1.4: Home Health Aide/Personal Care Aide Tasks

Home health aides typically provide assistance to people with every-day tasks so that they can be as independent as possible while remaining in their own homes. Typical tasks include bathing, dressing, and assisting a patient with using a bedpan, urinal, commode, or toilet. HHAs may also be involved with purchasing and preparing food and assisting a patient with eating during meals. Depending on the state in which they live, HHAs may also participate in health care activities such as taking vital signs (such as checking blood pressure, pulse, respiration rate, and temperature) and assisting with prescribed medications under supervision, by providing reminders to patients. Personal care aides, however, may not perform the above health care activities.

Other tasks, such as light housekeeping duties such as vacuuming, laundry, and washing dishes, help to maintain the home of the person to whom care is being provided. It is important that home health aides and personal care aides keep accurate records of the services they provide and the tasks they complete. They must document all services provided and those that were unable to be provided due to time constraints or patient refusal. Home health aides and personal care aides also keep records of their patient’s progress and must report any changes in their patient’s condition to their supervisor. Developing a trusting relationship and providing companionship for the person for whom they are caring for is an important aspect of being a home health aide and personal care aide. This can also be one of the most rewarding aspects of the job. Since HHAs and PCAs are providing intimate and important care to their patient, they have an opportunity to get to know him or her as a person very well.

Example of Tasks Performed by HHAs and PCAs

• Bathing
• Dressing
• Toileting
• Purchasing and preparing food
• Eating
• Monitoring vital signs (for HHAs only)
• Housekeeping duties (vacuuming, laundry, dishes)
• Companionship
• Record keeping

Scope of Practice for HHAs

Scope of practice defines the tasks that health care workers are legally allowed to perform. For example, there are some procedures that HHAs may not perform because they are considered to be outside of the scope of practice. In the U.S., there are variations that exist from state to state about what a HHA can do. It is important to be aware of the rules and regulations that pertain to the state in which the HHA works. According to the New York State Department of Health (2009), the following includes a list of tasks that HHAs may not perform:

Tasks that HHAs may not perform include:

HHAs may not administer medications unless trained and allowed to do so by their state and agency. In certain situations and with special training a HHA may assist patients with self-administration of medications.

HHAs may not insert or remove tubes from a patient’s body. Examples may include, but are not limited to insertion of catheters, fecal containment devices, nasogastric tubes, feeding tubes, and intravenous catheters. Insertion of a tube or object is considered an invasive procedure and may only be performed by licensed professionals.

HHAs may not perform sterile procedures. This includes changing dressings on deep, open wounds which require sterile technique. HHAs may assist a licensed professional with completion of these tasks by gathering supplies, distracting a patient, or assisting with cleanup after the procedure once the sterile area has been covered.

HHAs may not perform a task or duty that is outside of their scope of practice or that has not been assigned to them. When working as an HHA, there may be situations in which a patient or family asks the HHA to do something they are not trained or allowed to do. In these situations, the HHA should explain that they are not allowed to perform that particular task. They should then seek the assistance of their direct supervisor. It is always the right of the HHA to refuse to complete a task that is outside of their scope of practice.

Scope of Practice for PCAs

In general, PCAs may not perform any medically-related task. They may not administer or assist patients with medications under any circumstance. They may not provide assistance with dressing changes, apply medicated lotions to a patient’s skin, or take vital signs.

Self Check Activity \(\PageIndex{1}\)

Which of the following tasks may an HHA perform? Select all that apply.

1. Provide assistance with feeding
2. Perform a sterile dressing change
3. Assist a patient to the toilet or commode
4. Insert a urinary catheter
5. Complete records of tasks you complete
6. Perform injections
7. Vacuum
8. Help a patient bathe and dress
9. Laundry
10. Administer medications without special training
11. Apply medicated lotion to a patient’s skin
12. Remind patients about taking medications
13. Brushing a patient’s teeth
14. Assisting the family with budgeting and paying bills
15. Assist a nurse with a clean dressing change
16. Take and record vital signs

Solution

These are tasks that MAY be performed: 1, 3, 5, 7, 8, 9, 11, 12, 13, 14, 15, 16

Self Check Activity \(\PageIndex{2}\)

Scope of Practice for PCAs

Which of the following tasks may a PCA perform? Select all that apply.

1. Provide assistance with feeding
2. Perform a sterile dressing change
3. Assist a patient to the toilet or commode
4. Insert a urinary catheter
5. Complete records of tasks you complete
6. Perform injections
7. Vacuum
8. Help a patient bathe and dress
9. Laundry
10. Administer medications
11. Assist patients with taking medications
12. Apply medicated lotion to a patient’s skin
13. Remind patients about taking medications
14. Brushing a patient’s teeth
15. Assisting the family with budgeting and paying bills
16. Assist a nurse with a clean dressing change
17. Take and record

Solution

These are tasks that MAY be performed by a PCA: 1, 3, 5, 7, 8, 9, 13, 14

Chain of Command

Care plans, which are the prescribed treatments and services a patient will receive are developed from input from all members of the team. There may be many care plans for a patient who has many needs. For example, a physical therapist will develop a care plan for mobility needs after assessing the patient. The registered dietician will develop a care plan for nutritional guidelines for the patient to follow. The supervisor, who is often a registered nurse, will coordinate the care the patient will receive.

Home health aides and personal care aides work under the supervision of a Registered Nurse (RN). The supervisor will provide the HHA/PCA with a care plan to follow. It is important that the instructions written on the care plan are followed. This ensures that the patient receives the proper and safe health care they deserve. It also protects the HHA/PCA and the agency for which they work from liability. Liability means that the employee (the HHA/PCA) or the agency for which they work can be held legally responsible for harming a patient. For example, if the HHA/PCA did not follow what was instructed in the care plan and performed a task outside of their scope of practice, such as inserting a urinary catheter, and harm comes to the patient, the HHA/PCA and the employer (the agency) are legally liable.

