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If you want to get into healthcare but don’t have the finances or time for a lengthy education, a certified nursing assistant (CNA) or home health aide (HHA) career could be a great place for you to start. Although many people use these terms interchangeably because they think CNAs and HHAs are the same, they would be mistaken in many states. Let’s discuss the importance of these two roles in healthcare and explore the major differences between them, including salary expectations for travel and staff jobs in various states.
What Are Certified Nursing Assistant and Home Health Aide Roles?
CNAs and HHAs are valued healthcare team members who perform essential tasks. As a nurse working with primarily CNAs daily, I personally can’t overstate the importance of these roles enough. CNAs and HHAs provide patients with a level of care they otherwise may not receive and help ensure a positive patient experience. CNAs typically work in hospitals and assist with supporting patient care, while HHAs focus on one-on-one patient care within patient’s homes.
How Are Scopes of Practice Different?
While some CNA and HHA tasks overlap in the personal care area, a significant difference between their scopes of practice is that HHAs can’t provide any medically related tasks. These tasks include administering medications, changing dressings, taking vital signs, applying medicated lotions to a patient’s skin and other similar tasks.
However, some states allow HHAs to administer medications under supervision and take vital signs. In most states, CNAs can perform medically related tasks that HHAs can’t, including administering medications and drawing blood after they receive appropriate training.
Neither CNAs nor HHAs can perform medical tasks like deep wound care, patient assessments or giving injections. They must follow a care plan developed by the care team. Both must comply with state regulations, respect patient confidentiality and can’t provide medical advice or perform tasks beyond their approved scope of practice.
Because allowed tasks can vary by state, it’s crucial for CNAs and HHAs to understand what they can and can’t do. If another healthcare professional tells you to do something outside your scope of care, you could jeopardize your job and professional certifications and even potentially face legal consequences.
Typical CNA Scope of Practice
CNA jobs are typically in healthcare facilities under the supervision of registered nurses (RNs) or licensed practical/vocational nurses (LPN/LVN). They assist patients with the following:
- Bathing
- Dressing
- Feeding
- Toileting
- Taking vital signs
- Recording patient information
- Reporting changes to nursing staff
- Helping with mobility
- Positioning
- Assisting with range of motion activities
- Providing emotional support and comfort care
Typical HHA Scope of Practice
HHAs, sometimes called personal care assistants, usually work unsupervised in patients’ homes. An HHA’s job usually includes providing personal care, housekeeping assistance and support to patients, including:
- Bathing
- Grooming
- Dressing
- Preparing meals
- Doing light housekeeping
- Providing support and companionship
- Reporting changes to a healthcare provider
Differences in Work Environments and Patient Interactions
CNAs work in various healthcare settings under direct supervision, following set protocols. The environment shapes their responsibilities, from the fast-paced acute care in hospitals to the more routine-focused care in nursing homes and goal-oriented rehabilitation settings. They may assist the healthcare team at:
- Hospitals
- CNAs may work in medical-surgical, emergency, ICU and maternity wards, responding to urgent medical needs by answering call bells and ensuring patient comfort.
- Nursing Homes and Long-Term Care
- CNAs provide daily assistance to residents with chronic illnesses or disabilities, helping with activities of daily living and monitoring their health to report to nursing staff.
- Rehabilitation Centers
- CNAs assist patients recovering from surgeries or injuries, working closely with therapists to aid their rehabilitation plans.
- Assisted Living
- CNAs assist residents with personal care tasks, promote their independence and provide additional support such as medication reminders and transport within the facility.
CNAs typically interact with multiple patients, providing care in a structured environment.
HHAs provide care in non-institutional settings. Various settings HHAs may work include:
- Private Homes
- HHAs deliver personalized care.
- Hospice Care
- HHAs focus on comfort and emotional support for patients with terminal illnesses, helping them maintain a high quality of life in their final stages.
- Adult Day Care Centers or Group Homes
- HHAs oversee daily activities, promote social interaction and ensure the well-being of their clients.
HHAs primarily offer one-on-one care that is highly personalized. They often form close, supportive relationships with their clients, focusing on enhancing their quality of life and comfort, especially in hospice settings.
RELATED: States with the Highest-Quality Home Health Agencies, According to Patients
Differences in Training and Certification Requirements
CNAs must have a high school diploma or equivalent. While there aren’t any educational requirements for HHAs, including a high school diploma, many employers do require one or the equivalent. Neither CNAs nor HHAs are federally required to be licensed, but some states may require CNAs to be licensed. However, many only require them to be certified and/or registered.
CNAs undergo a state-approved training program and must pass a competency exam to become CNA certified. Many states require them to register on a CNA registry so they may be certified and registered. CNAs may also earn specialty certifications based on the patient populations they work with, such as Certified Hospice and Palliative Nursing Assistant. They can take the Medication Aide Certification Exam to qualify to administer medications to patients, primarily in long-term care settings.
