Certified Nurse Assistant/Home Health Aide
*These occupations are grouped together in a single profile because clients interested in becoming a certified nurse assistant (CNA) may also wish to consider completing the additional home health aide (HHA) course of study (HHA course requires an additional 40 hours of training). Because per diem opportunities are strong and demand is ever-increasing for home health aides and demand for CNAs appears to be declining (general care hospitals are relying less on CNAs), this is an important extra step CNAs can take to expand their employment opportunities.
Occupational Descriptions Certified nurse assistants (CNAs) work under the supervision of nursing and medical staff, most often in the skilled nursing setting. Typical job duties include serving meals, making beds, emptying bedpans, helping patients to dress, bathe and transfer. Nursing aides that work in skilled nursing facilities (SNFs) have more interaction with patients and their family members, often because these types of facilities employ fewer registered nurses. Depending on the needs of the patient and the type of facility, the CNA may provide the most frequent care to the patient and this may allow CNAs to develop more clinical skills and a deeper knowledge of patient needs, but it does not change their scope of practice. CNAs function as supporting staff and do not make independent clinical decisions; they work under the direction of Licensed Vocational Nurses and Registered Nurses. CNAs in the acute care setting (such as a general hospital) usually have a regular schedule and work full-time or part-time. The job market is highly competitive in acute care hospitals. There is still some competition for jobs in skilled nursing facilities, but it is far less severe than in the general hospital setting. Home health aides (HHAs) help elderly, convalescent, or disabled persons to return to or to remain in their own home as long as possible. Home health aides are usually utilized when the patient is unable to care for themself and needs more extensive care than the family support network can effectively provide. Though some independent home health aides may provide limited health-related services such as administering previously prescribed oral medications or checking pulse and temperature, HHAs that work for an agency typically provide services related to housekeeping and personal care such as changing and laundering bed linens, assisting the patient with transfers to and from bed, and assisting with bathing, toileting, and feeding the patient. Home health aides do NOT change catheters, change dressings that are more complex than a simple bandage or that require sterile techniques, assist with respiratory equipment or give injections. Certified Nurse Assistant vs. Home Health Aide - Most individuals that have spent any time working in both occupations have a preference for one or the other, and many choose not to cross over to work in the other area, simply because they prefer either the hospital or home environment. It is important to understand the nature of both industries and a good idea to have the credentials to work in both areas should an individual need to take on a survival job. Below is a discussion of the advantages and disadvantages of working in the clinical and home care settings. Some individuals prefer working as a CNA because the schedule is more consistent, the environment is consistently cleaner, safer and more fast-paced, and the wages may be slightly higher in certain organizations and benefits may be available. If an individual is hoping to become a registered nurse, working with nurses and other health professionals is also an incentive to work in the hospital environment because the patient population generally has more diverse health needs. However, according to several individuals who provided information for the Healthcare Navigator project, CNAs sometimes feel underappreciated or disrespected because their role is not valued in every hospital. This can lead to low levels of job satisfaction and the desire for more independence in the workplace. Some people prefer working in home health, however, because of the independence, flexibility that the industry affords, and the fact that they can take care of patients in a non-medical environment. Home health aides often assist with errands and cooking, so the work feels less clinical. Though home health aides must be on-time to all of their appointments, the environment is not as fast-paced and aides are able to devote more individual attention to their patients and some feel this allows them to provide a higher level of care to their patients. Home health aides may also work with the same patients for a long period of time and have more of an opportunity to form friendship bonds with them, if they choose. On the contrary, some homes and patients are extremely difficult to care for and because the home health aide is working for the patient in his or her home, patients sometimes feel they can treat their aides however they see fit (this occurs less frequently in a neutral environment such as a skilled nursing facility). Significant Points
Education / Certification All CNA/HHA applicants who have ever been convicted of a crime should review the list of disqualifying penal code sections available through the department of health services (click here) to avoid wasting their time, effort and money by training, testing and submission of fingerprints since they cannot receive the required certification if they have been convicted of one of these violations. To become a Certified Nursing Assistant, an individual must complete an accredited training program an earn certification. Unlike some other allied health professionals, CNAs and home health aides are not required by law to have a high school diploma or GED, and the lack thereof does not affect eligibility for certification or for the most part, employment. When selecting a CNA/HHA training program, only programs accredited by the Department of Health Services, Licensing and Certification Program-Aides and Technician's Certification Section (commonly referred to as ATCS) should be considered as graduation from an ATCS-accredited program is required for eligibility for certification. To see a list of ATCS-accredited programs, click here. Employers do not appear to prefer graduates of a single training program. ATCS-accredited certified nursing assistant training programs consist of a minimum of 50 hours of theory, followed by 100 hours of supervised clinical instruction. Upon enrollment, accredited training programs require individuals to submit proof of required vaccinations, negative TB tests and satisfactory health status. After the individual completes the 50 hours of theory, which is lecture-based and held in a classroom at the training program site, the supervised clinical, or internship, component of training begins and is held in a skilled nursing or intermediate care facility or step-down ward. The students are able to observe patients and to provide basic services under the supervision of a registered nurse. Once the 100 hours have been completed, the supervising nurse signs off on the individual's ATCS form and s/he is eligible to take the competency exam. The test is offered through the Red Cross (the Santa Cruz County Chapter offers the CNA-CEP program for individuals and training programs may also schedule group testing for their students). Individuals are given three opportunities to pass the CNA competency exam in two years, after which they must repeat the course. If s/he passes the CNA competency exam, s/he will receive notification and a certificate in the mail. Provided the individual has an application on file with the ATCS, the nurse assistant may work as long as s/he has proof of passing the competency exam, not to exceed 4 months. Home health aide training can be completed in as little as two weeks, or 40 additional hours, once an individual has completed the CNA requirements. A separate application is required with proof of course completion signed by the instructor before certification is issued. (Note: Competency is demonstrated through completion of the course of study, NOT through an exam.) Individuals that have earned certification as CNA and/or HHA are added to a registry maintained by the Department of Health Services. Employers can then verify that their employees certifications are up to date. Certified individuals should periodically view the registry to be sure that their entry is error-free. Though it is possible to complete a home health aide program independent of a CNA program, the course of study would be 120 hours for only the HHA certification and due to the increased job opportunities that having both certificates would afford, it would be wise to complete the 190 hour combined course of study and earn both the CNA and HHA certificates. CNAs must complete 48 hours of continuing education/inservice hours every 2 years. HHAs must complete 12 inservice hours every 2 years. If an individual has dual certification, s/he could apply the HHA requisite 12 hours toward their CNA continuing education requirement (a total of 48 hours every two years would be needed to maintain both certificates, not 60).
