• Job prospects for nursing and home health aides will be very good because of fast growth and high replacement needs in these large occupations.
• Minimum education or training is generally required for entry-level jobs, but earnings are low.

Nursing aides, also known as nursing assistants, geriatric aides, unlicensed assistive personnel, or hospital attendants, perform routine tasks under the supervision of nursing and medical staff. They answer patients’ call bells, deliver messages, serve meals, make beds, and help patients eat, dress, and bathe. Aides also may provide skin care to patients; take temperatures, pulse, respiration, and blood pressure; and help patients get in and out of bed and walk. They also may escort patients to operating and examining rooms, keep patients’ rooms neat, set up equipment, store and move supplies, or assist with some procedures. Aides observe patients’ physical, mental, and emotional conditions and report any change to the nursing or medical staff.

Nursing aides employed in nursing homes often are the principal caregivers, having far more contact with residents than other members of the staff. Because some residents may stay in a nursing home for months or even years, aides develop ongoing relationships with them and interact with them in a positive, caring way.

Psychiatric aides, also known as mental health assistants or psychiatric nursing assistants, care for mentally impaired or emotionally disturbed individuals. They work under a team that may include psychiatrists, psychologists, psychiatric nurses, social workers, and therapists. In addition to helping patients dress, bathe, groom, and eat, psychiatric aides socialize with them and lead them in educational and recreational activities. Psychiatric aides may play games such as cards with the patients, watch television with them, or participate in group activities such as sports or field trips. They observe patients and report any physical or behavioral signs that might be important for the professional staff to know. They accompany patients to and from examinations and treatments. Because they have such close contact with patients, psychiatric aides can have a great deal of influence on their outlook and treatment.

Home health aides help elderly, convalescent, or disabled persons live in their own homes instead of in a health facility. Under the direction of nursing or medical staff, they provide health-related services, such as administering oral medications. (Personal and home care aides, who provide mainly housekeeping and routine personal care services, are discussed elsewhere in the Handbook.) Like nursing aides, home health aides may check pulse, temperature, and respiration; help with simple prescribed exercises; keep patients’ rooms neat; and help patients move from bed, bathe, dress, and groom. Occasionally, they change nonsterile dressings, give massages and alcohol rubs, or assist with braces and artificial limbs. Experienced home health aides also may assist with medical equipment such as ventilators, which help patients breathe.

Most home health aides work with elderly or disabled persons who need more extensive care than family or friends can provide. Some help discharged hospital patients who have relatively short-term needs.

In home healthcare agencies, a registered nurse, physical therapist, or social worker usually assigns specific duties and supervises home health aides. Aides keep records of services performed and patients’ condition and progress. They report changes in patients’ conditions to the supervisor or case manager.

Aides often have unpleasant duties, such as emptying bedpans and changing soiled bed linens. The patients they care for may be disoriented, irritable, or uncooperative. Psychiatric aides must be prepared to care for patients whose illness may cause violent behavior. While their work can be emotionally demanding, many aides gain satisfaction from assisting those in need.

Home health aides may go to the same patient’s home for months or even years. However, most aides work with a number of different patients, each job lasting a few hours, days, or weeks. Home health aides often visit multiple patients on the same day.

Home health aides generally work alone, with periodic visits by their supervisor. They receive detailed instructions explaining when to visit patients and what services to perform. Aides are individually responsible for getting to patients’ homes, and they may spend a good portion of the working day traveling from one patient to another. Because mechanical lifting devices available in institutional settings are seldom available in patients’ homes, home health aides are particularly susceptible to injuries resulting from overexertion when assisting patients.

The Federal Government has enacted guidelines for home health aides whose employers receive reimbursement from Medicare. Federal law requires home health aides to pass a competency test covering 12 areas: Communication skills; documentation of patient status and care provided; reading and recording vital signs; basic infection control procedures; basic body functions; maintenance of a healthy environment; emergency procedures; physical, emotional, and developmental characteristics of patients; personal hygiene and grooming; safe transfer techniques; normal range of motion and positioning; and basic nutrition.

