Types of Elder Care Providers
Non-Certified Aides Personal Care Aides / Home Helpers
The non-certified aide or assistant provides custodial, supportive, long-term personal care services which may also include housekeeping, meal preparation, and companionship. However, this can be very confusing depending on which state you live in as there are many variations in job titles, duties and costs. As a general rule these types of non-certified aides usually work as either private-duty hires for families or as employees of non-medical home care agencies.
Services are privately paid for and not reimbursable under Medicare and private health insurance regardless of whether they are employed with a non-medical home care agency or hired privately. Some long-term care insurance plans may cover these services, therefore, it is a good idea to check with your insurance carrier prior to hiring. Non-certified aides can provide general routine personal care services, which is commonly needed to help care for a loved one at home.
Homemakers / Chore Workers / Companions
Homemakers fall under this non-certified category also and usually perform light household duties, meal preparation, laundry and other similar tasks. Chore workers sometimes do heavier types of cleaning such as washing windows. Both of these workers are supervised and they do not provide direct personal care as a rule. Companions also without formal training do not perform direct personal care but instead are more limited to providing comfort and companionship to those people who cannot be left alone and unsupervised.
Certified Aides Certified Nursing Assistants (CNA) / Home Health Aides (HHA)
Certified nursing assistants and home health aides work as an essential part of the home health care team under the supervision of other health care professionals such as nurses and rehab therapists. Both CNA's and HHA's are certified with similar required training that varies from state to state. CNA's and HHA's have successfully completed a training course, passed both a written and practical exam and placed on a state registry. In some states the HHA has additional training in the home care field while in other states the CNA has broader healthcare training including but not limited to home care.
Certified nursing assistants and home health aides are employed at both medical home health agencies and non-medical home care agencies. CNA's and HHA's services, when employed by Medicare / Medicaid licensed home health agencies, may be reimbursed when certain requirements are met. These requirements include working under supervision of licensed professionals and a physician approved plan of care authorizing supplemental aide services to skilled care. In contrast aide services are usually not covered by Medicare and private insurance when provided through a non-medical home care agency or private hiring. However privately paying for CNA's and HHA's for needed personal care assistance might be the best or only option when skilled care is not necessary.
CNA's and HHA's both assist patients with activities of daily living (ADLs) including personal care, ambulation, nutritional, medications, toileting, health monitoring (i.e. blood pressure) and sometimes light housekeeping. The certified nursing assistant must be skilled in actual procedures and also make competent observations of a patient's condition for reporting to professionals.
CNA's and HHA's are CPR certified and based on level of training (again varying from state to state) may provide additional bedside care. Such care might include wound / bedsore treatments and dressing changes, tube feedings, catheter care, ostomy changes, and diabetic monitoring under the supervision of a registered rurse (RN) or licensed practical nurse (LPN).
Nurses Licensed Practical Nurse (LPN) / Licensed Vocational Nurses (LVN)
LPN's sometimes known LVN's or practical nurses must pass rigorous specific state curriculum requirements and a standardized national exam after completion of their college program to obtain their nursing license. They are qualified to perform certain skilled nursing procedures and must work under the supervision of a Registered Nurse (RN) or a physician.
Registered Nurses (RN)
Registered nurses (RN's) have more extensive education and must pass rigorous state curriculum requirements and a standardized national exam after completion of their college program to obtain their nursing license. They are competent to perform all aspects of skilled nursing care in addition to supervising other members of the health team including LPN's/ LVN's, CNA's, and / or HHA's.