As of 2007, applicants for Nurse Assistant and home Health Aide are no longer required to send fees or payments for certification. In addition, each health facility that is operating as a health care facility and is used as a clinical skills site for nurse assistant certification training (through operation of its own training program or through contract with a training program) shall arrange for and pay the cost of Live Scan services for those trainees. These are important changes for students as application fees were expensive and LiveScan fingerprinting process was cumbersome and expensive. These updates will save students money. Wages CNAs who are employed in skilled nursing facilities or residential care homes may earn $13-$18/hr. Full-time general hospital CNAs can earn as much as $16-$21/hr with benefits, but these jobs are rare and the market is competitive at this level. Some facilities employ primarily per diem or part-time employees and have few full-time, benefitted CNAs on staff. Certified home health aides who are working for a licensed agency typically earn between $8 and $13 per hour, with majority of aides earning closer to $11 per hour. Individuals may work as health aides independently and can usually earn $15-$20/hr. Demand Demand for home health aides is strong for per diem employment and is expected to increase as the population ages. Combined with the high staff turnover that is common in home health care, it is likely that the demand for qualified home health aides will remain consistent. Due to the nature of the industry, it is unlikely that full-time employment through a single employer will be the standard. Individuals interviewed indicated that it is possible to work 40 hours per week through various agencies, particularly if one is available to work late at night or early in the morning, though it is highly unlikely that home health aides will get full time employment through a single employer. Though there is a need for home health aides, some find piecing together hours and not having a consistent schedule or paycheck frustrating, and this is something to consider before pursuing training in this area. Some home health aides work part-time for an agency and then supplement their income by securing independent private assignments outside of agencies. These opportunities can often be found through a variety of sources, some of which are listed at the bottom of this page, and the wages are generally higher, usually between $15 and $20/hr (some private contractors earn more than $20/hr-this is more common for a 1 or 2 hour assignment). Though some home health aides market themselves independently and can work full-time by securing contract positions with clients, it can be difficult to guarantee payment, adjust schedules to accommodate clients' needs, and to deal with the administrative aspects of the job. Career Ladder Opportunities Click here to view the Career Ladder diagrams for select healthcare occupations. CNA/HHA is the absolute entry-level job in patient care-few individuals seek out training with the goal of being a career nurse assistant or home aide. It is important that individuals understand that it can be difficult to reach a self-sustaining position on the career ladder when starting at the first rung and that they understand what it takes to access the higher-skilled jobs in allied health care. Individuals trying to complete nursing prerequisites or who plan to pursue another allied health training program in the near future might find the flexible schedule and opportunity for non-traditional work hours that home health aide employment provides allows them to climb the career ladder more quickly than if they had pursued an entry-level position with a firm hourly commitment. The Gavilan College LVN program gives admissions preference to Gavilan CNAs (many students matriculate within one year and work part-time during their LVN training), and Mission College's CNA program is recommended for individuals applying for admission to the Mission College LVN program. Because demand for home health aides has increased significantly in the South Bay Area, Gavilan is now offering a Home Health Aide course as an adjunct to their CNA-LVN-RN program. The career ladder model may not be realistic for some CNAs or home health aides, and sometimes, people do spend a career in entry level home or skilled care. Because certified home health aides must also be certified nursing assistants (CNA), many individuals work as home health aides to build experience while waiting for general hospital CNA positions to open. General hospital CNA positions are unionized and the wages are usually $16-$21/hr with benefits for full time employees. Though this is not a step up on the career ladder, it is often a significant wage increase. Some hospitals, however, have pared down their full-time CNA staff and the remaining jobs are more competitive. The majority of CNA vacancies are still in skilled nursing facilities or in home health care, where the wages are considerably lower. Resources Select Programs Mission College CNA/HHA Program Gavilan College CNA/HHA Program Sunnyvale-Cupertino Adult Education Center Additional Information Trends, Issues, and Projections of Supply and Demand for Nursing Aides and Home Health Care Workers Department of Health Services report on legislation and issues driving home health industry Fact sheet on Red Cross certification testing Silicon Valley CNA / HHA Employers Pathways Home Health and Hospice Sunrise Senior Living Facility Network-Bay Area |