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Nursing, Psychiatric, and Home Health Aides

Significant Points
  • Home health aides is projected to be the fastest growing occupation through 2014.
  • Numerous job openings and excellent job opportunities are expected.
  • Most jobs are in nursing and residential care facilities, hospitals, and home health care services.
  • Modest entry requirements, low pay, high physical and emotional demands, and lack of advancement opportunities characterize this occupation.
Nature of the Work

Nursing and psychiatric aides help care for physically or mentally ill, injured, disabled, or infirm individuals confined to hospitals, nursing care facilities, and mental health settings. Home health aides have duties that are similar, but they work in patients’ homes or residential care facilities.

Nursing aides—also known as nursing assistants, certified nursing assistants, geriatric aides, unlicensed assistive personnel, orderlies, or hospital attendants—perform routine tasks under the supervision of nursing and medical staff. They answer patients’ call lights; deliver messages; serve meals; make beds; and help patients to eat, dress, and bathe. Aides also may provide skin care to patients; take their temperature, pulse rate, respiration rate, and blood pressure; and help them to get into 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, and 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 care facilities often are the principal caregivers, having far more contact with residents than do other members of the staff. Because some residents may stay in a nursing care facility for months or even years, aides develop ongoing relationships with them and interact with them in a positive, caring way.

Home health aides help elderly, convalescent, or disabled persons live in their own homes instead of in a health care facility. Under the direction of nursing or medical staff, they provide health-related services, such as administering oral medications. Like nursing aides, home health aides may check patients’ pulse rate, temperature, and respiration rate; help with simple prescribed exercises; keep patients’ rooms neat; and help patients to 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 health agencies, a registered nurse, physical therapist, or social worker usually assigns specific duties to and supervises home health aides, who keep records of the services they perform and record each patient’s condition and progress. The aides report changes in a patient’s condition to the supervisor or case manager.

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 to dress, bathe, groom themselves, 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 treatment. Because they have such close contact with patients, psychiatric aides can have a great deal of influence on their patients’ outlook and treatment.

Working Conditions

Most full-time aides work about 40 hours a week, but, because patients need care 24 hours a day, some aides work evenings, nights, weekends, and holidays. Many work part time. In 2004, 25 percent of aides worked part time compared with 16 percent of all workers. Aides spend many hours standing and walking, and they often face heavy workloads. Aides must guard against back injury because they may have to move patients into and out of bed or help them to stand or walk. Aides also may face hazards from minor infections and major diseases, such as hepatitis, but can avoid infections by following proper procedures.

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 from 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 they assist patients.

Training, Other Qualifications, and Advancement

In many cases, a high school diploma or equivalent is necessary for a job as a nursing or psychiatric aide. However, a high school diploma generally is not required for jobs as home health aides. Hospitals may require previous experience as a nursing aide or home health aide. Nursing care facilities often hire inexperienced workers, who must complete a minimum of 75 hours of mandatory training and pass a competency evaluation as part of a State-approved training program within 4 months of their employment. Aides who complete the program are known as certified nurse assistants (CNAs) and are placed on the State registry of nursing aides. Some States also require psychiatric aides to complete a formal training program. However, most psychiatric aides learn their skills on the job from experienced workers.

Nursing and psychiatric aide training is offered in high schools, vocational-technical centers, some nursing care facilities, 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 to bathe, eat, and groom themselves, also are taught.

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

The Federal Government has guidelines for home health aides whose employers receive reimbursement from Medicare. Federal law requires home health aides to pass a competency test covering a wide range of areas: Communication; documentation of patient status and care provided; reading and recording of vital signs; basic infection-control procedures; basic bodily 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 receive 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 Center for Medicare and Medicaid Services. State regulations for training programs vary.

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. Some States also require aides to be licensed.

Aides must be in good health. A physical examination, including State-regulated tests such as those for tuberculosis, may be required. A criminal background check also is usually required for employment.

Applicants should be tactful, patient, understanding, emotionally stable, and dependable and should have a desire to help people. They also should 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. They also will need access to their own car or public transportation to reach patients’ homes.

For some individuals, these occupations serve as entry-level jobs, as in the case of high school and college students who may work while also attending school. In addition, experience as an aide can help individuals decide whether to pursue a career in health care. Opportunities for advancement within these occupations are limited. Aides generally need additional formal training or education in order to enter other health occupations. The most common health care occupations for former aides are licensed practical nurse, registered nurse, and medical assistant.


Nursing, psychiatric, and home health aides held about 2.1 million jobs in 2004. Nursing aides held the most jobs—approximately 1.5 million. Home health aides held roughly 624,000 jobs and psychiatric aides held about 59,000 jobs. Around 42 percent of nursing aides worked in nursing care facilities, and another 27 percent worked in hospitals. Most home health aides—about 34 percent—were employed by home health care services. Others were employed in nursing and residential care facilities and social assistance agencies. Around 54 percent of all psychiatric aides worked in hospitals, primarily in psychiatric and substance abuse hospitals, although some also worked in the psychiatric units of general medical and surgical hospitals. Others were employed in State government agencies; residential mental retardation, mental health, and substance abuse facilities; outpatient care centers; and nursing care facilities.

