When a doctor orders home health care, families often picture a nurse. And a nurse may well come. But the person who shows up most often, helps with the shower, and notices that Mom seems more tired than usual is frequently a home health aide. It’s one of the most hands-on jobs in senior care, and also one of the most misunderstood, partly because the title gets used in several different ways.

This guide covers what a home health aide does and doesn’t do, the federal training they complete, how aide visits work under Medicare compared with privately hired aides, what aide care typically costs, and how aides compare with certified nursing assistants (CNAs) and personal care aides.

A Familiar Face Three Mornings a Week

Picture a woman in her late seventies coming home after a hip replacement. Her home health plan includes visits from a nurse and a physical therapist, plus an aide three mornings a week. The aide helps her shower safely, gets her dressed, walks her through the exercises the therapist assigned, and mentions to the nurse that the skin near her incision looks a little red.

Her son is grateful, and a little confused. Can the aide also change the bandage? Refill the pill organizer? Stay through the afternoon? The answers depend on what the aide is trained and allowed to do, who employs them, and who is paying, which is what the rest of this guide sorts out.

What a Home Health Aide Does

In a Medicare-certified home health agency, a registered nurse or therapist assigns the aide to each patient and gives written instructions for that person’s care. Under the federal rules for home health aides, an aide’s duties typically include:

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  • Hands-on personal care, such as bathing, dressing, grooming, oral care, and help using the bathroom
  • Help with walking, transfers (such as moving from bed to chair), and safe movement around the home
  • Helping with prescribed exercises as an extension of the therapist’s work
  • Simple procedures as an extension of nursing care, such as taking temperature, pulse, and breathing rate
  • Helping with medications the person would ordinarily take on their own, such as reminders and opening containers
  • Watching for changes in skin, appetite, mood, or alertness, and reporting them to the nurse
  • Light tasks connected to the plan of care, such as tidying up after bathing

The aide’s role is to carry out the parts of the care plan that don’t require a nurse’s or therapist’s skills, and to serve as an extra set of eyes between clinical visits.

Home health nurse helping an older woman with a walker at home

What a Home Health Aide Generally Doesn’t Do

The exact limits depend on state law and the agency’s policies, but home health aides generally don’t:

  • Perform skilled nursing tasks such as giving injections, managing IV lines, or caring for complex wounds
  • Assess a person’s condition, change medications, or make decisions about the plan of care
  • Provide housekeeping, shopping, or errands unrelated to the care plan, which Medicare doesn’t cover
  • Provide 24-hour or overnight care as part of a Medicare home health plan

So, in the example above, the bandage and the redness would generally go to the nurse, the pill organizer depends on state rules and the care plan, and staying through the afternoon would fall outside Medicare’s part-time visit limits.

Training and Supervision Requirements

Aides who work for Medicare-certified home health agencies are expected to meet federal training standards. According to the federal home health aide regulation:

  • Training totals at least 75 hours, including at least 16 hours of supervised practical training.
  • Required topics include communication and documentation, observing and reporting changes, taking vital signs, infection control, emergency procedures, personal hygiene, safe transfers, range of motion, nutrition and fluid intake, and recognizing skin changes.
  • A registered nurse evaluates each aide’s competency, including watching the aide perform certain skills.
  • Aides complete at least 12 hours of in-service training every year.
  • An aide who goes 24 months in a row without paid work as an aide generally needs to complete training again.
  • A registered nurse or therapist checks on the aide’s work at least every 14 days when the patient is also receiving skilled care, and at least every 60 days when they aren’t.

Some states add requirements beyond the federal minimum. Aides hired through non-medical home care agencies, or directly by families, aren’t covered by these federal rules, so their training varies widely. The Bureau of Labor Statistics notes that aides working in certified home health or hospice agencies complete formal training and pass a standardized test, while requirements for other aides vary by state.

How Home Health Aide Visits Work Under Medicare

According to Medicare’s home health coverage page, home health aide services are covered only when the person is also getting skilled nursing care or therapy. A few other points shape how aide visits typically work:

  • For people with Original Medicare who qualify, there’s generally no cost for covered home health services, including aide visits.
  • The person generally needs to meet Medicare’s home health eligibility rules, including a doctor’s order, a plan of care, and being homebound.
  • Skilled nursing and aide time combined is generally limited to 8 hours a day and 28 hours a week, with somewhat more allowed for a short period (up to 35 hours a week).
  • Aide visits are usually brief and scheduled around specific tasks, such as a morning bath, rather than long blocks of time.
  • When skilled care ends, Medicare-covered aide visits generally end too, even if the person still needs help with daily activities.
  • Medicare Advantage plans (private plans that provide Medicare benefits) cover home health as well, though they may use networks and require prior authorization. Our article on Medicare Advantage and home health care covers those differences.
  • Medicaid’s home health benefit, one of the mandatory Medicaid benefits, also includes aide services, though eligibility and details vary by state.