HHAs may need certification at the state level, which may involve passing an exam. Even when it isn’t required, becoming certified may enhance your career options. The American Caregiver Association offers a National Caregiver Certification Course that allows you to be placed on the National Caregiver Registry once completed. However, employers usually don’t require it.
State-specific training requirements vary significantly for both roles, so aspiring CNAs and HHAs should check their state’s regulations and training requirements before pursuing certification. For example, California and Florida have specific training mandates for HHAs that they must fulfill to work in licensed home care agencies.
CNA Certification
CNA certificate programs are offered by community colleges, vocational schools and healthcare facilities. They typically last 4 to 12 weeks and combine classroom instruction and clinical training to prepare students for their roles in healthcare settings. Some nursing homes also offer CNA training and you can find online CNA courses, but ensure the course qualifies you to take the certification exam. The federal government sets minimum training requirements for CNAs but leaves implementation up to the states.
Upon completing the training program, CNAs must pass a competency exam with written and practical components. As of June 2024, 13 states, Washington, D.C. and three U.S. territories use The National Nurse Aide Assessment Program (NNAAP) for the exam. It includes a written or oral exam and a skills demonstration. Candidates must pass both parts to earn certification. The other 37 states have their own CNA exams, which typically follow similar guidelines to the NNAAP.
HHA Requirements
Home healthcare agencies, vocational schools and community colleges offer HHA training. Programs vary in duration but generally encompass classroom instruction and practical training. HHAs aren’t federally required to be certified if the company they work for is private. However, if the company that employs them accepts Medicare, they can only use certified home health aides. No matter the company type, many states and employers mandate certification.
Certification usually involves passing a competency exam that assesses basic care skills. In some states, HHAs must be listed on a state registry like CNAs. Prospective HHAs should verify their state’s regulations and training prerequisites to ensure compliance with local standards.
Career Pathways and Advancement Opportunities
CNAs and HHAs have several opportunities for career advancement through further education and certifications. CNAs can advance to become LPNs or RNs by completing additional education and passing the relevant exams. They can also specialize in geriatrics, phlebotomy or other areas to enhance their skills and job prospects. With experience, CNAs can move into supervisory or training roles within healthcare facilities.
HHAs can become CNAs by completing a certification program or advance to LPN or RN roles with further education. They can also obtain specialized certifications in hospice care, dementia care or palliative care. HHAs often focus on personalized patient care, which can lead to supervisory roles in home care settings.
Related: The Pros and Cons of a Career as a Home Health Nurse
CNA or HHA: Who Makes More Money?
Location, experience and specialization influence CNA and HHA salary levels. Urban areas and certain states, like Florida and New York, typically offer higher wages due to greater demand for healthcare services. Experience plays a key role. Like most positions, entry-level workers earn less, but salaries increase over time. Geriatrics or hospice care specializations can further boost earnings by providing advanced certification.
The following table represents average salaries for CNAs and HHAs in staff and travel roles in various states. We used salary data from Vivian Health on May 21, 2024, based on weekly rates, ranked by highest to lowest paying staff rate. We calculated staff weekly rates by multiplying the hourly wage by a 40-hour workweek. Because travel roles for these professionals are limited, salary data wasn’t available for many states.
| State | Profession | Staff | Travel |
| Idaho | CNA | $557 | N/A |
| Idaho | HHA | $557 | N/A |
| Washington | CNA | $650 | $1,148 |
| Washington | HHA | $650 | N/A |
| Florida | CNA | $668 | $1,140 |
| Florida | HHA | $668 | N/A |
| New York | CNA | $746 | $998 |
| New York | HHA | $746 | N/A |
Jobs Prospects and Demand for CNAs and HHAs
According to the Bureau of Labor Statistics, the demand for nursing assistants should grow by 4% from 2022 to 2032. This increase is slightly above average for most occupations, translating to an estimated addition of 5,840 jobs annually.
As of May 21, 2024, 132 jobs were available under the umbrella of CNA. The table below shows job availability on Vivian’s jobs marketplace, where new jobs are added hourly.
| Staff Roles | Travel Jobs | |
| CNA | 118 | 5 |
| Acute Care CNA | 25 | 4 |
| Clinic CNA | 15 | 0 |
| Mental Health CNA | 10 | 0 |
| HHA | 5 | 0 |
Choosing a path depends on your goals. CNAs may prefer structured environments with clear advancement opportunities in nursing. HHAs might value personalized home care and close patient relationships. Both careers offer vital contributions and advancement opportunities in healthcare.
Sign up for the Vivian app to search for CNA and HHA jobs in your area and set up job alerts for when new jobs that match your needs post on our jobs marketplace.
