New93 role standards, now public
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Role standards

Clinical support

Home health or personal care aide

What an aide working alone in a client's home must do safely from the first visit: help with personal care and moving without injury, notice and report the same day what has changed, report suspected abuse, and keep a record that matches what actually happened. Drawn from the federal training requirements every Medicare-certified home health agency must meet.

Practice this assessmentHire for this role
Expectations
10
Safety red lines
5
Sources
2
Version
1

Built from Centers for Medicare & Medicaid Services, Electronic Code of Federal Regulations, Centers for Medicare & Medicaid Services. Reviewed by clinicians, last on .

01What the role is measured on#

Every verdict is made of the same five dimensions. Each is scored on its own, so a candidate sees where they are strong and where to work.

  • Clinical skillsThe hands-on and judgement work of the role: recognising what matters, acting in the right order, and knowing when something cannot wait.
  • Workflow and toolsGetting the work done in a real setting: the systems, records, equipment and handoffs the role runs on, used correctly and on time.
  • Patient communicationHow the role talks with patients, families and colleagues: listening, explaining plainly, and confirming what was understood.
  • Compliance and safetyThe rules that protect people: privacy, consent, infection control, reporting duties and the safety checks the role is accountable for.
  • Role knowledgeKnowing the job itself: what the role is responsible for, where its scope ends, and who to bring in when it does.

02What a ready hire does#

What a competent home health or personal care aide does on day one, dimension by dimension.

Clinical skills

  • Helps with bathing, toileting, dressing, grooming and eating as the care plan directs, safely and with the client doing what they can.
  • Moves, transfers and walks with a client using the method the care plan specifies, protecting the client and themselves.

Workflow and tools

  • Records each visit's times, tasks and observations accurately and truthfully, so the agency nurse and the payer can rely on it.
  • Keeps what they learn about a client and their home confidential, sharing only with those entitled to it.

Patient communication

  • Communicates with a client living with dementia in a way that lowers distress and gets care done without force.
  • Asks about and respects the client's own preferences, beliefs and routines in how care is given.

Compliance and safety

  • Spots and reduces fall hazards in the home and responds safely when a client has fallen.
  • Recognises signs of abuse, neglect, self-neglect and financial exploitation and reports them to the agency and the state's reporting line without investigating or waiting for proof.

Role knowledge

  • Does only the tasks the care plan and state law allow, and declines and reports a request outside them rather than obliging.
  • Reports a change in the client to the agency nurse the same day, calls 911 for an emergency, and makes sure someone has heard and is acting.

03Safety red lines#

Any one of these keeps a candidate from Ready Day One, whatever the rest of the score. They are published so nobody meets them for the first time in the assessment.

  • Would transfer or move a client by a method the care plan does not allow - alone when it calls for two people or a mechanical lift, or without the gait belt it requires - or would lift a client off the floor after a fall before they have been checked for injury.

    A dropped client or a fall during an unsafe transfer can cause a hip fracture or head injury, and lifting an injured client off the floor can worsen a fracture or spinal injury.

  • Keeps a sign or disclosure of abuse, neglect or financial exploitation to themselves, promises the client to keep it secret, only confronts the suspected person, or waits for proof before reporting to the agency and the state's reporting line.

    The client stays in danger, confronting the abuser can raise the risk to the client, and failing to report is a breach of the reporting duty most states place on home care workers.

  • Would record tasks, visits or hours that did not happen - signing off care not given, clocking in or out at times they were not there, or having the client sign a timesheet for time not worked.

    The nurse plans care from a false record, the client goes without care the record says they had, and billing Medicare or Medicaid for services not provided is fraud.

  • Would hold down, restrain, lock in, threaten or force care on a client with dementia who is refusing or resisting.

    Forced care causes injury and terror, escalates distress, and is abuse under state law.

  • Notices a change such as a fall, new confusion, breathlessness, chest pain, a new wound or missed medicines and leaves the home without reporting it to the agency nurse that day, or does not call 911 for an emergency.

    An aide may be the only professional who sees the client for days; a change not reported that day may not be seen again until it is an emergency.

04Outside the role#

Knowing where the role stops is part of the standard. Going past it is not extra credit.

  • Does not give medication - drawing up or injecting insulin, putting tablets in the client's mouth, giving eye drops - beyond reminding the client and helping with medicines they take themselves, and only to the extent the state and the care plan allow.Reminds the client, reports missed or refused doses and any difficulty to the agency nurse the same day.
  • Does not perform skilled tasks such as wound or sterile dressings, catheter insertion, oxygen changes, or nail cutting for a client with diabetes or poor circulation, unless the care plan assigns it and they have been trained and checked on it.Leaves it for the nurse and reports that it needs doing.
  • Does not change the care plan, add tasks the plan does not include, or give medical advice to the client or family.Tells the client the nurse will follow up, and calls the agency nurse with the request.
  • Does not handle a client's money, sign documents for them, or accept gifts beyond agency policy, and does not investigate suspected abuse themselves. Reporting duties and routes differ by state.Refers money and legal matters to the agency, and reports concerns to the agency and to adult protective services or the police as the state requires.

05How it is assessed#

  • A spoken assessment

    An examiner talks the candidate through realistic cases from this role, and follows up the way a senior colleague would.

  • Five dimensions

    Each answer is read against the expectations above and rated on the same four-level scale.

  • The 70 bar

    Every scorecard shows the score against 70, overall and for each dimension, with the reason for the verdict.

  • Safety first

    Crossing one of the safety red lines holds a pass back, however strong the rest was.

The four levels

  1. Not yet
  2. Developing
  3. Proficient
  4. Exemplary
How a verdict is made

06Sources and review#

Drawn from the certification frameworks and practice standards below, and reviewed by clinicians. Version 1, last reviewed .

Cited as sources. Not an endorsement by the organizations named.

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