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A nursing home, convalescent home, skilled nursing facility (SNF), care home, rest home or intermediate care provides a type of residential care. They are a place of residence for people who require continual nursing care and have significant deficiencies with activities of daily living. Nursing aides and skilled nurses are usually available 24 hours a day.

Residents include the elderly and younger adults with physical or mental disabilities. Residents in a skilled nursing facility may also receive physical, occupational, and other rehabilitative therapies following an accident or illness. Some nursing homes assist people with special needs, such as Alzheimer patients.

Medicaid coverage of Nursing Facility Services is available only for services provided in a nursing home licensed and certified by the state survey agency as a Medicaid Nursing Facility (NF).

In many cases it is not necessary to transfer to another nursing home when payment source changes to Medicaid NF. Many nursing homes are also certified as a Medicare skilled nursing facility (SNF), and most accept long term care insurance and private payment.

Wherever there is a need for personal care, certified Nursing Assistants (CNA), or nurses aides, are there.

Certified nurse assistants (CNAs)  

Certified nurse assistants (CNAs) work under the supervision of nursing and medical staff, most often in the skilled nursing setting. Typical job duties include serving meals, making beds, emptying bedpans, helping patients to dress, bathe and transfer.

Nursing aides that work in skilled nursing facilities (SNFs) have more interaction with patients and their family members, often because these types of facilities employ fewer registered nurses. Depending on the needs of the patient and the type of facility, the CNA may provide the most frequent care to the patient and this may allow CNAs to develop more clinical skills and a deeper knowledge of patient needs, but it does not change their scope of practice. CNAs function as supporting staff and do not make independent clinical decisions; they work under the direction of Licensed Vocational Nurses and Registered Nurses.

CNAs in the acute care setting (such as a general hospital) usually have a regular schedule and work full-time or part-time. The job market is highly competitive in acute care hospitals. There is still some competition for jobs in skilled nursing facilities, but it is far less severe than in the general hospital setting.

Home health aides (HHAs) 

Home health aides (HHAs) help elderly, convalescent, or disabled persons to return to or to remain in their own home as long as possible. Home health aides are usually utilized when the patient is unable to care for themself and needs more extensive care than the family support network can effectively provide.

Though some independent home health aides may provide limited health-related services such as administering previously prescribed oral medications or checking pulse and temperature, HHAs that work for an agency typically provide services related to housekeeping and personal care such as changing and laundering bed linens, assisting the patient with transfers to and from bed, and assisting with bathing, toileting, and feeding the patient. Home health aides do NOT change catheters, change dressings that are more complex than a simple bandage or that require sterile techniques, assist with respiratory equipment or give injections.

Certified Nurse Assistant vs. Home Health Aide

Most individuals that have spent any time working in both occupations have a preference for one or the other, and many choose not to cross over to work in the other area, simply because they prefer either the hospital or home environment. It is important to understand the nature of both industries and a good idea to have the credentials to work in both areas should an individual need to take on a survival job. Below is a discussion of the advantages and disadvantages of working in the clinical and home care settings.
Some individuals prefer working as a CNA because the schedule is more consistent, the environment is consistently cleaner, safer and more fast-paced, and the wages may be slightly higher in certain organizations and benefits may be available. If an individual is hoping to become a registered nurse, working with nurses and other health professionals is also an incentive to work in the hospital environment because the patient population generally has more diverse health needs. However, according to several individuals who provided information for the Healthcare Navigator project, CNAs sometimes feel underappreciated or disrespected because their role is not valued in every hospital. This can lead to low levels of job satisfaction and the desire for more independence in the workplace.
Some people prefer working in home health, however, because of the independence, flexibility that the industry affords, and the fact that they can take care of patients in a non-medical environment. Home health aides often assist with errands and cooking, so the work feels less clinical. Though home health aides must be on-time to all of their appointments, the environment is not as fast-paced and aides are able to devote more individual attention to their patients and some feel this allows them to provide a higher level of care to their patients. Home health aides may also work with the same patients for a long period of time and have more of an opportunity to form friendship bonds with them, if they choose. On the contrary, some homes and patients are extremely difficult to care for and because the home health aide is working for the patient in his or her home, patients sometimes feel they can treat their aides however they see fit (this occurs less frequently in a neutral environment such as a skilled nursing facility).

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