“Caregivers” is a term that can include a wide range of individuals – anyone from friends and family with no training to medical professionals can be a caregiver. While most in-home support is provided by family and friends, support can be found through personal care assistants, nursing aides, and home health aides. Licensed practical nurses and registered nurses can provide home care services as well, but they are more likely to be found in a supervisory role.
What kind of credentials should you look for when selecting a caregiver? Your specific needs and the situation at hand should guide the type of caregiver you select.
Types of Caregivers
| Does not provide medical care | Can perform medical tasks | ||||
|---|---|---|---|---|---|
| Least Training | Most Training | ||||
| Family/Friends Informal Carers/Volunteers* | Professional Companion/Personal Care Aide/Home Care Aide | Nursing Aide/Certified Nursing Aide/Certified Nursing Assistant | Home Health Aide | Licensed Practical Nurse | Registered Nurse |
| *Generally unpaid; all the rest are paid | |||||
Informal Caregivers: Friends, Family and Volunteers
Family caregivers and friends that are taking part in caregiving are known as “informal caregivers” because they provide care based on having a personal relationship with their care recipient. Other — typically unpaid — informal caregivers can be close friends or neighbors who, although not part of the family, are still providing regular care or assistance.
This category also includes volunteer caregivers, who are individuals who provide free services, usually in support of an organization. Whether offering to assist a senior who is aging in place through an elder helper program or providing support to hospice patient and their family, volunteer caregivers provide help on a temporary basis. Usually, they will have received basic safety training through the organization with which they are volunteering.
While informal caregivers do not perform medical tasks, they are essential in supporting individuals who need help with activities of daily living (ADLs), including helping with personal hygiene, such as bathing and dressing, meal preparation, and assistance with mobility. Additionally, caregivers often provide companionship, especially for those who may be isolated or living alone.
Informal caregivers are an integral part of the home care system.
Formal Help from Professional Companions, Personal Care Assistants, Aides & Nurses
Formal help means help that is paid by the patient and/or their inner circle and the term usually connotes some level of formal training, and often credentialing, for the person delivering the care. If a home health agency is used, the caregiver is an employee of the agency, but if the caregiver is hired and paid directly, then an employer-employee relationship is established.
Personal Care Assistants
Personal care assistants, or PCAs, are also known as personal care aides, home care aides, and professional companions. PCAs assist with non-medical, personal tasks and are governed by few federal or state requirements for their training.
Their job is to support the independence and improve the life quality of their clients by offering home care services like:
- Help with personal care
- Meal preparation
- Transportation to appointments
- Companionship
PCAs provided under a state’s Medicaid waiver program must be from a Medicaid-certified agency or meet Medicaid requirements for Personal Care Aides in that state.
Certified Nursing Assistants
A Certified Nursing Assistant (CNA) is a healthcare professional that provides direct care to patients and supports nursing staff.
As part of their duties, CNAs can:
- Provide physical support to assist patients in performing daily living activities, including rising out of bed, bathing, dressing, feeding, toileting, walking or exercising
- Turn or re-position bedridden patients
- Record vital signs and dietary intake as well as urinary and fecal output
- Assist with medications or treatments as directed by a medical professional
In terms of qualifications, CNAs have:
- A minimum of a high school diploma
- Passed a state-specific training program (which may be as short as four to eight weeks)
- Been certified by the state they work in
CNA certification programs are overseen by a state’s Department of Health or Department of Public Health. The certification examination includes both written and clinical skills components.
Many states maintain a registry of CNAs on their websites, which can verify certification and see if there have been any findings of abuse, neglect, or misappropriation of property against them. They may work in a variety of places, including individual residences, nursing homes, and other facilities. Certified Nursing Assistants may also be employed by a larger care provider, like an agency or a hospice organization, that offers CNA services.
Home Health Aides
Home Health Aides fill a role for individuals who have ongoing medical needs but prefer to stay in the comfort of their own home rather than move to a nursing facility or hospital. Home health aides are trained to provide both personal care and medical assistance and can perform tasks such as monitoring vital signs, assisting with medication and simple dressing changes, and assisting with physical therapy exercises.
Home health aides work under the supervision of a registered nurse or a licensed healthcare provider to guarantee that all medical aspects of a patient’s care are properly managed.
As with Certified Nursing Assistants, requirements vary by state (Source: PHI). In general, home health aides are required to:
- Be at least sixteen (16) years of age
- Have successfully completed a state-specific training program, which includes an examination to test the applicant’s knowledge and skills related to basic patient care services
- Maintain a criminal record clearance
- Hold an active Certified Nursing Assistant certificate or equivalent training per state requirements
Licensed Practical Nurses
Licensed Practical Nurses, also known as Licensed Vocational Nurses, have more training than Home Health Aides and focus on providing medical assistance, not personal care. Licensed Practical Nurses are empowered to take vital signs, administer medication, place catheters, dress wounds, and carry out healthcare instructions created by the nurse, physician, and other care team members.
