Caregiver roles explained: who does what at home

The same job gets different names, and the same name means different things from one state to the next. A "home health aide" in New Jersey is a certified homemaker-home health aide with a Board of Nursing certificate. In Connecticut, home health aides work for agencies licensed by the Department of Public Health. A "personal care aide" has a defined training minimum in New York.

What matters in the end is what the person coming to your home is allowed to do, what they were trained for, and who is responsible for them. This guide goes role by role, then gives you questions to ask any agency.

A companion keeps a person company and keeps the day safe: conversation, meals, light housekeeping, errands, rides to appointments, and reminders. Connecticut law defines companion services as "basic supervision" to ensure the safety and well-being of a person at home, and homemaker services as supportive help with cooking, cleaning, laundry, personal hygiene and other household chores.

Training. New Jersey's official guide says a companion isn't certified to provide personal or health care services. Rules differ by state, so ask any agency what its caregivers learn before the first shift.

You need one when your parent can wash and dress without hands-on help but shouldn't be alone all day, or when meals, errands and company are what's slipping.

A personal care aide helps with the body-level parts of the day: bathing, dressing, grooming, toileting and eating, along with the housekeeping around them. New York defines personal care services as help with personal hygiene, dressing, feeding and household tasks essential to the patient's health, prescribed by a physician under a plan of care supervised by a registered nurse.

Training. New York's Department of Health says a personal care aide (Level II) holds a certificate from an approved program that must offer a minimum of 40 hours, and that a PCA may perform fewer health-related tasks than a home health aide. We found no state training-hour rule for personal care aides in Connecticut. In New Jersey, the statute says personal care services, such as bathing, toileting, transferring and dressing, are performed by licensed or certified personnel.

You need one when your parent needs hands-on help with the daily routine of washing, dressing or moving about.

A home health aide gives hands-on help with daily activities and, under a nurse's direction, some health-related tasks. Home health aides work for agencies licensed or certified for it, and a registered nurse supervises them. In Connecticut, the Department of Public Health licenses home health aide agencies; in New Jersey, the title is certified homemaker-home health aide (CHHA).

Training. Federal rules for Medicare-certified agencies require at least 75 hours of classroom and supervised practical training, plus 12 hours of in-service training every 12 months. New York requires a minimum of 75 hours. New Jersey requires a CHHA program of at least 76 hours. In Connecticut, DPH says home health aides have completed an aide training program and passed a competency evaluation.

You need one when care involves a nurse's plan, such as help after a hospital stay or a condition a nurse is managing. In Connecticut, home health aides come through Endurance Home Health, a separate company from Endurance Home Care.

A CNA is a nurse aide who completed a state-approved training and competency program. CNA training was built for nursing homes, and in home care a CNA brings the hands-on skills of bathing, dressing, transferring and mobility. Endurance's caregivers are mostly CNAs.

Training. Federal rules set a minimum of 75 hours, including at least 16 hours of supervised practical training. Connecticut requires programs of at least 100 hours. New Jersey's course is 90 hours, 50 in the classroom and 40 clinical. New York extended the federal 75-hour requirement on an interim basis.

A CNA isn't a nurse and doesn't provide nursing care. CNA and home health aide are separate credentials, though federal rules count a state-approved nurse aide program toward home health aide training.

A care manager looks after the plan. At Endurance, the Care Manager looks after the plan and keeps the family posted, and a Care Coordinator looks after the schedule and the caregiver match. A registered nurse visits first and writes the care plan with the family.

Training. We found no Connecticut, New Jersey or New York license for the title "care manager," and no official definition, so we won't attach hours or credentials to it. Some care managers hold a nursing or social work license, and some hold private certifications. Ask any agency what its care manager's background is and how often your family will hear from them.

Nurses are state-licensed professionals. Connecticut law describes a registered nurse's practice as diagnosing human responses to actual or potential health problems, providing supportive and restorative care, teaching, and executing the medical regimen under the direction of a physician, dentist or advanced practice registered nurse. A licensed practical nurse performs selected tasks and shares responsibility under the direction of a registered nurse, an advanced practice registered nurse or a physician. New York and New Jersey define the two roles in much the same way.

At home, nurses do the assessment, medication management, wound care and the care plan that a companion or aide can't. At Endurance Home Care, a registered nurse visits first and writes the plan. In Connecticut, skilled nursing comes from Endurance Home Health.

You need one when there's a medical need: new medicines to manage, a wound, an injection, or a condition that changes quickly.

Both are licensed professions. Connecticut law defines physical therapy as the evaluation and treatment of a person using the effective properties of physical measures, and occupational therapy as the evaluation, planning and implementation of a program of purposeful activities to develop or maintain the skills needed for daily pursuits.

In everyday terms, a physical therapist works on strength, balance and walking; an occupational therapist works on the tasks of daily life, such as dressing, cooking and using the bathroom safely. In Connecticut, physical therapy comes through Endurance Home Health. Endurance Home Care caregivers support the routine around it.

Start from what's getting hard, and leave the title for later. If it's company, meals and errands, a companion. If it's washing and dressing, personal care. If a nurse is managing a condition, a home health aide under that nurse's plan. If there are medicines to manage, wounds or injections, a nurse. Many families need a mix, and the mix changes over time.

Ask the agency as well as the caregiver. A title alone doesn't tell you what a person is trained or allowed to do. Good questions are specific: what is this person's title, what credential do they hold, who employs them, and who do I call when something changes.

In Connecticut you can check an agency's registration at CT eLicense, and the Department of Consumer Protection says its registration isn't an endorsement of quality. Ask for the registration number. Endurance is registered in Connecticut as a Homemaker-Companion Agency, HCA.0002450, and in New Jersey as a Health Care Service Firm, HP0435100. In New York, Endurance provides companion care only.

Also ask about the caregiver: how long they've done this, what training they had on dementia, mobility and your parent's condition, and whether the agency introduces them before the first visit. Background checks, reference checks and verification of qualifications should happen before hire. Endurance does these, orients caregivers before the first shift, and offers monthly training. Most of its caregivers are CNAs.