Today we are going to talk about the four different types of in-home aides.  When looking at purchasing services from a private home care company, you should know the different types of credentialed and non-credentialed aides that are available to provide care.

The four we are talking about today are:

  • Companions
  • Home Health Aides
  • Certified Nursing Assistants 
  • Nurses

Now, I should make it clear that not all private home care companies operate the same way.  Different companies have different views on which caregivers are appropriate in certain situations.  So all I can speak to is how Minute Women Home Care operates.



Companions are aides that provide more domestic-focused work in the home.  They may not be interested in providing help with more intimate tasks that some seniors need.  

Just because someone is a companion does not mean they do not have higher credentials like an HHA or CNA license.  They may be a little older and wish to work in a less strenuous environment.  

Additionally, just because someone is without credentials and is labeled a “companion” does not mean they don’t have years of experience providing personal care or care for specific diseases (dementia, Parkinson’s or ALS for example) but since they do not have a certificate, we do label them as a companion.

As a customer, I would recommend you weigh the experience and the office’s opinion of a caregiver over if someone has a home health aide certificate or not.  As I feel real-world experience always is better than classroom experience in many cases.

Some of the tasks you can expect a companion to provide assistance with is:

  • Transportation
  • Meal Preparation
  • Laundry
  • Linens
  • Garbage
  • Bring in the mail
  • Assistance with walking


Home Health Aides

Home health aides are individuals who have completed 75-hours of classroom training and passed an exam to allow them to become a certified home health aide.  After receiving this certificate, they can work for a non-medical home care company, like Minute Women.

Most of our HHAs receive their certificate from the American Red Cross, but some do go to private schools in the area as well.  

Home health aides are not allowed to work in a skilled facility, like an assisted living, rehab facility or a hospital.  They are only allowed to work for private home care companies.

If you have a long-term care insurance policy, make sure you find out if the aide that you are looking to get reimbursed for is required to have the HHA certificate or not.  Some LTCI policies require this and some do not. 

A home health aide can provide all the care that a companion can provide but also can handle the more intimate services like:

  • Bathing
  • Dressing
  • Bathroom use
  • Catheters
  • Ostomy
  • Sponge/Bed Baths


Certified Nurses Assistant

In the private home care work, CNAs and HHAs are an interchangeable designation for us.  While we recognize that there is a difference between the two certifications, for the purpose of in-home care, there is not.

Often we are asked what the difference is between the two.  A CNA is an individual who gets their license and it must be renewed every two years.  A CNA is not only performing the tasks that an HHA can perform but also is allowed to perform medical tasks when supervised by a nurse in a skilled unit (rehab facility or hospital). 

Since the CNA is being supervised hourly be a nurse, they are allowed to perform tasks such as:

  • Wound Care
  • Infection Control
  • Taking Vital Signs

Sometimes a CNAs decides they no longer want to work in the skilled side of care.  They might wish to have flexible hours or work more closely one-on-one with an individual, both things per diem private home care jobs can provide.

For this reason, CNAs are hired by private home care companies, but they are only allowed to perform non-medical tasks in the home.  None of the tasks that a CNA can perform under the supervision of a nurse are allowed to be done in a private residence.

This is because;

  • Private home care is a non-medical model
  • There is no nurse supervision
  • Insurance reasons

So for private home care companies sending an HHA or CNA is interchangeable because CNAs are not allowed to perform all the medical tasks they have learned while in a private residence.

We do recognize that CNAs do have medical care and experience that may be desirable to some clients.  We make it clear that we are non-medical, but if they wish to have a CNA over an HHA we try and make that happen.



Nurses are the most skilled professionals that you can receive as an in-home aide.

When I talk about nurses, I do not mean the type that comes out for a specific task or two for short periods of time like a VNA does.  I am speaking about those that have hours and shifts like a home health aide.  

These types of nurses and home care agencies provide service to folks who need multiple blocks of hours of care, including up to 24 hours per day.

Of course, having nurses costs a lot more money per hour than an HHA, so expect a BIG price increase if you decide to investigate this service.  Additionally, just because you have someone in the house that is skilled in medical care, doesn’t mean they are going to always be using the knowledge.

What I mean by this is the few private nurses I have met have told me the majority of the time they provide the type of care an HHA can provide.  Now, don’t get me wrong, I am sure there are people out there who have the means to age in their home and need a skilled aide for whatever reason . . . but there are also people who could easily use an HHA but for whatever reason, they perfect to have skilled care and nurses in their home.

In the end, if they have the means, they can have whatever kind of care they want.