Licensed Practical Nurses must have:
- Earned a high school diploma or a GED
- Completed a state-specific vocational training course (generally about 12 months long)
- Passed the National Council Licensure Examination for Practical Nurses
- Been licensed in the state where they are working
Licensing in all states except New York and Pennsylvania also includes having passed a background check. As with CNAs, states maintain registries so that active licensure can be verified.
Registered Nurses
Registered Nurses (RNs) are highly trained medical professionals with a broad spectrum of responsibilities. They contribute to patients’ care plans, administer medication including intravenous medications, perform some procedures, work without supervision in certain circumstances, and provide advice and emotional support to patients.
To be a registered nurse, a person must have:
- completed a state-accredited nursing program
- earned an associate degree in nursing or Bachelor of Science in Nursing (BSN) (two to four years of training)
- taken and passed the National Council Licensure Examination for registered nurses (NCLEX-RN)
- become licensed in the state where they will be working. States maintain registries so that active licensure can be verified
Some RNs go on to further specialize, for example in addiction treatment, pediatrics, hospice, or intensive care.
A Summary of Types of Home Care Services and Who Provides Them
| Title | Also Called | Job Description | How to Find | Qualifications*+ | How Regulated# |
|---|---|---|---|---|---|
| Companions | Friends and Family | Be there for you | Asking | Being ‘your’ people | None |
| Personal Care Aides | Caregiver, Home Care Aide, Personal Care Assistant, Personal Care Assistant | In addition to assisting with activities of daily living (ADL’s), they also help with housekeeping, chores, meal preparation, and medication management | Employ directly, through an agency, or through matching apps. | Vary by state, usually at least 16 years of age, a high school graduate, and a valid driver’s license | Individual states may require registration, usually through Department of Health, Public Health, or Social Services |
| Nursing Assistants | Certified Nursing Assistant, Certified Nursing Aide, Nursing Attendant, Nursing Aide | Assist with ADL’s including rising out of bed, bathing, dressing, feeding, toileting, walking or exercising; turn or re-position bedridden patients; record vital signs and dietary intake as well as urinary and fecal output; assist with medications or treatments as directed | Employ directly, through an agency, or through matching apps | Minimum of a high school diploma, a state-specific training program, and a state certification Certification examination includes both written and clinical skills component | Most states maintain a registry so that active certification can be verified |
| Home Health Aides | Certified Home Health Aide, Home Health Attendant, Home Care Aide | In addition to helping with ADL’s they may perform simple wound care, blood pressure readings, and other minor medical activities | Employ directly, through an agency, or through matching apps | Must successfully complete additional training and pass the HHA examination after receiving CNA certification | Most states maintain a registry so that active certification can be verified |
| Licensed Practical Nurse | Licensed Vocational Nurses | Takes vital signs, administers medication, places catheters, dresses wounds, and carries out healthcare instructions created by the RN, physician, and other care team members | May be employed directly, or sent by home health care agency or hospice | Earning a high school diploma or GED, completing a vocational training course, passing the National Council Licensure Examination for Practical Nurses (NCLEX-PN) | States maintain registries so that active licensure can be verified |
| Registered Nurse | Registered nurses have a broad spectrum of responsibilities – contributing to patients’ care plans, administering medication, providing advice and emotional support to patients May further specialize | May be employed directly or sent by home health care agency or hospice | Either complete a state-accredited nursing program, an associate degree in nursing, or Bachelor of Science in Nursing (BSN); take and pass the National Council Licensure Examination for registered nurses (NCLEX-RN), become licensed in the state where working | States maintain registries so that active licensure can be verified | |
| * Vary from state to state. https://www.ncsbn.org/nursing-regulation/licensure/nurse-licensure-guidance.page – For Personal Care Aides search here: https://www.phinational.org/advocacy/personal-care-aide-training-requirements/ – For Certified Nursing Assistants search here: https://www.registerednursing.org/certified-nursing-assistant/certification/ – For Home Health Aides search here: https://www.phinational.org/advocacy/home-health-aide-training-requirements-state-2016/ – For LPN’s search here: https://www.nursingworld.org/content-hub/resources/becoming-a-nurse/how-to-become-a-licensed-practical-nurse/ – For RN’s search here: https://nursinglicensemap.com/ + All states require a background check to be registered or licensed # To verify registration: Search {state} Board of Health or Department of Social Services; To verify licensure: Search {state} Board of Nursing | |||||
After taking the time to identify the type of in-home care or home health care support you’ll need, you will need to reach out to various sources to get that help. Learn about the ways you can find help in your area.
