As you live your life with ALS, you will most likely be supported by many different home care workers, each responsible for providing specific types of care and services to you. Here’s a review of the various types of workers who could be on your home support team.
Assistive care providers
Assistive care is non-‐medical supportive care. The services provided by assistive care personnel can range from helping with personal care (e.g., bathing, dressing, grooming, eating, toileting, and moving) to light housekeeping, grocery shopping, and preparing meals. Some assistive care providers are also able to provide limited assistance with medications. Assistive care providers may have different titles, including personal care aide (PCA), home health aide (HHA), and certified nurse assistant (CNA). Although the job responsibilities may be similar, there are differences among the three in terms of training requirements and scope of practice (i.e., the tasks they are legally permitted to do).
Personal care aides
Personal care aides provide personal care in addition to other services, such as cleaning, running errands, preparing meals, and arranging for transportation. Unlike home health aides and certified nurse assistants, personal care aides do not support the delivery of health care. There are no federally mandated training requirements for personal care aides, although some states or employers may require personal care aides to complete a training program.
Home health aides
Home health aides assist clients with personal care tasks (such as bathing and dressing), light housekeeping tasks (such as laundry and vacuuming), and tasks related to preparing and serving meals (such as grocery shopping and cooking). They may also provide some basic health care– related services (such as measuring vital signs, administering medications, or assisting with medical equipment) under the supervision of a licensed health care professional.
Although formal training is not required to become a home health aide, home health aides who work for a Medicare-‐certified home health agency must be certified. To achieve certification, a home health aide candidate must complete a minimum of 75 hours of formal training (including classroom lecture, hands-‐on skill practice, and supervised experience in a health care setting) through a state-‐approved program and pass the state’s certification examination. To remain certified, the home health aide must complete a minimum of 12 hours of in-‐service training (continuing education) each year. Home health aides who do not work for Medicare-‐certified home health agencies may only be required to complete an employer’s on-‐the-‐job training program.
Certified nursing assistants
Certified nursing assistants (CNAs) assist with the delivery of nursing care by performing basic nursing tasks under the supervision of a registered nurse (RN) or a licensed practical/vocational nurse (LPN/LVN). Examples of basic nursing tasks include helping with personal hygiene and grooming, assisting with toileting, helping clients to move from place to place, helping clients to eat, changing bed linens, measuring vital signs, and assisting with range-‐of-‐motion exercises and other therapies. Some certified nurse assistants receive additional training that allows them to assist with medications or other more advanced nursing procedures. Certified nursing assistants may work in a variety of health care settings, including the home. Certified nursing assistants who work in the home setting may also perform light housekeeping duties related to maintaining a clean environment or ensuring proper nutrition (e.g., laundry, meal preparation).
All certified nursing assistants must complete a minimum of 75 hours of training through a state-‐ approved training program and pass the state’s certification exam. To remain certified, certified nursing assistants must complete a minimum of 12 hours of in-‐service training each year.
Skilled care providers
Skilled care providers, such as nurses and therapists, often are part of the home health care team. In addition to providing direct care, skilled care providers may be involved in overseeing the care you receive, and managing other care providers. Generally speaking, the tasks that skilled care providers perform are those that require specialized knowledge and advanced training to do safely.
Registered nurses perform assessments, develop care plans, provide nursing care, and supervise other members of the nursing team, including licensed practical/vocational nurses, home health aides, and certified nursing assistants. In the home health setting, registered nurses often function as case managers (i.e., staff members who are responsible for planning, coordinating, and overseeing all aspects of the care that the client receives through the agency). The registered nurse who is serving as the case manager may also be responsible for providing hands-‐on nursing care to the client, or these tasks may be handled by another registered nurse or licensed practical/vocational nurse on the team.
A registered nurse holds a Bachelor of Science degree in nursing (BSN) obtained from a 4-‐year college or an associate’s degree in nursing (ADN) obtained from a 2-‐year college. In order to practice, a registered nurse must also pass a state-‐administered licensing examination.
Licensed practical/vocational nurses
Licensed practical/vocational nurses help plan and deliver certain types of nursing care under the direction of a registered nurse. The tasks that licensed practical/vocational nurses are legally permitted to do vary depending on the health care setting and the state. Certification (obtained by completing a 12-‐ to 18-‐month training program) as well as licensure (obtained by passing a state-administered examination) is required to work as a licensed practical/vocational nurse.
Therapists specialize in helping people with injuries or disabilities to maintain existing abilities and— whenever possible— to regain abilities that have been lost. Therapy helps a person to be as fully functional and independent as possible, which increases the person’s ability to live a full and enjoyable life.
- Physical therapists (PTs) use techniques such as strengthening exercises and stretching to promote mobility, maintain strength, and reduce pain. A physical therapist may also teach clients how to use special equipment (such as a brace or walker) properly. Physical therapists must hold a doctor of physical therapy (DPT) degree and obtain state licensure.
- Occupational therapists help people retain or regain the ability to perform everyday tasks. The primary goal of occupational therapy is to maintain or improve the person’s independence. Like physical therapists, occupational therapists may teach exercises and show clients how to use special equipment, such as eating and grooming aids. Occupational therapists can also assess the home or workplace and make recommendations for modifications that will make it easier for the client to do things for him-‐ or herself. Occupational therapists must have, at minimum, a master’s degree in occupational therapy. Some have doctoral degrees. In addition, all states require occupational therapists to be licensed.
- Speech-language pathologists (sometimes called speech therapists) assess and manage speech, chewing, and swallowing difficulties. The speech-‐language pathologist can recommend devices and exercises to facilitate communication and teach techniques to improve the ability to eat and drink safely. Speech-language pathologists typically hold at least a master’s degree and are required by most states to be licensed.
- Respiratory therapists evaluate breathing problems, teach clients techniques and exercises to make breathing easier, and provide instruction in the use of equipment such as ventilators. Respiratory therapists must have either an associate’s degree or a bachelor’s degree, and all states except for Alaska require licensure.