Why Don't Home Health Aides Provide Skilled Care?

What the home health aide (HHA) can and cannot do is regulated by both the state and the home care agency, as well as national nursing guidelines.

Helpful Highlights

  • If you've ever been frustrated because your home health aide (HHA) does not perform more advanced care tasks, read on.

  • HHAs with advanced training, under the oversight of a registered nurse, can perform a limited set of medical tasks in some states.

  • Just because state regulations allow the HHA to perform these medical tasks, does not mean that the agency must provide those services. It is their choice.

  • Unless fully qualified and permitted, HHAs should not be providing advanced care to your loved one, no matter how much you trust them.

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When engaging the services of a Home Health Aide (HHA), there's often an expectation that the HHA will offer a level of care comparable to that provided by a family caregiver. This includes a broad range of responsibilities, from housekeeping and personal care to more advanced tasks such as administering medications and performing medical procedures.

Advanced care

Advanced care encompasses a diverse set of activities, ranging from routine procedures like glucometer testing and eye/ear drops to more intricate responsibilities like wound care, tracheostomy suctioning, and catheterization. Families often find it perplexing that, despite providing permission and training, HHAs are restricted from performing these medical tasks, and they get upset.

The crux of the matter lies in the classification of these tasks as skilled care. Skilled care typically necessitates a provider order and is commonly reserved for licensed professionals, notably nurses. While family caregivers are often trained to perform these tasks, the expectation that HHAs can seamlessly assume these responsibilities is a misunderstanding.

The HHA's inability to undertake medical tasks isn't indicative of a lack of care or willingness to assist in every way possible. Instead, it results from restrictions imposed by the state, the agency, or a lack of required training and nursing oversight. Understanding the intricacies of these restrictions is vital to appreciating the HHA's role and capabilities.

State Regulations

State regulations significantly influence whether HHAs can perform medical tasks, with some states outright prohibiting such activities. Others permit the facilitation of self-administration or "hand-over-hand" assistance, allowing HHAs to support individuals in performing these tasks independently. Some states have nursing or permitted delegation, granting HHAs with advanced training the ability to perform various medical tasks under the oversight of a registered nurse.

Agency Policies

Home care agencies are bound by state regulations but retain the autonomy to decide the extent to which they implement these regulations. Legal, compliance complexity, financial considerations, and staffing issues are factors that influence agency choices regarding the provision of advanced care by HHAs.

Required Training and Oversight

Even in states allowing HHAs to perform medical tasks, not every task is included, and not every HHA possesses the advanced training and nursing oversight required. Nurses must adhere to state laws, national nursing delegation guidelines, and the capacity for the HHA to manage the entire process. If advanced care is needed, collaboration with an agency ensuring appropriate staffing is crucial.

Comfort Level

The HHA, despite advanced training, may not feel sufficiently acquainted with your loved one or a specific medical task, leading to discomfort. Acknowledging this discomfort is not a weakness but a recognition of the need for practical experience. In such cases, a nurse may accompany the HHA for additional training* or recommend a change in HHA.

*There is an additional charge for nurse visits.

Held to a different standard

While it might be tempting to allow HHAs to provide advanced care despite rules and regulations, this logic is flawed. HHAs, though trusted, are not more qualified than family members. Expecting them to perform medical tasks goes beyond their hired duties and holds them to a higher standard, potentially leading to blame if mistakes occur.

Trust is a cornerstone in your relationship. While HHAs may be trusted like family, the provision of advanced care is complex and fraught with potential risks. Without proper training, oversight, and adherence to regulations, neither you nor the HHA can be confident in the safety of providing medical care. Ignoring established rules jeopardizes the well-being of your loved one and limits recourse in case of harm.


AARP - Nurse Delegation

Care.com - Caregiver Tasks Dos and Dont's: How to Know if You're Asking Too Much

Bridges, G. (2018, January 01). Rules limit tasks for home aides. AARP. Link

Interim Healthcare - The Duties of a Home Health Aide

National Council of State Boards of Nursing (NCSBN) and the American Nurses Association (ANA). (2019, April 01). National guidelines for nursing delegation. NCSBN and ANA Boards of Directors. Link

National Research Council (US) Committee on the Role of Human Factors in Home Health Care. (2010). The role of human factors in home health care: Workshop summary - 3) Home health care tasks and tools. Washington (DC): National Academies Press (US). Link

New York State Department of Health - Home Health Aide Matrix

no content in this app, regardless of date, should ever be used as a substitute for any direct legal advice you receive from your lawyer or other qualified legal professionals.

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