CNAs and HHCAs perform similar tasks, although their work settings differ.
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In some ways, the jobs of certified nursing assistants and home health care aides are very similar. In other ways, however, they are very different. Both of these positions -- strongly dominated by women for years -- include unlicensed health care workers who provide basic care under the supervision of a licensed professional such as a registered nurse. Many of their tasks are the same, but work settings differ considerably.

Certified Nurse Assistants

Nurse aides or assistants -- the terms are often used interchangeably -- are typically employed in skilled nursing facilities. The U.S. Bureau of Labor Statistics notes 55 percent of NAs worked in that setting in 2010. They provide bed baths or showers and help patients eat, walk or use the toilet. Most nurse aides have a high school diploma and a postsecondary certificate. Training programs usually last about six weeks, according to Explore Health Careers, and include hands-on supervised experience. In many states, a nurse aide must pass a competency exam to become a certified nurse aide, or CNA.

Home Health Care Aides

Home health care aides provide services to patients who remain in their homes. Formal education is not required, according to the BLS. Most HHCAs learn their skills through on-the-job training. In some states, formal training may be required and the HHCA may need to pass a competency exam. In Washington, for example, HHCAs complete 75 hours of training that includes basic training in duties, hands-on skill practice and safety training. Most HHCAs work in home health care services, but some also work in residential facilities that care for the developmentally or physically disabled. HHCAs who work for certified hospice or home health agencies must have formal training and pass a written test, according to the BLS.


Background checks are usually required prior to employment for both CNAs and HHCAs, as these workers care for vulnerable patients and in settings in which it is difficult for supervisors to monitor their behavior. Some CNAs work in home health care, where they perform the same tasks as an HHCA. HHCAs and CNAs who work in home care both provide services such as bathing patients, changing soiled linen and helping patients eat, but may also perform light housekeeping or prepare meals. Either might work in a nursing care facility in some states.


CNAs may be required to obtain continuing education to maintain certification, while HHCAs have no continuing education requirements. CNAs often work under stressful conditions in which the work is physically hard and the CNA may have to care for many patients in a work shift, according to Explore Health Careers. HHCAs only care for one patient at a time. In some states, CNAs can take an additional course to become certified as a medication aide, which allows them to administer medications to a group of patients. Although an HHCA might be able to give a patient medications in the home, this practice is limited to a few states and certification is not available.

Your Choice

CNAs require formal training and ongoing continuing education to maintain certification. Employment prospects for HHCAs are likely to be better, although CNAs earn more. Job growth for HHCAs is expected to be 70 percent through 2020, according to the BLS, more than four times faster than the average for all occupations. Job growth is expected to be 20 percent for CNAs. CNAs have opportunities for advancement in some states as medication aides. A person who prefers working alone in a one-on-one situation might prefer becoming an HHCA, while one who would rather work with a team might be happier as a CNA. Either may have the opportunity to build long-term relationships with patients.

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