Types of Caregivers

Non-Certified Aides / Home Helper / Personal Care Aides / Homemakers / Companions

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 but need to check with insurance carrier first. Non-certified aides can provide general routine personal care services that often is what is needed most to help care for a loved one at home.

Homemakers and chore-workers 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 Nurse's Aides (CNA) / Home Health Aides (HHA)

Certified Nurse's Aides (or 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 CNAs and HHAs are certified with similar required training that varies from state to state. CNAs and HHAs 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 homecare field while in other states the CNA has broader healthcare training including but not limited to homecare.

Certified nurse's aides 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 with Medicare / Medicaid 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 CNAs and HHAs for needed personal care assistance might be the best or only option when skilled care is not necessary.

CNAs and HHAs 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 assistant must be skilled in actual procedures and also make competent observations of a patient's condition for reporting to professionals.

CNAs and HHAs 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 Nurse (RN) or Licensed Practical Nurse (LPN).

Licensed Practical Nurse (LPN) / Licensed Vocational Nurses (LVN)

LPNs sometimes known LVNs 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 (RNs) 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 LPNs/ LVNs, CNAs, and / or HHAs.

Physical Therapists (PT) / Occupational Therapists (OT) / Speech Therapists (ST)

Therapists including physical therapists, speech therapists and occupational therapists assist in the rehab of those with physical injuries or disease. Restoration of mobility, strength, dexterity, balance, communication skills is often the purpose for therapy. Helping individuals who are disabled by physical injuries or disease to regain maximum function with activities of daily living is always a main priority.

Social Workers (SW) / Medical Social Workers (MSW)

Social Workers assist in the evaluation of social, emotional and environmental factors affecting the ill and disabled. They may provide family or individual counseling for those in need or a crisis situation. Medical social workers offer support and often help identify and locate appropriate community resources.

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