Both certified nursing assistants and home health aides support nurses and physicians in providing medical care to patients. CNAs and home health aides come in close contact with patients and perform many types of direct patient care, such as taking vital signs, feeding, bathing, dressing and helping with ambulation. However, the duties of CNAs and home health aides are different in many ways. In addition, regulations governing the two are different in most states.
Nursing assistants may work with patients in a number of settings, such as hospitals and clinics. They are hired by an institution and stay in one work environment during their employment. Most work in skilled nursing facilities or nursing homes. Home health aides, by definition, work with patients in their own homes. They are hired by home health agencies and travel to several different homes during a single day. While CNAs work with many other people and often around licensed practical and registered nurses, doctors, family members and a large number of patients, home health aides generally work alone, although they must report regularly to and receive regular visits from a supervisor.
Training requirements for nursing assistants and home health aides are similar, but can vary by state. In Massachusetts, the American Red Cross offers a health care assistant training program, which combines instruction for both home health aides and nursing assistants, so that graduates can find jobs in either field. Federal law requires that all nurse aides who work in skilled nursing facilities undergo a minimum of a 75-hour training class. These training classes usually divide their time between classroom hours and clinical training with real patients. Federal law also requires that home health aides who work for an agency that accepts Medicaid or Medicare to undergo a minimum of 75 hours of training as well. 16 hours of practical training must be finished before an aide has any direct contact with a real patient.
Nursing assistants who work in skilled nursing facilities are also required to take and pass a state competency exam. Most states require that all nursing assistants pass a state exam before being certified or placed on the nurse aide registry. Home health aides who work at agencies that take Medicare or Medicaid must also take a competency exam.
Though their jobs are similar, nursing assistants overall earn more than home health aides. According to the Bureau of Labor Statistics, in 2008, the median hourly wage for nursing assistants was $11.46. However, the median hourly wage for home health aides in 2008 was $9.22.
Job opportunities for both home health aides and nursing assistants are expected to grow quickly during the years between 2008 and 2018. Home health aide employment is projected to grow the fastest, with a 50 percent increase, while nursing assistant job growth is projected at 18 percent.