Home health aides are trained caregivers who help people with daily living activities and basic health-related tasks in their own homes. They work with older adults, people with disabilities, and those recovering from illness or surgery, providing a mix of personal care, light housekeeping, and limited medical support under the supervision of a nurse or other licensed professional. The national median rate for these services is $35 per hour.
What Home Health Aides Actually Do
The day-to-day work of a home health aide spans personal care, household tasks, and basic health monitoring. On the personal care side, that includes helping with bathing, dressing, grooming, feeding, and walking. For household support, aides handle laundry, vacuuming, dishwashing, grocery shopping, meal preparation (including dietary restrictions), scheduling appointments, and arranging transportation.
The health-related duties are what set home health aides apart from other types of caregivers. Depending on the state, an HHA may check a client’s pulse, temperature, and breathing rate. They can help with simple prescribed exercises and assist with medications. Some change bandages, provide skin care, or help with braces and prosthetic limbs. With additional training, experienced aides may work with medical equipment like ventilators.
All clinical tasks happen under the direction of a nurse or other healthcare practitioner. HHAs do not administer IV medications, insert or remove catheters, change sterile dressings on complex wounds, or make medical assessments. Those tasks are reserved for licensed nurses.
HHA vs. PCA vs. CNA
Three titles come up frequently in home care, and they differ in training and what each worker is legally allowed to do:
- Personal care aides (PCAs) provide nonmedical support: companionship, cleaning, cooking, errands, and transportation. They do not support the delivery of health care. There are no federal training requirements, though some states or employers set their own.
- Home health aides (HHAs) do everything a PCA does, plus basic health tasks like measuring vital signs, helping with medications, and assisting with medical equipment, all under a licensed professional’s supervision. Federal law requires a minimum of 75 hours of training for those working at Medicare-certified agencies.
- Certified nursing assistants (CNAs) have the broadest clinical scope of the three and typically complete more extensive training programs. CNAs often work in nursing facilities as well as in homes.
If your family member needs only companionship and help around the house, a PCA may be sufficient. If there’s any health monitoring, medication assistance, or wound care involved, an HHA or CNA is the appropriate choice.
Training and Certification Requirements
Federal rules set the floor: home health aides working for Medicare-certified agencies must complete at least 75 hours of training, including a minimum of 16 hours of classroom instruction and 16 hours of supervised hands-on practice. Training covers personal hygiene, reading and recording vital signs, infection control, and basic nutrition. After completing the program, candidates must pass a state certification exam and then complete at least 12 hours of continuing education each year to maintain certification.
Many states require significantly more. Maine leads with 180 total hours including 70 clinical hours. Alaska requires 140 hours with 80 clinical hours. California, Idaho, Illinois, and Wisconsin each require 120 hours. Only 17 states and the District of Columbia exceed the federal minimum, and just six states plus D.C. meet the 120-hour standard recommended by the National Academy of Medicine. HHAs who work for agencies that don’t accept Medicare may only need to complete their employer’s on-the-job training, which varies widely.
How Medicare Covers Home Health Aide Services
Medicare will pay for a home health aide, but only under specific conditions. You must be “homebound,” meaning leaving your home requires considerable effort due to illness or injury, such as needing a wheelchair, walker, cane, or another person’s help. You can still leave for medical appointments, religious services, or other short, infrequent outings and remain eligible. Attending adult day care doesn’t disqualify you either.
The critical requirement: Medicare only covers home health aide services when you’re also receiving skilled care at the same time, such as skilled nursing, physical therapy, occupational therapy, or speech-language pathology. The aide’s help with bathing, grooming, walking, feeding, and changing bed linens is covered as part of that broader care plan. If personal care is the only thing you need, with no skilled medical component, Medicare will not pay for it. That type of custodial care falls outside Medicare’s coverage.
Coverage is also limited to part-time or intermittent care. If you need full-time, around-the-clock assistance, Medicare won’t cover it through the home health benefit.
Medicaid and Self-Directed Care Options
Medicaid offers broader home care coverage than Medicare, and many states run programs that let you choose and manage your own caregivers. Through what’s known as self-directed services, you can recruit, hire, train, and supervise the person who provides your care. In some states, this includes paying a family member to serve as your aide.
Several federal authorities make this possible, including Home and Community-Based Services waivers (1915(c)), Community First Choice (1915(k)), and Self-Directed Personal Assistance Services (1915(j)). The specific program names, eligibility criteria, and whether family members can be paid all vary by state. Your state Medicaid office or a local Area Agency on Aging can tell you which options are available where you live.
Costs When You’re Paying Out of Pocket
The national median hourly rate for home health aide and homemaker services is $35, reflecting a 3% increase over the prior year. At that rate, four hours of daily help five days a week runs roughly $700 per week, or about $36,400 per year. Rates vary significantly by region, with urban areas and states with higher costs of living generally charging more.
Agency vs. Independent Hire
You can hire a home health aide through an agency or find one independently, and the choice affects both cost and responsibility. Agencies handle background checks, credential verification, payroll, and taxes. They’re typically the employer of record, which means less administrative burden for your family. The tradeoff is higher hourly rates, since the agency takes a portion.
Hiring independently, whether through word of mouth or a caregiver matching app, usually costs less per hour. But you take on the role of employer. That means running your own background checks, drafting a contract, and managing payroll and tax reporting. If you find an aide through an app or website, the platform may handle the background check, but payroll and taxes still fall to you. When contacting any agency, ask directly whether they are the employer of record or whether that responsibility shifts to you.