What a Home Health Aide Can and Cannot Do in New York: A Plain-English Guide for Families

What Can a Home Health Aide Do? The Short Version

Families ask “what can a home health aide do” before care starts and again when an aide declines a task. In New York, an aide’s work is defined by two things: the type of certification the aide holds, and the written plan of care that a registered nurse prepares for your loved one.

If a task is in the plan of care and within the aide’s training, the aide can do it. If it is outside the plan, the aide should not do it until the nurse updates the plan. If it is a clinical task that requires a license, no plan of care can turn it into an aide task.

It also helps to know the two main job titles. A personal care aide (PCA) completes about 40 hours of state-approved training and focuses on personal care and household support. A home health aide (HHA) completes at least 75 hours, including 16 hours of supervised practical training, and can also help with certain health-related tasks under nurse supervision. Our guide on HHA vs PCA and which your loved one needs goes deeper on choosing between them, and what a certified home health aide (CHHA) is explains the certification itself.

Everyday Personal Care an Aide Can Help With

Most of what an aide does is hands-on help with activities of daily living. This is also the part of care that Medicaid uses to decide hours, because it measures how much help a person needs with these tasks rather than the diagnosis itself.

• Bathing and grooming: showers, sponge or bed baths, hair care, shaving, nail care that does not involve cutting for someone with diabetes or poor circulation (that usually goes to a podiatrist).
• Dressing: choosing weather-appropriate clothes, help with buttons, socks, compression stockings if ordered, and braces.
• Toileting and continence care: help getting to the bathroom or commode, changing briefs, perineal care, emptying a urinary drainage bag.
• Transfers and walking: moving from bed to chair, standing up safely, walking with a cane or walker, and using a mechanical lift if the aide is trained and the plan calls for it.
• Eating: preparing meals, cutting food, following a prescribed diet, and feeding someone who cannot feed themselves.
• Positioning: turning and repositioning someone who spends most of the day in bed, which helps protect the skin.

Household and Daily-Life Support

Aides also handle tasks that keep the home safe and livable for the person receiving care. This includes light cleaning of the areas the client uses, the client’s laundry, washing dishes, making the bed, grocery shopping, picking up prescriptions, and going with the client to medical appointments. Companionship matters too: conversation, reading aloud, short walks, and noticing changes in mood or memory are part of good care.

Notice the phrase “for the person receiving care.” An aide is not a housekeeper for the whole household. Cooking dinner for the family, cleaning a relative’s bedroom, babysitting grandchildren, or walking the dog is outside the job, even when everyone means well.

Medications: Assistance Versus Administration

This is the area that causes the most confusion. In New York, an aide can remind your parent to take medicine, bring the pill organizer or labeled bottle, open a container, hand over a glass of water, and observe that the medication was taken. An HHA may assist with medications that are self-administered or already pre-poured, for example by a family member or a pharmacy blister pack, when the plan of care allows it.

What the aide cannot do is decide which pill to take, fill a weekly pill box from the bottles, change a dose because your parent “seems better today,” or give medication by injection. Insulin injections, blood thinner injections, and similar shots are given by the person, a family member, or a nurse. Eye drops and topical creams are handled according to the plan of care, so ask the agency nurse how they will be written in.

If your parent cannot manage medications even with reminders, tell the agency and the doctor. The answer is often a pharmacy that prepares blister packs, a family member who pre-pours the week, or a visiting nurse for injections. Our article on what home care services Medicaid covers in New York explains how nursing visits fit alongside aide hours.

Health-Related Tasks: What Needs a Nurse

An HHA may help with some routine health-related tasks when a nurse has assessed the situation, written the task into the plan, and supervises the aide. Examples include taking temperature, helping with prescribed exercises, assisting with braces or a prosthesis, and simple routine care that the nurse has taught and approved. The exact list depends on the agency’s policies and the plan of care.

Tasks that require clinical judgment stay with licensed staff. These include:

• Giving injections or IV medications.
• Changing sterile dressings or packing wounds.
• Inserting catheters or feeding tubes, or giving medications through a tube.
• Assessing a new symptom and deciding what it means.
• Adjusting oxygen settings or other prescribed equipment.

If your parent came home with a surgical wound, for example, a visiting nurse handles the dressing while the aide handles bathing around it, meals and mobility. Our guide to wound care after surgery: visiting nurse vs home care aide walks through that split in detail.

Why the Plan of Care Is the Rulebook

Every home care case in New York runs on a written plan of care. If care is through a Medicaid managed long-term care (MLTC) plan, the plan’s nurse assesses your loved one and authorizes hours. The home care agency’s nurse then writes the detailed task list the aide follows. Our explainer on what happens at the MLTC nurse visit shows how that document gets written.

Because the aide follows the plan, the fastest way to fix a “she says she can’t do that” moment is to call the agency. If the task is appropriate but missing from the plan, the nurse can add it. If needs have grown, for example your mother now needs help at night, the plan and the hours may need a reassessment.

Common Gray Areas Families Ask About

• Driving: Aides usually escort clients on public transit, Access-A-Ride, or in a car service. Driving the client in the aide’s own car is generally not part of a Medicaid case. Ask the agency about its policy.
• Heavy cleaning: Moving furniture, washing windows, or deep cleaning is outside the job. Light cleaning to keep the client’s space safe and sanitary is included.
• Money: Aides should not manage bank accounts, sign checks, or accept gifts. Small shopping errands with receipts are normal.
• Overnight: On a live-in case the aide sleeps in the home and needs a place to sleep and rest breaks. If your parent needs someone awake all night, that is a different arrangement.

How to Set Expectations on Day One

Most friction comes from expectations that were never written down. On the first day, walk through the home with the aide, show where supplies are kept, and go over the plan of care together. Share the doctor’s contact information and the pharmacy name. Our guide on what to expect on the first day of home care has a full checklist.

Related Guides

HHA vs PCA: Which Does Your Loved One Need? · What Is a Certified Home Health Aide? · How Many Medicaid Home Care Hours Can You Get? · How to Get Started With Home Care in NYC