Home Health Aide vs. CNA - What's the Difference?

Deborah Chiaravalloti - 03/21/19

There are many different levels of nursing, and all of them allow you to be intimately involved in patient care. If you are interested in the healthcare profession but don’t have the time or money to pursue an undergraduate or advanced degree, there are still ways for you to be involved in nursing and the care of other human beings. Home health aides (HHA) and certified nursing assistants (CNAs) are on the front lines of patient care and can make a significant difference in a patient’s life. Here is what you need to know about each position.

The basic difference between a home health aide and a CNA is that states do not require specific certification for HHAs unless you work in a facility that receives Medicare/Medicaid funding. On the other hand, a CNA must take certain courses and pass a CNA certification exam to obtain a state-approved CNA license, regardless of the facility or organization of employment.

Here are some of the other differences between an HHA and a CNA.

Place of employment and responsibilities: 

HHA: A home health aide usually works with patients in their home. They do not perform clinical tasks. Instead, they help the patient with activities of daily living which can include:

  • Light housekeeping and laundry
  • Meal preparation
  • Transportation
  • Companionship
  • Grocery shopping and errands
  • Understanding and complying with treatment and medication plans

There are many reasons why an individual needs the support of an HHA. The person may be:

  • A senior who needs help with daily activities in order to age in place
  • Recovering from illness or injury
  • Chronically ill
  • Suffering from cognitive deficiencies like dementia and requires supervision

An HHA works with one client at a time and can get to know them and spend time with them.

CNA: A certified nursing assistant’s role is to support their patient’s health. They may be responsible for many patients in a unit or on a floor at the same time. As part of the healthcare team, a CNAs responsibility can include:

  • Maintaining a patient’s hygiene while in the healthcare facility
  • Administering medication
  • Helping to prevent and control infections by changing dressings and bandages
  • Tracking patient conditions, documenting patient care, reporting to supervising nurse

Certified Nursing Assistants can work in virtually any healthcare organization. They can include hospitals, rehabilitation centers, hospices, skilled nursing homes, retirement communities, assisted living facilities, adult day care centers, and more.


HHA: A home health aide does not need certification. However, if there is an interest in pursuing it, a Medication Aide Certification (MACE) is available. Usually it is administered to CNAs, but check the MACE directory for your state and ask if you can sit for the exam as an HHA.

CNA: Becoming a CNA requires completion of a very specific series of courses, passing the CNA exam and obtaining a state license. Each state has its own certification requirements. Classes are offered by many different organizations including the American Red Cross which offers CNA training and online classes.

Career advancement and salary

HHA: Home health aides usually remain in the same position due to the structure of most home health agencies. Without clinical training, there is not a higher-level job to advance to.

Salaries vary by state and healthcare organization, but in general, an HHA can expect to earn about $22,000 a year.

CNA: Because of the wide variety of healthcare settings in which a CNA can work, there is usually opportunity for advancement. An organization may offer to support a CNA as he or she pursues advanced certification, or they may offer the opportunity to advance into an administrative role of some type.

These wages vary by state as well, but in general a CNA can expect to earn between $27,00 and $35,000 a year.

A great career 

The American Red Cross says that there are more than 1.4 million nurse’s assistants employed in the United States – and the job prospects are only going to grow. According to the American Red Cross, job growth, “is faster than average, with an expected growth of 20% or more by 2020. A total of more than 300,000 additional employees will be needed.”

If you are interested in patient care, consider becoming an HHA or a CNA. Taking care of people and contributing to their health and well-being is a high calling.