A home health aide may take training before taking the competency test. Federal law suggests at least 75 hours of classroom and practical training supervised by a registered nurse. Training and testing programs may be offered by the employing agency, but must meet the standards of the Health Care Financing Administration. Training programs vary depending upon State regulations.

The National Association for Home Care offers national certification for home health aides. The certification is a voluntary demonstration that the individual has met industry standards.

Nursing aide training is offered in high schools, vocational-technical centers, some nursing homes, and some community colleges. Courses cover body mechanics, nutrition, anatomy and physiology, infection control, communication skills, and resident rights. Personal care skills such as how to help patients bathe, eat, and groom also are taught.

Some facilities, other than nursing homes, provide classroom instruction for newly hired aides, while others rely exclusively on informal on-the-job instruction from a licensed nurse or an experienced aide. Such training may last several days to a few months. From time to time, aides may also attend lectures, workshops, and in-service training.

These occupations can offer individuals an entry into the world of work. The flexibility of night and weekend hours also provides high school and college students a chance to work during the school year.

Applicants should be tactful, patient, understanding, healthy, emotionally stable, dependable, and have a desire to help people. They should also be able to work as part of a team, have good communication skills, and be willing to perform repetitive, routine tasks. Home health aides should be honest, and discreet because they work in private homes.

Aides must be in good health. A physical examination, including State regulated tests such as those for tuberculosis, may be required.

Opportunities for advancement within these occupations are limited. To enter other health occupations, aides generally need additional formal training. Some employers and unions provide opportunities by simplifying the educational paths to advancement. Experience as an aide can also help individuals decide whether to pursue a career in the healthcare field.

Nursing aide employment will not grow as fast as home health aide employment, largely because nursing aides are concentrated in the relatively slower-growing nursing home sector. Nevertheless, employment of nursing aides is expected to grow faster than the average for all occupations in response to increasing emphasis on rehabilitation and the long-term care needs of a rapidly growing elderly population. Financial pressure on hospitals to discharge patients as soon as possible should produce more nursing home admissions. Modern medical technology will also increase the employment of nursing aides. This technology, while saving and extending more lives, increases the need for long-term care provided by aides.

Employment of psychiatric aides--the smallest of the three occupations--is expected to grow as fast as the average. The number of jobs for psychiatric aides in hospitals, where one-half of psychiatric aides work, will decline due to attempts to contain costs by limiting inpatient psychiatric treatment. Employment in other sectors will rise in response to growth in the number of older persons—many of whom will require mental health services, increasing public acceptance of formal treatment for drug abuse and alcoholism, and a lessening of the stigma attached to those receiving mental health care.

Numerous openings for nursing and home health aides will arise from a combination of fast growth and high replacement needs for these large occupations. Turnover is high, a reflection of modest entry requirements, low pay, high physical and emotional demands, and lack of advancement opportunities. For these same reasons, many people are unwilling to perform this kind of work. Therefore, persons who are interested in this work and suited for it should have excellent job opportunities.

Nursing and psychiatric aides in hospitals generally receive at least 1 week’s paid vacation after 1 year of service. Paid holidays and sick leave, hospital and medical benefits, extra pay for late-shift work, and pension plans also are available to many hospital and some nursing home employees.

Median hourly earnings of home health aides were $8.23 in 2000. The middle 50 percent earned between $7.13 and $9.88 an hour. The lowest 10 percent earned less than $6.14, and the highest 10 percent earned more than $11.93 an hour. Median hourly earnings in the industries employing the largest numbers of home health aides in 2000 were as follows:

General information about training and referrals to State and local agencies about opportunities for home health aides, a list of relevant publications, and information on certification are available from:

31-1011.00, 31-1012.00, 31-1013.00