For a fuller look at eligibility, see our guides to home health care for seniors and what homebound means for home health eligibility.

elderly woman patient receiving hospice medical care medication

Privately Hired Aides and What They Cost

Many families keep an aide after Medicare home health ends, or want more hours than Medicare covers from the start. In those cases, families typically hire help through a home care agency or directly:

  • Home care agencies often employ aides with home health aide or CNA training, though job titles vary. Their work follows the family’s arrangement rather than a Medicare plan of care, so it can include longer shifts, overnight care, meals, housekeeping, and companionship.
  • Hiring an aide directly may cost less per hour, but the family generally takes on screening, scheduling, backup coverage, and employer responsibilities. Because household employment can carry tax obligations, families may want to talk with a qualified tax professional before hiring directly.

As for cost, the Bureau of Labor Statistics reports a median wage of $17.21 an hour for home health and personal care aides as of May 2025. That’s what aides earn, not what families pay. Agency rates are typically higher, since they cover payroll taxes, insurance, training, supervision, and backup staffing. Rates also vary widely by region and by the number of hours.

Families commonly pay for private aide care through savings and income, long-term care insurance, Medicaid home and community-based services (HCBS) waivers where eligible, or veterans benefits. Our guide on how to pay for in-home care walks through each option, and our guide to personal care assistance for seniors covers hands-on daily help in more detail.

Home Health Aide vs. CNA vs. Personal Care Aide

These three titles often overlap in job listings and agency brochures. Here’s how they generally differ:

  • Home health aide: Works in the person’s home, usually for a home health agency. Provides personal care plus basic health-related tasks under a nurse’s or therapist’s direction. Aides at Medicare-certified agencies meet the federal 75-hour training standard and ongoing supervision rules.
  • Certified nursing assistant (CNA): According to the Bureau of Labor Statistics, most CNAs work in nursing homes and hospitals. They complete a state-approved training program, pass a state competency exam, and are listed on a state registry. Under federal rules, a CNA in good standing on the state registry can also qualify to work as a home health aide.
  • Personal care aide: Provides non-medical help such as bathing, dressing, meals, cleaning, errands, and companionship, typically through a home care agency or private arrangement. There’s no federal training standard for this role, and state requirements vary.

The tasks can look similar from the outside, especially bathing and dressing. The real differences are training, supervision, who employs the aide, and how the care is paid for. Our guides to companion care for seniors and personal care vs. companion care cover the non-medical side further.

Older mother and adult daughter on the porch of the family home with a for sale sign in the yard

Questions Families Often Ask an Agency

Whether the aide comes through Medicare home health or a private arrangement, families often find these questions helpful:

  • Is the agency Medicare-certified, licensed by the state, or both?
  • What training or certification does the aide have?
  • Who supervises the aide, and how often?
  • Which tasks can the aide help with in our state, and which go to the nurse?
  • Does the same aide come to each visit, or does it rotate?
  • What happens if the aide is sick or can’t make a scheduled visit?
  • How does the aide report changes in condition, and to whom?

Medicare-certified agencies can be compared on Medicare’s Care Compare tool. For local help finding non-medical services, the Eldercare Locator (1-800-677-1116) can connect families with their Area Agency on Aging.

Finding Home Health Aide Services

A home health aide can make a big difference in whether a parent feels safe and comfortable recovering at home. Knowing what aides do, how they’re trained, and how Medicare covers their visits makes it easier to ask the right questions and plan for the hours an aide isn’t there.

Senioridy’s directory can help families get started. Browse home health providers for Medicare home health services, or in-home care providers for privately arranged aide care and daily help.

This article is for informational purposes only and does not constitute legal, financial, tax, or medical advice. Medicare coverage rules, federal and state training requirements, and wage data are subject to change, and what aides may do varies by state. Medicare Advantage plans may have different network, prior authorization, and cost-sharing rules than Original Medicare. For free, personalized Medicare guidance, contact your State Health Insurance Assistance Program (SHIP) counselor at shiphelp.org, available in every state at no cost. For questions about a specific health condition, talk with a physician, and for questions about hiring a caregiver directly, consider consulting a qualified tax professional. Always confirm current requirements with official program representatives.

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