Job Outlook

Numerous job openings for nursing, psychiatric, and home health aides will arise from a combination of fast employment growth and high replacement needs. High replacement needs in this large occupation reflect modest entry requirements, low pay, high physical and emotional demands, and lack of opportunities for advancement. For these same reasons, many people are unwilling to perform the kind of work required by the occupation, limiting the number of entrants. Many aides also leave the occupation to attend training programs for other health care occupations. Therefore, persons who are interested in, and suited for, this work should have excellent job opportunities.

Overall employment of nursing, psychiatric, and home health aides is projected to grow much faster than average for all occupations through the year 2014, although individual occupational growth rates will vary. Home health aides is expected to be the fastest growing occupation, as a result of both growing demand for home services from an aging population and efforts to contain costs by moving patients out of hospitals and nursing care facilities as quickly as possible. Consumer preference for care in the home and improvements in medical technologies for in-home treatment also will contribute to much-faster-than-average employment growth for home health aides.

Nursing aide employment will not grow as fast as home health aide employment, largely because nursing aides are concentrated in slower growing nursing care facilities and hospitals. Employment of nursing aides is expected to grow faster than average for all occupations through 2014, in response to the long-term care needs of an increasing elderly population. Financial pressures on hospitals to discharge patients as soon as possible should boost admissions to nursing care facilities. As a result, job opportunities will be more numerous in nursing and residential care facilities than in hospitals. Modern medical technology also will drive demand for nursing aides because, as the technology saves and extends more lives, it increases the need for long-term care provided by aides.

Employment of psychiatric aidesthe smallest of the three occupations—is expected to grow more slowly than average for all occupations. Most psychiatric aides currently work in hospitals, but most job growth will be in residential mental health facilities and in home health care agencies. There is a long-term trend toward treating mental health patients outside of hospitals because it is more cost effective and allows patients to live more normal lives. Demand for psychiatric aides in residential facilities will rise in response to growth in the number of older persons—many of whom will require mental health services—but also as an increasing number of mentally disabled adults, who were formerly cared for by their elderly parents, seek care. Job growth also could be affected by changes in government funding of programs for the mentally ill.


Median hourly earnings of nursing aides, orderlies, and attendants were $10.09 in May 2004. The middle 50 percent earned between $8.59 and $12.09 an hour. The lowest 10 percent earned less than $7.31, and the highest 10 percent earned more than $14.02 an hour. Median hourly earnings in the industries employing the largest numbers of nursing aides, orderlies, and attendants in May 2004 were as follows:

Employment services $11.29
Local government 11.10
General medical and surgical hospitals 10.44
Nursing care facilities 9.86
Community care facilities for the elderly 9.56

Nursing and psychiatric aides in hospitals generally receive at least 1 week of 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 employees and to some nursing care facility employees.

Median hourly earnings of home health aides were $8.81 in May 2004. The middle 50 percent earned between $7.52and $10.38an hour. The lowest 10 percent earned less than $6.52, and the highest 10 percent earned more than $12.32an hour. Median hourly earnings in the industries employing the largest numbers of home health aides in May 2004 were as follows:

Nursing care facilities $9.11
Residential mental retardation, mental health and substance abuse facilities 8.97
Home health care services 8.57
Community care facilities for the elderly 8.57
Individual and family services 8.47

Home health aides receive slight pay increases with experience and added responsibility. Usually, they are paid only for the time worked in the home, not for travel time between jobs. Most employers hire only on-call hourly workers and provide no benefits.

Median hourly earnings of psychiatric aides were $11.19 in May2004. The middle 50 percent earned between $9.09and $14.09 an hour. The lowest 10 percent earned less than $7.63, and the highest 10 percent earned more than $16.74an hour. Median hourly earnings in the industries employing the largest numbers of psychiatric aides in May 2004 were as follows:

General medical and surgical hospitals $11.31
Psychiatric and substance abuse hospitals 11.06
Residential mental retardation, mental health and substance abuse facilities 9.37

Related Occupations

Nursing, psychiatric, and home health aides help people who need routine care or treatment. So do childcare workers, licensed practical and licensed vocational nurses, medical assistants, occupational therapist assistants and aides, personal and home care aides, physical therapist assistants and aides, and registered nurses.

Sources of Additional Information

Information about employment opportunities may be obtained from local hospitals, nursing care facilities, home health care agencies, psychiatric facilities, State boards of nursing, and local offices of the State employment service.

Information on licensing requirements for nursing and home health aides, and lists of State-approved nursing aide programs are available from State departments of public health, departments of occupational licensing, boards of nursing, and home care associations.

    • Source: Bureau of Labor Statistics, U.S. Department of Labor, Occupational Outlook Handbook, 2006-07 Edition

    See also Home Health Care Resources

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