Home Health Aide
A home health aide provides hands-on personal care such as bathing, grooming, dressing, toileting, and simple delegated tasks under a written aide care plan established by a registered nurse or therapist. Under Medicare home health, aide services are a dependent service: they are covered only while the patient also receives skilled nursing, physical therapy, occupational therapy, or speech-language pathology.
What aides can and cannot do
Covered aide services center on personal care the patient cannot safely perform alone: bathing, skin care, hair and mouth care, dressing, toileting, transfers and ambulation assistance, and simple tasks like recording vitals when assigned. Aides work from a written, task-specific care plan prepared by the RN (or therapist when therapy is the skilled service), and they may not perform anything requiring clinical judgment: no medication administration, no wound care beyond what the plan explicitly delegates as aide-appropriate, no assessments. Duties beyond the aide care plan are a survey deficiency waiting to happen, so the care plan must be updated as the patient changes.
Training, competency, and supervision requirements
The Conditions of Participation set specific personnel standards. Home health aides must complete a 75-hour training program or pass a competency evaluation, and receive at least 12 hours of in-service training per 12-month period. Supervision requirements are equally concrete:
- For patients receiving skilled care, an RN or appropriate skilled professional must make an on-site supervisory visit at least every 14 days (the aide does not need to be present)
- For aide-only patients (non-Medicare or other payers), an RN must visit on site at least every 60 days
- Each aide must be observed performing care during an annual on-site visit
Missed supervisory visits are among the most common survey citations in home health.
Aide services under Medicare payment
Aide visits are part-time or intermittent, ordered on the plan of care with frequency and duration, and bundled into the PDGM 30-day period payment. Two operational facts matter. First, aide visits are billable visits on the home health claim, so they count toward the period's total visit count and the LUPA threshold, though aide utilization should always follow assessed need rather than payment math. Second, because aides are a dependent service, the aide schedule must end when the last qualifying skilled discipline discharges. Continuing aide visits past that point creates non-covered care and refund exposure.
What good aide programs look like
High-performing agencies treat aides as outcome drivers, not commodity labor. Aides see the patient more than anyone else and are often first to notice skin breakdown, falls risk, confusion, or a deteriorating caregiver. Build a simple escalation path so aide observations reach the case manager the same day. Keep aide care plans current at recertification and after every significant condition change, match aide assignments to documented competencies, and close the loop on the 14-day supervisory visit schedule so it never depends on memory.
Frequently asked questions
Can a patient get a home health aide without skilled care under Medicare?
No. Aide services are dependent: Medicare covers them only while the patient receives skilled nursing or qualifying therapy. Aide-only personal care falls to Medicaid programs, private duty, or private pay.
How often must a home health aide be supervised?
For patients receiving skilled care, an RN or skilled professional must make an on-site supervisory visit at least every 14 days, and each aide must be observed providing care at least annually. Aide-only patients require an RN on-site visit every 60 days.
Can a home health aide give medications?
No. Medication administration requires a licensed nurse. Aides may provide reminders where state rules allow, but anything involving clinical judgment or administration is outside the aide scope and the aide care plan.