Choosing a caregiver
CNA, HHA or PCA: which caregiver do you need?
Don't start with the title. Start with what's getting hard at home, then match it to the person who can safely help.
Which caregiver do I need: a CNA, an HHA or a PCA?
Start from the need. Company, meals and errands call for a companion. Hands-on help with bathing, dressing and moving about calls for personal care, often from a CNA or PCA. Tasks a nurse delegates call for a home health aide. Medicines, wounds and injections call for a nurse. Many families need a mix, and it changes over time.
Match the need
What is getting hard at home?
Find the sentence that sounds like your family, and follow it to the role.
"Mom shouldn't be alone all day, but she manages on her own."
A companion: company, meals, light housekeeping, errands, rides and reminders. Available in Connecticut, New Jersey and New York.
"She needs help washing and dressing."
Personal care: a CNA or personal care aide, with hands-on help. Endurance provides it in Connecticut and New Jersey.
"A nurse is managing his condition and wants an aide to help."
A home health aide, working under a registered nurse's plan. In Connecticut, through Endurance Home Health.
"There are new medicines, a wound or an injection."
A nurse. Companions and personal care aides at a registered homemaker-companion agency don't manage medicines or wounds.
"She's walking less and falling more."
Ask her doctor about therapy: a physical therapist evaluates and treats. Alongside that, a caregiver can help her move safely day to day. In Connecticut, physical therapy comes through Endurance Home Health.
"Nights are the hard part."
Overnight, live-in or 24-hour care, as companion or personal care depending on the help needed. In Connecticut, overnight and 24-hour care is offered in Fairfield and New Haven counties.
When is a licensed or certified person required?
The line depends on the state and on the task, and it's where families most often get surprised.
Medical tasks, any state
Connecticut's Department of Consumer Protection says registered homemaker-companion agencies may not administer medications or shots, direct physical therapy, or provide nursing services such as assessing blood pressure or wound care. Those need licensed professionals.
New Jersey
Personal care services, such as bathing, toileting, transferring and dressing, are performed by licensed or certified personnel. Companion services do not include help with activities of daily living.
New York
An agency providing nursing, home health aide or personal care services must hold a Department of Health license. An agency providing only companionship with light housekeeping does not need one, according to the state's business portal. That page is dated, so confirm with the Department of Health.
Connecticut
Homemaker services under the statute include personal hygiene. Home health aide services come through agencies licensed by the Department of Public Health.
When is a companion enough?
A companion is enough when the person can handle their own washing, dressing and moving about, and what's slipping is company, meals, errands, a safe house and someone to notice changes. Many families start there, and add personal care later if the need grows. The schedule and the kind of help are separate choices, so you can change one without changing the other.
Does it matter whether I hire through an agency?
It matters for the role. New Jersey's statute allows a home health aide to follow a delegated nursing regimen only under an agency-provided registered nurse. New Jersey's consumer guide says a privately hired individual won't have had a criminal history check and that the family owes the withholding taxes. Connecticut requires registries to tell consumers they may be considered an employer responsible for taxes and workers' compensation.
How does Endurance match a caregiver to the need?
A registered nurse visits first and writes the care plan with your family. The Care Coordinator chooses the caregiver for your parent, and you meet before the first visit. A Care Manager keeps the family posted and the plan is reviewed as needs change. Most of our caregivers are CNAs. For nursing, home health aides and physical therapy in Connecticut, Endurance Home Health is a separate company.
Checklist
Questions to ask any agency about a caregiver's role
Tick the lines as you go, or print them.
The role and the credential
- What is the caregiver's title on your contract, and what is the credential behind it?
- Is the caregiver a CNA, a home health aide, a personal care aide or a companion?
- How many hours of training did that credential require in this state?
- Can I see the agency's registration or license number, and how do I check it?
- Is the caregiver your employee, or an independent contractor?
What they will and won't do
- Which tasks are in the care plan: bathing, toileting, transfers, meals, errands, rides?
- What do your caregivers do about medicines: reminders only, or more?
- Which tasks need a nurse, and who provides one?
- In my state, which of these tasks does the law reserve for licensed or certified staff?
Oversight and backup
- Who supervises the caregiver, and how often?
- Who writes the care plan, and who reviews it when needs change?
- Who do I call when something changes, and who answers?
- What happens if the caregiver is sick or the match isn't working?
- Will I meet the caregiver before the first visit?
Screening and training
- What checks happen before hire: background, references, verification of qualifications?
- What orientation happens before the first shift?
- What ongoing training is there, including dementia training?
- Does the agency give me a written contract or service plan, and when?
Questions families ask
Which caregiver do I need for my parent?
Start from what's getting hard. Company, meals and errands call for a companion. Help with bathing, dressing and moving about calls for personal care from a trained caregiver such as a CNA. Medicines, wounds and injections call for a nurse. We help sort it out on the first call.
Can a companion help with bathing?
It depends on the state. New Jersey says companion services don't include help with activities of daily living, and bathing is performed by licensed or certified personnel. Connecticut lists personal hygiene within homemaker services. At Endurance, hands-on personal care is offered in Connecticut and New Jersey, and in New York companion care only.
Is a CNA better than a home health aide?
Neither is a step up. They're different credentials for different settings. A home health aide works under a registered nurse's supervision and can carry out health-related tasks a nurse delegates. A CNA has nurse aide training. Ask the agency which credential fits your parent's needs.
Do I need a nurse as well as a caregiver?
Only if there's a medical need, such as new medicines to manage, a wound or an injection. A registered homemaker-companion agency can't do those. Many families use a private caregiver for daily help and a home health agency for the nursing. In Connecticut, Endurance Home Health provides nursing.
What if my parent's needs change?
The plan changes with them. A registered nurse visits first and writes the care plan, and plans are reviewed as needs change. In Connecticut and New Jersey you can move from companion care to personal care without changing agencies, and the schedule can change where the county's schedules allow it.
How do I know a caregiver is qualified?
Ask for the credential and the hours behind it, then check the agency's registration. In Connecticut, verify at CT eLicense. Endurance checks backgrounds and references and verifies qualifications before hire, and most of its caregivers are CNAs. The checklist below lists the rest of the questions.
Does Endurance send nurses and home health aides?
Skilled nursing, home health aides and physical therapy in Connecticut come from Endurance Home Health, a separate company from Endurance Home Care. Endurance Home Care provides companion care and, in Connecticut and New Jersey, personal care. In New York it's companion care only.
Talk with our care team
Let's talk about the help you need
Tell us a little about what's happening, and we'll call to talk it through. The first conversation is free, and nothing starts until you say so.
Sources for this page (10)
- Connecticut Department of Consumer Protection, Homemaker-Companion Agency Registration
- Connecticut DCP, A Consumer's Guide to Homemaker-Companion Agencies
- Connecticut General Statutes 20-670, definitions for homemaker-companion agencies
- Connecticut Department of Public Health, Home Health Unit
- Connecticut eLicense, verify an agency or registry
- New Jersey P.L.2019, c.48, health care service firms, companion and personal care definitions
- New Jersey Division of Consumer Affairs, home health care consumer guide
- New York Public Health Law 3605, home care services agency license
- New York Public Health Law 3602, definitions
- New York Business Express, home care services agency license