bureau of Labor Statistics. (2014, January 8). Home health aides. In Occupational Outlook Handbook, 2014-15 Edition. Retrieved from http://www.bls.gov/ooh/healthcare/home-health-aides.htm

U.S. Department of Labor, Bureau of Labor Statistics. (2014, January 8). Licensed Practical and Licensed Vocational Nurses. In Occupational Outlook Handbook, 2014-15 Edition. Retrieved from http://www.bls.gov/ooh/healthcare/licensed-practical-and-licensed-vocational-nurses.htm

U.S. Department of Labor, Bureau of Labor Statistics. (2014, January 8). Occupational Therapist. In Occupational Outlook Handbook, 2014-15 Edition. Retrieved from http://www.bls.gov/ooh/healthcare/occupational-therapists.htm

U.S. Department of Labor, Bureau of Labor Statistics. (2014, January 8). Personal Care Aide. In Occupational Outlook Handbook, 2014-15 Edition. Retrieved from http://www.bls.gov/ooh/healthcare/personal-care-aides.htm

U.S. Department of Labor, Bureau of Labor Statistics. (2014, January 8). Physical Therapists. In Occupational Outlook Handbook, 2014-15 Edition. Retrieved from http://www.bls.gov/ooh/healthcare/physical-therapists.htm

U.S. Department of Labor, Bureau of Labor Statistics. (2014, January 8). Physicians and Surgeons. In Occupational Outlook Handbook, 2014-15 Edition. Retrieved from http://www.bls.gov/ooh/healthcare/physicians-and-surgeons.htm

U.S. Department of Labor, Bureau of Labor Statistics. (2014, January 8). Registered Nurses. In Occupational Outlook Handbook, 2014-15 Edition. Retrieved from http://www.bls.gov/ooh/healthcare/registered-nurses.htm

U.S. Department of Labor, Bureau of Labor Statistics. (2014, January 8). Social Workers. In Occupational Outlook Handbook, 2014-15 Edition. Retrieved from http://www.bls.gov/ooh/community-and-social-service/social-workers.htm

U.S. Department of Labor, Bureau of Labor Statistics. (2014, January 8). Speech-Language Pathologists. In Occupational Outlook Handbook, 2014-15 Edition. Retrieved from http://www.bls.gov/ooh/healthcare/speech-language-pathologists.htm

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What Is Home Health Care? by Kimberly B. McLain, Erin K. O'Hara-Leslie, Andrea C. Wade is licensed under a Creative Commons Attribution 4.0 International License, except where otherwise noted.