Care plans are updated regularly to ensure the patient’s needs are being met. They are also updated when there are changes in a patient’s condition. As the person on the healthcare team who spends the most time directly with the patient, the HHA/PCA will have first-hand knowledge of the patient’s condition. It is important that they immediately report any change in patient condition to their supervisor, and that these changes are documented. For example, an HHA/PCA may observe that the patient is weaker than a previous visit, which puts the patient at a greater risk for a fall. It is important that these observations are documented and reported to a supervisor. Other examples of changes that may be noticed include: a change in the patient’s behavior, unexplained bruises, skin breakdown, or an unsafe situation in the home, such as cluttered hallways, which may be a trip hazard. These would be important observations to document and inform a supervisor about.

While patients always have the right to refuse treatments or assistance, it is important that the HHA/PCA document these refusals and inform their supervisor. Under an HHA/PCA’s employment conditions and certification requirements, they may be legally liable to report changes in patient conditions and within patient environments. If an HHA/PCA is ever unsure of a situation or an observation, they should talk to their supervisor. It is important to follow the care plan and instructions from supervisors to protect oneself, the agency, and most importantly, the patient.

Self Check Activity \(\PageIndex{3}\)

Which of these situations should a HHA/PCA report to their supervisor? Check all that apply.

1. A patient falls
2. The HHA/PCA notices a bruise on a patient that was not there before
3. The patient refuses to allow the HHA/PCA to perform a task on the care plan
4. The patient tells the HHA/PCA a family member has been abusive
5. The HHA/PCA notices there does not appear to be enough food in the home
6. The HHA/PCA is unable to make it to work or will be late

Solution

If you checked all of these situations, you are correct. All of these examples should be reported to a supervisor.

Qualities of Home Health Aides and Personal Care Aides

Taking care of someone requires that you have good physical health. Assisting a person to walk, transfer into a wheelchair or shower, and completing household tasks such as cleaning and cooking can be physically demanding. According to the U.S. Department of Labor, Bureau of Labor Statistics (2014), Home Health Aides and Personal Care Aides have a higher rate of injury and illness as compared to other jobs. It is important that a HHA/PCA take good care of their physical health and protect themselves against injury. Using proper body mechanics will help protect a person from back, muscle, joint, and other injuries. Proper body mechanics will be discussed throughout this course.

Grooming on a regular basis is important to maintain good physical health and appearance. It helps a person to feel good about oneself and shows others that they care about them. Showering or bathing daily, brushing teeth, using deodorant, and keeping hair and/or facial hair well-groomed are important tasks to help a HHA/PCA care for themselves and others. Uniforms should be freshly laundered and appear neat, without rips, tears, or stains. Long hair should be tied or held back. Jewelry should be kept to a minimum. Makeup should be kept to a minimum, and strong cologne or perfume should be avoided, as it could be irritating to patients. Fingernails should be kept trimmed and clean. Artificial nails harbor bacteria and should be avoided. Hand hygiene is extremely important, as it is the best way to prevent the transmission of infectious diseases. A health care worker should always wash their hands prior to and after performing a task where patient contact is involved, and any time hands appear dirty. Gloves should be worn when providing patient care where there is possible contact with body fluids.

Working as a Home Health Aide/Personal Care Aide is very rewarding, but can also be emotionally challenging. A HHA/PCA may work with a person with a cognitive or emotional disability who may display difficult behaviors. Patients who are in pain or who do not feel well may have mood swings or display behaviors that may be challenging to work with. Throughout this course, we will discuss ways to work with people who may have difficult behaviors. The skills for developing good communication with patients will be discussed throughout this course.

Providing supportive care also requires that the HHA/PCA is dependable, organized, responsible, trustworthy, patient, caring, and compassionate. As they work with people on a daily basis, it is important to be people-oriented and enjoy working with others. Patients and families allow home care workers to come into the privacy of their homes and take care of them in very personal ways. It is important that an HHA/PCA is trustworthy, honest, and respectful. This means that the HHA/PCA must respect a patient’s right to refuse a treatment or care, right to privacy, and right to practice any customs or traditions important to them.

Both the agency the HHA/PCA works for and the patient the HHA/PCA cares for relies on the HHA/PCA. An HHA/PCA should report to work on time. Home health aides/personal care aides work as part of a team, but are also required to work independently. This means that they are asked to complete tasks that have been assigned to them by their supervisor and the agency for which they work. They are also expected to document completion of these tasks. The entire health care team and especially the patient depend on home health aides/personal care aides to complete assigned tasks and to document their completion honestly. If a problem with completing a task occurs, the HHA/PCA should seek direction and assistance from their supervisor. Part of this documentation will include the time spent performing patient tasks and any travel time or mileage. Many agencies may reimburse for mileage and will have policies in place for the time spent traveling to the work site.

Example \(\PageIndex{4}\)

Which of the following behaviors could lead a HHA/PCA to get dismissed from their position? Check all that apply.

1. Being on time
2. Completing a task outside the scope of practice
3. Stealing from a patient or their home
4. Falsely documenting that a task was completed
5. Providing privacy during bathing of a patient
6. Respecting a patient’s right to refuse a service or medication
7. Not following agency policies and procedures
8. Repeatedly showing up late for work
9. Showing compassion for patients
10. Lying about the hours you spent working with the patient
11. Being culturally sensitive and respecting differences of others

Solution

The following could get you DISMISSED: 2, 3, 4, 7, 8, 10