What is a home health aide (HHA)?

A home health aide gives hands-on help with the personal side of the day: bathing, dressing, feeding, grooming and moving about, along with incidental household tasks. What sets the role apart is who is responsible for the aide. Home health aides work under the supervision of a registered nurse, who may delegate certain health-related tasks.

Connecticut's Department of Public Health describes home health aide agencies as providing supportive services such as help with personal hygiene, dressing, feeding and incidental household tasks, supervised by a registered nurse.

For agencies certified by Medicare, 42 CFR 484.80 sets the floor: classroom and supervised practical training that totals at least 75 hours, with at least 16 hours of classroom training before 16 hours of supervised practical training. Aides also need at least 12 hours of in-service training in every 12-month period.

A state-approved nurse aide program also meets the requirement, if the person is in good standing on the state nurse aide registry. When an aide serves a patient receiving skilled care, an RN or other skilled professional must assess the aide's services at least every 14 days.

New York's Department of Health requires a home health aide training program of at least 75 hours: at least 59 classroom hours plus 16 hours of supervised practical training. Testing isn't counted in the 75. The program is made up of a 40-hour Home Care Curriculum and a 35-hour Health Related Task Curriculum.

The employing agency must provide nursing supervision and 12 hours of in-service training each year. A home health aide's certification lapses two years from the date the person last worked at a home health agency in New York State. Licensed registered nurses and licensed practical nurses can work as home health aides without the training.

Endurance provides companion care only in New York, so it does not send home health aides there.

In Connecticut, the Department of Public Health licenses two kinds of agency. Home health care agencies provide nursing plus other services, including home health aide services. Home health aide agencies provide only aide services, with the oversight of a registered nurse. DPH describes home health aides at both levels as people who completed an aide training program and passed a competency evaluation.

Homemaker-companion agencies such as Endurance Home Care are a separate category, registered with the Department of Consumer Protection. By statute, a homemaker-companion agency doesn't include a home health care agency or a home health aide agency. In Connecticut, home health aides come through Endurance Home Health, a separate company.

A companion offers company and safety and does not provide hands-on care. A personal care aide helps with bathing, dressing and eating. New York's Department of Health says its personal care aides, trained in a minimum 40-hour program, perform fewer health-related tasks than a home health aide. A home health aide works under a nurse's supervision and can carry out health-related tasks that nurse delegates.

The practical difference is the nurse. If a nurse is managing a condition and needs an aide to carry out part of the plan, that's a home health aide. If your parent needs help to wash, dress and get through the day, personal care may be what's needed.

When a nurse's plan is in place and an aide is part of it, as after a hospital stay with skilled nursing or therapy at home. Medicare covers part-time or intermittent home health aide care only when you're also getting skilled nursing care, physical therapy, speech-language pathology or occupational therapy at the same time, and only from a Medicare-certified agency.

If the help is mostly daily living and company, you may not need one. Many families start with a private caregiver and add a home health agency when a nurse gets involved. In Connecticut, Endurance Home Health provides skilled nursing, home health aides and physical therapy.